Cases reported "Spinal Cord Injuries"

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1/14. Interfacing the body's own sensing receptors into neural prosthesis devices.

    Functional electric stimulation (FES) is today available as a tool in muscle activation used in picking up objects, in standing and walking, in controlling bladder emptying, and for breathing. Despite substantial progress over nearly three decades of development, many challenges remain to provide a more efficient functionality of FES systems. The most important of these is an improved control of the activated muscles. Instead of artificial sensors for feedback, new developments in electrodes to do long-term and reliable recordings from peripheral nerves emphasize the use of the body's own sensors. These are already installed and optimised through millions of years of natural evolution. This paper presents recent results on a system using electrical stimulation of motor nerves to produce movement and using the natural sensors as feedback signals to control the stimulation that can replicate some of the functions of the spinal cord and its communication with the brain. We have used the nerve signal recorded from cutaneous nerves in two different human applications: (1) to replace the external heel switch of a system for correction of spastic drop foot by peroneal stimulation, and (2) to provide an FES system for restoration of hand grasp with sensory feedback from the fingertip. For the bladder function, the sacral root stimulator is a useful control tool in emptying the bladder. To decide when to stimulate, we are at present carrying out experiments on pigs and cats using cuff electrodes on the pelvic nerve and sacral roots to record the neural information from bladder afferents. This information can potentially be used to inhibit unwanted bladder contractions and to trigger the FES system and thereby bladder emptying. Future research will show whether cuffs and other types of electrodes can be used to reliably extract signals from the large number of other receptors in the body to improve and expand on the use of natural sensors in clinical FES systems.
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2/14. Spinal cord injury in the newborn infant.

    Birth injury to the spinal cord secondary to traction forces during delivery is a common but frequently undiagnosed disorder. The injury usually affects the cervicodorsal junction, with both extradural hematoma and direct cord damage at that level. Clinical findings of a paraplegic infant with abdominal breathing are sometimes obscured by secondary pneumonia and/or hypoxia. Radiologic manifestations include a bell shaped chest indicative of loss of the external muscles of respiration; spinal roentgenograms are usually normal. myelography in neonatal spinal injury demonstrates a block in the subarachnoid space; infrequently localized cord atrophy may be identified.
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3/14. Aerophagia as a cause of ineffective phrenic nerve pacing in high tetraplegia: a case report.

    We report an unusual case of aerophagia after traumatic spinal cord injury (SCI), which shows the profound effects of abdominal distension on respiratory ability in such individuals. In this case, abdominal distension resulting from aerophagia reduced the effectiveness of phrenic nerve pacing on diaphragm function necessitating greater use of positive-pressure ventilatory (PPV) support. Reduction of postprandial gastric air and abdominal distension with insertion of a percutaneous endoscopic gastrostomy tube ameliorated the condition and allowed for more effective phrenic nerve pacing and greater PPV-free breathing. We are unaware of a similar case involving an individual with an SCI.
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4/14. Breathlessness associated with abdominal spastic contraction in a patient with C4 tetraplegia: a case report.

    A tetraplegic patient with C4 cervical cord injury reported breathlessness during episodes of spastic contraction of the abdominal muscles. To determine the mechanism, we performed electrophysiologic testing of the phrenic nerves. We measured abdominal pressure, esophageal pressure, and transdiaphragmatic pressure (Pdi) during a maximal inspiratory effort (Pdi max), a maximal sniff maneuver (sniff Pdi) during resting breathing, and during the episodes of breathlessness. Electrophysiologic testing of the phrenic nerves showed axonal neuropathy on the left. Sniff Pdi and Pdi max were 38cmH(2)O and 42cmH(2)O, respectively. Transient spastic contractions of abdominal muscles were associated with an increase in abdominal pressure greater than 30cmH(2)O, with a decrease in abdominal volume; this rise in abdominal pressure was transmitted to the esophageal pressure. Inspiration became effective only when esophageal pressure fell below the resting baseline value. Achieving this decrease required an increase in inspiratory effort, characterized by swings in esophageal pressure and Pdi of 30cmH(2)O and 40cmH(2)O (approximately 100% of Pdi max), respectively. During these periods, minute ventilation was markedly reduced. This is the first report that spastic abdominal muscle contractions can impose a significant load on the diaphragm, uncovering moderate diaphragmatic weakness. This has important clinical implications; abolition of the spastic abdominal muscle contraction in this patient completely resolved her intermittent respiratory symptoms.
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5/14. Functional electrical stimulation (FES) for spinal cord injury.

    Restoration of respiratory motion by stimulation of the phrenic nerve was investigated. Respiratory motion was restored successfully by introducing a breathing pacemaker to a patient with respiratory disturbance due to upper cervical spinal cord injury. Breathing pacemakers are considered to be more similar to physiological conditions compared to mechanical ventilators. Although the system is very expensive, its cost effectiveness may be excellent, provided that it can be used for long hours each day over an extended period. The system is effective in improving patient QOL because it dramatically increases patient mobility. From these findings, it is concluded that breathing pacemakers should be used more frequently in japan, and that various forms of support are necessary to cope with economic and other concerns.
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6/14. cheyne-stokes respiration, periodic circulation, and pulsus alternans in spinal cord injury patients.

    STUDY DESIGN: case reports. OBJECTIVES: To describe cheyne-stokes respiration (CSR) and associated circulatory abnormalities in three patients with spinal cord lesions. SETTING: veterans Administration Hospital, USA. SUBJECTS: One paraplegic patient with coronary artery disease in congestive heart failure, one tetraplegic patient with alcoholic cardiomyopathy and postural hypotension, and one tetraplegic complete patient with cardiomegaly, severe aortic atherosclerosis, and postural hypotension. methods: Breathing activity was measured with a nasal thermistor or abdominal stretch transducer. Cardiac activity was estimated with a photoelectric sensor for cutaneous blood flow placed on the forehead or a piezoelectric transducer for pressure positioned over an artery or the cardiac apex. Tracings were drawn on a strip chart recorder. The subjects were at rest in semireclining positions. RESULTS: Survey times were 17-21 min, and cycling periods were 41-72 s. Periodic changes in the depth of breathing were accompanied by periodic changes in amplitude of forehead cutaneous pulse, blood pressure, or apical cardiac impulse in all patients. Peak circulation occurred at or following peak respiration. In addition, cyclical pulsus alternans occurred in two patients. CONCLUSION: Three spinal cord injury patients sustained CSR and circulatory periodicity associated with cardiac disease and postural hypotension.
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7/14. Effect of acute aminophylline administration on diaphragm function in high cervical tetraplegia: a case report.

    theophylline has been shown to have beneficial effects on phrenic nerve and diaphragm activation. This case report involves a C5-C6 chronic tetraplegic patient with acute respiratory failure and ventilator dependence. IV aminophylline was administered in increasing doses (2 mg/kg, 4 mg/kg, and 6 mg/kg) over the course of 1 day. diaphragm surface electromyography (sEMG), measures of respiration (tidal volume, minute ventilation, and frequency), and serum theophylline levels were captured. diaphragm sEMG activity increased by a maximum of 50% at therapeutic levels. The rapid shallow breathing index dropped from 112 to 86. The subject was successfully weaned from ventilatory support. We conclude that administration of aminophylline facilitated weaning from ventilatory support in this tetraplegic patient.
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8/14. Obstructive disordered breathing during sleep in patients with spinal cord injury.

    Little is known about respiration and sleep in spinal cord injured (SCI) patients, and yet they frequently have complaints related to sleep. Four SCI patients with various sleep complaints were evaluated with nocturnal polysomnography. All 4 had evidence of obstructive sleep apnea (disordered breathing). These findings suggest that obstructive sleep apnea may be contributing to disruptive sleep in SCI patients and may be responsible for many of their daytime symptoms.
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9/14. Scuba diving: taking the wheelchair out of wheelchair sports.

    In the past, physicians prohibited patients with neuromuscular disease or disability from participating in scuba diving. This report highlights the opportunities that self-contained underwater breathing apparatus (scuba) affords to physically handicapped individuals, to move without assistive devices in a gravity-free environment. The experience of a person with T10 paraplegia is used to illustrate the applicability of a new system of evaluation, training, and certification for scuba diving to patients with a wide variety of disabilities, such as paraplegia, quadriplegia, amputation, cerebral palsy, and poliomyelitis. This review also discusses equipment needs, potential risks, and safety precautions. physicians are encouraged to support those handicapped individuals who choose to explore the submerged two thirds of our planet for its recreational as well as its potential vocational opportunities.
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10/14. Undiagnosed spinal cord injuries in brain-injured children.

    Four children with brain injury were later found to have coexisting spinal cord injury (SCI). Findings that warrant investigation for coexisting SCI include a dermatome pattern sensory loss; absence of movement and reflexes in either both arms or both legs with preservation in the remaining extremities; flaccidity; absence of sacral reflexes; diaphragmatic breathing without use of accessory respiratory muscles; bradycardia with hypotension; autonomic hyperreflexia; poikilothermia; unexplained urinary retention; history of neck pain; unexplained ileus; priapism; and the presence of clonus in an unconscious patient without decerebrate rigidity. If any of the above are present, the spine should be stabilized until either further diagnostic studies confirm SCI with treatment instituted or serial neurologic examinations confirm the absence of SCI.
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