Research on clinical-paraclinical and evolutive aspects in pati-ents with post spinal cord injury (SCI) statuses and Covid-19 – a systematic literature review

The COVID-19 pandemic has generated a lot of interest among doctors as well as scientists around the world. Studies on the impact of the Covid-19 pandemic, including in people with post SCI sufferance, are ongoing, aiming to understand the pathophysiological mechanisms of SARS-CoV2 in target tissues, to optimize related methods of diagnosis and treatment in both, in-itial and later phases of the disease – e.g.: ”long Covid” status – and thus, to make a substantial contribution to the quality of life improvement of the affected patients. After using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (acronym PRISMA) method to quest for afferent knowledge, it resulted a quite small number (12) of arti-cles, most of them indirectly approaching this topic. Therefore, is important to deepen this niche – which is scarcely approached – in order to find new therapeutic approaches able to combat COVID-19-associated to SCI manifestations – like, for instance, to check whether the principle of intermittent hypoxia treatment is effective and worth to be included in the rehabilitation treat-ment protocols – as neither an indubitable effective drug or vaccine, or respectively, cure for SCI, has been provided so far

Cellular and Molecular Homeostatic Microenvironmental imbalances in Osteoarthritis and Rheumatoid Arthritis

Human movement is a complex and multifactorial process due to the interaction between the body and the environment. Movement is the result of activities of all the structures that make up a joint (i.e., ligaments, tendons, muscles, fascicles, blood vessels, nerves, etc.) and of the control actions of the nervous system on them. Therefore, many pathological conditions can affect the Neu-ro-Myo-Arthro-Kinetic System (NMAK). Osteoarthritis (OA) is the degenerative form of arthritis with a high incidence and a pro-longed course that affects articular and periarticular tissues such as articular cartilage, subchondral bone, and synovium, a degenerative consequence. Instead, Rheumatoid arthritis (RA) is an immune-mediated synovial disease caused by a complex interaction between genetic and environmental factors. This review aims to compare Osteoar-thritis (OA) and Rheumatoid Arthritis (RA) in terms of pathogenesis and microenvironment and determine the main changes in a joint microenvironment regarding immunological defense elements and bioenergetics which can explain the pathological development with new thera-peutical opportunities

Mobile Mechatronic/Robotic Orthotic Devices to Assist–Rehabilitate Neuromotor Impairments in the Upper Limb: A Systematic and Synthetic Review

This paper overviews the state-of-the-art in upper limb robot-supported approaches, focusing on advancements in the related mechatronic devices for the patients' rehabilitation and/or assistance. Dedicated to the technical, comprehensively methodological and global effectiveness and improvement in this inter-disciplinary field of research, it includes information beyond the therapy administrated in clinical settings-but with no diminished safety requirements. Our systematic review, based on PRISMA guidelines, searched articles published between January 2001 and November 2017 from the following databases: Cochrane, Medline/PubMed, PMC, Elsevier, PEDro, and ISI Web of Knowledge/Science. Then we have applied a new innovative PEDro-inspired technique to classify the relevant articles. The article focuses on the main indications, current technologies, categories of intervention and outcome assessment modalities. It includes also, in tabular form, the main characteristics of the most relevant mobile (wearable and/or portable) mechatronic/robotic orthoses/exoskeletons prototype devices used to assist-rehabilitate neuromotor impairments in the upper limb

Clinical-therapeutic and recuperators complex aspects in a chronic ethanol-consuming patient with incomplete AIS/Frankel D tetraplegia after cervical SCI on the background of ankylosing spondylitis, with C6 transosus fracture operated (by mixed osteosynthesis) and immobilized in the halo-vest by falling from its own level and the posterior cerebral artery ischemic stroke (possibly by vertebral artery dissection)

Spinal cord injuries and strokes are frequent causes of motor deficit in patients of all ages, with complex family and social consequences (through sensitivity and movement disorders). On the other hand, toxic-nutritional abuses (especially ethanolic) cause morpho-physiological changes throughout the body, with frequent consecutive neuro-psychic manifestations, followed by (potentially) various traumatic injuries. Therefore, the biological and scientific clinical follow-up of traumatized vertebro-medullary patients is of particular importance. With the approval of the Bioethics Commission of the Bagdasar Arseni Emergency Clinical Hospital (TEHBA) Bucharest (number 9181 dated April 11, 2018), we will present the special case of a patient admitted to the Neuromuscular Recovery Clinic of THEBA for incomplete tetraplegia motor deficit AIS/Frankel D, with neurologic level C6 after a vertebral-medullary trauma (produced in conditions of ethanol abuse) and with parieto-occipital ischemic vascular accident produced simultaneously. The peculiarities of this case are the possible (but less common) immediate consequences of vertebralmedullary traumas: paravertebral nervous ganglion lesions; arterial (carotid / vertebral) dissections, which can cause ischemic lesions, all requiring appropriate clinical and therapeutic management. Spinal cord injuries can be favored by toxic-nutritional abuse and may have immediate, late, and permanent morpho-physiological consequences. However, sometimes the clinical evolution and prognosis are surprisingly positive

From “cage to independence”: good outcomes of an unstable (burst) lumbar fracture, surgically managed with an expandable titanium vertebral cage implant, with posterior transpedicular instrumentation, and rehabilitation program – case presentation

Introduction: The thoracolumbar junction (T11-L2) is biomechanically prone to spinal cord injuries (SCI), as it marks the transition from the rigid thoracic segment to the flexible lumbar spine. The damage of the spinal cord is due to a high-energy trauma (mainly motor vehicle accidents, falls from height, etc), in most cases resulting burst fractures of the lumbar region. The vertebral body is crushed in all directions, retro pulsed bony fragments are spread out towards the spinal canal, damaging the spinal cord, and causing neurologic injuries. Case report: This is a retrospective case study of a slim 43-year-old woman who suffered on 23.06.2018 a polytrauma (accidental fall from 3m height, from tree), associating thoraco-abdominal contusions, without cranial trauma and a severe L1 vertebral comminuted / burst fracture, followed by flaccid T12 AIS-A (complete) paraplegia. She underwent a complex neurosurgical approach, with a self-expandable metallic cage (Stryker) and posterior transpedicular stabilization for decompression and circumferential fusion in one stage, without cavity involvement. In an early post-acute stage she was admitted to the Rehabilitation Clinic (from 10.07.2018 until 31.08.2018) as a T12 AIS-C paraplegia (incomplete neurological lesion, with a global motor score 59/100; lower legs motor score 9/50 [4/25 R+5/25 L], with neurogenic bowel and bladder. The evolution was favorable and she was discharged as L2 AIS-D paraplegia (global motor score 70/100; lower legs motor score 20/50 [10/25 R+10/25 L]. Discussion: This case report emphasizes the benefits and functional outcomes after a comprehensive therapeutic approach, of a patient with unstable (burst) lumbar fracture, surgically managed with an expandable titanium vertebral cage implant with posterior transpedicular instrumentation, followed by a complex rehabilitation program, Stryker distractible vertebral body replacement implant is an expandable device, which can adapt to the patient`s anatomy, enabling the neurosurgeons to treat severe burst fractures. Rehabilitation objectives were focused on B-ADL independence (activity, component of the ICF-DH framework) – transfers, orthostatic posture, restore walking, bladder control. The vital prognosis and functional outcome were favorable. Although she was able to use a walking frame at discharge, there were a few drawbacks in what concerns the professional reintegration, due to specific external barriers (she was a military personnel, had neither driving licensee, nor an adapted car). Conclusions: This clinical case underlines the importance of a complex and multidisciplinary approach, prompt surgical intervention and rehabilitation during the early post-acute phase

Complex therapeutical rehabilitation approach in the case of a polytrauma patient with traumatic brain and spinal cord injuries – Case report

The multidisciplinary approach of polytrauma cases including traumatic brain and spinal cord injuries, the survival represents one of the greatest challenges, but the decrease of dysfunction and minimizing the psycho-cognitive sequels are at least as important, regarding the patient’s future quality of life. Material and method Under THEBA Bioethics Commission approval (9181 / 11.04.2018), this paper presents a case of a 28-year-old patient with AIS / Frankel (A) paraplegia after a spinal cord injury SCI T3 level secondary to T4-T5 fracture surgically treated. SCI was associated with moderate traumatic brain injury TBI (subarachnoid haemorrhage), thoraco-abdominal contusion (pneumothorax stg, hepatic trauma) and multiple fractures (sternum and costal, operated), neurogenic bladder and bowel. This condition was due to a car accident, occurred on November 13, 2017. The patient was admitted with a psycho-cognitive status, complete bilateral motor deficit in the lower limbs - paraplegia, sensitivity disorders anaesthesia type and sphincter disorders. The patient was clinically, paraclinical and functionally assessed according to the standardized protocols implemented in our clinic through the assessment scales: AIS, FIM, QoL-Quality of Life, Ashworth, Penn, FAC, WISCI II. Results: The patient's evolution was slow but favourable. He benefited of neurosurgical care and had thoracic surgery to extract the osteosynthesis material at the sternum. Meanwhile he learned the technique of intermittent catheterisation. As a result of rehabilitation program the patients finally reached the level of wheelchair locomotion and have completely restored the cognitive function. Conclusion: The multidisciplinary team approach consisting of physicians, kinetotherapist, nurses and auxiliary healthcare personnel was the key of the patient’s survival, eliminated the cognitive dysfunction and reduced as much as possible the locomotor one

ACUTE SPINAL EPIDURAL HEMATOMA, CLINICAL AND ETIOPATHOGENIC DIAGNOSTIC DIFFICULTIES – CASE PRESENTATION AND SYNTHESIS OF THE LITERATURE

Introduction: Epidural hematoma has a double anatomopathological topography: intracranial and/ or spinal. Its etiology is complex: post-traumatic (spinal trauma, or lumbar puncture), iatrogenic (secondary to an inadequate anticoagulation or antiplatelet treatment), congenital or acquired disorders of coagulation (leukemia, hepatic cirrhosis), secondary to intense Valsalva maneuvers (e.g. during labor, or an intense physical effort), and idiopathic. The purpose of this article is to present a clinical case of acute spinal epidural hematoma (SEDH) with atypical clinical picture and a puzzled pathophysiological mechanism, and also a brief review of the relevant literature. Case presentation: An 80-years-old male patient, with locomotor disability (bilateral congenital foot deformity), and multiple cardiovascular comorbidities (chronic atrial fibrillation (AF), dilated cardiomyopathy and contractile dysfunction (chronic heart failure, with left ventricle ejection fraction 40 %), chronically anticoagulated with a vitamin K antagonist (acenocumarol). The elderly submitted a body-level fall without cranial trauma, event followed by a short loss of consciousness (without convulsions or sphincter relaxation). He suffered a low-energy cervical fracture (C7 vertebral injury) and a posterolateral acute SEDH at C3-Th2 vertebral levels. Decompressive hemilaminectomy at the C4-Th2 levels and evacuation of the SEDH, was performed during the early sub-acute phase. The patient was transferred in our rehabilitation clinic as C4 AIS-C tetraplegia (global motor score 50/100), neurogenic bladder and bowel, with post surgical wound dehiscence (healed per secundam). The subject had a favorable neurological evolution and was discharged as C7 AIS-D tetraplegia (global motor score 81/100). Discussion: The case particularity consists in a puzzled etiopathogenetic mechanisms and difficulty to accurately indicate the chronological chain of events generating the acute SEDH. An overdosed anticoagulant therapy might be incriminated as an iatrogenic cause for a “spontaneous” SEDH, but most probably its etiology is complex, probably traumatic, consequence of the cervical spine fracture due the low-intensity biomechanical impact. The complex predisposing circumstances to accidental fall in our elderly patient were due to the: - impaired, unstable locomotor function, secondary to his bilateral congenital clubfoot deformity / disability - chronic AF, contractile dysfunction and hypodiastolic phenomena, with cardiogenic syncope and global brain ischemia or transient ischemic cerebral attack. Despite the good immediate outcomes, his future functional prognosis might be poor, due to the advanced age, severe cardiovascular pathology and the complex disturbances of the neuro-myo-artro-kinetic apparatus (major impediments of the somatic / body functions and structure). This health-related condition had severe repercussions on the subject`s activity (related to tasks and basic activities of daily living) and participation, affecting the outcome of rehabilitation, and his quality of life. Conclusions: Clinicians should consider the remote risk of SEDH (even with atypical clinical presentation) in patients with AF and anticoagulant medication. Despite a postponed decompressive intervention (imposed by the severe comorbidities), our patient neurologically improved without recurrence, following a complex neurorehabilitation program

Psycho-cognitive syndrome, blindness and tetraplegia after severe traumatic brain injury in polytraumatic context (road acc.) with favorable recovery of cognitive and motor deficits

Introduction The impact of accidents is important both for younger and older people. We live in a multisensory environment and the interaction between our genes and the environment shapes our brains. Cortical blindness as a result of head trauma (to the brain's occipital cortex) is a rare phenomenon and can be a total or partial loss of vision in a normal-appearing eye. How patients will adjust to the loss of vision and its consequences might be a challenge let along if they have mobility imparement (tetraplegia) as well. Adaptation and reintegration of patients into society after motor recovery in the context of visual sensory deficit. TBI survivors themselves and their families are likely more interested in quality-of-life outcomes, such as reintegration into the community, successful return to work or school, and functional capacity in everyday life. Cognitive and behavioural changes, difficulties maintaining personal relationships and coping with school and work are reported by survivors as more disabling than any residual physical deficits. As with all rehabilitation, the goal is to help the person achieve the maximum degree of return to their previous level of functioning. Case presentation Having the patient and TEHBA Bioethics Committee aproval, we will present the evolution of a case with postraumatic spastic tetraplegia post severe traumatic brain injury, blindness post traumatic bilateral occipital lesions and psycho-cognitive syndrome. Clinical and paraclinical aspects will be discussed (patient history and clinical examination, results of imaging and laboratory tests, the neuromioartrokinetic exam, specific rating scales, both medical and kinetotherapeutic treatments).We will address the case in terms of particularities and treatment approach (neurorehabilation of a motor deficit in the context of a major sensory deficiency) and evolution during hospitalization. Conclusions Trauma has been known to result in cortical blindness but the exact pathophysiology remains unknown and remains a matter of continued debate. Cortical blindness may occur after trauma, however, most cases regardless of etiology, are reversible and have no long term sequelae. While TBI can cause long-term physical disability, it is the complex neurobehavioural sequelae that produce the greatest disruption to quality of life. As with all rehabilitation, the goal is to help the person achieve the maximum degree of return to their previous level of functioning. In the setting of polytrauma, a careful ophthalmologic and neurologic examination of the trauma patient, together with a high index of suspicion, is necessary for the diagnosis of this condition. Heightened awareness of the causes should be followed with appropriate imaging and management

Methods and results – therapeutical rehabilitative approaches of a patient with a behaviour and psycho-cognitive status (minimally responsive state) after severe trauma brain injury (TBI) in a polytraumatic context – Case report

This case presentation was evaluated and endorsed by the hospital ethics committee, respecting the rights, safety and comfort of the patient. THEBA Bioethics Commission approval (9181 / 11.04.2018)

Complex rehabilitation and therapeutic care involving a polytraumatized patient with traumatic brain injury, cervical spinal cord injury and multiple associated lesions - case report

The subject matter of the present scientific paper is the report of the therapeutic and rehabilitation program of a polytraumatized patient with severe traumatic brain injury and mild cervical spinal cord injury, that led to serious functional consequences: psychocognitive, neuromotor, neurosensitive and autonomous