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O63 SERUM CYSTATIN C AS A MARKER OF RENAL FUNCTION IN PATIENTS WITH SPINAL CORD INJURY Author(s): IL Johannesen, EJ Erlandsen, SA Thomassen and E Randers Name of ISCoS Member (Author): Inger Lauge Johannesen Main institution where the work was done: Department of Spinal Cord Injury, Viborg Hospital, Viborg, Denmark Serum cystatin C is a new marker of glomerular filtration rate independent of muscle mass and gender contrary to serum creatinine. The aim of the study was to compare the ability of serum cystatin C and serum creatinine to detect decreased kidney function in patients with spinal cord injury in relation to the reference intervals. Thirty-six women and 94 men aged between 16.8 and 80.4 years were included in the study. Ninety-three (71.5%) were motoric complete (ASIA A and B) and 37 (28.5%) motoric incomplete (ASIA C and D). The duration of the spinal lesions ranged from 0.3 to 36.7 years. Serum cystatin C was measured by the Dade Behring Cystatin C assay and serum creatinine by an enzymatic method. Three women (8.3%) had decreased kidney function according to serum cystatin C whereas all women had normal kidney function according to serum creatinine. Eighteen men (19.4%) had decreased kidney function according to serum cystatin C whereas only three (3.2%) had decreased kidney function according to serum creatinine. In conclusion serum cystatin C is a better marker of the renal function in patients with spinal cord injury compared to serum creatinine; cystatin C being independent of muscle mass. O64 Autonomic Disreflexia: Provokative Testing For Early Diagnosis and Management Author(s): Inder Perkash ISCoS Member (author): Inder Perkash Aims of Study: Hypothesis: Autonomic Disreflexia is a serious condition with significant increase in B.P.usually encounterd with full bladder in Spinal Injured Patients (SCI) with lesions above T6. Gentle bedside suprapubic tapping and also during cystometric (CMG) studies, AD can be precipitated for early diagnosis in such patients. Adequacy of TURS can also be assessed by bedside bladder tapping and cystometric examinations with B.P. monitoring as well. Methods: This study includes 51 male SCI patients (T5 and higher) who were studied . Following medical mangement with poor control of AD, they opt ed for TURS to improve bladder drainage and also have definitive management of AD. Bedside Tapping and Cystomanometric examination before and later 3 months after TURS was accomplished using the same equipment. During CMG the rise in systolic and diastolic B.P. maximum at bladder capacity, maximum bladder pressures, and post void residual urine volumes were recorded. Results: Previously published studies in Non SCI patients show a mean rise in systolic and diastolic pressure of 9.3 ( 10-18) and diastolic rise of 6.0 mm hg. (Range 2-8 mm hg). Mean rise in SCI patients of systolic B.P. before TURS was 31.0 mm hg ( Range10-60 mm hg). However, in 4 of these patients there was a rise of 60 to100 mm hg. After TURS the mean rise was 12.0 mm hg (Range 0-20). This was significant (p-value < .001). Mean diastolic rise before TURS was 12.3 mm Hg ( Range 5-40) and after TURS was 5.1 (0-20) (p-value <.0028 ). After TURS 8 patients showed a systolic rise of 40 to 80 mm hg and diastolic rise of 20 to 40 mm hg. This correlated clinically with difficulty in emptying, with high residuals and high voiding pressures and significant AD still requiring medications. Repeat TURS improved voiding and significantly ameliorated AD in all these patients both on bedside tapping and during CMG . Conclusions: Bedside tapping before and after gentle bladder tapping can alert the potential of serious AD and mandates management. Adequacy of TURS can be evaluated with BP monitoring both bedside and during CMG studies. This study emphasizes the association of AD and DSD as a complex syndrome which is relieved following adequate TURS. Presence of significant AD after TURS also indicates inadequate TURS. O65 Sweating Response in Patients with Spinal Cord Injury Author(s): Hyun-Yoon Ko, M.D., Yong Beom Shin, M.D. Name of ISCoS Member (Author): Hyun-Yoon Ko, M.D. Main institution where the work was done: Pusan National University College of Medicine Spinal cord injury results in various disturbances of autonomic function below the lesion. Of the autonomic function, sweating is a thermoregulatory reaction induced by raising body temperature or environmental temperature. Sweating responses in 24 patients with complete spinal cord injuries (8 cervical cord injuries, 16 thoracic cord injuries) were studied. To measure local sweating responses, 8-channel humidity sensors were affixed to the sensory key areas of the 4 segments (including the segment of level of injury) above and 4 segments below the level of injury. Voltage changes while the patients were exposed to elevated environmental temperature were recorded. There were no sweating responses in 6 of 8 cervical cord injuries; however, one cervical cord injury had sweating response in the segments above the level including 3 segments below the level, and one patient showed sweating response above the level. Sweating responses above the level were present in all of 4 upper thoracic cord injuries. However, sweating responses in the patients with lower thoracic cord injuries were variable: 5 in the segments above the level, 4 below the level, and no sweating response in 2. Our observations imply that sweating responses in patients with spinal cord injuries show no typical patterns according to the level of injury. O66 Vascular Changes in Spinal Cord Injured Individuals After 4 Weeks Training With a Hybrid FES-Cycle Ergometer Author(s): H.J.M. van Kuppevelt1, D. Thijssen2, P. Heesterbeek3, J. Duysens3, M. Hopman2 Name of ISCoS Member (Author): H.J.M. van Kuppevelt Main institution where the work was done: 1 Rehabilitation Center St Maartenskliniek Nijmegen, 2 Department of physiology, University Medical Center Nijmegen, 3 St Maartenskliniek Research Nijmegen, the Netherlands. Former studies showed that vascular changes in the legs of spinal cord injured (SCI) individuals are reversible by functional electrical stimulation (FES) training. Training with a hybrid bike system(Berkelbike), which trains both arms and legs, may cause even more vascular remodelling Purpose: Finding vascular changes in SCI individuals after 4 weeks of hybrid FES-training. Methods: 10 SCI (age 39 ± 9 years) individuals trained 8-10 times over a 4 week period with the Berkelbike, a mobile FES-cycle and arm ergometer that can be used at home or outdoor. Forearm, calf and thigh blood flow (BF), vascular resistance (VR) and reactive hyperemia (RH) were measured by venous occlusion plethysmography before first training and after 4 weeks of training. BF and RH were measured 5 minutes before and immediately after 13 minutes of ischaemia (with suprasystolic pressure of 220 mmHg), respectively. VR could be calculated by dividing mean arterial pressure (MAP) by leg blood flow. Results: Calf BF remained unchanged whereas thigh and forearm BF increased significantly. Calf and forearm RH did not differ before and after training while thigh RH increased. Forearm and calf mean VR showed no change. Thigh mean VR was significant decreased. Forearm, calf and thigh minimal VR did not change. Discussion: An explanation of the absence of calf vascular adaptations after 4 weeks of hybrid FES-ergometry may be the short period of training or the non-stimulation of the calf during the training. Conclusion: The results of the present study suggest that 4 weeks of hybrid ergometer training already leads to marked vascular adaptations in the exercised thigh and forearm muscles. O67 BWS therapy for spinal cord injury patients: backward and in place stepping Author(s): Scivoletto G., Grasso R., Ivanenko Y.P., Zago M., Molinari M., Lacquaniti F. Name of ISCoS Member (Author): Scivoletto G. Main institution where the work was done: IRCCS Fondazione S. Lucia, Department of Neuroscience – Tor Vergata University, Institute of Neurology – Catholic University, Rome Aims: to evaluate whether walking recovery after BWS training depends on re-activation of normal motor patterns or on learning new motor strategies. Patients: Six SCI-patients trained with BWS who recovered the shape and the step-by step reproducibility of normal foot motion were asked to step backward and in place; two patients were trained to perform these tasks. Evaluation: three-dimensional motion analysis and surface EMG analysis. Results: in contrast to healthy subjects who can immediately reverse the direction of walking by time-reversing the kinematic waveforms, patients were unable to step backward and in place. After appropriate training patients developed control of foot motion for these tasks. Conclusions: Since locomotor recovery does not transfer to untrained tasks, present data suggest that recovery of locomotion after SCI relies on the development of new motor patterns based on reorganized neural networks and not on re-activation of prelesional locomotor circuits.
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O69 A model for combined bladder emptying and neuromodulation using independent anterior and posterior sacral nerve stimulation Author(s): John Bycroft, Alex Kirkham, Sarah Knight, Sharon Wood, Julian Shah and Michael Craggs Name of ISCoS Member (Author): Prof. Michael Craggs Main institution where the work was done: Spinal Research Centre, Stanmore, UK. INTRODUCTION The Sacral Anterior Root Stimulator Implant (SARSI) is an established method of lower urinary tract management in spinal cord injury (SCI). Traditionally SARSI is performed along with posterior rhizotomy to prevent reflex detrusor-sphincter dyssynergia (DSD) and neurogenic detrusor overactivity (NDO). Rhizotomy results in further neural destruction and loss of reflex erections and ejaculation. Stimulation of pudendal afferent fibres (hence posterior sacral nerve roots) can suppress NDO. We describe a novel implant configuration that allows combined bladder emptying and bladder suppression. METHODS A 37 year old male with a T7 SCI was selected for implant. Pre-operative videourodynamic studies demonstrated NDO and DSD, and dorsal penile nerve stimulation confirmed that neuromodulation significantly increased bladder capacity. A three channel (S3 anterior, S3 posterior and S4 mixed nerve roots) intrathecal implant was inserted. Posterior nerve roots were not divided. RESULTS Post-implant, sacral reflexes (including reflex erections) were preserved. Stimulation of S3 anterior nerve roots alone provided effective bladder emptying using the technique of post-stimulus voiding. Both low-level S3 posterior and S4 mixed stimulation demonstrated effective conditional and continuous neuromodulation. CONCLUSION This new configuration presents a novel method of combined bladder emptying and suppression by independent stimulation of posterior and anterior sacral nerve roots.
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