Validation of inertial measurement units for the assessment of trunk control in subjects with spinal cord injury.

BACKGROUND: Trunk control (TC) constitutes one of the main objectives in the rehabilitation of people with a spinal cord injury (SCI), but there are few clinically validated tests to assess it. Accelerometers have been proposed as sensitive and suitable procedures to assess TC. OBJECTIVE: To evaluate test-retest reliability, construct and criterion validity of accelerometer parameters to assess TC in people with SCI. METHODS: A cross-sectional study of simultaneous application of Clinical Trunk Control Test (CTCT) and accelerometer evaluation was conducted. Accelerometers were placed on the trunks of 27 people with SCI and 15 people without SCI. Reliability was assessed by three repeated measures in random order of selected static and dynamic TC tasks. Acceleration on three axes was analyzed using five metrics. Criterion validity was assessed by analyzing correlation of acceleration to CTCT scores. Construct validity was assessed by analyzing capacity of inertial measurement units (IMU) to differentiate individual's characteristics, ASIA Impairment scale, gait capacity, level of TC, and neurological level of injury. RESULTS: Reliable IMU data were obtained in people with SCI and without SCI, of all accelerometer axes, metrics, and tested items of the CTCT. Reliability of acceleration decreases with the increasing demand for TC tasks. Ten acceleration parameters showed construct and criterion validity. CONCLUSION: Accelerometer parameters are reliable, valid, and sensitive to evaluate TC in people with SCI. SIGNIFICANCE: A set of IMU parameters were validated as reliable and valid measures to evaluate TC, which could be useful for the assessment of progression of people with SCI and clinical interventions.

Nerve transfer rehabilitation in tetraplegia: Comprehensive assessment and treatment program to improve upper extremity function before and after nerve transfer surgery, a case report.

CONTEXT: A 28-year-old male, sustained a traumatic Spinal Cord Injury (SCI) in January 2015, and was classified as AIS A, neurological level of injury (NLI) C4. As an inpatient at the SCI rehabilitation unit, he underwent multidisciplinary assessment involving SCI specialists, peripheral nerve surgeons, psychologists, occupational and physical therapists. Team consensus determined he was a candidate for nerve transfer surgery to improve upper extremity function. The patient undertook a pre-surgical neurorehabilitation program of 3 months duration. Surgery was performed bilaterally at 11 and 13 months after SCI (right and left arm respectively). FINDINGS: Upon completion of surgical procedures, the patient underwent an intensive post-surgical rehabilitation program based on established goals, with follow-up every 3 months, up to 24 months after the surgery. Notable improvements were wheelchair propulsion, the ability to relieve pressure, grasp, pinch, and release an object. Standardized measures for SCI individuals (SCIM-III, CUE-Q, LiSAT-9 and UEMS) showed significant improvements. CLINICAL RELEVANCE: Nerve transfers in tetraplegia are an underused technique. The benefits of surgery along with an intensive neurorehabilitation program, can improve independence and function in daily living activities for a properly selected group of individuals.

Prognostic validity of a clinical trunk control test for independence and walking in individuals with spinal cord injury.

Objective: The objective of the present work was to determine the prognostic validity of the trunk control test for walking and independence in individuals with SCI.Design: A cohort, prospective study was carried out in all individuals with sub-acute SCI.Setting: All inpatients at the Mexico City based National Rehabilitation Institute (INR).Participants: Ninety individuals with a clinical diagnosis of sub-acute SCI, American Spinal Injury Association Impairment Scale (AIS) A-D, and that have not participated in a rehabilitation program were included. Thirty-five individuals had good initial trunk control and the remaining 55 had poor trunk control. All individuals participated in a standard rehabilitation program subsequently.Interventions: N/AOutcome Measures: The trunk control test was performed at baseline. At 1, 3, 6, 9 and 12 months after the first evaluation, walking and independence were assessed.Results: Survival Analysis revealed that 62.5% and 100% individuals with good trunk control at baseline assessment were respectively walking and independent in ADL at 12 months and 14% and 48% individuals with poor trunk control were walking and independent in ADL. Cox regression analysis revealed that individuals with good trunk control were 4.6 times more likely to walk independently at 12 months and 2.9 times more likely to be independent in activities of daily living.Conclusion: The present study revealed that the trunk control test is useful for providing a prognosis of independence and walking at 1 year in individuals with SCI, independently of the neurologic level and the severity of the injury.

Walking speed is not the best outcome to evaluate the effect of robotic assisted gait training in people with motor incomplete Spinal Cord Injury: A Systematic Review with meta-analysis.

CONTEXT: While there are previous systematic reviews on the effectiveness of the use of robotic-assisted gait training (RAGT) in people with spinal cord injuries (SCI), as this is a dynamic field, new studies have been produced that are now incorporated on this systematic review (SR) with meta-analysis, updating the available evidence on this area. OBJECTIVE: To synthesise the available evidence on the use of RAGT, to improve gait, strength and functioning. METHODS: SR and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions were implemented. Cochrane Injuries Group Specialized Register, PubMed, MEDLINE, EMBASE, CINAHL, ISIWeb of Science (SCIEXPANDED) databases were reviewed for the period 1990 to December 2016. Three researchers independently identified and categorized trials; 293 studies were identified, 273 eliminated; remaining 15 randomized clinical trials (RCT) and five SR. Six studies had available data for meta-analysis (222 participants). RESULTS: The pooled mean demonstrated a beneficial effect of RAGT for WISCI, FIM-L and LEMS (3.01, 2.74 and 1.95 respectively), and no effect for speed. CONCLUSIONS: The results show a positive effect in the use of RAGT. However, this should be taken carefully due to heterogeneity of the studies, small samples and identified limitations of some of the included trials. These results highlight the relevance of implementing a well-designed multicenter RCT powered enough to evaluate different RAGT approaches.

[Analysis of maternal deaths in Mexico occurred during 2009]. / Análisis de las muertes maternas en México ocurridas durante 2009.

BACKGROUND: Mexico reported 955 maternal deaths in 2011, with a ratio of 49 deaths per 100,000 live births. For 2015, the WHO commitment is to reduce the ratio to 22, equivalent to 415 maternal deaths. METHODS: it is a descriptive and retrospective study. In 1257 maternal deaths in 2009, we reviewed a sample of 173 records. Simple frequencies and percentages were calculated. RESULTS: direct causes of maternal death were preeclampsia-eclampsia, infection and obstetrical hemorrhage secondary to uterine atony, placental accreta and placenta previa. Fifteen patients died from abortion complications. Four patients died from extra-uterine pregnancy, because of delayed diagnosis and treatment. Indirect causes of maternal death were neoplasms, abdominal sepsis, vascular events, metabolic problems and heart disease; twenty-five patients died of atypical pneumonia and 11 more of influenza A H1N1. CONCLUSIONS: it is feasible to reduce maternal mortality by means of an adequate prenatal care, in quantity and quality of consultations, and avoiding high risk pregnancies caused by a history of obstetric factors and associated severe diseases. Influenza A H1N1 interrupted the downward trend in maternal mortality.

Introducción: en 2011 ocurrieron 955 defunciones maternas en México, 49.9 por 100 000 nacidos vivos. La meta de la Organización Mundial de la Salud para 2015 es reducir la tasa a 22.5: 560 defunciones anuales. Métodos: estudio descriptivo y retrospectivo de 1257 muertes maternas ocurridas en México durante 2009, con una muestra representativa de 173 expedientes. Se calcularon frecuencias simples y porcentajes. Resultados: las muertes maternas ocurrieron por causas directas como preeclampsia-eclampsia, infección y hemorragia obstétrica secundaria a atonía uterina, acretismo placentario y placenta previa. Quince mujeres tuvieron complicaciones por abortos. Cuatro murieron por embarazo extrauterino debido a diagnóstico y tratamiento tardíos. Las causas indirectas de la muerte materna fueron neoplasias, sepsis abdominal, eventos vasculares, problemas metabólicos y cardiopatías. Veinticinco pacientes fallecieron por neumonía atípica y 11 por influenza A H1N1. Conclusiones: es factible disminuir la mortalidad materna mediante suficientes consultas prenatales de calidad y evitar embarazos con riesgo alto por los antecedentes obstétricos y los padecimientos asociados. La influenza A H1N1 interrumpió la tendencia descendente de la mortalidad materna.

[Analysis of dengue fever deaths in Mexico: 2009]. / Defunciones por dengue en México. Análisis del año 2009.

OBJECTIVE: to describe the dengue fever mortality. METHODS: a descriptive and retrospective study including 104 files reported deaths caused by dengue fever during 2009 to march 2010, was done. RESULTS: sixty (58 %) were women and 44 (42 %) men. An increased mortality between the ages of 11 and 40 years old (47 %) was observed. Colima was a state with high incidence of cases and Jalisco had the highest mortality. Thrombocytopenia was the rule (90.4 %) and in one third of the cases platelets were below 50,000/mm(3). A quarter of cases were associated with comorbility. The initial clinical manifestations included: bleeding, hypovolemia by depletion or hemorrhage, tachycardia, paleness, depressed level of consciousness and circulatory failure. The main cause of death was hypovolemic shock or sepsis. In 42 cases, severe dengue was considered. CONCLUSIONS: an association between the severity of dengue fever and mortality was observed. The main cause of mortality was a shock state.