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POSTER
PRESENTATIONS
P141
Pathological
fracture in spinal cord injury
Author(s): Zarina Mohammad Esman, Asiah Ibrahim
Name of ISCoS Member (Author): Ibrahim, Asiah
Main institution where the work was done: Hospital
Kuala Lumpur, Malaysia
Background:
Immobility has adverse effects on the body including bone metabolism.
A person with spinal cord injury (SCI) is at risk for pathological
fracture due to osteoporosis.
Objective:
Reporting pathological fracture occurred during inpatient Spinal Rehabilitation
program.
Method:
Case Report
Results:
Case 1
Mr. H is forty years old with paraplegia ASIA A, due to thoracic fracture
(T4) following a road accident. On the third year, he was admitted
for management of non-healing ulcer at the right gluteal region and
depression. During passive range of motion exercises, the right thigh
suddenly give way and x-ray showed right femur fracture. He was managed
with skin traction for six weeks.
Case 2
Mr. C is thirty eight year old with tetraplegia ASIA A due to cervical
fracture (C5) following a road accident. He was discharge home after
acute care. He was dependent for activities of daily living. As his
carer needs to work, he spends most of the day lying in bed. One year
post injury he was admitted for spinal rehabilitation program. He
develops right knee swelling after a minor accident during transfer
activity. X-ray showed suprocondylar fracture of the right femur.
Fracture unites after six weeks of knee bracing.
P142
International SCI Rehabilitation -A joint venture between SCI units
in the West Bank & Norway
Author(s): Gunnbjørg Aune Marianne
Holth, , Silje Mæland, Anne Kristine Schanke, Jon Ivar Sørland,
Johan Stanghelle
Name of ISCoS Member (Author): Johan Stanghelle
Main institution where the work was done: Sunnaas
Rehabilitation Hospital, Oslo, Norway & K. Abu Raya Rehabilitation
Centre, Ramallah, the West Bank
Purpose:
Evaluate a possible cooperation between Sunnaas Rehabilitation Hospital
in Oslo, Norway and Abu Raya Rehabilitation Centre, Ramallah, West
Bank.
Aim:
Mutual program to assist further development of rehabilitation of
SCI patients in Ramallah.Method: In 2003, upon request of the Norwegian
Association of the Disabled (NAD), two visits to Ramallah were made
by interdisciplinary teams from Sunnaas. The first visit assessed
the potential for cooperation and the second visit focused on clinical
work, exchanging knowledge and experiences, and focusing on interdisciplinary
work.
Results:
Two reports were written, discussing the possibilities and limitations
for cooperation. The reports described common challenges, i.e. treatment
of spasticity, decubitis, urinary tract problems, psychosocial distress
and interdisciplinary work.
Discussion:
The reports highlighted several ways of accomplishing a flow of knowledge
and upgrading of skills in Ramallah. Focusing on an active rehabilitation
philosophy was proposed to empower the patients. This issue was a
potential area for cooperation between the centres.
Conclusion:
These study trips showed clearly that the difficult situation in the
Middle East results in isolation of the rehabilitation professionals.
The visits also showed that professionals from Sunnaas, in cooperation
with NAD, can provide exchange of knowledge and expertise in the rehabilitation
of SCI patients in Ramallah.
P143
COMPREHENSIVE MANAGEMENT OF PRESSURE SORES – SHEFFIELD MODEL
Author(s): RAVICHANDRAN G, THUMBIKAT P, MCCLELLAND
M R
Name of ISCoS Member (Author): RAVICHANDRAN G
Main institution where the work was done: PRINCESS
ROYAL SPINAL CORD INJURIES CENTRE, SHEFFIELD UK
Most rehabilitative institutes around the World have evolved methods
to avoid the development of pressure sores in the paralysed individual,
contain it, and where necessary, treat it surgically.
During the last 20 years, surgical intervention has played a key part
in the management of deep pressure sores in Sheffield. During this period
a model of pressure sore management has evolved. This includes notification
by the client, liaison with the Community Based nurses, Spinal Cord
Injury Nurses visiting the patient at home, planned assessment at this
Centre and elective admission for surgical closure. The pre and post
operative management is carried out in a dedicated ward environment
with all nursing and ancillary facilities to reduce hospital stay. The
post operative mobilisation programme includes assessment of wheelchair
and seating, and the assessment of care needs and domestic environment.
A post-discharge community based assessment by the Liaison Team completes
the care of the pressure sore episode.
The authors have performed over 1000 pressure sore repairs during this
period. The concept of pressure sore management and the adequacy of
this service to our population will be presented.
P144
Profile of spinal cord injured patients admitted to the Acute Spinal
Cord Injury Unit, at Groote Schuur Hospital, Cape Town, South Africa
Author(s): Marlene Stander (B.Sc Physiotherapy)
Merle Futter (B.Sc Physiotherapy)
Main institution where the work was done: ASCI Unit,
Groote Schuur Hospital, Cape Town, South Africa
Context:
In the USA, spinal cord injury affects approximately 10 000 new patients
every year. Motor vehicle accidents, violence and falls are the most
common causes. Statistics like these are not readily available in Cape
Town, South Africa.Study
Design:
Retrospective survey of all patients admitted to the Unit from 1 April
2003 to 31 March 2004.
Objective:
To compile a patient profile.
Method:
The study population comprised all patients admitted to the unit during
the first 12 months after the ASCI Unit was first established. Medical
records are reviewed and the relevant data are entered into a data capture
sheet. The latter was developed based on clinical findings and from
the literature review. The data capture sheets will be analysed by using
Statgraphic computer programme.
P145
Sustained remission of CIDP associated with Evans syndrome
Author(s): Hans Knecht, Aurelio Tobòn,
Andreas Steck, Michael Baumberger
Name of ISCoS Member (Author): Michael Baumberger
Main institution where the work was done: Swiss Paraplegic
Center Nottwil, Switzerland
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired,
immune-mediated polyneuropathy that targets the myelin sheets of peripheral
nerves. Diagnosis is based on clinical presentation and course, nerve
conduction studies, nerve biopsy findings and CSF studies. Evans’
syndrome was originally described as a combined immune-mediated thrombocytopenia
and hemolytic anemia associated with non-malignant conditions. The auto-antibodies
involved in CIDP and Evans’ syndrome are polyclonal in nature
and thought to reflect an underlying immune-dysregulation.
A patient with CIDP developed Evans’syndrome despite of different
immunomodulatory treatments (corticosteroids, intravenous immunoglobulins
(IVIg), plasma exchange, azathioprine and cyclophosphamid) 17 months
after onset of symptoms. In persence of progressive disease (Rankin
scale 4) a new therapeutic approach with the chimeric monoclonal anti-CD20
antibody rituximab, that destroys B-cells from the early pre-B stage
through maturation up to plasmacytoid stage, was decided. Applying a
clinical protocol (rituximab 375mg/m2 at days 1, 8, 15, 22) our patient
normalized the platelet count already at the end of the fourth rituximab
infusion. A total of five additional single courses over one year were
performed. 17 months after completion of therapy signs and symptoms
of CIDP have nearly disappeared (Rankin scale 1). Thus, rituximab may
represent a successful therapy in otherwise refractory CIDP.
P146
Update on Spinal Cord’s “Silent” Disease: Pulmonary
Embolism
Author:
Paul R. Meyer, Jr. MD; Lisa Ann Wuermser, MD; Steven H Hurovitz, BS
Main institution where the work was done: Northwestern
University Feinberg School of Medicine, Chicago, Il. USA
The proverb “Nothing new under the sun” may be true, yet
the relationship and incidence of DVT and Pulmonary Embolism in Spinal
Cord Injury bare continued vigilance. The literature elicits warnings:
(1) multiple trauma; (2) extremity trauma; (3) paralysis (4) prolonged
admission; (5) recumbency; (6) great vessel compression during surgery;(
7) septic shock; (8) homeostatic changes, with (9) preexisting co-morbidities
to include hypercoagulable states. Age is compounding, and rarely
the single factor. The ultimate, an unexplained sudden death.
Thrombophlebitis (the initiator of intravascular emboli) varies widely.
Monitored by either invasive or non-invasive plethysmography (ultrasonography),
reveals occurrence rates between 2% in patients admitted to a SCI
center under 72 hours, to 26% in those between 8-28 days.(European
data).
Mechanical intervention includes lower extremity compression stockings
or intermittent pneumatic compression (IPC). Systemic prophylaxis
includes heparin, low molecular heparin, warfarin, and re-hydration.
Each carry adverse effects. If anticoagulation is contraindicated
or insufficient, an Inferior Vena Cava (IVC) umbrella becomes the
choice.
All admissions to Northwestern University’s Acute Spine Injury
service receive some form of lower extremity compression for DVT-PE
prophylaxis. Those with neurological injury also receive a variant
of systemic anticoagulation or IVC filter placement.
Data will be presented.
P147
DECUBITUS ULCER AS A SOLE SYMPTOM OF SPINAL LIPOMA
Author(s): Erhan B, Gunduz B, Tanriverdi T,
Hanci M
Name of ISCoS Member (Author):Erhan( Gencosmanoglu)
B
Main institution where the work was done:70. Yil
Istanbul PMR Training Hospital, Istanbul, Turkey
Design:
A case report of a patient with a major complaint of a decubitus ulcer
secondary to an intradural lumbar lipoma.
Objectives:
To report an unusual presentation of a lumbar lipoma and want to call
attention to these rare spinal tumors.
Case report:
A 35-year-old man admitted to our rehabilitation department with one
and a half year history of decubitus ulcer (a grade-4 decubitus ulcer
with 10x8 cm in diameter) on the left ischial area. A detailed physical
examination and a magnetic resonance (MR) imaging of the lumbar region
were performed. The patient was found out to have cauda equina syndrome
according to ASIA classification. MRI disclosed a large intraspinal,
intradural lipomatous mass extending from L1 to L4, a tethered cord,
and syringohydromyelia. Surgery for the lipoma was recommended but
the patient refused surgical intervention. The ulcer was debrided
and repaired with full-thickness skin flab including biceps femoris
muscle. The postoperative period was uneventful and the patient underwent
a rehabilitation program.
Conclusion:
A patient may present with unusual symptom(s) secondary to spinal
pathologies. Since early detection may prevent catastrophic results,
physical and neurological examination of such patients should be performed
carefully.
P148
Central cord syndrome (CCS): study of special clinical aspects
Author(s): K.Petropoulou, C.A.Rapidi, A. Galata,
A.Artemi, G.Lygizos, K.Athanassopoulos
Name of ISCoS Member (Author):C.A.Rapidi
Main institution where the work was done:B? Department
of Rehabilitation, National Rehabilitation Centre, Athens- Greece,
Head of Department: Dr K. Petropoulou
Purpose:
To study the characteristics of CCS, as a syndrome of incomplete tetraplegia,
especially concerning spasticity and neurogenic bladder, after spinal
shock.
Material and method:
In a total of 53 inpatients with tetraplegia (during 2000-2004) we
found 37 with incomplete tetraplegia, among whom 23 (62.2%) were characterized
as CCS according to American Spinal Injury Association (ASIA): a dissociation
in degree of weakness with lower limbs stronger than upper limbs and
sacral sparing.
Results:
In the total of 23 patients with CCS at discharge day (mean time of
hospitalization 5.8 months): a) 14 (60.9%) had cervical injury, 6
(26.1%) had disc herniation and 3 (13%) had spondylosis, b) 13 were
ASIA C (56.5%) and 10 ASIA D (43.5%), c) therapeutic approach for
spasticity was needed in 20 patients (86.9%): baclofen per os (20/20)
and injections of botulinum toxin A in lower limbs (5/20) - in 2 patients
the severity of spasticity led to intrathecal baclofen bolus test,
d) neurogenic bladder dysfunction (DESD or underactive detrusor) in
12 patients (52.2%) was managed with intermittent cathetirization
and the rest patients (47.8%) emptied their bladder with normal voiding
.
Conclusions:
Our findings are in agreement with bibliography, that patients with
CCS are of rather good prognosis (50-80% ambulation and hand function
recovery), but on the other hand consistent and effective management
of spasticity and neurogenic bladder are of great importance.
P149
Using a video projected Virtual Reality system for patients with spinal
cord injury
Author(s): Rachel Kizony, Liat Raz, Noomi Katz,
Harold Weingarden , Gabriel Zeilig and Patrice L. (Tamar) Weiss
Main institution where the work was done: School of
Occupational Therapy, Hadassah-Hebrew University, Jerusalem, Israel,
The Chaim Sheba Medical Center, Affiliated to the Tel-Aviv University,
Neurological Rehabilitation Dept., Tel Hashomer, Israel & Department
of Occupational Therapy, University of Haifa, Israel
In recent years, clinical studies have demonstrated the effectiveness
of virtual reality (VR) as an interventional rehabilitation tool in
neurological disorders. This presentation describes the results of a
study of VividGroup’s Gesture Xtreme VR, a video-capture system,
for balance training in patients with paraplegia due to spinal cord
injury (SCI). The advantages of this system include providing the user
with natural control of movements, the ability to use as many parts
of the body as are deemed suitable within the context of therapeutic
goals, flexibility in the way the system can be adapted to suit specific
therapeutic objectives, and the functionally meaningful contexts that
facilitate a patient’s residual motor and sensory abilities. To
date, ten participants with paraplegic SCI have completed the study
protocol. They experienced three virtual environments. A relationship
was found between the percent success and perceived difficulty of the
task. Responses to a questionnaire showed high levels of virtual “presence”.
Performance by the patient group was significantly lower than the performance
of a comparison group of 15 healthy participants. These initial results
demonstrate the potential of using VR during rehabilitation of patients
with SCI. We are currently collecting data on additional participants.
P150
VASCULAR SPINAL CORD LESION: RECOVERY PROCESS AND FUNCTIONAL OUTCOME
Author(s): LBerbatiotou , M.Micha ,G.Lygizos , A.Artemi
, L.Lili , C.Athanassopoulos , E.Maragoudaki , and C.Petropoulou
Main institution where the work was done: B’
Department of Physical and Rehabilitation Medicine , National Rehabilitation
Center
Aim:
we reviewed cases of vascular spinal cord lesions. We studied the process
of recovery and the functional outcome. Patients-Method: we studied
the clinical course of 10 patients (pts) with non-traumatic vascular
spinal cord lesion (vSCL) due to operated aortic aneurysm (6 cases),
non operated aortic aneurysm (3 cases), operated coarctation of aorta
(1 case), spinal hemorrhage of unknown etiology (2 cases).Mean follow
up 9, 8 months.
Results:
During initial evaluation 3 pts presented, according to the American
Spinal Cord Injury Association (ASIA), as ASIA A, 4 pts ASIA B and 3
pts ASIA C. All pts had neuropathic bladder presented as hyporeflexic
detrusor . Follow up: neurologic improvement in 3pts, stability in 5
pts and further deterioration in 2 pts. Spasticity developed in 2 pts
Upper motor neuron syndrome signs presented in 6 out of 10 pts. Neuropathic
bladder: 4 pts developed hyperreflexic detrusor with detrusor-sphincter
dyssyrergia and 2 pts had normal micturition. Ambulation: 7pts ambulate
with orthoses, 1 pts ambulates without orthoses and 2 pts are wheelchair
users.
Conclusions:
Paraplegia due to vSCL is pathology with dinstict and eterogenous clinical
picture, often long and difficult to predict recovery procedure and
functional outcome.
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