Degenerative bone and joint diseases that commonly accompany spinal cord injury (SCI) may be exacerbated by physical activity of the lower extremities. To determine if orthopaedic stress imposed by electrically stimulated cycling exercise is associated with osteonecrosis or osteoarthrosis in persons with chronic SCI, ten quadriplegics and paraplegics who had each undergone electrical stimulation cycle ergometry exercise two or three times weekly for longer than 1.5 years underwent magnetic resonance examinations of the femoral heads and the dominant knee. Three of the ten subjects had no evidence of meniscal or bone marrow pathologies, osteochondritis dessicans, avascular necrosis, joint effusion or accumulation or soft tissue tears. The magnetic resonance scans of six subjects were noted to have very mild effusion, slight meniscal degeneration and minimal chondromalacia patellae. Consistent patterns of bone or joint pathology were not discernible among these scans, and the positive findings did not represent threatening clinical states. The scans of one subject showed heterogenous regions of bone infarct characteristic of osteochondritis and avascular necrosis, observations that were atypical of all other subjects. No injuries consistent with the biomechanics of cycling exercise were observed in any subject. Despite the high sensitivity of magnetic resonance imaging in detecting bone and joint deterioration, significant bone and joint findings represented only 14 of 150 observations, less than previously reported in sedentary subjects with SCI. This study suggests that electrical stimulation cycle ergometry does not foster bone or joint deterioration in individuals with chronic SCI.

Adolescent↗

PubMed1994

Autonomic functions and orthostatic responses 24 h after acute intense exercise in paraplegic subjects.

We tested the hypothesis that a bout of graded exercise designed to elicit maximal effort would increase the sensitivity of autonomically mediated baroreflexes and enhance blood pressure (BP) stability in subjects prone to postural hypotension. Therefore, we measured heart rate (HR), BP, forearm vascular resistance (FVR), and vasoactive hormone responses before and during 15 min of 70 degrees head-up tilt (HUT) in 10 paraplegic subjects (21-65 yr) on two occasions: 1) 24 h after maximal arm-crank exercise (postexercise) and 2) without exercise (control). During HUT, HR increased 30 beats/min in both postexercise and control, but the reduction in systolic BP (SBP) during control (-12.0 +/- 4.6 mmHg) was larger (P = 0.017) than that during HUT after exercise (-0.3 +/- 4.3 mmHg). The postexercise increase in FVR from supine to HUT of 17.0 +/- 2.4 to 24.8 +/- 3.2 peripheral resistance units (PRU) was greater (P = 0.042) than the increase observed during control (18.3 +/- 3.7 to 19.5 +/- 3.1 PRU). The gain of the carotid-cardiac baroreflex was also increased (P = 0.049) after exercise. Responses in norepinephrine, vasopressin, and plasma renin-angiotensin induced by HUT were similar for control and postexercise, and there was no difference in either leg compliance or plasma volume between the two conditions. Additionally, HR and SBP responses to phases II and IV of the Valsalva maneuver, indexes of integrated baroreflex sensitivity, were increased (P < 0.05) after maximal exercise compared with control. Thus acute intense exercise eliminated orthostatic hypotension in paraplegics, was associated with increased FVR and baroreflex sensitivity, and was independent of blood volume changes.

Adult↗

PubMed1993

Negative affect, absorption, and immunity.

Relationships between the psychological characteristics absorption and neuroticism, and in vitro and in vivo measures of cell-mediated immunity were examined. Thirty-nine female subjects responded to questionnaires, donated blood for analysis of T-cell numbers, and were tested for delayed hypersensitivity skin responses. Consistent with the experimental hypothesis, subjects classified as repressors of negative affect (low absorption/low neuroticism), or extreme expressors of negative affect (high absorption/high neuroticism), showed lower immune responses than other groups of subjects. For the in vitro T-cell measures and the in vivo skin induration measures, there were also pervasive main effects of neuroticism, with subjects higher in neuroticism showing higher immunity than subjects lower in neuroticism.

Adult↗

PubMed1993

Loneliness and life satisfaction in Japan and Australia.

We examined the relationship between loneliness and life satisfaction in 121 residents of Fukoku, Japan, and 139 residents of Melbourne, Australia, using the Satisfaction With Life Scale (Diener, Emmons, Larsen, & Griffin, 1983) and the Revised UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1980). Australian subjects reported significantly less loneliness and significantly greater life satisfaction than Japanese subjects. A high inverse correlation was found between loneliness and life satisfaction in Australian subjects, with a much smaller inverse relationship observed among the Japanese, suggesting that loneliness in Japanese subjects did not emotionally translate into life dissatisfaction as it did in Australian subjects. Instead, the experience of loneliness in Japanese individuals may remain largely independent of general life satisfaction.

Adolescent↗

PubMed1992

Enhanced carotid-cardiac baroreflex response and elimination of orthostatic hypotension 24 hours after acute exercise in paraplegics.

To test the hypothesis that an acute bout of maximal exercise can ameliorate orthostatic hypotension consequent to prolonged wheelchair confinement, we evaluated heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure responses during 15 minutes of 70 degrees head-up tilt (HUT) in 10 paraplegic subjects 24 hours after arm crank exercise designed to elicit maximal effort, and during a control (no exercise) conditions. Additionally, the carotid baroreceptor stimulus-cardiac response relationship was determined by measurement of R-R interval during external application of graded pressures to the carotid sinuses. One week separated the treatment conditions. The maximum slope of the carotid-cardiac baroreflex response was increased (p = 0.049) by exercise (6.2 +/- 1.7 msec/mmHg) compared to control (3.3 +/- 0.6). During control HUT, HR increased from 61 +/- 1 to 90 +/- 7 bpm (p = 0.001) while SBP decreased from 118 +/- 5 to 106 +/- 9 mmHg (p = 0.025). During HUT 24 hours after exercise, HR increased from 60 +/- 2 to 90 +/- 4 bpm (p = 0.001), but the reduction in SBP was essentially eliminated (116 +/- 5 to 113 +/- 5 mmHg). The reduction in SBP during control HUT (-12.0 +/- 4.6 mmHg) was four-fold larger (p = 0.017) than during HUT following exercise (-3.1 +/- 3.9 mmHg). DBP during HUT was not altered in either condition. A single bout of intense, dynamic arm crank exercise eliminated orthostatic hypotension in paraplegics. Equal HR response with smaller reduction in SBP during HUT after exercise was consistent with a measured increased sensitivity of the carotid-cardiac baroreflex.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

An examination of dietary intakes and nutritional status of chronic healthy spinal cord injured individuals.

To examine the nutritional composition of the dietary intake of chronic healthy spinal cord injured (SCI) individuals, 33 subjects affiliated with 3 SCI rehabilitation centers logged their food consumption for 7 days. Prior to record keeping, subjects were trained by a registered dietitian on the accurate recording of their standard food choices and portion size, and were provided with scales to weigh food accurately. Dietary macro and micronutrients were analyzed with a computer software package, with nutritional analysis compared to the recommended daily allowances (RDA) of the Food and Nutrition Board of the National Academy of Sciences. Analysis showed caloric intake to be 75% of that recommended for able bodies persons, with a high reliance on fat for calories. Fat intake accounted for 37.9% of calories, well above the recommended level of 30%, but typical of the American diet. The ratio of polyunsaturated to saturated fat was approximately one half the recommended level, with carbohydrate calories averaging 16.5% below optimal RDA. Protein consumption was within normal range, but average dietary fiber was only 25% of recommended levels. Micronutrient analysis showed deficiencies in both water and fat-soluble vitamins, with suboptimal intake of multiple minerals. Given the apparent reliance on a high-fat and low-carbohydrate diet, this research shows that nutritional intervention and education of SCI persons are needed, and that a registered dietitian should be included in the SCI health care team.

Adolescent↗

PubMed1991

Reversal of adaptive left ventricular atrophy following electrically-stimulated exercise training in human tetraplegics.

Left ventricular (LV) myocardial atrophy and diminished cardiac function have been shown to accompany chronic human tetraplegia. These changes are attributable both to physical immobilisation and abnormal autonomic circulatory regulation imposed by a spinal cord injury (SCI). To test whether exercise training increases LV mass following chronic SCI, 8 neurologically complete quadriplegic males at 2 SCI rehabilitation and research centres underwent one month of electrically-stimulated quadriceps strengthening followed by 6 months of electrically-stimulated cycling exercise. Resting M-mode and 2-D echocardiograms were measured before and after exercise training to quantify the interventricular septal and posterior wall thicknesses at end-diastole (IVSTED and PWTED, respectively), and the LV internal dimension at end-diastole (LVIDED). LV mass was computed from these measurements using standard cube function geometry. Results showed a 6.5% increase in LVIDED following exercise training (p less than 0.02), with increases in IVSTED and PWTED of 17.8 (p less than 0.002) and 20.3% (p less than 0.01), respectively. Computed LV mass increased by 35% following exercise training (p = 0.002). These data indicate that myocardial atrophy is reversed in tetraplegics following electrically-stimulated exercise training, and that the changes in cardiac architecture are likely to be the result of both pressure and volume challenge to the heart imposed by exercise.

Adaptation, Physiological↗

PubMed1991

Impairment of carotid-cardiac vagal baroreflex in wheelchair-dependent quadriplegics.

The incidence of orthostatic hypotension can increase after prolonged exposure to chair rest and bedrest and is associated with post-bed rest impairment of the carotid-cardiac baroreflex response. We therefore hypothesized that the hypotension observed in humans confined to wheelchairs may be manifested by a reduced baroreflex sensitivity. We compared baroreflex responses of 16 wheelchair-dependent (WCD) quadriplegics with those of 15 able-bodied subjects (ABS) matched for age, height, and weight. Beat-to-beat R-R intervals were measured during application of graded pressures from 40 to -65 mmHg using a neck chamber for noninvasive stimulation of the carotid baroreceptors. Changes of R-R intervals were plotted against carotid distending pressures. The maximum slope of the stimulus-response relationship was greater (P less than 0.0001) in ABS (6.1 +/- 0.6 ms/mmHg) than in WCD (2.6 +/- 0.4 ms/mmHg). The range of the R-R interval response, i.e., the capacity to buffer blood pressure changes, was only 138 +/- 19 ms in WCD compared with 253 +/- 19 ms in ABS (P less than 0.001). Mean sitting systolic-to-diastolic blood pressures in WCD (92/60 mmHg) were less (P less than 0.0001) than in ABS (120/77 mmHg), although there were no significant differences between groups in supine resting blood pressures. Chronic loss of stimulation to carotid baroreceptors by routine standing posture is associated with attenuated sensitivity and reduced buffer capacity of the arterial baroreflex and hypotension during sitting in WCD patients.

Adult↗

PubMed1979

Spinal cord injury. State of the art in Florida.

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Adult↗

PubMed1975

Pressure sores: classification and management.

Four grades of pressure can be recognized on the basis of pathophysiology of soft tissue breakdown overlying bony prominences. Management is correlated with the extent of the lesion and ranges from local wound care, turning and systemic support for Grade I and II, to local and radical excision with soft tissue flap closure for the more extensive Grades III and IV.

Humans↗

PubMed1973

Autonomic hyperreflexia in spinal cord injury.

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Adult↗