Invasive Procedures

Neurostimulation techniques and surgical procedures, such as augmentation cystoplasty and other urinary diversions, are used mostly for people with myelopathies from SCI and MS who cannot maintain a low-pressure detrusor with intermittent catheterization. These patients run the risk of recurrent urinary infection, vesicoureteral reflux, and stone formation. Table 8-1. Pharmacologic Manipulation of Bladder Dysfunction Facilitate emptying internal sphincter dyssynergia Facilitate emptying due to...

Task Oriented Training

This approach includes muscle strengthening, strategies that meet the requirements of walking such as training on a treadmill, and practice under varied conditions on different surfaces and at greater walking speeds (see Chapter 5). Task-specific therapy for gait, including treadmill training, shows promise for improving the quality and speed of overground ambulation and enhancing fitness and strength compared to conventional training.5,30-32 BODY WEIGHT-SUPPORTED TREADMILL TRAINING With the...

References

Observational gait analysis. In Scully R, Barnes M, eds. Physical Therapy. Philadelphia JB Lippincott, 1989 670-695. 2. Rancho Professional Staff Association. Normal and Pathological Gait Syllabus. Downey, CA Rancho Los Amigos Hospital, 1981. 3. Lehmann J, de Lateur B, Price R. Biomechanics of abnormal gait. Phys Med Rehabil Clin N Am 1992 3 125-138. 4. Krebs D, Edelstein J, Fishman S. Reliability of observational kinematic gait analysis. Phys Ther 1985 65 1027-1034. 5. Richards C,...

The Primary Motor Cortex and Locomotion

Supraspinal motor regions are quite active in humans during locomotion.45,46 In electro-physiologic studies of the cat, motoneurons in M1 discharge modestly during locomotion over a flat surface under constant sensory conditions. The cells increase their discharges when a task requires more accurate foot placement, e.g., for walking along a horizontally positioned ladder, compared to overground or treadmill locomotion. Changing the trajectory of the limbs to step over obstacles also increases...

Memory Disorders

Patients are called upon to encode and retrieve new information during rehabilitation. Memory disturbances may have a proportionately negative influence on the compensatory learn ing that underlies much of the rehabilitation process. The incidence and risk factors for memory loss and for dementia caused by one or more strokes have become increasingly appreci-ated.378'381,384-386 Up to 30 of all stroke survivors have a disturbance in memory. In a population study, dementia was 9 times greater in...

Body Weight Supported Treadmill Training

As an adjunct to traditional physical therapies, the suspension of a patient over a treadmill belt to control the level of weight bearing and cadence of stepping may serve as a safety measure to prevent falls and allow therapists to more easily assess and correct gait deviations. Ideally, BWSTT allows mass practice that is task-oriented (Chapter 6). With BWSTT for patients with SCI, up to 50 of body weight is suspended in a climbing harness connected to an overhead hydraulic lift (Fig. 10-3)....

Bowel And Bladder

Neurogenic bowel and bladder dysfunction rank among the most life-limiting problems of people with SCI. No more than 15 regain normal control.25 Fecal incontinence, constipation, and impaction affect most SCI patients until a practical bowel program is attained.67 Digital stimulation with a lubricated and gloved finger in a gentle, circular motion will induce reflex peristalsis in patients with an intact conus medullaris. Glycerine suppositories and contact irritants, stool softeners, colonic...

Assistive Devices

Assistive devices include a wide variety of braces, canes, and walkers. Randomized trials of the utility of common assistive devices or Table 6-7. Rationales for and Against Body Weight-Supported Treadmill Training Initiates step training and upright posture as early as possible after onset of disability Therapists can readily optimize kinematics, kinetics, and temporal parameters of walking Allows practice at normal walking velocities Encourages exercise to increase fitness, prevent disuse leg...

Limit Glial Scar

Immediately after a spinal cord contusion, pe-techial hemorrhages and tissue damage spread and enlarge in centripetal and rostrocaudal directions for up to several days. Resident and activated inflammatory cells infiltrate an increasingly necrotic cavity. Neutrophils, mi-croglia, and proinflammatory chemokines and cytokines initiate macrophage phagocytosis. Within a week, T-lymphocytes and circulating monocytes enter the region of injury. These cells move throughout the perilesional area for...

Eight Potential Pitfalls of Animal Models

What is the study population In animal research, vendors provide healthy, highly inbred rats and mice. The rodents are the same species and strain, same age, weight, and gender. Males tend to be used most often to avoid the hormonal fluxes of the estrous cycle. The experiments are usually carried out on neonates and young adults, approximately 3-6 months old (an old rat is 2 years old). The CNS of a neonate may still be developing, allowing for far greater opportunity for morphologic...

Functional Electrical Stimulation

Among all the neurologic disabilities, the most scientific attention to the limitations and benefits of fitness training and testing has been given to paraplegia and tetraplegia.172 After SCI, cardiovascular conditioning can be limited by exercising only the upper body's small muscle mass, by pooling of blood in the leg muscles that reduces cardiac preloading, and by impaired cardiovascular reflexes. Functional electrical stimulation-induced leg cycle er-gometry can improve both peripheral...

Pharmacologic Facilitation

Rehabilitation physicians have probably tried more neuropharmacologic agents in individual TBI patients to attempt to modify cognition and behavior than for any other disease. On occasion, a positive experience or single-case study design has led to a small randomized clinical trial, but not often enough to provide evidence for practices. Drugs for postinjury behavioral and psychiatric disorders have been more clearly efficacious and are discussed later in this chapter. Table 11-15 lists some...

Neurostimulators and Neuroprostheses

Functional Neuromuscular Stimulation Nerve Cuffs Neuroaugmentation Spinal Cord Stimulators Brain-Machine Interfaces Sensory Prostheses ROBOTIC AIDS Upper Extremity Lower Extremity TELETHERAPY SUMMARY Along with the generation of axons and neurons to aid neurorecovery, the first quarter of the 21st century will see the creation of interfaces that allow neurons to drive or be driven by computers and micromachines (Table 4-1). Such human-machine interfaces may reduce impairments and disabilities....

Adjuvant Pharmacotherapy

Attempts to develop pharmacotherapy for neu-rorehabilitation are drawn from animal and human studies of drug-induced enhancement of learning and neuroplasticity (see Chapter 1)288-291 gome drug interventions are drawn from biologic responses in rats and applied to humans after a focal brain or spinal cord injury, which is a precarious leap (see Chapter 2). Neurotransmitters and neuromodulators given in pharmacologic dosages may augment the activation of a network during a specific task, but...

Interventions for Personal Independence

For neurologic rehabilitation, theories about assessment and intervention by the occupational therapist have evolved over the past 10 years in parallel to those of physical therapy.101,102 The approaches of OT rely on behavioral and educational techniques that combine skills training, compensation, and environmental adaptation. Therapists demonstrated in a randomized trial of outpatients with schizophrenia that a program of training in independent living skills and psychosocial functioning...