A nationwide survey on the incidence and characteristics of traumatic spinal cord injury in Japan in 2018.

STUDY DESIGN: Retrospective epidemiological study. OBJECTIVES: Since the causes and incidences of traumatic spinal cord injury (TSCI) in each country change over time, up-to-date epidemiological studies are required for countermeasures against TSCI. However, no nationwide survey in Japan has been conducted for about 30 years. The purpose of this study was therefore to investigate the recent incidence and characteristics of TSCI in Japan. SETTING: Japan METHODS: Survey sheets were sent to all hospitals (emergency and acute care hospitals) that treated TSCI persons in Japan in 2018 and case notes were retrospectively reviewed. Frankel grade E cases were excluded from analysis. RESULTS: The response rate was 74.4% (2804 of 3771 hospitals). The estimated annual incidence of TSCI excluding Frankel E was 49 per million, with a median age of 70.0 years and individuals in their 70s as the largest age group. Male-to-female ratio was 3:1. Cervical cord injuries occurred in 88.1%. Frankel D was the most frequent grade (46.3%), followed by Frankel C (33.0%). The most frequent cause was fall on level surface (38.6%), followed by traffic accident (20.1%). The proportion of fall on level surface increased with age. TSCI due to sports was the most frequent cause in teenagers (43.2%). CONCLUSIONS: This nationwide survey in Japan showed that estimated incidence of TSCI, rate of cervical cord injury, and incomplete injury by falls appear to be increasing with the aging of the population.

Comparative analysis of effects of various toilet seat cushions on buttock pressure during toileting in persons with spinal cord injury.

OBJECTIVES: To measure buttock pressure during toilet seating in persons with spinal cord injury (SCI). DESIGN: A case series study. SETTING: Kibikogen Rehabilitation Center for Employment Injuries. METHODS: The study included 41 persons with SCI. Buttock pressure was measured during toilet seating, with or without a toilet seat cushion (foam cushion, gel cushion, air cushion) on the toilet seat. RESULTS: The subjects were classified into three groups according to the site of the maximum pressure [greater trochanter (GT) region, ischial tuberosities (IT), and sacral region (SR)] recorded on the pressure map of the non-cushioned toilet seat, into the GT, IT and SR groups, respectively. All three types of cushions altered the buttock pressure distribution during no-cushion toilet seating. In the GT group, all three cushions significantly reduced the peak pressure in the GT area, compared to the control (no-cushion). The foam cushion significantly increased the peak pressure in the IT area (Pisch) in the GT group, relative to the control. However, the foam cushion significantly increased while the gel cushion significantly reduced Pisch, relative to the control. In SR group, the air cushion significantly reduced the peak pressure in the SR, relative to the control. CONCLUSION: We recommend the use of the gel cushion for the IT group and the air cushion in GT and SR group to reduce buttock pressure during toilet seating in persons with SCI.

Autonomic dysreflexia during a bowel program in patients with cervical spinal cord injury.

The purpose of the present study was to investigate the relationship between bowel maneuvers and autonomic dysreflexia (AD) in patients with cervical spinal cord injuries (CSCI). Fifteen consecutive, clinically stable patients with CSCI participated. We evaluated changes in blood pressure (BP), pulse rate (PR) and classic symptoms of AD before, during and after a bowel program involving the manual removal of stool in lateral recumbency. The insertion of rectal medication induced a significant increase in systolic BP, which persisted during additional digital rectal stimulation. Furthermore, the manual removal of stool induced AD, with maximal increases of systolic BP (169.1(+-)19.5 mmHg, mean(+-)SD). However, the insertion of a finger into the anus after the end of stool flow did not cause a further increase in systolic BP. Systolic BP recovered to pre-program values within 5 min after defecation. Our study demonstrated that the combined effects of rectal and/or anal sphincter distension and uninhibited rectal contraction in response to the manual removal of stool might induce AD. We recommend avoiding, if at all possible, the manual removal of stool in order to prevent AD in patients with CSCI.

Kinesiological study of the push-up motion in spinal cord injury patients: involving measurement of hand pressure applied to a force plate.

We studied the pressure exerted by hands during push-ups in 21 paraplegic and 2 tetraplegic patients employing 4 different hand positions. In the fingers-spread position, the initial force exerted was a vertical force (Fz), followed by a medio-lateral force (Fy) and then an antero-posterior force (Fx). In the other 3 positions, the order of force type exertion was Fz, Fx, and then Fy. All subjects with neurological injury levels above T4 and subjects between T5 and T10 without spinal instrumentation could not push themselves up in the fingers-spread position. The fact that Fy is initiated before Fx in the fingers-spread position indicates that lateral balancing of the trunk is critical in this position, thus explaining why subjects without spinal instrumentation with neurological injury at a level higher than T10 could not control their spinal columns while performing push-ups. In contrast, antero-posterior balancing takes priority in the other hand positions. We believe that spinal instrumentation helps balance the trunk in the lateral direction, converting the thoracic spine into a rigid body in subjects with neurological injury at levels above T10.

Finding the optimal setting of inflated air pressure for a multi-cell air cushion for wheelchair patients with spinal cord injury.

Pressure distribution patterns of the seating interface on the multi-cell air cushion (ROHO High Profile) of 36 adults with spinal cord injury (SCI) (Neurological level Th3 -L1) were measured at different air pressure levels by a pressure mat measurement system. Stress distribution relative to the inflated air pressure in the air cushion on the patients' wheelchairs was analyzed to determine the appropriate inflated air pressure of the cushion for patients. The maximum pressure points in all subjects were at the areas of the ischial tuberosities (82 to 347 mmHg). The optimal reduction in interface pressure at the ischial tuberosities was obtained just before bottoming out. The cushion air pressure at that point was between 17 and 42 mmHg, and correlated well to body weight (r = 0.495, P = 0.0021). In contrast, the maximum pressure levels did not correlate to body weight or the Body Mass Index (BMI). Pressure at the ischial area could be reduced, but not eliminated, by adjusting the air pressure. The maximum pressure levels seemed to be related to the shape of the buttocks, especially the amount of soft tissue, and exceeded the defined threshold for pressure ulcers (> 80 g/cm2).