Ten caucasian male quadriplegics were compared with eight sedentary caucasian male controls in regards to left ventricular dimensions and mass obtained from echocardiograrns. The interventricular septum (IVS), left ventricular posterior wall (LVPW) and left ventricular internal diameter (LVII) were within normal limits for both groups. However, the INS in the SCI were significantly thicker than controls (p <0.05). Myocardial thickness was larger in SCI subjects (p <0.05). Absolute left ventricular mass (LVM) and total left ventricular volume was not different ( p > 0.05), but SCI subjects had significantly greater LVM to lean body mass ratios. Echocardiographically, SCI patients demonstrate concentric hypertrophy. This suggests adaptive response to chronic increase in afterload pressure secondary to their daily activities and muscle spasticity.

No description available.

Thesis (MA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: The traumatic nature of spinal cord injury (SCI) imposes major and permanent life changes that necessitate physical, social and vocational adjustments for the individual, as well as placing strain on the family. The importance of psychological aspects of adjustment and rehabilitation has progressively become recognised as an integral part of facilitating a higher quality of life for individuals and their families living with SCI. While it has been established that psychological disturbance is not an inevitable long-term consequence of SCI, researchers have found that a proportion of this population has marked difficulty adapting psychologically to their new lifestyle and the challenges it poses. It has been found that the SCI population has an increased risk for divorce, substance abuse, self-neglect and suicide. In the mid-1990's, researchers involved in SCI rehabilitation started developing cognitivebehaviour therapy (CBT) interventions to assist individuals with their psychological adjustment to the traumatic injury. Lazarus and Folkman's (1984) cognitive theory of stress and coping has been the theoretical grounding for some of these interventions. The primary objective of this literature review is to ascertain the effectiveness of CBT in assisting individuals with their psychological adjustment to SCI and to make recommendations for future research in this area. / AFRIKAANSE OPSOMMING: Die traumatiese aard van 'n spinale koord besering (SKB) veroorsaak 'n beduidende en permanente lewensverandering, wat fisieke-, sosiale- en werksaanpassing vir die individu verg, asook spanning op die familie plaas. Die belangrikheid van sielkundige aspekte rakende aanpassing en rehabilitasie word toenemend herken as 'n integrale deel in die fasilitering van 'n hoër kwaliteit van lewe vir die individue en hulle families wat lewe met 'n SKB. Alhoewel daar gevind is dat sielkundige versteuring nie 'n noodwendige langtermyn gevolg van 'n SKB is nie, het navorsers wel gevind dat 'n gedeelte van die populasie beduidende sielkundige aanpassingsprobleme ervaar ten opsigte van hul nuwe lewenstyl en uitdagings. Daar is gevind dat die SKB populasie 'n verhoogde risiko loop vir egskeidings, substansmisbruik, self-verwaarlosing en selfmoord. In die middel van die 1990's, het SKB- en rehabilitasie-navorsers kognitiewe-gedragsterapie (KGT) intervensies ontwikkelom individue te help met sielkundige aanpassing na 'n SKB. Lazarus en Folkman's (1984) se kognitiewe teorie oor stres en streshantering, het die teoretiese grondslag gevorm vir sommige van hierdie intervensies. Die primêre doel van hierdie literatuuroorsig is om die effektiwiteit van KGT te bepaal in die ondersteuning van individue met sielkundige aanpassing na SKB, en om voorstelle te maak oor toekomstige navorsing wat met hierdie onderwerp verband hou.

Traumatic injuries to the spinal cord (SCI) and peripheral nerve (PNI) affect several thousand people worldwide every year. At present, there is no effective treatment for SCI and despite continuous improvements in microsurgical reconstructive techniques for PNI, many patients are still left with permanent, devastating neurological dysfunction. This thesis investigates the effects of mesenchymal stem cells (MSC) derived from adipose (ASC) and dental (DSC) tissue and chitosan/microRNA-124 polyplex particles on regeneration after spinal cord and peripheral nerve injury in adult rats. Dental stem cells were obtained from apical papilla, dental pulp, and periodontal ligament. ASC and DSC expressed MSC surface markers (CD73, CD90, CD105 and CD146) and various neurotrophic molecules including BDNF, GDNF, NGF, VEGF-A and angiopoietin-1. Growth factor stimulation of the stem cells resulted in increased secretion of these proteins. Both ASC and DSC supported in vitro neurite outgrowth and in contrast to Schwann cells, ASC did not induce activation of astrocytes. Stimulated ASC also showed an enhanced ability to induce capillary-like tube formation in an in vitro angiogenesis assay. In a peripheral nerve injury model, ASC and DSC were seeded into a fibrin conduit, which was used to bridge a 10 mm rat sciatic nerve gap. After 2 weeks, both ASC and DSC promoted axonal regeneration in the conduit and reduced caspase-3 expression in the dorsal root ganglion (DRG). ASC also enhanced GAP-43 and ATF-3 expression in the spinal cord, reduced c-jun expression in the DRG and increased the vascularity of the implant. After transplantation into injured C3-C4 cervical spinal cord, ASC continued to express neurotrophic factors and laminin and stimulated extensive ingrowth of 5HT-positive raphaespinal axons into the trauma zone. In addition, ASC induced sprouting of raphaespinal terminals in C2 contralateral ventral horn and C6 ventral horn on both sides. Transplanted cells also changed the structure and the density of the astroglial scar. Although the transplanted cells had no effect on the density of capillaries around the lesion site, the reactivity of OX42-positive microglial cells was markedly reduced. However, ASC did not enhance recovery of forelimb function. In order to reduce activation of microglia/macrophages and the secondary tissue damage after SCI, the role of microRNA-124 was investigated. In vitro transfection of chitosan/microRNA-124 polyplex particles into rat microglia resulted in the reduction of reactive oxygen species and TNF-α levels and lowered expression of MHC-II. Upon microinjection into uninjured rat spinal cords, particles formed with Cy3-labeled control sequence RNA, were specifically internalized by OX42 positive macrophages and microglia. Alternatively, particles injected in the peritoneum were transported by macrophages to the site of spinal cord injury. Microinjections of chitosan/microRNA-124 particles significantly reduced the number of ED-1 positive macrophages after SCI. In summary, these results show that human MSC produce functional neurotrophic and angiogenic factors, creating a more desirable microenvironment for neural regeneration after spinal cord and peripheral nerve injury. The data also suggests that chitosan/microRNA-124 particles could be potential treatment technique to reduce neuroinflammation.

We have investigated the role of the metabotropic glutamate receptor 7 (mGluR7) and the gastrin releasing peptide receptor (Grpr) population that are involved at different levels of itch transmission. We found that mGuR7 deficient mice displayed an anaphylaxis-like behavior when provoked with histamine. Analysis of blood revealed elevated plasma levels of histamine and mouse mast cell protease-1 (mMCP1), two indicators of anaphylaxis, in mGluR7 deficient mice compared with control mice. Inhibition of the neurokinin 1 receptor, by preventing binding of the corresponding ligand substance P (SP), prior to provocation with histamine prevented the development of anaphylaxis in mGluR7 deficient animals. However, blocking GRPR (gastrin releasing peptide receptor) only resulted in decreased itch levels in mGluR7 deficient mice but did not prevent the systemic anaphylaxis-like behavior. Our findings indicate that mGluR7 normally functions as a brake on histaminergic itch that is mediated through GRPR as well as anaphylaxis through Substance P. Grpr has previously been shown to mediate both histaminergic and non-histaminergic itch but little is known about the GRPR neuronal population. We used a BAC cloning strategy to construct a Grpr-Cre line, which we crossed with the reporter lines tdTomato and Viaat-egfp as well as with Vglut2-lox. We could conclude that Grpr-Cre neurons are mainly excitatory interneurons located in lamina II-IV, that convey itch using VGLUT2-mediated glutamatergic transmission to the next, currently unknown, step in the labeled line of chemical itch. To eventually deduce the function of the endogenous opioids dynorphin and enkephalin, which are hypothesized to be involved in gating pain and itch in the spinal cord, we constructed two Cre lines using BAC cloning that targeted the precursor proteins preprodynorphin and preproenkephalin, respectively. Preprodynorphin-Cre neurons were mainly located in lamina II-IV and overlapped to 47% with Vglut2 mRNA, while the co-expression with the inhibitory markers Viaat-egfp and PAX2 was 13% and 28% respectively in the spinal cord. Preproenkephalin neurons were more localized to lamina III in the dorsal horn, furthermore single cell analysis showed that they overlapped to 94% with Vglut2 mRNA while 7% and 13% expressed Viaat-egfp and PAX2 respectively.

Bakgrund Idag används olika medicinsktekniska produkter för helkroppsimmobilisering vid misstanke om spinal skada prehospitalt. Valet av immobiliseringsutrustning som skall användas görs av ansvarig sjuksköterska på plats. Den vanligaste utrustningen är ryggbräda, vaccummadrass, Kendric Extration Device (KED-väst) och nackkrage. Då utbildningen Pre Hospital Trauma Life Support (PHTLS) varit en del av specialistutbildningen för ambulanssjuksköterskor under en längre period har det funnits lite anledning till att ifrågasätta helkroppsimmobilisering och dess utrustning. All immobiliseringsutrustning klassificeras under klass 1 av Läkemedelsverket, vilket kan innebära att få vetenskapliga studier har gjorts för att utvärdera immobilieringsutrustning. Patientsäkerhetslagen ska efterlevas vad gäller vetenskaplig och beprövad metod i omvårdnaden av patienter med misstänkt spinal skada. Syfte Att genom en litteraturgranskning undersöka rekommendationer och eventuella risker med helkroppsimmobilisering vid misstanke av spinal skada prehospitalt utifrån patientsäkerhet och ett historiskt perspektiv. Metod Studien genomförs som litteraturgranskning med artikelgranskning och ett retrospektivt, deskriptivt perspektiv. Resultat Forskning rekommenderade helkroppsimmobilisering på traumapatienter där det fanns misstanke om spinal skada. Behandlingsriklinjerna följde nuvarande forskningsrekommendationer. Forskningskvaliten hade blivit bättre över tid och resultaten hade ökat i trovärdighet. Flera forskare påvisade risker med helkroppsimmobilisering. Riskerna var relaterade till dagens immobiliseringsutrustning. Ett antal alternativ till dagens immobiliseringsutrusning fanns beskrivna, men användes inte och var inte omnämnda i behandlingsriktlinjer. Slutsats Forskning rekommenderar helkroppsimmobilisering på traumapatienter där det finns misstanke om spinal skada. Immobiliseringutrustning har bevisligen flera risker för patienter, vilka orsakar allvarliga konsekvenser för hälsan. En lågt sittande ryggskada kanske inte behöver helkroppsimmobiliseras. Det kanske räcker med halvkroppsimmobilisering för vissa patienter. / Background Today, there are various medical devices for full body immobilisation in cases of suspected spinal injury prehospital. The choice of immobilisation devices to be used is the charge nurse’s on site. The most common equipment is back board, vaccummadrass, Kendric extraction Device (KED - West) and cervical collar. Because When training Pre Hospital Trauma Life Support (PHTLS) has been part of the specialist training of ambulance nurses over a longer period , there has been little reason to question full body immobilisation and its equipment . All immobilisation devices classified under Class 1 of the Medical Product Agency (MPA) , which may mean that few scientific studies have been done to evaluate immobilisation devices. The Patient Safety Act must be complied with in terms of scientific and proven method in the care of patients with suspected spinal injury. Aim Through a literature review examining recommendations and possible risks of full body immobilisation on suspicion of spinal injury pre-hospital based on patient safety and a historical perspective. Method The study is conducted as a literature review with the article review and a retrospective, descriptive perspective. Result Research recommended full body immobilisation on trauma patients where there was suspicion of spinal injury. Treatment guidelines followed the current research recommendations. The research quality had improved over time and results in increased credibility. Several researchers demonstrated the risks of full body immobilisation. The risks were related to today's immobilisation devices. A number of alternatives to current immobilisation devices was described, but was not used and was not mentioned in the treatment guidelines. Conclusion Research recommends full body immobilisation of trauma patients where there is a suspected spinal injury. Immobilisation devices has proven more risks for patients , which cause serious health consequences. A low sitting back injury may not need full body immobilisation. It might suffice with a half body immobilisation for some patients.

Résumé : Le muscle squelettique étant d’une grande plasticité, il peut être la cible lors de thérapies en réhabilitation motrice. Toutefois, les structures neurales impliquées dans cette plasticité sont encore peu connues. Afin de déterminer si un mécanisme spinal est suffisant pour induire une plasticité musculaire, le nerf innervant le gastrocnémien latéral et le soleus a été sectionné unilatéralement chez 4 chats ayant retrouvé une locomotion au niveau des pattes arrières suite à une spinalisation complète. Des enregistrements électromyographiques et cinématiques ont été enregistrés avant et jusque 8 semaines après dénervation chez ces chats. Des analyses histologiques ont été réalisées pour les deux gastrocnémiens médial et latéral chez les 4 chats spinalisés et chez 4 chats intacts servant de contrôle. Chez les chats spinaux, la durée de cycle pour la patte ispilatérale et controlatérale à la dénervation pouvait être diminuée ou augmentée par rapport aux valeurs de pré-dénervation. Pour la durée de la phase d’appui, elle était généralement augmentée pour la patte controlatérale et diminuée pour la patte ipsilatérale. L’amplitude EMG du MG était augmentée bilatéralement après la dénervation et est restée élevée 8 semaines post dénervation. Concernant le poids des muscles, chez les chats spinaux, le LG ipsilatéral était significativement plus petit que le LG controlatéral alors que le MG ipsilatéral était plus gros que le MG controlatéral. Les analyses histologiques ont montré une plus grande aire pour les fibres de type IIa pour le MG ipsilatéral pour 3 des 4 chats. La densité de capillaires sanguins dans le MG ipsilatéral était aussi plus élevée que dans le MG controlatéral. Pour les chats intacts, aucune différence n’a été observée pour le poids, l’aire des fibres ou la densité capillaire entre les 2 MG. Ces résultats montrent que le muscle squelettique peut s’adapter même après une lésion de la moelle épinière, ce qui souligne l’importance de son utilisation en réhabilitation motrice. / Abstract : Skeletal muscle is highly plastic and can be targeted for motor rehabilitation. Although neural activity potently regulates muscle phenotype, the neural structures required are poorly defined. To determine if a spinal mechanism is sufficient for adaptive muscle plasticity, the nerve supplying the lateral gastrocnemius and soleus muscles was sectioned unilaterally in four cats that had recovered hindlimb locomotion following spinal transection. In these spinal cats, kinematics and electromyography (EMG) were collected before and for 8 weeks after denervation. Muscle histology was performed on the lateral (LG) and medial (MG) gastrocnemii bilaterally in four spinal and four intact cats. In spinal cats, cycle duration for the hindlimb ipsilateral or contralateral to the denervation could be increased or decreased compared to pre-denervation values. Stance duration was generally increased and decreased for the contralateral and ipsilateral hindlimbs, respectively. The EMG amplitude of MG was increased bilaterally following denervation and remained elevated 8 weeks post-denervation. In spinal cats, the ipsilateral LG was significantly smaller than the contralateral LG whereas the ipsilateral MG weighed significantly more than the contralateral MG. Histological characterizations revealed significantly larger fiber areas for Type IIa fibers of the ipsilateral MG in three of four spinal cats. Microvascular density in the ipsilateral MG was significantly higher than the contralateral MG. In intact cats, no differences were found for muscle weight, fiber area or microvascular density between homologous muscles. Results show that skeletal muscle remains remarkably adaptable after complete spinal cord injury, highlighting its importance to maximize force production in motor rehabilitation.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2006. / Postoperative rehabilitation programs have shown little efficacy in decreasing pain and disability in short and long term outcomes for lumbar discectomy. Preoperative education in other disciplines of medicine and physiotherapy has shown to decrease pain and disability postoperatively. No studies to date have been published on preoperative education for spinal lumbar surgery patients with radiculopathy. Objective: The objective of this study was to contribute towards further understanding of the preoperative educational requirements of patients undergoing lumbar surgery for lumbar radiculopthy. Method Two surveys were conducted. A new questionnaire was developed for patients to determine their preoperative educational needs regarding spinal surgery due to radiculopathy. These questionnaires were administered at 4-weeks postoperatively to patients from four spinal surgeons in the Greater Kansas City metropolitan area of the US. A second physiotherapist survey was developed and distributed to physiotherapists registered with the Kansas and Missouri State Boards who were actively involved in treating spinal surgery patients in Kansas and Missouri. The data collected from completed questionnaires were analyzed using descriptive and inferential statistical tests....

<p>Modulation of neural activity with electrical stimulation is a widespread therapy for treating neurological disorders and diseases. Two notable applications that have had striking clinical success are deep brain stimulation (DBS) for the treatment of movement disorders (e.g., Parkinson's disease) and spinal cord stimulation (SCS) for the treatment of chronic low back and limb pain. In these therapies, the battery life of the stimulators is much less than the required duration of treatment, requiring patients to undergo repeated battery replacement surgeries, which are costly and obligate them to incur repeatedly the risks associated with surgery. Further, deviations in lead position of 2-3 mm can preclude some or all potential clinical benefits, and in some cases, generate side-effects by stimulation of non-target regions. Therefore, despite the success of DBS and SCS, their efficiency and ability to activate target neural elements over non-target elements, termed selectivity, are inadequate and need improvement.</p><p>We combined computational models of volume conduction in the brain and spine with cable models of neurons to design novel electrode configurations for efficient and selective electrical stimulation of nervous tissue. We measured the efficiency and selectivity of prototype electrode designs in vitro and in vivo. Stimulation efficiency was increased by increasing electrode area and/or perimeter, but the effect of increasing perimeter was not as pronounced as increasing area. Cylindrical electrodes with aspect (height to diameter) ratios of > 5 were the most efficient for stimulating neural elements oriented perpendicular to the axis of the electrode, whereas electrodes with aspect ratios of < 2 were the most efficient for stimulating parallel neural elements.</p><p>Stimulation selectivity was increased by combining two or more electrodes in multipolar configurations. Asymmetric bipolar configurations were optimal for activating parallel axons over perpendicular axons; arrays of cathodes with short interelectrode spacing were optimal for activating perpendicular axons over parallel axons; anodes displaced from the center of the target region were optimal for selectively activating terminating axons over passing axons; and symmetric tripolar configurations were optimal for activating neural elements based on their proximity to the electrode. The performance of the efficient and selective designs was not be explained solely by differences in their electrical properties, suggesting that field-shaping effects from changing electrode geometry and polarity can be as large as or larger than the effects of decreasing electrode impedance.</p><p>Advancing our understanding of the features of electrode geometry that are important for increasing stimulation efficiency and selectivity facilitates the design of the next generation of stimulation electrodes for the brain and spinal cord. Increased stimulation efficiency will increase the battery life of IPGs, increase the recharge interval of rechargeable IPGs, and potentially reduce stimulator volume. Greater selectivity may improve the success rate of DBS and SCS by mitigating the sensitivity of clinical outcomes to malpositioning of the electrode.</p> / Dissertation

published_or_final_version / Anatomy / Doctoral / Doctor of Philosophy