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Starosta AJ, Wright KS, Bombardier CH, Kahlia F, Barber J, Accardi-Ravid MC, Wiechman SA, Crane DA, Jensen MP. A Case Study of Hypnosis Enhanced Cognitive Therapy for Pain in a Ventilator Dependent Patient during Inpatient Rehabilitation for Spinal Cord Injury. J Clin Med 2023; 12:4539. [PMID: 37445573 DOI: 10.3390/jcm12134539] [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: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Early, acute pain following spinal cord injury (SCI) is common, can negatively impact SCI rehabilitation, and is frequently not responsive to biomedical treatment. Nonpharmacological interventions show promise in reducing pain for individuals with SCI. However, most psychological interventions rely heavily on verbal interaction between the individual being treated and the clinician, making them inaccessible for individuals with impaired verbal output due to mechanical ventilation. This case study aims to describe the adaptation and implementation of hypnotic cognitive therapy (HYP-CT) intervention for early SCI pain in the context of mechanical ventilation dependence and weaning. The participant was a 54-year-old male with C2 AIS A SCI requiring mechanical ventilation. Four sessions of HYP-CT were provided during inpatient rehabilitation with assessment prior to intervention, after the intervention sessions, and prior to discharge. The participant reported immediate reductions in pain intensity following each intervention session. Overall, he reported increases in self-efficacy and pain acceptance. He did not report any negative treatment effects and thought the intervention provided support during mechanical ventilation weaning. During treatment, he discontinued opioid pain medications and reported actively using intervention strategies. Our results support the potential for early, hypnotic cognitive therapy for individuals with SCI experiencing pain or distress while dependent on mechanical ventilation.
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Affiliation(s)
- Amy J Starosta
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Katherine S Wright
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Faran Kahlia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195, USA
| | - Michelle C Accardi-Ravid
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT 84132, USA
| | - Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Deborah A Crane
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
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Graco M, Arora M, Berlowitz DJ, Craig A, Middleton JW. The impact of sleep quality on health, participation and employment outcomes in people with spinal cord injury: Analyses from a large cross-sectional survey. Ann Phys Rehabil Med 2023; 66:101738. [PMID: 37084505 DOI: 10.1016/j.rehab.2023.101738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 04/23/2023]
Abstract
BACKGROUND Poor sleep is common in people with spinal cord injury (SCI), yet little is known about its impact on employment and participation outcomes. OBJECTIVES This study aimed to (1) describe the sleep quality of a large sample of Australians with SCI and compare the results to data from an adult control and other clinical populations; (2) examine associations between sleep quality and participant characteristics; and (3) explore the relationship between sleep and outcomes. METHODS Cross-sectional data from the Australian arm of the International Spinal Cord Injury (Aus-InSCI) survey from 1579 community-dwelling people aged >18 years with SCI were analysed. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Relationships between participant characteristics, sleep quality and other outcomes were examined with linear and logistic regression. RESULTS The PSQI was completed by 1172 individuals; 68% reported poor sleep (global PSQI score >5). Subjective sleep quality in people with SCI was poor (mean PSQI = 8.5, SD 4.5) when compared to adults without SCI (PSQI = 5.00, SD 3.37) and with traumatic brain injury (PSQI = 5.54, SD 3.94). Financial hardship and problems with secondary health conditions were significantly associated with worse sleep quality (p < 0.05). Poor sleep quality was strongly associated with lower emotional wellbeing and energy, and greater problems with participation (p < 0.001). Individuals engaged in paid work reported better sleep quality (mean PSQI = 8.1, SD 4.3) than unemployed individuals (mean PSQI = 8.7, SD 4.6; p < 0.05). Following adjustment for age, pre-injury employment, injury severity and years of education, better sleep quality remained strongly associated with being employed (OR 0.95, 95% CI 0.92 to 0.98; p = 0.003). CONCLUSIONS This study demonstrated pervasive and impactful relationships between sleep quality and important SCI outcomes. Poor sleep quality was strongly associated with worse emotional wellbeing and vitality, unemployment and lower participation. Future studies should aim to determine whether treating sleep problems can improve outcomes for people living with SCI.
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Affiliation(s)
- Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia; Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia; Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Spinal Outreach Service, Royal Rehab, Ryde, New South Wales, Australia
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Craig A, Pozzato I, Arora M, Middleton J, Rodrigues D, McBain C, Tran Y, Davis GM, Gopinath B, Kifley A, Krassioukov A, Braithwaite J, Mitchell R, Gustin SM, Schoffl J, Cameron ID. A neuro-cardiac self-regulation therapy to improve autonomic and neural function after SCI: a randomized controlled trial protocol. BMC Neurol 2021; 21:329. [PMID: 34445983 PMCID: PMC8387669 DOI: 10.1186/s12883-021-02355-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is associated with autonomic imbalance and significant secondary conditions, including cardiac and brain dysfunction that adversely impact health and wellbeing. This study will investigate the effectiveness (intention-to-treat) of a neuro-cardiac self-regulation therapy to improve autonomic and neural/brain activity in adults with SCI living in the community. METHODS A two-arm parallel, randomised controlled trial in which adults with SCI living in the community post-rehabilitation will be randomly assigned to a treatment or control group. The treatment group (N = 60) aged 18-70 years with a chronic traumatic or non-traumatic SCI, will receive intervention sessions once per week for 10 weeks, designed to regulate autonomic activity using computer-based feedback of heart rate variability and controlled breathing (called HRV-F). Comprehensive neurophysiological and psychological assessment will occur at baseline, immediate post-treatment, and 6 and 12-months post-treatment. Primary outcome measures include electrocardiography/heart rate variability (to assess autonomic nervous system function) and transcranial doppler sonography (to assess cerebral blood circulation in basal cerebral arteries). Secondary outcomes measures include continuous blood pressure, electroencephalography, functional near-infrared spectroscopy, respiration/breath rate, electrooculography, cognitive capacity, psychological status, pain, fatigue, sleep and quality of life. Controls (N = 60) will receive usual community care, reading material and a brief telephone call once per week for 10 weeks and be similarly assessed over the same time period as the HRV-F group. Linear mixed model analysis with repeated measures will determine effectiveness of HRV-F and latent class mixture modelling used to determine trajectories for primary and selected secondary outcomes of interest. DISCUSSION Treatments for improving autonomic function after SCI are limited. It is therefore important to establish whether a neuro-cardiac self-regulation therapy can result in improved autonomic functioning post-SCI, as well as whether HRV-F is associated with better outcomes for secondary conditions such as cardiovascular health, cognitive capacity and mental health. TRIAL REGISTRATION The study has been prospectively registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12621000870853 .aspx). Date of Registration: 6th July 2021. Trial Sponsor: The University of Sydney, NSW 2006. Protocol version: 22/07/2021.
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Affiliation(s)
- Ashley Craig
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia.
| | - Ilaria Pozzato
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Mohit Arora
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - James Middleton
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Dianah Rodrigues
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Candice McBain
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Yvonne Tran
- Macquarie University Hearing (MU Hearing), Macquarie University, North Ryde, NSW, 2113, Australia
| | - Glen M Davis
- Exercise and Sports Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Bamini Gopinath
- Macquarie University Hearing (MU Hearing), Macquarie University, North Ryde, NSW, 2113, Australia
| | - Annette Kifley
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Andrei Krassioukov
- ICORD, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Health Systems Research, Macquarie University, North Ryde, NSW, 2113, Australia
| | - Rebecca Mitchell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Health Systems Research, Macquarie University, North Ryde, NSW, 2113, Australia
| | - Sylvia M Gustin
- School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia
| | - Jacob Schoffl
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Ian D Cameron
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
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