Lower extremity BMD loss increases with distance from the spine. An intensive lower extremity ES program may attenuate BMD loss locally after acute motor complete SCI, although it is unknown whether these benefits are maintained in the long term.
Abstract-Osteoporosis is a significant secondary condition that occurs acutely after spinal cord injury (SCI). This article reports on a patient with motor incomplete SCI and asymmetric lower-limb bone loss as it correlates with lower-limb motor function and gait characteristics. A 32-year-old Caucasian male completed a comprehensive inpatient rehabilitation program, including 3 months of robotic body-weight-supported treadmill training three times a week. Bone mineral density (BMD) was monitored up to 1.5 years post-SCI by dual-energy X-ray absorptiometry. Ground reaction forces were measured through an instrumented treadmill for bilateral weight-bearing comparison. At 1.5 years postinjury, neurological examination revealed thoracic 4 American Spinal Injury Association Impairment Scale D SCI with less strength, reduced weight bearing, and lower BMD in the more neurologically impaired leg. These results suggest that osteoporosis may vary according to severity of impairment within individuals and that monitoring lower-limb BMD is especially important for patients who ambulate.
The only payer group for which all beneficiaries received wheelchairs that met standard of care were power wheelchairs provided by WC/VA. Fewer than 90% of people whose manual wheelchair was paid for by Medicare and self pay, and whose power wheelchair was paid for by Medicaid/DVR, Medicare, and self pay did not meet standard of care. Although these findings need to be correlated with long-term risks, such as overuse injuries, breakdowns, and participation, this study demonstrates that disparities in wheelchair procurement by insurance provider persist.
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