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Device to help injured nerves to regrow faster.

Saturday 28 April 2012 - 21:09:48 | Non Physiotherapy News

Nerve damage caused by traumatic accidents may heal faster after researchers at University of Sheffieldidea.jpg developed a new method that could make medical devices help the nerves to repair naturally. The devices called nerve guidance conduits or NGCs will help to regrow after injury. The method is based on laser direct writing, which enables the fabrication of complex structures from computer files via the use of CAD/CAM (computer aided design/manufacturing), and has allowed the research team to manufacture NGCs with designs that are far more advanced than previously possible.

Currently patients with severe traumatic nerve damage suffer a devastating loss of sensation and/or movement in the affected limb. The traditional course of action, where possible, is to surgically suture or graft the nerve endings together. However, reconstructive surgery often does not result in complete recovery.

"When nerves in the arms or legs are injured they have the ability to re-grow, unlike in the spinal cord; however, they need assistance to do this," said University of Sheffield Professor of Bioengineering, John Haycock. "We are designing scaffold implants that can bridge an injury site and provide a range of physical and chemical cues for stimulating this regrowth," he stated.

The new conduit is made from a biodegradable synthetic polymer material based on polylactic acid and has been designed to guide damaged nerves to re-grow through a number of small channels.

"Nerves aren't just like one long cable, they're made up of lots of small cables, similar to how an electrical wire is constructed," said lead author Dr Frederik Claeyssens, of the University's Department of Materials Science and Engineering. "Using our new technique we can make a conduit with individual strands so the nerve fibres can form a similar structure to an undamaged nerve," Claeyssens added. Once the nerve is fully regrown, the conduit biodegrades naturally.

The team hopes that this approach will significantly increase recovery for a wide range of peripheral nerve injuries. In laboratory experiments, nerve cells added to the polymer conduit grew naturally within its channelled structure and the research team is now working towards clinical trials.

"If successful we anticipate these scaffolds will not just be applicable to peripheral nerve injury, but could also be developed for other types of nerve damage too. The technique of laser direct writing may ultimately allow production of scaffolds that could help in the treatment of spinal cord injury," said Dr Claeyssens. "What's exciting about this work is that not only have we designed a new method for making nerve guide scaffolds which support nerve growth, we've also developed a method of easily reproducing them through micromolding. This technology could make a huge difference to patients suffering severe nerve damage," he added.
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Employment Rate Decreases For Patients With Traumatic Brain Injury After One Year.

Sunday 22 April 2012 - 17:41:05 | International Physiotherapy News

Most patients after traumatic brain injury tends to get rehired in the period of 3 months to 1 year afteremploymentsmall.jpg the injury, and that rate goes down after the initial year. The study conducted by Grauwmeijer. E of Netherland and his team also reveals that patients who develop cognitive impairements are at an increased risk of being unemployable.

The subjects of the study were patients with moderate and severe TBI discharged from the neurosurgery departments of 3 level 1 trauma centers in The Netherlands. The Patient group was aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73% men) who were hospitalized with moderate (26% of patients) to severe (74% of patients) TBI. A total of ninety-four patients (83%) completed the 3-year follow-up.The main outcome measure of the study was employment status. Potential predictors included patient characteristics, injury severity factors, functional outcome measured at discharge from the acute hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), and FIM, and cognitive functioning measured with the Functional Assessment Measure (FAM).

According to the study, the employment rate dropped from 80% preinjury to 15% at 3 months postinjury and gradually increased to 55% after 3 years. The employment rate significantly increased from 3 months up to 1 year, but it did not change significantly from 1 to 3 years postinjury. Age, length of hospital stay, discharge to a nursing home (vs home), psychiatric symptoms, and BI, GOS, FIM, and FAM scores were found to be significant univariate determinants for employment status. By using multiple logistic regression analysis, the FAM score (adjusted odds ratio 1.1; P<.000) and psychiatric symptoms (adjusted odds ratio .08; P<.019) were selected as independent predictors for employment status. A FAM cutoff score of less than 65 to identify patients at risk of long-term unemployment had a good diagnostic value.

Patients with TBI with psychiatric symptoms and impaired cognitive functioning at hospital discharge are at the highest risk of long-term unemployment. The authors considers that these factors should be the focus of vocational rehabilitation for such patients.
Authors of the study: Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM.

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