ABSTRACT
Deficient ankle control after incomplete spinal cord injury (iSCI) often accentuates walking impairments. Transcutaneous electrical spinal cord stimulation (tSCS) has been shown to augment locomotor activity after iSCI, presumably due to modulation of spinal excitability. However, the effects of possible excitability modulations induced by tSCS on ankle control have not yet been assessed. This study investigated the immediate (i.e., without training) effects during single-sessions of tonic tSCS on ankle control, spinal excitability, and locomotion in ten individuals with chronic, sensorimotor iSCI (American Spinal Injury Association Impairment Scale D). Participants performed rhythmic ankle movements (dorsi- and plantar flexion) at a given rate, and irregular ankle movements following a predetermined trajectory with and without tonic tSCS at 15 Hz, 30 Hz, and 50 Hz. In a subgroup of eight participants, the effects of tSCS on assisted over-ground walking were studied. Furthermore, the activity of a polysynaptic spinal reflex, associated with spinal locomotor networks, was investigated to study the effect of the stimulation on the dedicated spinal circuitry associated with locomotor function. Tonic tSCS at 30 Hz immediately improved maximum dorsiflexion by +4.6° ± 0.9° in the more affected lower limb during the rhythmic ankle movement task, resulting in an increase of +2.9° ± 0.9° in active range of motion. Coordination of ankle movements, assessed by the ability to perform rhythmic ankle movements at a given target rate and to perform irregular movements according to a trajectory, was unchanged during stimulation. tSCS at 30 Hz modulated spinal reflex activity, reflected by a significant suppression of pathological activity specific to SCI in the assessed polysynaptic spinal reflex. During walking, there was no statistical group effect of tSCS. In the subgroup of eight assessed participants, the three with the lowest as well as the one with the highest walking function scores showed positive stimulation effects, including increased maximum walking speed, or more continuous and faster stepping at a self-selected speed. Future studies need to investigate if multiple applications and individual optimization of the stimulation parameters can increase the effects of tSCS, and if the technique can improve the outcome of locomotor rehabilitation after iSCI.
ABSTRACT
STUDY DESIGN: This is a retrospective, non-randomized cohort study, with data collected during the regular annual visits between 2001 and 2019. OBJECTIVES: The aim of this study was to evaluate the efficacy of coccygectomy for coccygeal pressure ulcers in individuals with paraplegia due to spinal cord injury or other neurological causes and to evaluate its role in the prophylaxis of ulcer recurrence. SETTINGS: This study included inpatients and outpatients with a coccygeal pressure ulcer who were treated surgically at our Institution REHAB Basel and were followed with regular annual check-ups. METHODS: Individuals with category 3 or 4 acute or chronic coccygeal pressure ulcer (classification according European Pressure Ulcer Advisory Panel (EPUAP)) received coccygectomy in addition to rotation flap surgery. The operative care was provided exclusively by the head of the plastic surgery department at REHAB Basel. Standardized follow-up treatment was carried out according to the "Basel Decubitus Concept" and thus allowed continuous and usually lifelong, regular follow-up care. RESULTS: Forty-nine individuals underwent coccygectomy from 2001 to 2019 due to coccygeal category 3 or 4 pressure ulcers. The observation period was between 1.5 and 18.3 years. In 86% of the individuals, no relapse occurred during the first year. Over the next 5 years 78% remained relapse free. CONCLUSIONS: In coccygeal pressure ulcer category 3 or 4, coccygectomy, in addition to sufficient rotation flap surgery, is a suitable method for recurrence prevention of pressure ulcer in this anatomic area.
Subject(s)
Paraplegia/complications , Pressure Ulcer/surgery , Sacrococcygeal Region/surgery , Aged , Female , Humans , Male , Middle Aged , Pressure Ulcer/etiology , Recurrence , Retrospective Studies , Secondary Prevention/methods , Treatment OutcomeABSTRACT
AIM: This study investigated factors which influence work after a spinal cord lesion using routinely collected outpatient data including an ICF-based questionnaire. METHODS: The retrospective analysis was based on a sample of 290 outpatients with chronic spinal cord lesions of whom 43% reported to work. 15 factors possibly affecting occupational activity were evaluated by bivariate analyses and multivariable regression modelling. RESULTS: Negative associations were identified between working activities and the factors "age at time of spinal cord injury" (OR: 0.96, 95%-KI: 0.93-0.99, p<0.002) and "problems with covering distances" (OR: 0.44, 95%-KI: 0.25-0.79, p<0.006). A similar tendency was observed for "problems with shopping". CONCLUSIONS: These findings indicate that age and aspects of mobility are important influencing factors for resumption of work after a spinal cord lesion. Therefore, mobility should be considered as an important target for interventions in long-term rehabilitation.
