Body image distortions following spinal cord injury

Background: Following spinal cord injury (SCI) or anaesthesia, people may continue to experience feelings of the size, shape, and posture of their body, suggesting that the conscious body image is not fully determined by immediate sensory signals. How this body image is affected by changes in sensory inputs from, and motor outputs to the body remains unclear. Methods: We tested paraplegic and tetraplegic SCI patients on a task that yields quantitative measures of body image. Participants were presented with an anchoring stimulus on a computer screen and told to imagine that the displayed body part was part of a standing mirror image of themselves. They then identified the position on the screen, relative to the anchor, where each of several parts of their body would be located. Veridical body dimensions were identified based on measurements and photographs of participants. Results: Compared to age-matched controls, paraplegic and tetraplegic patients alike perceived their torso and limbs as elongated relative to their body width. No effects of lesion level were found. Conclusions: The common distortions in body image across patient groups, despite differing SCI levels, imply that a body image may be maintained despite chronic sensory and motor loss. Systematic alterations in body image follow SCI, though our results suggest these may reflect prolonged changes in body posture and wheelchair use, rather than loss of specific sensorimotor pathways. These findings provide new insight into how the body image is maintained, and may prove useful in treatments that intervene to manipulate the body image

Body image distortions following spinal cord injury

ABSTRACT Background Following spinal cord injury (SCI) or anaesthesia, people may continue to experience feelings of the size, shape and posture of their body, suggesting that the conscious body image is not fully determined by immediate sensory signals. How this body image is affected by changes in sensory inputs from, and motor outputs to, the body remains unclear. Methods We tested paraplegic and tetraplegic SCI patients on a task that yields quantitative measures of body image. Participants were presented with an anchoring stimulus on a computer screen and told to imagine that the displayed body part was part of a standing mirror image of themselves. They then identified the position on the screen, relative to the anchor, where each of several parts of their body would be located. Veridical body dimensions were identified based on measurements and photographs of participants. Results Compared with age matched controls, paraplegic and tetraplegic patients alike perceived their torso and limbs as elongated relative to their body width. No effects of lesion level were found. Conclusions The common distortions in body image across patient groups, despite differing SCI levels, imply that a body image may be maintained despite chronic sensory and motor loss. Systematic alterations in body image follow SCI although our results suggest these may reflect changes in body posture, rather than loss of specific sensorimotor pathways. These findings provide new insight into how the body image is maintained, and may prove useful in treatments that intervene to manipulate the body image

Walking Outcome After Traumatic Paraplegic Spinal Cord Injury: The Function of Which Myotomes Makes a Difference?

BACKGROUND: Accurate prediction of walking function after a traumatic spinal cord injury (SCI) is crucial for an appropriate tailoring and application of therapeutical interventions. Long-term outcome of ambulation is strongly related to residual muscle function acutely after injury and its recovery potential. The identification of the underlying determinants of ambulation, however, remains a challenging task in SCI, a neurological disorder presented with heterogeneous clinical manifestations and recovery trajectories. OBJECTIVES: Stratification of walking function and determination of its most relevant underlying muscle functions based on stratified homogeneous patient subgroups. METHODS: Data from individuals with paraplegic SCI were used to develop a prediction-based stratification model, applying unbiased recursive partitioning conditional inference tree (URP-CTREE). The primary outcome was the 6-minute walk test at 6 months after injury. Standardized neurological assessments ≤15 days after injury were chosen as predictors. Resulting subgroups were incorporated into a subsequent node-specific analysis to attribute the role of individual lower extremity myotomes for the prognosis of walking function. RESULTS: Using URP-CTREE, the study group of 361 SCI patients was divided into 8 homogeneous subgroups. The node specific analysis uncovered that proximal myotomes L2 and L3 were driving factors for the differentiation between walkers and non-walkers. Distal myotomes L4-S1 were revealed to be responsible for the prognostic distinction of indoor and outdoor walkers (with and without aids). CONCLUSION: Stratification of a heterogeneous population with paraplegic SCI into more homogeneous subgroups, combined with the identification of underlying muscle functions prospectively determining the walking outcome, enable potential benefit for application in clinical trials and practice

Rehabilitation of hand function after spinal cord injury using a novel handgrip device: a pilot study

BackgroundActivity-based therapy (ABT) for patients with spinal cord injury (SCI), which consists of repetitive use of muscles above and below the spinal lesion, improves locomotion and arm strength. Less data has been published regarding its effects on hand function. We sought to evaluate the effects of a weekly hand-focused therapy program using a novel handgrip device on grip strength and hand function in a SCI cohort.MethodsPatients with SCI were enrolled in a weekly program that involved activities with the MediSens (Los Angeles, CA) handgrip. These included maximum voluntary contraction (MVC) and a tracking task that required each subject to adjust his/her grip strength according to a pattern displayed on a computer screen. For the latter, performance was measured as mean absolute accuracy (MAA). The Spinal Cord Independence Measure (SCIM) was used to measure each subject's independence prior to and after therapy.ResultsSeventeen patients completed the program with average participation duration of 21.3 weeks. The cohort included patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (n = 12), AIS B (n = 1), AIS C (n = 2), and AIS D (n = 2) injuries. The average MVC for the cohort increased from 4.1 N to 21.2 N over 20 weeks, but did not reach statistical significance. The average MAA for the cohort increased from 9.01 to 21.7% at the end of the study (p = .02). The cohort's average SCIM at the end of the study was unchanged compared to baseline.ConclusionsA weekly handgrip-based ABT program is feasible and efficacious at increasing hand task performance in subjects with SCI