11/44. Restoration of locomotion in paraplegics with aid of autologous bypass grafts for direct neurotisation of muscles by upper motor neurons--the future: surgery of the spinal cord?OBJECTIVES: paraplegia means a lifelong sentence of sensory loss, paralysis and dependence. Complete spinal cord lesions cannot heal up to now despite intensive experimental research, remarkable efforts and recent achievements in bio-technology and re-engineering. Traumatic paraplegia due to spinal cord injury (SCI) is a quite frequent condition and related to the socio-economical situation of the population. It is experienced disproportionately by young people. The rise in gunshot wounds is dramatic. SCI has appeared refractory to treatment. patients AND methods: Since 1980 G.A.B. had tried surgical repair of the spinal cord (SC) after experimental bisection in rats, and since 1993 research was done on monkeys (macaca fascicularis) to be closer to human physiology. The sciatic nerve was removed and used as an autologous graft from the lateral bundle of the spinal cord (tractus corticospinalis ventro lateralis) to the three muscles of both legs being known to be most important for locomotion: M. gluteus maximus, M. gluteus medius and M. quadriceps femoris. The first fruitful transplantation in a human being was performed in July 2000. RESULTS: The results in rats were promising and fulfilled the requirements of the American Task Force of the National Institute of Neurological and Communicative Disorders and stroke of the US. The results in monkeys confirmed the paradigm so that we performed the first operation in a young lady suffering for four months from complete SC lesion T9 after approval by the ethical committee. First voluntary movements of the connected muscles after 17 months. 27 months after op she was able to walk up to 60 steps with the help of a walker and to climb steps in the water. Improvement is still continuing. DISCUSSION: SCI has appeared refractory to any kind of treatment. Compensatory strategies are still experimental in human beings. Autologous nerve grafts from the spinal cord tissue (the lateral spinal bundle) connected to peripheral muscle nerves seem promising in paraplegics. But the physiology is still unclear when the glutamatergic upper motor neuron connected to motor end-plates (cholinergic) does work like in our patient. CONCLUSION: Further studies in primates and paraplegic patients are necessary to clarify the bypass grafting of the SC to muscle groups distal to the complete SCI to restore locomotion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/44. Development of a hybrid gait orthosis: a case report.OBJECTIVE: The purpose of this case study was to improve stability, posture, and speed of gait in an individual with paraplegia through the application of a hybrid system including trunk-hip-knee-ankle-foot orthosis (THKAFO) with lockable joints and multichannel functional electrical stimulation (FES) with implanted electrodes. methods: Two hybrid orthoses were implemented and evaluated on a person with complete absence of motor function and sensation below the T-9 level spinal cord injury. The first hybrid was a modified isocentric reciprocal gait orthosis (IRGO) with the knees controlled by FES, the ankles fixed at neutral, and the hips coupled with a reciprocator. The second hybrid had a THKAFO instrumented with lockable joints using wrap-spring clutches at the hips and knees (THKAFO-LJ) that provided free extension and allowed for flexion only when disengaged by solenoids. A microprocessor-controlled stimulator provided muscle stimulation and activation signals for the solenoids. These two hybrid systems were compared with an FES-only system. RESULTS: The IRGO hybrid system with the hip reciprocator engaged provided a stable gait with erect posture with minimal anterior trunk lean using only quad canes for support. However, the walking speed was slow, due to limited step length imposed by the reciprocator. The walking speed with the THKAFO-LJ hybrid system was significantly faster than that with the IRGO hybrid with the reciprocator engaged, and was comparable with the FES-only gait; however, it resulted in excessive anterior trunk lean. A walker with 2 wheels was required to maintain balance. CONCLUSION: The results point to the need for a hybrid system that allows for unencumbered hip and knee joint motion for stepping without excessive anterior trunk lean. Such a hybrid system could provide a reasonable speed in gait powered by muscle stimulation, without the usual joint motion constraints imposed by the bracing, while providing stability that is normally seen only with bracing. Further advantages would include reduction in required stimulation during standing and support phases of gait.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
13/44. Metabolic and cardiac responses to robotic-assisted locomotion in motor-complete tetraplegia: a case report.BACKGROUND/OBJECTIVE: To examine acute metabolic responses to treadmill locomotion in a participant with motor-complete tetraplegia. methods: The participant--a woman with a chronic asia B C3-C4 spinal cord injury--walked on a treadmill with 40% body weight support (BWS) and robotic assistance. oxygen consumption (VO2), minute ventilation (VE), and heart rate (HR) were measured during seated resting, supported standing, and 40 minutes of walking with stepping assistance from a Lokomat-driven gait orthosis. RESULTS: A resting VO2 equal to 50 milliliters per minute was predictably low, and did not change after the participant assumed an upright posture. Both VO2 and VE increased immediately upon onset of locomotion, suggesting a neurogenic rather than a humoral regulatory response to movement. VO2 averaged 2.4 metabolic units (METS) during locomotion at an average expenditure of 2.98 kilocalories per minute. HR was unaltered by standing, but during locomotion averaged 1 7 beats higher than during resting. Increases in VE but not VO2 upon standing, and decreases in VO2 but not VE immediately after walking, rule out changes in VE alone as the source for increased VO2 during walking. CONCLUSION: The data collected on this single participant show that treadmill locomotion with BWS and robotic assistance elicits a metabolic response to treadmill gaiting characterized by increased VO2, VE, HR, and caloric expenditure.- - - - - - - - - - ranking = 1.5keywords = motion (Clic here for more details about this article) |
14/44. spinal cord separation: MRI evidence of healing after omentum-collagen reconstruction.INTRODUCTION: animal experimentation has demonstrated that omental-collagen bridge reconstruction of a transected spinal cord in cats can result in the growth of axons crossing the transection site which resulted in the return of motor and sensory activity. This paper raises the possibility that a comparable spinal cord reconstruction model could be possible for human application. methods: cats had their spinal cord transected at the T-9 level. This led to a gap at the transection site that was filled with semi-liquid collagen, followed by omental transposition onto the underlying collagen bridge, which had subsequently hardened. A comparable technique was used on a patient who had, as reported by magnetic resonance imaging (MRI), a complete spinal cord transection at the T-6 level. RESULTS: Reconstruction of a transected spinal cord in cats using an omental-collagen bridge resulted in axons that grew across the transection site at the rate of 1 mm/day. Several animals developed forelimb and hindlimb locomotion. The patient in this paper had omental-collagen reconstruction of her cord and has clinically progressed to the point where she can ambulate with the use of a walker. The patient had a spinal cord defect of 4 cm, which, with multiple MRI studies, has shown the longitudinal development of a spinal cord connection in the area of the omental-collagen bridge that connects the proximal and distal ends of the transected spinal cord. CONCLUSION: This report suggests that a transected spinal cord has the ability to heal when the spinal cord separation is reconstructed using an omental-collagen bridge. This technique has led to neurological improvement.- - - - - - - - - - ranking = 0.16666666666667keywords = motion (Clic here for more details about this article) |
15/44. Use of a motorized bicycle exercise trainer to normalize frequency-dependent habituation of the h-reflex in spinal cord injury.BACKGROUND/OBJECTIVES: Spasticity in patients with spinal cord injury (SCI) is difficult to manage. exercise and stretching is advocated as a management tool, but these activities are difficult to perform for most patients as a result of multiple barriers. This report shows the effect of passive range-of-motion exercise in a walking-like pattern on frequency-dependent habituation of the h-reflex in the lower extremities of an individual with spastic tetraplegia due to SCI. methods: The participant, a man with a chronic asia B C7 SCI due to a gunshot wound, used a motorized bicycle exercise trainer (MBET) developed at the Jackson T. Stephens spine & neurosciences Institute at the University of arkansas for Medical Sciences that could be operated from the individual's wheelchair. He used the MBET for 1 hour, 5 days a week, for 13 weeks. h-reflex habituation was tested at the beginning of the study and then periodically over the course of 17 weeks, including 4 weeks after exercise had ceased. RESULTS: Significant habituation of the h-reflex was evident beginning at the 10th week of training. The habituation in the h-reflex reached a normal level at 5- and 10-Hz frequencies at 12 weeks. Subjective assessment of spasticity indicated that it was significantly reduced. The h-reflex amplitude was maintained at normal levels during the remaining week of the course of exercise and for 2 additional weeks after exercise ceased. The h-reflex habituation, however, returned to near baseline when reassessed at week 17, 4 weeks after the exercise program had concluded. Subjective assessment indicated that spasticity also had returned to pretraining levels. CONCLUSIONS: Habituation of the h-reflex, and perhaps spasticity, can be managed by a routine passive range-of-motion exercise program using a MBET, but the exercise program may need to be continuous. The benefit of reduced medication for spasticity and possibly improved quality of life could be a motivating factor for an individual with SCI and spasticity to continue the program. Because of the low complexity of the program, ease of use, and small size, this system could be inexpensive and could be used by an individual in the home. Ongoing studies will determine the minimum amount of MBET training required for maintaining long-term h-reflex habituation.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
16/44. Clinical evaluation of traumatic central cord syndrome: emphasis on clinical significance of prevertebral hyperintensity, cord compression, and intramedullary high-signal intensity on magnetic resonance imaging.BACKGROUND: We evaluated the prognostic and clinical value of radiological findings including prevertebral hyperintensity (HI), cord compression, intramedullary high-signal intensity (IMHSI) and instability in patients with traumatic central cord syndrome without evidence of fracture and dislocation. methods: The radiological and clinical findings of 23 patients who had undergone surgery between 1996 and 2002 were reviewed retrospectively. All of the patients underwent dynamic motion study and magnetic resonance (MR) imaging after trauma. Neurologic status was evaluated with American Spinal Injury association motor score pre- and postoperatively and compared with the radiological findings. Anterior decompression and fusion were performed in 12 patients with 1- or 2-level lesions, and posterior decompression was done for 11 cases of multilevel lesions. RESULTS: Prevertebral HI was found in 17 patients. Among them, instability was revealed in 11 patients. There was significant correlation between prevertebral HI and instability (P = .014). Cord compression was found in varying degrees in all patients on MR imaging. Intramedullary high-signal intensity was found preoperatively in 19 (83%) of 23 patients, and it was revealed at the most compressed level of the spinal cord in all cases. The neurologic level was consistent with the level of instability (100%), IMHSI (95%), and cord compression (87%). Mean American Spinal Injury association motor scores in patients with instability were lower than in those without instability (P < .05). CONCLUSIONS: The presence of prevertebral HI, IMHSI, and cord compression influenced the neurologic status of the patients. The instability was significantly associated with poor prognosis for neurologic outcome. Prevertebral HI on T2 MR imaging may be a possible indicator of instability in patients with central cord syndrome after hyperextension injury.- - - - - - - - - - ranking = 0.16666666666667keywords = motion (Clic here for more details about this article) |
17/44. Development of a novel type of shoe to improve the efficiency of knee-ankle-foot orthoses with a medial single hip joint (Primewalk orthoses): a novel type of shoe for Primewalk orthosis.The purpose of the study was to develop and evaluate a new heel cushion in shoes for use with knee-ankle-foot orthoses having a medial single hip joint (Primewalk orthoses) in order to improve walking velocity and efficiency. Primewalk orthoses and shoes were made for a 24-year-old man having paraplegia with flaccid paresis (level T-7; grade A, asia impairment scale) of 2 years' duration. walking exercises were assigned. shoes were modified with the sole made of hard rubber and the addition of soft rubber heel cushions. The walking speed, centre of foot pressure during walking, and ground reaction force were evaluated. The patient also subjectively assessed the devices. The modifications to the shoes resulted in a 1.94-fold increase in walking speed (8.6 to 16.7 m/min), a 1.87-fold increase in step length (16.7 to 31.3 cm) and a 54.8% decrease in the physiological cost index (7.7 to 3.48 beats/min). The centre of foot pressure during walking was found to deviate towards the lateral margin of the foot. The horizontal rotation of the pelvis increased simultaneously. The patient reported increased amplitude of flail motion of the trunk and decreased burden to the upper limbs. It was concluded that the modified new heel cushion of the shoe provided freedom to the lower legs and thereby increased walking efficiency.- - - - - - - - - - ranking = 0.16666666666667keywords = motion (Clic here for more details about this article) |
18/44. Effusion of the hips in a patient with tetraplegia.BACKGROUND: patients with spinal cord injury are at risk for knee effusion, most likely as a result of repetitive microtrauma. patients with paralysis are susceptible to effusions of the hip similar to those seen in documented cases regarding the knee. The etiology is likely similar and is related to repetitive microtrauma, such as that experienced when aggressive range of motion exercises are applied. DESIGN: Case report. SETTING: Acute rehabilitation department of a spinal cord injury center. FINDINGS: A 19-year-old man with a complete cervical spinal cord injury presented to acute rehabilitation on postinjury day 25 with a C6 American Spinal Injury association classification A injury, complete. He was found to have bilateral hip effusions. Joint aspiration yielded a right sterile hydroarthrosis and a left sterile hemarthrosis. During his rehabilitation stay, the patient developed one mildly elevated alkaline phosphatase level, but he showed no radiographic evidence of heterotopic ossification and maintained full passive range of motion of the hips. CONCLUSION: This case indicates that hip effusion may be a similar, less-common occurrence than knee effusion in patients with spinal cord injury. In this case, bilateral aseptic hip effusion was not associated with heterotopic ossification. More research is needed to determine the etiology and sequelae of this condition.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
19/44. The combined use of vibrostimulation and in vitro fertilization: successful pregnancy outcome from a retrograde specimen obtained from a spinal cord-injured male.While pregnancies have been documented through the independent use of the vibrator method, from other methods of procuring ejaculate from spinal cord injured men, and from artificial insemination using a retrograde specimen, we believe that this is the first case report of a live birth resulting from a retrograde ejaculate obtained by vibration from a spinal cord-injured male whose partner underwent in vitro fertilization. Vibrostimulation may well be successful in the two-thirds of men whose spinal cord lesions are at the T10 neurological level and above, who have an intact bulbocavernosus reflex and anal tone but no pain or temperature sensation of the genitalia. blood pressure monitoring, prevention of autonomic dysreflexia, alkalinization, dilution and infection control of urine, and retrograde specimen retrieval are all important techniques to ensure patient safety and optimal ejaculates. The timing of ovulation and insemination is the crucial factor for the partner of a SCI male whose sperm quality is poor. A complete gynecological workup, including studies of tubal patency, should be done before embarking on a series of artificial inseminations. Stimulation of ovulation and well-timed inseminations should optimize the chance of conception. Depending on semen analysis, female partner factors, and emotional and financial costs, IVF can appropriately be either an early or a final option.- - - - - - - - - - ranking = 0.16666666666667keywords = motion (Clic here for more details about this article) |
20/44. Technical considerations in pectoralis major transfer for treatment of the paralytic elbow.Modification of pectoralis major transfer as originally described by Clark in 1946 have not addressed concerns such as diminished strength and excursion of the transfer, along with obligatory supination of the forearm. Postoperative scarring from the long oblique chest incision further compounds the psychological impairment that accompanies brachial plexopathy. One hundred forty-three brachial plexopathies were seen over a five-year period. Seven pectoralis major transfers were done to restore elbow flexion in patients with C5-6 and C5-6-7 cord injuries. Mean age and follow-up were 26 years and 25 months respectively. The modifications of this transfer we use improve strength and range of motion by preserving dual innervation of the muscle, by tubularization of the transfer, and by restoration of the transverse aponeurosis as a fascial pulley. By transfer of the pectoralis insertion to the acromion, further anterior shoulder stability may be obtained. Aesthetics can also be improved by use of selected midline and deltopectoral incisions, along with preservation of the remaining pectoralis major and minor.- - - - - - - - - - ranking = 0.16666666666667keywords = motion (Clic here for more details about this article) |
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