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Effect of Muscle Morphology due to Cervical Spine Injury
In most cases, cervical spinal injury results in life long disability and hence there is an urgent need for ongoing research in this area. The National Institutes of Health on September 30 – October 1, 1996, sponsored a scientific workshop in a bid to gather the emerging concepts spinal cord injury among leaders and experts in fields like immunology, stroke and development. In normal scenario, spinal cord helps to coordinate movement and various sensations in the body of an individual. It constitutes of a complex network of nerve cells, supporting cells, and nerve fibers originating from the brain. The spinal cord is divided into various segments. While the higher segments are concerned with the control of movements and the sensation in the upper part of the body, the lower segments are concerned with controlling the same in the lower half of the body. Any injury in these segments is mirrored in the respective parts of the body that they are concerned with. There are various categories of disability resulting from spinal cord injury according to the degree of severity and injury type. Apart from the partial or complete paralysis and loss of sensation, cervical spinal injury can sometimes leave a patient vulnerable to various respiratory problems as well as pressure sores. It has been found that the damage caused due to injury to the spinal cord in general and to the cervical spinal cord in particular continues until several hours following the trauma or injury. As a result, the delayed injury can be taken as an opportunity for reducing his extent of damage and disability as well as for treatment. It has been estimated that there are more than 10,000 spinal injury cases annually in America resulting from accidents or violence and more then two hundred thousand individuals are inflicted by the debilitating influence of spinal injury. It has been found that it is during the early adulthood (early 20’s) and to some extent during old age (due to degenerative diseases and falls) that individuals are vulnerable to this form of trauma. Supportive care is very crucial and extremely expensive especially when it involves young adults who have to be put in care for a long time. Through animal models and nervous system development, studies and researches huge leaps have been taken in the area designing neural prosthesis for spinal cord injury patients.
Damage to the cervical spinal cord can result in partial or complete loss of sensation, skeletal and muscular coordination, paralysis in the upper parts and limbs of the body as well as complication of the respiratory system functioning. There may be secondary damage leading to twitching in the upper parts of the body like in the eyes, abnormal or exaggerated responses, looping of the mouth, and loss of speech to name a few.
It has been found that following a spinal injury the muscle strength as well as the cross sectional area of the muscle declines. The study was specifically designed to investigate the decline in the muscle cross sectional area following a cervical spinal injury and its effects.
In this particular study the role of cervical spinal injury (CSI) on the artificial muscle morphology due to CSI and its effect within six months of the trauma, was examined. Magnetic resonance (MR) images of the arm were taken right after the patients were diagnosed to be medically and clinically stable. This was six weeks following the injury, and eleven and twenty four weeks after the cervical spinal injury. This was done in order to evaluate the average muscle cross sectional area (CSA). Apart from this, an MR image of nine individuals (control group) who had not experienced any injury or trauma was also taken twice at two separate points. The second MR image was taken eighteen weeks after the first one for the control group. From this study, it became evident that the control group showed no alteration in any of the variable despite the time lapse. There were various changes marked in the patients however. There was a differential atrophy of, P=0.0001, in the muscle of the wrist. In the case of the brachia and brachial, muscle of the anterior bicep the cross sectional area of the muscle declined by twenty-four and twelve percents respectively. Due to this it was found in the muscle specific atrophy, that the ratio of the average CSA of muscle coracobrachialis to muscle brachia, muscle brachia to brachial, and muscle brachiallis to muscle brachia decreased (P=0.0001). The average cross sectional area and muscle tone of the posterior muscles, Namely long head, lateral heads and medial head also decreases by sixteen, fourteen and sixteen percentage respectively(P less than or equal to 0.0045). However, no differential atrophy was evident in these muscles. Thus the ratio of the cross sectional muscular are remained unaltered. Among the patients, the average of the CSA of the atrophied muscle was forty five to eighty percentage of that found in the normal healthy control group of individuals. It was also noted that the flexion/extension movement of arms of the muscles around the joint varied from zero to 80% in comparison to that of individuals in the control group. There was also decline marked the muscle tone of patients following a spinal injury in comparison to that of normal healthy bodied individuals. It can be concluded from this study that there is loss of the contractile protein in the early stages right after the cervical spinal injury, and this differs in the various areas of the skeletal muscle. The mechanism for this decline of CRA of the muscle did not emerge very clearly. It was however very clear that and the progress of muscular imbalance as well as the declining muscle mass in the early stages contributed to the loss of potential for force. As a result of loss of muscle, mass there is consequential loss of strength and the patient is bound to experience fatigue and weakness following a cervical spinal injury. Further studied scan be done to find out how this loss of muscle mass following a trauma can be avoided and how the loss of muscle mass can be regained in a manner that doesn’t compromise on the health of the patient. The effects of increase in muscle mass in comparison to when there was a decline can be studied. It was found from the above study that many times a cervical injury patient may experience varying degrees of loss of sensation, coordination as well as paralysis (depending on the severity of the injury). Due to this the patient is not able to user move his/her limbs as he/she used to before the injury. This lack of movement (unused of muscle) may also contribute to loss of muscle mass and strength.
There are various ethical considerations that should be taken into account while conducting studies involving human subject and even in the case of animal models.There are various fundamental principles to be followed in researches and studies involving animal and human subjects. In medical and clinical researches the welfare of the human subject including his/her dignity, privacy, life and health are the most vital considerations for the physician or the medical researcher. In any research, which involves human subjects the generally accepted principles of science, must be abided by meticulously. These in turn must be based on rigorous study and thorough knowledge of scientific literature, relevant information from authentic sources, and a well-equipped laboratory. The human subject must provide an informed consent for participating in the experiment. In the case of individuals who are incapable of giving consent, the consent of an adult or proxy member of the immediate family member can be provided. In the experimental procedure where human subjects are utilized, the performance and design must be lucidly laid out an experimental protocol. This must be examined by a group of experts in this field.
In the Declaration of Geneva of the World Medical Association binds the physician has to abide by their pledge, “The health of my patient will be my first consideration,”. The International Code of Medical Ethics makes the declaration that, “A physician shall act only in the patient’s interest when providing medical care which might have the effect of weakening the physical and mental condition of the patient.” Since the success and progress of medical success is dependant on the participation of human subjects. Medical studies for researchers on human subjects should undertake only by a competent scientists who is advised by an expert physician or clinical and medical personnel. Such experiments should be carried out if the main objective of the study is far outweighs the subjective risks and inconveniences. All studies should stop if the physical finds that the patients life and safety is being compromised
Cervical spinal Injury leads to host of problems for the patient. There is a need to carry out studies and research in this particular area. However, various ethical considerations have to be taken into account before initiating such studies.
1.CASTRO M. J., ET. al, 1999, Influence of complete spinal cord injury on skeletal muscle cross-sectional area within the first 6 months of injury vol. 80, no4, pp. 373-378 (30 ref.), http://cat.inist.fr/?aModele=afficheN&cpsidt=1895707)
2.Weiqing Ge, et.al, December 2005, Vertebral position alters paraspinal muscle spindle responsiveness in the feline spine: effect of positioning duration, The Journal of Physiology, Volume 569 Page 655 Issue 2, http://jp.physoc.org/cgi/content/abstract/569/2/655
3.BETH A. WINKELSTEIN,(2001),An anatomical investigation of the human cervical facet capsule, quantifying muscle insertion area,Journal of Anatomy , 198: 455-461 Cambridge University Press, http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=76915
4.Caroline Ingham, September 2000,My Journey from Informed Consent to Mutual Inquiry and Collaborative Decision Making Between Client and Therapist, The University of Sydney, http://www2.fhs.usyd.edu.au/arow/arer/013.htm
5.Yael Waknine, April 18, 2006 , Spinal Fixation System Recalled Due to Potential for Failure, http://jp.physoc.org/cgi/content/abstract/569/2/655
6.Todd Mccall, Posted 03/29/2006,Cervical Spine Trauma in Children: A Review, American Association of Neurological Surgeons, http://www.medscape.com/viewarticle/527718
7.Shrawan Kumar, 2005, Looking Away From Whiplash: Effect of Head Rotation in Rear Impacts, Spine. Lippincott Williams & Wilkins ; 30 (7): 760-768. http://www.medscape.com/viewarticle/502445
8.Panjabi, Manohar, et.al, November 1, 2004,Cervical Spine Ligament Injury during Simulated Frontal Impact. Spine. 29(21):2395-2403, Spine. Lippincott Williams & Wilkins , http://www.spinejournal.com/pt/re/spine/abstract.00007632-200411010-00010.htm;jsessionid=F87pky2R8TLw0rgMQnLG39pGvv5s3cm31mkp97tQpQp32ltG5C9P!336912420!-949856144!8091!-1