Vol. 42, No. 5 JRRD tipsheet: Focus on spinal cord injury and prosthetics

The current issue of the Journal of Rehabilitation Research and Development (JRRD) includes eight articles on spinal cord injury--addressing topics such as bone mineral density, women's sexuality, and chronic pain--and three articles on prosthetics research. Other articles in this issue focus on robotic therapy for stroke rehabilitation, the diabetic foot, and vocational rehabilitation for patients with schizophrenia. Full-text articles are available, free, online at www.rehab.research.va.gov.

Majority of veterans with spinal cord injury report chronic pain, pg. 573
In a telephone survey of veterans with spinal cord injury (SCI), 76 percent of participants reported chronic pain. A group of veterans with SCI who received care from one regional Department of Veterans Affairs SCI Center during a 3-year period completed a telephone survey about pain frequency, duration, intensity, exacerbating factors, and effects on daily activities. The majority of the chronic pain components occurred daily and lasted most of the day. Average pain intensity in the week before the interview was high-moderate to severe, while worst pain intensity was severe. Two-thirds of the chronic pain components interfered with daily activities.

Chronic pain patterns stable in patients with spinal cord injury, pg. 585
In a recent study of pain and spinal cord injury (SCI), investigators found that specific pain patterns (e.g., pain below the level of injury, upper-limb pain in tetraplegia, and severe, persistent pain) were stable in chronic SCI. They conducted two surveys 18 months apart to examine the stability of pain characteristics and pain-induced interference with sleep and daily activities. While pain locations, pain descriptors, pain intensities, and temporal aspects were similar between surveys, aching pain and sleep interference significantly increased. Information about the long-term course of pain in the SCI population is important for improved management of pain.

Video capture virtual reality system beneficial for spinal cord injury rehabilitation, pg. 595
A team of researchers from Israel conducted a study that suggests video-capture virtual reality (VR) training has many benefits for patients with paraplegic spinal cord injury (SCI) who require balance training. Thirteen participants with SCI experienced three virtual environments. Researchers compared their performance in the virtual environments with the performance of a group of 12 nondisabled participants. They found that the VR system provided the user with natural movement control, the ability to use as many parts of the body as deemed suitable within the context of therapeutic goals, and the flexibility to adapt the system to meet specific therapeutic objectives.

Sexual response in women with spinal cord injury, pg. 609
Women with spinal cord injury (SCI) commonly have a decreased ability to achieve genital sexual arousal. This study examined whether vibratory stimulation would increase genital arousal. Results revealed that vibratory clitoral stimulation increased vaginal blood flow as compared with manual clitoral stimulation in both SCI and nondisabled women; however, these differences were not statistically different. Subjective levels of arousal were also compared between SCI and nondisabled women. Both vibratory and manual clitoral stimulation resulted in significantly increased arousal levels in both groups; however, statistically significant differences between the two conditions were only noted in nondisabled women. The authors recommend that repetitive vibratory stimulation may be a means to train a spinal pattern generator and improve genital sexual arousal post-SCI.

Heart rate as a predictor of energy expenditure in people with spinal cord injury, pg. 617
Accurate estimates of energy expenditure for people with spinal cord injury (SCI) are needed to help monitor programs aimed at meeting the recommendations of public health initiatives for increased physical activity. Thirteen individuals with SCI underwent exercise testing, followed by heart rate and metabolic testing during five activities of daily living (ADL). Data revealed that heart rate can be used to estimate energy expenditure during relatively higher intensity ADL in individuals with SCI. This information may be useful in making activity recommendations for individuals with SCI for reduction of cardiovascular disease risk in this population.

Vitamin D derivative increases bone mineral density in people with spinal cord injury, pg. 625
The bone mineral density (BMD) of people with spinal cord injury (SCI) increased slightly while taking Hectorol, a synthetic derivative of vitamin D. People with SCI have severe osteoporosis of the paralyzed limbs. Vitamin D has been shown to increase BMD and reduce fractures in osteoporosis. A double-blind, placebo-controlled trial was conducted to determine the effect of Hectorol on the bone mass of people with chronic SCI. Forty volunteers with chronic SCI received either Hectorol or a placebo daily for 24 months. A regional lower-limb x-ray was performed at baseline and at 6, 12, 18, and 24 months. By 6 months, volunteers taking Hectorol had increased leg BMD that was maintained over the course of the study.

Weighing treatment options for restoring upper-limb function in persons with tetraplegia, pg. 635
A technique is introduced to help a treatment team share its opinions with patients needing arm-hand reconstruction following spinal cord injury (SCI). A rehabilitation treatment team and persons with tetraplegia compared the performance of two treatments in the following areas: functional results, risks, treatment intensity, user friendliness, and social acceptance of the treatments. For certain persons with a C6-level SCI with active elbow flexor muscles and one active wrist extensor muscle, the treatment team preferred the functional results of surgery combined with functional electrical stimulation. Regarding all performance characteristics, the team preferred tendon transfer. Persons with tetraplegia gave more weight to the treatment intensity, whereas the treatment team gave more weight to the functional outcomes of the treatment.

Gabapentin provides minimal relief for chronic phantom limb and residual limb pain, pg. 645
Gabapentin, a popular treatment for phantom and residual limb pain, was found ineffective in a recent double-blind trial. Twenty-four adults with phantom limb pain and/or residual limb pain were randomly assigned to receive gabapentin or placebo and later crossed over to the other treatment. Pain intensity, pain interference, depression, life satisfaction, and functioning were measured throughout the study. More than half of the participants reported a meaningful decrease in pain while taking gabapentin compared with about one-fifth who reported a meaningful decrease in pain while taking the placebo. However, gabapentin did not significantly affect any of the other outcomes.

Color analysis of silicone cosmetic prostheses for upper-limb amputees, pg. 655
This study identified and resolved problems in color analysis of silicone prostheses. The current prosthetic production cycle has the following drawbacks: subjectivity in color choice, high production costs, and long time frames for patient tests and prosthesis production. Investigators analyzed various systems that automatically detect human skin color and assessed the possibility of introducing an automatic color detection system into the prosthetic production cycle. They found that automatic color detection for prosthesis production is complex due to intrinsic factors of the silicone. The systems tested require further development to meet the needs of prosthetic manufacturers.

Foot deformity linked to ulcer development, pg. 665
People with diabetes are at risk for developing foot ulcers due to poor circulation and nerve damage, putting them at risk for amputation. This study explored the relationship between foot type and foot deformity and ulcer occurrence. Information on diabetes, health, foot, and functional status was collected from nearly 400 patients at baseline, 1 year, and 2 years. Data suggests a strong relationship between foot deformity and ulceration and between foot deformity and foot type. Understanding how foot shape and foot deformity relate to ulceration will improve the standard of foot care.

Cognitive-behavioral therapy for vocational rehabilitation in schizophrenia, pg. 673
A recent study showed that cognitive-behavioral therapy (CBT) along with work services may help veterans with schizophrenia participate and succeed in existing vocational rehabilitation programs. Investigators studied whether CBT helped veterans with schizophrenia engage in more productive work activity over a 6-month period. Fifty veterans with schizophrenia received either standard support services or CBT and were offered 6-month work placements. Veterans who received CBT worked more weeks and had better work performance than veterans who received standard support. They also continued to have higher levels of hope and self-esteem.

Robotic therapy beneficial for patients many years poststroke, pg. 683
Findings from a recent study demonstrate that individuals with severe upper-limb (UL) impairment many years poststroke benefit from robotic rehabilitation. This study investigated the effect of robotic therapy on motor function and robot-derived performance measures in patients with chronic, severe UL impairments after stroke. Fifteen individuals with chronic stroke performed 18 sessions of robot-assisted UL rehabilitation consisting of goal-directed, planar reaching tasks over 3 weeks. Study volunteers had reduced UL impairment and improved movement control.

Lower-limb prosthesis prescription, pg. 693
In this article, researchers describe a multimethod approach to prosthetic prescription for individuals with lower-limb amputations. A panel of experts in the Netherlands conducted a systematic literature review, a survey of national clinical practice on prosthesis prescription, and interviews with experts. These activities resulted in 45 postulates about prosthesis prescription. The postulates were categorized according to amputation level and partitioned into different domains. The process resulted in the development of draft clinical guidelines for prescription of prostheses for the lower limb.

Lip perception of electrotactile stimulation, pg. 705
An initial study on tactile sensory characteristics of the lips showed that the lips required very low intensities for effective electrotactile stimulation. Three stimulators of different sizes presented electrotactile patterns onto the lips of eight volunteers to measure performance in relation to stimulator size and spacing. As the stimulator diameter increased in size, the average stimulation intensity decreased for both upper and lower lips. Results showed that both upper and lower lips possessed high spatial discriminating ability. This study paves the way for development of a miniaturized lip-based tactile display for people with sensory disabilities.


About the Journal
JRRD has been a leading research journal in the field of rehabilitation medicine and technology for more than 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines. JRRD's mission is to responsibly evaluate and disseminate scientific research findings impacting the rehabilitative healthcare community. For more information about JRRD, visit www.rehab.research.va.gov.

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