The sacral exam-what is needed to best care for our patients?

The sacral exam-what is needed to best care for our patients? Spinal Cord Ser Cases. 2020;6:3 Authors: Previnaire JG, Alexander M Abstract Sacral reflexes are important to allow the SCI practitioner to gain information about the state of the sacral spinal cord segments. The presence of the bulbocavernosus and/or the anal wink reflex indicate an intact spinal reflex arc and reflex conal autonomic function (as part of the upper motor neuron syndrome); their absence defines a lower motor neuron syndrome. The assessment of sacral reflexes helps predict the type of bladder, bowel and sexual functions and the related therapeutic interventions. We suggest adding the sacral component of the International Standards for the Assessment of Autonomic Function after SCI (ISAFSCI) to the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) examination so there can be a detailed description of these important functions. As an alternative, the performance of sacral reflexes should be routinely required as part of the neurologic examination after SCI. Whether the sacral motor neuron system is classified as upper or lower motor neuron injury is also quite useful and as such should be present in the ISCNSCI. PMID: 31934355 [PubMed - in process]
Source: Anal Sci - Category: Chemistry Authors: Tags: Spinal Cord Ser Cases Source Type: research

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Abstract The examination of sacral reflexes provides an important method to differentiate an upper motor neuron vs lower motor neuron spinal cord injury (SCI). Two common sacral mediated reflexes used as part of the neurological assessment include the bulbocavernosus reflex (BCR) and anal reflex. As the clinical information from these tests are similar, we suggest that the anal reflex provides a better first option as a non-invasive clinical assessment of sacral reflex status in clinical practice in SCI as the testing for the anal reflex is less intrusive and already being performed as part of the International St...
Source: Anal Sci - Category: Chemistry Authors: Tags: Spinal Cord Ser Cases Source Type: research
Abstract The output from a motor nucleus is determined by the synaptic input to the motor neurons and their intrinsic properties. Here, we explore whether the source of synaptic inputs to the motor neurons (cats) and the age or post-stroke conditions (humans) may change the recruitment gain of the motor neuron pool. In cats, the size of Ia EPSPs in triceps surae motor neurons (input) and monosynaptic reflexes (MSRs; output) was recorded in the soleus and medial gastrocnemius motor nerves following graded stimulation of dorsal roots. The MSR was plotted against the EPSP thereby obtaining a measure of the recruitmen...
Source: Experimental Brain Research - Category: Neuroscience Authors: Tags: Exp Brain Res Source Type: research
In conclusion, the site of action of σ1R for opioid modulation on acute thermal nociception is located at the peripheral and supraspinal levels, and the opioid-potentiating effect is independent of the spinal noradrenaline increase produced by S1RA. Introduction The sigma-1 receptor (σ1R) has been described as the first ligand-regulated molecular chaperone located at the endoplasmic reticulum and plasma membranes whose activity is regulated in an agonist-antagonist manner. The σ1R is expressed in key areas for pain control and there is cumulative evidence supporting an involvement of the σ1R...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Conclusions: We demonstrated in the SOD1G93A model of ALS that increased levels of several cytokines were associated with a shorter lifespan. However, their role as prognostic biomarkers is unclear as their expression was very variable depending on both the disease stage and the subject. Nevertheless, cytokines may be potential therapeutic targets. Introduction Amyotrophic Lateral Sclerosis (ALS) is one of the most common rare diseases of unknown origin that leads to progressive motor neuron degeneration and muscle denervation (1). In particular, it has been described that either distal axonopathy or neuromuscular ju...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Objective : To evaluate a new portable toolkit for quantifying upper and lower extremity muscle tone in patients with upper motor neuron syndrome (UMNS). Approach : Cross-sectional, multi-site, observational trial to test and validate a new technology. Setting : Neurorehabilitation clinics at tertiary care hospitals. Participants : Four cohorts UMNS patient,>6 mo post acquired brain injury, spinal cord injury, multiple sclerosis and cerebral palsy, and a sample of healthy age-matched adult controls. Measures : Strength: grip, elbow flexor and extensor, and knee extensor; range of motion (ROM): passive ROM (contrac...
Source: Physiological Measurement - Category: Physiology Authors: Source Type: research
Abstract The BCR consists of the contraction of the bulbocavernosus muscle in response to squeezing the glans penis or clitoris, and is mediated through the pudendal nerve. In case of a complete lesion, the presence of BCR is indicative of intact S2-S4 spinal reflex arcs and loss of supraspinal inhibition, determining an upper motor neuron (UMN) lesion, its absence a lower motor neuron (LMN) lesion. The BCR further helps distinguish conus medullaris from cauda equina syndromes. Sensory or motor function in the most caudal sacral segments, not BCR, defines the sacral sparing as part of the International Standards f...
Source: Anal Sci - Category: Chemistry Authors: Tags: Spinal Cord Ser Cases Source Type: research
Conclusion: The occurence of erectile dysfunction is significantly more prevalent among neurologically disabled men, particularly those with lesions below S2–S4, than among men without neurologic disability. Considering the prevalence of erectile dysfunction among neurologically disabled men, sexual functioning should be regularly evaluated during acute and long-term rehabilitation, and any existing sexual dysfunction should be addressed in the treatment plan. Introduction Penile erection is a neurovascular event characterized by the dilation of arteries that cause the corpora cavernosa and corpora spongiosum of the ...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Current Issue Medical Issues Neurologic Systems and Symptoms Neurology Neuromuscular Disease Original Research Neurogenic SD; Erectile Dysfunction; sexual health; Quality of life Source Type: research
Conclusion: The occurence of erectile dysfunction is significantly more prevalent among neurologically disabled men, particularly those with lesions below S2–S4, than among men without neurologic disability. Considering the prevalence of erectile dysfunction among neurologically disabled men, sexual functioning should be regularly evaluated during acute and long-term rehabilitation, and any existing sexual dysfunction should be addressed in the treatment plan. Introduction Penile erection is a neurovascular event characterized by the dilation of arteries that cause the corpora cavernosa and corpora spongiosum of the ...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Current Issue Medical Issues Neurologic Systems and Symptoms Neurology Neuromuscular Disease Original Research Neurogenic SD; Erectile Dysfunction; sexual health; Quality of life Source Type: research
Pelvic floor electrophysiological tests, including electromyography (EMG) of external anal sphincter (EAS) muscle, sacral reflex examinations, bulbocavernosus reflex (BCR), pudendus electroneuronography and somatosensory evoked potentials (SEPs), have proved useful in the evaluation of sacral lower motor neuron lesions (Ertekin and Reel, 1976; Podnar, 2014; Podnar, 2007b; Ertekin et al., 1985; Sander et al., 1999). However, the use of electrophysiological tests has not been sufficiently investigated in patients with upper motor neuron (UMN) disorders.
Source: Clinical Neurophysiology - Category: Neuroscience Authors: Source Type: research
Abstract In this review of neurocontrol of movement after spinal cord injury, we discuss neurophysiological evidences of conducting and processing mechanisms of the spinal cord. We illustrate that external afferent inputs to the spinal cord below the level of the lesion can modify, initiate, and maintain execution of movement in absence or partial presence of brain motor control after chronic spinal cord injury. We review significant differences between spinal reflex activity elicited by single and repetitive stimulation. The spinal cord can respond with sensitization, habituation, and dis‐habituation to regular repetiti...
Source: Artificial Organs - Category: Transplant Surgery Authors: Tags: Review Source Type: research
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