Correlation among lesion level, muscle strength and hand function in cervical spinal cord injury.

BACKGROUND: Few epidemiological data are available regarding distribution of cervical spinal cord injury with respect to level of lesion and the relationship between the neurological level of lesion and residual hand function. Such data are important to evaluate the relevance of innovative therapeutic approaches, and to plan prospective clinical trials. AIM: To examine the frequency distribution of neurological level of lesion and to investigate the correlation among level, active muscles in the arm and the relation to hand function. DESIGN: Cross-sectional study. SETTING: Two spinal units in the Lombardy region of Italy. POPULATION: Patients with cervical spinal cord lesion. METHODS: Consecutive records, taken from an 8-year interval of admission to either spinal unit, of patients with a cervical spinal cord lesion were examined, and individuals with a C5 to C7 neurological level of lesion were called in for clinical examination. The arm muscles were evaluated according to the International Classification for Surgery of the Hand in Tetraplegia (ICSHT), and hand function was tested with the Action Research Arm Test (ARAT). A correlation analysis was made of the ICSHT, ARAT and neurological level of lesion. RESULTS: In 253 clinical records we found the most frequent lesions to be C5 (21%), C6 (31%) and C7 (21%); 76 of these patients were enrolled for a clinical evaluation. Both ICSHT (Spearmans' rho=0.6; P<0.001) and ARAT (rho=0.2; P<0.05) were poorly correlated with the neurological level of lesion. ARAT was also poorly correlated with the ICSHT group (rho=0.5; P<0.001). CONCLUSION: Our study suggests that 73% of tetraplegic subjects have a neurological level of lesion between C5 and C7, and that it is not possible to accurately predict residual hand function from the level of lesion obtained from the clinical records, or from an ICSHT evaluation. CLINICAL REHABILITATION IMPACT: The results of our work show that a large number of patients with cervical spinal cord lesion have impaired hand function. Residual hand function must be assessed with specific functional tests; it cannot be derived simply from a lesion's neurological level.

Controlling the alien hand through the mirror box. A single case study of alien hand syndrome.

Disruption of motor control in the alien hand syndrome might result from a dissociation between intentions and sensory information. We hypothesized that voluntary motor control in this condition could improve by restoring the congruency between motor intentions and visual feedback. The present study shows that, in one patient with right alien hand syndrome, the use of a mirror box paradigm improved motor speed. We speculate that the visual feedback provided by the mirror increases the sense of congruence between intention and sensory feedback, leading to motor improvement.

Influenza vaccines: antibody responses to split virus and MF59-adjuvanted subunit virus in an adult population.

The humoral immune response generated by two commercial influenza vaccines was evaluated in a randomised, double-blind trial performed in the Public Department of Dolo Health District (North-east Italy) during the winter season 1997-1998. Ninety-eight subjects were immunised with a split virus vaccine and ninety-six with a MF59-adjuvanted subunit virus vaccine (SU/MF59). The pre- and postvaccination (approximately 30 days) antibody titres were determined by hemagglutination inhibition test (HI). After immunisation protective titre rates (> or = 1:40) were near 100% against virus A strain and 82.5% against B strain. Both vaccines caused significant rises in geometric mean antibody titres (GMTs); however, people who received SU/MF59 vaccine were found to develop a greater immune response compared to the group immunised with SVV. According to logistic regression analysis the unprotective prevaccination immune status and the use of SU/MF59 were identified as independent factors significantly increasing the response to immunisation.