OBJECTIVES: To investigate the effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury. METHODS: A total of 80 patients with incomplete spinal cord injury caused by thoracolumbar fracture admitted in Ningbo Yinzhou No.2 Hospital from April 2020 to December 2021 were randomly divided into control group and study group, with 40 cases in each group. In addition to routine training, the control group received torso training on stable surface and the study group received torso training on unstable surface. The gait, lower limb muscle strength, balance function, lower limb function, mobility and nerve function of the two groups were compared. RESULTS: After treatment, the stride length, stride frequency and comfortable walking speed improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05). The muscle strength of quadriceps femoris, gluteus maximus, hamstring, anterior tibialis and gastrocnemius were improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05); the total trajectories of static eye opening and static eye closing gravity center movement in the two groups were significantly shorter (all P<0.05), and the improvements in the study group were more significant (all P<0.05). The dynamic stability limit range and the American Spinal Injury Association (ASIA) lower extremity motor score, Berg balance scale, modified Barthel index scale in the two groups were significantly higher (all P<0.05), and these scores in study group were significantly higher than those in the control group (all P<0.05). Both groups showed a significant improvement in ASIA grade (all P<0.05), and the improvement in the study group was significantly better (P<0.05). CONCLUSIONS Torso training on unstable surface can effectively improve the gait and lower limb muscle strength of patients with incomplete spinal cord injury and improve the lower limb motor function.
Humans ; Walking/physiology* ; Spinal Cord Injuries ; Gait/physiology* ; Lower Extremity ; Torso

Robots are being used to assist the recovery of walking ability for patients with neurologic disorders. This study aimed to evaluate the feasibility and functional improvement of training with robot-assisted gait training (RAGT) using the Morning Walk®, an end-effector type robot using footplates and saddle seat support. A total of 189 individuals (65.1% men, 34.9% women; mean age, 53.2 years; age range: 5–87 years) with brain lesions, spinal cord injuries, Parkinson's disease, peripheral neuropathies, and pediatric patients were involved in this retrospectively registered clinical trial. Each participant performed 30 minutes of RAGT, five times a week, for a total of 24 sessions. Failure was defined as an inability to complete all 24 sessions, and the reasons for discontinuation were analyzed. Parameters of Medical Research Council scales and Functional Ambulation Categories were analyzed before and after RAGT training. Among the 189 patients, 22 (11.6%) failed to complete the RAGT. The reasons included decreased cooperation, musculoskeletal pain, saddle seat discomfort, excessive body-weight support, joint spasticity or restricted joint motion, urinary incontinence from an indwelling urinary catheter, and fatigue. Comparison between the pre- and post-training motor and ambulatory functions showed significant improvement. The result of the study indicates that the Morning Walk® is feasible and safe and useful for functional improvement in patients with various neurologic disordersTRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003627
Brain ; Fatigue ; Female ; Gait ; Humans ; Information Services ; Joints ; Male ; Muscle Spasticity ; Musculoskeletal Pain ; Nervous System Diseases ; Parkinson Disease ; Peripheral Nervous System Diseases ; Retrospective Studies ; Spinal Cord Injuries ; Urinary Catheters ; Urinary Incontinence ; Walking ; Weights and Measures

The development of microsurgical techniques has also increased the success rate of replantation surgery. This paper reports the results of limb replantation performed on a lower extremity amputation that was associated with crush amputation and an ipsilateral comminuted fracture in and elderly patient. A 68-year-old female presented with a right distal tibia amputation due to a traffic accident. At that time, with a comminuted fracture in the distal femoral condyle, simple wound repair was recommended, but the caregivers strongly wanted replantation. Three years after surgery, normal walking was possible without a cane and the patient was satisfied with the function and aesthetics. What used to be contraindicated in limb replantation in the past are now indications due to the development of microsurgical techniques, surgical experience, and postoperative rehabilitation treatment. If the patient is willing to be treated, good results in contraindications can be obtained.
Accidents, Traffic ; Aged ; Amputation ; Canes ; Caregivers ; Esthetics ; Extremities ; Female ; Fractures, Comminuted ; Humans ; Leg ; Lower Extremity ; Rehabilitation ; Replantation ; Tibia ; Walking ; Wounds and Injuries

OBJECTIVE: To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis.METHODS: We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest.RESULTS: There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively).CONCLUSION: When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.
Bias (Epidemiology) ; Bone Density ; Bone Transplantation ; Chemotherapy, Adjuvant ; Decompression ; Financial Management ; Financing, Organized ; Humans ; Neoplasm Metastasis ; Outcome Assessment (Health Care) ; Radiotherapy ; Risk Factors ; Spinal Injuries ; Spine ; Transplants ; Walking

Stroke patients often experience a walking dysfunction caused by decreased mobility, weakened muscular strength, abnormal posture control, and cognitive dysfunction. Anxiety/depression is the most important and prevalent neuropsychiatric complication of stroke survivors. Brain injury and the presence of malnutrition after stroke contribute to metabolic status and clinical outcome of patients. We examined the level of nutrition intake in stroke patients according to their degree of anxiety/depression. The data were obtained from 2013 to 2015 through the Korea National Health and Nutrition Examination Survey (KNHANES). Study subjects were categorized to either a group having no problem of anxiety/depression (n = 274) or a group having a problem of anxiety or depression (n = 104). The EuroQoL-5 Dimensions Health Questionnaire (EQ-5D) index score was derived from the first description of an individual health status based on the EQ-5D classification system, including mobility, self-care, usual daily activities, pain/discomfort, and anxiety/depression. The mean age was 67.4 years in the normal group and 68.0 years in the anxiety or depression group. In the anxiety or depression group, 39.4% were men vs. 53.3% in the normal group. The total energy intake (p = 0.013), riboflavin (p = 0.041), and niacin (p = 0.038) was significantly higher in stroke patients with no anxiety/depression than those in stroke patients with having an anxiety/depression. The group having no problem of anxiety/depression had significantly higher EQ-5D index compared to the group having a problem of anxiety/depression group (p < 0.001) had. The results suggest the association between nutrition intake, usual activities and pain/discomfort status in the stroke patients with having an anxiety/depression.
Anxiety ; Brain Injuries ; Classification ; Depression ; Energy Intake ; Humans ; Korea ; Male ; Malnutrition ; Niacin ; Nutrition Surveys ; Posture ; Riboflavin ; Self Care ; Stroke ; Survivors ; Walking

PURPOSE: Soft tissue reconstruction of a defect around the foot and ankle is a particularly challenging procedure due to the anatomical and functional characteristics of this area. Hence, only a limited number of treatment options are available. Moreover, if patients wish to avoid additional scars on the ipsilateral lower leg for cosmetic reasons, even fewer options are available for treatment. The authors used an anterolateral thigh perforator flap for soft tissue defects in this area, when other surgical options were inadequate. The aim of this study was to report the clinical results and the efficacy of this procedure. MATERIALS AND METHODS: Sixteen cases of soft tissue defects around the foot and ankle were included. Participants included 12 male and 4 female subjects, and the mean age was 34 years. The most common cause of defect was acute trauma, and the average follow-up period was 33 months. Flap survival time, surgical complications, and ambulation status at the final follow-up stage were evaluated. RESULTS: All 16 flaps successfully survived, except for one case with partial flap necrosis that was thought to be due to weight bearing earlier than scheduled. All patients were able to walk independently without any aid at the final follow-up stage. No patients showed other significant surgical complications. CONCLUSION: The anterolateral thigh perforator flap is a good alternative for soft tissue defects of the foot and ankle, when other options are not applicable. This study also demonstrated that surgery using an anterolateral thigh perforator flap is safe and highly reliable.
Ankle* ; Cicatrix ; Female ; Follow-Up Studies ; Foot* ; Humans ; Leg ; Male ; Necrosis ; Operative Time ; Perforator Flap* ; Reconstructive Surgical Procedures ; Soft Tissue Injuries ; Thigh* ; Walking ; Weight-Bearing

Spinal subarachnoid hematoma (SSH) following diagnostic lumbar puncture is very rare. Generally, SSH is more likely to occur when the patient has coagulopathy or is undergoing anticoagulant therapy. Unlike the usual complications, such as headache, dizziness, and back pain at the needle puncture site, SSH may result in permanent neurologic deficits if not properly treated within a short period of time. An otherwise healthy 43-year-old female with no predisposing factors presented with fever and headache. Diagnostic lumbar puncture was performed under suspicion of acute meningitis. Lumbar magnetic resonance imaging was performed due to hypoesthesia below the level of T10 that rapidly progressed after the lumbar puncture. SSH was diagnosed, and high-dose steroid therapy was started. Her neurological symptoms rapidly deteriorated after 12 hours despite the steroids, necessitating emergent decompressive laminectomy and hematoma removal. The patient’s condition improved after the surgery from a preoperative motor score of 1/5 in the right leg and 4/5 in the left leg to brace-free ambulation (motor grade 5/5) 3-month postoperative. The patient was discharged with no neurologic deficits. Critical complications such as SSH can be fatal. Therefore, a patient undergoing lumbar puncture must be carefully observed. A hematoma that convincingly compresses the spinal cord or cauda equina on imaging results requires early surgical decompression and hematoma removal.
Adult ; Back Pain ; Cauda Equina ; Causality ; Decompression, Surgical ; Dizziness ; Female ; Fever ; Headache ; Hematoma* ; Humans ; Hypesthesia ; Laminectomy ; Leg ; Magnetic Resonance Imaging ; Meningitis ; Needles ; Neurologic Manifestations ; Punctures ; Spinal Cord ; Spinal Cord Injuries ; Spinal Puncture* ; Steroids ; Walking

OBJECTIVE: To identify different contributions of motor and sensory variables for independent ambulation of patients with incomplete spinal cord injury (SCI), and reveal the most significant contributors among the variables. METHODS: The retrospective study included 30 patients with incomplete SCI and lesions were confirmed by magnetic resonance imaging. Motor and sensory scores were collected according to the International Standards for Neurological Classification of Spinal Cord Injury. The variables were analyzed by plotting ROC (receiver operating characteristic) curves to estimate their differential contributions for independent walking. The most significant functional determinant was identified through the subsequent logistic regression analysis. RESULTS: Motor and sensory scores were significantly different between the ambulators and non-ambulators. The majority was associated to the function of lower extremities. Calculation of area under ROC curves (AUC) revealed that strength of hip flexor (L2) (AUC=0.905, p < 0.001) and knee extensor (L3) (AUC=0.820, p=0.006) contributed the greatest to independent walking. Also, hip flexor strength (L2) was the single most powerful predictor of ambulation by the logistic regression analysis (odds ratio=6.3, p=0.049), and the model fit well to the data. CONCLUSION: The most important potential contributor for independent walking in patients with incomplete SCI is the muscle strength of hip flexors, followed by knee extensors compared with other sensory and motor variables.
Classification ; Gait* ; Hip ; Humans ; Knee ; Locomotion ; Logistic Models ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Strength ; Rehabilitation ; Retrospective Studies ; ROC Curve ; Sensation ; Spinal Cord Injuries* ; Spinal Cord* ; Walking

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.
Abdominal Pain ; Aged* ; Colon, Sigmoid ; Colostomy ; Compliance ; Constipation ; Defecation ; Diabetes Complications ; Diagnosis ; Dietary Fiber ; Disabled Persons ; Early Ambulation ; Fecal Impaction ; Female ; Free Tissue Flaps* ; Hand ; Humans ; Immobilization* ; Lower Extremity ; Shock, Septic ; Thigh* ; Thumb* ; Walking ; Wounds and Injuries

OBJECTIVE: To investigate the feasibility of a knee proprioception evaluation using a dynamometer as a tool for evaluating proprioception of the lower extremities in patients with incomplete spinal cord injury (SCI), and to explore its usefulness in predicting the ambulatory outcome. METHODS: A total of 14 SCI patients (10 tetraplegic, 4 paraplegic; all AIS D) were included in this study. The passive repositioning error (PRE) and active repositioning error (ARE) were measured with a dynamometer, along with tibial somatosensory evoked potential (SSEP) and abductor hallucis motor-evoked potential (MEP). Ambulatory capacity was assessed with the Walking Index for Spinal Cord Injury II (WISCI-II), both at the time of the proprioception test (WISCI_i) and at least 6 months after the test (WISCI_6mo). RESULTS: The PRE showed a negative correlation with WISCI_i (r=-0.440, p=0.034) and WISCI_6mo (r=-0.568, p=0.010). Linear multiple regression showed the type of injury, lower extremities motor score, MEP, and PRE accounted for 75.4% of the WISCI_6mo variance (p=0.080). CONCLUSION: Proprioception of the knee can be measured quantitatively with a dynamometer in patients with incomplete SCI, and PRE was related to the outcome of the ambulatory capacity. Along with the neurological and electrophysiological examinations, a proprioception test using a dynamometer may have supplementary value in predicting the ambulatory capacity in patients with incomplete SCI.
Evoked Potentials, Somatosensory ; Humans ; Knee ; Lower Extremity ; Proprioception* ; Spinal Cord Injuries* ; Spinal Cord* ; Walking