Extracorporeal shock wave for plantar flexor spasticity in spinal cord injury: A case report and review of literature.

BACKGROUND: Approximately 65%-78% of patients with a spinal cord injury (SCI) develop any symptom of spasticity. The aim of this study was to investigate the tolerability and short-term effects of radial extracorporeal shock wave therapy (rESWT) on plantar flexor spasticity in a patient with incomplete SCI. CASE SUMMARY: An 18-year-old man with an incomplete SCI completed five sessions of rESWT. The primary outcomes were the changes in ankle-passive range of motion (A-PROM) and passive resistive force to ankle dorsiflexion. The outcomes were assessed at baseline (T0), immediately after treatment (T1) and 1 wk after the end of treatment (T2). The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0. The passive resistive force to ankle dorsiflexion at low velocity decreased by 33% at T1 and 55% at T2 in the gastrocnemius muscle and by 41% at T1 and 39% at T2 in the soleus muscle compared with T0. At high velocity, it also decreased by 44% at T1 and 30% at T2 in the gastrocnemius muscle compared with T0. However, in the soleus muscle, the change was minor, with a decrease of 12% at T1 and increased by 39% at T2 compared with T0. CONCLUSION: In this patient, the findings showed that rESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term. Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.

Is it Feasible to Use a Low-Cost Wearable Sensor for Heart Rate Monitoring within an Upper Limb Training in Spinal Cord Injured Patients?: A Pilot Study.

(1) Background: Cervical spinal cord injury (SCI) patients have impairment in the autonomic nervous system, reflected in the cardiovascular adaption level during the performance of upper limb (UL) activities carried out in the rehabilitation process. This adaption level could be measured from the heart rate (HR) by means of wearable technologies. Therefore, the objective was to analyze the feasibility of using Xiaomi Mi Band 5 wristband (XMB5) for HR monitoring in these patients during the performance of UL activities; (2) Methods: The HR measurements obtained from XMB5 were compared to those obtained by the professional medical equipment Nonin LifeSense II capnograph and pulse oximeter (NLII) in static and dynamic conditions. Then, four healthy people and four cervical SCI patients performed a UL training based on six experimental sessions; (3) Results: the correlation between the HR measurements from XMB5 and NLII devices was strong and positive in healthy people (r = 0.921 and r = 0.941 (p < 0.01) in the static and dynamic conditions, respectively). Then, XMB5 was used within the experimental sessions, and the HR oscillation range measured was significantly higher in healthy individuals than in patients; (4) Conclusions: The XMB5 seems to be feasible for measuring the HR in this biomedical application in SCI patients.

Phase II/III placebo-controlled randomized trial of safety and efficacy of growth hormone treatment in incomplete chronic traumatic spinal cord injury.

STUDY DESIGN: This is a double blind phase II/III placebo-controlled randomized trial of the safety and efficacy of GH treatment in incomplete chronic traumatic spinal cord injury. OBJECTIVE: The aim of this study was to investigate the possibility to use exogenous GH administration for motor recovery in chronic traumatic incomplete human SCI. The objectives were to establish safety and efficacy of a combined treatment of subcutaneous GH (or placebo) and rehabilitation in this population. SETTING: Hospital Nacional de Parapléjicos METHODS: The pharmacological treatment was a subcutaneous daily dose of growth hormone (GH, Genotonorm 0.4 mg, Pfizer Pharmaceuticals) or placebo for one year. The pharmacological treatment was performed, during the first six months under hospitalization and supervised rehabilitation. RESULTS: The main findings were that the combined treatment of GH plus rehabilitation treatment is feasible and safe, and that GH but not placebo increases the ISNCSCI motor score. On the other hand, the motor-score increment was marginal (after one-year combined treatment, the mean increment of the motor-score was around 2.5 points). Moreover, we found that intensive and long-lasting rehabilitation program per se increases the functional outcome of SCI individuals (measured using SCIM III and WISCI II). CONCLUSIONS: It is important to highlight that our aim was to propose GH as a possible treatment to improve motor functions in incomplete SCI individuals. At least with the doses we used, we think that the therapeutic effects of this approach are not clinically relevant in most subjects with SCI.

RehabHand: Oriented-tasks serious games for upper limb rehabilitation by using Leap Motion Controller and target population in spinal cord injury.

BACKGROUND: There is a growing interest in the use of technology in the field of neurorehabilitation in order to quantify and generate knowledge about sensorimotor disorders after neurological diseases, understanding that the technology has a high potential for its use as therapeutic tools. Taking into account that the rehabilitative process of motor disorders should extend beyond the inpatient condition, it's necessary to involve low-cost technology, in order to have technological solutions that can approach the outpatient period at home. OBJECTIVE: to present the virtual applications-based RehabHand prototype for the rehabilitation of manipulative skills of the upper limbs in patients with neurological conditions and to determine the target population with respect to spinal cord injured patients. METHODS: Seven virtual reality applications have been designed and developed with a therapeutic sense, manipulated by means of Leap Motion Controller. The target population was determined from a sample of 40 people, healthy and patients, analyzing hand movements and gestures. RESULTS: The hand movements and gestures were estimated with a fitting rate between the range 0.607-0.953, determining the target population by cervical levels and upper extremity motor score. CONCLUSIONS: Leap Motion is suitable for a determined sample of cervical patients with a rehabilitation purpose.

Lesión medular en pacientes mayores de 65 años / Spinal cord injury in patients over 65 years of age

Introducción. La población de mayores de 65 años activos físicamente continúa en aumento, lo que condiciona un mayor riesgo de caídas y de lesión medular en un rango de edad con importante presencia de patología crónica. Objetivo. Revisar la incidencia, el tipo de lesión, las complicaciones asociadas y los resultados funcionales de las lesiones medulares ocurridas en pacientes mayores de 65 años. Pacientes y métodos. Estudio descriptivo retrospectivo en lesionados medulares agudos mayores de 65 años ingresados en el Hospital Nacional de Parapléjicos desde enero de 2010 hasta diciembre de 2011. Las variables del estudio fueron datos demográficos y de lesión, antecedentes personales, complicaciones ocurridas durante el ingreso y capacidad funcional al alta medida con las escalas Spinal Cord Independence Measure (SCIM III) y Walking Index Spinal Cord Injury (WISCI). Resultados. Se incluyeron 111 individuos con una media de edad de 72,5 años. La incidencia anual fue de 17,3 pacientes/100 ingresos. El 33,3% eran lesiones cervicales y fueron incompletas el 66,7%. La etiología médica fue más frecuente que la traumática. El 5% no presentaba otras enfermedades intercurrentes. El 97% sufrió algún tipo de complicación. La media alcanzada para la SCIM III fue de 42 puntos y el 35% consiguió capacidad de marcha. Conclusiones. En los últimos años se ha producido un aumento de lesión medular en mayores de 65 años, en los que la etiología traumática no es superior a la médica; más frecuentemente son lesiones incompletas que asocian mayor comorbilidad que la población general, y se consiguen resultados funcionales más pobres a pesar de las mejoras neurológicas (AU)

Introduction. Physically active population over 65 years old is increasing, they are at risk of falls and spinal cord injury in a range of age with significant presence of chronic pathology. Aim. To review the incidence, type of injury, associated complications and functional recovey of spinal cord injury in patients over 65 years. Patients and methods. Retrospective descriptive study about patients over 65 years admitted in Hospital Nacional de Parapléjicos with spinal cord injury from January 2010 to December 2011. Demographic and lesion data, complications during admission and fuctional recovery measured with SCIM III (Spinal Cord Independence Measure) and WISCI II scales (Walking Index Spinal Cord Injury) were reviewed. Results. 111 patients were included, mean age was 72.5 years, 33.3% were cervical injury and 66.7% were incomplete injuries, medical disease was more frequent than traumatic disease. Only 5% did not present other associated diseases. Up to 97% suffered some complications. SCIM III average was 42 points and only 35% got walking function. Conclusions. There has been an increase in aging spinal cord injury patients in recent years. Unlike general population traumatic etiology is not more frequent than medical. Incomplete injuries are common and usually associated with more comorbility, getting poorer functional recovery despite neurological improvement (AU)

[Spinal cord injury in patients over 65 years of age]. / Lesión medular en pacientes mayores de 65 años.

INTRODUCTION: Physically active population over 65 years old is increasing, they are at risk of falls and spinal cord injury in a range of age with significant presence of chronic pathology. AIM: To review the incidence, type of injury, associated complications and functional recovey of spinal cord injury in patients over 65 years. PATIENTS AND METHODS: Retrospective descriptive study about patients over 65 years admitted in Hospital Nacional de Paraplejicos with spinal cord injury from January 2010 to December 2011. Demographic and lesion data, complications during admission and fuctional recovery measured with SCIM III (Spinal Cord Independence Measure) and WISCI II scales (Walking Index Spinal Cord Injury) were reviewed. RESULTS: 111 patients were included, mean age was 72.5 years, 33.3% were cervical injury and 66.7% were incomplete injuries, medical disease was more frequent than traumatic disease. Only 5% did not present other associated diseases. Up to 97% suffered some complications. SCIM III average was 42 points and only 35% got walking function. CONCLUSIONS: There has been an increase in aging spinal cord injury patients in recent years. Unlike general population traumatic etiology is not more frequent than medical. Incomplete injuries are common and usually associated with more comorbility, getting poorer functional recovery despite neurological improvement.

TITLE: Lesion medular en pacientes mayores de 65 años.Introduccion. La poblacion de mayores de 65 años activos fisicamente continua en aumento, lo que condiciona un mayor riesgo de caidas y de lesion medular en un rango de edad con importante presencia de patologia cronica. Objetivo. Revisar la incidencia, el tipo de lesion, las complicaciones asociadas y los resultados funcionales de las lesiones medulares ocurridas en pacientes mayores de 65 años. Pacientes y metodos. Estudio descriptivo retrospectivo en lesionados medulares agudos mayores de 65 años ingresados en el Hospital Nacional de Paraplejicos desde enero de 2010 hasta diciembre de 2011. Las variables del estudio fueron datos demograficos y de lesion, antecedentes personales, complicaciones ocurridas durante el ingreso y capacidad funcional al alta medida con las escalas Spinal Cord Independence Measure (SCIM III) y Walking Index Spinal Cord Injury (WISCI). Resultados. Se incluyeron 111 individuos con una media de edad de 72,5 años. La incidencia anual fue de 17,3 pacientes/100 ingresos. El 33,3% eran lesiones cervicales y fueron incompletas el 66,7%. La etiologia medica fue mas frecuente que la traumatica. El 5% no presentaba otras enfermedades intercurrentes. El 97% sufrio algun tipo de complicacion. La media alcanzada para la SCIM III fue de 42 puntos y el 35% consiguio capacidad de marcha. Conclusiones. En los ultimos años se ha producido un aumento de lesion medular en mayores de 65 años, en los que la etiologia traumatica no es superior a la medica; mas frecuentemente son lesiones incompletas que asocian mayor comorbilidad que la poblacion general, y se consiguen resultados funcionales mas pobres a pesar de las mejoras neurologicas.

Effects of electromyostimulation on muscle and bone in men with acute traumatic spinal cord injury: A randomized clinical trial.

OBJECTIVE: To study the effect of 14 weeks of electromyostimulation (EMS) training (47 minutes/day, 5 days/week) on both muscle and bone loss prevention in persons with recent, complete spinal cord injury (SCI). DESIGN: Prospective, experimental, controlled, single-blind randomized trial with external blind evaluation by third parties. METHODS: Eight men with recent SCI (8 weeks from injury; ASIA Impairment Scale (AIS) "A") were randomized into the intervention or the control groups. Cross-sectional area of the quadriceps femoris (QF) muscle was quantified using magnetic resonance imaging. Bone mineral density changes were assessed with a dual-energy X-ray absorptiometry. Several bone biomarkers (i.e. total testosterone, cortisol, growth hormone, insulin-growth factor I, osteocalcin, serum type I collagen C-telopeptide), lipid, and lipoprotein profiles were quantified. A standard oral glucose tolerance test was performed before and after the 14-week training. All analyses were conducted at the beginning and after the intervention. RESULTS: The intervention group showed a significant increase in QF muscle size when compared with the control group. Bone losses were similar in both groups. Basal levels of bone biomarkers did not change over time. Changes in lipid and lipoprotein were similar in both groups. Glucose and insulin peaks moved forward after the training in the intervention group. CONCLUSIONS: This study indicates that skeletal muscle of patients with complete SCI retains the ability to grow in response to a longitudinal EMS training, while bone does not respond to similar external stimulus. Increases in muscle mass might have induced improvements in whole body insulin-induced glucose uptake.

Time-course response in serum markers of bone turnover to a single-bout of electrical stimulation in patients with recent spinal cord injury.

The objective of the present repeat-measures study was to determine whether plasma serum levels of testosterone, cortisol, osteocalcin or type I collagen C-telopeptide (CT) are acutely affected following an electro-myostimulation (EMS) bout, and their relation to bone mineral density and muscle mass. Ten men with recent (8 weeks) thoracic spinal cord injury (SCI) (ASIA A) and 10 age-matched able-bodied (AB) men performed one EMS bout on the quadriceps femoris muscle. Blood samples were drawn at basal condition, immediately after EMS, and 15 min, 30 min, 24 h and 48 h post-EMS. Muscle cross-sectional area was measured by magnetic resonance imaging. Bone mineral density (BMD) was determined by dual-energy X-ray absorptiometry. In the SCI group, a significant decrease in testosterone, cortisol and CT together with a significant increase in testosterone/cortisol ratio and osteocalcin/CT ratio was observed after EMS. For the AB subjects, only testosterone and CT decreased significantly following EMS. Muscle size was only related to testosterone/cortisol ratio in the SCI sample (R = 0.659, p < 0.05), whereas BMD did not show any relation to any biomarker. Acute EMS in recent spinal cord injured men seems to induce positive effects on bone turnover biomarkers, and anabolic and catabolic hormones.