| 1. |
|
|
| 2. |
- Falci, S, et al.
(författare)
-
Obliteration of a posttraumatic spinal cord cyst with solid human embryonic spinal cord grafts : first clinical attempt.
- 1997
-
Ingår i: Journal of Neurotrauma. - : Mary Ann Liebert Inc. - 0897-7151 .- 1557-9042. ; 14, s. 875-
-
Tidskriftsartikel (refereegranskat)abstract
- Cystic lesions of the spinal cord (syringomyelia) may occur after spinal cord injury. Posttraumatic syringomyelia may result in a myelopathy causing symptoms of sensory and motor loss, as well as worsening spasticity, pain, hyperhidrosis, and autonomic dysreflexia. Shunting of the cyst cavity along with untethering of the scarred spinal cord is widely accepted as the treatment of choice. However, the long-term stabilization of the progressive myelopathy caused by a posttraumatic cyst is suboptimal because of arachnoidal rescarring, shunt tube blockage, and cyst reexpansion. A new neurosurgical strategy to overcome the complication of cyst reexpansion was designed. Experimental studies have shown the successful use of embryonic spinal cord grafts, including human grafts, to obliterate induced spinal cord cavities in rats. The authors report the first use of solid human embryonic spinal cord grafts to successfully obliterate 6 cm of a large cyst cavity in a patient becoming myelopathic from a posttraumatic cyst. The grafts are well visualized by MRI to the 7-month postoperative follow-up and cyst obliteration is seen in the region where the grafts were placed.
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
- Norrbrink Budh, C, et al.
(författare)
-
Gender related differences in pain in spinal cord injured individuals.
- 2003
-
Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 41:2, s. 122-8
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Out of a population of 456 patients with spinal cord injuries (SCI), 130 having pain were selected after matching, based on gender, age, American Spinal Injury Association (ASIA) impairment grade and level of lesion.OBJECTIVE: To investigate whether gender differences with regard to pain perception and prevalence exist in a population of patients following spinal cord injury.SETTING: Spinalis SCI Unit (out-patient clinic), Stockholm, Sweden.METHOD: 130 patients suffering from pain were assessed over a 12-month period in a yearly health control.RESULTS: SCI women had a higher prevalence of nociceptive pain than men and their use of analgesics was greater. However, no differences between the sexes could be seen regarding pain and localization, onset, distribution, factors affecting pain, number of painful body regions, pain descriptors, ratings of pain intensities or in pain and life satisfaction.CONCLUSION: This study showed that SCI men and women describe their pain very similarly. However, SCI women had a higher prevalence of nociceptive pain than men and their use of opiates and non-steroid anti-inflammatory drugs (NSAIDs) was greater.
|
|
| 9. |
|
|
| 10. |
- Sköld, C, et al.
(författare)
-
Simultaneous Ashworth measurements and electromyographic recordings in tetraplegic patients.
- 1998
-
Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier. - 0003-9993 .- 1532-821X. ; 79:8, s. 959-965
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: A recent prevalence study of 353 spinal cord injured (SCI) individuals in the greater Stockholm area showed problematic spasticity in 30% of this population. To treat spasticity, the evaluation becomes crucial. The modified Ashworth scale (MAS) is the clinically most-used scale to grade degree of spasticity. This study evaluated whether the MAS correlated with electromyographic (EMG) recordings of muscle activity.STUDY DESIGN: This cross-sectional study was performed at an outpatient clinic that has the responsibility to do a standardized, yearly follow-up of all SCI patients in the greater Stockholm area. Thirty-eight SCI individuals met the inclusion criteria; 15 of the 38 were randomly selected for the study. They were all motor-complete tetraplegic men; mean age was 33 years and mean time since injury was 9 years. Spasticity evaluation was performed by flexing and extending the knees during simultaneous EMG recordings and MAS assessment of the thigh muscle activity.RESULTS: Eighty percent of the individual EMG recordings correlated significantly with the corresponding Ashworth measurements. The spastic resistance, as measured both clinically and electromyographically, was stronger and lasted longer during extension than flexion movements. Spearman coefficients for correlation of quantitative spasticity measures with MAS grades were calculated. EMG and clinical measures of spasticity were more closely correlated for flexion movements. Among EMG parameters, duration of movement-associated electrical activity invariably correlated significantly with the MAS grades (p < .05). Furthermore, Ashworth measurements of movement-associated spasticity showed a positive correlation with the EMG parameters mean, peak, and start to peak of electrical activity. Each increasing grade on the MAS corresponded to increasing myoelectric activity levels for each movement.CONCLUSION: EMG parameters were significantly positively correlated with simultaneous MAS measurements of the spastic muscle contraction. The Ashworth scale may therefore accurately reflect the movement-provoked spasticity in motor-complete tetraplegic patients.
|
|
| 11. |
|
|
| 12. |
|
|
| 13. |
|
|
| 14. |
- Alm, M., et al.
(författare)
-
Clinical evaluation of seating in persons with complete thoracic spinal cord injury
- 2003
-
Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 41:10, s. 563-571
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design: Consecutive male patients studied with photographic measurement of a combination of clinical methods. Objectives: To describe seating in individuals with complete thoracic spinal cord injury (SCI) by using a combination of clinical methods. Setting: Spinalis SCI unit, Stockholm, Sweden. Methods: Wheelchair specifications were documented. Measurements of posture from photographs in 30 male subjects with complete thoracic SCI, sitting in a relaxed and an upright position on a standardized surface and in a wheelchair were calculated. A comparison was made between positions and seating surfaces. An examiner's classification of lower trunk position in wheelchair was compared to subjects' evaluations. SCI subjects reported sitting support, satisfaction, and wishes for improvement. Results: Most SCI subjects used similar wheelchair specifications. None of the backrests were custom designed. Relatively small differences were found between the relaxed and upright position in the wheelchair regarding measurements of posture and according to the examiner's classification of the lower trunk position. Only 13/30 SCI subjects were sitting with the lower trunk centered relative to the backrest in the upright position. The examiner's classification and the subjects' evaluation of asymmetric sitting were not always in agreement. Only 12/30 SCI subjects were satisfied with their way of sitting. Conclusion: Current wheelchair specifications and adjustments seem to inhibit a postural correction towards upright sitting and fail to provide sufficient lateral support. Findings indicate an inability for SCI subjects to vary their sitting position in a wheelchair to a large extent. Both an examiner's classification and subjects' evaluation of asymmetric sitting are necessary to obtain a sufficient knowledge base for subsequent adjustment. By using methods regarding different aspects of seating, a more comprehensive view of seating was achieved. The combination of clinical methods seems to be useful in order to describe seating in individuals with complete thoracic SCI.
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
|
|
| 19. |
|
|
| 20. |
|
|
| 21. |
|
|
| 22. |
|
|
| 23. |
|
|
| 24. |
|
|
| 25. |
|
|
| 26. |
|
|
| 27. |
|
|
| 28. |
|
|
| 29. |
- Gutierrez-Farewik, Elena M., et al.
(författare)
-
Measuring seating pressure, area, and asymmetry in persons with spinal cord injury
- 2004
-
Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 13:4, s. 374-379
-
Tidskriftsartikel (refereegranskat)abstract
- The goal of this study was to measure characteristics of seat loading in manual wheelchair users with complete spinal cord injury (SCI). Pressure distribution on the seating area of 25 adult males with SCI and eight non-injured adult males was measured in a relaxed and an upright posture on a standardized hard surface. Subjects with SCI were also tested in their wheelchairs. Maximum pressure, contact area, area of the highest pressure, and three asymmetry indices were compared. Subjects with SCI have higher pressure distributed over a smaller area, have a much smaller contact area, and distribute the loading more asymmetrically than non-injured subjects. Upright posture only corrects for some loading problems, while the wheelchair corrects for more loading parameters. Routine clinical seat loading evaluation may lead to improved chair and cushion selection for patients with SCI and may even alert clinicians to patients at high risk for complications due to high or unbalanced loads.
|
|
| 30. |
|
|
| 31. |
- Holmgren, T, et al.
(författare)
-
The Influence of Spinal Cord Injury on Breastfeeding Ability and Behavior
- 2018
-
Ingår i: Journal of human lactation : official journal of International Lactation Consultant Association. - : SAGE Publications. - 1552-5732. ; 34:3, s. 556-565
-
Tidskriftsartikel (refereegranskat)abstract
- Lactation dysfunction following spinal cord injury has been noted in the literature. However, researchers have often grouped together all women of physical disability or do not account for injury level. The extent of lactation dysfunction and influence of spinal cord injury on breastfeeding ability and behavior is not well understood. Research aim: This study aimed to identify major barriers to lactation and breastfeeding related to spinal cord injury, specifically comparing high- and low-level injuries. Methods: A retrospective cross-sectional survey design was used. Two online questionnaires were developed and completed by women ( N = 52) who chose to breastfeed with spinal cord injury, primarily in Canada and Sweden. Results: The first questionnaire was completed by 52 women with spinal cord injury; 38 of the original 52 participants completed the second questionnaire. Of the 52 women, 28 (53.8%) had high-level spinal cord injury (at or above T6) and 24 (46.1%) had low-level injury (below T6). On the second questionnaire, 14 (77.8%) women with high-level injury reported insufficient milk production or ejection. Only 35% of women ( n = 7) with low-level injury reported the same. Autonomic dysreflexia was experienced by 38.9% of women ( n = 7) with high-level injury. Exclusive breastfeeding duration was significantly shorter ( p < .05) in the high-level injury group (3.3 months) compared with women with low-level injury (6.5 months). Conclusion: These results further support the notion that spinal cord injury (particularly at or above T6) disrupts lactation and is associated with shorter breastfeeding duration. Autonomic dysreflexia should be addressed in prospective mothers with high-level spinal cord injury.
|
|
| 32. |
- Holmlund, L, et al.
(författare)
-
Mapping Out One's Own Paths Toward Work: Focus on Experiences of Return to Work After Spinal Cord Injury
- 2018
-
Ingår i: Qualitative health research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 28:13, s. 2020-2032
-
Tidskriftsartikel (refereegranskat)abstract
- Involving persons with spinal cord injury (SCI) as experts in their lives is important for research to design relevant health care interventions. The purpose of this study was to use photovoice methods to explore experiences of barriers and possibilities in return to work among working adults with SCI. The photovoice group consisted of six persons living with SCI that met weekly over 2 months to share and discuss photos related to return to work. Five themes were identified: (a) there is only one way, (b) welcome back—or not, (c) to be like anyone else—or to be perceived as someone else, (d) friction in the absence of clarity, and (e) finding integrated strategies for everyday life with work. Work was experienced as rewarding and viable, but due to lack of societal and workplace support, a need to map out one’s own paths toward work was identified.
|
|
| 33. |
|
|
| 34. |
- Holmlund, Tobias, et al.
(författare)
-
Energy expenditure in people with motor-complete paraplegia.
- 2017
-
Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 55:8, s. 774-781
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: The present descriptive clinical and laboratory study is cross-sectional in design.OBJECTIVES: The primary aim is to describe and compare resting energy expenditure (REE) and energy expenditure (EE) during different standardized sedentary, non-exercise and exercise activities in people with motor-complete paraplegia (Th7 to Th12.). A secondary aim was to compare men and women.METHODS: Thirty-eight adults (10 women) with SCI, T7-T12 AIS A-B, were recruited. All the data were collected through indirect calorimetry. REE was measured in supine for 30 min after 8 h of overnight fasting. Activity energy expenditure (AEE) for activities was measured for seven minutes during sedentary, non-exercise physical activity (NEPA) and exercise activities.RESULTS: AEE increased four to eight times when engaging in NEPA compared to that in sedentary activities. Men had significantly higher resting oxygen uptake compared to women, 0.19 vs 0.15 l min(-1) (P=0.005), REE per 24 h, 1286 vs 1030 kcal (P=0.003) and EE during weight-bearing activities. However, these became nonsignificant after adjustment for body weight and speed of movement, with a mean resting oxygen uptake of 2.47 ml O2 per kg min(-1) for the whole group (women 2.43 and men 2.57 ml O2 kg(-1) min(-1), P=0.49).CONCLUSIONS: NEPA increases AEE up to eight times compared to sedentary activities. Gender differences in oxygen uptake during both rest and weight-bearing activities were diminished after adjustment for body weight. The mean resting oxygen uptake for the whole group was 2.47 ml O2 kg(-1) min(-1). These results highlight the importance, especially of NEPA, for increasing total daily EE in the target population.
|
|
| 35. |
|
|
| 36. |
- Hultling, C, et al.
(författare)
-
Assisted ejaculation and in-vitro fertilization in the treatment of infertile spinal cord-injured men : the role of intracytoplasmic sperm injection.
- 1997
-
Ingår i: Human Reproduction. - : Oxford University Press. - 0268-1161 .- 1460-2350. ; 12:3, s. 499-502
-
Tidskriftsartikel (refereegranskat)abstract
- The objective of the present longitudinal descriptive study was to extend previous observations on the benefit of in-vitro fertilization (IVF) in cases of anejaculatory infertility due to spinal cord injuries (SCI) and to report results achieved by intracytoplasmic sperm injection (ICSI). The study was performed in a national referral unit for SCI, Spinalis SCI Research Unit, the Karolinska Institute. The patient material consisted of couples with SCI men seeking treatment for their infertility. The inclusion criteria were: stable relationship, motile spermatozoa in a diagnostic sample and no female contraindications. Spermatozoa were retrieved through electroejaculation or vibratory stimulation. If the sperm quality was judged to be sufficient, standard IVF was performed. ICSI was employed if the semen quality was extremely poor. We have treated 25 couples in 52 cycles, leading to 81 ovum retrievals and 47 embryo transfers. Total sperm counts were very variable (0.01-978 x 10(6)). Before the introduction of ICSI the fertilization rate was 30%. ICSI increased the fertilization rate to 88%. There was no association between the pregnancy rate and the sperm count, level of injury or fertilization technique. A total of 16 clinical pregnancies was established, leading to 11 deliveries. This gives a cumulative pregnancy rate per couple of 56%.
|
|
| 37. |
- Hultling, C, et al.
(författare)
-
Assisted ejaculation combined with in vitro fertilisation : an effective technique treating male infertility due to spinal cord injury.
- 1994
-
Ingår i: Paraplegia. - : Springer Science and Business Media LLC. - 0031-1758. ; 32:7, s. 463-467
-
Tidskriftsartikel (refereegranskat)abstract
- Infertility due to spinal cord injury (SCI) in males has been identified for decades as an area of major concern and techniques for assisted ejaculation are available. There has not been an overall consensus regarding which type of assisted procreation is the most appropriate for these couples. We describe here our experience from a programme based on assisted ejaculation combined with in vitro fertilization (IVF). Twelve couples have been treated so far and altogether 22 cycles with ovum pick-up have been completed. Fertilisation of the oocytes was obtained in 18 of these cycles. The overall oocyte fertilisation rate was 49%. Embryo transfer took place in 17 cycles, leading to seven clinical pregnancies. Four of the pregnancies are delivered or are ongoing, whereas three ended in first trimester spontaneous abortion. Thus our initial experience suggests that assisted ejaculation in combination with IVF is an effective option for these couples.
|
|
| 38. |
|
|
| 39. |
|
|
| 40. |
- Hultling, C
(författare)
-
-Paraplegia and fertility
- 1996
-
Ingår i: Geburtshilfe und Frauenheilkunde. - 0016-5751. ; 56:2, s. X-XII
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 41. |
|
|
| 42. |
|
|
| 43. |
- Hultling, C, et al.
(författare)
-
Semen retrieval and analysis in men with myelomeningocele.
- 2000
-
Ingår i: Developmental Medicine & Child Neurology. - : Wiley-Blackwell. - 0012-1622 .- 1469-8749. ; 42:10, s. 681-684
-
Tidskriftsartikel (refereegranskat)abstract
- The introduction of advanced assisted reproduction technologies (ART) has created opportunities for the treatment of infertility among patients with myelomeningocele (MMC). The aim of this study was to assess the possibility of semen retrieval and to analyse the semen quality in men with MMC. Nine men, aged 22 to 39 with MMC participated in the study. Two participants were able to achieve unassisted ejaculation. Vibratory stimulation was unsuccessfully attempted in the remaining seven participants who then underwent electroejaculation under general anaesthesia. In total, enough spermatozoa for intracytoplasmic spermatozoa injection were retrieved from five participants. In four cases, no spermatozoa were observed in the ejaculates. Testicular biopsies, however, revealed spermatogenesis, and thus a reproductive potential, in one of these men. Therefore, in six of the nine men with MMC, fatherhood seemed possible with modern ART, despite the semen quality generally being very poor.
|
|
| 44. |
- Hultling, C
(författare)
-
Spinalis SCI research unit
- 1998
-
Ingår i: UPSALA JOURNAL OF MEDICAL SCIENCES. - 0300-9734. ; , s. 57-57
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 45. |
|
|
| 46. |
|
|
| 47. |
|
|
| 48. |
|
|
| 49. |
|
|
| 50. |
- Klefbeck, B, et al.
(författare)
-
Obstructive sleep apneas in relation to severity of cervical spinal cord injury.
- 1998
-
Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 36:9, s. 611-628
-
Tidskriftsartikel (refereegranskat)abstract
- Thirty-three subjects (28 men, five women) with complete or incomplete cervical cord injury representing a wide range of neurological impairment were investigated with regard to the prevalence of Obstructive Sleep Apnea (OSA). The relation between OSA and neurological function, respiratory capacity, body mass index and symptoms associated with OSA were studied. Overnight sleep recordings employed combined oximetry and respiratory movement monitoring. Pulmonary function tests included static and dynamic spirometry, maximal static inspiratory and expiratory pressures at the mouth. The subjects answered a questionnaire concerning sleep quality and tiredness. The prevalence of OSA was 15% (5/33) in this nonobese cervical cord injury study population. Nine percent of the subjects (3/33) fulfilled the criteria for obstructive sleep apnea syndrome, but daytime sleepiness or fatigue were also common in subjects without OSA. There was an inverse correlation between oxygen desaturation index and American Spinal Injury Association (ASIA) motor score in the subjects with complete injury, while there was no such correlation in the whole study group. There were significant correlations between maximal inspiratory and expiratory pressures and vital capacity and between ASIA motor score and vital capacity.
|
|
