Artykuły w czasopismach: „Paraplegic men”

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Dionyssiotis, Yannis, Konstantina Petropoulou, Christina-Anastasia Rapidi, Panagiotis Papagelopoulos, Nikolaos Papaioannou, Antonios Galanos, Paraskevi Papadaki i Georgios P. Lyritis. "Body Composition in Paraplegic Men". Journal of Clinical Densitometry 11, nr 3 (lipiec 2008): 437–43. http://dx.doi.org/10.1016/j.jocd.2008.04.006.

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Gross, A. J., D. H. Sauerwein, J. Kutzenberger i R. H. Ringert. "Penile prostheses in paraplegic men". British Journal of Urology 78, nr 2 (sierpień 1996): 262–64. http://dx.doi.org/10.1046/j.1464-410x.1996.08021.x.

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Pruthi, N., Chanchal Pruthi i P. Sutharamn. "Protective Clothing for Paraplegic Men". Journal of Human Ecology 20, nr 2 (październik 2006): 103–8. http://dx.doi.org/10.1080/09709274.2006.11905911.

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Gass, G. C., E. M. Camp, E. R. Nadel, T. H. Gwinn i P. Engel. "Rectal and rectal vs. esophageal temperatures in paraplegic men during prolonged exercise". Journal of Applied Physiology 64, nr 6 (1.06.1988): 2265–71. http://dx.doi.org/10.1152/jappl.1988.64.6.2265.

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This study investigated the rectal (Tre), esophageal (Tes), and skin (Tsk) temperature changes in a group of trained traumatic paraplegic men pushing their own wheelchairs on a motor-driven treadmill for a prolonged period in a neutral environment. There were two experiments. The first experiment (Tre and Tsk) involved a homogeneous group (T10-T12/L3) of highly trained paraplegic men [maximum O2 uptake (VO2max) 47.5 +/- 1.8 ml.kg-1.min-1] exercising for 80 min at 60–65% VO2max.Tre and Tsk (head, arm, thigh, and calf) and heart rate (HR) were recorded throughout. O2 uptake (VO2), minute ventilation (VE), CO2 production (VCO2), and heart rate (HR) were recorded at four intervals. During experiment 1 significant changes in HR and insignificant changes in VCO2, VE, and VO2 occurred throughout prolonged exercise. Tre increased significantly from 37.1 +/- 0.1 degrees C (rest) to 37.8 +/- 0.1 degrees C after 80 min of exercise. There were only significant changes in arm Tsk. Experiment 2 involved a nonhomogeneous group (T5-T10/T11) of active paraplegics (VO2max 39.9 +/- 4.3 ml.kg-1.min-1) exercising at 60–65% VO2max for up to 45 min on the treadmill while Tre and Tes were simultaneously recorded. Tes rose significantly faster than Tre during exercise (dT/dt 20 min: Tes 0.050 +/- 0.003 degrees C/min and Tre 0.019 +/- 0.005 degrees C/min), and Tes declined significantly faster than Tre at the end of exercise. Tes was significantly higher than Tre at the end of exercise. Our results suggest that during wheelchair propulsion by paraplegics, Tes may be a better estimate of core temperature than Tre.

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Sindrup, J. H., H. Wroblewski, J. Kastrup i F. Biering-Sørensen. "Nocturnal variations in lower-leg subcutaneous blood flow in paraplegic men". Clinical Science 82, nr 1 (1.01.1992): 47–54. http://dx.doi.org/10.1042/cs0820047.

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1. Lower-leg subcutaneous adipose tissue blood flow rates were measured over 12-20 h under ambulatory conditions by means of the 133Xe-washout technique in nine paraplegic men, all with complete spinal cord lesions at or below the Th 6 level, and in nine age-matched healthy men. Portable CdTe(Cl) detectors and datastorage units were used. 2. The central and local sympathetic vasoconstrictive activity at the lower leg was measured under laboratory conditions by means of the l33Xe-washout technique and a stationary NaI(TI) detector system. 3. The paraplegic men were found to have intact central and local sympathetic vasoconstrictive activity in their lower legs. Moreover, they all had a nocturnal hyperaemic blood flow phase of the same magnitude and duration as the control subjects. 4. The possibility that the somaesthetic nerves play a role in the hyperaemic response could be excluded, as all the paraplegic men suffered from complete lower-leg somaesthetic denervation. 5. A significant correlation was found between the time of going to bed and the nightly hyperaemic response in the right and left lower legs (P < 0.01). 6. It is concluded that the present data are in accordance with the concept of a central nervous or humoral elicitation of nocturnal hyperaemia, although local metabolic and other factors might participate as well. Paraplegic men have an intact regulation of the postural and nocturnal changes in peripheral blood flow whether of central sympathetic or humoral origin.

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BRINDLEY, G. S., D. SAUERWEIN i W. F. HENDRY. "Hypogastric Plexus Stimulators for Obtaining Semen from Paraplegic Men". British Journal of Urology 64, nr 1 (lipiec 1989): 72–77. http://dx.doi.org/10.1111/j.1464-410x.1989.tb05526.x.

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Blockmans, D., i O. Steeno. "Physostigmine as a Treatment for Anejaeulation with Paraplegic Men/Physostigmin als Behandlung bei Anejakulation infolge Paraplegie". Andrologia 20, nr 4 (24.04.2009): 311–13. http://dx.doi.org/10.1111/j.1439-0272.1988.tb00692.x.

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Gass, G. C., i E. M. Camp. "Effects of prolonged exercise in highly trained traumatic paraplegic men". Journal of Applied Physiology 63, nr 5 (1.11.1987): 1846–52. http://dx.doi.org/10.1152/jappl.1987.63.5.1846.

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This study investigated the cardiovascular and metabolic responses to prolonged wheelchair exercise in a group of highly trained, traumatic paraplegic men. Six endurance-trained subjects with spinal cord lesions from T10 to T12/L3 underwent a maximal incremental exercise test in which they propelled their own track wheelchairs on a motor-driven treadmill to exhaustion to determine maximal O2 uptake (VO2max) and related variables. One week later each subject exercised in the same wheelchair on a motorized treadmill at 60–65% of VO2max for 80 min in a thermoneutral environment (dry bulb 22 degrees C, wet bulb 17 degrees C). Approximately 10 ml of venous blood were withdrawn both 20 min and immediately before exercise (0 min), after 40 and 80 min of exercise, and 20 min postexercise. Venous blood was analyzed for hematocrit (Hct), hemoglobin (Hb), and lactate, and the separated plasma was analyzed for glucose, K+, Na+, Cl-, free fatty acid (FFA), and osmolality. VO2, CO2 production (VCO2), minute ventilation (VE), respiratory exchange ratio (R), net efficiency, and wheelchair strike rate were determined at four intervals throughout the exercise period. Data were analyzed with an analysis of variance repeated-measures design and a Scheffe post hoc test. VO2max was 47.5 +/- 1.8 (SE) ml.min-1.kg-1 with maximal VE BTPS and maximal heart rate (HR) being 100.1 +/- 3.8 l/min and 190 +/- 1 beats/min, respectively. During prolonged exercise there were no significant changes in VO2, VCO2, VE, R, net efficiency, wheelchair strike rate, and lactate, glucose, and Na+ concentrations. Significant increases occurred in HR, FFA, K+, Cl-, osmolality, Hb, and Hct throughout exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

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Cutajar, Ruth, i Anne Roberts. "The Relationship between Engagement in Occupations and Pressure Sore Development in Saudi Men with Paraplegia". British Journal of Occupational Therapy 68, nr 7 (lipiec 2005): 307–14. http://dx.doi.org/10.1177/030802260506800704.

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Various research studies have explored the factors that predispose people with spinal cord injuries to pressure sore development. Two hundred risk factors have been associated with pressure sore occurrence. One of the variables commonly reported to affect pressure sore occurrence is a decreased level of activity (Vidal and Sarrias 1991, Fuhrer et al 1993). This concurs with the philosophy of occupational therapy that a reduction in activity can generate pathology (Miller et al 1988). This research study investigated whether decreased participation in occupational activities (work, leisure and activities of daily living) was related to pressure sore occurrence in paraplegic men. The sample was selected randomly from the occupational therapy discharge files of a rehabilitation facility in Saudi Arabia. The data were collected by means of a telephone questionnaire from a total of 58 men, over a 3-month period. The study showed that there was a large increase in unemployment in paraplegic men following injury (from 10% to 59%) and, as might be expected, manual workers were more vulnerable than office workers. The study found no significant association between pressure sore occurrence and whether or not the individual was employed. However, it showed a statistically significant association between unemployment and pressure sores severe enough to lead to hospitalisation. The study also found a statistically significant association between individuals' independence in activities of daily living and the number of pressure sores that they had reported in the last 2 years. These findings indicate the potential importance of clients remaining occupationally active for their wellbeing and the significant contribution that occupational therapists can make by enabling rehabilitation of occupational activities.

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Mungovan, Sean, Greg Gass i Elizabeth Gass. "Effects Of Lower Limb Elevation And Compression On Cardiovascular Function In Men Who Are Paraplegic". Medicine & Science in Sports & Exercise 37, Supplement (maj 2005): S313. http://dx.doi.org/10.1249/00005768-200505001-01625.

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Mungovan, Sean, Greg Gass i Elizabeth Gass. "Effects Of Lower Limb Elevation And Compression On Cardiovascular Function In Men Who Are Paraplegic". Medicine & Science in Sports & Exercise 37, Supplement (maj 2005): S313. http://dx.doi.org/10.1097/00005768-200505001-01625.

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Dawson, B., J. Bridle i R. J. Lockwood. "Thermoregulation of paraplegic and able bodied men during prolonged exercise in hot and cool climates". Spinal Cord 32, nr 12 (grudzień 1994): 860–70. http://dx.doi.org/10.1038/sc.1994.132.

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Gass, E. M., L. A. Harvey i G. C. Gass. "Maximal physiological responses during arm cranking and treadmill wheelchair propulsion in T4–T6 paraplegic men". Spinal Cord 33, nr 5 (maj 1995): 267–70. http://dx.doi.org/10.1038/sc.1995.60.

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SERBAN, Diana-Elena, Cristina Octaviana DAIA, Ioana NEGOESCU CHEREGI, Vlad CIOBANU, Liliana ONOSE, Cristina POPESCU i Gelu ONOSE. "Topical Systematic and Synthetic Literature Review Regarding Men Sexual Dysfunctions after Spinal Cord Injury". Balneo Research Journal, Vol.11, no.4 (5.12.2020): 421–24. http://dx.doi.org/10.12680/balneo.2020.372.

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Introduction Spinal cord injury (SCI) is a life-altering event usually associated with loss of motor and sensory, as well as with bladder, bowel and sexual, functions impairment. Recovering sexual function is one of the most important function tightly coupled with the life quality. In this respect, in the related literature can be found data regarding mainly: diagnosis/evaluation issues therapeutic/assistive-rehabilitative interventions (including connected to fertility troubles) and of psychological and or educational specific counseling, kind. Materials and methods.This paper presents a current systematic (of Preferred Reporting Items for Systematic Reviews and Meta-Analyses – PRISMA – type) and synthetic literature review on sexual dysfunctions and respected available management options in male subjects with SCI, using the following search keywords/ combinations of key words: “men”, “sexual dysfunction”/ “fertility” / “erectile dysfunction”/ “ejaculatory problems” / “sexual disorder“, “spinal cord injury”, “paraplegia”/ ”tetraplegia” /“paraplegic”/ ”tetraplegic”, “management”/ “treatment”, by interrogating international renown data bases: NCBI/PubMed, NCBI/PMC, Elsevier, PEDro and respectively, ISI Web of Knowledge/Science – to check whether the selected articles are published in ISI indexed journals – considering publications from January 2009 to June 2019, written in English, open access articles and being “fair”/“high” quality on our PEDro inspired, customized quality classification of the selected papers – the basic criterion, being the weighted citations number per year. Results. We have found initially 647 articles and eventually, after accomplishing the PRISMA stages (without meta-analysis), we have selected 16 articles matching all the above mentioned quest method’s requests (see further the figure representing our PRISMA type completed flow-diagram), covering (together with knowledge acquired from extra bibliographic resources, too). Conclusions. Sexual disfunctions after SCI are complex and strongly add to the severe and multimodal disability the affected people – in the case of our work: men – experience. Therefore, they worth being fathomed and periodically reappraised. Keywords: Spinal Cord injury (SCI), men sexual dysfunctions, systematic literature review, rehabilitation,

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Petrofsky, Jerrold Scott, i Michael Laymon. "Blood pressure and heart rate responses during a fatiguing isometric exercise in paraplegic men with hypertension". European Journal of Applied Physiology 83, nr 4-5 (14.11.2000): 274–82. http://dx.doi.org/10.1007/s004210000294.

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Yildiz, Necmettin, Nilufer Kutay Ordu Gokkaya, Fusun Koseoglu, Serkan Gokkaya i Didem Comert. "Efficacies of papaverine and sildenafil in the treatment of erectile dysfunction in early-stage paraplegic men". International Journal of Rehabilitation Research 34, nr 1 (marzec 2011): 44–52. http://dx.doi.org/10.1097/mrr.0b013e32833d6cb2.

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Pacy, P. J., R. Hesp, D. A. Halliday, D. Katz, Gillian Cameron i J. Reeve. "Muscle and bone in paraplegic patients, and the effect of functional electrical stimulation". Clinical Science 75, nr 5 (1.11.1988): 481–87. http://dx.doi.org/10.1042/cs0750481.

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1. Four paraplegic men volunteered for an exercise programme in which their paralysed quadriceps muscles were stimulated by means of computer-regulated electrical impulses applied through external electrodes. The first exercise regimen consisted of leg raising against a graded load, and during the second regimen exercise took the form of cycling on a modified bicycle ergometer. Each subject exercised five times weekly for 10 weeks during the first regimen and 32 weeks during the second regimen. 2. Whole-body protein turnover determined by l-[1-13C]leucine during feeding remained constant during both exercise regimens, when expressed either in terms of body weight or fat-free mass derived from measurements of total body potassium. 3. Quadriceps muscle protein synthetic rate increased during the study, from 0.0712 to 0.0985%/h (P < 0.05), as did quadriceps muscle area assessed by computed tomography. 4. Bone mineral content for lumbar vertebrae was normal in all four patients, but for the femoral mid-shaft bone mineral content averaged only 66% of normal for three of the patients. Trabecular bone density in the distal tibia ranged from normal to 2% of normal for the men with the shortest and longest periods of disability, respectively. No changes in bone mineral content or bone density occurred during the exercise period.

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Ribeiro Neto, Frederico, Rodrigo Rodrigues Gomes Costa, Ricardo Tanhoffer, Martim Bottaro i Rodrigo Luiz Carregaro. "Differences of Relative and Absolute Strength of Individuals With Spinal Cord Injury From Able-Bodied Subjects: A Discriminant Analysis". Journal of Sport Rehabilitation 28, nr 7 (1.09.2019): 699–705. http://dx.doi.org/10.1123/jsr.2018-0104.

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Context:Strength training is one of the most common interventions employed to increase functional independence during rehabilitation of individuals with spinal cord injury (SCI). However, in the literature, different results have been reported in terms of strength modifications after a SCI compared with a control group (CG).Objective:This study aimed to verify whether discriminant analysis using relative and absolute strength is able to discriminate individuals with different levels of SCI from a CG and to compare strength values of men with different levels of SCI with a CG.Design:Cross-sectional study.Setting:Rehabilitation hospital setting.Participants:A total of 36 individuals with SCI stratified in tetraplegia (TP; C6–C8), high paraplegia (HP; T1–T6), and low paraplegia (LP; T7–L2), and 12 matched control subjects were enrolled in the study.Main Outcome Measures:The subjects performed a maximum strength test of elbow extension/flexion and also shoulder abduction/adduction and flexion/extension in an isokinetic dynamometer. Discriminant analysis was carried out to identify which strength variables would be able to discriminate the TP, HP, or LP groups from the CG. A 1-way analysis of variance was performed to compare peak torque and agonist/antagonist ratio means.Results:Shoulder adduction, followed by elbow extension peak torque, was the best variable for discriminating the TP group from the CG (function coefficients: −0.056 and 0.051, respectively, Wilks Λ = 0.41,P ≤ .05). There were no significant differences between the HP group, LP group, and CG.Conclusions:The strength similarity of the paraplegic groups and the CG should not be extrapolated for activities of daily living or sports. The TP group demonstrated lower peak torque for all movements than the CG.

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Schneider, Donald A., Darlene A. Sedlock, Elizabeth Gass i Greg Gass. "V˙O2peak and the gas-exchange anaerobic threshold during incremental arm cranking in able-bodied and paraplegic men". European Journal of Applied Physiology and Occupational Physiology 80, nr 4 (sierpień 1999): 292–97. http://dx.doi.org/10.1007/s004210050595.

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SUBAČIŪTĖ, Jadvyga. "Spinal meningioma surgery: predictive factors of outcome". Acta medica Lituanica 17, nr 3-4 (1.07.2010): 133–36. http://dx.doi.org/10.15388/amed.2010.21686.

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Object. The aim of this report is to evaluate the predictive factors of poor functional outcome in spinal cord meningioma surgery. Materials and methods. One hundred patients with spinal cord meningioma (14 men and 86 women at the age of 13–87) operated in our Neurosurgical Clinic were analyzed. Statistical data analysis evaluated the importance of symptoms, duration and neurological status before surgery and meningioma localization according to the spinal cord axis for the results of surgery. Results. Total tumour removal was achieved in 92 and subtotal in 8 cases. In the early postoperative period, 61% of patients recovered and improved. The results of surgery reliably depended on the duration of symptoms before operation (p = 0.05). The risk of unimprovement prevailed in patients with paraplegia in comparison with other motor deficits. The risk of poor outcome increased with a 95% confidence index when tumour localization was ventral and caudal as compared with the dumbbell, dorsal and epidural localization taken together. Mortality was 3% after the subtotal removal of tumour, and in 3% of cases neoplasma recurred. The mean follow up was 1–22 years. The outcome at the last followup was good in 50% of cases. Conclusions. Functional outcome after surgery reliably dependeds on: 1) the duration of symptoms before hospitalization (with a poor outcome when the duration of illness was more than 3 years); 2) the preoperative neurological condition of patients (a poor prognosis in paraplegic patients); 3) tumour localization with respect to the spinal cord axis (risk of unimprovement when the tumour was of ventral and caudal localization). Keywords: meningioma of spinal cord, surgery, outcome, predictive factors, late prognosis

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Svoboda, Antonin, i Josef Soukup. "Stimulation of nerve endings via medical device". MATEC Web of Conferences 157 (2018): 02049. http://dx.doi.org/10.1051/matecconf/201815702049.

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This solution describes solution of vibromechanism for stimulation nerve paths and nerve endings injured patients. Medical doctors stimulate nerve paths and nerve endings patients after injury of spine or after another injury where was broken nerve endings. These methods are in primary designed for tetraplegic and paraplegic patients specially for men. For this request was developed device and mechanism for vibrostimulation of nerve paths and nerve endings. In develop of construction has been paying attention to safety of mechanism. Next were taken into account the construction of other devices, especially their shortcomings in the operation on the accumulator. For mains powered vibrators 230 (110) Volt were assessed for safety and noise vibrating mechanism. The sum of all failures was proposed structure described below. The success rate of this vibration method is reported mostly between 60-80%.

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Mogharnasi, Mehdi, Hossein TaheriChadorneshin, Seyed Amin Papoli-Baravati i Asma Teymuri. "Effects of upper-body resistance exercise training on serum nesfatin-1 level, insulin resistance, and body composition in obese paraplegic men". Disability and Health Journal 12, nr 1 (styczeń 2019): 29–34. http://dx.doi.org/10.1016/j.dhjo.2018.07.003.

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Tørhaug, Tom, Berit Brurok, Jan Hoff, Jan Helgerud i Gunnar Leivseth. "Arm Crank and Wheelchair Ergometry Produce Similar Peak Oxygen Uptake but Different Work Economy Values in Individuals with Spinal Cord Injury". BioMed Research International 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/5481843.

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Objective.To study whether values for peak oxygen uptake (VO2peak) and work economy (WE) at a standardized workload are different when tested by arm crank ergometry (ACE) and wheelchair ergometry (WCE).Methods.Twelve paraplegic men with spinal cord injury (SCI) in stable neurological condition participated in this cross-sectional repeated-measures study. We determinedVO2peakand peak power output (POpeak) values during ACE and WCE in a work-matched protocol. Work economy was tested at a standardized workload of 30 Watts (W) for both ACE and WCE.Results.There were no significant differences inVO2peak(mL·kg−1·min−1) between ACE (27.3±3.2) and WCE (27.4±3.8) trials, and a Bland-Altman plot shows that findings are within 95% level of agreement. WE or oxygen consumption at 30 W (VO2-30W) was significantly lower during WCE compared to ACE (P<0.039). Mean (95% CI)POpeak(W) were 130 (111–138) and 100 (83–110) during ACE and WCE, respectively.Conclusion.The findings in the present study support the use of both ACE and WCE for testing peak oxygen uptake. However, WE differed between the two test modalities, meaning that less total energy is used to perform external work of 30 W during wheelchair exercise when using this WCE (VP100 Handisport ergometer). Clinical Trials Protocol Record isNCT00987155/4.2007.2271.

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Bassuino, Mauricio Sprenger, Elisa Lettnin Kaminski, Laís Oliveira Garcia, Rafael Linden, Marina Venzon Antunes, Rodolfo Herberto Schneider i Denise Cantarelli Machado. "Factors related to decreased vitamin D levels in men with spinal cord injury living in a subtropical region". Scientia Medica 28, nr 2 (7.02.2018): 28381. http://dx.doi.org/10.15448/1980-6108.2018.2.28381.

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AIMS: To evaluate the levels of vitamin D, parathyroid hormone and calcium in individuals with spinal cord injury and to identify related factors.METHODS: A cross-sectional study included men with spinal cord injury, living in the South Region of Brazil. A questionnaire was applied to evaluate socioeconomic data, life habits and health. The time elapsed since the spinal cord injury was considered. Vitamin D was evaluated in plasma via liquid chromatography; calcium and PTH were measured in serum by a colorimetric method and electrochemiluminescence respectively. For data analysis, linear regression and chi-square test were utilized. Values of p<0.05 were considered significant. RESULTS: The study included 39 paraplegic or tetraplegic men with spinal cord injury. The mean age was 35.52±9.78 years, and the mean time since injury was 6.09±5.55 years. The mean biochemical levels were: 19.0 ±6.98 ng/mL for vitamin D; 9.54±0.52 mg/dL for total calcium; and 34.81±10.84 pg/mL for parathyroid hormone. Individuals with sun exposure for more than two hours daily had higher vitamin D levels than those exposed up to one hour per day (p=0.001). Linear regression identified an inverse relationship between lesion time and vitamin D levels (regression coefficient: -0.424; p=0.029), while the other parameters did not show significant differences regarding the time elapsed since the lesion. Subjects with income above four minimum wages had higher vitamin D values (mean 25.67±5.45 ng/mL) when compared to those with income up to four minimum wages (mean 18.43±6.79 ng/mL) (p=0.021). CONCLUSIONS: Levels of vitamin D were inversely correlated to the time elapsed since the spinal cord injury, probably due to insufficient sun exposure resulting from prolonged limitation of mobility. In addition, lower levels of vitamin D were associated to lower income. These factors may aggravate bone loss associated with decreased mobility resulting from spinal cord injury.

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Azevedo, ERFBM, KC Alonso i A. Cliquet. "Body composition assessment by bioelectrical impedance analysis and body mass index in individuals with chronic spinal cord injury". Journal of Electrical Bioimpedance 7, nr 1 (8.08.2019): 2–5. http://dx.doi.org/10.5617/jeb.2421.

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Abstract Purpose: To assess body composition and obesity in individuals with spinal cord injury (SCI) who practice and do not practice physical activity using body mass index (BMI) and bioelectrical impedance analysis (BIA). Methods: 39 patients with SCI went through BIA evaluation and BMI was assessed. Patients were divided into four groups according to injury level (paraplegia or tetraplegia) and physical activity achievement (active or inactive). Results: 22 individuals with paraplegia (7 active and 15 inactive) and 17 with tetraplegia (5 active and 12 inactive) were evaluated. BMI, fat percentage, fat mass, lean tissue mass, total body water (TBW), and TBW percentage were assessed in groups. Tetraplegic inactive groups showed higher fat percentage featuring obesity. For paraplegic active group mean fat percentage was 19.61% (±9.27) and mean fat mass was 16.66 kg (±9.71) and for paraplegic inactive group fat percentage was 23.27% (±5.94) and fat mass 18.59 kg (±7.58). For tetraplegic groups in active group the fat percentage was 17.14% (±6.32) and fat mass was 11.22 kg (±5.16) and for inactive group mean fat percentage was 33.68% (±4.74) and fat mass was 25.59 kg (±2.91). When paraplegic and tetraplegic inactive groups were compared differences were observed in fat percentage (p = 0.0003) and fat mass (p = 0.0084). Also, when tetraplegic groups (activeXinactive) were compared differences in percentage (p = 0.0019) and fat mass (p = 0.034) were observed. Only for the paraplegic inactive group BMI result was higher than 25 kg/m2. Conclusion: BMI does not discriminate between obesity levels in individuals with SCI and physical activity can improve body composition and prevent obesity in SCI patients.

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Mudzi, W., A. Steward i C. Eales. "Spinal cord injured patients’ knowledge of pressure sores". South African Journal of Physiotherapy 57, nr 4 (30.11.2001): 9–13. http://dx.doi.org/10.4102/sajp.v57i4.516.

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Despite much effort being put into educating spinal cord injured patients on pressure sore prevention, pressure sores remain a major cause of morbidity and mortality. This study sought to establish: i) paraplegics’ knowledge on pressure sore prevention prior to discharge; ii) the influence of knowledge on pressure sore occurrence during hospitalization; iii) sources of paraplegics’ knowledge on pressure sore prevention. A total of twenty-six men and two women with paraplegia aged between 18 and 45 years participated in the study. A rospective pre-test post-test method using a structured questionnaire was used to test paraplegics’ knowledge on pressure sore prevention. The first interview was done within one week of mobilising in a wheelchair and the second one after two months or a few days before discharge. Pressure sore occurrence and the source of knowledge were also recorded. The results showed that paraplegics’ knowledge on pressure sore prevention at discharge is incomplete. Knowledge gain does not seem to determine whether one will develop pressure sores or not. Physiotherapists (89%), nurses (82%) and occupational therapists (68%) are the main educators of paraplegics on pressure sore prevention in rehabilitation hospitals.

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Caco, Gentian, Dhurata Golemi i Eriola Likaj. "Straight configuration saphenous vein transposition to popliteal artery for vascular access". Journal of Vascular Access 18, nr 2 (marzec 2017): e15-e17. http://dx.doi.org/10.5301/jva.5000608.

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Introduction The saphenous vein is commonly used as a vascular graft in peripheral artery surgery but rarely used for vascular access. The literature on straight configuration saphenous vein transposition to the popliteal artery is scarce. Here we present two cases of straight configuration saphenous vein transposition to the popliteal artery for vascular access, the surgical technique and respective follow-up. Case report Two young men, aged 29 and 36 years, were chosen for lower-limb vascular access for hemodialysis. The first patient was paraplegic since birth. He used his arms to move so upper extremity vascular access was avoided. The second patient presented with an infected upper extremity arteriovenous graft (AVG) and after multiple closed AVFs he had no more available arm veins. Both patients received autologous lower extremity straight configuration saphenous vein transpositions to the popliteal artery under spinal anesthesia in May and October 2012, respectively. Cannulation of the fistula was allowed after one month. There were no early complications. Slight swelling on the leg appeared in one of the patients. Both fistulas were still functional after 36 and 32 months, respectively. Conclusions The straight configuration saphenous vein transposition to popliteal artery is simple to perform, offers a long and straight segment for cannulation and may be a suitable autologous vascular access in selected patients.

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Zehnder, Yvonne, Markus L�thi, Dieter Michel, Hans Knecht, Romain Perrelet, Isolde Neto, Marius Kraenzlin, Guido Z�ch i Kurt Lippuner. "Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men". Osteoporosis International 15, nr 3 (1.03.2004): 180–89. http://dx.doi.org/10.1007/s00198-003-1529-6.

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GFÖHLER, MARGIT, THOMAS ANGELI i PETER LUGNER. "MODELING OF ARTIFICIALLY ACTIVATED MUSCLE AND APPLICATION TO FES CYCLING". Journal of Mechanics in Medicine and Biology 04, nr 01 (marzec 2004): 77–92. http://dx.doi.org/10.1142/s0219519404000850.

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Functional Electrical Stimulation (FES) enables paraplegics to move their paralyzed limbs; the skeletal muscles are artificially activated. The purpose of this study is to establish a mechanical muscle model for an artificially activated muscle, based on a Hill-type muscle model. In comparison to modeling a physiologically activated muscle, for the artificially activated muscle, a number of additional parameters and their influence on the force generation has to be considered. The model was implemented into a forward dynamic simulation of paraplegic cycling. The stimulation patterns were optimized for surface stimulation of gluteus maximus, quadriceps, hamstrings, and peronaeus reflex. A simulation of a startup with 50% of maximum activation in the optimized stimulation intervals analyses drive torques and mean power per cycle and the resulting riding performance of the rider-cycle system. For validation of the simulation, the results were compared to measurements of the forces applied to the crank during steady-state cycling of a paraplegic test person.

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Studsgaard Slot, Sofie Dagmar, Simon Mark Dahl Baunwall, Anton Emmanuel, Peter Christensen i Klaus Krogh. "The Monitoring Efficacy of Neurogenic Bowel Dysfunction Treatment on Response (MENTOR) in a Non-Hospital Setting". Journal of Clinical Medicine 10, nr 2 (12.01.2021): 263. http://dx.doi.org/10.3390/jcm10020263.

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Background: Most patients with a spinal cord injury (SCI) suffer from neurogenic bowel dysfunction (NBD). In spite of well-established treatment algorithms, NBD is often insufficiently managed. The Monitoring Efficacy of Neurogenic bowel dysfunction Treatment On Response (MENTOR) has been validated in a hospital setting as a tool to support clinical decision making in individual patients. The objective of the present study was to describe clinical decisions recommended by the MENTOR (either “monitor”, “discuss” or “act”) and the use of the tool to monitor NBD in a non-hospital setting. Methods: A questionnaire describing background data, the MENTOR, ability to work and participation in various social activities was sent by mail to all members of The Danish Paraplegic Association. Results: Among 1316 members, 716 (54%) responded, 429 men (61%) and 278 women (39%), aged 18 to 92 (median 61) years. Based on MENTOR, the recommended clinical decision is to monitor treatment of NBD in 281 (44%), discuss change in treatment in 175 (27%) and act/change treatment in 181 (28%). A recommendation to discuss or change treatment was associated with increasing age of the respondent (p = 0.016) and with impaired ability to work or participate in social activities (p < 0.0001). Conclusion: A surprisingly high proportion of persons with SCI have an unmet need for improved bowel care. The MENTOR holds promise as a tool for evaluation of treatment of NBD in a non-hospital setting.

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Oliveira, José Igor Vasconcelos de, Lúcia Inês Guedes Leite de Oliveira, Manoel da Cunha Costa, Raphael José Perrier-Melo, Mário Antônio de Moura Simim i Saulo Fernandes Melo de Oliveira. "Impacts of home-based physical exercises on the health of people with spinal cord injury: a systematic review". Revista Brasileira de Atividade Física & Saúde 26 (4.05.2021): 1–13. http://dx.doi.org/10.12820/rbafs.26e0192.

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The confinement period caused by the SARS-COV2 pandemic is another barrier to the practice of physical exercise by people with spinal cord injury (SCI). In view of the countless therapies targeted at this public, it is necessary to highlight the benefits of exercises performed at home. Thus, our objective was to determine the main characteristics of physical exercise training modes performed at home and their effects on people with SCI. We searched for intervention studies in five databases (PubMed, ScienceDirect, SPORTDiscus, Scopus and Cochrane CENTRAL) by including the terms and descriptors: “spinal cord injury”, “home-based”, exercise”, “video game”, “home-based physical activity”. The selected studies were described by means of a narrative synthesis. Of 69,843 studies, only 10 met the eligibility criteria, totaling 153 investigated individuals (25 women and 128 men). Regarding the type of injury, 118 participants were paraplegic and 33 tetraplegic. The studies addressed functional electrical stimulation (n = 4), electronic assistive devices (n = 5) and stretching exercises (n = 1). We observed that the focus of the interventions was the morphological, motor neuron, quality of life and functional aspects. The studies showed improvements in muscle strength andmorphology, in the ability to perform daily activities, in quality of life and in functional capacities, with no reported adverse situations. Although our review included a low number of randomized studies, we can conclude that several modes of exercise in the home environment promote benefits for people with SCI and can be options for maintaining or developing the health of this population.

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Kern, Nicole I., Ronald J. Triolo, Rudi Kobetic, Musa Audu i Roger D. Quinn. "A Convertible Spinal Orthosis for Controlled Torso Rigidity". Applied Bionics and Biomechanics 10, nr 1 (2013): 59–73. http://dx.doi.org/10.1155/2013/924247.

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A traditional spinal orthosis in conjunction with a hip-knee-ankle-foot orthosis (HKAFO) improves posture in persons with paraplegia during standing and walking. It also limits the wearer's range of motion when worn during other activities, such as vehicle transfer or sitting and reaching for objects. In order to regain full torso flexibility the user would need to remove the spinal orthosis which can be arduous and time consuming. A Convertible Spinal Orthosis (CSO) that allows the user to switch between Locked rigid torso support and Unlocked free motion has been designed, fabricated and tested. It shows promise for increasing functionality, wear time and subject comfort. Analysis of movement has been performed with an able-bodied and a paraplegic subject wearing a rigid spinal orthosis, the CSO in both states, and without any bracing. Configuration state had the most impact on lateral bending. Mean values for the paraplegic subject of 27°, 38°, 48°, and 48° and for the able-bodied subject of 22°, 26°, 48°, and 45° were found for lateral bending of the upper torso relative to the thighs in theRigid,Locked,Unlocked, andNo-Bracestates, respectively.

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Komachali, Sajad Rafiee, Zakieh Siahpoosh i Mansoor Salehi. "Two novel mutations in ALDH18A1 and SPG11 gene found by whole-exome sequencing in spastic paraplegia disease patients in Iran". Genomics & Informatics 20, nr 3 (30.09.2022): e30. http://dx.doi.org/10.5808/gi.22030.

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Hereditary spastic paraplegia is a not common inherited neurological disorder with heterogeneous clinical expressions. ALDH18A1 (located on 10q24.1) gene-related spastic paraplegias (SPG9A and SPG9B) are rare metabolic disorders caused by dominant and recessive mutations that have been found recently. Autosomal recessive hereditary spastic paraplegia is a common and clinical type of familial spastic paraplegia linked to the SPG11 locus (locates on 15q21.1). There are different symptoms of spastic paraplegia, such as muscle atrophy, moderate MR, short stature, balance problem, and lower limb weakness. Our first proband involves a 45 years old man and our second proband involves a 20 years old woman both are affected by spastic paraplegia disease. Genomic DNA was extracted from the peripheral blood of the patients, their parents, and their siblings using a filter-based methodology and quantified and used for molecular analysis and sequencing. Sequencing libraries were generated using Agilent SureSelect Human All ExonV7 kit, and the qualified libraries are fed into NovaSeq 6000 Illumina sequencers. Sanger sequencing was performed by an ABI prism 3730 sequencer. Here, for the first time, we report two cases, the first one which contains likely pathogenic NM_002860: c.475C>T: p.R159X mutation of the ALDH18A1 and the second one has likely pathogenic NM_001160227.2: c.5454dupA: p.Glu1819Argfs Ter11 mutation of the SPG11 gene and also was identified by the whole-exome sequencing and confirmed by Sanger sequencing. Our aim with this study was to confirm that these two novel variants are direct causes of spastic paraplegia.

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Čichoň, Rostislav, Adam Maszczyk, Petr Stastny, Petr Uhlíř, Miroslav Petr, Ondřej Doubrava, Aleksandra Mostowik, Artur Gołaś, Paweł Cieszczyk i Piotr Żmijewski. "Effects of Krankcycle Training on Performance and Body Composition in Wheelchair Users". Journal of Human Kinetics 48, nr 1 (1.12.2015): 71–78. http://dx.doi.org/10.1515/hukin-2015-0093.

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AbstractInnovation in training equipment is important for increasing training effectiveness, performance and changes in body composition, especially in wheelchair users with paraplegia. The main objective of a workout session is to induce an adaptation stimulus, which requires overload of involved muscles by voluntary effort, yet this overload may be highly influenced by the size of the spinal cord lesion. Krancykl construction is designed to allow exercise on any wheelchair and with adjustable height or width of crank handles, where even the grip handle may be altered. The aim of this study was to determine the differences in body composition, performance and the rate of perceived exertion (RPE) in paraplegics with a different level of paralyses after a 12 week training programme of a unilateral regime on Krankcycle equipment (a crank machine). The study sample included four men and one women at a different spine lesion level. The 12 weeks programme was successfully completed by four participants, while one subject got injured during the intervention process. Three participants were paraplegics and one was quadriplegic with innervation of the biceps humeri, triceps humeri and deltoideus. The Krankcycle 30 min programme was followed by four other exercises, which were performed after themselves rather than in a circuit training manner as the latter would result in much longer rest periods between exercises, because paraplegics have to be fixed by straps during exercise on hydraulic machines. The RPE after the workout decreased following the twelve week adaptation period.

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Costa, Bianca Teixeira, Larissa Amaral Torrecilha, Simone Antunes Paloco, Joice Maria Victoria de Assunção Spricigo, Roger Burgo de Souza i Suhaila Mahmoud Smaili Santos. "Sexual profile and adaptations of men after spinal cord injury". Acta Fisiátrica 21, nr 4 (9.12.2014): 177–82. http://dx.doi.org/10.11606/issn.2317-0190.v21i4a103867.

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Spinal cord injury (SCI) refers to any type of injury to the neural elements of the spinal canal, resulting in countless damages, one of them being the change in patterns of sexual response, conditioned by physical, psychological, and social aspects. Due to these changes, patients need to make adjustments to maintain sexual activity. Objective: To verify the sexual profile and adaptations of men after SCI and to associate the neurofunctional diagnosis with sexual frequency, erection, use and type of adaptation, and the use of adaptation with sexual frequency and sexual satisfaction. Method: Cross-sectional study with 36 men with spinal cord injuries. They were interviewed with the (QSH-LM) questionnaire. Results: The mean age was 36.64 years old with the majority of injuries stemming from traffic accidents, resulting in paraplegia or complete injury. After the SCI, 52.8% of the subjects remained married, 75.5% maintained sexual activity, whereas 44.4% have less than one intercourse/week, 80.6% are sexually satisfied, 50% have erection, 38.9% ejaculation, and 44.4% orgasm. Regarding the use of adaptations to achieve and maintain an erection, 61.1% of the subjects use them, 25.5% because they fail to maintain an erection and 22% have opted for the penis ring. There was a significant association between paraplegics who use adjustments more frequently and prefer the penis ring and patients who use sexual adaptations having greater sexual frequency and being sexually satisfied (p = 0.02). Conclusion: Through this work it is possible to know the sexual profile of patients after SCI and the most used sexual adaptations. These results support the information that might assist healthcare professionals to monitor and guide their patients properly.

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Lanke, Ravindra S., Ulhas J. Dudhekar, Girish B. Mote i Chandrashekhar M. Badole. "Community based rehabilitation by paraplegic - a case report". International Journal of Research in Medical Sciences 5, nr 3 (20.02.2017): 1116. http://dx.doi.org/10.18203/2320-6012.ijrms20170672.

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A journey of a young man started from day one in the hospital. When he came with the traumatic paraplegia, no doubt a paraplegic has to face a lot of challenges in his life when he came to know that his both legs are not working. He became bedridden and his moral is also become down for his future planning. But we accept the challenge, a team work by an orthopaedician and a physio-occupational therapist make it little easier. Postoperatively we prefer to offer rehabilitation through community base programme. Inspiration of hospital environment and equipment are going to help him for such kind of programme he accepts the challenge, basic aim of providing this programme is to reduce duration as well as incurred monitor losses. Special attraction of this case report is homemade bicycle, which served the purpose of providing repetitive rhythmic mobilisation of bilateral lower limbs which facilitates normal pattern of ambulation. Now he is ambulatory and goes back to his work. So, a person with spinal cord injury involved with their community with a little modification in his activity and equipment is worth for him. Traumatic paraplegia offers a big challenge to physio- occupational therapist due to long term recovery it takes. For Such patients on regular follow up till complete recovery, we preferred community based rehabilitation. This made him independent and incurred reduced monitory losses.

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Ohana, Nissim, Daniel Benharroch i Dimitri Sheinis. "Challenge of handling a Charcot spinal arthropathy with a novel hybrid fibular autograft and expandable cage". Journal of Neurosurgery: Spine 29, nr 1 (lipiec 2018): 34–39. http://dx.doi.org/10.3171/2017.10.spine17606.

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A 26-year-old man, who was paraplegic for 6 years due to a motor vehicle accident, presented to the authors’ clinic following his incapacity to withstand a sitting posture, the frequent sensation of “clicks” in his back, and a complaint of back pain while in his wheelchair. On imaging, his dorsal spine showed a complete arthrodesis of the primarily fused vertebrae. However, distal to this segment, a Charcot spinal arthropathy with subluxation of T12–L1 was evident. Repair of this complex, uncommon, late complication of his paraplegia by the frequently used fusion techniques was shown to be inappropriate. A novel and elaborate surgical procedure is presented by which a complete fusion of the affected spine was secured. A left retrodiaphragmatic approach was used. Complete corpectomy of both the T-12 and L-1 vertebrae to the preserved endplates was performed. Most of the patient’s fibula was resected and shaped for engrafting. The segment of the fibula was introduced into a mesh cage, before its intramedullary implantation into the T-12 and L-1 vertebrae. This 2-step procedure combined the hybrid use of a fibular autograft and an expandable mesh cage, incorporated one into the other, in an innovative intramedullary position. This intervention allowed the patient to resume his former condition as an extremely physically active patient with paraplegia. Nine years later, an asymptomatic early-stage Charcot spine was found at L5–S1, but no treatment is planned at this point.

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Chaudhary, Vandana, Narsingh Verma, Sunita Tiwari, R. N. Srivastava i Dileep Verma. "Study of 24 Hours/2 day Monitoring of Blood Pressure in Subjects with Traumatic Paraplegia". European Journal of Medical and Health Sciences 3, nr 4 (14.07.2021): 53–58. http://dx.doi.org/10.24018/ejmed.2021.3.4.837.

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Cardiovascular dysfunction and cognitive decline are more common in traumatic spinal cord injury (SCI). Most people with a cervical or upper-thoracic SCI usually experience conditions called orthostatic hypotension and autonomic dysreflexia, which are described by the serious changes in systemic blood pressure. To evaluate baseline heart rate (HR), baseline blood pressure (BP) and ABPM monitoring in traumatic paraplegia patients. In this study, total 36 diagnosed of paraplegia patients was based on Asia Impairment Scale (AIS), paralysed by RTA, or fall from height within 7 days of injury were included in this study. The blood pressure was monitoring for 24 hour/2 day and repeated after 12th day of first monitoring. Ambulatory blood pressure was monitored by ABPM machine at HALF hourly from 6 am – 10 pm and one hourly from 10 pm – 6 am. All the continuous variables were compared by t- test. The night dipping (Systole) and morning surge (Systole) were significantly lower at 12th days as compared to within 7 Days (p=0.002). Whereas the diurnal Index (Diastole) and diurnal Index (MAP) were comparable in between within 7 days and 12th days. The mean SBP max and SBP min were significantly lower at 12th day as compared to within 7 days. Whereas DBP max and min were comparable in between within 7 days and at 12th days. The changes in min., max and mean double product (All, active periods, and passive periods) were also not found to be statistically significant in between within 7 days and at 12th day. The traumatic paraplegic patients have altered diurnal index, morning surge, night dipping and systolic blood pressure on APBM monitoring.

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Servelhere, Katiane R., Ingrid Faber, Ana Carolina Coan i Marcondes França Junior. "Translation and validation into Brazilian Portuguese of the Spastic Paraplegia Rating Scale (SPRS)". Arquivos de Neuro-Psiquiatria 74, nr 6 (czerwiec 2016): 489–94. http://dx.doi.org/10.1590/0004-282x20160047.

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ABSTRACT Hereditary spastic paraplegias (HSP) are characterized by progressive lower limb weakness and spasticity. There are no validated instruments to quantify disease severity in Portuguese. Objective To translate and validate the Spastic Paraplegia Rating Scale (SPRS) into Brazilian-Portuguese. Method Two experienced and English-fluent neurologists translated SPRS into Portuguese, creating SPRS-BR. We then assessed inter and intra-rater reliability of this version using coefficients of correlation and variability in a cohort of 30 patients. Results Mean age of patients and disease duration were 47.7 ± 10.5 and 17.0 ± 10.6 years, respectively. Twenty-one had pure HSP and SPG4 was the most frequent genotype. Mean Rankin and SPRS-BR scores were 2.2 ± 0.9 and 19.9 ± 9.9, respectively. Mean intra and inter-rater correlation coefficients of SPRS-BR scores were 0.951 and 0.934, whereas coefficients of variation were 11.5% (inter-rater) and 9.9% (intra-rater). Cronbach’s alpha for the whole SPRS-BR scale was 0.873. Conclusion SPRS-BR is a useful, reliable and valid clinical instrument.

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Tan, Timothy Shao Ern, i Saad Ahmad. "Acute dyspnoea in a paraplegic man". British Journal of Hospital Medicine 78, nr 3 (2.03.2017): 173. http://dx.doi.org/10.12968/hmed.2017.78.3.173.

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Liang, Huey-Wen, Yen-Ho Wang, Shin-Liang Pan, Tyng-Guey Wang i Tien-Shang Huang. "Asymptomatic Median Mononeuropathy Among Men With Chronic Paraplegia". Archives of Physical Medicine and Rehabilitation 88, nr 9 (wrzesień 2007): 1193–97. http://dx.doi.org/10.1016/j.apmr.2007.05.018.

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Blanes, Leila, Lana Lourenço, Maria Isabel Sampaio Carmagnani i Lydia Masako Ferreira. "Clinical and socio-demographic characteristics of persons with traumatic paraplegia living in São Paulo, Brazil". Arquivos de Neuro-Psiquiatria 67, nr 2b (czerwiec 2009): 388–90. http://dx.doi.org/10.1590/s0004-282x2009000300003.

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OBJECTIVE: To evaluate the clinical profile of individuals with paraplegia living in São Paulo, Brazil. METHOD: The sample consisted of 60 outpatients with traumatic paraplegia from whom clinical and demographic data were obtained. RESULTS: The patients were predominately men (86.7%), single (61.7%), with mean age of 32.9 (SD=9.47) years, and complete or incomplete primary education (63.3%). Although 41.7% were born in different states, all patients were current residents of São Paulo, Brazil. The most frequent cause of paraplegia was firearm injury (63.3%) followed by car accident (20%). The most common complications observed in the patients were urinary (88.3%) and anal (45%) incontinence, muscle spasm (65%), and pressure ulcers (26.7%). CONCLUSION: The data revealed that the sample consisted predominantly of young males with low education level, showing complications due to SCI, and who were victims of urban violence.

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Jandial, Rahul, Brandon Kelly i Mike Yue Chen. "Posterior-only approach for lumbar vertebral column resection and expandable cage reconstruction for spinal metastases". Journal of Neurosurgery: Spine 19, nr 1 (lipiec 2013): 27–33. http://dx.doi.org/10.3171/2013.4.spine12344.

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Object The increasing incidence of spinal metastasis, a result of improved systemic therapies for cancer, has spurred a search for an alternative method for the surgical treatment of lumbar metastases. The authors report a single-stage posterior-only approach for resecting any pathological lumbar vertebral segment and reconstructing with a medium to large expandable cage while preserving all neurological structures. Methods The authors conducted a retrospective consecutive case review of 11 patients (5 women, 6 men) with spinal metastases treated at 1 institution with single-stage posterior-only vertebral column resection and reconstruction with an expandable cage and pedicle screw fixation. For all patients, the indications for operative intervention were spinal cord compression, cauda equina compression, and/or spinal instability. Neurological status was classified according to the American Spinal Injury Association impairment scale, and functional outcomes were analyzed by using a visual analog scale for pain. Results For all patients, a circumferential vertebral column resection was achieved, and full decompression was performed with a posterior-only approach. Each cage was augmented by posterior pedicle screw fixation extending 2 levels above and below the resected level. No patient required a separate anterior procedure. Average estimated blood loss and duration of each surgery were 1618 ml (range 900–4000 ml) and 6.6 hours (range 4.5–9 hours), respectively. The mean follow-up time was 14 months (range 10–24 months). The median survival time after surgery was 17.7 months. Delayed hardware failure occurred for 1 patient. Preoperatively, 2 patients had intractable pain with intact lower-extremity strength and 8 patients had severe intractable pain, lower-extremity paresis, and were unable to walk; 4 of whom regained the ability to walk after surgery. Two patients who were paraplegic before decompression recovered substantial function but remained wheelchair bound, and 2 patients remained paraparetic after the surgery. No patients had lasting intraoperative neuromonitoring changes, and none died. Complications included 2 reoperations, 1 delayed hardware failure (cage subsidence that did not require revision), and 3 incidental durotomies (none of which required reoperation). No postoperative pneumonia, ileus, or deep venous thrombosis developed in any patient. Conclusions A posterior-only approach for vertebral segment resection with preservation of spinal nerve roots is a viable technique that can be used throughout the entire lumbar spine. Extensive mobilization of the nerve roots is of utmost importance and allows for insertion and expansion of medium-sized, in situ expandable cages in the midline. This approach, although technically challenging, might reduce the morbidity associated with an anterior approach.

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DePasse, J. Mason, Roy Ruttiman, Adam E. M. Eltorai, Mark A. Palumbo i Alan H. Daniels. "Assessment of malpractice claims due to spinal epidural abscess". Journal of Neurosurgery: Spine 27, nr 4 (październik 2017): 476–80. http://dx.doi.org/10.3171/2016.12.spine16814.

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OBJECTIVESpinal epidural abscesses (SEAs) can be difficult to diagnose and may result in neurological compromise or even death. Delays in diagnosis or treatment may worsen the prognosis. While SEA presents a high risk for litigation, little is known about the medicolegal ramifications of this condition. An enhanced understanding of potential legal implications is important for practicing spine surgeons, emergency medicine physicians, and internists.METHODSThe VerdictSearch database, a large legal-claims database, was queried for “epidural abscess”–related legal cases. Demographic and clinical data were examined for all claims; any irrelevant cases or cases with incomplete information were excluded. The effects of age of the plaintiff, sex of the plaintiff, presence of a known infection, resulting paraplegia or quadriplegia, delay in diagnosis, and delay in treatment on the proportion of plaintiff rulings and size of payments were assessed.RESULTSIn total, 56 cases met the inclusion criteria. Of the 56 cases, 17 (30.4%) were settled, 22 (39.3%) resulted in a defendant ruling, and 17 (30.4%) resulted in a plaintiff ruling. The mean award for plaintiff rulings was $5,277,468 ± $6,348,462 (range $185,000–$19,792,000), which was significantly larger than the mean award for cases that were settled out of court, $1,914,265 ± $1,313,322 (range $100,000–$4,500,000) (p < 0.05). The mean age of the plaintiffs was 47.0 ± 14.4 years; 23 (41.1%) of the plaintiffs were female and 33 (58.9%) were male. The proportion of plaintiff verdicts and size of monetary awards were not affected by age or sex (p > 0.49). The presence of a previously known infection was also not associated with the proportion of plaintiff verdicts or indemnity payments (p > 0.29). In contrast, juries were more likely to rule in favor of plaintiffs who became paraplegic or quadriplegic (p = 0.03) compared with plaintiffs who suffered pain or isolated weakness. Monetary awards for paraplegic or quadriplegic patients were also significantly higher (p = 0.003). Plaintiffs were more likely to win if there was a delay in diagnosis (p = 0.04) or delay in treatment (p = 0.006), although there was no difference in monetary awards (p > 0.57). Internists were the most commonly sued physician (named in 13 suits [23.2%]), followed by emergency medicine physicians (named in 8 [14.3%]), and orthopedic surgeons (named in 3 [5.4%]).CONCLUSIONSThis investigation is the largest examination of legal claims due to spinal epidural abscess to date. The proportion of plaintiff verdicts was significantly higher in cases in which the patient became paraplegic or quadriplegic and in cases in which there was delay in diagnosis or treatment. Additionally, paralysis is linked to large sums awarded to the plaintiff. Nonsurgeon physicians, who are often responsible for initial diagnosis, were more likely to be sued than were surgeons.

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Huang, Kai, i Yansheng Zhu. "Successful management of rhabdomyolysis with acute infection resulting from chronic sacrococcygeal pressure ulcers in a paraplegic patient: a case report". Journal of International Medical Research 49, nr 9 (wrzesień 2021): 030006052110398. http://dx.doi.org/10.1177/03000605211039820.

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Rhabdomyolysis, a potentially life-threatening syndrome, is caused by the breakdown of skeletal muscle cells and leakage of intramyocellular contents into the bloodstream. The treatment of rhabdomyolysis resulting from chronic sacrococcygeal pressure ulcers has been rarely reported. A 62-year-old man developed a high fever and dark-colored urine. For the past 30 years, he had lived with paraplegia, which led to his immobility. Physical examination showed evidence of repeated dehiscence and exudation of the wound on his sacrococcygeal region with loss of skin sensation. Upon corroboration of the physical examination findings and laboratory test results, the patient was diagnosed with rhabdomyolysis with an acute infection resulting from sacrococcygeal pressure ulcers. We first debrided the necrotic tissue and then repaired the chronic ulcer. The wound dressing was changed frequently, and antimicrobial therapy and nutritional support were included in the treatment. The fever and dark-colored urine gradually resolved postoperatively. The patient’s renal function also improved according to the typical laboratory indicators, and the size of the pressure ulcers decreased to some extent. The patient was discharged after 1 month of hospitalization. This case highlights that accurate diagnosis is critical for administration of precise treatment to paraplegic patients with progressive rhabdomyolysis.

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Kucher, Klaus, Donald Johns, Doris Maier, Rainer Abel, Andreas Badke, Hagen Baron, Roland Thietje i in. "First-in-Man Intrathecal Application of Neurite Growth-Promoting Anti-Nogo-A Antibodies in Acute Spinal Cord Injury". Neurorehabilitation and Neural Repair 32, nr 6-7 (czerwiec 2018): 578–89. http://dx.doi.org/10.1177/1545968318776371.

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Background. Neutralization of central nervous system neurite growth inhibitory factors, for example, Nogo-A, is a promising approach to improving recovery following spinal cord injury (SCI). In animal SCI models, intrathecal delivery of anti-Nogo-A antibodies promoted regenerative neurite growth and functional recovery. Objective. This first-in-man study assessed the feasibility, safety, tolerability, pharmacokinetics, and preliminary efficacy of the human anti-Nogo-A antibody ATI355 following intrathecal administration in patients with acute, complete traumatic paraplegia and tetraplegia. Methods. Patients (N = 52) started treatment 4 to 60 days postinjury. Four consecutive dose-escalation cohorts received 5 to 30 mg/2.5 mL/day continuous intrathecal ATI355 infusion over 24 hours to 28 days. Following pharmacokinetic evaluation, 2 further cohorts received a bolus regimen (6 intrathecal injections of 22.5 and 45 mg/3 mL, respectively, over 4 weeks). Results. ATI355 was well tolerated up to 1-year follow-up. All patients experienced ≥1 adverse events (AEs). The 581 reported AEs were mostly mild and to be expected following acute SCI. Fifteen patients reported 16 serious AEs, none related to ATI355; one bacterial meningitis case was considered related to intrathecal administration. ATI355 serum levels showed dose-dependency, and intersubject cerebrospinal fluid levels were highly variable after infusion and bolus injection. In 1 paraplegic patient, motor scores improved by 8 points. In tetraplegic patients, mean total motor scores increased, with 3/19 gaining >10 points, and 1/19 27 points at Week 48. Conversion from complete to incomplete SCI occurred in 7/19 patients with tetraplegia. Conclusions. ATI335 was well tolerated in humans; efficacy trials using intrathecal antibody administration may be considered in acute SCI.

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Grasmücke, Dennis, Amrei Zieriacks, Oliver Jansen, Christian Fisahn, Matthias Sczesny-Kaiser, Martin Wessling, Renate C. Meindl, Thomas A. Schildhauer i Mirko Aach. "Against the odds: what to expect in rehabilitation of chronic spinal cord injury with a neurologically controlled Hybrid Assistive Limb exoskeleton. A subgroup analysis of 55 patients according to age and lesion level". Neurosurgical Focus 42, nr 5 (maj 2017): E15. http://dx.doi.org/10.3171/2017.2.focus171.

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ObjectiveAge and lesion level are believed to represent outcome predictors in rehabilitation of patients with chronic spinal cord injury (SCI). The Hybrid Assistive Limb (HAL) exoskeleton enables patients to perform a voluntary controlled gait pattern via an electromyography-triggered neuromuscular feedback system, and has been introduced as a temporary gait training tool in patients with SCI. The aim of this prospective pre- and postintervention study was to examine functional outcomes as a function of age and lesion level in patients with chronic incomplete SCI (iSCI) or chronic complete SCI (cSCI) with zones of partial preservation (ZPP) by using the HAL as a temporary training tool.MethodsFifty-five participants with chronic iSCI or cSCI (mean time since injury 6.85 ± 5.12 years) were classified according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and divided by age (< 50 or ≥ 50 years), independent of lesion level, and also into 4 homogeneous groups according to lesion level. The subgroups were as follows: Subgroup 1, tetraplegic iSCI (n = 13) (C2–8, AIS C [n = 8] and AIS D [n = 5]); Subgroup 2, paraplegic iSCI with spastic motor behavior (n = 15) (T2–12, AIS C [n = 8] and AIS D [n = 7]); Subgroup 3, paraplegic cSCI with complete motor paraplegia and absence of spastic motor behavior (n = 18) (T11–L4 [AIS A], and ZPP from L-3 to S-1); and Subgroup 4, paraplegic iSCI with absence of spastic motor behavior (n = 9) (T12–L3, AIS C [n = 8] and AIS D [n = 1]). The training paradigm consisted of 12 weeks of HAL-assisted treadmill training (5 times/week). Baseline status was documented prior to intervention by using the AIS grade, Walking Index for SCI II (WISCI II) score, the 10-meter walk test (10MWT), and the 6-minute walk test (6MinWT). Training effects were assessed after 6 and 12 weeks of therapy, without HAL assistance.ResultsOverall, a time reduction of 47% in the 10MWT, self-selected speed (10MWTsss) (< 50 years = 56% vs ≥ 50 years = 37%) and an increase of 50% in the 6MinWT were documented. The WISCI II scores showed a mean gain of 1.69 levels. At the end of the study, 24 of 55 patients (43.6%) were less dependent on walking aids. Age had a nonsignificant negative influence on the 10MWTsss. Despite a few nonsignificant subgroup differences, participants improved across all tests. Namely, patients with iSCI who had spastic motor behavior improved to a nonsignificant, lesser extent in the 6MinWT.ConclusionsThe HAL-assisted treadmill training leads to functional improvements in chronic iSCI or cSCI, both in and out of the exoskeleton. An improvement of approximately 50% in the 10MWTsss and in gait endurance (6MinWT) can be expected from such training. The influences of SCI lesion level and age on functional outcome were nonsignificant in the present study. Older age (≥ 50 years) may be associated with smaller improvements in the 10MWTsss. An iSCI in paraplegic patients with spastic motor behavior may be a nonsignificant negative predictor in gait endurance improvements.Clinical trial registration no.: DRKS00010250 (https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_DE.do)

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Beck, Lisa A., Jeffry L. Lamb, Elizabeth J. Atkinson, Lisa-Ann Wuermser i Shreyasee Amin. "Body composition of women and men with complete motor paraplegia". Journal of Spinal Cord Medicine 37, nr 4 (26.11.2013): 359–65. http://dx.doi.org/10.1179/2045772313y.0000000151.

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Manns, Patricia J., Jeffrey A. McCubbin i Daniel P. Williams. "Fitness, Inflammation, and the Metabolic Syndrome in Men With Paraplegia". Archives of Physical Medicine and Rehabilitation 86, nr 6 (czerwiec 2005): 1176–81. http://dx.doi.org/10.1016/j.apmr.2004.11.020.

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Szollar, S. M., E. M. E. Martin, J. G. Parthemore, D. J. Sartoris i L. J. Deftos. "Demineralization in tetraplegic and paraplegic man over time". Spinal Cord 35, nr 4 (kwiecień 1997): 223–28. http://dx.doi.org/10.1038/sj.sc.3100401.

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