Can the Initial Parameters of Functional Scales Predict Recovery in Patients with Complete Spinal Cord Injury? A Retrospective Cohort Study.

Regaining greater independence in performing daily activities constitutes a priority for people with tetraplegia following spinal cord injury (SCI). The highest expectations are connected with the improvement of hand function. Therefore, it is so important for the clinician to identify reliable and commonly applicable prognostic factors for functional improvement. The aim of this study was to conduct an analysis to assess the impact of initial functional factors on the clinical improvement in patients during early neurological rehabilitation (ENR). This study assessed 38 patients with complete SCI aged 17-78 who underwent ENR in 2012-2022. The analysis included the motor score from the AIS (MS), the Barthel Index (BI) and the SCIM scale values at the beginning of the ENR program and after its completion. During ENR, patients achieved a statistically significant improvement in MS, BI and SCIM. The initial MS and the level of neurological injury constituted the predictors of functional improvement during ENR. Significant statistical relationships were observed primarily in the correlations between the initial MS and BI, and the increase in the analyzed functional scales of SCI patients. Higher initial MS may increase the chances of a greater and faster functional improvement during ENR.

Is older still good, or even better? Evaluation of possibility of using Miller laryngoscope for intubation in adults and comparison with the most widely used Macintosh laryngoscope. Protocol of a crossover randomized control trial.

Background: Macintosh laryngoscope is the most widely used laryngoscope for intubation. In some patients, e.g. with flaccid, drooping, aplastic epiglottis, usage of this laryngoscope, or even videolaryngoscopes, may not provide visualization of a glottis. Elevation of the laryngopharynx, like in intubation with Miller laryngoscope, may significantly improve intubating conditions. Methods: An anaesthesiologist with over 20 years of experience will perform direct laryngoscopy with randomly chosen Miller or Macintosh blade, evaluating the visibility of rima glottidis with Cormack-Lehane classification and POGO score with and without external laryngeal pressure. Then the second evaluation of glottis with other blade type will be obtained and the patient will be intubated. Comparison of the rima glottidis visibility when using both blades will be the primary endpoint of the study. The secondary endpoints consist of: demonstrating whether there is a group of adult patients in whom the use of the Miller blade associated with better vocal cord visibility may be predicted based on an anesthesiological examination, and whether external laryngeal pressure improves vocal cord visualization more when using the Miller blade compared with the Macintosh blade. Sample size: We performed minimal sample size calculations based on the data derived from the first 60 patients. We assessed the minimal sample size to obtain the alpha of 5 % and power of 90 %. We decide to enroll at least 286 patients. Discussion: this will be the first trial assessing Miller and Macintosh blades in the same population of adult patients. It will determine group of patients in whom Miller laryngoscope will provide better visualization of rima glottidis than Macintosh blade and associated technique, diminishing rate of prolonging intubations and reducing possible aftermaths of hypoxia.

Spinal cord injury during early pregnancy: Problems in the course of rehabilitation and infant care, a case report.

CONTEXT: Spinal cord injury (SCI) sustained during pregnancy may be dangerous to the mother and her child. The risk is associated both with necessary diagnostic work-up and with the therapeutic process (radiographic investigations, surgical procedures, anesthesia, spinal shock, SCI complications, delivery). However, infant care is an enormous challenge for a woman with motor disability. The authors present a case report concerning the problems of treatment, rehabilitation and infant care in an SCI woman. To our knowledge, it is the first paper to describe SCI at such an early stage of gestation (2.5 weeks of gestational age/WGA). FINDINGS: A 20-year old paraplegic woman after SCI was pregnant. The period of diagnostics (MRI, X-ray), surgery and rehabilitation was associated with minor complications for the mother and no complications for the child. At discharge from the rehabilitation center the patient presented Th11 paraplegia (AIS-C), 24.5 WGA, and she could walk using a walker with a knee-ankle-foot-orthosis on the right and an ankle-foot-orthosis on the left lower limb. She delivered at 38 WGA via cesarean section (girl, birth weight 2960 g, length 50 cm, APGAR = 9 and 10). Bathing the baby and walking with it were the main problems of the post-delivery period. CONCLUSIONS: Factors potentially threatening the mother and child's health in SCI during pregnancy do not always contribute to the complications of the clinical status and health of the child. Comprehensive approach to the treatment, rehabilitation and care of pregnant women with SCI facilitates the course of pregnancy, delivery and child care.

Influence of Intermediate Annealing Treatment on the Kinetics of Bainitic Transformation in X37CrMoV5-1 Steel.

Intermediate annealing treatment (IAT) is a new process that accelerates the bainitic transformation in steels. This stimulation is crucial, especially in the prolonged production of nanobainitic steels. Among other recognised methods, it seems to be an effective and economical process. However, there are very few research works in this area. The objective of this study was to collate microstructural changes caused by IAT with differences in the kinetics of the subsequent bainitic transformation in the X37CrMoV5-1 tool steel. Differential dilatometry, LM and SEM microscopic observations, EDS and XRD analysis, and computer simulations were used to investigate the effect of IAT on the kinetics of bainitic transformation. The study has revealed that introducing an additional isothermal heating stage immediately after austenitising significantly affects the kinetics of bainitic transformation-it can accelerate or suppress it. The type and strength of the effect depends on the concentration, distribution, and morphology of the precipitations that occurred during IAT.

Adherence to prescriptions of therapeutic exercises in patients with traumatic spinal cord injury.

INTRODUCTION: Spinal cord injury (SCI), which disrupts motor, sensory and autonomic functions, causes significant changes in the functioning of an individual. It is believed that most of the conditions secondary to SCI, i.e. osteoporosis, spasticity or cardiopulmonary diseases, are associated with immobility. The aim of the study is to assess the adherence to prescriptions of therapeutic exercises (APTE) in patients with SCI after acute phases of rehabilitation. MATERIAL AND METHODS: The criterionfor APTE recognition was the performance at least twice a week for a minimum of 30 minutes of active exercises with resistance, and exercises maintaining the range of movement of the joints The research tools were own questionnaire and the WHOQOL-BREF scale. RESULTS: 46 subjects (63.9%) met the APTE criteria. The most frequent place for performing the exercises was the subject's home with 43 subjects (93.5%) with APTE performed the exercises in their homes. 17 subjects (36.9%) with APTE performed exercises during stays at various rehabilitation centres. The main cause for the lack of APTE was the limited availability of facilities considered necessary by the respondents to adhere to the instructions. In statistical analysis, the level of neurological injury correlated with meeting the APTE criteria. It was discovered that a subjective assessment of the exercise dose correlated with the place where the exercises were performed, but did not correlate with meeting the APTE criteria. CONCLUSIONS: The basic place for performing exercises (as instructed in hospital) was the subject's home. Limited access to reimbursed environmental therapy resulted in an increased cost of exercises supervised by commercially-employed physiotherapists. The current gaps in the system of supervision and counselling of subjects post-SCI necessitate changes in the Polish health care system.

Analysis of prognostic factors for locomotion in patients after amputation of the tibia performed due to atherosclerotic critical limb ischemia.

Background. Our study aimed to analyze retrospectively the locomotion performance in patients following below-the-knee amputation (BKA) for atherosclerotic critical limb ischaemia (CLI) in relation to factors which may influence the final outcome. Material and methods. Two groups of patients were analyzed: Group I (n = 53), which underwent fitting of prosthesis and rehabilitation immediately after healing of the stump ("early prosthesising"), and Group II (n = 45), in whom prosthesis fitting and rehabilitation were begun after some time spent on a waiting list (from amputation to admission for rehabilitation). Eight parameters which, according to the authors' experience, may influence the effect of prosthesis fitting and rehabilitation in respect to locomotion possibilities were analyzed using survival curves and Cox multi-variant analysis. Results. In Group I the outcome was judged good or very good in over half of the patients (56.9%), while in Group II the respective results did not reach one-third (28.8%). It was demonstrated that early prosthesis fitting and rehabilitation increase more than four-fold the chance to achieve very good or good locomotion performance and shortens two-fold the time needed to reach this goal. Conclusions. The most important factors slowing the recovery of ambulatory functions are: delay in fitting the prosthesis, knee joint flexion contracture of the amputated limb, and concomitant diseases resulting from the generalized character of atherosclerosis.

Multi-stage management of multiple severe decubitus ulcers in a patient with spinal cord injury: A case report.

The article presents the multi-stage treatment of severe decubitus ulcers in a male patient, 26 years of age, with posttraumatic tetraplegia resulting from a cervical spinal cord injury that had occurred 8 years prior to admission. The patient presented with extensive and deep ulcerations in the sacral region and both trochanteric regions. Due to the destruction of the joint bilateral hip resection was also necessary. The entire hospital stay lasted 7 months and resulted in complete healing of all three decubitus lesions. There was no recurrence of pressure ulcers during the 2-year observation period.

The outcome of a bilateral leg amputation according to Syme;s technique as a result of posttraumatic complications: a case report.

Background. The purpose of this article is to present the problems encountered in treatment and rehabilitation, including prosthesis fitting, in the case of a 17-year-old female patient who underwent a bilateral leg amputation using Syme's method. Case history. The patient incurred crushing injuries of both feet and the knee joints, resulting from a severe multi-organ injury. As a result of post-traumatic changes and deformations of the feet, including algodystrophic changes, amputation proved to be the only procedure that would restore the patient locomotive capacity. Outcome. As a result of the treatment applied, the patient regained the ability to move about, while the primary limitation on her locomotive abilities turned out to be the status of her knee joints, which had been severely damaged in the accident.

Pathomechanism and diagnostics of upper limb disorders in the course of degenerative changes in the cervical spine.

As a result of arthrotic changes in the cervical spine related to age, trauma, and mechanical wear on the tissues, the functionality of the nerve roots is compromised. Radiculopathy causes dysfunction of the upper limb. The present study, based on historical and contemporary sources, discusses the clinical and diagnostic problems of radiculopathy typical for degenerative diseases of the cervical spine. The anatomical and biomechanical complexity of the cervical spine, along with the particular pathomechanical conditions, explain the clinical features of radiculopathy. An understanding of these processes is crucial for the choice of ancillary tests to verify the clinical diagnosis confirmation and the interpretation of their results, as well as proper clinical management.

[The value of the Syme amputation in selected cases of diabetic foot]. / Wartosc amputacji goleni metoda Syme'a w wybranych przypadkach stopy cukrzycowej.

The aim of this paper was to assess the surgical and functional results of Syme's amputation in patients with infected necrosis of the fore- and midfoot caused by diabetes. The material consisted of 5 patients (4 men) age ranging from 44 to 78 years. No stump healing was achieved in a 44 year old man with arteriosclerosis who did not agree to a higher amputation. Prostheses were implemented in patients whose wounds healed 3-6 weeks after surgery. Follow-up period ranged from 2 to 6 years. Three patients died 4-5.5 years after surgery. One patient (equipped with a prosthesis) was observed for a period of 2 years, after which she gave up further medical care. One patients is doing well and using his prosthesis 6 years after surgery. In selected cases of diabetic foot, the Syme's amputation is a useful method of treatment, both from a surgical and functional aspect.