Secondary complications and restoration of function in SCI



Identical twins studied to determine impact of SCI on energy expenditure and lean muscle mass (page 1)

Investigators measured energy expenditure and fat-free mass, as well as the relationships between these parameters, in persons with spinal cord injury (SCI). Thirteen pairs of identical twins discordant for SCI were studied. Twins with SCI had lower energy expenditure than their able-bodied co-twins. Regardless of paralysis, direct relationships existed between energy expenditure and lean mass. In persons with SCI, lean mass is reduced, and this reduction is directly related to energy expenditure.

Wingate Anaerobic Testing indicator of upper-body strength in persons with tetraplegia (pg 9)

This study examined a range of resistance loads during arm Wingate Anaerobic Testing (WAnT) in persons with different levels of cervical SCI. The WAnT is a commonly used test of muscle power, which requires pedaling or arm-cranking at maximum speed against a constant resistance. Investigators determined that the appropriate external load for arm WAnT is specific to the level of tetraplegia. This simple and quick test may serve as a useful assessment of upper-body power in persons with cervical-level SCI.

Passive joint moments may lead to enhanced neuroprostheses for people with SCI (pg 15)

This study quantified and compared lower-limb passive joint moments in able-bodied volunteers and volunteers with SCI. Passive joint moments help control movement. Measuring and modeling the changes in passive properties following SCI will facilitate the development of better lower-limb musculoskeletal models. These models may aid in the development of enhanced neuroprostheses that use functional electrical stimulation to restore standing and walking in individuals with paraplegia.

Variable-frequency-train stimulation not effective in reducing muscle fatigue after SCI (pg 33)

Variable-frequency-train (VFT) stimulation has received considerable interest for countering the fatigue that occurs in the muscles of able-bodied individuals during functional electrical stimulation. There is also much interest in using electrical stimulation for the rehabilitation of individuals with SCI. This study investigated the effectiveness of VFT stimulation on reducing quadriceps muscle fatigue in persons with complete SCI. The data provide the first evidence that VFT stimulation may not be effective at reducing fatigue without prior conditioning with electrical stimulation. The results may lead to an improved clinical use of electrical stimulation.

Portable neuromuscular stimulator aids exercise and mobility for individuals with paraplegia (pg 41)

Over the past 25 years, functional electrical stimulation has become a viable rehabilitative tool for the paraplegic population. The design and development of a portable, neuromuscular stimulator for use by individuals with paraplegia is described in this article. Potential uses of the neuromuscular stimulator include exercise, mobility and preventive skin care. The stimulator passed all relevant safety and reliability testing, making it suitable for home use.

Neostigmine and glycopyrrolate promote bowel movement (pg 53)

This study assessed the effects of neostigmine alone or neostigmine combined with glycopyrrolate on pulmonary suppression in individuals with SCI. The data suggest that although neostigmine promoted bowel movement, it also caused bronchoconstriction, which may worsen a weak respiratory system. When neostigmine is combined with glycopyrrolate, bowel movement is facilitated while bronchoconstriction is prevented. For patients with SCI who require bowel evacuation assistance, neostigmine and glycopyrrolate should be administered in combination.

Bronchodilator responses to metaproterenol sulfate among subjects with spinal cord injury (pg 59)

This study compared bronchodilator responsiveness to metaproterenol sulfate between individuals with chronic tetraplegia and those with low paraplegia. Among individuals with tetraplegia, respiratory problems are a significant cause of morbidity and mortality. The use of agents to promote bronchodilation, or opening of the airways, may help these individuals to clear mucous and reduce the incidence of pulmonary complications. Data from this study suggest that individuals with tetraplegia may benefit from chronic use of a beta-2 adrenergic agonist such as inhaled metaproterenol sulfate. Longer-term studies are warranted.

Rear-wheel position impact on seating ergonomics and mobility efficiency in wheelchair users (pg 65)

This pilot study explored the relationship between seating and propulsion ergonomics. Individuals with paraplegia performed two different activities: propulsion on a treadmill and computer work. Propulsion efficiency, seating comfort and propulsion qualities were registered at different loads during the treadmill session. In the computer session, pelvic position, estimated seating comfort and estimated activity performance were measured. Rear wheel position had a significant effect on seat inclination and weight distribution, which in turn affected stroke angle and push frequency.

Identifying predictors of long-term pain in persons with SCI (pg 75)

This longitudinal study of SCI patients sought to identify physical and psychological factors associated with the consistent reporting of pain. Ninety-six persons with SCI were measured over 10 years (1988 to 1998) on consistency of pain, demographic and injury-related data, physical and psychological health, function, and social support. Approximately half of the men and three-fourths of the women consistently reported pain. Among men, predictors of consistent pain reports were decreased impairment and social support, and increased independence and stress. For women, stress was the sole predictor.

Effects of spinal cord injury level on carotid and femoral arteries (pg 89)

The effect of SCI level on the carotid (neck) and femoral (thigh) arteries is explored in this manuscript. From a lying position, volunteers with and without SCI were asked to slowly tilt their heads to a 45 angle to measure artery dilation and blood flow. Investigators found that carotid diastolic diameter and flow were not significantly different in persons with SCI, compared with able-bodied individuals, as previously reported. While lying down, carotid diameter and flow were significantly increased in the tetraplegia group compared with the paraplegia group.

Neuromuscular stimulation may prove an effective treatment strategy for SCI bowel care (pg 95)

Constipation adversely affects the quality of life after SCI and its treatment places a burden on healthcare resources. This article describes the pathogenesis of constipation and its management. The data indicate that colonic motility may be especially depressed during sleep after SCI, and this may exacerbate a sluggish colon transit time. In the study, measures that increased contraction of abdominal muscles facilitated defecation; this was especially helpful in participants with higher-cord injury who lacked abdominal muscle control. Although the data need confirmation, results from this study may contribute toward lowering the cost of SCI-related bowel- care programs and increasing the quality of life in individuals with SCI.

Routine abdominal ultrasound in patients with chronic SCI unwarranted (pg 101)

Guidelines for assessing and tracking healthcare issues unique to SCI patients are discussed. The researchers reviewed the electronic records and ultrasound exams of 174 patients with chronic SCI. They found a high incidence of abnormalities in the liver, pancreas, spleen, gallbladder and kidney. However, no specific interventions, such as liver biopsy, had resulted from the detection of the abnormalities. The researchers argue against routine ultrasound of chronic SCI patients.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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