This study explored the meaning people with spinal cord injuries give to physical activity and recreation participation as they make the transition from the protected environment of hospital rehabilitation to the reality of returning to their homes and communities. The experiences of 4 individuals between 15 and 24 years of age who had sustained spinal cord injuries within the previous five years were captured using the phenomenological methods of semi-structured individual interviews, focus group interviews, photographs, and field notes. Rimmers (1999) model of health promotion for people with disabilities combined with Peters (1996) model of disablement provided the conceptual framework for the study and facilitated the interpretation of the findings. The participants indicated that physical activity was a very important component to living a psychologically, socially and physically healthy lifestyle following a spinal cord injury. A thematic analysis revealed three themes: (a) as my body heals, (b) learning to be me, and (3) getting back to life. The importance of physical activity in maintaining a healthy lifestyle following a spinal cord injury was reflected in stories of physical activity as a component of hospital rehabilitation, the importance of physical activity during the transition from the hospital to the challenges of returning home, and finally, engagement in community based physical activity. A gap in the continuity of physical activity opportunities during the transition from in-hospital rehabilitation to the return to the community was identified.

Spinal cord injury (SCI) is a devastating condition characterized by the loss of neuronal pathways responsible for coordinating motor and sensory information between the brain and the rest of the body. The mammalian spinal cord is limited in its ability to repair itself, so treatments devised to replace damaged tissue and promote regeneration are essential towards developing a cure. This work describes the development of a guidance channel strategy for spinal cord transection. Chitosan guidance channels were designed as a delivery vehicle for neural stem/progenitor cell (NSPC) transplants and drug-eluting poly(lactic-co-glycolic acid) (PLGA) microspheres. PLGA microspheres were embedded into chitosan channels by a spin-coating method. These microsphere-loaded channels demonstrated the ability for controlled short-term bioactive release of the small molecule drug dibutyryl cyclic-AMP (dbcAMP) and long-term bioactive release of the protein alkaline phosphatase. NSPCs were shown to be responsive to dbcAMP delivery, which results in greatly enhanced differentiation into neurons. The effect of directed neuronal differentiation was investigated after spinal cord transection in rat, resulting in a dramatic increase in NSPC transplant survival. Guidance channels containing NSPCs treated with dbcAMP resulted in robust tissue bridge formation after SCI, demonstrating extensive axonal regeneration and promoting functional recovery.

The adaptation of inverse dynamics was performed to quantitatively examine the subtle locomotor changes, previously undetectable, in rodent locomotion following nervous system injury. The first experiment performed an injury with known effects, a unilateral lesion of the medial and lateral branches of the left tibial nerve of Long-Evans rats, and measured the resulting data via inverse dynamics. Special effort was made to account for skin movement artefacts using a global optimization method for marker digitization. The second experiment attempted to apply this technique to Long-Evans rats with spinal hemisections at spinal level T-10. After the peripheral nerve injury to the tibial nerve branches, the main findings were that ankle joint still produces an extensor moment and positive power without the active contraction of the gastrocnemius m. It is possible that this phenomenon is due to passive contractile elements of the muscle and tendon. In addition, the knee and hip of the lesion leg stiffen, resulting in substantial reductions in moment generation and nearly total losses of both negative and positive power production. There were also compensations made by the opposite hindlimb and contralateral forelimb. The spinal cord hemisection produced subtle, complicated intra and interlimb changes in both joint moment and joint power analysis that could not be seen by looking at joint angles alone.

This study explored the meaning people with spinal cord injuries give to physical activity and recreation participation as they make the transition from the protected environment of hospital rehabilitation to the reality of returning to their homes and communities. The experiences of 4 individuals between 15 and 24 years of age who had sustained spinal cord injuries within the previous five years were captured using the phenomenological methods of semi-structured individual interviews, focus group interviews, photographs, and field notes. Rimmers (1999) model of health promotion for people with disabilities combined with Peters (1996) model of disablement provided the conceptual framework for the study and facilitated the interpretation of the findings. The participants indicated that physical activity was a very important component to living a psychologically, socially and physically healthy lifestyle following a spinal cord injury. A thematic analysis revealed three themes: (a) as my body heals, (b) learning to be me, and (3) getting back to life. The importance of physical activity in maintaining a healthy lifestyle following a spinal cord injury was reflected in stories of physical activity as a component of hospital rehabilitation, the importance of physical activity during the transition from the hospital to the challenges of returning home, and finally, engagement in community based physical activity. A gap in the continuity of physical activity opportunities during the transition from in-hospital rehabilitation to the return to the community was identified.

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

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.

Anodal transcranial direct current stimulation (tDCS) is an intervention which is thought to enhance motor learning in healthy and stroke-injured states, when applied adjunctively during skill learning. We set out to investigate whether anodal tDCS might enhance functional rehabilitation from incomplete tetraplegic SCI. To address current limitations in the measurement of task-dependent skill, a novel integrated skill training and measurement task, the Motor Skill Rehabilitation Task (MSRT) was designed and developed. Measures of performance from this task delivered the functional measure of spatial motor skill learning, Task Productivity Rate (TPR). TPR was analysed and validated as a univariate dependent outcome, which is of potential importance to the future development of clinical measures measuring goal-directed motor skills. The MSRT was included alongside conventional behavioural measures in a repeated-measures RCT pilot study, the first to investigate the effect of anodal tDCS on rehabilitation of motor skill from chronic spinal cord injury. Adjunctive application of anodal tDCS had a statistically significant benefit upon retention of skill in the incomplete spinal cord injured population, but only when the independent factor of sensory acuity was included in the analysis. Differences between the development of task-dependent skill and generic dexterity over time suggested that spatial skill development was subject to an interaction of short-term and lasting effects. A larger study in healthy persons further investigated these phenomena, also applying Transcranial Magnetic Stimulation (TMS)–evoked measurements to investigate intervention-dependent effects upon the excitability of projections between the primary motor cortex and muscles involved in the prehension task. The findings revealed that active tDCS did not enhance skill learning at 7 days beyond the training period, but did significantly alter the development of motor skill following a period of learning and subsequent skill consolidation which was associated with underlying perturbation of motor control strategy. Significant and divergent patterns of cortical plasticity were evoked in projections to muscles necessary for reaching and grasping. The main findings of this thesis do not support anodal tDCS as an effective adjunctive means of enhancing spatial motor skill in rehabilitation from incomplete tetraplegic SCI. If applied in patient populations, the clinical benefits of anodal tDCS may be contingent both on the nature of the sensorimotor deficit affecting upper limb function and the spatial demands of the behavioural task. The findings of this project serve to inform further research in relation to the effect of anodal tDCS on the brain and behavioural outcomes, the potential for efficacy in target patient groups and the sensitivity of outcome measures to spatial and temporal dimensions of practical motor skills.

Traumatic brain and spinal cord injury continue to be substantial clinical problems with few available treatment strategies. Individuals who are at a greater risk for sustaining a central nervous system (CNS) injury, such as professional athletes and military personnel, may benefit from a prophylactic supplement that would intervene in the neurodegenerative pathways immediately following injury. The high demand for selenium within the central nervous system, as well as the synthesis of selenoproteins by neurons and astrocytes suggests a critical role of selenium within the brain and spinal cord. Studies were designed to test the efficacy of enriched dietary selenium status in providing neuroprotective benefits in rodent models of spinal cord and traumatic brain injury. Levels of selenium storage within the CNS are increased relative to the amount of selenium present in the diet, indicating that selenium compounds effectively cross the blood brain barrier. In a model of moderate severity spinal cord contusion injury, dietary selenium supplementation reduced the number of days until recovery of independent bladder function following injury. These benefits did not translate to improvements in locomotor function during open field testing or reduction in overall lesion volume in the injured animal groups. Examination of gene expression changes 24 hours after spinal cord injury revealed that dietary selenium enrichment increased expression of genes involved in DNA repair, mitochondrial respiration, and transcriptional regulation. By expanding the scope of these studies to include models of traumatic brain injury, these data show the importance of selenium in the cortex as well. In particular, when compared to diets deficient in selenium, higher levels of dietary selenium improve spatial memory performance and mitochondrial respiration. The results of this dietary study show modest improvements following both traumatic brain and spinal cord injury and suggest that while selenium enrichment may not have a profound effect on the secondary injury cascade immediately following injury, the presence of adequate dietary selenium is critical for mitochondrial respiration. Together the results of these studies suggest that dietary supplementation may play a subtle role in injury mechanisms within the CNS and warrant further investigation.