| 1. |
- Krassioukov, Andrei V, et al.
(författare)
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Assessment of autonomic dysfunction following spinal cord injury: rationale for additions to International Standards for Neurological Assessment.
- 2007
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Ingår i: Journal of rehabilitation research and development. - 0748-7711. ; 44:1, s. 103-12
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Tidskriftsartikel (refereegranskat)abstract
- We present a preliminary report of the discussion of the joint committee of the American Spinal Injury Association (ASIA) and the International Spinal Cord Society concerning the development of assessment criteria for general autonomic function testing following spinal cord injury (SCI). Elements of this report were presented at the 2005 annual meeting of the ASIA. To improve the evaluation of neurological function in individuals with SCI and therefore better assess the effects of therapeutic interventions in the future, we are proposing a comprehensive set of definitions of general autonomic nervous system dysfunction following SCI that should be assessed by clinicians. Presently the committee recommends the recognition and assessment of the following conditions: neurogenic shock, cardiac dysrhythmias, orthostatic hypotension, autonomic dysreflexia, temperature dysregulation, and hyperhidrosis.
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| 2. |
- Wallin, Gunnar B, 1936, et al.
(författare)
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Sympathetic single axonal discharge after spinal cord injury in humans: activity at rest and after bladder stimulation
- 2014
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 52:6, s. 434-438
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Clinical experimental mechanistic study. Objectives: (1) To determine in three spinal cord-injured patients whether individual muscle sympathetic nerve fibres below the level of the spinal lesion display spontaneous activity. (2) To determine in these patients if individual sympathetic vasoconstrictor fibres show a prolonged discharge following a bladder stimulus. Methods: Microneurographic recordings of action potentials from individual muscle nerve sympathetic fibres in a peroneal nerve. Recordings of skin blood flow and electrodermal responses in a foot. Results: In all patients, there was sparse ongoing spontaneous impulse traffic in individual sympathetic fibres. Brisk mechanical pressure over the urinary bladder evoked a varying number of action potentials in individual fibres, but the activity was brief and did not continue after the end of the evoked multiunit burst. Conclusion: Prolonged discharges in individual sympathetic fibres are unlikely to contribute to a long duration of blood pressure increases induced by brief bladder stimuli.
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| 3. |
- Alexander, M S, et al.
(författare)
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International standards to document remaining autonomic function after spinal cord injury.
- 2008
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 47:1, s. 36-43
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Experts opinions consensus. OBJECTIVE: To develop a common strategy to document remaining autonomic neurologic function following spinal cord injury (SCI). BACKGROUND AND RATIONALE: The impact of a specific SCI on a person's neurologic function is generally described through use of the International Standards for the Neurological Classification of SCI. These standards document the remaining motor and sensory function that a person may have; however, they do not provide information about the status of a person's autonomic function. METHODS: Based on this deficiency, the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) commissioned a group of international experts to develop a common strategy to document the remaining autonomic neurologic function. RESULTS: Four subgroups were commissioned: bladder, bowel, sexual function and general autonomic function. On-line communication was followed by numerous face to face meetings. The information was then presented in a summary format at a course on Measurement in Spinal Cord Injury, held on June 24, 2006. Subsequent to this it was revised online by the committee members, posted on the websites of both ASIA and ISCoS for comment and re-revised through webcasts. Topics include an overview of autonomic anatomy, classification of cardiovascular, respiratory, sudomotor and thermoregulatory function, bladder, bowel and sexual function. CONCLUSION:This document describes a new system to document the impact of SCI on autonomic function. Based upon current knowledge of the neuroanatomy of autonomic function this paper provides a framework with which to communicate the effects of specific spinal cord injuries on cardiovascular, broncho-pulmonary, sudomotor, bladder, bowel and sexual function.
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| 4. |
- Bennegård, Gun-Marie, et al.
(författare)
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Higher glucose uptake in paralysed spastic leg.
- 2008
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 46:2, s. 103-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Insulin resistance and diabetes mellitus have been reported in the spinal cord injured (SCI). The group exhibits risk factors, as decreased physical activity, as well as episodes of stimulation of sympathetic nervous system below the level of lesion known to stimulate lipolysis, which in turn could induce insulin resistance. However, data are inconsistent, which might indicate the presence of protective mechanisms. OBJECTIVE: To investigate the glucose uptake in spastic paralysed SCI legs compared to able-bodied. To investigate regional differences between glucose handling in the arm and leg. STUDY DESIGN: Experimental controlled study. SETTINGS: Institution of Clinical Neuroscience and Physiology, Spinal Injures Unit, Sahlgrens University Hospital, Goteborg, Sweden. METHODS: Nine SCI subjects (2 C7, 7 T1-T4 ASIA A: 8, ASIA B: 1) were compared to 10 weight- and age-matched controls. Plasma flow in arm and leg was analysed by venous occlusion strain gauge plethysmography, and plasma derived from artery and veins in the arm and leg was analysed for glucose, insulin and lactate during fasting resting conditions. RESULTS: Glucose uptake was higher in SCI legs compared to controls. There was no difference in insulin uptake or lactate production. Plasma flow was higher in SCI legs compared to controls. Controls showed a higher glucose uptake and lactate production in arm than leg. CONCLUSIONS: Spasticity may counteract the risk of diabetes by inducing an insulin-independent glucose uptake. The regional difference in metabolism in able-bodied make it hazardous to do generalizations to whole body metabolism from arm or leg measurements.
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| 5. |
- Dahlgren, A, et al.
(författare)
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Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale.
- 2007
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 45:7, s. 475-84
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cross-sectional study. OBJECTIVES: (1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale. SETTING: Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS: Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale. RESULTS: Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items. CONCLUSION: The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.
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| 6. |
- Dahlgren, Annika, 1964, et al.
(författare)
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Linking the Klein-Bell ADL Scale to the International Classification of Functioning, Disability, and Health (ICF) : Linking an ADL scale to the ICF
- 2013
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 45:4, s. 351-7
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The main objective of this study was to link the Klein-Bell Activities of Daily Living (KB) Scale to the International Classification of Functioning, Disability and Health (ICF), in order to validate the KB Scale content-wise. Design: A qualitative approach was used with directed content analysis. Methods: Concepts in the KB Scale items were linked to ICF categories according to established rules. This was followed by 4 analyses: examination of the linked categories' frequency distribution; comparison of these categories with Core Sets for spinal cord injury (SCI) and occupational therapists; calculation of content density, content diversity and range of linked categories; and calculation of agreement between two independent linkage versions. Results: All except one identified KB Scale concept could be linked to ICF categories. The occupational therapists Core Sets were most consistent with linked categories in the KB Scale. Content density, content diversity and range varied between the different KB Scale dimensions. Agreement was reliable for the whole KB Scale and for 5 of 6 dimensions. Conclusion: The ICF has provided a valuable reference to identify and quantify the concepts in the KB Scale. Furthermore, comparison between the KB Scale and ICF Core Sets provides insights into areas covered by these instruments.
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| 7. |
- Karlsson, Ann-Katrin, 1950
(författare)
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Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs
- 2006
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Ingår i: Progress in Brain Research. - 0079-6123. ; 152, s. 1-8
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Forskningsöversikt (refereegranskat)abstract
- Spinal cord injury and especially cervical spinal cord injury implies serious disturbances in autonomic nervous system function. The clinical effects of these disturbances are striking. In the acute phase, the autonomic imbalance and its effect on cardiovascular, respiratory system and temperature regulation may be life threatening. Serious complications such as over-hydration with the risk of pulmonary edema or hyponatremia are seen. The cord-injured person suffers from autonomic nervous system dysfunction also affecting bladder and bowel control, renal and sexual function. Paralytic ileus may cause vomiting and aspiration, which in turn interferes with respiratory function in those with cervical spinal cord injury. The cord-injured person is at risk to develop pressure sores from the moment of the accident. Two to three months post-injury the cord-injured person with a lesion level above the fifth thoracic segment may develop autonomic dysreflexia, characterised by sympathetically mediated vasoconstriction in muscular, skin, renal and presumably gastrointestinal vascular beds induced by an afferent peripheral stimulation below lesion level. The reaction might cause cerebrovascular complications and has effects on metabolism. Some of the autonomic disturbances are transient and a new balance is reached months post-injury, while others persist for life.
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| 11. |
- Pazooki, David, 1958, et al.
(författare)
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Continent cutaneous urinary diversion in patients with spinal cord injury.
- 2006
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 44:1, s. 19-23
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Retrospective study. OBJECTIVE: To examine the functional results and effect on quality of life of continent cutaneous urinary diversion in spinal cord injured patients. SETTING: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden. SUBJECTS: A total of 10 patients with spinal cord injury (SCI). METHOD: The patients were operated on with an ileal reservoir (Kock reservoir or T-pouch), Cr-EDTA clearance was determined preoperatively and at follow-up. The patients answered a questionnaire concerning reservoir function, various activities and quality of life. The patient charts were reviewed. RESULTS: One patient died of pulmonary embolism 3 years after surgery. Two patients were reoperated on for reservoir perforation. All patients were satisfied/very satisfied with their reservoirs. Half of them reported improved ability to perform various activities. Eight out of nine patients reported improved quality of life. CONCLUSION: For a selected group of patients with SCI, continent cutaneous urinary diversion provides successful outcome with improved quality of life.
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| 12. |
- Pettersson-Hammerstad, Karin, et al.
(författare)
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Impaired renal function in newly spinal cord injured patients improves in the chronic state--effect of clean intermittent catheterization?
- 2008
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Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 180:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We investigated renal function in spinal cord injured subjects in relation to the level and completeness of injury and bladder emptying regimen in the acute and chronic stages. MATERIALS AND METHODS: A retrospective chart review was performed of 169 spinal cord injured subjects treated at the Spinal Cord Injury Unit, Sahlgrenska Hospital between 1985 and 2002. Renal function based on glomerular filtration rate was evaluated by chromium ethylenediaminetetraacetic acid clearance 3 to 4 months after injury and at followup 3 to 5 years after injury. RESULTS: The glomerular filtration rate was lower than expected in the first investigation in the whole group (82% of the expected value). When divided according to level of lesion the figure was lower in the cervical (81%) and thoracic (88%) levels of the lesion and in the American Spinal Injury Association A group compared to the American Spinal Injury Association B-E group. In the second investigation we found a significant improvement in the whole group of 6%. When dividing the group according to bladder emptying regimen we found that in the group that emptied the bladder by clean intermittent catheterization glomerular filtration rate improved significantly (+7%). CONCLUSIONS: Spinal cord injury affects renal function and has a deteriorating effect on glomerular filtration rate. The reduction is seen on the cervical and thoracic levels of injury and in complete injuries. Renal function improves with time after injury and improvement is seen most clearly in the group that uses clean intermittent catheterization as a bladder emptying method.
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| 13. |
- Rutberg, Lena, et al.
(författare)
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Amenorrhoea in newly spinal cord injured women: an effect of hyperprolactinaemia?
- 2008
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 46:3, s. 189-191
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Prospective, single centre study. OBJECTIVES: Previous studies have suggested a relationship between stress reaction and elevated levels of prolactine. The aim of the present study was to investigate if there was a relationship between s-prolactine and menstrual cycle status following spinal cord injury (SCI). SETTING: Spinal Cord Injury Unit, Göteborg, Sweden. METHODS: S-prolactine and menstrual cycle status were investigated in 16 consecutive women with SCI, treated at the SCI Unit, Sahlgrens University Hospital, Göteborg, Sweden. Level of injury ranged from C1 to L5, ASIA A-D. Mean age at injury was 45 years (range 20-79). RESULTS: S-Prolactine showed a mean value of 741 mIU/l (standard deviation (s.d.): 625; 95% confidence interval (CI): 435-1788 mIU/l, reference value <400 mIU/l). When dividing the group according to fertility status we found hyperprolactinaemia in the women who were in childbearing age (n=9): mean value 1050 mIU/l (s.d.: 678; 95% CI: 607-1493 mIU/ml), whereas it was normal in the group in menopause (n=7): mean value 343 mIU/l (s.d.: 185, 95% CI: 206-480 mIU/l) (P<0.01 when comparing groups). The group that developed amenorrhoea showed the highest values of s-prolactine. All values but one was normalised 3-6 months later. CONCLUSION: Amenorrhoea following SCI is correlated to level of s-prolactine. We found no correlation between level of s-prolactine and level or degree of injury.
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