Reversed cortical over-activity during movement imagination following neurofeedback treatment for central neuropathic pain.

Objective: One of the brain signatures of the central neuropathic pain (CNP) is the theta band over-activity of wider cortical structures, during imagination of movement. The objective of the study was to investigate whether this over-activity is reversible following the neurofeedback treatment of CNP.

Methods: Five paraplegic patients with pain in their legs underwent from twenty to forty neurofeedback sessions that significantly reduced their pain.

Spinal Cord Injury Caused by Stab Wounds: Incidence, Natural History, and Relevance for Future Research.

Spinal cord injury caused by stab wounds (SCISW) results from a partial or complete transection of the cord, and presents opportunities for interventional research. It is recognized that there is low incidence, but little is known about the natural history or the patient's suitability for long-term clinical outcome studies. This study aims to provide population-based evidence of the demographics of SCISW, and highlight the issues regarding the potential for future research.

Abdominal functional electrical stimulation to enhance mechanical insufflation-exsufflation.

Context: Respiratory complications, attributed to the build-up of secretions in the airway, are a leading cause of rehospitalisation for the tetraplegic population. Previously, we observed that the application of Abdominal Functional Electrical Stimulation (AFES) improved cough function and increased demand for secretion removal, suggesting AFES may aid secretion clearance. Clinically, secretion clearance is commonly achieved by using Mechanical insufflation-exsufflation (MI-E) to simulate a cough.

The mechanism of neurofeedback training for treatment of central neuropathic pain in paraplegia: a pilot study.

Background: Central neuropathic pain has a prevalence of 40% in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia.

Bone morphology of the femur and tibia captured by statistical shape modelling predicts rapid bone loss in acute spinal cord injury patients.

After spinal cord injury (SCI), bone loss in the paralysed limbs progresses at variable rates. Decreases in bone mineral density (BMD) in the first year range from 1% (slow) to 40% (rapid). In chronic SCI, fragility fractures commonly occur around the knee, with significant associated morbidity.

Abdominal Functional Electrical Stimulation to Assist Ventilator Weaning in Acute Tetraplegia: A Cohort Study.

Background: Severe impairment of the major respiratory muscles resulting from tetraplegia reduces respiratory function, causing many people with tetraplegia to require mechanical ventilation during the acute stage of injury. Abdominal Functional Electrical Stimulation (AFES) can improve respiratory function in non-ventilated patients with sub-acute and chronic tetraplegia. The aim of this study was to investigate the clinical feasibility of using an AFES training program to improve respiratory function and assist ventilator weaning in acute tetraplegia.

Decreases in bone mineral density at cortical and trabecular sites in the tibia and femur during the first year of spinal cord injury.

Background: Disuse osteoporosis occurs in response to long-term immobilization. Spinal cord injury (SCI) leads to a form of disuse osteoporosis that only affects the paralyzed limbs. High rates of bone resorption after injury are evident from decreases in bone mineral content (BMC), which in the past have been attributed in the main to loss of trabecular bone in the epiphyses and cortical thinning in the shaft through endocortical resorption.

Hybrid brain-computer interface and functional electrical stimulation for sensorimotor training in participants with tetraplegia: a proof-of-concept study.

Background And Purpose: Impaired hand function decreases quality of life in persons with tetraplegia. We tested functional electrical stimulation (FES) controlled by a hybrid brain-computer interface (BCI) for improving hand function in participants with tetraplegia.

Methods: Two participants with subacute tetraplegia (participant 1: C5 Brown-Sequard syndrome, participant 2: complete C5 lesion) took part in this proof-of-concept study.

Dynamic oscillatory signatures of central neuropathic pain in spinal cord injury.

Unlabelled: Central neuropathic pain (CNP) is believed to be accompanied by increased activation of the sensorimotor cortex. Our knowledge of this interaction is based mainly on functional magnetic resonance imaging studies, but there is little direct evidence on how these changes manifest in terms of dynamic neuronal activity. This study reports on the presence of transient electroencephalography (EEG)-based measures of brain activity during motor imagery in spinal cord-injured patients with CNP.

Prediction of risk of fracture in the tibia due to altered bone mineral density distribution resulting from disuse: a finite element study.

The disuse-related bone loss that results from immobilisation following injury shares characteristics with osteoporosis in post-menopausal women and the aged, with decreases in bone mineral density leading to weakening of the bone and increased risk of fracture. The aim of this study was to use the finite element method to: (i) calculate the mechanical response of the tibia under mechanical load and (ii) estimate of the risk of fracture; comparing between two groups, an able-bodied group and spinal cord injury patients group suffering from varying degrees of bone loss. The tibiae of eight male subjects with chronic spinal cord injury and those of four able-bodied age-matched controls were scanned using multi-slice peripheral quantitative computed tomography.

Isometric hip and knee torque measurements as an outcome measure in robot assisted gait training.

Background: Strength changes in lower limb muscles following robot assisted gait training (RAGT) in subjects with incomplete spinal cord injury (ISCI) has not been quantified using objective outcome measures.

Objective: To record changes in the force generating capacity of lower limb muscles (recorded as peak voluntary isometric torque at the knee and hip), before, during and after RAGT in both acute and subacute/chronic ISCI subjects using a repeated measures study design.

Methods: Eighteen subjects with ISCI participated in this study (Age range: 26-63 years mean age = 49.

Development and validation of a low-cost, portable and wireless gait assessment tool.

Background: Performing gait analysis in a clinical setting can often be challenging due to time, cost and the availability of sophisticated three-dimensional (3D) gait analysis systems. This study has developed and tested a portable wireless gait assessment tool (wi-GAT) to address these challenges.

Aim: To investigate the concurrent validity of the wi-GAT in measuring spatio-temporal gait parameters such as stride length, stride duration, cadence, double support time (DST), stance and swing time compared to a 3D Vicon motion analysis system.

Investigation of robotic-assisted tilt-table therapy for early-stage spinal cord injury rehabilitation.

Damage to the spinal cord compromises motor function and sensation below the level of injury, resulting in paralysis and progressive secondary health complications. Inactivity and reduced energy requirements result in reduced cardiopulmonary fitness and an increased risk of coronary heart disease and cardiovascular complications. These risks may be minimized through regular physical activity.

Changes in pulmonary function measures following a passive abdominal functional electrical stimulation training program.

Objective: To demonstrate the effect of a passive abdominal functional electrical stimulation (AFES) training program on unassisted respiratory measures in tetraplegia.

Design: Longitudinal feasibility study.

Setting: National spinal injuries unit in a university teaching hospital.

Comparison of peak cardiopulmonary performance parameters during robotics-assisted treadmill exercise and arm crank ergometry in incomplete spinal cord injury.

Objective: (i) to compare cardiopulmonary performance parameters obtained from incremental exercise tests (IETs) performed using a robotics-assisted treadmill and an arm crank ergometer; (ii) to investigate test-retest reliability during both modes of exercise.

Design: Each participant performed two IETs to the limit of tolerance on both a robotics-assisted treadmill and an arm crank ergometer.

Setting: A Spinal Injuries Unit in the United Kingdom.

Cardiopulmonary exercise testing during body weight supported treadmill exercise in incomplete spinal cord injury: a feasibility study.

Body weight supported (BWS) treadmill exercise could potentially improve the cardiopulmonary fitness of those with an incomplete spinal cord injury (SCI). Despite this, methods for estimating key cardiopulmonary performance parameters have not been investigated. We investigated whether new exercise test protocols for BWS treadmill exercise in incomplete SCI enable accurate determination of key cardiopulmonary performance parameters and examined how these parameters change with training.

Role of peripheral quantitative computed tomography in identifying disuse osteoporosis in paraplegia.

Objective: Disuse osteoporosis is a major long-term health consequence of spinal cord injury (SCI) that still needs to be addressed. Its management in SCI should begin with accurate diagnosis, followed by targeted treatments in the most vulnerable subgroups. We present data quantifying disuse osteoporosis in a cross-section of the Scottish paraplegic population to identify subgroups with lowest bone mineral density (BMD).

Cardiorespiratory and power adaptations to stimulated cycle training in paraplegia.

Purpose: The extent to which cardiorespiratory fitness and cycling power can be improved in individuals with paraplegia by progressive, high-volume, home-based, electrically stimulated (ES) cycle training was investigated using a novel, sensitive method and protocol that allowed high-resolution power output analyses to be performed for the first time in ES cycling.

Methods: Nine male and two female individuals with paraplegia trained progressively at home for up to five 60-min sessions x wk(-1) for 12 months. Peak power and cardiorespiratory parameters were estimated during quarterly feedback-controlled incremental work rate tests in the laboratory.

Improving respiration in patients with tetraplegia by functional electrical stimulation: an anatomical perspective.

Patients with tetraplegia often have respiratory complications because of paralysis of the abdominal and intercostal muscles. Functional electrical stimulation (FES) has been used to improve breathing in these patients by applying surface stimulation to the abdominal muscles. We aimed to find the best nerves to stimulate directly to increase tidal volume and make cough more effective.

Spinal injuries in Scottish mountaineers.

Objective: To identify the frequency and pattern of spinal injury sustained in mountaineering accidents.

Methods: All patients with spinal injuries sustained while mountaineering who were treated at the Queen Elizabeth National Spinal Injuries Unit from 1992 to 2001 were studied. Information was obtained from hospital notes, and each patient completed a questionnaire.