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1.
Medicine (Baltimore) ; 98(50): e18286, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852105

RESUMO

RATIONALE: Spinal cord injury (SCI) patients who experience difficulties with independent walking use gait-assistive devices such as a cane, walker, or wheelchair. Few studies have explored gait patterns or cardiopulmonary function in chronic SCI patients after powered exoskeleton training. We investigated whether the cardiopulmonary function of a patient with an incomplete chronic cervical SCI and a hemiplegic gait pattern could be improved by walking training using a powered exoskeleton (Angelegs). PATIENT CONCERNS: A 57-year-old male was diagnosed with an SCI at C3-C4. The right upper and lower limb motor functions differed when evaluated before entry into the program. Motor function was good in the right leg but poor in the left one. Before program entry, the patient could walk for about 10 m using a cane. He did not have a history of severe medical or psychological problems and was not cognitively impaired. DIAGNOSIS: The patient was tetraplegia with incomplete SCI at C3-C4. INTERVENTIONS: The patient was trained for 6 weeks using a powered exoskeleton. The training program consisted of sit-to-stand and stand-to-sit movements, maintenance of balanced standing for 5 minutes, and walking for 15 minutes. OUTCOMES: After 6 weeks of training, gait speed improved in the timed up-and-go test, and cardiac function was enhanced as measured by the metabolic equivalent and VO2 tests. LESSIONS: Walking training using a powered exoskeleton can facilitate the effective rehabilitation and improve the gait speed and cardiopulmonary function of patients with chronic SCIs or strokes.


Assuntos
Vértebras Cervicais/lesões , Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Extremidade Inferior/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Velocidade de Caminhada/fisiologia , Caminhada/fisiologia , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/fisiopatologia
2.
Medicine (Baltimore) ; 98(39): e17322, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574865

RESUMO

BACKGROUND: This study will aim to assess the effectiveness of the rehabilitation training (RT) combined acupuncture for the treatment of patients with neurogenic bladder (NB) secondary to the spinal cord injury (SCI). METHODS: We will conduct a comprehensive literature search from the following databases from the inceptions to the present with no language limitation: PUBMED, EMBASE, Cochrane Library, SinoMed, Web of Science, Allied and Complementary Medicine Database, VIP, WANGFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. Additionally, we will also search gray literature, including dissertations and conference proceedings. RevMan V.5.3 software will be used for the study selection, assessment of bias of bias, and data synthesis. RESULTS: This study will synthesize the available evidence of RT combined with acupuncture for NB secondary to SCI, including episodes of urinary incontinence, urinary retention, urinary tract infection, bladder overactivity, quality of life, and adverse events. CONCLUSION: This study will determine whether RT combined acupuncture is an effective and safety therapy for NB secondary to SCI. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019146127.


Assuntos
Terapia por Acupuntura/métodos , Traumatismos da Medula Espinal , Bexiga Urinaria Neurogênica , Humanos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Resultado do Tratamento , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia
3.
Artigo em Russo | MEDLINE | ID: mdl-31626155

RESUMO

BACKGROUND: Spinal cord injury causes significant impairments of both motor and pelvic organ functions. Latest studies have shown impressive potentials for using transcutaneous spinal cord electrical stimulation (TcSCES) in the late period of injury to restore motor functions. All results were obtained in a limited number of patients in the specific conditions of a physiological experiment. It remains unclear how effective a TcSCES cycle is in restoring motor activity in patients after spinal cord injury in real clinical conditions. AIM: The main objective of this investigation was to study the effectiveness of TcSCES in combination with the standard rehabilitation of patients after a spinal cord injury. An additional objective was to evaluate the effect of TcSCES to excretory functions in patients with spinal cord injury. SUBJECTS AND METHODS: The studies were conducted at Saint Petersburg City Hospital Forty, which included 15 patients with thoracic spinal injury at 2.4±2.06 years after injury; the severity of the latter was American Spinal Injury Association (ASIA) Grades B and C. All the patients underwent a 2-week standard cycle of rehabilitation treatment; of them 7 patients (a study group) received additionally TcSCES. Standard scales were used to assess neurological status and muscle strength and sensitivity. The patients filled out a urinary diary; residual urine volume was monitored using bladder catheterization or ultrasound. RESULTS: An increase in muscle strength was recorded in 6 patients of the study group and in 1 patient of the control one. The end of the treatment cycle was marked by a 1-score spasticity increase in 1 patient of the study group and in 2 patients in the control one. In the study group, the level of anesthesia decreased per segment in 1 patient; an improvement in deep and proprioceptive sensitivity was recorded in 2 patients; no change in sensitivity was observed in the control group. In the study group, 2 patients showed a reduction in the severity of injury from ASIA Grade B to ASIA Grade C. In three patients of the study group, the residual urine volume decreased and control and a sensation of urgency to urinate appeared; in the control group, these parameters remained unchanged after the treatment cycle. DISCUSSION: The main result of the study is evidence for the efficiency of using TcSCES in the complex therapy of motor neurorehabilitation. The performed cycle of TcSCES in patients was noted to result in better motor and excretory functions. CONCLUSION: The use of a short-term TcSCES cycle in the motor rehabilitation program for patients with spinal cord injury contributes to recovery of severe motor disorders and is accompanied by an improvement in urinary functions.


Assuntos
Traumatismos da Medula Espinal/reabilitação , Estimulação da Medula Espinal/métodos , Humanos , Espasticidade Muscular/fisiopatologia , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento
4.
Artigo em Russo | MEDLINE | ID: mdl-31513166

RESUMO

BACKGROUND: The relevance of rehabilitation of children with vertebral column and spinal cord injury (VCSCI) is due to the steady growth in the number of such patients. The mandatory conditions for early motor rehabilitation are to size efforts, to exclude fatigue and overtraining, and to gradually increase loads. The priority tasks of drawing up an individual motor program are to determine the rehabilitation abilities of a child and his/her willingness to perform the proposed load. AIM: To investigate whether the motor rehabilitation program can be personalized for children with severe VCSCI on the basis of estimation of exercise tolerance. METHODS: The investigation enrolled 25 patients with VCSCI (12 people with superior paraparesis or inferior paraplegia and 13 with inferior paraparesis or inferior paraplegia); their mean age was 12.1±5.0 years. An individual active motor rehabilitation program was worked out for all the patients according to the results of exercise tolerance testing. The latter was performed using ergospirometry to determine the maximum oxygen consumption (VO2 max) and the time to reach the anaerobic threshold. RESULTS: After a rehabilitation cycle, all the patients showed an increase in VO2 max and time to reach the anaerobic threshold. The obtained results about the increase in VO2 max with active exercises and the expansion of the aerobic corridor in both patient groups suggest that the exercise tolerance was enhanced due to increases in muscle strength and total body endurance. By the end of the rehabilitation cycle, all the patients displayed an increase in the motor density of exercises to 29.2±4.3 (64.9%) of the 45 min. Passive load decreased to 15.8±4.3 (35.1%) min. CONCLUSION: Assessment of the individual capabilities of a patient allows one to personalize the motor rehabilitation program. Ergospirometry is a technique to monitor the adequacy of the proposed program.


Assuntos
Terapia por Exercício/métodos , Tolerância ao Exercício , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Coluna Vertebral/reabilitação , Adolescente , Criança , Feminino , Humanos , Masculino , Medicina de Precisão
6.
Rev. neurol. (Ed. impr.) ; 69(4): 135-144, 16 ago., 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184071

RESUMO

Introducción. La lesión de la médula espinal es un estado funcional complejo que limita gravemente la vida de la persona. Por ello, la recuperación de la funcionalidad del miembro superior en la tetraplejía se considera un objetivo primordial, ya que mejora significativamente la calidad de vida de estas personas. Además de las terapias convencionales, la realidad virtual supone un nuevo enfoque terapéutico en la rehabilitación del lesionado medular. Objetivo. Realizar una revisión sistemática sobre la efectividad de la rehabilitación del miembro superior en pacientes con lesión medular a través de la realidad virtual. Pacientes y métodos. Se recopilaron datos de ensayos clínicos hasta abril de 2018 que investigaran la rehabilitación con sistemas de realidad virtual en los miembros superiores de pacientes con lesión medular completa e incompleta. Las bases de datos consultadas en esta revisión incluyeron: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL y Brain. Resultados. Se analizaron cinco artículos, los cuales incluyeron ensayos controlados aleatorizados y ensayos clínicos. Los principales resultados de los estudios muestran buena tendencia de la rehabilitación a través de la realidad virtual en combinación con terapia convencional. Conclusiones. Las limitaciones encontradas en los estudios, así como su baja calidad metodológica, suponen la necesidad de mayores investigaciones acerca de la efectividad de esta nueva herramienta. Aun así, la buena tendencia de los estudios se considera de interés para futuras investigaciones


Introduction. Spinal cord injury is a complex and life-disrupting condition. The functional recovery of the upper limb has been considered as an important objective in tetraplegia because it improves significantly the quality of living in these patients. Virtual reality is a new emerging tool of rehabilitation in spinal cord injured patients. Aim. To carry out a systematic review about the information about the application of these systems in spinal cord injury in the rehabilitation of the upper limb. Patients and methods. This review includes clinical trials dated until April 2018, which investigate the functional recovery of the upper limb through virtual reality systems in patients with complete or incomplete tetraplegia. The following databases were used to search for those clinical trials: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL and Brain. Results. Five articles were selected for this review, including randomized clinical trials and clinical trials. The main results show a good tendency on the functional recovery with the combination of virtual reality systems and conventional therapy. Conclusions. The main limitations and the low quality of the studies show the necessity of further investigations with this new tool of rehabilitation. However, the incorporation of virtual reality systems as a rehabilitation supplement might be a beneficial tool on the functional recovery in spinal cord injury


Assuntos
Humanos , Masculino , Feminino , Terapia de Exposição à Realidade Virtual/métodos , Traumatismos da Medula Espinal/reabilitação , Braço , Ensaios Clínicos como Assunto
7.
BMC Neurol ; 19(1): 171, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324152

RESUMO

BACKGROUND: Spinal cord injury (SCI) is a life-changing experience for the individuals with SCI and their families. This study aimed to investigate physical strategies used for overcoming physical disability in individuals with SCI. METHODS: In this qualitative study, 17 SCI persons and 13 family caregivers were selected by a purposeful sampling. Settings of the study were Brain and SCI research (BASIR) center of Tehran University of Medical Sciences and Southern Social Welfare Center of Tehran and SCI Association of Tehran, Iran. Data were collected by face-to-face semi-structured interviews, which were continued until data saturation. The gathered data were concurrently analyzed by the content analysis method. RESULTS: The data analysis revealed one main theme (towards overcoming physical disability) and three sub-themes: 1) physical rehabilitation by various methods; 2) tendency towards the use of alternative medical methods; and 3) making effort for self-reliance. CONCLUSION: The participants used physiotherapy and occupational therapy as an effective and essential approach offered by the healthcare team. Some individuals with SCI with help of their family had invented simple rehabilitation equipment for help to their physical rehabilitation. However, most participants had referred to different complimentary medicine specialists based on advice friends and relatives and they often had spent a lot of time and money ineffectively. Therefore, they need training and support of the healthcare team as well as social support to achieve physical independence and physical recovery. Further research is suggested to investigate the barriers to achieving physical empowerment in people with SCI in Iran.


Assuntos
Avaliação da Deficiência , Traumatismos da Medula Espinal/reabilitação , Adulto , Cuidadores , Pessoas com Deficiência , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Apoio Social
8.
BMC Health Serv Res ; 19(1): 391, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208427

RESUMO

BACKGROUND: Fall prevention is a priority in Canadian tertiary rehabilitation hospitals. We aimed to understand the perspectives of hospital administrators on the challenges experienced when implementing fall prevention policies/procedures for patients with spinal cord injury (SCI) in tertiary rehabilitation hospitals. METHODS: Semi-structured interviews were conducted with 10 administrators employed in six Canadian tertiary rehabilitation hospitals. Guided by an interpretive description framework, interviews were analyzed using a constant comparison approach. RESULTS: Challenges with fall prevention experienced by administrators fell into the three categories: 1) fall prevention policy and procedural challenges (e.g. fall prevention policy not SCI-specific, expectation of zero falls, determining contributing factors, learning from falls, and overall effectiveness of the fall prevention policy), 2) clinician-related challenges (e.g. variable staff adherence with the organizations' fall prevention procedures, inconsistent delivery of fall prevention education, and integrating individualized fall risks to guide clinical practice), and 3) patient-related challenges (e.g. balancing risk vs independence and rehabilitation progress, responsibility for fall prevention, and non-preventable falls). CONCLUSIONS: Fall prevention policies/procedures required by the hospitals were insufficient for clinical practice in SCI rehabilitation.


Assuntos
Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Administradores Hospitalares , Hospitais de Reabilitação , Traumatismos da Medula Espinal/reabilitação , Canadá/epidemiologia , Coleta de Dados , Comportamentos Relacionados com a Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Guias de Prática Clínica como Assunto , Fatores de Risco , Traumatismos da Medula Espinal/epidemiologia
9.
Medicine (Baltimore) ; 98(25): e15851, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232920

RESUMO

BACKGROUND: Central nervous system diseases such as stroke, spinal cord injury, traumatic brain injury, and multiple sclerosis can be fatal or cause sequelae, affecting sensorimotor and cardiorespiratory systems and quality of life. These subjects present a low response to aerobic and resistance exercise, due to decreased recruitment of muscle fibers and reduction of metabolic capacity. Aerobic exercises bring benefits in terms of fatigue retardation, gait improvement, regulation of the autonomic nervous system, neuroprotection of the brain, stimulation of the production of endogenous neutrotransmitters related to general well-being, and a favoring of neuroplasticity. Photobiomodulation (PBM Therapy) (previously known as low-level laser therapy), and especially transcranial PBM Therapy, has shown benefits in animals and humans such as cognitive improvement, memory, and behavioral improvement, including attenuation of depression and anxiety, and increased cortical oxygenation. The aims of this trial will be to evaluate the parameters related to the function of the musculoskeletal and cardiorespiratory system and the impact of PBM therapy on these parameters, as part of a rehabilitation and training program for people with reduced mobility. METHODS: This is a randomized, double-blind, placebo-controlled trial with 3 groups: Control, only cardiorespiratory rehabilitation (CCR), CCR with PBM Therapy (CR-PBM), CCR and placebo PBM Therapy (CR-PlaceboPBM). n = 90, 30 per group. PBM Therapy parameters: 810 nm laser, 0.028 cm, 100 mW, 3.5 W/cm, 30 seconds per point, 3 J per point, 107.1 J /cm to 3 electroencephalogram points F7 and F8 and AFz. The trial will be conducted at the University Clinics and the sessions will be 1 hour twice a week for 9 weeks. Baseline, intermediate (4th week), final (9th week), and 2-month follow-up will be performed. Muscular activation, heart rate variability, lung volumes and capacities, fatigability, exercise tolerance, cognition, and quality of life at baseline will be evaluated. Subsequent to baseline evaluations, the PBM Therapy groups will be offered laser therapy (active or inactive); all groups will then receive CCR. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID - NCT03751306 (approval date: November 22, 2018).


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Terapia com Luz de Baixa Intensidade , Esclerose Múltipla/reabilitação , Traumatismos da Medula Espinal/reabilitação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/radioterapia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/radioterapia , Testes Neuropsicológicos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Testes de Função Respiratória , Traumatismos da Medula Espinal/radioterapia , Resultado do Tratamento , Adulto Jovem
10.
BMC Neurol ; 19(1): 140, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234791

RESUMO

BACKGROUND: Body weight supported treadmill training (BWSTT) is a frequently used approach for restoring the ability to walk after spinal cord injury (SCI). However, the duration of BWSTT is usually limited by fatigue of the therapists and patients. Robotic-assisted body weight supported treadmill training (RABWSTT) was developed to tackle the aforesaid limitation. Currently, limited randomized controlled trials are available to investigate its effectiveness, especially on cardiopulmonary function. The aim of this two-arm, parallel-group randomized controlled trial is to examine the feasibility of adapting an EMG-biofeedback system for assist-as-needed RABWSTT and its effects on walking and cardiopulmonary function in people with SCI. METHODS: Sixteen incomplete SCI subjects were recruited and randomly allocated into an intervention group or control group. The intervention group received 30 min of RABWSTT with EMG biofeedback system over the vastus lateralis muscle to enhance active participation. Dose equivalent passive lower limbs mobilization exercise was provided to subjects in the control group. RESULTS: Significant time-group interaction was found in the Walking Index for Spinal Cord Injury version II (WISCI II) (p = 0.020), Spinal Cord Independence Measure version III (SCIM III) mobility sub-score (p < 0.001), bilateral symmetry (p = 0.048), maximal oxygen consumption (p = 0.014) and peak expiratory flow rate (p = 0.048). Wilcoxon signed-rank test showed that the intervention group had significant improvement in the above-mentioned outcomes after the intervention except WISCI II, which also yielded marginal significance level. CONCLUSION: The present study demonstrated that the use of EMG-biofeedback RABWSTT enhanced the walking performance for SCI subjects and improve cardiopulmonary function. Positive outcomes reflect that RABSTT training may be able to enhance their physical fitness. TRIAL REGISTRATION: The study protocol was approved by the Research Ethics Committee (Kowloon Central/ Kowloon East), Hospital Authority on 6 December 2013, and the Human Subjects Ethics Sub-committee of The Hong Kong Polytechnic University on 15 May 2013, with reference numbers KC/KC-13-0181/ER-2 and HSEARS20130510002 respectively. The study was registered in ClinicalTrials.gov on 20 November 2013, with reference number NCT01989806 .).


Assuntos
Biorretroalimentação Psicológica , Aptidão Cardiorrespiratória , Eletromiografia/métodos , Robótica/instrumentação , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Caminhada/fisiologia , Adolescente , Adulto , Peso Corporal , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Modalidades de Fisioterapia/instrumentação
11.
BMC Public Health ; 19(1): 803, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234804

RESUMO

BACKGROUND: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a useful tool for evaluating the impact of programs in community settings. RE-AIM has been applied to evaluate individual programs but seldom used to evaluate the collective impact of community-based, public health programming developed and delivered by multiple autonomous organizations. The purposes of this paper were to (a) demonstrate how RE-AIM can be operationalized and applied to evaluate the collective impact of similar autonomous programs that promote health and well-being and (b) provide preliminary data on the collective impact of Canadian spinal cord injury (SCI) peer mentorship programs on the delivery of peer mentorship services. METHODS: Criteria from all five RE-AIM dimensions were operationalized to evaluate multiple similar community-based programs. For this study, nine provincial organizations that serve people with SCI were recruited from across Canada. Organizations completed a structured self-report questionnaire and participated in a qualitative telephone interview to examine different elements of their peer mentorship program. Data were analyzed using summary statistics. RESULTS: Having multiple indicators to assess RE-AIM dimensions provided a broad evaluation of the impact of Canadian SCI peer mentorship programs. Peer mentorship programs reached 1.63% of the estimated Canadian SCI population. The majority (67%) of organizations tracked the effectiveness of peer mentorship through testimonials and reports. Setting-level adoption rates were high with 100% of organizations offering peer mentorship in community and hospital settings. On average, organizations allocated 10.4% of their operating budget and 9.8% of their staff to implement peer mentorship and 89% had maintained their programming for over 10 years. Full interpretation of the collective impact of peer mentorship programs was limited as complete data were only collected for 52% of survey questions. CONCLUSIONS: The lack of available organizational data highlights a significant challenge when using RE-AIM to evaluate the collective impact of multiple programs that promote health and well-being. Although researchers are encouraged to use RE-AIM to evaluate the collective impact of programs delivered by different organizations, documenting limitations and providing recommendations should be done to further the understanding of how best to operationalize RE-AIM in these contexts.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Implementação de Plano de Saúde/métodos , Tutoria/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Canadá , Serviços de Saúde Comunitária/métodos , Humanos , Tutoria/métodos , Grupo Associado , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Inquéritos e Questionários
12.
Nat Med ; 25(6): 898-908, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31160817

RESUMO

Individuals with spinal cord injury (SCI) can face decades with permanent disabilities. Advances in clinical management have decreased morbidity and improved outcomes, but no randomized clinical trial has demonstrated the efficacy of a repair strategy for improving recovery from SCI. Here, we summarize recent advances in biological and engineering strategies to augment neuroplasticity and/or functional recovery in animal models of SCI that are pushing toward clinical translation.


Assuntos
Traumatismos da Medula Espinal/terapia , Animais , Materiais Biocompatíveis/uso terapêutico , Bioengenharia , Modelos Animais de Doenças , Humanos , Modelos Neurológicos , Plasticidade Neuronal , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Regeneração da Medula Espinal , Pesquisa Médica Translacional
13.
BMC Neurol ; 19(1): 117, 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176359

RESUMO

BACKGROUND: Following spinal cord injury (SCI), family members are often called upon to undertake the caregiving role. This change in the nature of the relationship between the individuals with SCI and their families can lead to emotional, psychological, and relationship challenges. There is limited research on how individuals with SCI and their family caregivers adapt to their new lives post-injury, or on which dyadic coping strategies are used to maintain relationships. Thus, the objectives of this study were to obtain an in-depth understanding of 1) the experiences and challenges within a caregiving relationship post-SCI among spouses, as well as parents and adult children; and 2) the coping strategies used by caregivers and care recipients to maintain/rebuild their relationships. METHODS: A qualitative descriptive approach with an exploratory design was used. Semi-structured face-to-face and telephone interviews were conducted. Thematic analysis was used to identify key themes arising from individuals with SCI's (n = 19) and their family caregivers' (n = 15) experiences. RESULTS: Individuals with SCI and family caregivers spoke in-depth and openly about their experiences and challenges post-injury, with two emerging themes (including subsequent sub-themes). The first theme of deterioration of relationship, which reflects the challenges experienced/factors that contributed to disintegration in a relationship post-injury, included: protective behaviours, asymmetrical dependency, loss of sex and intimacy, and difficulty adapting. The second theme of re-building/maintaining the relationship, which reflects the strategies used by dyads to adjust to the changes within the relationship brought upon by the injury, included: interdependence, shifting commonalities, adding creativity into routine, and creating a new normal. CONCLUSIONS: These findings should alert healthcare professionals and peer support groups as to the need for possible education and training (e.g., coping strategies, communication skills training) as well as counseling prior to discharge to assist individuals with SCI and family caregivers with adaptation to a new life post-injury.


Assuntos
Adaptação Psicológica , Cuidadores/psicologia , Relações Familiares/psicologia , Traumatismos da Medula Espinal/enfermagem , Traumatismos da Medula Espinal/reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
14.
Artigo em Russo | MEDLINE | ID: mdl-31095129

RESUMO

BACKGROUND: The number of children who have received severe spinal cord injury (SCI) is steadily increasing during the recent years. The clinical picture of the post-injury condition is characterized by psychological and psychiatric disorders of varying severity. The literature publications concern emotions experienced after SCI by the adult patients whereas the data on the emotional disorders in the children and the approaches to their medical treatment are virtually absent. Nor is enough information about the status of the children in the early period after the spinal trauma treated jointly by a psychiatrist and a psychologist. AIM: The objective of the present study was the evaluation of the emotions and motivations in the children following the severe spinal trauma in the course of the early rehabilitation period as well as the development of an algorithm for the interaction of a psychiatrist and a psychologist in their joint efforts to manage the emotional and motivational disorders. MATERIAL AND METHODS: The study included 35 children at the age from 8 to 18 years presenting with the severe spinal trauma who had been admitted for the treatment and rehabilitation based at the Research Institute of Emergency Pediatric Surgery and Traumatology, Moscow Health Department, during the period from 2016 to 2018. All the patients were examined by a psychiatrist and a psychologist in dynamics, viz. before the beginning of the rehabilitation course as well as within the 7-10th and 21-25th days after its initiation. The relevant diagnostic scales and questionnaires were used to detect depression and assess the severity of individual symptoms. RESULTS: Three groups of children who had experienced the severe spinal trauma were distinguished depending on the character of emotional disorders and their severity. Group 1 was comprised of the children with depression (n=6) including 2 boys and 4 girls at the age from 14 to17 years (17.2%). Group 2 consisted of the children with emotional disorders, such as high anxiety, impaired motivation with sub-depressive prerequisites (n=11) including 4 girls and 7 boys at the age from 12 to16 years (31.4%). Group 3 was composed of the children free from depression or depressive manifestations (n=18) including 15 boys, 3 girls at the age from 8 to17 years (51.4%). The algorithm for the combined rehabilitative treatment of the children during the early period after the severe spinal trauma with the participation of the psychiatrist and the psychologist has been developed. It was shown that the patients with a reduced intensity of emotional expression combined with a moderate or low level of anxiety and sufficient motivation needed the supervision by the psychologist alone. The children with a reduced intensity of emotional expression combined with a moderate or high level of anxiety and impaired motivation had to be supervised and treated by both the psychiatrist and the psychologist. The children with pronounced depression, high anxiety and low motivation required the supervision and treatment by a psychiatrist with simultaneous pharmacological correction of their condition. CONCLUSION: The results of this study give evidence that 48.6% of the children after severe spinal trauma suffer from the emotional and motivational disorders requiring specialized psychiatric care including the differentiated psychological and psychiatric treatment during the early rehabilitation period with the use of the algorithm for the combined treatment based on the joint efforts of the psychiatrist and the psychologist supplemented by the pharmacological correction.


Assuntos
Psicoterapia , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Adolescente , Algoritmos , Ansiedade , Criança , Terapia Combinada , Depressão , Feminino , Humanos , Masculino , Moscou , Índices de Gravidade do Trauma
15.
Sensors (Basel) ; 19(10)2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31108970

RESUMO

Patients with paralysis, spinal cord injury, or amputated limbs could benefit from using brain-machine interface technology for communication and neurorehabilitation. In this study, a 32-channel three-dimensional (3D) multielectrode probe array was developed for the neural interface system of a brain-machine interface to monitor neural activity. A novel microassembly technique involving lead transfer was used to prevent misalignment in the bonding plane during the orthogonal assembly of the 3D multielectrode probe array. Standard microassembly and biopackaging processes were utilized to implement the proposed lead transfer technique. The maximum profile of the integrated 3D neural device was set to 0.50 mm above the pia mater to reduce trauma to brain cells. Benchtop tests characterized the electrical impedance of the neural device. A characterization test revealed that the impedance of the 3D multielectrode probe array was on average approximately 0.55 MΩ at a frequency of 1 KHz. Moreover, in vitro cytotoxicity tests verified the biocompatibility of the device. Subsequently, 3D multielectrode probe arrays were implanted in rats and exhibited the capability to record local field potentials and spike signals.


Assuntos
Técnicas Biossensoriais , Encéfalo/fisiopatologia , Sistemas Microeletromecânicos/métodos , Neurônios/patologia , Potenciais de Ação/fisiologia , Animais , Interfaces Cérebro-Computador , Impedância Elétrica , Eletrodos Implantados , Eletroencefalografia , Humanos , Microeletrodos , Neurônios/fisiologia , Ratos , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação
16.
Phys Med Rehabil Clin N Am ; 30(2): 301-318, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954149

RESUMO

This article describes the application of neuromodulation in different ways to motor recovery, to replace lost function, or to improve function of organ systems for those who have experienced spinal cord injury or stroke. Multiple devices have been developed and are currently available for use whereas others are still in the experimental stage. Multiple uses of neuromodulation are described.


Assuntos
Terapia por Estimulação Elétrica , Reabilitação Neurológica , Terapia por Estimulação Elétrica/instrumentação , Terapia por Estimulação Elétrica/métodos , Humanos , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos
17.
Phys Med Rehabil Clin N Am ; 30(2): 337-354, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954151

RESUMO

Spinal cord epidural stimulation (scES) combined with activity-based training can promote lower limb motor function recovery in chronic, motor complete spinal cord-injured individuals. Task- and individual-specific scES parameters modulate the excitability of human spinal circuitry so that sensory information and residual descending input can serve as sources of control for generating motor patterns appropriate for standing, stepping, and volitionally moving the lower limb. Task-specific activity-based training with scES is crucial for promoting neural plasticity and motor function improvement. Future studies with more individuals and advanced stimulation technology are needed to better understand the recovery potential in this population.


Assuntos
Reabilitação Neurológica , Traumatismos da Medula Espinal/reabilitação , Estimulação da Medula Espinal , Humanos , Extremidade Inferior/fisiopatologia , Reabilitação Neurológica/métodos , Traumatismos da Medula Espinal/fisiopatologia , Estimulação da Medula Espinal/métodos
18.
Phys Med Rehabil Clin N Am ; 30(2): 367-384, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954153

RESUMO

Tetraplegia resulting from cervical injury is the most frequent neurologic category after spinal cord injury and causes substantial disability. The residual strength of partially paralyzed muscles is an important determinant of independence and function in tetraplegia. Small improvements in upper extremity function can make a clinically significant difference in daily activities. Major advances in rehabilitation technologies over the past 2 decades have allowed testing of robotic devices in rehabilitation of motor impairments. This literature assessment provides an overview of robotic-assisted training research for improving arm and hand functions after cervical spinal cord injury.


Assuntos
Medula Cervical/lesões , Reabilitação Neurológica , Robótica , Traumatismos da Medula Espinal/reabilitação , Terapia Assistida por Computador , Humanos , Reabilitação Neurológica/instrumentação , Quadriplegia/etiologia , Quadriplegia/fisiopatologia , Quadriplegia/reabilitação , Traumatismos da Medula Espinal/fisiopatologia , Terapia Assistida por Computador/instrumentação , Extremidade Superior/fisiopatologia
19.
Biomed Res Int ; 2019: 3290894, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931325

RESUMO

The management involving stem cell (SC) therapy along with physiotherapy offers tremendous chance for patients after spinal cord injury (SCI), traumatic brain injury (TBI), stroke, etc. However, there are still only a limited number of reports assessing the impact of stem cells (SCs) on the rehabilitation process and/or the results of the simultaneous use of SC and rehabilitation. Additionally, since there is still not enough convincing evidence about the effect of SCT on humans, e.g., in stroke, there have been no studies conducted concerning rehabilitation program formation and expected outcomes. It has been shown that bone marrow-derived mesenchymal stem cell (BMSCs) transplantation in rats combined with hyperbaric oxygen therapy (HBO) can promote the functional recovery of hind limbs after SCI. An anti-inflammatory effect has been shown. One case study showed that, after the simultaneous use of SCT and rehabilitation, an SCI patient progressed from ASIA Grade A to ASIA Grade C. Such promising data in the case of complete tetraplegia could be a breakthrough in the treatment of neurologic disorders in humans. Although SCT appears as a promising method for the treatment of neurological conditions, e.g., complete tetraplegia, much work should be done towards the development of rehabilitation protocols.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Transplante de Células-Tronco Mesenquimais/tendências , Reabilitação Neurológica/tendências , Recuperação de Função Fisiológica , Células da Medula Óssea/citologia , Lesões Encefálicas Traumáticas/patologia , Humanos , Células-Tronco Mesenquimais/citologia , Reabilitação Neurológica/métodos , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/tendências
20.
Rev. neurol. (Ed. impr.) ; 68(7): 290-294, 1 abr., 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183313

RESUMO

Introducción. Estudios realizados en otros países señalan que el 1,6-3% de las lesiones medulares se adquieren por intento de autolisis, y la mayoría se producen por precipitación. Objetivos. Determinar la frecuencia de intento de suicidio como causa de lesión medular en un hospital de neurorrehabilitación y describir las características de estos pacientes en términos psiquiátricos y de discapacidad funcional. Pacientes y métodos. Estudio retrospectivo en el que se revisaron todos los pacientes con lesión medular por intento de autolisis en un período de 15 años en un hospital de neurorrehabilitación. Resultados. El intento de autolisis ocasionó el 2% de las lesiones medulares en la muestra (n = 61). El 93% de los pacientes estaba diagnosticado de patología psiquiátrica y el 26% había realizado tentativas previas. Aunque el 60% estaba vinculado a salud mental, solo tres consultaron por urgencias días antes de la precipitación y seis realizaron la tentativa en el contexto de servicios psiquiátricos. El diagnóstico más frecuente fue la paraplejía asociada a fracturas en las extremidades inferiores y traumatismos torácicos. Conclusiones. La precipitación por intento de autolisis provoca el 2% de las lesiones medulares, y la depresión y los trastornos psicóticos son las patologías psiquiátricas previas más prevalentes. Tras el período de rehabilitación, esta población requiere especial atención por parte de los equipos de salud mental, ya que combina factores de riesgo para cometer suicidio, como la historia de tentativas previas, y la presencia de una condición crónica discapacitante


Introduction. Studies published in other countries indicate that 1.6-3% of spinal cord injuries are acquired due to suicide attempt, the majority being produced by precipitation in patients with previous psychiatric disorders. Aims. To determine the frequency of attempted suicide as a cause of spinal cord injuries in a eurorehabilitation hospital and to describe the characteristics of these patients in psychiatric terms and functional disability. Patients and methods. Retrospective study in which all patients with spinal cord injuries due to suicide attempt in a period of 15 years in a neurorehabilitation hospital were reviewed. Results. Suicide attempt caused 2% (n = 61) of spinal cord injuries in our population. Although 93% of the patients were diagnosed with psychiatric pathology, 60% were linked to mental health facilities and only three consulted for emergency the days before the precipitation. Six attempts were made in the context of psychiatric services and 26% of patients had made previous attempts. The most frequent medical diagnosis was paraplegia associated with fractures in the lower extremities and chest trauma. Conclusions. Precipitation due to suicide attempt causes 2% of spinal cord injuries, with depression and psychotic disorders being the most prevalent psychiatric disorders. After the rehabilitation period, this population requires special attention from the mental health teams since they combine risk factors to commit suicide such as the history of previous attempts and the presence of a chronic disabling condition


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/reabilitação , Transtornos Mentais , Tentativa de Suicídio , Estudos Retrospectivos , Fatores Socioeconômicos
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