Body mass index in spinal cord injury -- a retrospective study.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To identify the prevalence of overweight and severely overweight (obese) in veterans with spinal cord injury. SETTING: Veterans Administration Hospital in Wisconsin. METHODS: A retrospective chart review of all the patients registered in the current database with the Spinal Cord Injury Unit in the Veterans Administration Hospital was undertaken Data collected for each patient included age, sex, height, date of assessment of the height, weight, date of assessment of the weight, duration of spinal cord injury and the type of spinal cord injury -- paraplegia versus quadriplegia. The body mass index (BMI) was subsequently calculated for each patient and the prevalence of overweight and obesity were determined. RESULTS: There were a total of 408 patients registered in the database with the Spinal Injury Unit. The median age was 56 years, and the mean age 55.8 years. Of all patients with spinal cord injury, 52.2% patients had paraplegia and 47.7% had quadriplegia. The mean duration of injury was 19 years. Of the total number of patients, 46.0% were ASIA A, 11.0% were ASIA B, 12.7% were ASIA C and 29.1% were ASIA D. In all, 27.9% patients had a normal BMI and 3.6% patients were undernourished (BMI less than 18.5 kg/m(2)). The prevalence of overweight was 65.8% and 29.9% patients were obese. CONCLUSION: Overweight and obesity are problems of a significant magnitude in veterans with spinal cord injury.

Use of capsaicin in the treatment of radicular pain in spinal cord injury.

BACKGROUND: Pain following spinal cord injury (SCI) is a common problem and can interfere with functional recovery. Radicular pain (pain at the level of injury) is one type of SCI pain. Traditional analgesic agents are sometimes ineffective and can have significant systemic side effects. METHODS: A retrospective review of 8 patients with radicular pain secondary to SCI who responded to topical capsaicin therapy. FINDINGS: Improvement was noted in 1-2 weeks, including 1 patient with a 12-year history of intractable pain. Long-term efficacy was seen in 2 patients treated for >2 years. CONCLUSION: Based on these favorable results and minimal side effects, topical capsaicin should be considered in the treatment of localized radicular pain secondary to SCI.

Return to school after spinal cord injury.

OBJECTIVE: To determine the typical time elapsed between discharge from an inpatient spinal cord injury (SCI) rehabilitation program and the physical return to school, and to identify barriers faced by patients attempting to return to school. STUDY DESIGN: A retrospective review of all patients ages 18 years or younger who sustained SCI between 1989 and 1995, with resultant paraplegia or tetraplegia, and who attended either primary or secondary school, completed their inpatient rehabilitation at our regional SCI center, and were using a wheelchair when discharged from the hospital. RESULTS: Fifteen of 16 eligible patients agreed to participate. The median time for subjects with paraplegia to return to school after hospital discharge was 10 days; subjects with tetraplegia required a median of 62 days. Architectural and transportation barriers that patients encountered were identified. CONCLUSION: Individuals with SCI return to school relatively soon after discharge from the hospital. Barriers do not prohibit a return to school, but they are problematic.

Physiological comparison of walking among bilateral above-knee amputee and able-bodied subjects, and a model to account for the differences in metabolic cost.

OBJECTIVE: To compare the metabolic cost for prosthetic ambulation among persons with bilateral above-knee amputation with that for able-bodied ambulation, and to test a model that differentiates the metabolic cost of walking into three components. DESIGN: Cross-sectional comparison. SETTING: Community-dwelling subjects studied at an academic medical center. PARTICIPANTS: Five bilateral above-knee amputee subjects with mean (+/-SD) age of 22 +/- 3 years, and five able-bodied control subjects matched for gender, height, weight, and age. INTERVENTION: Subjects performed 6-minute bouts of walking at three paced speeds and their chosen walking speed with oxygen uptake being determined during the last 2 minutes of each bout. MAIN OUTCOME MEASURES: Chosen walking speed and oxygen uptake during each walking condition. RESULTS: The chosen walking speed was 21% slower and induced aerobic demands 49% higher for the amputee subjects. Across specified paced speeds, aerobic demands were 55% to 83% higher for the amputee subjects than for the able-bodied subjects. The described model suggests that the higher metabolic costs for the amputee subjects resulted from greater demands for maintenance of balance and posture and for performing the walking movement. CONCLUSIONS: Prosthetic ambulation by young healthy persons with bilateral above-knee amputation induces significantly greater metabolic demands than walking by able-bodied individuals. Although the chosen walking speed of persons with bilateral above-knee amputation is slower, the reduction in speed is insufficient to equalize their metabolic cost with that of able-bodied individuals walking at their chosen walking speed.

Clonidine in the treatment of brainstem spasticity. Case report.

This report describes a patient who developed spasticity after a medullary infarct. No improvement in her spasticity was achieved by baclofen therapy and the side effects of the drug necessitated its gradual withdrawal. Recent reports of the success of clonidine in the management of spasticity due to spinal cord injury prompted an attempt at clonidine therapy. When clonidine therapy was initiated, the patient responded rapidly with both subjective and objective improvements in her spasticity. This case suggests a potential role for clonidine in the treatment of spasticity resulting from brainstem infarction.

Amitriptyline and carbamazepine in the treatment of dysesthetic pain in spinal cord injury.

Dysesthetic pain after spinal cord injury is a common problem. The pathophysiology of this disorder is unclear and treatment modalities have been of inconsistent effectiveness. Various pharmacologic approaches have been advocated for treatment of chronic pain in spinal cord injury, including the use of either anticonvulsants or antidepressants. This case report describes the successful use of carbamazepine in conjunction with amitriptyline in the treatment of dysesthetic pain in a patient with spinal cord injury.

Acute somatic pain can refer to sites of chronic abdominal pain.

We report a case of a latissimus dorsi muscle strain that presented as a recurrence of chronic abdominal pain. One explanation of the referral of acute pain to a site of chronic pain is the convergence-projection theory, which hypothesizes that pain signals of visceral and somatic origin converge at some point in the sensory pathway. Upon reaching the cortex, these signals are interpreted as coming from the afferents which have previously excited this pathway. In this case an extensive gastrointestinal diagnostic evaluation was pursued unsuccessfully before the latissimus dorsi muscle strain was diagnosed. Outpatient therapy of spray and stretch combined with a home stretching program produced a prompt and persistent resolution of the symptoms.