Spinal Cord Series and Cases最新文献

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.

Study design: Mixed methods service improvement project. Retrospective analysis of clinical documentation and qualitative focus group with clinicians.

Objectives: Although traumatic brain injury (TBI) and spinal cord injury (SCI) often co-occur, many barriers have been found to identifying TBI in SCI rehabilitation and adapting treatment accordingly. This study aimed to compare the number of individuals with a TBI detected at England's National Spinal Injuries Centre to figures found in previous research and understand the barriers to adapting SCI rehabilitation in the presence of TBI.

Setting: England's National Spinal Injuries Centre at Stoke Mandeville Hospital.

Methods: This mixed methods study assessed the documentation at each stage of 88 patients' treatment where a TBI could be detected and used to inform rehabilitation, and subsequently, a focus group was conducted with staff to explore the barriers to detecting TBI and adapting SCI rehabilitation.

Results: Results suggested that data related to TBI were inconsistently recorded, the number of individuals recorded as having a TBI at the centre was lower than a recent study, and several barriers were interpreted from the focus group.

Conclusions: TBI in SCI populations may be an invisible unmet need. Several barriers may exist which prevent clinicians from detecting TBI in this population and adapting rehabilitation accordingly. Findings have implications for rehabilitation for individuals with TBI and SCI admitted to the service.

Introduction: Spinal cord arteriovenous malformations (SCAVM) are rare congenital vascular malformations, characterized by two or more AVMs affecting any of the spinal segments. SCAVM has complex pathophysiology and may be associated with acute, or progressively neurological deficits.

Case presentation: A 12-year old girl, presented with progressive neurologic deficits secondary to compressive cervical myelopathy due to a cervical metameric SCAVM. She was successfully treated with a staged surgical-endovascular approach and regained normal neurological function with radiological stability.

Discussion: SCAVM is a rare disease with complex management, and in many cases, the treatment is focused on palliative care. With multimodality management, of a combined surgical-endovascular approach, the patient achieved neurological, functional, and structural stability over the follow-up period.

Introduction: Medially routed biceps-to-triceps tendon transfer for elbow extension reconstruction in spinal cord injury (SCI) has proven to be a reliable procedure. This technique classically places the tendon transfer superficial to a paralyzed ulnar nerve, with a theoretical risk of compression neuropathy.

Case presentation: A 21-year-old male with a C5 American Spinal Injury Association Impairment Scale (AIS) grade B SCI who underwent bilateral biceps-to-triceps tendon transfers presented with new-onset paresthesias in the ring and small fingers 10.5 years following initial reconstructive surgery. These symptoms were accompanied by triggered upper extremity spasticity following repeated elbow flexion exercises. Clinical exam findings and ultrasound imaging were consistent with bilateral ulnar nerve compression. Surgical exploration revealed that the ulnar nerve was severely compressed by the tendinous part of the biceps bilaterally. The surgical technique used to decompress the ulnar nerve and perform an anterior transposition without taking down the rerouted biceps tendon is described. The patient demonstrated favorable post-operative outcomes.

Conclusion: Compression of a paralyzed ulnar nerve in a tetraplegic patient after medially routed biceps-to-triceps tendon transfer can present with both classical and/or atypical findings. Although rare, this complication can be managed surgically by anterior transposition of the ulnar nerve without taking down the rerouted biceps tendon. The senior authors have modified their technique and now recommend passing the rerouted biceps tendon deep to the ulnar nerve to avoid compression neuropathy.

Introduction: Spontaneous spinal epidural hematoma (SSEH) is the rarest cause of spinal cord compression, causing paraparesis or quadriparesis. They account for less than 1% (0.1 patients per 100,000 patients per year) of all spinal canal space-occupying lesions, thus resulting in a paucity of literature. Here, we report three cases of SSEH; all had a neurological deficit on presentation and were surgically managed with decompressive laminectomy and evacuation of the hematoma.

Case presentation: Of the three patients, one had a history of coronary artery disease and was on anticoagulants. In the remaining two, no cause could be identified. The hematoma was located at the thoracic region in 2 patients and at the cervical in one. Hematoma were located dorsal to cord in 2 patients and ventral in one. Two cases presented within 30 h of the onset of symptoms with the ASIA (American Spinal Injury Association) impairment scale (AIS) A and B neurology. Both showed a complete recovery during their latest follow-up. However, one case presented after 2 days with AIS A neurology and improved to AIS B post-operatively at 30 months follow-up.

Discussion: The myriad of symptoms and the need for an MRI for diagnosis have made SSEH difficult to diagnose clinically. Unlike other spinal pathologies where the severity of the preoperative neurological deficit is the best predictor of prognosis, in SSEH, time is the best predictor of prognosis. Our series highlights the fact that irrespective of the severity of the preoperative neurological deficit, timely diagnosis and early, adequate decompression surgery are essential for complete neurological recovery.

Introduction: A spinal cord injury (SCI) leads to an alteration of the central nervous system which significantly impacts the health, function and quality of life of those affected. Since SCI leads to a loss lower limbs usage, sublesional osteoporosis is a common and established consequence with high risk of fracture in this population. The mechanical loading remains the most effective approach to stimulate physiologic bone remodeling. Furthermore, functional electrical stimulation, by producing active muscle contractions, would also increase bone mineral density. Combining functional electrical stimulation (FES) with mechanical stress during functional task such as walking or cycling would provide better results on BMD.

Case presentation: This case report describes a 64-years old man with a chronic complete SCI (T2-T3; AIS A) who was gradually exposed to mechanical stress (walking robot, standing, bicycle) coupled with FES for 26 months. Bone mineral density of the femoral head (BMDf) was defined at 3 different time points (baseline, after 10 and 26 months). The Fracture Risk Assessment Tool (FRAX) was used to calculate T-scores based on BMDf. Before the intervention, BMDf indicated severe osteoporosis in this man. After 10 months of combined intervention, the BMDf decreased to reach the level of osteopenia after 26 months.

Discussion: The implementation of an intervention combining weight-bearing during robotic-assisted walking and FES would improve bone mineral density and could reduce the risk of fracture in people with complete SCI.

Study design: A methodological study.

Objectives: To establish the criterion-related validity of the Nepali version of the Spinal Cord Independence Measure Self-Report (SCIM-SR).

Setting: Outpatient Department of the Spinal Injury Rehabilitation Center and community of Province no. 3, Nepal.

Methods: Community-dwelling individuals with spinal cord injury were enrolled. Participants self-administered the Nepali version of the SCIM-SR while a clinician concurrently administered the SCIM III. Descriptive statistics characterized the sample, while Spearman's rank correlation coefficient and Intraclass correlation coefficient assessed the association between the SCIM III and the Nepali version of the SCIM-SR. Bland Altman's analysis determined the differences.

Results: The Spearman's rank correlation coefficient for the total score was 0.961, self-care subscale was 0.590, respiration and sphincter management subscale was 0.897, and mobility subscale was 0.891. The ICC (2,1) and confidence interval for the total score, self-care subscale, respiration and sphincter management subscale, and mobility subscale were 0.989 (0.983-0.993), 0.873 (0.804-0.918), 0.955 (0.931-0.971) and 0.991 (0.987-0.994), respectively. The SCIM-SR scores were lower than the SCIM III in total and all subscale scores. The Bland-Altman's difference for the total score, self-care subscale, respiration and sphincter management subscale, and mobility subscale were 2.55, 1.34, 0.83, and 0.38, respectively.

Conclusions: The Nepali version of the SCIM-SR was validated and can be used to evaluate the functional status of individuals with spinal cord injury in the community setting of Nepal.