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Guízar-Sahagún G, Grijalva I, Franco-Bourland RE, Madrazo I. Aging with spinal cord injury: A narrative review of consequences and challenges. Ageing Res Rev 2023; 90:102020. [PMID: 37487887 DOI: 10.1016/j.arr.2023.102020] [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: 03/29/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
Given the increase in life expectancy, aging with a pre-existing spinal cord injury (SCI) is becoming more common. This condition is challenging as compromised health status and functional independence can worsen. We aimed to provide an updated overview of the consequences of aging with SCI, highlighting the main challenges facing this population in a narrative review of the current literature we retrieved from the PubMed database from 2000 to 2022 on any aspect related to aging in persons with SCI. Here we address adverse circumstances that increase disability and hinder an active lifestyle, such as progressive physical deterioration, secondary health conditions, limitations in personal activity, changes in family and social support structures, aging of caregivers, and depletion of economic resources. Favorable changes are also observed, including psychosocial adjustments that improve quality of life. Additionally, various interventions are discussed to promote well-being, health, and social participation. Due to the relevance of this issue, people with SCI and all those who take care of them must have up-to-date information to carry out the necessary measures to promote healthy aging in a more inclusive social environment.
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Affiliation(s)
- Gabriel Guízar-Sahagún
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico.
| | - Israel Grijalva
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
| | - Rebecca E Franco-Bourland
- Department of Biochemistry, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 289 Calzada México-Xochimilco, Mexico City, Mexico
| | - Ignacio Madrazo
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
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Vaughan S, Sankari A, Carroll S, Eshraghi M, Obiakor H, Yarandi H, Chowdhuri S, Salloum A, Badr MS. Tetraplegia is associated with increased hypoxic ventilatory response during nonrapid eye movement sleep. Physiol Rep 2022; 10:e15455. [PMID: 36065854 PMCID: PMC9446393 DOI: 10.14814/phy2.15455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023] Open
Abstract
People with cervical spinal cord injury (SCI) are likely to experience chronic intermittent hypoxia while sleeping. The physiological effects of intermittent hypoxia on the respiratory system during spontaneous sleep in individuals with chronic cervical SCI are unknown. We hypothesized that individuals with cervical SCI would demonstrate higher short- and long-term ventilatory responses to acute intermittent hypoxia (AIH) exposure than individuals with thoracic SCI during sleep. Twenty participants (10 with cervical SCI [9 male] and 10 with thoracic SCI [6 male]) underwent an AIH and sham protocol during sleep. During the AIH protocol, each participant experienced 15 episodes of isocapnic hypoxia using mixed gases of 100% nitrogen (N2 ) and 40% carbon dioxide (CO2 ) to achieve an oxygen saturation of less than 90%. This was followed by two breaths of 100% oxygen (O2 ). Measurements were collected before, during, and 40 min after the AIH protocol to obtain ventilatory data. During the sham protocol, participants breathed room air for the same amount of time that elapsed during the AIH protocol and at approximately the same time of night. Hypoxic ventilatory response (HVR) during the AIH protocol was significantly higher in participants with cervical SCI than those with thoracic SCI. There was no significant difference in minute ventilation (V.E. ), tidal volume (V.T. ), or respiratory frequency (f) during the recovery period after AIH in cervical SCI compared to thoracic SCI groups. Individuals with cervical SCI demonstrated a significant short-term increase in HVR compared to thoracic SCI. However, there was no evidence of ventilatory long-term facilitation following AIH in either group.
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Affiliation(s)
- Sarah Vaughan
- Department of MedicineJohn D. Dingell VA Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State UniversityDetroitMichiganUSA
| | - Abdulghani Sankari
- Department of MedicineJohn D. Dingell VA Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State UniversityDetroitMichiganUSA
- Department of Medical EducationAscension Providence HospitalSouthfieldMichiganUSA
| | - Sean Carroll
- Department of MedicineJohn D. Dingell VA Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State UniversityDetroitMichiganUSA
| | - Mehdi Eshraghi
- Department of MedicineJohn D. Dingell VA Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State UniversityDetroitMichiganUSA
| | - Harold Obiakor
- Department of MedicineJohn D. Dingell VA Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State UniversityDetroitMichiganUSA
| | - Hossein Yarandi
- Department of Internal MedicineWayne State UniversityDetroitMichiganUSA
| | - Susmita Chowdhuri
- Department of MedicineJohn D. Dingell VA Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State UniversityDetroitMichiganUSA
| | - Anan Salloum
- Department of MedicineJohn D. Dingell VA Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State UniversityDetroitMichiganUSA
| | - M. Safwan Badr
- Department of MedicineJohn D. Dingell VA Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State UniversityDetroitMichiganUSA
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Li J, Li Y, Liu H, Lin S, Xie H, Pan R, Chang X, Lu J, Li S, Zhou J. Preliminary Study of an Adjustable, Wearable, Noninvasive Vest Providing Chest Compression to Assist with Breathing. J Biomed Nanotechnol 2022; 18:1172-1179. [PMID: 35854446 DOI: 10.1166/jbn.2022.3323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Respiratory muscle paralysis caused by acute cervical spinal cord injury usually leads to pulmonary ventilation dysfunction and even death from respiratory failure. In addition to invasive treatments such as mechanical ventilation, the utilization of noninvasive respiratory support equipment plays an important role in long-term assisted breathing. In this study, we describes a wearable, noninvasive vest with adjustable pressure that enables assisted breathing and with an automatic alarm, and we aims to explore its safety and effectiveness on healthy adult participants. The vest monitors the human heart rate and the blood oxygen index data in real time, the alarm is automatically activated when the data is abnormal. Eight healthy participants had no obvious discomfort during the test while wearing the vest. Lung volumes, antero-posterior diameters, and left-right diameters at the second, fourth, and sixth ribs levels were acquired before and after inflation of the vest airbag, the data acquired by the imaging analysis using chest computed tomography showed significant differences before and after the inflation (p < 0.05). Thus, The vest designed for this study can achieve uniform and effective compression of the thorax, significantly changed the size of the thorax and lungs. It is expected to be applied as noninvasive support for patients with respiratory dysfunction.
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Affiliation(s)
- Jianwen Li
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Yujiang Li
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Huazhu Liu
- Dongguan University of Technology International Institute of Microelectronics, Dongguan, Guangdong, 523808, China
| | - Shengxin Lin
- Dongguan University of Technology International Institute of Microelectronics, Dongguan, Guangdong, 523808, China
| | - Haihui Xie
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Ruilan Pan
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Xueqin Chang
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Jianfeng Lu
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Songbo Li
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
| | - Jianping Zhou
- Department of Spine Surgery, Thoracic and Cardiovascular Surgery and Anesthesiology, Dongguan People's Hospital/Affiliated Dongguan Hospital, Southern Medical University, Dongguan, Guangdong, 523069, China
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Satkunendrarajah K, Karadimas SK, Fehlings MG. Spinal cord injury and degenerative cervical myelopathy. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:241-257. [PMID: 36031307 DOI: 10.1016/b978-0-323-91532-8.00006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Spinal cord injury (SCI) often results in impaired respiratory function. Paresis or paralysis of inspiratory and expiratory muscles can lead to respiratory dysfunction depending on the level and severity of the injury, which can affect the management and care of SCI patients. Respiratory dysfunction after SCI is more severe in high cervical injuries, with vital capacity (VC) being an essential indicator of overall respiratory health. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Respiratory management includes mechanical ventilation and tracheostomy in high cervical SCI, while noninvasive ventilation is more common in patients with lower cervical and thoracic injuries. Mechanical ventilation can negatively impact the function of the diaphragm and weaning should start as soon as possible. Patients can sometimes be weaned from mechanical ventilation with assistance of electrical stimulation of the phrenic nerve or the diaphragm. Respiratory muscle training regimens may also improve patients' inspiratory function following SCI. Despite the critical advances in preventing, diagnosing, and treating respiratory complications, they continue to significantly affect persons living with SCI. Additional studies of interventions to reduce respiratory complications are likely to further decrease the morbidity and mortality associated with these injuries.
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Affiliation(s)
- Kajana Satkunendrarajah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Neuroscience, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Spyridon K Karadimas
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, ON, Canada.
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