Do ambulatory patients with spinal cord injury walk symmetrically?

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To explore the levels of walking symmetry in ambulatory participants with spinal cord injury (SCI), and compare levels of walking symmetry among those with different degrees of lesion severity and those who walked with various types of walking devices. SETTING: A tertiary rehabilitation center and many communities in Thailand. METHODS: Forty-six participants were assessed for their demographics, SCI characteristics and types of walking device used. Then they were recorded for the ability of walking over a 10-m walkway using a digital camera. The levels of walking symmetry were analyzed using a method of manual digitization and reported in terms of percents of step length ratio. RESULTS: Although the participants had bilateral sensorimotor impairments, they showed some degrees of walking asymmetry (~90%), particularly those with American Spinal Injury Association C (AIS C) (85%) and those who walked with a standard walker (78%). Their levels of walking symmetry also significantly differed from those with AIS D (92%; P<0.05) and those who walked without a walking device (95%; P<0.01). CONCLUSIONS: Walking symmetry has been reported as an important variable for the ability of well-controlled walking. Therefore, apart from levels of independent walking, rehabilitation professionals need to emphasize improvements in walking symmetry among these individuals.

Ambulatory assistive devices and walking performance in patients with incomplete spinal cord injury.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To primarily explore types of ambulatory assistive device (AAD) used and secondarily describe walking performance in independent ambulatory patients with spinal cord injury (SCI) who walked without and with various AADs as determined using walking speed and distance walked in 6 min. SETTING: A tertiary rehabilitation center and community hospitals, Thailand. METHODS: The data of 195 independent ambulatory patients with SCI were used to describe the use of an AAD. Among these, only 140 subjects were assessed for their walking speed and distance walked in 6 min. RESULTS: More than half of the subjects (64%) walked with an AAD in which most of them used a standard walker (45%), followed by a single-tip cane (11%) and bilateral crutches (8%), respectively. The walking speed and distance showed significant differences among the groups (P<0.001), except those who used walker versus crutches, and those who used crutches versus cane (P>0.05). Among the significant variables, types of AAD used had the greatest influence on walking speed and distance of the subjects. CONCLUSION: More than half of ambulatory subjects with SCI walked with an AAD in which most of them used a standard walker. However, the non-significant differences of walking performance between the groups may suggest the heterogeneity of walking ability in subjects who used the same type of AAD. Therefore, a method to facilitate the use of an AAD with less supportive ability would increase levels of independence for the patients.

Optic nerve head behavior in Posner-Schlossman syndrome.

PURPOSE: To analyze the effect of glaucomatocyclitic crisis on the optic nerve head, as well as its consequent structural and hemodynamic changes. To evaluate the surgical indication for Posner-Schlossman syndrome. MATERIALS AND METHODS: Four Posner-Schlossman syndrome cases were evaluated for an analysis of the phenomena occurring in the optic disc by means of retinal confocal tomography and Scanning Laser Doppler Flowmetry, and their correlation with visual function as measured with automated computerized perimetry. In all cases the images were obtained in the mediate period after the attack, while in case 1, measurements were performed in the immediate and mediate periods before, during and after the attack. RESULTS: Significant differences were found between optic nerve head parameters and retinal flow measurements in the different phases evaluated. No permanent optic nerve head damage was demonstrated in any of the cases studied, except for case 4 (Posner-Schlossman syndrome associated with traumatic glaucoma). All the variables analyzed returned to normal values after remission of the acute rise in intraocular pressure. CONCLUSIONS: During the attacks of ocular hypertension the optic nerve head experiences significant morphologic changes and hemodynamic variations; nevertheless since they are transient, they fail to cause permanent damage. There was only one case, in which there was optic disc damage and visual field loss. It can be concluded that surgery should be restricted to those cases with severe and disabling symptoms (relative surgical indication) or to cases with progressive optic neuropathy with visual field loss, when the syndrome is associated with glaucoma (absolute surgical indication).