Melvin Mejia

A Descriptive Study on Vitamin D Levels in Individuals With Spinal Cord Injury in an Acute Inpatient Rehabilitation Setting

To determine the prevalence of inadequate or severely deficient levels of vitamin D in patients with spinal cord injury (SCI) admitted to an inpatient rehabilitation service and to describe any associations between patient demographics and injury characteristics and vitamin D levels.

Upper Extremity Assessment in Tetraplegia: The Importance of Differentiating Between Upper and Lower Motor Neuron Paralysis

Scientific advances are increasing the options for improved upper limb function in people with cervical level spinal cord injury (SCI). Some of these interventions rely on identifying an aspect of paralysis that is not uniformly assessed in SCI: the integrity of the lower motor neuron (LMN). SCI can damage both the upper motor neuron and LMN causing muscle paralysis. Differentiation between these causes of paralysis is not typically believed to be important during SCI rehabilitation because, regardless of the cause, the muscles are no longer under voluntary control by the patient. Emerging treatments designed to restore upper extremity function (eg, rescue microsurgical nerve transfers, motor learning-based interventions, functional electrical stimulation) all require knowledge of LMN status. The LMN is easily evaluated using surface electrical stimulation and does not add significant time to the standard clinical assessment of SCI. This noninvasive evaluation yields information that contributes to the development of a lifetime upper extremity care plan for maximizing function and quality of life. Given the relative simplicity of this assessment and the far-reaching implications for treatment and function, we propose that this assessment should be adopted as standard practice for acute cervical SCI.

Early Predictors of Functional Outcome After Trauma

Despite the availability of routinely collected trauma data, researchers who investigate rehabilitation outcomes, functional evaluation, and comparative effectiveness have not incorporated this potentially clinically meaningful information in their modeling as predictors or adjustors.

The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization

Sacral pressure ulcers are a significant problem following spinal cord injury and are felt to be in part due to the high interface-pressures generated while strapped to the spine board. The objective of this study was to determine sacral interface-pressure and sensing area in healthy volunteers on a spine board and the effects of a gel pressure dispersion liner. Thirty-seven volunteers were placed on a pressure-sensing mat between the subject and the spine board. Measurements were carried out with and without a gel liner. Pressures and sensing area were recorded every minute for 40 minutes. The highest pressure was generated at the sacral prominence of each subject. Mean interface-pressures were higher on the spine board alone than with the gel liner (p < .0001). Overall, mean sensing area was lower on the spine board than with the gel liner (p < .0001). Standard spinal immobilization causes high sacral interface-pressures. The addition of a gel liner on the spine board decreased overall mean sacral pressures and increased mean sensing area. Generation of sacral pressure ulcers may be related to the initial interface-pressures generated while the patient is strapped to the spine board. The addition of a gel liner may reduce the incidence of sacral pressure ulcers.

Preventive Health Care Among Community-Dwelling Persons with Spinal Cord Injury

To describe preventive health examinations/tests and behaviors of persons with traumatic spinal cord injury (SCI).

An investigation of the relationship between autonomic dysreflexia and intrathecal baclofen in patients with spinal cord injury

Objective: To study the relationship between autonomic dysreflexia and intrathecal baclofen in patients with spinal cord injury. Design: Retrospective chart review. Setting: Inpatient and outpatient acute rehabilitation facility. Participants: Thirty-four subjects. Interventions: We reviewed patients’ medical records to ascertain the presence of symptomatic autonomic dysreflexia (AD) prior to and after implantation of an intrathecal baclofen (ITB) pump for spasticity in spinal cord injury patients. We recorded risk factors for autonomic dysreflexia including kidney and bladder stones, heterotopic ossification (HO), and ischial / sacral pressure ulcers. Outcome Measures: Presence of autonomic dysreflexia pre and post-intrathecal baclofen pump placement, presence of risk factors associated with autonomic dysreflexia including (1) kidney or bladder stones, (2) heterotopic ossification, and (3) pressure ulcers. Results: Of the 34 subjects, 25 (73.5%) experienced AD prior to ITB pump placement and only 2 (5.9%) after placement. Four subjects (11.8%) had kidney or bladder stones, of which, all had AD prior to placement and none had AD afterwards. Twenty-six subjects (76.5%) had pressure ulcers, of which, all experienced AD prior to placement and only one (0.02%) afterwards. Six patients (17.6%) had HO, of which 5 (83%) had AD prior to placement and none afterwards. Additionally, three patients (8.8%) had at least 2 of the above risk factors, of which, all had AD prior to ITB placement and none afterwards. Conclusion: This study showed a significant reduction of symptomatic episodes of autonomic dysreflexia after spinal cord injury, even in those with additional risk factors for development of autonomic dysreflexia.

Percutaneous peripheral nerve stimulation for treatment of shoulder pain after spinal cord injury: A case report

Context: This describes the first person with spinal cord injury (SCI) treated with percutaneous peripheral nerve stimulation for chronic shoulder pain. Findings: From baseline to one-week after treatment, the subjects worst pain in the last week, rated on a 0–10 numerical rating scale (BPI-SF3), decreased by 44%. Pain interference decreased and remained below baseline 12 weeks after the end of treatment. There was an associated improvement in the mental component of quality of life. Conclusion: This case demonstrates the feasibility of treating shoulder pain in patients with SCI with percutaneous PNS. To demonstrate efficacy further studies are required.

Redesign of a spine board: Proof of concept evaluation

ABSTRACT Sacral pressure ulcers are a significant problem in individuals following spinal cord injury (SCI) and are felt to be in part due to the high interface-pressures applied to the body while lying on a standard spine board (SSB) during emergency transport. The aim of the present study was to assess the interface pressures and sensing areas between the body and the SSB and two proof of concept spine board prototypes (P-1 and P-2). Ten able-bodied individuals were assessed on each board. Interface pressures and sensing area were recorded every minute over 15 minutes. The highest pressure was generated at the sacral-iliac region. The mean of the peak pressures on the SSB, P-1, and P-2 was 288.6, 202.8, and 102.8 mmHg, respectively. The mean of the sensing areas on the SSB, P-1, and P-2 was 78.2, 98.5, and 109.4 in2, respectively. An analysis using pairwise comparisons test showed the interface pressures were significantly reduced (p = 0.003) and the sensing area was significantly increased (p < 0.001) on P-2 in the sacral-iliac location. This study’s procedures can be used when determining critical factors to guide the redesign of an SSB that reduces interface pressure and increases sensing area.

Poster 387: Transcutaneous Peroneal Nerve Stimulation for Foot Drop in Incomplete Spinal Cord Injury

(n 64), whereas the controls received no treatment. Main Outcome Measures: CDAD, verified by enzyme immunoassay testing for toxins A and B or colonoscopy. Results: Of the patients receiving prophylactic Lactobacillus, zero contracted CDAD, whereas 17 of 809 controls did (P .25). The treatment group received more antibiotics (2.3 1.7) than the controls (1.1 1.3, P .001) and had longer hospital stays (32 25 days) than the controls (16 15, P .001). When controlled for length of stay and number of antibiotics, the controls had 13 of 253 (P .069) and 16 of 334 (P .076) incidences of CDAD, respectively. Conclusions: Spinal cord injury patients are at an increased risk for development of CDAD. Treatment with probiotics, such as the Lactobacillus species, may provide safe, effective prophylaxis against CDAD in spinal cord inpatients. Although our retrospective study did not reach statistical significance, the trend suggests that a larger prospective study might be worth undertaking to address this because it may lead to a decrease in morbidity on the rehabilitation unit. In addition, cost analysis will be important in future studies in the current health care climate to elucidate savings from this relatively inexpensive treatment.