STUDY DESIGN: A quasi-experimental single-blinded study. PURPOSE: To investigate the effects of ‘graded exercise integrated with education’ on physical fitness, exercise self-efficacy (ESE), and physical activity (PA) levels among subacute and chronic wheelchair-dependent paraplegia patients. OVERVIEW OF LITERATURE: Most of the chronic spinal cord injury (SCI) patients had low physical fitness due to a sedentary lifestyle and lack of ESE after discharge from a rehabilitation program. Education may encourage them to engage with exercise to regain and maintain their physical fitness. However, there is a lack of research to support the effects of exercise integrated with education after an SCI. METHODS: A total of 44 participants will be assigned to either the experimental group (graded exercise integrated with education) or active control (conventional physical therapy). The experimental group will receive graded strength and aerobic exercise training according to their progression criteria. They will attend an education program during and after the rehabilitation program. The control group will only receive conventional physical therapy during their in-rehabilitation program. This study will be conducted during a period of 16 weeks, consisting of 8 weeks of in-rehabilitation and 8 weeks post-rehabilitation. Statistical analysis will be performed using the IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA) at a significance level of p≤0.05. RESULTS: The primary outcome measures will be upper-limb isokinetic strength, isometric grip strength, and cardiorespiratory fitness. The secondary outcomes will be ESE and PA levels. CONCLUSIONS: An intervention that combines exercise training and education may be warranted to enhance the physical fitness, ESE, and PA levels in SCI patients. This trial was registered with ClinicalTrials.gov (NCT03420170).
Education ; Exercise ; Hand Strength ; Health Education ; Humans ; Motor Activity ; Non-Randomized Controlled Trials as Topic ; Outcome Assessment (Health Care) ; Paraplegia ; Physical Fitness ; Rehabilitation ; Sedentary Lifestyle ; Self Efficacy ; Spinal Cord Injuries ; Spinal Cord ; Spine

Three male patients diagnosed with surfer's myelopathy (19–30 years) were admitted to our hospital. All three patients were novice surfers showing a typical clinical course of rapid progression of paraplegia following the onset of back pain. Typical history and magnetic resonance imaging features indicated the diagnosis of surfer's myelopathy. Two patients received high-dose steroid therapy and the other was treated with induced hypertension. One patient treated with induced hypertension showed almost full recovery; however, two patients who received high-dose steroid therapy remained completely paraplegic and required catheterization for bladder and bowel dysfunction despite months of rehabilitation. Our case series demonstrates the potentially devastating neurological outcome of surfer's myelopathy; however, early recovery in the initial 24–72 hours of presentation can occur in some patients, which is in accordance with previous reports. Ischemic insult to the spinal cord is thought to play a crucial role in the pathophysiology of surfer's myelopathy. Treatment recommendations include hydration, induced hypertension, early spinal angiography with intra-arterial intervention, intravenous tissue plasminogen activator, and high-dose steroid therapy; however, there is no standardized treatment option available. Early recovery appears to be important for long-term neurological outcome. Induced hypertension for initial treatment can be helpful for improving spinal cord perfusion; therefore, it is important for early and long-term neurological recovery. Education and awareness are essential for preventing surfer's myelopathy and avoiding further deterioration of neurological function.
Angiography ; Back Pain ; Catheterization ; Catheters ; Diagnosis ; Education ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Paraplegia ; Perfusion ; Rehabilitation ; Spinal Cord ; Spinal Cord Diseases ; Spinal Cord Injuries ; Tissue Plasminogen Activator ; Urinary Bladder

OBJECTIVE: To evaluate the clinical features that could serve as predictive factors for improvement in gait speed after robotic treatment. METHODS: A total of 29 patients with motor incomplete spinal cord injury received 4-week robot-assisted gait training (RAGT) on the Lokomat (Hocoma AG, Volketswil, Switzerland) for 30 minutes, once a day, 5 times a week, for a total of 20 sessions. All subjects were evaluated for general characteristics, the 10-Meter Walk Test (10MWT), the Lower Extremity Motor Score (LEMS), the Functional Ambulatory Category (FAC), the Walking Index for Spinal Cord Injury version II (WISCI-II), the Berg Balance Scale (BBS), and the Spinal Cord Independence Measure version III (SCIM-III) every 0, and 4 weeks. After all the interventions, subjects were stratified using the 10MWT score at 4 weeks into improved group and non-improved group for statistical analysis. RESULTS: The improved group had younger age and shorter disease duration than the non-improved group. All subjects with the American Spinal Injury Association Impairment Scale level C (AIS-C) tetraplegia belonged to the non-improved group, while most subjects with AIS-C paraplegia, AIS-D tetraplegia, and AIS-D paraplegia belonged to the improved group. The improved group showed greater baseline lower extremity strength, balance, and daily living function than the non-improved group. CONCLUSION: Assessment of SCIM-III, BBS, and trunk control, in addition to LEMS, have potential for predicting the effects of robotic treatment in patients with motor incomplete spinal cord injury.
Gait* ; Humans ; Locomotion ; Lower Extremity ; Paraplegia ; Quadriplegia ; Rehabilitation ; Robotics ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries ; Walking

OBJECTIVE: To evaluate the usefulness of various magnetic resonance imaging (MRI) findings in the prognosis of neurological recovery in paraplegics with thoracolumbar fracture using association analysis with clinical outcomes and electrodiagnostic features. METHODS: This retrospective study involved 30 patients treated for paraplegia following thoracolumbar fracture. On axial and sagittal T2-weighted MRI scans, nerve root sedimentation sign, root aggregation sign, and signal intensity changes in the conus medullaris were independently assessed by two raters. A positive sedimentation sign was defined as the absence of nerve root sedimentation. The root aggregation sign was defined as the presence of root aggregation in at least one axial MRI scan. Clinical outcomes including the American Spinal Injury Association impairment scale, ambulatory capacity, and electrodiagnostic features were used for association analysis. RESULTS: Inter-rater reliability of the nerve root sedimentation sign and the root aggregation sign were kappa=0.67 (p=0.001) and kappa=0.78 (p<0.001), respectively. A positive sedimentation sign was significantly associated with recovery of ambulatory capacity after a rehabilitation program (chi2=4.854, p=0.028). The presence of the root aggregation sign was associated with reduced compound muscle action potential amplitude of common peroneal and tibial nerves in nerve conduction studies (chi2=5.026, p=0.025). CONCLUSION: A positive sedimentation sign was significantly associated with recovery of ambulatory capacity and not indicative of persistent paralysis. The root aggregation sign suggested the existence of significant cauda equina injuries.
Action Potentials ; Cauda Equina ; Conus Snail ; Electrodiagnosis ; Humans ; Magnetic Resonance Imaging* ; Neural Conduction ; Paralysis ; Paraplegia ; Prognosis ; Rehabilitation ; Retrospective Studies ; Spinal Injuries ; Tibial Nerve

Spinal subarachnoid hemorrhages (SAH) can extend into the intracranial subarachnoid space, but, severe cerebral vasospasm is rare complication of the extension of intracranial SAH from a spinal subarachnoid hematoma. A 67-year-old woman started anticoagulant therapy for unstable angina. The next day, she developed severe back pain and paraplegia. MRI showed intradural and extramedullar low signal intensity at the T2-3, consistent with intradural hematoma. High signal intensity was also noted in the spinal cord from C5 to T4. We removed subarachnoid hematoma compressing the spinal cord. The following day, the patient complained of severe headache. Brain CT revealed SAH around both parietal lobes. Three days later, her consciousness decreased and left hemiplegia also developed. Brain MRI demonstrated multiple cerebral infarctions, mainly in the right posterior cerebral artery territory, left parietal lobe and right watershed area. Conventional cerebral angiography confirmed diffuse severe vasospasm of the cerebral arteries. After intensive care for a month, the patient was transferred to the rehabilitation department. After 6 months, neurologic deterioration improved partially. We speculate that surgeons should anticipate possible delayed neurological complications due to cerebral vasospasm if intracranial SAH is detected after spinal subarachnoid hematoma.
Aged ; Angina, Unstable ; Back Pain ; Brain ; Cerebral Angiography ; Cerebral Arteries ; Cerebral Infarction ; Consciousness ; Female ; Headache ; Hematoma* ; Hemiplegia ; Humans ; Critical Care ; Magnetic Resonance Imaging ; Paraplegia ; Parietal Lobe ; Posterior Cerebral Artery ; Rehabilitation ; Spinal Cord ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Vasospasm, Intracranial*

OBJECTIVE: To investigate employment status after spinal cord injury (SCI) and identify personal, family, and injury characteristics those affect their employment in South Korea. METHODS: Participants were 334 community-dwelling persons 20-64 years of age who had sustained SCI for more than one year. Investigators visited each participant's home to carry out the survey. Bivariate and binary logistic regression analyses were performed to identify personal, family, and injury characteristics that influenced employment after SCI. RESULTS: Employment rate decreased significantly from 82.5% to 27.5% after SCI. Logistic regression showed that the probability of employment was higher in men than women, and in individuals older than 45 years at the time of injury than those aged 31-45 years of age. Moreover, employment was higher in individuals injured for longer than 20 years than those injured for 1-5 years and in individuals with incomplete tetraplegia than those with complete paraplegia. Employment was lower in individuals with SCI caused by industrial accidents than those injured in non-industrial accidents. CONCLUSION: Injury characteristics are the most important predictors of employment in persons with SCI. For persons with lower employment rate, individualized vocational rehabilitation and employment-support systems are required.
Accidents, Occupational ; Employment* ; Female ; Humans ; Logistic Models ; Male ; Paraplegia ; Quadriplegia ; Rehabilitation, Vocational ; Republic of Korea* ; Research Personnel ; Spinal Cord Injuries* ; Spinal Cord*

Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic disease, characterized by mass forming inflammatory lesions which respond well to steroid therapy. Pancreas is the most common site of involvement, and other organ involvements are also common. However, there are only a few reports about central nervous system involvement. We report a case of IgG4-related sclerosing disease which involves spinal cord causing paraplegia. A middle-aged female presented with sudden lower limb weakness. Magnetic resonance imaging showed a soft tissue mass which was diffusely compressing spinal cord along the C7 to T5 levels. Intravenous steroid pulse therapy and emergent operation was performed. The immunopathologic findings revealed IgG4-related sclerosing pachymeningitis postoperatively. There was no evidence of other organ involvement. Her neurologic deficit remained unchanged after two months of comprehensive rehabilitation therapy.
Central Nervous System ; Female ; Humans ; Immunoglobulin G ; Immunoglobulins ; Lower Extremity ; Magnetic Resonance Imaging ; Meningitis ; Neurologic Manifestations ; Pancreas ; Paraplegia* ; Rehabilitation ; Spinal Cord ; Spinal Cord Compression

STUDY DESIGN: Retrospective study. PURPOSE: The goal of care for paraplegic people is the enhancement of their "well-being". However, despite the frequent use of the term "well-being", its definition remains unclear and there is little information in the literature concerning the paraplegic's own perspective. The study was conducted to explore the Pakistani paraplegia's perspective of well-being. OVERVIEW OF LITERATURE: Studies have shown that paraplegia changes not only physical and psychological, but also socioeconomic, states, which have significant impact on an individual's "subjective well-being", however there is no clear definition of well-being and the methods of measuring the phenomena. METHODS: Fifty paraplegic adults from different rehabilitation centers of Pakistan participated in an in-depth interview using natural inquiry method. The interviews were audio-taped, transcribed, and analyzed. RESULTS: Three commonly used meanings of well-being and eight components were identified and included in the definition. The results indicated that the meaning of well-being is an individual's perception, which includes both objective and subjective values and experiences. CONCLUSIONS: The study provides information that was used to develop specific rehabilitation program for the paraplegic Pakistani adults to enhance their well-being.
Activities of Daily Living ; Adult ; Humans ; Pakistan ; Paraplegia ; Rehabilitation Centers ; Retrospective Studies ; Spinal Cord Injuries

OBJECTIVETo evaluate the beneficial effects of application of a self-designed reciprocating gait orthosis (RGO) combined with comprehensive rehabilitation training on bladder and bowel function in paraplegic patients sustaining spinal cord injuries (SCI).

METHODSTwelve paraplegic patients with complete spinal cord injury at the levels between T(4) and L(1) received the RGO with a comprehensive rehabilitation exercise program carried out before and after fixing. Cold water and colon excretion tests were performed before and 3 months after application of the RGO, and the bladder volume, residue bladder volume, and bladder and bowel pressures were measured in these patients.

RESULTSThe 12 paraplegic patients all showed positive results in cold water test before and after RGO application. Before RGO application, 11 of these patients were positive for urine bacteria and only 1 patient was still positive 3 months after the application. The bladder volume and bowel pressure of the patients were significantly increased (P<0.05), while the residue volume and pressure of the bladder were significantly reduced 3 months after RGO application (P<0.05).

CONCLUSIONRGO combined with comprehensive rehabilitation training can effectively improve the bladder and bowel function and the quality of life of patients with complete spinal cord injury, suggesting much clinical value for its extensive application.

Adult ; Female ; Humans ; Intestines ; physiopathology ; Male ; Middle Aged ; Orthotic Devices ; Paraplegia ; etiology ; physiopathology ; rehabilitation ; Spinal Cord Injuries ; complications ; Urinary Bladder ; physiopathology ; Walkers ; Young Adult

This paper suggested a new method of spacial risk-trend trace (SRTT) to assess and monitor the spacial balance condition during paraplegic walking assisted by functional electrical stimulation (FES), which main component was a measurement system of upper limb support based on a standard walker. With the support data, the spacial positions of moving center of gravity could be located through the upper body mechanical model and, combining with the definition of walker rolling index, transmitted into SRTT to describe the balance conditions at different axial space. The experimental and clinical results demonstrated the new SRTT method was reliable and real-time. Its potential clinical usefulness in evaluating and monitoring FES-assisted paraplegic walking ability may provide the foundation to enact the relevant national rehabilitation criterions for effective FES usage.
Electric Stimulation Therapy ; instrumentation ; methods ; Humans ; Monitoring, Physiologic ; methods ; Paraplegia ; rehabilitation ; Postural Balance ; physiology ; Self-Help Devices ; Therapy, Computer-Assisted ; methods ; Walking ; physiology