The Care and Management of Spinal Cord Injuries

Bedbrook, George M.

doi:10.1007/978-1-4613-8087-0

Cited by 67 publications

(37 citation statements)

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“…His treatment was duly as vigorous in attacking the problem within a comprehensive medical regime and an army of therapists espousing the concept of 'total care' in the treatment of SCI. 21,22 As may be expected, Sir Ludwig and Sir George became close friends. Both are recognized as the fathers of modern rehabilitation.…”

Section: The Autonomic Motor Systemmentioning

confidence: 69%

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Neuropathology: the foundation for new treatments in spinal cord injury

2004

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The first step essential in the search for a cure of human spinal cord injury (SCI) is to appreciate the complexity of the disorder. In this regard, it is not only the loss of ambulation but the sensory and autonomic changes that are equally important in recovery. In addition, there are the serious social emotional psychological and lifestyle effects of SCI which should also be taken into account. It is also true that no two SCI lesions are alike as each is the result of a SCI unique to that individual. Clinically of utmost importance is the segmental level of injury and whether it is complete, incomplete or discomplete (loss of all neurological functions below the injury but with physiological or anatomical continuity of Central nervous system tracts across the lesion). We are not concerned here with primary and secondary prevention or methods designed to limit the severity of the lesion after the event, important as they are, but with the requirements for a cure. Clearly, the greater the number of nerve fibers that can be preserved in the acute stage, the better will be the end result. Our focus at present is on the end-stage lesion with the aim of showing that a cure for SCI will depend upon establishing functionally useful central axonal regeneration and reestablishing physiological reconnections. Existing experimental methods are based on stimulating axonal regeneration by neutralizing inhibitory factors, adding positive trophisms and creating a permissive environment. Better results are obtained by bridging the gap with grafts of peripheral nerves or transplants of Schwann cells and genetically engineered fibroblasts. Recently, the potential for stem cells to enhance this process has created great interest. This is because of the ability of pluripotential cells to differentiate into neural tissue. A cure based on the physiopathology of SCI requires pyramidal, extrapyramidal, sensory, cerebellar and autonomic pathways to be regenerated with their appropriate neurotransmitters restored and reflexes integrated physiologically and in synchrony. In human SCI, there is a very long distance anatomically for axonal regrowth to occur in order to reach their relevant nuclei. This is because of continuing Wallerian degeneration. It also presumes that the target neurons are intact and that there has been no transneuronal degeneration above or below the lesion. Alternatively, in place of regenerated long axons, a multisynaptic pathway may be constructed from stem cells that have developed into neurons. Whether such a pathway would restore useful neurological functions is unknown. At present, the transplant and grafting research teams are exploring these possibilities in experimental animals. Moderate success in gaining axonal regeneration has been reported; however, it must be appreciated that the human lesion differs considerably from that of the experimental animal. In order to be successful, the neuropathology and neurophysiology of human SCI must be taken into account. The purpose of this review is to place the req...

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Section: The Autonomic Motor Systemmentioning

confidence: 69%

“…This policy was soon accepted worldwide commensurate with establishment of spinal units. 20,21 The basis for conservative management of SCI was at first empirical. However, neuropathological studies that followed were able to confirm that there were few indications for intervention.…”

Section: The Autonomic Motor Systemmentioning

confidence: 99%

Neuropathology: the foundation for new treatments in spinal cord injury

2004

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“…In 1981 Bedbrook 6 considered the surgical rehabilitation of hand function of more value in the¯accid than in the spastic type of hand.…”

Section: Introductionmentioning

confidence: 99%

The role of upper limb surgery in tetraplegia

et al. 2003

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Study design: A retrospective follow-up study. Objectives: To assess the value of surgery on the tetraplegic hand to improve its function. Setting: Spinal unit. Hospital La Fe. Valencia (Spain). Method: We reviewed the functional results obtained in 15 patients (10 males and 5 females) operated on at our hospital between 1988 and 1997. We performed 66 surgical procedures on 20 upper limbs. After a year or more the patients were evaluated by two independent examiners not related with the surgeons, using the questionnaire of Lamb and Chan modi®ed by Mohammed, taking into account the change in the performance of activities of daily living (ADL), the patient's satisfaction, and the ful®lment of their expectations. Results: A good or excellent result was obtained in 71.4% of our patients, 85.7% were satis®ed with the operation and 57.2% said that the surgery did not meet their expectations. The bad results occurred in patients with previous joint rigidity, ocular sensibility, pain, and lack of motivation. Conclusion: Hand surgery improved the function of tetraplegics and should be performed more frequently. The hands should be cared for from the very beginning to keep them supple. The information given to the patients should be realistic. Spinal Cord (2003) 41, 90 ± 96.

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“…Chronic bacterial prostatitis is known to be a cause of chronic urinary tract infection, and this also holds for spinal cord injury patients (Bedbrook, 1981;Cukier et al, 1976). The diagnosis of prostatitis is difficult, and the value of the different diagnostic procedures in patients with a neuropathic bladder is uncertain.…”

Section: Introductionmentioning

confidence: 99%

Chronic prostatitis in spinal cord injury patients

Wyndaele

1985

Spinal Cord

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Six spinal cord injury patients with chronic prostatitis were reviewed, all of whom had been treated with an indwelling Foley catheter during the phase of spinal shock.The 3 glass urine specimen test, the bladder wash-out test, a study of antibody coated bacteria and urethrography had limited diagnostic value. A specific diagnostic 5 glass specimen test proved to be useful and reliable.Longterm antibiotic treatment was successful in only one patient. Injection of antibiotics into the prostate gland was ineffective in the five patients in whom it was carried out. During a follow up from 1 to 5 years urological complications were rare in all five patients who remained infected.

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The Care and Management of Spinal Cord Injuries

Cited by 67 publications

References 0 publications

Neuropathology: the foundation for new treatments in spinal cord injury

Neuropathology: the foundation for new treatments in spinal cord injury

The role of upper limb surgery in tetraplegia

Chronic prostatitis in spinal cord injury patients

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