Early Intervention of Cold-Water Swimming on Functional Recovery and Spinal Pain Modulation Following Brachial Plexus Avulsion in Rats.

Brachial plexus avulsion (BPA) causes peripheral nerve injury complications with motor and sensory dysfunction of the upper limb. Growing evidence has shown an active role played by cold-water swimming (CWS) in alleviating peripheral neuropathic pain and functional recovery. This study examined whether CWS could promote functional recovery and pain modulation through the reduction of neuroinflammation and microglial overactivation in dorsal horn neurons at the early-stage of BPA. After BPA surgery was performed on rats, they were assigned to CWS or sham training for 5 min twice a day for two weeks. Functional behavioral responses were tested before and after BPA surgery, and each week during training. Results after the two-week training program showed significant improvements in BPA-induced motor and sensory loss (p < 0.05), lower inflammatory cell infiltration, and vacuole formation in injured nerves among the BPA-CWS group. Moreover, BPA significantly increased the expression of SP and IBA1 in dorsal horn neurons (p < 0.05), whereas CWS prevented their overexpression in the BPA-CWS group. The present findings evidenced beneficial rehabilitative effects of CWS on functional recovery and pain modulation at early-stage BPA. The beneficial effects are partially related to inflammatory suppression and spinal modulation. The synergistic role of CWS combined with other management approaches merits further investigation.

Safe and Supportive Neurorehabilitation Environments: Results of a Structured Observation of Physical Features Across Two Rehabilitation Facilities.

OBJECTIVE: This research aimed to identify the extent to which physical features of two neurorehabilitation units appeared to support positive patient experience and recovery. BACKGROUND: Neurorehabilitation inpatient facilities must be focused on safety management and efficiency of care, as well as being supportive of the patient experience. While occupational safety and risk management is paramount, the supportive nature of the physical setting for inpatient neurorehabilitation following spinal cord injury or acquired brain injury is unclear. METHOD: Structured observation of two physical environments using an adapted observational tool comprising 237 items across 8 area zones, and 3 major categories (patient safety, worker safety and efficiency, and holistic patient experience). RESULTS: Results indicated that across both neurorehabilitation settings, the built environment attended well to occupational safety, risk reduction, harm prevention and internal security (up to 87% in spinal injury unit [SIU] and 95% in brain injury unit [BIU] patient rooms), but with limited evidence of physical features to support psychosocial needs or promote positive user experiences (up to 30% in SIU and 45% in BIU patient rooms). CONCLUSION: The built environments observed appeared to be an underutilized resource for supporting positive psychosocial neurorehabilitation experiences (including complex behavior support) beyond hazard management.

The Effect of Hospital Transfer on Patient Outcomes After Rehabilitation for Spinal Injury.

OBJECTIVE: Spine fractures, including associated spinal cord injury, account for 3%-6% of all skeletal fractures annually in the United States. Patients who undergo interhospital transfer after injury may have a greater likelihood of nonroutine disposition, longer hospital stay, and higher cost. We evaluated the effects of patient transfer on functional outcomes after spine trauma. METHODS: Patients were treated after acute traumatic spine injury at a rehabilitation hospital in 2011-2017. Compared patients were those directly admitted to the tertiary hospital or transferred from a community hospital. RESULTS: A total of 188 patients (mean age 46.1 ± 18.6 years, 77.1% men) were evaluated, including 130 (69.1%) directly admitted and 58 (30.9%) transferred patients. The most common levels of injury were at C5 (19.1%) and C6 (12.2%), and most injuries were American Spinal Injury Association injury severity score grade D (33.2%) or grade A (32.1%). No statistical difference in age, injury pattern, timing from injury to surgery, or rehabilitation length of stay was seen between admitted and transferred patients. A significant improvement in ambulation distances was seen at discharge for directly admitted compared with transferred patients (447.7 ± 724.9 vs. 159.9 ± 359.5 feet; P = 0.005). However, no significant difference primary outcomes, namely American Spinal Injury Association injury severity score distribution (P = 0.2) or Functional Independence Measures (Δ30.9 ± 15.9 vs. 30.1 ± 17.1; P = 0.7), were seen between admitted and transferred patients at time of rehabilitation discharge. CONCLUSIONS: Interhospital transfer status did not diminish time to rehabilitation after injury or reduce functional recovery, suggesting early surgical treatment in community settings may have merit prior to transfer.

Outcomes of an interdisciplinary work rehabilitation program.

BACKGROUND: Work rehabilitation programs were developed to help workers with an injury return to work (RTW). While studies have examined intervention characteristics, prognostic factors, and disability level, there is little or no research examining interdisciplinary interventions, lifting capacity/strength and the level of a patient's RTW status (e.g., not working, new job, or ongoing restrictions) at the time of discharge. OBJECTIVE: To evaluate outcomes (RTW status and lifting capacity/strength changes) of an interdisciplinary work rehabilitation program and examine whether time off work prior to the program and type of injury were related to RTW status and strength changes. METHODS: A retrospective database analysis was conducted with a sample of 495 participants (Mage = 44.44 years, SD = 10.13) of which 375 (76%) were male. Participants were workers with injuries who participated in an interdisciplinary work rehabilitation program from 2006 to 2010. RESULTS: A significantly higher number of participants were working at the end of the program than at the beginning (83.9% vs. 31.6%, p < 0.0001). Mean strength was higher at the time of discharge compared to at admission (p < 0.0001). The participants that did not RTW had had significantly more days off work prior to the program (U = 11757, z = -3.152, p = 0.002). The type of injury was not related to strength at the time of discharge. CONCLUSIONS: Findings suggest the interdisciplinary program is associated with positive outcomes and early intervention may be an important factor when treating patients with work-related injuries.

[Personalized approach to working up an early motor rehabilitation program for children with vertebral column and spinal cord injury, taking into account exercise tolerance]. / Personalizirovannyi podkhod k sostavleniiu programmy rannei dvigatel'noi reabilitatsii detei s pozvonochno-spinnomozgovoi travmoi s uchetom tolerantnosti k fizicheskoi nagruzke.

BACKGROUND: The relevance of rehabilitation of children with vertebral column and spinal cord injury (VCSCI) is due to the steady growth in the number of such patients. The mandatory conditions for early motor rehabilitation are to size efforts, to exclude fatigue and overtraining, and to gradually increase loads. The priority tasks of drawing up an individual motor program are to determine the rehabilitation abilities of a child and his/her willingness to perform the proposed load. AIM: To investigate whether the motor rehabilitation program can be personalized for children with severe VCSCI on the basis of estimation of exercise tolerance. METHODS: The investigation enrolled 25 patients with VCSCI (12 people with superior paraparesis or inferior paraplegia and 13 with inferior paraparesis or inferior paraplegia); their mean age was 12.1±5.0 years. An individual active motor rehabilitation program was worked out for all the patients according to the results of exercise tolerance testing. The latter was performed using ergospirometry to determine the maximum oxygen consumption (VO2 max) and the time to reach the anaerobic threshold. RESULTS: After a rehabilitation cycle, all the patients showed an increase in VO2 max and time to reach the anaerobic threshold. The obtained results about the increase in VO2 max with active exercises and the expansion of the aerobic corridor in both patient groups suggest that the exercise tolerance was enhanced due to increases in muscle strength and total body endurance. By the end of the rehabilitation cycle, all the patients displayed an increase in the motor density of exercises to 29.2±4.3 (64.9%) of the 45 min. Passive load decreased to 15.8±4.3 (35.1%) min. CONCLUSION: Assessment of the individual capabilities of a patient allows one to personalize the motor rehabilitation program. Ergospirometry is a technique to monitor the adequacy of the proposed program.

Housing for People with an Acquired Brain or Spinal Injury: Mapping the Australian Funding Landscape.

This research aimed to synthesize housing supports funded by 20 major insurance-based schemes for Australians with an acquired brain injury (ABI) or spinal cord injury (SCI). Publicly available grey literature (i.e., primary information from respective scheme websites) was systematically reviewed and compared. There were notable differences between the different scheme types (disability vs. workers compensation schemes) and across different States. Collectively, scheme funding was more likely to be focused on housing infrastructure and service delivery, than on tenancy support. Australians who are least likely to benefit from the current funding context are those whose home cannot be reasonably modified, are wanting to build or purchase a new home, do not have suitable, alternative short- or long-term housing options if their current home is not feasible, require support to maintain occupancy of their home or financial assistance to move into a new home, may benefit from case management services, family supports, and assistance animals, and/or cannot afford their rent or home loan repayments. Several interactions, inconsistencies, contradictions, and gaps that warrant further attention were also revealed. This review has highlighted the need for policy makers to provide transparent information about housing entitlements for individuals with ABI or SCI, and their families. A unified, evidence-based framework to guide the funding of housing and housing support services may increase the consistency of interventions available to people with ABI or SCI and, therefore, improve outcomes.

Management of cervical spine trauma in children.

PURPOSE: Paediatric cervical spine injuries are fortunately a rare entity. However, they do have the potential for devastating neurological sequelae with lifelong impact on the patient and their family. Thus, management ought to be exceptional from the initial evaluation at the scene of the injury, through to definitive management and rehabilitation. METHODS: We set out to review cervical spine injuries in children and advise on current best practice with regards to management. RESULTS: Epidemiology, initial management at the scene of injury, radiological findings and pitfalls of cervical spine trauma are outlined. Strategies for conservative and surgical management are detailed depending on the pattern of injury. The management of spinal cord injuries without radiological abnormality (SCIWORA) and cranio-cervical arterial injuries is also reviewed. CONCLUSIONS: Due to a paucity of evidence in these rare conditions, expert opinion is necessary to guide best practice management and to ensure the best chance of a good outcome for the injured child.

"Everything Happens in the Hallways": Exploring User Activity in the Corridors at Two Rehabilitation Units.

OBJECTIVES: This research aimed to examine the role of the corridors in specialist inpatient rehabilitation units to inform future design of these spaces. BACKGROUND: In healthcare settings, such as rehabilitation units, corridors have often been designed simply as spaces allowing movement between other locations. However, research suggests that corridors may be places where important social and care-related activities take place. How corridors are used and understood by patients and staff in inpatient rehabilitation settings is unclear, and a greater understanding of the role of corridors in these settings could help to inform more supportive design of these spaces. METHODS: Independent observations of user activity were conducted at a major metropolitan inpatient spinal injury unit (SIU) and brain injury unit (BIU). Interviews were conducted with SIU patients ( n = 12), and focus groups were conducted with SIU staff ( n = 23), BIU patients ( n = 12), and BIU staff ( n = 10). RESULTS: Results from the observations showed that the corridors were used frequently across the day, particularly by staff. Thematic analysis of staff and patient experiences found three key themes describing how corridors were used: (1) moving around, (2) delivery and experiences of quality care, and (3) a "spillover space." CONCLUSIONS: Results demonstrate that corridors not only have an important role as connective spaces but are also used as flexible, multipurpose spaces for delivery of quality care and patient experiences. Future design should consider how these spaces can more deliberately support and contribute to patient and staff experiences of rehabilitation.

Physical Activity Levels, Perceived Barriers to Exercise and Development of Secondary Conditions in Community Dwelling Persons with Spinal Cord Injury / Niveles de Actividad física, Barreras Percibidas para Ejercitar, y Desarrollo de Condiciones Secundarias en Personas con Lesión de la Médula Espinal que Viven en sus Comunidades

ABSTRACT Objective: To determine physical activity levels of community dwelling persons with spinal cord injury (SCI) who received inpatient rehabilitation at the Sir John Golding Rehabilitation Centre (SJGRC). This study also explored the perceived barriers to exercise and the development of secondary health complications. Methods: A non-experimental cross-sectional analysis of relationships was done. Participants were recruited from the SJGRC discharge files. Three questionnaires (The Physical Activity and Disability Scale, Spinal Cord Injury Secondary Conditions Scale and the Barriers to Exercise and Disability Scale) were administered via a telephone interview. Results: Only 58.3% of patients were engaged in some form of exercise and of that amount only 6% engaged in vigorous exercise. The main secondary conditions affecting both persons with paraplegia and quadriplegia were spasticity, chronic, muscle and joint pain. There were no significant differences between persons having paraplegia and quadriplegia in relation to physical activity levels, development of secondary conditions or barriers to exercise. Most persons were interested in an exercise programme but the most common barriers to exercise were cost and not knowing where they could go to exercise. Conclusion: Regardless of injury level, persons with spinal cord injury living in their communities in Jamaica are not engaged in adequate levels of exercise to confer health benefits and aid with healthy ageing. Barriers like cost, availability and accessibility of facilities must be addressed if this situation is to improve.

RESUMEN Objetivo: Determinar los niveles de actividad física de las personas con lesión de la médula espinal (LME) que viven en sus comunidades -es decir, en sus casas en vez de asilos o instituciones asistenciales-y que recibieron rehabilitación hospitalaria en el Centro de Rehabilitación Sir John Golding (SJGRC, en inglés). Este estudio también exploró las barreras percibidas para hacer ejercicios, y el desarrollo de complicaciones secundarias de salud. Métodos: Se realizó un análisis transversal no experimental de las relaciones. Los participantes fueron reclutados a partir de los archivos de altas del Centro SJGRC. Se aplicaron tres cuestionarios mediante entrevista telefónica (Escala de Actividad Física y Discapacidad, Escala de Condiciones Secundarias de la Lesión Medular, y Escala de Discapacidad y Barreras al Ejercicio). Resultados: Sólo el 58.3% de los pacientes se hallaban participando en alguna forma de ejercicio, y de este número sólo el 6% practicaba ejercicios fuertes. Las condiciones secundarias principales que afectaban a ambas personas con paraplejia y cuadriplejia eran la espasticidad, y el dolor muscular y articular crónico. No había diferencias significativas entre las personas que tenían paraplejia y cuadriplejia en lo referente a los niveles de actividad física, el desarrollo de condiciones secundarias o las barreras al ejercicio. La mayoría de las personas estaban interesadas en un programa de ejercicios, pero las barreras más comunes eran el costo y el no saber dónde ir a hacerlos. Conclusión: Independientemente del nivel de la lesión, las personas con lesión medular que viven en sus comunidades en Jamaica no participan en niveles adecuados de ejercicio que brinden beneficios de salud y ayuden a un envejecimiento saludable. Las barreras como el costo, la disponibilidad y la accesibilidad de las instalaciones deben ser abordadas, si se quiere mejorar esta situación.

The Need of Validated Disease-Specific Outcome Instruments for Spine Trauma.

This article focuses on patient-reported and clinician-reported outcome measures in spine trauma care. The measurement of the quality of care and functional and health-related quality of life outcomes of spine trauma patients has become increasingly important. However, no outcome instrument is specifically designed, validated, or universally adapted for this specific patient population. Issues specific to spinal trauma patients may not be adequately addressed by the instruments that are currently used in the literature and the daily clinical practice. The AOSpine Knowledge Forum Trauma initiated a project to develop and validate such instruments for spine trauma patients. To reflect the different perspectives of patients and the treating surgeons, 2 separate tools are being developed: the Patient Reported Outcome Spine Trauma (AOSpine PROST) and Clinician Reported Outcome Spine Trauma (AOSpine CROST). These tools hold promise, as useful instruments to measure the outcomes of spine trauma patients with and without neurological deficit, making it more feasible for clinical use as well. Treating surgeons around the world are encouraged to use the AOSpine PROST and AOSpine CROST in daily clinical practice and for research purposes to create and contribute to evidence-based and patient-centered care. Using the same outcome measures that are specifically developed and validated for traumatic spine injuries will allow us to compare the outcomes of various treatments in a valid and reproducible fashion. This contributes to a reduction of the ongoing controversies and providing the best treatments for our patients.

An Antimicrobial Stewardship Program Based on Systematic Infectious Disease Consultation in a Rehabilitation Facility.

OBJECTIVE To assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital. DESIGN Quasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation. SETTING 150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries. INTERVENTION Beginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions). Antibiotic consumption, occurrence of CDI, and antimicrobial resistance patterns of selected microorganisms were compared between periods before and after the ASP implementation. RESULTS Antibiotic consumption decreased from 42 to 22 defined daily dose (DDD) per 100 patient days (P<.001). The main reductions involved carbapenems (from 13 to 0.4 DDD per 100 patient days; P=.01) and fluoroquinolones (from 11.8 to 0.99 DDD per 100 patient days; P=.006), with no increases in mortality or length of stay. The incidence of CDI decreased from 3.6 to 1.2 cases per 10,000 patient days (P=.001). Between 2011 and 2014, the prevalence of extensively drug-resistant (XDR) strains decreased from 55% to 12% in P. aeruginosa (P<.001) and from 96% to 73% in A. baumannii (P=.03). The prevalence of ESBL-producing strains decreased from 42% to 17% in E. coli (P=.0007) and from 62% to 15% in P. mirabilis (P=.0001). In K. pneumoniae, the prevalence of carbapenem-resistant strains decreased from 42% to 17% (P=.005), and the prevalence of in methicillin-resistant S. aureus strains decreased from 77% to 40% (P<.0008). CONCLUSIONS An ASP based on ID consultation was effective in reducing antibiotic consumption without affecting patient outcomes and in improving antimicrobial resistance patterns in a rehabilitation hospital. Infect Control Hosp Epidemiol. 2016;1-7.

Spinal-Exercise Prescription in Sport: Classifying Physical Training and Rehabilitation by Intention and Outcome.

CONTEXT: Identification of strategies to prevent spinal injury, optimize rehabilitation, and enhance performance is a priority for practitioners. Different exercises produce different effects on neuromuscular performance. Clarity of the purpose of a prescribed exercise is central to a successful outcome. Spinal exercises need to be classified according to the objective of the exercise and planned physical outcome. OBJECTIVE: To define the modifiable spinal abilities that underpin optimal function during skilled athletic performance, clarify the effect of spinal pain and pathologic conditions, and classify spinal exercises according to the objective of the exercise and intended physical outcomes to inform training and rehabilitation. DESIGN: Qualitative study. DATA COLLECTION AND ANALYSIS: We conducted a qualitative consensus method of 4 iterative phases. An exploratory panel carried out an extended review of the English-language literature using CINAHL, EMBASE, MEDLINE, and PubMed to identify key themes and subthemes to inform the definitions of exercise categories, physical abilities, and physical outcomes. An expert project group reviewed panel findings. A draft classification was discussed with physiotherapists (n = 49) and international experts. Lead physiotherapy and strength and conditioning teams (n = 17) reviewed a revised classification. Consensus was defined as unanimous agreement. RESULTS: After the literature review and subsequent analysis, we defined spinal abilities in 4 categories: mobility, motor control, work capacity, and strength. Exercises were subclassified by functionality as nonfunctional or functional and by spinal displacement as either static (neutral spinal posture with no segmental displacement) or dynamic (dynamic segmental movement). The proposed terminology and classification support commonality of language for practitioners. CONCLUSIONS: The spinal-exercise classification will support clinical reasoning through a framework of spinal-exercise objectives that clearly define the nature of the exercise prescription required to deliver intended physical outcomes.

[Sanatorium-and-surgical treatment of patients with complicated spinal trauma in a specialized department of a sanatorium].

We studied the results of sanatorium treatment of 256 patients with complicated spinal injury and decubital ulcers. 74% of patients were male patients aged 38.5 ± 11.8 years. 89.4% of patients suffered from severe abnormalities, mild abnormalities were registered in 10.6% of patients. In 82.6% of patients decubital ulcers were localized to the skin only on one site, in 17.4% was registered multiple localization. Duration of the patients'follow-up varied from one to three years or more. Patients were divided into 2 clinical groups: the first group consisted of 132 patients who were applied during the preoperative preparation balneological factors and nanosilver, 124 patients included in the second group, which preoperative preparation was carried out in conventional-manner. Using complex medical factors in preparation for operations contributed to reducing the duration of training from 26 ± 3 days to 14 ± 2 days. The application of complex restorative treatment system allowed in the first group compared with the second group increased the number of patients with good results.

Transcranial direct current stimulation is not effective in the motor strength and gait recovery following motor incomplete spinal cord injury during Lokomat(®) gait training.

OBJECTIVE/HYPOTHESIS: Transcranial direct current stimulation (tDCS) is a potential tool to improve motor recovery in patients with neurological disorders. Safety and efficacy of this procedure for lower extremity motor strengthe and gait function in motor incomplete spinal cord injury (SCI) have not yet been addressed. The aim of this study is to optimize the functional outcome in early phases of gait rehabilitation assisted by Lokomat(®) in motor incomplete SCI patients using tDCS as an additional treatment to physical therapy. METHODS: We performed in a SCI unit a single-centre randomized, double-blind, sham-controlled study to investigate safety and efficacy of anodal tDCS of over leg motor cortex in motor incomplete SCI patients. Twenty-four SCI patients received either daily sessions of anodal tDCS (n=12) at 2mA for 20min to the vertex (leg motor cortex) during twenty days or sham tDCS (n=12). Motor deficit was assessed by the lower extremity motor score (LEMS) and for gait function: ten meter walking test (10MWT) and Walking Index for SCI (WISCI II) at baseline, after last tDCS session (after 4 weeks of stimulation), and after 8 weeks (from baseline) for follow-up. RESULTS: No side effects were detected during either tDCS or sham. In both groups, there was a significant improvement in LEMS (p<0.03), which did not significantly differ when comparing anodal and sham tDCS groups. During follow-up, in both group 5 of 12 patients could perform gait, without significant differences in gait velocity, cadence, step length and WISCI-II between both groups. CONCLUSION: Combination twenty sessions of daily tDCS to the leg motor cortex and Lokomat(®) gait training appear to be safe in motor incomplete SCI patients. There was an expected improvement in both LEMS and gait scales however, did not differ between patients treated with anodal or sham tDCS.

Return-to-Play Recommendations After Cervical, Thoracic, and Lumbar Spine Injuries: A Comprehensive Review.

CONTEXT: Currently, there is a national focus on establishing and disseminating standardized guidelines for return to play for athletes at all levels of competition. As more data become available, protocols and guidelines are being refined and implemented to assist physicians, coaches, trainers, players, and parents in making decisions about return to play. To date, no standardized criteria for returning to play exist for injuries to the spine. EVIDENCE ACQUISITION: Electronic databases including PubMed and MEDLINE and professional orthopaedic, neurosurgical, and spine organizational websites were reviewed between 1980 and 2015. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Although clinical guidelines have been published for return to play after spine injury, they are almost exclusively derived from expert opinion and clinical experience rather than from well-designed studies. Furthermore, recommendations differ and vary depending on anatomic location, type of sport, and surgery performed. CONCLUSION: Despite a lack of consensus and specific recommendations, there is universal agreement that athletes should be pain free, completely neurologically intact, and have full strength and range of motion before returning to play after spinal injury.

Don't look at my wheelchair! The plasticity of longlasting prejudice.

CONTEXT: Scientific research has consistently shown that prejudicial behaviour may contribute to discrimination and disparities in social groups. However, little is known about whether and how implicit assumptions and direct contact modulate the interaction and quality of professional interventions in education and health contexts. OBJECTIVES: This study was designed to examine implicit and explicit attitudes towards wheelchair users. METHODS: We investigated implicit and explicit attitudes towards wheelchair users in three different groups: patients with traumatic spinal cord injury (SCI); health professionals with intense contact with wheelchair users, and healthy participants without personal contact with wheelchair users. To assess the short-term plasticity of prejudices, we used a valid intervention that aims to change implicit attitudes through brief direct contact with a patient who uses a wheelchair in an ecologically valid real-life interaction. RESULTS: We found that: (i) wheelchair users with SCI held positive explicit but negative implicit attitudes towards their novel in-group; (ii) the amount of experience with wheelchair users affected implicit attitudes among health professionals, and (iii) interacting with a patient with SCI who contradicts prejudices modulated implicit negative bias towards wheelchair users in healthy participants. CONCLUSIONS: The use of a wheelchair immediately and profoundly affects how a person is perceived. However, our findings highlight the dynamic nature of perceptions of social identity, which are not only sensitive to personal beliefs, but also highly permeable to intergroup interactions. Having direct contact with people with disabilities might foster positive attitudes in multidisciplinary health care teams. Such interventions could be integrated into medical education programmes to successfully prevent or reduce hidden biases in a new generation of health professionals and to increase the general acceptance of disability in patients.

Does live music benefits patients with brain and spinal injury?

OBJECTIVE: The purpose of this study is to examine the feasibility and prospective success associated with implementing and evaluating a six-week live music intervention on an inpatient neurorehabilitation ward. PATIENTS AND METHODS: In total 26 patients were included in this study. Out of which, 15 were patients and 11 were staff members. Staff participants completed wellbeing measures at before and after music. Patients completed an assortment of validated measures at five consecutive time points from baseline to follow-up. Staff participants experienced a minor decrease in wellbeing over time. RESULTS: The majority of the data collected from patients illustrated positive trends, with improvements in wellbeing, pain, cognition functioning, independent functioning, and mobility. The feasibility indicates that with modifications that this project is a viable venture. CONCLUSIONS: We found that live music appears to be promising new addition to neurorehabilitation.

Traumatic spondyloptosis: a series of 20 patients.

OBJECT Spondyloptosis represents the most severe form of spondylolisthesis, which usually follows high-energy trauma. Few reports exist on this specific condition, and the largest series published to date consists of only 5 patients. In the present study the authors report the clinical observations and outcomes in a cohort of 20 patients admitted to a regional trauma center for severe injuries including spondyloptosis. METHODS The authors performed a retrospective chart review of patients admitted with spondyloptosis at their department over a 5-year period (March 2008-March 2013). Clinical, radiological, and operative details were reviewed for all patients. RESULTS In total, 20 patients with spondyloptosis were treated during the period reviewed. The mean age of the patients was 27 years (range 12-45 years), and 17 patients were male (2 boys and 15 men) and 3 were women. Fall from height (45%) and road traffic accidents (35%) were the most common causes of the spinal injuries. The grading of the American Spinal Injury Association (ASIA) was used to assess the severity of spinal cord injury, which for all patients was ASIA Grade A at the time of admission. In 11 patients (55%), the thoracolumbar junction (T10-L2) was involved in the injury, followed by the dorsal region (T1-9) in 7 patients (35%); 1 patient (5%) had lumbar and 1 patient (5%) sacral spondyloptosis. In 19 patients (95%), spondyloptosis was treated surgically, involving the posterior route in all cases. In 7 patients (37%), corpectomy was performed. None of the patients showed improvement in neurological deficits. The mean follow-up length was 37.5 months (range 3-60 months), and 5 patients died in the follow-up period from complications due to formation of bedsores (decubitus ulcers). CONCLUSIONS To the authors' best knowledge, this study was the largest of its kind on traumatic spondyloptosis. Its results illustrate the challenges of treating patients with this condition. Despite deformity correction of the spine and early mobilization of patients, traumatic spondyloptosis led to high morbidity and mortality rates because the patients lacked access to rehabilitation facilities postoperatively.

[Dynamics of the cognitive function in the school-age children presenting with a natal injury to the cervical spine in the course of the combined spa and health resort-based treatment with the use of manual therapy].

AIM: The objective of the present work was to study dynamics of the cognitive function in the school-age children presenting with a natal injury in the cervical region of the spine in the course of the combined spa and health resort-based treatment with the use of manual therapy based at a health resort facility. THE PATIENTS AND METHODS: A total of 110 schoolchildren at the age from 8 to 15 years (mean age 13.0 ± 0.4 years) were examined during the residual period of a natal injury in the cervical region of the spine. All the participants of the study were divided into to randomized groups. The main group was comprised of 55 school-age children (mean age 13.0 ± 0.4 years) given the comprehensive spa and health resort-based treatment with the application of manual therapy and the group of comparison that contained the remaining 55 schoolchildren (mean age 13.0 ± 0.4 years) who received the same balneotherapeutic treatment but without manual therapy. We analyzed the indicators of cognitive function after the application of manual therapy in 55 children and adolescents aged from 8 to 15 years who underwent the natal trauma to the cervical spine associatedwith the symptoms of postural disorders of varying severity. RESULTS AND DISCUSSION: The article presents the results of the analysis of cognitive function dynamics in the children and adolescents under the influence of the combined spa and health resort-based treatment with the use of manual therapy of functional blocks. It was shown that the combined spa and health resort-based rehabilitative treatment with the use of the manual therapeutic techniques makes it possible to significantly improve the condition of the cervical spine and exerts the positive influence on the dynamics of the cognitive function, has beneficial effect on the mental and motor functions, increases the flexibility and backup capabilities of the nervous system, and may be instrumental in resolving the problems arising from school disadaptation.