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United and flexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study. 团结和灵活:脊柱科早期职业康复的合作方法。一项现实主义研究。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-13 DOI: 10.1038/s41394-023-00587-1
Emily Timothy, John Bourke, Jennifer Dunn, Rachelle Martin, Jo Nunnerley

Study design: Qualitative study using realist review.

Objectives: To conceptualise how Early Intervention Vocational Rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation.

Setting: New Zealand Spinal Unit.

Methods: People with newly acquired SCI and members of their rehabilitation team were observed in a range of rehabilitation sessions, team meetings and therapeutic interactions. Participants were also interviewed to explore how EIVR functioned alongside the multidisciplinary team (MDT). Interviews and observations were transcribed, coded and analysed using realist methods.

Results: We identified three primary contexts which influenced how EIVR was delivered within the MDT: (1) a united approach, (2) a flexible approach, and (3) a hesitant approach. These contexts generated four work-related outcomes for people with SCI; enhanced work self-efficacy, strengthened hope for work, maintained work identity, and the less desirable outcome of increased uncertainty about work.

Conclusions: To optimise work outcomes for people after SCI, it is important to consider how EIVR is delivered and integrated within the wider MDT. Such an understanding can also inform the establishment of new EIVR services in different settings. Results suggest that unity, flexibility and clarity between EIVR services and the wider MDT are essential foundations for supporting people with SCI on their journey to employment.

Sponsorship: This research was funded by Health Research Council NZ grant in partnership with Canterbury District Health Board.

研究设计:采用现实主义审查方法进行定性研究:对脊髓损伤(SCI)康复过程中,早期干预职业康复(EIVR)如何在住院多学科背景下发挥作用进行概念化:环境:新西兰脊柱科:方法:观察新近获得 SCI 的患者及其康复团队成员在一系列康复治疗、团队会议和治疗互动中的表现。还对参与者进行了访谈,以探讨EIVR如何与多学科团队(MDT)一起发挥作用。采用现实主义方法对访谈和观察结果进行了转录、编码和分析:我们确定了影响多学科小组如何开展 EIVR 的三种主要环境:(1) 团结的方法,(2) 灵活的方法,以及 (3) 犹豫不决的方法。这些环境为 SCI 患者带来了四种与工作相关的结果:提高了工作自我效能感、增强了对工作的希望、保持了工作认同感,以及工作不确定性增加这一不太理想的结果:为了优化 SCI 患者的工作成果,必须考虑如何在更广泛的 MDT 中提供和整合 EIVR。这种认识也可以为在不同环境中建立新的EIVR服务提供参考。研究结果表明,EIVR服务和更广泛的MDT之间的统一性、灵活性和明确性是支持 SCI患者就业的重要基础:本研究由新西兰卫生研究委员会(Health Research Council NZ)与坎特伯雷区卫生局(Canterbury District Health Board)合作资助。
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引用次数: 0
Acute changes in antioxidants and oxidative stress to vigorous arm exercise: an intervention trial in persons with spinal cord injury and healthy controls. 剧烈手臂运动后抗氧化剂和氧化应激的急性变化:脊髓损伤患者和健康对照组的干预试验。
IF 1.2 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-13 DOI: 10.1038/s41394-023-00590-6
Matthijs F Wouda, Hanne Bjørg Slettahjell, Eivind Lundgaard, Nasser E Bastani, Truls Raastad, Rune Blomhoff, Emil Kostovski

Study design: Intervention trial.

Background: Literature remains unclear on possible health benefits and risks assosciated with high intensity exercise for persons with SCI. Elevated oxidative stress levels might influence their ability to exercise at high intensity. We investigated several biomarkers of oxidative stress and antioxidant defense at rest, during and after vigorous exercise among persons with chronic SCI.

Setting: Sunnaas Rehabilitation Hospital, Norway.

Methods: Six participants (five males) with chronic SCI (AIS A, injury level thoracic 2-8, >1 year postinjury) and six matched able-bodied controls performed two maximal arm-cranking tests, with one-three days in between. During the second exercise test, participants performed three bouts with four minutes arm cranking at high intensity (85-95% of peak heart rate (HRpeak)), before they reached maximal effort. Blood and urine biomarkers for oxidative stress and antioxidant levels were collected at six time points at the day of the second exercise test; baseline, at high intensity exercise, at maximal effort, at five, 30 and 60 min post-exercise, and 24 h post exercise.

Results: Participants with SCI had significant lower levels of creatinine (∆16 µmol/L, p = 0.03), α-carotene (∆0.14 nmol/L, p < 0.001) and β-carotene (∆0.51 nmol/L, p = 0.001) at baseline compared to controls. Urine and blood biomarkers of oxidative stress and antioxidant levels showed similar response to vigorous exercise in the SCI and control group.

Conclusions: SCI participants showed similar changes in redox status during high intensity exercise compared to matched able-bodied. SCI participants had lower levels of exogen antioxidants both before, during and after vigorous exercise.

研究设计背景:干预试验:关于高强度运动对 SCI 患者可能带来的健康益处和风险,目前尚无明确的文献资料。氧化应激水平升高可能会影响他们进行高强度运动的能力。我们研究了慢性 SCI 患者在休息时、剧烈运动期间和运动后氧化应激和抗氧化防御的几种生物标志物:地点:挪威桑纳斯康复医院:六名慢性 SCI 患者(五名男性)(AIS A,受伤级别为胸椎 2-8,伤后超过一年)和六名匹配的健全对照组患者进行了两次最大臂力曲柄运动测试,两次测试之间间隔一至三天。在第二次运动测试中,参与者在达到最大努力之前,进行了三次四分钟的高强度臂力曲柄运动(心率峰值的 85-95%)。在第二次运动测试当天的六个时间点收集了血液和尿液中氧化应激和抗氧化剂水平的生物标志物;基线、高强度运动时、最大努力时、运动后5分钟、30分钟和60分钟以及运动后24小时:与匹配的健全人相比,SCI 参与者在高强度运动中显示出相似的氧化还原状态变化。在剧烈运动前、运动中和运动后,SCI 参与者的外源性抗氧化剂水平都较低。
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引用次数: 0
Autogenic biofeedback training improves autonomic responses in a participant with cervical motor complete spinal cord injury- case report. 自发生物反馈训练改善了一名颈部运动性完全脊髓损伤患者的自律神经反应--病例报告。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-12 DOI: 10.1038/s41394-023-00593-3
Rachel D Torres, Hani Rashed, Prateek Mathur, Camilo Castillo, Thomas Abell, Daniela G L Terson de Paleville

Study design: Single-subject case design OBJECTIVE: To evaluate the Autogenic Feedback Training Exercise (AFTE) on autonomic nervous system responses.

Introduction: AFTE combines specific autogenic exercises with biofeedback of multiple physiological responses. Originally developed by the National Aeronautics and Space Administration (NASA), AFTE is used to improve post-flight orthostatic intolerance and motion sickness in astronauts. Individuals with cervical or upper thoracic spinal cord injury (SCI) often present symptoms of autonomic dysfunction similar to astronauts. We hypothesize that AFTE challenges nervous system baroreflex, gastric and vascular responses often impaired after SCI.

Methods: Using a modified AFTE protocol, we trained a hypotensive female participant with cervical motor complete (C5/6-AIS A) SCI, and a male non-injured control participant (NI) and measured blood pressure (BP), heart rate (HR), gastric electrical activity, and microvascular blood volume before, during and after AFTE. The participants were instructed to complete breathing and imagery exercises to help facilitate relaxation. Subsequently, they were instructed to use stressful imagery and breathing exercises during arousal trials.

Results: Both participants completed 8 sessions of approximately 45 min each. Microvascular blood volume decreased 23% (SCI) and 54% (NI) from the beginning to the end of the stimulation cycles. The participant with SCI became progressively more normotensive and improved levels of gastric electrical activity, while the NI participant's changes in HR, gastric electrical activity, and BP were negligible.

Conclusions: AFTE may offer a novel non-pharmacologic intervention to minimize symptoms of dysautonomia in people with SCI.

研究设计:目标:评估自体反馈训练(AFTE)对自律神经系统反应的影响:自体反馈训练结合了特定的自体运动和多种生理反应的生物反馈。AFTE 最初由美国国家航空航天局(NASA)开发,用于改善宇航员飞行后的直立性不耐受和晕动病。颈椎或上胸椎脊髓损伤(SCI)患者通常会出现与宇航员类似的自主神经功能紊乱症状。我们假设,AFTE 可挑战神经系统的气压反射、胃和血管反应,而这些反应在 SCI 后往往会受损:我们使用修改后的 AFTE 方案,对一名患有颈部运动完全性(C5/6-AIS A)SCI 的低血压女性参与者和一名未受伤的男性对照参与者(NI)进行了训练,并在 AFTE 之前、期间和之后测量了血压(BP)、心率(HR)、胃电活动和微血管血容量。参与者在指导下完成呼吸和想象练习,以帮助放松。随后,他们被要求在唤醒试验中使用压力想象和呼吸练习:结果:两名参与者都完成了 8 次训练,每次约 45 分钟。从刺激周期开始到结束,微血管血容量分别下降了 23%(SCI)和 54%(NI)。SCI 参与者的血压逐渐趋于正常,胃电活动水平也有所提高,而 NI 参与者的心率、胃电活动和血压变化微乎其微:AFTE可能是一种新型的非药物干预方法,可最大程度地减轻SCI患者的自律神经失调症状。
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引用次数: 0
First report of lumbar spinal epidural hematoma after pelvic ring fracture. 首次报告骨盆环骨折后出现腰椎硬膜外血肿。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-11 DOI: 10.1038/s41394-023-00589-z
Moritz Wagner, Tino Riegger, Alexander Brunner, Dietmar Dammerer, Benjamin Ulmar, Hedye Aliabadi

Introduction: Spinal epidural hematoma is a rare condition that most commonly occurs as a complication of spinal surgery. For patients with neurological deficits, surgical decompression can generally provide good outcome.

Case: A 56-year-old, otherwise healthy, patient was admitted to the orthopedic emergency department with a pelvic ring fracture. Over the course of 4 days, a lumbar spinal epidural hematoma developed, with the patient complaining of pain radiating to the S1 dermatome and saddle paresthesia. The hematoma was surgically decompressed, and the patient had a complete recovery.

Discussion: To our knowledge, this is the first report of a spinal epidural hematoma after pelvic ring fracture. The etiology of spinal epidural hematoma is diverse, but it is most frequently observed after spinal surgery. It has rarely been observed after lumbar spinal fractures, nearly exclusively in patients with ankylosing spondylitis.

Conclusion: Pelvic ring fracture might result in spinal epidural hematoma. The presence of neurological deficits after such fractures is an indication for lumbosacral MRI. Surgical decompression will generally resolve the neurological symptoms.

简介脊柱硬膜外血肿是一种罕见病,最常见于脊柱手术并发症。对于有神经功能缺损的患者,手术减压通常可以取得良好的疗效:病例:一名 56 岁、身体健康的患者因骨盆环形骨折被送入骨科急诊室。4 天后,患者出现腰椎硬膜外血肿,主诉疼痛放射至 S1 皮节,并伴有鞍部麻痹。经过手术对血肿进行减压,患者完全康复:据我们所知,这是第一例骨盆环骨折后脊柱硬膜外血肿的报告。脊柱硬膜外血肿的病因多种多样,但最常见于脊柱手术后。腰椎骨折后很少出现这种情况,几乎只出现在强直性脊柱炎患者身上:结论:骨盆环骨折可能导致脊柱硬膜外血肿。结论:骨盆环骨折可能导致脊髓硬膜外血肿,此类骨折后出现神经功能缺损是腰骶部磁共振成像的适应症。手术减压一般可缓解神经症状。
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引用次数: 0
Inactivation of spinal cord stimulator implanted pulse generators after elective surgery: an under-recognized problem. 脊髓刺激器植入脉冲发生器在择期手术后失活:一个认识不足的问题。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-11 DOI: 10.1038/s41394-023-00591-5
Jordan N Norris, Nathan Esplin, Rosh Bharthi, Michael Patterson, Nestor D Tomycz

Study design: We retrospectively analyzed a database of implanted pulse generators (IPGs) for spinal cord stimulation (SCS) implanted by a single surgeon (NDT). We additionally report a series of five illustrative patient cases.

Objectives: The electronics of SCS IPGs are susceptible to damage when implanted patients undergo surgery. Some SCSs have a dedicated surgery mode, while others recommend turning the SCS off to protect it from damage. IPG inactivation may require resetting or replacement surgery. We aimed to explore the prevalence of this real-world problem which has not been studied.

Setting: Pittsburgh, Pennsylvania.

Methods: Using a single surgeon SCS database, we identified cases of IPG inactivation after a non-SCS surgery and analyzed the management. We then reviewed the charts of five illustrative cases.

Results: Among 490 SCS IPG implantations between 2016-2022, 15 (3%) of the 490 patients' IPGs became inactivated after another non-SCS surgery. 12 (80%) required surgical IPG replacement, while 3 (20%) were able to have their IPG function restored non-operatively. In cases analyzed thus far, surgery mode was often not activated prior to surgery.

Conclusion: SCS IPG inactivation by surgery is not a rare problem and is presumably engendered by monopolar electrocautery. Premature IPG replacement surgery carries risks and reduces the cost-effectiveness of SCS. Awareness of this problem may prompt more preventative measures to be taken by surgeons, patients, and caretakers, and encourage technological advances to render IPGs less vulnerable to surgical tools. Further research is needed to determine what quality improvement measures could prevent electrical damage to IPGs.

研究设计:我们回顾性分析了由一名外科医生(NDT)植入的用于脊髓刺激(SCS)的植入式脉冲发生器(IPG)数据库。此外,我们还报告了五例典型患者的系列病例:SCS IPG 的电子元件在植入患者接受手术时很容易损坏。有些 SCS 有专门的手术模式,有些则建议关闭 SCS 以防止其受损。IPG 失活可能需要重置或更换手术。我们的目的是探索这一尚未研究过的现实问题的普遍性:地点:宾夕法尼亚州匹兹堡:利用单个外科医生 SCS 数据库,我们确定了非 SCS 手术后 IPG 失活的病例,并分析了处理方法。然后,我们查看了五个典型病例的病历:结果:在 2016-2022 年间植入的 490 例 SCS IPG 中,有 15 例(3%)患者的 IPG 在另一次非 SCS 手术后失活。12例(80%)需要手术更换IPG,3例(20%)通过非手术恢复了IPG功能。在迄今为止分析的病例中,手术模式通常在手术前未被激活:结论:手术导致 SCS IPG 失活并非罕见问题,可能是由单极电烧引起的。过早进行 IPG 更换手术会带来风险,并降低 SCS 的成本效益。对这一问题的认识可能会促使外科医生、患者和护理人员采取更多预防措施,并鼓励技术进步,使 IPG 不易受手术工具的影响。要确定哪些质量改进措施可以防止 IPG 受到电损伤,还需要进一步的研究。
{"title":"Inactivation of spinal cord stimulator implanted pulse generators after elective surgery: an under-recognized problem.","authors":"Jordan N Norris, Nathan Esplin, Rosh Bharthi, Michael Patterson, Nestor D Tomycz","doi":"10.1038/s41394-023-00591-5","DOIUrl":"10.1038/s41394-023-00591-5","url":null,"abstract":"<p><strong>Study design: </strong>We retrospectively analyzed a database of implanted pulse generators (IPGs) for spinal cord stimulation (SCS) implanted by a single surgeon (NDT). We additionally report a series of five illustrative patient cases.</p><p><strong>Objectives: </strong>The electronics of SCS IPGs are susceptible to damage when implanted patients undergo surgery. Some SCSs have a dedicated surgery mode, while others recommend turning the SCS off to protect it from damage. IPG inactivation may require resetting or replacement surgery. We aimed to explore the prevalence of this real-world problem which has not been studied.</p><p><strong>Setting: </strong>Pittsburgh, Pennsylvania.</p><p><strong>Methods: </strong>Using a single surgeon SCS database, we identified cases of IPG inactivation after a non-SCS surgery and analyzed the management. We then reviewed the charts of five illustrative cases.</p><p><strong>Results: </strong>Among 490 SCS IPG implantations between 2016-2022, 15 (3%) of the 490 patients' IPGs became inactivated after another non-SCS surgery. 12 (80%) required surgical IPG replacement, while 3 (20%) were able to have their IPG function restored non-operatively. In cases analyzed thus far, surgery mode was often not activated prior to surgery.</p><p><strong>Conclusion: </strong>SCS IPG inactivation by surgery is not a rare problem and is presumably engendered by monopolar electrocautery. Premature IPG replacement surgery carries risks and reduces the cost-effectiveness of SCS. Awareness of this problem may prompt more preventative measures to be taken by surgeons, patients, and caretakers, and encourage technological advances to render IPGs less vulnerable to surgical tools. Further research is needed to determine what quality improvement measures could prevent electrical damage to IPGs.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"9 1","pages":"29"},"PeriodicalIF":0.7,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10336009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10190694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Experiences and recommendations from people with spinal cord injury following participation in a disability education session at an allopathic medical school: a qualitative study. 脊髓损伤患者参加全科医学院残疾教育课程后的经历和建议:一项定性研究。
IF 1.2 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-07 DOI: 10.1038/s41394-023-00582-6
Renée Pekmezaris, Vidhi Patel, Paige Herman, Adam B Stein, Ona Bloom

Background: Students in half of US medical schools do not receive formal instruction in providing medical care for people with disabilities. To address this gap in training, our medical school developed several strategies, including a session for second year medical students to address communication skills, knowledge, and attitudes relevant to delivering healthcare for people with disabilities. Here, our objective was to explore perceptions of people with spinal cord injury (SCI) who participated in the session on its content and structure.

Methods: Qualitative research using a focus group of people with SCI who participated in an educational session for medical students in an LCME accredited allopathic US medical school. A purposive sample of adults with SCI (N = 8) participated in a focus group. Data were analyzed using a six-phase thematic analysis.

Results: Participants favorably viewed the educational session, felt their participation was valuable, and had suggestions for its improvement. Four major themes were identified: (1) session format, content; (2) addressing student discomfort and avoidance behaviors; (3) increasing student knowledge and preparation; and (4): important lessons from discussions of past and role-played doctor-patient interactions.

Conclusions: First-person input from people with SCI is critical to improve medical education and healthcare provision to the SCI community. To our knowledge, this is the first study to report feedback from stakeholders providing specific recommendations for teaching disabilities awareness to undergraduate medical students. We expect these recommendations to be relevant to the SCI and medical education communities in improving healthcare for people with SCI and other disabilities.

背景:在美国的医学院中,有一半的学生没有接受过为残障人士提供医疗服务的正式指导。为了弥补这一培训缺口,我们医学院制定了多项策略,其中包括为二年级医学生开设一门课程,讲授与为残障人士提供医疗服务相关的沟通技巧、知识和态度。在此,我们的目的是探讨参与该课程的脊髓损伤(SCI)患者对课程内容和结构的看法:定性研究:在美国一所经 LCME 认证的对抗疗法医学院中,对参加医学生教育课程的 SCI 患者进行焦点小组讨论。有目的性的成年 SCI 患者(N = 8)参加了焦点小组。采用六阶段主题分析法对数据进行了分析:结果:参与者对教育课程评价良好,认为自己的参与很有价值,并提出了改进建议。确定了四大主题:(1) 会议形式和内容;(2) 解决学生的不适和回避行为;(3) 增加学生的知识和准备;以及 (4):从过去的讨论和角色扮演的医患互动中吸取重要教训:来自 SCI 患者的第一手资料对于改善医学教育和为 SCI 群体提供医疗保健服务至关重要。据我们所知,这是第一项报告利益相关者反馈意见的研究,为本科医学生的残障意识教学提供了具体建议。我们希望这些建议能为 SCI 和医学教育界改善 SCI 和其他残障人士的医疗保健提供帮助。
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引用次数: 0
Acute presentation of Chiari malformation type I in adulthood with arm swelling, a case report and literature review. 一例病例报告和文献综述:成年后因手臂肿胀而急性出现的奇拉氏畸形 I 型。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-06 DOI: 10.1038/s41394-023-00583-5
Bassam Fallatah, Haitham Ben Ali, Muhammad Imran Bhatti, Shahid Bashir

Introduction: Chiari malformation type I (CM-I) with cervicothoracic syringomyelia can progress slowly this condition which is very common in clinical practice, particularly in children.

Case presentation: Patients typically present with chronic complaints, including headache, dizziness, and numbness, although are few reports in the literature describing pediatric patients who developed acute neurological deficits caused by CM-I. Here, we report an unusual presentation of this condition; the patient presented with sudden onset arm swelling with no precipitating factors that could explain the diagnosis.

Discussion: This is an illustrated case report and literature review. The patient's condition improved post-operatively; in terms of arm and hand swelling which resolved, but he still complained of persistent numbness on a follow-up visit.

导言:Ⅰ型奇异畸形(Chiari malformation I,CM-I)合并颈胸椎鞘膜积液可缓慢进展,这种情况在临床上非常常见,尤其是在儿童中:患者通常表现为头痛、头晕和麻木等慢性症状,但很少有文献报道儿童患者因 CM-I 而出现急性神经功能缺损。在此,我们报告了一个不寻常的病例:患者突然出现手臂肿胀,但没有任何诱发因素可以解释其诊断:讨论:这是一份图文并茂的病例报告和文献综述。患者术后情况有所改善,手臂和手部肿胀消失,但在复诊时仍主诉持续麻木。
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引用次数: 0
Implications of thumb position and trajectory in tetraplegia grip reconstruction - a cohort study. 拇指位置和轨迹对四肢瘫痪握力重建的影响--一项队列研究。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-01 DOI: 10.1038/s41394-023-00581-7
Rémy Liechti, Silvia Schibli, Sabrina Koch-Borner, Jan Fridén

Study design: This study represents a retrospective observational cohort study.

Objectives: The objective of this study was to investigate the impact of thumb position on postoperative patient-rated and functional outcomes in grip reconstruction surgery.

Setting: All consecutive adult patients with tetraplegia undergoing grip reconstruction surgery at the Swiss Paraplegic Centre between 06/2008 and 11/2020 were assessed for eligibility.

Methods: Standardized photo or film documentation was used for individually recreating and categorizing thumb position and trajectory during key pinch. Outcome measurements included key pinch strength, Canadian Occupational Performance Measure (COPM) and Grasp Release Test (GRT).

Results: Fifty-six hands of 44 patients (mean age 42.2 years, range 18-70 years) with a mean follow-up of 14.8 months (range 6 months to 12 years) were included. There was a significant postoperative improvement of key pinch strength, COPM score and GRT. COPM improvement was more pronounced for hands with more palmar abducted trajectories of the thumb.

Conclusions: Regardless of reconstruction type, pinch strength, patient satisfaction and grasp and release abilities improved significantly after surgery. Thumb position and trajectory are strong determining factors for the selected outcome measurements.

研究设计本研究是一项回顾性观察队列研究:本研究旨在调查拇指位置对握力重建手术术后患者评分和功能结果的影响:研究对象: 2008年6月至2020年11月期间在瑞士截瘫中心接受握力重建手术的所有连续成年四肢瘫痪患者:方法:采用标准化的照片或胶片记录,对捏关键时的拇指位置和轨迹进行单独再现和分类。结果测量包括捏键强度、加拿大职业表现测量(COPM)和抓握释放测试(GRT):共纳入 44 名患者的 56 只手(平均年龄 42.2 岁,18-70 岁不等),平均随访时间为 14.8 个月(6 个月至 12 年不等)。术后关键捏力、COPM评分和GRT均有明显改善。对于拇指外展轨迹较多的手,COPM的改善更为明显:结论:无论重建类型如何,术后捏合力量、患者满意度、抓握和松开能力都有显著改善。拇指位置和轨迹是选定结果测量的重要决定因素。
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引用次数: 0
Intensity of overground robotic exoskeleton training in two persons with motor-complete tetraplegia: a case series. 两名运动性完全四肢瘫痪患者的地面机器人外骨骼训练强度:病例系列。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-01 DOI: 10.1038/s41394-023-00584-4
Katelyn D Bosteder, Ashlyn Moore, Ariana Weeks, Jonathan D Dawkins, Molly Trammell, Simon Driver, Rita Hamilton, Chad Swank

Introduction: Participation in moderate-to-vigorous intensity physical activity (MVPA) is recommended to reduce chronic disease risk in individuals with tetraplegia. Assessing exercise intensity using traditional methods, such as heart rate, may be inaccurate in patients with motor-complete tetraplegia due to autonomic and neuromuscular dysfunction. Direct gas analysis may be more accurate. Overground robotic exoskeleton (ORE) training can be physiologically demanding. Yet, its utility as an aerobic exercise modality to facilitate MVPA in patients with chronic and acute motor-complete tetraplegia has not been explored.

Case presentation: We present the results of two male participants with motor-complete tetraplegia who completed one ORE exercise session while intensity was assessed using a portable metabolic system and expressed in metabolic equivalents (METs). METs were calculated using a rolling 30-s average with 1 MET defined as 2.7 mL/kg/min and MVPA defined as MET ≥ 3.0. Participant A (28-year-old) with a chronic (12 yrs) spinal cord injury (C5, AIS A) completed 37.4 min of ORE exercise (28.9 min walking) achieving 1047 steps. Peak METs were 3.4 (average 2.3) with 3% of walk time spent in MVPA. Participant B (21-year-old) with an acute (2 months) spinal cord injury (C4, AIS A) completed 42.3 min of ORE exercise (40.5 min walking) achieving 1023 steps. Peak METs were 3.2 (average 2.6) with 12% of walk time spent in MVPA. Both participants tolerated activity well without observed adverse responses to activity.

Discussion: ORE exercise may be an effective aerobic exercise modality that may increase participation in physical activity in patients with motor-complete tetraplegia.

导言:建议参加中等强度到高强度的体育锻炼(MVPA),以降低四肢瘫痪患者患慢性病的风险。由于自主神经和神经肌肉功能障碍,使用心率等传统方法评估运动强度对运动完全性四肢瘫痪患者来说可能并不准确。直接气体分析可能更为准确。地面机器人外骨骼(ORE)训练对生理要求很高。然而,作为一种有氧运动方式,它在促进慢性和急性运动功能完全性四肢瘫痪患者进行有氧运动方面的效用尚未得到探讨:我们介绍了两名患有运动性完全四肢瘫痪的男性参与者完成一次 ORE 运动的结果,他们的运动强度使用便携式代谢系统进行评估,并以代谢当量(METs)表示。代谢当量采用 30 秒滚动平均值计算,1 MET 定义为 2.7 mL/kg/min,MVPA 定义为 MET ≥ 3.0。参与者 A(28 岁)患有慢性(12 年)脊髓损伤(C5,AIS A),完成了 37.4 分钟的 ORE 运动(28.9 分钟步行),走了 1047 步。峰值 METs 为 3.4(平均 2.3),3% 的步行时间用于 MVPA。参与者 B(21 岁)患有急性(2 个月)脊髓损伤(C4,AIS A),完成了 42.3 分钟的 ORE 运动(40.5 分钟步行),走了 1023 步。峰值 METs 为 3.2(平均 2.6),12% 的步行时间用于 MVPA。两位参与者对活动的耐受性都很好,没有观察到对活动的不良反应:讨论:ORE运动可能是一种有效的有氧运动方式,可以提高运动性完全四肢瘫痪患者参与体育锻炼的积极性。
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引用次数: 0
Inpatient rehabilitation outcomes in patients with the new diagnosis of COVID-19 tractopathy: a case series. 新诊断为 COVID-19 牵引病的患者的住院康复效果:病例系列。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-07-01 DOI: 10.1038/s41394-023-00586-2
James B Meiling, Christopher T Ha, Kristin L Garlanger, Brittany A Snider, Eoin P Flanagan, Ronald K Reeves

Study design: Retrospective Case Series.

Objectives: Describe the inpatient rehabilitation outcomes of four patients with COVID-19 tractopathy.

Setting: Olmsted County, Minnesota, United States of America.

Methods: Retrospective review of medical records was performed to collect patient data.

Results: Four individuals (n = 4, 3 men and 1 woman, mean age 58.25 years [range 56-61]) completed inpatient rehabilitation during the COVID-19 pandemic. All presented after COVID-19 infection and were admitted to acute care with progressive paraparesis. None were able to ambulate on admission to acute care. All received extensive evaluations which were largely negative except for mildly elevated CSF protein and MRI findings of longitudinally extensive T2 hyperintensity signal changes in the lateral (n = 3) and dorsal (n = 1) columns. All patients experienced incomplete spastic paraparesis. All patients experienced neurogenic bowel dysfunction; a majority experienced neuropathic pain (n = 3); half experienced impaired proprioception (n = 2); and a minority experienced neurogenic bladder dysfunction (n = 1). Between rehabilitation admission and discharge, the median improvement in lower extremity motor score was 5 (0-28). All patients were discharged home, but only one was a functional ambulator at time of discharge.

Conclusion: While the underlying mechanism is yet to be elucidated, in rare cases a COVID-19 infection can lead to a tractopathy, presenting as weakness, sensory deficits, spasticity, neuropathic pain, and neurogenic bladder/bowel. Patients with COVID-19 tractopathy would benefit from inpatient rehabilitation to enhance their functional mobility and independence.

研究设计回顾性病例系列:描述四名 COVID-19 道病患者的住院康复结果:美国明尼苏达州奥姆斯特德县:方法:对病历进行回顾性审查,收集患者数据:结果:四名患者(n = 4,3 男 1 女,平均年龄 58.25 岁 [范围 56-61])在 COVID-19 大流行期间完成了住院康复治疗。他们都是在感染 COVID-19 后因进行性瘫痪被急诊收治的。他们入院时都无法行走。除了脑脊液蛋白轻度升高和核磁共振成像发现侧柱(3 例)和背柱(1 例)纵向广泛的 T2 高强度信号变化外,所有患者均接受了广泛的评估,结果大多为阴性。所有患者均出现不完全痉挛性瘫痪。所有患者均有神经源性肠功能障碍;大多数患者有神经性疼痛(3 例);半数患者有本体感觉受损(2 例);少数患者有神经源性膀胱功能障碍(1 例)。从康复入院到出院,下肢运动评分的中位改善率为 5(0-28)分。所有患者均已出院回家,但只有一名患者在出院时能正常行走:结论:虽然COVID-19感染的潜在机制尚待阐明,但在极少数情况下,COVID-19感染可导致牵引障碍,表现为乏力、感觉障碍、痉挛、神经性疼痛和神经源性膀胱/肠病。COVID-19牵引病变患者将受益于住院康复治疗,以提高其功能活动能力和独立性。
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Spinal Cord Series and Cases
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