No description available.

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There is a dearth of published literature that documents the levels of functional ability post spinal cord injury (SCI) resulting in paraplegia, at discharge from in-patient rehabilitation facilities within Gauteng. In addition, the factors that influence functional ability are poorly defined in individuals with paraplegia, at their discharge from in-patient rehabilitation facilities in Gauteng. This necessitated further investigation since it is vital for the rehabilitation of individuals with SCI resulting in paraplegia. The aim of the study was to determine the functional ability and the factors that affect the functional ability in individuals with a SCI resulting in paraplegia, at discharge from rehabilitation facilities in Gauteng. The first objective of the study was to establish the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. The second objective of the study was to describe the physical and demographic factors of the study population. The third objective of the study was to establish the demographic and physical factors that influence the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. This was a cross-sectional, observational study design. Three instruments were used in this study: a self-designed questionnaire to establish the factors that influence the level of functional ability in patients with SCI at discharge from an in-patient rehabilitation unit; the American Spinal Injury Association (ASIA) classification scale of neurological impairment to describe the level and completeness of the lesion and the Spinal Cord Independence Measure III (SCIM III) to determine the level of functional ability. The main results of the study were as follows: The average SCIM score in this population was 64.6 (±27.6) with the lowest score being 20 and the highest score being 84. Participants with non traumatic SCI had 16.87% lower SCIM scores than those with traumatic SCI. After multivariate analysis the following factors were found to influence function: For every one year increase in the age of the participant, there was 0.18% decrease in the SCIM score. For every day increase in LOS, there was a corresponding increase of 0.06% in the SCIM score. With respect to the presence of a pressure sore from the acute hospital, those who had pressure sores had 9% lower SCIM scores than those who did not have pressure sores. Participants with spasticity had 8.3% lower SCIM scores relative to those that did not have spasticity. Relative to participants in government funding classification, workman’s compensation participants had 4.82% lower SCIM score followed by the medical aid participants with 8.07% lower SCIM and the private participants with 10.84% lower SCIM scores. For every unit increase in the ASIA motor score, there was an increase of 1.29% in the SCIM score. Conclusion: Majority of the participants in this study were discharged from rehabilitation without reaching functional independence. The following categories of patients with SCI may need to be monitored more for functional outcomes during rehabilitation and assisted in order to attain good functional ability: older age, a short rehabilitation length of stay, funded privately, a low ASIA motor score, having a pressure sore or spasticity, and higher level of SCI. Key words: Functional outcomes, paraplegia, rehabilitation, neurological level, spinal cord injury.

Digitized by Kansas Correctional Industries

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Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 129-150).

This thesis examined two aspects of information processing by the feline spinal cord during centrally-evoked motor activity: 1) the modification of transmission from different sensory afferents and 2) the neuronal elements of reflex pathways from group II muscle afferents during fictive motor behaviours (i.e motoneuron activity under neuromuscular blockade). Fictive locomotion was evoked by electrical stimulation in the midbrain and fictive scratch was triggered by stimulation of the skin covering the ears following curare application to cervical dorsal roots in decerebrate in vivo feline preparations. Both monosynaptic and longer latency components of muscle and cutaneous afferent-evoked field potentials were reduced in amplitude during fictive locomotion and scratch, but field potentials evoked by muscle group II afferents were suppressed more than those evoked by cutaneous and group I muscle afferents recorded at the same spinal locations. The novel finding, that field potentials evoked at the same spinal locations by muscle and cutaneous afferents are suprressed differently, suggests that there is a preferential and non-uniform control of transmission from muscle and cutaneous fibres during motor activity. Extracellular recordings from neurons within the lumbar spinal segments showed that suppression of group II afferent input during fictive motor activity results in a powerful reduction of the activation of neurons with input from muscle group II afferents in 93% of the examined neurons after short trains of stimuli were delivered to peripheral nerves. However, more neurons remained recruitable by group II intensity stimulation if train duration was sufficiently long with only 33% showing a reduction in sensory-evoked firing. The majority of the neurons that remained responsive to muscle group II afferent input during fictive locomotion had axonal projections to supralumbar, or supraspinal areas and showed spontaneous, often rhythmic, firing activity. Overall, the studies presented in this thesis provide insights into the mechanisms by which the mammalian spinal cord processes sensory information and on how sensory input is able to control motor activity in spite of suppressive control provided by the nervous system. / October 2006

Spinal cord injuries can cause the catastrophic loss of motor and sensory function. The neurological deficits that result are the consequence of not only the primary injury to the spinal cord, but also a complex milieu of secondary pathological processes that are now beginning to be understood. The major mechanisms that underlie this secondary pathology include vascular disruption, ischemia, oxidative stress, excitotoxicity, and inflammation. In light of this, the fact that this secondary pathology occurs after the initial impact makes it potentially amenable to therapeutic intervention. Pharmacotherapies may attenuate some of these processes and minimize secondary damage. Some of the promising treatments that are emerging for acute spinal cord injury are drugs that are already used by physicians for the treatment of unrelated diseases. These drugs, which have already been established to be safe for humans, offer the unique advantage over other novel therapeutic interventions that have yet to be tested in humans. This would save a tremendous amount of time and money needed for human safety studies, if considered as a treatment for spinal cord injury. Examples of such drugs include minocycline (an antibiotic), erythropoietin (a recombinant hormone used to treat anemia), and statins (a popular class of blood cholesterol reducers), all of which have demonstrated the ability to attenuate the various pathophysiological processes initiated after trauma to the central nervous system. In a series of studies, erythropoietin, darbepoetin, atorvastatin, simvastatin, and minocycline were all evaluated for their ability to improve neurologic recovery in a clinically relevant model of spinal cord injury. My experiments revealed that erythropoietin, darbepoetin, atorvastatin and minocycline did not significantly improve neurological recovery. These negative results were in stark contrast to the positive findings which had been published in the literature suggesting that differences in experimental models and methodology influence the neuroprotective efficacy of these drugs. Simvastatin, on the other hand, demonstrated significant improvements in locomotor and histological outcomes. Although this is indeed exciting, the results were modest at best. My results highlight the need for further preclinical work on the above treatments to refine and optimize them prior to proposing them for human testing.