Search Results (1,905)

Background: Pressure injuries (PIs) are common in patients with limited mobility and may require flap reconstruction for definitive management. However, postoperative complications and PI recurrence frequently occur. Certain flap types may be more prone to poor outcomes. This study evaluated outcomes after flap reconstruction for PIs in a medically complex population. Methods: We performed a retrospective review of patients who underwent flap reconstruction for sacral, ischial, trochanteric, or lateral malleolar PIs by a single surgeon at a tertiary care center between 2015 and 2023. Patient demographics, comorbidities, neurologic status, wound characteristics, flap type, and postoperative outcomes were collected. Outcomes were analyzed at the flap level. Results: Sixty-eight patients underwent 101 flap reconstructions. Most patients were male (68%), and spinal cord injury was present in 71%. Medical comorbidity burden was high, including anemia (61%), malnutrition (42%), preoperative osteomyelitis (44%), stool exposure near the wound (49%), and near-universal urinary incontinence. Postoperative complications were common across flap types, most commonly wound dehiscence and PI recurrence. New PIs developed at non-operative sites in about 14% of reconstructions during recovery. During the eight-year follow-up period, 19 (28%) patients expired and 21% of reconstructions were complicated by recurrence at the operative site. Conclusions: Flap reconstruction remains an important treatment for advanced PIs but is associated with high complication and recurrence rates in patients with substantial comorbidities and limited mobility. These findings support careful patient selection, preoperative optimization, and multidisciplinary postoperative care focused on preventing new PIs. Full article

Vocational integration (VI) services aim to support sustainable employment for persons with disabilities. However, in individuals with spinal cord injury, evidence on effective intervention targets and the evaluation of sustainable integration remains limited. The Work–Life Study aims to build an evidence base for supporting sustainable employment in Switzerland by (1) identifying typical work–life trajectories; (2) examining key work–life transitions and their predictors; (3) establishing a multi-state model for intervention targets; (4) exploring individual work–life narratives; and (5) developing guidelines for personalized VI practice. The study combines a mixed methods design with a collaborative Integrated Knowledge Translation approach, actively involving VI professionals and individuals with spinal cord injury. Participants are recruited from the Swiss Spinal Cord Injury Cohort Study (SwiSCI). Work–life history data are collected through a Biographical Survey and Biographical Interviews and analyzed alongside SwiSCI data. Guideline development includes a stakeholder meeting with representatives from the Swiss Paraplegic Group, spinal cord injury clinics, individuals with spinal cord injury, employers, and disability insurers. Of 2041 eligible SwiSCI participants, 478 (23.4%) completed the Biographical Survey (median age 57.5 years; median time since injury 19.1 years), with responders and non-responders showing comparable characteristics. Work–life data closely matched existing SwiSCI data (rho > 0.8), indicating good recall. The resulting guidelines will help VI providers coordinate rehabilitation services to optimally promote sustainable employment for individuals with spinal cord injury. Full article

The human spinal cord is increasingly recognized as an active and adaptable component of sensorimotor function, contributing to motor control, pain modulation, and recovery after neurological injury. Within this framework, the Hoffmann reflex (H-reflex) has evolved from a classical electrophysiological phenomenon into a useful probe of spinal circuit function. Rather than reflecting motoneuron excitability alone, H-reflex amplitude and modulation arise from the interaction of Ia afferent transmission, presynaptic inhibition, homosynaptic depression, and interneuronal networks that regulate sensorimotor gain in a state-dependent manner. This review synthesizes classical and contemporary evidence to position the H-reflex as an indirect measure of spinal inhibitory function in humans. We integrate physiological mechanisms with findings from studies in chronic pain syndromes, spasticity, Parkinson’s disease, and recovery after central nervous system injury, where alterations in spinal inhibitory processes have been described. We further discuss methodological and conceptual challenges that limit clinical translation, including state dependence, protocol heterogeneity, and the lack of normative reference frameworks. Finally, we outline directions for integrating H-reflex paradigms with complementary approaches to improve the interpretation of spinal circuit function and its relation to clinical phenomena. Framed in this context, the H-reflex can be considered a valuable experimental and translational tool, whose utility depends on careful methodological implementation and physiologically informed interpretation. Full article

Background: Variants in anoctamin 3 (ANO3) are linked to autosomal dominant dystonia, commonly known as DYT-ANO3 (OMIM: #615034). While craniocervical dystonia constitutes the most frequently observed phenotype, its clinical manifestations display significant heterogeneity. Nevertheless, the data concerning the genetic characteristics, clinical features, and therapeutic outcomes of ANO3-related dystonia within Asian populations remain scarce. Methods: Whole-exome sequencing was conducted on 661 Chinese patients, comprising 356 individuals with dystonia and 305 individuals with non-dystonic movement disorders who served as an internal disease–control cohort. Candidate ANO3 variants were evaluated based on population frequency, predicted deleteriousness, ACMG criteria, and aggregate frequency analyses. A retrospective review was performed of clinical features and treatment responses. Results: Fifteen rare ANO3 missense variants were identified in 16 patients with dystonia and one non-dystonic individual, including one pathogenic variant, six likely pathogenic variants, and nine previously unreported variants. The rare ANO3 variants were significantly enriched in the dystonia cohort compared with the controls. ANO3-related dystonia exhibited broad clinical heterogeneity, with frequent cervical involvement (62.5%) and tremulous features (75%), and occasionally extended beyond classical isolated dystonia. Oral medication and botulinum toxin showed variable benefit, whereas deep brain stimulation was associated with marked improvement in selected medically refractory patients. Conclusions: This study broadens the genetic and clinical spectrum of ANO3-related movement disorders in a Chinese cohort. The findings support substantial clinical heterogeneity in DYT-ANO3 and suggest that deep brain stimulation, especially STN-DBS, may be considered in selected refractory cases, although further studies are needed. Full article

Background: Quality of life (QoL) after spinal cord injury (SCI) is influenced by psychosocial factors, yet less is known about how these factors are examined across national contexts. Objective: This scoping review mapped studies examining depression, employment, and social participation in relation to QoL or health-related QoL (HRQoL) among individuals with SCI in the United States and South Korea. Methods: Following PRISMA-ScR guidelines, five databases were searched for peer-reviewed English- and Korean-language studies published between 2007 and 2025. Results: Sixteen studies were included: nine from South Korea and seven from the United States. Depression and psychological distress were associated with lower QoL/HRQoL in both countries, although South Korean studies more often examined depression with stress and functional concerns, whereas U.S. studies situated depression within participation, spirituality, and youth psychosocial functioning. Employment was linked to QoL/HRQoL in both contexts, with South Korean studies emphasizing economic activity, vocational rehabilitation, and financial strain, and U.S. studies emphasizing employment status and vocational outcomes. Social participation was important in both countries, but South Korean studies focused more on community transition, functional independence, and social attitudes, whereas U.S. studies emphasized participation contexts, accessibility, and social relationships. Conclusions: Across the three domains, depression, employment, and social participation emerged as recurring psychosocial domains associated with QoL/HRQoL after SCI in both countries. These differences suggest that psychosocial adaptation after SCI should be understood within cultural and rehabilitation contexts. Full article

Spinal cord injury (SCI) is frequently accompanied by abnormal muscle tone and spasticity, which impair voluntary motor control, mobility, and quality of life. Although classically defined as velocity-dependent hyperreflexia, tone abnormalities after SCI encompass a broader spectrum, including sustained muscle activation, co-contraction, clonus, and non–velocity-dependent resistance to movement. These manifestations arise from distributed changes across spinal and supraspinal motor systems. At the segmental level, SCI induces maladaptive plasticity involving motoneurons, interneurons, sensory afferents, and muscle, including dysregulated persistent inward currents, altered inhibitory neurotransmission, afferent hyperexcitability, synaptic reorganization, and structural muscle remodeling. In parallel, supraspinal adaptations—including cortical motor map reorganization, reduced intracortical inhibition, corticospinal–reticulospinal imbalance, loss of monoaminergic modulation, and altered brainstem and cerebellar regulation—further amplify spinal circuit gain and impair inhibitory control of tone. Current pharmacologic treatments largely suppress symptoms without addressing these underlying circuit changes, while invasive neuromodulatory strategies are limited by surgical risk or state-dependent effects. This review synthesizes emerging insights into the multilevel mechanisms regulating abnormal tone after SCI and examines neuromodulatory approaches targeting spinal and supraspinal networks. Particular attention is given to transcutaneous spinal cord stimulation (TcSCS), a non-invasive method capable of modulating segmental reflex circuits and descending control pathways. Advances in transcriptomic and epigenetic profiling may further enable mechanism-based therapies and biomarker-guided strategies for treating spasticity. Full article

People living with neurological disorders frequently experience gait impairments that substantially reduce mobility, independence, and quality of life. This pilot study aimed to evaluate the feasibility, safety, and preliminary functional outcomes of integrating the EksoNR robotic exoskeleton (Ekso Bionics, San Rafael, CA, USA) into outpatient neurorehabilitation practice in individuals with chronic neurological impairments. Over an eight-month period, five participants with heterogeneous neurological conditions (two spinal cord injuries, one cerebellar ataxia, one ischemic stroke, and one spastic paraparesis) completed a four-week robotic gait training program consisting of 15 intervention sessions. Functional outcomes were assessed before and after the intervention using standardized clinical tests. Cardiovascular endurance was evaluated using the 6-Minute Walk Test (6MWT), while physical and psychological well-being were assessed with the Functional Independence Measure (FIM) and the Barthel Index, in addition to the WHO Quality of Life (WHOQOL) and EQ-5D-5L questionnaires. Mobility and balance were evaluated using the Timed Up and Go (TUG), Berg Balance Scale (BBS), Tinetti Performance-Oriented Mobility Assessment (POMA), and Walking Index for Spinal Cord Injury II (WISCI II), where applicable. In addition, device-recorded gait parameters, including step count, step length, walking distance, and walking duration, were analyzed. Significant improvements were observed in several device-derived gait parameters, including the number of steps performed with the exoskeleton (p < 0.001), step length (p = 0.003), walking distance (p = 0.002), and walking duration (p < 0.05). Significant improvements were also identified in balance performance (BBS: p = 0.006; Tinetti POMA: p = 0.001), cardiovascular endurance (6MWT: p = 0.017), and EQ-5D-5L scores (p = 0.038). Functional independence measures (FIM and BI), TUG performance, and WHOQOL domains did not demonstrate statistically significant changes. No serious adverse events or device-related injuries occurred during the intervention period. Due to the small and clinically heterogeneous sample, these findings should be interpreted as preliminary exploratory results. Nevertheless, the study supports the feasibility and potential clinical utility of EksoNR-assisted gait rehabilitation and provides a basis for larger controlled investigations. Full article

Neuropathic pain is a debilitating condition lacking objective and quantitative assessment tools, as current evaluations rely largely on subjective reports. Hyperspectral imaging (HSI) is a non-invasive technology that quantifies spatial and spectral tissue characteristics and has been applied in rheumatologic and metabolic disorders. This study investigated whether HSI-detected paw skin alterations correlate with graded nerve injury severity in a chronic constriction injury (CCI) model. Sprague–Dawley rats were assigned to sham or CCI groups with one to four sciatic nerve ligatures. Behavioral assessments (CatWalk XT gait analysis, thermal hyperalgesia, and mechanical allodynia) and paw HSI measurements were performed longitudinally. Histological and molecular analyses were conducted from paw skin to dorsal spinal cord tissues. At 1100 nm, HSI demonstrated progressive and significant spectral deviations proportional to injury severity across all CCI groups, whereas 1300 nm changes were only detected in severe injuries. Histology revealed increased fibrosis, NGF, TNF-α, synaptophysin, and microglial activation with greater injury severity, alongside reduced PGP9.5, neurofilament, AChR, Desmin, GAP-43, Pax3, and BDNF expression. These molecular findings were supported by electrophysiological and behavioral impairments, which correlated with injury grade by HSI. In conclusion, HSI at 1100 nm provides a sensitive and objective indicator of neuropathic pain severity and holds promise as a quantitative translational tool. Full article

“Spinal cord stimulation (SCS)” is an established therapy for chronic pain and an emerging modality for functional recovery after spinal cord injury (SCI) and other clinical applications. Despite its clinical potential, current implantable SCS systems remain constrained by high power consumption, limited adaptability, device size, and long-term stability. Recent advances in closed-loop neuromodulation and integrated circuit (IC) design are enabling more adaptive, efficient, and miniaturized SCS systems. This narrative review focuses on integrated circuit and system-on-chip (SoC) architectures that enable more advanced closed-loop SCS modalities, including stimulation, sensing, and wireless power/data subsystems. Specifically, the present work examines stimulation drivers and charge-balancing circuits that ensure safe and precise current delivery, wireless power transfer, telemetry methods which maintain reliable energy and data flow in implanted systems, and analog front-end circuits that enable closed-loop biopotential monitoring for adaptive feedback control. It aims to highlight innovations in IC design, energy harvesting, and wireless communication strategies while discussing trade-offs in power efficiency, die area, thermal limits, and biocompatibility. Emerging trends emphasize miniaturized and adaptive neural implants that integrate circuit-level efficiency with therapeutic flexibility, thereby advancing the next generation of closed-loop neuromodulation technologies. Ultimately, innovations in microelectronics are paving the way for enhanced long-term efficacy, safety, and clinical applicability of implantable SCS systems to optimize functional impacts. Full article

Spinal cord injury (SCI) is associated with respiratory dysfunction, chronic inflammation, and oxidative stress, and can increase pulmonary tissue stress during exercise. Thus, hydrogen peroxide (H₂O₂) and nitrite (NO₂⁻) concentrations in exhaled breath condensate (EBC) were compared during an official wheelchair rugby match. 14 males and two females with SCI (33.3 ± 6.5 years), anthropometry, baseline spirometry, and the International Wheelchair Rugby Federation classification (IWRF) were recorded. Playing time (23.6 ± 7.49 min), Borg scale (4.3 ± 1.64), and [H₂O₂] EBC and [NO₂⁻] EBC were determined before and 20 min after the match. In the total sample, [H₂O₂] EBC and [NO₂⁻] EBC increased post-match (p = 0.0042 and p = 0.031, respectively). When segmented according to IWRF classification, the highest functional capacity, H group (>1.5 points; n = 11) increased its [H₂O₂] EBC per exercise (p = 0.0029) and showed a trend for [NO₂⁻] EBC (p = 0.09), while the lowest classification, L group (≤1.5 points; n = 5) showed a higher baseline concentration in both EBC markers with no changes per exercise. Baseline IWRF classification was inversely correlated with [H₂O₂] EBC, while body mass index (BMI) was positively associated with [NO₂⁻] EBC. In conclusion, in the sample analyzed, a short period of moderate intensity during a wheelchair rugby match increases H₂O₂ and NO₂⁻ in the airway with a potentially greater effect in SCI athletes with better functional capacity; it remains to be determined whether this phenomenon corresponds to a physiological or pathological process. Full article

Sports injuries, especially musculoskeletal and neurological types from strenuous exercise, are a global public health challenge. Characterized by a high incidence and slow recovery, these injuries differ from typical trauma, often resulting in severe mechanical transmission loss and an imbalanced immune microenvironment. Consequently, standard interventions struggle to achieve true tissue regeneration. Gelatin, a collagen-derived biomaterial, offers RGD-mediated cell adhesion, MMP-responsive degradation, and high modifiability. These qualities make it an excellent foundation for biomimetic repair scaffolds. This paper reviews the design principles and recent advances in gelatin-based multifunctional hydrogels in sports medicine. First, we analyse their structure and engineering advantages. Next, we summarise strategies and mechanisms for modules like conductivity, antibacterial activity, self-healing, stimulus responsiveness, and tissue adhesion. The review links these modules to types of injuries: bone or cartilage, tendon or ligament, skeletal muscle, spinal cord, and peripheral nerve. It clarifies their clinical and translational value in remodelling immune microenvironments, regulating electrophysiology, promoting interfacial regeneration, and restoring motor function. This review provides focused insights from materials science and sports rehabilitation to advance precision treatments for sports injuries. Full article

Oligodendrocytes (OLs) are specialized glial cells essential for the formation and maintenance of the myelin sheath within the central nervous system (CNS). Historically, OLs were considered a functionally homogeneous population. However, the advent and widespread application of single-cell and single-nucleus RNA sequencing (scRNA-seq/snRNA-seq) technologies since 2015 have revealed substantial transcriptional heterogeneity, varying according to developmental stage, anatomical region, and disease state. In this review, we synthesized current advances in the understanding of OL heterogeneity. Nine OL cell classes have been identified in the mouse somatosensory cortex and hippocampal CA1 region, later expanding to 13 distinct subpopulations across ten CNS regions. Furthermore, we characterized disease-associated oligodendrocytes (DAOs)/disease-associated oligodendrocyte lineages (DOLs), identified in various neurological diseases, including multiple sclerosis (MS), Alzheimer’s disease (AD), and spinal cord injury, focusing on their molecular markers, spatial distribution, and pathophysiological roles. We summarized key transcriptional regulatory networks underlying DAO induction, including the signal transducer and activator of transcription (STAT)/interferon regulatory factor (IRF) family, the Yin Yang 1 (YY1)/nuclear factor kappa B (NF-κB) axis, and the SOX9/SOX10 regulatory system. The utility of region-specific brain analyses using spatial transcriptomics (ST) in conjunction with these approaches was also discussed. Finally, we compiled the implications of patient stratification according to white matter glial response patterns derived from large-scale snRNA-seq analyses of patients with progressive MS. Our synthesis shows that oligodendrocytes consist of multiple distinct subtypes that vary across development, brain regions, and disease conditions. In pathological states, they adopt specific disease-associated programs that reflect context-dependent responses and may influence disease progression and repair. This work provides a framework for understanding how oligodendrocyte diversity contributes to neurological disease and may support the development of targeted remyelination therapies. Full article

NG2 glia, also known as oligodendrocyte progenitor cells, represent a unique population of glial cells characterized by dynamic morphology and the ability to extend branched processes that actively contact neurons and other cellular elements. These structural and functional interactions enable NG2 glia to contribute to the regulation of axonal excitability, electrical activity, and axonal architecture. Unlike most other glial cells, NG2 glia receive direct synaptic input from neurons and can generate action potentials, defining their distinctive physiological status. A particularly important feature of this cell population is the expression of the chondroitin sulfate proteoglycan NG2/CSPG4, which serves as a key molecular marker and plays an essential role in intercellular interactions. Following spinal cord injury (SCI), NG2 glia rapidly become activated, undergo phenotypic changes, and engage in extensive interactions with neurons, astrocytes, microglia, and endothelial cells. These interactions form a complex regulatory network that influences both the severity of secondary injury and the effectiveness of remodeling and repair processes. Mechanisms of particular importance include the secretion of chondroitin sulfate proteoglycans and alterations in extracellular matrix properties. Finally, this review highlights potential therapeutic approaches aimed at modulating NG2 glial activity and their intercellular interactions. The focus is on strategies designed to reduce the inhibitory effects of proteoglycans while enhancing the remyelinating and neuroprotective potential of these cells, thereby opening new perspectives for regenerative therapies after SCI. Full article

Objectives: To present novel strategies in the diagnosis and management of spondylodiscitis in a patient with tetraplegia. Case Presentation: A 44-year-old man presented with increased spasms despite having a SynchroMed II Medtronic for intrathecal infusion of baclofen. The C-reactive protein level was raised. Infection was suspected, but there were no localising signs. Positron Emission Tomography (PET) was performed to identify the focus of infection. PET showed an increased Fluorodeoxyglucose uptake in the L-5 vertebral body and the associated ill-defined soft tissue anteriorly. There was significant erosion and destruction of the S-1 vertebra. Magnetic Resonance Imaging of the lumbo-sacral spine revealed destruction and collapse of the S-1 vertebral body and a 6 cm × 2 cm anterior paravertebral abscess collection. This patient was managed in his home. Intravenous administration of 1 g of Ertapenem daily was provided by community nurses for eight weeks. Blood tests were performed in the community setting, and the patient was monitored by spinal unit doctors. Results: Follow-up CT revealed abnormal soft tissue, expanding and replacing the S-1 vertebral body, with appearances in keeping with an infective process. Using CT guidance and the Madison bone biopsy kit, multiple cores were obtained from the left sacral bone. Four of the five specimens showed no growth after extended incubation. Propionibacterium acnes were isolated after 10 days of incubation from the tissue from the sacral bone biopsy only. A shared decision was made towards active surveillance. Follow-up CT of the abdomen showed a stable appearance of the lumbar and sacral spine. Conclusions: A complex case of spondylodiscitis can be diagnosed and managed while the patient stays mainly in their home, avoiding prolonged admission to the spinal unit, in alignment with the “hospital to community” aspect of the National Health Service’s 10-year Health Plan for England. A diagnostic pathway with PET-CT as the first approach proved useful when the site of infection was unclear. Active surveillance obviated the need for extended periods of antibiotic therapy, which could have led to complications such as antibiotic-induced toxicity and microbial resistance to antibiotics. Full article

Spinal cord injury (SCI) triggers a secondary injury cascade characterized by neuroinflammation, reactive gliosis, and neuronal apoptosis. While many pro-inflammatory cytokines contributing to this cascade reach peak upregulation within 24 h, Interleukin-18 (IL-18) exhibits a delayed upregulation profile, typically peaking 7 days post-injury. This review examines the temporal regulation and cell-specific roles contributing to the rise in IL-18 after SCI. Following primary insult, damage-associated molecular patterns prime and activate the NLRP3 inflammasome, which in turn drives latent IL-18 secretion. Cellularly, microglia function as the primary producers of IL-18 via the TLR4/p38-MAPK pathway, while astrocytes serve as the primary responders through IL-18R/p65-NF-κβ signaling. The microglia-astrocyte cross-talk propagates reactive gliosis, drives neuropathic pain, facilitates neuronal loss, and potentially contributes to the formation of the astrocytic border. Targeted therapeutic interventions such as upstream inhibition of NLRP3 inflammasome assembly or direct IL-18 neutralization successfully mitigate neuroinflammation. By either inhibiting NLRP3 inflammasome activation or directly neutralizing IL-18, these treatments shift the microglial toward a protective state, restrict histological damage, and significantly improve functional recovery. Full article