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Secondary sarcopenia in spinal cord injured subjects
e240
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
ISPR8-0322
Secondary sarcopenia in spinal cord injured subjects Y. Dionyssiotis 1,∗ , G. Skarantavos 2 , N. Papaioannou 3 , P. Papagelopoulos 4 , J. Papathanasiou 5 , G. Lyritis 3 1 European Interbalkan Medical Center, Physical Medicine and Rehabilitation, Thessaloniki, Greece 2 General University Hospital Attikon, Rheumatology and Metabolic Bone Diseases Unit, 1st Department of Orthopedics, Chaidari, Greece 3 University of Athens, Laboratory for Research of the Musculoskeletal System, Kifissia, Greece 4 General University Hospital Attikon, 1st Department of Orthopedics, Chaidari, Greece 5 University of Padova-Italy, Physical & Rehabilitation Medicine, Padova, Italy ∗ Corresponding author. E-mail address: yannis [email protected] (Y. Dionyssiotis) Introduction/Background The European Working Group on Sarcopenia in Older People (EWGSOP) categorized sarcopenia in primary-age related and secondary sarcopenia. Whole body Dualenergy X-ray Absorptiometry (DXA) measurement remains the gold standard for muscle mass measurements. Sarcopenia is defined by measuring muscle mass (ratio of appendicular skeletal mass (ASM)/height2 (kg/m2 ), (skeletal muscle index, SMI) and muscle strength. An alternative for muscle strength (in Newton, N) is muscle cross- sectional area (CSA) in cm2 (a surrogate for muscle effectiveness or loading-force). The present study investigated if a similar approach to define secondary sarcopenia in spinal cord injured subjects. Material and method The study included 31 paraplegics with complete paraplegia compared with 50 controls. All were examined by whole body DXA (Norland XR 36, USA) regarding muscle mass (relative appendicular skeletal mass (RASM), in Kg) and peripheral quantitative computed tomography (pQCT XCT-3000, Stratec, Germany) in 66% of tibia’s length (muscle CSA, mm2 ). Sarcopenia in the spinal cord injured subjects was defined as SMI, as well as relative ASM, RASM) by the residual method, respectively. Results Paraplegics had significantly lower values in muscle area (CSA) and RASM (P < 0.001) compared to controls. In the adjusted analysis according to age, height and relative fat mass, paraplegia was associated with lower values of RASM (beta ± se; −2.74 ± 0.28, P < 0.001). Conclusion In SCI paraplegics muscle CSA can be measured. Muscle mass can be measured also. This study suggests that we may categorize paraplegics with the current functional definition of EWGSOP for sarcopenia for research purposes. The sensitivity and specificity of this measurement remains unclear. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.556 ISPR8-2144
Prevalence of health problems experience by persons with spinal cord injury in Malaysia
J. Patrick Engkasan ∗ , N. Hasnan University of Malaya, Rehabilitation Medicine, Kuala Lumpur, Malaysia ∗ Corresponding author. E-mail address: [email protected] (J. Patrick Engkasan) Introduction/Background Spinal cord injury (SCI) is known to have a risk of developing secondary health problems which can be debilitating and increases the burden of care on patient and their caregiver. Our aim is to address the prevalence of health problems experience by people with SCI that living in the community and to
investigate the relationship between secondary health problems with SCI characteristics. Material and method This is a database analysis of International Spinal Cord Injury (InSCI) Survey, which was carried out in Malaysia from March 2017 to February 2018. Total of eight rehabilitation centres nationwide participated in this study. However as of this point of this study analysis was conducted, only data from four centres were included for analysis. Data were extracted and analysed based on 3 items: personal background (PB), lesion characteristics (LC) and health problems (HP). We conducted analysis on 7 out of 10 sub-items from PB, all sub-items from LC and 15 out of 16 sub-items from HP. Results A total of 117 eligible participants were included in this study. More than half of the participants are from the age group of 25–44 years old (52%), most were single (47%). As for education, 73% of participants reported to at least completed Upper Secondary level. In relation to hierarchy of associated health problems, sexuality is the highest number of health concerns with 67% participants classified as high severity. This is followed by contractures and spasticity with percentage of 59 and 56% respectively. Except for prevalence of joint contractures, there is no difference in the prevalence of secondary health problems between participants with paraplegia and tetraplegia. Conclusion Sexuality, contractures and spasticity are the top three health problems reported in persons with SCI. The occurrence of health problems among persons with paraplegia and tetraplegia is similar. Keywords Rehabilitation; Sexuality; Contractures Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.557 ISPR8-0667
Paired associative stimulation after spinal cord injury: Who should undergo?
E. Novak ∗ , O. Uvarova , V. Daminov National Medical Surgery Center named by N.I.Pirogov, Neurorehabilitation, Moscow, Russia ∗ Corresponding author. E-mail address: [email protected] (E. Novak) Introduction/Background Paired associative stimulation (PAS) combines electrical stimulation of peripheral nerves (ESPN) with transcranial magnetic stimulation (TMS) and is believed to induce plastic changes in the human corticospinal tract after spinal cord injury (SCI). The aim of the present study was to investigate the advantages of PAS added to the general rehabilitation protocol for chronic SCI. Material and method The study was monocentric shamcontrolled. Patients with lower paraplegia 3–12 months after the trauma were randomly divided into study and control groups: 11 and 9 respectively. TMS was delivered over vertex using a round coil with 90–100% absolute intensity. ESPN of both N. peroneous and N. tibialis was performed with supramaximal intensity at fossa poplitea for 5 minutes for each nerve. The interval between TMS and ESPN was 0.2ms. The intervention consisted 30 sessions of 1 Hz PAS in total. Results After the intervention, the improvement of motor and sensory function (via ASIA impairment scale) was observed in both groups but the intergroup difference was insignificant (MannWhitney U test, P = 0.0675). Spasticity (via modified Ashworth scale) was not changed significantly but 4 patients noticed more uncontrolled movements. Noticeably, patients with no peripheral M-response at the beginning do not demonstrated any improvements. The best functional outcome was found into patients with preserved MEP in the study group. Two patients with no MEP at
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
ISPR8-0322
Secondary sarcopenia in spinal cord injured subjects Y. Dionyssiotis 1,∗ , G. Skarantavos 2 , N. Papaioannou 3 , P. Papagelopoulos 4 , J. Papathanasiou 5 , G. Lyritis 3 1 European Interbalkan Medical Center, Physical Medicine and Rehabilitation, Thessaloniki, Greece 2 General University Hospital Attikon, Rheumatology and Metabolic Bone Diseases Unit, 1st Department of Orthopedics, Chaidari, Greece 3 University of Athens, Laboratory for Research of the Musculoskeletal System, Kifissia, Greece 4 General University Hospital Attikon, 1st Department of Orthopedics, Chaidari, Greece 5 University of Padova-Italy, Physical & Rehabilitation Medicine, Padova, Italy ∗ Corresponding author. E-mail address: yannis [email protected] (Y. Dionyssiotis) Introduction/Background The European Working Group on Sarcopenia in Older People (EWGSOP) categorized sarcopenia in primary-age related and secondary sarcopenia. Whole body Dualenergy X-ray Absorptiometry (DXA) measurement remains the gold standard for muscle mass measurements. Sarcopenia is defined by measuring muscle mass (ratio of appendicular skeletal mass (ASM)/height2 (kg/m2 ), (skeletal muscle index, SMI) and muscle strength. An alternative for muscle strength (in Newton, N) is muscle cross- sectional area (CSA) in cm2 (a surrogate for muscle effectiveness or loading-force). The present study investigated if a similar approach to define secondary sarcopenia in spinal cord injured subjects. Material and method The study included 31 paraplegics with complete paraplegia compared with 50 controls. All were examined by whole body DXA (Norland XR 36, USA) regarding muscle mass (relative appendicular skeletal mass (RASM), in Kg) and peripheral quantitative computed tomography (pQCT XCT-3000, Stratec, Germany) in 66% of tibia’s length (muscle CSA, mm2 ). Sarcopenia in the spinal cord injured subjects was defined as SMI, as well as relative ASM, RASM) by the residual method, respectively. Results Paraplegics had significantly lower values in muscle area (CSA) and RASM (P < 0.001) compared to controls. In the adjusted analysis according to age, height and relative fat mass, paraplegia was associated with lower values of RASM (beta ± se; −2.74 ± 0.28, P < 0.001). Conclusion In SCI paraplegics muscle CSA can be measured. Muscle mass can be measured also. This study suggests that we may categorize paraplegics with the current functional definition of EWGSOP for sarcopenia for research purposes. The sensitivity and specificity of this measurement remains unclear. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.556 ISPR8-2144
Prevalence of health problems experience by persons with spinal cord injury in Malaysia
J. Patrick Engkasan ∗ , N. Hasnan University of Malaya, Rehabilitation Medicine, Kuala Lumpur, Malaysia ∗ Corresponding author. E-mail address: [email protected] (J. Patrick Engkasan) Introduction/Background Spinal cord injury (SCI) is known to have a risk of developing secondary health problems which can be debilitating and increases the burden of care on patient and their caregiver. Our aim is to address the prevalence of health problems experience by people with SCI that living in the community and to
investigate the relationship between secondary health problems with SCI characteristics. Material and method This is a database analysis of International Spinal Cord Injury (InSCI) Survey, which was carried out in Malaysia from March 2017 to February 2018. Total of eight rehabilitation centres nationwide participated in this study. However as of this point of this study analysis was conducted, only data from four centres were included for analysis. Data were extracted and analysed based on 3 items: personal background (PB), lesion characteristics (LC) and health problems (HP). We conducted analysis on 7 out of 10 sub-items from PB, all sub-items from LC and 15 out of 16 sub-items from HP. Results A total of 117 eligible participants were included in this study. More than half of the participants are from the age group of 25–44 years old (52%), most were single (47%). As for education, 73% of participants reported to at least completed Upper Secondary level. In relation to hierarchy of associated health problems, sexuality is the highest number of health concerns with 67% participants classified as high severity. This is followed by contractures and spasticity with percentage of 59 and 56% respectively. Except for prevalence of joint contractures, there is no difference in the prevalence of secondary health problems between participants with paraplegia and tetraplegia. Conclusion Sexuality, contractures and spasticity are the top three health problems reported in persons with SCI. The occurrence of health problems among persons with paraplegia and tetraplegia is similar. Keywords Rehabilitation; Sexuality; Contractures Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.557 ISPR8-0667
Paired associative stimulation after spinal cord injury: Who should undergo?
E. Novak ∗ , O. Uvarova , V. Daminov National Medical Surgery Center named by N.I.Pirogov, Neurorehabilitation, Moscow, Russia ∗ Corresponding author. E-mail address: [email protected] (E. Novak) Introduction/Background Paired associative stimulation (PAS) combines electrical stimulation of peripheral nerves (ESPN) with transcranial magnetic stimulation (TMS) and is believed to induce plastic changes in the human corticospinal tract after spinal cord injury (SCI). The aim of the present study was to investigate the advantages of PAS added to the general rehabilitation protocol for chronic SCI. Material and method The study was monocentric shamcontrolled. Patients with lower paraplegia 3–12 months after the trauma were randomly divided into study and control groups: 11 and 9 respectively. TMS was delivered over vertex using a round coil with 90–100% absolute intensity. ESPN of both N. peroneous and N. tibialis was performed with supramaximal intensity at fossa poplitea for 5 minutes for each nerve. The interval between TMS and ESPN was 0.2ms. The intervention consisted 30 sessions of 1 Hz PAS in total. Results After the intervention, the improvement of motor and sensory function (via ASIA impairment scale) was observed in both groups but the intergroup difference was insignificant (MannWhitney U test, P = 0.0675). Spasticity (via modified Ashworth scale) was not changed significantly but 4 patients noticed more uncontrolled movements. Noticeably, patients with no peripheral M-response at the beginning do not demonstrated any improvements. The best functional outcome was found into patients with preserved MEP in the study group. Two patients with no MEP at