Influence of different types of seat cushions on the static sitting posture in individuals with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To evaluate the efficacy of the Postural Assessment Software PAS/SAPO in the posture analysis of individuals with spinal cord injury (SCI) during sitting position and to analyze if the use of different types of seat cushions-gel and foam, with no cushion-can interfere in the individual's posture during sitting position. SETTING: Centre of Rehabilitation at the University Hospital (FMRP-USP), Ribeirão Preto, Brazil. METHODS: Eight individuals, four paraplegics and four tetraplegics with SCI and 20 healthy individuals participated in the study. Photos were taken of individuals in the sitting position using foam, gel cushions and with no cushion. They were analyzed using the PAS/SAPO. The alignment of the anterior-superior iliac spine (ASIS) and the posterior pelvic tilt were evaluated from the angle formed between the ASIS and the greater trochanter of the femur. RESULTS: The group of healthy individuals presented the best postural alignment when compared with the group with SCI, both for the ASIS alignment (P<0.05) and for the degree of posterior pelvic tilt (P<0.05). No significant differences were found in the variables analyzed when the seat cushions were compared. CONCLUSION: The different types of cushions did not alter the sitting posture; however, individuals with SCI showed worse postural alignment than the healthy individuals. PAS/SAPO was demonstrated to be useful for postural assessment.

Evaluation of the influence of different types of seats on postural control in individuals with paraplegia.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To assess the importance of proprioceptive and vision information on different types of wheelchair seats with regard to postural control in paraplegic individuals during static posture. SETTING: Centre of Rehabilitation at the University Hospital/FMRP-USP and Rehabilitation Outpatient Clinic at University Hospital/UNICAMP, Brazil. METHODS: This study involved 11 individuals with paraplegia. All individuals were submitted to an evaluation of static balance with their eyes open and closed in three different types of seats: wheelchair seat, foam seat and gel seat. Balance evaluation was performed by using the Polhemus system, in which body displacements and anteroposterior and mediolateral speeds were assessed in a static seated position in the different types of seats. Data were analyzed using analysis of variance. The differences were considered at P<0.05. RESULTS: No statistical differences were found between the three types of seats in terms of displacements and anteroposterior and mediolateral speeds, or between seats with individuals keeping their eyes open or closed (P>0.05). However, it was observed that body displacements were more prominent toward an anteroposterior than a mediolateral direction. CONCLUSION: This study suggests that individuals with paraplegia tend to exhibit a more anteroposterior body displacement than a mediolateral one, with no significant differences between the types of seats in both situations of eyes open and closed.

Relationship between median nerve somatosensory evoked potentials and spinal cord injury levels in patients with quadriplegia.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To observe if there is a relationship between the level of injury by the American Spinal Cord Injury Association (ASIA) and cortical somatosensory evoked potential (SSEP) recordings of the median nerve in patients with quadriplegia. SETTING: Rehabilitation Outpatient Clinic at the university hospital in Brazil. METHODS: Fourteen individuals with quadriplegia and 8 healthy individuals were evaluated. Electrophysiological assessment of the median nerve was performed by evoked potential equipment. The injury level was obtained by ASIA. N(9), N(13) and N(20) were analyzed based on the presence or absence of responses. The parameters used for analyzing these responses were the latency and the amplitude. Data were analyzed using mixed-effect models. RESULTS: N(9) responses were found in all patients with quadriplegia with a similar latency and amplitude observed in healthy individuals; N(13) responses were not found in any patients with quadriplegia. N(20) responses were not found in C5 patients with quadriplegia but it was present in C6 and C7 patients. Their latencies were similar to healthy individuals (P>0.05) but the amplitudes were decreased (P<0.05). CONCLUSION: This study suggests that the SSEP responses depend on the injury level, considering that the individuals with C6 and C7 injury levels, both complete and incomplete, presented SSEP recordings in the cortical area. It also showed a relationship between the level of spinal cord injury assessed by ASIA and the median nerve SSEP responses, through the latency and amplitude recordings.

Immune recognition in the streptococcal carditis of mice: the role of macrophages in the generation of heart-reactive lymphocytes.

The role of immune T cells and of streptococcus-pulsed M phi in the production of cardiac lesions, as well as the ability of M phi to present streptococcal antigens to mouse lymphocytes, was investigated. Cells of mice infected with extracts of group A streptococcus were able to induce the appearance of heart lesions when transferred to syngeneic receptors as well as to transfer DTH reactions to syngeneic heart extracts. Streptococcus-pulsed M phi were also able to induce heart lesions and an increase in the serum CPK activity when injected into syngeneic receptors. This last phenomenon was only observed in mice aged 5 mo or more. Furthermore, it was shown in an in vitro model of T cell proliferation that peritoneal M phi pulsed with group A streptococci are able to induce a specific response to syngeneic cardiac extracts. M phi pulsed with group G streptococcus failed to induce such a response. Those findings are discussed as part of a model for the induction of rheumatic cardiac lesions in which M phi display a central role by selecting antigenic determinants from the pathogenic organism for presentation to immunocompetent cells.