Title: The evaluation of functional sitting stability of paraplegics Objectives: The aim of this work is to evaluate the functional stability of paraplegics sitting through tests. Another objective is to determine what is the effect of fourteen days rehabilitation intervention on the sitting patients. Methods: Designed experiment was processed by the form of quantitative research. There were 10 pacients with spinal cord injuries, especially paraplegics included - 5 men and 5 women. The history was detected with the main emphasis on assessment ASIA score. Measurement of unsupported upright sitting was done thanks to the Plantograf V09. It records the current pressure distribution and movement of the center of pressure (COP). Functional T - shirt test was evaluated by using a stopwatch. Probands responded two questions about their current condition after rehabilitation after the output measuring. The therapist rating was included in the results. All data were further processed in Microsoft Office Excel 2007. Results: Measurements confirmed the reliability of both used tests. The t-shirt test can be used as an objective method of assessing functional stability of sitting. Test of unsupported upright sitting measured by Plantografu is also usable. It would be appropriate to set the measuring apparatus...

Despite tremendous progress in medicine, injuries of the adult central neural system remain without satisfactory solution. Regenerative medicine employs tissue engineering, cellular therapies, medical devices, gene therapy, or growth factors with the aim to bridge the lesion, re-establish lost connections and enhance endogenous repair in order to restore neural function. The aim of my thesis was to evaluate therapeutic potential of two approaches, transplantation of human mesenchymal stromal cells (hMSCs) and biological scaffolds derived from extracellular matrix (ECM) for neural regeneration, particularly in models of spinal cord injury (SCI). First, hMSCs from various sources - bone marrow (BM), adipose tissue (AT) and Wharton's jelly (WJ) - were isolated and characterized in vitro. All cell types met the minimal criteria for MSC phenotype and displayed similar properties in terms of their surface marker expression, differentiation potential, migratory capacity, and secretion of cytokines and growth factors. On the other hand, the cell yield from WJ and AT was significantly higher, and MSCs isolated from these tissues proliferated better than from BM. Therapeutic effect of intrathecal application of hWJ-MSCs was then evaluated in SCI compression model in rats. The effect of low (0.5 million) and...

Introduction et objectifs: La survenue d’une lésion traumatique de la moelle épinière (LTME) entraine des conséquences dévastatrices. Afin de pallier les déficits encourus, les patients entreprennent un processus de réadaptation qui se déroule en quatre phases : l’hospitalisation aigüe, la réadaptation fonctionnelle intensive, la réintégration communautaire et le maintien des acquis. L’hospitalisation aigüe représente une partie cruciale du cheminement clinique puisqu’elle représente une période unique afin de minimiser les complications médicales et d’optimiser la récupération fonctionnelle tôt dans le processus de réadaptation. Ainsi, l’évolution clinique lors de la phase de réadaptation aigüe ne doit pas être négligée puisqu’il a été démontré que celle-ci influence l’issue à moyen et long terme. Notamment, la prévention des plaies de pression (PP) est primordiale puisque l’hospitalisation aigue représente la période ayant le risque le plus élevé de développer une PP et la survenue de celle-ci influence négativement la récupération fonctionnelle à long terme. Or, l’impact de multiples facteurs sur la survenue de plaies de pression (PP) lors de la phase aigüe spécifiquement ainsi que les objectifs qui doivent être priorisés par l’équipe de réadaptation aigüe afin d’optimiser l’issue fonctionnelle au congé de l’hospitalisation aigüe demeurent imprécis. Ainsi l’objectif principal de ce travail est d’identifier comment l’équipe de réadaptation aigüe peut optimiser la récupération fonctionnelle lors de l’hospitalisation aigüe et diminuer la survenue de PP suite à une LTME. Méthodes et résultats: Une étude de cohorte prospective de soixante et un patients et la revue d’une banque de données prospective de 301 patients avec une LTME aigüe admis dans un centre tertiaire de traumatologie spécialisé ont été complétées. Le pointage SCIM total moyen au congé des soins aigus était de 42.1 + 25.2 après une durée de séjour moyenne de 22.7 ±14.4 jours. Les analyses de régression linéaire multivariée hiérarchique ont démontré que lorsqu’ajustée pour la sévérité de la LTME, une durée de séjour plus longue en soins aigus était associée à des résultats fonctionnels plus faibles au congé de ceux-ci. Les analyses de régression logistique multivariées hiérarchiques ont démontré que lorsqu’ajustées pour le niveau et la sévérité de la LTME, la survenue d'une pneumonie (OR = 2.1, IC = 1.1 à 4.1) était significativement associée à la survenue de PP. Un délai d’admission plus long dans notre centre tertiaire de traumatologie spécialisé, la survenue de complications médicales (PP, pneumonie et infection urinaires) et un temps de thérapie (physiothérapie et ergothérapie) moyen inférieur étaient associés à un plus long séjour en soins aigus lorsqu’ajustés pour les possibles facteurs confondants non modifiables. Conclusions: Afin d’optimiser l’issue fonctionnelle au congé des soins aigus, l’équipe de réadaptation aigüe doit adresser les facteurs ayant un impact sur la durée de l’hospitalisation aigüe, notamment le transfert rapide des patients vers un centre spécialisé en LTME, la prévention des complications médicales (PP, pneumonie, infection urinaire) et l’optimisation du temps de thérapie, afin de diminuer la durée de séjour en soins aigus et ainsi d’optimiser l’évolution clinique du patient. Puisque les patients avec des LTME ayant des niveaux neurologiques plus hauts et plus sévères, ainsi que ceux développant une pneumonie sont à plus haut risque de développer une PP, nous croyons que ceux-ci devraient être priorisés afin de recevoir un volume de thérapie plus important et faire l’objet de protocoles de prévention plus agressifs. Enfin, le SCIM pourrait sous-estimer les gains fonctionnels rencontrés lors de l'hospitalisation aigüe, puisque les objectifs de cette phase visent plutôt de s’assurer que le patient dispose de bases solides (ex. : équilibre du tronc) lui permettant d’entreprendre une RFI efficace. / Introduction and objectives: Traumatic Spinal cord injuries (TSCI) have devastating consequences. To minimise the deficits incurred, patients undertake a rehabilitation process consisting of four phases: acute care hospitalization, intensive functional rehabilitation, community reintegration and maintenance of gains. The acute care hospitalization represents an important part of the clinical pathway as many important decisions about the subsequent rehabilitation plan are taken. It also represents a unique period to minimize medical complications and optimize functional recovery early in the rehabilitation process. Thus, the clinical evolution during the acute care shouldn’t be neglected as it has been shown to influence medium to long term outcome. In particular, pressure injuries (PI) prevention is essential as the acute hospitalization represents the period with the highest PI risk and its occurrence adversely affects long-term functional recovery.Yet, the impact of multiple factors on the occurrence of PI during acute care specifically as well as the goals that must be prioritized by the acute rehabilitation team to optimize the functional outcome at discharge from acute care remain imprecise. Thus, the main objective of this work is to identify how the acute rehabilitation team may optimize functional recovery during acute care and decrease the occurrence of PI following a TSCI. Methods and results: A prospective cohort study of sixty-one patients and the review of a prospective database of 301 patients with acute TSCI admitted to a SCI-specialized level-1 trauma center were completed. The mean total spinal cord independence measure (SCIM) score at discharge was 42.1 ±25.2 after a mean acute care length of stay (LOS) of 22.7 ±14.4 days. Hierarchical multivariate linear regression analyses showed that when controlled for the severity of the TSCI, longer LOS was significantly associated with poorer functional outcome at discharge from acute care. Hierarchical multivariate logistic regression analyses showed that when controlling for the level and severity of the TSCI, the occurrence of pneumonia (OR=2.1, CI= 1.1-4.1) was significantly associated with the occurrence of PI. Greater admission delay to our SCI-specialised level-1 trauma center, the occurrence of medical complications (PI, pneumonia and urinary tract infection) and lesser total daily therapy (physiotherapy and occupational therapy) resulted in significantly longer acute care LOS when controlled for possible non-modifiable cofounding factors. Conclusions: In order to optimize functional outcome at discharge from acute care, the rehabilitation team must address factors that influence acute care LOS, particularly early transfer to SCI-specialized trauma centers, medical complications prevention (PI, pneumonia, urinary tract infection) and the optimization of therapy time, in order to decrease acute care length of stay and thus optimize the patient’s clinical evolution. As patients with higher and more severe TSCI, as well as those developing a pneumonia during acute care are at higher risk of developing PI, we believe they should be prioritized to receive a larger volume of therapy and more aggressive prevention protocols. Finally, functional gains during the acute care hospitalisation may be underestimated by the SCIM, which do not measure interventions during acute rehabilitation that are aimed towards ensuring strong foundations (e.g. trunk balance) to undertake efficient IFR.

<div>Glutamate is the principal excitatory neurotransmitter in the central nervous system. As one of the most abundant neurotransmitters, glutamate plays an essential role in many processes of the central nervous system and beyond. As a result, any disruption that causes an abnormal glutamate level can significantly impact the central nervous system's neurological functions. Glutamate excitotoxicity is a neuropathology that persists in many neurodegenerative disorders such as Parkinson's and Alzheimer's disease as well as in the traumatic brain and spinal cord injuries. Thus, the ability to obtain precise information about the extracellular glutamate level in the living brain and spinal cord tissue may provide new insights into the fundamental understanding of glutamate in neurological disorders and neurophysiological phenomena.</div><div><br></div><div>Conventional bioanalytical techniques that characterize glutamate levels <i>in vivo</i> have a low spatiotemporal resolution that has impeded our understanding of this dynamic event. The electrochemical sensor has emerged as a promising solution that can satisfy the requirement for highly reliable and continuous monitoring methods with an excellent spatiotemporal resolution for the characterization of extracellular glutamate concentration. In this thesis, I present various amperometric biosensors fabricated using a simple direct ink writing technique for<i> ex vivo </i>and <i>in vivo</i> glutamate monitoring.</div><div><br></div><div>The amperometric biosensor is fabricated by immobilizing glutamate oxidase on nanocomposite electrodes made of platinum nanoparticles, multiwalled carbon nanotubes, and a conductive polymer. The biosensors demonstrate good sensitivity and selectivity that can be inserted into a spinal cord and measure extracellular glutamate concentration. Additionally, another type of glutamate biosensor is fabricated from commercially available activated carbon with platinum microparticles. We utilize astrocyte cell culture to demonstrate our biosensor's ability to monitor the glutamate uptake process. We also present a direct measurement of glutamate release from optogenetic stimulation in mouse primary visual cortex brain slides. </div><div><br></div><div>Moreover, we explore a new type of material, perovskite nickelate-Nafion heterostructure, to fabricate biosensors and measure glutamate inside the mouse brain. Finally, by utilizing the nanocomposite ink and direct ink writing technique, we also fabricate the gold-ruthenium non-enzymatic glucose biosensor. We apply a modified Butler-Volmer non-linear model to evaluate the impact of geometrical and chemical design parameters of non-enzymatic biosensor performance. </div><div><br></div>

No description available.

The development of therapies promoting recovery after spinal cord injury is a challenge. Alginate hydrogels offer the possibility to develop biocompatible implants with mechanical properties tailored to the nervous tissue, which could provide a permissive environment for tissue repair. Here, the effects of non-functionalized soft calcium alginate hydrogel were investigated in a rat model of thoracic spinal cord hemisection and compared to lesioned untreated controls. Open field locomotion tests were employed to evaluate functional recovery. Tissue analysis was performed with label-free multiphoton microscopy using a multimodal approach that combines coherent anti-Stokes Raman scattering to visualize axonal structures, two-photon fluorescence to visualize inflammation, second harmonic generation to visualize collagenous scarring. Treated animals recovered hindlimb function significantly better than controls. Multiphoton microscopy revealed that the implant influenced the injury-induced tissue response, leading to decreased inflammation, reduced scarring with different morphology and increased presence of axons. Demyelination of contralateral white matter near the lesion was prevented. Reduced chronic inflammation and increased amount of axons in the lesion correlated with improved hindlimb functions, being thus relevant for locomotion recovery. In conclusion, non-functionalized hydrogel improved functional outcome after spinal cord injury in rats. Furthermore, label-free multiphoton microscopy qualified as suitable technique for regeneration studies.

La santé sexuelle, promue par l’Organisation mondiale de la santé, revêt une importance fondamentale pour la santé physique et émotionnelle et le bien-être des personnes. Chez les femmes, la survenue d’une lésion médullaire (LME) peut, comme chez les hommes, altérer la fonction et l’activité sexuelles, et l’amélioration de leur sexualité peut avoir une influence positive sur leur qualité de vie. Très peu de données sont actuellement disponibles concernant la sexualité des femmes lésées médullaires (LM) en France et les modalités de prise en charge des troubles associés. L’objectif de cette thèse est de décrire l’expérience de ces femmes en matière de sexualité et la diversité des modalités de prise en charge potentielles des troubles associés.Ce travail, qui repose sur une approche de santé publique interdisciplinaire, biomédicale, psychosociale et épidémiologique, qualitative et quantitative, comprend trois parties.Une revue systématique et qualitative de la littérature a permis d'identifier les recommandations, les conseils d'experts, ou les données d'études destinées à l'éducation sexuelle des femmes LM.La bonne gestion des complications de la lésion, un abord prudent, multidisciplinaire, l’implication des pairs, l’accompagnement dans la durée apparaissent au premier plan des enseignements de cette littérature.Une étude réalisée à partir des données recueillies au sein d’une nouvelle consultation de gynécologie, dédiée à la prise en charge de femmes en situation de handicap, a montré que des femmes LM insérées dans un réseau de soins multidisciplinaire et spécialisé n’avaient que rarement bénéficié des soins gynécologiques et des mesures de préventions nécessaires, y compris en lien avec une activité sexuelle majoritairement préservée. Ce type de consultation pourrait constituer une opportunité pour aborder leur vie sexuelle et identifier leurs besoins éventuels dans ce domaine.Une enquête qualitative menée auprès de 20 participantes a montré que la survenue d’une LME constituait une rupture biographique importante au delà de la lésion elle-même. Ces femmes peuvent avoir des réactions très différentes en fonction de leur histoire et de leur situations personnelles et ont ainsi une expérience bouleversée de leur sexualité.Ces travaux éclairent ainsi les besoins en termes de prise en charge de la sexualité chez les femmes blessées médullaires, et proposent des orientations pour les modalités de prises en charge futures. / Sexual health, as advocated by the World Health Organization, is key to physical, emotional health and well-being.As well as in men, the occurrence of a spinal cord lesion (SCL) in women may negatively impact their sexual function and sexual activity. Improving their sexual function and sexual activity would improve their quality of life. However, very little data is currently available on the sexuality of spinal cord injured women in France. The aim of this thesis was to describe these women’s experiences with sexuality and the diversity of potential management modalities for associated disorders.Based on an interdisciplinary public health approach this work associated biomedical, psychosocial and epidemiological, qualitative and quantitative perspectives. It included three steps.A systematic and qualitative review of the literature identified recommendations, expert advices, or research data for sex educating women with SCL; in order to identify practical strategies for setting up such support. Well-managed complications of the lesion, a careful, multidisciplinary approach, peer support and long-term follow-up are at the top of this literature's teaching priorities.Data collected from a newly equipped outpatient gynecological clinic specifically for women with disabilities were analyzed. They showed that despite a frequently preserved sexual activity, women with SCL had hardly received any gynecological and specific preventive care despite a persistent sexual activity. Moreover, this was also true in those who were in a multidisciplinary and specialized care network. However, this type of consultation could be an opportunity to address their sexuality and identify their potential needs in this area.A qualitative study conducted with 20 participants showed that the occurrence of a SCL represented a significant biographical disruption beyond the lesion itself. These women may have very different reactions depending on their history and personal circumstances and thus have a life-changing experience of their sexuality.This work sheds some light on the needs in terms of sexual care for women with SCL, and suggests guidelines for future care modalities.

Indiana University-Purdue University Indianapolis (IUPUI) / After spinal cord injury (SCI), poor axonal regeneration of the central nervous system, which mainly attributed to glial scar and low intrinsic regenerating capacity of severely injured neurons, causes limited functional recovery. Combinatory strategy has been applied to target multiple mechanisms. Schwann cells (SCs) have been explored as promising donors for transplantation to promote axonal regeneration. Among the central neurons, descending propriospinal neurons (DPSN) displayed the impressive regeneration response to SCs graft. Glial cell line-derived neurotrophic factor (GDNF), which receptor is widely expressed in nervous system, possesses the ability to promote neuronal survival, axonal regeneration/sprouting, remyelination, synaptic formation and modulate the glial response. We constructed a novel axonal permissive pathway in rat model of thoracic complete transection injury by grafting SCs over-expressing GDNF (SCs-GDNF) both inside and caudal to the lesion gap. Behavior evaluation and histological analyses have been applied to this study. Our results indicated that tremendous DPSN axons as well as brain stem axons regenerated across the lesion gap back to the caudal spinal cord. In addition to direct promotion on axonal regeneration, GDNF also significantly improved the astroglial environment around the lesion. These regenerations caused motor functional recovery. The dendritic plasticity of axotomized DPSN also contributed to the functional recovery. We applied a G-mutated rabies virus (G-Rabies) co-expressing green fluorescence protein (GFP) to reveal Golgi-like dendritic morphology of DPSNs and its response to axotomy injury and GDNF treatment. We also investigated the neurotransmitters phenotype of FluoroGold (FG) labeled DPSNs. Our results indicated that over 90 percent of FG-labeled DPSNs were glutamatergic neurons. DPSNs in sham animals had a predominantly dorsal-ventral distribution of dendrites. Transection injury resulted in alterations in the dendritic distribution, with dorsal-ventral retraction and lateral-medial extension of dendrites. Treatment with GDNF significantly increased the terminal dendritic length of DPSNs. The density of spine-like structures was increased after injury and treatment with GDNF enhanced this effect.

Une lésion médullaire traumatique (LMT) a des conséquences neurologiques importantes, dont l’altération de la capacité à marcher. Prédire précocement cette capacité suite au traumatisme a inspiré le développement de multiples règles de prédiction. Simples et précises, elles prédisent la marche intérieure sur de courtes distances, sans considérer la qualité de la marche. L’utilité et la valeur ajoutée de ces règles n’ont jamais été évaluées comparativement au jugement non structuré des cliniciens à qui elles sont dédiées. L’objectif était d’identifier des éléments de l’évaluation aiguë standardisée ISNCSCI (International Standards for Neurological Classification of Spinal Cord Injury) permettant de développer une règle de prédiction clinique pour la marche communautaire extérieure indépendante un an après une LMT, tout en assurant une bonne validité externe et une utilité clinique lorsque comparée au jugement des cliniciens. La force segmentaire du membre inférieur le plus fort et la préservation de la sensibilité au toucher léger sont de meilleurs prédicteurs d’une marche indépendante. Une règle de prédiction clinique a également pu être développée : elle est pertinente; généralisable; simple; tient compte de la qualité de la marche; et est axée sur la vie communautaire, la participation sociale et la qualité de vie. La performance d’une règle de prédiction de la marche intérieure est statistiquement similaire à celle de cliniciens utilisant leur jugement non structuré, mais peut varier. Cette recherche recommande l’utilisation de règles de prédiction clinique comme aide à la décision chez les patients après une LMT, dont celle développée pour la marche communautaire indépendante. / Traumatic spinal cord injury (TSCI) has important neurological consequences including impaired walking ability. Predicting early the ability to walk again after the trauma has inspired the development of multiple clinical prediction rules. Simple and accurate, they do predict walking on short indoor distances but do not consider the quality of walking. Moreover, the usefulness and added value of these rules have never been evaluated and compared to the unstructured clinical judgment of the physicians for whom they are intended. The objective of this thesis was to identify elements of the acute INSCSCI (International Standards for Neurological Classification of Spinal Cord Injury) standardized evaluation that would allow the development of a clinical prediction rule for outdoor independent community walking one year after a TSCI, ensuring good internal and external validity as well as clinical usefulness when compared to clinical judgment. The strength of the strongest lower limb and preserved light touch sensation are the best predictors of independent walking. A clinical prediction rule was developed to meet the objective: this rule is relevant; generalizable; simple; takes into consideration the quality of walking; and is focused on community living, social participation and quality of life. The performance of a clinical prediction rule for indoor walking is statistically similar to that of clinicians using their unstructured judgment, but can vary depending on different factors. This research recommends the use of clinical prediction rules as a decision aid in patients who have undergone a TSCI, including the one developed for independent functional community walking.

No description available.