Search Results (24)

Objective: Our objective was to report the successful in situ management of Staphylococcus epidermidis meningitis following intrathecal baclofen pump implantation without removing the device. Design: This was a single case report with clinical follow-up. Subjects/Patients: We discuss a 34-year-old tetraplegic patient with severe generalized spasticity due to cerebral anoxia at birth who developed meningitis six weeks after intrathecal baclofen pump implantation. Methods: We used a multidisciplinary management approach. This involved aggressive intravenous and intrathecal antibiotic therapy while preserving the intrathecal baclofen device. Treatment included intravenous Meropenem. This was followed by intravenous Vancomycin and oral Linezolid. Calculated intrathecal Vancomycin was administered through the implanted pump. Results: The treatment resulted in a complete resolution of infection with negative cerebrospinal fluid cultures and polymerase chain reaction analysis. The patient had significant functional improvement throughout treatment with intrathecal baclofen. Six months post-infection, the patient remained stable, with continued efficacy of intrathecal baclofen and no recurrence of infection. Conclusion: In carefully selected patients with intrathecal baclofen pump-associated Staphylococcus epidermidis meningitis, successful in situ management is possible without device removal, preserving functional benefits while achieving infection eradication through aggressive antibiotic therapy. Full article

In our previous work, we developed a neuromorphic decoder of intended movements of tetraplegic patients using ECoG recordings from the brain motor cortex, called Motor Control Decoder (MCD). Even though the training data are labeled based on the desired movement, there is no guarantee that the patient is satisfied by the action of the effectors. Hence, the need for the classification of brain signals as satisfactory/unsatisfactory is obvious. Based on previous work, we upgrade our neuromorphic MCD with a Neural Response Decoder (NRD) that is intended to predict whether ECoG data are satisfactory or not in order to improve MCD accuracy. The main aim is to design an actor–critic structure able to adapt via reinforcement learning the MCD (actor) based on NRD (critic) predictions. For this aim, NRD was trained using not only an ECoG signal but also the MCD prediction or prescribed intended movement of the patient. The achieved accuracy of the trained NRD is satisfactory and contributes to improved MCD performance. However, further work has to be carried out to fully utilize the NRD for MCD performance optimization in an on-line manner. Possibility to include feedback from the patient would allow for further improvement of MCD-NRD accuracy. Full article

Background/Objective: Coxitis is an inflammation of the hip joint, often resulting in pain and functional decline. It can be caused by various factors, including avascular necrosis, trauma, and infection. Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat due to its resistance profile and destructive potential. To the best of our knowledge, there are limited studies on MRSA-induced purulent coxitis, specifically in patients with human immunodeficiency virus (HIV) and tetraplegia, making this case particularly valuable for expanding the understanding of this rare and complicated condition. The aim is to describe the clinical presentation, diagnostic workup, antimicrobial management, surgical intervention, and follow-up of a patient with an atypical hip joint infection. A brief literature review is also provided. Case Report: We report a case of suppurative coxitis caused by MRSA in a 38-year-old man with HIV disease and post-traumatic tetraplegia, which posed significant diagnostic and therapeutic challenges. The patient was diagnosed with MRSA bacteremia and suppurative coxitis after extensive work-up. Synovial fluid cultures were negative, likely due to previous antibiotic use. Targeted antimicrobial therapy was initiated based on blood culture and susceptibility testing. Surgical debridement and femoral head resection were performed. The patient showed progressive clinical and biochemical improvement with combined antimicrobial and surgical therapy. Conclusions: This case highlights the difficulty in diagnosing septic arthritis in patients with neurological disorders and immunosuppression, especially in the absence of classic symptoms. It emphasizes the importance of multidisciplinary care and early imaging in patients with persistent fever and unclear source of infection. Full article

Background: Facial features are the first basic sign of medical knowledge of children and adults with congenital malformations. Children born with multiple contractures almost always receive the misdiagnosis of arthrogryposis multiplex. Larsen syndrome can easily be diagnosed at birth via the proper interpretations of its characteristic facial features and multiple dislocations. Comprehensive clinical diagnosis can facilitate an orthopedic strategy for early treatment and can enhance the recognition of unreported craniocervical malformation complexes. Material and Methods: Six children (four boys and two girls, with ages ranging from a few months to 7 years old) were referred to our department for diagnosis and treatment. All children received their first misdiagnosis by the pediatricians as manifesting arthrogryposis multiplex congenita. The clinical phenotype was our first decisive tool for diagnosis. All children exhibited the classical phenotype of dish-like facies associated with multiple joint dislocations. Radiological phenotypic characteristics confirmed our clinical diagnosis of Larsen syndrome. Three children out of six showed unpleasant cervical spine deformities. The first child, a 2-year-old, became tetraplegic after minor trauma. One child presented with progressive rigid cervical kyphosis. The third child was a product of a first-relative marriage and was born with congenital tetraplegia. A genotype was carried out for confirmation. Results: Three children underwent open reduction for congenital hip and knee dislocations. One child underwent spinal fusion CO-C7 because of tetraplegia. A 3D-reformatted and reconstruction CT scan of the craniocervical junction showed two forms of unusual dys-segmentation, firstly along C2-3 effectively causing the development of acute-angle cervical kyphosis. Secondly, an infant with congenital tetraplegia showed a serious previously undescribed atlanto–axial malformation complex. Namely, atlanto–axial maldevelopment (dys-segmentation) of (C1/C2) was associated with hypoplasia of the anterior and the posterior rings of the atlas. Genetic tests of these children were compatible with the autosomal dominant type of Larsen syndrome and manifested a heterozygous mutation in FLNB mapped 3p14.3, encoding an actin-binding protein, filamin B. The child with congenital tetraplegia showed no mutations in FLNB, though his clinical and radiological phenotype and his family history of first-relative marriage were totally compatible with the diagnosis of the autosomal recessive type of Larsen syndrome. Conclusions: Our strategy was and still is based on a coherent clinical and radiological diagnosis, which is based on comprehensive clinical and radiological phenotypic characterizations. We implemented a 3D-reformatted CT scan to further understand the craniocervical junction pathology in three children. Strikingly, prenatal onset of lethal maldevelopment (dys-segmentation) of the atlanto–axial spine segments has been diagnosed in an infant with congenital tetraplagia. A less serious cervical spine malformation was detected in two children who presented with progressive acute-angle cervico and cervico-thoracic kyphosis. Our clinical strategy can form the basis for a thorough clinical assessment for infants and children born with multiple malformation complexes and can lead to recognition of novel understandings. Full article

Current technological solutions for Brain-machine Interfaces (BMI) achieve reasonable accuracy, but most systems are large in size, power consuming and not auto-adaptive. This work addresses the question whether current neuromorphic technologies could resolve these problems? The paper proposes a novel neuromorphic framework of a BMI system for prosthetics control via decoding Electro Cortico-Graphic (ECoG) brain signals. It includes a three-dimensional spike timing neural network (3D-SNN) for brain signals features extraction and an on-line trainable recurrent reservoir structure (Echo state network (ESN)) for Motor Control Decoding (MCD). A software system, written in Python using NEST Simulator SNN library is described. It is able to adapt continuously in real time in supervised or unsupervised mode. The proposed approach was tested on several experimental data sets acquired from a tetraplegic person. First simulation results are encouraging, showing also the need for a further improvement via multiple hyper-parameters tuning. Its future implementation on a neuromorphic hardware platform that is smaller in size and significantly less power consuming is discussed too. Full article

Background/Objectives: Nerve transfer surgery is a state-of-the-art surgical approach to restore hand and arm function in individuals living with tetraplegia, significantly impacting daily life. While nearly a third of all individuals with chronic spinal cord injury may benefit from this intervention, variability in outcomes can limit the functional impact. A bedside to bench approach was taken to address the variable response of tetraplegic individuals to nerve transfer surgery. Methods: We used a hierarchical multiple factor analysis to evaluate the effects of conditioning electrical stimulation (CES) on outcomes in a mouse model of nerve transfer to treat chronic cervical spinal cord injury. Results: We found that CES of donor nerves one week prior to nerve transfer surgery enhanced anatomical and functional measures of innervation of targeted muscles. Furthermore, CES increased the rate of recovery of naturalistic behavior. Conclusions: While the model has some limitations due to the small size of the rodent, our results support the use of CES as an effective approach to improve outcomes in clinical nerve repair settings. Full article

Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the paralyzed extremities, expanding the available muscle mass for exercise. Methods: The authors provide an evidence-based approach using expertise from diverse fields, supplemented by evidence from key studies toward the management of electrical stimulation therapies in individuals with SCIs. Literature searches were performed separately using the PubMed, Medline, and Google Scholar search engines. The keywords used for the searches included functional electrical stimulation cycling, hybrid cycling, neuromuscular electrical stimulation exercise, spinal cord injury, cardiovascular health, metabolic health, muscle strength, muscle mass, bone mass, upper limb treatment, diagnostic and prognostic use of functional electrical stimulation, tetraplegic hands, and hand deformities after SCI. The authors recently presented this information in a workshop at a major rehabilitation conference. Additional information beyond what was presented at the workshop was added for the writing of this paper. Results: Functional electrical stimulation (FES) cycling can improve aerobic fitness and reduce the risk of cardiovascular and metabolic diseases. The evidence indicates that while both FES leg cycling and neuromuscular electrical stimulation (NMES) resistance training can increase muscle strength and mass, NMES resistance training has been shown to be more effective for producing muscle hypertrophy in individual muscle groups. The response to the electrical stimulation of muscles can also help in the diagnosis and prognosis of hand dysfunction after tetraplegia. Conclusions: Electrical stimulation activities are safe and effective methods for exercise and testing for motor neuron lesions in individuals with SCIs and other paralytic or paretic conditions. They should be considered part of a comprehensive rehabilitation program in diagnosing, prognosing, and treating individuals with SCIs to improve function, physical activity, and overall health. Full article

Mobility experience has a positive impact on activity, participation, socialisation, language and cognition, but children with cerebral palsy (CP), Gross Motor Function Classification System (GMFCS) level V require assistive devices or assistance in all environments. Supported standing devices afford upright, weight-bearing positions to promote muscle, bone, joint and overall health. Supported stepping devices afford stepping and upright independent mobility, positively impacting self-esteem and participation, while power mobility is the only possibility for effective, independent community mobility. These devices and opportunities should be introduced at the age when children who are typically developing are pulling to stand, moving and exploring their environment. A detailed case description including lived experience and device use data is presented for female twins with dystonic tetraplegic CP born at 25 weeks gestational age and functioning at GMFCS level V. The feasibility of using power mobility, standing and stepping devices in home and community settings within the first two years is illustrated. The twins transitioned from spending 24 h in lying positions or being held in arms to spending more than 2 h daily in upright positions and having opportunities to move independently. Positioning and mobility devices can help to address all the F-words for child development: functioning, family, fitness, fun, friends and future. Full article

Cerebral palsy (CP) is the most common movement disorder in children, with a prevalence ranging from 1.5 to 4 per 1000 live births. CP is caused by a non-progressive lesion of the developing brain, leading to progressive alterations of the musculoskeletal system, including spasticity, often leading to the development of fixed contractures, necessitating tendon lengthening surgery. Total RNA-sequencing analysis was performed on semitendinosus tendons from diplegic and tetraplegic CP patients subjected to tendon lengthening surgery compared to control patients undergoing anterior cruciate ligament reconstructive surgery. Tetraplegic CP patients showed increased expression of genes implicated in collagen synthesis and extracellular matrix (ECM) turnover, while only minor changes were observed in diplegic CP patients. In addition, tendons from tetraplegic CP patients showed an enrichment for upregulated genes involved in vesicle-mediated transport and downregulated genes involved in cytokine and apoptotic signaling. Overall, our results indicate increased ECM turnover with increased net synthesis of collagen in tetraplegic CP patients without activation of inflammatory and apoptotic pathways, similar to observations in athletes where ECM remodeling results in increased tendon stiffness and tensile strength. Nevertheless, the resulting increased tendon stiffness is an important issue in clinical practice, where surgery is often required to restore joint mobility. Full article

Background and Objectives: This study aimed to evaluate the effectiveness of a wheelchair skills training program (WSTP) in improving sitting balance and pulmonary function in patients with chronic tetraplegia resulting from cervical spinal cord injury (cSCI). Materials and Methods: Twenty-four patients were randomly divided into WSTP and control groups. The WSTP group participated in the WSTP for eight weeks, while the control group underwent conventional physical therapy for the same eight-week period. Sitting balance was evaluated using the activity-based balance level evaluation (ABLE) scale, and pulmonary function was evaluated using forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF). Results: The WSTP group showed significant improvements in both sitting balance and pulmonary function during the intervention period (p < 0.05), whereas the control group did not show any significant changes. A strong positive correlation was found between ABLE scores and all three pulmonary function parameters across all time points. Conclusions: Our results suggest that the WSTP significantly improves sitting balance and specific aspects of lung function in patients with tetraplegia. Full article

This study addresses the characterization of normal gait and pathological deviations induced by neurological diseases, considering knee angular kinematics in the sagittal plane. We propose an unsupervised approach based on Dynamic Time Warping (DTW) to identify different normal gait profiles (NGPs) corresponding to real cycles representing the overall behavior of healthy subjects, instead of considering an average reference, as done in the literature. The obtained NGPs are then used to measure the deviations of pathological gait cycles from normal gait with DTW. Hierarchical Clustering is applied to stratify deviations into clusters. Results show that three NGPs are necessary to finely characterize the heterogeneity of normal gait and accurately quantify pathological deviations. In particular, we automatically identify which lower limb is affected for Hemiplegic patients and characterize the severity of motor impairment for Paraplegic patients. Concerning Tetraplegic patients, different profiles appear in terms of impairment severity. These promising results are obtained by considering the raw description of gait signals. Indeed, we have shown that normalizing signals removes the temporal properties of signals, inducing a loss of dynamic information that is crucial for accurately measuring pathological deviations. Our methodology could be exploited to quantify the impact of therapies on gait rehabilitation. Full article

Optimizing nutritional intake and timing helps athletes to improve performance and long-term health. Different training phases can require varying nutritional needs. In this study, we conducted a descriptive assessment of dietary intake, energy availability (EA), and blood biochemical parameters in elite wheelchair athletes during distinct training phases. Data analyzed in this study were collected as part of a randomized controlled crossover trial exploring the feasibility of probiotics and prebiotic supplementation. Data were obtained from consecutive three-day diaries and blood samples, both collected at four different time points across four consecutive months. We included 14 athletes (mean (standard deviation) age 34 (9) years, eight females, and six males) active in different wheelchair sports. The mean daily nutritional intake (g/kg body mass) for females and males was 2.7 (0.9) and 4.0 (0.7) for carbohydrates, 1.1 (0.3) and 1.5 (0.3) for protein, and 0.8 (0.3) and 1.4 (0.2) for fat. EA did not change across the four time points in either female (p = 0.30) or male (p = 0.05) athletes. The mean EA was lower in female athletes compared to male athletes (p = 0.03). Low EA (≤30 kcal/ kg fat-free mass/day) was observed in female (58 (29) % of days) and male (34 (23) % of days) athletes. Iron deficiency with anemia was observed in two female athletes. Mean vitamin D levels were insufficient (<75 nmol/L). Macronutrient intake, EA, and blood biochemical parameters were suboptimal in this cohort of elite wheelchair athletes, especially in female athletes. Full article

This research deals with the problem of the accessibility of urban forests and parks for people with disabilities in wheelchairs. Through an analysis of spatial data, trails were categorized on the basis of the measurements of the independent movements of eight subjects on six trails. The critical longitudinal slopes were determined for independent movement in wheelchairs, complex independent movement with certain risk, and categories of trails that are not suitable for wheelchair movement. The results indicate that a slope of 5.50% was the tipping point, after which all respondents experienced some uncertainty. In addition, a gradient of more than 9.01% was almost impassable for people in wheelchairs, with respect to the gravel trails examined in this study. Modern measurement technology was used in the field, including the mobile apps GAIA GPS and GNSS GPS, and a total (geodetic) station; the subjects’ heart rates were measured using a Garmin Fenix 6 Pro watch. In addition, people with disabilities were included in the implementation of the research through the Croatian Association of Paraplegics and Tetraplegics (HUPT). The results indicate the zones/trails that disabled people in wheelchairs can pass independently, the zones that can be accessed with a certain risk, and those that are not accessible, all according to the defined longitudinal slope zones using measurements of the movement of people in a wheelchair, their heart rate loads, and personal communication with the subjects regarding the insecurity they felt. Full article

The upper extremity behavior in smoothness and efficiency metrics should be different between paraplegic and tetraplegic patients. The aim of this article was to analyze the behavior of these metrics after receiving upper extremity training with the humanoid robot Robic as a treatment. Ten pediatric patients participated in the study and completed ten experimental sessions with Robic. Patients were assessed at baseline and at ending the training using the Box and Block test and a non-immersive virtual application based on the Leap Motion Controller available in the RehabHand software. From this application, the smoothness metric was calculated as the number of peaks or units of movement detected in the velocity profile of the hand during the execution of the task, and the efficiency metric was assessed by calculating the length of the hand trajectory. Patients with tetraplegia had a significantly longer trajectory (286.01 ± 59.87 mm) than paraplegics (123.61 ± 17.14 mm) in the baseline situation. However, at the end of the training, there were no differences between them. In the Box and Block test, the paraplegic group passed more cubes than tetraplegics. In conclusion, the first experience with a Robic robot in SCI was very positive, with observed improvements in upper extremity dexterity in trained patients. Full article

This prospective observational clinical study in a population of tetraplegic and paraplegic dogs (n = 488) with or without deep pain sensation, similar to humans ASIA A and B, investigated the prevalence of clinical occurrences in a rehabilitation center with a hospitalization regime between 15 days and 9 months. A checklist of occurrences was used for easy identification and monitoring, resulting in a total of 79.5% occurrences. There were 58% of dogs with neurogenic bladder, 35.5% with diarrhea, 21.3% with urinary incontinence, and 20.5% with fecal incontinence. A low incidence of respiratory problems (e.g., pneumonia) and urinary tract infections may suggest the efficacy of some applied measures in this study, such as thoracic and abdominal POCUS evaluation, positioning strategies, physical exercises, respiratory kinesiotherapy, and early implementation of a functional neurorehabilitation protocol. These can be essential measures to prevent clinical occurrences, mainly in breeds such as the French Bulldog and the Dachshund. Full article