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Spinal Cord Injury Update

Summer 2007: Volume 16, Number 3

 

Literature Review

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Recovery Research

Electrophysiological evidence that olfactory cell transplants improve function after spinal cord injury.
Transplants of olfactory cells are a potential treatment for SCI. A number of clinical trials are in progress, but the extent to which transplants improve recovery of function remains unclear and there are contradictory reports on the extent to which they support axonal regeneration. This study used anatomical and electrophysiological techniques to investigate the repair promoted by olfactory cell transplants after a dorsal column lesion in rats. Regeneration of dorsal column axons was compared following transplants of pure olfactory ensheathing cells from neonatal animals and mixed olfactory cells from both neonatal and adult rats. Two to three months after lesioning, numerous regenerating fibres could be seen in each type of transplant. However, tracing of ascending dorsal column fibres showed that few regenerated beyond the lesion, even when transplanted with mixed olfactory cells from the adult olfactory bulb. Despite the absence of axonal regeneration across the injury site, there was improved spinal cord function in sensory pathways investigated electrophysiologically. Cord dorsum potentials were significantly larger than those recorded from lesioned controls, and sensory evoked potentials recorded over the sensorimotor cortex were larger and detectable over a more extensive area in transplanted animals. These results provide direct evidence that transplants of olfactory cells preserve the function of circuitry in the region of the lesion site and of ascending pathways originating near the injury.
Toft A, Scott DT, Barnett SC, Riddell JS.
Brain. 2007 Apr;130(Pt 4):970-84.

Bladder management

Repeated botulinum-A toxin injections in the treatment of myelodysplastic children and patients with spinal cord injuries with neurogenic bladder dysfunction.
Nineteen children with myelodysplasia and 25 adults with spinal cord-injured who had severe detrusor hyperreflexia (bladder overactivity) and incontinence were treated with repeated detrusor (bladder muscle) injections of botulinum-A toxin (BTX). These patients were resistant to and/or could not tolerate anticholinergic medications. Bladder activity and incontinence improved significantly after each injection (approximately every 7-9 months) over a period of 3-5 years. BTX was well tolerated, did not damage the bladder, and its effect did not diminish over time at a stable dose. There were no complications associated with the injection procedure itself. These findings provide evidence that BTX injection is a safe and effective treatment for neurogenic detrusor hyperreflexia and repeat treatments are as effective as the first.
Akbar M, Abel R, Seyler TM, et al.
BJU Int. 2007 May 26

Pain & Other Symptoms

Symptom burden in persons with spinal cord injury.
This study examined the frequency and severity of seven symptoms and their association with functioning in persons with SCI. A survey that measured pain, fatigue, numbness, weakness, shortness of breath, vision loss, and memory loss, community integration and psychological functioning, was mailed to 339 persons with SCI; 147 (43%) were completed. The most common symptoms were pain, weakness, fatigue, and numbness. All symptoms were reported to remain the same or get worse more often than they were reported to improve once they began. Pain, weakness, fatigue, and memory loss were the symptoms most closely associated with patient functioning. Of 7 symptoms studied, pain, weakness, and fatigue appeared to be most common and most closely linked to patient social and mental health functioning.
Jensen MP, Kuehn CM, Amtmann D, Cardenas DD.
Arch Phys Med Rehabil. 2007 May;88(5):638-45.

Sexuality

Sexual activity and satisfaction in men with traumatic spinal cord lesion.
A questionnaire on sexual activity, sexual desire and orgasm, and a clinical examination, were given to 92 men with SCI (79% of all males with SCI in Helsinki); mean age 49; mean age at injury 30; 48% with complete injuries; 51% with tetraplegia (quadriplegia). In total, 86% of the subjects experienced sexual desire and 68% had been sexually active during the last 12 months. A total of 65% of subjects reported experiencing orgasm since the injury, but most subjects rated it as weaker than before the injury. The completeness of the lesion had no effect. Men with paraplegia reported a more satisfactory sex life than those with tetraplegia.
Dahlberg A, Alaranta HT, Kautiainen H, Kotila M.
J Rehabil Med. 2007 Mar;39(2):152-5.

Spasticity

Spasticity experience domains in persons with spinal cord injury.
To understand the everyday life experiences of persons who have spasticity associated with SCI, an open-ended, semi-structured, in-depth interview was conducted with 24 individuals (17 males). Analysis of interview data revealed seven domains and subcategories associated with experiences of spasticity: physical (types of movement, severity, pain, timing, triggers, and course); activity; emotional; economic; interpersonal; management of symptoms: and cognitive (how people understand their spasticity). Patients personalized the meaning of spasticity and expressed their understandings of the condition in ways that may not be consistent with clinical definitions or fit neatly with a biomedical understanding of spasticity. Some preferred being able to control rather than totally suppress spasticity. Spasticity-related interventions need to be aimed at what matters most to the patient. It is critical for clinicians to understand patients’ experiences to make accurate assessments and select appropriate management strategies.
Mahoney JS, Engebretson JC, Cook KF, et al.
Arch Phys Med Rehabil. 2007 Mar;88(3):287-94.

Respiratory

Estimated prevalence of obstructive sleep apnea-hypopnea syndrome after cervical cord injury.
Forty-one adults (34 males) with cervical SCI (greater than six months duration) underwent clinical exam, overnight polysomnography (sleep study) and a medical history that focused on symptoms of obstructive sleep apnea (cessation of breathing) and hypopnea (abnormally shallow breathing) syndrome (OSAHS). Information was collected on injury, current medication, sleeping habits, daytime sleepiness, body mass index (BMI), and neck circumference of each participant. Twenty-two (53%) patients were found to have OSAHS. Daytime sleepiness, BMI of 30 kg/m2 or higher, and 3 or more awakenings during sleep were the best predictive (risk) factors of OSAHS. No association was found between the presence of OSAHS and the participants’ age, sex, SCI level, ASIA impairment scale (completeness of injury), benzodiazepines or baclofen. These results, like other studies, indicate a high rate of OSAHS among individuals with cervical SCI. Physicians should suspect OSAHS in this population, especially inpatients with daytime sleepiness, obesity and frequent awakenings during sleep.
Leduc BE, Dagher JH, Mayer P, et al.
Arch Phys Med Rehabil. 2007 Mar;88(3):333-7.

Acute respiratory infections in persons with spinal cord injury.
Respiratory disorders are the leading cause of death for persons with both acute and chronic spinal cord injury (SCI), and much of the morbidity and mortality associated with respiratory disorders is related to acute respiratory infections. Pneumonia is the best recognized respiratory infection associated with mortality in this population. Recent evidence supports some management strategies that differ from those recommended for the general population. Upper respiratory tract infections and acute bronchitis may be precipitating factors in the development of pneumonia or ventilatory failure in patients with chronic SCI. This review emphasizes management principles for treatment and prevention of respiratory infections in persons with SCI.
Burns SP
Phys Med Rehabil Clin N Am. 2007 May;18(2):203-16, v-vi. Review

Upper limb surgery for tetraplegia (quadriplegia)

Perceptions of people with tetraplegia regarding surgery to improve upper-extremity function.
Despite estimates that at least 65% of the 100,000 people with tetraplegia (quadriplegia) in the U.S. would benefit from upper-extremity reconstructive surgery to improve function, currently only 10% of this population have these procedures. This cross-sectional survey administered to 50 participants identified the attitudes and beliefs of people with tetraplegia that may dissuade potential candidates from receiving these surgeries. Overall, 21 (42%) ranked upper-extremity function as their first priority for restoring function and 22 (44%) were interested in upper-extremity reconstruction. However, 13 (26%) had never heard of upper-extremity reconstructive surgery, and those who had were significantly more likely to have a negative first impression of the surgery if they first learned about it from a primary care or rehabilitation physician rather than from other sources. People with tetraplegia who had a negative first impression of these procedures were far less likely to want reconstruction. Among patients who learned about these procedures from their physicians, 10 (67%) had a negative first impression. The physician factor is the dominant reason for national underuse of upper-extremity procedures in this population and needs to be addressed in order to assist patients to make rational decisions about a procedure that can markedly affect their recovery.
Wagner JP, Curtin CM, Gater DR, Chung KC.
J Hand Surg [Am]. 2007 Apr;32(4):483-90.

Psychosocial

Psychological or physiological? Why are tetraplegic patients content?
Surveys to assess physical and emotional aspects of quality of life were given to 20 subjects with high-cord (T6 and above) complete SCI, 10 subjects with low-cord (T7 and below) complete SCI and 11 able-bodied control subjects. Overall, satisfaction with life was the same among the groups. While high- and low-cord SCI subjects reported lower physical functioning than controls, there were no differences in perceived physical role, physical health or social function. Furthermore, high-cord SCI subjects reported better perceived mental health than controls, and better perceived emotional role in society and greater vitality than both low-cord SCI and control subjects. Analysis showed that for complete SCI patients, the worse their physical impairment, the better their overall mental health. This unexpected finding suggests that psychological coping alone is unlikely to explain these observations, and the role of physiologic and neurocognitive changes need further examination.
Abrantes-Pais F, Friedman JK, Lovallo WR, Ross ED
Neurology 2007;69:261-7

Psychological impact of sports activity in spinal cord injury patients.
A total of 137 men with SCI at least 5 years post injury (38% with tetraplegia (quadriplegia); 62% with paraplegia) completed questionnaires that collected information on demographics, injury, education, and participation in sports, as well as assessments of anxiety, depression, and personality (extraversion/introversion). Forty-four percent of the tetraplegic group and 57% of the paraplegic group participated in sports. Results showed that those who did not participate in sports showed higher anxiety and depression scores and lower extraversion scores than sports participants, regardless of injury level. Findings demonstrate that sports activity is associated with better psychological status in individuals with SCI.
Gioia MC, Cerasa A, Di Lucente L, et al.
Scan J Med Sci Sports 2006;16:412-416

Community participation after spinal cord injury.
A sample of 357 people (response rate, 44%) with SCI recruited through the British Columbia Paraplegic Association completed mailed surveys on community participation, activity and relationships. Average age of respondents was 46 and time since injury 13 years. Life satisfaction and happiness were assessed using the Satisfaction With Life Scale and Happiness Scale. No limitations to participation were experienced by 18.5% of the respondents. Satisfaction with transportation was associated with owning one’s own vehicle. Being physically active was important to a majority and 75% were currently engaged in physical activity. Respondents were generally happy and satisfied with life, and higher income was associated with greater satisfaction but had no effect on happiness. Findings show that life satisfaction is more strongly related to community participation than impairment or physical limitations, and environmental factors are significantly related to participation.
Carpenter C, Forwell SJ, Jongbloed LE, Backman CL.
Arch Phys Med Rehabil. 2007 Apr;88(4):427-33.

How to obtain the complete articles

You may obtain copies of the complete articles through your local medical library or through the University of Washington Health Sciences Library Document Service at http://healthlinks.washington.edu/hsl/docservices/illiad.htm. (There is a fee for this service.)