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O52 Perceptual threshold to cutaneous electrical stimulation in patients with spinal cord injury Author(s): Savic G1, Bergström EMK1, Frankel HL1, Jamous MA1, Davey NJ2 Name of ISCoS Member (Author): Savic G1, Bergström EMK1, Frankel HL1, Jamous MA1 Main institution where the work was done:1National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK, 2Imperial College Faculty of Medicine, London, UK Aim: To establish if perceptual threshold (PT) to cutaneous electrical stimulation could be a useful quantitative sensory test in patients with spinal cord injury (SCI). Material and methods: PT testingref was performed at ASIA sensory key points bilaterally in 30 patients with SCI (60 tests). The level of SCI according to PT results was established for right and left side in each patient as the last segment in which the patients' PT was within the control group PT range (mean +/- 2SD). PT levels were then compared with clinical sensory levels derived according to ASIA standards. Results: PT and clinical levels agreed in 20 of the 60 tests. In 32 cases the PT level was higher than the clinical level (in 21 cases by one segment only, in five by two segments and in six by tree or more segments). In eight cases it was lower (in two cases by one segment, in two by two segments and in four by three or more segments). Conclusions: PT could be useful for assessing the level of SCI. It may be more sensitive than clinical testing for detecting minor sensory impairments, since the PT level was higher in majority of cases. Reference: Savic G, Bergström EMK, Frankel HL, Jamous MA, Davey NJ. Perceptual threshold to cutaneous electrical stimulation. IMSOP&ASIA 1st Joint Meeting Abstract Compendium. Vancouver, Canada, May 2002; p43. Acknowledgement: Supported by the International Spinal Research Trust UK. O53 Advantages of Phrenic Nerve Stimulation Treatment for patients with high-levelled tetraplagia Author(s): Exner, G. Hirschfeld, S. Wenck, B. Name of ISCoS Member (Author): Dr. med. Gerhard Exner Main institution where the work was done: SCIC, Berufsgenossenschaftliches Unfallkrankenhaus Hamburg, Germany Exposition: Phrenical Nerve Stimulation (PNS) and Mechanical Ventilation (MV) are both artifical ventilation systems for patients with lifelong necessity to be ventilated. The goal of this investigation was to comparize whether one of these methods would have more advantages concerning health and patients comfort. Method: Two samples (n = 18 each group) of patients treated with PNS or MV were checked. Concerning gender, level of lesion (C0 – C3) and other statistical items both groups were quite comparable. Statistical investigations were done including terms of significance.Results:Survival time was in the average 6 years in both groups, maximum 11 (PNS) and 18 (MV), minimum 2,9 (PNS) and 2,3 (MV).Ability to speak with a loud voice was in 66,6% the highest advantage of the PNS-Sample, up to 94% could use their voice otherwise. In the MV-patients we found loud voice pronunciation in 38%, 28% were able to whisper and about 11% had no voice activity.Pulmonary infection rate was significantly different. In PNS-patients we found at the start of the treatment and before implantation a rate of 3,16/100 days. At the end of the treatment and after implantation this rate was 0,64 and after discharge 0,05. In MV-patients we found at the same points of checking 2,52/100 days, 2,27 respectively 0,197. We think this depends on the more physiological and like natural ventilation functioning PNS-method (permanent negative pressure ventilation).Concerning comfort and satisfaction 83,3% of our PNS-patients did not want to change the system, otherwise 55,5% of the MV-population wanted to do so. Conclusions: Up to now we were not able to prefer the PNS-method by proven causes. Now we can say that this method give better results concerning ability to speak, in pulmonary infection rate and quality of life. So we recommend it for all patients with a lesion above C3 with intact motoneuron and the lack of contra-indication as given in the literature. Literatur: Baer,G., Exner, G. (eds) Functional Electrical Stimulation in paralyzed respiratory muscles. Electronic publication http://tampub.uta.fi O54 RELIABILITY AND VALIDITY OF DANISH TETRAPLEGIA HAND FUNCTION TEST IN A FOUR COUNTRY MULTICENTER STUDY Author(s): Gregersen H, Hagen E, Ingemarsson A, Koerhuis E, Leiulfsrud A, Lybæk M, Biering-Sørensen F, Clinic for Para- and Tetraplegia, The NeuroScience Center, Copenhagen University Hospital, Hornbaek, Denmark. Name of ISCoS Member (Author): Biering-Sørensen, Fin Main institution where the work was done: Clinic for Para- and Tetraplegia, The NeuroScience Center, Copenhagen University Hospital, Hornbaek, Denmark. Methodology: The intra-rater reliability was assessed in 7 occupational therapists from Denmark. In the inter-rater reliability study 26 occupational therapists from Denmark, Sweden, The Netherlands and Norway have individually tested 5 videorecorded patients. The patients had all complete tetraplegic lesions C4 – C6. The participating centers received the same testing material including detailed instructions of how to perform the testing. The intra-rater reliability evaluation study is still ongoing. Results: In the intra-rater reliability study 85 % had identical scores. In the inter-rater reliability study 26 therapists have performed 2600 scores on 5 patients. 20 scores on each patient per therapist. In average 90 % of the scores were identical. Some of the tasks have a higher reliability than others, ranging from 85 % to 94 % identical scores in the different tasks. Validity is evaluated with correlation to the ASIA upper extremity motor score and the FIM motor score. Conclusion: The hand function test is easy to perform and gives a good impression of the manual ability of the tetraplegic hand . O55 Prospective Validity and Responsiveness to Change of the Walking Scale for Spinal Cord Injury (WISCI) in a Randomized Clinical Trial Author(s): Ditunno JF, Jr., Dobkin BH, and Spinal Cord Injury Locomotor Trial (SCILT) Study Group. Name of ISCoS Member (Author): Ditunno JF, Jr Main institution where the work was done: Thomas Jefferson University/Magee Hospital Spinal Cord Injury Center, Philadelphia PA, USA Objective: To demonstrate the prospective criterion concurrent validity and responsiveness to change in motor strength of the WISCI scale in a Clinical Trial of Body Weight Support Training (BWST). Design: Prospective multicenter, randomized clinical trial (RCT) of a task-oriented walking intervention for subjects with an acute traumatic spinal cord injury (SCI).Method: BWST was compared to a conventional arm with randomization of 146 subjects, with incomplete SCI from below C-4 to T-10 and at T-11 to L-3 entered within 8 weeks of a SCI and treated for 12 weeks. Primary outcome measures (OM); Functional Independence Measure (FIM) and for those who walked, maximal speed for walking 50 feet and 6-minute walk, tested 6 and 12 months. Secondary OM were Lower Extremity Motor Scores (LEMS), WISCI level, Berg Balance Scale(BBS). LEMS (0-50), WISCI (0-20), FIM walking score(1-7)and BBS (max 56), performed at each of 5 centers by observers blinded to the intervention. Correlation of primary and secondary OM were performed. Results: In 113 subjects over a 6 month period the WISCI levels changed from 1.2 to 12, LEMS 22 to 33, FIM 1.4 to 4.8, BBS 6 to 32, Both the intervention and control arms of the study showed similar results. Conclusion: The WISCI scale demonstrated a similar response to change in both the treatment and control arms of the study and correlated with change in LEMS, FIM walking levels and BBS. These findings establish the prospective validity of this walking measure for multicenter clinical trials. O56 Psychometric Analysis of a Clinically Focussed Measure of Outcome: The Needs Assessment Checklist (NAC) Author(s): Kennedy P and Berry C Name of ISCoS Member (Author): Kennedy P Main institution where the work was done: Stoke Mandeville Hospital Objective: To evaluate the psychometric reliability and validity of a clinically focused measure of rehabilitation outcome, known as the Needs Assessment Checklist (NAC). Participants: 43 Spinal cord injured (SCI) in-patients (38 male and 5 female). Intervention: Test-retest and concurrent assessment, conducted in one administration, within a week of routine clinical assessment. Reliability analyses were performed examining the NAC’s internal consistency, test-retest reliability, and concurrent validity. Main Outcome Measures: The Needs Assessment Checklist is a rehabilitation outcome measure, specifically developed for the SCI population, that is used to assess patient attainment in core rehabilitation areas at mobilisation and prior to discharge. The Spinal Cord Independence Measure (SCIM) and Hospital Anxiety and Depression Scale (HADS) were also employed as comparable benchmark assessment measures with established psychometric properties Results: Reliability analyses yielded high internal consistency coefficients (mean alpha = .8587, SD = .918). All subscales performed above the specified level (.7). The Mean item-internal validity correlation for NAC subscales was .5921 (SD = 0.1411). Test-retest correlations ranged between .694 (Bladder Management) and .904 (Skin Management) (p = < .01). The mean percentage of agreement between clinical and test-retest assessment over all NAC Subscales was 75.5% (SD = 5.01%). Concurrent validity analyses correlating individual subscale scores with SCIM and HADS subscales produced high correlations between .850 (ADL with SCIM Self Care, p = < .01) and -.466 (Psychological Issues with HADS – Depression, p = < .01). Conclusion: The findings of this study provide support to the development of the NAC as a psychometrically reliable and valid clinical measure of rehabilitation outcome. O57 A Longitudinal Analysis of Psychological Impact , Coping Strategies and Post Traumatic Psychological growth following SCI: The First Ten Years Author(s): Pollard C and Kennedy P Name of ISCoS Member (Author): Paul Kenendy Main institution where the work was done: Stoke Mandeville Hospital Objective: To review psychological impact, growth and coping strategies in a sample of traumatic spinal cord injured people from 12 weeks post injury to 10 years post discharge. Design: Longitudinal multiple wave panel design. Setting: Hospital and community based longitudinal sample. Participants: 87 people with traumatically acquired Spinal Cord Injuries were assessed 12 weeks post injury and followed up 10 years later, (43% of the original sample). Measures: The Beck Depression Inventory, the state Anxiety Inventory, the COPE scale, the Posttraumatic Growth Inventory and the FIM. Results: Rates of Anxiety and depression changed little over the ten year period, two thirds of the sample showed no signs or symptoms of depression. Coping strategies remained relatively stable over time, statistically significant regression models (coping strategies at week 12) predicted one third of the variance in depression at year ten. Rates of posttraumatic psychological growth were associated with higher levels of distress. Conclusions: These results suggest that many people living with severe acquired disabilities rise to the challenge without significant levels of psychopathology however the coping strategies they employ remain critical. The relationship between posttraumatic growth and well-being is complex and requires further exploration. O58 Neuropsychological complications in and treatment of patients with a severe degree of tetraplegia – outcome measures Author(s): Strubreither,W.; Jonas,H.P.; Herrmann-Gruber,M.; Hackbusch-Traxler,B.; Schaffer-Werlberger,B. Name of ISCoS Member (Author): Strubreither,W., Jonas,H.P. Main institution where the work was done: Rehabilitation Centre Haering of ther Austrian Worker´s Compensation Board Aim: One particular problem encountered in the treatment of patients with a severe degree of tetraplegia is the incidence of cerebral disorders, which consequently lead to psychotic organic disorders and then, on a psychological level, may lead to an Organic Psychic Syndrome (OPS). Psychotic organic disorders related to severe degrees of tetraplegia may be due to diminished innervation of of the respiratory muscles, hypoxia, higher lesions, intensive care complications, long term mechanical ventilatory support, phrenic paralysis, etc. and therefore must be considered as a possible complication of a severe degree of tetraplegia. Method: From 1999-2003 patients with tetraplegia / tetraparesis in RC-Haering were reviewed in the initial stages of treatment. Post traumatic stress disorder in the form of an organic psychosis was recorded by 12,1% of these patients. After recovering from organic psychosis, 59,7% of these patients developed psychological disturbances in areas of performance and personality, that is to say an OPS. In addition, a special neuropsychological training programme with different methods was put through. Results: With intensive training/therapy organic psychic syndrome is reversible both in a qualitative and a quantitative way. Following therapy 50% of the patients showed no signs of OPS. Patients with a severe or extremely severe degree improved towards a minor or moderate degree. But: 4% of the patients notwithstanding intensive treatment. Conclusion: The completed investigation techniques, the ensuing repercussions of this disorder, the treatment strategies and the resultant findings of the neuropsychological therapy are discussed as necessary for the comprehensive care of tetraplegic patients. O59 Comparison between fetal spinal cord-and forebrain-derived neural stem/progenitor cells as a source of transplantation for spinal cord injury Author(s): Kota Watanabe, Masaya Nakamura, Akio Iwanami, Hideyuki Okano, Yoshiaki Toyama Name of ISCoS Member (Author):Masaya Nakamura Main institution where the work was done:Department of Orthopaedic Surgery, Department of Physiology, Keio University Recently, we have shown that the transplantation of spinal cord-derived neural stem/progenitor cells (NSPCs) can contribute to the repair of injured spinal cord in adult rats, which may correspond to a behavioral recovery. To apply these results to clinical practice, a system for supplying human NSPCs on a large-scale must be established. However, a low proliferative potency limits the feasibility of large-scale spinal cord-derived NSPC use. In this study, we compared spinal cord- and forebrain-derived NSPCs transplanted into injured spinal cord with respect to their fates in vivo as well as the animals’ functional recovery. Both spinal cord- and forebrain-derived NSPCs promoted functional recovery in rats with spinal cord injuries. While both spinal cord- and forebrain-derived NSPCs survived, migrated, and differentiated into neurons, astrocytes and oligodendrocytes in response to the microenvironment within the injured spinal cord after transplantation. Immunohistological examinations revealed that forebrain-derived NSPCs differentiated into more neurons and fewer oligodendrocytes, compared to spinal cord-derived NSPCs. In both groups significantly better motor functional recovery was observed compared to the control animals. In conclusion, forebrain-derived NSPCs could be used as an alternative to spinal cord-derived NSPCs as a potential therapeutic agent for spinal cord injuries.
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