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Eriks-Hoogland IE, Barth MA, Müller LL, Braun D, Curt A, Arora M, Middleton JW, Pannek J. COVID-19 and spinal cord injury: clinical presentation, clinical course, and clinical outcomes of people hospitalised. Spinal Cord Ser Cases 2024; 10:5. [PMID: 38351025 PMCID: PMC10864293 DOI: 10.1038/s41394-024-00617-6] [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: 05/04/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
STUDY DESIGN Retrospective study OBJECTIVES: To describe the presenting symptoms/signs, clinical course and outcomes in hospitalised people with spinal cord injury (SCI) and symptomatic COVID-19 infections. SETTING One university hospital and two SCI centres in Switzerland. METHODS Descriptive analysis of symptoms/signs, clinical course and outcomes of people with SCI with symptomatic COVID-19 infections and need for hospitalisation. RESULTS Twenty-two people with SCI were included, 15 (68%) were male, median age 64.5 years (interquartile range, IQR, 52-73 years). Nine (41%) had tetraplegia, and eight (36%) were classified with motor-complete lesions. Frequent clinical symptoms were fever (59%), coughing (54%), fatigue (50%), and dyspnoea (27%). Most frequent complications were bacterial pulmonary superinfection (18%), and acute respiratory distress syndrome (18%). Fifteen persons (68%) needed oxygen therapy during the course of hospitalisation, and 7 (32%) people were ventilated. Median length of stay (LOS) was 23 days (IQR 15-35), varying by age for people under 60 years with a median LOS of 9 days (IQR 8-27), and for those older than 60 years with a median of 34 days (IQR 17-39), respectively. In total, 3 persons (14%) died during hospitalisation, all older with paraplegia. CONCLUSIONS Typical symptoms like fever and coughing were not present in all people. People with tetraplegia did not demonstrate worse outcomes, on the contrary, they had shorter LOS, no difference in ventilation needs, and no higher mortality compared to people with paraplegia. Older people showed longer LOS. This study recommends close supervision of the SCI population to detect early signs and symptoms of COVID-19 infection.
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Affiliation(s)
- Inge E Eriks-Hoogland
- Swiss Paraplegic Centre, Nottwil, Switzerland.
- Faculty of Health Sciences and Medicine at the University of Lucerne, Lucerne, Switzerland.
- Swiss Paraplegic Research, Nottwil, Switzerland.
| | | | | | - Dominique Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jürgen Pannek
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bloom O, Bryce TN, Botticello AL, Galea M, Delgado AD, Dyson-Hudson TA, Zanca JM, Spungen A. Health impacts reported in the Spinal Cord Injury COVID-19 Pandemic Experience Survey (SCI-CPES). J Spinal Cord Med 2023:1-10. [PMID: 37769141 DOI: 10.1080/10790268.2023.2260959] [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: 09/30/2023] Open
Abstract
CONTEXT In people with spinal cord injury (SCI), infections are a leading cause of death, and there is a high prevalence of diabetes mellitus, obesity, and hypertension, which are all comorbidities associated with worse outcomes after COVID-19 infection. OBJECTIVE To characterize self-reported health impacts of COVID-19 on people with SCI related to exposure to virus, diagnosis, symptoms, complications of infection, and vaccination. METHODS The Spinal Cord Injury COVID-19 Pandemic Experience Survey (SCI-CPES) study was administered to ask people with SCI about their health and other experiences during the COVID-19 pandemic. RESULTS 223 community-living people with SCI (male = 71%; age = 52±15 years [mean±SD]; paraplegia = 55%) completed the SCI-CPES. Comorbidities first identified in the general population as associated with poor outcomes after COVID-19 infection were commonly reported in this SCI sample: hypertension (30%) and diabetes (13%). 23.5% of respondents reported a known infection exposure from someone who visited (13.5%) or lived in their home (10%). During the study, which included a timeframe when testing was either unavailable or scarce, 61% of respondents were tested for COVID-19; 14% tested or were presumed positive. Fever, fatigue, and chills were the most common symptoms reported. Of the 152 respondents surveyed after COVID-19 vaccines became available, 82% reported being vaccinated. Race and age were significantly associated with positive vaccination status: most (78%) individuals who were vaccinated identified as Non-Hispanic White and were older than those who reported being unvaccinated (57±14 vs. 43±13 years, mean±SD). CONCLUSIONS Self-reported COVID-19 symptoms were relatively uncommon and not severe in this sample of people with SCI. Potential confounders and limitations include responder, recruitment and self-reporting biases and changing pandemic conditions. Future studies on this topic should query social distancing and other behavioral strategies. Large retrospective chart review studies may provide additional data on incidence and prevalence of COVID-19 infections, symptoms, and severities in the SCI population.
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Affiliation(s)
- Ona Bloom
- The Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Physical Medicine and Rehabilitation, Northwell Health, Manhasset, New York, USA
| | - Thomas N Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Amanda L Botticello
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marinella Galea
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Spinal Cord Injury and Disorders Service and Spinal Cord Damage Research Center, James J Peters VA Medical Center, Bronx, New York, USA
| | - Andrew D Delgado
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jeanne M Zanca
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ann Spungen
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Spinal Cord Injury and Disorders Service and Spinal Cord Damage Research Center, James J Peters VA Medical Center, Bronx, New York, USA
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Vives Alvarado JR, Miranda-Cantellops N, Jackson SN, Felix ER. Access limitations and level of psychological distress during the COVID-19 pandemic in a geographically-limited sample of individuals with spinal cord injury. J Spinal Cord Med 2022; 45:700-709. [PMID: 34935595 PMCID: PMC9542807 DOI: 10.1080/10790268.2021.2013592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Assess changes in access and psychological status during the COVID-19 pandemic in people with spinal cord injury (SCI). STUDY DESIGN Cohort telephone survey study. SETTING South Florida SCI Model System (SF-SCIMS). PARTICIPANTS A convenience sample of 51 individuals with traumatic SCI who had previously completed SCIMS Form II follow-up interviews. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Questionnaire administration included assessments of resilience, depressive symptoms, satisfaction with life, anxiety, pain, alcohol and substance use, COVID-19 diagnoses and symptoms, and impact of early COVID-19 community restrictions on various aspects of life. RESULTS Of the individuals interviewed, 78% reported limited access to their regular activities, 40% to healthcare information and services, 38% to personal protective equipment (PPE), 37% to food/groceries, and 34% to medication refills. Sixteen percent of the participants had at least moderate levels of depression, and 10% had at least moderate levels of anxiety. Statistically significant increases in depressive symptoms (Patient Health Questionnaire 9; P = 0.004) and significant decreases in resilience (SCI-Quality of Life Resilience subscore; P = 0.010) were found when comparing scores on measures of psychological function at the time of the study to scores collected during the previous SCIMS Form II interview (within 2 years pre-COVID-19). CONCLUSION(S) Limitations to basic needs and face-to-face communication can exacerbate challenges in access for persons with disabilities. Our results show increased levels of psychological distress related to decreased access to goods and services in individuals with SCI due to the COVID-19 pandemic. The results of this study can help the SCI community to target strategies for enhanced access, outreach, shared information, and social support in preparation for future community health or weather emergencies.
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Affiliation(s)
- Jose R. Vives Alvarado
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Natalia Miranda-Cantellops
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sequoia N. Jackson
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth R. Felix
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA,Research Service, Miami Veterans Affairs (VA) Healthcare System, Miami, Florida, USA,Correspondence to: Elizabeth R. Felix, Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL33101, USA. E-mail:
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Lam CY, Koljonen PA, Yip CCH, Su IYW, Hu Y, Wong YW, Cheung KMC. Functional recovery priorities and community rehabilitation service preferences of spinal cord injury individuals and caregivers of Chinese ethnicity and cultural background. Front Neurol 2022; 13:941256. [PMID: 35989936 PMCID: PMC9382587 DOI: 10.3389/fneur.2022.941256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Spinal cord injury (SCI) causes significant and permanent disability affecting motor, sensory and autonomic functions. We conducted a survey on the priorities of functional recovery and preferences for community rehabilitation services in a cohort of Chinese individuals with SCI as well as the primary caregivers. The study also investigated their views on advanced technology and research. Methods An online platform with a self-administered questionnaire was used to collect the opinions of clients that received services from an SCI follow-up clinic, a self-help association, or a non-government organization from 1 September−31 December 2021. Results Eighty-seven subjects (74 individuals with SCI−48 tetraplegic, 26 paraplegic, and 13 caregivers) responded to the survey. Recovery of arm/hand function was given the highest priority among tetraplegics, followed by upper trunk/body strength and balance, and bladder/bowel function. Sexual function had a significant lower ranking than all priority areas except normal sensation (p < 0.05). Paraplegics viewed bladder/bowel function as the most important area of functional recovery, followed by walking movement, upper trunk/body strength and balance, elimination of chronic pain, and regaining normal sensation. There was no statistically significant difference among the top priority areas (p > 0.05). In contrast to previous studies done in Western populations, the study revealed that sexual function was ranked as the lowest by all 3 groups of respondents (tetraplegics, paraplegics, and caregivers). The majority of participants thought community rehabilitation services were inadequate. Most of the respondents were interested to try advanced technology which would facilitate their daily life and rehabilitation. About half of the individuals with SCI thought advance in technology and research could bring significant improvement in their quality of life in the coming 10 years. Conclusion This survey is the first study specifically looking into the recovery and rehabilitation priorities of a Chinese population of individuals with SCI. This is also the first study to investigate the priorities of the primary caregivers of SCI individuals. The findings are useful as a reference for planning of future research and provision of rehabilitation services for the SCI community locally and in other parts of China.
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Affiliation(s)
- Chor Yin Lam
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- *Correspondence: Chor Yin Lam
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Christopher Chun Hei Yip
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | | | - Yong Hu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yat Wa Wong
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Henke AM, Billington ZJ, Gater DR. Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review. J Pers Med 2022; 12:jpm12071110. [PMID: 35887607 PMCID: PMC9320320 DOI: 10.3390/jpm12071110] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 12/20/2022] Open
Abstract
The autonomic nervous system (ANS), composed of the sympathetic and parasympathetic nervous systems, acts to maintain homeostasis in the body through autonomic influences on the smooth muscle, cardiac muscles, blood vessels, glands and organs of the body. The parasympathetic nervous system interacts via the cranial and sacral segments of the central nervous system, and the sympathetic nervous system arises from the T1–L2 spinal cord segments. After a spinal cord injury (SCI), supraspinal influence on the ANS is disrupted, leading to sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. Further, afferent signals to the sympathetic cord elicit unabated reflex sympathetic outflow in response to noxious stimuli below the level of SCI. This article outlines the pathophysiology of SCI on the ANS, clinical ramifications of autonomic dysfunction, and the potential long-term sequelae of these influences following SCI.
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Affiliation(s)
- Austin M. Henke
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.H.); (Z.J.B.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - Zackery J. Billington
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.H.); (Z.J.B.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.H.); (Z.J.B.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Correspondence:
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Frohman EM, Villemarette-Pittman NR, Rodriguez A, Glanzman R, Rugheimer S, Komogortsev O, Zamvil SS, Cruz RA, Varkey TC, Frohman AN, Frohman AR, Parsons MS, Konkle EH, Frohman TC. Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease. J Neurol Sci 2021; 426:117463. [PMID: 33971376 PMCID: PMC8055502 DOI: 10.1016/j.jns.2021.117463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic has devastated individuals, families, and institutions throughout the world. Despite the breakneck speed of vaccine development, the human population remains at risk of further devastation. The decision to not become vaccinated, the protracted rollout of available vaccine, vaccine failure, mutational forms of the SARS virus, which may exhibit mounting resistance to our molecular strike at only one form of the viral family, and the rapid ability of the virus(es) to hitch a ride on our global transportation systems, means that we are will likely continue to confront an invisible, yet devastating foe. The enemy targets one of our human physiology's most important and vulnerable life-preserving body tissues, our broncho-alveolar gas exchange apparatus. Notwithstanding the fear and the fury of this microbe's potential to raise existential questions across the entire spectrum of human endeavor, the application of an early treatment intervention initiative may represent a crucial tool in our defensive strategy. This strategy is driven by evidence-based medical practice principles, those not likely to become antiquated, given the molecular diversity and mutational evolution of this very clever "world traveler".
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Affiliation(s)
- Elliot M Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
| | | | - Adriana Rodriguez
- Department of Emergency Medicine, Cook Children's Medical Center, Ft. Worth, TX, United States of America
| | - Robert Glanzman
- Clene Nanomedicine, Inc., Salt Lake City, UT 84121, United States of America.
| | - Sarah Rugheimer
- Department of Physics, University Oxford, Oxford OX1 3PU, UK.
| | - Oleg Komogortsev
- Department of Computer Sciences, Texas State University, San Marcos, TX, United States of America.
| | - Scott S Zamvil
- Department of Neurology and Program in Immunology, University of California San Francisco, San Francisco, CA, United States of America.
| | - Roberto Alejandro Cruz
- Department of Neurology, Doctor's Health at Renaissance Health Neurology Institute, United States of America; Department of Neurology, University of Texas Rio Grande Valley School of Medicine, United States of America.
| | - Thomas C Varkey
- Dell Medical School, University of Texas at Austin, United States of America.
| | | | | | - Matthew S Parsons
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, United States of America; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States of America.
| | | | - Teresa C Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
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Clinical features and prognosis of COVID-19/SARS-CoV-2 infections in persons with spinal cord injury: a review of current literature. Spinal Cord Ser Cases 2021; 7:58. [PMID: 34257266 PMCID: PMC8276211 DOI: 10.1038/s41394-021-00420-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 12/28/2022] Open
Abstract
Study design Focused literature review. Objectives Objective of the study was to perform a literature search and summarise the clinical features and prognosis of persons with spinal cord injury (SCI) infected with COVID-19 from the published articles. Setting India. Methods PubMed, CENTRAL and MEDLINE were systematically searched using specific keywords. The study assessed 2747 scientific studies involving COVID-19 and SCI for possible inclusion in a meta-analysis of SCI and SARS-COV-2. Studies involving persons with SCI who were tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the nasopharyngeal or throat swab polymerase chain reaction were included. Results Out of 2747 articles, 11 articles (206 participants), including six case reports, were included in this review. Fever was the most frequently observed symptom of COVID-19 infection in the SCI population. C-reactive protein (CRP) and lymphocytopenia were common abnormal laboratory parameters. The most common radiological finding in COVID-19 infection was ground glass opacities in lung fields. Prophylactic/therapeutic anticoagulation was given in a significant number of SCI persons infected with COVID-19. Persons with SCI who were diagnosed early showed good outcomes. Conclusions Based on the few studies published on COVID-19 and SCI populations since 2019, this study determined fever, elevated CRP, lymphocytopenia and ground glass opacities, which indicated inflammation, compromised immune response, and lung edema, as the main clinical features of COVID-19 infection in SCI population. Though COVID-19 infection reported an increased number of deaths in few studies, a significant number of SCI populations with positive RT-PCR were treated successfully and discharged at home.
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