- Email: [email protected]
Sitting position and wheelchair appropriateness in patients with spinal cord injury: Assessment of professional practices in a specialist unit
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
function and autonomy. Sub-analysis revealed a significant effect on strength only for bottom-up strategy. All other sub-analyzes albeit non-significant revealed at least a medium effect size for all outcomes with exception to the very small effect size displayed for somesthesia. Conclusion These results support the effectiveness of UL rehabilitation on strength using. There is a potential interest of using bottom-up and neuromodulation strategies to improve hand function and autonomy but with heterogeneity between interventions and participants. Conversely, there is no evidence for top-down strategy and interventions targeting somesthesia appear ineffective. Further effort on funding may promote high-quality multi-centric studies with increased standardization in intervention and participants to completely address UL rehabilitation effectiveness after tetraplegia while separating recovery and compensation effects. Keywords Top-down; Bottom-up; Neuromodulation Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.563 ISPR8-1583
Melatonin secretion in patients with spinal cord injury R. Daville-blicq 1,∗ , M.A. Quera Salva 2 , D. Ben Smail 1 CHU Raymond-Poincare-Garches, Spinal cord injury rehabilitation department, Paris, France 2 CHU Raymond-Poincare-Garches, Sleep laboratory, Paris, France ∗ Corresponding author. E-mail address: [email protected] (R. Daville-blicq)
1
Introduction/Background We evaluated the secretion of melatonin and the sleep quality in spinal cord injury patients versus healthy volunteers. Material and method This observational non-randomised study was conducted from June 2016 to January 2018 includes tetraplegics, paraplegics and healthy volunteers. Urinary 6sulfatoxy-melatonin (U6SM) was measured during 5 period per day (8h–12h; 12h–16h; 16h–20h; 20h–00h; 00h–8h). Sleep quality was evaluated on Pittsburgh Sleep Quality Index and sleepiness on Epworth Sleepiness Scale. Correlation between U6SM dosage and sleep quality and sleepiness was analysed. Results Preliminary results 12 tetraplegic patients AIS A and B (10 men and 2 women) and 7 paraplegics AIS A and B were included in the study. No patient took neuroleptics or beta-blockers. No patient had a brain trauma associated. Eight tetraplegic patients (66.6%) had an absence of melatonin secretion, 4 (33.3%) had a decreased secretion with a shift of melatonin secretion. Unlike data of the literature, secretion of melatonin was not strictly normal in paraplegic patients: 4 (57.1%) had an absence of melatonin secretion, one T10 AIS A patient had a shift of melatonin secretion, 2 (28.5%) T9 and T10 AIS A patients had a normal melatonin secretion. The Pittsburgh Sleep Quality Index showed a poor sleep quality in tetraplegics (10.18 ± 4.62) versus (7.57 ± 3.64) in paraplegics and Epworth Sleepiness Scale showed a moderate sleepiness in tetraplegics (11.18 ± 4.30) versus (4.57 ± 2.50) in paraplegics. Conclusion Secretion of melatonin is abnormal in patients with tetraplegia. It may partly explain sleep impairment of patients with tetraplegia. Further studies are needed to better understand the impact of this absence of melatonin secretion and to assess the effect of melatonin treatment in this population of patients. Keywords Spinal cord injury; Sleep; Melatonin Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.564
e243
ISPR8-2036
Sitting position and wheelchair appropriateness in patients with spinal cord injury: Assessment of professional practices in a specialist unit M. Le Fort 1,∗ , S. Ferréol 2 , M. Sarda 1 , G. Genty 1 , A. Piers 1 , P. Kieny 1 , B. Perrouin-Verbe 1 1 CHU de Nantes, Neurological PMR department, Nantes, France 2 CHU de Nantes, PMR Pole Quality, Nantes, France ∗ Corresponding author. E-mail address: [email protected] (M. Le Fort) Introduction/Background Skill profiles of a wheelchair, notably leading to the initial choice after a spinal cord injury (SCI), include the patient’s comfort, his/her safety as well as physical and social performances. The multidisciplinary team of first rehabilitation within a spinal unit wondered about the quality of the patients’ positioning. The team consequently wished to create an indoor reference document as well as a simple helping tool, so as to choose correctly the wheelchair, to settle any patient in a convenient manner and to check this settling. Material and method Frontal and profile photos were taken of SCI individuals in the sitting position in a manual or a powered wheelchair. A multidisciplinary specialist team working in a spinal unit (doctors, nurses, physiotherapists, occupational therapists and caregivers) analyzed each patient positioning within his/her wheelchair, mentored by trained medical quality practitioners. A review of the literature relating any component and accessories of the wheelchairs was then carried-out and compared with data from the previous analysis. Results An illustrated reference notebook was created, describing the choice of the wheelchair according to the motor level of the SCI patient, then according to the characteristics of his/her positioning and the adaptation of components and accessories. A checklist form was also developed to make easier the procedure of settling and then its revision, as a potential tool for the transmissions of detected anomalies between the various professionals. Both documents will be assessed by using them for the analysis of a new series of photos. Conclusion The whole staff of the neurological PMR department will then be trained with these documents that will afterwards be placed in the documentary management system of our University Hospital. They could be useful as information tools for already involved staffs either or as training tools for professionals newly dealing with SCI patients. Keywords Reference notebook; Multidisciplinarity Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.565 ISPR8-2201
Effect of early treatment with zoledronic acid on prevention of bone loss in patients with acute spinal cord injury – Hospital-based randomised controlled study
S. Sethi ∗ , S. Goenka SMS Medical College Jaipur, Physical Medicine & Rehabilitation, Jaipur, India ∗ Corresponding author. E-mail address: [email protected] (S. Sethi) Introduction/Background Osteoporosis following spinal cord injury is well known and is indicated by low bone mass with deterioration of skeletal micro-architecture. Decrease in bone mineral density is early & rapid and incidence of osteoporotic/fragility
function and autonomy. Sub-analysis revealed a significant effect on strength only for bottom-up strategy. All other sub-analyzes albeit non-significant revealed at least a medium effect size for all outcomes with exception to the very small effect size displayed for somesthesia. Conclusion These results support the effectiveness of UL rehabilitation on strength using. There is a potential interest of using bottom-up and neuromodulation strategies to improve hand function and autonomy but with heterogeneity between interventions and participants. Conversely, there is no evidence for top-down strategy and interventions targeting somesthesia appear ineffective. Further effort on funding may promote high-quality multi-centric studies with increased standardization in intervention and participants to completely address UL rehabilitation effectiveness after tetraplegia while separating recovery and compensation effects. Keywords Top-down; Bottom-up; Neuromodulation Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.563 ISPR8-1583
Melatonin secretion in patients with spinal cord injury R. Daville-blicq 1,∗ , M.A. Quera Salva 2 , D. Ben Smail 1 CHU Raymond-Poincare-Garches, Spinal cord injury rehabilitation department, Paris, France 2 CHU Raymond-Poincare-Garches, Sleep laboratory, Paris, France ∗ Corresponding author. E-mail address: [email protected] (R. Daville-blicq)
1
Introduction/Background We evaluated the secretion of melatonin and the sleep quality in spinal cord injury patients versus healthy volunteers. Material and method This observational non-randomised study was conducted from June 2016 to January 2018 includes tetraplegics, paraplegics and healthy volunteers. Urinary 6sulfatoxy-melatonin (U6SM) was measured during 5 period per day (8h–12h; 12h–16h; 16h–20h; 20h–00h; 00h–8h). Sleep quality was evaluated on Pittsburgh Sleep Quality Index and sleepiness on Epworth Sleepiness Scale. Correlation between U6SM dosage and sleep quality and sleepiness was analysed. Results Preliminary results 12 tetraplegic patients AIS A and B (10 men and 2 women) and 7 paraplegics AIS A and B were included in the study. No patient took neuroleptics or beta-blockers. No patient had a brain trauma associated. Eight tetraplegic patients (66.6%) had an absence of melatonin secretion, 4 (33.3%) had a decreased secretion with a shift of melatonin secretion. Unlike data of the literature, secretion of melatonin was not strictly normal in paraplegic patients: 4 (57.1%) had an absence of melatonin secretion, one T10 AIS A patient had a shift of melatonin secretion, 2 (28.5%) T9 and T10 AIS A patients had a normal melatonin secretion. The Pittsburgh Sleep Quality Index showed a poor sleep quality in tetraplegics (10.18 ± 4.62) versus (7.57 ± 3.64) in paraplegics and Epworth Sleepiness Scale showed a moderate sleepiness in tetraplegics (11.18 ± 4.30) versus (4.57 ± 2.50) in paraplegics. Conclusion Secretion of melatonin is abnormal in patients with tetraplegia. It may partly explain sleep impairment of patients with tetraplegia. Further studies are needed to better understand the impact of this absence of melatonin secretion and to assess the effect of melatonin treatment in this population of patients. Keywords Spinal cord injury; Sleep; Melatonin Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.564
e243
ISPR8-2036
Sitting position and wheelchair appropriateness in patients with spinal cord injury: Assessment of professional practices in a specialist unit M. Le Fort 1,∗ , S. Ferréol 2 , M. Sarda 1 , G. Genty 1 , A. Piers 1 , P. Kieny 1 , B. Perrouin-Verbe 1 1 CHU de Nantes, Neurological PMR department, Nantes, France 2 CHU de Nantes, PMR Pole Quality, Nantes, France ∗ Corresponding author. E-mail address: [email protected] (M. Le Fort) Introduction/Background Skill profiles of a wheelchair, notably leading to the initial choice after a spinal cord injury (SCI), include the patient’s comfort, his/her safety as well as physical and social performances. The multidisciplinary team of first rehabilitation within a spinal unit wondered about the quality of the patients’ positioning. The team consequently wished to create an indoor reference document as well as a simple helping tool, so as to choose correctly the wheelchair, to settle any patient in a convenient manner and to check this settling. Material and method Frontal and profile photos were taken of SCI individuals in the sitting position in a manual or a powered wheelchair. A multidisciplinary specialist team working in a spinal unit (doctors, nurses, physiotherapists, occupational therapists and caregivers) analyzed each patient positioning within his/her wheelchair, mentored by trained medical quality practitioners. A review of the literature relating any component and accessories of the wheelchairs was then carried-out and compared with data from the previous analysis. Results An illustrated reference notebook was created, describing the choice of the wheelchair according to the motor level of the SCI patient, then according to the characteristics of his/her positioning and the adaptation of components and accessories. A checklist form was also developed to make easier the procedure of settling and then its revision, as a potential tool for the transmissions of detected anomalies between the various professionals. Both documents will be assessed by using them for the analysis of a new series of photos. Conclusion The whole staff of the neurological PMR department will then be trained with these documents that will afterwards be placed in the documentary management system of our University Hospital. They could be useful as information tools for already involved staffs either or as training tools for professionals newly dealing with SCI patients. Keywords Reference notebook; Multidisciplinarity Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.565 ISPR8-2201
Effect of early treatment with zoledronic acid on prevention of bone loss in patients with acute spinal cord injury – Hospital-based randomised controlled study
S. Sethi ∗ , S. Goenka SMS Medical College Jaipur, Physical Medicine & Rehabilitation, Jaipur, India ∗ Corresponding author. E-mail address: [email protected] (S. Sethi) Introduction/Background Osteoporosis following spinal cord injury is well known and is indicated by low bone mass with deterioration of skeletal micro-architecture. Decrease in bone mineral density is early & rapid and incidence of osteoporotic/fragility