Shashank Yeshwant Kothari, Shashi Gupt, Ajay Gupta
BACKGROUND Prolonged immobilization of the body following Spinal Cord Injury (SCI) is associated with certain metabolic changes in calcium (Ca) metabolism leading to hypercalciuria. This is associated with an increased risk of developing urinary calculi, urinary tract infection, & osteoporosis. Excretion of excess 24 hours urinary calcium in these cases can be reduced with weight bearing in the form of tilt table standing along with passive and active strengthening exercises. MATERIALS AND METHODS A prospective study was conducted on 18 patients with spinal cord injury hospitalized for post-acute rehabilitation program after observing all ethical formalities. Urinary calcium excretion was measured for 24 hours period before and after a structured weight bearing given on tilt table for 1 hour a day and passive and active upper limb strengthening exercise program given half an hour daily, for 2 weeks. RESULTS All the patients belonged to traumatic SCI with immobilization ranging from 2 to 8 months and the structured treatment program lead to significant reduction in hypercalciuria. The level of lesion, diagnosis and different periods of immobilization did not influence the outcome significantly. CONCLUSION This being a short term longitudinal study, the demographics differed from larger earlier studies. Majority of our patients (94%) were young males of 15-50 years age. Paraplegics constituted 72% of our patients while 28% were quadriplegics. The significant reduction in hypercalciuria after a standard regimen of tilt table standing coupled with exercises in all the cases established the value of the treatment. There was no correlation between the periods of immobilization to the change in urine calcium excretion in response to our treatment. It was a short term, small sample study and needs further validation with a larger study of longer duration to establish the efficacy of tilt table standing coupled with exercises.
