[Metabolic changes and nutritional status in the spinal cord injured patient ASIA A. Evaluation and monitoring with routine laboratories, a feasible option]. / Cambios metabólicos y estado nutricional en el paciente lesionado raquimedular cervical ASIA A. Evaluación y monitoreo con laboratorios de rutina, una opción viable.

INTRODUCTION: Spinal Cord Injury ASIA A (tetraplegia) is a frequent pathology that may affect population regardless of age, sex or race, and that can induce metabolic abnormalities that may worsen the nutritional status of these patients. There are no existing specific protocols to treat these disorders in the specialized units in Mexico. MATERIAL AND METHODS: We analyzed 16 patients at the Spine Clinic SS-DF, 18 years or older without any drug treatment or any previous disease, known or diagnosed when admitted to the hospital. Laboratory samples were obtained as well as the nutritional status was calculated at their admittance and discharge. Individually calculated nutritional support was administered starting at their third day of hospital stay. RESULTS: 100% of the patients showed some type of metabolic disorder associated to the neurological injury. 50% of the patients were classified with severe malnutrition, 25% moderate and 25% mild, all improved at their discharge. CONCLUSIONS: We confirmed the presence of metabolic changes in these patients, the efficacy of routine laboratory in the Spine Clinic SS-DF for their evaluation, and that adequate nutritional support may help correct metabolic disorders in this patients.

Improvement of metabolic and cardiorespiratory responses through treadmill gait training with neuromuscular electrical stimulation in quadriplegic subjects.

This work assessed the influence of treadmill gait training with neuromuscular electrical stimulation (NMES) on the metabolic and cardiorespiratory responses in quadriplegic subjects. The gait group (GG) (n=11) performed 6 months of treadmill training with 30-50% body weight support and with the help of physiotherapists, twice a week, allotting 20 min for each session. The control group (CG) (n=10), during the 6 months of training, did not perform any activity using NMES, performing instead conventional physiotherapy. Metabolic and cardiorespiratory responses (O(2) uptake [VO(2)], CO(2) production [VCO(2)], pulmonary ventilation (V(E)), heart rate [HR], and blood pressure [BP]) were measured on inclusion and after 6 months. For the GG, differences were found in all parameters after training (P<0.05), except for HR and diastolic BP. During gait, VO(2) (L/min) increased by 36%, VCO(2) (L/min) increased by 42.97%, V(E) (L/min) increased by 30.48%, and systolic BP (mm Hg) increased by 4.8%. For the CG, only VO(2) and VCO(2) (L/min) significantly increased at rest (30.82 and 16.39%, respectively) and during knee-extension exercise (26.29 and 17.37%, respectively). Treadmill gait with NMES was, therefore, more efficient toward increasing the aerobic capacity due to yielding higher metabolic and cardiovascular stresses.

Energy expenditure during rest and treadmill gait training in quadriplegic subjects.

STUDY DESIGN: The analysis of oxygen uptake (VO(2)) and energy consumption in quadriplegics after 6 months of treadmill gait with neuromuscular electrical stimulation (NMES). OBJECTIVES: To compare metabolic responses in quadriplegics after 6 months of treadmill training, with NMES (30-50% body weight relief), with quadriplegics who did not perform gait. SETTING: Ambulatory of University Hospital, Brazil. METHODS: Quadriplegics were separated into gait and control groups (CGs). On inclusion, all subjects performed VO(2) test. In the gait group (GG) (n=11), the protocol consisted of 8 min of rest, 10 min of treadmill walking using NMES and 10 min of recovery. In the CG (n=10), testing consisted of 8 min rest, 15 min of quadriceps endurance exercise in sitting position with NMES and 10 min recovery. VO(2), carbon dioxide production (VCO(2)) and energy consumption were measured. The GG performed 6 months of treadmill training, using NMES, for 20 min, twice a week. The CG did not practice any activity with NMES, performing conventional physiotherapy only; the CG was stimulated only during the cardiorespiratory test. RESULTS: All parameters increased significantly for the GG: 36% for VO(2) (l/min), 43% for VCO(2) (l/min) and 32.5% for energy consumption (J/kg/s). For the CG, during knee extension exercise, VO(2) increased without changes in the energy consumption (P<0.05); smaller values were obtained for all parameters when compared to those obtained during gait. CONCLUSIONS: Quadriplegic gait was efficient towards increasing VO(2) and energy consumption, which can decrease the risk of cardiovascular diseases.