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1.
Ideggyogy Sz ; 73(7-08): 269-273, 2020 Jul 30.
Artigo em Húngaro | MEDLINE | ID: mdl-32750244

RESUMO

A 21 year female polytraumatized patient was admitted to our unit after a serious motorbike accident. We carried out CT imaging, which confirmed the fracture of the C-II vertebra and compression of spinal cord. Futhermore, the diagnostic investigations detected the compound and comminuted fracture of the left humerus and femur; the sacrum and the pubic bones were broken as well. After the stabilization of the cervical vertebra, a tracheotomy and the fixation of her limbs were performed. She spent 1.5 years in our unit. Meanwhile we tried to fix all the medical problems related to tetraplegia and respiratory insufficiency. As part of this process she underwent an electrophysiological examination in Uppsala (Sweden) and a diaphragm pacemaker was implanted. Our main goal was to reach the fully available quality of life. It is worth making this case familiar in a wider range of public as it could be an excellent example for the close collaboration of medical and non-medical fields.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Diafragma/diagnóstico por imagem , Quadriplegia/reabilitação , Insuficiência Respiratória/terapia , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/terapia , Tomografia Computadorizada por Raios X/métodos , Cuidados Críticos , Feminino , Humanos , Quadriplegia/etiologia , Quadriplegia/fisiopatologia , Qualidade de Vida , Traumatismos da Medula Espinal/fisiopatologia , Traqueotomia , Resultado do Tratamento , Adulto Jovem
2.
Medicine (Baltimore) ; 99(34): e21507, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846761

RESUMO

BACKGROUND: In recent years, some studies indicated that repetitive transcranial magnetic stimulation (rTMS) could relieve neuropathic pain (NP) following a spinal cord injury (SCI), whereas some studies showed no pain relief effect. In addition, some studies showed the analgesic effect of transcranial direct current stimulation (tDCS) on NP post SCI, whereas other studies showed no effect. METHODS: We systematically searched on the PubMed, Web of Science, EMBASE, Medline, Google Scholar for studies exploring the analgesic effect of rTMS or tDCS on NP post SCI until November 2019. Meta-analysis was conducted to summarize results of these studies. RESULTS: The present quantitative meta-analysis indicated no significant difference in the effect of treatment on NP following SCI between rTMS and sham rTMS over the motor cortex at about 1 week after the end of the rTMS period (standardized mean difference (SMD) = 2.89, 95% confidence interval (CI) = -0.27 to 6.04). However, the study indicated that rTMS showed significantly better pain relief of treatment compared with sham rTMS between 2 and 6 weeks after the end of the rTMS period (SMD = 3.81, 95%CI: 0.80-7.52). However, no sufficient evidence could be provided to make a meta-analysis for the analgesic effect of tDCS on NP following SCI over the primary motor area (M1). CONCLUSIONS: In conclusion, the present meta-analysis suggested that rTMS did not show early analgesic effect on NP after SCI, but showed better middle-term analgesic effect, compared with sham rTMS. More large scale, blinded randomized controlled trials (RCTs) were needed to explore the analgesic effect of rTMS and tDCS on NP following SCI.


Assuntos
Neuralgia/terapia , Traumatismos da Medula Espinal/reabilitação , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Humanos , Neuralgia/etiologia , Traumatismos da Medula Espinal/complicações
3.
PLoS One ; 15(8): e0238116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857793

RESUMO

INTRODUCTION: Wheelchair users with spinal cord injury are at a high risk of falls. However, the perspectives of wheelchair users with spinal cord injury on their fall circumstances and their preferences for fall prevention strategies/interventions remain understudied. Therefore, we aimed to: a) describe the circumstances of falls experienced by wheelchair users with spinal cord injury over a six-month period, b) explore their perspectives of why falls occurred in certain situations, and c) explore their perspectives on recommended content/structure of fall prevention strategies/interventions. METHODS: This sequential explanatory mixed methods study had two phases. Phase I involved tracking of falls experienced by wheelchair users with spinal cord injury over six months, in which participants completed a survey after experiencing a fall to track the number/circumstance of each fall. Data from the surveys were descriptively reported. Phase II involved a photovoice focus group discussion of the survey findings and their preferences for fall prevention strategies/interventions. Data from the focus group discussion were analyzed using a thematic analysis. RESULTS: Thirty-two participants completed phase I. More than half of the participants fell at least once in six months. Falls commonly occurred in the afternoon during a transfer, or when participants were wheeling over uneven ground. One-third of the falls caused an injury. Eleven participants that fell during phase I participated in the focus group. Two main themes were identified from the discussion: 1) "circumstances surrounding the falls" (e.g. when falls occurred, the home is a 'safe space') and 2) "suggestions and preferences for fall prevention strategies/interventions" (e.g. fall prevention involves all, fall prevention training available as needed). CONCLUSION: Fall prevention strategies/interventions should be an integral component of rehabilitation practices across the lifespan. Participants recommend customizing fall prevention strategies/interventions to their specific needs to guide the structure, content, and delivery of targeted fall prevention programs.


Assuntos
Acidentes por Quedas/prevenção & controle , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Cadeiras de Rodas/psicologia , Adulto , Idoso , Pessoas com Deficiência , Feminino , Grupos Focais , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Preferência do Paciente , Medicina de Precisão , Adulto Jovem
4.
Orv Hetil ; 161(29): 1200-1207, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32628619

RESUMO

In recent years, several technological innovations have emerged to improve the rehabilitation of traumatic spinal cord injury (SCI). Among them, robotic orthosis, also known as human exoskeletons, are prominent devices for lower limb therapy. Since the early 2000s, numerous clinical studies have begun to investigate the efficacy of these devices, demonstrating the beneficial effects of exoskeletons regarding the prevention and deceleration of the progression of complications following spinal cord injury and subsequent immobilization. Previous works also deal with physiological, psycho-social and social effects, and presents possible risk factors following SCI. In this paper, the main results of the relevant international research is reviewed, the structure and operation of the first devices (ReWalkTM P6.0) in Hungary are presented, also, the main modalities of robotic assisted rehabilitation activity at international level are demonstrated. Based on the international results, the training protocol for a multicentre controlled clinical trial, involving the University of Pécs and the National Institute for Medical Rehabilitation is presented in this work. According to our hypothesis, high intensity exoskeleton-assisted complex rehabilitation induces positive changes in bone density, in the urogenital and gastrointestinal tract. Changes are quantified by objective urodynamic and defecative parameters. The difference in bone density is assessed with DEXA scan, and the effects on mental status are evaluated by questionnaires. The aim of this research is to promote a complementary therapeutic procedure based on validated results for SCI patients with paraplegia, also to establish recommendations for home use of the robotic exoskeletons, and to conceivably join to international scientific research projects. Orv Hetil. 2020; 161(29): 1200-1207.


Assuntos
Exoesqueleto Energizado , Robótica , Traumatismos da Medula Espinal/reabilitação , Humanos , Hungria , Extremidade Inferior
5.
Arch Phys Med Rehabil ; 101(9): 1532-1540, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32502564

RESUMO

OBJECTIVES: This study investigated (1) the effect of engaging with 20-minute simulated natural environments delivered via virtual reality (VR) on current mood state and (2) the effect of engaging with multiple VR sessions over a period of a week on the depressive symptoms of people with a spinal cord injury (SCI). DESIGN: Randomized controlled trial design. SETTING: Spinal Cord Injury Rehabilitation Unit in Australia. PARTICIPANTS: Participants (N=24) were assigned to a group engaging in VR sessions during week 1 (group 1, n=10) or week 2 (group 2, n=14). INTERVENTIONS: The intervention week involved participation in up to three 20-minute VR sessions over 3 consecutive days. The control condition involved regular rehabilitation practice over a week. MAIN OUTCOME MEASURES: The Patient Health Questionnaire-8 (PHQ-8) was completed prior to the first week (T1), after the first week and prior to the second week (T2), and after the second week (T3). Current feeling states, including depressed/happy, anxious/relaxed, and not feeling good/feeling good, were rated immediately prior and after each VR session. RESULTS: Levels of happiness, relaxation, and feeling good were significantly higher subsequent to engaging with each VR session. Between-group differences in PHQ-8 scores were significantly greater for participants who experienced the intervention during the first week compared to participants within the control group: intervention participants had significant improvements in psycho-emotional health. Within-group PHQ-8 scores were reduced for each group subsequent to experiencing the intervention; however, differences were not significant. CONCLUSIONS: Engaging with simulated natural environments delivered via VR can favorably affect the psycho-emotional health of people with SCI receiving rehabilitation in hospital. Future research including larger samples and investigating the effect over a longer time period is required to confirm the findings presented.


Assuntos
Depressão/terapia , Saúde Mental , Traumatismos da Medula Espinal/reabilitação , Realidade Virtual , Adulto , Afeto , Idoso , Idoso de 80 Anos ou mais , Austrália , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Natureza , Projetos Piloto , Fatores Socioeconômicos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Índices de Gravidade do Trauma
6.
Arch Phys Med Rehabil ; 101(9): 1563-1569, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32502566

RESUMO

OBJECTIVES: To derive accelerometer count thresholds for classifying time spent in sedentary, light intensity, and moderate-to-vigorous physical activity (MVPA) in manual wheelchair users (MWUs) with spinal cord injury (SCI). DESIGN: Participants completed 18 activities of daily living and exercises for 10 minutes each with a 3-minute break between activities while wearing a COSMED K4b2 portable metabolic cart and an ActiGraph activity monitor on the dominant wrist. A linear regression was computed between the wrist acceleration vector magnitude and SCI metabolic equivalent of task (MET) for 80% of the participants to obtain thresholds for classifying different activity intensities, and the obtained thresholds were tested for accuracy on the remaining 20% of participants. This cross-validation process was iterated for 1000 times to evaluate the stability of the thresholds on data corresponding to different proportions of sedentary, light intensity, and MVPA. MET values of 1.5 or lower were classified as sedentary behavior, MET values between 1.5 and 3 were classified as light intensity, and MET values of 3 or higher were classified as MVPA. The final thresholds were then validated on an out-of-sample independent dataset. PARTICIPANTS: MWUs (N=17) with SCI in the out-of-sample validation data set. INTERVENTIONS: Not applicable. SETTING: Research lab, community MAIN OUTCOME MEASURES: Accelerometer thresholds to classify sedentary, light intensity, and MVPA were obtained and their accuracy tested using cross-validation and an out-of-sample dataset. RESULTS: The threshold between sedentary and light intensity was 2057 counts-per-minute, and the threshold between light intensity and MVPA was 11,551 counts per minute. Based on the out-of-sample validation, the obtained thresholds had an overall accuracy of 85.6%, with a sensitivity and specificity of 95.3% and 97.4% for sedentary behavior, 87.8% and 84.5% for light intensity, 68.5% and 96.3% for MVPA, respectively. CONCLUSION: Accelerometer-based thresholds can be used to accurately identify sedentary behavior. However, thresholds may not provide accurate estimations of MVPA throughout the day when participants engage in more resistance-based activities.


Assuntos
Actigrafia/instrumentação , Exercício Físico/fisiologia , Traumatismos da Medula Espinal/reabilitação , Atividades Cotidianas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sedentário , Sensibilidade e Especificidade , Cadeiras de Rodas , Punho
7.
Arch Phys Med Rehabil ; 101(9): 1556-1562, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32531222

RESUMO

OBJECTIVE: To determine whether the "sacral sparing" definition for completeness of traumatic spinal cord injury (SCI) is a more stable definition than the previously used Frankel Classification. DESIGN: Retrospective analysis of individuals enrolled in the Spinal Cord Injury Model Systems (SCIMS) database between 2011 and 2018. SETTING: SCIMS centers. PARTICIPANTS: Individuals (N=804) with traumatic SCI who were at least 16 years old at time of injury, were admitted to rehabilitation within 30 days, had American Spinal Injury Association Impairment Scale (AIS) grades A-D at admission, and had complete neurologic data at the time of admission and 1 year. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Frankel and AIS scores were computed for a cohort of 804 eligible cases. Stability was compared between the 2 classification systems by calculating the proportions of cases in which regression (conversion to a more severe impairment level) was observed. RESULTS: A larger proportion of individuals classified with "incomplete" injuries (grades B-D) at the time of admission using the Frankel system regressed to complete status at 1 year compared with the AIS criteria (9.4% vs 2.0%). Those with grade B injuries regressed to grade A more often using the Frankel system compared with the AIS system (19.7% to 5.4%). A larger proportion of people diagnosed as Frankel grade C or D regressed to Frankel grade A compared with individuals diagnosed as AIS grade C or D who regressed to AIS grade A (5.0% to 1.1%). CONCLUSIONS: More individuals diagnosed with neurologically incomplete SCI regressed to complete status at 1 year when using the Frankel system compared with AIS classification, which is based on sacral sparing. This reinforces the finding that the "sacral sparing" definition is a more stable classification in traumatic SCI.


Assuntos
Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/reabilitação , Índices de Gravidade do Trauma , Adulto , Fatores Etários , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos
8.
Muscle Nerve ; 61(6): 708-718, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32413247

RESUMO

The loss of upper limb motor function can have a devastating effect on people's lives. To restore upper limb control and functionality, researchers and clinicians have developed interfaces to interact directly with the human body's motor system. In this invited review, we aim to provide details on the peripheral nerve interfaces and brain-machine interfaces that have been developed in the past 30 years for upper extremity control, and we highlight the challenges that still remain to transition the technology into the clinical market. The findings show that peripheral nerve interfaces and brain-machine interfaces have many similar characteristics that enable them to be concurrently developed. Decoding neural information from both interfaces may lead to novel physiological models that may one day fully restore upper limb motor function for a growing patient population.


Assuntos
Amputados/reabilitação , Pesquisa Biomédica/tendências , Robótica/tendências , Traumatismos da Medula Espinal/reabilitação , Extremidade Superior/fisiologia , Pesquisa Biomédica/métodos , Interfaces Cérebro-Computador/tendências , Previsões , Humanos , Robótica/métodos , Traumatismos da Medula Espinal/fisiopatologia
9.
Exerc Sport Sci Rev ; 48(3): 125-132, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32412926

RESUMO

Acute intermittent hypoxia (AIH) and task-specific training (TST) synergistically improve motor function after spinal cord injury; however, mechanisms underlying this synergistic relation are unknown. We propose a hypothetical working model of neural network and cellular elements to explain AIH-TST synergy. Our goal is to forecast experiments necessary to advance our understanding and optimize the neurotherapeutic potential of AIH-TST.


Assuntos
Terapia por Exercício/métodos , Neurônios Motores/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Hipocampo/metabolismo , Humanos , Hipóxia/fisiopatologia , Glicoproteínas de Membrana/metabolismo , Plasticidade Neuronal , Receptor trkB/metabolismo , Medula Espinal/metabolismo
10.
Spinal Cord Ser Cases ; 6(1): 21, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: covidwho-66206

RESUMO

STUDY DESIGN: An online survey. OBJECTIVES: To query the international spinal cord medicine community's engagement with and response to the novel coronavirus (COVID-19) pandemic and to assess pandemic-specific information needs and patient concerns. SETTING: An international collaboration of authors and participants. METHODS: Two near-identical surveys (one English and one Spanish language) were distributed via the internet. Responses from those questions shared between the surveys were pooled then analyzed; four questions' responses (those not shared) were analyzed separately. RESULTS: A total of 783 responses were submitted from six continents. Few participants (5.8%) had tested their outpatients with SCI/D for COVID-19; only 4.4% reported having a patient with SCI/D with the virus. Of respondents who worked at an inpatient facility, 53.3% reported that only individuals with symptoms were being screened and 29.9% said that no screening was occurring. Participants relayed several concerns offered by their patients with SCI/D, including vulnerability to infection (76.9%) and fragility of caretaker supply (42%), and those living in countries with guaranteed health care were more likely to report widespread availability of COVID-19 testing than were those living in countries without universal care, χ2 (3, N = 625) = 46.259, p < 0.001. CONCLUSION: There is substantial variability in the rehabilitation medicine community in COVID-19 screening practices and availability of screening kits. People living with SCI/D are expressing legitimate and real concerns about their vulnerability to COVID-19. More and rapid work is needed to address these concerns and to standardize best-practice protocols throughout the rehabilitation community.


Assuntos
Acesso à Informação , Infecções por Coronavirus/diagnóstico , Pessoal de Saúde , Pneumonia Viral/diagnóstico , Reabilitação , Traumatismos da Medula Espinal , Betacoronavirus , Cuidadores , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Assistência à Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Pacientes Internados , Programas de Rastreamento , Pandemias , Pneumonia Viral/complicações , Traumatismos da Medula Espinal/reabilitação , Inquéritos e Questionários , Populações Vulneráveis
11.
Spinal Cord Ser Cases ; 6(1): 21, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32296046

RESUMO

STUDY DESIGN: An online survey. OBJECTIVES: To query the international spinal cord medicine community's engagement with and response to the novel coronavirus (COVID-19) pandemic and to assess pandemic-specific information needs and patient concerns. SETTING: An international collaboration of authors and participants. METHODS: Two near-identical surveys (one English and one Spanish language) were distributed via the internet. Responses from those questions shared between the surveys were pooled then analyzed; four questions' responses (those not shared) were analyzed separately. RESULTS: A total of 783 responses were submitted from six continents. Few participants (5.8%) had tested their outpatients with SCI/D for COVID-19; only 4.4% reported having a patient with SCI/D with the virus. Of respondents who worked at an inpatient facility, 53.3% reported that only individuals with symptoms were being screened and 29.9% said that no screening was occurring. Participants relayed several concerns offered by their patients with SCI/D, including vulnerability to infection (76.9%) and fragility of caretaker supply (42%), and those living in countries with guaranteed health care were more likely to report widespread availability of COVID-19 testing than were those living in countries without universal care, χ2 (3, N = 625) = 46.259, p < 0.001. CONCLUSION: There is substantial variability in the rehabilitation medicine community in COVID-19 screening practices and availability of screening kits. People living with SCI/D are expressing legitimate and real concerns about their vulnerability to COVID-19. More and rapid work is needed to address these concerns and to standardize best-practice protocols throughout the rehabilitation community.


Assuntos
Acesso à Informação , Infecções por Coronavirus/diagnóstico , Pessoal de Saúde , Pneumonia Viral/diagnóstico , Reabilitação , Traumatismos da Medula Espinal , Betacoronavirus , Cuidadores , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Assistência à Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Pacientes Internados , Programas de Rastreamento , Pandemias , Pneumonia Viral/complicações , Traumatismos da Medula Espinal/reabilitação , Inquéritos e Questionários , Populações Vulneráveis
12.
Int J Rehabil Res ; 43(3): 206-213, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32282573

RESUMO

Overground robotic exoskeleton gait training is increasingly utilized during inpatient rehabilitation yet without clear guidelines. We describe clinical characteristics associated with robotic exoskeleton gait training and examine outcomes of people with spinal cord injury and stroke who completed usual rehabilitation care with or without robotic exoskeleton gait training. Retrospective review of medical records over a 36 months period. Inpatients with spinal cord injury or stroke and ≥1 robotic exoskeleton gait training session were included. After obtaining a complete list of robotic exoskeleton gait training participants, medical records were reviewed for comparable matches as determined by gait functional independence measure score <4, age 18-100 years, meeting exoskeleton manufacturer eligibility criteria, and participating in usual care only. Functional independence measure was collected on all patients. For spinal cord injury, we collected the walking index for spinal cord injury II. For stroke, we collected the Stroke Rehabilitation Assessment of Movement Measure. Fifty-nine people with spinal cord injury (n = 31 robotic exoskeleton gait training; n = 28 usual care) and 96 people post-stroke (n = 44 robotic exoskeleton gait training; n = 52 usual care) comprised the medical record review. Fifty-eight percent of patients with spinal cord injury and 56% of patients post-stroke completed 5+ robotic exoskeleton gait training sessions and were included in analyses. Robotic exoskeleton gait training dosage varied between our patients with spinal cord injury and patients post-stroke. Robotic exoskeleton gait training utilization during inpatient rehabilitation required consideration of unique patient characteristics impacting functional outcomes. Application of robotic exoskeleton gait training across diagnoses may require different approaches during inpatient rehabilitation.


Assuntos
Exoesqueleto Energizado , Marcha , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício , Feminino , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Centros de Reabilitação , Estudos Retrospectivos , Traumatismos da Medula Espinal/reabilitação , Adulto Jovem
13.
J Neuroeng Rehabil ; 17(1): 49, 2020 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-32276627

RESUMO

Neuroprostheses that activate musculature of the lower extremities can enable standing and movement after paralysis. Current systems are functionally limited by rapid muscle fatigue induced by conventional, non-varying stimulus waveforms. Previous work has shown that sum of phase-shifted sinusoids (SOPS) stimulation, which selectively modulates activation of individual motor unit pools (MUPs) to lower the duty cycle of each while maintaining a high net muscle output, improves joint moment maintenance but introduces greater instability over conventional stimulation. In this case study, implementation of SOPS stimulation with a real-time feedback controller successfully decreased joint moment instability and further prolonged joint moment output with increased stimulation efficiency over open-loop approaches in one participant with spinal cord injury. These findings demonstrate the potential for closed-loop SOPS to improve functionality of neuroprosthetic systems.


Assuntos
Terapia por Estimulação Elétrica/métodos , Músculo Esquelético/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Adulto , Retroalimentação , Humanos , Articulação do Joelho/fisiologia , Masculino , Movimento/fisiologia , Fadiga Muscular/fisiologia , Paralisia/etiologia , Paralisia/fisiopatologia , Paralisia/reabilitação , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia
14.
J Neuroeng Rehabil ; 17(1): 51, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299483

RESUMO

BACKGROUND: Participation in physical and therapeutic activities is usually severely restricted after a spinal cord injury (SCI). Reasons for this are the associated loss of voluntary motor function, inefficient temperature regulation of the affected extremities, and early muscle fatigue. Hydrotherapy or swim training offer an inherent weight relief, reduce spasticity and improve coordination, muscle strength and fitness. METHODS: We present a new hybrid exercise modality that combines functional electrical stimulation (FES) of the knee extensors and transcutaneous spinal cord stimulation (tSCS) with paraplegic front crawl swimming. tSCS is used to stimulate the afferent fibers of the L2-S2 posterior roots for spasticity reduction. By activating the tSCS, the trunk musculature is recruited at a motor level. This shall improve trunk stability and straighten the upper body. Within this feasibility study, two complete SCI subjects (both ASIA scale A, lesion level Th5/6), who have been proficient front crawl swimmers, conducted a 10-week swim training with stimulation support. In an additional assessment swim session nine months after the training, the knee extension, hip extension, and trunk roll angles where measured using waterproof inertial measurement units (IMUs) and compared for different swimming conditions (no stimulation, tSCS, FES, FES plus tSCS). RESULTS: For both subjects, a training effect over the 10-week swim training was observed in terms of measured lap times (16 m pool) for all swimming conditions. Swimming supported by FES reduced lap times by 15.4% and 8.7% on average for Subject A and Subject B, respectively. Adding tSCS support yielded even greater mean decreases of 19.3% and 20.9% for Subjects A and B, respectively. Additionally, both subjects individually reported that swimming with tSCS for 30-45 minutes eliminated spasticity in the lower extremities for up to 4 hours beyond the duration of the session. Comparing the median as well as the interquartile range of all different settings, the IMU-based motion analysis revealed that FES as well as FES+tSCS improve knee extension in both subjects, while hip extension was only increased in one subject. Trunk roll angles were similar for all swimming conditions. tSCS had no influence on the knee and hip joint angles. Both subjects reported that stimulation-assisted swimming is comfortable, enjoyable, and they would like to use such a device for recreational training and rehabilitation in the future. CONCLUSIONS: Stimulation-assisted swimming seems to be a promising new form of hybrid exercise for SCI people. It is safe to use with reusable silicone electrodes and can be performed independently by experienced paraplegic swimmers except for transfer to water. The study results indicate that swimming speed can be increased by the proposed methods and spasticity can be reduced by prolonged swim sessions with tSCS and FES. The combination of stimulation with hydrotherapy might be a promising therapy for neurologic rehabilitation in incomplete SCI, stroke or multiples sclerosis patients. Therefore, further studies shall incorporate other neurologic disorders and investigate the potential benefits of FES and tSCS therapy in the water for gait and balance.


Assuntos
Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Paraplegia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Natação/fisiologia , Adulto , Terapia por Estimulação Elétrica/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Paraplegia/etiologia , Projetos Piloto , Traumatismos da Medula Espinal/complicações
15.
BMC Health Serv Res ; 20(1): 298, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293434

RESUMO

BACKGROUND: Specialized Institution-Based Rehabilitation (SIBR) is the cornerstone of care and treatment for individuals with spinal cord injury, but most people with chronic spinal cord injury (CSCI) living in China have no SIBR experience after acute care hospital discharge. In 2009, an SIBR facility was set up in Shanghai (China) to fill this important gap in care. The purpose of the study was to evaluate the effectiveness of an integrated rehabilitation training program among individuals with CSCI living in Shanghai. METHODS: A within-subject pre-posttest design was used to evaluate the SIBR. The sample included 455 individuals ≥1 year post-SCI, who were older than 18 years of age and were enrolled in a rehabilitation center in Shanghai, China, between 2013 and 2019. The data included individuals' sociodemographic and injury characteristics, and twenty-three indicators were used as outcome measurements to evaluate basic life skills and their applications in family and social life. Multivariate linear regression was conducted to determine which factors might have influenced the effectiveness of the SIBR. RESULTS: All basic life skills and their applications in family and social life were improved, but with variations across socio-demographics. Female individuals with CSCI had better outcomes in basic life skills than did males. In terms of basic life skills and their applications in family and social life, individuals with a low level (thoracic or lumbosacral) of injury achieved more significant functional gains than those with a higher level (cervical). The baseline score was also a relevant factor in functional outcome. CONCLUSIONS: Even for individuals with a long SCI history, SIBR training can improve basic life skills and the applications of those skills in family and social life settings.


Assuntos
Traumatismos da Medula Espinal/reabilitação , Adulto , China , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Centros de Reabilitação
16.
BMC Health Serv Res ; 20(1): 299, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293443

RESUMO

BACKGROUND: Preventing patient falls is a priority in tertiary spinal cord injury (SCI) rehabilitation. Falls can result in patient or staff injury, delayed rehabilitation, and hospital liability. A comprehensive overview of fall prevention/management policies and procedures in Canadian SCI rehabilitation is currently lacking. We describe and compare the fall prevention/management policies and procedures implemented in Canadian tertiary hospitals that provide SCI rehabilitation. METHODS: Fall prevention/management documents implemented in SCI rehabilitation at six Canadian tertiary rehabilitation hospitals across five provinces were analyzed using a document analysis. Analysis involved multiple readings of the documents followed by a content and thematic document analysis. RESULTS: Fall prevention/management policies and procedures in SCI rehabilitation were organized into three main categories: 1) pre-fall policies and procedures; 2) post-fall policies and procedures; and, 3) communication between and amongst staff, patients, and families. Pre-fall policies and procedures encompassed: a) the definition of a fall; b) fall risk assessments in SCI rehabilitation; and, c) fall prevention strategies. The post-fall policies and procedures included: a) recovery from a fall; b) incident reporting process; and, c) fall classification. Components of fall prevention/management policies and practices that differed between hospitals included the fall risk assessments, post-fall huddles, and fall classifications. CONCLUSIONS: Fall prevention/management is a required organizational practice for all hospitals. Although Canadian tertiary hospitals that provide SCI rehabilitation have similar components of fall prevention/management policies and procedures, the specific requirements differ at each site. There is a need for evidence-informed, consensus-driven implementation of SCI-specific fall prevention and management procedures across Canadian SCI rehabilitation settings.


Assuntos
Acidentes por Quedas/prevenção & controle , Política Organizacional , Gestão da Segurança/organização & administração , Traumatismos da Medula Espinal/reabilitação , Canadá , Hospitais de Reabilitação/organização & administração , Humanos , Centros de Atenção Terciária/organização & administração
17.
Am J Phys Med Rehabil ; 99(6): 532-539, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32167958

RESUMO

OBJECTIVE: The aim of the study was to assess factors determining the utilization of physical and occupational therapy in people with spinal cord injury. DESIGN: Data from the German Spinal Cord Injury study conducted in 2017 were analyzed. The 12-mo prevalence of physical therapy and occupational therapy utilization was determined. To identify underlying determinants, multivariable logistic regression was used. RESULTS: Of 1479 participants (response = 26.4%), 72.9% were male, with a mean (SD) age of 55.3 (14.6) yrs and a mean (SD) time since injury of 14.0 (12.0) yrs; 51.2% were people with paraplegia and 66.3% had an incomplete spinal cord injury. In the past 12 mos, 78.1% received physical and 29.3% occupational therapy. Physical therapy and occupational therapy were significantly associated with time since spinal cord injury occurrence, participation in lifelong care programs, and electric wheelchair dependency. Spinal cord injury characteristics, level of impairment, and time since spinal cord injury had a greater impact on occupational therapy than on physical therapy utilization. CONCLUSIONS: The use of physical therapy and occupational therapy is much higher in Germans with spinal cord injury than in the general population and in people with similar neurological conditions. Further research should focus on the frequency of use and the types of interventions. Guidelines for lifelong care should include recommendations on physical therapy and occupational therapy.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Terapia Ocupacional , Modalidades de Fisioterapia , Traumatismos da Medula Espinal/reabilitação , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
18.
J Neuroeng Rehabil ; 17(1): 36, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111245

RESUMO

BACKGROUND: FES (Functional Electrical Stimulation) neuroprostheses have long been a permanent feature in the rehabilitation and gait support of people who had a stroke or have a Spinal Cord Injury (SCI). Over time the well-known foot switch triggered drop foot neuroprosthesis, was extended to a multichannel full-leg support neuroprosthesis enabling improved support and rehabilitation. However, these neuroprostheses had to be manually tuned and could not adapt to the persons' individual needs. In recent research, a learning controller was added to the drop foot neuroprosthesis, so that the full stimulation pattern during the swing phase could be adapted by measuring the joint angles of previous steps. METHODS: The aim of this research is to begin developing a learning full-leg supporting neuroprosthesis, which controls the antagonistic muscle pairs for knee flexion and extension, as well as for ankle joint dorsi- and plantarflexion during all gait phases. A method was established that allows a continuous assessment of knee and foot joint angles with every step. This method can warp the physiological joint angles of healthy subjects to match the individual pathological gait of the subject and thus allows a direct comparison of the two. A new kind of Iterative Learning Controller (ILC) is proposed which works independent of the step duration of the individual and uses physiological joint angle reference bands. RESULTS: In a first test with four people with an incomplete SCI, the results showed that the proposed neuroprosthesis was able to generate individually fitted stimulation patterns for three of the participants. The other participant was more severely affected and had to be excluded due to the resulting false triggering of the gait phase detection. For two of the three remaining participants, a slight improvement in the average foot angles could be observed, for one participant slight improvements in the averaged knee angles. These improvements where in the range of 4circat the times of peak dorsiflexion, peak plantarflexion, or peak knee flexion. CONCLUSIONS: Direct adaptation to the current gait of the participants could be achieved with the proposed method. The preliminary first test with people with a SCI showed that the neuroprosthesis can generate individual stimulation patterns. The sensitivity to the knee angle reset, timing problems in participants with significant gait fluctuations, and the automatic ILC gain tuning are remaining issues that need be addressed. Subsequently, future studies should compare the improved, long-term rehabilitation effects of the here presented neuroprosthesis, with conventional multichannel FES neuroprostheses.


Assuntos
Algoritmos , Terapia por Estimulação Elétrica/instrumentação , Transtornos Neurológicos da Marcha/reabilitação , Próteses e Implantes , Traumatismos da Medula Espinal/reabilitação , Adulto , Terapia por Estimulação Elétrica/métodos , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia
19.
J Neuroeng Rehabil ; 17(1): 40, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138780

RESUMO

BACKGROUND: Loss of hand function following high level spinal cord injury (SCI) is perceived as a high priority area for rehabilitation. Following discharge, it is often impractical for the specialist care centre to provide ongoing therapy for people living with chronic SCI at home, which can lead to further deterioration of hand function and a direct impact on an individual's capability to perform essential activities of daily living (ADL). OBJECTIVE: This pilot study investigated the therapeutic effect of a self-administered home-based hand rehabilitation programme for people with cervical SCI using the soft extra muscle (SEM) Glove by Bioservo Technologies AB. METHODS: Fifteen participants with chronic cervical motor incomplete (AIS C and D) SCI were recruited and provided with the glove device to use at home to complete a set task and perform their usual ADL for a minimum of 4 h a day for 12 weeks. Assessment was made at Week 0 (Initial), 6, 12 and 18 (6-week follow-up). The primary outcome measure was the Toronto Rehabilitation Institute hand function test (TRI-HFT), with secondary outcome measures including pinch dynamometry and the modified Ashworth scale. RESULTS: The TRI-HFT demonstrated improvement in hand function at Week 6 of the therapy including improvement in object manipulation (58.3 ±3.2 to 66.9 ±1.8, p ≈ 0.01), and palmar grasp assessed as the length of the wooden bar that can be held using a pronated palmar grip (29.1 ±6.0 cm to 45.8 ±6.8 cm, p <0.01). A significant improvement in pinch strength, with reduced thumb muscle hypertonia was also detected. Improvements in function were present during the Week 12 assessment and also during the follow-up. CONCLUSIONS: Self-administered rehabilitation using the SEM Glove is effective for improving and retaining gross and fine hand motor function for people living with chronic spinal cord injury at home. Retention of improved hand function suggests that an intensive activity-based rehabilitation programme in specific individuals is sufficient to improve long-term neuromuscular activity. Future studies should characterise the neuromuscular mechanism of action and the minimal rehabilitation programme necessary with the assistive device to improve ADL tasks following chronic cervical SCI. TRIAL REGISTRATION NUMBER: Trial registration: ISRCTN, ISRCTN98677526, Registered 01/June/2017 - Retrospectively registered, http://www.isrctn.com/ISRCTN98677526.


Assuntos
Exoesqueleto Energizado , Traumatismos da Medula Espinal/reabilitação , Atividades Cotidianas , Adulto , Feminino , Mãos/fisiopatologia , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Desempenho Psicomotor , Equipamentos de Autoajuda
20.
Arch Phys Med Rehabil ; 101(7): 1162-1169, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32145278

RESUMO

OBJECTIVE: This study examined the effects of health and rehabilitation service use, unmet need for services, and service obstacles on health-related quality of life (HR QoL) and psychological well-being after discharge from spinal cord injury (SCI) rehabilitation. DESIGN: Prospective cohort study, with participants followed up at 6 and/or 12 months after discharge from SCI inpatient rehabilitation. SETTING: Community setting. PARTICIPANTS: People with SCI (N=55; mean age 51y; 76.4% men; 61.8% traumatic injury; mean length of stay 137d). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Service Usage Scale, Service Obstacles Scale, the EuroQol-5D, and the Depression Anxiety and Stress Scale short form. Eight predictors of outcome were considered: service use (ie, use of general practitioner, medical specialist, nursing, and allied health, and rehospitalization), unmet need, and service obstacles (ie, finances and transport). Possibly important predictors of each outcome were identified via penalized regression, and a final model was fit using Bayesian hierarchical regression with a Gaussian or zero-inflated Poisson response distribution. RESULTS: Financial obstacles were associated with a poorer HR QoL (ß [95% credible interval]= -0.095 [-0.166 to -0.027]) and higher anxiety (odds ratio, OR [95% credible interval]=1.63 [1.16-2.23]). Rehospitalization was associated with a lower EuroQol visual analog scale (ß= -11.2 [-19.7 to -2.5]) and, interestingly, lower anxiety (OR=1.63 [1.16-2.23]). Use of allied health was associated with higher anxiety (OR=2.48 [1.42-4.44]). CONCLUSION: The varying degrees of financial hardship experienced after injury with complex rehabilitation needs requires investigation, as does the interactive effects of service use, unmet need, and service obstacles on outcomes like QoL and psychological well-being.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Alta do Paciente , Qualidade de Vida , Centros de Reabilitação , Traumatismos da Medula Espinal/reabilitação , Adaptação Fisiológica , Adaptação Psicológica , Adulto , Fatores Etários , Idoso , Teorema de Bayes , Estudos de Coortes , Feminino , Humanos , Escala de Gravidade do Ferimento , Pacientes Internados/estatística & dados numéricos , Tempo de Internação , Masculino , Saúde Mental , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Queensland , Medição de Risco , Fatores Sexuais , Traumatismos da Medula Espinal/diagnóstico
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