Spinal cord injury(SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina whichoccurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic...Spinal cord injury(SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina whichoccurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients' family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary.展开更多
AIM: To evaluate the short and long-term effects of the complex cell therapy of 202 cases of spinal cord injury(SCI).METHODS: The main arm included 202 cases of SCI and the control arm included 20 SCI cases. For the t...AIM: To evaluate the short and long-term effects of the complex cell therapy of 202 cases of spinal cord injury(SCI).METHODS: The main arm included 202 cases of SCI and the control arm included 20 SCI cases. For the therapy the hematopoietic stem cells(HSCs) and progenitor cells(PCs) were mobilized to peripheral blood by 8 subcutaneous injections of granulocyte colonystimulating factor(G-CSF) for 4 d and are harvested at day 5. The cells were administered to the main arm intrathecally every 3 mo for a long term(3-5 years) according to the internal research protocol international medical institute of tissue engineering. Magnetic resonance imaging of the site of injury and urodyna-mic tests were performed every 6 mo. Motor evoked potentials(MEP), somatosensory evoked potentials(SSEP) were evaluated every 3 mo. The patients were evaluated with american spianl injury association(ASIA) index, functional independence measure index, the Medical Research Council Scale, the International Standards for Neurological Classification of Spinal Cord Injury(ISCSCI-92) and specifically developed scales. The function of bladder was evaluated by a specifically developed clinical scale. The long-term clinical outcomes were assessed for the SCI patients who received no less than 20 intrathecal transplantations of HSCs and hematopoietic precursors(HPs).RESULTS: The restoration of neurologic deficit after HSCs and HPs transplantations was proved stable and evident in 57.4% of the cases. In 42.6% cases no neurologic improvement has been observed. In 50% of the cases the motor restoration began after the first transplantation, which is confirmed in average by 9.9 points improvement in neurologic impairment as compared to the baseline(P < 0.05). Repair of the urinary system was observed in 47.7% of the cases. The sensitivity improved from baseline 124.3 points to 138.4 after the first and to 153.5 points after the second transplantations of HSCs and HPs(P < 0.05, between the stages of research). The evaluation with ASIA index demonstrated regress of neurologic symptoms in 23 cases. Motor progress was also assessed with the ISCISCI-92 motor and sensory scores, and the data coincided with those received with the specifically developed scale. The number of the patients with the signs of locomotive repair was 56.9%. No life threatening complications or adverse effects have been observed.CONCLUSION: The method is safe, effective and considerably improves the life quality of SCI patients. The therapy is approved for clinical use as the treatment of choice.展开更多
Objective: To compare the effectiveness of ab-dominal weights and incentive spirometry for improving the strength of diaphragm in tetra-plegics. Setting: Department of Physical Medicine and Rehabilitation, Christian M...Objective: To compare the effectiveness of ab-dominal weights and incentive spirometry for improving the strength of diaphragm in tetra-plegics. Setting: Department of Physical Medicine and Rehabilitation, Christian Medical College, Vel-lore, Tamil Nadu, India. Study Design: Two group comparison study Methods: Seventeen patients who fulfilled the inclusion criteria were assigned into an ABW or INS treatment groups using judgment sampling after obtaining an informed consent. Evaluation of the chest, respiratory status, vital signs and strength of diaphragm were done during initial assessment. ABW group underwent diaphrag-matic strengthening using Abdominal weights (ABW) and INT group with Incentive Spirometer (INS) for 15 minutes daily, 6 days a week, for a period of 6 weeks. The pre and post training values of peak amplitude in electro myogram (EMG) of the diaphragm, intercostals and ster-nocleidomastoid muscles were measured. Statistical analysis: The analysis was done using SPSS 11. The pre and post-training values of peak EMG amplitudes of the diaphragm, inter- costals and sternocleidomastoid were com- pared within the groups using Wilicoxon’s sign test and between the two groups using Mann- Whitney’s test. Results: The peak EMG of diaphragm of ABW group raised from 1.1289 to 1.3036 milli-volts with a significance of p&lt;0.001, whereas it fell from 1.7001 to 1.0441 milli-volts among INS group subjects with a significance of p&lt;0.001. Comparison between the 2 groups showed sta-tistically significant improvement in diaphrag-matic strength among the ABW group. Conclusion: The results of this study sug-gests that, in the pulmonary rehabilitation of motor complete tetraplegic subjects abdominal weighted training of the diaphragm has better results in improving the strength of the muscle.Sponsorship: Fluid research grant of Christian Medical College, Vellore.展开更多
Objective: Abdominal weights was used to strengthen the diaphragm of a C6 ASIA (A) tetraplegic subject with the aim of studying the long term effect of the technique as a part of respiratory rehabilitation. Setting: D...Objective: Abdominal weights was used to strengthen the diaphragm of a C6 ASIA (A) tetraplegic subject with the aim of studying the long term effect of the technique as a part of respiratory rehabilitation. Setting: Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India. Study Design: Prospective case study. Material and methods: The peak EMG amplitude of the diaphragm (DIA), intercostals (INT) and sternoclidomastiod (SCM) were assessed using a surface EMG and inspired lung volume (ILV) was assessed using an adjustable portable spirometer. The measurements were repeated after 3, 6, 9 and 12 months of inspiratory muscle training for a period of 15 minutes daily, 6 days a week for 12 months. Results and discussion: Peak amplitudes recorded by the EMG of DIA and SCM muscles showed a progressive increase, INT muscle did not show a consistent change. INV showed a gradual rise from 1772ml to 2760 ml over the study period. These values have the following significance: 1) Use of abdominal weights as a part of respiratory rehabilitation has beneficial long term effects;2) In patients with tetraplegia, respiratory muscles in particular the diaphragm, are trainable in terms of muscle efficiency;3) The improvement in the muscle efficiency obtained during the early rehabilitation can be maintained or improved using simple non sophisticated exercises like abdominal weights post discharge. Conclusions: Abdominal weights can be used as an effective adjunct to pulmonary rehabilitation in improving the efficiency of diaphragm on a long term basis, thereby reducing the risks associated with pulmonary complications.展开更多
文摘Spinal cord injury(SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina whichoccurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients' family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary.
文摘AIM: To evaluate the short and long-term effects of the complex cell therapy of 202 cases of spinal cord injury(SCI).METHODS: The main arm included 202 cases of SCI and the control arm included 20 SCI cases. For the therapy the hematopoietic stem cells(HSCs) and progenitor cells(PCs) were mobilized to peripheral blood by 8 subcutaneous injections of granulocyte colonystimulating factor(G-CSF) for 4 d and are harvested at day 5. The cells were administered to the main arm intrathecally every 3 mo for a long term(3-5 years) according to the internal research protocol international medical institute of tissue engineering. Magnetic resonance imaging of the site of injury and urodyna-mic tests were performed every 6 mo. Motor evoked potentials(MEP), somatosensory evoked potentials(SSEP) were evaluated every 3 mo. The patients were evaluated with american spianl injury association(ASIA) index, functional independence measure index, the Medical Research Council Scale, the International Standards for Neurological Classification of Spinal Cord Injury(ISCSCI-92) and specifically developed scales. The function of bladder was evaluated by a specifically developed clinical scale. The long-term clinical outcomes were assessed for the SCI patients who received no less than 20 intrathecal transplantations of HSCs and hematopoietic precursors(HPs).RESULTS: The restoration of neurologic deficit after HSCs and HPs transplantations was proved stable and evident in 57.4% of the cases. In 42.6% cases no neurologic improvement has been observed. In 50% of the cases the motor restoration began after the first transplantation, which is confirmed in average by 9.9 points improvement in neurologic impairment as compared to the baseline(P < 0.05). Repair of the urinary system was observed in 47.7% of the cases. The sensitivity improved from baseline 124.3 points to 138.4 after the first and to 153.5 points after the second transplantations of HSCs and HPs(P < 0.05, between the stages of research). The evaluation with ASIA index demonstrated regress of neurologic symptoms in 23 cases. Motor progress was also assessed with the ISCISCI-92 motor and sensory scores, and the data coincided with those received with the specifically developed scale. The number of the patients with the signs of locomotive repair was 56.9%. No life threatening complications or adverse effects have been observed.CONCLUSION: The method is safe, effective and considerably improves the life quality of SCI patients. The therapy is approved for clinical use as the treatment of choice.
文摘Objective: To compare the effectiveness of ab-dominal weights and incentive spirometry for improving the strength of diaphragm in tetra-plegics. Setting: Department of Physical Medicine and Rehabilitation, Christian Medical College, Vel-lore, Tamil Nadu, India. Study Design: Two group comparison study Methods: Seventeen patients who fulfilled the inclusion criteria were assigned into an ABW or INS treatment groups using judgment sampling after obtaining an informed consent. Evaluation of the chest, respiratory status, vital signs and strength of diaphragm were done during initial assessment. ABW group underwent diaphrag-matic strengthening using Abdominal weights (ABW) and INT group with Incentive Spirometer (INS) for 15 minutes daily, 6 days a week, for a period of 6 weeks. The pre and post training values of peak amplitude in electro myogram (EMG) of the diaphragm, intercostals and ster-nocleidomastoid muscles were measured. Statistical analysis: The analysis was done using SPSS 11. The pre and post-training values of peak EMG amplitudes of the diaphragm, inter- costals and sternocleidomastoid were com- pared within the groups using Wilicoxon’s sign test and between the two groups using Mann- Whitney’s test. Results: The peak EMG of diaphragm of ABW group raised from 1.1289 to 1.3036 milli-volts with a significance of p&lt;0.001, whereas it fell from 1.7001 to 1.0441 milli-volts among INS group subjects with a significance of p&lt;0.001. Comparison between the 2 groups showed sta-tistically significant improvement in diaphrag-matic strength among the ABW group. Conclusion: The results of this study sug-gests that, in the pulmonary rehabilitation of motor complete tetraplegic subjects abdominal weighted training of the diaphragm has better results in improving the strength of the muscle.Sponsorship: Fluid research grant of Christian Medical College, Vellore.
文摘Objective: Abdominal weights was used to strengthen the diaphragm of a C6 ASIA (A) tetraplegic subject with the aim of studying the long term effect of the technique as a part of respiratory rehabilitation. Setting: Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India. Study Design: Prospective case study. Material and methods: The peak EMG amplitude of the diaphragm (DIA), intercostals (INT) and sternoclidomastiod (SCM) were assessed using a surface EMG and inspired lung volume (ILV) was assessed using an adjustable portable spirometer. The measurements were repeated after 3, 6, 9 and 12 months of inspiratory muscle training for a period of 15 minutes daily, 6 days a week for 12 months. Results and discussion: Peak amplitudes recorded by the EMG of DIA and SCM muscles showed a progressive increase, INT muscle did not show a consistent change. INV showed a gradual rise from 1772ml to 2760 ml over the study period. These values have the following significance: 1) Use of abdominal weights as a part of respiratory rehabilitation has beneficial long term effects;2) In patients with tetraplegia, respiratory muscles in particular the diaphragm, are trainable in terms of muscle efficiency;3) The improvement in the muscle efficiency obtained during the early rehabilitation can be maintained or improved using simple non sophisticated exercises like abdominal weights post discharge. Conclusions: Abdominal weights can be used as an effective adjunct to pulmonary rehabilitation in improving the efficiency of diaphragm on a long term basis, thereby reducing the risks associated with pulmonary complications.
