Transanal irrigation bowel routine for people with Cauda Equina Syndrome.

OBJECTIVE: Neurologic bowel incontinence and dysfunction are common with Cauda Equina Syndrome (CES). The study objective was to evaluate the efficacy of Peristeen Anal Irrigation System (PAIS)TM in people with CES. DESIGN: Clinical Trial. SETTING: Spinal Cord Rehabilitation outpatient clinic at the Health Sciences Centre in Winnipeg. METHODS: Twelve participants with a mean age of 46.2 years (range 34-72 years, 4 females) with CES used PAISTM bowel routine for 10 weeks. OUTCOME MEASURES: Change in Neurogenic Bowel Dysfunction Score (NBD) over 10 weeks relative to baseline. Secondary outcomes: Change in St. Mark's Fecal Incontinence score (SMFI), Cleveland Clinic Constipation score (CCC), and modified Rectal Surgeons Fecal Incontinence Quality of Life Score (QOL) at week 1, 2, 4, 6, 8 and 10 compared to baseline, and self-rating of bowel function at baseline and 10 weeks. Additionally, colonic transit times were assessed using the radioactive markers (Sitzmarks) method. RESULTS: Ten participants completed the study. Post-intervention primary outcome NBD score improved (p < 0.01). Secondary outcomes also improved significantly, including SMFI (p < 0.01), CCC (p < 0.01), QOL (p < 0.01), self-rating of bowel function (p < 0.01), and transit time improved by 22% (p < 0.05). CONCLUSION: Overall, a significant improvement was observed with the PAISTM for both primary, as well as secondary outcome measures, without any significant adverse effects. As this non-pharmaceutical method of bowel management is effective and has the potential to improve symptoms of bowel dysfunction in people with CES, it should be considered for those in which traditional methods of managing neurogenic bowel fail.

A randomized double-blind, placebo-controlled, cross-over trial assessing the effect of tadalafil (Cialis) on the cardiovascular response in men with complete spinal cord injury above the sixth thoracic level: A Pilot Study.

STUDY DESIGN: Double-blind, randomized cross-over placebo-controlled pilot study. OBJECTIVES: To determine the effects of tadalafil on systolic blood pressure (SBP), heart rate (HR), and dizziness of men with American Spinal Injury Association Impairment Scale-A (AIS-A) spinal cord injury (SCI) between cervical-4 (C4) and thoracic-5 (T5) levels. SETTING: Outpatient rehabilitation clinic. DESIGN: Double-blind, randomized cross-over placebo-controlled pilot study. METHODS: 20 males with AIS-A SCI, C4-T5 received either tadalafil 20 mg or placebo for the first arm, and then were crossed-over after 1 week to the second arm. SBP, HR, and Visual Analogue Scale (VAS) for dizziness upon sitting up from lying were measured at baseline and again 1, 2, 4, 12, 22, 29, and 36 h post dose administration. The change in each outcome measure (SBP, HR, VAS dizziness) was observed from pre-dose to each time point. A change in VAS dizziness of 2 cm or greater (scale 0-10 cm) was considered positive. RESULTS: SBP did not change significantly in either group. However, HR increased significantly in the tadalafil group at several time points (12 h p < 0.05, 22 h p <0.05, 29 h p <0.01, and 36 h p <0.05), with no change in the placebo group. The VAS dizziness significantly increased (range 2-6 cm changes) at some time point in 1/4 of the subjects after tadalafil, but not in the placebo group; all reports of dizziness were at 12 h or later. CONCLUSIONS: Tadalafil use in people with SCI above T6 is safe with respect to not causing hypotension; hemodynamic changes that occurred 12-36 h post administration were compensated for by elevations in HR. SPONSORSHIP: The Manitoba Medical Services Foundation and the Health Sciences Centre Foundation.

The Effects of Aging and Dual Tasking on Human Gait Complexity During Treadmill Walking: A Comparative Study Using Quantized Dynamical Entropy and Sample Entropy.

Quantized dynamical entropy (QDE) has recently been proposed as a new measure to quantify the complexity of dynamical systems with the purpose of offering a better computational efficiency. This paper further investigates the viability of this method using five different human gait signals. These signals are recorded while normal walking and while performing secondary tasks among two age groups (young and older age groups). The results are compared with the outcomes of previously established sample entropy (SampEn) measure for the same signals. We also study how analyzing segmented and spatially and temporally normalized signal differs from analyzing whole data. Our findings show that human gait signals become more complex as people age and while they are cognitively loaded. Center of pressure (COP) displacement in mediolateral direction is the best signal for showing the gait changes. Moreover, the results suggest that by segmenting data, more information about intrastride dynamical features are obtained. Most importantly, QDE is shown to be a reliable measure for human gait complexity analysis.

The interacting effects of treadmill walking and different types of visuospatial cognitive task: Discriminating dual task and age effects.

OBJECTIVE: The objective of this study is to examine the influence that visuospatial cognitive tasks have on gait function during DT treadmill walking, and as a function of age. Conversely, to examine the influence that walking has on executive functions involving visuospatial processing. METHODS: Twenty-five young (26±6.1years) and 25 older adults (76±3.9) performed different types of computerized visuomotor (VM) tracking and visuospatial cognitive tasks (VCG) while standing and treadmill walking. Spatiotemporal gait variables, average values and co-efficient of variation (COV) were obtained from 40 consecutive steps during single- and dual-task walk trials. Performance-based measures of the VM and VCG task were obtained during standing and walking. RESULTS: VM dual-task walking had a significant effect on gait measures in the young age group (YG), but no DT effect was observed in the old age group (OG). Visuomotor tracking performance, however, was significantly reduced in the OG as compared to the YG when tested in both standing and walking. The opposite was true for VCG; a significant DT effect on gait performance was observed in the OG, but no DT effect was observed in the YG. Success rate of the VCG task decreased during walking, but only for OG. CONCLUSION: Controlling gait speed and objective evaluation of the visuospatial cognitive tasks helps to determine the level of engagement in the DT tasks. This is important in order to determine the strategies used during the DT test protocols, i.e. cross-domain interference.

Computerized Dual-Task Testing of Gait and Visuospatial Cognitive Functions; Test-Retest Reliability and Validity.

The common occurrence of age decline in mobility and cognition does cause a decrease in the level of physical activity and an increased falls risk. Consequently, dual -task (DT) assessment that simultaneously addresses both mobility skills and cognitive functions are important because, continued difficulties and fall injuries will have a sizable impact in this population. The first objective of the present study was to assess test-retest reliability of a computerized DT treadmill walking protocol and concurrent outcome measures of gait and visuospatial executive function in a group of healthy older adults. Secondly, discriminative validity was evaluated by examining the effect of DT conditions (single task vs. dual-task) on; (a) spatiotemporal gait measures (average and coefficient of variation) and (b) visuomotor and visuospatial executive performance measures. Twenty-five community-dwelling individuals median age 65 (range 61-67) were recruited from a Fitness Facility. Participants performed a computerized visuomotor tracking task and a visuospatial executive game task in standing and while treadmill walking. Testing was conducted on two occasions, 1 week apart. Moderate to high test-retest reliability (ICC values of 0.65-0.88) were observed for spatiotemporal gait variables. No significant differences between the group means were observed between test periods in any gait variable. Moderate test-retest reliability (ICC values of 0.6-0.65) was observed for measures of visuomotor and visuospatial executive performance during treadmill walking. Significant DT effects were observed for both spatiotemporal gait variables and visuospatial executive performance measures. This study demonstrates the reliability and reproducibility of the computer-based assessment tool for dual task treadmill walking. The high to moderate ICC values and the lack of systematic errors in the measures indicate that this tool has the ability to repeatedly record reliable data from community-dwelling older adults. The present computerized dual-task protocols broaden the types of standardized visuomotor and visuospatial executive activities for use with DT treadmill walking that has previously been reported.

The virtual hallway consult as an effective means of continuing professional development in physiatry.

BACKGROUND: A personal learning project (PLP) is an accredited form of Continuing Professional Development (CPD) in Canada, and is a self-initiated learning activity that is stimulated by a question, issue or dilemma in one's professional practice. Many complex cases or issues have no answers that are readily available. Many physicians rely day to day on other physician colleagues that they may consult in their institution. Given the paucity of same specialty Physical Medicine and Rehabilitation colleagues in Canadian centres, the idea of Virtual Spinal Cord Injury (SCI) Hallway germinated, to provide a simple tool to extend our hallways to reach colleagues with similar interests across the country. METHODS: The Virtual SCI Hallway is a service set up on Yahoo Groups, with no cost to the users. On this invite-only site, members may post a question, and then all members receive the post by email. Any member may respond. RESULTS: The SCI Hallway has been running successfully for over 13 years. As of January 2017, there were 38 members, with 2124 messages within approximately 324 conversations. Activity has been consistent since 2003. Questions and posts are not always medical expert related; there are also advocacy, professional, and scholar-role related posts. DISCUSSION: Communication amongst specialists about practice and management of complicated problems is important for CPD, yet is difficult in subspecialized areas of medicine. Although there are many chat-pages in different areas of medicine on the internet, to our knowledge, there is not another secure, invite-only site that is low-maintenance and no cost.