1/44. The treatment of immature heterotopic ossification in spinal cord injury with combination surgery, radiation therapy and NSAID.Heterotopic ossification (HO) is a frequent complication associated with spinal cord injury. Management of HO consists of a combination of range-of-motion, diphosphonates, nonsteroidal antiinflammatory agents, radiation therapy, and in some cases, surgical resection. The appropriate timing of surgical resection has traditionally been based on maturity of the HO. The case presented is that of a 33-year-old male with T8 complete paraplegia who developed HO about the left hip resulting in impaired sitting. The patient underwent successful surgical wedge resection of the HO despite apparent immaturity of the HO. A comprehensive review of the literature is presented which suggests that early resection of immature HO may not be predictive of a higher recurrence rate.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/44. 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 Moreover, such problems may increase as the time since injury lengthens and the patient becomes more withdrawn and isolated in all spheres of activity.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 = motion (Clic here for more details about this article) |
3/44. Outcome of functional electrical stimulation in the rehabilitation of a child with C-5 tetraplegia.hand function was provided for a six-year-old child with C-5 American spinal injuries association (asia) classification-A tetraplegia through a percutaneous intramuscular (i.m.) functional electrical stimulation (FES) system. In conjunction with implantation of 10 percutaneous i.m. electrodes for provision of grasp and release of her right hand, reconstructive surgery was performed to provide upper extremity positioning to optimize hand use. The subject participated in FES training over a nine-week period for approximately five hours weekly, with an additional five hours each week dedicated to exercise and conditioning of her arm muscles. Physical and functional assessments included range of motion (ROM), manual muscle testing (MMT), activities of daily living (ADL) abilities and the Canadian Occupational Performance Measure (COPM), used to evaluate the effect of stimulated hand function and surgical reconstruction on functional ability. These were conducted prior to FES and surgery and repeated after rehabilitation training. With rehabilitation and training, the child was able to control her FES system. Physical assessments revealed increased strength of both shoulders and more useful range of arm movement. Functional assessments show that the FES system enabled her to perform age-appropriate ADL that previously were achievable only with physical assistance. Her overall level of independence in ADL ability increased, as did self-rated levels of satisfaction and performance on chosen activities. Positive gains demonstrated here suggest the need for further studies of FES systems in young children with SCI.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/44. Locomotor training after human spinal cord injury: a series of case studies.Many individuals with spinal cord injury (SCI) do not regain their ability to walk, even though it is a primary goal of rehabilitation. mammals with thoracic spinal cord transection can relearn to step with their hind limbs on a treadmill when trained with sensory input associated with stepping. If humans have similar neural mechanisms for locomotion, then providing comparable training may promote locomotor recovery after SCI. We used locomotor training designed to provide sensory information associated with locomotion to improve stepping and walking in adults after SCI. Four adults with SCIs, with a mean postinjury time of 6 months, received locomotor training. Based on the American Spinal Injury association (asia) Impairment Scale and neurological classification standards, subject 1 had a T5 injury classified as asia A, subject 2 had a T5 injury classified as asia C, subject 3 had a C6 injury classified as asia D, and subject 4 had a T9 injury classified as asia D. All subjects improved their stepping on a treadmill. One subject achieved overground walking, and 2 subjects improved their overground walking. Locomotor training using the response of the human spinal cord to sensory information related to locomotion may improve the potential recovery of walking after SCI.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
5/44. Patient requested removal of ventilatory support in high-level tetraplegia: guidelines for the health care provider.Determining treatment and extent of care has been returned to the patient with the advent of the durable power of attorney and reinforcement of patients' rights. To a great extent, patient autonomy replaced the medical team's role of beneficence in the decision-making process. Professionals acknowledge the patient's right in the decisional process of his/her care, though there is skepticism of such decisions being made by the patient who has suffered high-level tetraplegia within the acute care arena. This article explores (a) basing decisions upon life experiences and knowledge, (b) differentiating between informed consent for withdrawing care and consent resulting from stress or depression, (c) assessing the patient's psychological balance, and (d) advocating for the patient when he/she chooses to end all treatment options. Guidelines provide assistance to the health professional and the patient through a potentially volatile ethical dilemma. These provide insight into potential problems for all involved and clearly define steps that individuals should take to assure that the decision is made with informed consent rather than emotions.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/44. Use of a latissimus dorsi flap for treatment of infection in a neuropathic shoulder joint.STUDY DESIGN: Case report. OBJECTIVES: To demonstrate the difficulties that can be encountered in diagnosis and treatment of an infected neuropathic shoulder in a paraplegic man. SETTING: Spinal cord injury center in germany. METHOD: Ultimately, radical debridement and transplantation of a latissimus dorsi muscle flap. RESULTS: Successful treatment of the infection, partial weight bearing, and limited restriction of range of motion in the affected shoulder. CONCLUSION: The latissimus dorsi muscle flap can resolve the infection of a neuropathic shoulder.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/44. rotator cuff repair in spinal cord injury patients.Previous studies on the treatment of rotator cuff tears in wheelchair-bound patients have concentrated on nonsurgical management. We conducted a retrospective review to determine the effectiveness of surgical repair of rotator cuff tears in spinal cord-injured patients. Five male patients with rotator cuff tears confirmed by physical examination and magnetic resonance imaging underwent rotator cuff repair. Two of eight shoulders were revisions. The patients were evaluated postoperatively with the American Shoulder and elbow Surgeons Scoring System. These results were compared with preoperative functional assessment. patients were given a subjective questionnaire to assess their overall experience. Postoperative range of motion improved in 6 of 8 shoulders. Strength was increased in 6 of 8 shoulders. patients reported satisfaction with the results in 7 of 8 shoulders, and all 5 patients would recommend the procedure to other spinal cord injury patients. At recent follow-up, 7 of 8 shoulders returned to their preinjury level of function. Surgery for spinal cord injury patients with rotator cuff tears can improve their functional capability and autonomy while reducing their pain. compliance with the demanding postoperative rehabilitation is essential; therefore proper patient selection is crucial for optimal results.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/44. Traumatic cervical instability associated with cord oedema and temporary quadriparesis.STUDY DESIGN: A case report of blunt cervical spine trauma associated with cord oedema at the C3/C4 level with temporary Frankel/American Spinal Injury association Grade A quadriparesis and motion segment instability without evidence of associated bony lesions (spinal cord injury without radiological abnormality, SCIWORA lesion). OBJECTIVES: By means of a rare and illustrative case, the reader's attention is focused on eventual marked cervical motion segment instability in SCIWORA patients. SETTING: A department of neurology in Quito, ecuador and a department of neurosurgery in Bern, switzerland. METHOD: A 73-year-old man sustained blunt cervical spine trauma. After resolution of paraparesis, dynamic studies of the cervical spine revealed translational instability of C3 over C4. The patient underwent segment fusion by intervertebral cage insertion and plate fixation. RESULTS: The patient had recovered almost completely from tetraparesis under conservative treatment. The postoperative course was uneventful. Solid bony fusion of the C3/C4 motion segment was obtained. CONCLUSION: Despite normal cervical alignment, the lack of bony lesions and neurological recovery, magnetic resonance imaging and dynamic studies may reveal marked translational cervical motion segment instability requiring segment fusion in order to prevent ongoing damage of the spinal cord.- - - - - - - - - - ranking = 4keywords = motion (Clic here for more details about this article) |
9/44. phenol block for hip flexor muscle spasticity under ultrasonic monitoring.Hip flexor spasticity, which is often associated with central nervous system (CNS) diseases, is a major impediment in rehabilitation. In order to cope with this problem, lumbar nerve blocking techniques developed by Meelhuysen and major and minor psoas muscle blocking techniques developed by Awad have been used in combination with physical therapies. Based on these techniques, we conducted major and minor psoas muscle phenol block (motor point block or intramuscular nerve block) under ultrasonic monitoring. phenol block was conducted in nine patients with cerebral infarction (13 blocking procedures) and three with spinal cord injuries (six blocking procedures) while keeping them in a lateral position with the operation side upside. The beginning of the femoral nerves and part of the lumbar artery were visualized by ultrasound in some patients. As a result of the improvement of hip flexor spasticity, the range of hip joint motion (determined by the Mundale technique, prone hip extension and Thomas test) improved shortly after blocking. When physical therapy was conducted after blocking, improvement of skin care management was observed in eight cases, ability to keep in a stable sitting position in nine, improvement of a standing posture in three, increases in the ability to walk in two and alleviation of pain in three. Although nerve block is reported to result in hematoma, decreases in muscle force, pain, cystic/rectal disorders and hypogonadism, we have observed no such complication in our patients.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/44. Functional electrical stimulation (FES) for spinal cord injury.Restoration of respiratory motion by stimulation of the phrenic nerve was investigated. Respiratory motion was restored successfully by introducing a breathing pacemaker to a patient with respiratory disturbance due to upper cervical spinal cord injury. Breathing pacemakers are considered to be more similar to physiological conditions compared to mechanical ventilators. Although the system is very expensive, its cost effectiveness may be excellent, provided that it can be used for long hours each day over an extended period. The system is effective in improving patient QOL because it dramatically increases patient mobility. From these findings, it is concluded that breathing pacemakers should be used more frequently in japan, and that various forms of support are necessary to cope with economic and other concerns.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
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