1/16. Virtual reality in paraplegia: a VR-enhanced orthopaedic appliance for walking and rehabilitation.spinal cord injuries (SCIs) have a profound physical, social and emotional cost to patients and their families. Obviously SCIs severely disrupt normal patterns of interaction with the environment. Firstly, the opportunities for active interaction are inevitably diminished due to motor or sensory impairment. Moreover, such problems may increase as the time since injury lengthens and the patient becomes more withdrawn and isolated in all spheres of activity. However, advances in Information technology are providing new opportunities for rehabilitation technology. These advances are helping people to overcome the physical limitations affecting their mobility or their ability to hear, see or speak. In this chapter an overview is given of the design issues of a VR-enhanced orthopaedic appliance to be used in SCI rehabilitation. The basis for this approach is that physical therapy and motivation are crucial for maintaining flexibility and muscle strength and for reorganizing the nervous system after SCIs. First some design considerations are described and an outline of aims which the tool should pursue given. Finally, the design issues are described focusing both on the development of a test-bed rehabilitation device and on the description of a preliminary study detailing the use of the device with a long-term SCI patient.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/16. The development of a nurse-directed computerized functional electrical stimulation program.Today's spinal-cord-injured (SCI) person is discharged from the inpatient clinical setting very early in his or her recovery process. Faced with the tremendous challenges of relearning the skills of daily living and psychologically adjusting to a catastrophic injury, the newly injured person is thrust into an overwhelming environment. As early as 1994, when inpatient stays were longer, concern was expressed about the impact of early discharge on the health and well-being of persons with SCI (Ditunno & Formal, 1994). For over 10 years, the Medical Illness counseling Center (MICC) has offered a community-based, nurse-directed program of Computerized Functional Electrical Stimulation (CFES) for persons with SCI. The program is founded on the belief that when multi-system deterioration associated with paralysis is avoided and a behavioral approach is used, the person with SCI will have a renewed sense of well-being that enables him or her to overcome the challenges of daily living. Over time, the need for expansion of the program became apparent; it evolved into a comprehensive package of medical, nursing, and psychological care. This article describes the essential elements that comprised a successful program design, the benefits of participation in CFES, and the significance of this technology in a nurse-managed setting.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/16. Spinal cord injury medicine. 4. Optimal participation in life after spinal cord injury: physical, psychosocial, and economic reintegration into the environment.This learner-directed module on spinal cord injury (SCI) presents a variety of perspectives of the process of personal and environmental adaptation for reintegration. Adaptation is unique to each person and does not predictably follow stages. Models used for understanding the process include biopsychosocial, ICIDH-2 (international classification of functioning, disability and health), and sector divisions of the environment. Home modification requires home (intermediate environment) evaluation and sociospatial behavioral mapping for planning and appropriation of remodeling in proportion to functional need and use. Options for access to the natural environment include specialized wheelchairs, climbing rigging, kayaks, and sail boats. sports participation with adaptations is expanding and includes a larger variety of organizations and leagues. Economic needs are effectively anticipated with development of a life care plan. Procreative options to overcome infertility after SCI include vibratory stimulation for ejaculation, intravaginal insemination, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. Approaches to requests for withdrawal of life-sustaining care include depression screening, pain evaluation, and assistance in accomplishment of person centered goals. overall, community reintegration after SCI is continually improving because of better acceptance, accessibility, and technology for building adaptations. overall ARTICLE OBJECTIVES: (a) To review models and theories of medical intervention and disablement and (b) to demonstrate their application in rehabilitation practice by designing unique treatment plans that meet patient person-centered goals.- - - - - - - - - - ranking = 8keywords = environment (Clic here for more details about this article) |
4/16. Management of life-threatening autonomic hyper-reflexia using magnesium sulphate in a patient with a high spinal cord injury in the intensive care unit.We report the successful use of i.v. magnesium sulphate to control life-threatening autonomic hyper-reflexia associated with chronic spinal cord injury in the intensive care environment. A 37-yr-old, male was admitted to the intensive care unit with a diagnosis of septic shock and acute renal failure secondary to pyelonephritis. He had been found unresponsive at home following a 2-day history of pyrexia and purulent discharge from his suprapubic catheter. He had sustained a T5 spinal cord transection 20 yr previously. Initial management included assisted ventilation, fluid resuscitation, vasopressor support, and continuous veno-venous haemofiltration. The sepsis was treated with antibiotic therapy and percutaneous nephrostomy drainage of the pyonephrosis. On the fifth day, the patient developed profuse diarrhoea. This was associated with paroxysms of systemic hypertension and diaphoresis, his arterial pressure rising on occasion to 240/140 mm Hg. A diagnosis of autonomic hyper-reflexia was made and a bolus dose of magnesium sulphate 5 g was administered over 15 min followed by an infusion of 1-2 g h(-1). There was an almost immediate decrease in the severity and frequency of the hypertensive episodes. There were no adverse cardiac effects associated with the administration of magnesium, only a slight decrease in minute ventilation as the plasma level approached the upper end of the therapeutic range (2-4 mmol litre(-1)). In view of the beneficial effects observed in this case we advocate further research into the use of magnesium sulphate in the treatment or prevention of autonomic hyper-reflexia secondary to chronic spinal cord injury in the intensive care unit.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/16. Locomotor training progression and outcomes after incomplete spinal cord injury.BACKGROUND AND PURPOSE: The use of locomotor training with a body-weight-support system and treadmill (BWST) and manual assistance has increased in rehabilitation. The purpose of this case report is to describe the process for retraining walking in a person with an incomplete spinal cord injury (SCI) using the BWST and transferring skills from the BWST to overground assessment and community ambulation. CASE DESCRIPTION: Following discharge from rehabilitation, a man with an incomplete SCI at C5-6 and an American Spinal Injury association (asia) Impairment Scale classification of D participated in 45 sessions of locomotor training. OUTCOMES: walking speed and independence improved from 0.19 m/s as a home ambulator using a rolling walker and a right ankle-foot orthosis to 1.01 m/s as a full-time ambulator using a cane only for community mobility. walking activity (mean /-SD) per 24 hours increased from 1,054 /-543 steps to 3,924 /-1,629 steps. DISCUSSION: In a person with an incomplete SCI, walking ability improved after locomotor training that used a decision-making algorithm and progression across training environments.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/16. Combined protocol of cell therapy for chronic spinal cord injury. Report on the electrical and functional recovery of two patients.BACKGROUND: This is a preliminary report on successful results obtained during treatment of two patients with chronic spinal cord injury. The therapeutic approach was based on the generation of controlled inflammatory activity at the injury site that induced a microenvironment for the subsequent administration of autologous, BM-driven transdifferentiated neural stem cells (NSC). methods: BM mesenchymal stem cells (MSC) were cocultured with the patient's autoimmune T (AT) cells to be transdifferentiated into NSC. Forty-eight hours prior to NSC implant, patients received an i.v. infusion of 5 x 10(8) to 1 x 10(9) AT cells. NSC were infused via a feeding artery of the lesion site. safety evaluations were performed everyday, from the day of the first infusion until 96 h after the second infusion. After treatment, patients started a Vojta and Bobath neurorehabilitation program. RESULTS: At present two patients have been treated. Patient 1 was a 19-year-old man who presented paraplegia at the eight thoracic vertebra (T8) with his sensitive level corresponding to his sixth thoracic metamere (T6). He received two AT-NSC treatments and neurorehabilitation for 6 months. At present his motor level corresponds to his first sacral metamere (S1) and his sensitive level to the fourth sacral metamere (S4). Patient 2 was a 21-year-old woman who had a lesion that extended from her third to her fifth cervical vertebrae (C3-C5). Prior to her first therapeutic cycle she had severe quadriplegia and her sensitive level corresponded to her second cervical metamere (C2). After 3 months of treatment her motor and sensitive levels reached her first and second thoracic metameres (T1-T2). No adverse events were detected in either patient. DISCUSSION: The preliminary results lead us to think that this minimally invasive approach, which has minor adverse events, is effective for the repair of chronic spinal cord lesions.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/16. Understanding and treating motivation difficulties in ventilator-dependent SCI patients.motivation for spinal cord injury rehabilitation is a difficult management task for clinicians. Ventilator-dependent quadriplegics experience conditions which are particularly likely to lead to motivational problems. The following article provides a theoretical model with which to understand patient motivation. The model conceptualizes patient motivation as a patient-rehabilitation environment fit problem and employs concepts from social learning theory to facilitate understanding and intervention with such difficulties. The model is applied to two ventilator-dependent rehabilitation cases. Recommendations for clinical practice are provided.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/16. Acute and chronic hypothermia in a man with spinal cord injury: environmental and pharmacologic causes.It is well known that people with spinal cord injuries can develop hypothermia when exposed to an unusually cold environment. hypothermia can also develop during inpatient rehabilitation, particularly as a side effect of certain medications. We present a patient with C4 incomplete spinal cord injury whose core body temperature was chronically subnormal, and who developed acute hypothermia on several occasions during inpatient rehabilitation. The results of tests of his autonomic function were abnormal. Acute hypothermia (core temperature approximately 34C) was induced when he was challenged with nifedipine. The serum level of phenytoin became elevated to toxic levels during two episodes of acute hypothermia, but the serum level of carbamazepine did not change appreciably. This case demonstrates that people with spinal cord injuries are at risk for hypothermia, that hypothermia can be induced by nifedipine, and that significant thermal challenges can occur during routine inpatient rehabilitation. In addition, hypothermia appears to affect the metabolism of phenytoin.- - - - - - - - - - ranking = 5keywords = environment (Clic here for more details about this article) |
9/16. Scuba diving: taking the wheelchair out of wheelchair sports.In the past, physicians prohibited patients with neuromuscular disease or disability from participating in scuba diving. This report highlights the opportunities that self-contained underwater breathing apparatus (scuba) affords to physically handicapped individuals, to move without assistive devices in a gravity-free environment. The experience of a person with T10 paraplegia is used to illustrate the applicability of a new system of evaluation, training, and certification for scuba diving to patients with a wide variety of disabilities, such as paraplegia, quadriplegia, amputation, cerebral palsy, and poliomyelitis. This review also discusses equipment needs, potential risks, and safety precautions. physicians are encouraged to support those handicapped individuals who choose to explore the submerged two thirds of our planet for its recreational as well as its potential vocational opportunities.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/16. Exposure hypothermia and the winter sports SCI participant.sensation is impaired in the individual with a complete spinal cord injury and it can be compromised in those with incomplete lesions. Quadriplegics and high paraplegics are, therefore, susceptible to environmental temperature changes (partially poikilothermics). physicians have assumed that SCI persons engaged in winter sports activities are sensitive to exposure hypothermia. To test this premise, participants were examined within five minutes following their arrival from the ski slopes. Sublingual temperature, pulse and respirations were obtained from nine participants. Exposure hypothermia was found in one-third of the selected individuals. We concluded that exposure hypothermia is one of the complications to look for in the winter sports SCI participant, and that cases could be misdiagnosed if physiological knowledge of the SCI person is lacking.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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