Acupuncture acupoints of spine and lower limb for pediatric backbend-induced thoracic spinal cord injury: Four case reports and literature review.

BACKGROUND: Backbend-induced pediatric thoracic spinal cord injury without radiologic abnormality (BBPT-SCIWORA) in children is rare in clinical practice and leads to lower limb motor dysfunction. There are few clinical studies on BBPT-SCIWORA and even fewer on treatments for BBPT-SCIWORA-induced lower limb motor dysfunction. OBJECTIVE: To explore the therapeutic effect of acupuncture at bilateral spine acupoints combined with lower limb acupoints in BBPT-SCIWORA. CASE PRESENTATION: This study reported four cases of BBPT-SCIWORA after dancing, two of which received a unique medium-frequency electroacupuncture treatment. They were all females aged between 5 and 12 years old. They were diagnosed with BBPT-SCIWORA by magnetic resonance imaging (MRI), transferred to the rehabilitation department for lower limb dysfunction, and received rehabilitation treatments and acupuncture. Cases 1 and 2 received acupuncture treatment for lower limb acupoints, while Cases 3 and 4 received acupuncture treatment at the bilateral spine acupoints beside the lesion and lower limb acupoints. Cases 3 and 4 achieved better American spinal injury association (AIS) grades and lower extremity motor scores (LEMS) than Cases 1 and 2 after treatment. CONCLUSION: Acupuncture treatment of beside bilateral spine acupoints plus lower limb acupoints therapy might facilitate early lower limb motor function recovery in children with BBPT-SCIWORA.

Noninvasive Neuromodulation Techniques in Difficult Tracheostomy Weaning of Patients With Spinal Cord Injury: Report of Two Cases.

High spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (>40 days) and hospital stay (>50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.

Efectividad de la ozonopuntura en pacientes con artrosis cervical / Effectiveness of ozonepuncture in patients with cervical osteoarthritis

Introducción: La artrosis vertebral es frecuente. Las causas y procesos fisiopatológicos que contribuyen a su avance son variados. Se plantea que 80 % de las personas mayores de 55 años de edad presentan alteraciones en la columna cervical. Objetivo: Evaluar la efectividad de la ozonopuntura para el alivio de síntomas y signos en pacientes con artrosis cervical. Métodos: Se realizó un estudio de intervención terapéutica en 80 pacientes con artrosis cervical, atendidos en la Consulta de Ortopedia y remitidos al Servicio de Medicina Tradicional y Natural del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde mayo del 2017 hasta marzo del 2019. Se dividieron aleatoriamente en 2 grupos: de estudio y de control, con 40 integrantes cada uno. Resultados: La enfermedad prevaleció en los pacientes de 50-59 años de edad, tanto del grupo de estudio como de control (35,0 y 30,0 %, respectivamente) y en el sexo femenino (85,0 % en el primero y 82,5 % en el segundo). La evolución fue buena y excelente en casi la totalidad de los integrantes del grupo de estudio. Conclusiones: La ozonopuntura fue efectiva en los pacientes con artrosis cervical y no se presentaron reacciones secundarias relacionadas con su aplicación. La evolución resultó satisfactoria y se observó una respuesta mayor en la desaparición de los síntomas y signos clínicos con la terapéutica acupuntural que con la convencional.

Introduction: The vertebral osteoarthritis is frequent. The pathophysiological causes and processes that contribute to its advance are varied. It is said that the 80 % of people over 55 years present cervical spine disorders. Objective: To evaluate the effectiveness of the ozonepuncture for the relief of symptoms and signs in patients with cervical osteoarthritis. Methods: A study of therapeutic intervention in 80 patients with cervical osteoarthritis was carried out, they were assisted in the Orthopedics Service and referred to the Traditional and Natural Medicine Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from May, 2017 to March, 2019. They were divided at random in 2 groups: study and control groups, with 40 members each one. Results: The disease prevailed in the 50-59 age group, in both groups (35.0 and 30.0 %, respectively) and in the female sex (85.0 % in the first one and 82.5 % in the second). The clinical course was good and excellent in almost all the members of the study group. Conclusions: The ozonepuncture was effective in the patients with cervical osteoarthritis and adverse reactions related to its application were not presented. The clinical course was satisfactory and a higher response was observed in the disappearance of the symptoms and clinical signs with the acupuntural therapeutic than with the conventional one.

Improving the staging of neck injuries using a new index, the Neck Functional Holistic Analysis Score: Clustering approach to determine degrees of impairment.

BACKGROUND: Traumatic cervical spine injuries are amongst the traffic injuries that can cause most harm to a person. Classifying subtypes of clinical presentations has been a method used in other pathologies to diagnose more efficiently and to address the appropriate treatment and the prognosis. The management of patients suffering from cervical injuries could be improved by classifying the severity of the impairment. This will allow clinicians to propose better treatment modalities according to the severity of the injury. MATERIALS AND METHODS: The present study is a retrospective cohort study performed with the clinical data from 772 patients stored at Fisi-(ON) Health Group. All the patients treated for cervical spine injuries are evaluated using the EBI-5® system, which is based on inertial measurement unit (IMU) technology. The normalized range of motion of each patient was incorporated into a single index, the Neck Functional Holistic Analysis Score (NFHAS). RESULTS: Clustering analysis of the patients according to their NFHAS resulted in five groups. The Kruskal-Wallis H test showed that there were statistically relevant differences in the ROM values and NFHAS of the patients depending on the cluster they were assigned to: FE X2(4) = 551.59, p = 0.0005; LB ROM X2(4) = 484.58, p = 0.0005; RT ROM X2(4) = 557.14, p = 0.0005; NFHAS X2(4) = 737.41, p = 0.0005. Effect size with ηp2 for the comparison of groups were: FE = 0.76, LB = 0.68, RT = 0.76 and NFHAS = 0.96. CONCLUSION: The NFHAS is directly correlated to the available ROM of the patient. The NFHAS serves as a good tool for the classification of cervical injury patients. The degree of impairment shown by the cervical injury can now be staged correctly using this new classification.

Effect of a Single Session of Facial Distortion Model Manual Physiotherapy and a Selected Foam Rolling Technique on Treatment Outcomes in Cervical Spine Overload. Pilot Study.

BACKGROUND: The prevalence of neck pain is on the increase. A sedentary life style, poor ergonomics in the workplace and in daily life, and stress all contribute to neck overload. The aim of this study was to assess the efficacy of a single session of a Fascial Distortion Model (FDM) intervention combined with foam rolling in patients with cervical spine overload. MATERIAL AND METHODS: The study enrolled 90 patients, who were randomized to an FDM group, a foam rolling group (who exercised with a Duoball against a wall) and a control group, of 30 patients each. Mobility was measured with a digital inclinometer, pain intensity was assessed with a VAS scale and (upper and middle) trapezius tone was evaluated by sEMG. These measurements were carried out twice in each group and analysed in Matlab and Statistica 13. RESULTS: Both groups subjected to a therapeutic intervention (FDM and foam rolling) reported a significant reduction in neck pain intensity and improved cervical spine mobility (p<0.01). The control group did not demonstrate changes in mobility or pain intensity. The resting trapezius tone did not change in any of the groups. Conclusions, 1. A single session of FDM therapy can effectively reduce and eliminate cervical spine pain, which may be of use in work-site rehabilitation. 2. Single sessions of FDM and foam rolling can effectively improve neck mobility in patients with cervical spine overload. 3. There is a rationale for conducting further prospective randomized studies of larger samples to assess the duration of the beneficial effects of both therapies and determine an optimum session frequency.

A therapeutic effect for males with spinal cord injury using abdominal functional electrical stimulation for sexual functioning.

INTRODUCTION: Sexual functioning is a high priority for people with a spinal cord injury (SCI) yet this area has received little attention. Two SCI case reports are presented which suggests there may be greater potential for the recovery of sexual functioning than previously recognised. CASE PRESENTATION: A 74-year-old SCI male (AIS D, C5/C6) and a 36-year-old SCI male (AIS A, T4/T5) were treated for neurogenic bowel using 6 weeks of abdominal FES (ABFES) (40 Hz, 300 µ pulse width (current typically 30-60 MA) simultaneously delivered (8 s contraction with 2 s ramps and 3 s off period) from both channels). The 74-year-old AIS D, C5/C6 participant reported improved strength and duration of erectile function after using ABFES for 3 weeks. The 36-year-old AIS A, T4/T5 participant reported improvements in ejaculatory function and urine flow. Both reported a reduction in time required for bowel management. DISCUSSION: The findings could be attributed to an improved vascularisation of the abdominal area, an improved body image and self-esteem, direct innervation of nerves involved in parasympathetic pathways or innervation of the T11/T1 area implicated in the alternative psychogenic pathway. Both participants reported they had not used ABFES during sexual activity suggesting a therapeutic effect from the treatment.

Cerebrovascular function is preserved during mild hyperthermia in cervical spinal cord injury.

STUDY DESIGN: Experimental study. OBJECTIVES: Compromised cerebrovascular function likely contributes to elevated neurological risk in spinal cord injury (SCI). Passive heating offers many cardiovascular and neurological health benefits; therefore, we aimed to determine the effects of an acute bout of heating on cerebrovascular function in chronic SCI. METHODS: Persons with cervical SCI (n = 15) and uninjured controls (CON; n = 15) completed 60 min of lower limb hot water immersion (40 °C). Assessments of middle cerebral (MCA) and posterior cerebral artery (PCA) velocities, pulsatilities, and neurovascular coupling (NVC) were performed using transcranial Doppler ultrasound. Duplex ultrasonography was used to index cerebral blood flow via the internal carotid artery (ICA), and carotid-femoral pulse-wave velocity (PWV) was measured using tonometry. The NVC response was quantified as the peak hyperemic value during 30-s cycles of visual stimulation. RESULTS: Mean arterial pressure changed differentially with heating [mean (standard deviation); SCI: +6(14) mmHg, CON: -8(12) mmHg; P = 0.01]. There were no differences in any intracranial artery measures (all P > 0.05), except for small (~10%) increases in MCA conductance in CON after heating vs. SCI (interaction P = 0.006). Resting ICA flow was greater in SCI vs. CON (P = 0.03) but did not change with heating in either group (interaction P = 0.34). There were also no between-group differences in the NVC response (ΔPCA conductance) pre- [SCI: 29(19)% vs. CON: 30(9)%] or post-heating [SCI 30(9)% vs. 25(9)%; interaction P = 0.22]. CONCLUSIONS: Mild acute heating does not impair or improve cerebrovascular function in SCI or CON. Thus, further study of the effects of chronic heating interventions are warranted.

Vision-aided brain-machine interface training system for robotic arm control and clinical application on two patients with cervical spinal cord injury.

BACKGROUND: While spontaneous robotic arm control using motor imagery has been reported, most previous successful cases have used invasive approaches with advantages in spatial resolution. However, still many researchers continue to investigate methods for robotic arm control with noninvasive neural signal. Most of noninvasive control of robotic arm utilizes P300, steady state visually evoked potential, N2pc, and mental tasks differentiation. Even though these approaches demonstrated successful accuracy, they are limited in time efficiency and user intuition, and mostly require visual stimulation. Ultimately, velocity vector construction using electroencephalography activated by motion-related motor imagery can be considered as a substitution. In this study, a vision-aided brain-machine interface training system for robotic arm control is proposed and developed. METHODS: The proposed system uses a Microsoft Kinect to detect and estimates the 3D positions of the possible target objects. The predicted velocity vector for robot arm input is compensated using the artificial potential to follow an intended one among the possible targets. Two participants with cervical spinal cord injury trained with the system to explore its possible effects. RESULTS: In a situation with four possible targets, the proposed system significantly improved the distance error to the intended target compared to the unintended ones (p < 0.0001). Functional magnetic resonance imaging after five sessions of observation-based training with the developed system showed brain activation patterns with tendency of focusing to ipsilateral primary motor and sensory cortex, posterior parietal cortex, and contralateral cerebellum. However, shared control with blending parameter α less than 1 was not successful and success rate for touching an instructed target was less than the chance level (= 50%). CONCLUSIONS: The pilot clinical study utilizing the training system suggested potential beneficial effects in characterizing the brain activation patterns.

Inspiratory muscle training is feasible and safe for patients with acute spinal cord injury.

OBJECTIVE: To investigate the feasibility and safety and, to a lesser extent efficacy, of inspiratory muscle training (IMT) for patients with acute complete cervical or thoracic spinal cord injury (SCI). DESIGN: Prospective, observational pilot study comprising a series of case reports. SETTING: Tertiary care, public hospital. PARTICIPANTS: Seven adult subjects with an acute complete cervical or thoracic SCI. INTERVENTIONS: Participants received IMT as soon as their respiratory condition was stable. A high-resistance, low-repetition program of IMT using a POWERbreathe KH1 device was instituted. Training comprised 3-6 sets of 6 breaths, commenced at 50% maximum inspiratory pressure with the training load progressively increased. OUTCOME MEASURES: Feasibility (number of sessions when the criteria to participate in IMT were met/not met), safety (symptoms and physiological stability) before, during and after IMT sessions and efficacy (lung function) were measured. RESULTS: There were 50 sessions in total where participants met the criteria to receive IMT, with a mean (range) of 7.1 (3-11) IMT sessions per participant delivered over 10.7 (4-17) days. IMT was feasible, with all 50 planned sessions of IMT able to be delivered, and safe, with stable physiological parameters and no adverse symptoms or events recorded before, during or after IMT. Maximal inspiratory pressure increased for four participants and forced vital capacity increased for three participants over the duration of their IMT sessions. CONCLUSION: A high-resistance, low-repetition program of IMT was feasible and safe in adults with an acute complete cervical or thoracic SCI whose respiratory status was stable. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN 12614000975695).

Acute heat stress reduces biomarkers of endothelial activation but not macro- or microvascular dysfunction in cervical spinal cord injury.

Cardiovascular diseases (CVD) are highly prevalent in spinal cord injury (SCI), and peripheral vascular dysfunction might be a contributing factor. Recent evidence demonstrates that exposure to heat stress can improve vascular function and reduce the risk of CVD in uninjured populations. We therefore aimed to examine the extent of vascular dysfunction in SCI and the acute effects of passive heating. Fifteen participants with cervical SCI and 15 uninjured control (CON) participants underwent ultrasound assessments of vascular function and venous blood sampling for biomarkers of endothelial activation (i.e., CD62e+) and apoptosis (i.e., CD31+/42b-) before and after a 60-min exposure to lower limb hot water immersion (40°C). In SCI, macrovascular endothelial function was reduced in the brachial artery [SCI: 4.8 (3.2)% vs. CON: 7.6 (3.4)%, P = 0.04] but not the femoral artery [SCI: 3.7 (2.6)% vs. CON: 4.0 (2.1)%, P = 0.70]. Microvascular function, via reactive hyperemia, was ~40% lower in SCI versus CON in both the femoral and brachial arteries ( P < 0.01). Circulating concentrations of CD62e+ were elevated in SCI versus CON [SCI: 152 (106) microparticles/µl vs. CON: 58 (24) microparticles/µl, P < 0.05]. In response to heating, macrovascular and microvascular function remained unchanged, whereas increases (+83%) and decreases (-93%) in antegrade and retrograde shear rates, respectively, were associated with heat-induced reductions of CD62e+ concentrations in SCI to levels similar to CON ( P = 0.05). These data highlight the potential of acute heating to provide a safe and practical strategy to improve vascular function in SCI. The chronic effects of controlled heating warrant long-term testing. NEW & NOTEWORTHY Individuals with cervical level spinal cord injury exhibit selectively lower flow-mediated dilation in the brachial but not femoral artery, whereas peak reactive hyperemia was lower in both arteries compared with uninjured controls. After 60 min of lower limb hot water immersion, femoral artery blood flow and shear patterns were acutely improved in both groups. Elevated biomarkers of endothelial activation in the spinal cord injury group decreased with heating, but these biomarkers remained unchanged in controls.

Post-infectious ankylosis of the cervical spine in an army veteran: a case report.

Background: Vertebral osteomyelitis is a rare, life-threatening condition. Successful management is dependent on prompt diagnosis and management with intravenous antibiotic therapy or surgery in addition to antibiotics. Reoccurrence is minimal after 1 year. However, very little is reported in the conservative spine literature regarding the long-term follow-up and the changes to the spine following management of the spinal infection. We report the dramatic radiologic findings of the long-term sequela of a cervical spine infection following a gunshot wound from 1969. Most impressive to the spine specialist is this patient's ability to return to work despite significant alterations to spinal biomechanics. Case presentation: A 69 year-old caucasian male presented to the chiropractic clinic at a Veterans Affairs Medical Center with complaint of chronic left shoulder pain secondary to an associated full thickness tear of the left infraspinatus. An associated regional assessment of the cervical spine ensued. Radiological imaging on file revealed ankylosis C2/C3 to C7/T1. The patient reported a history of multiple fragment wounds in 1969 to the left anterior neck and shoulder 45 years earlier. Osteomyelitis of the cervical spine resulted from the wounds. Conclusion: Potential sequela of osteomyelitis is ankylosis of affected joints. In this particular case, imaging provides evidence of regional ankylosis of the cervical spine. Considering the patient did not complain of cervical pain or related symptoms apart from lack of cervical range of motion, and his Neck Disability Index score was 2 out of 50 (4%), no intervention was provided to the cervical spine. The patient reported he self-managed well, worked full-time as a postal worker after he was discharged due to the injury to his neck, and planned to retire in less than one month at age 70. The patient demonstrates successful return to work with pending retirement at age 70 following spondylodiscitis and subsequent ankylosis of the cervical region.

An Early Description of Using Oral Route for the Management of Cervical Vertebra Fracture by Ibn al-Quff in the Thirteenth Century.

OBJECTIVE: This study presents information regarding the treatment of fractures and dislocations of the vertebrae, including the use of the oral route for upper cervical fractures, presented in certain chapters of the book titled Kitab al-'Umda fi Sina'a al-Jiraha (Ibn al-Quff, thirteenth century ad). METHODS: A printed copy of the second volume of the book was studied. Chapters 22 ("On treatment of vertebral fractures") and 33 ("On treatment of vertebral dislocation") of the seventeenth treatise of this book were translated from Arabic into English. Each section is presented (in full text) in the Results section of this article. The findings were compared with the relevant literature and discussed to determine whether Ibn al-Quff presented novel information compared with that presented by his predecessors. RESULTS: The writings of Ibn al-Quff regarding vertebral dislocations seem to summarize information derived from his predecessors. Moreover, he modified certain approaches, previously described for vertebral dislocations, and used them for correcting vertebral fractures. Ibn al-Quff introduced the most novel use of a bridlelike instrument for anterior cervical fracture through the oral route. By introducing the device in the mouth, he described a pushing maneuver to the cervical vertebrae from the ventral site and a simultaneous pulling maneuver by cupping on the neck from the dorsal site. CONCLUSIONS: The use of the oral route introduced by Ibn al-Quff may be one of the earliest examples of novel, practical, and advanced treatment for cervical vertebral fracture.

Criteria to Screen for Traumatic Cervical Spine Instability: A Consensus of Chiropractic Radiologists.

OBJECTIVE: The purpose of this study was to establish consensus on a radiographic definition for cervical instability for routine use in chiropractic patients who sustain trauma to the cervical spine. METHOD: We conducted a modified Delphi study with a panel of chiropractic radiologists. Panelists were asked to rate potential screening criteria for traumatic cervical spine instability when assessing cervical spine radiographs. Items rated as important for inclusion by at least 60% of participants in round 1 were submitted for a second round of voting in round 2. Items rated for inclusion by at least 75% of the participants in round 2 were used to create the consensus-based list of screening criteria. Participants were asked to vote and reach agreement on the final screening criteria list in round 3. RESULTS: Twenty-nine chiropractic radiologists participated in round 1. After 3 rounds of survey, 85% of participants approved the final consensus-based list of criteria for traumatic cervical spine instability screening, including 6 clinical signs and symptoms and 5 radiographic criteria. Participants agreed that the presence of 1 or more of these clinical signs and symptoms and/or 1 or more of the 5 radiographic criteria on routine static radiographic studies suggests cervical instability. CONCLUSION: The consensus-based radiographic definition of traumatic cervical spine instability includes 6 clinical signs and symptoms and 5 radiographic criteria that doctors of chiropractic should apply to their patients who sustain trauma to the cervical spine.

Awake Fiberoptic Intubation in Cervical Spine Injury: A Comparison between Atomized Local Anesthesia versus Airway Nerve Blocks.

Background In cooperative patients with cervical spine injury, awake fiberoptic intubation is an excellent option for elective and semi urgent situations. It allows documentation of neurologic examination before and after intubation and surgical positioning. We have compared anesthesia of airway by nerve block and the local anesthesia atomizer undergoing awake fiberoptic intubation in cervical spine injury patients, in terms of the intubation time and discomfort. Objective To compare the intubation time and discomfort in patient with cervical spine injury with anticipated difficult airway potential to aggravate pre-existing injury undergoing awake fiberoptic intubation, based on cough and gag scores, between anesthesia of airway by (transtracheal and bilateral superior laryngeal) nerve block with local anesthetic agent and the local anesthesia atomizer. Method After institutional ethical approval and having informed written consent, 30 patients scheduled for elective surgery who require awake fiberoptic intubation, were included in the study. Patients were allotted by computer-generated random series into two groups; Group N received nerve block (transtracheal and bilateral recurrent laryngeal nerve block) and Group A received atomized lignocaine. Result The time taken for awake fiberoptic intubation was significantly lower in nerve blocks group as compared with the atomizer group [Group N: 90.2±11.7secs and Group A: 210.4±10.6 secs (p=0.041)]. Atomizer group had an increased coughing and gagging episodes than nerve block group [Group N: one patient, Group A: 11 patients (p=0.006)]. Ease of intubation and patient comfort were significantly better in nerve block group. Demographic and hemodynamic parameters were comparable in the two groups. Conclusion The nerve blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) provides adequate airway anesthesia, lesser patient discomfort, and faster intubation to aid in awake fiberoptic intubation in patients with anticipated difficult airway as compared to topical anesthesia using atomizer.

Acute effects of glossopharyngeal insufflation in people with cervical spinal cord injury.

OBJECTIVES: To evaluate acute effects of glossopharyngeal insufflation (GI) on lung function, airway pressure (Paw), blood pressure and heart rate (HR) in people with cervical spinal cord injury (CSCI). DESIGN: Case-control design. SETTING: Karolinska Institutet, Stockholm, Sweden. PARTICIPANTS: Ten participants with CSCI suffering from lesions between C4 and C8, and ASIA classification of A or B were recruited. Ten healthy particpants familiar with GI were recruited as a reference group. OUTCOME MEASURES: Spirometry, mean arterial blood pressure (MAP), Paw, and HR were measured in a sitting and a supine position before, during, and after GI. RESULTS: GI in the study group in a sitting position increased total lung capacity (TLC) by 712 ml: P < 0.001, vital capacity (VC) by 587 ml: P < 0.0001, Paw by 13 cm H2O: P < 0.01, and HR by 10 beats/min: P < 0.001. MAP decreased by 25 mmHg, P < 0.0001. Significant differences were observed between groups comparing baseline with GI. The reference group had a higher increase in; TLC (P < 0.01), VC (P < 0.001), Paw (P < 0.001) and HR (P < 0.05) and a higher decrease in MAP (P < 0.001). With GI in a sitting compared to a supine position, TLC, MAP, HR, Paw remained unchanged in the study group, while residual volume decreased in the supine position (P < 0.01). CONCLUSION: There was a difference between the groups in the increase in TLC; VC; Paw, HR and in the decrease in MAP with GI, however MAP, HR and Paw responded in similar way in both groups in a sitting as well as a supine position. If performed correctly, the risks of GI resulting in clinically significant hemodynamic changes is low, although syncope may still occur.

'Instead of popping pills, perhaps you should add frog breathing': experiences of glossopharyngeal insufflation/breathing for people with cervical spinal cord injury.

BACKGROUND: People with cervical spinal cord injury have impaired function of the respiratory muscles, which results in reduced ventilation. Glossopharyngeal insufflation/breathing increases total lung capacity and improves cough function, however, knowledge of the experiences regarding learning and practicing glossopharyngeal insufflation in everyday life is missing. PURPOSE: To describe and explore the experiences of learning and practicing glossopharyngeal insufflation among people with cervical spinal cord injury. METHODS: Twenty six individuals with cervical spinal cord injury, who had participated in a previous intervention study on glossopharyngeal insufflation, were interviewed. Semi-structured telephone interviews were analyzed with qualitative content analysis. RESULTS: An overall theme and seven categories emerged. Glossopharyngeal insufflation was perceived as a possibility to make a difference in one's life by improving respiratory function, both immediately and for time ahead and thereby ease everyday activities, and by increasing participation, independence, and overall health. The participants with cervical spinal cord injury described that they could learn glossopharyngeal insufflation, but it could be perceived as difficult. However, the use of glossopharyngeal insufflation could be experienced by the individual as being different, and there were sometimes doubts about its effectiveness. CONCLUSIONS: Use of glossopharyngeal insufflation can enable people with cervical spinal cord injury to increasingly participate in everyday activities. Increased autonomy might lead to improved self-esteem and provide well-being. However, ambivalence about the usefulness of glossopharyngeal insufflation may arise and the technique can be difficult to learn. Therefore, individualized information and instructions from health professionals are required. Implications for Rehabilitation Practicing glossopharyngeal insufflation leads to increased participation in everyday activities for people with cervical spinal cord injuries and provides the individual hope to influence future life situation. People with cervical spinal cord injuries therefore need support from health care professionals in order to be motivated to learn and then use the glossopharyngeal insufflation technique also as health promotion Glossopharyngeal insufflation can improve respiratory function and also increase awareness of breathing; health professionals should therefore be able to assess which patients who can benefit from glossopharyngeal insufflation in order to make the technique become an important part of the rehabilitation. The technique can be difficult to perform perfectly and is sometimes perceived as uncomfortable. It may also cause unpleasant side effects and therefore individualized information and instructions regarding glossopharyngeal insufflation are required.

Current practice and usual care of major cervical disorders in Korea: A cross-sectional study of Korean health insurance review and assessment service national patient sample data.

Neck pain is a highly common condition and is the 4th major cause of years lived with disability. Previous literature has focused on the effect of specific treatments, and observations of actual practice are lacking to date. This study examined Korean health insurance review and assessment service (HIRA) claims data to the aim of assessing prevalence and comparing current medical practice and costs of cervical disorders in Korea.Current practice trends were determined through assessment of prevalence, total expenses, per-patient expense, average days in care, average days of visits, sociodemographic characteristics, distribution of medical costs, and frequency of treatment types of high frequency cervical disorders (cervical sprain/strain, cervical intervertebral disc displacement [IDD], and cervicalgia).Although the number of cervical IDD patients was few, total expenses, per-patient expense, average days in care, and average days of visits were highest. The proportion of women was higher than men in all 3 groups with highest prevalence in the ≥50s middle-aged population for IDD compared to sprain/strain. Primary care settings were commonly used for ambulatory care, of which approximately 70% chose orthopedic specialist treatment. In analysis of medical expenditure distribution, costs of visit (consultation) (22%-34%) and physical therapy (14%-16%) were in the top 3 for all 3 disorders. Although heat and electrical therapies were the most frequently used physical therapies, traction use was high in the cervical IDD group. In nonnarcotics, aceclofenac and diclofenac were the most commonly used NSAIDs, and pethidine was their counterpart in narcotics.This study investigated practice trends and cost distribution of treatment regimens for major cervical disorders, providing current usage patterns to healthcare policy decision makers, and the detailed treatment reports are expected to be of use to clinicians and researchers in understanding current usual care.

Is neck massage safe? A rare case of tetraplegia and spinal shock after neck manipulation.

Neck manipulation is associated with spinal cord injury. However, occurrence of such cases is infrequent. This article presents a 33-year-old gentleman who sustained acute tetraplegia after neck manipulation. The aim of this case report is to create awareness that vigorous neck manipulation could cause injury to the spinal cord.

Danger of injudicious use of tui-na therapy in ankylosing spondylitis.

Tui-na is a very important component of Chinese medicine. It is a well-respected treatment modality known to be helpful and safe for a wide range of conditions. It can be considered as a certain kind of massage which is performed at acupoints, meridians, and collaterals by pushing, finger twisting, grasping thumb waving pressing, patting, palm twisting, and other manipulation techniques. At present, it is extensively used for relieving pain and stiffness associated with ankylosing spondylitis in China, even though there is a lack of evidence to support its validation and feasibility. The patient in this case was treated by tui-na massage at acute flare-up of ankylosing spondylitis and ended up with catastrophic results.

The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study.

BACKGROUND: Cervicogenic dizziness is a disabling condition commonly associated with cervical dysfunction. Although the growing interest with the importance of normal sagittal configuration of cervical spine, the missing component in the management of cervicogenic dizziness might be altered structural alignment of the cervical spinal region itself. AIM: To investigate the immediate and long-term effects of a 1-year multimodal program, with the addition of cervical lordosis restoration and anterior head translation (AHT) correction, on the severity of dizziness, disability, cervicocephalic kinesthetic sensibility, and cervical pain in patients with cervicogenic dizziness. DESIGN: A randomized controlled study with a 1 year and 10 weeks' follow-up. SETTING: University research laboratory. POPULATION: Seventy-two patients (25 female) between 40 and 55 years with cervicogenic dizziness, a definite hypolordotic cervical spine and AHT posture were randomly assigned to the control or an experimental group. METHODS: Both groups received the multimodal program; additionally, the experimental group received the Denneroll™ cervical traction. Outcome measures included AHT distance, cervical lordosis, dizziness handicap inventory (DHI), severity of dizziness, dizziness frequency, head repositioning accuracy (HRA) and cervical pain. Measures were assessed at three time intervals: baseline, 10 weeks, and follow-up at 1 year and 10 weeks. RESULTS: Significant group × time effects at both the 10 week post treatment and the 1-year follow-up were identified favoring the experimental group for measures of cervical lordosis (P<0.0005) and anterior head translation (P<0.0005). At 10 weeks, the between group analysis showed equal improvements in dizziness outcome measures, pain intensity, and HRA; DHI scale (P=0.5), severity of dizziness (P=0.2), dizziness frequency (P=0.09), HRA (P=0.1) and neck pain (P=0.3). At 1-year follow-up, the between-group analysis identified statistically significant differences for all of the measured variables including anterior head translation (2.4 cm [-2.3;-1.8], P<0.0005), cervical lordosis (-14.4° [-11.6;-8.3], P<0.0005), dizziness handicap inventory (29.9 [-34.4;-29.9], P<0.0005), severity of dizziness (5.4 [-5.9;-4.9], P<0.0005), dizziness frequency (2.6 [-3.1;-2.5], P<0.0005), HRA for right rotation (2.8 [-3.9;-3.3], P<0.005), HRA for left rotation (3.1 [-3.5;-3.4, P<0.0005], neck pain (4.97 [-5.3;-4.3], P<0.0005); indicating greater improvements in the experimental group. CONCLUSIONS: The addition of Denneroll™ cervical extension traction to a multimodal program positively affected pain, cervicocephalic kinesthetic sensibility, dizziness management outcomes at long-term follow-up. CLINICAL REHABILITATION IMPACT: Appropriate physical therapy rehabilitation for cervicogenic dizziness should include structural rehabilitation of the cervical spine (lordosis and head posture correction), as it might to lead greater and longer lasting improved function.