No abstract

Survival related strongly to extent of neurological impairment. Future research should focus on identifying contextual factors, personal or environmental, that may contribute to the reduced life expectancy after SCI.

Objective: To investigate age, gender, and left-right differences in cutaneous electrical perceptual threshold (EPT) testing in an able-bodied, Australian sample. Study Design: Prospective experimental. Setting: Hospital-based spinal cord injuries unit. Methods: Cutaneous electrical stimulation of the 28 dermatomes at ASIA sensory key points (C2-S4/S5) was performed on 29 female and 16 male healthy volunteers aged 21 to 76 years. Mean EPTs for each dermatome were compared (repeated measures ANOVA) for left-right, gender-related, and age-related (,/ .50 years of age) differences. Results: There was no group difference between sides (repeated measures ANOVA, P 5 0.934). Women across all ages had lower group mean EPTs than men (P , 0.0001). Women younger than age 50 years had lower mean EPTs than those older than age 50 years (P 5 0.008). There was no group difference between younger and older men (P 5 0.371). Analysis of individual dermatomes revealed no significant differences in thoracic dermatomes between genders or age groups, contrary to the limb dermatomes. Conclusion: There were gender differences in EPT values across all ages. Women had higher EPTs as they advanced in age, but this was less clear in men. There was considerable somatotopic variability in EPTs, especially in the lower limbs. If EPT testing is to be applied to detect subclinical changes within a dermatome, establishment of age-and gender-specific somatotopic normograms is a prerequisite.

Background/Objective: To investigate inter-rater and intra-rater reliability of electrical perceptual threshold (EPT) testing in assessing somatosensory function in healthy volunteers. Study Design: Prospective experimental. Setting: Hospital-based spinal cord injuries unit. Methods: Cutaneous electrical stimulation of 4 dermatomes at ASIA sensory key points (C3, T1, L3, and S2) was performed on 40 control subjects. The lowest ascending stimulus intensity at which sensation was perceived was recorded as the EPT. Mean EPT values for each dermatome, as determined by 2 testers at 2 time points, were examined and plotted against a normative template. Differences and associations between intra-and inter-rater measurements and left-right measurements were studied. EPT results for 2 people with spinal cord injuries were also examined. Results: EPT measurements from left and right sides, obtained from the 2 time points and 2 testers, were found to be strongly associated, with the exception of left and right side measurements at the S2 dermatome. No significant differences in the mean EPT for tester or time period were found. The intra-and inter-rater reliability was good for all dermatomes tested. Mean EPT measurements fell within the range of a normative template at each of the 4 dermatomes tested. Conclusion: EPT is an objective, reproducible, and quantifiable method of assessing sensation in a control group. However, caution should be applied in certain dermatomes such as S2, where there was large variation between left and right side measurements.

Study design: Case report. Objectives: Subacute delayed ascending myelopathy (SDAM), also known as subacute post-traumatic ascending myelopathy, is a rare early neurological complication of spinal cord injury (SCI), and the aetiology, pathogenesis and optimal management of this condition are poorly understood. The radiological features together with the clinical picture appear to be the most useful. We aim to increase awareness and further characterise SDAM. Setting: Spinal Cord Injuries Unit, Royal North Shore Hospital, Sydney, Australia. Methods and Results: We report two cases with radiological findings consistent with SDAM, and review the literature. Only a small number of cases have been reported and importantly, we report the first case occurring following a non-traumatic SCI. There are several hypotheses regarding pathogenesis, with several factors in our cases implicating a vascular mechanism. Conclusion: There is a lack of data characterising SDAM, and ascending myelopathy in a stable SCI should alert the clinician. Importantly, we propose that SDAM is the appropriate terminology.

Objectives: To investigate the use of electrical perceptual threshold (EPT) testing to follow the natural history of sensory progression after complete and incomplete acute spinal cord injury (SCI) and to compare EPT changes with the American Spinal Injuries Association (ASIA) Impairment Scale (AIS). Study Design: Prospective descriptive study. Methods: ASIA examination and EPT testing was performed on 17 patients (7 AIS A, 10 AIS B-D), within 1, 3, and 6 months after acute SCI. EPT assessment was carried out bilaterally at ASIA sensory points from 2 levels above the neurological level to all levels below, including the sacral segments. Comparisons of EPT values above, at, and below the SCI were made at the three time points as well as comparisons of EPT data to ASIA assessment. Results: There was poor agreement between lowest normal level on EPT and ASIA assessment. Over time, EPTs tended to deteriorate above and at the ASIA level in AIS A patients with modest changes below the neurological level of injury (NLI), mainly where EPTs correlated with the zone of partial preservation. Sacral sparing was detected in one patient with EPT testing, but not with ASIA assessment. AIS B-D patients showed improvement at the ASIA level and extensive changes, both improvement and deterioration, below the NLI. Conclusion: EPT testing has sufficient sensitivity to detect subclinical changes in sensory function as early as the first month post-SCI, which is not apparent in ASIA examination. In particular, the testing is able to show abnormalities at and around the injury site for both complete and incomplete SCI. In addition, EPT allows for the detection and monitoring of alterations, both improvements and deterioration, in the abnormal range of sensation.

Rehabilitation registrars score better in prevention questions, but poorer in management questions, which reflects academic rather than experiential knowledge. There are also differences in management knowledge among nurses, based on work area rather than years of experience. Although knowledge does not necessarily reflect practice, this calls for better standardisation and implementation of wound management pathways.

BackgroundThere is a known positive relationship between time in therapy and therapy outcomes. Effective rehabilitation should therefore include larger doses of therapy. However, individuals participating in inpatient rehabilitation have low levels of activity throughout the day. This level of inactivity may limit rehabilitation potential. New technologies which deliver personalised exercise programs and track time spent on exercises may lead to greater activity levels and therefore improve functional outcomes in rehabilitation. This pilot randomised control trial aimed to investigate whether an app-based supplemental exercise program in orthopaedic rehabilitation will be feasible and acceptable to participants, increase activity levels and improve functional outcomes.MethodsParticipants were randomised to receive supplemental exercise via an app (PTPal™) on a tablet device additional to usual care or usual care alone. Primary outcome measures were participant satisfaction with app-based supplemental exercise, total repetitions of each activity and time in supplemental exercise programs. Secondary measures were 10-m walk test (10MWT), 6-min walk test (6MWT), Timed Up and Go (TUG), Functional Independence Measure and length of stay assessed by a blinded assessor.ResultsTwenty individuals admitted into an inpatient private general rehabilitation unit for orthopaedic rehabilitation over a 4-week duration were included in this study. High acceptance of the app-based supplemental exercise program was demonstrated. Those using the app completed an additional 549 exercise repetitions during their admission (694 supplemental app-based repetitions vs 146 supplemental paper-based repetitions in the control group, mean difference [MD] 549, 95% CI 95 to 1002, p = 0.02) and an additional 157 min in supplemental exercise throughout their admission (195.3 min vs 38.7 min, MD 157 min, 95% CI 0.9–312.3 min, p = 0.05). There was insufficient power to demonstrate statistical significance in functional outcomes, but a trend towards improved functional outcomes was observed in the intervention group.ConclusionAn app-based exercise program increases activity levels, is feasible and is a safe intervention with the potential to improve functional outcomes. This pilot study should be followed with a larger study powered to demonstrate functional effects with more participants having greater impairment.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR); trial number ACTRN12617000817347. This study was retrospectively registered (registration date 05/06/2017).