No description available.

No description available.

No description available.

No description available.

<p>Spinal cord injury is a devastating condition, and its consequences impact on many facets of an individual&rsquo / s life. Activities of daily living such as personal care and housework might be difficult to perform post injury. The majority of spinal cord injury patients receive hospital-based rehabilitation to address these consequences. The normal length of hospital stay among spinal cord injury patients ranges from three to twelve months, and an increased length of stay are caused by development of secondary complications such as pressure sores, urinary tract infection and respiratory infection. The purpose of this study was to determine factors affecting length of hospital stay for individuals with spinal cord injuries at Kanombe Military Hospital in Rwanda. To achieve this, a retrospective study, utilising a quantitative approach was used. The records of individuals with spinal cord injuries discharged from the hospital between 1st January1996 and 31st December 2007 were reviewed to collect data. A data gathering instrument was developed by the researcher and there after used to capture the relevant information from the patients&rsquo / folders. Information collected included demographic data, information relating to the injury, occurrence of medical complications and length of hospital stay. One hundred and twenty four medical folders of patients discharged from 1st January 1996 to 31st December 2007 at Kanombe Military Hospital were reviewed for data extraction. The Statistical Package for Social Sciences (SPSS) version 16.0 for windows was used to analyse the data. Both descriptive and inferential statistics were determined in SPSS. Associations were made between demographic factors and occurrence of secondary medical complications with length of hospital stay. These were computed by means of chi-square tests. One level of significance, alpha set at 5% was used throughout. The linear regression analysis was used to determine factors affecting the length of stay.</p>

Background: Traumatic spinal cord injury (SCI) results in vascular disruption which appears to contribute to the pathobiology of SCI. Vascular endothelial growth factor (VEGF) is known for vascular development and repair, and more recently for its neuroprotective properties. Given this, I investigated the temporal-spatial changes to the spinal vasculature, as well as examined the role of VEGF as a therapeutic approach for SCI. Hypothesis: It is hypothesized that clip-compression injury will result in significant vascular changes, and that ZFP-VEGF gene therapy will enhance molecular and functional recovery following spinal cord injury. Methods: Briefly, female Wistar rats received a two-level laminectomy and a 35g clip-compression injury at T6-T7 for 1 minute. Control animals received a laminectomy only. AdV-ZFP-VEGF or AdV-eGFP was administered 24 hour post-injury by intraspinal injection. For molecular and vascular analysis, tissues were extracted at various time points between 1 hour and 14 days post-SCI. For behavioural experiments animals were studied for 8 consecutive weeks. Results: I have shown that vasculature undergoes structural and functional changes, which occur as early as 1 hour following SCI. Although endogenous improvement is observed, SCI results in permanent vascular damage. Animals receiving AdV-ZFP-VEGF treatment had increased levels of VEGF mRNA and protein. AdV-ZFP-VEGF resulted in neuroprotection, as observed by increased NF200 protein and NeuN counts, and decreased TUNEL staining. Animals treated with AdV-ZFP-VEGF also showed an increased number of newly formed vessels (angiogenesis), as well as an increase in total number of vessels. Moreover, animals treated with AdV-ZFP-VEGF showed significant increases in hindlimb weight support and reduction neuropathic pain. Conclusions: I have characterized the dramatic temporal-spatial changes which occur in the spinal vasculature following SCI. Additionally, I have demonstrated that AdV-ZFP-VEGF administration results in beneficial molecular and functional outcomes. Overall, the results of this study indicate that AdV-ZFP-VEGF administration can be delivered in a clinically relevant time-window following SCI (24 hours) and provide significant molecular and neurobehavioural benefits, by acting through angiogenic and neuroprotective mechanisms.

Background: Traumatic spinal cord injury (SCI) results in vascular disruption which appears to contribute to the pathobiology of SCI. Vascular endothelial growth factor (VEGF) is known for vascular development and repair, and more recently for its neuroprotective properties. Given this, I investigated the temporal-spatial changes to the spinal vasculature, as well as examined the role of VEGF as a therapeutic approach for SCI. Hypothesis: It is hypothesized that clip-compression injury will result in significant vascular changes, and that ZFP-VEGF gene therapy will enhance molecular and functional recovery following spinal cord injury. Methods: Briefly, female Wistar rats received a two-level laminectomy and a 35g clip-compression injury at T6-T7 for 1 minute. Control animals received a laminectomy only. AdV-ZFP-VEGF or AdV-eGFP was administered 24 hour post-injury by intraspinal injection. For molecular and vascular analysis, tissues were extracted at various time points between 1 hour and 14 days post-SCI. For behavioural experiments animals were studied for 8 consecutive weeks. Results: I have shown that vasculature undergoes structural and functional changes, which occur as early as 1 hour following SCI. Although endogenous improvement is observed, SCI results in permanent vascular damage. Animals receiving AdV-ZFP-VEGF treatment had increased levels of VEGF mRNA and protein. AdV-ZFP-VEGF resulted in neuroprotection, as observed by increased NF200 protein and NeuN counts, and decreased TUNEL staining. Animals treated with AdV-ZFP-VEGF also showed an increased number of newly formed vessels (angiogenesis), as well as an increase in total number of vessels. Moreover, animals treated with AdV-ZFP-VEGF showed significant increases in hindlimb weight support and reduction neuropathic pain. Conclusions: I have characterized the dramatic temporal-spatial changes which occur in the spinal vasculature following SCI. Additionally, I have demonstrated that AdV-ZFP-VEGF administration results in beneficial molecular and functional outcomes. Overall, the results of this study indicate that AdV-ZFP-VEGF administration can be delivered in a clinically relevant time-window following SCI (24 hours) and provide significant molecular and neurobehavioural benefits, by acting through angiogenic and neuroprotective mechanisms.

The purpose of this research was to develop a theoretical understanding of the influences on participation for individuals with spinal cord injury (SCI) from a self-perceived perspective, with particular focus on the role of assistive technology (AT) in self-perceived participation. The theoretical underpinning, symbolic interactionism, was used to gain an understanding of the ways that adults with SCI ascribe meaning to the interaction between themselves and their unique environments in a process of participation. A grounded theory study of 19 adults with SCI was conducted. Participants engaged in individual in-depth interviews, used photovoice as a framework for taking photographs of aspects of their environment that promoted and restricted participation, and engaged in focus groups. The constructed grounded theory is summarized as follows: Negotiating the Body-environment Interface is a continuous process for those living with a SCI. Despite the relative stability of their changed body, they Live in a Changed World, one perceived differently after SCI. Four sets of strategies are used by individuals to interact within their unique environments: creating an accessible proximal environment; using AT and adaptations; advocating and educating; and gaining information and knowledge. Strategies were selected to engage in a Process of Participation, a process that consisted of a sense of inclusion, autonomy, accomplishment, and reciprocity. Intervening conditions were the physical (architectural, natural), socio-cultural (social supports, societal attitudes), and institutional (services, policies) environmental aspects that served as barriers or facilitators to the process of participation. The study has added to the growing body of literature on self-perceived participation that forefronts the sense of connectivity and engagement people feel within their environment. The findings highlighted how AT holds unique meaning, and how decisions around use of technology for participation is influenced by personal factors, and physical, socio-cultural, and institutional environments. A new definition of AT was constructed that acknowledges the environmental influences and importance of self-perceived participation as an outcome of AT use. This research highlights the instrumental role of the environment in supporting self-perceived participation of adults with SCI. Further research on developing ways to create inclusive and supportive environments for assistive technology users is warranted.

Apart from motor and sensory function loss, an injury to the spinal cord can cause sympathetic dysfunction, which has been shown to affect immune responses. In this thesis, data from five experimental studies have been collected to compare physiological and psychophysiological exercise responses between wheelchair athlete subgroups with different disabilities (tetraplegic, paraplegic, and non-spinal cord-injured). In two preparatory studies, physiological exercise responses to exhaustive (Chapter 4) and submaximal exercise (Chapter 5) were investigated in all three disability subgroups. Whilst reliability measures for peak oxygen uptake (VO2peak) were in a range observed previously in able-bodied athletes, the variation in tetraplegic athletes was larger when expressed relative to their VO2peak, questioning the use of this variable to track small changes in aerobic capacity in athletic populations. Submaximal physiological and psychophysiological exercise responses were found to be similar between disability subgroups when expressed as a percentage of VO2peak, justifying the protocol used in the laboratory study on mucosal immune function, which was based on the same percentages of VO2peak for all disability subgroups. The most extensive study of this thesis, detailed in Chapter 6, showed that single laboratory-controlled 60-min exercise sessions increase both salivary secretory immunoglobulin A (sIgA), a marker of mucosal immunity, and α-amylase, a marker of sympathetic activation in all three disability subgroups. However, the impaired sympathetic nervous system in tetraplegic athletes seemed to influence the fine-tuning of their sIgA response when compared with paraplegic and non-spinal cord-injured athletes, resulting in a larger exercise-induced increase of sIgA secretion rate when compared to paraplegic and non-spinal cord-injured athletes. Based on these results, the study detailed in Chapter 7 investigated sIgA responses in tetraplegic athletes during wheelchair rugby court training. Despite their disability, these athletes showed responses thought to be governed by the sympathetic nervous system, such as reductions of saliva flow rate as a result of strenuous exercise. Similarly, the responses observed in Chapter 8 imply a comparable trend of chronic sIgA exercise responses in tetraplegic athletes as found in the able-bodied population, namely a decrease in sIgA secretion rate during periods of heavy training. These are the first studies in wheelchair athlete populations to investigate mucosal immune responses. Interestingly, despite the disruption of their sympathetic nervous system, some responses in tetraplegic athletes are comparable with findings in able-bodied populations. It is possible that due to their highly trained nature, these tetraplegic individuals are able to compensate for their loss of central sympathetic innervation. This may be by way of adapted spinal reflex or parasympathetic nervous system activity, or increased sensitivity of receptors involved in autonomic pathways. Therefore, sympathetic nervous function in tetraplegic athletes may be qualitatively altered, but in parts still be functional.

Cardiovascular control in the human is significantly impaired after spinal cord injury(SCI) having a direct effect on the sympathetic nervous system (SNS) causing an inability toregulate vasoconstriction below the level of the lesion. The effects of SCI on the two majorcomponents of blood pressure regulation, control of plasma volume and neural control of theheart and peripheral vasculature are poorly understood. In particular, no index to diagnosedisorders to autonomic control of the heart and vasculature has been developed. The presentstudy primarily utilized noninvasively acquired, easily accessible variables that may havepromise as indicators of autonomic activity for assessing the level of autonomic injury andrecovery of visceral control following SCI. The most significant results and the clearestdifferences between the three groups (able-bodied, paraplegic and tetraplegic) were evident inspectral analysis obtained in the frequency domain: Arterial blood pressure and lower body (at aregion on the shin) skin perfusion spectral power in the low frequency (LF) region are ofsignificance. These variables could be good discriminators of the three groups, as well as showlevel of SCI and autonomic function.