Predictive factors of hospitalization in adults with pediatric-onset SCI: a longitudinal analysis

Longitudinal Comparisons in Health, Participation, Life Satisfaction, and Depressive Symptoms From Pre- to Post-COVID-19 Pandemic Among People With Spinal Cord Injuries

OBJECTIVE

To identify changes in health, health care utilization, participation, life satisfaction, and depressive symptoms from before the coronavirus disease 2019 pandemic to after among ambulatory and nonambulatory participants with spinal cord injury.

DESIGN

Longitudinal study with the first measurement taken within 3 months prior to pandemic restrictions and 2 follow-ups at approximately 1-year intervals.

SETTING

Medical university.

PARTICIPANTS

Adult participants (N=219) with spinal cord injury, including ambulatory (n=155) and nonambulatory (n=64).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Self-report assessment of health outcomes from the Behavioral Risk Factor Surveillance System; health service utilization including physician visits, emergency department visits, and hospitalizations; items from the Craig Handicap Assessment Reporting Technique; 3 life satisfaction scales from the Life Situation Questionnaire; and the brief version of the Patient Health Questionnaire.

RESULTS

After using a z score correction for nonnormality, none of the time effects or interaction effects of time by ambulatory status were significant. Six comparisons between ambulatory and nonambulatory were statistically significant. Ambulatory participants reported 3 more days in poor physical health (P=.02; statistically significant) and 2 more days feeling worried, tense, or anxious in the last 30 days (P=.03). They visited the emergency department on 0.3 fewer occasions (P=.02) while reporting leaving the house 1 more day every week (P=.02), 2 hours more of sitting tolerance (P<.01), and 1 higher score of vocational satisfaction (P=.03).

CONCLUSIONS

The absence of statistically significant changes from before to after the pandemic and the absence of time by ambulatory status interactions suggest stability of outcomes, even in the presence of pandemic challenges.

Anxiety and Depression in Pediatric-Onset Traumatic Spinal Cord Injury: A Systematic Review

BACKGROUND

Traumatic spinal cord injury (TSCI) is a debilitating neurological condition with significant long-term consequences on the mental health and well-being of affected individuals. We aimed to investigate anxiety and depression in individuals with pediatric-onset TSCI.

METHODS

PubMed, Scopus, and Web of Science databases were searched from inception to December 20th, 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and studies were included according to the eligibility criteria.

RESULTS

A total of 1013 articles were screened, and 18 studies with 4234 individuals were included in the final review. Of these, 1613 individuals (38.1%) had paraplegia, whereas 1658 (39.2%) had tetraplegia. A total of 1831 participants (43.2%) had complete TSCI, whereas 1024 (24.2%) had incomplete TSCI. The most common etiology of TSCI with 1545 people (36.5%) was motor vehicle accidents. The youngest mean age at the time of injury was 5.92 ± 4.92 years, whereas the oldest was 14.6 ± 2.8 years. Patient Health Questionnaire-9 was the most common psychological assessment used in 9 studies (50.0%). Various risk factors, including pain in 4 studies (22.2%), reduced sleep quality, reduced functional independence, illicit drug use, incomplete injury, hospitalization, reduced quality of life, and duration of injury in 2 (11.1%) studies, each, were associated with elevated anxiety and depression.

CONCLUSIONS

Different biopsychosocial risk factors contribute to elevated rates of anxiety and depression among individuals with pediatric-onset TSCI. Individuals at risk of developing anxiety and depression should be identified, and targeted support should be provided. Future large-scale studies with long-term follow-up are required to validate and extend these findings.

The primary and secondary causes of hospitalizations during the first five years after spinal cord injury

STUDY DESIGN

Cohort study. Retrospective analysis of uniform billing discharge data (UB-04).

OBJECTIVES

To compare and contrast the primary and secondary causes of hospitalization by type of admission, emergency department (ED) versus inpatient only (IP), during the first five years after the traumatic spinal cord injury (SCI).

SETTING

Academic Medical University in the Southeastern USA.

METHODS

At total of 2569 adults with traumatic SCI were identified from a population-based registry and matched to billing data. The main outcome measures were primary and secondary diagnoses associated with hospital admissions in non-federal, state hospitals.

RESULTS

Overall, there were 9733 hospital admissions in the five years after SCI onset, not including the initial hospitalization; 53% were admissions through the ED. The primary causes of hospitalizations after SCI varied by year post injury and admission type (ED versus IP). The top 15 secondary diagnoses included several secondary health conditions associated with SCI, as well as chronic health conditions.

CONCLUSIONS

Rehabilitation diagnoses were much more prominent during the first year, compared with subsequent years. Septicemia was the leading cause of admissions through the ED, whereas chronic ulcers of the skin were prominent for IP only admissions. This is consistent with the acute nature of septicemia compared with more planned hospitalization for rehabilitation and skin ulcers. These conditions should be targeted for prevention strategies that include patient/family education and early and appropriate access to primary care.

Exploring the Role of Pain as an Early Indicator for Individuals at Risk of Pressure Ulcer Development: A Systematic Review

BACKGROUND

Pressure ulcer (PU) development begins with an inflammatory response, arising due to pressure and shear forces causing changes to the cytoskeletal structure of cells. Thus, pain, synonymous with inflammation, may be an indicator of PU development.

AIM

To explore the role of pain as an indicator of PU development and to determine how this pain was measured.

METHOD

We searched PUBMED, CINAHL, SCOPUS, Cochrane, and EMBASE databases. A total of 879 records were returned, with eight satisfying the inclusion criteria. Narrative data synthesis was undertaken. The quality of studies was assessed using the evidence-based librarianship (EBL) checklist.

RESULTS

The studies were conducted between 2000 and 2019, and 75% (n = 6) employed a cross-sectional design. The mean sample size was 760 participants (SD = 703). Of the included studies, 87.5% (n = 7) identified that pain was associated with PU development. The most frequent pain assessment tool was the numeric rating scale (37.5%; n = 3). Using the EBL checklist, 62.5% (n = 5) of the studies scored ≥75%, reflecting validity.

LINKING EVIDENCE TO ACTION

Pain is associated with PU development; however, further research is required to validate these findings and assess the characteristics associated with pain as a symptom preceding PU development.

Association between sleep quality and participation in people with spinal cord injury: A preliminary study

OBJECTIVE

To explore the association between perceived sleep quality and participation in people with spinal cord injury (SCI).

DESIGN

Cross-sectional study.

SETTING

Spinal unit at the Città della Salute e della Scienza University Hospital of Turin, Italy.

PARTICIPANTS

From May to July 2019, 55 consecutive outpatients were recruited.

OUTCOME MEASURES

A set of structured questionnaires was administered. It included sociodemographic data, the Pittsburgh Sleep Quality Index, the Utrecht Scale for Evaluation of Rehabilitation-Participation, the Spinal Cord Independence Measure Self-Report, the Short Form version 12.2, and the Hospital Anxiety and Depression Scale. T-tests were used to highlight differences between participation and participant characteristics. Bivariate analyses and linear regressions were performed to identify associations between sleep quality and participation.

RESULTS

Differences in participation occurred mainly in individuals with a higher level of injury, caregiver dependency, and lower functional level. Participants reporting better sleep quality had more frequent (r = -0.36, P < 0.01), less restricted (r = -0.32, P < 0.05), and more satisfactory participation (r = -0.33, P < 0.01). Linear regression analyses showed that poor sleep quality was significantly associated with reduced participation frequency (β = -0.30, P = 0.03) and less satisfaction with participation (β = -0.49, P < 0.001). Moreover, age, number of hours slept at night, and time since injury were associated with satisfaction with participation.

CONCLUSIONS

An association was found between sleep quality and participation in people with SCI. Given the high prevalence of sleep problems and their association with all dimensions of participation, the promotion of sleep quality should be encouraged because it may positively affect participation.

The association between participation and quality of life indicators with hospitalizations in ambulatory adults with spinal cord injury

STUDY DESIGN

Statistical modeling of self-report assessments (SRA) as predictors of future hospitalizations, measured by administrative billing data.

OBJECTIVES

To examine the relationships between self-reported participation and quality of life (QOL) indicators and future hospital admissions among ambulatory adults with chronic spinal cord injury (SCI).

SETTING

Data were collected from participants living in and utilizing hospitals in the state of South Carolina.

METHODS

Participants were identified through the South Carolina SCI Surveillance System Registry. Between 2011 and 2015, 615 ambulatory adults (>18 years old) with chronic (>1-year), traumatic SCI completed mailed SRA. Participant socio-demographic, injury, health, participation, and QOL indicators were assessed using self-report data. Administrative billing data were used to measure hospital utilization in nonfederal, South Carolina hospitals in the year following the SRA.

RESULTS

Prior year discharges, current pressure ulcers, number of chronic conditions, walking 150 feet more often (never, less than once per week, at least once per week, once or twice per day, or several times per day), and greater home life satisfaction were associated with an increased risk of subsequent hospitalization. Walking 10 feet more frequently and greater global satisfaction were associated with a decreased risk of hospital admission.

CONCLUSIONS

Specific participation and QOL items may increase the risk of hospitalization in ambulatory adults with SCI. Further study is necessary to understand better the relationships between walking distance and frequency, home life and global satisfaction, and inpatient admissions.

Muscle Activation Patterns During Movement Attempts in Children With Acquired Spinal Cord Injury: Neurophysiological Assessment of Residual Motor Function Below the Level of Lesion

Introduction: Characterization of residual neuromotor capacity after spinal cord injury (SCI) is challenging. The current gold standard for measurement of sensorimotor function after SCI, the International Society for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam, seeks to determine isolated intentional muscle activation, however many individuals with SCI exhibit intentional movements and muscle activation patterns which are not confined to specific joint or muscle. Further, isolated muscle activation is a feature of the neuromuscular system that emerges during development, and thus may not be an appropriate measurement standard for children younger than 6.

Methods: We utilized neurophysiological assessment methodology, long studied in adult SCI populations, to evaluate residual neuromotor capacity in 24 children with SCI, as well as 19 typically developing (TD) children. Surface electromyography (EMG) signals were recorded from 11 muscles bilaterally, representing spinal motor output from all regions (i.e., cervical, thoracic, and lumbosacral), during standardized movement attempts. EMG records were subjectively analyzed based on spatiotemporal muscle activation characteristics, while the voluntary response index (VRI) was utilized for objective analysis of unilateral leg movement tasks.

Results: Evidence of intentional leg muscle activation below the level of lesion was found in 11/24 children with SCI, and was classified based on activation pattern. Trace activation, bilateral (generalized) activation, and unilateral or isolated activation occurred in 32, 49, and 8% of movement tasks, respectively. Similarly, VRI analyses objectively identified significant differences between TD and SCI children in both magnitude (p < 0.01) and similarity index (p < 0.05) for all unilateral leg movement tasks. Activation of the erector spinae muscles, recorded at the T10–T12 vertebral level, was observed in all children with SCI, regardless of injury level or severity.

Conclusions: Residual descending influence on spinal motor circuits may be present after SCI in children. Assessment of multi-muscle activation patterns during intentional movement attempts can provide objective evidence of the presence and extent of such residual muscle activation, and may provide an indicator of motor recovery potential following injury. The presence of residual intentional muscle activation has important implications for rehabilitation following pediatric-onset SCI.

Trajectories of Rehabilitation across Complex Environments (TRaCE): design and baseline characteristics for a prospective cohort study on spinal cord injury and acquired brain injury

PURPOSE

Trajectories of Rehabilitation across Complex Environments (TRaCE), a consented prospective cohort study, addresses a critical need to better understand access to the healthcare system after acute treatment and specialist inpatient rehabilitation for acquired disability. It is expected that this study will produce new knowledge on access to healthcare through the linkage of administrative, survey, and spatial datasets on the one cohort. This paper outlines the study design and baseline characteristics of the cohort.

METHODS

The TRaCE cohort is comprised of 165 inpatients who are currently being followed up for 12 months after discharge from specialist rehabilitation for acquired brain injury (ABI) and spinal cord injury (SCI). This project combines a data linkage framework on health service use with a prospective survey on psychosocial wellbeing, geographical information systems to examine spatial accessibility to services, and qualitative interviews with a sub-cohort on experiences of service access.

CONCLUSION

Ultimately, TRaCE will have strong translational impact on strategies for more targeted interventions to improve the healthcare system and support individuals with acquired disabilities in the long-term.

Interdisciplinary, Intensive, Activity-Based Treatment for Intrauterine Spinal Cord Infarct: A Case Report

Intrauterine spinal cord infarcts (IUSCI) with resulting tetraplegia are extremely rare, and there is minimal evidence describing outcomes in this population. This case describes the functional progress of a 3-year-old girl born with IUSCI who participated in activity-based therapies (ABT). Children have developing nervous systems and are particularly suited to benefit from ABT. Over the course of treatment, the child in this case has demonstrated improvements in developmental milestone achievement including fine and gross motor skills and social/cognitive development. Intense, interdisciplinary ABT should be considered for the treatment of children with IUSCI.

Activity-Based Therapy: From Basic Science to Clinical Application for Recovery After Spinal Cord Injury

BACKGROUND AND PURPOSE

Collaboration between scientists and clinicians effectively accelerated translation of scientific evidence for activity-based therapies (ABTs) into rehabilitation. This article addresses the basic scientific findings of activity-dependent plasticity that led to locomotor training, an ABT, and its principles to advance recovery in adult and pediatric populations with spinal cord injury (SCI). Expansion to new therapies based on these common principles is highlighted, for example, epidural stimulation. The article also describes a recently developed measure, the Neuromuscular Recovery Scale (NRS), and its psychometric properties.

SUMMARY OF KEY POINTS

Locomotor training has led to recovery of walking in some individuals with motor-incomplete SCI even years after injury. Recent studies resulted in individuals with motor-complete SCI regaining some voluntary movements and standing in the presence of epidural stimulation. The level of success for locomotor training and epidural stimulation appears dependent on spinal networks maintaining the appropriate central state of excitability for the desired task. As these new advances in restorative therapies required an outcome measure that measured performance without compensation, the NRS was developed. The NRS has strong psychometric properties in adults, and a pediatric version is under development. Application of locomotor training in children is still novel. Preliminary evidence suggests that locomotor training can improve trunk control and also foster participation in children with chronic SCI.

RECOMMENDATIONS FOR CLINICAL PRACTICE

ABTs may effectively promote neuromuscular recovery and improve function and participation in adults and children post-SCI. Evaluation of outcomes with valid measures, such as the NRS, is necessary to document the ability to perform functional tasks and to assess progress as function improves.