edited by Jian’an Li, Guangxu Xu, People’s Military Medical Publishing House, officially published on 2013-1. This book of nearly 1 million words is divided into 7 chapters detailing the current status and progress of spinal cord injury development, common diseases causing spinal cord injury, examination and assessment methods of spinal cord injury, acute management and surgical treatment strategies of spinal cord injury, management of common comorbidities and complications after spinal cord injury, rehabilitation of spinal cord injury, and spinal cord injury The book provides guidance, practical and useful information. This book is highly instructive, practical and operable, and can be used by medical personnel engaged in spinal cord injury rehabilitation in rehabilitation, orthopedics, neurosurgery, urology, etc. Zhang Tingfeng, Rehabilitation Center of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine Practical Spinal Cord Injury Rehabilitation – Preface Spinal cord injury is an injury that has existed since the birth of mankind. The paraplegia caused by spinal cord injury before 3,000 A.D. was described in the parchment surgical works of Dr. Edwin Smith in ancient Egypt. Later Hippocrates described the role of traction therapy. Spinal cord injury is a condition in which the spinal cord is subjected to external forces or pathological changes in the internal environment, resulting in compression, ischemia and necrosis of the spinal cord tissue. The etiology is not only traumatic, but also includes inflammation, infection, mechanical compression, congenital malformations, and many other factors. Primary dysfunctions of spinal cord injury include motor disorders (muscle paralysis), sensory disorders (loss, diminished and abnormal sensation), excretory disorders (neurogenic bladder vs. neurogenic bowel), sexual dysfunction, autonomic nervous system dysregulation, and respiratory disorders (high injury); secondary dysfunctions include pressure sores, infections, pain, spasticity and contractures, heterotopic ossification, autonomic hyperreflexia, urinary stones deep vein thrombosis, complex regional pain syndrome, psychological disorders, and developmental malformations in children. It can be said that spinal cord injury is the most clinically extensive syndrome. Due to the wide range of primary and secondary disorders of spinal cord injury, there must be a very close connection with several clinical disciplines, including orthopedics, neurology, neurosurgery, urology, pediatrics, emergency medicine, etc.; also including nutrition, respiratory medicine, clinical psychology, psychiatry, obstetrics and gynecology, reproductive medicine, Chinese medicine, acupuncture, etc. The rehabilitation medical team includes not only rehabilitation physicians, rehabilitation nurses and rehabilitation therapists, but also involves orthopedic technicians and rehabilitation bioengineering specialists, psychological counseling specialists, social workers, etc. Spinal cord injury is one of the most serious and complex clinical syndromes, and one of the main factors leading to disability. The majority of patients’ injuries last a lifetime, and rehabilitation medicine is a key discipline for patients to improve their function and gain independence in life, as well as a medical specialty that accompanies them throughout their lives. Spinal cord injury rehabilitation has been universally recognized internationally. Many patients have achieved good functional recovery and outstanding achievements. For example, 31-year-old Wang Jiapeng, who suffered a spinal cord injury at the age of 12 and was paraplegic in both lower extremities, took a university course in English through rehabilitation training and enrolled in the United World College in Norway in 1998, becoming the first mainland Chinese student there. 1999 saw him participate in the 36th International Para-Skiing Competition, winning two gold medals. In 1999, he won two gold medals in the 36th International Para-Skiing Competition. He has also worked as a senior executive in several multinational companies, such as the Chairman and CEO of Akunas China. The 18-episode TV series “Hold Up the Blue Sky of Life”, which is based on his experience, was broadcasted nationwide. There are many such spinal cord injury patients in China and abroad who have been able to stand on their own feet and excel after recovery. The main purpose of this book is to provide a comprehensive description of the clinical, functional assessment and rehabilitation treatment system for the functional impairment of spinal cord injury, with an emphasis on the practicality of the content. The authors of this book are all well-known experts in their respective fields in China. Director Xu Guangxu invested a lot of energy in the writing and organization of this book. Prof. Wang Dajue from the UK and Prof. El Massary, former president of the International Spinal Cord Injury Society, have made important contributions to the quality of this book. They are the backbone of this book. This book is suitable for rehabilitation physicians, rehabilitation therapists and rehabilitation nurses involved in spinal cord injury rehabilitation, as well as orthopedics, neurology, neurosurgery, pediatrics and other medical personnel involved in the management of spinal cord injuries. As a textbook, it can be used as a teaching material in spinal cord injury rehabilitation. As a tool book, it can be used as a practical tool for medical and nursing professionals in the functional impairment of spinal cord injury patients. As the first practical technical monograph on spinal cord injury in China, although all of the authors’ editors-in-chief have done their best, errors and misconduct are inevitable. We sincerely look forward to your valuable comments on the contents of this book. We hope to make continuous improvements so that this book will eventually become a domestic masterpiece in this direction. Li Jian’an 2012/9/20 Zhou Shifang: Preface In 2011, the World Health Organization and the World Bank jointly released and officially published the World Report on Disability, which defines the concept of disability in a new way. In the past, I understood disability as an “outcome”, i.e., a functional impairment that exists after congenital or acquired injury from various factors and after clinical and rehabilitation treatment. Now the new definition is: “Disability (diminished or lost function) is a state of human existence” and states that “almost everyone has a temporary or permanent impairment at some point in their lives; and those who enter old age will experience increasing functional impairment”. This greatly extends the concept of disability to almost everyone, especially the elderly. The report goes on to state that “disability is complex, and the interventions to overcome the disadvantages of disability are diverse and systemic, and change with the context”. The above is a spur to every rehabilitation medicine worker, which not only expands the scope and object of our work, but also requires us to have a higher pursuit in the depth and breadth of our business: that is, in addition to continuous improvement in both theory and technology in rehabilitation treatment, we also need to have a better understanding of the basic knowledge and progress of various clinical disciplines; moreover, we need to have a better understanding of the related fields of rehabilitation medicine and closely related fields, such as biology, physiology, physiology, and other related fields. In addition, we need to have a certain understanding of the related fields of rehabilitation medicine, such as biology, physics, mechanics, etc. The rehabilitation of spinal cord injury is one of the most important and important aspects of rehabilitation medicine. With the frequent occurrence of various natural disasters (including earthquakes, tsunamis, extreme weather changes, etc.) and man-made disasters (including traffic accidents, war, various kinds of violence, etc.), the incidence of spinal injuries is increasing at an alarming rate; and because of the rapid development of life sciences brought about by timely rescue, rapid diagnosis, and improved clinical treatment techniques, the survival rate has increased significantly, thus further highlighting the need for functional recovery. The task of rehabilitation treatment is becoming increasingly serious. The rehabilitation of the spine after injury is extensive and involves almost all aspects of rehabilitation medicine. However, the basic theory of functional recovery after loss of innervation has not been thoroughly understood because the mechanism of motor function recovery is extremely complex, including the regeneration of spinal nerves and the factors influencing functional remodeling, which requires further research and attention. In order to improve the success rate of stem cell transplantation, new measures are needed not only in the selection of the source of stem cells and the implantation route, but also in the post-implantation treatment, which requires more attention to prevent the formation of tumors due to overgrowth, in addition to trying to promote viability and induce the formation of synapses with the original neurons! All of the above require a lot of attention. For example, due to the progress of protein research, troponin has replaced other enzymatic indicators and become the most sensitive and important marker for the diagnosis of myocardial infarction; for example, C-reactive protein has become a predictor of certain inflammatory diseases; other biomarkers include Other biomarkers include cytokines including interleukins (IL) family, tumor necrosis factors such as TNF, etc.; mediators such as nitric oxide, prostaglandins, etc.; growth factors such as transforming growth factor (TGF), insulin-like growth factor (IGF), collagenogenic growth factor (FGF), etc.; enzymes such as matrix metalloproteinases (MMPs) and aggregated proteoglycans (aggrecan); transcription factors such as Sox-9, NF-γB and AP-1, which play a regulatory role in inflammation; and certain neurotransmitters that are closely related to functional plasticity, such as dopamine and acetylcholine (extremely important for cognition and memory). All of these markers are directly or indirectly related to many rehabilitation (including spinal injury) targets. The use of these biomarkers can provide targeted leadership (early detection and treatment) or facilitate (modification or change of treatment or dosage according to changes in biomarker indicators) in the diagnosis and treatment of patients; however, biomarkers have not been given sufficient attention in the rehabilitation medicine community. For this reason, the Department of Rehabilitation at the University of Pittsburgh has coined the term “Rehabomics” (where the suffix -omics refers to the integration of biomarker-related studies), emphasizing the close relevance and importance of rehabilitation medicine (Wagner AK. PM R 2011;3:S28- S30). 2. Robotic-assisted movement therapy has been applied in rehabilitation treatment: regarding the promotion of functional recovery, there are both conventional functional exercises and functional electrical stimulation including epidural electrodes displaying electrical stimulation; moreover, robotic devices assist in movement therapy, together with the audio-visual feedback of virtual scenes, to further improve the therapeutic effect. The progress of robotics is changing day by day, first robotics, electric hands, intelligent hands, later upper limb robots, lower limb robots, etc. and combined with functional electrical stimulation, in terms of appearance, movement refinement and accuracy continue to improve and enhance, in improving the quality of life has significant results, has been used in the rehabilitation sector, and welcomed. However, due to the high price, especially the upper and lower limb robots, popularization is still difficult. 3, Internet, Internet of things and aerospace positioning system in rehabilitation medicine: the human body organs of physiological, pathological function of various signals, information, including the contraction function of muscle groups, and virtual or real human image, to take various methods to collect, but through the Internet and even the Internet of things to transmit, transmit, receive and display to the relevant rehabilitation treatment personnel, the latter can clearly and timely understand the patient’s The latter can clearly understand the patient’s current condition and give advice or suggestions in a timely manner, ultimately improving the effectiveness of rehabilitation treatment and preventing accidents such as falls or angina attacks that may occur during community treatment. This ideal form of communication is quietly making its way into the rehabilitation family. The range of telecommunication is being greatly expanded by the establishment of the Global Positioning System (GPS) for aerospace technology and, in particular, our BeiDou positioning system (which is network compatible with GPS). What needs to be emphasized at present is how to reduce signal interference, increase the content of information that can be transmitted, and the miniaturization of related facilities and the rationalization of prices, etc. 4, from the diagnosis of the condition, both a clinical diagnosis, but also a functional diagnosis: diagnosis is to better understand the patient’s situation, guide treatment. The original functional diagnosis after spinal injury only emphasized movement, and by 1992, sensory assessment was added, complete and incomplete spinal cord injury was defined, and the modified Frankel score was changed to ASIA score, which was widely used clinically and significantly improved the effectiveness of rehabilitation treatment. 2009, the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) and other related groups, organized by seven European and American countries, 32 experts (including 14 experts from the United States) collectively wrote an international assessment standard for autonomic function including bladder function after spinal injury, to supplement the original standard, and requested global promotion. Only some provincial and municipal hospitals in China have adopted it, and it is being gradually promoted. 5, the application of Chinese and Western medicine rehabilitation treatment techniques: this is the focus of China’s requirements. So far, massage, acupuncture, cupping, fumigation therapy, etc. have been more widely used, Chinese herbal medicine in the prevention and treatment of some complications has also received attention, the identification of Chinese medicine used to improve the quality of rehabilitation treatment, etc., but are still lack of evidence-based medical information, is the goal of our joint efforts. In order to continuously improve the quality and effectiveness of rehabilitation treatment, talent is the key, and a high-quality professional book or reference book is essential. My evaluation of a good book is that it requires basic, cutting-edge, knowledgeable, practical and compatible content, with special emphasis on practicality and compatibility. There is no doubt about the practicality, except that it is operationally feasible and provides in-depth exposition of some common clinical conditions; for compatibility here contains the compatibility of theory and practice, compatibility of Chinese – Western medicine, compatibility of conventional treatment and the latest treatment methods and compatibility of clinical and research. Readability is required from the text, preferably with illustrations. I am convinced that this book can meet the above requirements as it is edited by Professors Li Jian’an and Xu Guangxu, with Professors Zhang Ning and Yin Guoyong as associate editors, and many domestic experts as co-writers. It can be used as a guide book for professional treatment, and it is also a reference and help for other professions and disciplines. I am glad to be the preface! Shi Fang Zhou in Nanjing