Browsing by Subject "Spinal cord injuries"

Now showing 1 - 7 of 7
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    Chx10+V2a interneurons in spinal motor regulation and spinal cord injury
    (Wolters Kluwer, 2023) Li, Wen-Yuan; Deng, Ling-Xiao; Zhai, Feng-Guo; Wang, Xiao-Yu; Li, Zhi-Gang; Wang, Ying; Neurological Surgery, School of Medicine
    Chx10-expressing V2a (Chx10+V2a) spinal interneurons play a large role in the excitatory drive of motoneurons. Chemogenetic ablation studies have demonstrated the essential nature of Chx10+V2a interneurons in the regulation of locomotor initiation, maintenance, alternation, speed, and rhythmicity. The role of Chx10+V2a interneurons in locomotion and autonomic nervous system regulation is thought to be robust, but their precise role in spinal motor regulation and spinal cord injury have not been fully explored. The present paper reviews the origin, characteristics, and functional roles of Chx10+V2a interneurons with an emphasis on their involvement in the pathogenesis of spinal cord injury. The diverse functional properties of these cells have only been substantiated by and are due in large part to their integration in a variety of diverse spinal circuits. Chx10+V2a interneurons play an integral role in conferring locomotion, which integrates various corticospinal, mechanosensory, and interneuron pathways. Moreover, accumulating evidence suggests that Chx10+V2a interneurons also play an important role in rhythmic patterning maintenance, left-right alternation of central pattern generation, and locomotor pattern generation in higher order mammals, likely conferring complex locomotion. Consequently, the latest research has focused on postinjury transplantation and noninvasive stimulation of Chx10+V2a interneurons as a therapeutic strategy, particularly in spinal cord injury. Finally, we review the latest preclinical study advances in laboratory derivation and stimulation/transplantation of these cells as a strategy for the treatment of spinal cord injury. The evidence supports that the Chx10+V2a interneurons act as a new therapeutic target for spinal cord injury. Future optimization strategies should focus on the viability, maturity, and functional integration of Chx10+V2a interneurons transplanted in spinal cord injury foci.
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    Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions: Preventing the Highs and Lows: Management of Blood Pressure, Sweating, and Temperature Dysfunction
    (American Spinal Injury Association, 2021) Krassioukov, Andrei; Linsenmeyer, Todd A.; Beck, Lisa A.; Elliott, Stacy; Gorman, Peter; Kirshblum, Steven; Vogel, Lawrence; Wecht, Jill; Clay, Sarah; School of Nursing
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    Feature Selection Techniques for a Machine Learning Model to Detect Autonomic Dysreflexia
    (Frontiers Media, 2022-08-10) Suresh, Shruthi; Newton, David T.; Everett, Thomas H., IV; Lin, Guang; Duerstock, Bradley S.; Medicine, School of Medicine
    Feature selection plays a crucial role in the development of machine learning algorithms. Understanding the impact of the features on a model, and their physiological relevance can improve the performance. This is particularly helpful in the healthcare domain wherein disease states need to be identified with relatively small quantities of data. Autonomic Dysreflexia (AD) is one such example, wherein mismanagement of this neurological condition could lead to severe consequences for individuals with spinal cord injuries. We explore different methods of feature selection needed to improve the performance of a machine learning model in the detection of the onset of AD. We present different techniques used as well as the ideal metrics using a dataset of thirty-six features extracted from electrocardiograms, skin nerve activity, blood pressure and temperature. The best performing algorithm was a 5-layer neural network with five relevant features, which resulted in 93.4% accuracy in the detection of AD. The techniques in this paper can be applied to a myriad of healthcare datasets allowing forays into deeper exploration and improved machine learning model development. Through critical feature selection, it is possible to design better machine learning algorithms for detection of niche disease states using smaller datasets.
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    Functional outcome following inpatient rehabilitation among individuals with complete spinal cord injury in Nepal
    (Springer Nature, 2021-10-07) Khatri, Prakriti; Jalayondeja, Chutima; Dhakal, Raju; Groves, Christine C.; Physical Medicine and Rehabilitation, School of Medicine
    Objectives: To describe functional outcomes using Spinal Cord Independence Measure III (SCIM III) following inpatient rehabilitation among individuals with complete spinal cord injury (SCI) in the low-income setting of Nepal; to evaluate functional changes from rehabilitation admission to discharge and to compare functional outcomes between neurological levels of injury (NLI) at discharge. Setting: Spinal Injury Rehabilitation Centre (SIRC), Kavrepalanchowk, Nepal. Methods: We present data of all individuals with complete SCI who completed rehabilitation at SIRC in 2017. Data collected included: demographics, aetiology, neurological assessment, admission/discharge SCIM III scores, and length of stay. Data were analyzed using descriptive statistics. Pre/post-SCIM III scores were analyzed using Related-Samples Wilcoxon signed-rank test. Comparative analysis between NLIs was done using the Kruskal Wallis ANOVA test followed by pairwise Mann-Whitney U tests. Results: Ninety-six individuals were included. Mean (SD) age was 33.5 (14.2) years, with a male/female ratio of 3.4:1. Median admission and discharge total SCIM III scores for cervical, thoracic and lumbosacral levels were 10 and 21, 16 and 61, and 41 and 79.5, respectively. Median total SCIM III score change between admission and discharge were 11 (p = 0.003), 43 (p < 0.001) and 40 (p = 0.068) for cervical, thoracic and lumbar groups, respectively. Conclusions: This study is the first of its kind to describe functional outcomes among individuals with complete SCI in the low-income setting of Nepal. All SCI groups showed a positive trend in SCIM III from admission to discharge, with improvements reaching statistical significance among groups with cervical and thoracic NLIs.
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    Patient handling and transportation from site of injury to tertiary trauma centres in Nepal following acute traumatic spinal cord injury: a descriptive study
    (Springer Nature, 2022-09-10) Shrestha, Saraswati; Shrestha, Kritan; Groves, Christine C.; Physical Medicine and Rehabilitation, School of Medicine
    Study design: Descriptive study. Objectives: To describe patient handling at injury site, number of healthcare centre transfers to reach tertiary trauma centre, modes of transportation, and time from injury to reaching tertiary trauma centres among individuals with acute traumatic spinal cord injury (tSCI). Setting: Acute SCI rehabilitation centre, Nepal. Methods: All individuals with new tSCI admitted for rehabilitation over period of 1 year were eligible for enrolment. Following written, informed consent, enroled individuals participated in structured one-on-one interview. Data collected included demographics, injury details, pre-hospital handling techniques, and transportation specifics to tertiary trauma centre. Results: In total, 211 individuals were enroled in the study. Eight (4%) individuals were assisted by first responders or traffic police, with majority (n = 203, 96%) assisted by untrained individuals. One was transferred from injury site using spinal motion restriction measures. Half were transported exclusively by ambulance while others used combinations of transportation. Six (3.4%) individuals were cared for by trained medical person during transport. Half required two or more hospital transfers prior to reaching a tertiary trauma centre. In total, 98 individuals required >24 h to reach the tertiary trauma centre. Conclusions: Individuals sustaining a tSCI in Nepal often experience improper handling, multiple hospital transfers, and prolonged time to reach tertiary trauma centres following acute tSCI. Further expanding emergency medical response systems throughout the country, training and equipping first responders in spinal motion restriction techniques, and establishing clear referral pathways for individuals with suspected tSCI are warranted. Development in these specific areas may reduce morbidity and mortality following acute tSCI.
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    Post-traumatic stress disorder among individuals with traumatic spinal cord injury in Nepal: a cross-sectional study
    (Springer Nature, 2023-04-06) Parajuli, Bikash; Acharya, Khagendra; Grooves, Christine C.; Dhakal, Raju; Shrestha, Jemina; Shrestha, Rahul; Manandhar, Mishu; Physical Medicine and Rehabilitation, School of Medicine
    Study design: Cross-sectional study OBJECTIVES: To identify the prevalence of posttraumatic stress disorder (PTSD) among the individuals with traumatic spinal cord injury (TSCI) and to examine the relationships between demographic and clinical characteristics, and PTSD. Setting: Spinal Injury Rehabilitation Center (SIRC) and Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Kavrepalanchowk, Nepal. Methods: Individuals above 18 years of age with TSCI of at least one month from trauma and admitted to SIRC and DH, KUH from June 2019 to May 2021 were included. The specific stress version of the PostTraumatic Stress Disorder Checklist (PCL), was utilized. To classify the neurological status of TSCI individuals, International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) was used. Hierarchical multiple regression analysis between independent variables and normalized PCL score was done to evaluate the predictors of PTSD. Results: Among 163 patients, the overall prevalence of PTSD was 27%, and the mean PCL score was 36 ± 13.9. Factors predictive of PTSD included gender, family type, ethnicity, and literacy rate. No significant association was found between the clinical characteristics and PTSD. Conclusions: PTSD appears to be considerably prevalent among individuals with TSCI in Nepal. Females, individuals from nuclear families, individuals with lower literacy, and individuals from lower caste are significantly vulnerable to developing PTSD. However, clinical characteristics do not appear to be influential in the development of PTSD.
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    SPINE: An Initiative to Reduce Pressure Sore Recurrence
    (Wolters Kluwer, 2022-11-15) Brown, Amanda L.; Hassanein, Aladdin H.; Gabriel, Keith; Mailey, Brian A.; Surgery, School of Medicine
    The recurrence rate after pressure sore reconstruction remains high. Primary inciting factors can be organized into efforts aimed at wound prevention: spasticity relief, pressure off-loading, infection and contamination prevention, nutrition optimization, and maximizing extremity function. This article presents our detailed protocol, SPINE, to address each inciting factor with a summary of cases at our facility and review best practices from evidence-based medicine in the literature.