Category: Research and Articles

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Long-term followup of renal function after spinal cord injury.

date: 09/01/1985
author: Kuhlemeier KV, Lloyd LK, Stover SL.
publication: J Urol. 1985 Sep;134(3):510-3.
pubmed_ID: 4032551

Effective renal plasma flow was measured in acute spinal cord injury patients for up to 10 years after injury to determine the extent of renal deterioration in these patients and to identify the factors associated with a loss of renal function. The over-all mean decrease in effective renal plasma flow for all patients as a whole was 4.5 ml. per year. Factors associated with a statistically significant reduction in effective renal plasma flow included age, gender, renal calculi, quadriplegia, and a history of chills and fever. Other factors examined but not found to be statistically significant included years since injury, presence of severe decubiti, bladder calculi, bacteriuria and extent of injury. This study suggests that renal function usually can be preserved in spinal cord injury patients if the treatable risk factors are managed properly.

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Lower extremity functional neuromuscular stimulation in cases of spinal cord injury.

date: 07/15/1984
author: Cybulski GR, Penn RD, Jaeger RJ.
publication: Neurosurgery. 1984 Jul;15(1):132-46.
pubmed_ID: 6382044
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/6382044
Functional neuromuscular stimulation (FNS) provides a mechanism for the activation of muscles paralyzed by injury to the spinal cord. Although this technique was first used to treat patients with spinal cord injury over 20 years ago, only recent advances in electronics and biomechanics have made it a promising aid for the rehabilitation of these patients. Thus far, restoration of palmar prehension and lateral prehension in quadriplegics and of standing and biped gait in paraplegics has been achieved under carefully controlled laboratory conditions. This article reviews the current status of FNS and its potential as a practical tool to aid spinal cord-injured patients. Neurosurgeons who care for these patients might be expected to be involved in the future use of FNS if implantable systems are developed and tested.

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Estimating the user population of a simple electrical stimulation system for standing.

date: 10/01/1990
author: Jaeger RJ, Yarkony GM, Roth EJ, Lovell L.
publication: Paraplegia. 1990 Oct;28(8):505-11
pubmed_ID: 2263407
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/2263407
Many laboratory demonstrations have been reported on standing or walking with the aid of electrical stimulation. These demonstrations have typically been in small numbers of selected spinal cord injured individuals. The extent to which this technology might ultimately be applicable to the spinal cord injured population at large is not presently known. This study reports estimates of the size of the potential user population of a specific surface electrical stimulation device and protocol. The medical records were reviewed of 192 patients with traumatic thoracic, lumbar, or sacral spinal cord injury resulting in paraplegia. Based on the inclusionary criteria, between 20 and 48 patients (10.4% and 25%) of this sample population could be considered eligible for this surface stimulation protocol. As approximately 45% of the USA population of spinal cord injured individuals have paraplegia, the results suggest that between 4.7% and 11.25% of all spinal cord injured persons in the USA might be potential users of this particular electrical stimulation technology.

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Cardiorespiratory fitness and muscular strength of wheelchair users.

date: 12/15/1981
author: Davis GM, Kofsky PR, Kelsey JC, Shephard RJ.
publication: Can Med Assoc J. 1981 Dec 15;125(12):1317-23.
pubmed_ID: 6459841

The classification of lower-limb disabilities is commonly based on the site of the spinal cord lesion or the amount of functional muscle. Another important variable in assessing wheelchair users is their ability to carry out the activities of daily living. The cardiorespiratory fitness of those with lower-limb disabilities is usually assessed with arm-ergometry and wheelchair tests, each of which has some advantages. Muscle strength and endurance are also important aspects of the disabled person’s ability to function. Fitness is often poor in the disabled, and normal wheelchair use does not seem to prove an adequate training stimulus. Exercise with an arm ergometer and with pulleys and participation in vigorous wheelchair sports can improve physical condition. Participation in exercise programs should be based on the results of a fitness assessment and on the level of the spinal cord lesion in those with paraplegia. Progression in such programs should be gradual to ensure that the exerciser does not become discouraged and drop out of classes before fitness is increased. Data on wheelchair athletes suggest that, with persistence, many individuals in wheelchairs can adjust relatively well to their disabilities.

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Functional neuromuscular stimulation for standing after spinal cord injury.

date: 03/01/1900
author: Yarkony GM, Jaeger RJ, Roth E, Kralj AR, Quintern J.
publication: Arch Phys Med Rehabil. 1990 Mar;71(3):201-6.
pubmed_ID: 2317138
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/2317138
A study was undertaken to determine if functional neuromuscular stimulation could be used to obtain standing in patients with traumatic spinal cord injury. Twenty-five subjects were selected during the study, and standing was accomplished in 21 using bilateral quadriceps stimulation with the hips in hyperextension. Four subjects elected not to continue participation to the point of standing. Stimulation parameters were 0 to 120V pulse amplitude, frequency 13Hz or 20Hz, and pulse width of 0.4msec. Confirmation of standing with support of 95% of the body weight by the legs was verified by quantitative measurements with a dual-scale force platform or a biomechanics force platform. Subjects initially selected had injury levels between C7 and T11 and ranged in age from 22 to 47 years, with duration of injury from one to 13 years. The subjects had complete lesions, with no active motor function below the last normal level, and absent sensation or partial sparing of sensation with vague perception of pinprick, but no position sense. Six subjects stood at home and 15 stood only in the laboratory. This five-year experience indicates that paraplegic individuals may obtain standing with functional neuromuscular stimulation.

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Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury.

date: 11/01/2001
author: Faghri PD, Yount JP, Pesce WJ, Seetharama S, Votto JJ.
publication: Arch Phys Med Rehabil. 2001 Nov;82(11):1587-95
pubmed_ID: 11689980
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/11689980
OBJECTIVE: To evaluate the effects of functional electric stimulation (FES) of lower limb muscles during 30 minutes of upright standing on the central and peripheral hemodynamic response in persons with spinal cord injury (SCI). DESIGN: A repeated-measure design. Subjects were used as their own control and underwent 2 testing protocols of FES-augmented standing (active standing) and non-FES standing (passive standing). SETTING: Rehabilitation hospital. PARTICIPANTS: Fourteen individuals with SCI (7 with tetraplegia, 7 with paraplegia). INTERVENTIONS: During active standing, FES was administered to 4 muscle groups of each leg in an overlapping fashion to produce a pumping mechanism during standing. During passive standing, subjects stood for 30 minutes using a standing frame with no FES intervention. MAIN OUTCOME MEASURES: Central hemodynamic responses of stroke volume, cardiac output, heart rate, arterial blood pressure, total peripheral resistance (TPR), and rate pressure product (RPP) were evaluated by impedance cardiography. All measurements were performed during supine and sitting positions before and after standing, and during 30 minutes of upright standing. RESULTS: Comparisons between the groups with paraplegia and tetraplegia showed a significant increase in heart rate in the paraplegics after 30 minutes of active standing. During active standing, paraplegics’ heart rate increased by 18.2% (p = .015); during passive standing, it increased by 6% (p = .041). TPR in the tetraplegics significantly (p = .003) increased by 54% when compared with the paraplegics during passive standing. Overall, the tetraplegic group had a significantly lower systolic blood pressure (p = .013) and mean arterial pressure (p = .048) than the paraplegics during passive standing. These differences were not detected during active standing. When data were pooled from both groups and the overall groups response to active and passive standing were compared, the results showed that cardiac output, stroke volume, and blood pressure significantly decreased (p < .05) during 30 minutes of passive standing, whereas TPR significantly increased (p < .05). All of the hemodynamic variables were maintained during 30 minutes of active standing, and there were increases in RPP and heart rate after 30 minutes of active standing. CONCLUSION: FES of the lower extremity could be used by persons with SCI as an adjunct during standing to prevent orthostatic hypotension and circulatory hypokinesis. This effect may be more beneficial to those with tetraplegia who have a compromised autonomic nervous system and may not be able to adjust their hemodynamics to the change in position. Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

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Calcium balance in paraplegic patients: influence of injury duration and ambulation.

date: 10/01/1978
author: Kaplan PE, Gandhavadi B, Richards L, Goldschmidt J.
publication: Arch Phys Med Rehabil. 1978 Oct;59(10):447-50.
pubmed_ID: 718407

Calcium metabolic balance determinations, which have been done in various clinical and experimental conditions, were applied to the study of 8 spinal cord injured patients receiving a diet with 1600 mg calcium and 85 to 120 gm protein daily. All of the patients had hypercalciuria prior to ambulation. Those with spinal cord injuries of less than 3 months duration (early group) had a calcium balance of -27 mg before ambulation and 235 mg after ambulation. Patients with spinal cord injuries of 6 months or more duration (late group) had calcium balances of 55 mg before ambulation and 175 mg after ambulation. Ambulation significantly decreased the hypercalciuria and modified the calcium balance in a positive direction. Smaller changes were noted in the responses of the late group than in those of the early group. Early ambulation will probably prevent bone loss, calcium stones in the genitourinary tract, and other sequellae of negative calcium balance.

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The effect of a weight-bearing physical activity program on bone mineral content and estimated volumetric density in children with spastic cerebral palsy.

date: 07/01/1999
author: Chad KE, Bailey DA, McKay HA, Zello GA, Snyder RE.
publication: J Pediatr 1999 Jul;135(1):115-7.
pubmed_ID: 10393617

After an 8-month physical activity intervention in children with cerebral palsy, increases in femoral neck bone mineral content (BMC) (9.6%), volumetric bone mineral density (v BMD) (5.6%), and total proximal femur BMC (11.5%) were observed in the intervention group (n = 9) compared with control subjects (n = 9; femoral neck BMC, -5. 8%; v BMD, -6.3%; total proximal femur BMC, 3.5%).

Publication Types:
? Clinical Trial
? Randomized Controlled Trial

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Bone mineral status in paraplegic patients who do or do not perform standing.

date: 05/01/1994
author: Goemaere S, Van Laere M, De Neve P, Kaufman JM.
publication: Osteoporos Int. 1994 May;4(3):138-43.
pubmed_ID: 8069052
:
Bone mineral density (BMD) was assessed by dual-photon X-ray absorptiometry at the lumbar spine (L3, L4), the proximal femur and the femoral shaft, and by single-photon absorptiometry at the forearm in 53 patients with complete traumatic paraplegia of at least 1 year’s duration and in age- and sex-matched healthy controls. The patients did (n = 38) or did not (n = 15) regularly perform passive weightbearing standing with the aid of a standing device. Compared with the controls, the BMD of paraplegic patients was preserved in the lumbar spine and was markedly decreased in the proximal femur (33%) and the femoral shaft (25%). When considering all patients performing standing, they had a better-preserved BMD at the femoral shaft (p = 0.009), but not at the proximal femur, than patients not performing standing. BMD at the lumbar spine (L3, L4) was marginally higher in the standing group (significant only for L3; p = 0.040). A subgroup of patients performing standing with use of long leg braces had a significantly higher BMD at the proximal femur than patients using a standing frame or a standing wheelchair (p = 0.030). The present results suggest that passive mechanical loading can have a beneficial effect on the preservation of bone mass in osteoporosis found in paraplegics.