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Activity limitations and participation restrictions four years after traumatic spinal cord injury in Cape Town, South Africavan Wyk, Vania January 2018 (has links)
Magister Scientiae (Physiotherapy) - MSc(Physio) / The distressing event of Spinal Cord Injury (SCI) leads to complete or incomplete injury, and results in many complications such as such as neurogenic shock, cardiovascular disease, temperature regulatory problems, respiratory complications, dysphagia, thromboembolism, and pressure ulcers amongst others. These complications limit the individual’s functioning and participation. Participation is fruitful and meaningful when you are actively involved in a specific activity. To understand the lack of participation within a specific setting, it is important to know what the limitations in activities are, and what causes these limitations. The goal of rehabilitation should be to reintegrate patients back into the community so that they can fulfil their roles.
Aim: The aim of the study was (1) To determine included participants’ socio-demographic and injury characteristics; (2) To describe healthcare services received by people living with long-term Traumatic Spinal Cord Injury (TCSI) over the past 12 months; (3) To determine the point prevalence of common activity limitations of survivors of TSCI four years after injury; (4) To determine the point prevalence of participation restrictions of survivors of TSCI four years after injury; and (5) To determine factors associated with activity limitations and selected participation restrictions four years after injury.
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The risk for cardiovascular disease following traumatic spinal cord injuries in the Cape Metropolitan in South AfricaNaidoo, Marc Anton January 2018 (has links)
Philosophiae Doctor - PhD / Given the devastating and debilitating impact of spinal cord injuries (SCI) globally and the effects on any population, its impact extends far beyond just the victim to people and institutions surrounding them and supporting them post-injury. Of growing concern is the increased risk that individuals with SCI have been seen to have a three-fold greater risk of developing cardio-vascular disease (CVD) than their able-bodied counterparts. Prevention strategies to curtail the onset of CVD in the SCI population is limited, and often developed for individuals from developed countries. The overall aim of this study was to assess and explore the need to implement CVD prevention programmes in a regional South African population with individuals after sustaining a traumatic spinal cord injury (TSCI). The study employed a mixed methods approach and was conducted in four (4) phases. Permission and ethics clearance were obtained from the Research Ethics Committee at the University of the Western Cape (UWC) and the Western Cape Department of Health. Phase One of the study utilized a questionnaire to collect TSCI incidence data of which 108 of the eligible 132 cases consented to take part in the study. The demographic findings of this study indicated that a person sustaining a TSCI in the Cape Metropolitan area in South Africa is most likely to be a male, young (20 to 29 years of age), from a Black African or Coloured race group and living in the Cape Flats suburbs. The male to female ratio was 6.2:1. The main cause of TSCI was assault at 58.33% (n=63) with males accounting for the majority of cases (88.89%, n=65). According to the AIS classification, ASIA A and D were the most common classification seen in 38.89% (n=42) and 39.81% (n=43) of the cohort respectively. Phase Two utilized a questionnaire and looked at CVD risk factors of the original cohort. A large portion of the cohort was engaged in high-risk behaviours, i.e. smoking and alcohol consumption. A low number of individuals reported a baseline history of hypertension diagnosis prior to their TSCI (5.56%, n=6). Phase Three of the study emplored semi-structured interviews and a focus group discussion to explore the experiences of persons with a TSCI regarding their ability to be physically active once reintegrated back into the community. Despite understanding the associated benefits of physical activity, several barriers to being physically active were reported; factors within their homes, access within their community, and transportation. The present study’s findings illustrated a growing concern among the SCI population for increased risk for developing CVD due to decreased physical activity. Phase Four of the study utilised a scoping review to identify CVD prevention programmes for individuals with a TSCI. Physical activity has been shown to have numerous health benefits of which reducing the risk of CVD is one. Engaging in physical activity, whether it be structured, unstructred or through a sporting activity can play a major role in combating the onset of CVD. Other tools used in reducing the onset of CVD were seen to be self-management strategies of which contrayer views were seen both for and against their use. Conclusion: Better education during the rehabilitation phase might be a key component to individuals with TSCI injury making more informed decisions about prioritising physical activity as they attempt to reintegrate back into their respective communities. The removal of socio-environmental barriers could allow motivated TSCI individuals better access to choosing how to increase their physical activity levels.
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LEVANTAMENTO EPIDEMIOLÓGICO DOS CASOS DE LESÃO MEDULAR ESPINHAL TRAUMÁTICA ATENDIDOS EM UNIDADE DE REABILITAÇÃO DE GOIÂNIA - GOIÁSNoronha, Juliana Batista de 25 June 2008 (has links)
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Previous issue date: 2008-06-25 / The present work aims at the epidemiological investigation of traumatic spinal cord
injury patients admitted at Dr. Henrique Santillo Rehabilitation Center in Goiânia -
Goiás. For that, a descriptive and analytical epidemiological study was conducted,
retrospectively, from cases with this injury. The sample of the study was
composed by all identified cases from records of the year of 2006, excluding
patients with non-traumatic injuries and medical records with lack of data. The
data collection was through analysis of fixed records in which the variables were:
age, sex, region of origin, family income, education, current occupation, level of
injury, classification of injury by the American Spinal Injury Association (ASIA),
period of injury, presence of rehabilitation in the institution, in another institution,
rehabilitation during hospitalization and presence of gait. 27,537 records were
consulted of which 47 had no traumatic injury and 156 had traumatic spinal cord
injury, composing the sample. In the descriptive distribution of variables there was
predominance of males (77.6%), between the age of 20 and 40 years old (57.7%),
individuals from the Metropolitan Region of Goiás (53.2%), family income from 0
1 minimum wage (31.1%), level of basic education (61.7%), occupation defined as
service rendering (25.7%), traffic accidents (32.7% ) and also the falls (23.7%),
thoracic injuries (45.8%), period of injury from 0 1 month (49.4%), lesions with
ASIA A (43.3%), rehabilitation in hospital (73.8%), presence of gait in 27.1% of the
cases at admission and 58.7% during rehabilitation. The correlations showed
significant difference between causes of injury by age (p = 0.006), region of origin
(p = 0.046), levels of cervical lesion (p <0,001) and chest lesion (p <0.001),
between classification of ASIA by levels of chest injury (p < 0.001) and lumbar
injury (p = 0.019), between period of injury by age (p = 0.033), cervical injury (p =
0.013), chest injury (p = 0.030) and ASIA (p = 0.034), between presence of
hospitalization for chest injury (p = 0.047) and period of injury (p <0.001), between
initial gait by chest injury (p = 0.002) and period of injury (p = 0.002). The
characterization of individuals who were exposed to spinal trauma and the
investigation of the factors that influenced the occurrence of different causes of
injury, in this study, allow more targeted and effective preventive actions. The
investigation of characteristics of the traumatic spinal cord injury, of rehabilitation
in hospitalization, and of presence of gait, as well as of the relations between
these variables, presented in this study, can guide the organization of
interventions by the rehab staff. The use of this study, as a source of data for the
rehabilitation professional, allows the promotion of health and the structure of
therapeutic activities. / O presente estudo apresentou como objetivo a investigação epidemiológica da
lesão medular traumática de pacientes atendidos no Centro de Reabilitação e
Readaptação Dr. Henrique Santillo, em Goiânia, Goiás. Para tanto foi realizado
um estudo epidemiológico descritivo e analítico, retrospectivo, dos casos de lesão
medular espinhal traumática. A amostra do estudo foi composta por todos os
casos identificados com lesão medular traumática, de prontuários expedidos no
ano de 2006, sendo excluídos os pacientes com lesão não traumática e os
prontuários com ausência de dados. A coleta de dados ocorreu através da análise
de prontuários fixos, verificando-se as variáveis: idade, sexo, região de origem,
renda familiar, escolaridade, profissão, ocupação atual, nível de lesão,
classificação da lesão pela Associação Americana de Lesão Medular (ASIA),
tempo de lesão, presença de reabilitação na instituição, em outra instituição,
reabilitação em internação e presença de marcha. Realizou-se a consulta de
27.537 prontuários, dos quais 47 apresentaram lesão não traumática e 156
apresentaram lesão medular traumática, compondo a amostra. Na distribuição
descritiva das variáveis, verificou-se predomínio do sexo masculino (77,6%), da
faixa etária de 20 e 40 anos (57,7%), dos indivíduos provenientes da Região
Metropolitana Goiana (53,2%), da renda familiar de 0 1 salário mínimo (31,1%),
do nível fundamental de ensino (61,7%), da profissão definida como prestação de
serviços (25,7%), dos acidentes de trânsito (32,7%) e quedas (23,7%), das lesões
torácicas (45,8%), do tempo de lesão de 0 1 mês (49,4%), das lesões com ASIA
A (43,3%), da reabilitação em regime de internação (73,8%); a marcha esteve
presente em 27,1% dos casos na admissão e em 58,7% durante a reabilitação.
As correlações apresentaram diferença significativa entre causas da lesão por
idade (p=0,006), região de origem (p=0,046), níveis de lesão cervical (p<0,001) e
torácico (p<0,001), entre classificação da ASIA por níveis de lesão torácico
(p<0,001) e lombar (p=0,019), entre tempo de lesão por idade (p=0,033), lesão
cervical (p=0,013), lesão torácica (p=0,030) e ASIA (p=0,034), entre presença de
internação por lesão torácica (p=0,047) e tempo de lesão (p<0,001), entre marcha
inicial por lesão torácica (p=0,002) e tempo de lesão (p=0,002). A caracterização
dos indivíduos que foram expostos ao trauma raquimedular e a investigação dos
fatores que influenciaram na ocorrência das diferentes causas de lesão, presentes
neste estudo, possibilitam ações preventivas mais direcionadas e efetivas. A
investigação de características da lesão medular traumática, da reabilitação em
internação e da presença de marcha, bem como das relações entre estas
variáveis, apresentadas neste estudo, podem nortear a organização das
intervenções pelas equipes de reabilitação. A utilização deste estudo, como fonte
de dados pelo profissional da reabilitação, possibilita sua atividade na promoção
da saúde e na estruturação das atividades terapêuticas.
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Behavioural and protective factors contributing to the risk and vulnerability to HIV/AIDS among individuals with spinal cord injuries in South AfricaLloyd, Jacobus January 2019 (has links)
Philosophiae Doctor - PhD / HIV/AIDS has made a huge impact on human development and sexual reproductive habits in this century in the world and especially in sub-Saharan Africa. It has only recently been acknowledged that HIV/AIDS has an equal if not greater effect on or threat to people with disabilities. Survivors of traumatic spinal cord injury (TSCI) with resultant disability are incorrectly believed to be sexually inactive, unlikely to use drugs or alcohol and at less risk of violence or rape than their non-disabled peers. This group can thus be described as economically, educationally and socially disadvantaged, which in itself, suggest that they are a high-risk group for HIV infection. The overall aim of this study is to examine the factors that could contribute to the risk and vulnerability to HIV/AIDS among individuals with spinal cord injuries in South Africa. The specific objectives of the study are to assess the behavioral and protective factors that could contribute to risk and vulnerability to HIV infection among individuals and spinal cord injuries; and to explore the socio-cultural issues that might increase individuals with spinal cord injuries’ vulnerability to HIV/AIDS. The design of this study was a mixed methods design, particularly the sequential explanatory strategy was used will used in this study. The study was conducted in four (4) conveniently selected provinces (highest prevalence of SCI). The Quad-Para Association of South Africa’s (QASA) provincial databases was used to invite individuals with SCI to participate in the study. Data for quantitative part of the study was collected by means of self-administered questionnaires. The questionnaire consisted of various sections requesting for information on: Demographics; HIV-Knowledge (HIV- KQ-18); Sexual behaviours; Sexual communication and negotiation skills; Self-efficacy to refuse sex. Separate binary logistics analysis was done to assess which of the selected factors are associated with risky sexual behaviour. The forced entry method approach was used to determine which of these factors have the greatest productive power to predict sexual risk behaviour. No “a priori” sample size was developed for the qualitative part, but participants were recruited until saturation has been reached of all the categories. Consenting participants were visited by the researcher for data collection in the environment indicated by the participant. Permission to conduct the study was obtained from the Research Ethics Committee at the University of the Western Cape (UWC). The study was conducted according to ethical practices pertaining to the study of human subjects as specified by the UWC and Faculty of Community and Health Sciences Research Ethics Committee of the UWC.
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The activity and participation profile of persons with traumatic spinal cord injury in the Cape Metropole, Western Cape, South Africa : a prospective, descriptive studyMaclachlan, Mirda 03 1900 (has links)
Thesis (MScPhysio)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background
Traumatic spinal cord injury (SCI) remains one of the most serious and devastating injuries often
resulting in permanent disability and with life changing implications for the individual and his/her
family. Successful reintegration into community life and employment after SCI is considered
important goals of rehabilitation as this has been positively associated with quality of life, self
esteem and life satisfaction. The International Classification of Functioning, Disability and Health
(ICF) allows researchers to identify the impact of environmental factors on functioning and
disability. Minimal research, particularly in South Africa, has been done on the impact of the
environment on persons living with various health conditions and specifically spinal cord injury.
Objectives
The main purpose of this study was to describe and compare the level of participation of persons
with traumatic SCI at two time points (discharge and six months after discharge) from the inpatient
rehabilitation setting and to identify the environmental barriers experienced.
Methods
A prospective, descriptive study was conducted using consecutive sampling. All patients with
traumatic SCI that were discharged from September 1, 2008 from the Western Cape Rehabilitation
Centre (WCRC) who were eligible for this study were included. Two questionnaires (one based on
the ICF and one purposely-developed) and the International Standards for the Classification of SCI
(ISCSCI) were used. Data were analyzed with the statistical software package STATISTICA.
Results
A person sustaining a traumatic SCI in the Cape Metropolitan area of the Western Cape Province is
most likely to be a male, young (20 to 29 years), of the Black or Coloured race and living in the
Cape Flats suburbs. More than half of the subjects had a grade eight to ten level of education which
together with the lack of employers’ responsibilities towards part-time workers might explain the
low percentage (11%) of employment at six months after discharge from the WCRC.
Complete paraplegia, occurring mainly in the thoracic cord, was the most common neurological
disability found in this study. The most common secondary condition was pain followed by
spasticity limiting function. The low incidence of pressure sores and urinary tract infections found
in this study contradicts findings of previous studies.The majority of the subjects were discharged to the same house they were living in at the time of
their injury. However, due to various architectural barriers, some of them were not able to function
independently in their homes.
Inaccessibility of public transport, the lack of recreational and sport facilities, lack of social support
structures in the community and inadequate financial resources were the main environmental
barriers experienced by these individuals.
Conclusion
The main finding of this study was the low employment rate and the difficulty experienced with
reintegration at community level after SCI. The results of this study confirm the significant
contribution of environmental factors in participation, especially those of transport and education in
return to work. Fourteen years after the publication of the Integrated National Disability Strategy
(INDS) White Paper (1997), legislative strategies to ensure that people with disabilities have equal
access to social and economic opportunities remain lacking. / AFRIKAANSE OPSOMMING: Agtergrond
Traumatiese spinaalkoordbesering (SKB) lei dikwels tot permanente verlamming en dit het
lewensveranderende implikasies vir die individu en sy/haar familie. Suksesvolle herintegrasie in die
gemeenskap en werkverrigting na SKB is belangrike doelstellings vir rehabilitasie omdat dit
positief met lewenskwaliteit, selfrespek en lewens-bevrediging geassosieer word. Die Internasionale
Klassifisering van Funksionering, Gestremdheid en Gesondheid (IKF) bied aan navorsers die
geleentheid om die impak van omgewingsfaktore op funksionering en gestremdheid te identifiseer.
Daar is veral in Suid-Afrika beperkte navorsing oor die impak van die omgewing op mense met
verskillende gesondheidstoestande, spesifiek SKB.
Doel
Die hoofdoel van hierdie studie was om die vlak van deelname van mense met traumatiese SKB op
twee verskillende tye te beskryf en te vergelyk, onmiddellik na hulle uit die rehabilitasiesentrum
ontslaan is, en ses maande later. Die studie het ook ten doel gehad om die omgewingsfaktore te
identifiseer wat deelname negatief beïnvloed.
Metode
Daar is van ’n beskrywende studie gebruik gemaak. Alle pasiënte met traumatiese SKB wat vanaf 1
September 2008 vanaf die Wes-Kaapse Rehabilitasiesentrum (WKRS) ontslaan is en wat voldoen
het aan die insluitingskriteria is ingesluit. Twee vraelyste is gebruik om data in te samel – een is op
die IKF gebaseer en een is spesifiek vir die studie ontwikkel. Daar is ook van die Internasionale
Standaarde vir die Klassifisering van SKB (ISKSKB) gebruik gemaak om data in te samel. Data is
met behulp van STATISTICA, ’n statistiese sagteware pakket, geanaliseer.
Resultate
Iemand wat ’n traumatiese SKB in die Kaapse metropolitaanse gebied van die Wes-Kaap provinsie
opdoen, is mees waarskynlik ’n jong man (20 tot 29 jaar) van die Swart of Kleurling ras wat
woonagtig in die voorstede op die Kaapse Vlakte is. Meer as die helfte van die deelnemers in die
studie het slegs ’n opvoedingsvlak van graad agt tot tien. Hierdie aspek, tesame met die gebrek aan
werkgewers se verantwoordelikheid teenoor deeltydse werknemers is dalk die rede waarom slegs
11% van die deelnemers ses maande na hulle uit die WKRS ontslaan is, werksaam was.
Volledige paraplegie, hoofsaaklik as gevolg van ’n besering van die torakale spinaalkoord, was die
algemeenste neurologiese besering wat in hierdie studie gevind is. Die algemeenste sekondêre
komplikasie wat voorgekom het, was pyn gevolg deur spastisiteit. Die lae voorkoms van druksere
en urienweginfeksies in dié studie is in teenstelling met bevindings van vorige studies.
Die meeste deelnemers is ontslaan na dieselfde huis waar hulle voor die besering gewoon het, maar
as gevolg van verskeie argitektoniese hindernisse, kon sommige van hulle nie onafhanklik binne
hulle wonings funksioneer nie.
Die ontoeganklikheid van openbare vervoer, die gebrek aan ontspannings- en sportfasiliteite, die
gebrek aan sosiale ondersteuningsnetwerke in die gemeenskap en onvoldoende finansiële
hulpbronne was die algemeenste omgewingshindernisse wat deur die deelnemers ondervind is.
Samevatting
Die belangrikste bevinding van dié studie was dat slegs ’n klein persentasie van die deelnemers ses
maande na hul ontslaan is, werksaam was en dat herintegrasie in die gemeenskap na ’n SKB baie
moeilik is. Die resultate van die studie bevestig die belangrike rol wat omgewingsfaktore by
deelname speel, veral die faktore wat te make het met vervoer en die opvoedingsvlak wanneer daar
na ’n werk teruggekeer word. Veertien jaar na die publikasie van die Geïntegreerde Nasionale
Gestremdheidstrategie in 1997, is wetgewende strategieë om gelyke toegang tot sosiale en
ekonomiese geleenthede vir persone met gestremdhede te verseker, steeds gebrekkig.
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Biomatériau à base de chitosane pour la restauration de la moelle épinière traumatique de rat : analyses anatomiques et fonctionnelles / Chitosan-based biomaterial for the restoration of rat traumatic spinal cord : anatomical and functional analysisChedly, Jamila 16 September 2016 (has links)
La régénération après une lésion de la moelle épinière (ME) est abortive. Elle est du à une cascade d'événements cellulaires et moléculaires, dont la rupture de la barrière hémato-encéphalique, une inflammation persistante, une cicatrice gliale et la formation d'une cavité, combinée à la présence de molécules inhibitrices pour la repousse. Actuellement, aucune thérapie n'est efficace, mais le design de biomatériaux implantables pourrait permettre leur développement. L'hydrogel de chitosane (hCh) apparait prometteur, notamment grâce à la modulation de ses propriétés biologiques, notamment en modifiant son degré de déacétylation (DA). J'ai donc testé, dans une hémisection dorsale de la ME de rat, différentes formulations d'hCh fragmenté et examiné leur capacité à s'intégrer dans le tissu hôte lésé, sans produire une inflammation ou une réaction astrocytaire excessive. Mon travail montre que l'implantation de fragments d'hCh avec un DA de 4% est favorable à la reconstruction du tissu, en attirant différents types cellulaires et en recréant une vascularisation fonctionnelle. Il permet aussi de moduler la réponse inflammatoire, en favorisant une polarisation des macrophages en un phénotype M2. La cicatrice gliale est aussi réduite et les processus astroytaires s'orientent vers l'implant, en s'associant aux axones qui régénèrent et caractérisés par traçage axonale et immunohistochimie. Plusieurs sont myélinisés ou entourés par des cellules de Schwann, au moins jusqu'à 10 semaines après la lésion. Enfin, le remodelage structural est associé à une récupération locomotrice significative. / Regeneration after traumatic spinal cord injury generally fails due to a cascade of cellular and molecular events, including blood-spinal cord barrier breakdown,persistent and uncontrolled inflammation, and glial scarring and cavity formation combined with the presence of axon growth-inhibitory molecules. While efficient therapies are still lacking, recent progress in the design of implantable biomaterials may well open up new possibilites for their development. Chitosan hydrogels (hCh) seem particularly promising as their biological properties can be fine-tuned, notably by their degree of acetylation (DA). In the context of a rat dorsal spinal cord hemisection, I have tested different formulations of fragmented hCh for their ability to integrate into lesioned host tissue without creating additional inflammation, or excessive astrocytic reaction. Thus, I found that implantation of hCh particles of 4% DA allows for tissue reconstruction by attracting different cell types and recreating a functional vasculature. Importantly, it modulates the inflammatory response, favoring polarization of invading macrophages towards the M2 phenotype. In lesioned-implanted animals, the glial scar is less fibrous, astrocyte processes are mainly oriented towards the lesion and accompany a robust regrowth of fibers, whose origin was identified by axon tracing and immunohistochemistry. Many of these fibers are myelinated or ensheathed by Schwann cells, maintained at long term in the implant. Finally, this structural remodeling is associated with significant, long-lasting recovery of locomotor function, as I have shown by open-field and gait analysis.
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Prédiction de la récupération neurofonctionnelle après une lésion médullaire traumatique : bien choisir les variables explicatives et préditesMputu Mputu, Pascal 04 1900 (has links)
Une lésion traumatique de la moelle épinière est une affection de la moelle épinière résultant d’un impact direct sur la colonne vertébrale. D’installation brusque par compression, lacération, distraction ou section de la moelle épinière, les lésions médullaires traumatiques entraînent l’interruption partielle ou totale de la transmission de l’influx nerveux et le développement des troubles neurologiques. Ces troubles sont de gravité et de durée variables, limitant significativement la capacité fonctionnelle du patient dans les activités quotidiennes. Il s’agit d’une affection lourde de conséquences à cause de la morbidité et mortalité élevées comparativement à la population générale et d’une qualité de vie amoindrie à la suite de diverses complications à long terme. Ces lésions représentent un fardeau considérable pour le patient, sa famille et le système de santé dans son ensemble. Ceux qui survivent d’une LTME présentent, selon les cas, des évolutions cliniques très variables. Les résultats à long terme vont d’une récupération complète à une incapacité fonctionnelle très sévère.
Selon les cas, différents scenarios sont possibles. Certains patients récupèrent considérablement sur le plan neurologique et sur le plan fonctionnel, tandis que d’autres patients ont une récupération très limitée, développant ainsi une invalidité qui les rend totalement dépendants. Au cours des dernières décennies, il y a eu beaucoup d’avancées médicales qui ont permis d’améliorer le diagnostic et la prise en charge rapide dans la phase aiguë. Fort malheureusement, très peu de progrès ont été réalisés sur les thérapies pouvant rétablir la transmission de l’influx nerveux interrompue et entraîner une restitution ad integrum. Tôt après la survenue de la lésion médullaire, la prédiction des résultats neurofonctionnels à long terme reste une préoccupation majeure pour les cliniciens, les patients et leurs familles. Cependant, les résultats à long terme suivant une LTME sont, à l’heure actuelle, difficiles à prédire avec précision à cause de la variabilité observée dans l’évolution clinique et la diversité des facteurs qui influencent ces résultats.
Quelques études ont identifié plusieurs prédicteurs de résultats à long terme suivant une lésion médullaire. Cependant, il existe encore des lacunes relatives à la modélisation prédictive dans ce domaine. Ces lacunes sont liées à la sélection des variables indépendantes à utiliser dans la prédiction mais aussi à la pertinence clinique des résultats à prédire.
L’objectif général de ce travail a consisté donc à étudier les caractéristiques de la phase d’hospitalisation aigue qui sont susceptibles de prédire les résultats neurofonctionnels à long terme après une LTME, et d’aider les cliniciens dans la prise en charge des patients. Plus précisément, ce travail consistait à (1) identifier les prédicteurs aigus des résultats neurologiques à long terme, (2) déterminer les prédicteurs aigus des résultats fonctionnels tout en établissant leur ordre d’importance et leurs points de coupure, (3) identifier les profils d’amélioration neurologique associés à la récupération fonctionnelle.
Dans une première étude, nous avons identifié par une revue systématique de la littérature les variables liées aux caractéristiques du patient, de la lésion et de la prise en charge ayant une valeur prédictive des résultats neurologiques à long terme. Ces prédicteurs ont ensuite été classifiés dans un cadre conceptuel en quatre catégories en fonction de la constance de leur valeur prédictive. Cette étude a permis de mettre en évidence l’existence des prédicteurs émergents comme les biomarqueurs céphalorachidiens, sanguins et radiologiques, qui ont démontré une association significative aux résultats neurologiques bien que non encore suffisamment explorés.
Deuxièmement, nous avons déterminé par une étude de cohorte, les prédicteurs aigus des résultats fonctionnels à long terme. Au moyen d’un arbre de régression, nous avons élaboré quatre phénotypes de récupération fonctionnelle en fonction des trois variables issues de l’examen neurologique initial, à savoir la sensibilité à la piqure, le score moteur ASIA des membres inférieurs et le score moteur ASIA des membres supérieurs. Cette étude a permis de déterminer les points de coupure sur ces variables d’intérêt. Enfin, dans une autre étude de cohorte, nous avons déterminé les profils d’amélioration neurologiques associés à la récupération fonctionnelle.
La validation externe des résultats de ces deux dernières études dans une large cohorte de blessés médullaires issus d’une population différente est une prochaine étape nécessaire pour la translation clinique de ces algorithmes. En effet, l’identification de profils/phénotypes cliniques pourrait permettre aux cliniciens de mieux orienter et évaluer les stratégies de traitement et de réadaptation pour la clientèle des blessés médullaires. / A traumatic spinal cord injury (SCI) is damage to the spinal cord resulting from a direct impact on the spine. From sudden installation by compression, laceration, distraction, or section of the spinal cord, traumatic SCI causes partial or total interruption of the conduction of nerve impulses and the development of neurological disorders. These disorders vary in severity and duration, significantly limiting the functional capacity of the patient in daily activities. Traumatic SCI is a disease with serious consequences due to high morbidity and mortality compared to the general population, and reduced quality of life because of various long-term complications. These injuries represent a tremendous burden to the patients, their families, and the health care system. Those surviving a SCI present variable clinical evolution, and the long-term outcomes range between a full recovery and a severe functional disability.
Depending on the case, different scenarios are possible. Some patients may significantly recover, both neurologically and functionally, while others have very limited recovery, the latter becoming dependent. In recent decades, there have been many medical advances that have improved diagnosis and rapid management in the acute phase. Unfortunately, very little progress has been made on effective therapies to restore the conduction of the interrupted nerve impulses. Early after the onset of a spinal cord injury, predicting long-term neurofunctional outcomes remains a major concern for clinicians, patients, and their families. However, it is currently difficult to accurately predict long-term neurofunctional outcomes, because of the variability in clinical evolution and the diversity of factors influencing these outcomes.
A few studies have identified several predictors of long-term outcomes following a SCI. However, there are still gaps in predictive modeling in this area. These gaps are related to the selection of independent variables to be used in prediction but also to the clinical relevance of the results to be predicted.
The overall objective of this work was to study the acute predictors of long-term neurofunctional outcomes following a SCI. More specifically, this work consisted of (1) identifying acute predictors of long-term neurological outcomes, (2) determining acute predictors of functional outcomes while determining their relative importance and cut-off, and (3) identifying neurological improvement profiles associated with functional recovery.
Firstly, we conducted a systematic review of the literature and identified predictors of long-term neurological outcomes that are related to the patient, SCI, and management characteristics. These predictors were then classified in a new conceptual framework into four categories based on the consistency in the studies and their predictive value. This study highlighted the significant role of the initial neurological variables, as well as the existence of emerging predictors such as cerebrospinal, blood, and radiological biomarkers, which demonstrated a significant association with neurological outcomes although not yet sufficiently studied.
Secondly, we conducted a cohort study to determine, the acute predictors of long-term functional outcomes. Using a regression tree, we determined four functional recovery phenotypes based on 3 variables from the initial neurological examination, namely the pinprick sensory score, the lower-extremity ASIA motor score, and the upper-extremity ASIA motor score. This study also defined the cut-off on these variables of interest. Finally, in another cohort study, we identified neurological improvement phenotypes associated with functional recovery.
External validation of these results in a large cohort of individuals with SCI from a different population is a necessary next step for the clinical translation of these algorithms. Indeed, the identification of clinical profiles/phenotypes could allow clinicians to better guide and evaluate treatment and rehabilitation strategies for patients with SCI.
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Pursuing More Aggressive Timelines in the Surgical Treatment of Traumatic Spinal Cord Injury (TSCI): A Retrospective Cohort Study with Subgroup AnalysisBock, Tobias, Heller, Raban Arved, Haubruck, Patrick, Raven, Tim Friedrich, Pilz, Maximilian, Moghaddam, Arash, Biglari, Bahram 04 May 2023 (has links)
Background: The optimal timing of surgical therapy for traumatic spinal cord injury (TSCI) remains unclear. The purpose of this study is to evaluate the impact of “ultra-early” (<4 h) versus “early” (4–24 h) time from injury to surgery in terms of the likelihood of neurologic recovery. Methods: The effect of surgery on neurological recovery was investigated by comparing the assessed initial and final values of the American Spinal Injury Association (ASIA) Impairment Scale (AIS). A post hoc analysis was performed to gain insight into different subgroup regeneration behaviors concerning neurological injury levels. Results: Datasets from 69 cases with traumatic spinal cord injury were analyzed. Overall, 19/46 (41.3%) patients of the “ultra-early” cohort saw neurological recovery compared to 5/23 (21.7%) patients from the “early” cohort (p = 0.112). The subgroup analysis revealed differences based on the neurological level of injury (NLI) of a patient. An optimal cutpoint for patients with a cervical lesion was estimated at 234 min. Regarding the prediction of neurological improvement, sensitivity was 90.9% with a specificity of 68.4%, resulting in an AUC (area under the curve) of 84.2%. In thoracically and lumbar injured cases, the estimate was lower, ranging from 284 (thoracic) to 245 min (lumbar) with an AUC of 51.6% and 54.3%. Conclusions: Treatment within 24 h after TSCI is associated with neurological recovery. Our hypothesis that intervention within 4 h is related to an improvement in the neurological outcome was not confirmed in our collective. In a clinical context, this suggests that after TSCI there is a time frame to get the right patient to the right hospital according to advanced trauma life support (ATLS) guidelines.
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Développement d’un outil d’évaluation neurologique simplifié pour les lésions médullaires traumatiques en contexte aiguPelletier-Roy, Rémi 07 1900 (has links)
La prise en charge rapide et systématique des patients en traumatologie par des protocoles tels que l’Advanced Trauma Life SupportTM maximise la survie. À l’intérieur de ces protocoles, l’examen le plus souvent proposé pour l’évaluation neurologique est l’International Standards For Neurological Classification of Spinal Cord Injury (ISNCSCI). Cet outil d’évaluation des patients avec une lésion médullaire traumatique (LMT) est le plus reconnu mondialement, mais n’est pas adapté à la prise en charge initiale en traumatologie de par son exhaustivité. L’objectif principal de ce mémoire était de combler le besoin pour un outil d’évaluation neurologique adapté au patient avec une LMT en contexte aigu.La première partie de ce travail consista au développement et à la validation d’une version simplifiée de l’ISNCSCI qui a été nommée le Montreal Acute Classification of Spinal Cord Injury (MAC-SCI). Sa validation par rapport à l’ISNCSCI révéla une capacité à déterminer correctement le grade de sévérité ainsi que l’étage lésionnel de la LMT dans 100% des cas. La seconde partie de ce travail évalua la capacité du MAC-SCI à détecter les variations neurologiques périopératoires et montra qu’aucune détérioration neurologique n’était ratée. Finalement, la troisième partie de ce travail évalua l’implémentation clinique du MAC-SCI et montra des taux de complétion 2,4 fois supérieurs à ceux de l’ISNCSCI. Nous souhaitons que le MAC-SCI soit incorporé dans les protocoles de traumatologie à grande échelle dans le but d’uniformiser l’évaluation neurologique des patients en situation de traumatologie et ultimement d’améliorer les soins prodigués aux patients blessés médullaires. / Rapid and systematic management of trauma patients using protocols such as the Advanced Trauma Life SupportTM maximizes survival. Within these protocols, the tool the most often suggested for neurological assessment is the International Standards For Neurological Classification of Spinal Cord Injury (ISNCSCI). This assessment tool for patients with traumatic spinal cord injury (TSCI) is the most recognized worldwide, but is not suitable for initial trauma care due to its comprehensiveness. The main objective of this thesis was to fulfill the need for a neurological assessment tool adapted to the patient with TSCI in an acute context. The first part of this study consisted in the development and validation of a simplified version of the ISNCSCI which was named the Montreal Acute Classification of Spinal Cord Injury (MAC-SCI). Its validation against the ISNCSCI revealed an ability to correctly determine the grade of severity as well as the neurological level of injury of the TSCI in 100% of cases. The second part of this study assessed the ability of the MAC-SCI to detect perioperative neurological variations and showed that no neurological deterioration was missed. Finally, the third part of this study evaluated the clinical implementation of the MAC-SCI and showed completion rates 2.4 times higher than the ISNCSCI. We would like the MAC-SCI to be incorporated into large-scale trauma protocols in order to standardize the neurological assessment of trauma patients and ultimately improve the care provided to patients with spinal cord injuries.
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Modelování Huntingtonovy choroby a bněčná terapie při poškození míchy. / Huntington's disease modeling and stem cell therapy in spinal cord disorders and injuryHruška-Plocháň, Marián January 2013 (has links)
Neurological disorders affect more than 14% of the population worldwide and together with traumatic brain and spinal cord injuries represent major health, public and economic burden of the society. Incidence of inherited and idiopathic neurodegenerative disorders and acute CNS injuries is growing globally while neuroscience society is being challenged by numerous unanswered questions. Therefore, research of the CNS disorders is essential. Since animal models of the CNS diseases and injuries represent the key step in the conversion of the basic research to the clinics, we focused our work on generation of new animal models and on their use in pre-clinical research. We generated and characterized transgenic minipig model of Huntington's disease (HD) which represents the only successful establishment of a transgenic model of HD in minipig which should be valuable for testing of long term safety of HD therapeutics. Next, we crossed the well characterized R6/2 mouse HD model with the gad mouse model which lacks the expression of UCHL1 which led to results that support the theory of "protective" role of mutant huntingtin aggregates and suggest that UCHL1 function(s) may be affected in HD disturbing certain branches of Ubiquitin Proteasome System. Traumatic spinal cord injury and Amyotrophic Lateral...
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