RESUMEN
STUDY DESIGN: Retrospective cohort analysis. OBJECTIVES: The objective of this study was to determine the in vitro fertilization (IVF) outcome after testicular sperm extraction (TESE) in a group of spinal cord injury (SCI) male patients not compatible with conservative fertility treatment. SETTING: University-affiliated medical center. METHODS: Thirty two SCI patients (C2 to L2) were referred to IVF after repeated trials of electroejaculation (EEJ) or penile vibratory stimulation (PVS), and full andrological evaluation. Testicular sperm aspiration (TESA) was the method of choice for sperm extraction. Open TESE was performed only after a negative TESA attempt. Clinical pregnancy and live birth rates were determined. RESULTS: A total of 106 testicular procedures were performed. Sperm was found in 95 cycles (89.6%). The average metaphase II (MII) oocyte number was 11.0±4.2, an average of 5.1±2.3 oocytes became normally fertilized after Intra Cytoplasmic Sperm Injection (ICSI) (fertilization rate 57.1%). On average, 2.7±1.2 embryos were replaced. The clinical pregnancy rate was 32/106 (30.2%) per cycle and 19/32 (59.3%) per couple. Live birth rate was 62.5% (20/32). CONCLUSIONS: TESA/E and IVF can provide excellent prognosis for SCI patients that cannot be treated by EEJ or PVS.
Asunto(s)
Resultado del Embarazo , Inyecciones de Esperma Intracitoplasmáticas/métodos , Recuperación de la Esperma , Traumatismos de la Médula Espinal/complicaciones , Adulto , Azoospermia/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos , Disfunciones Sexuales Fisiológicas/etiologíaRESUMEN
BACKGROUND: Disability scales do not enable the transmission of concise, meaningful and daily function description for clinical purposes. STUDY DESIGN: Cross-sectional statistical analysis of 328 patients' Spinal Cord Independence Measure (SCIM) III item scores (SIS). OBJECTIVE: To develop a concise and clinically interpretable data-based characterization of daily task accomplishment for patients with spinal cord lesions (SCLs). SETTING: Multi-center study at 13 spinal units in 6 countries. METHODS: Patients were grouped into clusters characterized by smaller differences between the patients' SIS within the clusters than between their centers, using the k-medoides algorithm. The number of clusters (k) was chosen according to the percent of SIS variation they explained and the clinical distinction between them. RESULTS: Analysis showed that k=8 SIS clusters offer a good description of the patient population. The eight functional clusters were designated as A-H, each cluster (grade) representing a combination of task accomplishments. Higher grades were usually (but not always) associated with patients implementing more difficult tasks. Throughout rehabilitation, the patients' functional grade improved and the distribution of patients with similar functional grades within the total SCIM III score deciles remained stable. CONCLUSIONS: A new classification based on SIS clusters enables a concise description of overall functioning and task accomplishment distribution in patients with SCL. A software tool is used to identify the patients' functional grade. Findings support the stability and utility of the grades for characterizing the patients' functional status.
Asunto(s)
Actividades Cotidianas/clasificación , Evaluación de la Discapacidad , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Anciano , Algoritmos , Estudios Transversales , Incontinencia Fecal/etiología , Incontinencia Fecal/rehabilitación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuadriplejía/etiología , Cuadriplejía/rehabilitación , Reproducibilidad de los Resultados , Estudios Retrospectivos , Traumatismos de la Médula Espinal/complicacionesRESUMEN
STUDY DESIGN: Multicenter international cohort study. OBJECTIVE: The objective of this study was to establish target values for Spinal Cord Independence Measure (SCIM) III scoring in rehabilitation for clinically complete spinal cord lesion (SCL) neurological levels. SETTING: In total, 13 spinal cord units in six countries from North America, Europe and the Middle East were taken. METHODS: Total SCIM III scores and gain at discharge from rehabilitation were calculated for SCL levels in 128 patients with American Spinal Injury Association Impairment Scale (AIS) grade A on admission to rehabilitation. RESULTS: Median, quartiles, mean and s.d., values of discharge SCIM III scores and SCIM III gain for the various SCL levels are presented. Total SCIM III scores and gain were significantly correlated with the SCL level (r=0.730, r=0.579, P<0.001). CONCLUSIONS: Calculated discharge SCIM III scores can be used as target values for functional achievements at various neurological levels in patients after AIS A SCL. They are generally, but not always, inversely correlated with SCL level.
Asunto(s)
Evaluación de la Discapacidad , Evaluación de Resultado en la Atención de Salud/métodos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/diagnóstico , Adulto , Europa (Continente) , Humanos , Cooperación Internacional , Persona de Mediana Edad , Medio Oriente , Examen Neurológico , América del Norte , Recuperación de la Función/fisiología , Reproducibilidad de los Resultados , Traumatismos de la Médula Espinal/rehabilitación , Adulto JovenRESUMEN
STUDY DESIGN: A multi-center international cohort study. OBJECTIVE: To evaluate the reliability and validity of the third version of the Spinal Cord Independence Measure (SCIM III), separately for patients with traumatic spinal cord lesions (SCLs). SETTING: A total of 13 spinal cord units in six countries from North America, Europe and the Middle-East. METHODS: SCIM III and Functional Independence Measure (FIM) were assessed for 261 patients with traumatic SCLs, on admission to rehabilitation and before discharge, by two raters. Conventional statistical measures were used to evaluate the SCIM III reliability and validity. RESULTS: In almost all SCIM III tasks, the total agreement between the paired raters was >80%. The κ coefficients were all >0.6 and statistically significant. Pearson's coefficients of the correlations between the paired raters were >0.9, the mean differences between raters were nonsignificant and the intraclass correlation coefficients (ICCs) were ≥ 0.95. Cronbach's α values for the entire SCIM III scale were 0.833-0.835. FIM and SCIM III total scores were correlated (r=0.84, P<0.001). SCIM III was more responsive to changes than FIM. In all subscales, SCIM III identified more changes in function than FIM, and in 3 of the 4 subscales, differences in responsiveness were statistically significant (P<0.02). CONCLUSION: The results confirm the reliability and validity of SCIM III for patients with traumatic SCLs in a number of countries.
Asunto(s)
Evaluación de la Discapacidad , Evaluación de Resultado en la Atención de Salud/métodos , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/rehabilitación , Encuestas y Cuestionarios/normas , Actividades Cotidianas/clasificación , Adulto , Estudios de Cohortes , Femenino , Humanos , Vida Independiente/normas , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
STUDY DESIGN: Retrospective analysis of civilians with spinal cord injuries (SCIs) due to terror explosions. OBJECTIVES: To analyze and describe the clinical characteristics and rehabilitation outcomes of civilians with SCI due to explosions admitted for in-patient rehabilitation from 2000-2004. SETTING: SCI rehabilitation service, Tel Hashomer, Israel. METHODS: Retrospective chart review. Civilians with SCI due to terror-related gunshot wounds (GSWs) served as a control group. RESULTS: Eleven civilians with SCI caused by penetrating atypical foreign objects (PAFOs) and eight with GSWs were identified. The male-to-female ratio was approximately 2:1. Foreign objects were present within the spinal canal in seven patients, causing bone injury without canal penetration in three, and one patient had both bone injury and canal penetration. The most common level of injury was thoracic. Seven had complete motor SCI. Three individuals improved in American Spinal Injury Association status: one individual improved from B to C (cervical); one from C to D (thoracic); and the third from D to E (lumbar). Despite the similar acute hospital length of stay and functional independence measure (FIM) scores on admission, the PAFO group had a shorter rehabilitation length of stay with higher FIM scores and higher FIM efficiency at discharge. CONCLUSIONS: Although the pathophysiology of PAFO blast injuries is similar to the high-velocity GSWs or the high-energy military munition injuries, better rehabilitation outcomes were seen, with slightly higher FIM efficiency and efficacy at discharge. This result is likely to be caused by less neurological tissue damage at impact.
Asunto(s)
Traumatismos por Explosión/diagnóstico , Explosiones/estadística & datos numéricos , Traumatismos de la Médula Espinal/diagnóstico , Médula Espinal/patología , Terrorismo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Traumatismos por Explosión/fisiopatología , Traumatismos por Explosión/rehabilitación , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Radiografía , Recuperación de la Función/fisiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Médula Espinal/diagnóstico por imagen , Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. METHOD: Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge. RESULTS: Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors. CONCLUSIONS: The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.
Asunto(s)
Evaluación de la Discapacidad , Enfermedades de la Médula Espinal/rehabilitación , Actividades Cotidianas , Estudios de Cohortes , Defecación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Paraplejía/rehabilitación , Cuadriplejía/rehabilitación , Reproducibilidad de los Resultados , Respiración , Autocuidado , MicciónRESUMEN
BACKGROUND: Navigation skills are required for performance of functional complex tasks and may decline due to aging. Investigation of navigation skills should include measurement of cognitive-executive and motor aspects, which are part of complex tasks. OBJECTIVE: to compare young and older healthy adults in navigation within a simulated environment with and without a functional-cognitive task. METHODS: Ten young adults (25.6±4.3 years) and seven community dwelling older men (69.9±3.8 years) were tested during a single session. After training on a self-paced treadmill to navigate in a non-functional simulation, they performed the Virtual Multiple Errands Test (VMET) in a mall simulation. Outcome measures included cognitive-executive aspects of performance and gait parameters. RESULTS: Younger adults' performance of the VMET was more efficient (1.8±1.0) than older adults (5.3±2.7; pâ<â0.05) and faster (younger 478.1±141.5âs, older 867.6±393.5âs; pâ<â0.05). There were no differences between groups in gait parameters. Both groups walked slower in the mall simulation. CONCLUSIONS: The shopping simulation provided a paradigm to assess the interplay between motor and cognitive aspects involved in the efficient performance of a complex task. The study emphasized the role of the cognitive-executive aspect of task performance in healthy older adults.
Asunto(s)
Cognición/fisiología , Orientación/fisiología , Realidad Virtual , Adulto , Anciano , Envejecimiento/psicología , Función Ejecutiva/fisiología , Femenino , Marcha/fisiología , Humanos , Masculino , Proyectos Piloto , Desempeño Psicomotor/fisiología , Tiempo de Reacción/fisiología , Adulto JovenRESUMEN
Acetyl cholinesterase (AChE) antibodies were shown to be associated with myasthenia-like neuromuscular disease. However, it is not clear whether they cause the disease, or their presence is secondary to the disease or an unrelated epiphenomenon. Therefore, AChE antibodies were studied in the sera of 135 patients with neurologic, muscular and autoimmune diseases, using enzyme linked immunosorbent assay (ELISA), immunoblotting and enzyme inhibition assay. In 12 sera the AChE binding by ELISA was greater than 2 standard deviations (SDs) above the mean value of the 20 healthy controls. However, this increased binding was not disease-specific, had no clinical correlates and could not be demonstrated using Western blotting and AChE enzyme inhibition assay, suggesting that these antibodies are naturally occurring, pathogenically unimportant autoantibodies. The finding also supports a possible pathogenic role for the previously reported, high titer, high affinity, inhibitory AChE antibodies in the neuromuscular disease.
Asunto(s)
Acetilcolinesterasa/inmunología , Autoanticuerpos/sangre , Enfermedades Autoinmunes/inmunología , Enfermedades Musculares/inmunología , Enfermedades del Sistema Nervioso/inmunología , Autoanticuerpos/inmunología , Enfermedades Autoinmunes/sangre , Western Blotting , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/inmunología , Electroforesis en Gel de Poliacrilamida , Ensayo de Inmunoadsorción Enzimática , Humanos , Enfermedades Musculares/sangre , Enfermedades del Sistema Nervioso/sangreRESUMEN
During the past 15 years fewer than 1% of those treated in the National Spinal Cord Injury Center were injured as a result of aviation accidents. In addition to 9 such patients treated at the center since 1973, another 6 were found among the many hundreds receiving ambulatory care in our clinics. 3 patients had survived a helicopter crash, 2 were injured while ejecting from combat aircraft, 3 were injured in crashes of light aircraft, 1 fell from a hand glider and 6 were injured in parachute drops. Of the 15 reviewed, 6 use wheelchairs, 3 walk assisted by orthopedic devices, while 6 ambulate freely. Although initial hospitalization was not substantially longer than in other patients with spinal cord injuries, extended ambulatory psychological intervention was necessary.
Asunto(s)
Accidentes de Aviación/estadística & datos numéricos , Traumatismos de la Médula Espinal/epidemiología , Hospitalización , Humanos , Israel/epidemiología , Traumatismos de la Médula Espinal/cirugía , Traumatismos de la Médula Espinal/terapiaRESUMEN
Three patients with paraplegia following corrective surgery for idiopathic scoliosis, using the Cotrel-Dubousset (CD) instrumentation, were admitted to our department over a period of 22 months. They were operated on by three different surgeons and they were the first serious neurological complications in these surgeons' careers. The monitoring method was the "wake-up" test, applied at the end of the correction maneuver with the instrument. One patient presented paraplegia at the "wake-up" test and the other two were paraplegic shortly after ceasing anesthesia. Electrophysiological spinal cord monitoring during surgery may reduce the risks of complications.
Asunto(s)
Fijadores Internos/efectos adversos , Paraplejía/etiología , Complicaciones Posoperatorias/etiología , Escoliosis/cirugía , Adolescente , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Monitoreo Fisiológico , Paraplejía/prevención & control , Médula Espinal/fisiologíaAsunto(s)
Biónica , Cuadriplejía/rehabilitación , Rehabilitación/métodos , Tecnología/tendencias , HumanosAsunto(s)
Mano , Cuadriplejía/rehabilitación , Actividades Cotidianas , Mano/cirugía , Humanos , Cuadriplejía/cirugíaRESUMEN
BACKGROUND: A third version of the Spinal Cord Independence Measure (SCIM III), made up of three subscales, was formulated following comments by experts from several countries and Rasch analysis performed on the previous version. OBJECTIVE: To examine the validity, reliability, and usefulness of SCIM III using Rasch analysis. DESIGN: Multicenter cohort study. SETTING: Thirteen spinal cord units in six countries from North America, Europe, and the Middle-East. SUBJECTS: 425 patients with spinal cord lesions (SCL). INTERVENTIONS: SCIM III assessments by professional staff members. Rasch analysis of admission scores. MAIN OUTCOME MEASURES: SCIM III subscale match between the distribution of item difficulty grades and the patient ability measurements; reliability of patient ability measures; fit of data to Rasch model requirements; unidimensionality of each subscale; hierarchical ordering of categories within items; differential item functioning across classes of patients and across countries. RESULTS: Results supported the compatibility of the SCIM subscales with the stringent Rasch requirements. Average infit mean-square indices were 0.79-1.06; statistically distinct strata of abilities were 3 to 4; most thresholds between adjacent categories were properly ordered; item hierarchy was stable across most of the clinical subgroups and across countries. In a few items, however, misfit or category threshold disordering were found. CONCLUSIONS: The scores of each SCIM III subscale appear as a reliable and useful quantitative representation of a specific construct of independence after SCL. This justifies the use of SCIM in clinical research, including cross-cultural trials. The results also suggest that there is merit in further refining the scale.
Asunto(s)
Evaluación de la Discapacidad , Psicometría/métodos , Traumatismos de la Médula Espinal/fisiopatología , Actividades Cotidianas , Adulto , Estudios de Cohortes , Femenino , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Reproducibilidad de los Resultados , Programas Informáticos , Encuestas y CuestionariosRESUMEN
STUDY DESIGN: Prospective study. OBJECTIVE: To identify and define dermatological conditions following acute traumatic spinal cord injury (ATSCI) during inpatient rehabilitation. SETTING: Spinal Cord Injury Unit, The Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Israel. METHODS: During a 1-year study, all patients following ATSCI were prospectively studied for new dermatological findings during their inpatient rehabilitation. Every new dermatological finding was defined concerning its location with regard to the patient's neurological level, the time from injury to appearance and the exact dermatological diagnosis. RESULTS: During the study year, 46 ATSCI patients were hospitalized in our department, of whom were 38 (82.6%) males and eight (17.4%) females (mean age 30.2 years). A total of 21 (45.6%) patients were tetraplegic and 25 (54.3%) paraplegic. Of the patients, 28 (60.9%) had complete neurological injuries and 18 (39.1%) incomplete. In all, 14 (30.4%) patients developed a dermatological condition. There was no significant age or sex correlation to the development of these complications. There was a greater likelihood of paraplegia (48 versus 9.5%, P=0.005) and being neurologically complete (42.9 versus 11.1%, P=0.02). The dermatological findings appeared on an average of 80.3 days after the initial neurological insult. There were a total of 22 different dermatological findings: 11 (50%) were local fungal infections, two (9.1%) psoriatic lesions, two (9.1%) hyperkeratotic lesions, two (9.1%) bacterial infections (one folliculitis, one impetigo) and single cases of seborrheic dermatitis, acne, alopecia, scabies and allergic reaction. Of the findings, 14 (63.6%) were below the neurological level, including all of the fungal infections. CONCLUSIONS: Dermatological findings are common during rehabilitation of ATSCI. The clinical impact of these findings is low, but nevertheless, they are troublesome to the patient. The most common dermatological disorder was a local fungal infection below the neurological level. Paraplegic patients are more susceptible to the development of this condition. Patient and staff education regarding proper skin care may reduce these infections.
Asunto(s)
Medición de Riesgo/métodos , Enfermedades de la Piel/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/rehabilitación , Enfermedad Aguda , Adulto , Femenino , Humanos , Incidencia , Israel/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Enfermedades de la Piel/diagnóstico , Traumatismos de la Médula Espinal/diagnósticoRESUMEN
We report on a traumatic paraparetic patient, who developed acute intermittent arteriomesenteric occlusion of the duodenum after the use of Harrington's spinal instrumentation. This rare condition was treated conservatively. It is presumed that some degree of hyperlordosis of the lumbar spine by the rods was responsible for this phenomenon.
Asunto(s)
Obstrucción Duodenal/etiología , Fijación de Fractura , Dispositivos de Fijación Ortopédica/efectos adversos , Traumatismos de la Médula Espinal/terapia , Síndrome de la Arteria Mesentérica Superior/etiología , Adulto , Bario , Humanos , Región Lumbosacra , Masculino , Radiografía , Traumatismos de la Médula Espinal/diagnóstico por imagen , Síndrome de la Arteria Mesentérica Superior/diagnóstico por imagenRESUMEN
Frenkel was born and later on practiced medicine in Heiden, Swizerland. This small town became, by his vigilant and innovative work, a place of pilgrimage for neurologists. He was the first to introduce the concept of exercise to restore dexterity and to improve ambulation and so pioneered the specialty of physical medicine and rehabilitation. Frenkel's method and philosophy became the foundation of treatment for many chronic neurological disabling diseases. His personality and work influenced many famous neurologists, worldwide.
Asunto(s)
Neurología/historia , Rehabilitación/historia , Historia del Siglo XIX , Historia del Siglo XX , Humanos , SuizaRESUMEN
We have had the opportunity to treat and follow up two young males with cauda equina syndromes after recurrent resection of intraspinal lipomas. This condition is relatively rare. The patients underwent myelographies, operations, long periods of hospitalisation, and rehabilitation. The syndromes included low back pain, arachnoiditis, and recurrence of the lipoma after several years and multiple operations. These are the problems that we were faced with: (1) Although the tumor is benign it is impossible to resect it completely. (2) There are complications which interfere with rehabilitation, including pain, arachnoiditis, and neurological deterioration. (3) Long term prognosis might be grave and the patient and family should know this. (4) Physiotherapy and sports: should these patients perform strenuous exercise or not?