Spinal Cord Series and Cases最新文献

Introduction: Traumatic spinal cord injury (SCI) tetraplegics are at an increased risk of deep venous thrombosis (DVT) due to immobility and altered hemostasis. Inflammatory bowel diseases such as ulcerative colitis (UC) face an elevated risk of thrombotic events due to chronic inflammation, in addition to the risk of diarrhea and bleeding. The case report underscores the potentially additive prothrombotic effects of ulcerative colitis and tetraplegia.

Case presentation: A 53-year-old male with UC and traumatic R C3 L C4 sensory, R C3 L C5 motor ASIA impairment C tetraplegia, developed a below the knee DVT during inpatient rehabilitation, despite DVT prophylaxis. Due to potential risk of progression, interventions ultimately included serial ultrasound examinations, IVC filter, and anticoagulation. However, due to bleeding complications, anticoagulation was discontinued, followed by worsening of DVT to the bilateral lower extremities which advanced above the knees. Subsequently, the patient developed clostridium difficile infection, further exacerbating his ulcerative colitis. Bowel program was impacted, and treatment was provided for both clostridium difficile and ulcerative colitis.

Discussion: Both UC and traumatic SCI increase have risk of thrombosis. UC exacerbations and bleeding pose challenges in the treatment of DVT. The need to discontinue anticoagulation due to bleeding risk led to a significant progression of the DVT. SCI bowel program required careful adjustments in the setting of an UC exacerbation, likely triggered by clostridium difficile infection.

Study design: A development and reliability study.

Objectives: To develop an assessment tool designed to categorize the care needs of inpatients with Spinal Cord Injuries.

Setting: Spinal Cord Injury Centre of Western Denmark.

Methods: Inspired by previous tools, NCA-SCI was refined through an iterative process with experienced clinicians. Content validity was established via consensus meetings and focus group interviews, resulting in 17 items across five categories: no/minor assistance, moderate assistance, severe nursing assistance, and unstable situations needing extensive nursing care. Face validity was ensured through iterative clinical feedback, and reliability was tested with four nurses scoring 36 patients.

Results: Content validity and feedback led to a comprehensive, practical tool. Inter-rater reliability showed 81.4% agreement (Kappa = 0.69), while intra-rater reliability had 78.9% agreement (Kappa = 0.65), indicating moderate reliability.

Conclusion: The NCA-SCI assesses nursing care needs in SCI rehabilitation, offering a practical tool with moderate reliability. The development of the NCA-SCI led to an easily usable tool for planning and coordinating daily care at a highly specialized unit.

Study design: A systematic review.

Objectives: Tuberculous myelitis, an uncommon disorder, often manifests as transverse myelopathy. The majority of the literature comprises isolated case reports, necessitating a systematic review for better understanding and management.

Setting: Uttar Pradesh India.

Methods: Our review followed PRISMA guidelines, searching PubMed, Scopus, Embase, and Google Scholar with no language constraints. Quality assessment of reports was based on selection, ascertainment, causality, and reporting. Data synthesis was qualitative with categorical and continuous data representation.

Results: We analyzed 34 reports describing 39 individuals. The majority (85%) had a duration of illness of one month or less. Upper motor neuron paraparesis was the most common neurological manifestation (69.2%), followed by areflexic paraparesis (15.3%). Paradoxical reactions occurred in 20.5% of cases. Microbiological confirmation was achievable in approximately 77% of cases. Neuroimaging abnormalities were present in 41% of cases, and chest imaging abnormalities in 53.9%. Longitudinally-extensive hyperintensities in cervical and thoracic regions were common spinal imaging abnormalities. Central nervous system tuberculosis was confirmed in 47.7% of cases, while pulmonary and disseminated tuberculosis were each found in 25.6%. Improvement was noted in 87.2% of cases, while 10.3% did not improve or died.

Conclusion: Tuberculous myelitis, is a distinct spinal cord disease. Most cases had microbiological confirmation, and the majority showed improvement with treatment.

Introduction: Loss of appetite is a neglected condition in individuals with spinal cord injury, often assessed as an emotional issue, without considering the autonomic dysfunctions that decrease gastric afferents, altering hunger perception, to the same extent as it causes autonomic dysreflexia, neurogenic bladder, and neurogenic bowel related to the interruption of information flow between effector organs and the brain. The objective of the report the side effect of appetite from the robotic exoskeleton for lower limbs with direct ground weight unloading.

Case presentation: A 30-year-old man with a complete SCI (T8, AIS A) and no appetite perception since the injury experienced an unexpected recovery of appetite during exoskeleton-assisted walking therapy. Appetite improvement occurred after two sessions and coincided with the onset of walking in the exoskeleton.

Discussion: The recovery of appetite during exoskeleton-assisted walking could be linked to autonomic and visceral afferent improvements. However, this observation is exploratory, and other factors, such as mood enhancement from experiencing walking, may have contributed. Further studies are needed to investigate these mechanisms.

Introduction: Individuals with spinal cord injury (SCI) experience alterations in metabolism that result in increased central obesity, insulin resistance, and dyslipidemia placing them at elevated risk for developing cardiometabolic disease (CMD). Increased exercise and dietary modifications are the primary interventions for preventing CMD. However, people with SCI face unique challenges that prevent them from increasing their physical activity and easily modifying their nutritional intake. Tirzepatide is a medication that has been approved by the Food and Drug Administration to be used in conjunction with lifestyle changes to treat obesity in adults with type 2 diabetes mellitus.

Case presentation: A male in his 40's with C6 American Spinal Injury Association Impairment Scale B SCI 15 years prior with a body mass index of 32 presented to his primary care provider for treatment of obesity. He previously worked with multiple dietitians and increased his physical activity to lose weight. Despite these interventions, he was unable to reduce his weight. He was started on tirzepatide. After 3 months of treatment, he lost 31 pounds and saw improvements in his lipid profile. The only adverse effect reported was heartburn.

Discussion: The metabolic dysfunction associated with SCI and barriers to adequate exercise for weight loss place individuals with SCI at increased risk for obesity and developing CMD. Tirzepatide may be an effective adjunct therapy to lifestyle interventions to help prevent CMD in those with SCI. Further research is indicated to examine the long-term efficacy, benefits, and adverse effects that may be associated with tirzepatide.

Study design: Cross-sectional explorative observational study.

Setting: The China Rehabilitation Research Center is one of the centers for spinal cord injury in China, and this study investigates the Chinese part of spinal cord injury.

Objective: To observe the changes of fecal short-chain fatty acids (SCFA) in patients with traumatic spinal cord injury (TSCI) compared with normal controls.

Methods: Thirty-eight patients with TSCI who were hospitalized in Beijing Boai Hospital of China Rehabilitation Research Center from April, 2017 to October, 2018 were recruited. Basic data such as age, gender, neurological level, etiology, and defecation method were recorded, and neurogenic bowel dysfunction score (NBD) was assessed. Twenty-one healthy subjects from the staffs of Beijing Bo'ai Hospital were recruited as the control group. Fresh stool samples were collected and gas chromatography-mass spectrometry (GC-MS) was used to determine the contents of caproic acid, isovaleric acid, isobutyric acid, valeric acid, butyric acid, propionic acid and acetic acid in feces of TSCI patients and controls. The Mann-Whitney U test was used to compare SCFA levels between the two groups.

Results: Compared with healthy controls, the levels of isovaleric acid and isobutyric acid in the feces of TSCI patients increased, while the levels of butyric acid and acetic acid decreased, and the differences were statistically significant (P < 0.05).

Conclusion: The fecal content of propionic acid and butyric acid decreased while that of isobutyric acid and isoamyl acid increased in patients with chronic TSCI.

Study design: An observational study design.

Objective: To translate the Impact on Participation and Autonomy Questionnaire (IPAQ) into the Hindi language and to assess the test-retest reliability of the supplemental data in the Indian spinal cord injury (SCI) population.

Setting: Delhi.

Methods: The English version of the IPAQ was translated into the Hindi language following the standardized Beaton guidelines for cross-cultural adaptation of self-reports. Reliability and validity were assessed in 80 subjects with SCI. Content validity was estimated using quantitative and qualitative methods. Internal consistency reliability was assessed in 20 participants. For test-retest reliability, 30 participants completed the IPAQ-H twice, one week apart. Subjects (N = 80) who met the inclusion criteria were included in the study after obtaining their informed consent.

Results: The IPAQ was translated into the Hindi language using the six-step Beaton guidelines, which were approved by the translators, expert panel members, subjects with SCI, and developers of the original English version of the IPAQ. Content validity estimation showed that all the items in the questionnaire were retained. The IPAQ-H has excellent internal consistency reliability (Cronbach's alpha -0.942) and excellent test-retest reliability (ICC single measure-0.568 and mean measure-0.929.

Conclusion: The supplemental data is a methodological step in translating the IPAQ into Hindi for a Hindi-literate population with high test-retest reliability. Healthcare practitioners can use the supplemental data as a valuable tool to gain clinical insights into the efficacy of IPA in the Indian Hindi-speaking population with SCI.

Introduction: By combining nerve and tendon transfer procedures, a more versatile hand function can be expected. Here we report the long-term outcomes of novel, individualized reconstruction strategies using combined nerve and tendon transfer procedures (CNaTT) to restore prehension and grasp in two patients with tetraplegia.

Case presentation: Two women, 45 years of age, underwent bilateral nerve transfer according to the Bertelli S-PIN (supinator to posterior interosseous nerve transfer) procedure. The grip reconstruction included tendon transfers using brachioradialis to flexor pollicis longus and extensor carpi radialis longus to flexor digitorum profundus, as well as balancing tenodesis, arthrodesis procedures and intrinsic reconstruction. At 6 months, the patients' pinch and grasp strength ranged between 1.0-2.0 and 2.2-5.0 kg, respectively, concomitant with improvements in activity and occupational performance. At 4-7 years after the grip reconstruction, both patients had full metacarpophalangeal (MCP) extension scoring M5 and M4, as well as full thumb extension scoring M5 and M4 on the right side. On the left side, MCP extension was weaker for both patients (M1/M2), whereas the thumb could extend against gravity (M3/M4). The maximal 1^st webspace opening measured between 5 and 11 cm. Pinch strength measured between 1.25 and 2.6 kg, and whole hand grip strength between 3.9 and 7.8 kg. The patients' grasps could fit around 80 and 50 mm wide cylinders using a normal right-handed grasp.

Discussion: The CNaTT procedure successfully restored useful grasp and release function with long-lasting effects. A large-scale controlled study is needed to confirm these findings.

Study design: Quasi-experimental pilot study.

Objectives: Evaluate the immediate effect of virtual reality (VR), gait-like muscle vibration (MV) and transcranial direct current stimulation (tDCS) combined or alone on neuropathic pain in individuals with spinal cord injury (SCI).

Setting: Inpatient rehabilitation centre.

Methods: Four participants (two women and two men) with neuropathic pain after SCI participated in the pilot study. All participants received one session per week for four weeks. Each session started with a single-blind administration of active or sham tDCS (20 min) delivered in a pseudo-randomized order, followed by three interventions applied in a pseudo-randomized order (10 min each): gait-like muscle vibration only, watching a walking self-avatar in VR only and the combination of muscle vibration and VR. The intensity of pain was evaluated using a numeric rating scale (0-10, minimal clinically important difference: 2 points) before and after each stimulation.

Results: Participants reported significant reduction of pain (reduction of two points or more) in 4/7 stimulations where VR was associated with muscle vibration, in 1/8 for VR-alone stimulations and in 1/7 for MV-only stimulations. Significant change in pain was found in 1/8 sham tDCS, but not after active tDCS.

Conclusions: Our pilot study showed immediate pain relief when a walking-avatar VR stimulation was associated with gait-like muscle vibration. Even though previous studies supported tDCS for pain reduction, we did not observe any changes in pain after tDCS, likely due to its application once a week. Further research is needed to strengthen these promising results.

Study design: Descriptive study.

Objectives: The National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) is a registry system to survey Traumatic Spinal Column/Spinal Cord Injuries (TSC/SCIs) patients and obtain the required data for quality-of-care assessment.

Setting: Iran.

Methods: In 2022, the pre-hospital, in-hospital, and post-hospital Quality of Care (QoC) of registered patients with TSC/SCIs in 8 referral hospitals in Iran were studied.

Results: Based on the study reports, TSCI/SCIs and their complication management were highly influenced by the health system's performance. In particular, the health system structure and medical process were identified to affect patient outcomes. According to the QoC study reports, several recommendations, including goal setting by emergency medical service providers to transport patients with possible spinal injury to first care facilities in <1 h and to an equipped care facility in <8 h, the dedication of operating room available 24/7 for patients with TSC/SCIs in referral centers, the distinction between early vs late surgery in patients with TSC/SCIs by healthcare insurance to increase the propensity for early surgery, operating a specialized SCI care unit with trained physicians and personnel in the management of acute complications following SCI and early rehabilitation in referral hospitals were specified.

Conclusion: This article provides a policy brief of this report. The role of the health system and medical process, as well as addressing TSC/SCIs health concerns by policymakers and stakeholders in the Ministry of Health and the parliament, to improve the QoC for patients with TSC/SCIs are discussed.