Epidemiology of post-traumatic spinal cord injury in a tertiary hospital / Epidemiologia do lesado medular pós-traumático em um hospital terciário

ABSTRACT Objective: to outline the profile of risk groups for spinal cord injury (SCI) at the Hospital de Clinicas de Campinas by an epidemiological survey of 41 patients with SCI. Methods: Data from patients with SCI were collected and analyzed: demographic data, level of neurological injury, visual analogue scale (VAS), and the current American Spinal Injury Association (ASIA) impairment scale (AIS), using questionnaires, medical records, and imaging tests. Fisher's exact test was used to assess the relationship between categorical variables, Spearman's correlation coefficient was used for numerical variables, and the Mann-Whitney and Kruskal-Wallis tests were used to analyze the relationship between categorical and numerical variables, with significance level of 5%. Results: There was a prevalence of 82.9% of men, a mean age of 26.5 years, and traffic accidents as the cause of SCI in 56.1% of cases. Conclusion: Results suggest the importance of SCI prevention campaigns directed at this population. Level of Evidence II, Retrospective Study.

RESUMO Objetivo: Traçar o perfil dos grupos de risco para trauma raquimedular (TRM) do Hospital das Clínicas de Campinas através de levantamento epidemiológico de 41 pacientes vítimas de TRM. Métodos: Foram coletados e analisados dados demográficos, nível da lesão neurológica, escala visual analógica (EVA) e American Spinal Injury Association impairment scale (AIS) atuais, através da aplicação de questionários, análise de prontuários e de exames de imagem. Para avaliar a relação entre as variáveis categóricas foi utilizado o teste exato de Fisher; para as variáveis numéricas foi utilizado o coeficiente de correlação de Spearman; e para a análise da relação entre variáveis categóricas e numéricas foram utilizados os testes de Mann-Whitney e Kruskal-Wallis, adotando nível de significância de 5%. Resultados: Houve prevalência de 82,9% do sexo masculino, média de idade de 26,5 anos e de 56,1% casos de TRM causados por acidente automobilístico. Conclusão: Os resultados sugerem a importância da realização de campanhas de prevenção ao TRM voltadas para essa população. Nível de Evidência II, Estudo Retrospectivo.

Intraoral device for sociodigital inclusion of patient with quadriplegia / Dispositivo intraoral para inclusão sócio-digital de paciente com tetraplegia

Introduction: The use of computers, tablets, and cell phones with the Internet by people with quadriplegia from spinal cord injuries is much lower when compared to the general population. The quality of life of these people can be substantially improved through access to these technologies, which would allow a quadriplegic to take advantage of the rapid evolution of information and communication. Many of these individuals have the function of preserved neck and mouth muscles, and it is possible to manipulate intraoral devices as an adaptation tool. Case Report: We report an intraoral device installation in a patient with quadriplegia, a victim of a firearm accident, who had a great desire to reuse the tablet for internet access. A device made of acrylic resin, similar to a myorelaxant plate, was designed to allow the use of a computer that was comfortable and at the same time, the patient could talk and not harm the dental structures. The person responsible agreed to participate in the research and signed the consent form. In addition, the work was submitted to an ethics committee. Considerations: The ideal intra-oral device for patient rehabilitation should be inexpensive, easy to adapt and promote muscle relaxation besides allowing the patient to expand their abilities and digitally increase their autonomy for society.

Introdução: O uso de computadores, tablets e celulares com internet por pessoas com tetraplegia por lesão medular é muito menor quando comparado à população geral. A qualidade de vida dessas pessoas pode ser, substancialmente, melhorada por meio do acesso a essas tecnologias, o que permitiria aos tetraplégicos aproveitar a rápida evolução da informação e da comunicação. Muitos desses indivíduos têm a função de músculos cervicais e bucais preservados, sendo possível a manipulação de dispositivos intraorais como ferramenta de adaptação. Relato de Caso: Relatamos a instalação de um dispositivo intraoral em um paciente com tetraplegia, vítima de acidente com arma de fogo, que tinha grande desejo de reutilizar o tablet para acesso à internet. Um dispositivo feito de resina acrílica, semelhante a uma placa miorrelaxante, foi projetado para permitir o uso de um computador que fosse confortável e, ao mesmo tempo, o paciente pudesse falar e não prejudicar as estruturas dentárias. O responsável concordou em participar da pesquisa e assinou o termo de consentimento. Além disso, o trabalho foi submetido a um comitê de ética. Considerações: O dispositivo intraoral ideal para a reabilitação do paciente deve ser barato, de fácil adaptação e promover o relaxamento muscular, além de permitir que o paciente amplie suas habilidades e aumente sua autonomia pessoal, digitalmente para a sociedade.

Eficácia da terapia a laser de tecidos profundos na cicatrização de úlceras por pressão em paciente com tetraplegia: relato de caso / Efficacy of deep tissue laser therapy in pressure ulcer healing in patient with quadriplegia: Case Report

CONTEXTO: Úlceras por pressão (UP) são a complicação mais comum observada em pacientes acamados. O objetivo deste relato de caso é explorar a eficácia da terapia a laser no infravermelho próximo de classe IV no tratamento de úlceras de pressão grandes e graves. DADOS: Um homem de 53 anos com diagnóstico de tetraplegia devido à tuberculose da coluna cervical no nível C5-C6 foi admitido em um hospital com úlcera por pressão instável sobre o sacro e úlceras de pressão do National Pressure Ulcer Advisory Panel estágio 3 sobre a área trocantérica direita para lesão por pressão. Não havia comorbidades associadas, como diabetes mellitus e hipertensão. Utilizou-se o Lite Cure Gallium-Aluminium-Arsenide (GaAlAs) classe IV laser próximo ao infravermelho, sem contato, emissão de feixe contínuo (não pulsante) no comprimento de onda de 980 nm. Os parâmetros de dosagem usados foram: 7,5 - 10 watts de potência; faixa de dosagem 7 J / cm2 - 9 J / cm2; área sacral (13 × 9) cm2 e área trocantérica (10 × 8) cm2; em diferentes densidades de energia; o tempo de tratamento varia entre 8 a 15 minutos para cada úlcera. No total, 19 sessões durante um período de 6 semanas foram administradas para tratar úlceras de pressão. Dimensões (área) e estágio de gravidade da úlcera por pressão foram anotados antes da intervenção e após a conclusão da intervenção. Os dados pós-tratamento revelaram melhora clínica em ambos os desfechos. CONCLUSÃO / SIGNIFICADO CLÍNICO: Este relato de caso demonstra um efeito anti-inflamatório, analgésico e bioestimulante de cicatrização do tratamento com laserterapia Classe IV, apresentando redução nas dimensões e gravidade das úlceras por pressão.

CONTEXT: Pressure ulcers (PU) are the most common complication noted in bed-ridden patients. The purpose of this case report is to explore the efficacy of class IV near-infrared laser therapy in the treatment of large and severe pressure ulcers. FINDINGS: A 53-years-old male diagnosed with quadriplegia due to cervical spine tuberculosis at level C5- C6 was admitted to a hospital with an unstageable pressure ulcer over the sacrum and National Pressure Ulcer Advisory Panel Pressure stage 3 ulcers over the right trochanteric area for pressure injury. No associated comorbidities like diabetes mellitus and hypertension were present. The Lite Cure Gallium-Aluminum-Arsenide (GaAlAs) class IV near-infrared laser, non-contact, continuous beam emission (non-pulsing) at 980nm wavelength, was used. The dosage parameters used were: 7.5 - 10 watts power; dose range 7 J/cm2 - 9 J/cm2; sacral area (13×9) cm2 and trochanteric area (10×8) cm2; at varying energy densities; treatment time ranges between 8 to 15 minutes for each ulcer. Total 19 sessions over 6 weeks were given to treat pressure ulcers. Dimensions (area) and severity stage of pressure ulcer were noted pre-intervention and after the intervention. The post-treatment data revealed the clinical improvement in both outcomes. CONCLUSION/ CLINICAL SIGNIFICANCE: This case report demonstrates the anti-inflammatory, analgesic, and bio-stimulative healing effects of Class IV laser therapy treatment showing a reduction in the dimensions and severity of pressure ulcers.

Identification and relationship of quality of life and self-care ability among Chinese patients with traumatic spinal cord injuries: a cross-sectional analysis

Improving the quality of life of patients with complete spinal cord injuries is an urgent objective of the Chinese Department of Health. For better management of spinal cord injuries, it is necessary to understand the background of the patients. A total of 392 patients aged ≥18 years with traumatic spinal cord injuries (≥1 year of history) were attending the rehabilitation center of the Institutes. A total of 7 (2%) patients reported low quality of life, 200 (51%) patients reported moderate quality of life, 181 (46%) patients reported good quality of life, and 4 (1%) patients reported excellent quality of life. Male patients (P=0.042), patients with college or more education (P=0.039), incomplete spinal cord injuries (P=0.045), paraplegia (P=0.046), and absence of pressure injury (P=0.047) were associated with higher quality of life. A total of 81 (21%) patients were dependent on the caregiver, 85 (22%) patients were highly dependent on the caregiver, 155 (40%) patients were moderately dependent on the caregiver, 60 (15%) patients were mildly dependent on the caregiver, and 11 (2%) patients were independent for activities of daily living. An incomplete spinal cord injury (P=0.045) and paraplegia (P=0.041) were associated with higher independence in activities of daily living of patients. The independence in activities of daily living and quality of life of the Chinese population with complete spinal cord injury and tetraplegia are poor (Level of Evidence: IV; Technical Efficacy Stage: 5).

Experiencias sobre el cuidado otorgado por madres de jóvenes con tetraplejia de origen traumático: un estudio cualitativo fenomenológico / Caregiving experience of mothers of young people with traumatic tetraplegia: a qualitative phenomenological study

Caregiving experience of mothers of young people with traumatic tetraplegia. A qualitative phenomenological study Introduction: Spinal cord injury (SCI) is defined as damage to the spine that results in a temporary or permanent change in its normal motor, sensory or autonomic function, with irreversible consequences. It is classified as paraplegia and tetraplegia, the latter makes the person highly dependent on care, requiring permanent help from another person to perform daily activities. Objective: To describe the experience of caregivers who are mothers of young people with traumatic tetraplegia, and who are patients of Instituto Teletón Santiago. Methodology: Qualitative study with descriptive phenomenological analysis. Data was gathered by means of semi-structured interviews, which were studied through qualitative content analysis with deductive categories. The overall sample was intentional, including the participation of five mothers who were primary caregivers of their children with tetraplegia, from Instituto Teletón Santiago. Results: The categories found were self-description, impact of the accident, care relationship, impact on the family and other significant factors, relation with the health care network, coping measures, beliefs and learning. The highlights of this type of dependent care included work overload, self-neglect, and deteriorated health. Significant situations from the moment of the accident reflect the experience as a whole. In these circumstances, love emerged as a pop-up topic and became known as the main value. The emotional burden of this experience has been contained and compensated by a positive approach to life, based on cultural and religious beliefs. Conclusion: Mothers become expert caregivers, providing holistic care that must be considered in the interventions of the rehabilitation team, to contribute to the reconstruction and resignification of this relationship of maternal/filial care.

Introducción: Lesión medular (LM) se define como un daño en la médula espinal resultando en un cambio transitorio o permanente, en su función normal motora, sensitiva o autonómica; con consecuencias irreversibles si esta es permanente. Se clasifica en paraplejia y tetraplejia, generando esta última gran dependencia en los cuidados personales de la vida diaria para quien la sufre, necesitando de otro de manera permanente. Objetivo: Describir las experiencias de madres cuidadoras de jóvenes con tetraplejia adquirida de origen traumático, usuarios de Teletón Santiago. Metodología: Estudio cualitativo con análisis fenomenológico, descriptivo. Para la recolección de datos se realizaron entrevistas semiestructuradas, las que fueron analizadas a través de análisis de contenido cualitativo con categorías deductivas. La muestra fue intencionada, participando cinco madres cuidadoras principales de hijos con tetraplejia del Instituto Teletón Santiago. Resultados: Las categorías encontradas fueron descripción de sí mismas, impacto del accidente, relación de cuidado, impacto en la familia y otros significativos, relación con la red de salud, medidas de afrontamiento, creencias y aprendizaje. Los aspectos destacados de este tipo de agente de cuidado dependiente incluyeron sobrecarga, abandono del yo y deterioro de su salud. Las situaciones significativas desde el momento del accidente reflejan la experiencia como un todo. En esta vivencia, el amor surgió como tema emergente y se dio a conocer como el valor principal. La carga emocional de esta experiencia ha sido contenida y compensada por un enfoque positivo sobre la vida, basado en creencias culturales y religiosas. Conclusión: Las madres se vuelven expertas cuidadoras, otorgando un cuidado holístico que debe ser considerado en las intervenciones del equipo de rehabilitación, para contribuir a la reconstrucción y resignificación de esta relación de cuidado materno/filial.

Reach and palmar grasp in tetraplegics with neuromuscular electrical stimulation / Alcance e preensão palmar em tetraplégicos com estimulação elétrica neuromuscular / Alcance y prensión palmar en tetrapléjicos con estimulación eléctrica neuromuscular

OBJECTIVE: To evaluate the movement strategies of quadriplegics, assisted by neuromuscular electrical stimulation, on reach and palmar grasp using objects of different weights. METHODS: It was a prospective clinical trial. Four chronic quadriplegics (C5-C6), with injuries of traumatic origin, were recruited and all of them had their reach and palmar grasp movement captured by four infrared cameras and six retro-reflective markers attached to the trunk and right arm, assisted or not by neuromuscular electrical stimulation to the triceps, extensor carpi radialis longus, extensor digitorum communis, flexor digitorum superficialis, opponens pollicis and lumbricals. It was measured by a Neurological and Functional Classification of Spinal Cord Injuries of the American Spinal Injury Association, Functional Independence Measure and kinematic variables. RESULTS: The patients were able to reach and execute palmar grasp in all cylinders using the stimulation sequences assisted by neuromuscular electrical stimulation. The quadriplegics produced lower peak velocity, a shorter time of movement and reduction in movement segmentation, when assisted by neuromuscular electrical stimulation. CONCLUSION: This study showed that reach and palmar grasp movement assisted by neuromuscular electrical stimulation was able to produce motor patterns more similar to healthy subjects. Level of evidence IV; Case series.

OBJETIVO: Avaliar as estratégias de movimento de quadriplégicos com o auxílio de estimulação elétrica neuromuscular sobre o alcance e a preensão palmar com objetos de diferentes pesos. MÉTODOS: Estudo clínico prospectivo. Quatro quadriplégicos crônicos (C5-C6) com lesões de origem traumática foram recrutados e todos tiveram o alcance e movimento de preensão palmar capturado por quatro câmeras infravermelho e seis marcadores retrorreflexivos fixados no tronco e braço direito, assistidos ou não por estimulação neuromuscular do tríceps, extensor radial longo do carpo, extensor dos dedos, flexor superficial dos dedos, oponente do polegar e músculos lumbricais. A medida foi feita com base na Classificação Neurológica e Funcional de Lesões Medulares da American Spinal Injury Association, na Medida de Independência Funcional e em variáveis cinemáticas. RESULTADOS: Os pacientes foram capazes de alcançar e realizar preensão palmar em todos os cilindros utilizando as sequências de estimulação auxiliadas por estimulação elétrica neuromuscular. Os quadriplégicos produziram menor velocidade de pico, menor tempo de movimento e redução na segmentação do movimento, quando foram auxiliados pela estimulação elétrica neuromuscular. CONCLUSÃO: Este estudo mostrou que o alcance e o movimento de preensão palmar assistidos por estimulação elétrica neuromuscular foi capaz de produzir padrões motores mais semelhantes aos dos indivíduos saudáveis. Nível de evidência IV; Série de casos.

OBJETIVO: Evaluar las estrategias de movimiento de cuadripléjicos, con el auxilio de estimulación eléctrica neuromuscular sobre el alcance y la prensión palmar con objetos de diferentes pesos. MÉTODOS: Estudio clínico prospectivo. Fueron reclutados cuatro cuadripléjicos crónicos (C5-C6) con lesiones de origen traumático y todos ellos tuvieron su alcance y movimiento de prensión palmar capturado por cuatro cámaras infrarrojas y seis marcadores retrorreflexivos fijados al tronco y al brazo derecho, asistidos o no por estimulación neuromuscular del tríceps, extensor radial largo del carpo, extensor de los dedos, flexor superficial de los dedos, oponente del pulgar y músculos lumbricales. La medición fue hecha con base en la Clasificación Neurológica y Funcional de Lesiones Medulares de la American Spinal Injury Association, en la Medida de Independencia Funcional y en variables cinemáticas. RESULTADOS: Los pacientes fueron capaces de alcanzar y realizar prensión palmar en todos los cilindros utilizando las secuencias de estimulación auxiliadas por estimulación eléctrica neuromuscular. Los cuadripléjicos produjeron menor velocidad de pico, menor tiempo de movimiento y reducción en la segmentación del movimiento, cuando fueron auxiliados por la estimulación eléctrica neuromuscular. CONCLUSIÓN: El presente estudio mostró que el alcance y el movimiento de prensión palmar asistidos por estimulación eléctrica neuromuscular fue capaz de producir patrones motores más similares a los individuos saludables. Nivel de evidencia IV; Serie de casos.

Transferencia del deltoides posterior al tríceps braquial en pacientes con lesiones medulares cervicales / Transposition du deltoïde postérieur sur le triceps brachial chez un patient atteint des lésions médullaires au niveau cervical / Transfer of Posterior Deltoid to the Brachial Triceps in Patients with Cervical Spinal Cord Injuries

Introducción: durante mucho tiempo, casi 50 siglos, se pensó que la tetraplejía no tenía tratamiento. El mayor por ciento de lesiones medulares cervicales ocurre por accidentes de tránsito en pacientes jóvenes donde la pérdida de la extensión activa del codo limita sus habilidades de realizar actividades cotidianas tan sutiles como peinarse o cepillarse los dientes, por lo que se convierten en individuos totalmente dependientes. Objetivo: describir los resultados de la transferencia del deltoides posterior al tríceps braquial en pacientes tetrapléjicos. Mètodo: se realizó un estudio longitudinal prospectivo en el que fueron intervenidos 9 pacientes (14 transferencias) a los que se les aplicó la técnica de Castro Sierra (transferencia del deltoides posterior al tríceps braquial), para restablecer la extensión activa del codo. Resultados: el 100 por ciento de los pacientes intervenidos lograron la extensión activa del codo. El 57 por ciento (8 codos) con fuerza grado III y 43 por ciento (6 codos) con fuerza grado IV. Los 9 pacientes (100 por ciento) quedaron satisfechos con los resultados de su operación. No se reportaron complicaciones. Conclusiones: La transferencia del deltoides posterior al tríceps braquial permite realizar la extensión activa del codo en pacientes tetrapléjicos(AU)

Introduction: for a long, almost 50 centuries, tetraplegia was thought to be untreated. The highest percentage of cervical spinal cord injury occurs due to traffic accidents in young patients whose loss of active elbow extension limits their ability to perform daily activities as subtle as combing their hair or brushing their teeth, so that they become totally individuals dependent. Objective: describe the results of transferring the posterior deltoid to the triceps in quadriplegic patients. Method: a prospective longitudinal study was carried out in nine patients (14 transfers) who were operated on and Castro Sierra technique was applied (transfer of posterior deltoid to the triceps brachii) to restore active elbow extension. Results: 100 percent of the patients underwent active elbow extension. 57 pencert (8 elbows) with grade III strength and 43 percent (6 elbows) with grade IV strength. All the nine patients (100 percent) were satisfied with the results of their operation. No complications were reported. Conclusions: transfer of posterior deltoid to the brachial triceps allows the active extension of the elbow in quadriplegic patients(AU)

Introduction: pendant de nombreuses années, presque 50 siècles, on a pensé que la tétraplégie n'avait pas de traitement. La plupart des lésions médullaires d'atteinte cervicale sont produites à cause des accidents de la route chez de jeunes patients dont la perte de l'extension active du coude empêche leur capacité de réaliser quelques activités de la vie quotidienne, telles que se peigner ou se brosser les dents, devenant ainsi des handicapés. Objectif: l'objectif de cette étude est de décrire les résultats de la transposition du deltoïde postérieur sur le triceps chez des patients tétraplégiques. Méthodes: une étude longitudinale et prospective, suivant 9 patients traités chirurgicalement (14 transpositions) par la technique de Castro Sierra (transposition du deltoïde postérieur sur le triceps brachial) afin de rétablir l'extension active du coude, a été réalisée. Résultats: dans 100 pourcent des cas (dont 57 pourcent à force grade III (8 coudes), et 43 pourcent à force grade IV (6 coudes)), les patients opérés ont récupéré l'extension active du coude. Les 9 patients (100 pourcent) ont été satisfaits des résultats. Aucune complication n'a été trouvée. Conclusions: la transposition du deltoïde postérieur sur le triceps brachial permet de réaliser l'extension active du coude chez des patients tétraplégiques(AU)

Posterior Deltoid-to-Triceps Tendon Transfer for Elbow Extension in a Tetraplegia Patient: A Case Report

In tetraplegia patients, activities of daily living are highly dependent on the remaining upper limb functions. In other countries, upper limb reconstruction surgery to improve function has been applied to diverse cases, but few cases have been reported in Korea. The current authors experienced a case of posterior deltoid-to-triceps tendon transfer and rehabilitation in a complete spinal cord injury with a C6 neurologic level, and we introduce the case-a 36-year-old man-with a literature review. The patient's muscle strength in C5 C6 muscles were normal, but C7 muscles were trace, and the Spinal Cord Independence Measure III (SCIM III) score was 24. The tendon of the posterior deltoid was transferred to the triceps brachii muscle, and then the patient received comprehensive rehabilitative treatment. His C7 muscle strength in the right upper extremity was enhanced from trace to fair, and his SCIM III score improved to 29.

Clinical and magnetic resonance imaging features of compressive cervical myelopathy with traumatic intervertebral disc herniation in cynomolgus macaque (Macaca fascicularis) / 한국실험동물학회지

Intervertebral disc herniation (IVDH) with nucleus pulposus extrusion, traumatic or not, is a devastating clinical condition accompanied by neurological problems. Here we report a cynomolgus macaque suffering from acute and progressive neurological dysfunction by a blunt trauma due to neck collar, an animal handling device. Tetraplegia, urinary incontinence, decreased proprioception, and imperception of pain were shown on physical and neurological examinations. MRI sagittal T2 weighted sequences revealed an extensive protrusion of disc material between C2 and C3 cervical vertebra, and this protrusion resulted in central stenosis of the spinal cord. Histopathologic findings showed a large number of inflammatory cells infiltrated at sites of spinal cord injury (SCI). This case is the first report of compressive cervical SCI caused by IVDH associated with blunt trauma.

The use of spect/ct in the evaluation of heterotopic ossification in para/tetraplegics

Objective: To evaluate the stage of maturation and the metabolism of neurogenic heterotopic ossification by using SPECT/CT. Methods: A total of 12 medical records of patients with spinal cord injury, all of them classified according to the ASIA protocol (disability scale from the American Spinal Injury Association) in complete lesion (A) and partial lesions (B, C and D) and registered at the Laboratory of Biomechanics and Rehabilitation of the Locomotor System, were submitted to SPECT/CT evaluation. Results: Sixteen hips with heterotopic ossification observed in X-ray were studied and only two (12.5%) had high osteoblastic activity. Five hips showed medium activity, three (18.75%) low activity and six (37.5%) did not present any activity detected by SPECT/CT. Conclusion: SPECT/CT helps to determinate which patients have a greater risk of relapse after surgical resection, proving to be a useful imaging study in preoperative evaluation that can be used to determinate the postoperative prognosis of these patients. Level of Evidence III, Investigating a Diagnostic Test. .

Avaliação da potência aeróbia de praticantes de Rugby em Cadeira de Rodas através de um teste de quadra / Evaluation of the aerobic power of Wheelchair Rugby practitioners in a through a test court

O presente estudo teve por finalidade estimar a potência aeróbia em atletas com LME praticantes de RCR, correlacionar os níveis de VO2máx com a classificação funcional (CF) dos atletas e analisar o comportamento da FC antes e pós-teste. A amostra foi composta por 10 atletas com LME, do sexo masculino e idade média de 29,6±6,5anos. Os atletas foram submetidos ao teste de corrida de 12 minutos e monitorados com o frequêncimetro cardíaco. A média do VO2máx foi de 18,3±8,1ml(kg.min)-1 e da FCmáx de 114,6±25,3bpm. Os valores de VO2máx obtidos no estudo são classificados como médio para a população com tetraplegia. Observou-se que existe correlação moderada (r=0,77) entre a CF e o VO2máx entre atletas praticantes de RCR e por fim, observou-se baixos valores de FC frente á um teste submáximo, fato que pode estar relacionado à diminuição da atuação simpática após LME.

The present study aimed to estimate aerobic power in wheelchair athletes with SCI. Other objetive was VO2max levels correlate with the functional classification of athletes and analyze the behavior of the FC before and after testing. The sample consisted of 10 male athletes with SCI and mean age was 29.6 ± 6.5 years. The athletes were tested for race 12 minutes and the heart rate monitor was used. The average VO2max was 18.3±8.1 ml (kg.min)-1, while the mean HRmax was 114.6±25.3bpm. The VO2max values obtained in the study are classified as medium for people with quadriplegia. It was observed that there is a moderate correlation (r = 0.77) between the functional classification and VO2max among athletes practicing WR and finally, was observed low values of HR will face a submaximal test, which may be related to decreased activity symphatetic after SCI.

Efeitos do treinamento em rugby em cadeira de rodas em atletas de elite com lesão da medula espinhal / Effects of wheelchair rugby training on elite athletes with spinal cord injury

O treinamento físico é capaz de proporcionar melhoras dos componentes fisiológicos, metabólicos e neuromusculares em indivíduos com LME cervical, dessa forma, o objetivo do estudo foi de analisar a influência do treinamento de rúgbi em cadeira de rodas nos aspectos fisiológicos e na capacidade funcional dos indivíduos com Lesão da Medula Espinhal. Foram avaliados sete atletas de RCR do sexo masculino com LME cervical (média do grupo de 28,57±6,52anos e tempo de lesão de 7±4,96 anos). Os sujeitos realizaram o Teste de Campo de corrida 12 minutos adaptado em dois momentos distintos, o primeiro antes de realizar a prática esportiva e o segundo momento, após intervenções do treinamento do RCR. Foram observadas diferenças significativas entre as médias da amostra referentes aos valores de Consumo Máximo de Oxigênio (VO2max), número de voltas realizadas (Voltas) e distância percorrida (D) (p?0.05), que inicialmente eram de 10,09 ± 6,91 ml(kg.min)-1, 15 ± 4,95voltas e 1151,3 ± 373,4 metros, respectivamente. Enquanto que, os valores obtidos no final do programa foram de 18,23 ± 8,21 ml(kg.min)-1, 21,14 ± 5,92 voltas e 1592,5 ± 446,5 metros. Conclui-se que a prática de forma regular no RCR gera adaptações e melhoras sobre os componentes fisiológicos e neuromusculares em atletas com LME.

Physical training is able to provide improved on physiological, metabolic and neuromuscular components in individuals with cervical SCI. Thus, the aim of this study was to analyze the influence of wheelchair rugby (WR) training on the physiological and functional capacity of individuals with spinal cord injury. A total of seven male athletes with cervical SCI (group average of 28.57 ± 6.52 years old and 7 ± 4.96 years injury time). The athletes performed the 12-minute adapted running Field Test at two different times; the first before practicing the sport and the second time after the WR training interventions. Significant differences were observed among the sample means regarding Maximum Oxygen Consumption (VO2max), number of laps (Laps) performed and distance (D) (p ? 0.05), which initially were 10.09 ± 6.91ml (kg.min) -1, 15 ± 4.95laps and 1151.3 ± 373.4m, respectively. The values obtained at the end of the program were 18.23 ± 8.21 ml(kg.min)-1, 21.14 ± 5.92laps and 1592.5 ± 446.5m. It can be concluded that regular practice in WR generates adaptations and improvements on the physiological and neuromuscular components in athletes with SCI.

Respostas cardiovasculares e avaliação da potência aeróbia em pessoas com lesão da medula espinhal / Cardiovascular responses and assessment of aerobic power in individuals with spinal cord injury

O objetivo deste estudo foi revisar na literatura atual os métodos e variáveis do consumo máximo de oxigênio/potência aeróbia e aspectos relacionados com a capacidade aeróbia em pessoas com lesão da medula espinhal. Foi utilizada a busca através da base de dados Sciverse - com os seguintes termos: Spinal cord injury, Tetraplegia, Paraplegia cruzados com Physical endurance, Exercise tolerance, Peak oxygen consumption. Para inclusão no estudo os artigos deveriam obedecer os seguintes critérios a) avaliação da potência aeróbia em pessoas com lesão da medula espinhal na fase crônica da lesão, b) resultados com tetraplégicos ou paraplégicos, c) interação dos itens anteriores com VO2máx (l/min ou ml/kg/min) e duração de esforço em cadeira de rodas, sendo publicados a partir do ano de 2000 até o presente momento da escrita do trabalho em 2012. Após cruzamentos de termos pré-selecionados, foram selecionados 26 artigos. A partir dos estudos revisados, observa-se uma grande variação de modelos, testes e maneiras de avaliar componentes fisiológicos relacionados aos sistemas cardiorrespiratórios e circulatórios. Esta gama de métodos parece estar relacionada à heterogeneidade da população/amostra e consequentemente, os resultados, por mais similares que sejam em alguns aspectos, apresentam valores discretos de proximidade, revelando uma necessidade de padronização para estes procedimentos nesta população. Com isto, é evidente a importância de estudos bem controlados e com nível tecnológico avançado para melhores prognósticos e acompanhamentos de pessoas com lesão da medula espinhal, seja para atividades esportivas, melhora de aspectos de riscos cardiovasculares ou para o cotidiano do dia a dia.

This study aimed to review in current literature methods and variables of maximal oxygen consumption, aerobic power and aspects related to aerobic capacity in people with spinal cord injury. The survey was through the Sciverse -website with the following terms: Spinal Cord Injury, quadriplegia, paraplegia crossed with physical endurance, exercise tolerance, peak oxygen power. To be included in the study the articles should present the following criteria a) assessment of aerobic power in people with spinal cord injury in the chronic phase of the injury, b) results with quadriplegics or paraplegics, c) interaction of the above items with VO2max (l / min or ml / kg / min) and duration of effort in wheelchair, being published from year 2000 to date the year 2012. After crossing the pre-selected terms, 26 full articles were selected. From the reviewed studies, it was noticed a wide variation of models, tests and ways to evaluate physiological components related to cardiorespiratory and circulatory systems. This range of methods seems to be related to the heterogeneity of the population sample and therefore, even the results resembled in some aspects, they are discrete proximity values, revealing a necessity to standardize these procedures for this sample group. Studies well controlled with high technological level are important to establish better prognostics for people with spinal cord injuries, becoming possible to establish cardiovascular risk factors in sport practice or daily living activities in this population.

Atypical Supernumerary Phantom Limb and Phantom Limb Pain in a Patient With Spinal Cord Injury: Case Report

Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.

Rugby em Cadeira de Rodas: aspectos técnicos e táticos e diretrizes para seu desenvolvimento / The Wheelchair Rugby: technical and tactical aspects and a guideline for development

O objetivo desse relato de experiência foi descrever aspectos técnicos e táticos do Rugby em Cadeira de Rodas e oferecer indicações de como trabalhá-los para um melhor rendimento do time. Utilizando o método de pesquisa observacional, coletamos informações de times nacionais e internacionais no período de setembro/2008 a dezembro/2009. A observação incluiu treinamentos e competições nacionais e internacionais. Nos resultados apresentamos três elementos técnicos: passe, recepção e domínio de bola. Ainda, jogadas de defesa e ataque, usadas nos âmbitos nacional e internacional são descritas. Concluímos que há um domínio de técnicas e táticas na equipe nacional, mas que a experiência de jogo, a falta de comunicação em quadra e o desconhecimento das regras são elementos que prejudicam o rendimento do time. Esperamos que este estudo auxilie pesquisadores e técnicos a dar continuidade à pesquisa e às ações em quadra, contribuindo para o desenvolvimento da modalidade no Brasil.

The aim of this case report was to describe tactical and technical aspects of Wheelchair Rugby and shows directions of how work them to achieve the better results for the team. The observational research methodology was used. Data collection was made from national and international teams between September/2008 to December/2009. The observations included training sessions and competition of nationals and international teams. In results we presented four technical elements: pass, reception, dislocation at the court and ball control. National and international defensives and offensives plays are also described. We conclude that the national teams have domain about technical and tactical skills however, the lack of game experience, lack of communication inside the court, and lack of knowledge about the rules are the weaker points that compromise team performance. We hope that this work helps researchers and coaches to continue the study and the actions in the court, contributing to the development of the modality in Brazil.

Upper Extremity Reconstruction Surgery for the Persons with Tetraplegia: Current Status and Solutions to Promote the Procedures in Korea

OBJECTIVE: To know the present status of upper extremity reconstruction surgery for the person with tetraplegia in Korea and to suggest solutions to promote the procedures. METHOD: 62 physiatrists and 42 hand surgeons were surveyed with self administered questionnaire. The questionnaire was made up of 5 categories: (1) whether physicians had experienced these procedures in the past three years, (2) if they have had no experience, what the reasons were, (3) whether physicians desired to be involved in these procedures, (4) what the solution to promote these procedures should be, (5) the attitudes and beliefs of physicians about these procedures. The last category was analyzed by odds ratio between physicians who desired to be involved in the procedure and who didn't. RESULTS: Only two physiatrists and six surgeons had experienced these procedures in the past three years. However many physicians desired to be involved in these procedures. The main reason of not performing these procedures was a lack of referral between physiatrists and surgeons. The physicians who desire to practice upper extremity reconstruction surgery or related rehabilitation had higher confidence on the benefits of the procedures and thought that they had knowledge and skills for the procedure. CONCLUSION: In spite of positive attitude to the upper extremity reconstruction for tetraplegic patients, few physicians have experienced in these procedures. This phenomenon was due to a lack of referral between physiatrists and surgeons. Advancing cross-specialty relationships and educating related physicians could be solutions to promote these procedures.

The Life of Persons with C4 Tetraplegia in the Community Residence

OBJECTIVE: To investigate the life of persons with C4 tetraplegia in the community residence. METHOD: This study was designed as a personal interview survey using the questionnaires for the general characteristics, Craig Handicap Assessment and Reporting Technique (CHART), Diener's satisfaction with life scale, and Rosenberg self esteem scale. The subjects were 15 persons with C4 tetraplegia. RESULTS: Among 15 persons, six were married, three of them were married after the injury. Five persons reported being employed, thirteen persons used computers. The number of cases for remodeling their houses were 13. Twelve persons reported being 'glad to be alive'. Their Diener's satisfactionof life scale was 16.6 (slightly dissatisfied). Rosenberg self esteem scale was 23.3. The CHART showed the following scores: physical independence 46, mobility 56, occupation 30, social integration 89, and economic self sufficiency 68. Diener's satisfaction with life scale of the subjects were significantly correlated with that of their caregiver (p=0.006). CONCLUSION: The life of the individual with C4 tetraplegia in the community was more active than expected, considering their substantial physical limitation. Therefore, appropriate post-discharge planning should be included in inpatient rehabilitation program for the C4 tetraplegics.

Non-invasive Intermittent Positive Pressure Ventilation Apply to Complete Tetraplegia due to C1 Spinal Cord Injury: A case report

The patients who have high cervical cord injury with paralysis of diaphragm are not able to live without mechanical ventilatory support. In conventional concept, tracheostomy is necessary for long-term use of mechanical ventilation. We reported a 33-year-old man diagnosed with complete tetraplegia due to C1 spinal cord injury. He had used intermittent mechanical ventilation via tracheostomy tube. He had no movement of diaphragm and showed hypercapnia and hypoxemia without ventilatory support for several hours. He showed 400 ml of vital capacity and un-obtainable peak cough flow level but it could be obtained 300 L/min of assisted peak cough flow. Noninvasive intermittent positive pressure ventilation (NIPPV) was applied from invasive method and decannulation and tracheostomy closure was performed successfully. He had no pulmonary complications for six months. This case could be a good model for the indication of NIPPV application and decannulation.

Comparative review of life satisfaction,living quality and mood symptomatology between UK and Chinese patients with tetraplegia / 中国康复理论与实践

@#ObjectiveTo compare differences in life satisfaction, quality of life and mood between UK and Chinese tetraplegia patients after rehabilitation.MethodsThe sample consisted of 44 tetraplegics, 22 from UK and 22 from China, the survey about life satisfaction, quality of life, anxiety and depression was made and analyzed.ResultsPatients of UK group were significantly more satisfied with their situations of vocational and financial, and family life than that in Chinese group, and more active with their value of life, meaning of life and mood than that in Chinese group. No significant differences were identified between two groups in life as a whole, self care, leisure situation, sexual life, partnership relations, contact with friends and ratings of overall quality of life.ConclusionIt is very important to enhance the psychological adaptation of disability so as to improve the quality of life of the tetraplegics in China.

The Significance of Posture on Assessment of Pulmonary Function after Pulmonary Rehabilitation in Tetraplegia

OBJECTIVE: In patients with cervical spinal cord injury (SCI), it is known that vital capacity of the supine position is larger than that of the sitting position, but after pulmonary rehabilitation treatment, the effect on assessment of vital capacity according to the posture is not yet clearly known. In this study, we evaluated the significance of posture on assessment of pulmonary function after pulmonary rehabilitation treatment in patients with cervical SCI. METHOD: Twenty-eight patients with cervical SCI were participated in this study. The pulmonary function was evaluated by measuring vital capacity (VC), tidal volume (TV), maximum insufflation capacity (MIC) and forced expiratory volume at the first second (FEV1) in both supine and sitting position, before and after the 4 weeks pulmonary rehabilitation treatment. The parameters of pulmonary function were analyzed and compared according to the posture. RESULTS: Before pulmonary rehabilitation treatment, VC, TV, MIC and FEV1 of the supine position were significantly larger than those of the sitting position (p0.05). CONCLUSION: For the proper assessment of the pulmonary function after pulmonary rehabilitation treatment in patients with cervical SCI, the significance of posture should be considered.