Background and aim: NeuroAiD is a Chinese medicinal supplement containing nine herbal ingredients. Besides neuroprotection, NeuroAiD also promotes neuroregeneration. These have been extensively investigated both in vivo and in vitro. It has gained favour, especially amongst stroke and traumatic brain injury populations, to facilitate neuro recovery. To our knowledge, the SATURN study by Kumar et al. is the only study that has shifted the focus of NeuroAiD usage to the spinal cord injury (SCI) population. We present a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. Methods: A 34-year-old police officer was involved in a helicopter crash in February 2020. He sustained a C6 vertebra burst fracture with severe spinal canal stenosis, C5 and C7 vertebrae fracture, and extensive cord oedema from C4 till T1, resulting in C4 AIS A Tetraplegia. Surgical fixation was performed on day 3. Upon admission to the rehabilitation ward at the end of March 2020, the best sensory level was C4, best motor C5, and total motor score 12. He regained some recovery throughout the stay, although he remained as C4 AIS A until discharged in April 2020. He started taking 2 capsules of NeuroAiD three times daily in May 2020 for six months. We followed him up until 1-year post-event to monitor his response. Results: The best sensory level improved to C5 at six months and C6 at 1-year, whilst the best motor level improved to C6 at six months and 1-year. The total motor score increased to 17 at six months and subsequently 22 at 1-year post-event. Overall, the neurological level of injury improved from C4 at three months to C5 at six months and C6 at 1-year post-event. AIS classification, however, remained A. Conclusion: The promising role of NeuroAiD in promoting neuro recovery in SCI is noteworthy for further exploration and investigation.
{"title":"Navigating Neurological Recovery with NeuroAiD in Severe Spinal Cord Injury: A Noteworthy Novelty?","authors":"Muhamad Faizal Zainudin, Esther Jimbih, Alicia Dixie Abraham, Mohd Razali Hasim","doi":"10.51200/bjms.vi.3742","DOIUrl":"https://doi.org/10.51200/bjms.vi.3742","url":null,"abstract":"Background and aim: NeuroAiD is a Chinese medicinal supplement containing nine herbal ingredients. Besides neuroprotection, NeuroAiD also promotes neuroregeneration. These have been extensively investigated both in vivo and in vitro. It has gained favour, especially amongst stroke and traumatic brain injury populations, to facilitate neuro recovery. To our knowledge, the SATURN study by Kumar et al. is the only study that has shifted the focus of NeuroAiD usage to the spinal cord injury (SCI) population. We present a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. Methods: A 34-year-old police officer was involved in a helicopter crash in February 2020. He sustained a C6 vertebra burst fracture with severe spinal canal stenosis, C5 and C7 vertebrae fracture, and extensive cord oedema from C4 till T1, resulting in C4 AIS A Tetraplegia. Surgical fixation was performed on day 3. Upon admission to the rehabilitation ward at the end of March 2020, the best sensory level was C4, best motor C5, and total motor score 12. He regained some recovery throughout the stay, although he remained as C4 AIS A until discharged in April 2020. He started taking 2 capsules of NeuroAiD three times daily in May 2020 for six months. We followed him up until 1-year post-event to monitor his response. Results: The best sensory level improved to C5 at six months and C6 at 1-year, whilst the best motor level improved to C6 at six months and 1-year. The total motor score increased to 17 at six months and subsequently 22 at 1-year post-event. Overall, the neurological level of injury improved from C4 at three months to C5 at six months and C6 at 1-year post-event. AIS classification, however, remained A. Conclusion: The promising role of NeuroAiD in promoting neuro recovery in SCI is noteworthy for further exploration and investigation.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90425760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siti Nur Hidayah Sudin, Mira Farhana Yaacob, Siti Suhaida Sudin, Yusniza Mohd Yusof
Background and aims: Solat (Islamic prayer) is the second pillar of Islam. Solat is performed at five appointed times in a day as commanded in the Quran, “Verily, Solat is an obligation on the believers to be observed at its appointed time” (Qur’an 4: 10). Muslims who preserved their solat show high levels of spirituality which correlated with enhanced quality of life and well-being, also lower levels of depression and psychological stress. However, from our experience, spinal cord injury (SCI) patients face many limitations to perform solat. Methods: An 18-year-old Malay lady with underlying follicular thyroid carcinoma and T-lymphoblastic lymphoma. She underwent multiple chemotherapies, which were complicated with transverse myelitis resulting in an incomplete paraplegia L2 level. She has a neurogenic bladder on the indwelling catheter, unregulated neurogenic bowel, and impaired mobility. She has good faith in Allah and had good compliance to solat before the illness. Results: Since being diagnosed in 2018, she unintentionally did not perform solat due to limited mobility to go to the bathroom for ablution. She also misunderstood that solat cannot be performed with an indwelling catheter and pampers in situ. She was unsure how to perform solat if unable to stand, lacked confidence with wheelchair hygiene, and thought that solat was not compulsory due to her illness. Some patients did not perform solat due to emotional or psychological issues such as anger toward God. However, this is not the issue with her, as her Spiritual Injury Scale was normal. Conclusion: It is essential to educate healthcare workers to identify the limitations/ out of norm/ rukhsah/ leniency in Islam related to solat and understand the conditions of the validity of solat. This is to equip patients with the knowledge and ensure they are well guided on performing solat. Education and reaffirmation of the modified way of performing solat among SCI patients will normalise their new norm.
{"title":"Performing Solat in Spinal Cord Injury Patients: Challenges and Solutions","authors":"Siti Nur Hidayah Sudin, Mira Farhana Yaacob, Siti Suhaida Sudin, Yusniza Mohd Yusof","doi":"10.51200/bjms.vi.3751","DOIUrl":"https://doi.org/10.51200/bjms.vi.3751","url":null,"abstract":"Background and aims: Solat (Islamic prayer) is the second pillar of Islam. Solat is performed at five appointed times in a day as commanded in the Quran, “Verily, Solat is an obligation on the believers to be observed at its appointed time” (Qur’an 4: 10). Muslims who preserved their solat show high levels of spirituality which correlated with enhanced quality of life and well-being, also lower levels of depression and psychological stress. However, from our experience, spinal cord injury (SCI) patients face many limitations to perform solat. Methods: An 18-year-old Malay lady with underlying follicular thyroid carcinoma and T-lymphoblastic lymphoma. She underwent multiple chemotherapies, which were complicated with transverse myelitis resulting in an incomplete paraplegia L2 level. She has a neurogenic bladder on the indwelling catheter, unregulated neurogenic bowel, and impaired mobility. She has good faith in Allah and had good compliance to solat before the illness. Results: Since being diagnosed in 2018, she unintentionally did not perform solat due to limited mobility to go to the bathroom for ablution. She also misunderstood that solat cannot be performed with an indwelling catheter and pampers in situ. She was unsure how to perform solat if unable to stand, lacked confidence with wheelchair hygiene, and thought that solat was not compulsory due to her illness. Some patients did not perform solat due to emotional or psychological issues such as anger toward God. However, this is not the issue with her, as her Spiritual Injury Scale was normal. Conclusion: It is essential to educate healthcare workers to identify the limitations/ out of norm/ rukhsah/ leniency in Islam related to solat and understand the conditions of the validity of solat. This is to equip patients with the knowledge and ensure they are well guided on performing solat. Education and reaffirmation of the modified way of performing solat among SCI patients will normalise their new norm.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88719931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zafefe bin Abd Rahman, Wong Yean Tzeh, Muhammad Nizamuddin bin Arbain, Sharon Anne Khor Keat Sim
Background and aim: Autonomic dysreflexia (AD) commonly occurs in high cervical spinal cord injury (SCI) patients. However, concurrent orthostatic hypotension (OH) makes the management of this condition more difficult. This case report highlighted the complicated condition that creates a dilemma for clinicians to prioritise the management. Methods: A 26-year-old man presented with traumatic cervical SCI C4 ASIA B secondary to C3 – C5 vertebral body fracture underwent anterior corpectomy and fusion. He had frequent episodes of AD in the rehabilitation clinic, presenting with sweating, headache, and high blood pressure (BP) while he was in a wheelchair. No other precipitating factors were identified except for his chronic sacral and ischial wounds. These AD episodes also happened multiple times daily at home with intermittent presyncope attacks. He was given stat doses of Nifedipine during the clinic visits but was never prescribed antihypertensive as no proper BP monitoring was done at home. Nonpharmacological measures for OH were already established. The rehabilitation team educated him on a side-lying position to alleviate his AD symptoms and preventive strategies such as optimal pressure relief with wheelchair cushions and using the reclining function on his motorised wheelchair. Results: He had difficulty achieving independent mobility because he could not tolerate upright sitting without having AD and intermittent OH. Conclusion: OH as a precipitating factor for AD should be considered. The lowest possible dose of antispastic medications for optimum spasm control and consideration of mineralocorticoid drugs for OH management may be helpful. Antihypertensives are commonly used for prophylaxis of chronic recurrent AD. However, its usage may be limited in patients with OH. Prazosin may be an option as studies have shown that it did not excessively lower baseline BP. Pressure mapping and surgical intervention to facilitate chronic non-healing wound closure also should be considered. Chronic recurrent AD with intermittent OH remains a challenging condition in high SCI.
背景与目的:自主神经反射障碍(AD)常见于高位颈脊髓损伤(SCI)患者。然而，并发体位性低血压(OH)使这种情况的管理更加困难。本病例报告强调了复杂的条件，创造了一个两难的临床医生优先管理。方法:一名26岁男性因C3 - C5椎体骨折继发的外伤性颈椎脊髓损伤C4 ASIA B行前椎体切除术和融合术。他在康复诊所经常发作阿尔茨海默病，当他坐在轮椅上时，表现为出汗、头痛和高血压。除了他的慢性骶骨和坐骨伤口外，没有发现其他促发因素。这些阿尔茨海默病发作也发生多次，每天在家中间歇性发作晕厥前。在门诊就诊时，他被给予两剂硝苯地平，但由于家中没有进行适当的血压监测，从未开过降压药。OH的非药物测量方法已经建立。康复小组教他侧躺的姿势，以减轻他的AD症状和预防策略，如使用轮椅垫和使用电动轮椅的斜倚功能来最佳缓解压力。结果:患者在没有AD和间歇性OH的情况下无法忍受直立坐姿，因此难以实现独立活动。结论:OH是AD的诱发因素之一。尽可能使用最低剂量的抗痉挛药物以达到最佳的痉挛控制，并考虑使用矿化皮质激素治疗OH可能会有所帮助。抗高血压药物通常用于预防慢性复发性AD。然而，它在OH患者中的使用可能受到限制。哌唑嗪可能是一种选择，因为研究表明它不会过度降低基线血压。还应考虑压力测绘和外科干预，以促进慢性不愈合伤口愈合。慢性复发性AD伴间歇性OH仍然是高脊髓损伤患者的一个挑战。
{"title":"Autonomic Dysreflexia with Concurrent Orthostatic Hypotension: A Clinical Approach Dilemma","authors":"Zafefe bin Abd Rahman, Wong Yean Tzeh, Muhammad Nizamuddin bin Arbain, Sharon Anne Khor Keat Sim","doi":"10.51200/bjms.vi.3747","DOIUrl":"https://doi.org/10.51200/bjms.vi.3747","url":null,"abstract":"Background and aim: Autonomic dysreflexia (AD) commonly occurs in high cervical spinal cord injury (SCI) patients. However, concurrent orthostatic hypotension (OH) makes the management of this condition more difficult. This case report highlighted the complicated condition that creates a dilemma for clinicians to prioritise the management. Methods: A 26-year-old man presented with traumatic cervical SCI C4 ASIA B secondary to C3 – C5 vertebral body fracture underwent anterior corpectomy and fusion. He had frequent episodes of AD in the rehabilitation clinic, presenting with sweating, headache, and high blood pressure (BP) while he was in a wheelchair. No other precipitating factors were identified except for his chronic sacral and ischial wounds. These AD episodes also happened multiple times daily at home with intermittent presyncope attacks. He was given stat doses of Nifedipine during the clinic visits but was never prescribed antihypertensive as no proper BP monitoring was done at home. Nonpharmacological measures for OH were already established. The rehabilitation team educated him on a side-lying position to alleviate his AD symptoms and preventive strategies such as optimal pressure relief with wheelchair cushions and using the reclining function on his motorised wheelchair. Results: He had difficulty achieving independent mobility because he could not tolerate upright sitting without having AD and intermittent OH. Conclusion: OH as a precipitating factor for AD should be considered. The lowest possible dose of antispastic medications for optimum spasm control and consideration of mineralocorticoid drugs for OH management may be helpful. Antihypertensives are commonly used for prophylaxis of chronic recurrent AD. However, its usage may be limited in patients with OH. Prazosin may be an option as studies have shown that it did not excessively lower baseline BP. Pressure mapping and surgical intervention to facilitate chronic non-healing wound closure also should be considered. Chronic recurrent AD with intermittent OH remains a challenging condition in high SCI.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"2 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88014164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lee Chon Kit, Wong Yean Tzeh, Nan Aisyah binti Long Ahmad Burhanuddin, Sharon Anne Khor Keat Sim
Background and aim: Spinal cord injury, especially tetraplegia, would severely disable an individual. The rare postoperative complication of cervical spine surgery, which caused bilateral blindness, would be catastrophic to a tetraplegic patient. Methods: A 60-year-old man sustained traumatic cervical cord injury (C2 AIS C) and underwent cervical decompression with dome laminoplasty of C3 – C6. He, unfortunately, developed bilateral central retinal artery occlusion, a rare postoperative complication leading to bilateral visual loss. Approximately 1-month post-injury, he was admitted to a rehabilitation ward with impairments of incomplete tetraplegia, non-perception of light in both eyes, orthostatic hypotension, neurogenic bladder, neurogenic bowel, neuropathic pain, multiple pressure injuries, and adjustment disorder with depressed mood. Results: Although the patient required caregiver assistance in most activities, functional improvement was observed by teaching him to incorporate other intact senses such as proprioception, stereognosis, and auditory sense. After 4 weeks of rehabilitation, the patient improved to C4 AIS D. His bed mobility required minimal assistance, transferred with the assistance of one person, was able to feed and groom with an assistive device. The rehabilitation process was complicated because the patient could not actively participate in therapy without assistance from his caregiver due to bilateral blindness and reduced sensation over all his limbs despite having adequate motor power for acquiring a certain level of independence in mobility and self-care. When vision loss presents together with sensory impairments, the impact of disability multiplies. Orientation and Mobility (O&M) training and sensory education were further strengthened with repeated verbal instructions to compensate for the loss of visual and sensory feedback to help the patient regain mobility and daily living skills. Three months post-rehabilitation, he was able to perform stand transfer with a walking frame under close supervision. Conclusion: Although total blindness with tetraplegia has severely disabled the patient, O&M strategies with remaining intact senses can be used to facilitate functional improvement.
{"title":"Managing Tetraplegia with Blindness: Rehabilitation Approach","authors":"Lee Chon Kit, Wong Yean Tzeh, Nan Aisyah binti Long Ahmad Burhanuddin, Sharon Anne Khor Keat Sim","doi":"10.51200/bjms.vi.3740","DOIUrl":"https://doi.org/10.51200/bjms.vi.3740","url":null,"abstract":"Background and aim: Spinal cord injury, especially tetraplegia, would severely disable an individual. The rare postoperative complication of cervical spine surgery, which caused bilateral blindness, would be catastrophic to a tetraplegic patient. Methods: A 60-year-old man sustained traumatic cervical cord injury (C2 AIS C) and underwent cervical decompression with dome laminoplasty of C3 – C6. He, unfortunately, developed bilateral central retinal artery occlusion, a rare postoperative complication leading to bilateral visual loss. Approximately 1-month post-injury, he was admitted to a rehabilitation ward with impairments of incomplete tetraplegia, non-perception of light in both eyes, orthostatic hypotension, neurogenic bladder, neurogenic bowel, neuropathic pain, multiple pressure injuries, and adjustment disorder with depressed mood. Results: Although the patient required caregiver assistance in most activities, functional improvement was observed by teaching him to incorporate other intact senses such as proprioception, stereognosis, and auditory sense. After 4 weeks of rehabilitation, the patient improved to C4 AIS D. His bed mobility required minimal assistance, transferred with the assistance of one person, was able to feed and groom with an assistive device. The rehabilitation process was complicated because the patient could not actively participate in therapy without assistance from his caregiver due to bilateral blindness and reduced sensation over all his limbs despite having adequate motor power for acquiring a certain level of independence in mobility and self-care. When vision loss presents together with sensory impairments, the impact of disability multiplies. Orientation and Mobility (O&M) training and sensory education were further strengthened with repeated verbal instructions to compensate for the loss of visual and sensory feedback to help the patient regain mobility and daily living skills. Three months post-rehabilitation, he was able to perform stand transfer with a walking frame under close supervision. Conclusion: Although total blindness with tetraplegia has severely disabled the patient, O&M strategies with remaining intact senses can be used to facilitate functional improvement.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81097264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhamad Faizal Zainudin, Pong Mei Yin, Nadzurah Mohamed Zainuddin
Background and aim: Anticholinergics such as tolterodine are notorious for their intolerability. Besides the commonly encountered side effects such as dry mouth and constipation, the medication has been shown to instigate cognitive impairment in the elderly population. In recent years, mirabegron, more commercially known as Betmiga, has garnered attention as an alternative to anticholinergics in treating Overactive Bladder (OAB) for its better tolerability and comparable efficacy. However, its usage in treating Neurogenic Detrusor Overactivity (NDO) is almost unheard of in rehabilitation. We present a case of young traumatic paraplegia who has been successfully treated with mirabegron. Methods: A 21-year-old man was transferred to the rehabilitation ward in August 2019. He had sustained a traumatic burst fracture of the T8 vertebra resulting in T8 complete paraplegia. He had multiple impairments, including neurogenic bladder, neurogenic bowel, and lower limb spasm. Single-channel cystometry was performed during the admission revealed a high-pressure bladder with poor compliance. He soon was started on tolterodine which subsequently worsened constipation, leading to autonomic dysreflexia. We switched to propiverine, the next available anticholinergic in our setting. Unfortunately, it perpetuated constipation and autonomic dysreflexia. The plan to remove the urinary catheter was abandoned. He was admitted for the second time in February 2020 for self-catheterisation training. Results: We started him on mirabegron 25 mg daily and trained him in self-catheterisation. The incontinence episodes reduced gradually, albeit not entirely. Therefore, we decided to optimise the dosage to 50 mg one month later, following which he no longer suffers leaking urine episodes. He tolerated the medication well without disturbance in the bowel routine and was free of autonomic dysreflexia ever since on mirabegron. Conclusion: Mirabegron is a promising treatment option in neurogenic bladder management. Marching forward, we should consider this novel avenue, especially in patients with sensitivity to anticholinergics.
{"title":"Marching Forward with Mirabegron: A Novel Treatment Option for Neurogenic Detrusor Overactivity in Traumatic Spinal Cord Injury","authors":"Muhamad Faizal Zainudin, Pong Mei Yin, Nadzurah Mohamed Zainuddin","doi":"10.51200/bjms.vi.3749","DOIUrl":"https://doi.org/10.51200/bjms.vi.3749","url":null,"abstract":"Background and aim: Anticholinergics such as tolterodine are notorious for their intolerability. Besides the commonly encountered side effects such as dry mouth and constipation, the medication has been shown to instigate cognitive impairment in the elderly population. In recent years, mirabegron, more commercially known as Betmiga, has garnered attention as an alternative to anticholinergics in treating Overactive Bladder (OAB) for its better tolerability and comparable efficacy. However, its usage in treating Neurogenic Detrusor Overactivity (NDO) is almost unheard of in rehabilitation. We present a case of young traumatic paraplegia who has been successfully treated with mirabegron. Methods: A 21-year-old man was transferred to the rehabilitation ward in August 2019. He had sustained a traumatic burst fracture of the T8 vertebra resulting in T8 complete paraplegia. He had multiple impairments, including neurogenic bladder, neurogenic bowel, and lower limb spasm. Single-channel cystometry was performed during the admission revealed a high-pressure bladder with poor compliance. He soon was started on tolterodine which subsequently worsened constipation, leading to autonomic dysreflexia. We switched to propiverine, the next available anticholinergic in our setting. Unfortunately, it perpetuated constipation and autonomic dysreflexia. The plan to remove the urinary catheter was abandoned. He was admitted for the second time in February 2020 for self-catheterisation training. Results: We started him on mirabegron 25 mg daily and trained him in self-catheterisation. The incontinence episodes reduced gradually, albeit not entirely. Therefore, we decided to optimise the dosage to 50 mg one month later, following which he no longer suffers leaking urine episodes. He tolerated the medication well without disturbance in the bowel routine and was free of autonomic dysreflexia ever since on mirabegron. Conclusion: Mirabegron is a promising treatment option in neurogenic bladder management. Marching forward, we should consider this novel avenue, especially in patients with sensitivity to anticholinergics.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"131 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73763520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mira Farhana Yaacob, Chai Min Ying, Siti Nur Hidayah Sudin, Siti Suhaida Sudin, Yusniza Mohd Yusof
Background and aim: Teleconsultation (TC) is a new medical service provided remotely via communication technology. In Klinik Pakar Spinal (KPS), Hospital Rehabilitasi Cheras (HRC), TC is offered to follow up patients who are supposed to come for physical clinic consultation since January 2021 because of the COVID-19 pandemic and movement control order (MCO). Those interested will be scheduled for either virtual clinic (VC) sessions via Google Meet or telephone consultation. Methods: TC was planned since 2020 with two workshops conducted in HRC to decide on the policy and workflow for the TC service. In January 2021, the first VC was done in KPS, and patients were selected among stable, follow-up cases. The patient must have a valid email address and own a device with a suitable VC platform. The setting up of the VC in KPS is done in a room equipped with a webcam, speakers, and a stable intranet. Patients will be scheduled for their VC sessions via Google Meet the day before, and an invitation will be sent via email, while telephone consultations will be arranged accordingly and conducted on the scheduled day and time. After teleconsultation, the clinical input will be documented in the patient’s case note. In KPS, 18.24% of spinal cord injury patients were agreeable for TC. Results: The benefits of TC include patients not having to travel and being followed up safely at their homes. It also reduces the crowding of patients in the clinic. Therefore, reduce the risk of transmission of COVID-19. TC is also useful for those patients who have the anxiety to attend appointments physically due to the pandemic. However, TC’s limitations include lack of human touch and inability to perform the physical examination on patients, communication difficulties, and IT failure. Conclusion: Teleconsultation is a beneficial service that needs further exploring and promoting access to rehabilitation care for many people throughout the COVID-19 pandemic.
{"title":"Sharing of Teleconsultation Experience with Spinal Cord Injury Patients","authors":"Mira Farhana Yaacob, Chai Min Ying, Siti Nur Hidayah Sudin, Siti Suhaida Sudin, Yusniza Mohd Yusof","doi":"10.51200/bjms.vi.3752","DOIUrl":"https://doi.org/10.51200/bjms.vi.3752","url":null,"abstract":"Background and aim: Teleconsultation (TC) is a new medical service provided remotely via communication technology. In Klinik Pakar Spinal (KPS), Hospital Rehabilitasi Cheras (HRC), TC is offered to follow up patients who are supposed to come for physical clinic consultation since January 2021 because of the COVID-19 pandemic and movement control order (MCO). Those interested will be scheduled for either virtual clinic (VC) sessions via Google Meet or telephone consultation. Methods: TC was planned since 2020 with two workshops conducted in HRC to decide on the policy and workflow for the TC service. In January 2021, the first VC was done in KPS, and patients were selected among stable, follow-up cases. The patient must have a valid email address and own a device with a suitable VC platform. The setting up of the VC in KPS is done in a room equipped with a webcam, speakers, and a stable intranet. Patients will be scheduled for their VC sessions via Google Meet the day before, and an invitation will be sent via email, while telephone consultations will be arranged accordingly and conducted on the scheduled day and time. After teleconsultation, the clinical input will be documented in the patient’s case note. In KPS, 18.24% of spinal cord injury patients were agreeable for TC. Results: The benefits of TC include patients not having to travel and being followed up safely at their homes. It also reduces the crowding of patients in the clinic. Therefore, reduce the risk of transmission of COVID-19. TC is also useful for those patients who have the anxiety to attend appointments physically due to the pandemic. However, TC’s limitations include lack of human touch and inability to perform the physical examination on patients, communication difficulties, and IT failure. Conclusion: Teleconsultation is a beneficial service that needs further exploring and promoting access to rehabilitation care for many people throughout the COVID-19 pandemic.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83343178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muthia Mukharoma, Wini Widiani, Florencia Wirawan, Andre Maharadja, Robby Tjandra Kartadinata, Lisa Nurhasanah
Background and aim: Brown Sequard Syndrome (BSS) is a rare clinical presentation of incomplete spinal cord injury and even rarer caused by blunt trauma in the paediatric population. We presented a case of a paediatric patient with high cervical spinal cord injury due to blunt trauma resulting in atlantoaxial rotatory subluxation (AARS). Methods: A 10-year-old boy acquired SCI AIS D and neurological level of C4 due to AARS Fielding 1 secondary to blunt trauma. He had right extremities weakness with the majority of key muscle’s strength of MRC 2-3 and impaired sensory function under the neurological level for light touch and pinprick. The tactile impairment was more prominent on the right side with preserved proprioception, pain, and temperature sensation. Results: The patient underwent Gardner Well Tongs (GWT) traction procedure which was maintained for 2 weeks and then prescribed with Minerva Brace. He also showed signs of reflexive neurogenic bladder. The patient was hospitalised for 2 weeks in the rehabilitation ward for independence and intermittent catheterisation training. He ambulated using a wheelchair at the time of discharge but could walk independently using a quadripod cane after 1 month of follow-up, showing good motor recovery. Conclusion: Most cases of traumatic Brown Sequard usually arise from penetrating or stab wound, while blunt trauma is usually accompanied by spine fracture or non-bony elements such as ligament instability or subluxation. This patient only had AARS fielding 1, but the extensive right side motor weakness might be caused by a direct acceleration-deceleration mechanism at the cervical spinal cord followed by secondary trauma due to oedema and diminished blood perfusion. As a result, this patient did not show pure classic BSS in terms of sensory impairment but had hemiplegia. For pediatric patients, determining the prognosis and optimisation of appropriate rehabilitation programs for children is crucial for maximal outcomes and long-term quality of life.
{"title":"A Case of Incomplete Spinal Cord Injury Associated with Brown Sequard Syndrome After Cervical Blunt Trauma with Atlanto-Axial Rotatory Subluxation in a Paediatric Patient","authors":"Muthia Mukharoma, Wini Widiani, Florencia Wirawan, Andre Maharadja, Robby Tjandra Kartadinata, Lisa Nurhasanah","doi":"10.51200/bjms.vi.3743","DOIUrl":"https://doi.org/10.51200/bjms.vi.3743","url":null,"abstract":"Background and aim: Brown Sequard Syndrome (BSS) is a rare clinical presentation of incomplete spinal cord injury and even rarer caused by blunt trauma in the paediatric population. We presented a case of a paediatric patient with high cervical spinal cord injury due to blunt trauma resulting in atlantoaxial rotatory subluxation (AARS). Methods: A 10-year-old boy acquired SCI AIS D and neurological level of C4 due to AARS Fielding 1 secondary to blunt trauma. He had right extremities weakness with the majority of key muscle’s strength of MRC 2-3 and impaired sensory function under the neurological level for light touch and pinprick. The tactile impairment was more prominent on the right side with preserved proprioception, pain, and temperature sensation. Results: The patient underwent Gardner Well Tongs (GWT) traction procedure which was maintained for 2 weeks and then prescribed with Minerva Brace. He also showed signs of reflexive neurogenic bladder. The patient was hospitalised for 2 weeks in the rehabilitation ward for independence and intermittent catheterisation training. He ambulated using a wheelchair at the time of discharge but could walk independently using a quadripod cane after 1 month of follow-up, showing good motor recovery. Conclusion: Most cases of traumatic Brown Sequard usually arise from penetrating or stab wound, while blunt trauma is usually accompanied by spine fracture or non-bony elements such as ligament instability or subluxation. This patient only had AARS fielding 1, but the extensive right side motor weakness might be caused by a direct acceleration-deceleration mechanism at the cervical spinal cord followed by secondary trauma due to oedema and diminished blood perfusion. As a result, this patient did not show pure classic BSS in terms of sensory impairment but had hemiplegia. For pediatric patients, determining the prognosis and optimisation of appropriate rehabilitation programs for children is crucial for maximal outcomes and long-term quality of life.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76550024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and aim: Syringobulbia is a rare progressive neurological condition characterised by the presence of syrinx or an elongated fluid-filled cavity in the brainstem with multiple possible underlying aetiologies. However, to date, only a few cases of syringobulbia presenting as a late complication of post-traumatic syringomyelia (PTS) have been reported. Methods: We present a case of a 26-year-old morbidly obese gentleman with T4 AIS C incomplete spinal cord injury following T7 burst fracture 2 years prior requiring spinal instrumentation. He then experienced implant failure 1 year later, necessitating implant removal. Subsequently, he reported worsening back pain and neurology deterioration over his left upper and lower limb. In addition to that, pain and muscle spasms over the left upper limb extending up to the left side of his neck, face, and head warranted a repeat imaging of the brain and spinal cord. Magnetic resonance imaging (MRI) revealed syringobulbia predominantly affecting the left side of the medulla oblongata with extensive syringomyelia originating from the C1 to T12 vertebral level. Moreover, the old T7 fracture site remained malunited. Results: Despite a successful second spinal decompressive surgery and combined rehabilitation, there was no neurological recovery. However, the patient described significant improvement in pain and spasms. Conclusion: PTS complicated with syringobulbia, although rare, is one of the causes of the delayed-onset neurological deterioration in spinal cord injured patients. It might be a diagnostic dilemma as some cases exhibit atypical presentations and mimic the pre-existing neurological deficit. Syrinx formation due to alteration of subarachnoid cerebrospinal fluid (CSF) flow in post-traumatic spinal deformity might benefit from decompressive surgery, avoiding the need for intradural shunt placement, coupled with medication and physical therapy. Even though there was no neurological recovery, symptomatic alleviation of neuropathic pain and spasm improved quality of life.
{"title":"An Uncommon Case of Post-Traumatic Syringobulbia: A Case Report","authors":"Izzat Zulhilmi Abd Rahman, Salmah Anim Abu Hassan","doi":"10.51200/bjms.vi.3754","DOIUrl":"https://doi.org/10.51200/bjms.vi.3754","url":null,"abstract":"Background and aim: Syringobulbia is a rare progressive neurological condition characterised by the presence of syrinx or an elongated fluid-filled cavity in the brainstem with multiple possible underlying aetiologies. However, to date, only a few cases of syringobulbia presenting as a late complication of post-traumatic syringomyelia (PTS) have been reported. Methods: We present a case of a 26-year-old morbidly obese gentleman with T4 AIS C incomplete spinal cord injury following T7 burst fracture 2 years prior requiring spinal instrumentation. He then experienced implant failure 1 year later, necessitating implant removal. Subsequently, he reported worsening back pain and neurology deterioration over his left upper and lower limb. In addition to that, pain and muscle spasms over the left upper limb extending up to the left side of his neck, face, and head warranted a repeat imaging of the brain and spinal cord. Magnetic resonance imaging (MRI) revealed syringobulbia predominantly affecting the left side of the medulla oblongata with extensive syringomyelia originating from the C1 to T12 vertebral level. Moreover, the old T7 fracture site remained malunited. Results: Despite a successful second spinal decompressive surgery and combined rehabilitation, there was no neurological recovery. However, the patient described significant improvement in pain and spasms. Conclusion: PTS complicated with syringobulbia, although rare, is one of the causes of the delayed-onset neurological deterioration in spinal cord injured patients. It might be a diagnostic dilemma as some cases exhibit atypical presentations and mimic the pre-existing neurological deficit. Syrinx formation due to alteration of subarachnoid cerebrospinal fluid (CSF) flow in post-traumatic spinal deformity might benefit from decompressive surgery, avoiding the need for intradural shunt placement, coupled with medication and physical therapy. Even though there was no neurological recovery, symptomatic alleviation of neuropathic pain and spasm improved quality of life.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"2015 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74009682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhamad Iman Jabilin, Khin Nyein Yin, Fatimah Ahmedy
Background and aim: The lifespan of individuals with spinal cord injury has increased significantly for the past decade due to improved healthcare and rehabilitation. However, ageing with SCI requires a unique management approach, including orthotic intervention for mobility function. This review explores the use of orthotic intervention among the elderly with SCI. Methods: A literature search was conducted via Medline and ScienceDirect for articles published from 2001 to 2021 with the following terms: “orthotic” or “orthosis” or “orthoses” and “spinal cord injury” and “elderly” or “geriatric” or “ageing”. Selected articles must be English and evaluate the usage of orthotic intervention among the elderly (aged >65 years) with a history of SCI. Reviews articles, case reports, and dissertations were excluded studies as well that included concomitant use of other interventions such as functional electrical stimulation devices. Results: The literature search yielded 25 articles, and after the screening, 3 studies fulfilled the eligibility criteria. Mostly used orthosis was reciprocal gait orthosis, hip-knee-ankle-foot orthosis, and knee-ankle-foot orthosis among the elderly with SCI. Between 25.8% to one-third of the studied population were reported not compliant with the orthotic interventions due to difficulties of donning and using them in day-to-day activities. Age was not a significant factor for poor compliance with the use of an orthosis (p > 0.05). None of the articles has evaluated the use of orthosis for improving hand function in tetraplegia. Conclusions: Longevity research in SCI must focus on orthotic interventions among ageing SCI individuals, especially on poor compliance and its causes, as well as the use of upper limb orthosis for tetraplegic hands.
{"title":"Orthotic Intervention for Ageing Individuals with Spinal Cord Injury: A Brief Review","authors":"Muhamad Iman Jabilin, Khin Nyein Yin, Fatimah Ahmedy","doi":"10.51200/bjms.vi.3745","DOIUrl":"https://doi.org/10.51200/bjms.vi.3745","url":null,"abstract":"Background and aim: The lifespan of individuals with spinal cord injury has increased significantly for the past decade due to improved healthcare and rehabilitation. However, ageing with SCI requires a unique management approach, including orthotic intervention for mobility function. This review explores the use of orthotic intervention among the elderly with SCI. Methods: A literature search was conducted via Medline and ScienceDirect for articles published from 2001 to 2021 with the following terms: “orthotic” or “orthosis” or “orthoses” and “spinal cord injury” and “elderly” or “geriatric” or “ageing”. Selected articles must be English and evaluate the usage of orthotic intervention among the elderly (aged >65 years) with a history of SCI. Reviews articles, case reports, and dissertations were excluded studies as well that included concomitant use of other interventions such as functional electrical stimulation devices. Results: The literature search yielded 25 articles, and after the screening, 3 studies fulfilled the eligibility criteria. Mostly used orthosis was reciprocal gait orthosis, hip-knee-ankle-foot orthosis, and knee-ankle-foot orthosis among the elderly with SCI. Between 25.8% to one-third of the studied population were reported not compliant with the orthotic interventions due to difficulties of donning and using them in day-to-day activities. Age was not a significant factor for poor compliance with the use of an orthosis (p > 0.05). None of the articles has evaluated the use of orthosis for improving hand function in tetraplegia. Conclusions: Longevity research in SCI must focus on orthotic interventions among ageing SCI individuals, especially on poor compliance and its causes, as well as the use of upper limb orthosis for tetraplegic hands.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80511308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ong Heng Khoon, Alice Vong Liew, Irwanee Raini, Tew Siew Peng, Jee Rou Chen
Background and aim: Miri is the second-largest city in Sarawak, and Miri hospital is the main referral hospital in Northern Sarawak that serves other hospitals such as Bintulu, Marudi, Limbang and Lawas hospitals. The rehabilitation medicine service in Miri hospital started on 14th February 2019. This study aims to explore the demographic characteristics among the referrals for the spinal cord injury populations. Methods: This is a retrospective descriptive study among inpatient referrals to the rehabilitation department taken from the patient’s registry record from 15th February 2019 to 13th April 2021. The descriptive statistical analysis described the demographic characteristics of the spinal cord injury patients. Results: A total of 70 patients were analysed in the study. Non-traumatic spinal cord injury comprises 2/3 of the total cases, with 65% being of infective origin. Most (77.1%) of the patients were referred to rehabilitation within the first 2 weeks of admission, with the average days from admission to the referral of 10 ± 10 days. The duration for co-management of the rehabilitation team with the primary team during inpatient stay was short, with an average of 6 ± 8 days. Rehabilitation management for most of the patients (67.1%) had to be carried out within a week of admission, whereas another 24.3% of the patients were given additional stay up to 2 weeks. From the functional aspect, the mean SCIM scored 29 ± 14, and the mean MBI scored 30 ± 20, indicating a high dependency level among the patients. Conclusion: Due to bed limitations in the hospital setting, the spinal cord injury patients at the high level of dependency were given early supported discharge plans. Identifying the demographic characteristics of the spinal cord population in Miri enables the ongoing development of spinal cord rehabilitation service that meets the need of the local population.
{"title":"Demographic Characteristics of Spinal Cord Injury Patients Referred for Rehabilitation in Miri Hospital","authors":"Ong Heng Khoon, Alice Vong Liew, Irwanee Raini, Tew Siew Peng, Jee Rou Chen","doi":"10.51200/bjms.vi.3746","DOIUrl":"https://doi.org/10.51200/bjms.vi.3746","url":null,"abstract":"Background and aim: Miri is the second-largest city in Sarawak, and Miri hospital is the main referral hospital in Northern Sarawak that serves other hospitals such as Bintulu, Marudi, Limbang and Lawas hospitals. The rehabilitation medicine service in Miri hospital started on 14th February 2019. This study aims to explore the demographic characteristics among the referrals for the spinal cord injury populations. Methods: This is a retrospective descriptive study among inpatient referrals to the rehabilitation department taken from the patient’s registry record from 15th February 2019 to 13th April 2021. The descriptive statistical analysis described the demographic characteristics of the spinal cord injury patients. Results: A total of 70 patients were analysed in the study. Non-traumatic spinal cord injury comprises 2/3 of the total cases, with 65% being of infective origin. Most (77.1%) of the patients were referred to rehabilitation within the first 2 weeks of admission, with the average days from admission to the referral of 10 ± 10 days. The duration for co-management of the rehabilitation team with the primary team during inpatient stay was short, with an average of 6 ± 8 days. Rehabilitation management for most of the patients (67.1%) had to be carried out within a week of admission, whereas another 24.3% of the patients were given additional stay up to 2 weeks. From the functional aspect, the mean SCIM scored 29 ± 14, and the mean MBI scored 30 ± 20, indicating a high dependency level among the patients. Conclusion: Due to bed limitations in the hospital setting, the spinal cord injury patients at the high level of dependency were given early supported discharge plans. Identifying the demographic characteristics of the spinal cord population in Miri enables the ongoing development of spinal cord rehabilitation service that meets the need of the local population.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"582 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77210370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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