Healthcare Library Current Awareness Bulletin – Spinal Cord Injuries

Objectives To perform an analysis of oral baclofen dosage in patients with traumatic spinal cord injuries over time and to ascertain the clinical determinants of long-term baclofen dosage trends.Study design Retrospective cohort study of patient records from the PM&R units at the Johns Hopkins Bayview Medical Center and the Johns Hopkins Hospital.Subjects A total of 115 PM&R patients suffering spinal cord injury due to trauma leading to either complete or incomplete paralysis. The modes of injury included were motor vehicle accidents (MVA) (n = 39), gunshot wounds (GSW) (n = 55), falls (n = 17), diving (n = 2), workplace (n = 1) and swimming (n = 1) accidents. The location of injury in the spinal cord was categorized into either cervical (n = 52), thoracic (n = 59), lumbar (n = 2), or unspecified (n = 2).Results From time of injury, an aggregate of all dosage assignments for each patient demonstrated a significant yearly increase in baclofen dosage (1.26 mg/year, p<0.01). Baclofen dosage for MVA cases were seen to rise at 4.99 mg/year (p<0.0001). KaplanMeier analysis revealed that GSW patients received their first baclofen dosage earlier than MVA patients (log-rank p<0.05, unadjusted).Conclusions We observed a marginal increase in baclofen dosage over nearly 25 years in a single provider's patient database and observed different timings of first dose between two causes of traumatic SCI. These results provide an estimate of baclofen dosage trends over time after spinal cord injury and may be useful for patient counseling or as a method to assess costs of providing SCI patient care. 2014 Elsevier B.V. All rights reserved. Publication type: Journal: Article Source: EMBASE 7.Title: Clinical Treatment of Orthostatic Hypotension After Spinal Cord Injury with Training Based on Electric Uprise Bed Coupled with Remote ECG and BP Monitor. Citation: Medical Science Monitor, 2014, vol./is. 20/(2767-75), 1234-1010;1643-3750 (2014) Author(s): Shen D, Huang H, Yuan H, Zhang X, Li M Language: English Abstract: Background The treatment for orthostatic hypotension (OH) after spinal cord injury (SCI) is an important part of rehabilitation in late-stage SCI. Electric uprise bed training is a relatively commonly used method in treating OH, and how to carry out uprise bed training safely and effectively is an urgent problem. In the early stage of SCI, we used a remote monitoring system to monitor the whole process of uprise bed training, and we explored a safe and efficient method of electric uprise bed training. Material and Methods The experimental group consisted of 36 patients diagnosed with orthostatic hypotension (OH) after SCI and who received training with an electric uprise bed coupled with remote monitoring system, and the control group of 18 subjects who used a traditional training method. Results There were no differences in baseline data between the 2 groups. There were no severe symptoms during training in the experimental group, but 3 patients had severe symptoms in the control group. Among the 32 enrolled subjects reaching upright training status within 30 days (17 subjects in the experimental group and 15 subjects in the control group), time interval of training from horizontal position to erect position in the experimental group was 18.00+/-3.12 days and 21.40+/-4.95 days in the control group. Time interval in the experimental group was significantly less than in the control group. However, among all 36 subjects, by combining results of follow-up, there was no significant difference of time interval of training from horizontal position to erect position between the experimental group and the control group. In the experimental group 90.52% of patients finished training compared to 78.19% in the control group (P<0.01). After training, values of OCs and OCd of the experimental group were lower than in the control group. There was no significant difference between groups in number of re-diagnosed OH. Conclusions Implementation of training with electric uprise bed coupled with remote monitoring system is generally safe for patients with OH after SCI. For patients who could reach standing training status within 30 days, implementation can improve efficiency of training by shortening time interval of training from horizontal position to erect position. It can increase orthostatic blood pressure change during position change. Publication type: Journal Article Source: MEDLINE 8.Title: Colonoscopy after spinal cord injury: a case-control study. Citation: Spinal Cord, January 2015, vol./is. 53/1(32-5), 1362-4393;1476-5624 (2015 Jan) Author(s): Morris BP, Kucchal T, Burgess AN Language: English Abstract: DESIGN: An ageand gender-matched case-control study.OBJECTIVE: To compare colonoscopy after spinal cord injury (SCI) with the general population in terms of indications, bowel preparation, technical success and disease detection.SETTING: Victoria, Australia.METHODS: Consecutive SCI colonoscopies between January 1998 and February 2013 were compared with a randomly selected ageand gender-matched control group. Injury level, indication for procedure and demographics were collected. Outcome measures included quality of bowel preparation, completion rates, procedural duration and benign and malignant disease detection.RESULTS: A total of 440 colonoscopies were assessed, comprising 148 SCI patients and 292 ageand gender-matched controls. Both the groups were of similar age (54.7 years vs 54.5 years, P=0.906) and comprised predominantly males (87.1% vs 86.3%, P=0.919). SCI colonoscopies were more often performed to investigate abnormalities (85.1% vs 58.2%, P<0.001) than for screening or surveillance (18.2% vs 40.8%, P<0.001). Unsatisfactory bowel preparation was recorded more often in the SCI group (36.0% vs 13.0%, P<0.001) and completion rates were lower (75.7% vs 93.1%, P<0.001). Overall disease detection was lower in the SCI group (45.3% vs 59.6%, P<0.006). The polyp detection rate was lower for SCI (11.4% vs 25.3%, P=0.001). The rate of diagnosis of malignancy was equivalent (2.7% vs 3.0%, P=0.904).CONCLUSION: SCI patients have the same risk of malignancy as the general population and are less likely to undergo screening colonoscopy. Colonoscopy is then limited by poor bowel preparation and lower completion rates with a subsequent lower polyp detection rate. Publication type: Journal Article Source: MEDLINE Full text: Available Nature Publishing Group at Spinal Cord 9.Title: Does extracorporeal shock wave introduce alteration of microenvironment in cell therapy for chronic spinal cord injury?. Citation: Spine, December 2014, vol./is. 39/26(E1553-9), 0362-2436;1528-1159 (2014 Dec 15) Author(s): Lee JY, Ha KY, Kim JW, Seo JY, Kim YH Language: English Abstract: STUDY DESIGN: Animal experimental study.OBJECTIVE: To present experimental evidence for cell therapy for spinal cord injury (SCI).SUMMARY OF BACKGROUND DATA: In chronic SCI, the efficacy of cell engraftment has been known to be low due to its distinct pathology. Alteration of microenvironment was tried using extracorporeal shock waves (ESW) for chronic SCI, and the efficacy of cell therapy was investigated.METHODS: A chronic contusive SCI model was made in 36 Sprague-Dawley rats. The rats were allocated into (1) control group (SCI only), (2) ESW control group (SCI + ESW), (3) IV group (SCI + intravenous transplantation of mesenchymal stem cells; MSCs), and (4) ESW + IV group (SCI + MSCs IV transplantation after ESW). ESW were applied at the energy determined by our preliminary trials. Engraftment of the cells and expressions of growth factors (brain-derived neurotrophic factor, neuronal growth factor) and cytokines (SDF-1, CXCR4, VEGF) at the epicenter were assessed. The Basso, Beattie, and Bresnahan locomotor scale was used for the clinical assessment.RESULTS: The mean numbers of engrafted cells were higher in the ESW+ IV than that in the IV with a statistical significance. The expression of SDF-1 was higher in the ESW groups than that in the control or IV group. CXCR4 was highly expressed in the transplanted groups. The expressions of growth factors in the treated group were higher in the treated group than those in the control group. However, various statistical significances were noted. The improvement of locomotor was higher in the transplanted groups than that in the control and ESW only group.CONCLUSION: At a given energy level, ESW presented more engraftment of the transplanted MSCs without any clinical deterioration in a chronic SCI. Based on this promising result and possible explanations, ESW may cause an alteration of the microenvironment for the cell therapy in chronic SCI.LEVEL OF EVIDENCE: N/A. Publication type: Journal Article Source: MEDLINE Full text: Available Ovid at Spine Full text: Available Ovid at Spine 10.Title: Does regular standing improve bowel function in people with spinal cord injury? A randomised crossover trial. Citation: Spinal Cord, January 2015, vol./is. 53/1(36-41), 1362-4393;1476-5624 (2015 Jan) Author(s): Kwok S, Harvey L, Glinsky J, Bowden JL, Coggrave M, Tussler D Language: English Abstract: STUDY DESIGN: A randomised crossover trial.OBJECTIVES: To determine the effects of a 6-week standing programme on bowel function in people with spinal cord injury.SETTING: Community, Australia and the United Kingdom.METHODS: Twenty community-dwelling people with motor complete spinal cord injury above T8 participated in a 16-week trial. The trial consisted of a 6-week stand phase and a 6-week no-stand phase separated by a 4-week washout period. Participants were randomised to one of two treatment sequences. Participants allocated to the Treatment First group stood on a tilt table for 30min per session, five times per week for 6 weeks and then did not stand for the next 10 weeks. Participants allocated to the Control First group did the opposite: they did not stand for 10 weeks and then stood for 6 weeks. Participants in both groups received routine bowel care throughout the 16-week trial. Assessments occurred at weeks 0, 7, 10 and 17 corresponding with pre and post stand and no-stand phases. The primary outcome was Time to First Stool. There were seven secondary outcomes reflecting other aspects of bowel function and spasticity.RESULTS: There were three dropouts leaving complete data sets on 17 participants. The mean (95% confidence interval) betweenintervention difference for Time to First Stool was 0min (-7 to 7) indicating no effect of regular standing on Time to First Stool.CONCLUSION: Regular standing does not reduce Time to First Stool. Further trials are required to test the veracity of some commonly held assumptions about the benefits of regular standing for bowel function. Publication type: Journal Article Source: MEDLINE Full text: Available Nature Publishing Group at Spinal Cord 11.Title: Effect of robotic-assisted gait training in patients with incomplete spinal cord injury. Citation: Annals of Rehabilitation Medicine, December 2014, vol./is. 38/6(719-25), 2234-0645;2234-0645 (2014 Dec) Author(s): Shin JC, Kim JY, Park HK, Kim NY Language: English Abstract: OBJECTIVE: To determine the effect of robotic-assisted gait training (RAGT) compared to conventional overground training.METHODS: Sixty patients with motor incomplete spinal cord injury (SCI) were included in a prospective, randomized clinical trial by comparing RAGT to conventional overground training. The RAGT group received RAGT three sessions per week at duration of 40 minutes with regular physiotherapy in 4 weeks. The conventional group underwent regular physiotherapy twice a day, 5 times a week. Main outcomes were lower extremity motor score of American Spinal Injury Association impairment scale (LEMS), ambulatory motor index (AMI), Spinal Cord Independence Measure III mobility section (SCIM3-M), and walking index for spinal cord injury version II (WISCI-II) scale.RESULTS: At the end of rehabilitation, both groups showed significant improvement in LEMS, AMI, SCIM3-M, and WISCI-II. Based on WISCIII, statistically significant improvement was observed in the RAGT group. For the remaining variables, no difference was found.CONCLUSION: RAGT combined with conventional physiotherapy could yield more improvement in ambulatory function than conventional therapy alone. RAGT should be considered as one additional tool to provide neuromuscular reeducation in patient with incomplete SCI. Publication type: Journal Article Source: MEDLINE 12.Title: Effects of training on upper limb function after cervical spinal cord injury: a systematic review. Citation: Clinical Rehabilitation, January 2015, vol./is. 29/1(3-13), 0269-2155;1477-0873 (2015 Jan) Author(s): Lu X, Battistuzzo CR, Zoghi M, Galea MP Language: English Abstract: OBJECTIVE: To summarize the evidence for the effectiveness of exercise training in promoting recovery of upper extremity function after cervical spinal cord injury.DATA SOURCES: Medline, Cochrane, CINAHL, EMBASE and PEDro were used to search the literature.REVIEW METHODS: Two reviewers independently selected and summarized the included studies. Methodological quality of the selected articles was scored using the Downs and Black checklist.RESULTS: A total of 16 studies were included, representing a total of 426 participants. Overall, the internal validity and reporting of the studies was fair to good, while power and external validity were poor. Interventions included exercise therapy, electrical stimulation, functional electrical stimulation, robotic training and repetitive transcranial magnetic stimulation. Most of the studies reported improvements in muscle strength, arm and hand function, activity of daily living or quality of life after intervention.CONCLUSIONS: Training including exercise therapy, electrical stimulation, functional electrical stimulation of the upper limb following cervical spinal cord injury leads to improvements in muscle strength, upper limb function and activity of daily living or quality of life. Further research is needed into the effects of repetitive transcranial magnetic stimulation and robotic training on upper limb function.Copyright The Author(s) 2014. Publication type: Journal Article Source: MEDLINE Full text: Available ProQuest at Clinical Rehabilitation 13.Title: Effects of underwater treadmill training on leg strength, balance, and walking performance in adults with incomplete spinal cord injury. Citation: Journal of Spinal Cord Medicine, January 2015, vol./is. 38/1(91-101), 1079-0268;1079-0268 (2015 Jan) Author(s): Stevens SL, Caputo JL, Fuller DK, Morgan DW Language: English Abstract: Objective To document the effects of underwater treadmill training (UTT) on leg strength, balance, and walking performance in adults with incomplete spinal cord injury (iSCI). Design Pre-test and post-test design. Setting Exercise physiology laboratory. Participants Adult volunteers with iSCI (n = 11). Intervention Participants completed 8 weeks (3 x /week) of UTT. Each training session consisted of three walks performed at a personalized speed, with adequate rest between walks. Body weight support remained constant for each participant and ranged from 29 to 47% of land body weight. Increases in walking speed and duration were staggered and imposed in a gradual and systematic fashion. Outcome measures Lower-extremity strength (LS), balance (BL), preferred and rapid walking speeds (PWS and RWS), 6minute walk distance (6MWD), and daily step activity (DSA). Results Significant (P < 0.05) increases were observed in LS (13.1 +/3.1 to 20.6 +/5.1 Nkg(-1)), BL (23 +/11 to 32 +/13), PWS (0.41 +/0.27 to 0.55 +/0.28 ms(-1)), RWS (0.44 +/0.31 to 0.71 +/0.40 ms(-1)), 6MWD (97 +/80 to 177 +/122 m), and DSA (593 +/782 to 1310 +/1258 steps) following UTT. Conclusion Physical function and walking ability were improved in adults with iSCI following a structured program of UTT featuring individualized levels of body weight support and carefully staged increases in speed and duration. From a clinical perspective, these findings highlight the potential of UTT in persons with physical disabilities and diseases that would benefit from weight-supported exercise. Publication type: Journal Article Source: MEDLINE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 14.Title: Efficacy of some non-conventional herbal medications (sulforaphane, tanshinone IIA, and tetramethylpyrazine) in inducing neuroprotection in comparison with interleukin-10 after spinal cord injury: A meta-analysis. Citation: Journal of Spinal Cord Medicine, January 2015, vol./is. 38/1(13-22), 1079-0268;1079-0268 (2015 Jan) Author(s): Koushki D, Latifi S, Norouzi Javidan A, Matin M Language: English Abstract: Context Inflammation after spinal cord injury (SCI) may be responsible for further neural damages and therefore inhibition of inflammatory processes may exert a neuroprotection effect. Objectives To assess the efficacy of some nonconventional herbal medications including sulforaphane, tanshinone IIA, and tetramethylpyrazine in reducing inflammation and compare them with a known effective anti-inflammatory agent (interleukin-10 (IL-10)). Methods We searched relevant articles in Ovid database, Medline (PubMed) EMBASE, Google Scholar, Cochrane, and Scopus up to June 2013. The efficacy of each treatment and study powers were compared using random effects model of meta-analysis. To our knowledge, no conflict of interest exists. Results Eighteen articles entered into the study. The meta-analysis revealed that exogenous IL-10 was more effective in comparison with the mentioned herbal extracts. The proposed pathways for each medication's effect on reducing the inflammation process are complex and many overlaps may exist. Conclusion IL10 has a strong effect in the induction of neuroprotection and neurorecovery after SCI by multiple pathways. Tetramethylpyrazine has an acceptable influence in reducing inflammation through the up-regulation of IL-10. Outcomes of sulforaphane and tanshinone IIA administration are acceptable but still weaker than IL-10. Publication type: Journal Article Source: MEDLINE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 15.Title: Emergence and prevention measures for multidrug resistant Pseudomonas aeruginosa in catheter-associated urinary tract infection in spinal cord injury patients. Citation: Spinal Cord, January 2015, vol./is. 53/1(70-4), 1362-4393;1476-5624 (2015 Jan) Author(s): Shigemura K, Takase R, Osawa K, Takaba K, Nomi M, Fujisawa M, Arakawa S Language: English Abstract: OBJECTIVE: To evaluate measures for preventing multidrug resistant Pseudomonas aeruginosa (MDRP) in catheter-associated urinary tract infection (CAUTI) in spinal cord injury patients.SETTING: Spinal Cord Injury Unit of Hyogo Prefectural Hyogo Prefectural Rehabilitation Center, Kobe, Japan.METHODS: We defined MDRP as resistance to amikacin, imipenem and levofloxacin. We had eight cases of MDRP-causing CAUTI in hospitalized neurogenic bladder patients caused by spinal cord injury in 2 months. Pulse-field gel electrophoresis (PFGE) was performed for epidemiological studies. We assessed prevention measures against MDRP emergence from the 2nd month, such as surveillance of CAUTI and infection control, and evaluated the outcomes of these measures over a total of 8 months.RESULTS: Our PFGE results showed that these eight MDRP isolates could be considered as closely related strains. We concluded that this was an MDRP outbreak that was causing CAUTI. The isolated ratio of MDRP began to decrease over 4 months of surveillance and significantly decreased in the 4th quarter (7th and 8th months) compared with the 1st quarter (1st and 2nd months) (P=0.021) even though urinary tract device usage significantly increased over the same period (P<0.001).CONCLUSION: We experienced an outbreak of emergent MDRP causing CAUTI in neurogenic bladder patients with spinal cord injury. Our preventive measures for isolating the outbreak, including surveillance, may have led to the decrease we observed in the ratio of MDRP isolated. Publication type: Journal Article Source: MEDLINE Full text: Available Nature Publishing Group at Spinal Cord 16.Title: Estimating the incidence and prevalence of traumatic spinal cord injury in australia. Citation: Archives of Physical Medicine & Rehabilitation, January 2015, vol./is. 96/1(76-83), 0003-9993;1532-821X (2015 Jan) Author(s): New PW, Baxter D, Farry A, Noonan VK Language: English Abstract: OBJECTIVES: To determine estimates of the incidence and prevalence of traumatic spinal cord injury (TSCI) in Australia as of June 30, 2011.DESIGN: Population modeling using cohort survival.SETTING: Australia.PARTICIPANTS: Hospital data regarding people with TSCI in Australia.INTERVENTIONS: Modeling using the following data: 2 populationbased databases of hospital separations of patients with TSCI, giving upper and lower estimates of incidence; national population profiles and life tables; levels of TSCI based on Australian Spinal Cord Injury Registry; and life expectancy for persons with spinal cord injury under 3 scenarios-1 constant and 2 with a trend standardized mortality ratio (SMR).MAIN OUTCOME MEASURES: Ageand sex-specific incidence and prevalence estimates.RESULTS: The lower estimate of incidence was 21.0 per million population per year, and the upper estimate was 32.3 per million population per year. The derived prevalence rates ranged from 490 per million population (10,944 persons-lower incidence, trend SMR with survival from 1948) up to 886 per million population (19,784 persons-higher incidence, constant SMR). The prevalence was highest in males, persons aged 46 to 60 years, and those with tetraplegia.CONCLUSIONS: We have reported a method for calculating an estimate of the prevalence of TSCI which provides information that will be vital to optimize health care planning for this group of highly disabled members of society.Copyright 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. Publication type: Journal Article Source: MEDLINE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 17.Title: Evoked EMG versus muscle torque during fatiguing functional electrical stimulation-evoked muscle contractions and short-term recovery in individuals with spinal cord injury. Citation: Sensors, 2014, vol./is. 14/12(22907-20), 1424-8220;1424-8220 (2014) Author(s): Estigoni EH, Fornusek C, Hamzaid NA, Hasnan N, Smith RM, Davis GM Language: English Abstract: This study investigated whether the relationship between muscle torque and m-waves remained constant after short recovery periods, between repeated intervals of isometric muscle contractions induced by functional electrical stimulation (FES). Eight subjects with spinal cord injury (SCI) were recruited for the study. All subjects had their quadriceps muscles group stimulated during three sessions of isometric contractions separated by 5 min of recovery. The evokedelectromyographic (eEMG) signals, as well as the produced torque, were synchronously acquired during the contractions and during short FES bursts applied during the recovery intervals. All analysed m-wave variables changed progressively throughout the three contractions, even though the same muscle torque was generated. The peak to peak amplitude (PtpA), and the m-wave area (Area) were significantly increased, while the time between the stimulus artefact and the positive peak (PosT) were substantially reduced when the muscles became fatigued. In addition, all m-wave variables recovered faster and to a greater extent than did torque after the recovery intervals. We concluded that rapid recovery intervals between FES-evoked exercise sessions can radically interfere in the use of m-waves as a proxy for torque estimation in individuals with SCI. This needs to be further investigated, in addition to seeking a better understanding of the mechanisms of muscle fatigue and recovery. Publication type: Journal Article, Research Support, Non-U.S. Gov't Source: MEDLINE 18.Title: Examining implicit bias of physicians who care for individuals with spinal cord injury: A pilot study and future directions. Citation: Journal of Spinal Cord Medicine, January 2015, vol./is. 38/1(102-10), 1079-0268;1079-0268 (2015 Jan) Author(s): Hausmann LR, Myaskovsky L, Niyonkuru C, Oyster ML, Switzer GE, Burkitt KH, Fine MJ, Gao S, Boninger ML Language: English Abstract: Context Despite evidence that healthcare providers have implicit biases that can impact clinical interactions and decisions, implicit bias among physicians caring for individuals with spinal cord injury (SCI) has not been examined. Objective Conduct a pilot study to examine implicit racial bias of SCI physicians and its association with functioning and wellbeing for individuals with SCI. Design Combined data from cross-sectional surveys of individuals with SCI and their SCI physicians. Setting Four national SCI Model Systems sites. Participants Individuals with SCI (N = 162) and their SCI physicians (N = 14). Outcome measures SCI physicians completed online surveys measuring implicit racial (pro-white/antiblack) bias. Individuals with SCI completed questionnaires assessing mobility, physical independence, occupational functioning, social integration, self-reported health, depression, and life satisfaction. We used multilevel regression analyses to examine the associations of physician bias and outcomes of individuals with SCI. Results Physicians had a mean bias score of 0.62 (SD = 0.35), indicating a strong pro-white/anti-black bias. Greater physician bias was associated with disability among individuals with SCI in the domain of social integration (odds ratio = 4.80, 95% confidence interval (CI) = 1.44, 16.04), as well as higher depression (B = 3.24, 95% CI = 1.06, 5.41) and lower life satisfaction (B = -4.54, 95% CI= 8.79, -0.28). Conclusion This pilot study indicates that SCI providers are susceptible to implicit racial bias and provides preliminary evidence that greater implicit racial bias of physicians is associated with poorer psychosocial health outcomes for individuals with SCI. It demonstrates the feasibility of studying implicit bias among SCI providers and provides guidance for future research on physician bias and patient outcomes. Publication type: Journal Article Source: MEDLINE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 19.Title: Failures on obstacle crossing task in independent ambulatory patients with spinal cord injury and associated factors. Citation: Archives of Physical Medicine & Rehabilitation, January 2015, vol./is. 96/1(43-8), 0003-9993;1532-821X (2015 Jan) Author(s): Amatachaya S, Pramodhyakul W, Srisim K Language: English Abstract: OBJECTIVES: To primarily explore the proportion and factors relating to failure on an obstacle crossing task in ambulatory participants with incomplete spinal cord injury (iSCI); and to compare balance ability between participants who passed and failed on an obstacle crossing task.DESIGN: Cross-sectional design.SETTING: Tertiary rehabilitation center.PARTICIPANTS: Independent ambulatory participants with an iSCI (N=113).INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Primary outcomes were the ability to walk over small obstacles of sizes that are commonly found in homes and communities and factors relating to failure on an obstacle crossing task. The secondary outcome was the data from the timed Up and Go (TUG) test.RESULTS: Of the participants, 33 failed to walk over an obstacle. Using a walker significantly increased chance of failure, whereas having incomplete paraplegia and American Spinal Injury Association Impairment Scale grade D were the protective factors for the event (P<.01). The number of failures was also significantly increased because of leg contact with a wide or relative large obstacle (4 and 8cm, P<.001). Furthermore, participants who failed required significantly longer time to complete the TUG test than those who passed an obstacle crossing task (P<.001).CONCLUSIONS: Apart from the ability of independent walking, rehabilitation professionals may need to emphasize the ability of movement modification of the lower extremities and balance control to improve safety issues for the patients.Copyright 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. Publication type: Journal Article Source: MEDLINE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 20.Title: Functional changes in deep dorsal horn interneurons following spinal cord injury are enhanced with different durations of exercise training. Citation: Journal of Physiology, January 2015, vol./is. 593/1(331-45), 0022-3751;1469-7793 (2015 Jan 1) Author(s): Rank MM, Flynn JR, Battistuzzo CR, Galea MP, Callister R, Callister RJ Language: English Abstract: KEY POINTS: Exercise training after spinal cord injury (SCI) enhances collateral sprouting from axons near the injury and is thought to promote intraspinal circuit reorganisation that effectively bridges the SCI. The effects of exercise training, and its duration, on interneurons in these de novo intraspinal circuits are poorly understood. In an adult mouse hemisection model of SCI, we used whole-cell patch-clamp electrophysiology to examine changes in the intrinsic and synaptic properties of deep dorsal horn interneurons in the vicinity of a SCI in response to the injury, and after 3 and 6 weeks of treadmill exercise training. SCI alone exerted powerful effects on the intrinsic and synaptic properties of interneurons near the lesion. Importantly, synaptic activity, both local and descending, was preferentially enhanced by exercise training, suggesting that exercise promotes synaptic plasticity in spinal cord interneurons that are ideally placed to form new intraspinal circuits after SCI.ABSTRACT: Following incomplete spinal cord injury (SCI), collaterals sprout from intact and injured axons in the vicinity of the lesion. These sprouts are thought to form new synaptic contacts that effectively bypass the lesion epicentre and contribute to improved functional recovery. Such anatomical changes are known to be enhanced by exercise training; however, the mechanisms underlying exercise-mediated plasticity are poorly understood. Specifically, we do not know how SCI alone or SCI combined with exercise alters the intrinsic and synaptic properties of interneurons in the vicinity of a SCI. Here we use a hemisection model of incomplete SCI in adult mice and whole-cell patch-clamp recording in a horizontal spinal cord slice preparation to examine the functional properties of deep dorsal horn (DDH) interneurons located in the vicinity of a SCI following 3 or 6 weeks of treadmill exercise training. We examined the functional properties of local and descending excitatory synaptic connections by recording spontaneous excitatory postsynaptic currents (sEPSCs) and responses to dorsal column stimulation, respectively. We find that SCI in untrained animals exerts powerful effects on intrinsic, and especially, synaptic properties of DDH interneurons. Plasticity in intrinsic properties was most prominent at 3 weeks post SCI, whereas synaptic plasticity was greatest at 6 weeks post injury. Exercise training did not markedly affect intrinsic membrane properties; however, local and descending excitatory synaptic drive were enhanced by 3 and 6 weeks of training. These results suggest exercise promotes synaptic plasticity in spinal cord interneurons that are ideally placed to form new intraspinal circuits after SCI.Copyright 2014 The Authors. The Journal of Physiology 2014 The Physiological Society. Publication type: Journal Article Source: MEDLINE 21.Title: Heart rate variability in individuals with thoracic spinal cord injury. Citation: Spinal Cord, January 2015, vol./is. 53/1(59-63), 1362-4393;1476-5624 (2015 Jan) Author(s): Serra-Ano P, Montesinos LL, Morales J, Lopez-Bueno L, Gomis M, Garcia-Masso X, Gonzalez LM Language: English Abstract: STUDY DESIGN: Cross-sectional study.OBJECTIVES: The main goal of our study was to explore the differences in heart rate variability (HRV) while sitting between able-bodied (AB) participants and paraplegic (P) individuals.SETTING: The study was conducted in the Physical Therapy department and the Physical Education and Sports department of the University of Valencia and Vall d'Hebron Hospital.METHODS: To record the HRV, a 1000-Hz Suunto Oy t6 heart rate monitor was used. The data were analyzed in the temporal and frequency domains, and nonlinear analysis was performed as well.RESULTS: We found significant differences between P and AB participants in SDNN: t(76)=2.81, P<0.01; root mean squared of the difference of successive RR intervals: t(76)=2.35, P<0.05; very low frequency: t(76)=2.97, P<0.01; low frequency: t(41.06)=2.33, P<0.05; total power of the spectrum: t(45.74)=2.57, P<0.05; SD1: t(76)=2.35, P<0.05; SD2: t(76)=2.82, P<0.01. Furthermore, there is a reduced variability in the P participants who adopted a sedentary lifestyle as could be observed in detrended fluctuation1 t(40)=-2.10; P<0.05.CONCLUSION: Although individuals in the P group were more active in sports than the AB group, they had an altered HRV when compared with AB individuals. It could be important to develop more intense sports programs to improve cardiac vagal tone, which in turn produces a decrease in work and oxygen consumption of the heart. Publication type: Journal Article Source: MEDLINE Full text: Available Nature Publishing Group at Spinal Cord 22.Title: Incidence and the risk factors of spinal deformity in adult patient after spinal cord injury: a single center cohort study. Citation: European Spine Journal, January 2015, vol./is. 24/1(203-8), 0940-6719;1432-0932 (2015 Jan) Author(s): Yagi M, Hasegawa A, Takemitsu M, Yato Y, Machida M, Asazuma T Language: English Abstract: STUDY DESIGN: A retrospective consecutive case series of adult spinal cord injuries (SCIs) patients.OBJECTIVE: To assess the incidence and risk factors of spinal deformity in a large sample of patients with SCIs. Post-traumatic spinal deformities are well-recognized sequelae of SCIs. Despite the devastating complications for SCI patients with trunk imbalance, the incidence, clinical outcomes, and independent risk factors of scoliosis after SCI remain controversial.MATERIALS AND METHODS: We assessed 214 consecutive adult compressive SCI patients who were hospitalized in our hospital. We compared patients who developed spinal deformities with those who did not. Univariate and multivariate analyses to determine the independent risk factors were performed. Age, gender, etiology, ASIA grade (American Spinal Injury Association) surgery, and other demographic data were analyzed to determine the risk factors for developing a spinal deformity.RESULTS: The average patient age was 58.3 years (20-86 years). The etiology was trauma (n = 158), ossification of ligament (n = 22), infectious (n = 17), and others. One hundred fifty-two patients had cervical spine involved, 62 had thoracic spine involved. 26 patients classified as ASIA A, 54 were ASIA B, 96 were ASIA C, and 42 were ASIA D 4. One hundred thirty-five patients had either decompression or decompression and fusion surgery. The incidence of spinal deformities was 21 % (44/214). The mean Cobb angle was 28.9 degrees (13-38degree). ASIA grade and surgery predicted the occurrence of spinal deformity in both the univariate model (ASIA grade, OR: 1.59 [95 % CI: 1.04-2.44; P = 0.032]; Surgery, OR: 4.47 [95 % CI: 1.89-10.06; P = 0.0007]) and the multivariate model (ASIA grade, OR: 1.63 [95 % CI: 1.04-2.57; P = 0.033]; Surgery, OR: 4.59 [95 % CI: 1.91-11.04; P = 0.0006]), whereas surgery was the most important risk factor in the Cox model (HR: 3.50 [95 % CI: 1.56-7.88; P = 0.0025]).CONCLUSIONS: The SCI patients with high ASIA grades and those who had undergone surgery had a higher likelihood of developing a spinal deformity. Of these risk factors, surgery was the stronger risk factor. Publication type: Journal Article Source: MEDLINE 23.Title: Intrathecal injection of a therapeutic gene-containing polyplex to treat spinal cord injury. Citation: Journal of Controlled Release, January 2015, vol./is. 197/(1-9), 0168-3659;1873-4995 (2015 Jan 10) Author(s): Hayakawa K, Uchida S, Ogata T, Tanaka S, Kataoka K, Itaka K Language: English Abstract: Spinal cord injury (SCI) is a serious clinical problem that suddenly deprives patients of neurologic function and drastically diminishes their quality of life. Gene introduction has the potential to be effective for various pathological states of SCI because various proteins can be produced just by modifying nucleic acid sequences. In addition, the sustainable protein expression allows to maintain its concentration at an effective level at the target site in the spinal cord. Here we propose an approach using a polyplex system composed of plasmid DNA (pDNA) and a cationic polymer, poly{N'-[N-(2-aminoethyl)-2-aminoethyl]aspartamide} [PAsp(DET)], that has high capacity to promote endosome escape and the long-term safety by self-catalytically degrading within a few days. We applied brain-derived neurotrophic factor (BDNF)-expressing pDNA for SCI treatment by intrathecal injection of PAsp(DET)/pDNA polyplex. A single administration of polyplex for experimental SCI provided sufficient therapeutic effects including prevention of neural cell death and enhancement of motor function recovery. This lasted for a few weeks after SCI, demonstrating the capability of this system to express BDNF in a safe and responsible manner for treatment of various pathological states in SCI. Copyright 2014 Elsevier B.V. All rights reserved. Publication type: Journal Article Source: MEDLINE Spinal cord injury (SCI) is a serious clinical problem that suddenly deprives patients of neurologic function and drastically diminishes their quality of life. Gene introduction has the potential to be effective for various pathological states of SCI because various proteins can be produced just by modifying nucleic acid sequences. In addition, the sustainable protein expression allows to maintain its concentration at an effective level at the target site in the spinal cord. Here we propose an approach using a polyplex system composed of plasmid DNA (pDNA) and a cationic polymer, poly{N'-[N-(2-aminoethyl)-2-aminoethyl]aspartamide} [PAsp(DET)], that has high capacity to promote endosome escape and the long-term safety by self-catalytically degrading within a few days. We applied brain-derived neurotrophic factor (BDNF)-expressing pDNA for SCI treatment by intrathecal injection of PAsp(DET)/pDNA polyplex. A single administration of polyplex for experimental SCI provided sufficient therapeutic effects including prevention of neural cell death and enhancement of motor function recovery. This lasted for a few weeks after SCI, demonstrating the capability of this system to express BDNF in a safe and responsible manner for treatment of various pathological states in SCI. Copyright 2014 Elsevier B.V. All rights reserved. Publication type: Journal Article Source: MEDLINE Full text: Available Journal of controlled release : official journal of the Controlled Release Society at Journal of Controlled Release 24.Title: Knowledge, attitudes and practices of medical staff towards obesity management in patients with spinal cord injuries: an International survey of four western European countries. Citation: Spinal Cord, January 2015, vol./is. 53/1(24-31), 1362-4393;1476-5624 (2015 Jan) Author(s): Wong S, van Middendorp J, Belci M, van Nes I, Roels E, Smith E, Hirani SP, Forbes A Language: English Abstract: OBJECTIVE: To (1) examine the opinions of medical staff working in spinal cord injury (SCI) centres (SCICs); (2) evaluate their knowledge, attitudes and practices towards obesity prevention and management; (3) report the number of beds and dietitians available at each SCIC.METHODS: A 37-item questionnaire was sent to 23 SCICs in the UK, the Netherlands, Belgium and the Republic of Ireland between September 2012 and January 2013.RESULTS: Eighteen SCICs returned the questionnaires for analysis. All respondents stated that they had an interest in obesity treatment but only 2.3% of the respondents received training in obesity management. Sixty-one percent of staff did not consider body mass index (BMI) to be appropriate for use in SCI patients and subsequently less than half of the respondents use BMI routinely. The majority of respondents reported that they are confident in dealing with overweight (74.5%) and obese (66.1%) SCI adults, less than half (44.1%) are confident in treating overweight and obese SCI children. Respondents also indicated the need for nationally adopted guidelines and a lack of physical activity provision. There were 17.5 whole-time equivalent (WTE) dietitians recorded in 22 SCICs, equivalent to 47.8 beds per WTE dietitians (range 10-420). Non-UK SCIC dietitians are significantly better resourced than in UK SCICs (beds per WTE dietitian: 36 vs 124, P=0.035).CONCLUSION: Medical staff expressed the need to participate in obesity prevention and management. Appropriate training should be considered for all medical staff and the development of specific weight management guidelines and dietetic provision should be considered. Publication type: Journal Article Source: MEDLINE Full text: Available Nature Publishing Group at Spinal Cord 25.Title: Lean tissue mass and energy expenditure are retained in hypogonadal men with spinal cord injury after discontinuation of testosterone replacement therapy. Citation: Journal of Spinal Cord Medicine, January 2015, vol./is. 38/1(38-47), 1079-0268;1079-0268 (2015 Jan) Author(s): Bauman WA, La Fountaine MF, Cirnigliaro CM, Kirshblum SC, Spungen AM Language: English Abstract: Objective To determine whether favorable changes to lean tissue mass (LTM), resting energy expenditure (REE), and testosterone (T) that occurred with 12 months of physiological testosterone replacement therapy (TRT) were retained 6 months after discontinuing treatment. Design Prospective, open-label, controlled drug intervention trial. Setting Metropolitan area hospitals. Subjects Eugonadal (n = 11) and hypogonadal (n = 13) men with chronic spinal cord injury (SCI). Interventions Hypogonadal subjects received a 5 or 10 mg transdermal T patch daily for 12 months, with adjustment of the dose to normalize the serum T concentration; TRT was discontinued after 12 months (TRT-12M) and subjects were followed for an additional 6 months and re-evaluated (Post-TRT). Total body dual energy X-ray absorptiometry and blood draws were performed at baseline (BL) prior to TRT, TRT-12M, and Post-TRT. Eugonadal subjects did not receive treatment and were evaluated at comparable time points. Results There were no significant differences between groups prior to TRT at BL for any of the study endpoints. In the hypogonadal group, a significant increase in LTM was observed from BL to TRT12M (50.2 +/7.4 vs. 52.9 +/6.8 kg, P < 0.01), which persisted Post-TRT compared to BL (52.2 +/7.8 kg, P < 0.05). The increase in REE from BL to TRT-12M (1283 +/246 vs. 1410 +/250 kcal/day) was also retained at Post-TRT (1393 +/220 kcal/day). These sustained improvements in LTM and REE after termination of anabolic hormonal therapy may be associated with persistent beneficial effects on health and physical function of hypogonadal men with chronic SCI. Publication type: Journal Article Source: MEDLINE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 26.Title: Lifestyle changes and pressure ulcer prevention in adults with spinal cord injury in the pressure ulcer prevention study lifestyle intervention. Citation: American Journal of Occupational Therapy, January 2015, vol./is. 69/1(6901290020p1-6901290020p10), 02729490;1943-7676 (2015 Jan-Feb) Author(s): Ghaisas S, Pyatak EA, Blanche E, Blanchard J, Clark F, PUPS II Study Group Language: English Abstract: Pressure ulcers (PrUs) are a major burden to patients with spinal cord injury (SCI), affecting their psychological, physical, and social well-being. Lifestyle choices are thought to contribute to the risk of developing PrUs. This article focuses on the interaction between lifestyle choices and the development of PrUs in community settings among participants in the University of Southern California-Rancho Los Amigos National Rehabilitation Center Pressure Ulcer Prevention Study (PUPS II), a randomized controlled trial of a lifestyle intervention for adults with SCI. We conducted a secondary cross-case analysis of treatment notes of 47 PUPS II participants and identified four patterns relating PrU development to lifestyle changes: positive PrU changes (e.g., healing PrUs) with positive lifestyle changes, negative or no PrU changes with positive lifestyle changes, positive PrU changes with minor lifestyle changes, and negative or no PrU changes with no lifestyle changes. We present case studies exemplifying each pattern. Copyright 2015 by the American Occupational Therapy Association, Inc. Publication type: Journal Article Source: MEDLINE Full text: Available ProQuest at American Journal of Occupational Therapy, The 27.Title: Low-energy extracorporeal shock wave therapy promotes vascular endothelial growth factor expression and improves locomotor recovery after spinal cord injury. Citation: Journal of Neurosurgery, December 2014, vol./is. 121/6(1514-25), 0022-3085;1933-0693 (2014 Dec) Author(s): Yamaya S, Ozawa H, Kanno H, Kishimoto KN, Sekiguchi A, Tateda S, Yahata K, Ito K, Shimokawa H, Itoi E Language: English Abstract: OBJECT: Extracorporeal shock wave therapy (ESWT) is widely used for the clinical treatment of various human diseases. Recent studies have demonstrated that low-energy ESWT upregulates the expression of vascular endothelial growth factor (VEGF) and promotes angiogenesis and functional recovery in myocardial infarction and peripheral artery disease. Many previous reports suggested that VEGF produces a neuroprotective effect to reduce secondary neural tissue damage after spinal cord injury (SCI). The purpose of the present study was to investigate whether low-energy ESWT promotes VEGF expression and neuroprotection and improves locomotor recovery after SCI.METHODS: Sixty adult female Sprague-Dawley rats were randomly divided into 4 groups: sham group (laminectomy only), sham-SW group (low-energy ESWT applied after laminectomy), SCI group (SCI only), and SCI-SW group (low-energy ESWT applied after SCI). Thoracic spinal cord contusion injury was inflicted using an impactor. Low-energy ESWT was applied to the injured spinal cord 3 times a week for 3 weeks. Locomotor function was evaluated using the Basso, Beattie, and Bresnahan (BBB) Scale (open field locomotor score) at different time points over 42 days after SCI. Hematoxylin and eosin staining was performed to assess neural tissue damage in the spinal cord. Neuronal loss was investigated by immunostaining for NeuN. The mRNA expressions of VEGF and its receptor, Flt-1, in the spinal cord were assessed using real-time polymerase chain reaction. Immunostaining for VEGF was performed to evaluate VEGF protein expression in the spinal cord.RESULTS: In both the sham and sham-SW groups, no animals showed locomotor impairment on BBB scoring. Histological analysis of H & E and NeuN stainings in the sham-SW group confirmed that no neural tissue damage was induced by the low-energy ESWT. Importantly, animals in the SCI-SW group demonstrated significantly better locomotor improvement than those in the SCI group at 7, 35, and 42 days after injury (p < 0.05). The number of NeuN-positive cells in the SCI-SW group was significantly higher than that in the SCI group at 42 days after injury (p < 0.05). In addition, mRNA expressions of VEGF and Flt-1 were significantly increased in the SCI-SW group compared with the SCI group at 7 days after injury (p < 0.05). The expression of VEGF protein in the SCI-SW group was significantly higher than that in the SCI group at 7 days (p < 0.01).CONCLUSIONS: The present study showed that low-energy ESWT significantly increased expressions of VEGF and Flt-1 in the spinal cord without any detrimental effect. Furthermore, it significantly reduced neuronal loss in damaged neural tissue and improved locomotor function after SCI. These results suggested that low-energy ESWT enhances the neuroprotective effect of VEGF in reducing secondary injury and leads to better locomotor recovery following SCI. This study provides the first evidence that low-energy ESWT can be a safe and promising therapeutic strategy for SCI. Publication type: Journal Article, Research Support, Non-U.S. Gov't Source: MEDLINE 28.Title: Medical complications and falls in patients with spinal cord injury during the immediate phase after completing a rehabilitation program. Citation: Journal of Spinal Cord Medicine, January 2015, vol./is. 38/1(84-90), 1079-0268;1079-0268 (2015 Jan) Author(s): Wannapakhe J, Arrayawichanon P, Saengsuwan J, Amatachaya S Language: English Abstract: Background/objectives Complications and falls are crucial problems in patients with spinal cord injury (SCI). However, existing evidence on complications comes from data from hospital records over a long period of time, and falls were mostly reported retrospectively in patients with incomplete SCI. This study prospectively explored the occurrence of complications and falls, and associated factors in patients with SCI during the 6 months after discharge. Methods One hundred subjects with SCI (50 wheelchair-bound (WB) and 50 ambulatory (AM) subjects) from a tertiary rehabilitation center completed the study. Every month, subjects were monitored for data on medical complications and falls. Descriptive information is provided for each group. Results Every WB subject had complications and 14 subjects were rehospitalized. The most frequent complications found in these subjects were neurogenic pain (36 subjects), urinary tract infection (UTI) (25 subjects), and pressure ulcers (21 subjects). In AM subjects, 38 subjects (76%) experienced complications and 3 subjects needed re-hospitalization. The most frequent complications included neurogenic pain (35 subjects) and UTI (11 subjects). Eighteen WB subjects (36%) and 27 AM subjects (54%) experienced falls. WB subjects had significantly increased odds for incidence of UTI and pressure ulcers, whereas AM subjects had significantly greater odds for falls (P < 0.05). Conclusion A number of subjects with SCI experienced complications and falls after completing a rehabilitation program. The findings add to our knowledge about complications and falls after SCI, and confirm the importance of effective strategies to minimize the occurrence of complications and falls in these individuals. Publication type: Journal Article Source: MEDLINE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 29.Title: Midodrine in patients with spinal cord injury and anejaculation: A double-blind randomized placebo-controlled pilot study. Citation: Journal of Spinal Cord Medicine, January 2015, vol./is. 38/1(57-62), 1079-0268;1079-0268 (2015 Jan) Author(s): Leduc BE, Fournier C, Jacquemin G, Lepage Y, Vinet B, Hetu PO, Chagnon M Language: English Abstract: Objective The objective of this study is to evaluate the efficacy of midodrine in the treatment of anejaculation in men with spinal cord injury (SCI). Study design Prospective, double-blind, randomized, placebo-controlled pilot study. Method Men with anejaculation associated with SCI (level of injury above T10) of more than 1 year in duration were approached. Those with no ejaculatory response to one penile vibratory stimulation (PVS) trial were assigned in a doubleblind manner to one of the two following interventions once a week for a maximum of 3 weeks or until ejaculation occurred: oral administration of flexible midodrine (7.5-22.5 mg max) followed by PVS (group M), or oral administration of flexible sham-midodrine (placebo) followed by PVS (group P). Sociodemographic data, medical characteristics, and plasma desglymidodrine concentration were collected for all participants. Outcome measure Ejaculation success rate in each group. Results Among the 78 men approached, 23 participants (level of SCI: C4-T9) were randomized. Three participants abandoned the study and 20 completed the study; 10 were assigned to group M, 10 to group P. Ejaculation was reached for one participant of group M and for two participants of group P. Autonomic dysreflexia associated to PVS occurred in three patients. Conclusion In this small sample study, treatment of anejaculation after SCI with midodrine and PVS did not result in a better rate of antegrade ejaculation in 10 men than in 10 men treated with a placebo and PVS. Publication type: Journal Article Source: MEDLINE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 30.Title: Nerve transfers for elbow and finger extension reconstruction in midcervical spinal cord injuries. Citation: Journal of Neurosurgery, January 2015, vol./is. 122/1(121-7), 0022-3085;1933-0693 (2015 Jan) Author(s): Bertelli JA, Ghizoni MF Language: English Abstract: OBJECT The objective of this study was to report the results of elbow, thumb, and finger extension reconstruction via nerve transfer in midcervical spinal cord injuries. METHODS Thirteen upper limbs from 7 patients with tetraplegia, with an average age of 26 years, were operated on an average of 7 months after a spinal cord injury. The posterior division of the axillary nerve was used to reinnervate the triceps long and upper medial head motor branches in 9 upper limbs. Both the posterior division and the branch to the middle deltoid were used in 2 upper limbs, and the anterior division of the axillary nerve in the final 2 limbs. For thumb and finger extension reconstruction, the nerve to the supinator was transferred to the posterior interosseous nerve. RESULTS In 22 of the 27 recipient nerves, a peripheral type of palsy with muscle denervation was identified. At an average of 19 months follow-up, elbow strength scored M4 in 11 upper limbs and M3 in 2, according to the British Medical Research Council scale. Thumb extension scored M4 in 8 upper limbs and scored M3 in 4. Finger extension scored M4 in 12 hands. No donor-site deficits were reported or observed. CONCLUSIONS Nerve transfers are effective at restoring elbow, thumb, and finger extension in patients with a midcervical spinal cord injury, which occurs in the majority of patients with a peripheral type of palsy with muscle denervation in their upper limbs. Efforts should be made to perform operations in these patients within 12 months of injury. Publication type: Journal Article Source: MEDLINE 31.Title: Neuroplasticity of imagined wrist actions after spinal cord injury: a pilot study. Citation: Experimental Brain Research, January 2015, vol./is. 233/1(291-302), 0014-4819;1432-1106 (2015 Jan) Author(s): Di Rienzo F, Guillot A, Mateo S, Daligault S, Delpuech C, Rode G, Collet C Language: English Abstract: Motor imagery (MI i.e., the mental representation of an action without physically executing it) stimulates brain motor networks and promotes motor learning after spinal cord injury (SCI). An interesting issue is whether the brain networks controlling MI are being reorganized with reference to spared motor functions. In this pilot study, we tested using magnetoencephalography (MEG) whether changes in cortical recruitment during MI were related to the motor changes elicited by rehabilitation. Over a 1-year period of inclusion, C6 SCI participants (n = 4) met stringent criteria for inclusion in a rehabilitation program focused on the tenodesis prehension (i.e., a compensatory prehension enabling seizing of objects in spite of hand and forearm muscles paralysis). After an extended baseline period of 5 weeks including repeated MEG and chronometric assessments of motor performance, MI training was embedded to the classical course of physiotherapy for five additional weeks. Posttest MEG and motor performance data were collected. A group of matched healthy control participants underwent a similar procedure. The MI intervention resulted in changes in the variability of the wrist extensions, i.e., a key movement of the tenodesis grasp (p < .05). Interestingly, the extent of cortical recruitment, quantified by the number of MEG activation sources recorded within Brodmann areas 1-8 during MI of the wrist extension, significantly predicted actual movement variability changes across sessions (p < .001). However, no such relationship was present for movement times. Repeated measurements afforded a reliable statistical power (range .70.97). This pilot study does not provide straightforward evidence of MI efficacy, which would require a randomized controlled trial. Nonetheless, the data showed that the relationship between action and imagery of spared actions may be preserved after SCI. Publication type: Journal Article