The primary purpose of this study was to determine the effect of ingesting an 8% carbohydrate (CHO) beverage during a moderate intensity exercise trial on performance outcomes, fuel utilization and blood glucose levels of wheelchair athletes (spinal cord injury (SC I) or cerebral palsy (CP)). The secondary purpose was to analyze the dietary intake of the eight participants and to determine if they were meeting current sport nutrition guidelines for macronutrients and fluids recommended in the joint position statement developed by the American Dietetic Association (ADA), the American College of Sports Medicine (ACSM) and Dietitians of Canada (DC).<p> Under random, double blind conditions eight athletes (6 males, 2 females); mean age 36 ± 8.5 y with a SCI (n = 7) or CP (n = 1) completed two exercise trials on an adapted stationary hand cycle; each trial was 60 minutes in duration at 65 % VO2peak followed immediately by a 30-minute performance trial. During the first 60-minutes the participants were given four 200 ml dosages (15, 30, 45, 60-min) of an 8% CHO beverage or a taste-matched placebo beverage. Blood lactate and glucose levels were sampled during the 60-minute exercise trial (pre, 20, 40, 60-min) and immediately after the 30-minute performance trial (post, 2, 5, 10-min). Heart rate was monitored continuously during the exercise and performance trial. Expired gas samples were also taken for 5-min periods during the exercise trial and then continuously during the performance trial. These values were used to calculate respiratory exchange ratio (RER) and carbohydrate oxidation. Dietary intake was assessed with a three day food record.<p> No significant differences were apparent between beverage trials for total distance (km), average speed (kmhr-1) or maximum speed achieved (kmhr-1). Significant differences were evident for blood glucose values, RER and CHO oxidation between the two beverage trials (p< .05). At the end of the 30-minute performance trial blood glucose values were significantly higher in the CHO trial (4.8 ± 1.3 mmol.l-1 vs. 4.0 ± 0.5 mmol.l-1 for placebo trial; p< .05). The CHO beverage resulted in higher CHO oxidation during the last 5 minutes of the performance trial, 2.1 ± 1.0 gmin-1 vs. the placebo beverage 1.9 ± 1.0 gmin-1 (p< .05). The CHO beverage trial resulted in significantly higher RER values during the final 5 minutes of the exercise trial and during the final 10 minutes of the performance trial. At the 20-25 minute mark RER values were significantly higher with the CHO beverage trial (1.04 ± 0.10) vs. the placebo trial (1.01 ± 0.11) (p< .05). During the final 5 minutes of the performance trial RER values were also significantly higher with the CHO beverage trial (1.06 ± 0.11) vs. the placebo trial (1.01 ± 0.10) (p< .05). The results indicated the participants were not meeting the current dietary guidelines for able-bodied athletes and active adults. Only 25% of the participants met the daily caloric requirements for active adults. Carbohydrate recommendations of 6 to 10 gkg-1 body weightd -1 were not met by any of the wheelchair athletes Seven participants were within the acceptable macronutrient range (AMDR) for CHO. For protein intake, 63% of the participants were meeting the protein recommendations active adults and all of them were within the AMDR. Average caloric intake from fat exceeded current recommendations of 20 to 25%; two participants were above the AMDR. The results demonstrate that the 8% CHO beverage consumed during exercise resulted in higher CHO oxidation rates and elevated blood glucose values, but it did not result in a performance gain.

Endast ett fåtal personer drabbas varje år av en traumatisk ryggmärgsskada. Den akuta vården av dessa patienter utövas på endast sex sjukhus i Sverige. Vårdbehovet för personer med en ryggmärgskada är stort eftersom en traumatisk ryggmärgsskada medför såväl fysiska även som stora psykiska omställningar i livet. När dessa personer senare i livet behöver vård saknas kunskapen om dessa patienters specifika omvårdnadsbehov utifrån ett personcentrerat förhållningssätt hos allmänsjuksköterskor. Syftet med studien var att belysa patienters upplevelse av livskvalitet efter en traumatisk ryggmärsskada. Studien utfördes som en litteraturstudie där elva kvalitativa och fyra kvantitativa vetenskapliga studier samt en avhandling valdes att granskas. Resultatet påvisade att olika copingstrategier användes för att anpassa sig till skadan och dess konsekvenser. Hopp beskrevs som en av de vanligaste copingstrategierna vilken var betydelsefull för patientens livskvalitet. Stöd från vänner, familj och andra patienter med en ryggmärgsskada visade sig vara betydande för dessa patienters anpassningsförmåga och deras upplevelse av livskvalitet. Flertalet patienter uttryckte att de inte fick någon hjälp från vårdpersonal i sin krisbearbetning. Vid omvårdnadsbeslut brast respekten för patienternas integritet då de inte fick vara med och fatta beslutet. Vidare framkom det att vårdpersonal kränkte patienternas integritet under omvårdnadsarbetet genom att tala över dennes huvud. För att kunna bemöta dessa patienter behövs mer forskning angående ryggmärgsskadans påverkan på dessa patienters livskvalitet. / The number of people that every year suffers from a traumatic spinal cord injury is relatively small. The emergency care of these patients is carried out in only six Swedish hospitals. A traumatic spinal cord injury results in major physical as well as psychological readjustments. When these patients later in life needs hospital care the lack of knowledge about their specific needs of care based on a person-centered approach, occurs to be a problem for the general nurse. This literature review aimed to highlight the experience of quality of life in patients with a traumatic spinal cord injury. The study contains eleven qualitative articles, four quantitative articles and one dissertation. The result indicated that different coping strategies were used to incorporate the injury and its consequences as a part of life. Hope was described as one of the most common coping strategy which were meaningful for the patient’s experience of quality of life. Support from friends, family and other injured patients proved to be important for the patients’ adaptability and the experience of quality of life. Several patients expressed that they didn´t get any support from the health care professionals to manage the crisis following the injury. In some cases the patient experienced that they weren’t asked to take part in the decision making regarding their care. Healthcare professionals often, during nursing actions, violate the patients’ integrity by not talking directly to the patient. Further research about the injuries impact on these patients quality of life is essential to improve the care of these patients.

<p>Spinal cord injury (SCI) and other neurological diseases and disorders can cause urinary dysfunction that can cause serious health problems and reduce an individual's quality of life. Current methods for treating urinary dysfunction have major limitations or provide inadequate improvement in urinary symptoms. Pudendal nerve stimulation is a potential means of restoring control of bladder function in persons with neurological disease or spinal cord injury. Bladder contraction and relaxation can be evoked by pudendal afferent stimulation, and peripheral pudendal afferent branches may be ideal targets for a bladder control neural prosthesis. This dissertation investigates control of bladder function by selective activation of pudendal afferents.</p> <p>This study investigated the ability to improve both urinary continence and micturition by both direct and minimally-invasive electrical stimulation of selected pudendal afferents in &#945;-chloralose anesthetized male cats. Direct stimulation of the pudendal afferents in the dorsal nerve of the penis (DNP), percutaneous DNP stimulation, and intraurethral stimulation were used to investigate the bladder response to selective activation of pudendal afferents. Finite element modeling of the cat lower urinary tract was used to investigate the impact of intraurethral stimulation location and intraurethral electrode configuration on activation of pudendal afferents. Also, the impact of pharmacological and surgical block of sympathetic activity to the bladder on the bladder reflexes evoked by DNP stimulation was investigated to determine the role of the sympathetic bladder innervation on the mechanism of bladder activation by pudendal afferent stimulation.</p> <p>The DNP is an ideal target for restoring urinary function because stimulation at low frequencies (5-10 Hz) improves urinary continence, while stimulation at high frequencies (33-40 Hz) improves urinary voiding. Intraurethral stimulation is a valid method for clinical investigation of the ability to evoke bladder inhibition and activation via selective activation of the DNP or cranial sensory branch (CSN) of the pudendal nerve. In the cat, intraurethral stimulation can activate the bladder via two distinct neural pathways, a supraspinal pathway reflex activated by the CSN and a spinal reflex activated by the DNP. Finite element modeling revealed the importance of urethral location for selective pudendal afferent activation by intraurethral stimulation. Finally, the sympathetic bladder pathway does not play a significant role in the mechanism mediating bladder activation by DNP stimulation. These findings imply that selective pudendal afferent stimulation is a promising approach for restoring control of bladder function to individuals with SCI or other neurological disorders.</p> / Dissertation

When modeling a neuron, modelers often focus on the values of parameters that produce a desired output. However, if these parameters are not unique, there could be a number of parameter sets that produce the same output. Thus, even though the values of the various maximum conductances, half activation voltages and so on differ, as a set they can produce the same spike height, firing rates, and so forth. To examine whether or not parameter sets are unique, a 3-compartment motoneuron model was created that has 15 target outputs and 59 parameters. Using parameter searches, over one hundred parameter sets were created for this model that produced the same output (within tolerances). Parameter values vary between parameter sets and indicate that the parameter values are not unique. In addition, some parameters are more tightly constrained than others. Principal component analysis is used to examine the dimensionality of the input and output spaces. However, neurons are more than static output generators. For example, a variety of neuromodulatory influences are known to shift parameter values to alter neuronal output. Thus the question arises as to whether this non-uniqueness extends from model outputs to the models sensitivities to its parameters. In this work, the non-unique parameter sets are further analyzed using sensitivity analyses and output correlations to show that these values vary significantly between these parameter sets. Therefore, each of these models will react to parameter variation differently. This work concludes that parameter sets are non-unique but have varying sensitivity analyses and output correlations. The ramifications of this are discussed for both modelers and neuroscientists.

Injury severs the axons in the spinal cord causing permanent functional loss. After injury, a series of events occur around the lesion site, including the deposition of growth cone inhibitory astroglial scar tissue containing chondroitin sulfate proteoglycan (CSPG)- rich regions. It is important to encourage axons to extend through these inhibitory regions for regeneration to occur. The work presented in this dissertation investigates the effect of three proteins, constitutively active (CA)-Cdc42, CA-Rac1, and brain-derived neurotrophic factor (BDNF) on axonal outgrowth through CSPGs-rich inhibitory regions after spinal cord injury (SCI). Cdc42 and Rac1 are members of the Rho GTPase family and BDNF is a member of the neurotrophin sub-family. These three proteins affect the actin cytoskeleton dynamics. Therefore, Cdc42, Rac1, and BDNF promote axonal outgrowth. The effect of CA-Cdc42 and CA-Rac1 on neurite extension through CSPG regions was determined in an in vitro model. Rac1 and Cdc42 s ability to modulate CSPG-dependent inhibition has yet to be explored. In this study, a stripe assay was utilized to examine the effects of modulating all three Rho GTPases on neurite extension across inhibitory CSPG lanes. Alternating laminin (LN) and CSPG lanes were created and NG108-15 cells and E9 chick dorsal root ganglions (DRGs), were cultured on the lanes. Using the protein delivery agent Chariot, the neuronal response to exposure of CA and dominant negative (DN) Rho GTPases, along with the bacterial toxin C3, was determined by quantifying the percent ratio of neurites crossing the CSPG lanes. CA-Cdc42, CA-Rac1, and C3 transferase significantly increased the number of neurites crossing into the CSPG lanes compared to the negative controls for both the NG108-15 cells and the E9 chick DRGs. We also show that these mutant proteins require the delivery vehicle, Chariot, to enter the neurons and affect neurite extension. Therefore, activation of Cdc42 and Rac helps overcome the CSPG-dependent inhibition of neurite extension. In an in vivo study, CA-Cdc42 and CA-Rac1 were locally delivered into a spinal cord cavity. Additionally, BDNF was delivered to the lesion site, either individually or in combination with either CA-Cdc42 or CA-Rac1. The dorsal over-hemisection model was utilized, creating a ~2mm defect that was filled with an in situ gelling hydrogel scaffold containing lipid microtubules loaded with the protein(s) to encourage axons. The lipid microtubules enable slow release of proteins while the hydrogel serves to localize them to the lesion site and permit axonal growth. The results from this study demonstrate that groups treated with BDNF, CA-Cdc42, CA-Rac1, BDNF/CA-Cdc42, and BDNF/CA-Rac1 had significantly higher percentage of axons from the corticospinal tract (CST) that traversed the CSPG-inhibitory regions, as well as penetrate the glial scar compared to the untreated and agarose controls. Although axons from the CST tract did not infiltrate the scaffold-filled lesion, NF-160+ axons were observed in the scaffold. Treatment with BDNF, CA-Cdc42, and CA-Rac1 also reduced the inflammatory response, quantified by analyzing GFAP and CS-56 intensity for reactive astrocytes and CSPGs, respectively, at the interface of the scaffold and host tissue. Therefore, the local delivery of CA-Cdc42, CA-Rac1 and BDNF, individual and combination demonstrated the ability of axons to extend through CSPG inhibitory regions, as well as reduce the glial scar components.

Transplantation of olfactory ensheathing cells (OECs) into injured spinal cord results in improved functional outcome through axonal regeneration, remyelination, and neuroprotection. However, because little is known of the fate of OECs transplanted into injured peripheral nerve, their myelin forming potential requires investigation. To study these issues OECs were isolated from the olfactory bulbs of adult green fluorescent protein (GFP)-expressing transgenic rats and transplanted into a sciatic nerve crush lesions. Five weeks to six months after transplantation the nerves were studied histologically and it was determined that GFP-expressing OECs survived in the lesion and distributed longitudinally across the lesion zone. Immunostaining revealed a high density of isoform Nav1.6 at the newly formed nodes of Ranvier which were flanked by paranodal Caspr staining. Immuno-electron microscopy for GFP revealed transplanted OECs form peripheral type myelin. These results indicate that transplanted OECs extensively integrate into transected peripheral nerve, form myelin on regenerated peripheral nerve fibers, and reconstruct nodes of Ranvier with proper sodium channel structure.

Thesis (Ph. D.)--University of Oklahoma. / Bibliography: leaves 109-119.

Thesis (M.S.)--University of Tennessee, Memphis, 2001.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.