Spinal cord lesions

Selected topics related to rehabilitation of individuals with spinal cord lesions are reviewed and commented upon. A 10-week arm-cranking programme improved aerobic capacity and endurance in tetraplegics. Furthermore, endurance training and forced vital capacity were found to be positively correlated. Rowing had additional positive effects for scapular retractor recruitment, which may well improve the shoulder stability. Increased abdominal circumference is an important correlate to dyslipidaemia. beta 2-adrenergic agonists can improve muscle strength and size even without simultaneous exercise. Hydrophilic low-friction catheters, for clean intermittent catheterization have performed as well as, or better than, conventional catheters in a long-term follow-up study. Urethral stenting of the bladder neck and the external sphincter seems, in selected patients, to be an attractive alternative to indwelling urethral catheter drainage or sphincterotomy. The majority (> 80%) of the first 500 sacral anterior root stimulators are still in use for micturition and for defecation. The management of impotence in men with spinal cord lesions using intercavernous injections has been confirmed, and oral terbutaline (5 mg) may be used to achieve penile detumescence in cases of prolonged erection. The use of penile implants in men with spinal cord lesions is a problem. Penile vibration with a peak-to-peak amplitude of 2.5 mm is sufficient to obtain ejaculation in most of these men. Age is more important for sexual adjustment than whether the relationship is established before or after the injury. Regular and frequent follow-up of patients with spinal cord injury is the best way to ensure that post-traumatic syringomyelia is diagnosed and managed (surgically drained) early in order to avoid further disability. Two-thirds of individuals with spinal cord injury rate their quality of life as good. Socialization is important in obtaining a good quality of life. Psychological morbidity in the first 2 years after the injury is found in approximately one-third of the population with spinal cord injury; antidepressant drugs should perhaps be used more widely.