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Banerjee R, Patel D, Farooque K, Gupta D, Seth A, Kochhar KP, Garg B, Jain S, Kumar N, Jain S. Cortical intermittent theta burst stimulation on gait pathomechanics and urinary tract dysfunction in incomplete spinal cord injury patients: Protocol for a randomized controlled trial. MethodsX 2024; 13:102826. [PMID: 39049927 PMCID: PMC11268124 DOI: 10.1016/j.mex.2024.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Gait impairment and neurogenic bladder are co-existing common findings in incomplete spinal cord injury (iSCI). Repetitive transcranial magnetic stimulation (rTMS), evident to be a promising strategy adjunct to physical rehabilitation to regain normal ambulation in SCI. However, there is a need to evaluate the role of Intermittent theta burst stimulation (iTBS), a type of patterned rTMS in restoring gait and neurogenic bladder in SCI patients. The aim of the present study is to quantify the effect of iTBS on spatiotemporal, kinetic, and kinematic parameters of gait and neurogenic bladder dyssynergia in iSCI. After maturing all exclusion and inclusion criteria, thirty iSCI patients will be randomly divided into three groups: Group-A (sham), Group-B (active rTMS) and Group-C (active iTBS). Each group will receive stimulation adjunct to physical rehabilitation for 2 weeks. All patients will undergo gait analysis, as well assessment of bladder, electrophysiological, neurological, functional, and psychosocial parameters. All parameters will be assessed at baseline and 6th week (1st follow-up). Parameters except urodynamics and gait analysis will also be assessed after the end of the 2 weeks of the intervention (post-intervention) and at 12th week (2nd follow-up). Appropriate statistical analysis will be done using various parametric and non-parametric tests based on results.
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Affiliation(s)
- Rohit Banerjee
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deeksha Patel
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamran Farooque
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwal Preet Kochhar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Jain
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Jain
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Bhattarai M, Shigemoto Y, Huang YC, Islam MT, Sorenson M. Mindfulness for health and wellbeing in adults with spinal cord injury: A scoping review. J Spinal Cord Med 2024:1-15. [PMID: 39007686 DOI: 10.1080/10790268.2024.2374130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
CONTEXT Individuals with spinal cord injury (SCI) require resources to prevent or self-manage complications in order to maintain optimum functioning and well-being. Rehabilitation literature suggests that mindfulness as an internal psychological resource can play a crucial role in promoting self-management and improving health and well-being. OBJECTIVES We sought to identify and synthesize existing evidence on the role of mindfulness and mindfulness-based interventions in health and well-being outcomes among adults with SCI. METHODS We conducted a scoping review, searching evidence across four electronic databases, CINAHL, PubMed, PsycINFO, and Web of Science, for articles published between 2000 and 2023. Additional articles were searched from the reference list of identified articles. RESULTS Of 354 articles identified in the search, 20 were included in the scoping review. Thirteen studies were interventional in design, while the other seven included cross-sectional and qualitative designs. Some interventional studies examined mindfulness as the major component of the interventions, whereas other studies integrated mindfulness as one component of the intervention program. Overall, mindfulness and mindfulness-based interventions were associated with a range of health and well-being outcomes among individuals with SCI. CONCLUSIONS Mindfulness and mindfulness-based interventions appear to positively impact health and well-being in adults with SCI. However, mindfulness interventions were inconsistent in terms of content, delivery frequency, and duration. It is essential to develop multifaceted, tailored mindfulness interventions utilizing a consumer-based approach and established theories of mindfulness and mindfulness-based practices for adults with SCI.
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Affiliation(s)
- Muna Bhattarai
- College of Nursing, Texas A&M University, College Station, TX, USA
| | - Yuki Shigemoto
- Department of Psychology, Prairie View A&M University, Prairie View, TX, USA
| | - Ya-Ching Huang
- College of Nursing, Texas A&M University, College Station, TX, USA
| | | | - Matthew Sorenson
- College of Nursing, Texas A&M University, College Station, TX, USA
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Kettlewell J, Radford K, Timmons S, Jones T, Fallon S, Westley R, White S, Kendrick D. What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel. Injury 2024:111722. [PMID: 39019749 DOI: 10.1016/j.injury.2024.111722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Major trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). DESIGN Online survey informed by the TDF and BCW. SETTING UK trauma rehabilitation pathway. POPULATION Rehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). ANALYSIS Mean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. RESULTS Most respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). 'Social/professional role and identity', 'knowledge' and 'emotion' (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including 'seen as tick-box exercise','not a priority', lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. CONCLUSIONS Although rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.
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Affiliation(s)
- Jade Kettlewell
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK.
| | - Kate Radford
- Centre for Rehabilitation & Ageing Research, School of Medicine, University of Nottingham, UK
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, UK
| | - Trevor Jones
- School of Medicine, University of Nottingham, UK
| | | | - Ryan Westley
- School of Medicine, University of Nottingham, UK
| | - Susan White
- School of Medicine, University of Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
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Lijodi B, Titus A, Louw Q, Joseph C. Activity limitations, participation restrictions, and environmental barriers among persons with traumatic spinal cord injury in Kenya. Disabil Rehabil 2024:1-7. [PMID: 38950895 DOI: 10.1080/09638288.2024.2365413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/02/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Spinal cord injury (SCI) is a life-changing condition, almost always leading to disability. The aim was to determine the period-prevalence of activity limitations, participation restrictions, and environmental barriers in community-dwelling persons with traumatic spinal cord injury (TSCI) in Kenya. METHODS A cross-sectional survey of 90 community-dwelling adult persons living with TSCI for more than 1 year, recruited from the database of the only specialised rehabilitation, in-patient, facility in Kenya. Modules of the International Spinal Cord Injury community survey (InSCI) used were demographic and injury characteristics; activity and participation; and environmental factors. RESULTS Most prevalent activity limitations and participation restrictions in the total sample were using public transportation (90%), standing unsupported (83%), getting to destination (76%), and toileting (76%). The top environmental barriers were inadequate finances (96%), inaccessibility of public places (92%), and problems with long distance transportation (90%). Participants with tetraplegia were more affected with activity limitations and participation restrictions than those with paraplegia. CONCLUSION Functioning problems and environmental barriers are prevalent among adults living with TSCI in Kenya. Although this is the best-case scenario with respect to healthcare services, where individuals received inpatient rehabilitation previously, a need exists to examine the principles and models of rehabilitation and explore the value proposition of primary care/community level rehabilitation to further optimise independence and functioning.
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Affiliation(s)
- Brenda Lijodi
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adnil Titus
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Conran Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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Althobaiti F, Maghrabi R, Alharbi N, Alwadai M, Almatrafi MK, Bajammal S. Anterior Spinal Artery Syndrome in a Patient With Multilevel Cervical Disc Disease: A Case Report. Cureus 2024; 16:e64577. [PMID: 39011315 PMCID: PMC11249051 DOI: 10.7759/cureus.64577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 07/17/2024] Open
Abstract
Anterior spinal artery syndrome (ASAS) is a rare form of spinal cord infarction, making its incidence and prevalence difficult to determine. We present the case of a 60-year-old woman with multiple vascular risk factors who experienced a sudden onset of severe lower limb weakness, raising immediate concerns about spinal cord ischemia. Diagnostic evaluations confirmed ASAS, although the exact cause and mechanism of her spinal cord infarction remained undetermined. The potential presence of significant cervical disc disease suggests fibrocartilaginous embolism (FCE) as a possible underlying mechanism, despite the lack of direct evidence. This case underscores the importance of clinical awareness and timely intervention in patients with similar symptoms and vascular risk factors. Early recognition, cause identification, and appropriate management are crucial for improving outcomes in spinal cord ischemia, guiding specific treatment strategies, and potentially preventing recurrence.
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Affiliation(s)
| | | | - Naif Alharbi
- Neurology, King Fahad General Hospital, Jeddah, SAU
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Bagdesar M, Samuel R, Brown TDG, Shetty S, Kaur J, Kong AC, George A, Ajwani S. Integrated oral care for patients with spinal cord injuries: perceptions of non-dental professionals. Disabil Rehabil 2024:1-10. [PMID: 38910433 DOI: 10.1080/09638288.2024.2367599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To understand the oral health attitudes, knowledge, and practices among non-dental professionals caring for patients with spinal cord injuries, as well as the barriers and facilitators to oral care across acute and rehabilitation hospital settings. MATERIALS AND METHODS This study was a descriptive qualitative study. Nine focus groups with spinal cord injury clinicians from two Sydney hospitals were conducted (n = 35). A thematic analysis was undertaken. RESULTS Four themes were constructed: understanding the impact of spinal cord injuries on oral health and wellbeing; limited support in the spinal cord injury unit to promote oral care; strategies that enable oral care promotion; and recommendations to expand scope in oral care and education. Although most clinicians considered oral health to be important there was a lack of guidelines to support standardised oral care practices. Barriers included lack of time, limited oral care resources, low priority and difficulty in accessing treatment. Staff were receptive to an integrated, multidisciplinary approach to oral care. CONCLUSION This Australian first study provides insight into spinal cord injury clinicians' knowledge and practices of oral care. The findings will help guide future research in developing appropriate models of care to promote oral health among patients with spinal cord injuries.
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Affiliation(s)
- Mary Bagdesar
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
| | - Rebecca Samuel
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
| | - Travis D G Brown
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
- Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Sachin Shetty
- Spinal Injuries Unit, Prince of Wales Hospital, Sydney, NSW, Australia
- Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Jasbeer Kaur
- Spinal Cord Injury Unit, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ariana C Kong
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, Australia
- ACIOH, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Ajesh George
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, Australia
- ACIOH, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Shilpi Ajwani
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, Australia
- Oral Health Services, Sydney Dental Hospital, Surry Hills, NSW, Australia
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Crul TC, Hacking EC, Visser-Meily JMA, Post MWM, Stolwijk-Swüste JM. Choosing non-pharmacological treatments for neuropathic pain in spinal cord injury: a qualitative study. Disabil Rehabil 2024:1-7. [PMID: 38840332 DOI: 10.1080/09638288.2024.2362402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE The aims of this study were to explore (1) the considerations of people with spinal cord injury (SCI) in choosing to use non-pharmacological treatments (N-PTs) for neuropathic pain (NP), (2) which factors influence their decision and who is involved in this choice. MATERIALS AND METHODS Eleven individuals with SCI and NP were interviewed. Interviews were transcribed verbatim, transcripts were analysed through thematic coding, following an inductive content analysis approach. RESULTS A journey towards finding and choosing N-PTs emerged. Key phases in this journey were: motives, strategy and practical considerations. Pain and its impact on their life led participants to consider N-PTs. Motives were participants' negative attitudes towards regular medication, willingness to try everything and disappointment and frustration with the guidance from their health care provider (HCP). The search strategies often involved third parties and the internet. This led them to choose a specific N-PT. The journey was influenced by one's attitude, previous personal experience, experience of HCPs, financial considerations, availability and convenience of the treatment. CONCLUSIONS The journey individuals with SCI and NP go through to find N-PTs to manage pain is difficult and often lonely. Findings highlight the importance of HCPs accompanying people with SCI in finding N-PTs.
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Affiliation(s)
- T C Crul
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - E C Hacking
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Centre for Rehabilitation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Chiu AK, Pease TJ, Prakash H, Oster BA, Smith RA, Sahlani M, Ratanpal AS, Amin I, Scalea TM, Bivona LJ, Jauregui JJ, Cavanaugh DL, Koh EY, Ludwig SC. The changing epidemiology of traumatic spine injuries: a trends analysis of 26 years of patients at a major level 1 trauma center in the United States. Spine J 2024:S1529-9430(24)00261-4. [PMID: 38843959 DOI: 10.1016/j.spinee.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/23/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND CONTEXT Traumatic spinal injuries (TSI) are associated with high morbidity, mortality, and resource utilization. The epidemiology of TSI varies greatly across different countries and regions and is impacted by national income levels, infrastructure, and cultural factors. Further, there may be changes over time. It is essential to investigate TSI to gain useful epidemiologic information. However, there have been no recent studies on trends for TSI in the US, despite the changing population demographics, healthcare policy, and technology. As a result, re-examination is warranted to reflect how the modern era has affected the epidemiology of US spine trauma patients and their management. PURPOSE To determine epidemiologic trends in traumatic spine injuries over time. STUDY DESIGN/SETTING Retrospective analysis; level 1 trauma center in the United States. PATIENT SAMPLE A total of 21,811 patients, between the years of 1996 and 2022, who presented with traumatic spine injury. OUTCOME MEASURES Age, sex, race, Injury Severity Score, mechanism of injury, injury diagnosis, injury level, rate of operative intervention, hospital length of stay, intensive care unit length of stay, discharge disposition, in-hospital mortality. METHODS Data was collected from our institutional trauma registry over a 26-year period. Inclusion criteria involved at least one diagnosis of vertebral fracture, spinal cord injury, spinal subluxation, or intervertebral disc injury. Exclusion criteria consisted of patients with no diagnosed spine injury or a diagnosis of strain only. A total of 21,811 patients were included in the analysis. Descriptive statistics were tabulated and ordinary least squares linear regression was conducted for trends analysis. RESULTS Regression analysis showed a significant upward trend in patient age (+13.83 years, β=+0.65/year, p<.001), female sex (+2.7%, β=+0.18%/year, p=.004), falls (+10.5%, β=+0.82%/year, p<.001), subluxations (+12.8%, β=+0.35%/year, p<.001), thoracic injuries (+1.5%, β=+0.28%/year, p<.001), and discharges to subacute rehab (+15.9%, β=+0.68%/year, p<.001). There was a significant downward trend in motor vehicle crashes (-7.8%, β=-0.47%/year, p=.016), firearms injuries (-3.4%, β=-0.19%/year, p<.001), sports/recreation injuries (-2.9%, β=-0.18%/year, p<.001), spinal cord injuries (-11.25%, β=-0.37%, p<.001), complete spinal cord injuries (-7.6%, β=-0.24%/year, p<.001), and discharges to home (+4.5%, β=-0.27%/year, p=.011). CONCLUSIONS At our institution, the average spine trauma patient has trended toward older females. Falls represent an increasing proportion of the mechanism of injury, on a trajectory to become the most common cause. With time, there have been fewer spinal cord injuries and a lower proportion of complete injuries. At discharge, there has been a surge in the utilization of subacute rehabilitation facilities. Overall, there has been no significant change in injury severity, rate of operative intervention, length of stay, or mortality.
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Affiliation(s)
- Anthony K Chiu
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Tyler J Pease
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Hans Prakash
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Brittany A Oster
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Ryan A Smith
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Mario Sahlani
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Amit S Ratanpal
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Idris Amin
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Thomas M Scalea
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, 22 South Greene St, Baltimore, MD 21201, USA
| | - Louis J Bivona
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Daniel L Cavanaugh
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Eugene Y Koh
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA
| | - Steven C Ludwig
- Department of Orthopaedics, University of Maryland Medical Center, 22 South Greene Street, Suite S11B, Baltimore, MD 21201, USA.
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Levett JJ, Elkaim LM, Niazi F, Weber MH, Iorio-Morin C, Bonizzato M, Weil AG. Invasive Brain Computer Interface for Motor Restoration in Spinal Cord Injury: A Systematic Review. Neuromodulation 2024; 27:597-603. [PMID: 37943244 DOI: 10.1016/j.neurom.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
STUDY DESIGN Systematic review of the literature. OBJECTIVES In recent years, brain-computer interface (BCI) has emerged as a potential treatment for patients with spinal cord injury (SCI). This is the first systematic review of the literature on invasive closed-loop BCI technologies for the treatment of SCI in humans. MATERIALS AND METHODS A comprehensive search of PubMed MEDLINE, Web of Science, and Ovid EMBASE was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Of 8316 articles collected, 19 studies met all the inclusion criteria. Data from 21 patients were extracted from these studies. All patients sustained a cervical SCI and were treated using either a BCI with intracortical microelectrode arrays (n = 18, 85.7%) or electrocorticography (n = 3, 14.3%). To decode these neural signals, machine learning and statistical models were used: support vector machine in eight patients (38.1%), linear estimator in seven patients (33.3%), Hidden Markov Model in three patients (14.3%), and other in three patients (14.3%). As the outputs, ten patients (47.6%) underwent noninvasive functional electrical stimulation (FES) with a cuff; one (4.8%) had an invasive FES with percutaneous stimulation, and ten (47.6%) used an external device (neuroprosthesis or virtual avatar). Motor function was restored in all patients for each assigned task. Clinical outcome measures were heterogeneous across all studies. CONCLUSIONS Invasive techniques of BCI show promise for the treatment of SCI, but there is currently no technology that can restore complete functional autonomy in patients with SCI. The current techniques and outcomes of BCI vary greatly. Because invasive BCIs are still in the early stages of development, further clinical studies should be conducted to optimize the prognosis for patients with SCI.
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Affiliation(s)
- Jordan J Levett
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Lior M Elkaim
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Farbod Niazi
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Michael H Weber
- Department of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Marco Bonizzato
- Department of Electrical Engineering and Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada; Department of Neuroscience and Centre interdisciplinaire sur le cerveau et l'apprentissage, University of Montreal, Montreal, Quebec, Canada
| | - Alexander G Weil
- Division of Neurosurgery, St-Justine University Hospital, Montreal, Quebec, Canada.
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Zwijgers E, van Dijsseldonk RB, Vos-van der Hulst M, Hijmans JM, Geurts ACH, Keijsers NLW. Efficacy of Walking Adaptability Training on Walking Capacity in Ambulatory People With Motor Incomplete Spinal Cord Injury: A Multicenter Pragmatic Randomized Controlled Trial. Neurorehabil Neural Repair 2024; 38:413-424. [PMID: 38661122 PMCID: PMC11097615 DOI: 10.1177/15459683241248088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Balance and walking capacity are often impaired in people with motor incomplete spinal cord injury (iSCI), frequently resulting in reduced functional ambulation and participation. This study aimed to assess the efficacy of walking adaptability training compared to similarly dosed conventional locomotor and strength training for improving walking capacity, functional ambulation, balance confidence, and participation in ambulatory people with iSCI. METHODS We conducted a 2-center, parallel-group, pragmatic randomized controlled trial. Forty-one people with iSCI were randomized to 6 weeks of (i) walking adaptability training (11 hours of Gait Real-time Analysis Interactive Lab (GRAIL) training-a treadmill in a virtual reality environment) or (ii) conventional locomotor and strength training (11 hours of treadmill training and lower-body strength exercises). The primary measure of walking capacity was maximal walking speed, measured with an overground 2-minute walk test. Secondary outcome measures included the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP), the Activities-specific Balance Confidence (ABC) scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). RESULTS No significant difference in maximal walking speed between the walking adaptability (n = 17) and conventional locomotor and strength (n = 18) training groups was found 6 weeks after training at follow-up (-0.05 m/s; 95% CI = -0.12-0.03). In addition, no significant group differences in secondary outcomes were found. However, independent of intervention, significant improvements over time were found for maximal walking speed, SCI-FAP, ABC, and USER-P restrictions scores. Conclusions. Our findings suggest that walking adaptability training may not be superior to conventional locomotor and strength training for improving walking capacity, functional ambulation, balance confidence, or participation in ambulatory people with iSCI. TRIAL REGISTRATION Dutch Trial Register; Effect of GRAIL training in iSCI.
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Affiliation(s)
- Eline Zwijgers
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Rosanne B. van Dijsseldonk
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Juha M. Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël L. W. Keijsers
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Sensorimotor Neuroscience, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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11
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Pasha S, Shepley MM. A Structured Literature Review on the Research and Design of Rehabilitation Environments. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241248604. [PMID: 38742748 DOI: 10.1177/19375867241248604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
AIM This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments. BACKGROUND Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills. METHOD We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments. RESULT AND CONCLUSION Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients.
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12
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Ceradini M, Losanno E, Micera S, Bandini A, Orlandi S. Immersive VR for upper-extremity rehabilitation in patients with neurological disorders: a scoping review. J Neuroeng Rehabil 2024; 21:75. [PMID: 38734690 PMCID: PMC11088157 DOI: 10.1186/s12984-024-01367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Neurological disorders, such as stroke and chronic pain syndromes, profoundly impact independence and quality of life, especially when affecting upper extremity (UE) function. While conventional physical therapy has shown effectiveness in providing some neural recovery in affected individuals, there remains a need for improved interventions. Virtual reality (VR) has emerged as a promising technology-based approach for neurorehabilitation to make the patient's experience more enjoyable. Among VR-based rehabilitation paradigms, those based on fully immersive systems with headsets have gained significant attention due to their potential to enhance patient's engagement. METHODS This scoping review aims to investigate the current state of research on the use of immersive VR for UE rehabilitation in individuals with neurological diseases, highlighting benefits and limitations. We identified thirteen relevant studies through comprehensive searches in Scopus, PubMed, and IEEE Xplore databases. Eligible studies incorporated immersive VR for UE rehabilitation in patients with neurological disorders and evaluated participants' neurological and motor functions before and after the intervention using clinical assessments. RESULTS Most of the included studies reported improvements in the participants rehabilitation outcomes, suggesting that immersive VR represents a valuable tool for UE rehabilitation in individuals with neurological disorders. In addition, immersive VR-based interventions hold the potential for personalized and intensive training within a telerehabilitation framework. However, further studies with better design are needed for true comparison with traditional therapy. Also, the potential side effects associated with VR head-mounted displays, such as dizziness and nausea, warrant careful consideration in the development and implementation of VR-based rehabilitation programs. CONCLUSION This review provides valuable insights into the application of immersive VR in UE rehabilitation, offering the foundation for future research and clinical practice. By leveraging immersive VR's potential, researchers and rehabilitation specialists can design more tailored and patient-centric rehabilitation strategies, ultimately improving the functional outcome and enhancing the quality of life of individuals with neurological diseases.
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Affiliation(s)
- Matteo Ceradini
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Elena Losanno
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Andrea Bandini
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
- Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Orlandi
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Badr MS, Martin JL, Sankari A, Zeineddine S, Salloum A, Henzel MK, Strohl K, Shamim-Uzzaman A, May AM, Fung CH, Pandya N, Carroll S, Mitchell MN. Intensive support does not improve positive-airway pressure use in spinal cord injury/disease: a randomized clinical trial. Sleep 2024; 47:zsae044. [PMID: 38422375 DOI: 10.1093/sleep/zsae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
STUDY OBJECTIVE Treatment of sleep-disordered breathing (SDB) with positive airway pressure (PAP) therapy has unique clinical challenges in individuals living with spinal cord injuries and diseases (spinal cord injury [SCI]/D). Interventions focused on increasing PAP use have not been studied in this population. We aimed to evaluate the benefits of a program to increase PAP use among Veterans with SCI/D and SDB. METHODS Randomized controlled trial comparing a behavioral Intervention (n = 32) and educational control (n = 31), both including one face-to-face and five telephone sessions over 3 months. The intervention included education about SDB and PAP, goal setting, troubleshooting, and motivational enhancement. The control arm included non-directive sleep education only. RESULTS Primary outcomes were objective PAP use (nights ≥4 hours used within 90 days) and sleep quality (Pittsburgh Sleep Quality Index [PSQI] at 3 months). These did not differ between intervention and control (main outcome timepoint; mean difference 3.5 [-9.0, 15.9] nights/week for PAP use; p = .578; -1.1 [-2.8, 0.6] points for PSQI; p = .219). Secondary outcomes included fatigue, depression, function, and quality of life. Only fatigue improved significantly more in the intervention versus the control group (p = .025). Across groups, more PAP use was associated with larger improvements in sleep quality, insomnia, sleepiness, fatigue, and depression at some time points. CONCLUSIONS PAP use in Veterans with SCI/D and SDB is low, and a 3-month supportive/behavioral program did not show significant benefit compared to education alone. Overall, more PAP use was associated with improved symptoms suggesting more intensive support, such as in-home assistance, may be required to increase PAP use in these patients. CLINICAL TRIALS INFORMATION Title: "Treatment of Sleep Disordered Breathing in Patients with SCI." Registration number: NCT02830074. Website: https://clinicaltrials.gov/study/NCT02830074?cond=Sleep%20Apnea&term=badr&rank=5.
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Affiliation(s)
- M Safwan Badr
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jennifer L Martin
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Abdulghani Sankari
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Medical Education, Ascension Providence Hospital, Southfield, MI, USA
| | - Salam Zeineddine
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Anan Salloum
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - M Kristina Henzel
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Kingman Strohl
- Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Afifa Shamim-Uzzaman
- Department of Neurology, VA Ann Arbor Healthcare System
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Anna M May
- Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Constance H Fung
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Nishtha Pandya
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sean Carroll
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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14
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Mori H, Satoh G, Takashima H, Masuda T, Mano T. Combined rehabilitation therapy with botulinum toxin to the upper limbs for acute spinal cord injury: A case report. Spinal Cord Ser Cases 2024; 10:33. [PMID: 38704389 PMCID: PMC11069564 DOI: 10.1038/s41394-024-00647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Patients with spinal cord injury (SCI) and incomplete paralysis may experience muscle immobilization due to functional impairment of agonist and antagonist muscles. This can induce spasticity and pain, with the risk of contracture increasing as the period of immobilization increases. This could be aggravated by pain, which interferes with rehabilitation. There is no established treatment for pain and joint contractures caused by acute SCI. Botulinum therapy plays a role in relieving muscle tension. Here, we report a case of acute SCI in which botulinum therapy was administered. CASE PRESENTATION The patient experienced a C5-cervical SCI due to a road traffic accident, with marked paralysis in the upper and lower limbs below the C5 level. The patient had persistent elbow flexion since the SCI and complained of excruciating pain, making adequate rehabilitation difficult. Botulinum toxin was administered to the biceps and brachialis muscles 15 days after the SCI. After administration, the patient experienced a reduction in pain with relaxation of the elbow flexor muscles, and rehabilitation treatment was resumed. This patient's contracture did not worsen, his pain decreased, and he was able to initiate self-feeding training. DISCUSSION In this case, occupational and physical therapy was administered with botulinum therapy. Together, they successfully reduced pain. Botulinum therapy provides analgesia and muscle relaxation and may lead to functional recovery, and we believe that treatment can be considered even in the acute phase.
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Affiliation(s)
- Haruki Mori
- Department of Rehabilitation, Nara Prefecture General Medical Center, Nara city, Japan
| | - Gosuke Satoh
- Department of Rehabilitation, Nara Prefecture General Medical Center, Nara city, Japan
| | - Hideki Takashima
- Department of Rehabilitation, Nara Prefecture General Medical Center, Nara city, Japan
| | - Takashi Masuda
- Department of Rehabilitation, Nara Prefecture General Medical Center, Nara city, Japan
| | - Tomoo Mano
- Department of Rehabilitation, Nara Prefecture General Medical Center, Nara city, Japan.
- Department of Neurology, Nara Medical University, Nara city, Japan.
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15
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Barrett B, Phillips SL, Bulat T, Lind JD, Ballistrea L, Ramrattan A, Friedman Y, Cowan L. Evaluation of a new assistive technology: the StandBar. Disabil Rehabil Assist Technol 2024; 19:671-681. [PMID: 36043947 DOI: 10.1080/17483107.2022.2115565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Evaluate the potential of a wheelchair assistive technology (StandBar) to promote power wheelchair users' ability to safely stand independently from their power wheelchair and determine the impact of the device use on psychological well-being for both power wheelchair users and their caregivers. MATERIALS AND METHODS A convenience sample of 11 power wheelchair users and caregiver dyads provided study data. Participants included power wheelchair users who were existing StandBar users or currently in training with the StandBar as part of their rehabilitation. Assessments were conducted at baseline and at six-month follow-up and included physiological assessments and functional testing with and without the StandBar. Monthly follow-up phone calls were completed to collect information on adverse events (e.g., falls, hospitalizations, and skin breakdown). A qualitative interview assessed StandBar users' and caregivers' perception at six-month follow-up. RESULTS AND CONCLUSIONS StandBar use provided power wheelchair users a higher level of independence, confidence, and safety. All participants highly recommended StandBar use to others with similar levels of functional impairment. StandBar use allowed many participants the ability to complete functional tasks that were otherwise not possible without assistance. Qualitative interviews reported improved independence and psychological well-being for StandBar users as well as reduced levels of anxiety and burden of care by caregivers. The StandBar is a cost-effective assistive technology that promotes independence and functionality for power wheelchair users and improves the psychological well-being of users and their caregivers. Implications for RehabilitationStandBar allows power wheelchair users to:Minimize negative effects of immobilization.Increase independence for activities of daily living (grooming, hygiene, toileting, transfers) and instrumental activities of daily living (social experiences).Improve their quality of life through increasing independence and confidence.Reduce need for assistance and corresponding caregiver burden.
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Affiliation(s)
- Blake Barrett
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, Tampa, FL, USA
| | - Sam L Phillips
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, Tampa, FL, USA
| | - Tatjana Bulat
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, Tampa, FL, USA
- Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Jason D Lind
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, Tampa, FL, USA
| | - Lisa Ballistrea
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, Tampa, FL, USA
| | - Anita Ramrattan
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, Tampa, FL, USA
| | - Yvonne Friedman
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, Tampa, FL, USA
| | - Linda Cowan
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, Tampa, FL, USA
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16
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Scott MM, Patel DV, Lucasti C, Vallee EK, Clark LD, Kowalski JM. Hospital Course and Complications of Subaxial Cervical Trauma Patients With Tetraplegia or Paraplegia: A Case Series and Literature Review. Clin Spine Surg 2024; 37:E152-E157. [PMID: 38158604 DOI: 10.1097/bsd.0000000000001571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN A single-institution, retrospective cohort study. OBJECTIVE The objective was to present demographic characteristics, mechanism of injuries, lengths of stay, intensive care unit (ICU) days, discharge locations, and causes of 90-day readmission for patients with subaxial spinal cord injuries resulting in paraplegia or tetraplegia. SUMMARY OF BACKGROUND DATA Spinal cord injuries resulting in paraplegia or tetraplegia are rare injuries with debilitating outcomes. Numerous advances have occurred in caring for these patients, but patients still experience multiple complications. The severity of these injuries and numerous complications result in prolonged hospital stays and the need for extensive rehabilitation. METHODS Twelve patients with subaxial spinal cord injury resulting in paraplegia or tetraplegia from a level 1 adult trauma center were reviewed. The primary outcomes included hospital length of stay, ICU days, intrahospital complications, 90-day readmission rates, and discharge location. We reviewed the literature for these outcomes in spinal cord injuries. RESULTS For patients with subaxial spinal cord injuries resulting in paraplegia and tetraplegia, the average age was 36.0 years, and most were male [91.7% (11/12)]. The most common mechanism of injury was gunshot wounds[41.7% (5/12)]. Patients spent an average of 46.3 days in the hospital and 30.7 days in the ICU. Respiratory complications were the most common (9 patients). Fifty percent of patients (6/12) were discharged to the inpatient spinal cord rehab center, and 16.7% (2/12) expired while in the hospital. Two patients (20.0%) were readmitted within 90 days of discharge. CONCLUSIONS Most patients with subaxial spinal cord injuries resulting in paraplegia or tetraplegia were young males with high-energy traumas. Many patients had intrahospital complications, and most were discharged to the hospital spinal rehab center. These findings likely stem from the severity of paraplegia and tetraplegia injuries and the need for rehabilitation.
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Affiliation(s)
| | - Dil V Patel
- UBMD Orthopaedics and Sports Medicine Doctors, Buffalo, NY
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17
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Irrgang S, Himmelhaus S, Allek K, Debecker I, Gemperli A, Kynast K, von Reumont A, Scheel-Sailer A. Assessments and interventions on body functions, structures and activity to prepare adults with acute spinal cord injury or disease for participation: a scoping review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1272682. [PMID: 38601217 PMCID: PMC11004486 DOI: 10.3389/fresc.2024.1272682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
Introduction In the acute phase after a spinal cord injury or disease (SCI/D), various therapeutic assessments and interventions are applied with the goal of restoring structures, preventing complications and preparing the patient as best as possible for further activity and finally participation. The goal was to identify and evaluate the available evidence on assessments and interventions for body functions and structures to prepare adults with acute spinal cord SCI/D for activity and participation during the first 14 days. Methods A scoping review was conducted. The search was performed on June 19, 2023 using the databases PubMed, PEDro, Cochrane library and Embase. These were screened for studies including patients with acute SCI/D and physiotherapeutic or occupational therapy assessments and interventions. Only studies in English or German published between 2012 and 2023 were included. Results Twelve publications met the inclusion criteria, namely three systematic reviews, two randomized controlled trials, two observational studies and five clinical practice guidelines. Assessments as the Spinal Cord Independence Measure, as well as exercises such as daily passive mobilization of body structures against contractures were used in the entire population, while others were only applied in subgroups of SCI/D such as the Graded Redefined Assessment of Strength, Sensation and Prehension or functional electrical stimulation with and without additional movements. The methodological quality of the studies found varied greatly from good to very poor. Discussion Heterogeneity in research design and study population as well as lack of high-quality studies do not cover the standard of clinical management in the acute phase and further comprehensive research is needed.
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Affiliation(s)
- Sophie Irrgang
- Health Services and Clinical Care Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sandra Himmelhaus
- Health Services and Clinical Care Group, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Kirstin Allek
- Spinal Cord Injury Center, Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - Armin Gemperli
- Health Services and Clinical Care Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Karen Kynast
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne von Reumont
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Anke Scheel-Sailer
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Center, Nottwil, Switzerland
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18
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Postol N, Barton J, Wakely L, Bivard A, Spratt NJ, Marquez J. "Are we there yet?" expectations and experiences with lower limb robotic exoskeletons: a qualitative evaluation of the therapist perspective. Disabil Rehabil 2024; 46:1023-1030. [PMID: 36861846 DOI: 10.1080/09638288.2023.2183992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/11/2023] [Accepted: 02/18/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Lower limb robotic exoskeletons can assist movement, however, clinical uptake in neurorehabilitation is limited. The views and experiences of clinicians are pivotal to the successful clinical implementation of emerging technologies. This study investigates therapist perspectives of the clinical use and future role of this technology in neurorehabilitation. METHODS Australian and New Zealand-based therapists with lower limb exoskeleton experience were recruited to complete an online survey and semi-structured interview. Survey data were transposed into tables and interviews transcribed verbatim. Qualitative data collection and analysis were guided by qualitative content analysis and interview data were thematically analysed. RESULTS Five participants revealed that the use of exoskeletons to deliver therapy involves the interplay of human elements - experiences and perspectives of use, and mechanical elements - the device itself. Two overarching themes emerged: the "journey", with subthemes of clinical reasoning and user experience; and the "vehicle" with design features and cost as subthemes, to explore the question "Are we there yet?" CONCLUSION Therapists expressed positive and negative perspectives from their experiences with exoskeletons, giving suggestions for design features, marketing input, and cost to enhance future use. Therapists are optimistic that this journey will see lower limb exoskeletons integral to rehabilitation service delivery.
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Affiliation(s)
- Nicola Postol
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
- Centre for Brain and Mental Health, Hunter Medical Research Institute, New Lambton, Australia
| | - Julia Barton
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
| | - Luke Wakely
- Department of Rural Health, University of Newcastle, Callghan, Australia
- Hunter New England Local Health District, New Lambton, Australia
| | - Andrew Bivard
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
- Centre for Brain and Mental Health, Hunter Medical Research Institute, New Lambton, Australia
- University of Melbourne, School of Medicine, Dentistry and Public Health, Melbourne, Australia
| | - Neil J Spratt
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
- Centre for Brain and Mental Health, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Local Health District, New Lambton, Australia
| | - Jodie Marquez
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
- Centre for Brain and Mental Health, Hunter Medical Research Institute, New Lambton, Australia
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Malik RN, Samejima S, Shackleton C, Miller T, Pedrocchi ALG, Rabchevsky AG, Moritz CT, Darrow D, Field-Fote EC, Guanziroli E, Ambrosini E, Molteni F, Gad P, Mushahwar VK, Sachdeva R, Krassioukov AV. REPORT-SCS: minimum reporting standards for spinal cord stimulation studies in spinal cord injury. J Neural Eng 2024; 21:016019. [PMID: 38271712 DOI: 10.1088/1741-2552/ad2290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/25/2024] [Indexed: 01/27/2024]
Abstract
Objective.Electrical spinal cord stimulation (SCS) has emerged as a promising therapy for recovery of motor and autonomic dysfunctions following spinal cord injury (SCI). Despite the rise in studies using SCS for SCI complications, there are no standard guidelines for reporting SCS parameters in research publications, making it challenging to compare, interpret or reproduce reported effects across experimental studies.Approach.To develop guidelines for minimum reporting standards for SCS parameters in pre-clinical and clinical SCI research, we gathered an international panel of expert clinicians and scientists. Using a Delphi approach, we developed guideline items and surveyed the panel on their level of agreement for each item.Main results.There was strong agreement on 26 of the 29 items identified for establishing minimum reporting standards for SCS studies. The guidelines encompass three major SCS categories: hardware, configuration and current parameters, and the intervention.Significance.Standardized reporting of stimulation parameters will ensure that SCS studies can be easily analyzed, replicated, and interpreted by the scientific community, thereby expanding the SCS knowledge base and fostering transparency in reporting.
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Affiliation(s)
- Raza N Malik
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tiev Miller
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alessandra Laura Giulia Pedrocchi
- Nearlab, Department di Electronics, Information and Bioengineering, and We-Cobot Laboratory, Polo Territoriale di Lecco, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Alexander G Rabchevsky
- Spinal Cord & Brain Injury Research Center, Department of Physiology, University of Kentucky, Lexington, KY, United States of America
| | - Chet T Moritz
- Departments of Electrical & Computer Engineering, Rehabilitation Medicine, and Physiology & Biophysics, and the Center for Neurotechnology, University of Washington, Seattle, WA, United States of America
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States of America
- Department of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, United States of America
| | - Edelle C Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, Georgia, United States of America
- Emory University School of Medicine, Division of Physical Therapy, Atlanta, Georgia, United States of America
- Georgia Institute of Technology, School of Biological Sciences, Program in Applied Physiology, Atlanta, Georgia, United States of America
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Emilia Ambrosini
- Nearlab, Department di Electronics, Information and Bioengineering, and We-Cobot Laboratory, Polo Territoriale di Lecco, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Parag Gad
- SpineX Inc., Los Angeles, Los Angeles, CA, United States of America
| | - Vivian K Mushahwar
- Department of Medicine and Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta, Edmonton, Alberta, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Spinal Cord Research Program, G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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20
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Meyers EC, Gabrieli D, Tacca N, Wengerd L, Darrow M, Schlink BR, Baumgart I, Friedenberg DA. Decoding hand and wrist movement intention from chronic stroke survivors with hemiparesis using a user-friendly, wearable EMG-based neural interface. J Neuroeng Rehabil 2024; 21:7. [PMID: 38218901 PMCID: PMC10787968 DOI: 10.1186/s12984-023-01301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/21/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE Seventy-five percent of stroke survivors, caregivers, and health care professionals (HCP) believe current therapy practices are insufficient, specifically calling out the upper extremity as an area where innovation is needed to develop highly usable prosthetics/orthotics for the stroke population. A promising method for controlling upper extremity technologies is to infer movement intention non-invasively from surface electromyography (EMG). However, existing technologies are often limited to research settings and struggle to meet user needs. APPROACH To address these limitations, we have developed the NeuroLife® EMG System, an investigational device which consists of a wearable forearm sleeve with 150 embedded electrodes and associated hardware and software to record and decode surface EMG. Here, we demonstrate accurate decoding of 12 functional hand, wrist, and forearm movements in chronic stroke survivors, including multiple types of grasps from participants with varying levels of impairment. We also collected usability data to assess how the system meets user needs to inform future design considerations. MAIN RESULTS Our decoding algorithm trained on historical- and within-session data produced an overall accuracy of 77.1 ± 5.6% across 12 movements and rest in stroke participants. For individuals with severe hand impairment, we demonstrate the ability to decode a subset of two fundamental movements and rest at 85.4 ± 6.4% accuracy. In online scenarios, two stroke survivors achieved 91.34 ± 1.53% across three movements and rest, highlighting the potential as a control mechanism for assistive technologies. Feedback from stroke survivors who tested the system indicates that the sleeve's design meets various user needs, including being comfortable, portable, and lightweight. The sleeve is in a form factor such that it can be used at home without an expert technician and can be worn for multiple hours without discomfort. SIGNIFICANCE The NeuroLife EMG System represents a platform technology to record and decode high-resolution EMG for the real-time control of assistive devices in a form factor designed to meet user needs. The NeuroLife EMG System is currently limited by U.S. federal law to investigational use.
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Affiliation(s)
- Eric C Meyers
- Medical Device Solutions, Battelle Memorial Institute, 505 King Ave, Columbus, OH, 43201, USA.
| | - David Gabrieli
- Health Analytics, Battelle Memorial Institute, 505 King Ave, Columbus, OH, 43201, USA
| | - Nick Tacca
- Medical Device Solutions, Battelle Memorial Institute, 505 King Ave, Columbus, OH, 43201, USA
| | - Lauren Wengerd
- Medical Device Solutions, Battelle Memorial Institute, 505 King Ave, Columbus, OH, 43201, USA
| | - Michael Darrow
- Medical Device Solutions, Battelle Memorial Institute, 505 King Ave, Columbus, OH, 43201, USA
| | - Bryan R Schlink
- Medical Device Solutions, Battelle Memorial Institute, 505 King Ave, Columbus, OH, 43201, USA
| | - Ian Baumgart
- Medical Device Solutions, Battelle Memorial Institute, 505 King Ave, Columbus, OH, 43201, USA
| | - David A Friedenberg
- Health Analytics, Battelle Memorial Institute, 505 King Ave, Columbus, OH, 43201, USA
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21
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Quinzaños-Fresnedo J, Contreras-Juvenal R, Quezada-López DC, Rodríguez-Barragán MA, Barrera-Ortiz A, Aguirre-Güemez AV. Determination of cut-off points in the Trunk control test for spinal cord injury to assess the ability to perform different activities of daily living. Spinal Cord 2024; 62:12-16. [PMID: 37974004 DOI: 10.1038/s41393-023-00940-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
STUDY DESIGN Observational, comparative, and transversal study. OBJECTIVE To identify the cut-off points in the Trunk Control Test (TCT) for individuals with Spinal Cord Injury (SCI) to determine the ability to perform independently the different activities of daily living (ADL) according to the Spinal Cord Independence Measure-III (SCIM-III). SETTING National Institute of Rehabilitation, Mexico City. METHODS Individuals with SCI of any neurologic level and severity according to ISNCSCI, in sub-acute and chronic phases were included. Receiver Operating Characteristic (ROC) curves were made to identify the cut-off points on the TCT that discriminate the individuals that can independently perform each of the ADL described in the SCIM-III. RESULTS A total of 604 participants were evaluated, 70.7% male; mean age of 34 (± 14) years; time since injury was 134 ± 360 days; predominating motor complete injury (50.1%). It was demonstrated through ROC curves, that there are different cut-off points in the TCT that are sensitive and specific to discriminate individuals that can independently perform the majority of the items of the SCIM-III of those who perform it with assistance. Domains that do not depend on an adequate trunk control (respiration and sphincter management) had poor areas under the curve, with low sensitivity and specificity. CONCLUSIONS The application of the TCT in individuals with SCI allows to discriminate between individuals who perform the different ADL independently of those who do not, at this subject institute. These results can guide the management of individuals with SCI, helping to establish short term goals.
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Affiliation(s)
- Jimena Quinzaños-Fresnedo
- National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Neurologic Rehabilitation division, Mexico-Xochimilco Av. 289, third floor, 14389, Mexico City, Mexico.
| | - Rodrigo Contreras-Juvenal
- National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Education Direction, Mexico City, Mexico
| | - Deanna C Quezada-López
- National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Education Direction, Mexico City, Mexico
| | - Marlene A Rodríguez-Barragán
- National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Neurologic Rehabilitation Division, Spinal Cord Injury Rehabilitation department, Mexico City, Mexico
| | - Aida Barrera-Ortiz
- National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Neurologic Rehabilitation Division, Spinal Cord Injury Rehabilitation department, Mexico City, Mexico
| | - Ana V Aguirre-Güemez
- National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Neurologic Rehabilitation Division, Spinal Cord Injury Rehabilitation department, Mexico City, Mexico
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22
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Bae Y, Jung H, Shin N, Rahmati M, Udeh R, Kazemi A, Li Y, Solmi M, Syafrudin M, Fitriyani NL, Fond G, Boyer L, Lee SW. Musculoskeletal morbidity in adults with spinal cord injuries: A nationwide cohort study. NeuroRehabilitation 2024; 54:599-610. [PMID: 38669487 DOI: 10.3233/nre-230263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
BACKGROUND An increase in the demand for quality of life following spinal cord injuries (SCIs) is associated with an increase in musculoskeletal (MSK) pain, highlighting the need for preventive measure research. OBJECTIVE This study aimed to evaluate the incidence and hazards of MSK morbidities among Korean adults with SCIs, as well as the influence of SCI location on MSK morbidities. METHODS Patient populations were selected from Korean National Health Insurance Service data (n = 276). The control group included individuals without SCIs (n = 10,000). We compared the incidences and determined the unadjusted and adjusted hazard ratios (HRs) of common MSK morbidities (osteoarthritis, connective tissue disorders, sarcopenia, myalgia, neuralgia, rheumatoid arthritis, myositis, and musculoskeletal infections) based on the location of injury (cervical, thoracic, or lumbar). RESULTS Adults with SCIs had a higher incidence of MSK morbidity (48.45% vs. 36.6%) and a lower survival probability than those without SCIs. The incidence of MSK morbidity and survival probabilities were not significantly different for cervical cord injuries, whereas both measures were significantly different for thoracic and lumbar injuries. CONCLUSION SCI increases the risk of MSK morbidity. Lumbar SCI is associated with a higher incidence and risk of MSK morbidity than are cervical or thoracic SCIs.
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Affiliation(s)
- Youngoh Bae
- Department of Neurosurgery, Pohang Naval Hospital, Pohang, Korea
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hohyun Jung
- Department of Statistics, Sungshin Women's University, Seoul, Korea
- Data Science Center, Sungshin Women's University, Seoul, Korea
| | - Nakyung Shin
- Department of Statistics, Sungshin Women's University, Seoul, Korea
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Raphael Udeh
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - Abdolreza Kazemi
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Yusheng Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Marco Solmi
- Department of Psychiatry, SCIENCES Lab, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Muhammad Syafrudin
- Department of Artificial Intelligence and Data Science, Sejong University, Seoul, Korea
| | - Norma Latif Fitriyani
- Department of Artificial Intelligence and Data Science, Sejong University, Seoul, Korea
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- FondaMental Foundation, Créteil, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- FondaMental Foundation, Créteil, France
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
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23
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Temel MH, Erden Y, Bağcıer F. Information Quality and Readability: ChatGPT's Responses to the Most Common Questions About Spinal Cord Injury. World Neurosurg 2024; 181:e1138-e1144. [PMID: 38000671 DOI: 10.1016/j.wneu.2023.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE This study aimed to assess the quality, readability, and comprehension of texts generated by ChatGPT in response to commonly asked questions about spinal cord injury (SCI). METHODS The study utilized Google Trends to identify the most frequently searched keywords related to SCI. The identified keywords were sequentially inputted into ChatGPT, and the resulting responses were assessed for quality using the Ensuring Quality Information for Patients (EQIP) tool. The readability of the texts was analyzed using the Flesch-Kincaid grade level and the Flesch-Kincaid reading ease parameters. RESULTS The mean EQIP score of the texts was determined to be 43.02 ± 6.37, the Flesch-Kincaid reading ease score to be 26.24 ± 13.81, and the Flesch-Kincaid grade level was determined to be 14.84 ± 1.79. The analysis revealed significant concerns regarding the quality of texts generated by ChatGPT, indicating serious problems with readability and comprehension. The mean EQIP score was low, suggesting a need for improvement in the accuracy and reliability of the information provided. The Flesch-Kincaid grade level indicated a high linguistic complexity, requiring a level of education equivalent to approximately 14 to 15 years of formal education for comprehension. CONCLUSIONS The results of this study show heightened complexity in ChatGPT-generated SCI texts, surpassing optimal health communication readability. ChatGPT currently cannot substitute comprehensive medical consultations. Enhancing text quality could be attainable through dependence on credible sources, the establishment of a scientific board, and collaboration with expert teams. Addressing these concerns could improve text accessibility, empowering patients and facilitating informed decision-making in SCI.
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Affiliation(s)
- Mustafa Hüseyin Temel
- Physical Medicine and Rehabilitation Clinic, Üsküdar State Hospital, İstanbul, Turkey.
| | - Yakup Erden
- Physical Medicine and Rehabilitation Clinic, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Turkey
| | - Fatih Bağcıer
- Physical Medicine and Rehabilitation Clinic, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
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24
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Barrett OEC, Ho AK, Finlay KA. Sexual function and sexual satisfaction following spinal cord injury: an interpretative phenomenological analysis of partner experiences. Disabil Rehabil 2024; 46:86-95. [PMID: 36576221 DOI: 10.1080/09638288.2022.2159073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/25/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This study explored how partners/spouses of people with Spinal Cord Injury (SCI) experienced intimacy, sexual function, and sexual satisfaction post-SCI. MATERIALS AND METHODS Qualitative, semi-structured interviews were conducted with the partners/spouses of people with SCI living in the community in the United Kingdom. Twelve participants (7 females; 5 males) were recruited using purposive sampling. A nine-item semi-structured interview design was used. Interviews were transcribed verbatim and analysed via Interpretative Phenomenological Analysis (IPA). RESULTS Three superordinate themes were demonstrated: (1) Stolen sex through unpreparedness; (2) Redefining sex; and (3) Compromised commitment. Partners struggled to come to terms with the shock of radically altered post-SCI sexual relationships, questioning how their changed sexual relationship and sexual identity conflicted with caring requirements. To minimise post-SCI relationship changes, some partners engaged in strategies to protect against, distract from and avoid sexual intimacy, whereas others were able to retain adapted pre-injury patterns of intimate behaviour. CONCLUSION Compromised sexual function and satisfaction significantly disrupt relationship dynamics post-SCI, initiate voluntary celibacy, and limit the perceived viability of continued sexual intimacy. Specialist partner-support provisions are urgently needed, recognising that partner support needs are not restricted to the inpatient rehabilitation phase but importantly extend long past discharge into the community.
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Affiliation(s)
- Olivia E C Barrett
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Aileen K Ho
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Katherine A Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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25
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Ji W, Nightingale TE, Zhao F, Fritz NE, Phillips AA, Sisto SA, Nash MS, Badr MS, Wecht JM, Mateika JH, Panza GS. The Clinical Relevance of Autonomic Dysfunction, Cerebral Hemodynamics, and Sleep Interactions in Individuals Living With SCI. Arch Phys Med Rehabil 2024; 105:166-176. [PMID: 37625532 DOI: 10.1016/j.apmr.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/25/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
A myriad of physiological impairments is seen in individuals after a spinal cord injury (SCI). These include altered autonomic function, cerebral hemodynamics, and sleep. These physiological systems are interconnected and likely insidiously interact leading to secondary complications. These impairments negatively influence quality of life. A comprehensive review of these systems, and their interplay, may improve clinical treatment and the rehabilitation plan of individuals living with SCI. Thus, these physiological measures should receive more clinical consideration. This special communication introduces the under investigated autonomic dysfunction, cerebral hemodynamics, and sleep disorders in people with SCI to stakeholders involved in SCI rehabilitation. We also discuss the linkage between autonomic dysfunction, cerebral hemodynamics, and sleep disorders and some secondary outcomes are discussed. Recent evidence is synthesized to make clinical recommendations on the assessment and potential management of important autonomic, cerebral hemodynamics, and sleep-related dysfunction in people with SCI. Finally, a few recommendations for clinicians and researchers are provided.
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Affiliation(s)
- Wenjie Ji
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Centre for Trauma Science Research, University of Birmingham, Birmingham, UK; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Fei Zhao
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI
| | - Nora E Fritz
- Department of Health Care Sciences, Program of Physical Therapy, Detroit, MI; Department of Neurology, Wayne State University, Detroit, MI
| | - Aaron A Phillips
- Department of Physiology and Pharmacology, Cardiac Sciences, Clinical Neurosciences, Biomedical Engineering, Libin Cardiovascular institute, Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada; RESTORE.network, University of Calgary, Calgary, AB, Canad
| | - Sue Ann Sisto
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Mark S Nash
- Department of Neurological Surgery, Physical Medicine & Rehabilitation Physical Therapy, Miami, FL; Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Research and Development, Detroit, MI; Departments of Physiology and Internal Medicine, Wayne State University, Detroit, MI
| | - Jill M Wecht
- James J Peters VA Medical Center, Department of Spinal Cord Injury Research, Bronx, NY; Icahn School of Medicine Mount Sinai, Departments of Rehabilitation and Human Performance, and Medicine Performance, and Medicine, New York, NY
| | - Jason H Mateika
- John D. Dingell VA Medical Center, Research and Development, Detroit, MI; Departments of Physiology and Internal Medicine, Wayne State University, Detroit, MI
| | - Gino S Panza
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI.
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26
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Gur Arie A, Toren T, Hadar R, Braun T, Efroni G, Glick Saar E, Madar Z, Amir A, Zeilig G, Haberman Y. Lack of gut microbiome recovery with spinal cord injury rehabilitation. Gut Microbes 2024; 16:2309682. [PMID: 38324278 PMCID: PMC10854366 DOI: 10.1080/19490976.2024.2309682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/19/2024] [Indexed: 02/08/2024] Open
Abstract
Spinal cord injury (SCI) is a devastating event that significantly changes daily function and quality of life and is linked to bowel and bladder dysfunction and frequent antibiotic treatment. We aimed to study the composition of the gut microbiome in individuals with SCI during the initial sub-acute rehabilitation process and during the chronic phase of the injury. This study included 100 fecal samples from 63 participants (Median age 40 years, 94% males): 13 cases with SCI in the sub-acute phase with 50 longitudinal samples, 18 cases with chronic SCI, and 32 age and gender-matched controls. We show, using complementary methods, that the time from the injury was a dominant factor linked with gut microbiome composition. Surprisingly, we demonstrated a lack of gut microbial recovery during rehabilitation during the sub-acute phase, with further deviation from the non-SCI control group in the chronic ambulatory SCI group. To generalize the results, we were able to show significant similarity of the signal when comparing to a previous cohort with SCI, to subjects from the American Gut Project who reported low physical activity, and to subjects from another population-based cohort who reported less normal stool consistency. Restoration of the microbiome composition may be another desirable measure for SCI recovery in the future, but further research is needed to test whether such restoration is associated with improved neurological outcomes and quality of life.
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Affiliation(s)
- Ayelet Gur Arie
- Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
- Department of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamar Toren
- Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rotem Hadar
- Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Tzipi Braun
- Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Gilat Efroni
- Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Glick Saar
- Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Zecharia Madar
- Department of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amnon Amir
- Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Zeilig
- Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
- School of health professions, Ono Academic College, Kiryat Ono, Israel
| | - Yael Haberman
- Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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27
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Choi HH, Ahn H, Jung WS. Estimation of peak oxygen consumption in individuals with spinal cord injury patients using multiple linear regression analysis: a preliminary study. Phys Act Nutr 2023; 27:26-33. [PMID: 38297473 PMCID: PMC10844726 DOI: 10.20463/pan.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024] Open
Abstract
PURPOSE This study aims to develop a regression model to estimate peak oxygen consumption (VO2peak) in individuals with spinal cord injury (SCI) by employing different variables. METHODS In this study, 34 participants were divided into two groups: 19 with cervical injury (CI) and 15 with thoracic injury (TI). Key measurements included VO2peak and related factors such as age, height, weight, body mass index (BMI), fat-free mass, body fat percentage, limb and trunk circumferences, spinal cord independence (SCIM III), Korean activities of daily living (K-ADL), and respiratory functions (forced vital capacity (FVC), peak expiratory flow (PEF), and maximum voluntary ventilation (MVV)). Statistical analyses were conducted using forward selection regression to examine the relationships between these variables. RESULTS Height, calf circumference, SCIM III score, and PEF were key variables in all patients with SCI (TSCI). For patients with CI, the key variables were height, calf circumference, and MVV, whereas for patients with TI, the key variable was calf circumference. The average explanatory powers of the VO2peak regression model for TSCI were 70.3% (R2) and 66.2% (adjusted R2), with an average standard error of estimate (SEE) of 2.94 ml/kg/min. The average explanatory power for patients with CI was 71.7% (R2) and 66.1% (adjusted R2), with an average SEE of 1.88 ml/kg/min. The average explanatory power for patients with TI was 55.9% (R2) and 52.5% (adjusted R2), with an average SEE of 3.41 ml/kg/min. There was no significant difference between the VO2peak measured and predicted VO2peak for each type of injury. CONCLUSION The regression model for estimating VO2peak in SCI patients in this preliminary study is as follows: TSCI=39.684-0.144×(Height)-0.513×(Calf)+0.136×(SCIM III)+1.187×(PEF), CI=38.842-0 .158×(Height) - 0.371×(Calf)+0.093×(MVV), TI=42.325-0.813×(Calf).
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Affiliation(s)
- Hyun-Hee Choi
- Department of Exercise Prescription, Dongseo University, Busan, Republic of Korea
| | - Hana Ahn
- Department of Senior Exercise Prescription, Dongseo University, Busan, Republic of Korea
| | - Won-Sang Jung
- Department of Senior Exercise Prescription, Dongseo University, Busan, Republic of Korea
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28
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André AD, Martins P. Exo Supportive Devices: Summary of Technical Aspects. Bioengineering (Basel) 2023; 10:1328. [PMID: 38002452 PMCID: PMC10669745 DOI: 10.3390/bioengineering10111328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Human societies have been trying to mitigate the suffering of individuals with physical impairments, with a special effort in the last century. In the 1950s, a new concept arose, finding similarities between animal exoskeletons, and with the goal of medically aiding human movement (for rehabilitation applications). There have been several studies on using exosuits with this purpose in mind. So, the current review offers a critical perspective and a detailed analysis of the steps and key decisions involved in the conception of an exoskeleton. Choices such as design aspects, base materials (structure), actuators (force and motion), energy sources (actuation), and control systems will be discussed, pointing out their advantages and disadvantages. Moreover, examples of exosuits (full-body, upper-body, and lower-body devices) will be presented and described, including their use cases and outcomes. The future of exoskeletons as possible assisted movement solutions will be discussed-pointing to the best options for rehabilitation.
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Affiliation(s)
- António Diogo André
- Associated Laboratory of Energy, Transports and Aeronautics (LAETA), Biomechanic and Health Unity (UBS), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal;
- Faculty of Engineering, University of Porto (FEUP), 4200-465 Porto, Portugal
| | - Pedro Martins
- Associated Laboratory of Energy, Transports and Aeronautics (LAETA), Biomechanic and Health Unity (UBS), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal;
- Aragon Institute for Engineering Research (i3A), Universidad de Zaragoza, 50018 Zaragoza, Spain
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29
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El Sammak S, Michalopoulos GD, Arya N, Bhandarkar AR, Moinuddin FM, Jarrah R, Yolcu YU, Shoushtari A, Bydon M. Prediction Model for Neurogenic Bladder Recovery One Year After Traumatic Spinal Cord Injury. World Neurosurg 2023; 179:e222-e231. [PMID: 37611802 DOI: 10.1016/j.wneu.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/06/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Neurogenic bladder is a common complication after spinal cord injury (SCI) that carries substantial burdens on the inflicted individual. The objective of this study is to build a prediction model for neurogenic bladder recovery 1 year after traumatic SCI. METHODS We queried the National Spinal Cord Injury Model Systems database for patients with traumatic SCI who had neurogenic bladder at the time of injury. The primary outcome of interest was the complete recovery of bladder function at 1 year. Multiple imputations were performed to generate replacement values for missing data, and the final imputed data were used for our analysis. A multivariable odds logistic regression model was developed for complete bladder recovery at 1 year. RESULTS We identified a total of 2515 patients with abnormal bladder function at baseline who had an annual follow-up. A total of 417 patients (16.6%) recovered bladder function in 1 year. Predictors of complete bladder recovery included the following baseline parameters: sacral sensation, American Spinal Injury Association (ASIA) impairment score, bowel function at baseline, voluntary sphincter contraction, anal sensation, S1 motor scores, and the number of days in the rehabilitation facility. The model performed with a discriminative capacity of 90.5%. CONCLUSIONS We developed a prediction model for the probability of complete bladder recovery 1 year after SCI. The model performed with a high discriminative capacity. This prediction model demonstrates potential utility in the counseling, research allocation, and management of individuals with SCI.
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Affiliation(s)
- Sally El Sammak
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgos D Michalopoulos
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Namrata Arya
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Phoenix, Arizona, USA
| | - Archis R Bhandarkar
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - F M Moinuddin
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan Jarrah
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz U Yolcu
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ali Shoushtari
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Goel T, Sharma N, Gehlot A, Srivastav AK. Effectiveness of immersive virtual reality training to improve sitting balance control among individuals with acute and sub-acute paraplegia: A randomized clinical trial. J Spinal Cord Med 2023; 46:964-974. [PMID: 34935603 PMCID: PMC10653758 DOI: 10.1080/10790268.2021.2012053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Spinal cord injury (SCI) is a disabling condition with physical, psychological, and financial consequences. The study's goal is to compare the effectiveness of immersive virtual reality (VR) training in balance among individuals with incomplete paraplegia to that of functional electrical stimulation (FES). DESIGN Two groups, randomized clinical trial. SETTING Neurological Physiotherapy Out Patient Department, Tertiary Care Hospital. PARTICIPANTS Eighteen people aged 18-60 years with incomplete SCI. INTERVENTIONS VR training along with conventional physical therapy (CPT) and FES for Rectus Abdominis and Erector Spinae with CPT five times a week for 4 weeks. OUTCOME MEASURES The outcome measures were Modified Functional Reach Test (mFRT) and Function in Sitting Test (FIST) to assess sitting balance and Spinal Cord Independence Measure III (SCIM III) for the level of independence. Assessments were taken before initiating treatment and at the end of the 2 and 4 weeks after treatment. Within-group analyses for the mFRT values were performed using Repeated Measures ANOVA test, and between-group analyses were performed using the independent t-test test. Friedman and Mann-Whitney U-tests were used for analyzing FIST and SCIM III. RESULTS All variables (mFRT and FIST) improved significantly in both groups (P < 0.05), with the VR + CPT group showing a more significant result than the FES + CPT group (P value < 0.05), except for SCIM III. CONCLUSION VR as an adjunct to CPT demonstrated proved to be an effective treatment to improve balance among individuals with incomplete paraplegia.Trial registration: Clinical Trials Registry India identifier: CTRI/2020/03/024080.
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Affiliation(s)
- Tanya Goel
- Department of Neurological Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, India
| | - Nidhi Sharma
- Department of Neurological Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, India
| | - Ajay Gehlot
- Neurosurgery, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, India
- Neurosurgery Department, RD Gardi Medical College and attached Hospital, Ujjain, India
| | - Adarsh Kumar Srivastav
- Department of Physiotherapy School of Health Sciences, Chhatrapati Shahu Ji Maharaj University, Kanpur, India
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Berla E, Kerzhner O, Caspi T, Shaklai S, Michaeli D. Acute Presentation and Long-Term Rehabilitation Follow-Up of Ischemic Myelopathy Due to Clinically Suspected Fibrocartilaginous Embolism in an Adolescent Male: A Case Report and Review. Neurol Int 2023; 15:1273-1289. [PMID: 37873837 PMCID: PMC10594434 DOI: 10.3390/neurolint15040080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023] Open
Abstract
Ischemic myelopathy is uncommon in the pediatric population, with fibrocartilaginous embolism (FCE) being one of its rarest causes. We present the case of an otherwise healthy 17-year-old student who experienced sudden onset of severe low-back pain amidst intensive physical training, which rapidly deteriorated to complete sensory-motor paralysis of his lower limbs. He was treated with IV Methylprednisolone and anticoagulation after the initial work-up suggested spinal cord infarction. After eight days, sufficient clinical-radiological correlation was achieved to support FCE diagnosis as the most likely cause of infarction. He subsequently received inpatient rehabilitation treatment for four months, after which he was followed as an outpatient for a total period of 16 months. While significant neurological and functional gains were achieved during this period, he also experienced some worsening. This case highlights the importance both of performing a thorough assessment and being familiar with FCE as a possible differential diagnosis of spinal cord infarction in children, to facilitate its timely identification and proper acute and long-term management. This case report was prepared following CARE guidelines after obtaining the patient's written informed consent.
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Affiliation(s)
- Einat Berla
- Israel Defense Forces Medical Corps, Ramat Gan 02149, Israel
| | - Oleg Kerzhner
- Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
| | - Tomm Caspi
- Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
| | - Sharon Shaklai
- Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
- Pediatric Rehabilitation Unit, Department of Physical Medicine and Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
| | - Dianne Michaeli
- Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
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Kim WK, Son YS, Lim JH, Kim WH, Kang BJ. Neural stem/progenitor cells from adult canine cervical spinal cord have the potential to differentiate into neural lineage cells. BMC Vet Res 2023; 19:193. [PMID: 37803301 PMCID: PMC10557334 DOI: 10.1186/s12917-023-03757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND • Neural stem/progenitor cells (NSPCs) are multipotent self-renewing cells that can be isolated from the brain or spinal cord. As they need to be isolated from neural tissues, it is difficult to study human NSPCs. To facilitate NSPC research, we attempted to isolate NSPCs from dogs, as dogs share the environment and having many similar diseases with humans. We collected and established primary cultures of ependymal and subependymal cells from the central canal of the cervical spinal cord of adult dogs. To isolate pure NSPCs, we employed the monolayer culture and selective medium culture methods. We further tested the ability of the NSPCs to form neurospheres (using the suspension culture method) and evaluated their differentiation potential. RESULTS • The cells had the ability to grow as cultures for up to 10 passages; the growth curves of the cells at the 3rd, 6th, and 9th passages showed similar patterns. The NSPCs were able to grow as neurospheres as well as monolayers, and immunostaining at the 3rd, 6th, and 9th passages showed that these cells expressed NSPC markers such as nestin and SOX2 (immunofluorescent staining). Monolayer cultures of NSPCs at the 3rd, 6th, and 9th passages were cultured for approximately 14 days using a differentiation medium and were observed to successfully differentiate into neural lineage and glial cells (astrocytes, neurons, and oligodendrocytes) at all the three passages tested. CONCLUSION • It is feasible to isolate and propagate (up to at least 10 passages) canine cervical spinal cord-derived NSPCs with the capacity to differentiate into neuronal and glial cells. To the best of our knowledge this is the first study to successfully isolate, propagate, and differentiate canine NSPCs derived from cervical spinal cord in the adult canine, and we believe that these cells will contribute to the field of spinal cord regeneration in veterinary and comparative medicine.
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Affiliation(s)
- Woo Keyoung Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Korea
- BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Seoul National University, Seoul, 08826, Korea
| | - Yeon Sung Son
- Medical Research Center, College of Medicine, Seoul National University, Seoul, 03080, South Korea
| | - Ji-Hey Lim
- Department of Neurology/Neurosurgery, College of Veterinary Medicine, University of Missouri, Columbia, 65211, USA
| | - Wan Hee Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Korea
| | - Byung-Jae Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Korea.
- BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Seoul National University, Seoul, 08826, Korea.
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Shackleton C, Swartz L, Skowno P, Evans R, West S, Albertus Y, Derman W, Bantjes J. A qualitative study of the perceived benefits of participating in a spinal cord rehabilitation intervention in a low-middle income country. Disabil Rehabil 2023:1-7. [PMID: 37789608 DOI: 10.1080/09638288.2023.2265816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Improving quality of life (QoL) is a major goal of rehabilitation following spinal cord injury (SCI). However, people with disabilities in resource constrained contexts have limited access to rehabilitation and poorer health outcomes, including QoL. There is a paucity of qualitative research on the experiences of persons with SCI involved in rehabilitation programmes in low-middle income countries. This study aimed to assess participants' perceptions of the benefits of a 24-week SCI rehabilitation programme delivered as part of a pilot randomized controlled trial (RCT) in South Africa. MATERIALS AND METHODS Sixteen participants, with chronic motor-incomplete tetraplegia, were enrolled in a two-arm pilot RCT involving robotic locomotor training, a novel technology, and standard activity-based training (Pan African Clinical Trial Registry (PACTR201608001647143)). Data were collected via in-depth interviews and analysed using thematic analysis. RESULTS Participants described several improvements in QoL, including enhanced functional independence; reduced secondary complications; and improved psychosocial and emotional well-being. CONCLUSIONS The holistic approach to rehabilitation calls for the involvement of individuals' views about what matters to them to inform clinical practice and to highlight the role that physical activity and the perceived successes play in shaping the lived experiences after SCI. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR201608001647143), registration date (21st May 2016), study start date (30th Nov 2016)https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1647.
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Affiliation(s)
- Claire Shackleton
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - Philippa Skowno
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Robert Evans
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Sacha West
- Department of Sport Management, Cape Peninsula University of Technology, Cape Town, Western Cape, South Africa
| | - Yumna Albertus
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Wayne Derman
- Faculty of Medicine and Health Sciences, Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, Western Cape, South Africa
- IOC Research Center, Cape Town, South Africa
| | - Jason Bantjes
- Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Ørtenblad L, Maribo T, Quistgaard B, Madsen E, Handberg C. The ambiguity of goal-setting: a study of patients' perspectives on goal-setting in outpatient multidisciplinary rehabilitation of patients with spinal cord injury. Disabil Rehabil 2023; 45:3342-3351. [PMID: 36131619 DOI: 10.1080/09638288.2022.2125087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Spinal cord injury (SCI) is a complex health condition requiring long-term rehabilitation. Person-centred goal-setting is a central component of rehabilitation. However, knowledge of patients' perspectives on the goal-setting in SCI rehabilitation is scarce. The purpose was therefore to explore patients' perspectives on goal-setting in multidisciplinary SCI rehabilitation. MATERIALS AND METHODS An anthropological study combining participant-observation and individual interviews. Data were analysed using reflexive thematic analysis. The COREQ checklist was used to report study quality. RESULTS Patients with SCI perceived goal-setting as ambiguous. On the one hand, they considered it insignificant, because it was complicated to transform complex needs of everyday life to recommended criteria of goals being measurable, specific, and realistic. On the other hand, they considered it a potentially useful guiding tool. Patients were uncertain of impact of goals and perceived goal-setting as vague during rehabilitation. Patient involvement was challenged by insufficient integration of patients' experience-based knowledge of everyday life and clinicians' profession-based knowledge. CONCLUSIONS Goal-setting in rehabilitation is not the patients' need but they accept it as the clinicians' framework for rehabilitation. For goal-setting to become meaningful to patients with SCI, patient involvement should be strengthened by equally integrating the patients' perspectives in the goal-setting process.Implications for rehabilitationHealth-care professionals have to strengthen patient involvement in SCI rehabilitation by to a greater extent integrating the patients' knowledge of their everyday life and preferences rather than primarily focusing on profession-based knowledge.Health-care professionals must support patients in setting goals which are practically meaningful and relevant to the patients' everyday life and achievably and if needed go beyond the structured measurement of SMART goals.In an acknowledgement of the dynamic nature of goal-setting, clinicians should emphasise formulating goals in a flexible and non-directive manner, thereby providing room for patients' changing needs and challenges over time.Goals in SCI rehabilitation cover a wide range from broad, value-based goals to more specific goals, and the health-care professionals must ensure inclusion of such a wide range of goals.
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Affiliation(s)
- Lisbeth Ørtenblad
- DEFACTUM - Public Health and Rehabilitation Research, Central Denmark Region, Denmark
| | - Thomas Maribo
- DEFACTUM - Public Health and Rehabilitation Research, Central Denmark Region, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Britta Quistgaard
- The Specialized Hospital for Polio- and Accident Victims, Rødovre, Denmark
| | - Ellen Madsen
- The Specialized Hospital for Polio- and Accident Victims, Rødovre, Denmark
| | - Charlotte Handberg
- Department of Public Health, Aarhus University, Aarhus, Denmark
- The National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Ørtenblad L, Maribo T, Quistgaard B, Madsen E, Handberg C. Goal-Setting in clinical practice: a study of health-care professionals' perspectives in outpatient multidisciplinary rehabilitation of patients with spinal cord injury. Disabil Rehabil 2023; 45:3330-3341. [PMID: 36137224 DOI: 10.1080/09638288.2022.2125086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Spinal cord injury is a complex condition requiring long-term rehabilitation. Goal-setting is considered an essential part of rehabilitation, however, knowledge of how goal-setting is practised across health-care professions, settings and diagnoses are scarce. The purpose of the study was therefore to explore health-care professionals' perspectives on goal-setting practice in outpatient multidisciplinary rehabilitation targeting patients with spinal cord injury. MATERIALS AND METHODS An anthropological study combining participant-observation and focus group interviews. Data were analysed using reflexive thematic analysis. COREQ checklist was used to report the study quality. RESULTS Health-care professionals experienced a field of tension between internationally recommended goal-setting criteria, requiring goals to be specific, measurable, realistic and time-based, and a practice influenced by patients presenting complex needs. The challenges were managed using a negotiation strategy characterized by a tinkering approach to adjust notions of measurability, realism and time frame into practice. Also, health-care professionals were challenged in relation to practising a person-centred rehabilitation approach. CONCLUSIONS We suggest rethinking the goal-setting process by allowing recommended goal-setting criteria to be adapted to a specific practice context while acknowledging goal-setting practice in its variety and flexibility as a strength. Furthermore, improved incorporation of patients' perspectives in the practice is needed. Implications for rehabilitationTo strengthen person-centred rehabilitation practice, clinicians should actively search for and engage patient-identified needs and preferences in shared goal-setting.Standard criteria of goal-setting should comply with the individual and specific participation in the everyday life of patients with SCI.SMART goals are not always the right way to formulate rehabilitation goals.A flexible and pragmatic approach is needed to reach a balance between the patients' complex needs and the recommendations for goals to be specific, measurable, realistic, and time-based.
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Affiliation(s)
- Lisbeth Ørtenblad
- DEFACTUM - Public Health and Rehabilitation Research, Central Denmark Region, Aarhus, Denmark
| | - Thomas Maribo
- DEFACTUM - Public Health and Rehabilitation Research, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Britta Quistgaard
- The Specialized Hospital for Polio- and Accident Victims, Rødovre, Denmark
| | - Ellen Madsen
- The Specialized Hospital for Polio- and Accident Victims, Rødovre, Denmark
| | - Charlotte Handberg
- Department of Public Health, Aarhus University, Aarhus, Denmark
- The National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Refy O, Blanchard B, Miller-Peterson A, Dalrymple AN, Bedoy EH, Zaripova A, Motaghedi N, Mo O, Panthangi S, Reinhart A, Torres-Oviedo G, Geyer H, Weber DJ. Dynamic spinal reflex adaptation during locomotor adaptation. J Neurophysiol 2023; 130:1008-1014. [PMID: 37701940 DOI: 10.1152/jn.00248.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023] Open
Abstract
The dynamics and interaction of spinal and supraspinal centers during locomotor adaptation remain vaguely understood. In this work, we use Hoffmann reflex measurements to investigate changes in spinal reflex gains during split-belt locomotor adaptation. We show that spinal reflex gains are dynamically modulated during split-belt locomotor adaptation. During first exposure to split-belt transitions, modulation occurs mostly on the leg ipsilateral to the speed change and constitutes rapid suppression or facilitation of the reflex gains, followed by slow recovery to baseline. Over repeated exposure, the modulation pattern washes out. We further show that reflex gain modulation strongly correlates with correction of leg asymmetry, and cannot be explained by speed modulation solely. We argue that reflex modulation is likely of supraspinal origins and constitutes an integral part of the neural substrate underlying split-belt locomotor adaptation.NEW & NOTEWORTHY This work presents direct evidence for spinal reflex modulation during locomotor adaptation. In particular, we show that reflexes can be modulated on-demand unilaterally during split-belt locomotor adaptation and speculate about reflex modulation as an underlying mechanism for adaptation of gait asymmetry in healthy adults.
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Affiliation(s)
- Omar Refy
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Legged Systems Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Belle Blanchard
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Abigail Miller-Peterson
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Ashley N Dalrymple
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, United States
| | - Ernesto H Bedoy
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Amelia Zaripova
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Nadim Motaghedi
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Owen Mo
- School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Shalini Panthangi
- School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Alex Reinhart
- Department of Statistics and Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Gelsy Torres-Oviedo
- Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Hartmut Geyer
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Legged Systems Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
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Wu J, Shiner CT, Faux SG, Watanabe Y. Implementation of an in-reach rehabilitation program can increase the rate of discharge home from acute hospital care. AUST HEALTH REV 2023; 47:619-625. [PMID: 37460091 DOI: 10.1071/ah23033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/28/2023] [Indexed: 10/06/2023]
Abstract
Objective This study describes how a model of early rehabilitation ('in-reach rehabilitation') can be integrated into acute care provision for hospitalised patients with high rehabilitation needs. This pragmatic evaluation aimed to assess service impact on home discharge rates from acute care. Methods An integrated early rehabilitation service was implemented at a tertiary teaching hospital in Sydney, Australia. Eligible patients were screened, placed on a waitlist, and treated in order of debility (six to eight patients concurrently). Routine data were collected and compared between those who received an in-reach rehabilitation program, and controls who remained on waitlist. Results From December 2021 to September 2022, 229 patients were identified as suitable for in-reach rehabilitation; of whom 100 received an in-reach program and the remaining 129 were waitlist controls. Patients who received in-reach rehabilitation achieved a significantly higher rate of discharge home from acute care compared to waitlist controls (46.0% vs 24.0%, P = 0.002) and lower rates of transfer to subacute inpatient rehabilitation (43.0% vs 62.0%). This was despite in-reach patients having high functional care needs (60% needed assistance from ≥two people to mobilise) and complex medical needs (median hospital length of stay 44.5 days, IQR 27.8-66.0). Conclusions It is feasible to deliver in-reach rehabilitation to hospitalised patients with heterogeneous diagnoses who have high rehabilitation needs. The rate of discharge home directly from acute wards is higher among those patients who received early in-reach rehabilitation compared to those on a waitlist.
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Affiliation(s)
- Jane Wu
- Department of Rehabilitation, St Vincent's Hospital Sydney, 170 Darlinghurst Road, Darlinghurst, NSW, Australia; and Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, 170 Darlinghurst Road, Darlinghurst, NSW, Australia; and Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, 170 Darlinghurst Road, Darlinghurst, NSW, Australia; and Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Yuriko Watanabe
- Department of Rehabilitation, St Vincent's Hospital Sydney, 170 Darlinghurst Road, Darlinghurst, NSW, Australia; and Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
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Vazquez S, Houten JK, Stadlan ZT, Greisman JD, Vaserman G, Spirollari E, Sursal T, Dominguez JF, Kinon MD. Thecal sac ligation in the setting of thoracic spondyloptosis with complete cord transection. Surg Neurol Int 2023; 14:304. [PMID: 37810299 PMCID: PMC10559368 DOI: 10.25259/sni_360_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/24/2023] [Indexed: 10/10/2023] Open
Abstract
Background Traumatic spondyloptosis (TS) with complete spinal cord transection and unrepairable durotomy is particularly rare and can lead to a difficult-to-manage cerebrospinal fluid (CSF) leak. Methods We performed a systematic review of the literature on TS and discuss the management strategies and outcomes of TS with cord transection and significant dural tear. We also report a novel case of a 26-year-old female who presented with thoracic TS with complete spinal cord transection and unrepairable durotomy with high-flow CSF leak. Results Of 93 articles that resulted in the search query, 13 described cases of TS with complete cord transection. The approach to dural repair was only described in 8 (n = 20) of the 13 articles. The dura was not repaired in two (20%) of the cases. Ligation of the proximal end of the dural defect was done in 15 (75%) of the cases, all at the same institution. One (5%) case report describes ligation of the distal end; one (5%) case describes the repair of the dura with duraplasty; and another (5%) case describes repair using muscle graft to partially reconstruct the defect. Conclusion Suture ligation of the thecal sac in the setting of traumatic complete spinal cord transection with significant dural disruption has been described in the international literature and is a safe and successful technique to prevent complications associated with persisting high-flow CSF leakage. To the best of our knowledge, this is the first report of thecal sac ligation of the proximal end of the defect from the United States.
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Affiliation(s)
- Sima Vazquez
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - John K Houten
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | - Zehavya T Stadlan
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - Jacob D Greisman
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - Grigori Vaserman
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - Eris Spirollari
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - Tolga Sursal
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, United States
| | - Merritt D Kinon
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, United States
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Buczak MK, Zollinger JM, Alsaleem A, Imburgia R, Rosenbluth J, George JA. Intuitive, Myoelectric Control of Adaptive Sports Equipment for Individuals with Tetraplegia. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941260 DOI: 10.1109/icorr58425.2023.10304759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This research aims to develop safe, robust, and easy-to-use adaptive technology for individuals with tetraplegia. After a debilitating spinal cord injury, clinical care focuses on improving quality of life. Participation in adaptive sports has been shown to improve several aspects of participants' well-being. The TetraSki is a power-assisted ski chair that allows individuals with tetraplegia to participate in downhill skiing by sipping and puffing air on an integrated straw to turn their skis. Here, we introduce a new intuitive and dexterous control strategy for the TetraSki using surface electromyography (sEMG) from the neck and shoulder muscles. As an initial assessment, six healthy participants completed a virtual ski racecourse using sEMG and Sip-and-Puff control. Participants also completed a detection response task of cognitive load and the NASA-TLX survey of subjective workload. No significant differences were observed between the performance of sEMG control and the performance of Sip-and-Puff control. However, sEMG control required significantly less cognitive load and subjective workload than Sip-and-Puff control. These results indicate that sEMG can effectively control the equipment and is significantly more intuitive than traditional Sip-and-Puff control. This suggests that sEMG is a promising control method for further validation with individuals with tetraplegia. Ultimately, long-term use of sEMG control may promote neuroplasticity and drive rehabilitation.
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Lee JM, Gebrekristos T, De Santis D, Nejati-Javaremi M, Gopinath D, Parikh B, Mussa-Ivaldi FA, Argall BD. An Exploratory Multi-Session Study of Learning High-Dimensional Body-Machine Interfacing for Assistive Robot Control. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941183 PMCID: PMC11059238 DOI: 10.1109/icorr58425.2023.10304745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Individuals who suffer from severe paralysis often lose the capacity to perform fundamental body movements and everyday activities. Empowering these individuals with the ability to operate robotic arms, in high degrees-of-freedom (DoFs), can help to maximize both functional utility and independence. However, robot teleoperation in high DoFs currently lacks accessibility due to the challenge in capturing high-dimensional control signals from the human, especially in the face of motor impairments. Body-machine interfacing is a viable option that offers the necessary high-dimensional motion capture, and it moreover is noninvasive, affordable, and promotes movement and motor recovery. Nevertheless, to what extent body-machine interfacing is able to scale to high-DoF robot control, and whether it is feasible for humans to learn, remains an open question. In this exploratory multi-session study, we demonstrate the feasibility of human learning to operate a body-machine interface to control a complex, assistive robotic arm. We use a sensor net of four inertial measurement unit sensors, bilaterally placed on the scapulae and humeri. Ten uninjured participants are familiarized, trained, and evaluated in reaching and Activities of Daily Living tasks, using the body- machine interface. Our results suggest the manner of control space mapping (joint-space control versus task-space control), from interface to robot, plays a critical role in the evolution of human learning. Though joint-space control shows to be more intuitive initially, task-space control is found to have a greater capacity for longer-term improvement and learning.
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Affiliation(s)
- Jongmin M. Lee
- Northwestern University, Evanston, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Temesgen Gebrekristos
- Northwestern University, Evanston, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | - Mahdieh Nejati-Javaremi
- Northwestern University, Evanston, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Deepak Gopinath
- Northwestern University, Evanston, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Biraj Parikh
- Northwestern University, Evanston, Illinois, USA
| | | | - Brenna D. Argall
- Northwestern University, Evanston, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
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Chu J, Glinsky JV, Liu H, Ben M, Spooren AI, Roberts S, Chen LW, Di Natal F, Tamburella F, Jørgensen V, Gollan EJ, Agostinello J, van Laake-Geelen C, Lincoln C, van der Lede J, Stolwijk JM, Bell C, Paddison S, Rainey D, Scivoletto G, Oostra KM, Jan S, Sherrington C, Harvey LA. Early and Intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): protocol of the process evaluation. BMJ Open 2023; 13:e072219. [PMID: 37643854 PMCID: PMC10465915 DOI: 10.1136/bmjopen-2023-072219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION People with spinal cord injury receive physical rehabilitation to promote neurological recovery. Physical rehabilitation commences as soon as possible when a person is medically stable. One key component of physical rehabilitation is motor training. There is initial evidence to suggest that motor training can enhance neurological recovery if it is provided soon after injury and in a high dosage. The Early and Intensive Motor Training Trial is a pragmatic randomised controlled trial to determine whether 10 weeks of intensive motor training enhances neurological recovery for people with spinal cord injury. This pragmatic randomised controlled trial will recruit 220 participants from 15 spinal injury units in Australia, Scotland, Italy, Norway, England, Belgium and the Netherlands. This protocol paper describes the process evaluation that will run alongside the Early and Intensive Motor Training Trial. This process evaluation will help to explain the trial results and explore the potential facilitators and barriers to the possible future rollout of the trial intervention. METHODS AND ANALYSIS The UK Medical Research Council process evaluation framework and the Implementation Research Logic Model will be used to explain the trial outcomes and inform future implementation. Key components of the context, implementation and mechanism of impact, as well as the essential elements of the intervention and outcomes, will be identified and analysed. Qualitative and quantitative data will be collected and triangulated with the results of the Early and Intensive Motor Training Trial to strengthen the findings of this process evaluation. ETHICS AND DISSEMINATION Ethical approval for the Early and Intensive Motor Training Trial and process evaluation has been obtained from the Human Research Ethics Committee at the Northern Sydney Local Health District (New South Wales) in Australia (project identifier: 2020/ETH02540). All participants are required to provide written consent after being informed about the trial and the process evaluation. The results of this process evaluation will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN12621000091808); Universal Trial Number (U1111-1264-1689).
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Affiliation(s)
- Jackie Chu
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Joanne V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Marsha Ben
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sharon Roberts
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Lydia W Chen
- Physiotherapy Department, Roayl North Shore Hospital, St Leonards, New South Wales, Australia
| | - Fernanda Di Natal
- Physiotherapy Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | | | - Vivien Jørgensen
- Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Emilie J Gollan
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jacqui Agostinello
- Physiotherapy Department, Royal Talbot Rehabilitation Centre, Kew, Victoria, Australia
| | - Charlotte van Laake-Geelen
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Claire Lincoln
- Physiotherapy Department, Queen Elizabeth National Spinal Injuries Unit, Glasgow, Scotland
| | - Jessica van der Lede
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Janneke M Stolwijk
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Chris Bell
- Physiotherapy Department, Repat Health Precinct, Daw Park, South Australia, Australia
| | - Sue Paddison
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital Trust, Stanmore, UK
| | - Donna Rainey
- Spinal Injury Unit, Royal Rehab, Ryde, New South Wales, Australia
| | | | - Kristine M Oostra
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Stephen Jan
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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Farì G, Ranieri M, Marvulli R, Dell’Anna L, Fai A, Tognolo L, Bernetti A, Caforio L, Megna M, Losavio E. Is There a New Road to Spinal Cord Injury Rehabilitation? A Case Report about the Effects of Driving a Go-Kart on Muscle Spasticity. Diseases 2023; 11:107. [PMID: 37754303 PMCID: PMC10528365 DOI: 10.3390/diseases11030107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/09/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) is a neurological disorder that causes a traumatic anatomical discontinuity of the spinal cord. SCI can lead to paraplegia, spastic, or motor impairments. Go-karting for people with SCI is an adapted sport that is becoming increasingly popular. The purpose of this case report is to shed light on the effects of driving a go-kart on a patient with SCI-related spasticity and to deepen understanding of the possible related role of whole-body vibration (WBV) and neuroendocrine reaction. METHODS The patient was a 50-year-old male with a spastic paraplegia due to traumatic SCI. He regularly practiced go-kart racing, reporting a transient reduction in spasticity. He was evaluated before (T0), immediately after (T1), 2 weeks after (T2), and 4 weeks after (T3) a go-kart driving session. On both sides, long adductor, femoral bicep, and medial and lateral gastrocnemius spasticity was assessed using the Modified Ashworth Scale (MAS), and tone and stiffness were assessed using MyotonPro. RESULTS It was observed that a go-kart driving session could reduce muscle spasticity, tone, and stiffness. CONCLUSIONS Go-kart driving can be a valid tool to obtain results similar to those of WBV and hormone production in the reduction of spasticity.
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Affiliation(s)
- Giacomo Farì
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | - Maurizio Ranieri
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Riccardo Marvulli
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Laura Dell’Anna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Annatonia Fai
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Lucrezia Tognolo
- Rehabilitation Unit, Department of Neuroscience, University of Padova, 35100 Padova, Italy;
| | - Andrea Bernetti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Laura Caforio
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Ernesto Losavio
- Neurorehabilitation and Spinal Unit, Clinical and Scientific Institutes Maugeri IRCCS, 70124 Bari, Italy;
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Ho JSW, Ko KSY, Law SW, Man GCW. The effectiveness of robotic-assisted upper limb rehabilitation to improve upper limb function in patients with cervical spinal cord injuries: a systematic literature review. Front Neurol 2023; 14:1126755. [PMID: 37621855 PMCID: PMC10445651 DOI: 10.3389/fneur.2023.1126755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Background Spinal Cord Injury (SCI) damages corticospinal tracts and descending motor pathways responsible for transmitting signals from the brain to the spinal cord, leading to temporary or permanent changes in sensation, motor function, strength, and body function below the site of injury. Cervical SCI (cSCI), which leads to tetraplegia, causes severe functional upper limb (UL) impairments that increase falls risk, limits independence, and leads to difficulties with activities of daily living (ADLs). Robotic therapy (RT) has been developed in recent decades as a new treatment approach for people with cervical spinal cord injuries (cSCI). The present review aimed to explore current available evidence and studies regarding the effectiveness of RT for individuals with cSCI in improving UL function, identify current research gaps and future research directions. Method This review was conducted by searching PubMed, CINAHL, Medline, Embase, and APA PsycInfo for relevant studies published from January 2010 to January 2022. Selected studies were analyzed with a focus on the patients' self-perception of limited UL function and level of independence in activities of daily living. In addition, the JBI Critical Appraisal checklist was used to assess study quality. Results A total of 7 articles involving 87 patients (74 males and 13 females) were included in the analysis, with four studies utilizing exoskeleton and three studies utilizing end-effector robotic devices, respectively. The quality of these studies varied between JBI Critical Appraisal scores of 4 to 8. Several studies lacked blinding and a control group which affected internal validity. Nevertheless, four out of seven studies demonstrated statistically significant improvements in outcome measurements on UL function and strength after RT. Conclusion This review provided mixed evidence regarding the effectiveness of RT as a promising intervention approach to improve upper limb function in participants with cSCI. Although RT was shown to be safe, feasible, and reduces active therapist time, further research on the long-term effects of UL RT is still needed. Nevertheless, this review serves as a useful reference for researchers to further develop exoskeletons with practical and plausible applications toward geriatric orthopaedics.
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Kröger I, Wackerle H, Maier D, Mach O, Augat P. [Movement analysis in spinal cord injuries : Assistance in clinical decision making]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04409-y. [PMID: 37490136 PMCID: PMC10400683 DOI: 10.1007/s00132-023-04409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/26/2023]
Abstract
For motor incomplete spinal cord injured patients, improvement of walking function is an important aim in the rehabilitation program. In specialized treatment centers, the 6‑minute walking test, the 10-meter walking test or the timed-up-and-go test are used as an assessment tool to determine walking ability, but these tests are not able to assess the quality of gait. Marker-based movement analysis can be used as a reliable method to evaluate the gait pattern. This allows an objective assessment of gait quality over time or can be used to support therapy planning. The benefit of such an analysis is presented by means of two case studies.
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Affiliation(s)
- Inga Kröger
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland.
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich.
| | - Hannes Wackerle
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
| | - Doris Maier
- Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Orpheus Mach
- Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Peter Augat
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
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Maldonado VV, Patel NH, Smith EE, Barnes CL, Gustafson MP, Rao RR, Samsonraj RM. Clinical utility of mesenchymal stem/stromal cells in regenerative medicine and cellular therapy. J Biol Eng 2023; 17:44. [PMID: 37434264 DOI: 10.1186/s13036-023-00361-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/19/2023] [Indexed: 07/13/2023] Open
Abstract
Mesenchymal stem/stromal cells (MSCs) have been carefully examined to have tremendous potential in regenerative medicine. With their immunomodulatory and regenerative properties, MSCs have numerous applications within the clinical sector. MSCs have the properties of multilineage differentiation, paracrine signaling, and can be isolated from various tissues, which makes them a key candidate for applications in numerous organ systems. To accentuate the importance of MSC therapy for a range of clinical indications, this review highlights MSC-specific studies on the musculoskeletal, nervous, cardiovascular, and immune systems where most trials are reported. Furthermore, an updated list of the different types of MSCs used in clinical trials, as well as the key characteristics of each type of MSCs are included. Many of the studies mentioned revolve around the properties of MSC, such as exosome usage and MSC co-cultures with other cell types. It is worth noting that MSC clinical usage is not limited to these four systems, and MSCs continue to be tested to repair, regenerate, or modulate other diseased or injured organ systems. This review provides an updated compilation of MSCs in clinical trials that paves the way for improvement in the field of MSC therapy.
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Affiliation(s)
- Vitali V Maldonado
- Department of Biomedical Engineering, University of Arkansas, 790 W Dickson St, Fayetteville, AR, USA
| | - Neel H Patel
- Department of Biomedical Engineering, University of Arkansas, 790 W Dickson St, Fayetteville, AR, USA
| | - Emma E Smith
- Department of Biomedical Engineering, University of Arkansas, 790 W Dickson St, Fayetteville, AR, USA
| | - C Lowry Barnes
- Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Raj R Rao
- Department of Biomedical Engineering, University of Arkansas, 790 W Dickson St, Fayetteville, AR, USA
- Interdisciplinary Graduate Program in Cell and Molecular Biology, University of Arkansas, Fayetteville, AR, USA
| | - Rebekah M Samsonraj
- Department of Biomedical Engineering, University of Arkansas, 790 W Dickson St, Fayetteville, AR, USA.
- Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Interdisciplinary Graduate Program in Cell and Molecular Biology, University of Arkansas, Fayetteville, AR, USA.
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Hejrati N, Wong R, Khazaei M, Fehlings MG. How can clinical safety and efficacy concerns in stem cell therapy for spinal cord injury be overcome? Expert Opin Biol Ther 2023; 23:883-899. [PMID: 37545020 DOI: 10.1080/14712598.2023.2245321] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Spinal cord injury (SCI) can lead to severe neurological dysfunction. Despite scientific and medical advances, clinically effective regenerative therapies including stem cells are lacking for SCI. AREAS COVERED This paper discusses translational challenges related to the safe, effective use of stem cells for SCI, with a focus on mesenchymal stem cells (MSCs), neural stem cells (NSCs), Schwann cells (SCs), olfactory ensheathing cells (OECs), oligodendrocyte precursor cells (OPCs), embryonic stem cells (ESCs), and induced pluripotent stem cells (iPSCs). We discuss approaches to enhance the efficacy of cell-based strategies by i) addressing patient heterogeneity and enhancing patient selection; ii) selecting cell type, cell source, cell developmental stage, and delivery technique; iii) enhancing graft integration and mitigating immune-mediated graft rejection; and iv) ensuring availability of cells. Additionally, we review strategies to optimize outcomes including combinatorial use of rehabilitation and discuss ways to mitigate potential risks of tumor formation associated with stem cell-based strategies. EXPERT OPINION Basic science research will drive translational advances to develop stem cell-based therapies for SCI. Genetic, serological, and imaging biomarkers may enable individualization of cell-based treatments. Moreover, combinatorial strategies will be required to enhance graft survival, migration and functional integration, to enable precision-based intervention.
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Affiliation(s)
- Nader Hejrati
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Raymond Wong
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Mohamad Khazaei
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Maggio MG, Bonanno M, Manuli A, Onesta MP, De Luca R, Quartarone A, Calabrò RS. Do Individuals with Spinal Cord Injury Benefit from Semi-Immersive Virtual Reality Cognitive Training? Preliminary Results from an Exploratory Study on an Underestimated Problem. Brain Sci 2023; 13:945. [PMID: 37371423 DOI: 10.3390/brainsci13060945] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
A spinal cord injury (SCI) is damage to any part of the spinal cord, caused by traumatic or non-traumatic events. Clinically, SCI is associated with partial or complete loss of motor, sensory, and autonomic functions below the site of injury. However, cognitive alterations in specific domains can also occur. The aim of this study was to evaluate the effects of semi-immersive virtual reality (VR) cognitive training (using the BTS Nirvana, Italy) in promoting global functional recovery in patients with SCI. Forty-two SCI patients were included in this retrospective case-control study, and the analysis was carried out using an electronic data retrieval system. The enrolled patients were divided into two groups with the same demographic and medical characteristics: the control group (CG: 21 patients) participated in traditional therapy, whereas the experimental group (EG: 21 patients) received training using semi-immersive VR. In both groups, there were patients with A- or B-grade impairments according to the American Spinal Injury Association (ASIA) scale. Both study groups underwent the same amount of cognitive training (but using a different type of training: conventional vs. innovative), consisting of three weekly sessions for eight weeks (24 sessions in total), each session lasting approximately sixty minutes, as well as the same amount of physiotherapy. The effect of the two treatments (EG/CG) was significantly different in global cognitive functioning (MOCA: p = 0.001), mood (BDI: p = 0.006), and overall quality of life (SF12 Total: p < 0.001), especially in physical perception (SF12-Physics: p = 0.004). Our results suggest that SCI patients could benefit from cognitive training using semi-immersive VR. Indeed, the integration of cognitive exercises that require movement and provide increased feedback could allow for better motor and cognitive recovery in people with SCI.
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Affiliation(s)
- Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, Via S. Sofia 64, 95125 Catania, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino Pulejo", S. S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Alfredo Manuli
- Rehabilitation Unit, AOU Policlinico "G. Martino", 98124 Messina, Italy
| | | | - Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino Pulejo", S. S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Angelo Quartarone
- IRCCS Centro Neurolesi "Bonino Pulejo", S. S. 113, Contrada Casazza, 98124 Messina, Italy
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Araneda OF, Rosales-Antequera C, Contreras-Briceño F, Tuesta M, Rossi-Serrano R, Magalhães J, Viscor G. Systemic and Pulmonary Inflammation/Oxidative Damage: Implications of General and Respiratory Muscle Training in Chronic Spinal-Cord-Injured Patients. BIOLOGY 2023; 12:828. [PMID: 37372113 DOI: 10.3390/biology12060828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Chronic spinal cord injury affects several respiratory-function-related parameters, such as a decrease in respiratory volumes associated with weakness and a tendency to fibrosis of the perithoracic muscles, a predominance of vagal over sympathetic action inducing airway obstructions, and a difficulty in mobilizing secretions. Altogether, these changes result in both restrictive and obstructive patterns. Moreover, low pulmonary ventilation and reduced cardiovascular system functionality (low venous return and right stroke volume) will hinder adequate alveolar recruitment and low O2 diffusion, leading to a drop in peak physical performance. In addition to the functional effects described above, systemic and localized effects on this organ chronically increase oxidative damage and tissue inflammation. This narrative review describes both the deleterious effects of chronic spinal cord injury on the functional effects of the respiratory system as well as the role of oxidative damage/inflammation in this clinical context. In addition, the evidence for the effect of general and respiratory muscular training on the skeletal muscle as a possible preventive and treatment strategy for both functional effects and underlying tissue mechanisms is summarized.
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Affiliation(s)
- Oscar F Araneda
- Integrative Laboratory of Biomechanics and Physiology of Effort (LIBFE), Kinesiology School, Faculty of Medicine, Universidad de los Andes, Monseñor Álvaro del Portillo, Las Condes, Santiago 12455, Chile
| | - Cristián Rosales-Antequera
- Physical Medicine and Rehabilitation Unit, Clínica Universidad de los Andes, Santiago 8320000, Chile
- Physiology Section, Department of Cell Biology, Physiology, and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Marcelo Tuesta
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
| | - Rafael Rossi-Serrano
- Physical Medicine and Rehabilitation Unit, Clínica Universidad de los Andes, Santiago 8320000, Chile
| | - José Magalhães
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology, and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain
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49
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Joseph C, Thurston C, Nizeyimana E, Scriba E, Conradsson DM, Rhoda A. Prevalence of secondary health conditions and mental status in persons with long-term spinal cord injury in South Africa: Comparison between public and private healthcare sectors. S Afr Med J 2023; 113:46-53. [PMID: 37170601 DOI: 10.7196/samj.2023.v113i5.16791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Spinal cord injuries typically result in a range of negative health outcomes and health states, which impacts overall functioning, health and well-being. It remains important to establish the prevalence (burden) of health outcomes to help with the development of optimal treatment strategies. OBJECTIVES To determine the prevalence and treatment rates of secondary health conditions (SHCs) and mental health states in persons with long-term spinal cord injury (SCI) receiving public compared with private healthcare services in South Africa. METHODS A cross-sectional survey included 200 community-dwelling persons with long-term SCI, 60% with paraplegia, 53% with complete injuries and 156 from the public and 44 from private healthcare sectors. The following modules of the International Spinal Cord Injury (InSCI) community survey were used: (i) demographic and injury characteristics; (ii) SHCs and treatment rates; and (iii) vitality and emotional well-being. All statistical analyses were stratified according to healthcare sector. RESULTS Pain (47% v. 57), sexual dysfunction (59% v. 41%) and muscle spasms (54% v. 43%) were the most common SHCs in both cohorts, and the period prevalence was significantly higher for sleeping problems (41% v. 25%), sexual dysfunction (59% v. 41%) and contractures (42% v. 20%) in the public compared with the private cohort. Persons with SCI in the private cohort received treatment more often for sleeping problems (100% v. 45%), autonomic dysreflexia (75% v. 27%) and pain (56% v. 33%) than their counterparts with public insurance. Negative mental health states were prevalent in both groups. CONCLUSION SHCs and negative mental health were common in persons with SCI in South Africa, while those with public insurance reporter a higher occurrence of sleep problems and contractures, as well as lower treatment rates. Overall, a need exists to better support persons with SCI in the long-term context to facilitate improved functioning and wellbeing.
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Affiliation(s)
- C Joseph
- Department of Health and Rehabilitation Sciences; Division of Physiotherapy; Stellenbosch University; Cape Town.
| | - C Thurston
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Sweden.
| | - E Nizeyimana
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa.
| | - E Scriba
- Spescare Medical Facility, Stellenbosch, Cape Town.
| | - D M Conradsson
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
| | - A Rhoda
- Deanery, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
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50
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Bykowski EA, Petersson JN, Dukelow S, Ho C, Debert CT, Montina T, Metz GAS. Identification of Serum Metabolites as Prognostic Biomarkers Following Spinal Cord Injury: A Pilot Study. Metabolites 2023; 13:metabo13050605. [PMID: 37233646 DOI: 10.3390/metabo13050605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
The assessment, management, and prognostication of spinal cord injury (SCI) mainly rely upon observer-based ordinal scales measures. 1H nuclear magnetic resonance (NMR) spectroscopy provides an effective approach for the discovery of objective biomarkers from biofluids. These biomarkers have the potential to aid in understanding recovery following SCI. This proof-of-principle study determined: (a) If temporal changes in blood metabolites reflect the extent of recovery following SCI; (b) whether changes in blood-derived metabolites serve as prognostic indicators of patient outcomes based on the spinal cord independence measure (SCIM); and (c) whether metabolic pathways involved in recovery processes may provide insights into mechanisms that mediate neural damage and repair. Morning blood samples were collected from male complete and incomplete SCI patients (n = 7) following injury and at 6 months post-injury. Multivariate analyses were used to identify changes in serum metabolic profiles and were correlated to clinical outcomes. Specifically, acetyl phosphate, 1,3,7-trimethyluric acid, 1,9-dimethyluric acid, and acetic acid significantly related to SCIM scores. These preliminary findings suggest that specific metabolites may serve as proxy measures of the SCI phenotype and prognostic markers of recovery. Thus, serum metabolite analysis combined with machine learning holds promise in understanding the physiology of SCI and aiding in prognosticating outcomes following injury.
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Affiliation(s)
- Elani A Bykowski
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Jamie N Petersson
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Department of Chemistry and Biochemistry, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Sean Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Chester Ho
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Tony Montina
- Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Department of Chemistry and Biochemistry, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
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