Browsing by Subject "Spinal cord injury"

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  • Eskola, Kaarina L; Koskinen, Eerika; Anttila, Heidi; Tallqvist, Susanna; Bergman, Paula H; Kallinen, Mauri; Hämäläinen, Harri; Kauppila, Anna-Maija; Täckman, Anni; Vainionpää, Aki; Arokoski, Jari; Rajavaara, Marketta; Hiekkala, Sinikka (2022)
    Abstract Objective: To explore work participation and the health-related factors affecting work participation among the Finnish Spinal Cord injury (FinSCI) study population (n = 884). Methods: A cross-sectional explorative observational study in the FinSCI community survey applying Patient-Reported Outcomes Measurement Information System (PROMIS®) forms on Social Health and Global Health. Analyses of socio-demographic and injury-related data were performed. Results: Employment among the study population (n = 452) was 26.5%. Physical, Mental, Social and General Health were better in the employed group compared with work-age persons not working. Logistic regression showed that work participation was related to all health domains, but Physical Health and Ability to Participate in Social Roles and Activities in Social Health were the strongest indicators of likelihood of being at work. Paraplegia and young age were associated with increased likelihood of work participation. Conclusion: The first national survey among people with spinal cord injury in Finland shows low level of employment. The results suggest that pain, physical function, and ability to participate in social roles should be monitored by health and vocational professionals when assessing a person's likelihood of being in work.
  • Pohjonen, Markus; Savolainen, Sarianna; Arokoski, Jari; Shulga, Anastasia (2021)
    Objectives: Earlier studies have shown how chronic spinal cord injury (SCI) patients have benefitted from paired associative stimulation (PAS), consisting of high-frequency peripheral nerve stimulation (PNS) and high-intensity transcranial magnetic stimulation (TMS). Since high-frequency PNS is poorly characterized, its therapeutic effect without TMS should be evaluated. We tested the effect of PNS combined with motor imagery in chronic SCI patients using the same parameters of PNS as in earlier PAS-based studies that also used TMS. Methods: Five patients with chronic incomplete SCI and tetraplegia received a 6-week treatment of PNS combined with motor imagery to the weaker upper limb. Patients were evaluated with Manual Muscle Testing (MMT), hand function tests (Box and block, grip and pinch strength dynamometry), and spasticity. Results: There was no significant change in hand function tests or spasticity. MMT values improved significantly immediately after the PNS period (0.59 +/- 0.17, p = 0.043) and in the 1-month follow-up visit (0.87 +/- 0.18, p = 0.043). However, improvement of MMT values was weaker than in chronic tetraplegic patients in a corresponding PAS study that used identical PNS stimulation but also included the TMS component omitted here (Tolmacheva et al., 2019a, Clin Neurophysiol Pract). Conclusions: The lack of effect on functional hand tests with the protocol presented here suggests that the synergistic effect of PNS and TMS components is essential for the full therapeutic effect previously observed with PAS intervention. The moderate improvement of the MMT score suggests the possible usefulness of PNS and motor imagery for some of those tetraplegic SCI patients who have contraindications to TMS. Significance: These results add to the understanding of the PAS therapeutic mechanism by highlighting the importance of dual stimulation for achieving the full therapeutic effect of long-term PAS with a high-frequency PNS component. (C) 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.
  • Tolmacheva, Aleksandra; Savolainen, Sarianna; Kirveskari, Erika; Brandstack, Nina; Mäkelä, Jyrki P.; Shulga, Anastasia (2019)
    Objectives Long-term paired associative stimulation (PAS) is a non-invasive combination of transcranial magnetic stimulation and peripheral nerve stimulation and leads to improved hand motor function in individuals with incomplete traumatic tetraplegia. Spinal cord injuries (SCIs) can also be induced by neurological diseases. We tested a similar long-term PAS approach in patients with nontraumatic neurological SCI. Methods In this case series five patients with nontraumatic tetraplegia received PAS to the weaker upper limb 3 to 5 times per week for 6 weeks. Patients were evaluated with manual muscle testing (MMT) before and immediately after therapy and at the 1- and 6-month follow ups. Patients were also evaluated for spasticity, hand mechanical and digital dynamometry, pinch, and Box and Blocks tests. Results All patients had improved MMT values at all post-PAS evaluations. The mean±standard error MMT increase was 1.44±0.37 points (p=0.043) immediately after PAS, 1.57±0.4 points (p=0.043) at the 1-month follow-up, and 1.71±0.47 points (p=0.043) at the 6-month follow up. The pinch, digital dynamometry values, and Box and Blocks test results also improved in all patients. Conclusions Long-term PAS may be a safe and effective treatment for improving hand function in patients with nontraumatic tetraplegia. Significance This is the first report demonstrating the therapeutic potential of PAS for neurological SCI.
  • Lipachev, Nikita; Arnst, Nikita; Melnikova, Anastasiia; Jäälinoja, Harri; Kochneva, Anastasiya; Zhigalov, Alexander; Kulesskaya, Natalia; Aganov, Albert V.; Mavlikeev, Mikhail; Rauvala, Heikki; Kiyasov, Andrey P.; Paveliev, Mikhail (2019)
    Perineuronal net (PNN) is a highly structured portion of the CNS extracellular matrix (ECM) regulating synaptic plasticity and a range of pathologic conditions including posttraumatic regeneration and epilepsy. Here we studied Wisteria floribunda agglutinin-stained histological sections to quantify the PNN size and enrichment of chondroitin sulfates in mouse brain and spinal cord. Somatosensory cortex sections were examined during the period of PNN establishment at postnatal days 14, 21 and 28. The single cell PNN size and the chondroitin sulfate intensity were quantified for all cortex layers and specifically for the cortical layer IV which has the highest density of PNN-positive neurons. We demonstrate that the chondroitin sulfate proteoglycan staining intensity is increased between P14 and P28 while the PNN size remains unchanged. We then addressed posttraumatic changes of the PNN expression in laminae 6 and 7 of cervical spinal cord following hemisection injury. We demonstrate increase of the chondroitin sulfate content at 1.6–1.8 mm rostrally from the injury site and increase of the density of PNN-bearing cells at 0.4–1.2 mm caudally from the injury site. We further demonstrate decrease of the single cell PNN area at 0.2 mm caudally from the injury site suggesting that the PNN ECM takes part in the posttraumatic tissue rearrangement in the spinal cord. Our results demonstrate new insights on the PNN structure dynamics in the developing and posttraumatic CNS.
  • Lipponen, Aino (Helsingin yliopisto, 2020)
    Spinal cord injury (SCI) in human patients is the most expensive clinical condition worldwide, restricting individuals’ ability to manage with daily-life activities independently. With very limited available treatment possibilities, the understanding and validating of regenerative mechanisms and treatment options in animal models is crucial for their translation to clinical practice. The majority of SCIs in human patients are contusive in the cervical level of the spinal cord. However, thoracic injury rodent model is more commonly studied, with only recent studies working with cervical contusion injury model. Chondroitin sulphate proteoglycans (CSPGs), and especially their CS chains, are thought to be the major inhibitory structures for neurite regeneration after SCI. However, current research has led to a new idea that the inhibitory effect of CS chains can be reversed to regeneration enhancing by heparin-binding growth-associated molecule (HB-GAM). This endogenously secreted molecule is highly up-regulated in the central nervous system (CNS) during postnatal development, but in the adult CNS the expression is down-regulated. This suggests that postnatal-level concentrations might be needed for inducing neurite regeneration in adult CNS. In this study, HB-GAM treatment was tested on both cervical hemicontusion and hemisection injury models. Here we show that repeated intrathecal injections of HB-GAM were sufficient to increase grey matter myelin optical density in mouse hemicontusion injury model, and partly induce functional recovery in hemisection model. Obtained anatomical evidence suggests that enhanced myelination is potentially involved in the repair mechanism of HB-GAM. The connection between HB-GAM treatment and functional recovery, and also other mechanisms of HB-GAM-induced regeneration need further exploration. In broader perspective, the results are promising for translation of a novel treatment approach to clinical use.