Rehabilitation and Therapy Commons^™

Targeting Mitoneet With Pioglitazone For Therapeutic Neuroprotection After Spinal Cord Injury, Alexander G. Rabchevsky, Samir P. Patel, Patrick G. Sullivan

Spinal Cord and Brain Injury Research Center Faculty Publications

No abstract provided.

A Clinical Practice Guideline For The Management Of Patients With Acute Spinal Cord Injury: Recommendations On The Use Of Methylprednisolone Sodium Succinate, Michael G. Fehlings, Jefferson R. Wilson, Lindsay A. Tetreault, Bizhan Aarabi, Paul A. Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory W. Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark R. Kotter, Shekar N. Kurpad, Brian Kwon, Ralph J. Marino, Allan R. Martin, Eric M. Massicotte, Geno J. Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Andrea C. Skelly, Anoushka Singh, Eve Tsai, Alexander R. Vaccaro, Albert Yee, James S. Harrop

Department of Rehabilitation Medicine Faculty Papers

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: The main conclusions …

Efficacy And Safety Of Methylprednisolone Sodium Succinate In Acute Spinal Cord Injury: A Systematic Review, Michael G. Fehlings, Jefferson R. Wilson, James S. Harrop, Brian Kwon, Lindsay A. Tetreault, Paul M. Arnold, Jeffrey M. Singh, Gregory W.J. Hawryluk, Joseph R. Dettori

Department of Neurosurgery Faculty Papers

Study Design: Systematic review and meta-analysis. Objective: The objective of this study was to conduct a systematic review to assess the comparative effectiveness and safety of high-dose methylprednisolone sodium succinate (MPSS) versus no pharmacological treatment in patients with traumatic spinal cord injury (SCI). Methods: A systematic search was performed in PubMed and the Cochrane Collaboration Library for literature published between January 1956 and June 17, 2015. Included studies were critically appraised, and Grades of Recommendation Assessment, Development and Evaluation methods were used to determine the overall quality of evidence for primary outcomes. Previous systematic reviews on this topic were collated …

A Clinical Practice Guideline For The Management Of Acute Spinal Cord Injury: Introduction, Rationale, And Scope, Michael G. Fehlings, Lindsay A. Tetreault, Jefferson R. Wilson, Brian K. Kwon, Anthony S. Burns, Allan R. Martin, Gregory Hawryluk, James S. Harrop

Department of Neurosurgery Faculty Papers

Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient’s physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of …

A Clinical Practice Guideline For The Management Of Patients With Acute Spinal Cord Injury: Recommendations On The Type And Timing Of Rehabilitation, Michael G. Fehlings, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, James Harrop, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno J. Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander R. Vaccaro, Jefferson R. Wilson, Albert Yee, Anthony S. Burns

Department of Neurosurgery Faculty Papers

Introduction: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest. Results: Based on …

Rehabilitation Services, Self-Advocacy And Psychosocial Adaptation As Determinants Of Employment Among Persons With Spinal Cord Injury, Veronica I. Umeasiegbu, Malachy L. Bishop

School of Rehabilitation Services & Counseling Faculty Publications

Objectives: The purpose of this study was to investigate the factors that determine employment in adults with Spinal Cord Injury (SCI).

Methods: Participants were community-dwelling adults with SCI from three states of the United States. Participants included 101 adults who have lived with SCI for at least one year before the onset of the study. Cross-sectional design through the use of questionnaire was used in this research. Participants were recruited through purposive sampling. Descriptive analysis, correlation analysis, regression analysis, and path analysis were used to analysis the study data.

Results: The results of this study suggest that age, education, and …

Evaluating Cardiovascular Dysfunction During Increased Activity And Exercise Rehabilitation Following Incomplete Thoracic Spinal Cord Injury In The Adult Rat., Kathryn A. Harman

Electronic Theses and Dissertations

Spinal cord injury (SCI) results in whole-body dysfunction. While the majority of SCI research is focused on improving locomotor function after injury, cardiovascular (CV) disease continues to be the leading cause of morbidity in the chronic SCI patient population. The combination of injury-induced destruction of autonomic pathways, maladaptive plasticity within lumbosacral circuits, and the progressive decline in physical fitness contribute to the poor CV status of SCI individuals. Currently, there is little emphasis on implementing appropriately-timed acute rehabilitation techniques aimed to curtail maladaptive remodeling and improve CV outcomes. Furthermore, no pre-clinical or clinical studies have investigated the most appropriate time-course …

Specialized Medical Home For Patients With Spinal Cord Injury, Mendel Kupfer Md, Marci Ruediger Pt, Ms, Norah V. Dixon Ma

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Assistive Technology Provision By Occupational Therapists : A Process And Tools For Managing Clients With Spinal Cord Injury, Ikechukwu Anthony Igbo

Occupational Therapy Program Student Theses, Dissertations and Capstones

Occupational therapy focuses on complex dynamic relationships between people, occupations and environments. For clients with spinal cord injuries (SCI), a way of improving the connection between these three aspects is by providing assistive technology (AT). A fundamental issue identified by consumers regarding AT provision was abandonment, which is caused by a mismatch between aspects of the person, the assistive product, and characteristics of the environment. One solution is engaging collaboratively with clients and recognizing individual needs, thereby allowing therapists to meet clients’ occupational expectations and provide clients with increased functional independence. During this capstone project, barriers to AT provision were …

Altered Cerebellar Circuitry Following Thoracic Spinal Cord Injury In Adult Rats, Nishant P. Visavadiya, Joe E. Springer

Physical Medicine and Rehabilitation Faculty Publications

Cerebellar function is critical for coordinating movement and motor learning. However, events occurring in the cerebellum following spinal cord injury (SCI) have not been investigated in detail. We provide evidence of SCI-induced cerebellar synaptic changes involving a loss of granule cell parallel fiber input to distal regions of the Purkinje cell dendritic tree. This is accompanied by an apparent increase in synaptic contacts to Purkinje cell proximal dendrites, presumably from climbing fibers originating in the inferior olive. We also observed an early stage injury-induced decrease in the levels of cerebellin-1, a synaptic organizing molecule that is critical for establishing and …

A Comprehensive Literature Review Of Secondary Complications Of Spinal Cord Injury, Noel A. Ysasi, Shelby Kerwin, Irmo Marini, Bradley Mcdaniels, Danielle Leigh Antol

School of Rehabilitation Services & Counseling Faculty Publications

Spinal cord injury (SCI) and secondary complications (SCs) that occur as a direct result of the injury can be a contributing factor for increased hospitalization and need for specialized healthcare. For instance, level of injury, time since injury, gender, age, and personal health care have shown to increase and/or decrease the incidence rate of specific SCs. The authors conducted a comprehensive literature review for 12 SCs to examine the relative prevalence of each for people with SCI. The data utilized was to determine the probability (>50%) versus the possibility (

Effect Of Individualized Bladder Rehabilitation Program In Patients With Neurogenic Lower Urinary Tract Dysfunction, A Pilot Study, Peir-Renn Wang, Wei-Che Wang, Sung-Lang Chen, Yu-Hui Huang, Yu-Fen Lai, Hsiu-Chun Yang

Rehabilitation Practice and Science

Objectives: Neurogenic lower urinary tract dysfunction (NLUTD) is one of the major sequelae after spinal cord injury (SCI) and a cause of increased morbidity and mortality in SCI patients. Current treatment strategies for NLUTD include medication, non-invasive conservative management, minimally invasive therapy, and surgical intervention. However, there are no studies regarding non-invasive conservative management that combines pelvic floor muscle (PFM) exercises and electrical stimulation (ES). This study was designed to evaluate the efficacy of individualized bladder rehabilitation programs, which included education on voiding behavior, PFM exercise training combined with electromyography (EMG) biofeedback, and ES (for bladder inhibition or PFM strengthening), …

Spinal Cord Injury Induced By Gun Shot Wounds: Implications For Occupational Therapy, Rosanne Dizazzo-Miller

The Open Journal of Occupational Therapy

People with spinal cord injuries secondary to gunshot wounds present with many unique occupational challenges in terms of their overall health and well-being, and often live in violent cultures that limit occupational performance. Further awareness and understanding of this subgroup can enable occupational therapists to develop appropriate strategies needed to address the many challenges faced by this population. An in-depth understanding of cultural competence is necessary in the identification, planning, and delivery of appropriate and effective treatment. Further, a case example demonstrates the significant influence occupational therapy can achieve in this area of practice.

Influence Of Pain On Depression And Quality Of Life In Patients With Spinal Cord Injury, Yao-Jen Chen, Hong-Ye Chen

Rehabilitation Practice and Science

Objective: To assess pain prevalence in a spinal cord injury (SCI) population and the influence of pain on depression and quality of life in patients with SCI. Methods: Two hundred twenty six SCI patients were asked to participate in this study after completing a questionnaire. The questionnaire included demographic data, clinical characteristics of SCI, performance of daily activities and pain intensity on a Numerical Rating Scale (NRS). The Chinese version of Identification (ID) of pain questionnaire was used to detect the neuropathic form of pain. The Taiwanese Depression Questionnaire (TDQ) was used for screening of depression and the Taiwan version …

The Prevalence And Related Factors Of Posttraumatic Stress Disorder Among Subjects With Spinal Cord Injury, Ching-Chi Chang, Yu-Ting Yang, Shu-Han Yu, Nai-Yin Chang, Vincent Chin-Hung Chen, Su-Ju Tsai

Rehabilitation Practice and Science

There are approximately 1200 new cases of traumatic spinal cord injury (SCI) each year in Taiwan. Traumatic SCI often results from motor vehicle crashes, acts of violence or sports injuries. These are potentially leading patients to suffer from posttraumatic stress disorder (PTSD). The characteristic symptoms of PTSD include persistent re-experiencing of the event, increased arousal and avoidance of stimuli associated with the trauma and numbing of general responsiveness. The symptoms must cause clinically significant distress or impairment in social, occupational or other important areas of functioning. Our purpose was to identify the prevalence and related factors of posttraumatic stress disorder …

T12 Compression Fracture Complicated With Delayed Spinal Epidural Hematoma: A Casereport, Chia-Wei Wu, Ching-Shiang Tseng, Lin-Fen Hsieh

Rehabilitation Practice and Science

Delayed spinal epidural hematoma (SEH) after a spinal compression fracture is a very rare but important cause of symptomatic spinal cord compression. We report a patient with spinal cord compression and cauda equina syndrome due to delayed SEH after a traumatic T12 compression fracture. A 74-year-old male patient had severe back pain without neurologic deficits after a traumatic T12 compression fracture. He developed progressive bilateral lower extremity weakness, sensory loss, and sphincter dysfunction 2.5 months after the injury. Magnetic resonance imaging of the spine revealed a huge spinal epidural hematoma at the level of T12 to L5. He then received …

Concurrent Ankylosing Spondylitis And Tophaceous Gout In Spine Causing Spinal Cord Compression: A Casereport, Chia-Chen Lin, Nai-Hsin Meng

Rehabilitation Practice and Science

Ankylosing spondylitis (AS) rarely coexists with tophaceous gout in the spine. We present a case of a 57-year-old businessman with AS who did not have previous history of hyperuricemia or gouty arthritis. He had a three-month history of progressive bilateral lower limb weakness caused by spinal cord compression (rooted on a tophaceous gout), leading to incomplete paraplegia. He received surgical decompressive laminectomy, which removed the hypertrophic ligamentum flavum and tophus in the level of thoracolumbar junction. There was no obvious neurologic recovery after the surgery. We reviewarticleed the incidence, clinical manifestations, and management of the spinal tophaceous gout coexisting with …

Spinal Cord Injury And Diffuse Asymptomatic Pulmonary Embolism After Percutaneous Vertebroplasty: A Casereport, Yao-Jen Chen, Pei-Pi Shih, Su-Ju Tsai

Rehabilitation Practice and Science

A 30-year-old woman with a history of 9th to 11th thoracic vertebral compression fracture developed complete thoracic spinal cord injury immediately after percutaneous vertebroplasty. The patient did not have any sign of neurological recovery after two operations for spinal decompression. The postoperative chest X ray and thoracic computed tomography scan revealed diffuse asymptomatic pulmonary embolism, but the patient did not have dyspnea or chest pain.Percutaneous vertebroplasty has been generally considered a minimally invasive and effective procedure for treatment of painful compression fracture. Complications after percutaneous vertebroplasty include infection, spinal cord injury, cardiopulmonary complications and stroke. In previous literature search, there …

The Effect Of Body Weight Support Treadmill Training On Walking Ability In Patients With Incomplete Spinal Cord Injury, Chien-Hsing Tseng

Rehabilitation Practice and Science

In modern health care systems that attach importance to acute treatment and health care, there is an increasing number of patients with incomplete spinal cord injury that have increased chance of regaining their ability to walk. However, how to effectively achieve this target of promoting the ability to walk is a question that must be urgently addressed by rehabilitation medicine and public health authorities. International research has already confirmed that body weight support treadmill training has a positive therapeutic effect on walking ability in patients with incomplete spinal cord injury, but in Taiwan not many relevant studies have been performed. …

Acute Abdominal Pain In Spinal Cord Injury Patient Induced By Indwelling Urethral Catheter Placed Into The Right Ureter Through The Ureteral Orifice: A Casereport, Chang-Jheng Wu, Huei-Yu Lo, Yau-Wai Wai, Han-Tin Lu

Rehabilitation Practice and Science

Diagnosis of acute abdomen in spinal cord injury (SCI) patients remains challenging. Classic peritoneal signs, such as rigid abdomen, rebounding pain and abdominal muscle guarding may be not reliable. It is still an important cause of morbidity and mortality in patients with SCI.A 45-year-old woman with SCI and 7th and 8th thoracic vertebrae fractures suffered from lower abdominal pain, fever and chills for three days. Physical examination revealed diffuse abdominal tenderness with muscle guarding. Laboratory studies showed severe leukocytosis and mild pyuria. Abdominal contrast-enhanced computed tomography scans (CTS) revealed a urinary catheter, which had been accidentally inserted into the right …

The Therapeutic Effect Of Selective Dorsal Rhizotomy On Severe Spasticity Related Spinal Cord Injury: A Casereport, Shin-Yo Lu, Tsui-Fen Yang, Tai-Tong Wong, Rai-Chi Chan, Chung-Yu Ho, Hung-Yi Chang

Rehabilitation Practice and Science

Spasticity refers to a velocity-dependent resistance to passive motion which was characterized as a symptom of upper motor neuron lesion. Though mild spasticity can help patients compensate for muscle weakness which is benefit for transferring and some daily living function, severe spasticity may cause difficulty in positioning, motor performance and predispose to pressure ulcer. The treatment option for spasticity includes physical therapy (positioning, stretching, range of motion exercise), splinting, oral medication (baclofen and diazepam are most commonly used), botulinum toxin or phenal block for focal spasticity, and more invasively, intrathecal baclofen pump (ITB) and selective dorsal rhizotomy (SDR). Selective dorsal …

The Able Scale: The Development And Psychometric Properties Of A New Outcome Measure For The Spinal Cord Injury Population, Elizabeth Ardolino

Seton Hall University Dissertations and Theses (ETDs)

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Electric Stimulation For The Bladder Dysfunction In Patients With Spinal Cord Injury, Chao-Min Wang, Yen-Ho Wang

Rehabilitation Practice and Science

Bladder dysfunction makes huge impact on the patients with spinal cord injury. It not only causes inconvenience in daily living, but also leads to many complications, including life-threatening renal failure. Traditional methods had been brought into greater use for the management of bladder dysfunction, such as indwelling catheter, clean intermittent catheterization, external condom catheter, bladder augmentation and so on. Electric stimulation is an effective treatment for both bladder voiding and storage dysfunction and it can be used in many different location. The electrodes can be placed on spinal cord, nerve root, peripheral nerve, bladder and skin by surgical implantation, needle …

Assessments Of Spasticity By Hoffmann Reflex Parameters In Patients With Spinal Cord Injury, Juei-Hsiang Wang, Yen-Ho Wang, Chein-Wei Chang, Shin-Liang Pan, Che-Sheng Lin

Rehabilitation Practice and Science

Muscle spasticity is a common problem that affects patients who have suffered spinal cord injury (SCI). It can affect the motor skills, activities of daily living, and quality of life of these patients. The modified Ashworth scale (MAS) is a widely used clinical rating scale for spasticity, but its validity and reliability have been questioned. Much attention has been devoted to the evaluation of spasticity by using electrophysiological approaches. Increased excitation of motor neurons, exaggerated stretch reflex, decreased presynaptic inhibition, and reduced reciprocal inhibition have been found to be associated with spasticity. In several previous studies, the Hoffmann (H) reflex …

The Recovery Index Of Oxygen Saturation From Orthostatic Syncope In Patients With Spinal Cord Injury, David S. Liu, Alice M. K. Wong, Shih-Ching Chen, Kang-Ping Lin, Chien-Hung Lai, Walter H. Chang

Rehabilitation Practice and Science

Orthostatic hypotension (OH) is a common clinical problem for patients with spinal cord injury (SCI) at the cervical or high thoracic level when they move from the supine position to the upright position. Patients with severe SCI frequently suffer from symptoms of OH during head-up tilt, ranging from slight lightheadedness to full syncope. Tilt-table training is commonly used in clinical physiotherapy to overcome OH syncope, but this also relies on carefully manual control of the tilt angle and training time by the therapist during training. Up till now, it still has no method to estimate the recovery process of OH …

A Pilot Trial Of A Telephone-Linked Patient Service System: Spinal Cord Injury Patients As An Example, Tsung-Yu Wei, Shao-Li Han, Wen-Hsien Tseng, Fong-Bin Yan, Kwan-Yu Chan, Polun Chang, Wai-Keung Lee

Rehabilitation Practice and Science

The pressure of lack of enough resources on our National Health Insurance program and an increasing population of the aged and chronic patients has made the tele-home care technology an important choice. The tele-home care service is also regarded by our government as one of the core new service businesses for 2008. In this study, a prototype Tele-Home Care system, composed of Telephone-linked Care (TLC), Automatic Speech Recognition (ASR), Text-To-Speech (TTS) and automatic questionnaire recognition, was developed and evaluated for spinal cord injury patient care.The prototype systems included a personal computer with an EASYTAPI voice card, a Fax card and …

Bladder Management And Urologic Outcome In Patients With Chronic Spinal Cord Lesions, Je-Kuei Yang, Su-Ju Tsai, I-Chun Chen, Liu-Ing Bih

Rehabilitation Practice and Science

Between February and September 2004, 73 patients with spinal cord lesions of greater than 2 years duration were enrolled in this study. A chart reviewarticle was conducted to record the manner in which the patients' bladder management, previous urologic complications, and any corresponding treatments and effects. Among the patients, 55 were male and 18 were female, with an average age of 29.3±12.1 and 32.0±13.0 years, respectively. The mean duration of the patients' injuries was 9.5±6.9 years in men, and 7.0±4.5 years in women, respectively.Group Ⅰ included 8 patients (11.0%) who had indwelling catheters since the time of their injury and …

Autonomic Dysreflexia In Ankylosing Spondylitis With Double Spinal Cord Injuries: A Casereport, Shu-Chun Huang, Wun-Jhong Tsai, Shih-Wei Chou, Chin-Man Wang, Alice M. K. Wong

Rehabilitation Practice and Science

This 54-year-old man underlying ankylosing spondylitis suffered from double spinal cord injuries with traumatic C6/7 dislocation and a neglected L1 vertebral body fracture which progressed to transverse fracture three weeks after the injury, acting as a powerful precipitant to autonomic dysreflexia. The dysreflexic symptoms happened at least three times when he practiced sitting during mat exercise and ameliorated soon by virtue of lying down. Compared with the previous record checked three weeks ago, neurologic examination revealed alteration of sensory level and loss of deep anal sensation. The patient received L1 laminectomy as well as T12 and L2 transpedicle screws fixation, …

Survey Of Spinal Cord Injuries Due To Diving Accidents In Taiwan, Ya-Wen Tu, Huey-Wen Liang, Yen-Ho Wang, Jiunn-Horng Kang, Liu-Ing Bih, Fuk-Tan Tang

Rehabilitation Practice and Science

Objective: To examine the clinical characteristics of diving-related spinal cord injuries (SCI) in Taiwan.Methods: This study is a retrospective reviewarticle of all hospitalized patients with spinal cord injuries due to diving accidents in three rehabilitation centers between January 1982 and July 2002. Demographic data and clinical features were presented and analyzed. Results: A total of 1216 spinal cord injuries were reviewarticleed, and 16 cases (1.3%) met the inclusion criteria. Their mean age at the time of injury was 26.8 years and 15 (94.0%) of the cases were male. All of the injuries resulted in tetraplegia and 11 (69.0%) were neurologically …

Follow-Up And Treatment Of Neurogenic Bladder Dysfunction With Compromised Upper Urinary Tract: A Casereport, Su-Ju Tsai, Yu-Hui Huang, Yu-Pei Chien, Fan-Fei Tseng

Rehabilitation Practice and Science

In spinal cod injury (SCI) patients with neurogenic bladder dysfunction (NBD), detrusor hyperreflexia and poor bladder compliance may lead to increased intravesical pressure and other adversities, including urinary tract infection, hydronephrosis, vesicoureteral reflux, and impairment of renal function. The primary objectives of urologic care after SCI are to provide an acceptable method for managing the lower urinary tract, to prevent urinary complications, and to preserve renal function. Because urologic status can change or deteriorate many years after the initial injury, sometimes without symptoms, lifelong urologic follow-up is fundamental for all SCI patients with NBD. Strategy of bladder management in individuals …