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Absence of high amplitude propagating contractions in subjects with chronic spinal cord injury

World Journal of Gastroenterology 2010年第43期16卷 5435-5439页

作者： Hanumantha R Ancha Noel R Fajardo William A Bauman Alan S Rosman Marinella Galea Graham Creasey Mark A Korsten rehabilitation Research and Development Center of Excellence for Medical Consequences of Spinal Cord injury James J. Peters VA Medical Center Medical service James J. Peters VA Medical Center Department of Medicine Mount Sinai School of Medicine Department of rehabilitation Medicine Mount Sinai School of Medicine Spinal Cord injury service James J. Peters VA Medical Center Spinal Cord injury service VA Medical Center

AIM: To investigate the presence or absence of high amplitude propagating contractions (HAPC), as well as the other measures of colonic motility, in persons with spinal cord injury (SCI). METHODS: Prolonged colonic ambulatory manometric studies were performed on 14 male volunteers: 8 with SCI (mean age, 59 ± 13 years; mean duration of injury, 13 ± 4 years) and 6 healthy able-bodied controls (mean age, 57 ± 10 years). A solid-state manometry catheter was endoscopically clipped to the splenic flexure. Recording was performed for > 24 h after manometric catheter placement. RESULTS: HAPC were absent in individuals with SCI during pre-sleep, sleep, and post-sleep phases. HAPC were significantly increased after awakening in non-SCI controls (0.8 ± 0.2 HAPC/h vs 10.5 ± 2.0 HAPC/h, P < 0.005). The motility index was lower in those with SCI than in controls preand post-sleep (SCI vs non-SCI: Pre-sleep, 2.4 ± 0.4 vs 8.8 ± 1.9, P < 0.01; Post-sleep, 4.3 ± 0.8 vs 16.5 ± 4.5, P < 0.05). However, a sleepinduced depression of colonic motility was observed in both the SCI and non-SCI groups (Pre-sleep vs Sleep, non-SCI: 8.8 ± 1.9 vs 2.1 ± 0.9, P < 0.002; SCI: 2.4 ± 0.4 vs 0.2 ± 0.03, P < 0.001), with the motility index of those with SCI during sleep not significantly different than that of the controls. CONCLUSION: HAPC were not observed in individuals with SCI preor post-sleep. A sleep-induced depression in general colonic motility was evident in SCI and control subjects.

关键词： Spinal cord injury Neurogenic bowel Bowel motility High amplitude propagating contractions Motility index

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Skeletal muscle mitochondrial health and spinal cord injury

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World Journal of Orthopedics 2016年第10期7卷 628-637页

作者： Laura C O'Brien Ashraf S Gorgey Spinal Cord injury and Disorders service Hunter Holmes McGuire VA Medical Center Department of Physiology and Biophysics Virginia Commonwealth University Department of Physical Medicine and rehabilitation Virginia Commonwealth University

Mitochondria are the main source of cellular energy production and are dynamic organelles that undergo biogenesis, remodeling, and degradation. Mitochondrial dysfunction is observed in a number of disease states including acute and chronic central or peripheral nervous system injury by traumatic brain injury, spinal cord injury(SCI), and neurodegenerative disease as well as in metabolic disturbances such as insulin resistance, type Ⅱ diabetes and obesity. Mitochondrial dysfunction is most commonly observed in high energy requiring tissues like the brain and skeletal muscle. In persons with chronic SCI, changes to skeletal muscle may include remarkable atrophy and conversion of muscle fiber type from oxidative to fast glycolytic, combined with increased infiltration of intramuscular adipose tissue. These changes contribute to a proinflammatory environment, glucose intolerance and insulin resistance. The loss of metabolically active muscle combined with inactivity predisposes individuals with SCI to type Ⅱ diabetes and obesity. The contribution of skeletal muscle mitochondrial density and electron transport chain activity to the development of the aforementioned comorbidities following SCI is unclear. A better understanding of the mechanisms involved in skeletal muscle mitochondrial dynamics is imperative to designing and testing effective treatments for this growing population. The current editorial will review ways to study mitochondrial function and the importance of improving skeletal muscle mitochondrial health in clinical populations with a special focus on chronic SCI.

关键词： Mitochondria Spinal cord injuries Body composition Diabetes mellitus Obesity Metabolism

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Dietary manipulation and testosterone replacement therapy may explain changes in body composition after spinal cord injury: A retrospective case report

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World Journal of Clinical Cases 2019年第17期7卷 2427-2437页

作者： Ashraf S Gorgey Robert M Lester Mina P Ghatas Sakita N Sistrun Timothy Lavis Spinal Cord injury and Disorders service Hunter Holmes McGuire VAMCRichmondVA 23249United States Department of Physical Medicine and rehabilitation Virginia Commonwealth UniversityRichmondVA 23249United States Bionutrition service Center for Clinical and Translational ResearchVirginia Commonwealth UniversityRichmondVA 23249United States

BACKGROUND Reduced level of physical activity,high-fat diet and skeletal muscle atrophy are key factors that are likely to contribute to deleterious changes in body composition and metabolic following spinal cord injury (SCI).Reduced caloric intake with lowering percentage macronutrients of fat and increasing protein intake may likely to improve body composition parameters and decrease ectopic adiposity after *** To highlight the effects of dietary manipulation and testosterone replacement therapy (TRT) on body composition after SCI METHODS A 31-year-old male with T5 SCI was administered transdermal TRT daily for 16 *** intake and percentage macronutrients were analyzed using dietary *** resonance imaging and dual-energy x-ray absorptiometry were used to measure changes in body *** Caloric intake and fat percentage were reduced by 445 kcal/d and 6.5%,*** body weight decreased by 8%,body fat decreased by 29%,and lean mass increased by 7%.Thigh subcutaneous adipose tissue cross-sectional area was reduced by 31%.CONCLUSION Manipulation of caloric intake,fat percentage,and protein percentage may have influenced body composition after SCI.

关键词： Spinal cord injury Diet High-protein Low-fat Nutrients Basal metabolic rate Case report

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Epidemiological data on acupuncture and physical and rehabilitation medicine in the European Union

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Journal of Traditional Chinese Medicine 2015年第4期35卷 478-482页

作者： María Victoria González-López-Arza Patrick Sautreuil Enrique Varela-Donoso Juan Rodríguez-Mansilla Elisa Garrido-Ardila Department of Medical-Surgical Therapy Medicine FacultyExtremadura University Neuro-orthopedic rehabilitation service Rothschild Hospital Department of Physical Medicine and rehabilitation Medicine FacultyComplutense University

OBJETIVE: To know the prevalence of acupuncturists within physical and rehabilitation medicine specialists in Europe and their characteristics,as well as to analyze the pathologies treated and therapeutic techniques ***: This is a cross-sectional descriptive study based on a structured and closed questionnaire. The study was carried out from October 2011 to May ***: A total of 115 specialists from 19 countries completed the questionnaire. The mean characteristics of the physical and rehabilitation medicine(PRM) specialists who are also acupuncturists in Europe were: women(62.6 %); mean age of47.91 years old; 4.20 years of physical and rehabilitation medicine school and 2.00 years of acupuncture training; 15.03 years of mean time of clinical practice as physical and rehabilitation medicine specialists and 10.42 years of experience as acupuncturists; 35.65 % had a doctorate(Ph D) degree,obtained at a mean age of 33.55 years old; working in a public hospital(80%); treating mainly neurological conditions(48.1%) and using mainly techniques such as kinesiotherapy(11.81%),orthosis(10.40%) and electrotherapy(9.92%). Acupuncture was applied by 32.2% of the participants mainly in musculoskeletal conditions(27.38%). A mean number of more than 20 patients a day were treated by47.04% of the specialists,being 41.8% of the patients(adults and children). Significant differences were found between the variables,acupuncture and gender(Pearson's correlation Index = 0.007).However,no differences were observed in relation to acupuncture and age,doctorate degree,years of clinical practice and workplace(all with P values >0.05).CONCLUSION: In the European area,physical and rehabilitation medicine specialists who are also acupuncturists are mainly female,middle-aged,with15 years of professional experience,Ph D holders,working in public hospitals,treating mainly neurological conditions with kinesiotherapy and acupuncture,and treating over 20 patients a day(adults and child

关键词： Epidemiology Physical and rehabilita-tion medicine Acupuncture Europe Professional practice

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Comparison of cognitive and UHDRS measures in monitoring disease progression in Huntington’s disease: a 12-month longitudinal study

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Translational Neurodegeneration 2014年第1期3卷 109-118页

作者： Eng A Toh Michael R MacAskill John C Dalrymple-Alford Daniel J Myall Leslie Livingston Sandy AD Macleod Tim J Anderson Department of Medicine Christchurch School of Medicine&Health SciencesUniversity of OtagoChristchurchNew Zealand New Zealand brain Research Institute ChristchurchNew Zealand Department of Psychology University of CanterburyChristchurchNew Zealand brain injury rehabilitation service Canterbury District Health BoardChristchurchNew Zealand Department of Neurology Canterbury District Health BoardChristchurchNew Zealand

Progressive cognitive decline is a feature of Huntington’s disease(HD),an inherited neurodegenerative movement *** neuropsychological testing is the‘gold standard’to establish cognitive status but is often impractical in time-constrained *** study evaluated the utility of brief cognitive tests(MMSE and MoCA),UHDRS measures and a comprehensive neuropsychological tests battery in monitoring short-term disease progression in ***-two manifest HD patients and 22 matched controls were assessed at baseline and 12-month.A linear mixed-effect model showed that although the HD group had minimal change in overall global cognition after 12 months,they did show a significant decline relative to the control *** controls exhibited a practice effect in most of the cognitive domain scores over *** decline at 12-month in HD was found in the executive function domain but the effect of this on global cognitive score was masked by the improvement in their language domain *** varying practice effects by cognitive domain with repeated testing indicates the importance of comparing HD patients to control group in research trials and that cognitive progression over 12 months in HD should not be judged by changes in global cognitive *** three brief cognitive tests effectively described cognition of HD patients on cross-sectional *** UHDRS cognitive component,which focuses on testing executive function and had low variance over time,is a more reliable brief substitute for comprehensive neuropsychological testing than MMSE and MoCA in monitoring cognitive changes in HD patients after 12 months.

关键词： Huntington’s disease Disease progression Cognition UHDRS Longitudinal

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Neuromuscular electrical stimulation and testosterone did not influence heterotopic ossification size after spinal cord injury: A case series

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World Journal of Clinical Cases 2016年第7期4卷 172-176页

作者： Pamela D Moore Ashraf S Gorgey Rodney C Wade Refka E Khalil Timothy D Lavis Rehan Khan Robert A Adler Spinal Cord injury service and Disorders Hunter Holmes Mc Guire VA Medical Center Physical Medicine and rehabilitation Virginia Commonwealth University Radiology service Hunter Holmes McG uire VA Medical Center Endocrinology service Hunter Holmes Mc Guire VA Medical Center Endocrine Division Virginia Commonwealth University School of Medicine

Neuromuscular electrical stimulation(NMES) and testosterone replacement therapy(TRT) are effective rehabilitation strategies to attenuate muscle atrophy and evoke hypertrophy in persons with spinal cord injury(SCI). However both interventions might increase heterotopic ossification(HO) size in SCI patients. We present the results of two men with chronic traumatic motor complete SCI who also had pre-existing HO and participated in a study investigating the effects of TRT or TRT plus NMES resistance training(RT) on body composition. The 49-year-old male, Subject A, has unilateral HO in his right thigh. The 31-year-old male, Subject B, has bilateral HO in both thighs. Both participants wore transdermal testosterone patches(4-6 mg/d) daily for 16 wk. Subject A also underwent progressive NMES-RT twice weekly for 16 wk. Magnetic resonance imaging scans were acquired prior to and post intervention. Cross-sectional areas(CSA) of thewhole thigh and knee extensor skeletal muscles, femoral bone, and HO were measured. In Subject A(NMES-RT + TRT), the whole thigh skeletal muscle CSA increased by 10%, the knee extensor CSA increased by 17%, and the HO + femoral bone CSA did not change. In Subject B(TRT), the whole thigh skeletal muscle CSA increased by 13% in the right thigh and 6% in the left thigh. The knee extensor CSA increased by 7% in the right thigh and did not change in the left thigh. The femoral bone and HO CSAs in both thighs did not change. Both the TRT and NMES-RT + TRT protocols evoked muscle hypertrophy without stimulating the growth of preexisting HO.

关键词： Heterotopic ossification Neuromuscular electrical stimulation Testosterone Resistance training Spinal cord injury

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Appropriateness of a Physiotherapic Treatment Protocol for the Axillary Web Syndrome, Applied in a Territorial rehabilitation service: Description of a Clinical Case

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Open Journal of Therapy and rehabilitation 2020年第3期8卷 53-59页

作者： Luca Collebrusco Antonietta Tufi Elisabetta Brunori rehabilitation Unit National Health Service of Umbria Perugia Italy The Centro Médico y de Rehabilitación Dr. Rozalén Madrid Espana

The “Axillary web syndrome” (AWS) is an early complication following breast cancer surgery with axillary lymph nodes dissection. Case Report: The patient is a 69-year-old woman, retired ex-employee, with outcome surgery right axillary lymphadenectomy with shoulder pain and functional limitation with diagnosis AWS it where it was recommended the physiotherapy. The patient had improvement in terms of shoulder function and pain and quality of life. Conclusions: The description of the clinical case afflicted with AWS and the treatment protocol applied, highlighted the good performance of the results, notably as concerns patient’s quality of life. This result could represent a starting point for creating clinical trials aimed at building appropriate rehabilitation route in territorial rehabilitation services.

关键词： Axillary Web Syndrome Manual Therapy Soft Tissue Mobilization Exercise Therapy Case Report

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Low-dose testosterone replacement therapy and electrically evoked resistance training enhance muscle quality after spinal cord injury

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Neural Regeneration Research 2021年第8期16卷 1544-1545页

作者： Raymond E.Lai Ashraf S.Gorgey Spinal Cord injury and Disorders Hunter Holmes McGuire VA Medical CenterPhysical Medicine and RehabilitationVirginia Commonwealth UniversityRichmondVIUSA

The current perspective is aimed to highlight the significance of adding low-dose testosterone replacement therapy(TRT) to electrically evoked resistance training(RT).Evoked RT is primarily designed to load the paralyzed lower extremity muscles to elicit muscle hypertrophy in persons with spinal cord injury(SCI)(Ryan et al.,2013;Gorgey et al.,2019).The rationale was based on previous work that indicated that highdose TRT is likely to enhance muscle quality。

关键词： TRT rational likely

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Semi-automated segmentation of magnetic resonance images for thigh skeletal muscle and fat using threshold technique after spinal cord injury

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Neural Regeneration Research 2018年第10期13卷 1787-1795页

作者： Mina P.Ghatas Robert M.Lester M.Rehan Khan Ashraf S.Gorgey Department of Spinal Cord injury and Disorders Hunter Holmes McGuire VA Medical Center Department of Radiology Hunter Holmes McGuire VA Medical Center Department of Physical Medicine and rehabilitation Virginia Commonwealth University

Magnetic resonance imaging is considered the ＂gold standard＂ technique for quantifying thigh muscle and fat cross-sectional area. We have developed a semi-automated technique to segment seven thigh compartments in persons with spinal cord injury. Thigh magnetic resonance images from 18 men（18–50 years old） with traumatic motor-complete spinal cord injury were analyzed in a blinded fashion using the threshold technique. The cross-sectional area values acquired by thresholding were compared to the manual tracing technique. The percentage errors for thigh circumference were（threshold： 170.71 ± 38.67; manual： 169.45 ± 38.27 cm2） 0.74%, subcutaneous adipose tissue（threshold： 65.99±30.79; manual： 62.68 ± 30.22） 5.2%, whole muscle（threshold： 98.18 ± 20.19; manual： 98.20 ± 20.08 cm2） 0.13%, femoral bone（threshold： 6.53 ± 1.09; manual： 6.53 ± 1.09 cm2） 0.64%, bone marrow fat（threshold： 3.12 ± 1.12; manual： 3.1 ± 1.11 cm2） 0.36%, knee extensor（threshold： 43.98 ± 7.66; manual： 44.61 ± 7.81 cm2） 1.78% and % intramuscular fat（threshold： 10.45 ± 4.29; manual： 10.92 ± 8.35%） 0.47%. Collectively, these results suggest that the threshold technique provided a robust accuracy in measuring the seven main thigh compartments, while greatly reducing the analysis time.

关键词： spinal cord injury magnetic resonance imaging semi-automated segmentation subcutaneous adipose tissue intramuscular fat

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Executive functioning in TBI from rehabilitation to social reintegration: COMPASS^(goal), a randomized controlled trial(grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013–2016)

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Military Medical Research 2015年第4期3卷 181-200页

作者： Alexander V.Libin Joel Scholten Manon Maitland Schladen Ellen Danford Nawar Shara Walter Penk Jordan Grafman Linda Resnik Dwan Bruner Samantha Cichon Miriam Philmon Brenda Tsai Marc Blackman Alexander Dromerick Mental Health service Washington DC VA Medical Center Med Star National rehabilitation Hospital Med Star Health Research Institute Physical Medicine and rehabilitation service Washington DC VA Medical Center Research service Washington DC VA Medical Center Texas A&M College of Medicine rehabilitation Institute of Chicago Research service Providence VA Medical Center

Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent ***/design: The COMPASSgoal(Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community reintegration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management(intervention) and supported discharge(control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment ***: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits

关键词： Executive function Traumatic brain injury Goal-setting Community reintegration Veterans Randomized controlled trial Manualized psychosocial intervention

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