Citations
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To investigate the ability of spinal cord injury (SCI) patients in the use mobile cellular devices, especially the smartphone.
Seventeen people with motor complete cervical SCI participated in the study. The assist-devices deemed most fitting were introduced to the patients: a mouth stick, multifunctional splint, activities of daily living (ADL) splint, universal cuff or none of the above. To determine the effective devices, a Multi-Directional Click Test (MDCT), Phone Number Test (PNT), and individual satisfaction inquiry were used. The most appropriate assist device was selected by MDCT. Subsequently PNT and individual satisfaction inquiry were performed with the conventional model and compared.
Those with C4 cord injury chose mouth stick. Those with C5 cord injury chose multifunctional splint (3 people) and ADL splint (2 people). Those with C6 cord injury chose universal cuff (3 people) or bare hands only. Those with C7 cord injury chose universal cuff (3 people). With a smartphone, all participants were able to complete the PNT. With a conventional model, only twelve participants (71%) were able to complete the same test. While it took 26.8±6.8 seconds with a conventional model to complete PNT, the same test took 18.8±10.9 seconds to complete with a smartphone (p<0.05). Overall, participants expressed higher satisfaction when using a smartphone.
The results offer a practical insight into the appropriate assist devices for SCI patients who wish to use mobile cellular devices, particularly smartphones. When the SCI patients are given the use of a smartphone with the appropriate assist devices, the SCI patients are expected to access mobile cellular device faster and with more satisfaction.
Citations
In order to determine the most suitable computer interfaces for patients with high cervical cord injury, we report three cases of applications of special input devices. The first was a 49-year-old patient with neurological level of injury (NLI) C4, American Spinal Injury Association Impairment Scale (ASIA)-A. He could move the cursor by using a webcam-based Camera Mouse. Moreover, clicking the mouse could only be performed by pronation of the forearm on the modified Micro Light Switch. The second case was a 41-year-old patient with NLI C3, ASIA-A. The SmartNav 4AT which responds according to head movements could provide stable performance in clicking and dragging. The third was a 13-year-old patient with NLI C1, ASIA-B. The IntegraMouse enabling clicking and dragging with fine movements of the lips. Selecting the appropriate interface device for patients with high cervical cord injury could be considered an important part of rehabilitation. We expect the standard proposed in this study will be helpful.
Citations
Method: The BTE work simulator was used on 17 cervical cord injuries to test the force and endurance during wheelchair propulsion. The 141 large wheel of BTE work simulator and standard wheelchair which was removed handrims was used for simulating wheelchair propulsion. Wilcoxon rank sum test was used to compare force and endurance among the groups.
Results: The wheelchair propulsion force and endurance showed significant differences between neurological levels and types of the life style. The lower the level, the higher the strength and endurance (p＜0.001). The wheelchair propulsion force of cervical cord injuries showed statistically significant differences between those with and without jobs (p＜0.05). The outdoor wheelchair users and wheelchair propulsion exercise group showed significantly high maximum isometric strengths compared to the indoor users and the only ROM exercise group, respectively (p＜0.05).
Conclusion: During the rehabilitation period cervical cord injured persons need the wheelchair propulsion exercise using BTE work simulator to improve the quality of life. (J Korean Acad Rehab Med 2003; 27: 49-57)
Objective: It was reported that nocturnal polyuria in cervical cord injured patients may be due to attenuation of diurnal variation of antidiuretic hormone (ADH) level. However, it has been unclear whether the attenuation of diurnal variation of ADH level caused nocturnal polyuria and bladder overdistension. To improve the management of neurogenic bladder with overdistension during the night, we investigated whether the attenuation of diurnal variation of ADH level is the cause of nocturnal polyuria or bladder overdistens-ion in patients with cervical cord injury.
Method: The subjects consisted of 17 patients with cervical cord injury. The age distribution ranged from 31 to 63 years with an average of 41.5 years. The duration of illness ranged from 5 months to 4 years. Oral intake was restricted below 2,000 ml per day. We measured urine volume and urine osmolarity during the day (8 AM∼8 PM) and night period (8 PM∼8 AM) and the level of plasma ADH and serum osmolarity at 2 PM and 2 AM.
Results: Plasma ADH level was 0.81⁑0.51 pg/ml during the day and 1.04⁑0.65 pg/ml during the night (p=0.17). Urine volume was 1050⁑410 ml during the day and 970⁑550 ml during the night (p=0.92). The average of urine osmolarity was 450.4⁑182.8 mosm during the day and 558.4⁑359 mosm during the night (p=0.25). The average of serum osmolarity was 292.4⁑14.5 mosm during the day and 290.4⁑9.3 mosm during the night (p=0.53).
Conclusion: This study showed that there was no significant difference in each parameter for two periods and urine volume was not increased in spite of attenuation of diurnal variation of ADH level. Therefore this indicated that attenuation of diurnal varia-tion of ADH was less likely responsible for nocturnal polyuria in patients with cervical cord injury.
Objective: Reflex sympathetic dystrophy (RSD) is a syndrome of post-traumatic neuropathic pain in association with dystrophic changes and signs of sympathetic overactivity. Pain following spinal cord injury occurs frequently, but RSD is not usually considered as one of the common sources of pain. There have only been a few reports of RSD in spinal cord injured patients, although this condition is well-known in the painful upper extremity of hemiplegia due to stroke. The purpose of this study was to investigate the rate of occurrence, characteristic clinical features and more objective evaluation tools for the diagnosis of RSD in cervical cord injured patients.
Method: Thirty-two cervical cord injured patients were evaluated for hand pain, swelling, vasomotor changes and dystrophic skin or nail changes. The patients were evaluated with studies such as three phase bone scintigrathy, digital infrared thermographic imaging (DITI) and plain roentgenograms of the hands.
Results: Eighteen patients (56.3%) were diagnosed as RSD based on the clinical symptoms and findings of three phase bone scintigraphy. Characteristic symptoms were hand pain, edema and dystrophic skin or nail changes, in the order of frequency. In patients with spasticity of the upper extremity, the incidence of RSD was higher than in patients without spasticity.
Conclusion: We should consider RSD as a cause of upper extremity pain in cervical cord injured patients. This will lead to early diagnosis and treatment of the condition and it will be helpful in preventing various complications.
The children with Down's syndrome are predisposed to atlantoaxial instability due to ligamentous laxity of the atlantoaxial joint. That can lead to cervical spinal cord compression. A careful neurologic examination and periodic screening for atlantoaxial instability would be very important for early detection and prompt management. We report a child with Down's syndrome who was diagnosed as atlantoaxial dislocation, long times after he showed progressive symptoms of cervical cord compression including respiratory distress.
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