Training and detraining of a tetraplegic subject: high-volume FES cycle training.

OBJECTIVE: To test the effect of high-volume FES cycle training on cardiopulmonary fitness and bone parameters in a tetraplegic subject. DESIGN: Case study of 1 yr of functional electrical stimulated (FES) cycle training with the highest possible power output in a tetraplegic subject. RESULTS: Depending on the training compliance (varying from 22.9 to 82.9%) maximal power output and peak oxygen uptake increased by 113 and 103%, respectively. After reduction in training intensity, these parameters reduced correspondingly. Bone mineral density of the distal femoral epiphysis showed an increase of 3.9% after 12 mos of cycle training. CONCLUSIONS: It is possible to increase maximal power output, cardiopulmonary fitness, and bone parameters of the paralyzed limbs in tetraplegia by high-volume cycle training. However, if training is not maintained, these improvements are lost. In tetraplegic subjects, it may be difficult to maintain the high level of training required to achieve benefits.

The effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury.

OBJECTIVES: To determine the effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury (SCI), and to compare it with the effects of other interventions. DESIGN: Crossover trial with 4 conditions. SETTING: Swiss paraplegic center. PARTICIPANTS: A volunteer sample of 12 people with spastic SCI (American Spinal Injury Association grade A or B). INTERVENTIONS: Hippotherapy, sitting astride a Bobath roll, and sitting on a stool with rocking seat. Each session lasted 25 minutes and was conducted twice weekly for 4 weeks; the control condition was spasticity measurement without intervention. MAIN OUTCOME MEASURES: Clinical rating by a blinded examiner of movement-provoked muscle resistance, using the Ashworth Scale; self-rating of spasticity by subjects on a visual analog scale (VAS); and mental well-being evaluated with the self-rated well-being scale Befindlichkeits-Skala of von Zerssen. Assessments were performed immediately after intervention sessions (short-term effect); data from the assessments were analyzed 3 to 4 days after the sessions to calculate the long-term effect. RESULTS: By analyzing the clinically rated spasticity, only the effect of hippotherapy reached significance compared with the control condition (without intervention); median differences in the Ashworth scores' sum before and after hippotherapy sessions ranged between -8.0 and +0.5. There was a significant difference between the spasticity-reducing effect of hippotherapy and the other 2 interventions in self-rated spasticity by VAS; median differences of the VAS before and after hippotherapy sessions ranged between -4.6 and +0.05cm. There were no long-term effects on spasticity. Immediate improvements in the subjects' mental well-being were detected only after hippotherapy (P=.048). CONCLUSIONS: Hippotherapy is more efficient than sitting astride a Bobath roll or on a rocking seat in reducing spasticity temporarily. Hippotherapy had a positive short-term effect on subjects' mental well-being.

Relationship between self- and clinically rated spasticity in spinal cord injury.

OBJECTIVES: To assess the relation between self- and clinically rated spasticity in spinal cord injury (SCI) and to determine the extent to which symptoms like pain are included in the patients' self-rating of spasticity. DESIGN: Part 1: an observational, prospective, cross-sectional study and part 2: an observational, prospective, longitudinal study. SETTING: Swiss paraplegic center. PARTICIPANTS: Forty-seven (part 1) and 8 (part 2) persons with spastic SCI (American Spinal Injury Association grade A or B). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical rating of movement-provoked spasticity using the Ashworth Scale; self-rating of general and present spasticity by the subject on a 4-point spasm severity scale and by using a visual analog scale (VAS); and questionnaires asking for antispasticity medication, impact of spasticity on daily life, body segment affected by spasticity, and symptoms associated with its occurrence. RESULTS: There was a poor correlation (rho=.36) between clinically rated (Ashworth Scale) spasticity and self-rated general spasticity and a modest correlation (rho=.70) between Ashworth Scale and self-rated present spasticity in the cross-sectional study in 47 subjects. Questionnaires showed that symptoms like pain and other sensations were associated by the patients with spasticity. There was a significant, but weak, correlation between VAS and Ashworth Scale in the longitudinal study in 3 of the 8 subjects and nonsignificant correlations in the remaining 5 subjects. CONCLUSIONS: A single clinical assessment of spasticity is a poor indication of a patient's general spasticity. Clinical measures of muscle tone-related spasticity should be complemented by self-rating that distinguishes muscle tone-related spasticity from spasticity affecting the sensory nervous system.

Role of thrombophilic gene polymorphisms in branch retinal vein occlusion.

OBJECTIVE: Branch retinal vein occlusion (BRVO) is a common cause of severe visual loss. Numerous risk factors, including arterial hypertension, diabetes mellitus, and arteriosclerosis, have been identified. Gene polymorphisms affecting hemostasis may also play a role in the pathogenesis of BRVO. The present study was therefore done to determine the prevalence of genetic polymorphisms in factors implicated in hypercoagulability among patients with BRVO. DESIGN: Retrospective case-control study. PARTICIPANTS: The study cohort consisted of 294 patients with BRVO and 294 control subjects, matched for age and gender. METHODS: Determination of genotypes was done by allele-specific digestion of polymerase chain reaction products, or by 5' exonuclease assay (TaqMan). MAIN OUTCOME PARAMETERS: Genotypes of factor V R506Q (factor V Leiden), prothrombin 20210G>A, fibrinogen beta -455G> A, factor XII (FXII) 46C>T, and ITGA2 807C>T (platelet glycoprotein Ia [GPIa] 807C>T) and ITGB3 L59P (platelet GPIIIa PlA1/PlA2) polymorphisms. RESULTS: Genotype distributions of the investigated gene polymorphisms did not differ significantly between patients and control subjects. In contrast, significantly increased prevalences of arterial hypertension and hypercholesterolemia were found among patients with BRVO. In a logistic regression analysis, the presence of arterial hypertension was associated with an odds ratio (OR) of 2.32 (95% confidence interval [CI], 1.62-3.32), whereas hypercholesterolemia yielded an OR of 2.54 (95% CI, 1.74-3.70) for BRVO. CONCLUSION: Our data indicate that the prevalences of the investigated gene polymorphisms do not differ significantly in patients with BRVO and control subjects. This suggests that these polymorphisms are not major risk factors for BRVO.