1
|
Burkhart L, Skemp L, Siddiqui S. Triangulation of veteran and provider models of preventing community-acquired pressure injuries in spinal cord injury to reveal convergence and divergence of perspectives. J Spinal Cord Med 2024; 47:549-558. [PMID: 36441027 PMCID: PMC11218588 DOI: 10.1080/10790268.2022.2135714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT/OBJECTIVE Community-acquired pressure injuries (CAPrI) are a common and costly complication of spinal cord injury (SCI). The majority of PrIs occur in the community, but there is little guidance in CAPrI prevention. This study describes how provider and veteran perspectives of CAPrI prevention converge and diverge. DESIGN The Farmer triangulation method was used to compare two models from previous qualitative research describing provider and veteran perspectives of CAPrI prevention based on the framework of CAPrI risks, resources, and preventive activities. The previous qualitative research revealed the provider model of CAPrI prevention using semi-structured interviews with interprofessional SCI providers at the Veteran Health Administration (VA) (n = 30). A qualitative descriptive design using photovoice (n = 30) with or without guided tours (n = 15) revealed the Veteran model of CAPrI prevention. SETTING The previous qualitative research was conducted at three geographically different VA spinal cord injury/disorder centers in the United States (north, south, west). PARTICIPANTS 30 interprofessional SCI providers; 30 Veterans living with SCI at three VA SCI Centers in the United States. INTERVENTIONS n/a. OUTCOME MEASURES Provider-Veteran perspectives of CAPrI prevention that demonstrated agreement, partial agreement, divergence, and silence. RESULTS Providers and veterans agreed on what is basic care, and the importance of family, caregiver and health provider/system supports, but they viewed motivation, veteran role, informal supports, and adequacy of supports differently. CONCLUSION Understanding how SCI providers and veterans living with SCI view prevention in the community informs how to promote preventive care in the context of veterans' lives.
Collapse
Affiliation(s)
- Lisa Burkhart
- Center of Innovation for Complex Chronic Healthcare, Hines VA, Hines, Illinois, USA
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - Lisa Skemp
- Center of Innovation for Complex Chronic Healthcare, Hines VA, Hines, Illinois, USA
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Sameer Siddiqui
- Spinal Cord Injuries/Disorders System of Care, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Varni JW, Zebracki K, Hwang M, Mulcahey M, Vogel LC. Pain, pain interference, social and school/work functioning in youth with spinal cord injury: A mediation analysis. J Spinal Cord Med 2024; 47:504-510. [PMID: 36149340 PMCID: PMC11218589 DOI: 10.1080/10790268.2022.2120232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT/OBJECTIVE The objective of the present study was to investigate the effects of pain severity, pain interference and social functioning in a serial multiple mediator model predicting school/work functioning in youth with spinal cord injury (SCI) from their perspective. DESIGN Explanatory or mechanistic study. SETTING Pediatric specialty hospital. PARTICIPANTS 125 youth with SCI ages 8-24. OUTCOME MEASURES The Pain Severity Item and Pain Interference Scale from the PedsQL™ Spinal Cord Injury Module, and the Social Functioning and School/Work Functioning Scales from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed. RESULTS Hierarchical multiple regression and serial multiple mediator model analyses were conducted to test the percent variability accounted for and the mediating effects of pain interference and social functioning in the association between pain severity and school/work functioning. Pain predictive effects on school/work functioning were serially mediated by pain interference and social functioning. In a predictive analytics model conducted with hierarchical multiple regression analysis, age, sex, pain, pain interference and social functioning accounted for 45% of the variance in youth-reported school/work functioning (P < 0.001), demonstrating a large effect size. CONCLUSION The mechanisms of the predictive effects of pain severity on school/work functioning in youth with SCI are explained in part by the serial multiple mediator effects of pain interference and social functioning. Identifying the multiple mediators of SCI pain on school/work functioning from the perspective of youth with SCI may facilitate future clinical research and practice to ameliorate impaired daily functioning and improve overall well-being.
Collapse
Affiliation(s)
- James W. Varni
- Department of Pediatrics, College of Medicine, Texas A&M University, College Station, Texas, USA
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas, USA
| | - Kathy Zebracki
- Shriners Children’s Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Miriam Hwang
- Shriners Children’s Chicago, Chicago, Illinois, USA
| | - M.J. Mulcahey
- Department of Physical Medicine, Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lawrence C. Vogel
- Shriners Children’s Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Rush Medical College, Chicago, Illinois, USA
| |
Collapse
|
3
|
Kraus B, Lakin A, Sherbrooke N. "The Other Thousand Hours": A Spinal Cord Injury Self-Management Program Qualitative Analysis. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241260648. [PMID: 38910541 DOI: 10.1177/15394492241260648] [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: 06/25/2024]
Abstract
People with spinal cord injury experience secondary health conditions (SHCs) at a high rate which impacts life expectancy and functional performance. Self-management (SM) is an evidence-based approach to reduce the negative effects of SHCs, but prior SM programs have not been successful for the spinal cord injury (SCI) population. We sought to describe the experiences of participants completing a group-based telehealth program that is tailored to the SCI population: The Spinal Cord Injury Self-Management (SCISM) Program. We conducted interviews using Interpretive Phenomenological Analysis to examine participants' experiences. Twenty-two participants completed the interviews. Four themes ("A Sense of Community," "Being Held Accountable," "I'm Still Learning," and "Being Proactive Instead of Reactive") emerged. People with SCI require continued support throughout the chronic stage of SCI particularly at the community level to address mental health as well as the learning and application of SM skills through tailored interventions that foster community and accountability.
Collapse
|
4
|
Wong V, Ippolito GM, Crescenze I. Integrating Patient Preferences with Guideline-Based Care in Neurogenic Lower Urinary Tract Dysfunction After Spinal Cord Injury. Urol Clin North Am 2024; 51:277-284. [PMID: 38609199 DOI: 10.1016/j.ucl.2024.02.002] [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: 04/14/2024]
Abstract
Individual and social factors are important for clinical decision-making in patients with neurogenic bladder secondary to spinal cord injury (SCI). These factors include the availability of caregivers, social infrastructure, and personal preferences, which all can drive bladder management decisions. These elements can be overlooked in clinical decision-making; therefore, there is a need to elicit and prioritize patient preferences and values into neurogenic bladder care to facilitate personalized bladder management choices. For the purposes of this article, we review the role of guideline-based care and shared decision-making in the SCI population with neurogenic lower urinary tract dysfunction.
Collapse
Affiliation(s)
- Vivian Wong
- Department of Urology, Ohio State University, 915 Olentangy River Road, Suite 3100, Room 3105, Columbus, OH 43212, USA.
| | - Giulia M Ippolito
- Department of Urology, University of Michigan, 1733 Monterey Court, Ann Arbor, MI 48108, USA
| | - Irene Crescenze
- Department of Urology, Ohio State University, 915 Olentangy River Road, 2nd Floor Suite 2000, Columbus, OH 43212, USA
| |
Collapse
|
5
|
Bochkezanian V, Henricksen KJ, Lineburg BJ, Myers-Macdonnell LA, Bourbeau D, Anderson KD. Priorities, needs and willingness of use of nerve stimulation devices for bladder and bowel function in people with spinal cord injury (SCI): an Australian survey. Spinal Cord Ser Cases 2024; 10:15. [PMID: 38514608 PMCID: PMC10957911 DOI: 10.1038/s41394-024-00628-3] [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: 06/06/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
STUDY DESIGN Anonymous online survey OBJECTIVES: To investigate the priorities, needs and willingness to adopt nerve stimulation devices for managing neurogenic bladder and bowel function in people with spinal cord injury (SCI) living in Australia. SETTING Online survey of people living with SCI in Australia. METHODS This anonymous online survey used Qualtrics and was advertised via standard communication channels, such as advocacy groups representing the SCI community in Australia, social media, attending SCI sporting events and by word-of-mouth. RESULTS Responses from 62 individuals (32% female, 68% male) were included. Bladder emptying through urethra without catheter was the highest priority for bladder function. Reducing time required for bowel routines and constipation were the top priorities regarding bowel function. The highest concern for internal/implanted devices was the 4% chance of device surgical removal, while wearing wires under the clothes was the main concern for external devices. 53% of respondents were willing to trial an implanted nerve stimulation device, while 70% would trial an external device to improve and gain independence in bladder and bowel function. CONCLUSION The findings of this study highlighted the potential role in which nerve stimulation can have in addressing bladder and bowel dysfunction in people with SCI, and have also identified that there was a need for Australian physiotherapists to evaluate their role in bladder and bowel dysfunction. Results from this study can help guide further research in nerve stimulation devices for bladder and bowel dysfunction in people with SCI. SPONSORSHIP n/a.
Collapse
Affiliation(s)
- Vanesa Bochkezanian
- School of Health, Medical and Applied Sciences College of Health Sciences Building 34 Office 1.02, Bruce Highway, CQUniversity Australia, Rockhampton North, QLD 4702, Australia.
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia.
| | - Kelsey J Henricksen
- School of Health, Medical and Applied Sciences College of Health Sciences, CQUniversity Australia 1/1.04-2, University Dr, Bundaberg, QLD, 4670, Australia
| | - Benjamin J Lineburg
- School of Health, Medical and Applied Sciences College of Health Sciences, CQUniversity Australia 1/1.04-2, University Dr, Bundaberg, QLD, 4670, Australia
| | - Louis A Myers-Macdonnell
- School of Health, Medical and Applied Sciences College of Health Sciences, CQUniversity Australia 1/1.04-2, University Dr, Bundaberg, QLD, 4670, Australia
| | - Dennis Bourbeau
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106, USA
- Cleveland FES Center, Cleveland, OH 44106, USA
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH 44106, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Kim D Anderson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH 44106, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| |
Collapse
|
6
|
Brady J, Loyola-Sanchez A, Crochetiere S, MacIsaac R, Kulik E, Okuma Y, Cwiklewich M, Mouneimne M, McFaul T, Bhatia Z, Parmar R, Ho C, Kainth H, Knox J, Charbonneau R. Urinary tract infections and urinary bladder health experiences of persons with spinal cord injury in a Canadian province: A mixed methods study showcasing infection prevention as health inequity case. J Spinal Cord Med 2024:1-13. [PMID: 38232152 DOI: 10.1080/10790268.2023.2287253] [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: 01/19/2024] Open
Abstract
CONTEXT/OBJECTIVE Urinary tract infections (UTIs) are one of the most frequent secondary complications among people with spinal cord injury (SCI). The prevention and management of UTIs is prioritized by stakeholders across Canada. The purpose of this study was to gain an in-depth understanding of the urinary bladder (bladder) management experiences of people with SCI in Alberta communities, especially how UTIs are experienced and managed. DESIGN Convergent mixed methods parallel databases variant. SETTING Communities across Alberta, Canada. PARTICIPANTS 39 survey participants and 19 interview participants, all with SCI. METHODS One-on-one phone semi-structured interviews analyzed using thematic analysis. Quantitative surveys included demographic, multichoice, and Likert Scale questions analyzed using descriptive analysis. Both methods explored people with SCI's experiences with bladder management and UTIs. Qualitative and quantitative results were integrated through a comparison joint display table and meta-inferences. OUTCOME MEASURES Qualitative themes and descriptive statistics further integrated as mixed core-statements. RESULTS Bladder routine is central to daily life and maintaining bladder health, avoiding UTIs, is the priority. Several health inequities are related to (1) financial barriers dictating how bladder is managed, (2) low perceived support for appropriate bladder management, (3) low healthcare access to appropriate UTI management and (4) low providers' capacity to support bladder management and build trust with persons with SCI. CONCLUSION Action is required to address identified health inequities, including improvement of financial support, like appropriate catheter coverage, decrease barriers to access appropriate care and improvement of providers' capacity to address SCI bladder care.
Collapse
Affiliation(s)
- Jocelyn Brady
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Adalberto Loyola-Sanchez
- Department of Medicine, University of Alberta, Edmonton, Canada
- Alberta Health Services, Edmonton, Canada
| | | | | | | | - Yoshino Okuma
- Department of Medicine, University of Alberta, Edmonton, Canada
- Alberta Health Services, Edmonton, Canada
| | | | | | | | | | - Raj Parmar
- Alberta Health Services, Calgary, Canada
| | - Chester Ho
- Department of Medicine, University of Alberta, Edmonton, Canada
- Alberta Health Services, Edmonton, Canada
| | - Hardeep Kainth
- Department of Medicine, University of Alberta, Edmonton, Canada
- Alberta Health Services, Edmonton, Canada
| | - Jason Knox
- Alberta Health Services, Calgary, Canada
| | - Rebecca Charbonneau
- Alberta Health Services, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| |
Collapse
|
7
|
Conti A, Pradovera E, Luciani M, Tesio M, Casabona E, Sperlinga R, Campagna S. Experiences of people with spinal cord injuries readmitted for continence-related complications: a qualitative descriptive study. Spinal Cord 2024; 62:26-33. [PMID: 38062213 DOI: 10.1038/s41393-023-00943-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: 02/21/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Abstract
STUDY DESIGN Qualitative descriptive. OBJECTIVES To describe the experiences of people with Spinal Cord Injury (SCI) re-admitted to the hospital due to continence-related complications. SETTING Inpatient service of a large spinal unit in North-West of Italy. METHODS Semi-structured interviews were conducted on a purposive sample of people with SCI (n = 11; age range 22-66 years, n = 5 females, n = 6 with cervical injuries), audio-recorded, and transcribed verbatim (duration range 38-52 min). Data were analysed inductively using the thematic analysis approach as described by Braun and Clarke. RESULTS Three main themes were identified: (i) managing the frustration of continence-related complications; (ii) finding your way to deal with continence-related complications; (iii) identifying precise needs to deal with continence-related complications. Obtained findings highlighted the perceived emotional and physical burden suffered by people with SCI and their caregivers regarding the constant look for solutions and renounces to social participation, the different strategies implemented to address continence-related complications, and the unmet or partially met needs of people with SCI regarding support in transition to the community, infrastructure, and reliable information or education. CONCLUSIONS Continence-related complications have a significant impact on the lives of people with SCI and their families. Interventions using technological tools and peer participation could reduce the burden associated with continence-related complications. Specific instruments are needed to facilitate evaluation, goal setting, and promote discussion of continence to allow HCPs to support people with SCI. Structured follow-up for SCI survivors should also focus on their needs to improve knowledge, facilitate decision making, and promote preventive behaviours.
Collapse
Affiliation(s)
- Alessio Conti
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Elena Pradovera
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | | | - Elena Casabona
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy.
| | - Riccardo Sperlinga
- Department of Continuing Education and Training in the Health Professions, Mauriziano Hospital of Turin, Turin, Italy
| | - Sara Campagna
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| |
Collapse
|
8
|
Gandara CK, Palacios JL, Luis Quintanar J, Zhang Y, Li X, Munoz A. Improvement of neurogenic urinary dysfunctions in female rats treated with an injection of botulinum toxin A at the epicenter of the spinal cord injured site. Neurourol Urodyn 2024; 43:246-257. [PMID: 37901953 DOI: 10.1002/nau.25311] [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: 06/13/2023] [Revised: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE To assess the effect of an injection of botulinum toxin A (BoNT/A) at the epicenter of the spinal cord injury (SCI) site on the recovery of lower urinary tract function in female rats with thoracic SCI. MATERIALS AND METHODS Twenty-four female Wistar rats with Sham (laminectomy at T8/T9 level) or SCI (at T8/T9; 30 g compression for 5 s) were assigned into Sham-SS (injected with 5 µL of saline solution), Sham-BoNT/A (injected with 15 pg/rat, equivalent to 7.5 Units/kg of BoNT/A in 5 µL volume), SCI-SS (injured and injected with saline), SCI-BoNT/A (injured and injected with BoNT/A), N = 6 per group. Weekly evaluation of stereotyped micturition behavior, hind-limb nociception, and locomotor activity was performed 1 week before and during 6 weeks after surgery. Subsequently, all groups underwent simultaneous electromyography of the external urethral sphincter (EUS-EMG) and cystometric (CMG) studies. RESULTS A compression SCI at the T8/T9 thoracic level significantly impairs sensory and locomotive functions, as well as stereotyped micturition behavior. However, these impairments were improved by BoNT/A injection after SCI. Neither injections of saline solution nor BoNT/A had an appreciable effect on the same parameters evaluated in the Sham groups. The combined EUS-EMG and CMG evaluations revealed important improvements of lower urinary tract physiology, particularly a reduction in the frequency of non-voiding contractions and the properties of EUS bursting activity indicated as the amplitude of the EUS-EMG signal and duration of burst electrical activity during effective voiding. CONCLUSION The severe impairments on sensory and locomotive functions as well stereotyped micturition caused by an SCI could be potentially attenuated by an injection of a small amount of BoNT/A directly into the epicenter of the SCI region. A reduction in the release of neurotoxic neurotransmitters requiring the SNARE complex may be the mechanism triggered by BoNT/A to reduce neurotoxicity and hyperexcitability created in the SCI area to improve the survival of spinal cord cells involved in micturition.
Collapse
Affiliation(s)
- Cynthia K Gandara
- Centro Universitario del Norte, Universidad de Guadalajara, Colotlán, Jalisco, México
| | - Jose L Palacios
- Facultad de Ciencias para el Desarrollo Humano, Universidad Autónoma de Tlaxcala, Tlaxcala, Tlaxcala, Mexico
| | - J Luis Quintanar
- Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, México
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Xuhong Li
- Department of Rehabilitation Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Alvaro Munoz
- Centro Universitario del Norte, Universidad de Guadalajara, Colotlán, Jalisco, México
| |
Collapse
|
9
|
Ramos D, Cruz CD. Involvement of microglia in chronic neuropathic pain associated with spinal cord injury - a systematic review. Rev Neurosci 2023; 34:933-950. [PMID: 37490300 DOI: 10.1515/revneuro-2023-0031] [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: 03/17/2023] [Accepted: 06/10/2023] [Indexed: 07/26/2023]
Abstract
In recent decade microglia have been found to have a central role in the development of chronic neuropathic pain after injury to the peripheral nervous system. It is widely accepted that peripheral nerve injury triggers microglial activation in the spinal cord, which contributes to heightened pain sensation and eventually chronic pain states. The contribution of microglia to chronic pain arising after injury to the central nervous system, such as spinal cord injury (SCI), has been less studied, but there is evidence supporting microglial contribution to central neuropathic pain. In this systematic review, we focused on post-SCI microglial activation and how it is linked to emergence and maintenance of chronic neuropathic pain arising after SCI. We found that the number of studies using animal SCI models addressing microglial activity is still small, compared with the ones using peripheral nerve injury models. We have collected 20 studies for full inclusion in this review. Many mechanisms and cellular interactions are yet to be fully understood, although several studies report an increase of density and activity of microglia in the spinal cord, both in the vicinity of the injury and in the spared spinal tissue, as well as in the brain. Changes in microglial activity come with several molecular changes, including expression of receptors and activation of signalling pathways. As with peripheral neuropathic pain, microglia seem to be important players and might become a therapeutic target in the future.
Collapse
Affiliation(s)
- David Ramos
- Faculty of Medicine of Porto, University of Porto, Porto, Portugal
- Department of Biomedicine, Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Célia Duarte Cruz
- Department of Biomedicine, Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Translational Neurourology, IBMC and Instituto de Investigação e Inovação em Saúde-i3S, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
| |
Collapse
|
10
|
Varni JW, Zebracki K, Hwang M, Mulcahey MJ, Vogel LC. Bladder and bowel function effects on emotional functioning in youth with spinal cord injury: a serial multiple mediator analysis. Spinal Cord 2023; 61:415-421. [PMID: 37414836 DOI: 10.1038/s41393-023-00912-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
STUDY DESIGN Preliminary explanatory or mechanistic cross-sectional study. OBJECTIVES This preliminary cross-sectional study investigates the hypothesized serial mediating effects of bladder/bowel worry, social worry, and social participation in the relationship between bladder function or bowel function and emotional functioning in youth with spinal cord injury (SCI) from their perspective. METHODS The Bladder Function, Bowel Function, Worry Bladder Bowel, Worry Social, and Social Participation Scales from the PedsQL™ Spinal Cord Injury Module and the Emotional Functioning Scale from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed by 127 youth with SCI ages 8-24. Serial multiple mediator model analyses were conducted to test the hypothesized sequential mediating effects of bladder/bowel worry, social worry, and social participation as intervening variables separately for the cross-sectional association between bladder function or bowel function and emotional functioning. RESULTS The separate cross-sectional negative association of bladder function and bowel function with emotional functioning were serially mediated by bladder/bowel worry, social worry and social participation, accounting for 28% and 31%, respectively, of the variance in youth-reported emotional functioning (p < 0.001), representing large effect sizes. CONCLUSIONS In this preliminary study, bladder/bowel worry, social worry, and social participation explain in part the cross-sectional negative association of bladder function and bowel function with emotional functioning in youth with SCI from the youth perspective. Identifying the hypothesized associations of bladder function and bowel function, bladder/bowel worry, social worry, and social participation with emotional functioning may help inform future clinical research and practice for youth with SCI.
Collapse
Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA.
| | - Kathy Zebracki
- Shriners Children's Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mary Jane Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Department of Physical Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lawrence C Vogel
- Shriners Children's Chicago, Chicago, IL, USA
- Department of Pediatrics, Rush Medical College, Chicago, IL, USA
| |
Collapse
|
11
|
Herbert AS, Welk B, Elliott CS. Internal and External Barriers to Bladder Management in Persons with Neurologic Disease Performing Intermittent Catheterization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6079. [PMID: 37372666 DOI: 10.3390/ijerph20126079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
People living with neurogenic lower urinary tract dysfunction (NLUTD) often have to use clean intermittent catheters (CIC) to manage their bladder function. The use of catheters presents multiple unique challenges, based on both the person's inherent characteristics and on the external limitations imposed by public toilets. We review the impact of age, sex, upper limb function, caregiver assistance, time required to perform CIC, and urinary incontinence on CIC in NLUTD, with special reference to their interaction with societal and public health factors. Public toilet limitations, such as lack of availability, adequate space and special accommodation for CIC, cleanliness, and catheter design are also reviewed. These potential barriers play a significant role in the perception and performance of bladder care in people living with NLUTD.
Collapse
Affiliation(s)
- Amber S Herbert
- Department of Urology, School of Medicine, Stanford University, Stanford, CA 94304, USA
| | - Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, Ontario, ON N6G 2M1, Canada
| | - Christopher S Elliott
- Department of Urology, School of Medicine, Stanford University, Stanford, CA 94304, USA
- Division of Urology, Santa Clara Valley Medical Center, San Jose, CA 95128, USA
| |
Collapse
|
12
|
Colostomy may offer hope in improving quality of life: a phenomenological qualitative study with patients dependent on a wheelchair. Qual Life Res 2023:10.1007/s11136-023-03368-3. [PMID: 36869961 DOI: 10.1007/s11136-023-03368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE This study aimed to evaluate the perspectives of patients who had spinal cord injuries and were wheelchair-dependent on colostomy surgery, which is among the bowel movement methods. METHODS In this qualitative study, which was based on Heidegger's hermeneutical phenomenological approach, the Van Manen method was used to reveal how patients were affected by their experiences. The data of the study were collected by directly interviewing the patients and using a semi-structured interview guide. The interviews were recorded with a voice recorder device with the permission of the participants. Nine patients who were leading a life dependent on a wheelchair as a result of spinal cord injury made up the sample of the study. RESULTS Six of the participants were female. The ages of participants ranged between 32 and 52, and all of them were married. The results of the interviews indicated that the experiences of participants who were dependent on a wheelchair about bowel movement management consisted of three main themes: (a) difficult experiences; (b) coping with difficulties; and (c) colostomy awareness experience. CONCLUSIONS Results showed that knowledge of a stoma obtained from different sources was a glimmer of hope for patients but that healthcare professionals did not exhibit a supportive attitude toward this hope.
Collapse
|
13
|
Jeon M, Kim O, Lee BS, Kim W, Kim JH, Kim EJ, Kim J. Influence of Sociodemographic Factors, Health Conditions, and Activity on Participation in People With Spinal Cord Injury in South Korea. Arch Phys Med Rehabil 2023; 104:52-62. [PMID: 36028101 DOI: 10.1016/j.apmr.2022.08.004] [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: 03/11/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To verify the causal relationship between sociodemographic factors, health conditions, and activities that influence the participation of people with spinal cord injury (SCI) using International Spinal Cord Injury (InSCI) Survey data and to investigate the moderation effects of environmental restrictions and health care system concerns. DESIGN Cross-sectional community survey and structural equation model. SETTING SCI databases of the Korea National Rehabilitation Center and Korea Spinal Cord Injury Association. PARTICIPANTS Community-dwelling adults (N=890) with SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The InSCI questionnaire domains included sociodemographic factors, health conditions, activity, participation, environmental restrictions, and health system concerns. Sociodemographic factors included age, education, and income. Health conditions included bowel dysfunction, respiratory problems, and pain, among others. Activity included "daily routine" and "using hands," among others. Participation included "interacting with people" and "intimate relationships," among others. Environmental restrictions included "public places" and "negative attitudes," among others. Health care system concerns included "nursing care" and "experience of being treated," among others. RESULTS The hypothesis that health conditions would have a significant effect on activity was supported because 51% of the total variance in activity factors was explained by health condition factors. The hypothesis that activity would have a significant effect on participation was also supported because 63.4% of total variance in participation factors was explained by activity factors. The moderation effect tests supported the hypotheses that health conditions, activity, and participation would differ depending on the extent of environmental restrictions as well as the extent of health system concerns. CONCLUSIONS When formulating policies and recommendations to promote the participation of people with SCI living in the South Korean community, the influence of environmental restrictions and health systems as well as the causal influence of health conditions and activity should be considered.
Collapse
Affiliation(s)
- Minjae Jeon
- Department of Healthcare and Public Health Research, Rehabilitation Research Institute, Korea National Rehabilitation Center, Seoul
| | - Onyoo Kim
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul.
| | - Bum-Suk Lee
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul.
| | - Wanho Kim
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul
| | - Jung Hwan Kim
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul
| | - Eun-Joo Kim
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul
| | - Jiin Kim
- Department of Community Reintegration Service, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul, Republic of Korea
| |
Collapse
|
14
|
Lauridsen SV, Averbeck MA, Krassioukov A, Vaabengaard R, Athanasiadou S. UTI assessment tool for intermittent catheter users: a way to include user perspectives and enhance quality of UTI management. BMC Nurs 2022; 21:272. [PMID: 36199133 PMCID: PMC9535847 DOI: 10.1186/s12912-022-01033-7] [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: 04/05/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urinary Tract Infections (UTIs) are among the most severe complications for users of intermittent catheterisation (IC), with numerous risk factors contributing to their occurrence. The aim of this study was to develop a tool to assess UTI risk factors among IC users in a systematic way that considers the perspective of the individual user. METHODS The Design Thinking Process was used to guide the development of the content and format of the tool. The UTI Risk Factors model by Kennelly et al. was used as a basis for developing the content. Insights on the appropriate content and format were collected via the Coloplast Nurse Advisory Boards and by conducting a qualitative evidence synthesis on user perspectives and practices in relation to UTIs. RESULTS The literature search identified a total of 3544 articles, out of which 22 met the inclusion criteria. Additionally, three rounds of meetings were conducted with approximately 90 nurses from the Nurse Advisory Boards across Europe. The qualitative evidence synthesis showed that users describe their UTI symptoms in different terms and that personal needs and priorities impact their adherence and catheter selection. Furthermore, some users lack relevant and updated knowledge about IC and UTIs. The nurses described that correct UTI diagnosis is essential. They pointed that they would assess the user's general condition, adherence, technique, and catheter type as potential areas of risk factors and emphasised the importance of adequate support for users. The study resulted in the development of the UTI assessment tool for intermittent catheter users, which comprises three elements: a guide for healthcare professionals, a dialogue board, and a notepad. The tool starts with a confirmation of the UTI incidence, and then assesses risk factors via questions on health, adherence, technique, and catheter, and concludes with a support section. CONCLUSIONS The UTI assessment tool for intermittent catheter users is designed to help healthcare professionals assess UTI risk factors in a systematic way, while engaging users and taking their perspective into account. By identifying the relevant risk factors, the use of this tool has the potential to reduce the occurrence of UTIs for the individual IC user.
Collapse
Affiliation(s)
- S V Lauridsen
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark. .,WHO-CC, Parker Institute, Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark.
| | | | - A Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Endowment Lands, Canada.,G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | | | | |
Collapse
|
15
|
Kroman MF, Jørgensen V, Groven KS. Making sense of invisible bodily changes and new ways of doing physical activity: experiences of individuals following traumatic incomplete spinal cord injury. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2112754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
| | | | - Karen Synne Groven
- Oslo Metropolitan University, Oslo, Norway
- VID Scientific University, Oslo, Norway
| |
Collapse
|
16
|
Ture SD, Ozkaya G, Sivrioglu K. Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury. J Spinal Cord Med 2022; 46:424-432. [PMID: 35108161 PMCID: PMC10114961 DOI: 10.1080/10790268.2021.2021043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES/CONTEXT To evaluate the relationship between severity of neurogenic bowel dysfunction (NBD) and functional status, depression, and quality of life in individuals with spinal cord injury (SCI) and to determine the factors associated with developing moderate-to-severe NBD. DESIGN Cross-sectional study. SETTING University hospital rehabilitation outpatient clinic. PARTICIPANTS Individuals with traumatic SCI, at least one year post-injury (N = 92). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Neurogenic Bowel Dysfunction Score, Functional Independence Measure (FIM), Beck Depression Inventory (BDI), and Short Form-36 (SF-36). RESULTS In the current sample, we found that half of the individuals with SCI had moderate-to-severe NBD. Individuals with moderate and severe NBD had lower motor FIM (P = 0.008 and P = 0.006, respectively) and SF-36 physical functioning (PF) scale (P = 0.020 and P = 0.031, respectively) scores than individuals with very minor NBD. There was no difference in the BDI scores among individuals with different levels of NBD. Individuals with American Spinal Injury Association Impairment Scale (AIS) A injuries were more likely to develop moderate-to-severe NBD than those with AIS C (odds ratio (OR) = 6.52; 95% confidence interval (CI) 1.13-37.79; P = 0.005) or AIS D (OR = 17.19; 95% CI 3.61-81.82; p < 0.001) injuries. CONCLUSION Individuals with moderate-to-severe NBD had higher levels of dependency in activities of daily living and lower SF-36 PF scale scores than individuals with very minor NBD. Among individuals with SCI, completeness of injury was a significant factor for developing moderate-to-severe NBD.
Collapse
Affiliation(s)
- Sevda Demir Ture
- Department of Physical Medicine and Rehabilitation, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Guven Ozkaya
- Department of Biostatistics, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Koncuy Sivrioglu
- Department of Physical Medicine and Rehabilitation, Bursa Uludag University School of Medicine, Bursa, Turkey
| |
Collapse
|
17
|
Spinal cord injury-mediated changes in electrophysiological properties of rat gastric nodose ganglion neurons. Exp Neurol 2022; 348:113927. [PMID: 34798136 PMCID: PMC8727501 DOI: 10.1016/j.expneurol.2021.113927] [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: 05/12/2021] [Revised: 10/30/2021] [Accepted: 11/11/2021] [Indexed: 02/03/2023]
Abstract
In preclinical rodent models, spinal cord injury (SCI) manifests as gastric vagal afferent dysfunction both acutely and chronically. However, the mechanism that underlies this dysfunction remains unknown. In the current study, we examined the effect of SCI on gastric nodose ganglia (NG) neuron excitability and on voltage-gated Na+ (NaV) channels expression and function in rats after an acute (i.e. 3-days) and chronic (i.e. 3-weeks) period. Rats randomly received either T3-SCI or sham control surgery 3-days or 3-weeks prior to experimentation as well as injections of 3% DiI solution into the stomach to identify gastric NG neurons. Single cell qRT-PCR was performed on acutely dissociated DiI-labeled NG neurons to measure NaV1.7, NaV1.8 and NaV1.9 expression levels. The results indicate that all 3 channel subtypes decreased. Current- and voltage-clamp whole-cell patch-clamp recordings were performed on acutely dissociated DiI-labeled NG neurons to measure active and passive properties of C- and A-fibers as well as the biophysical characteristics of NaV1.8 channels in gastric NG neurons. Acute and chronic SCI did not demonstrate deleterious effects on either passive properties of dissociated gastric NG neurons or biophysical properties of NaV1.8. These findings suggest that although NaV gene expression levels change following SCI, NaV1.8 function is not altered. The disruption throughout the entirety of the vagal afferent neuron has yet to be investigated.
Collapse
|
18
|
Barriers and facilitators to changing bowel care practices after spinal cord injury: a Theoretical Domains Framework approach. Spinal Cord 2022; 60:664-673. [PMID: 34997189 PMCID: PMC9287175 DOI: 10.1038/s41393-021-00743-0] [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: 06/29/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Improvement to autonomic processes such as bladder, bowel and sexual function are prioritised by individuals with spinal cord injury (SCI). Bowel care is associated with high levels of dissatisfaction and decreased quality of life. Despite dissatisfaction, 71% of individuals have not changed their bowel care routine for at least 5 years, highlighting a disconnect between dissatisfaction with bowel care and changing routines to optimise bowel care. OBJECTIVE Using an integrated knowledge translation approach, we aimed to explore the barriers and facilitators to making changes to bowel care in individuals with SCI. METHODS Our approach was guided by the Behaviour Change Wheel and used the Theoretical Domains Framework (TDF). Semi-structured interviews were conducted with individuals with SCI (n = 13, mean age 48.6 ± 13.1 years) and transcribed verbatim (duration 31.9 ± 7.1 min). Barriers and facilitators were extracted, deductively coded using TDF domains and inductively analysed for themes within domains. RESULTS Changing bowel care after SCI was heavily influenced by four TDF domains: environmental context and resources (workplace flexibility, opportunity or circumstance, and access to resources); beliefs about consequences; social influences (perceived support and peer mentorship); and knowledge (knowledge of physiological processes and bowel care options). All intervention functions and policy categories were considered viable intervention options, with human (61%) and digital (33%) platforms preferred. CONCLUSIONS Modifying bowel care is a multi-factorial behaviour. These findings will support the systematic development and implementation of future interventions to both enable individuals with SCI to change their bowel care and to facilitate the optimisation of bowel care approaches.
Collapse
|
19
|
Sebesta EM, Connors EL, Rourke E, Reynolds WS, McKernan LC. Psychosocial Factors in Neurogenic Lower Urinary Tract Dysfunction: Implications for Multidisciplinary Care. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-021-00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
20
|
Who recovers independent bowel management during the first year following a traumatic spinal cord injury? A case-control study. Am J Phys Med Rehabil 2021; 101:307-313. [PMID: 34483265 DOI: 10.1097/phm.0000000000001871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 1) document the characteristics of patients with impaired bowel functioning during the subacute and chronic phases; 2) identify factors associated with recovery of independent bowel functioning during the first year following TSCI in patients who present impaired bowel functioning during the subacute phase, when bowel rehabilitation is completed. DESIGN Case-control study on 123 adult TSCI patients. Bowel function assessments using item 7 of the SCIM-III were obtained 3-months following TSCI and during the early chronic phase. Univariate and multivariate analyses were conducted to identify predictors associated with recovery of independent bowel functioning between the initial assessment and follow-up. RESULTS Of the 110 patients available for analysis, 54 (49%) displayed impaired bowel functioning 3-months following TSCI. Of these, 19 (35%) recovered independent bowel functioning over the following 9 months. The total motor score (TMS) was the only significant predictor of this outcome. A TMS lower than 42 was 100% predictive of absence of recovery. CONCLUSION Recovering independent bowel management 1-year after TSCI was possible in 35% of patients despite impaired bowel functioning during the subacute phase. TMS measured 3-months post-injury could be useful for prognosticating potential for bowel functioning recovery since patients with TMS < 42 are unlikely to recover.
Collapse
|
21
|
Pryor J, Haylen D, Fisher MJ. The usual bowel care regimes of people living in the community with spinal cord injury and factors important for integrating bowel care into everyday life. Disabil Rehabil 2021; 44:6401-6407. [PMID: 34470558 DOI: 10.1080/09638288.2021.1966678] [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: 10/20/2022]
Abstract
PURPOSE To describe the usual bowel care regimes of people living in the community with spinal cord injury and factors important for integrating bowel care into everyday life. METHODS AND MATERIALS Descriptive and interpretive thematic analysis of transcribed semi-structured interviews with 11 men living with spinal cord injury, aged 23-77 years, 8-45 years post injury. RESULTS Participants had different levels and types of injuries. While there were common aspects of the bowel care routines of study participants, none was exactly the same as any other. Each had developed a routine in accordance with the needs of their own body, preferences, and convenience in relation to availability of carers and work commitments. Personal factors in the person with SCI were important for successful integration of bowel care into their everyday life. CONCLUSION An appropriate and consistent bowel care routine was found to be significant in enabling people with spinal cord injury to experience wellness and quality in their everyday lives. Characteristics and actions of the person with SCI enabled the person to actively drive the process of integrating bowel care into their everyday life. How best to foster the development of these personal factors warrant further investigation.IMPLICATIONS FOR REHABILITATIONSupport for the ongoing development of self-management of bowel dysfunction expertise by people living with spinal cord injury needs to continue after discharge from hospital.Characteristics of the person with spinal cord injury, such as a state of mind indicating acceptance of their situation, motivation to avoid bowel accidents and constipation, and willingness to take responsibility, are important factors influencing the integration of bowel care into everyday life.Actions undertaken by the person with spinal cord injury, such as discipline to establish, refine and maintain a bowel care regime, and proactive self-management are important factors influencing the integration of bowel care into everyday life.This small study suggests the role of personal factors in the development of self-management expertise, for example the development of a self-management mindset and the acquisition of skills to drive that process, should be considered during rehabilitation.
Collapse
Affiliation(s)
- Julie Pryor
- Royal Rehab, Sydney and Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | | | - Murray J Fisher
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Australia and Royal Rehab, Sydney, Australia
| |
Collapse
|
22
|
Malone IG, Nosacka RL, Nash MA, Otto KJ, Dale EA. Electrical epidural stimulation of the cervical spinal cord: implications for spinal respiratory neuroplasticity after spinal cord injury. J Neurophysiol 2021; 126:607-626. [PMID: 34232771 DOI: 10.1152/jn.00625.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Traumatic cervical spinal cord injury (cSCI) can lead to damage of bulbospinal pathways to the respiratory motor nuclei and consequent life-threatening respiratory insufficiency due to respiratory muscle paralysis/paresis. Reports of electrical epidural stimulation (EES) of the lumbosacral spinal cord to enable locomotor function after SCI are encouraging, with some evidence of facilitating neural plasticity. Here, we detail the development and success of EES in recovering locomotor function, with consideration of stimulation parameters and safety measures to develop effective EES protocols. EES is just beginning to be applied in other motor, sensory, and autonomic systems; however, there has only been moderate success in preclinical studies aimed at improving breathing function after cSCI. Thus, we explore the rationale for applying EES to the cervical spinal cord, targeting the phrenic motor nucleus for the restoration of breathing. We also suggest cellular/molecular mechanisms by which EES may induce respiratory plasticity, including a brief examination of sex-related differences in these mechanisms. Finally, we suggest that more attention be paid to the effects of specific electrical parameters that have been used in the development of EES protocols and how that can impact the safety and efficacy for those receiving this therapy. Ultimately, we aim to inform readers about the potential benefits of EES in the phrenic motor system and encourage future studies in this area.
Collapse
Affiliation(s)
- Ian G Malone
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, Florida.,Breathing Research and Therapeutics Center (BREATHE), University of Florida, Gainesville, Florida
| | - Rachel L Nosacka
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
| | - Marissa A Nash
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
| | - Kevin J Otto
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, Florida.,Breathing Research and Therapeutics Center (BREATHE), University of Florida, Gainesville, Florida.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida.,Department of Neuroscience, University of Florida, Gainesville, Florida.,Department of Neurology, University of Florida, Gainesville, Florida.,Department of Materials Science and Engineering, University of Florida, Gainesville, Florida.,McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Erica A Dale
- Breathing Research and Therapeutics Center (BREATHE), University of Florida, Gainesville, Florida.,Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida.,Department of Neuroscience, University of Florida, Gainesville, Florida.,McKnight Brain Institute, University of Florida, Gainesville, Florida
| |
Collapse
|
23
|
Debelle A, de Rooster H, Bianchini E, Lonys L, Huberland F, Vanhoestenberghe A, Lambert P, Acuña V, Smets H, Giannotta F, Delchambre A, Sandersen C, Bolen G, Egyptien S, Deleuze S, Devière J, Nonclercq A. Optimization and assessment of a novel gastric electrode anchoring system designed to be implanted by minimally invasive surgery. Med Eng Phys 2021; 92:93-101. [PMID: 34167717 DOI: 10.1016/j.medengphy.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Abstract
A novel electrode anchoring design and its implantation procedure, aiming for a minimally invasive solution for gastric electrical stimulation, are presented. The system comprises an anchor made of a flexible body embedding two needle-shaped electrodes. The electrodes can easily switch from a parallel position - to pierce the stomach - to a diverging position - enabling them to remain firmly anchored into the muscular layer of the stomach. Key device parameters governing anchoring stability were assessed on a traction test bench, and optimal values were derived. The device was then implanted in six dogs by open surgery to assess its anchoring durability in vivo. Computed tomography images showed that the electrodes remained well placed within the dogs' gastric wall over the entire assessment period (more than one year). Finally, a prototype of a surgical tool for the minimally invasive device placement was manufactured, and the anchoring procedure was tested on a dog cadaver, providing the proof of concept of the minimally invasive implantation procedure. The use of our electrode anchoring system in long-term gastric electrical stimulation is promising in terms of implantation stability (the anchor withstands a force up to 0.81 N), durability (the anchor remains onto the stomach over one year) and minimal invasiveness of the procedure (the diameter of the percutaneous access is smaller than 12 mm). Moreover, the proposed design could have clinical applications in other hollow organs, such as the urinary bladder.
Collapse
Affiliation(s)
- Adrien Debelle
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Erika Bianchini
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Laurent Lonys
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - François Huberland
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, Department of Materials and Tissue, University College London, Stanmore, United Kingdom
| | - Pierre Lambert
- Transfers, Interfaces and Processes Department (TIPS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Vicente Acuña
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Hugo Smets
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabrizio Giannotta
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Delchambre
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Charlotte Sandersen
- Fundamental and Applied Research for Animal & Health (FARAH), Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Geraldine Bolen
- Fundamental and Applied Research for Animal & Health (FARAH), Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Sophie Egyptien
- Fundamental and Applied Research for Animal & Health (FARAH), Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Stefan Deleuze
- Fundamental and Applied Research for Animal & Health (FARAH), Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Nonclercq
- Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
24
|
Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury Suggested citation: Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Mark Korsten. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Journal of Spinal Cord Med. 2021. Doi:10.1080/10790268.2021.1883385. J Spinal Cord Med 2021; 44:442-510. [PMID: 33905316 PMCID: PMC8115581 DOI: 10.1080/10790268.2021.1883385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jeffery Johns
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Haller
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas, USA
| | | | - Walter Longo
- Department of Surgery, Division of Gastrointestinal Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Mark Korsten
- Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, Division of Gastroenterology, New York, New York, USA
| |
Collapse
|
25
|
Round AM, Joo MC, Barakso CM, Fallah N, Noonan VK, Krassioukov AV. Neurogenic Bowel in Acute Rehabilitation Following Spinal Cord Injury: Impact of Laxatives and Opioids. J Clin Med 2021; 10:jcm10081673. [PMID: 33919666 PMCID: PMC8069767 DOI: 10.3390/jcm10081673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/16/2021] [Accepted: 04/10/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: To explore the association between bowel dysfunction and use of laxatives and opioids in an acute rehabilitation setting following spinal cord injury (SCI). Methods: Data was collected regarding individuals with acute traumatic/non-traumatic SCI over a two-year period (2012–2013) during both the week of admission and discharge of their inpatient stay. Results: An increase in frequency of bowel movement (BM) (p = 0.003) and a decrease in frequency of fecal incontinence (FI) per week (p < 0.001) between admission and discharge was found across all participants. There was a reduction in the number of individuals using laxatives (p = 0.004) as well as the number of unique laxatives taken (p < 0.001) between admission and discharge in our cohort. The number of individuals using opioids and the average dose of opioids in morphine milligram equivalents (MME) from admission to discharge were significantly reduced (p = 0.001 and p = 0.02, respectively). There was a positive correlation between the number of laxatives and frequency of FI at discharge (r = 0.194, p = 0.014), suggesting that an increase in laxative use results in an increased frequency of FI. Finally, there was a significant negative correlation between average dose of opioids (MME) and frequency of BM at discharge, confirming the constipating effect of opioids (r = −0.20, p = 0.009).
Collapse
Affiliation(s)
- Andrew M. Round
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.M.R.); (C.M.B.); (V.K.N.)
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- Department of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON K1H 8M2, Canada
| | - Min Cheol Joo
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan 570-749, Korea;
| | - Carolyn M. Barakso
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.M.R.); (C.M.B.); (V.K.N.)
| | - Nader Fallah
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada
| | - Vanessa K. Noonan
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.M.R.); (C.M.B.); (V.K.N.)
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.M.R.); (C.M.B.); (V.K.N.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
- Correspondence: ; Tel.: +1-604-675-8819
| |
Collapse
|
26
|
Rocchi MA, Shi Z, Shaw RB, McBride CB, Sweet SN. Identifying the outcomes of participating in peer mentorship for adults living with spinal cord injury: a qualitative meta-synthesis. Psychol Health 2021; 37:523-544. [PMID: 33754920 DOI: 10.1080/08870446.2021.1890729] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Peer mentorship is a flagship program utilized by Canadian community-based spinal cord injury (SCI) organizations. Through connecting trained SCI peer mentors with fellow adults with SCI, these programs help adults adapt and thrive following their injury. The objective of this meta-synthesis was to work with SCI community organizations and to identify outcomes of participating in community- or rehabilitation-based peer mentorship programs using an integrated knowledge translation approach. DESIGN A meta-synthesis of 21 qualitative peer-reviewed studies and 66 community documents was conducted. MAIN OUTCOME MEASURES A total of 87 outcomes of peer mentorship were identified. RESULTS The outcomes of peer mentorship were grouped according to six higher-order themes: 1) Independence: enhanced self-sufficiency; 2) Personal growth: positive psychological changes; 3) Activities and participation: greater participation in activities and events; 4) Adaptation: adapting to life with disability; 5) Knowledge: obtaining new information, resources, and opportunities; and 6) Connection: developing and maintaining social relationship. CONCLUSION The positive nature of the identified outcomes suggests that participating in peer mentorship can promote improved health and quality of life for adults with SCI. Furthermore, the integrated knowledge translation approach helped identify outcomes that were previously not examined within SCI peer mentorship research, thus providing important insight for future research.
Collapse
Affiliation(s)
- Meredith A Rocchi
- Department of Communication, University of Ottawa, Ottawa, Canada.,Department of Kinesiology and Physical Education, McGill University, Montreal, Canada.,Centre for Interdisciplinary Rehabilitation Research in Metropolitan Montreal, Montreal, Canada
| | - Zhiyang Shi
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada.,Centre for Interdisciplinary Rehabilitation Research in Metropolitan Montreal, Montreal, Canada
| | - Robert B Shaw
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | | | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada.,Centre for Interdisciplinary Rehabilitation Research in Metropolitan Montreal, Montreal, Canada
| |
Collapse
|
27
|
Pryor J, Haylen D, Fisher M. Problems people with spinal cord injury experience accessing help with bowel care when hospitalised outside a specialist spinal injury service. J Clin Nurs 2021; 30:1633-1644. [PMID: 33590956 DOI: 10.1111/jocn.15717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 01/25/2023]
Abstract
AIMS AND OBJECTIVES To examine the nature of problems experienced by people with spinal cord injury (SCI) when accessing help to maintain recommended bowel regimes while hospitalised outside a specialist spinal injury service. BACKGROUND Bowel dysfunction is one particularly undesirable aspect of life with a SCI, with constipation and incontinence common. DESIGN Descriptive qualitative. METHODS Accounts of problems encountered in hospitals in New South Wales Australia collected during interviews with 11 people living with SCI and 12 responses provided by spinal clinicians via an online survey were subjected to thematic analysis. The COREQ guidelines were followed for reporting. RESULTS There were similarities across data collected from both sources. Individuals with SCI described instances where their bowel care needs did not fit with the pace and processes in acute hospitals. The clinician data pointed to a failure of healthcare professionals to assist people with SCI to maintain bowel care regimes recommended by specialist spinal services. Both groups described times when bowel care received was unreliable and fragmented, along with reports of staff who were unwilling and/or unable to provide the assistance required. Many and varied physical and psychosocial repercussions for individuals were associated with these system failures. In some instances, rather than restoring health, being admitted to hospital represented a significant health risk. CONCLUSION A failure of hospital systems to meet the bowel care needs of people with SCI when hospitalised outside a specialist spinal unit was identified. System and individual factors contributed to these problems, hence addressing them requires both system and individual responses. RELEVANCE TO CLINICAL PRACTICE If this problem is left unaddressed, the health and quality of life of people with SCI will continue to be compromised. Nursing scope of practice needs to be clarified and communicated to nurses outside specialist spinal injury units in relation to their role in maintaining bowel care regimes recommended for their patients by spinal specialists, and nurses need to ensure they possess the skills required. To allocate the time needed to provide this care, individual nurses need the support of the whole nursing team, including managers who are prepared to arrange additional staff when needed.
Collapse
Affiliation(s)
- Julie Pryor
- Royal Rehab, Ryde, NSW, Australia.,Susan Wakil School of Nursing & Midwifery, The University of Sydney, Sydney, NSW, Australia
| | | | - Murray Fisher
- Royal Rehab, Ryde, NSW, Australia.,Susan Wakil School of Nursing & Midwifery, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
28
|
Jörgensen S, Hedgren L, Sundelin A, Lexell J. Global and domain-specific life satisfaction among older adults with long-term spinal cord injury. J Spinal Cord Med 2021; 44:322-330. [PMID: 31099721 PMCID: PMC7952060 DOI: 10.1080/10790268.2019.1610618] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Although life expectancy after spinal cord injury (SCI) has increased, knowledge of life satisfaction and associated factors among older adults with long-term SCI is still very limited. The objective of this study was, therefore, to assess global and domain-specific life satisfaction among older adults with long-term SCI and investigate the association with sociodemographics, injury characteristics and secondary health conditions. DESIGN Cross-sectional cohort study. Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). SETTING Community settings in southern Sweden. PARTICIPANTS Seventy-eight individuals (32% women, injury levels C1-L3, American Spinal Injury Association Impairment Scale (AIS) A-D) mean age 68 years, mean time since injury 31 years. INTERVENTIONS Not applicable. OUTCOME MEASURES The Life Satisfaction Questionnaire (LiSat-11). RESULTS The participants were at least rather satisfied with most of the 11 life domains. They rated the lowest satisfaction with sexual life, activities of daily living and somatic health. Having a partner and being vocationally active was associated with greater satisfaction with life as a whole and with several other life domains. Participants with AIS D injuries were less satisfied with their somatic health than those with tetraplegia AIS A-C and paraplegia AIS A-C injuries. More secondary health conditions were negatively associated with satisfaction in five life domains. CONCLUSION Life satisfaction can be affected many years after SCI. The social context, participation in meaningful activities and minimizing secondary health conditions seem to be important for maintaining life satisfaction in older adults with a long-term injury.
Collapse
Affiliation(s)
- Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden,Correspondence to: Sophie Jörgensen, Department of Health Sciences, Rehabilitation Medicine Research Group, PO Box 157, Lund University, SE-221 00Lund, Sweden; Ph: +46 46 222 18 73 (secretary); +46 46 222 19 91 (direct).
| | - Linn Hedgren
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anna Sundelin
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| |
Collapse
|
29
|
Restoring both continence and micturition after chronic spinal cord injury by pudendal neuromodulation. Exp Neurol 2021; 340:113658. [PMID: 33639209 DOI: 10.1016/j.expneurol.2021.113658] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/23/2021] [Accepted: 02/22/2021] [Indexed: 01/23/2023]
Abstract
Neurogenic bladder management after spinal cord injury (SCI) is very challenging. Daily urethral catheterization is most commonly used to empty the bladder, which causes frequent infections of the lower urinary tract. This study reports a novel idea to restore both continence and micturition after SCI by an implantable pudendal nerve stimulator (PNS). The PNS was surgically implanted in four cats with complete SCI at T9-T10 spinal level and tested weekly for 13-14 weeks under awake conditions. These chronic SCI cats consistently exhibited large residual bladder volumes (average 40-50 ml) due to their inability to void efficiently, while urine leakage also occurred frequently. The PNS which consisted of stimulating the pudendal nerve at 20-30 Hz to trigger a spinal reflex bladder contraction and at the same time blocking the pudendal nerves bilaterally with 10 kHz stimulation to relax the external urethral sphincter and reduce the urethral outlet resistance successfully induced highly efficient (average 80-100%), low pressure (<50 cmH2O) voiding. The PNS at 5 Hz also promoted urine storage by inhibiting reflex bladder activity and increasing bladder capacity. At the end of 14-week chronic testing, low pressure efficient voiding induced by PNS was further confirmed under anesthesia by directly measuring voiding pressure using a bladder catheter inserted through the bladder dome. This study demonstrated the efficacy and safety of the PNS in awake chronic SCI cats, suggesting that a novel neuroprosthesis can be developed for humans to restore bladder function after SCI by stimulating and/or blocking the pudendal nerves.
Collapse
|
30
|
Nunnerley JL, Martin RA, Aldridge M, Bourke JA, Simpson I. Access to community support workers during hospital admission for people with spinal cord injury: a pilot study. Spinal Cord Ser Cases 2021; 7:3. [PMID: 33468996 DOI: 10.1038/s41394-020-00370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN A descriptive qualitative study. OBJECTIVES To evaluate a pilot project enabling people with spinal cord injury (SCI) to have their support workers accompany them into a non-SCI specialist/public hospital (excluding ICU) to perform selected care. SETTING The study was conducted in New Zealand. METHODS Interviews and focus groups with people with SCI, support workers, care agency staff, and hospital staff who participated in the pilot project. RESULTS Twenty-five individuals participated in the study. Two themes captured participants' experiences of the pilot: 'Maintaining individualised care' and 'Role, tasks and responsibilities. Support workers were described as knowledgeable about SCI care needs and being better positioned to provide individualised care for people with SCI than general nursing staff. Participants with SCI felt less anxious having a support worker with them, and perceived less risk of acquiring secondary health complications during the hospital admission. Good communications is important to ensure there is a shared understanding of the role and responsibilities of having an unregistered support worker in the hospital environment. CONCLUSIONS Having their regular support worker during admission to public hospital improved the SCI-specific care received. Support workers reduced the demand on hospital nursing staff who did not always have the time or specialist SCI knowledge to provide individualised care. People with SCI may be more likely to access medical assistance earlier and not defer hospital admissions if they can have support workers accompany them into hospital.
Collapse
Affiliation(s)
- Joanne L Nunnerley
- Burwood Academy of Independent Living, Christchurch, New Zealand. .,Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
| | - Rachelle A Martin
- Burwood Academy of Independent Living, Christchurch, New Zealand.,Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Matthew Aldridge
- Burwood Academy of Independent Living, Christchurch, New Zealand
| | - John A Bourke
- Burwood Academy of Independent Living, Christchurch, New Zealand.,Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia.,Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Ian Simpson
- Burwood Academy of Independent Living, Christchurch, New Zealand
| |
Collapse
|
31
|
Blanke EN, Holmes GM, Besecker EM. Altered physiology of gastrointestinal vagal afferents following neurotrauma. Neural Regen Res 2021; 16:254-263. [PMID: 32859772 PMCID: PMC7896240 DOI: 10.4103/1673-5374.290883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The adaptability of the central nervous system has been revealed in several model systems. Of particular interest to central nervous system-injured individuals is the ability for neural components to be modified for regain of function. In both types of neurotrauma, traumatic brain injury and spinal cord injury, the primary parasympathetic control to the gastrointestinal tract, the vagus nerve, remains anatomically intact. However, individuals with traumatic brain injury or spinal cord injury are highly susceptible to gastrointestinal dysfunctions. Such gastrointestinal dysfunctions attribute to higher morbidity and mortality following traumatic brain injury and spinal cord injury. While the vagal efferent output remains capable of eliciting motor responses following injury, evidence suggests impairment of the vagal afferents. Since sensory input drives motor output, this review will discuss the normal and altered anatomy and physiology of the gastrointestinal vagal afferents to better understand the contributions of vagal afferent plasticity following neurotrauma.
Collapse
Affiliation(s)
- Emily N Blanke
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Gregory M Holmes
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Emily M Besecker
- Department of Health Sciences, Gettysburg College, Gettysburg, PA, USA
| |
Collapse
|
32
|
Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Wilson C, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2021; 27:75-151. [PMID: 34108835 PMCID: PMC8152174 DOI: 10.46292/sci2702-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jeffery Johns
- Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | | | - Janice Eng
- University of British Columbia, Vancouver Canada
| | | | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas USA
| | | | | | | | - Catherine Wilson
- Diplomate, American Board of Professional Psychology (RP) Private Practice, Denver, Colorado
| | - Mark Korsten
- Icahn School of Medicine @ Mt Sinai, New York, New York USA
| |
Collapse
|
33
|
Cimino SR, Hitzig SL, Craven BC, Bassett-Gunter RL, Li J, Guilcher SJT. An exploration of perceived social isolation among persons with spinal cord injury in Ontario, Canada: a qualitative study. Disabil Rehabil 2020; 44:3400-3409. [PMID: 33356633 DOI: 10.1080/09638288.2020.1861485] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To advance the understanding of perceived social isolation among persons with spinal cord injury (SCI), the objectives of the present study were to explore: (1) experiences of perceived social isolation and (2) factors that contribute to perceived social isolation. METHODS Interpretive description qualitative methodology was used to conduct semi-structured interviews with 30 individuals with SCI from across Ontario (Canada) from November 2016 to August 2017. Data were analyzed using thematic analysis. RESULTS Participants identified disruption to social networks that seemed to impact perceived social isolation. Five major themes were identified: (1) impact on structure and frequency of social network; (2) importance of feeling heard; (3) importance of employment, hobbies, and sports; (4) need to improve physical accessibility and built environment; and (5) individual characteristics. Changes in quality of social networks, rather than size, contributed to greater feelings of perceived social isolation. The built environment, maintenance of employment, hobbies, and sports, social media, and technology use, as well as individual traits, were also found to impact perceived social isolation. CONCLUSION Future research should focus on the development of programs to help maintain or improve social network quality for persons with SCI to minimize the impact of perceived social isolation.IMPLICATIONS FOR REHABILITATIONPerceived social isolation, resulting from physical and environmental barriers, is a challenge that is faced by many individuals who are living in the community with a spinal cord injury (SCI).Rehabilitation and community programs should utilize an individualized approach to find solutions to challenges faced by this population to prevent the effects of perceived social isolation.Education on how to adapt to changes in social network, together with the provision of access to peer-to-peer support groups, and SCI specific return to work or leisure programs, is recommended as an essential component of rehabilitation.
Collapse
Affiliation(s)
- Stephanie R Cimino
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, Faculty of Medicine,, University of Toronto, Toronto, Canada
| | - B Catharine Craven
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Neural Engineering & Therapeutics Team, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Joyce Li
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| |
Collapse
|
34
|
Showen A, Copp HL, Allen IE, Baradaran N, Liaw A, Hampson LA. Characteristics Associated With Depression, Anxiety, and Social Isolation in Adults With Spina Bifida. Urology 2020; 149:255-262. [PMID: 33221413 DOI: 10.1016/j.urology.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify demographic and clinical characteristics associated with depression, anxiety, and social isolation among adults with spina bifida. We hypothesize that lower urinary tract dysfunction is associated with poor psychosocial outcomes. METHODS An anonymous survey was distributed via Facebook advertising to individuals with congenital urologic conditions. Adults with spina bifida were included in our analysis. Lower urinary tract dysfunction was assessed with the Neurogenic Bladder Symptom Score. Depression, anxiety, and social isolation T-scores were measured using Patient-Reported Outcome Measures Information System instruments. A composite depression-anxiety score was calculated. Separate adjusted linear models assessed the association between lower urinary tract dysfunction and depression, anxiety, composite depression-anxiety, and social isolation. RESULTS Around 195 participants were included. Rates of depression, anxiety, and social isolation were 48%, 47%, and 43%, respectively. Comorbid depression and anxiety occurred in 39% of subjects. On adjusted regression analysis, lower urinary tract dysfunction was associated with depression (P < 001), anxiety (P <.001), composite depression-anxiety (P <.001), and social isolation (P = .010). CONCLUSION Depression, anxiety, and social isolation are common in individuals with spina bifida relative to the general population, and associated with lower urinary tract dysfunction. Interventions focused on optimizing lower urinary tract symptoms and function, transition-age adults, group psychotherapy, and comorbid depression and anxiety may be of particular value in this population.
Collapse
Affiliation(s)
- Amy Showen
- Department of Pediatrics, University of California, San Francisco, CA
| | - Hillary L Copp
- Department of Urology, University of California, San Francisco, CA
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Aron Liaw
- Department of Urology, University of California, Irvine, CA
| | | |
Collapse
|
35
|
Sex, support and society: a journey to reclaiming sexuality for individuals living with paraplegia in Cape Town, South Africa. Spinal Cord 2020; 59:225-233. [PMID: 33051560 DOI: 10.1038/s41393-020-00558-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Qualitative descriptive study with inductive thematic content analysis. OBJECTIVES To explore how individuals living with paraplegia in South Africa experience sex and intimacy and how they perceive the related health services and support they received whilst adapting to life post injury. SETTING Community based in Cape Town, South Africa. METHODS Purposive and snowball sampling were combined to enrol ten individuals with paraplegia who were all users of the public health system and had been injured for more than 1 year. Semi-structured interviews were conducted, and data analysed using inductive thematic content analysis. RESULTS Four categories were derived and captured by the overarching theme of 'a journey to reclaiming sexuality', as depicted by each participant. Psychological consequences of the injury led to challenges with sex and intimacy including a strong emphasis on partner satisfaction. A perceived lack of support mechanisms particularly in relation to poor timing of health services and insufficient peer support led to a lack of understanding and difficulties adjusting to changes in sexual function. Meaningful relationships including elements of sex and/or intimacy were rediscovered following a re-adjustment period although participants often felt disabled by society as socio-cultural norms, such as gender concepts, influenced each individual journey. CONCLUSIONS Complex interactions between intrinsic psychological factors, such as low sexual self-esteem and external factors such as socio-cultural norms, affect sex and intimacy in individuals with paraplegia in this novel context. South Africa's health system should be strengthened to support optimal sexual outcomes of persons with a spinal cord injury.
Collapse
|
36
|
Welk B, Myers JB, Kennelly M, McKibbon M, Watson J, Gervais K. A qualitative assessment of psychosocial aspects that play a role in bladder management after spinal cord injury. Spinal Cord 2020; 59:978-986. [DOI: 10.1038/s41393-020-00538-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/09/2022]
|
37
|
Needs, priorities, and attitudes of individuals with spinal cord injury toward nerve stimulation devices for bladder and bowel function: a survey. Spinal Cord 2020; 58:1216-1226. [PMID: 32895475 PMCID: PMC7642195 DOI: 10.1038/s41393-020-00545-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 01/28/2023]
Abstract
Study Design: Survey. Objectives: To investigate the needs and priorities of people with spinal cord injury for managing neurogenic bladder and bowel function and to determine their willingness to adopt neuromodulation interventions for these functions. Methods: Anonymous online survey. It was advertised by word-of-mouth by community influencers and social media, and by advertisement in newsletters of advocacy groups. Results: Responses from 370 individuals (27% female, 73% male) were included. Bladder emptying without catheters was the top priority for restoring bladder function, and maintaining fecal continence was the top priority for restoring bowel function. The biggest concerns regarding external stimulation systems were wearing a device with wires connecting to electrodes on the skin and having to don and doff the system daily as needed. The biggest concerns for implanted systems were the chances of experiencing problems with the implant that required a revision surgery or surgical removal of the whole system. Respondents were willing to accept an external (61%) or implanted (41%) device to achieve improved bladder or bowel function. Conclusions: Bladder and bowel dysfunction remain important unmet challenges for individuals living with SCI who answered our survey. These individuals are willing to accept some potential risks of nerve stimulation approaches given potential benefits. Additional consumer input is critical for guiding both research and translation to clinical use and personalized medicine.
Collapse
|
38
|
Waddell O, McCombie A, Frizelle F. Colostomy and quality of life after spinal cord injury: systematic review. BJS Open 2020; 4:1054-1061. [PMID: 32852897 PMCID: PMC7709367 DOI: 10.1002/bjs5.50339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/07/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) has a significant impact on the quality of life (QoL) of affected patients. The aim of this review was to determine whether colostomy formation improves QoL in patients with SCI. METHODS The Cochrane Register, MEDLINE, Embase and CINAHL were searched using medical subject headings. The search was extended to the reference lists of identified studies, ClinicalTrials.gov and the WHO International Clinical Trials Registry. All clinical trials that included spinal injury and QoL, time spent on bowel care, and patient satisfaction with stoma were assessed. RESULTS A total of 15 studies were found (including 488 patients with a stoma), of which 13 were retrospective cross-sectional studies and two were case-control studies, one of which was prospective research. Nine of 11 studies focusing on QoL reported that patients' QoL was improved by the stoma, whereas the remaining two studies found no difference. Time spent on bowel care was significantly reduced in all 13 studies that considered this outcome, with patients reducing the average time spent on bowel care from more than 1 h to less than 15 min per day. All 12 studies assessing patient satisfaction with their stoma reported high patient satisfaction. CONCLUSION Stoma formation improves QoL, reduces time spent on bowel care, and increases independence. Stoma is an option that could be discussed and offered to patients with spinal cord injury.
Collapse
Affiliation(s)
- O. Waddell
- Department of SurgeryUniversity of Otago Christchurch2 Riccarton Avenue, Christchurch Central CityChristchurch8011New Zealand
| | - A. McCombie
- Department of SurgeryUniversity of Otago Christchurch2 Riccarton Avenue, Christchurch Central CityChristchurch8011New Zealand
| | - F. Frizelle
- Department of SurgeryUniversity of Otago Christchurch2 Riccarton Avenue, Christchurch Central CityChristchurch8011New Zealand
| |
Collapse
|
39
|
Chambel SS, Tavares I, Cruz CD. Chronic Pain After Spinal Cord Injury: Is There a Role for Neuron-Immune Dysregulation? Front Physiol 2020; 11:748. [PMID: 32733271 PMCID: PMC7359877 DOI: 10.3389/fphys.2020.00748] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating event with a tremendous impact in the life of the affected individual and family. Traumatic injuries related to motor vehicle accidents, falls, sports, and violence are the most common causes. The majority of spinal lesions is incomplete and occurs at cervical levels of the cord, causing a disruption of several ascending and descending neuronal pathways. Additionally, many patients develop chronic pain and describe it as burning, stabbing, shooting, or shocking and often arising with no stimulus. Less frequently, people with SCI also experience pain out of context with the stimulus (e.g., light touch). While abolishment of the endogenous descending inhibitory circuits is a recognized cause for chronic pain, an increasing number of studies suggest that uncontrolled release of pro- and anti-inflammatory mediators by neurons, glial, and immune cells is also important in the emergence and maintenance of SCI-induced chronic pain. This constitutes the topic of the present mini-review, which will focus on the importance of neuro-immune dysregulation for pain after SCI.
Collapse
Affiliation(s)
- Sílvia S Chambel
- Department of Biomedicine, Experimental Biology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,Translational NeuroUrology Group, Instituto de Investigação e Inovação em Saúde - i3S, Universidade do Porto, Porto, Portugal
| | - Isaura Tavares
- Department of Biomedicine, Experimental Biology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,Pain Research Group, Instituto de Investigação e Inovação em Saúde - i3S, Universidade do Porto, Porto, Portugal
| | - Célia D Cruz
- Department of Biomedicine, Experimental Biology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,Translational NeuroUrology Group, Instituto de Investigação e Inovação em Saúde - i3S, Universidade do Porto, Porto, Portugal
| |
Collapse
|
40
|
Non-invasive neuromodulation for bowel, bladder and sexual restoration following spinal cord injury: A systematic review. Clin Neurol Neurosurg 2020; 194:105822. [DOI: 10.1016/j.clineuro.2020.105822] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 01/30/2023]
|
41
|
Neurogenic Bowel: Traditional Approaches and Clinical Pearls. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
Murphy C, Laine C, Macaulay M, Fader M. Development and randomised controlled trial of a Continence Product Patient Decision Aid for men postradical prostatectomy. J Clin Nurs 2020; 29:2251-2259. [DOI: 10.1111/jocn.15223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Catherine Murphy
- School of Health Sciences University of Southampton Southampton UK
| | - Christine Laine
- School of Health Sciences University of Southampton Southampton UK
| | | | - Mandy Fader
- School of Health Sciences University of Southampton Southampton UK
| |
Collapse
|
43
|
Gater DR. Neurogenic bowel and bladder evaluation strategies in spinal cord injury: New directions. J Spinal Cord Med 2020; 43:139-140. [PMID: 32105585 PMCID: PMC7054921 DOI: 10.1080/10790268.2020.1718469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- David R. Gater
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA,Correspondence to: David R. Gater, Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, CRC 958, Miami, FL 33136.
| |
Collapse
|
44
|
Alexander M, Carr C, Alexander J, Chen Y, McLain A. Assessing the ability of the Sacral Autonomic Standards to document bladder and bowel function based upon the Asia Impairment Scale. Spinal Cord Ser Cases 2019; 5:85. [PMID: 31700683 PMCID: PMC6821794 DOI: 10.1038/s41394-019-0228-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 12/30/2022] Open
Abstract
Study design Retrospective review of data. Objective To determine if there is a relationship between the Asia Impairment Scale (AIS) and the bladder and bowel components of the International Standards to Document Remaining Autonomic Function after SCI (ISAFSCI). Setting University-Based Academic Rehabilitation Program. Methods Retrospective cross-sectional study assessing International Standards for Neurologic Classification After SCI (ISNCSCI) examination along with bladder and bowel components of the ISAFSCI. Results Subjects with AIS A injuries were statistically less likely to have history of bladder control and bowel control per investigator determination and bladder sensation via self-report versus patients categorized with AIS B injuries. Self-reported history of bowel sensation and control of voiding were more likely in subjects with C, D, or E injuries than with B injuries. Bowel and bladder control as determined by investigator and bladder and bowel sensation and control as self-reported were all statistically less likely in persons with AIS A injuries versus CDE. Conclusions This retrospective study provides initial data regarding components of the bladder and bowel sections of the sacral ISAFSCI and AIS. Further prospective research is needed to further characterize the relationship between retention of bladder and bowel sensation and function and the AIS. We suggest that incorporation of the sacral components of the ISAFSCI into the ISNCSCI may be beneficial to obtain further information about retention of sacral function with specific patterns of injury.
Collapse
Affiliation(s)
- Marca Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | - Conley Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | | | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | - Amie McLain
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| |
Collapse
|
45
|
Optimal Bladder Management Following Spinal Cord Injury: Evidence, Practice and a Cooperative Approach Driving Future Directions in Australia. Arch Phys Med Rehabil 2018; 99:2118-2121. [DOI: 10.1016/j.apmr.2018.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/20/2022]
|
46
|
Abstract
PURPOSE OF REVIEW To evaluate and report current evidence regarding the management of bowel dysfunction in spinal cord injury. There is a paucity of high-quality large studies on which to base management advice. RECENT FINDINGS Recent research has focused on defining the nature of symptomatology of bowel dysfunction in SCI and describing the effects on quality of life and social interactions. Technical aspects of colonoscopy have received attention, and aspects of understanding the pathophysiology in relation to both neural and non-neural dysfunction have been studied. There has been refinement and expansion of the pharmacological and non-pharmacological treatment options for bowel dysfunction in SCI. Management of bowel dysfunction in SCI requires a comprehensive and individualized approach, encompassing lifestyle, toileting routine, stimulation, diet, medications, and surgery. Further high-quality research is required to inform best practice.
Collapse
Affiliation(s)
- Zhengyan Qi
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- The University of Sydney, Sydney, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Kolling Institute of Medical Research, Level 12, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Allison Malcolm
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- The University of Sydney, Sydney, Australia.
| |
Collapse
|
47
|
Wheeler TL, de Groat W, Eisner K, Emmanuel A, French J, Grill W, Kennelly MJ, Krassioukov A, Gallo Santacruz B, Biering-Sørensen F, Kleitman N. Translating promising strategies for bowel and bladder management in spinal cord injury. Exp Neurol 2018; 306:169-176. [PMID: 29753647 PMCID: PMC8117184 DOI: 10.1016/j.expneurol.2018.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 12/18/2022]
Abstract
Loss of control over voiding following spinal cord injury (SCI) impacts autonomy, participation and dignity, and can cause life-threatening complications. The importance of SCI bowel and bladder dysfunction warrants significantly more attention from researchers in the field. To address this gap, key SCI clinicians, researchers, government and private funding organizations met to share knowledge and examine emerging approaches. This report reviews recommendations from this effort to identify and prioritize near-term treatment, investigational and translational approaches to addressing the pressing needs of people with SCI.
Collapse
Affiliation(s)
- Tracey L Wheeler
- Craig H. Neilsen Foundation, 16830 Ventura Blvd, Suite 352, Encino, CA 91436, United States.
| | - William de Groat
- University of Pittsburgh, Department of Pharmacology and Chemical Biology, W-1352 Starzl Biomedical Science Tower, University of Pittsburgh Medical School, 200 Lothrop Street, Pittsburgh, PA 15261, United States.
| | - Kymberly Eisner
- Craig H. Neilsen Foundation, 16830 Ventura Blvd, Suite 352, Encino, CA 91436, United States
| | - Anton Emmanuel
- GI Physiology Unit, University College Hospital, London NW1 2BU, UK.
| | - Jennifer French
- Neurotech Network, PO Box 16776, Saint Petersburg, FL 33733, United States.
| | - Warren Grill
- Duke University, Department of Biomedical Engineering, Fitzpatrick CIEMAS, Room 1427, Box 90281, Durham, NC 27708-0281, United States.
| | - Michael J Kennelly
- Carolinas HealthCare System, McKay Urology, 1023 Edgehill Road South, Charlotte, NC 28207, United States.
| | - Andrei Krassioukov
- ICORD, University of British Columbia, GF Strong Rehabilitation Centre, 818 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | | | - Fin Biering-Sørensen
- Rigshospitalet (2081), Blegdamsvej 9, DK-2100 Copenhagen, Denmark; University of Copenhagen, Clinic for Spinal Cord Injuries, NeuroScience Centre Havnevej 25, DK-3100 Hornbæk, Denmark
| | - Naomi Kleitman
- Craig H. Neilsen Foundation, 16830 Ventura Blvd, Suite 352, Encino, CA 91436, United States
| |
Collapse
|
48
|
Cobb JE, Leblond J, Dumont FS, Noreau L. Perceived influence of intrinsic/extrinsic factors on participation in life activities after spinal cord injury. Disabil Health J 2018; 11:583-590. [PMID: 29650349 DOI: 10.1016/j.dhjo.2018.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/01/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Various types of limitations on community participation are experienced by people with spinal cord injury (SCI). OBJECTIVES To determine: 1) the perceived influence of six intrinsic/extrinsic factors (i.e. physical impairment, emotional condition, thinking skills, environment, lack of assistance, discrimination) on participation in 26 life activities, 2) if this influence varied based on extent of participation, and 3) if personal or environmental characteristics influenced perceptions. METHODS Secondary analysis of a cohort (SCI Community Survey, n = 1508) using the SCI Person-Perceived Participation in Daily Activities Questionnaire. Frequency tables, Fisher's exact tests and correspondence analyses. RESULTS Respectively, 79.6% and 38.5% of respondents perceived that their physical impairment and the natural and/or built environment were the main factors that limited participation across all activities. Considering participation between three groups (no participation; less than wanted; as much as wanted), significant differences (p < 0.001) of perceptions were observed in 65% of the combinations (26 activities x 6 factors). The hypothesis that respondents who did not participate would perceive the highest proportion of limitations was confirmed in 41% of the combinations. Perceived influence of the intrinsic/extrinsic factors on participation was not significantly influenced by other personal or environmental characteristics. CONCLUSION A majority of people with SCI perceived that their participation is limited by one or more of intrinsic/extrinsic factors. Perceptions regarding which factors influence participation differ between activities and these perceptions appear related to the extent of participation suggesting that those who actively participate could be the most sensitive to limitations in certain activities.
Collapse
Affiliation(s)
- John E Cobb
- Vancouver General Hospital, 899 W 12th Ave, Vancouver, V5Z 1M9, British Columbia, Canada.
| | - Jean Leblond
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, 525 blv. Wilfrid-Hamel, Quebec City, Quebec, G1M 2S8, Canada.
| | - Frédéric S Dumont
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, 525 blv. Wilfrid-Hamel, Quebec City, Quebec, G1M 2S8, Canada.
| | - Luc Noreau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, 525 blv. Wilfrid-Hamel, Quebec City, Quebec, G1M 2S8, Canada; Department of Rehabilitation, Université Laval, 2325 Rue de l'Université, Quebec City, Quebec, G1V 0A6, Canada.
| |
Collapse
|
49
|
Neural pathways for colorectal control, relevance to spinal cord injury and treatment: a narrative review. Spinal Cord 2017; 56:199-205. [PMID: 29142293 DOI: 10.1038/s41393-017-0026-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN Narrative review. OBJECTIVES The purpose is to review the organisation of the nerve pathways that control defecation and to relate this knowledge to the deficits in colorectal function after SCI. METHODS A literature review was conducted to identify salient features of defecation control pathways and the functional consequences of damage to these pathways in SCI. RESULTS The control pathways for defecation have separate pontine centres under cortical control that influence defecation. The pontine centres connect, separately, with autonomic preganglionic neurons of the spinal defecation centres and somatic motor neurons of Onuf's nucleus in the sacral spinal cord. Organised propulsive motor patterns can be generated by stimulation of the spinal defecation centres. Activation of the somatic neurons contracts the external sphincter. The analysis aids in interpreting the consequences of SCI and predicts therapeutic strategies. CONCLUSIONS Analysis of the bowel control circuits identifies sites at which bowel function may be modulated after SCI. Colokinetic drugs that elicit propulsive contractions of the colorectum may provide valuable augmentation of non-pharmacological bowel management procedures.
Collapse
|