Albert C. Recio

High-voltage electrical stimulation for the management of Stage III and IV pressure ulcers among adults with spinal cord injury: Demonstration of its utility for recalcitrant wounds below the level of injury

Abstract Context Patients with spinal cord injury (SCI) have many factors that are associated with pressure ulcer formation, including paralysis, loss of sensation, poor nutrition, anemia, and skin maceration related to incontinence. Treatment of these ulcers involves relieving pressure, improving nutrition and skin hygiene, treating infections, removing necrotic tissues, and applying the appropriate dressings. However, some cases are not responsive to the above treatment. Electrical stimulation (ES) is thought to enhance soft tissue healing through promotion of protein synthesis, inhibition of bacterial growth, facilitation of epithelial tissue migration, improvement of blood flow, and tensile strength. This data is mainly based on evidence from animal studies and very few rigorously controlled studies conducted in humans. Objective To demonstrate the effectiveness of ES in the treatment of recalcitrant pressure ulcers. Methods Retrospective case series describing the care of adults with SCI and recalcitrant pressure ulcers. ES was applied directly into the wound bed: 60 minutes per session, 3–5 times per week; with an intensity of 100 milliamperes and a frequency of 100 pulses per second. Polarity was negative initially and was switched weekly. The amplitude and wave form were maintained throughout. Results The long-standing (11–14 months) pressure ulcers were completely healed after 7 to 22 weeks of treatment with high-voltage ES. Conclusion/clinical relevance This case series demonstrates the effectiveness of ES for enhanced healing of Stage III–IV ulcers otherwise unresponsive to standard wound care. Further study is needed to identify the most effective protocol for ES therapy in the treatment of recalcitrant pressure ulcers.

Use of a virtual reality physical ride-on sailing simulator as a rehabilitation tool for recreational sports and community reintegration: a pilot study

ABSTRACTParticipation in sailing by people with disabilities, particularly in small sailboats, is widely regarded as having positive outcomes on self-esteem and general health for the participants. However, a major hurdle for people with no previous experience of sailing, even by those without disabilities, is the perception that sailing is elitist, expensive, and dangerous. Real-time “ride-on” sailing simulators have the potential to bridge the gap between dry-land and on-the-water sailing. These provide a realistic, safe, and easily supervised medium in which nonsailors can easily and systematically learn the required skills before venturing out on the water. The authors report a 12-wk pilot therapeutic sailing program using the VSail-Access sailing simulation system followed by on-water experience. After completion of the training, all subjects demonstrated the ability to navigate a simple course around marker buoys (triangular configuration) on the computer screen, the ability to sail independently in winds of moderate strength (up to 14 knots) on water, and measurable improvements in their psychologic health. In addition, the subjects were able to participate in a sports activity with their respective family members and experienced a sense of optimism about their future.

Activity-Based Restorative Therapies after Spinal Cord Injury: Inter-institutional conceptions and perceptions

This manuscript is a review of the theoretical and clinical concepts provided during an inter-institutional training program on Activity-Based Restorative Therapies (ABRT) and the perceptions of those in attendance. ABRT is a relatively recent high volume and intensity approach toward the restoration of neurological deficits and decreasing the risk of secondary conditions associated with paralysis after spinal cord injury (SCI). ABRT is guided by the principle of neuroplasticity and the belief that even those with chronic SCI can benefit from repeated activation of the spinal cord pathways located both above and below the level of injury. ABRT can be defined as repetitive-task specific training using weight-bearing and external facilitation of neuromuscular activation. The five key components of ABRT are weight-bearing activities, functional electrical stimulation, task-specific practice, massed practice and locomotor training which includes body weight supported treadmill walking and water treadmill training. The various components of ABRT have been shown to improve functional mobility, and reverse negative body composition changes after SCI leading to the reduction of cardiovascular and other metabolic disease risk factors. The consensus of those who received the ABRT training was that ABRT has much potential for enhancement of recovery of those with SCI. Although various institutions have their own strengths and challenges, each institution was able to initiate a modified ABRT program.

Functional electrical stimulation as a component of activity-based restorative therapy may preserve function in persons with multiple sclerosis

Abstract Objective To examine the effect of functional electrical stimulation (FES) cycling on disability progression in persons with multiple sclerosis (MS). Design Retrospective cohort, 40 participants with mean follow-up of 15 months. Setting International Center for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore, a rehabilitation referral center. Participants Forty consecutive persons with MS undergoing rehabilitation from 2007 to 2011, with at least two evaluations based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Interventions FES cycling as part of activity-based restorative therapy interventions. Outcome measures Change in Expanded Disability Status Scale (EDSS) and ISNCSCI motor, light touch, and pin prick scores from baseline to latest evaluation. Results In 71% of patients, activity-based rehabilitation included FES cycling. There was no disability progression on the EDSS. Lower extremity motor scores improved or stabilized in 75% of patients with primary progressive MS (PPMS), 71.4% with secondary progressive MS (SPMS), and 54.5% with relapsing remitting MS (RRMS). Among patients with improved or stabilized lower extremity motor function, PPMS recorded a mean 9% improvement, SPMS 3% and RRMS 6%. In PPMS, use of FES showed trend towards improvement in motor scores (P = 0.070). Conclusions FES as part of activity-based rehabilitation may help preserve or improve neurological function in patients with MS.

Rehabilitation in transverse myelitis.

ABSTRACT The consequences of neurologic injuries related to transverse myelitis (TM) are long-lasting and require rehabilitative interventions in about two-thirds of cases. Because numerous neural repair mechanisms are dependent on maintenance of an optimal amount of activity both above and below the injury level, rehabilitation and exercise are useful not only for compensatory functional purposes but also as tools in neural system restoration. The application of established neurophysiologic principles to post-TM rehabilitation has substantial impact on optimizing residual functional capabilities while facilitating the processes of central plasticity and reorganization of sensory and motor programming. The process of neurorehabilitation thereby serves both to treat the patient with TM and to help physicians interrogate and dissect the mechanisms involved in spinal cord injury, neuroprotection, and, ultimately, recovery. Post-TM rehabilitation is lifelong and should be integrated into daily living in a home setting as part of the global management of paralysis, a chronic condition with significant comorbidities.

Independent sailing with high tetraplegia using sip and puff controls: integration into a community sailing center

Background: We are continually rediscovering how adapted recreational activity complements the rehabilitation process, enriches patients’ lives and positively impacts outcome measures. Although sports for people with spinal cord injuries (SCI) has achieved spectacular visibility, participation by high cervical injuries is often restricted due to poor accessibility, safety concerns, lack of adaptability, and high costs of technology. Methods: We endeavor to demonstrate the mechanisms, adaptability, accessibility, and benefits the sport of sailing creates in the rehabilitative process. Our sailor is a 27-year-old man with a history of traumatic SCI resulting in C4 complete tetraplegia. Results: The participant completed an adapted introductory sailing course, and instruction on the sip-and-puff sail and tiller control mechanism. With practice, he navigated an on-water course in moderate winds of 5 to 15 knots. Discussion: Despite trends toward shorter rehabilitation stays, aggressive transdisciplinary collaboration with recreation therapy can provide community and natural environment experiences while inpatient and continuing post discharge. Such peak physical and psychological experiences provide a positive perspective for the future that can be shared on the inpatient unit, with families and support systems like sailing clubs in the community. Conclusion: Rehabilitation theory directs a team process to achieve patient self-awareness and initiate self-actualization in spite of disablement. Utilization of local community sailing centers that have provided accessible assisted options provides person-centered self-realization of goals as assisted by family and natural supports. Such successful patients become native guides for others seeking the same experience.

Transfemoral Amputation Following Chronic Spinal Cord Injury: A Prosthetic Solution for Improved Balance, Seating, Dynamic Function and Body Image

Background: Advances in the care and rehabilitation of patients with spinal cord injuries (SCI) have resulted in extended survival. As SCI patients age, chronic lower extremity ischemic complications are resulting in amputations. The literature relating to lower extremity amputation and prosthesis in SCI patients is sparse. Limb amputation may cause weight distribution imbalances, leading to back pain and increased risk of pressure ulcer formation. Lower extremity amputation challenges skin management, sitting balance, functional range and body image. Case Description and Methods: We report a systematic retrospective review of a disability adaptation equipment entrepreneur with T4 AIS B paraplegia patient who underwent right transfemoral amputation because of poor wound healing in the setting of severe peripheral vascular disease. The prosthetic prescription included a total-contact socket with a knee-flexed formed prosthesis, mirroring the opposite limb. The socket design allowed decompression of the right ischium and secured the patient in the wheel chair for seated reach and leverage in work. The patient consistently used the prosthesis over 10 years and recognized a variety of benefits including improved seating stability, functional reach, transfers, cosmesis, dressing options and body image, and documented increase in community activity. Conclusion: Lower extremity prosthesis fitting for patients with SCI and amputation can improve posture, seating, transfers, static and dynamic balance, participation in functional activities, and community reintegration. Clinical Significance: Active patients with paraplegia and new transfemoral amputation should be offered a trial of a prothesis to enhance mobility. Many of the medical and functional consequences of amputation after SCI can be prevented with careful prosthesis selection, prescription, and training patients in the use of lower extremity prosthesis.

Aquatic-Based Therapy in Spinal Cord Injury Rehabilitation: Effective Yet Underutilized

Purpose of reviewThe objective of this article is to review aquatic therapy, a historically effective yet highly underutilized therapeutic modality, in order to demonstrate that it is a valuable therapeutic tool in patients with spinal cord injuries (SCIs) and that it is an intervention that provides an environment of support and resistance which elicits motor performance improvements for patients with SCI.Recent findingsAquatic therapy has been shown to improve mobility and quality of life and lessen spasticity and pain. It is highly effective in promoting overall recovery from SCI. Recent research shows that more people with SCI, particularly those who were perhaps previously excluded (colostomy bags, incontinence, mechanical ventilators), can participate in aquatic therapy interventions.SummaryAlthough the use of aquatic therapy has been shown to improve function, more research is required to thoroughly investigate it and to develop protocols and safety measures that increase the variety of patients with access to this therapy. Patients with spinal cord dysfunction should be given access to aquatic therapy in their local communities and rehabilitation centers so that the benefits of skilled aquatic-based therapies can be more widely achieved and integrated. Accessible community pools provide a setting for recreation and exercise with family and attendants, thus promoting improvement and maintenance of skills.

Functional electrical stimulation therapy

Functional electrical stimulation (FES) is defined as the application of an electrical stimulus to p…