The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization.

Sacral pressure ulcers are a significant problem following spinal cord injury and are felt to be in part due to the high interface-pressures generated while strapped to the spine board. The objective of this study was to determine sacral interface-pressure and sensing area in healthy volunteers on a spine board and the effects of a gel pressure dispersion liner. Thirty-seven volunteers were placed on a pressure-sensing mat between the subject and the spine board. Measurements were carried out with and without a gel liner. Pressures and sensing area were recorded every minute for 40 minutes. The highest pressure was generated at the sacral prominence of each subject. Mean interface-pressures were higher on the spine board alone than with the gel liner (p < .0001). Overall, mean sensing area was lower on the spine board than with the gel liner (p < .0001). Standard spinal immobilization causes high sacral interface-pressures. The addition of a gel liner on the spine board decreased overall mean sacral pressures and increased mean sensing area. Generation of sacral pressure ulcers may be related to the initial interface-pressures generated while the patient is strapped to the spine board. The addition of a gel liner may reduce the incidence of sacral pressure ulcers.

Effects of Dietary Milk Thistle (Silybum marianum) Supplementation in Ducks Fed Mycotoxin-Contaminated Diets.

The medicinal plant milk thistle (Silybum marianum) has been widely used due to its hepatoprotective properties. The main objective of our study was to investigate the health protective effects of dietary milk thistle seed (MS), oil (MO), and seed cake (MSC) in ducks fed diets naturally contaminated with deoxynivalenol (DON; 3.43-3.72 mg/kg feed) and zearalenone (ZEN; 0.46-0.50 mg/kg feed). Female White Hungarian ducks were randomly allocated to four dietary treatments consisting of the control diet (C), the control diet supplemented with 0.5% MS, 0.5% MSC, or 0.1% MO. The feeding of experimental diets did not result in mortality cases, clinical signs of mycotoxicosis, or in differences of clinical chemistry values of blood serum. The positive effect of MO on vacuolar hepatocyte degeneration exceeded that of the MSC on d14 and both MS and MSC on d42. Each treatment was equally effective in the decrease of the severity of solitary cell death and infiltration of lympho- and histiocytes in the liver on d28 as well as in the prevention of lymphocyte depletion in the spleen and bursa of Fabricius on d14. In conclusion, the applied treatments have been proven effective in the prevention of histopathological changes caused by DON and ZEN.

Pushrim kinetics during advanced wheelchair skills in manual wheelchair users with spinal cord injury.

OBJECTIVE: To assess the peak force during wheelchair propulsion of individuals with spinal cord injury propelling over obstacles from the Wheelchair Skills Test. PARTICIPANTS/METHODS: Twenty-three individuals with spinal cord injury (SCI) who are full-time manual wheelchair users were included in this prospective study. A SmartWheel (Three Rivers Holdings, LLC) was used to analyze each push while subjects negotiated standardized obstacles used in the Wheelchair Skills Test, including tile, carpet, soft surface, 5° and 10° ramps, 2 cm, 5 cm, and 15 cm curbs. RESULTS: When the peak forces of the advanced skills were compared to level 10 m tile/10 m carpet, there was a statistically significant increase in all peak forces (P value ranged from .0001 to .0268). DISCUSSION: It is well documented that a large number of individuals with SCI develop upper limb pain. One of the recommendations to preserve the upper limb is to minimize force during repetitive tasks. CONCLUSION: Advanced wheelchair skills require an increase in force to accomplish. The increase in forces ranged from 18% to 130% over that required for level 10 m tile/10 m carpet.

Emergency evacuation readiness of full-time wheelchair users with spinal cord injury.

OBJECTIVES: To determine the percentage of full-time wheelchair users with spinal cord injuries who felt they could evacuate from various locations, and the percentage who have a plan for evacuation. Study results will help clinicians and emergency officials understand needs related to evacuation preparedness. DESIGN: Convenience sample survey. SETTING: Six Spinal Cord Injury Model System centers, part of the national database funded through the Department of Education, National Institute on Disability and Rehabilitation Research. PARTICIPANTS: People (N=487) with spinal cord injuries who use a wheelchair more than 40 hours a week. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The percentage of wheelchair users who felt they would be able to safely evacuate, had a plan for safe evacuation, or reported a need for assistive technology and human assistance to evacuate from various locations in the event of an emergency. RESULTS: The highest percentage of participants felt they would be able to safely evacuate and had a plan for work evacuation. The lowest percentage of participants reported they could evacuate from their city/town in the event of an emergency and had a plan to evacuate their city/town in the event of a natural disaster. A large difference exists between the percentage of participants who felt they could evacuate and those who have a plan for evacuation. CONCLUSIONS: A large discrepancy exists between the perception that one can evacuate and actually having a plan. The perception that one can evacuate without a plan or the use of assistive technology is an area of concern that must be further addressed by educators. Education must emphasize the need to have a defined evacuation plan and effective utilization of assistive technology.

Implanted electrical stimulation of the trunk for seated postural stability and function after cervical spinal cord injury: a single case study.

OBJECTIVES: To explore and quantify the physical and functional effects of stabilizing the torso with electrical stimulation of the paralyzed hip and trunk musculature after motor complete tetraplegia. DESIGN: Single-subject case study with repeated measures and concurrent controls. SETTING: Academic outpatient rehabilitation center. PARTICIPANTS: Forty-four-year-old man with C4 American Spinal Injury Association grade A tetraplegia 20 years postspinal cord injury. INTERVENTION: A surgically implanted multichannel pulse generator and intramuscular stimulating electrodes to activate lumbar erector spinae, quadratus lumborum, and gluteus maximus muscles bilaterally. MAIN OUTCOME MEASURES: Outcomes assessed with and without stimulation included (1) spinal alignment and pelvic orientation, (2) pulmonary function and ventilatory volumes, (3) forward bimanual reaching distance, (4) seated stability and resistance to externally applied disturbances, (5) maximal force and speed of rowing-like movements, and the ability to (6) independently return to an erect seated position from full forward or lateral flexion and (7) roll in bed without assistance. RESULTS: Stimulation improved spinal convexity and kyphosis by 26 degrees and 21 degrees , reduced posterior pelvic tilt by 11 degrees , increased forced expiratory volume and vital capacity by 10% and 22%, and improved forward reach by more than 7cm. Average resistance to sagittal disturbances increased by more than 40% (P<.002), and mean force exerted during underhanded pulling more than doubled (P=.014) with stimulation. Restoration of upright sitting in both sagittal and coronal planes and bed turning was made possible through appropriately timed activation of the hip and trunk muscles. CONCLUSIONS: A neuroprosthesis for controlling the paralyzed torso can positively impact spinal alignment, seated posture, pulmonary function, trunk stability, and reach. Stimulation of hip and trunk muscles can improve performance of activities of daily living as well as enable independent wheelchair and bed mobility.

Preventive health care among community-dwelling persons with spinal cord injury.

OBJECTIVE: To describe preventive health examinations/tests and behaviors of persons with traumatic spinal cord injury (SCI). DESIGN: Survey. SETTING: SCI clinic and telephone contact. PARTICIPANTS: A total of 59 persons ≥18 years of age with traumatic SCI. INTERVENTION: None. MAIN OUTCOME MEASURES: Preventive health examinations/tests and reason for not receiving an examination or test. RESULTS: Preventive health tests/examinations received within the past year: flu vaccination (40.7%); eye examination (50.8%); dental check-up (64.4%); physical examination (61.0%); vitamin D level (56.0%); cholesterol level (25.4%); and blood glucose level (39.0%). For men, 20.0% had a prostate examination and 20.0% had a colonoscopy. For women, 25.0% had a pelvic examination and 62.5% had a mammogram in the past 2 years. The most endorsed reasons for not getting an examination/test was "It was my choice" followed by "No one told me to have [examination/test]." The number of years injured had an inverse relationship with having vitamin D level checked (r = -334) and had a positive association with having serum cholesterol level checked (r = .474). CONCLUSION: Preventive health tests and examinations in the SCI population are being obtained at about the same rate as in the U.S. population with some exceptions (ie, cholesterol level check, colonoscopy, and pelvic examination); however, the rates are far from the goals of Healthy People 2020. Primary care and SCI clinicians should be proactive in educating their patients about the importance of preventive health, especially those who have been injured for a long time.

Contralaterally controlled neuromuscular electrical stimulation for recovery of ankle dorsiflexion: a pilot randomized controlled trial in patients with chronic post-stroke hemiplegia.

OBJECTIVE: The aim of this study was to compare the effects of contralaterally controlled neuromuscular electrical stimulation (CCNMES) vs. cyclic neuromuscular electrical stimulation (NMES) on lower extremity impairment, functional ambulation, and gait characteristics. DESIGN: Twenty-six survivors of stroke with chronic (≥6 mos) foot drop during ambulation were randomly assigned to 6 wks of CCNMES or cyclic NMES. Both groups had ten sessions per week of self-administered home application of either CCNMES or cyclic NMES plus two sessions per week of gait training with a physical therapist. Primary outcomes included lower extremity Fugl-Meyer score, modified Emory Functional Ambulation Profile, and gait velocity. Assessments were made at pretreatment and posttreatment and at 1 and 3 mos after treatment. RESULTS: There were no significant differences between the groups in the outcome trajectories for any of the measures. With data from both groups pooled, there were significant but modest and sustained improvements in the Fugl-Meyer score and the modified Emory Functional Ambulation Profile but not in gait velocity. CONCLUSIONS: The results support the hypothesis that gait training combined with either CCNMES or cyclic NMES reduces lower extremity impairment and functional ambulation but do not support the hypothesis that CCNMES is more effective than cyclic NMES in patients with chronic post-stroke hemiplegia.

A descriptive study on vitamin D levels in individuals with spinal cord injury in an acute inpatient rehabilitation setting.

OBJECTIVE: To determine the prevalence of inadequate or severely deficient levels of vitamin D in patients with spinal cord injury (SCI) admitted to an inpatient rehabilitation service and to describe any associations between patient demographics and injury characteristics and vitamin D levels. DESIGN: Retrospective case series. SETTING: Academic inpatient SCI rehabilitation program. SUBJECTS: One hundred patients with SCI who were consecutively admitted to acute inpatient rehabilitation from January to December 2007. METHODS: Data were retrospectively abstracted from the patient's medical chart. OUTCOME MEASURE: VitD-25(OH). RESULTS: The prevalence of VitD-25(OH) inadequacy or severe deficiency was 93% in this sample of patients with SCI. The mean VitD-25(OH) level was 16.29 +/- 7.73 ng/mL, with a range from 7.00 to 36.80 ng/mL. Twenty-one percent of the sample had VitD-25(OH) levels that were considered as severely deficient (< or =10 ng/mL). African-American subjects had statistically significant lower mean VitD-25(OH) levels compared with Caucasian subjects (12.96 versus 17.79 ng/mL; P = .003). Persons with an incomplete injury had significant lower mean VitD-25(OH) levels compared with complete injuries (14.64 versus 18.15 ng/mL; P = .023). CONCLUSIONS: Inadequate or severely deficient levels of VitD-25(OH) were highly prevalent in patients with SCI admitted to an acute inpatient rehabilitation service. Evaluation of serum VitD-25(OH) levels are recommended in patients with SCI because low levels may contribute to osteoporosis.