Study design: Individuals who are treated with intrathecal Baclofen (ITB) pump delivery system for intractable spasticity can suffer from severe morbidity as a result of acute overdose or withdrawal of ITB, which can also be life threatening. Current literature has a number of single case studies with different approaches to the management in such states. Objectives: The aim of this article is to consolidate available evidence and develop treatment pathways for acute ITB overdose and withdrawal states. Methods: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases using the keywords 'intrathecal', 'baclofen', 'withdrawal', 'overdose' to identify studies (published up to December 2010) that focused on presentation or treatment of acute overdose and withdrawal state in ITB therapy. Only original articles in English involving adult population were included. Results: Initial search revealed 130 articles. After reading the abstract, 13 studies on ITB overdose and 23 studies on ITB withdrawal were deemed suitable for inclusion. All studies were either single-case studies or case series. Conclusion: Acute ITB overdose is managed with immediate cessation of baclofen delivery through the system, reducing the baclofen load by cerebrospinal fluid aspiration and by providing supportive treatment in an intensive care setting. There is no specific antidote for reversing overdose symptoms. Acute ITB withdrawal is managed by restoring the delivery of ITB, providing supportive care in an intensive care setting and using drugs like low dose propofol or benzodiazepines in selected cases. Early involvement of ITB physicians is strongly recommended.

Study design: Review. Objectives: To assess current available options for bladder management in SCI patients the post-acute phase. Methods: Relevant articles were extracted from medline and Cinahl between 1966 ± 1999. In addition, references earlier than 1966 that were listed in these articles were identi®ed and extracted. Results: Catheterisation (indwelling or self intermittent) is still carried out by the majority of SCI patients with more morbidity for indwelling catheterisation. Other methods include condom drainage, suprapubic tapping and supreapubic pressure are used and are associated with less complications. Complicated procedures like sacral anterior root stimulator and entero-cystoplasty are carried out with the onset of or impending complications. Conclusion: Several methods of bladder management are available in the post-acute phase of SCI. The method used has to be based on urodynamic characteristics with the aim of producing a continent bladder with adequate low pressure storage capacity. Modern management of the bladder in SCI has successfully reduced renal related mortality in SCI from 95% in the ®rst half of the 20th century to the present 3%. Spinal Cord (2001) 39, 355 ± 361

Technological advances have helped to improve functional ability in spinal cord injury survivors. The aim of this study is to systematically review the evidence for functional electrical stimulation (FES) on functional tasks involving the upper limb in people with spinal cord injuries. The authors systematically searched from September 2009 to September 2014 in relevant databases using a combination of keywords covering spinal cord injury and FES. Studies were selected using pre-determined criteria. The search yielded 144 studies. Only five studies met the inclusion criteria. All five reported improvements immediately and at follow-up in functional ability as a result of FES or FES combined with conventional therapy. There is some preliminary evidence that FES may reduce disability due to upper limb-related activity limitations in tetraplegic spinal cord injury. Further work needs to examine the role of FES in more detail and in combination with other treatments.

A case of extensive heterotopic ossification involving the left hip in a 16 year old girl who sustained non traumatic spinal paralysis at T4 ASIA scale A. This case demonstrates the practical difficulties facing clinicians involved in the rehabilitation of this paraplegic patient who required intervention before full maturation of her left hip heterotopic ossification (HO). The patient was developing a rapidly progressive fixed scoliosis and severe difficulty in achieving a proper seating posture. In addition there was difficulty with the application of a suitable orthosis to try and limit the progression of scoliosis as a result of the HO. Discussants will comment on heterotopic ossification in general and the course of action in this particular case.

Objective To determine whether an indwelling catheter on free drainage provides a constantly low intravesical pressure in patients with a neuropathic bladder. Patients and methods Thirty patients with complete spinal‐cord injury (SCI) whose bladders were managed exclusively with an indwelling catheter were assessed urodynamically using natural‐fill urodynamics (ambulatory monitoring) while their catheters were left on free drainage. Their upper urinary tracts were assessed using plain X‐rays and ultrasonography. Results Detrusor contractions causing intravesical pressure rises of >40 cmH2O for up to 4.5 min were observed in 11 patients. Renal scarring was observed in nine patients; of these, six were in the group with contractions of >40 cmH2O, whereas only five of 21 patients with normal kidneys had such pressure rises. Conclusion An indwelling catheter on free drainage is no guarantee of a constantly low intravesical pressure. This study provides evidence to suggest that there is an association between phasic bladder contractions which occur despite catheter drainage and upper urinary tract damage in permanently catheterized patients with SCI.

Injury to the cervical spinal cord results in bilateral deficits in arm/hand function reducing functional independence and quality of life. To date little research has been undertaken to investigate control strategies of arm/hand movements following cervical spinal cord injury (cSCI). This study aimed to investigate unimanual and bimanual coordination in patients with acute cSCI using 3D kinematic analysis as they performed naturalistic reach to grasp actions with one hand, or with both hands together (symmetrical task), and compare this to the movement patterns of uninjured younger and older adults. Eighteen adults with a cSCI (mean 61.61 years) with lesions at C4-C8, with an American Spinal Injury Association (ASIA) grade B to D and 16 uninjured younger adults (mean 23.68 years) and sixteen uninjured older adults (mean 70.92 years) were recruited. Participants with a cSCI produced reach-to-grasp actions which took longer, were slower, and had longer deceleration phases than uninjured participants. These differences were exacerbated during bimanual reach-to-grasp tasks. Maximal grasp aperture was no different between groups, but reached earlier by people with cSCI. Participants with a cSCI were less synchronous than younger and older adults but all groups used the deceleration phase for error correction to end the movement in a synchronous fashion. Overall, this study suggests that after cSCI a level of bimanual coordination is retained. While there seems to be a greater reliance on feedback to produce both the reach to grasp, we observed minimal disruption of the more impaired limb on the less impaired limb. This suggests that bimanual movements should be integrated into therapy.

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Injury to the cervical spinal cord results in deficits in bimanual control, reducing functional independence and quality of life. Despite this, little research has investigated the control strategies which underpin bimanual arm/hand movements following cervical spinal cord injury (cSCI). Using kinematics and surface electromyography this study explored how task symmetry affects bimanual control, in patients with an acute cSCI (< 6 m post injury), as they performed naturalistic bimanual reach-to-grasp actions (to objects at 50% and 70% of their maximal reach distance), and how this differs compared to uninjured age-matched controls. Twelve adults with a cSCI (mean age 69.25 years), with lesions at C3–C8, categorized by the American Spinal Injury Impairment Scale (AIS) at C or D and 12 uninjured age-matched controls (AMC) (mean age 69.29 years) were recruited. Participants with a cSCI produced reach-to-grasp actions which took longer, were slower, less smooth and had longer deceleration phases than AMC (p < 0.05). Participants with a cSCI were less synchronous than AMC at peak velocity and just prior to object pick up (p < 0.05), but both groups ended the movement in a synchronous fashion. Peak muscle activity occurred just prior to object pick up for both groups. While there seems to be a greater reliance on the deceleration phase of the movement, we observed minimal disruption of the more impaired limb on the less impaired limb and no additional effects of task symmetry on bimanual control. Further research is needed to determine how to take advantage of this retained bimanual control in therapy.Electronic supplementary materialThe online version of this article (10.1007/s00221-018-5354-8) contains supplementary material, which is available to authorized users.