Spinal cord injury (SCI) causes a lesion-dependent impairment in cardiorespiratory function that may limit exercise capacity. The aims of this thesis were to describe cardiorespiratory function in highly-trained athletes with low-cervical SCI, and to investigate whether abdominal binding enhances cardiorespiratory function at rest and during exercise in this population. Using body plethysmography, bilateral phrenic nerve stimulation and transthoracic ultrasound, it was demonstrated that Paralympic athletes with cervical SCI exhibit a restrictive pulmonary defect, impaired diaphragm and expiratory muscle function, and low left ventricular mass and ejection fraction compared to able-bodied controls. Using the same methods, it was shown that abdominal binding improves resting cardiorespiratory function by reducing operating lung volumes, and increasing vital capacity, twitch transdiaphragmatic pressure, expiratory muscle strength and cardiac output. A further finding was a positive relationship between binder tightness and cardiorespiratory function. During a field-based assessment of fitness, abdominal binding reduced the time taken to complete an acceleration/deceleration test and increased the distance covered during a repeated maximal 4-min push test. During laboratory-based incremental wheelchair propulsion, abdominal binding altered breathing mechanics by reducing operating lung volumes and attenuating the rise in the pressure-time index of the diaphragm. Furthermore, abdominal binding increased peak oxygen uptake and reduced peak blood lactate concentration, despite no change in peak work rate. Peak oxygen uptake in the laboratory was related to the distance covered during the maximal 4-min push, suggesting that the improvement in field-based performance with binding was due to an improvement in aerobic capacity. In conclusion, this thesis demonstrates that abdominal binding significantly enhances cardiorespiratory function at rest, improves exercise performance in the field, and improves operating lung volumes, breathing mechanics and peak oxygen uptake during incremental treadmill exercise. Thus, abdominal binding provides a simple, easy-to-use tool that can be used to enhance cardiorespiratory function at rest and during exercise in highly-trained athletes with cervical SCI.

Orientador: Alberto Cliquet Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T19:04:20Z (GMT). No. of bitstreams: 1 Cacho_EnioWalkerAzevedo_D.pdf: 1807435 bytes, checksum: 38ebb707d0aa2cd9d8808391db1f768e (MD5) Previous issue date: 2010 / Resumo: Vários são os instrumentos de avaliação dedicados aos tetraplégicos. A compreensão de suas relações é de fundamental importância para o desenvolvimento e elaboração de abordagens terapêuticas voltadas à reabilitação da extremidade superior desses indivíduos. Assim, o objetivo deste estudo foi analisar as correlações entre as avaliações clínicas, funcionais e cinemáticas da extremidade superior durante os movimentos de alcance-preensão em tetraplégicos. Vinte tetraplégicos crônicos e vinte participantes controles foram selecionados para o estudo. Os instrumentos utilizados para a avaliação foram: o padrão de classificação da Associação Americana de Lesão Medular - ASIA, a Medida de Independência Funcional - MIF, a Mensuração de Independência da Medula espinhal - SCIM II, e a avaliação cinemática do movimento de alcance-preensão. Foram utilizadas as seguintes variáveis cinemáticas: deslocamento anterior do tronco e protração do ombro, amplitude articular do ombro, cotovelo e punho nos planos sagital e horizontal, índice de curvatura, pico de velocidade máxima, razão do pico de velocidade máxima, tempo de movimento e número de picos. O deslocamento anterior do tronco, protração do ombro e as amplitudes articulares do ombro e cotovelo não apresentaram diferenças significativas entre os tetraplégicos e os controles. Apenas a amplitude de flexoextensão do punho foi significativamente maior em tetraplégicos. Os movimentos dos tetraplégicos foram mais lentos, segmentados e menos harmoniosos, quando comparados com os controles. Foi encontrada uma correlação positiva entre o índice motor total e a MIF (r = 0.6089; p = 0.0044) e SCIM II (r = 0.5229; p = 0.018). As avaliações funcionais apresentaram correlação positiva entre si (r = 0.8283; p < 0.0001). Foi encontrada também correlação entre o índice motor direito e esquerdo, a MIF motora e o SCIM II, com várias variáveis cinemáticas estudadas (pico de velocidade máxima, tempo de movimento, índice de curvatura, número de picos e razão do pico de velocidade máxima de velocidade). Dentre as amplitudes articulares de movimento (ombro, cotovelo e punho), apenas a amplitude do punho demonstrou correlação com a variável clínica. Este estudo demonstra que a força muscular avaliada pelo índice motor da ASIA se correlaciona moderadamente com as variáveis cinemáticas relacionadas à harmonia de trajetória dos movimentos de alcance-preensão em tetraplégicos. Já as avaliações funcionais apresentaram forte correlação entre si e moderada correlação com o índice motor direito, esquerdo e total, mas não apresentaram uma correlação constante com as variáveis cinemáticas avaliadas à direita e à esquerda. / Abstract: Several assessment tools are dedicated to understanding tetraplegics. The understanding of their relationships has a fundamental importance for the development and elaboration of therapeutic approaches aiming rehabilitation of the upper extremity of these individuals. The objective of this study is to analyze the correlations between clinical, functional and kinematics assessments of upper extremity during reaching-grasping movements in tetraplegics. Twenty chronic tetraplegic patients and 20 control participants were selected for this study. The instruments used for evaluation were the standard classification of the American Association of Spinal Cord Injury - ASIA, the Functional Independence Measure - FIM, the Spinal Cord of Independence Measurement - SCIM II and the kinematics evaluation of the reach-grasp movement. The following kinematic variables were used: anterior displacement of the trunk and protraction of the shoulder, joint range of motion of shoulder, elbow and wrist in sagittal and horizontal planes, curvature index, peak speed, ratio of peak speed, movement time and peak number. The anterior displacement of the trunk, shoulder protraction and range of motion of shoulder and elbow showed no significant differences between groups of tetraplegic patients and controls. Only the flexion-extension amplitude of the wrist was significantly greater in tetraplegics. The movements in quadriplegic patients were slower, targeted and less harmonious when compared with controls. There was a positive correlation between the total motor index and functional FIM (r = 0.6089; p = 0.0044) and SCIM II (r = 0.5229; p = 0.018). Both functional scores showed positive correlation within each other (r = 0.8283; p < 0.0001). There was also correlation between the right and left motor indices, the motor FIM and the SCIM with most of the kinematics studied (peak of velocity, movement time, index of curvature, number of peaks and peak velocity ratio of the maximum velocity). On the other hand, for the joint range of motion (shoulder, elbow and wrist), only the wrist in the horizontal plane demonstrated correlation with clinical variables. This study demonstrates that muscle strength assessed by the ASIA motor index correlates moderately with the kinematic variables related to the harmony and the trajectory of the reaching-grasping movement in tetraplegics. Yet, functional assessments showed strong correlation among themselves, and moderate correlation with right, left and total motor index, but did not show a constant correlation with kinematic variables measured on the right and left. / Doutorado / Pesquisa Experimental / Doutor em Cirurgia

A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI. The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI. In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity &gt;30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids. In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity &gt;30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).

Upper limb function is important for individuals with tetraplegia because upper limb function supports global function for these individuals. As a result, a great deal of time and effort has been devoted to the restoration of upper limb function. Appropriate outcome measures that can be used to characterize the neurological status of the upper limb have been one of the current barriers in substantiating the efficacy of interventions. Techniques and protocols to evaluate changes in upper limb neurological status have not been applied to the SCI population adequately. The objectives of this thesis were to develop a measure; which is called the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP). Development of the scoring approach, testing for reliability and construct validity, and determining impairment and function relationships specific to the upper limb neurological were established. The GRASSP is a clinical measure of upper limb impairment which incorporates the construct of “sensorimotor upper limb function”; comprised of three domains which include five subtests. The GRASSP was designed to capture information on upper limb neurological impairment for individuals with tetraplegia. The GRASSP defines neurological status with numerical values, which represent the deficits in a predictive pattern, is reliable and valid as an assessment technique, and the scores can be used to determine relationships between impairment and functional capability of the upper limb. The GRASSP is recommended for use in the very early acute phases after injury to approximately one year post injury. Use of the GRASSP is recommended when a change in neurological status is being assessed.

Upper limb function is important for individuals with tetraplegia because upper limb function supports global function for these individuals. As a result, a great deal of time and effort has been devoted to the restoration of upper limb function. Appropriate outcome measures that can be used to characterize the neurological status of the upper limb have been one of the current barriers in substantiating the efficacy of interventions. Techniques and protocols to evaluate changes in upper limb neurological status have not been applied to the SCI population adequately. The objectives of this thesis were to develop a measure; which is called the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP). Development of the scoring approach, testing for reliability and construct validity, and determining impairment and function relationships specific to the upper limb neurological were established. The GRASSP is a clinical measure of upper limb impairment which incorporates the construct of “sensorimotor upper limb function”; comprised of three domains which include five subtests. The GRASSP was designed to capture information on upper limb neurological impairment for individuals with tetraplegia. The GRASSP defines neurological status with numerical values, which represent the deficits in a predictive pattern, is reliable and valid as an assessment technique, and the scores can be used to determine relationships between impairment and functional capability of the upper limb. The GRASSP is recommended for use in the very early acute phases after injury to approximately one year post injury. Use of the GRASSP is recommended when a change in neurological status is being assessed.

Uppskattningsvis 2000 personer lever med diagnosen tetraplegia i Sverige idag. Orsaken till skadan är trauma mot halskotpelaren som resulterar i total förlamning i bålen och de nedre extremiteterna. Ju högre upp skadan är placerad, desto större blir även förlamningen i de övre extremiteterna. Det traditionella sättet, att driva en manuell rullstol framåt med hjälp av drivringen, är med dessa funktionsbortfall, inte optimalt för att ta sig framåt eller över hinder. Ett prototyphjälpmedel, som förändrar rörelsemönstret till att större delen av kraften riktas i tangentiell riktigning framåt, med hjälp av de starkaste kvarvarande musklerna, utvecklades i projektet. Projektet har tillämpat dynamisk produktutveckling, med användarna i fokus, för att få fram en prototyp som uppfyller användarnas krav och som framförallt är användarvänlig. Detta har gjorts genom insamling av data under bland annat studiebesök, marknadsundersökningar och användarträffar. Prototypframtagningen skedde genom kontakt med näringslivet. Resultaten som kom fram vid användartesterna visade att prototypen kunde hjälpa till att öka maxkraften, för en av de två testpersonerna, som krävdes för att ta sig upp över en tröskel. Prototypen gav dock en upplevd försämring av manövreringsförmågan, då inte alla prototypens komponenter fungerad optimalt. Det krävs ytterligare tester och utvecklingsarbete innan produkten kan fungera i större utsträckning och för en större målgrupp. / An estimated 2000 people are today living in Sweden with a diagnosis of tetraplegi. The cause of the injury is trauma towards the cervical spine resulting in paralysis of the trunk as well as the lower limbs. The higher the positioning (i.e. the lower numbering of the vertebrae) of the cervical vertebrae damaged by the trauma, the more functions are lost in the upper extremities. When this happens, the traditional way of wheelchair propulsion with the push rim becomes less convenient. During the project, a prototype aid was developed. With the help of the aid, the users are able to change their pattern of movement when using the wheelchair. The new pattern allows the tetraplegi users to use their power in a tangential direction to the wheel. In addition they will be using mainly their strongest muscles in their arms, optimising their ability to move forward. In the project, dynamic product development was applied, focusing on the users in order to develop a user-friendly prototype which meets their requirements. To achieve this goal the project group collected data from people working with the rehabilitation of tetraplegics as well as people involved in the supply and distribution of rehabilitation aids. This benchmarking as well as meetings with intended users was helpful when gathering information. The prototype was developed with in close cooperation with various companies. User tests showed that the prototype could help increase maximum propulsive force required to climb over a threshold, for one of the two test persons. The prototype gave, however, a decrease in experienced maneuverability, as all of the components of the prototype were not working optimally. Further tests and development are needed before the product can operate for an extended use and for a wider target group.

The theme of thesis is to define the living costs of person with the spinal cord injury in the cervical spine - tetraplegics. Tetraplegics are specific group of people with injury. Partial goal is to find out, whether state contributes and compensates health handicap of citizens enough. Thesis describes spends needed on one side and possibilities of state contributions on the other side. First part of theoretical part clarifies handicap of spinal cord injury and associated complications. It describes necessary compensational and medical equipment including process of its aquirement. Second part of theoretical part is based on Czech legislation and analyzes savings, advantages and contributions provided by social system of Czech Republic for disabled people. Practical part evaluates survey as a background for final conclusion of economic situation of tetraplegics. Key words tetraplegia, healthcare system, Czech Republic

Orientador: Alberto Cliquet Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T11:25:08Z (GMT). No. of bitstreams: 1 Medina_GiovannaIgnacioSubira_M.pdf: 4494302 bytes, checksum: 6f25ed31ea0d7dac8ce1a714d5be6094 (MD5) Previous issue date: 2011 / Resumo: A lesão da medula espinhal é uma afecção incapacitante e que é acompanhada de inúmeras complicações diretas e indiretas. No Brasil, ocorrem cerca de 6 a 8 mil novos casos por ano de LME e, desde o momento do trauma, os pacientes lesados medulares necessitam de cuidados direcionados que devem persistir mesmo após passados anos da lesão. A dor no ombro é o processo doloroso mais comum entre os pacientes com lesão medular que se queixam de dor nos membros superiores perfazendo 71% do total. Este é um estudo clínico e radiográfico que avaliou o ombro de pacientes tetraplégicos e paraplégicos que estavam em programa de reabilitação no Laboratório de Biomecânica e Reabilitação do Aparelho locomotor do Hospital das Clínicas da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP). Os objetivos foram estabelecer a utilidade da radiografia como exame de triagem para dor no ombro de pacientes lesados medulares. Trinta e dois ombros de 16 pacientes foram avaliados clinica e radiograficamente. Os pacientes foram divididos em 2 grupos: paraplégicos e tetraplégicos. Um grupo controle de 16 indivíduos normais, voluntários, foi selecionado. Dor no ombro foi encontrada em 89% dos tetraplégicos e em 43% dos paraplégicos. O tempo desde a lesão variou de 1.5-22 anos (média 7.88 anos); a média de idade dos pacientes foi de 35 anos (variou de 21-57 anos). A medida da articulação acromioclavicular variou de 0.03-0.7cm para o lado direito e 0.15-0.7cm para o lado esquerdo, com média de 0.37cm e 0.41cm respectivamente. Não foi encontrada correlação alguma entre dor no ombro e sexo, idade ou tempo da lesão. Houve uma tendência a correlação entre dor no ombro e tipo de lesão, com tendência dos tetraplégicos em apresentar sintomas dolorosos. Na média, os tetraplégicos apresentaram menores medidas da articulação acromioclavicular. Com os dados deste estudo, não houve confirmação da hipótese de que achados radiográficos pudessem indicar risco de desenvolver dor no ombro em pacientes lesados medulares / Abstract: Spinal Cord injury is a very disabling condition that has many direct and indirect complications. In Brazil, there are around 6 to 8 thousand new cases each year and the patients need specific care from the moment of the lesion even through years after the SCI. Shoulder pain is the most common painful process among SCI patients that complaint of pain in the upper extremities, representing 71% of the total. This was a clinical and radiographic study which evaluated the shoulders of tetraplegic and paraplegic patients who attend the rehabilitation program of the Biomechanics and Locomotor-System Rehabilitation Laboratory of the University Hospital of the Faculty of Medical Sciences of the State University of Campinas (UNICAMP). The objective was to establish the usefulness of radiography as a screening exam for shoulder pain in spinal cord injured patients. Thirty two shoulders of sixteen patients were evaluated by clinical exam and radiography. Patients were divided into two groups: paraplegic and tetraplegic. A control group of 16 normal volunteer subjects was selected. Shoulder pain was reported in 89% of tetraplegic and 43% of paraplegic. The time of injury ranged from 1.5 - 22 years (mean 7.88 years); patients had a mean age of 35 years (range, 21-57 years). The acromioclavicular joint space ranged from 0.03-0.7cm on the right side and 0.15-0.7cm on the left side, with a mean of 0.37 and 0.41cm respectively. No correlation was found between shoulder pain and gender, age or time since injury. There was a trend to correlation between shoulder pain and type of injury with tetraplegic having a tendency to pain symptoms. On average, tetraplegic had smaller acromioclavicular joint. With this study we were not able to confirm the hypothesis that radiography could be used to predict risk factor for developing shoulder pain among SCI patients / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Spinal Cord Injury (SCI) is a physically debilitative impairment with a poor prognosis that disrupts the connection between the brain and body. Reduced somatic and autonomic nervous system control over motor and sensory function of muscles and organs causes paralysis and dysregulation of physiological systems. Complications, such as deep vein thromboses, urinary tract infections, and chronic pain, often cause high, life-long economic burdens. Seniors with SCI also have an increased risk of developing cognitive decline. Development of Major Neurocognitive Disorder (Dementia) is characterized by a reduced ability to perform daily activities. In addition to the physical impairments due to SCI, older adults would experience further decreased quality of life. There are various postulations about what contributes to an increased risk of cognitive decline in SCI patients, although the specific mechanism is uncertain. This research project is focused on examining whether blood pressure dysregulation may play a key role in inducing cognitive decline in older adults with SCI. To fulfill this goal, published reviews and clinical and laboratory data from 1997 to 2023 have been analytically reviewed following the presentation of background physiological and pathophysiological information. The outcomes demonstrated that SCI above T6 leads to an increased risk of blood pressure dysregulation and other conditions associated with an increased risk of cognitive decline, including orthostatic hypotension, vascular dementia, and deficient dynamic cerebral autoregulation. Overall, the findings suggest that blood pressure dysregulation that causes cerebral hypoperfusion may be a major contributor to cognitive decline in older adults with SCI.

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