Spinal Cord Injury Rehabilitation in Nepal

This study aims to explore the perspectives of rehabilitation professionals regarding the barriers to spinal cord injury (SCI) rehabilitation services in Nepal. A qualitative study involved 15 rehabilitation professionals working in the Spinal Injury Rehabilitation Center in Nepal. After obtaining informed consent, in-depth semistructured interviews were conducted using Zoom and phone calls between June and July 2023. Braun and Clarke's thematic analysis approach was utilized to analyze the interviews and generate themes from the participants' responses. The participants represented nine different rehabilitation professions. Over half of them were female (53.33%), and 86.67% had one to 10 years of experience in SCI rehabilitation. From in-depth interviews, four themes depicting barriers to rehabilitation were identified: (a) resource constraints within the rehabilitation centers, (b) concerns related to finance, awareness, and support mechanisms, (c) systemic problems coupled with geographical and physical barriers, and (d) beliefs and practices influencing access and adherence to rehabilitation. Delivering effective rehabilitation services for people with SCI presents a range of barriers. Considering the critical importance of rehabilitation for this population, the findings underscore the necessity of engaging stakeholders at multiple levels, individuals, communities, and government agencies to address the identified barriers and improve rehabilitation services in Nepal. The implications of the findings are further discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature.

Spinal cord injuries affect nearly five to ten individuals per million every year. Spinal cord injury causes damage to the nerves, muscles, and the tissue surrounding the spinal cord. Depending on the severity, spinal injuries are linked to degeneration of axons and myelin, resulting in neuronal impairment and skeletal muscle weakness and atrophy. The protection of neurons and promotion of myelin regeneration during spinal cord injury is important for recovery of function following spinal cord injury. Current treatments have little to no effect on spinal cord injury and neurogenic muscle loss. Clemastine, an Food and Drug Administration-approved antihistamine drug, reduces inflammation, protects cells, promotes remyelination, and preserves myelin integrity. Recent clinical evidence suggests that clemastine can decrease the loss of axons after spinal cord injury, stimulating the differentiation of oligodendrocyte progenitor cells into mature oligodendrocytes that are capable of myelination. While clemastine can aid not only in the remyelination and preservation of myelin sheath integrity, it also protects neurons. However, its role in neurogenic muscle loss remains unclear. This review discusses the pathophysiology of spinal cord injury, and the role of clemastine in the protection of neurons, myelin, and axons as well as attenuation of skeletal muscle loss following spinal cord injury.

Excitotoxicity-induced in vivo injury models are vital to reflect the pathophysiological features of acute spinal cord injury (SCI) in humans. The duration and concentration of chemical treatment controls the extent of neuronal cell damage. The extent of injury is explained in relation to locomotor and behavioural activity. Several SCI in vivo methods have been reported and studied extensively, particularly contusion, compression, and transection models. These models depict similar pathophysiology to that in humans but are extremely expensive (contusion) and require expertise (compression). Chemical excitotoxicity-induced SCI models are simple and easy while producing similar clinical manifestations. The kainic acid (KA) excitotoxicity model is a convenient, low-cost, and highly reproducible animal model of SCI in the laboratory. The basic impactor approximately cost between 10,000 and 20,000 USD, while the kainic acid only cost between 300 and 500 USD, which is quite cheap as compared to traditional SCI method. In this study, 0.05mM KA was administered at dose of 10µL/100g body weight, at a rate of 10µL/min, to induce spinal injury by intra-spinal injection between the T12 and T13 thoracic vertebrae. In this protocol, detailed description of a dorsal laminectomy was explained to expose the spinal cord, following intra-spinal kainic acid administration at desired location. The dose, rate and technique to administer kainic acid were explained extensively to reflect a successful paraplegia and spinal cord injury in rats. The postoperative care and complication post injury of paraplegic laboratory animals were also explained, and necessary requirements to overcome these complications were also described to help researcher. This injury model produced impaired hind limb locomotor function with mild seizure. Hence this protocol will help researchers to induce spinal cord injury in laboratories at extremely low cost and also will help to determine the necessary supplies, methods for producing SCI in rats and treatments designed to mitigate post-injury impairment. Kainic acid intra-spinal injection at the concentration of 0.05mM, and rate 10µL/min, is an effective method create spinal injury in rats, however more potent concentrations of kainic acid need to be studied in order to create severe spinal injuries.

Objective To discuss the selection and clinical efficacy of operative methods for subaxial cervical dislocation without spinal cord injury. Methods A retrospective study was performed on 11 patients with subaxial cervical dislocation without spinal cord injury treated from January 2004 to June 2009. According to Allen' s classification, all patients suffered from retracted flexion injuries, including seven patients with Ⅰ degree dislocation, one with Ⅱ degree dislocation and three with Ⅲ degree dislocation. There were eighth patients with old dislocation and three with fresh dislocation, both of which were simple cervical trauma without other organ injuries. Open reduction, internal fixation and iliac bone graft spinal fusion were performed in seven patients and combined posterior and anterior open reduction,internal fixation and iliac bone graft spinal fusion in four. All the patients were followed up for observation of clinical effect. Results All operations were completed successfully. There were 11 patients at Frankel grade E preoperatively and 11 at grade E postoperatively. X-ray photographs showed that the sequence and curvature of the cervical spine recovered to normal after operation. All patients were followed up for 3-31 months postoperatively, which showed no redislocation or symptoms of spinal cord injury.Conclusion For lower cervical dislocation combined with locked facet, one-stage combined anterior and posterior reduction and internal fixation should be performed. While for those without locked facet, simple anterior reduction and bone graft spinal fusion is needed. Open reduction, internal fixation and bone graft spinal fusion are effective method for treatment of subaxial cervical dislocation without spinal cord injury. Key words: Spinal injuries; Cervical vertebrae; Dislocations; Surgical procedures, operative

Spinal cord injury has a catastrophic effect on an individual′s life causing multisystem physiological dysfunctions that lead to a series of complications: medical, physical, psychological, social and financial. These physiological impairments and nonclinical changes remain in a dynamic state for the rest of a person′s life. Owing to medical advances and early interventions the prognosis for a person following a spinal cord injury has improved markedly from nearly certain early death to a survivable disability for the majority who may lead active, productive lives into their 60s and 70s and beyond. Therefore it has become necessary to address the effects of normal ageing on the injuries and lifestyles of people with spinal cord injury. Ageing produces physiological and psychosocial changes in all people, but in people with a spinal cord injury ageing increases the wear and tear that living with such an injury imposes on cardiovascular, metabolic, respiratory, immune, musculoskeletal, gastrointestinal, genitourinary and nervous systems, as well as on skin health and psychosocial aspects of ageing. People with a spinal injury need lifelong follow-up, treatment and monitoring by multi- and interdisciplinary teams of health and social care professionals to minimize the complications of ageing with a spinal cord injury.

Study objectives were: (a) to examine the causes and incidence of major spinal cord injuries sustained by ice hockey players; and (b) to add recently reported Canadian cases to the Canadian Ice Hockey Spinal Injury Registry to determine the effectiveness of prevention efforts. The study was a review of questionnaires returned retrospectively by physicians and other sources reporting ice hockey related spinal injuries in Canada. Physicians reported on the mechanism of injury, vertebral level of injury, presence of neurologic deficit, type of event, and type of fracture. Between 1943 and 1999, 271 major spinal injuries were reported in Canadian ice hockey players, of which 49.0% occurred to players 16-20 years of age. Ontario has had a disproportionately large number of injuries compared to some provinces, especially Quebec. Of the spinal cord injuries, 65.8% resulted from colliding with the boards, and 36.6% were due to players being pushed or checked from behind. The recent survey shows that there has been a decline in the number of major spinal cord injuries in Canadian ice hockey, especially those causing paralysis due to checking or pushing from behind. Impact of the head with the boards after being checked or pushed from behind was the most common mechanism of spinal cord injury. Injury prevention programs are becoming effective in reducing the overall number of injuries, especially those due to checking from behind. Greater awareness of the occurrence and mechanisms of injury through educational programs and rules changes by organized hockey have reduced the annual incidence of catastrophic spinal injuries in Canadian ice hockey.

The objectives of this study were to determine whether routine state-wide hospitalization data can be used for population level surveillance of the incidence of spinal cord injury (SCI) from motor vehicle traffic crashes (MVTCs) and to verify the coverage of the Australian Spinal Cord Injury Register. A method was developed to identify new injury incidents from routine South Australian hospitalization data. Mapping software was then used to derive the Abbreviated Injury Scale (AIS) and Injury Impairment Scale (IIS) codes for each incident case of spinal injury using the principal diagnosis code on the hospital data file. IIS code values in the range from 3 to 6 were considered to be comparable with the SCI coding criteria utilized by the Australian Spinal Cord Injury Register (ASCIR) which were based on the criteria of the American Spinal Injury Association. The number of estimated new incident cases of SCI based on the IIS coding of hospitalization data was compared with the actual number reported from the ASCIR. The case numbers were highly comparable overall and also by time and age group suggesting that the coverage of the ASCIR was very high. The results of the study support use of the IIS for estimating incident case numbers of MVTC-related SCI from routine state-wide hospitalization data. If routine hospital separations data elsewhere were suitable for the purpose and the IIS also proves to be applicable to non-MVTC-related SCI, the incidence of SCI could be monitored in state and national populations using the IIS and this could provide an alternative data source where registers of SCI do not exist. In addition, the IIS provides a means to assess coverage where registers do exist.

The syndromes of spasticity and chronic pain are diagnosed in the majority of patients in different periods of recovering from spinal injury. Current synthetic or semi-synthetic matrixes, tissue and cell transplants, which are used in the treatment of spinal cord injuries, can affect the development of the syndrome of spasticity and chronic pain.Objective. To examine the effect of fetal cerebellum tissue transplantation (FCTT) on the course of the spasticity and chronic pain syndrome after experimental spinal cord injury.Materials and methods. Animals – albino outbred male rats (5.5 months, 300 grams, inbred line, the original strain – Wistar); main experimental groups: 1 – spinal cord injury only (n = 16), 2 – spinal cord injury + immediate homotopical implantation of a fragment of the fetal cerebellum tissue (n = 15). Model of injury – left-side spinal cord hemisection at Т11 level; verification of spasticity – by Ashworth scale and electroneuromyography, severe pain syndrome – by autophagy.Results. FCTT does not affect the frequency of severe neuropathic pain syndrome, is accompanied by early (1st week) debut of spasticity signs, significantly increases the level of spasticity (1st-3rd weeks), which is most likely due to glutamatergic effect of descendants of immature transplant cells – cerebellar granular neurons precursors. The maximum increase of the spasticity in the case of FCTT was observed at the 3rd week, in the control group – within the 1st and 4th weeks; from the 4th week after FCTT till the end of the experiment stabilization of spasticity rate in the range of 1.8-2.1 points was observed, which is probably due to the autoimmune motoneurons loss in the perifocal area. At the 24th week the level of spasticity in the case of FCTT succumbed to 2.1 ± 0.3 points, in the control group – 2.6 ± 0.4 Ashworth’s points (p > 0.05).Conclusion. Immediate fetal cerebellum tissue transplantation in rats with spinal cord injury causes early pro-spastic effect, in the long term – stabilizes spasticity level.

To examine four key areas: (1) the effectiveness and cost-effectiveness of spinal fixation surgery, (2) the consequences of immediate versus delayed referral to a spinal injuries unit (SIU), (3) the number of people with a new spinal cord injury (SCI) who are discharged from hospital without ever being transferred to an SIU, and (4) the effectiveness and cost-effectiveness of steroids for people with SCI. Searches were carried out on several databases and also on the Internet. Specialist SCI and spinal injury related websites were searched, specifically the Spinal Injuries Association, the British Association of Spinal Cord Injury Specialists and the National Spinal Cord Injury Association. Three separate search strategies were devised to find studies relating to the four key areas. Two reviewers independently screened all study citations for inclusion. The lists of all retrieved studies were scanned for additional studies. Quality of studies was assessed and data were extracted by one reviewer then checked by the second. Data from included studies were summarised within each key area. For dichotomous data, relative risks were calculated with 95% confidence intervals. Pooled relative risks were calculated as appropriate. For continuous data, mean differences with 95% confidence intervals were calculated and, if data were pooled, weighted mean differences were calculated. Searches were carried out to identify economic evaluations, details of these together with a critical appraisal of quality are presented in structured tables. Quality was assessed using a checklist supplemented with additional comments on the adequacy of methodology where appropriate. For spinal fixation versus no fixation, 68 retrospective observational studies were found that suggested some benefits of fixation surgery. Only four studies were found on fixation surgery in SIUs compared with non-SIU hospitals and no significant differences were seen. All 28 studies concerning delayed referral to a SIU were retrospective observational studies. In most, study details were poorly reported and there was doubt over the comparability of groups at baseline and on confounding factors. Times of referral and transfer were not reported separately. Evidence suggested an effect in favour of the SIU group for neurological improvement. No relevant published studies of any design were found regarding how many people with a new SCI are discharged from hospital without ever being transferred to an SIU. Two systematic reviews were found that assessed the effectiveness of steroids. No studies were identified that considered both costs and the impact on patient outcomes of a given intervention. Although there was evidence to suggest some benefits of fixation surgery and also a benefit of immediate referral to SIUs compared with delayed or no referral, owing to the limitations of the data these should be interpreted with caution. Not enough data were found to assess whether surgery is more beneficial when carried out in SIUs and further research is required in this area. Well-designed prospective observational studies with appropriately matched controls are needed. High-dose methylprednisolone steroid therapy may be effective in promoting some degree of neurological recovery if given within 8 hours of injury. There is a need for more randomised controlled trials (RCTs) of pharmacological therapy for acute SCI. No published studies of any design were found to answer the question of how many people with acute SCI are discharged from hospital without ever being transferred to an SIU. Primary research involving audit of selected hospital records should be commissioned and published. The search strategy did not identify any full economic evaluations. Future research should include full economic evaluations, possibly alongside a large RCT, which fully consider the costs and consequences of implementing interventions.

Functional recovery after spinal cord injury likely depends, in part, on the reorganization of undamaged spinal circuitry. Segmental afferent input from the limbs remains largely intact after spinal injury and may provide an important source of activation and regulation of the spinal circuits that have lost descending input as a result of the injury. This purpose of this study was to investigate the contribution of cutaneous afferent inputs to the recovery of motor function after spinal injury in the chick. After lateral thoracic spinal hemisection, the motion of the ipsilateral limb was impaired during both walking and swimming. By 2 weeks postoperatively, limb motion recovered to preoperative values for walking but not for swimming. It was hypothesized that phasic afferent inputs experienced during walking, but not swimming, contributed to recovery of limb motion during walking. When a source of phasic cutaneous input was provided during swim training sessions, limb motion gradually improved to preoperative values. After 2 weeks of training, this improved motion was retained even after the source of cutaneous stimulation was removed. The proposed mechanism is an experience-dependent strengthening of the circuits activated during the improved limb motion, leading to a permanent change in limb action during swimming. Thus, the afferent inputs experienced during movement repetition are important during the acquisition of learned movements after spinal injury. These results are discussed in terms of behavioral, physiological, and anatomical evidence for spinal plasticity in other species. It is concluded that the spinal cord has significant plastic capabilities, and efforts should be directed toward maximizing the contribution of this plasticity to functional recovery after spinal cord injury.

Objective To observe the clinical efficacy of screwing via the paraspinal muscle approach plus single-segment laminectomy decompression via the dorsomedian approach for thoracolumbar fractures complicated with spinal cord injury. Methods From February 2013 to September 2015, 21 patients with thoracolumbar fracture plus spinal cord injury were treated at our department. They were 15 men and 6 women, aged from 20 to 54 years (average, 33.2 years). The injury was located at T11 in 2 cases, at T12 in 6, at T12 and L1 in one, at L1 in 7 and at L2 in 5; the injury was rated as grade A in one case, grade B in 3 cases, grade C in 8 and grade D in 9 according to the American Spinal Injury Association (ASIA) grading system. Al the patients were treated by screwing via the paraspinal muscle approach followed by single-segment laminectomy decompression via the dorsomedian approach. Results The operation time averaged 116.1+24.5 minutes and the amount of bleeding 580.7+80.8 mL. At 3 days after surgery and the final follow-up, their visual analogue scale (VAS) score, anterior vertebral height and cobb angle were significantly improved in comparison with the preoperative values(P< 0.05). At the final follow-up, their Japanese Orthopaedic Association (JOA) the score were also significantly better than the preoperative one (P< 0.05), giving 12 excellent cases, 6 good ones and 3 fair ones. Their ASIA grading at the final follow-up showed one case of grade B, 2 cases of grade C, 6 cases of grade D and 12 cases of grade E. Conclusion Treatment of thoracolumbar fractures complicated with spinal cord injury by crewing via the paraspinal muscle approach plus single-segment laminectomy decompression via the dorsomedian approach is a good way due to limited invasion, less bleeding, simple operation, excellent reduction, reliable fixation and rapid recovery. Key words: Spinal fractures; Fracture fixation, internal; Bone nails; Paraspinal muscle approach; Median approach

To detect the expression of telomerase in glial scar and its correlation with glial scar. There were 120 Sprague Dawley rats were randomly divided into non-interference group of telomerase, interference group of telomerase and control group. Non-interference group and interference group were for spinal cord injury, which adopted Allen's Weight Dropping to make molding; control group was for sham operation to open the vertebral plate and expose spinal marrow, in which spinal cord injury would not be caused. The expression of telomerase and glial fibrillary acidic profein (GFAP) was detected by PCR-ELISA and Western blot, and the formation of glial scar was observed by immunofluorescence on the 1st, 3rd, 5th, 7th, 14th, 28th, 42 th and 56th day after the spinal injury, and analyzed its relativity. The expression of telomerase in non-interference group was (0.180 ± 0.004 - 1.217 ± 0.072), which was significantly higher than those in interference group (0.028 ± 0.007 - 0.092 ± 0.004, χ(2) = 28.753 - 37.518, P < 0.05) and control group (0.072 ± 0.007 - 0.075 ± 0.004, χ(2) = 18.618 - 41.093, P < 0.05) at all the time, with statistical significance. The expression of GFAP in non-interference group was (1.98 ± 0.15 - 19.40 ± 0.55) which was significantly higher than those in interference group (1.10 ± 0.13 - 16.64 ± 1.02, χ(2) = 14.538 - 37.366, P < 0.05) and control group (0.44 ± 0.05 - 0.48 ± 0.04, χ(2) = 16.733 - 34.041, P < 0.05) at all the time, with statistical significance. The expression of GFAP showed a linear correlation with that of telomerase in non-interference group, and with statistical differences (r = 0.755, P < 0.01). The expression of telomerase in interference group and control group were always negative. Glial scar observed by immunofluorescence in non-interference group was heavier than that in interference group, and control group showed no formation of glial scar. Telomerase shows a dynamic expression in glial scar and has positive correlational linear relationship with GFAP which shows the formation of glial scar. And the telomerase may be an important factor in promoting the formation of glial scar.

To compare the safety and effectiveness of two different thromboprophylactic protocols in the management of patients with spinal cord injury - one using heparin/warfarin and the other using enoxaparin. Retrospective. Princess Royal Spinal Injuries Unit, Sheffield, UK. Retrospective review of two cohorts of patients with acute spinal injury admitted to a supra-regional spinal injuries centre and treated with different pharmacological agents. One group received heparin/warfarin in combination with antiembolism stockings and mechanical measures for thromboprophylaxis whereas the second group received enoxaparin in combination with the other measures. Patients who developed clinical symptoms suggestive of deep vein thrombosis or pulmonary embolism were investigated as appropriate. Four of the 101 patients on heparin/warfarin developed symptoms of venous thromboembolism compared to 13 of the 72 who were on enoxaparin. Of the 13, three had been on 40 mg of enoxaparin daily and 10 on 20 mg enoxaparin daily. Six patients on enoxaparin and one patient on warfarin developed thromboembolic complications after they had been mobilised and the anticoagulant discontinued. Eight patients on warfarin prophylaxis and three patients on enoxaparin developed haemorrhagic complications necessitating cessation of therapy. This study suggests that the traditional protocol of warfarin/heparin for thromboprophylaxis in spinal cord injury patients remains a safer option than enoxaparin.

Spinal fractures and/or spinal cord injuries are associated with orthopedic and internal organ injuries in proximity to the spinal injury