The Influence of Age on Functional Recovery of Adults With Spinal Cord Injury or Disease After Inpatient Rehabilitative Care: A Pilot Study.

The influence of age on functional recovery of adults with spinal cord injury or disease after inpatient rehabilitative care: a pilot study.

Aging Clin Exp Res. 2013 Jun 20;
Furlan JC, Hitzig SL, Craven BC

BACKGROUND AND AIMS: The impact of age on functional recovery after spinal cord injury/disease (SCI/D) is still unclear. Given this, we sought to examine the potential influence of patient’s age on functional recovery following SCI/D. METHODS: This retrospective cohort study included consecutive adults with SCI/D admitted to a tertiary rehabilitation center from January 2003 to April 2004. The main outcome was functional recovery during inpatient rehabilitation. Functional recovery was assessed using the Spinal Cord Independence Measure (SCIM) and Functional Independence Measure (FIM). FIM and SCIM mean admission scores were subtracted from mean discharge scores and compared to thresholds for minimal clinically important differences. Potential confounders included gender, mechanism of SCI/D, level, and severity of SCI/D. RESULTS: There were 30 patients (11 females, 19 males; ages 30-83 years) with traumatic (n = 11) or non-traumatic SCI/D (n = 19). Mean baseline SCIM and FIM scores were 55.1 ± 4.3 and 82.7 ± 3.6, respectively. After a mean follow-up time of 71 days, patients achieved a mean SCIM of 70.6 ± 4.2 and mean FIM score of 107.3 ± 2.8. SCIM scores were not associated with age in the analyses either using univariate analysis (p = 0.137) or regression analysis (p = 0.215). FIM scores were not associated with age either using univariate analysis (p = 0.266) or regression analysis (p = 0.551). CONCLUSIONS: Our results indicate that age is not associated with functional recovery after rehabilitation for SCI/D. Clinicians and allied health professionals should have a greater awareness of the potential of adult patients with SCI/D to achieve functional recovery regardless of age. HubMed – rehab

Can the Ordered Multi-Stepping Over Hoop test be useful for predicting fallers among older people? A preliminary 1 year cohort study.

Aging Clin Exp Res. 2013 Jun 20;
Tsutsumimoto K, Doi T, Misu S, Ono R, Hirata S

BACKGROUND AND AIMS: To prevent falls among older people, we developed a new fall-risk assessment, the “Ordered Multi-Stepping Over Hoop (OMO)” test. The aims of this study were preliminary: to investigate the association of the OMO with cognitive and physical function and to investigate whether the OMO could predict incidents of falling. METHODS: Fifty-nine community-dwelling older people (mean age = 88.0 ± 0.87, female = 49) were recruited. We assessed cognitive and physical function including the OMO test at baseline and monitored the falls of participants during a 12-month follow-up period from the baseline. We investigated whether the OMO was associated with cognitive function, physical function, and incidents of falling. To investigate whether the OMO could predict incidents of falling, a receiver operating characteristic analysis was conducted. RESULTS: The OMO time in fallers was significantly slower than for non-fallers. There were significant correlations between slower OMO times and lower physical functions and executive function. The area under the ROC curve in the OMO was 0.71 (p < 0.05). Times above 21.9 s for the OMO identified those more likely to fall. CONCLUSIONS: The OMO time was correlated with cognitive function, physical function, and incidents of falling. Our preliminary study indicates that the OMO may help to make a distinction between fallers and non-fallers among older people as effectively as other tests. HubMed – rehab

Mechanisms of postural instability in hereditary spastic paraplegia.

J Neurol. 2013 Jun 20;
Nonnekes J, de Niet M, Nijhuis LB, de Bot ST, van de Warrenburg BP, Bloem BR, Geurts AC, Weerdesteyn V

Hereditary spastic paraplegia (HSP) is characterized by progressive lower extremity spasticity and weakness, due to retrograde axonal degeneration of the corticospinal tract and posterior spinal columns. HSP patients fall frequently. We hypothesized that delayed postural responses contribute to their balance impairments. To distinguish between a delay in afferent and efferent signals, we combined postural responses with a startling acoustic stimulus (SAS). The SAS triggers a postural response directly, bypassing afferent proprioceptive input. We performed two experiments. First, 18 HSP patients and nine healthy controls stood on a balance platform and were instructed to counteract forward and backward balance perturbations, without taking a step or grabbing a handrail. Second, 12 HSP patients and nine controls received backward perturbations, while a SAS accompanied onset of platform motion in 25 % of trials. HSP patients were less successful than controls in maintaining balance following backward and forward perturbations. Furthermore, latencies of postural responses were significantly delayed in HSP-patients, by 34 ms in gastrocnemius following forward, and by 38 ms in tibialis anterior following backward perturbations. A SAS accelerated postural responses in all participants, but more so in HSP patients whose latencies were normalized. Our results suggest that delayed postural responses in HSP patients contribute to their balance problems. Combining balance perturbations with a SAS restored normal latencies, suggesting that conduction of efferent signals (presumably by the reticulospinal tract) is normal. We therefore suggest that the delayed postural responses in HSP are caused by slowed conduction time via the posterior spinal columns. HubMed – rehab

Preliminary evidence of early bone resorption in a sheep model of acute burn injury: an observational study.

J Bone Miner Metab. 2013 Jun 20;
Klein GL, Xie Y, Qin YX, Lin L, Hu M, Enkhbaatar P, Bonewald LF

Treatment with bisphosphonates within the first 10 days of severe burn injury completely prevents bone loss. We therefore postulated that bone resorption occurs early post burn and is the primary explanation for acute bone loss in these patients. Our objective was to assess bone for histological and biomechanical evidence of early resorption post burn. We designed a randomized controlled study utilizing a sheep model of burn injury. Three sheep received a 40 % total body surface area burn under isoflurane anesthesia, and three other sheep received cotton-smoke inhalation and served as control. Burned sheep were killed 5 days post procedure and controls were killed 2 days post procedure. Backscatter scanning electron microscopy was performed on iliac crests obtained immediately postmortem along with quantitative histomorphometry and compression testing to determine bone strength (Young’s modulus). Blood ionized Ca was also determined in the first 24 h post procedure as was urinary CTx. Three of three sheep killed at 5 days had evidence of scalloping of the bone surface, an effect of bone resorption, whereas none of the three sheep killed at 2 days post procedure had scalloping. One of the three burned sheep killed at 5 days showed quantitative doubling of the eroded surface and halving of the bone volume compared to sham controls. Mean values of Young’s modulus were approximately one third lower in the burned sheep killed at 5 days compared to controls, p = 0.08 by unpaired t test, suggesting weaker bone. These data suggest early post-burn bone resorption. Urine CTx normalized to creatinine did not differ between groups at 24 h post procedure because the large amounts of fluids received by the burned sheep may have diluted urine creatinine and CTx and because the urine volume produced by the burned sheep was threefold that of the controls. We calculated 24 h urinary CTx excretion, and with this calculation CTx excretion/24 h in the burned sheep was nearly twice that of the controls. Moreover, whole blood ionized Ca measured at 3- to 6-h intervals over the first 24 h in both burn and control sheep showed a 6 % reduction versus baseline in the burned sheep with <1 % reduction in the control animals. This sheep model was previously used to demonstrate upregulation of the parathyroid calcium-sensing receptor within the timeframe of the present study. Because both early bone resorption, supported by this study, and calcium-sensing receptor upregulation, consistent with the observed reduction in blood ionized Ca, are mediated by proinflammatory cytokines that are present as part of the post-burn systemic inflammatory response, we may postulate that post-burn upregulation of the parathyroid calcium-sensing receptor may be an adaptive response to clear the blood of excess calcium liberated by cytokine-mediated bone resorption. HubMed – rehab