Hypertensive Intracerebral Hemorrhage Due to Autonomic Dysreflexia in a Young Man With Cervical Cord Injury.

Hypertensive intracerebral hemorrhage due to autonomic dysreflexia in a young man with cervical cord injury.

J UOEH. 2013 Jun; 35(2): 159-64
Sumiya T

The author reports the case of a 36 year old man with cervical cord injury in whom autonomic dysreflexia developed into intracerebral hemorrhage during inpatient rehabilitation. This patient showed complete quadriplegia (motor below C6 and sensory below C7) due to fracture of the 6th cervical vertebra. An indwelling urethral catheter had been inserted into the bladder for 3 months, diminishing bladder expansiveness. Bladder capacity decreased to 200 ml and the patient frequently experienced headaches whenever his bladder was full.To obtain smoother urine flow, a supra-pubic cystostomy was performed. The headaches were temporarily cured, but soon relapsed with extreme increases in blood pressure, representing typical symptoms of autonomic dysreflexia. However, no potential triggers were identified or removed, and lack of blood pressure management led to left putaminal hemorrhage. Despite operative treatment, the right upper extremity showed progressive increases in muscle tonus and finally formed a frozen shoulder with elbow flexion contracture. Two factors contributed to this serious complication: first, autonomic dysreflexia triggered by minor malfunction and/or irritation from the cystostomy catheter; and second, the medical staff lacked sufficient experience in and knowledge about the management of autonomic dysreflexia.It is of the utmost importance for medical staff engaging in rehabilitation of spinal patients to share information regarding triggers of autonomic dysreflexia and to be thorough in ensuring proper medical management. HubMed – rehab

Thinking Through Every Step: How People With Spinal Cord Injuries Relearn to Walk.

Qual Health Res. 2013 Jun 17;
Jordan MM, Berkowitz D, Hannold E, Velozo CA, Behrman AL

In this article we explore how people with incomplete spinal cord injury (iSCI) create meaning out of their changing bodies as they undergo a therapeutic intervention called locomotor training (LT). Therapeutic interventions like LT are used to promote the recovery of walking ability among individuals with iSCI. The chronological nature of this study-interviews at three points throughout the 12-week intervention-enhances understanding of the recovering self after spinal cord injury. Drawing on a constructivist theoretical framework, we organize data according to three narrative frames. Participants interpreted LT as (a) a physical change that was meaningful because of its social significance, (b) a coping strategy for dealing with the uncertainty of long-term recovery, and (c) a moral strategy to reconstitute the self. We offer findings that lay the conceptual groundwork for generating new knowledge about what is important to people with iSCI as they relearn how to walk. HubMed – rehab

T2 Texture Index of Cartilage Can Predict Early Symptomatic OA Progression: Data from the Osteoarthritis Initiative.

Osteoarthritis Cartilage. 2013 Jun 14;
Urish KL, Keffalas MG, Durkin JR, Miller DJ, Chu CR, Mosher TJ

OBJECTIVE: There is an interest in using Magnetic Resonance Imaging (MRI) to identify pre-radiographic changes in osteoarthritis (OA) and features that indicate risk for disease progression. The purpose of this study is to identify image features derived from MRI T2 maps that can accurately predict onset of OA symptoms in subjects at risk for incident knee OA. METHODS: Patients were selected from the Osteoarthritis Initiative (OAI) control cohort and incidence cohort and stratified based on the change in total WOMAC score from baseline to three year follow-up (80 non-OA progression and 88 symptomatic OA progression patients). For each patient, a series of image texture features were measured from the baseline cartilage T2 map. A linear discriminant function and feature reduction method was then trained to quantify a texture metric, the T2 texture index of cartilage (TIC), based on 22 image features, to identify a composite marker of T2 heterogeneity. RESULTS: Statistically significant differences were seen in the baseline T2 TIC between the non-progression and symptomatic OA progression populations. The baseline T2 TIC differentiates subjects that develop worsening of their WOMAC score OA with an accuracy between 71% and 76%. The T2 TIC differences were predominantly localized to a dominant knee compartment that correlated with the mechanical axis of the knee. CONCLUSION: Baseline heterogeneity in cartilage T2 as measured with the T2 TIC index is able to differentiate and predict individuals that will develop worsening of their WOMAC score at 3-year follow-up. HubMed – rehab

Walking ability and quality of life in subjects with transfemoral amputation: a comparison of osseointegration with socket prostheses.

Arch Phys Med Rehabil. 2013 Jun 14;
Van de Meent H, Hopman MT, Frölke JP

OBJECTIVE: To investigate walking ability and quality of life of osseointegrated leg prostheses compared to socket prostheses. DESIGN: Prospective case-control study SETTING: University Medical Centre PARTICIPANTS: Twenty two subjects with transfemoral amputation (one bilateral) referred to our centre because of socket related skin and residual limb problems resulting in limited prosthesis use, mean age 46.5 yrs (23-67 yrs) mean time since amputation 16.4 yrs (2-45 yrs). Cause of amputation: trauma (n=20), tumor (n=2). INTERVENTION: Implantation of an osseointegration prosthesis (OIP) MAIN OUTCOME MEASURES: Global score of the Questionnaire for persons with a Transfemoral Amputation (Q-TFA), prosthesis use, six minute walk test (6MWT), timed up and go test (TUG) and oxygen consumption during treadmill walking. RESULTS: With the socket prosthesis the Q-TFA global score, prosthesis use, 6MWT, TUG and oxygen consumption were; 39 points (SD 4.7), 56 hours per week (SD 7.9), 321 m (SD 28), 15.1 s (SD 2.1) and 1330 ml/min (SD 310), respectively, and significantly improved with OIP to 63 points (SD 5.3), 101 hours per week (SD 2.4), 423 m (SD 21), 8.1 s (SD 0.7) and 1093 ml/min (SD 361), respectively. CONCLUSIONS: Osseointegration is a suitable intervention for persons that suffer from reduced prosthesis use as a result of socket related problems. Subjects with OIP significantly increased their walking ability and prosthesis related quality of life. HubMed – rehab

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