1
|
Shavelle RM, DeVivo M, Brooks JC, Strauss DJ. Update on the long-term survival of persons who are ventilator dependent after spinal cord injury. J Spinal Cord Med 2024; 47:459-460. [PMID: 36260484 PMCID: PMC11044744 DOI: 10.1080/10790268.2022.2118489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
| | - Michael DeVivo
- Spain Rehabilitation Center, University of Alabama, Birmingham
| | | | | |
Collapse
|
2
|
Bødker C, Riisbøl MF, Khan BYA, Hansen RM, Severinsen KE. Urologic surveillance of persons with spinal cord injuries - a scoping review. Spinal Cord 2024; 62:91-98. [PMID: 38182679 DOI: 10.1038/s41393-023-00955-6] [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: 10/30/2022] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
STUDY DESIGN Scoping review - standardized according to the Equator-network and the Prisma-Statement guidelines with PRISMA-ScR. OBJECTIVES Review the literature concerning surveillance of the urinary- and renal systems in persons with spinal cord injuries (SCI). Specifically, to assess: #1 the usability of non-invasive and non-ultrasound methods, #2 the usage of systematic ultrasound surveillance #3 patient characteristics which predispose to urinary tract abnormalities (UTA) or renal function deterioration. METHODS The literature assessed was collected from PubMed by creating a search string comprised of three main phrases: #1 persons with SCI, #2 kidney function and #3 surveillance program. The final search resulted in 685 studies. Eligibility criteria were defined prior to the search to assess the studies systematically. RESULTS Four studies found serum cystatin C (s-cysC) to be accurate in estimating the glomerular filtration rate in persons with SCI. One study found no difference in UTA between surveillance adherent and surveillance non-adherent persons up to 30 years post injury. UTA and especially renal function deterioration seems rare the first 15 years post-injury. Non-traumatic SCI, time since injury, high detrusor pressure, upper urinary tract dilation, vesicourethral reflux, trabeculated bladder, history of calculi removal are significant risk factors for developing UTA or renal function deterioration. CONCLUSION Measurements of S-cysC should be considered to replace serum creatinine in most cases. Surveillance non-adherent persons are not at higher risk of developing UTA. A selective surveillance based on a baseline risk profile may be beneficial for patients and caretakers.
Collapse
Affiliation(s)
| | - Maja F Riisbøl
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
| | | | - Rikke M Hansen
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
| | | |
Collapse
|
3
|
Galehdar N, Heydari H. Explaining the challenges of Iranian caregivers in provision of home health care to spinal cord injury patients: a qualitative study. BMC Nurs 2024; 23:142. [PMID: 38419004 PMCID: PMC10903105 DOI: 10.1186/s12912-024-01797-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The incidence of spinal cord injury (SCI) is increasing across the globe. The caregivers of patients with spinal cord injuries experience many problems during providing care to these patients. Identifying the problems experienced by caregivers can facilitate the process of care provision to these patients. So, the aim of this study was to explore the challenges of caregivers in provision of home health care to SCI patients. METHODS This study was conducted by qualitative description approach in Iran from Apr 2021 to Dec 2022. The participants included the caregivers of SCI patients recruited by purposive sampling. The data were collected by face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. RESULTS Two themes emerged from the data analysis, including burnout (with the categories of physical challenge and psychological challenges) and coping strategies (with the categories of social support and professional support). CONCLUSION Resolving the obstacles and problems faced by home caregivers can improve the circumstances of care provision so that they can be relieved of their own physical and psychological conundrums and deliver suitable home care to SCI patients. TRIAL REGISTRATION NUMBER Not applicable.
Collapse
Affiliation(s)
- Nasrin Galehdar
- Social Determinates of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Heshmatolah Heydari
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
- French Institute of Research and High Education (IFRES-INT), Paris, France.
| |
Collapse
|
4
|
Izzy S. Traumatic Spinal Cord Injury. Continuum (Minneap Minn) 2024; 30:53-72. [PMID: 38330472 PMCID: PMC10869103 DOI: 10.1212/con.0000000000001392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article provides a review of the initial clinical and radiologic evaluation and treatment of patients with traumatic spinal cord injuries. It specifically highlights essential knowledge for neurologists who encounter patients with these complex injuries. LATEST DEVELOPMENTS There has been improvement in the care of patients with traumatic spinal cord injuries, particularly in the prehospital evaluation, approach for immediate immobilization, standardized spinal clearance, efficient triage, and transportation of appropriate patients to traumatic spinal cord injury specialized centers. Advancements in spinal instrumentation have improved the surgical management of spinal fractures and the ability to manage patients with spinal mechanical instability. The clinical evidence favors performing early surgical decompression and spine stabilization within 24 hours of traumatic spinal cord injuries, regardless of the severity or location of the injury. There is no evidence that supports the use of neuroprotective treatments to improve outcomes in patients with traumatic spinal cord injuries. The administration of high-dose methylprednisolone, which is associated with significant systemic adverse effects, is strongly discouraged. Early and delayed mortality rates continue to be high in patients with traumatic spinal cord injuries, and survivors often confront substantial long-term physical and functional impairments. Whereas the exploration of neuroregenerative approaches, such as stem cell transplantation, is underway, these methods remain largely investigational. Further research is still necessary to advance the functional recovery of patients with traumatic spinal cord injuries. ESSENTIAL POINTS Traumatic spinal cord injury is a complex and devastating condition that leads to long-term neurologic deficits with profound physical, social, and vocational implications, resulting in a diminished quality of life, particularly for severely affected patients. The initial management of traumatic spinal cord injuries demands comprehensive interdisciplinary care to address the potentially catastrophic multisystem effects. Ongoing endeavors are focused on optimizing and customizing initial management approaches and developing effective therapies for neuroprotection and neuroregeneration to enhance long-term functional recovery.
Collapse
|
5
|
Duff J, Ellis R, Kaiser S, Grant LC. Psychological Screening, Standards and Spinal Cord Injury: Introducing Change in NHS England Commissioned Services. J Clin Med 2023; 12:7667. [PMID: 38137735 PMCID: PMC10743880 DOI: 10.3390/jcm12247667] [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: 10/30/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Psychologist resourcing across the United Kingdom (UK) spinal cord injury centres (SCICs) varies considerably, which has detrimentally impacted standardising service provision for people with spinal cord injuries/disorders (PwSCI/D) compared with other nations. This paper presents the outcome of a project involving the Spinal Cord Injury Psychology Advisory Group (SCIPAG) and NHS England Clinical Reference Group/SCI transformation groups to agree upon screening and standards and shares data from the National Spinal Injuries Centre (NSIC) and the Yorkshire and Midlands Regional SCICs. Inpatients completed the GAD-7, the PHQ-9, and the short form of the Appraisals of DisAbility: Primary and Secondary Scale (ADAPSSsf), assessing adjustment. A total of 646 participants were included, with 43% scoring above the clinical threshold on at least one of the measures on admission. A subset of 272 participants also completed discharge measures and 42% remained above the threshold on discharge, demonstrating sustained psychological need. This paper provides support for services to move to a screen-and-assessment model supplemented by referral options for those with changing needs or who present with difficulties outside the remit of screening. The findings also support the efficacy of universal screening across the system and consideration of screening and standards for psychological care by the wider psychology community.
Collapse
Affiliation(s)
- Jane Duff
- Department of Clinical Psychology, National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury HP21 8AL, UK
| | - Rebecca Ellis
- Department of Clinical Health Psychology, Yorkshire Regional Spinal Injuries Centre, Mid Yorkshire NHS Trust, Wakefield WF1 4DG, UK;
| | - Sally Kaiser
- Department of Clinical Psychology, Midlands Centre for Spinal Injuries, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK;
| | - Lucy C Grant
- Department of Clinical Psychology, National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury HP21 8AL, UK
| |
Collapse
|
6
|
Zheng X, Liu Z, He Z, Xu J, Wang Y, Gong C, Zhang R, Zhang SC, Chen H, Wang W. Preclinical long-term safety of intraspinal transplantation of human dorsal spinal GABA neural progenitor cells. iScience 2023; 26:108306. [PMID: 38026209 PMCID: PMC10661464 DOI: 10.1016/j.isci.2023.108306] [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: 08/10/2023] [Revised: 09/28/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Human pluripotent stem cell (hPSC)-derived neurons have shown promise in treating spinal cord injury (SCI). We previously showed that hPSC-derived dorsal spinal γ-aminobutyric acid (GABA) neurons can alleviate spasticity and promote locomotion in rats with SCI, but their long-term safety remains elusive. Here, we characterized the long-term fate and safety of human dorsal spinal GABA neural progenitor cells (NPCs) in naive rats over one year. All grafted NPCs had undergone differentiation, yielding mainly neurons and astrocytes. Fully mature human neurons grew many axons and formed numerous synapses with rat neural circuits, together with mature human astrocytes that structurally integrated into the rat spinal cord. The sensorimotor function of rats was not impaired by intraspinal transplantation, even when human neurons were activated or inhibited by designer receptors exclusively activated by designer drugs (DREADDs). These findings represent a significant step toward the clinical translation of human spinal neuron transplantation for treating SCI.
Collapse
Affiliation(s)
- Xiaolong Zheng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhixian Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ziyu He
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jia Xu
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Stem Cell Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - YaNan Wang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - ChenZi Gong
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ruoying Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Su-Chun Zhang
- Waisman Center, Department of Neuroscience and Department of Neurology, University of Wisconsin, Madison, WI, USA
- Program in Neuroscience & Behavioral Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Hong Chen
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Stem Cell Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan 430030, China
- Key Laboratory of Neurological Diseases of Chinese Ministry of Education, the School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| |
Collapse
|
7
|
Safdarian M, Trinka E, Rahimi-Movaghar V, Thomschewski A, Aali A, Abady GG, Abate SM, Abd-Allah F, Abedi A, Adane DE, Afzal S, Ahinkorah BO, Ahmad S, Ahmed H, Amanat N, Angappan D, Arabloo J, Aryannejad A, Athari SS, Atreya A, Azadnajafabad S, Azzam AY, Babamohamadi H, Banik PC, Bardhan M, Bashiri A, Berhie AY, Bhat AN, Brown J, Champs AP, Charalampous P, Chukwu IS, Coberly K, Dadras O, Yada DY, Dai X, Dandona L, Dandona R, Dessalegn FN, Desta AA, Dhingra S, Diao N, Diaz D, Dibas M, Dongarwar D, Dsouza HL, Ekholuenetale M, El Nahas N, Elhadi M, Eskandarieh S, Fagbamigbe AF, Fares J, Fatehizadeh A, Fereshtehnejad SM, Fischer F, Franklin RC, Garg T, Getachew M, Ghaffarpasand F, Gholamrezanezhad A, Gholizadeh Mesgarha M, Ghozy S, Golechha M, Goleij P, Graham SM, Gupta VK, Haagsma JA, Hamidi S, Harlianto NI, Harorani M, Hasanian M, Hassan A, Hassen MB, Hoveidaei AH, Iravanpour F, Irilouzadian R, Iwu CCD, Jacob L, Jaja CJ, Joseph N, Joshua CE, Jozwiak JJ, Kadashetti V, Kandel A, Kantar RS, Karaye IM, Karkhah S, Khader YS, Khan EA, Khan MJ, Khayat Kashani HR, Khonji MS, Khormali M, Kim G, Krishnamoorthy V, Kumaran SD, Malekpour MR, Meretoja TJ, Mesregah MK, Mestrovic T, Micheletti Gomide Nogueira de Sá AC, Miller TR, Mirahmadi A, Mirghaderi SP, Mirza M, Misganaw A, Misra S, Mohammad Y, Mohammadi E, Mokdad AH, Möller H, Momtazmanesh S, Moni MA, Mostafavi E, Mulita F, Naghavi M, Nassereldine H, Natto ZS, Nejati K, Nguyen HLT, Nguyen VT, Nogueira de Sá AT, Olagunju AT, Olufadewa II, Omotayo AO, Owolabi MO, Patil S, Pawar S, Pedersini P, Petcu IR, Polinder S, Pourbagher-Shahri AM, Qureshi MF, Raghav PR, Rahman M, Rahnavard N, Rajabpour-Sanati A, Rashidi MM, Rawaf S, Roberts NLS, Saddik B, Saeed U, Samadzadeh S, Samy AM, Sarveazad A, Seylani A, Shafie M, Shahbandi A, Sharew MMS, Sheikhi RA, Shetty PH, Yigit A, Shobeiri P, Shool S, Shorofi SA, Sibhat MM, Sinaei E, Singh P, Singh S, Solomon Y, Sotoudeh H, Tadesse BA, Umair M, Valadan Tahbaz S, Valdez PR, Venketasubramanian N, Vu LG, Wickramasinghe ND, Zare I, Yazdanpanah F, Wu AM, Zhang ZJ. Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2023; 22:1026-1047. [PMID: 37863591 PMCID: PMC10584692 DOI: 10.1016/s1474-4422(23)00287-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) is a major cause of health loss due to premature mortality and long-term disability. We aimed to report on the global, regional, and national incidence, prevalence, and years of life lived with disability (YLDs) for SCI from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS Using GBD 2019 data pooled in DisMod-MR 2.1, a Bayesian meta-regression tool, we systematically derived numbers and age-standardised rate changes with 95% uncertainty intervals (95% UIs) for the incidence, prevalence, and YLDs for SCI from 1990 to 2019 for the whole world, 21 GBD regions, and 204 countries and territories. We report trends based on age, sex, year, cause of injury, and level of injury. FINDINGS Globally, 20·6 million (95% UI 18·9 to 23·6) individuals were living with SCI in 2019. The incidence of SCI was 0·9 million (0·7 to 1·2) cases with an estimated 6·2 million (4·5 to 8·2) YLDs. SCI rates increased substantially from 1990 to 2019 for global prevalence (81·5%, 74·2 to 87·1), incidence (52·7%, 30·3 to 69·8), and YLDs (65·4%, 56·3 to 76·0). However, global age-standardised rates per 100 000 population showed small changes in prevalence (5·8%, 2·6 to 9·5), incidence (-6·1%, -17·2 to 1·5), and YLDs (-1·5%, -5·5 to 3·2). Data for 2019 shows that the incidence of SCI increases sharply until age 15-19 years, where it remains reasonably constant until 85 years of age and older. By contrast, prevalence and YLDs showed similar patterns to each other, with one peak at around age 45-54 years. The incidence, prevalence, and YLDs of SCI have consistently been higher in men than in women globally, with a slight and steady increase for both men and women from 1990 to 2019. Between 1990 and 2019, SCI at neck level was more common than SCI below neck level in terms of incidence (492 thousand [354 to 675] vs 417 thousand [290 to 585]), prevalence (10·8 million [9·5 to 13·9] vs 9·7 million [9·2 to 10·4]), and YLDs (4·2 million [3·0 to 5·8] vs 1·9 million [1·3 to 2·5]). Falls (477 thousand [327 to 683] cases) and road injuries (230 thousand [122 to 389] cases) were the two leading causes of SCI globally in 2019. INTERPRETATION Although age-standardised rates of incidence, prevalence, and YLDs for SCI changed only slightly, absolute counts increased substantially from 1990 to 2019. Geographical heterogeneity in demographic, spatial, and temporal patterns of SCI, at both the national and regional levels, should be considered by policy makers aiming to reduce the burden of SCI. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
8
|
Rybachuk O, Nesterenko Y, Pinet É, Medvediev V, Yaminsky Y, Tsymbaliuk V. Neuronal differentiation and inhibition of glial differentiation of murine neural stem cells by pHPMA hydrogel for the repair of injured spinal cord. Exp Neurol 2023; 368:114497. [PMID: 37517459 DOI: 10.1016/j.expneurol.2023.114497] [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: 03/15/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023]
Abstract
Currently, several therapeutic methods of treating the effects of spinal cord injury (SCI) are being considered. On the one hand, transplantation of stem cells (SCs), in particular, neural stem/progenitor cells (NSPCs), is promising, as these cells have the potential to differentiate into nervous tissue cells, able to enhance endogenous regeneration and prevent the development of inflammatory processes. On the other hand, it is quite promising to replace the damaged nervous tissue with synthetic matrices, in particular hydrogels, which can create artificial conditions for the regenerative growth of injured nerve fibers through the spinal cord injury area, i.e. stimulate and support axonal regeneration and myelination. In this work, we combined both of these novel approaches by populating (injecting or rehydrating) a heteroporous pHPMA hydrogel (NeuroGel) with murine hippocampal NSPCs. Being inside the hydrogel (10 days of cultivation), NSPCs were more differentiated into neurons: 19.48% ± 1.71% (the NSPCs injection into the hydrogel) and 36.49% ± 4.20% (the hydrogel rehydration in the NSPCs suspension); in control cultures, the level of differentiation in neurons was only 2.40% ± 0.31%. Differentiation of NSPCs into glial cells, in particular into oligodendrocyte progenitor cells, was also observed - 8.89% ± 2.15% and 6.21% ± 0.80% for injection and rehydration variants, respectively; in control - 28.75% ± 2.08%. In the control NSPCs culture, there was a small number of astrocytes - 2.11% ± 0.43%. Inside the hydrogel, NSPCs differentiation in astrocytes was not observed. In vitro data showed that the hydrogel promotes the differentiation of NSPCs into neurons, and inhibits the differentiation into glial cells. And in vivo showed post-traumatic recovery of rat spinal cord tissue after injury followed by implantation of the hydrogel+NSPCs complex (approximately 7 months after SCI). The implant area was closely connected with the recipient tissue, and the recipient cells freely grew into the implant itself. Inside the implant, a formed dense neuronal network was visible. In summary, the results are primarily an experimental ground for further studies of implants based on pHPMA hydrogel with populated different origin SCs, and the data also indicate the feasibility and efficiency of using an integrated approach to reduce possible negative side effects and facilitate the rehabilitation process after a SCI.
Collapse
Affiliation(s)
- Oksana Rybachuk
- Bogomoletz Institute of Physiology NAS of Ukraine, Kyiv 01601, Ukraine; State Institution National Scientific Center the M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine, NAMS of Ukraine, Kyiv 03680, Ukraine.
| | - Yuliia Nesterenko
- Bogomoletz Institute of Physiology NAS of Ukraine, Kyiv 01601, Ukraine
| | | | - Volodymyr Medvediev
- Bogomoletz Institute of Physiology NAS of Ukraine, Kyiv 01601, Ukraine; Bogomolets National Medical University, Kyiv 01601, Ukraine
| | - Yurii Yaminsky
- State Institution "Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine", Kyiv 04050, Ukraine
| | - Vitaliy Tsymbaliuk
- Bogomolets National Medical University, Kyiv 01601, Ukraine; State Institution "Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine", Kyiv 04050, Ukraine
| |
Collapse
|
9
|
Rau Y, Thietje R, Matrisch L, Hirschfeld S. Anterior Fusion and Long-Term Cervical Mobility in Patients With Traumatic Spinal Cord Injury: An Observational Study. Cureus 2023; 15:e45549. [PMID: 37868381 PMCID: PMC10586349 DOI: 10.7759/cureus.45549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Objective This study aims to determine and quantify the impairment of cervical mobility and range of motion in patients with traumatic spinal cord injury (SCI) and subsequent cervical subaxial fusion surgery. Methods A total of 89 patients who underwent interbody fusion of the cervical spine and were admitted to the Spinal Cord Injury Center of the BG Klinikum Hamburg, Germany between 2003 and 2018 were examined after their in-facility rehabilitation was successfully completed. Reclination, inclination, tilt, and rotation of the cervical spine were examined and documented in addition to overall patient characteristics and fusion extent. Results We could identify fusion length and age to be independently negatively correlated with the cervical range of motion in different degrees of movement. We could also show a significant decrease in cervical mobility within our patients when compared to healthy adults. The ability to tilt and rotate the cervical spine was particularly impaired. Conclusions Patients with traumatic SCI and intervertebral fusion suffer from significant impairment of mobility in different degrees of movement. This knowledge can be used to evaluate the rehabilitative challenges and reintegrative needs of individuals after traumatic SCI. Rehabilitation should be adjusted accordingly.
Collapse
Affiliation(s)
- Yannick Rau
- Arbeitsgruppe (AG) Forschung (Working Group Research), University of Lübeck, Lübeck, DEU
| | - Roland Thietje
- Spinal Cord Injury Center, BG Klinikum Hamburg, Hamburg, DEU
| | - Ludwig Matrisch
- Arbeitsgruppe (AG) Forschung (Working Group Research), University of Lübeck, Lübeck, DEU
| | - Sven Hirschfeld
- Spinal Cord Injury Center, BG Klinikum Hamburg, Hamburg, DEU
| |
Collapse
|
10
|
Li Y, Khan N, Ritzel RM, Lei Z, Allen S, Faden AI, Wu J. Sexually dimorphic extracellular vesicle responses after chronic spinal cord injury are associated with neuroinflammation and neurodegeneration in the aged brain. J Neuroinflammation 2023; 20:197. [PMID: 37653491 PMCID: PMC10469550 DOI: 10.1186/s12974-023-02881-z] [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: 05/04/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Medical advances have made it increasingly possible for spinal cord injury (SCI) survivors to survive decades after the insult. But how SCI affects aging changes and aging impacts the injury process have received limited attention. Extracellular vesicles (EVs) are recognized as critical mediators of neuroinflammation after CNS injury, including at a distance from the lesion site. We have previously shown that SCI in young male mice leads to robust changes in plasma EV count and microRNA (miR) content. Here, our goal was to investigate the impact of biological sex and aging on EVs and brain after SCI. METHODS Young adult age-matched male and female C57BL/6 mice were subjected to SCI. At 19 months post-injury, total plasma EVs were isolated by ultracentrifugation and characterized by nanoparticle tracking analysis (NTA). EVs miR cargo was examined using the Fireplex® assay. The transcriptional changes in the brain were assessed by a NanoString nCounter Neuropathology panel and validated by Western blot (WB) and flow cytometry (FC). A battery of behavioral tests was performed for assessment of neurological function. RESULTS Transcriptomic changes showed a high number of changes between sham and those with SCI. Sex-specific changes were found in transcription networks related to disease association, activated microglia, and vesicle trafficking. FC showed higher microglia and myeloid counts in the injured tissue of SCI/Female compared to their male counterparts, along with higher microglial production of ROS in both injured site and the brain. In the latter, increased levels of TNF and mitochondrial membrane potential were seen in microglia from SCI/Female. WB and NTA revealed that EV markers are elevated in the plasma of SCI/Male. Particle concentration in the cortex increased after injury, with SCI/Female showing higher counts than SCI/Male. EVs cargo analysis revealed changes in miR content related to injury and sex. Behavioral testing confirmed impairment of cognition and depression at chronic time points after SCI in both sexes, without significant differences between males and females. CONCLUSIONS Our study is the first to show sexually dimorphic changes in brain after very long-term SCI and supports a potential sex-dependent EV-mediated mechanism that contributes to SCI-induced brain changes.
Collapse
Affiliation(s)
- Yun Li
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, 685 W. Baltimore Street, MSTF, Room 6-034D, Baltimore, MD, 21201, USA
| | - Niaz Khan
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, 685 W. Baltimore Street, MSTF, Room 6-034D, Baltimore, MD, 21201, USA
| | - Rodney M Ritzel
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, 685 W. Baltimore Street, MSTF, Room 6-034D, Baltimore, MD, 21201, USA
| | - Zhuofan Lei
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, 685 W. Baltimore Street, MSTF, Room 6-034D, Baltimore, MD, 21201, USA
| | - Samantha Allen
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, 685 W. Baltimore Street, MSTF, Room 6-034D, Baltimore, MD, 21201, USA
| | - Alan I Faden
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, 685 W. Baltimore Street, MSTF, Room 6-034D, Baltimore, MD, 21201, USA
| | - Junfang Wu
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research (STAR), University of Maryland School of Medicine, 685 W. Baltimore Street, MSTF, Room 6-034D, Baltimore, MD, 21201, USA.
| |
Collapse
|
11
|
Thorogood NP, Noonan VK, Chen X, Fallah N, Humphreys S, Dea N, Kwon BK, Dvorak MF. Incidence and prevalence of traumatic spinal cord injury in Canada using health administrative data. Front Neurol 2023; 14:1201025. [PMID: 37554392 PMCID: PMC10406385 DOI: 10.3389/fneur.2023.1201025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/09/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Incidence and prevalence data are needed for the planning, funding, delivery and evaluation of injury prevention and health care programs. The objective of this study was to estimate the Canadian traumatic spinal cord injury (TSCI) incidence, prevalence and trends over time using national-level health administrative data. METHODS ICD-10 CA codes were used to identify the cases for the hospital admission and discharge incidence rates of TSCI in Canada from 2005 to 2016. Provincial estimates were calculated using the location of the admitting facility. Age and sex-specific incidence rates were set to the 2015/2016 rates for the 2017 to 2019 estimates. Annual incidence rates were used as input for the prevalence model that applied annual survivorship rates derived from life expectancy data. RESULTS For 2019, it was estimated that there were 1,199 cases (32.0 per million) of TSCI admitted to hospitals, with 123 (10% of admissions) in-hospital deaths and 1,076 people with TSCI (28.7 per million) were discharged in Canada. The estimated number of people living with TSCI was 30,239 (804/million); 15,533 (52%) with paraplegia and 14,706 (48%) with tetraplegia. Trends included an increase in the number of people injured each year from 874 to 1,199 incident cases (37%), an older average age at injury rising from 46.6 years to 54.3 years and a larger proportion over the age of 65 changing from 22 to 38%, during the 15-year time frame. CONCLUSION This study provides a standard method for calculating the incidence and prevalence of TSCI in Canada using national-level health administrative data. The estimates are conservative based on the limitations of the data but represent a large Canadian sample over 15 years, which highlight national trends. An increasing number of TSCI cases among the elderly population due to falls reported in this study can inform health care planning, prevention strategies, and future research.
Collapse
Affiliation(s)
| | | | - Xiaozhi Chen
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Nicolas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada
| | - Brian K. Kwon
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Marcel F. Dvorak
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
12
|
Looby A, Davies H, Mealing S, Smith AB, Avey B, Laezza A, Crossland A, Lane EF, Ridler M, Cawson M. Time trade-off study to establish utility decrements in individuals with a spinal cord injury who perform intermittent catheterisation. J Med Econ 2023; 26:430-440. [PMID: 36892952 DOI: 10.1080/13696998.2023.2189395] [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: 03/10/2023]
Abstract
AIMS To generate utility decrements for three attributes associated with catheterisation for individuals with a spinal cord injury (SCI): the process of catheterisation, the physical impact of urinary tract infections (UTIs) and worry associated with hospitalisation. MATERIALS AND METHODS Health state vignettes comprising various levels of the three attributes were developed. Two cohorts of respondents, corresponding to people with SCIs and a sample broadly representative of the UK population, were presented with nine vignettes (three vignettes for the mild, moderate and severe health states in addition to a random set of six vignettes). It was assumed no or a nominal decrement was associated with the mild health state. Utility decrements were derived from analysing the data obtained from the online time trade-off (TTO). A proportion of the SCI cohort (n = 57) also completed the EQ-5D-5L questionnaire. RESULTS Utility decrements were generated using statistical models for the general population (n = 358), the SCI population (n = 48) and the two populations combined (merged model, n = 406). Results from the two cohorts showed minimal differences. For the merged model, SCI status was not statistically significant. All interaction terms, excluding SCI and the severe level of the physical attribute, were not statistically significant. Compared to the mild level, the greatest utility decrement calculated was the severe level of the emotional (worry) attribute (0.09, p < 0.001) for the SCI population. A significant decrement of 0.02 (p <0.001) was calculated for the moderate level of the emotional attribute for all models. The mean utility score for those with SCI having completed the EQ-5D-5L was 0.371. LIMITATIONS Modest sample size of respondents from the SCI population (n = 48). CONCLUSIONS Worry associated with hospitalisation had the greatest impact on patients' health-related quality of life (HRQoL). The catheterisation process, such as the lubrication and repositioning of the catheter, also impacted on patients' HRQoL.
Collapse
Affiliation(s)
- A Looby
- York Health Economics Consortium
| | - H Davies
- York Health Economics Consortium
| | | | | | - B Avey
- York Health Economics Consortium
| | | | | | - E F Lane
- York Health Economics Consortium
| | | | | |
Collapse
|
13
|
Medvediev VV, Oleksenko NP, Pichkur LD, Verbovska SA, Savosko SI, Draguntsova NG, Lontkovskyi YA, Vaslovych VV, Tsymbalyuk VI. Implantation Effect of a Fibrin Matrix Associated with Mesenchymal Wharton’s Jelly Stromal Cells on the Course of an Experimental Spinal Cord Injury. CYTOL GENET+ 2023. [DOI: 10.3103/s0095452723010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
|
14
|
Waller M, Jörgensen S, Lexell J. Changes over 6 years in secondary health conditions and activity limitations in older adults aging with long-term spinal cord injury. PM R 2023; 15:157-167. [PMID: 35092167 DOI: 10.1002/pmrj.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/19/2021] [Accepted: 12/28/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The number of individuals aging with long-term spinal cord injury (SCI) is increasing. Still, there is limited knowledge about changes in secondary health conditions (SHCs) and activity limitations over time. OBJECTIVES To determine changes in SHCs and activity limitations in older adults aging with long-term SCI over 6 years, and to investigate how changes in SHCs and activity limitations are associated with gender, age, and injury characteristics. DESIGN Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS). SETTING Community settings, Sweden. PARTICIPANTS From the initial 123 participants in the SASCIS: 78 individuals (32% women); mean age 68 years; mean time since injury 31 years; injury levels C1-L3, AIS A-D. INTERVENTIONS Not applicable MAIN OUTCOME MEASURE: Bowel and bladder function and problems, pain, spasticity, and the Spinal Cord Independence Measure (SCIM III). RESULTS Over 6 years, bowel-related problems increased (31% to 47%, p = .015) and the occurrence of constipation doubled to 24% (p = .013). There were increases in frequent urinary tract infections (10% to 26%, p = .004), use of indwelling urinary catheters (15% to 23%, p = .031), and other bladder-related problems (4% to 22%, p < .001). The occurrence of pain was high (85%), with no significant change. Spasticity increased from 41% to 62% (p < .001). Activity limitations increased (SCIM III total score mean 67 to 61, p < .001, with significant decreases in all subscales). The increase in bowel-related problems was greater in males, and the deterioration in self-care was greater in participants with longer time since injury and with traumatic injuries. CONCLUSIONS These findings support the notion that SHCs and activity limitations increase over time in older adults aging with long-term SCI. The results can inform clinicians and call for a proactive, holistic approach in the long-term follow-up to support healthy and active aging.
Collapse
Affiliation(s)
- Mikael Waller
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Rehabilitation Medicine, Sunderby Hospital, Norrbotten County Council, Luleå, Sweden
| | - Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
15
|
Sertkaya Z, Koyuncu E, Nakipoğlu Yüzer GF, Özgirgin N. Investigation of health literacy level and its effect on quality of life in patients with spinal cord injury. J Spinal Cord Med 2023; 46:62-67. [PMID: 34726584 PMCID: PMC9897774 DOI: 10.1080/10790268.2021.1991162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To determine the health literacy (HL) level in patients with traumatic spinal cord injury (SCI) and evaluate the relationship between HL and the quality of life (QoL). STUDY DESIGN Cross-sectional study. SETTING Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Turkey. PARTICIPANTS A total of 77 patients with traumatic SCI aged 15-65 years where the trauma had occurred at least a month ago before data collection and who were attending the rehabilitation program at the hospital as inpatients we included in the study. OUTCOME MEASURES The European Health Literacy Questionnaire Turkish Adaptation (HLS-TR) was used for the evaluation of the HL level, and the Short Form-36 was used for the evaluation of the QoL. RESULTS The HL level was inadequate in 32.5%, problematic-limited in 40.3%, sufficient in 19.5%, and excellent in 7.8% of the patients. The vitality and mental health subdimensions of the QoL were found to be statistically significantly better in participants with excellent, sufficient or problematic-limited HL compared to those with an inadequate level. CONCLUSIONS According to our results, the HL level of the majority of patients with SCI who are hospitalized in our hospital is low, and there is a relationship between HL and QoL. In conclusion, steps need to be taken to increase the HL levels of patients to improve their QoL, taking into account the important effect of HL on the QoL.
Collapse
Affiliation(s)
- Zilan Sertkaya
- Department of Physical Medicine and Rehabilitation, Soma State Hospital, Soma/Manisa, Turkey
| | - Engin Koyuncu
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital Physical Medicine and Rehabilitation Hospital, Ankara, Turkey,Department of Physical Medicine and Rehabilitation, University of Medical Sciences, Ankara, Turkey,Correspondence to: Engin Koyuncu, Department of Physical Medicine and Rehabilitation, Ankara City Hospital Physical Medicine and Rehabilitation Hospital, University of Medical Sciences, Ankara, Turkey; Ph: 05052553671.
| | - Güldal Funda Nakipoğlu Yüzer
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital Physical Medicine and Rehabilitation Hospital, Ankara, Turkey,Department of Physical Medicine and Rehabilitation, University of Medical Sciences, Ankara, Turkey
| | - Neşe Özgirgin
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital Physical Medicine and Rehabilitation Hospital, Ankara, Turkey,Department of Physical Medicine and Rehabilitation, University of Medical Sciences, Ankara, Turkey
| |
Collapse
|
16
|
Shavelle R, DeVivo M, Savic G, Brooks J, Strauss D. International comparison: Spinal cord injury in the USA and UK. NeuroRehabilitation 2023; 53:595-598. [PMID: 37899064 DOI: 10.3233/nre-230153] [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: 10/31/2023]
Abstract
BACKGROUND Long-term survival after spinal cord injury (SCI) has been extensively studied in the US and UK. OBJECTIVE To compare SCI epidemiology and survival results between the US and UK for the same time period and patient groups. METHODS We restricted attention to persons injured at ages 18 and older who had survived at least 2 years post injury and were not ventilator dependent. We performed survival analysis using logistic regression on person-year data with time-dependent covariates. The resulting mortality rates were used to construct life tables in order to obtain life expectancies. RESULTS The average age at injury, percentage male, and level/grade of injury were rather similar between the two countries. After adjustment for risk factors, UK mortality was 85% of that in the US (95% c.i. 80% to 91%, p < 0.0001). Mortality increased by 0.3% per year over the 1980 to 2012 study period (HR = 1.003); this was not statistically significant (p = 0.44). The US and UK life expectancies are nearly the same percentage of their respective general population values, differing by at most 2%. CONCLUSION Long-term mortality after SCI in the UK is roughly 15% lower than that in the US. The general population mortality in the UK is also approximately 15% lower, however, and thus the percentages of normal life expectancy in the two countries prove to be strikingly similar.
Collapse
Affiliation(s)
| | - Michael DeVivo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gordana Savic
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare, Aylesbury, UK
| | | | | |
Collapse
|
17
|
Furlan JC, Shen T, Kurban D. Sex-Related Discrepancies in the Access to Optimal Care and Outcomes After Traumatic Spinal Cord Injury: A Retrospective Cohort Study Using Data From a Canadian Registry. Arch Phys Med Rehabil 2023; 104:1-10. [PMID: 36170894 DOI: 10.1016/j.apmr.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare males and females who were stratified into subgroups corresponding to premenopausal, perimenopausal, and postmenopausal ages, regarding access to optimal care and their outcomes after traumatic spinal cord injury (tSCI). STUDY DESIGN Retrospective cohort study. SETTING Eighteen acute care centers and 13 rehabilitation facilities across Canada. PARTICIPANTS This study included 5571 individuals with tSCI at C1-L2 who were enrolled in the Rick Hansen Spinal Cord Injury Registry from July 2004 to September 2019 (N=5571). Females were compared with males in the younger (aged ≤40 years), middle-aged (ages 41-50), and older (aged >50 years) subgroups. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Females were compared with males in each subgroup with regard to their demographic data, pre-existing comorbidities, injury characteristics, management choices, access to optimal care, and clinical, neurologic, and functional outcomes after tSCI. RESULTS In the younger subgroups, females (n=408) were significantly younger, had a greater proportion of aboriginals and transportation-related tSCIs, underwent surgical treatment more often, and had a greater sensory score change than males (n=1613). In the middle-aged subgroups, females (n=174) had a greater proportion of high-thoracic tSCIs than males (n=666). In the older subgroups, females (n=660) were significantly older, had more fall-related and less severe tSCIs, had a shorter stay at the rehabilitation center, had less spasticity, and were discharged home less often than males (n=2050). CONCLUSIONS The results of this study suggest some sex-related differences in individuals' demographics and injury characteristics, but fewer discrepancies between females and males regarding their access to optimal care and outcomes after tSCI. Overall, future clinical trials could consider inclusion of males and females of all age groups to enhance recruitment and augment generalizability.
Collapse
Affiliation(s)
- Julio C Furlan
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; KITE Research Institute, University Health Network, Toronto, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Tian Shen
- Praxis Spinal Cord Institute, Vancouver, Canada
| | | |
Collapse
|
18
|
Kang D, Park J, Eun SD. A preliminary study on the feasibility of community game-based respiratory muscle training for individuals with high cervical spinal cord injury levels: a novel approach. BMC Sports Sci Med Rehabil 2022; 14:137. [PMID: 35869532 PMCID: PMC9306039 DOI: 10.1186/s13102-022-00534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background Respiratory disorders result in rehospitalization and premature death of patients with cervical spinal cord injuries (CSCI). Community game-based respiratory muscle training (RMT) programs could reduce secondary complications. Methods We examined the feasibility and preliminary efficacy of RMT as a community-based exercise program. Among the 10 included participants (eight male and two female), four, one, one, and four reported C3, C4, C5, and C6 complete injuries, respectively (eight graded by American Spinal Injury Association impairment scale [ASIA] A and two by ASIA B). Their mean age was 43 ± 12.3 y. The time since injury was 10 ± 6.7 y. The participants completed an RMT program for 60 min/day, twice weekly, for 8 weeks. The participants were trained in the use of a newly developed game-based RMT device. The device provides consistent pressure for respiratory muscle strength and endurance training. Seven RMT devices were modified to allow 10 game-based RMT programs. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), vital capacity (VC), inspiratory capacity (IC), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and peak cough flow (PCF) were measured. Results There were improvements after RMT compared to pre-RMT in FVC (p = 0.027, 10.62%, 0.22 effect size [ES]), PEF (p = 0.006, 23.21%, 0.45 ES), VC (p = 0.002, 35.52%, 0.60 ES), IC (p = 0.001, 46.94%, 0.81 ES), IRV (p = 0.001, 90.53%, 1.22 ES), MIP (p = 0.002, 97.25%, 1.32 ES), MEP (p = 0.005, 141.12%, 1.07 ES), and PCF (p = 0.001, 35.60%, 0.74 ES). The participants reported a positive impact of the program. Conclusions Community game-based RMT for individuals with CSCI appears to be safe and feasible. Community exercise with RMT use may have a positive impact on the respiratory measures for patients with CSCI who are vulnerable to respiratory compromise. Trial registration KCT0005980.
Collapse
|
19
|
McRae J, Morgan S, Wallace E, Miles A. Oropharyngeal Dysphagia in Acute Cervical Spinal Cord Injury: A Literature Review. Dysphagia 2022:10.1007/s00455-022-10535-0. [DOI: 10.1007/s00455-022-10535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
AbstractDysphagia (swallowing impairment) is a frequent complication of cervical spinal cord injury (cSCI). Recently published national guidance in the UK on rehabilitation after traumatic injury confirmed that people with cSCI are at risk for dysphagia and require early evaluation while remaining nil by mouth [National Institute for Health and Care Excellence. Rehabilitation after traumatic injury (NG211), 2022, https://www.nice.org.uk/guidance/ng21]. While the pathogenesis and pathophysiology of dysphagia in cSCI remains unclear, numerous risk factors have been identified in the literature. This review aims to summarize the literature on the risk factors, presentation, assessment, and management of dysphagia in patients with cSCI. A bespoke approach to dysphagia management, that accounts for the multiple system impairment in cSCI, is presented; the overarching aim of which is to support effective management of dysphagia in patients with cSCI to prevent adverse clinical consequences.
Collapse
|
20
|
Girão AF, Serrano MC, Completo A, Marques PAAP. Is Graphene Shortening the Path toward Spinal Cord Regeneration? ACS NANO 2022; 16:13430-13467. [PMID: 36000717 PMCID: PMC9776589 DOI: 10.1021/acsnano.2c04756] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Along with the development of the next generation of biomedical platforms, the inclusion of graphene-based materials (GBMs) into therapeutics for spinal cord injury (SCI) has potential to nourish topmost neuroprotective and neuroregenerative strategies for enhancing neural structural and physiological recovery. In the context of SCI, contemplated as one of the most convoluted challenges of modern medicine, this review first provides an overview of its characteristics and pathophysiological features. Then, the most relevant ongoing clinical trials targeting SCI, including pharmaceutical, robotics/neuromodulation, and scaffolding approaches, are introduced and discussed in sequence with the most important insights brought by GBMs into each particular topic. The current role of these nanomaterials on restoring the spinal cord microenvironment after injury is critically contextualized, while proposing future concepts and desirable outputs for graphene-based technologies aiming to reach clinical significance for SCI.
Collapse
Affiliation(s)
- André F. Girão
- Centre
for Mechanical Technology and Automation (TEMA), Department of Mechanical
Engineering, University of Aveiro (UA), Aveiro, 3810-193, Portugal
- Instituto
de Ciencia de Materiales de Madrid (ICMM), Consejo Superior de Investigaciones Científicas (CSIC), Calle Sor Juana Inés de la
Cruz 3, Madrid, 28049, Spain
- (A.F.G.)
| | - María Concepcion Serrano
- Instituto
de Ciencia de Materiales de Madrid (ICMM), Consejo Superior de Investigaciones Científicas (CSIC), Calle Sor Juana Inés de la
Cruz 3, Madrid, 28049, Spain
- (M.C.S.)
| | - António Completo
- Centre
for Mechanical Technology and Automation (TEMA), Department of Mechanical
Engineering, University of Aveiro (UA), Aveiro, 3810-193, Portugal
| | - Paula A. A. P. Marques
- Centre
for Mechanical Technology and Automation (TEMA), Department of Mechanical
Engineering, University of Aveiro (UA), Aveiro, 3810-193, Portugal
- (P.A.A.P.M.)
| |
Collapse
|
21
|
White WD, Mansfield JT, Gosai EV, Groah SL. Vertebral insufficiency fractures as a cause of autonomic dysreflexia in a patient with chronic tetraplegia: A case report. J Spinal Cord Med 2022; 45:769-772. [PMID: 33054643 PMCID: PMC9542342 DOI: 10.1080/10790268.2020.1829421] [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: 12/15/2022] Open
Abstract
Context: Osteoporosis is a known complication in spinal cord injury patients and can result in an increased risk of fractures and associated morbidity. Bone demineralization is most common in long bones below the level of injury. The pathogenesis is complex and not fully understood.Findings: We present the case of a 65-year-old male with chronic spinal cord injury who was found to have multiple vertebral compression fractures causing autonomic dysreflexia and new onset spasticity.Conclusion/Clinical Relevance: This case illustrates the need for improved awareness, diagnosis, and prevention for this disease process.
Collapse
Affiliation(s)
- William D. White
- Department of Rehabilitation Medicine, MedStar Georgetown University, Washington, DC, USA,MedStar National Rehabilitation Hospital, Washington, DC, USA,Correspondence to: W. Daniel White, Department of Rehabilitation Medicine, MedStar Georgetown University, 102 Irving St. NW, Washington, DC, 20010, USA; Ph: 202-877-1000.
| | - John T. Mansfield
- Department of Rehabilitation Medicine, MedStar Georgetown University, Washington, DC, USA,MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Erika V. Gosai
- MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Suzanne L. Groah
- Department of Rehabilitation Medicine, MedStar Georgetown University, Washington, DC, USA,MedStar National Rehabilitation Hospital, Washington, DC, USA
| |
Collapse
|
22
|
Impact of Rehabilitation Nutrition and Healthy Weight Maintenance in Motor-Complete Tetraplegia Patients. J Clin Med 2022; 11:jcm11174970. [PMID: 36078901 PMCID: PMC9456762 DOI: 10.3390/jcm11174970] [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: 06/23/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 11/16/2022] Open
Abstract
Cachexia and low muscle mass in motor-complete tetraplegia are associated with poor outcomes. This study aimed to document anthropometric, body composition, and nutritional indices in patients and to assess the effect of a comprehensive rehabilitation nutrition program in cachexia and low muscle mass. For 34 motor-complete tetraplegia in the subacute phase, a comprehensive rehabilitation nutrition program was provided for 8 to 9 weeks. Risk of malnutrition, anthropometric and body composition indices, as well as laboratory tests were assessed upon admission and at discharge. A body mass index of less than 20.2 kg/m2 was used as the cut-off value for obesity. Upon admission, 73.5% of patients were classified as obese, half were at risk of malnutrition, and 29.4% were compatible with cachexia. Compared to the premorbid state, the non-obese group showed greater weight reduction (p < 0.01) and higher prevalence of low muscle mass (p = 0.004) than the obese group. Disease duration was different between groups (p < 0.01). After rehabilitation, malnutrition risk, protein levels, and hemodynamic results improved in both groups (p < 0.05). A significant time × group interaction was observed for muscle mass, skeletal muscle mass, and appendicular lean mass index (p < 0.05). Muscle mass was maintained while fat components increased in both groups. Functional improvement was negatively correlated with an increase in fat components (p < 0.05). A personalized rehabilitation nutrition intervention improved the nutritional status, body composition, and functional outcomes in motor-complete tetraplegia. The increase in muscle mass was associated with functional gain; healthy weight gain or maintenance may improve the level of independence. Further studies to endorse this beneficial evidence of rehabilitation nutrition in the maintenance of muscle component are needed.
Collapse
|
23
|
Investigating Dynamics of the Spinal Cord Injury Adjustment Model: Mediation Model Analysis. J Clin Med 2022; 11:jcm11154557. [PMID: 35956172 PMCID: PMC9369731 DOI: 10.3390/jcm11154557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) is a severe neurological injury that results in damage to multiple bodily systems. SCI rehabilitation requires a significant focus on improving adjustment to the injury. This paper presents a detailed description of the Spinal Cord Injury Adjustment Model (SCIAM), which clarifies how individuals adjust to SCI and contends that adjustment to SCI is a multifactorial process involving non-linear dynamic adaptation over time. Evidence supporting SCIAM is also discussed. Mediation analyses were conducted to test the mediator dynamics proposed by the model. The analyses tested the relationship between two moderators (self-care and secondary health conditions), mediators (two self-efficacy items and appraisal of quality of life or QoL), and positive versus negative vitality/mental health as outcomes. Results showed that higher self-efficacy and perceived QoL was related to greater independence in self-care and reduced negative impacts of secondary health conditions. This study supported the mediation role of self-efficacy and other appraisals such as perceived QoL in enhancing self-care and buffering the negative impact of health challenges. In conclusion, it is important to employ a holistic model such as SCIAM to conceptualise and increase understanding of the process of adjustment following a severe neurological injury such as SCI.
Collapse
|
24
|
Mifflin KA, Brennan FH, Guan Z, Kigerl KA, Filous AR, Mo X, Schwab JM, Popovich PG. Spinal Cord Injury Impairs Lung Immunity in Mice. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 209:157-170. [PMID: 35697382 PMCID: PMC9246940 DOI: 10.4049/jimmunol.2200192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Pulmonary infection is a leading cause of morbidity and mortality after spinal cord injury (SCI). Although SCI causes atrophy and dysfunction in primary and secondary lymphoid tissues with a corresponding decrease in the number and function of circulating leukocytes, it is unknown whether this SCI-dependent systemic immune suppression also affects the unique tissue-specific antimicrobial defense mechanisms that protect the lung. In this study, we tested the hypothesis that SCI directly impairs pulmonary immunity and subsequently increases the risk for developing pneumonia. Using mouse models of severe high-level SCI, we find that recruitment of circulating leukocytes and transcriptional control of immune signaling in the lung is impaired after SCI, creating an environment that is permissive for infection. Specifically, we saw a sustained loss of pulmonary leukocytes, a loss of alveolar macrophages at chronic time points postinjury, and a decrease in immune modulatory genes, especially cytokines, needed to eliminate pulmonary infections. Importantly, this injury-dependent impairment of pulmonary antimicrobial defense is only partially overcome by boosting the recruitment of immune cells to the lung with the drug AMD3100, a Food and Drug Administration-approved drug that mobilizes leukocytes and hematopoietic stem cells from bone marrow. Collectively, these data indicate that the immune-suppressive effects of SCI extend to the lung, a unique site of mucosal immunity. Furthermore, preventing lung infection after SCI will likely require novel strategies, beyond the use of orthodox antibiotics, to reverse or block tissue-specific cellular and molecular determinants of pulmonary immune surveillance.
Collapse
Affiliation(s)
- Katherine A Mifflin
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
| | - Faith H Brennan
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
| | - Zhen Guan
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
| | - Kristina A Kigerl
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
| | - Angela R Filous
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
- Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH; and
| | - Xiaokui Mo
- Department of Biomedical Informatics, The Ohio State University, Center for Biostatistics, Columbus, OH
| | - Jan M Schwab
- Department of Neuroscience, The Ohio State University, Columbus, OH
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
- Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH; and
| | - Phillip G Popovich
- Department of Neuroscience, The Ohio State University, Columbus, OH;
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH
| |
Collapse
|
25
|
Lu D, Yang Y, Zhang P, Ma Z, Li W, Song Y, Feng H, Yu W, Ren F, Li T, Zeng H, Wang J. Development and Application of Three-Dimensional Bioprinting Scaffold in the Repair of Spinal Cord Injury. Tissue Eng Regen Med 2022; 19:1113-1127. [PMID: 35767151 DOI: 10.1007/s13770-022-00465-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 01/04/2023] Open
Abstract
Spinal cord injury (SCI) is a disabling and destructive central nervous system injury that has not yet been successfully treated at this stage. Three-dimensional (3D) bioprinting has become a promising method to produce more biologically complex microstructures, which fabricate living neural constructs with anatomically accurate complex geometries and spatial distributions of neural stem cells, and this is critical in the treatment of SCI. With the development of 3D printing technology and the deepening of research, neural tissue engineering research using different printing methods, bio-inks, and cells to repair SCI has achieved certain results. Although satisfactory results have not yet been achieved, they have provided novel ideas for the clinical treatment of SCI. Considering the potential impact of 3D bioprinting technology on neural studies, this review focuses on 3D bioprinting methods widely used in SCI neural tissue engineering, and the latest technological applications of bioprinting of nerve tissues for the repair of SCI are discussed. In addition to introducing the recent progress, this work also describes the existing limitations and highlights emerging possibilities and future prospects in this field.
Collapse
Affiliation(s)
- Dezhi Lu
- School of Medicine, Shanghai University, Shanghai, 200444, China
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yang Yang
- Department of Rehabilitation Medicine, Shandong Provincial Third Hospital, Shandong, 250000, China
| | - Pingping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang, 261053, China
| | - Zhenjiang Ma
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Wentao Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yan Song
- School of Rehabilitation Medicine, Weifang Medical University, Weifang, 261053, China
| | - Haiyang Feng
- School of Rehabilitation Medicine, Weifang Medical University, Weifang, 261053, China
| | - Wenqiang Yu
- School of Rehabilitation Medicine, Weifang Medical University, Weifang, 261053, China
| | - Fuchao Ren
- School of Rehabilitation Medicine, Weifang Medical University, Weifang, 261053, China
| | - Tao Li
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
| | - Hong Zeng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Jinwu Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| |
Collapse
|
26
|
Swank C, Holden A, McDonald L, Driver S, Callender L, Bennett M, Sikka S. Foundational ingredients of robotic gait training for people with incomplete spinal cord injury during inpatient rehabilitation (FIRST): A randomized controlled trial protocol. PLoS One 2022; 17:e0267013. [PMID: 35536844 PMCID: PMC9089894 DOI: 10.1371/journal.pone.0267013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
As technological advances allow the use of robotic exoskeleton devices with gait training, there is a critical need to establish a robotic gait training (RGT) program to meet the needs of people with spinal cord injury (SCI) during inpatient rehabilitation. The purposes of this study are to prospectively examine the efficacy of a stakeholder informed RGT program compared to usual care gait training (UC) during inpatient rehabilitation in people with incomplete SCI and compare the intensity of RGT and UC gait training during inpatient rehabilitation.
Study design
128 patients with incomplete SCI admitted to our inpatient rehabilitation facility will be screened for eligibility and randomized to either the RGT or UC group. RGT sessions will use the Ekso robotic exoskeleton [class II medical device (United States FDA)]. UC sessions will use traditional gait training approaches such as manually assisted overground gait training with walkers and orthotics and body weight–supported treadmill training (BWSTT). Our primary outcome is gait function as characterized by the Walking Index for Spinal Cord Injury–II (WISCI-II). Secondary outcomes are gait speed, Spinal Cord Independence Measure (SCIM), Numeric Pain Rating Scale (NPRS), Fatigue Severity Scale (FSS), Penn Spasm Frequency Scale (PSFS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder– 7 (GAD-7), International Spinal Cord Injury Quality of Life Basic Data Set, and a Qualitative Questionnaire. Assessments of primary and secondary outcomes will occur at admission and discharge from inpatient rehabilitation. General or generalized linear models will be used to analyze differences between groups for all measures.
Clinical impact
Successful completion of this study will provide a usable, replicable, stakeholder informed RGT intervention for use with individuals with incomplete SCI during inpatient rehabilitation.
Collapse
Affiliation(s)
- Chad Swank
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Alexandria Holden
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
- * E-mail:
| | - Lacy McDonald
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
| | - Simon Driver
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
| | - Librada Callender
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
| | - Monica Bennett
- Baylor Scott & White Health, Dallas, Texas, United States of America
| | - Seema Sikka
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, United States of America
- Baylor Scott & White Health, Dallas, Texas, United States of America
| |
Collapse
|
27
|
Bowel and Bladder Care in Patients With Spinal Cord Injury. J Am Acad Orthop Surg 2022; 30:263-272. [PMID: 34932503 DOI: 10.5435/jaaos-d-21-00873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/21/2021] [Indexed: 02/01/2023] Open
Abstract
Complete and incomplete spinal cord injuries affect between 250,000 and 500,000 people on an annual basis worldwide. In addition to sensory and motor dysfunction, spinal cord injury patients also suffer from associated conditions such as neurogenic bowel and bladder dysfunction. The degree of dysfunction varies on the level, degree, and type of spinal cord injury that occurs. In addition to the acute surgical treatment of these patients, spine surgeons should understand how to manage neurogenic bowel and bladder care on both a short- and long-term basis to minimize the risk for complications and optimize potential for rehabilitation.
Collapse
|
28
|
Kasabwala K, Borofsky M, Grove S, Lenherr SM, Myers JB, Stoffel JT, Welk B, Elliott SP. Association of stone surgery with patient-reported complications after spinal cord injury. Neurourol Urodyn 2022; 41:820-829. [PMID: 35114016 DOI: 10.1002/nau.24887] [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: 08/26/2021] [Revised: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Abstract
AIMS To determine if a history of urinary stone surgery in individuals with spinal cord injury (SCI) is associated with an increased incidence of SCI-related complications and lower quality of life (QOL). METHODS The Neurogenic Bladder Research Group (NBRG) registry is a multicenter, prospective, observational study which measures QOL after acquired SCI. Over 1.5 years, 1479 participants were enrolled and grouped according to history of stone surgery. We evaluated SCI-related complications, QOL, and associations between patient factors and prior stone surgery using multivariable regression. RESULTS Participants were a median of 11 years post-SCI and 189 (12.8%) reported prior bladder or kidney stone surgery; 95.8% of these occurred after the SCI. Median time between SCI and first stone was 5.6 years (IQR: 1.8-12.8). Hospitalizations were higher for those with prior stone surgery, with common reasons including UTIs, blood clots, pressure ulcers, and pneumonia (p < 0.001). During the year of observation, the incidence of stone surgery was 17% in those with a prior history of stone surgery and 2% per year in those without prior stone surgery (p < 0.001). Controlling for covariates, bladder management strategy, age, BMI, and years since SCI were associated with history of stone surgery. CONCLUSIONS People with SCI and a history of surgical stone disease are at high risk for episodes of recurrent stones and increased hospitalizations, particularly those with kidney stones and indwelling catheter use. Identification of high-risk patients may guide tailored surveillance for complications and stone prevention strategies.
Collapse
Affiliation(s)
- Khushabu Kasabwala
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shawn Grove
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara M Lenherr
- Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Blayne Welk
- Department of Surgery (Urology), Western University, London, Ontario, Canada
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
29
|
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
|
30
|
Catz A. Conceptual changes needed to improve outcomes in rehabilitation medicine: A clinical commentary. NeuroRehabilitation 2022; 51:341-345. [PMID: 35527581 PMCID: PMC9535547 DOI: 10.3233/nre-220069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 12/04/2022]
Abstract
Rehabilitation medicine has expanded the horizon of all medicine and brought about new human achievements. To facilitate continued advances in achievement, several changes are suggested in customary rehabilitation strategic goals, concepts, and practices. The main rehabilitation goals should focus on prolonged survival, contrary to the opinions of most authors on rehabilitation, and on achievement of maximum ability realization, rather than of independence or any given (including previous) level of functioning. Setting rehabilitation goals should benefit the patient, rather than the caregiver or the insurer. Training should focus on tasks that contribute to the patients' interests and desires, rather than on any task that reduces the burden of care. The main criterion for admission to a rehabilitation ward should be based on expected advantage in prolonging patient survival and maximizing ability realization.
Collapse
Affiliation(s)
- Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel E-mail:
| |
Collapse
|
31
|
Wong S, Subong P, Graham A, Wail A, Derry F, Saif M, Belci M. Predictive equations over estimating resting metabolic rate in individual with spinal cord injury requiring mechanical ventilation support - A case series. J Spinal Cord Med 2022; 45:151-154. [PMID: 32202479 PMCID: PMC8890569 DOI: 10.1080/10790268.2020.1737789] [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: 10/24/2022] Open
Abstract
Context: The impact of mechanical ventilation on energy expenditure after spinal cord injury (SCI) is sparse. The objective of this case-series is to measure 15-minutes resting metabolic rate (RMR) to determine 24-hours measured-RMR (m-RMR) using QUARK indirect calorimeter (IC) and; compare the m-RMR with estimated RMR (e-RMR) using four commonly used predictive equations (Harris-Benedict, Mifflin St-Jeor, Henry and Schofield).Findings: We measured the RMR of four patients with SCI (one male and three female; mean age: 58.3 years) all with complete tetraplegia (ISNCSCI A) twice in a one-week interval using an IC with two sampling flow settings during a six month period. The median (IQ) of all m-RMRs was 1094 (340.2) kcal/day. The median m-RMR was 40.1% lower than the median calculated with four different e-RMRs using predictive equations. All four predictive equations overestimated RMR in SCI patients requiring mechanical ventilation by 4.1-61.1% (Harris-Benedict: 28.8-60.6%; Mifflin St-Jeor: 6.9-61.1%; Henry: 4.1-58.9% and; Schofield: 6-54.6%).Conclusion/clinical relevance: There is a high variability of e-RMR and m-RMR in patients with SCI who are dependent on mechanical ventilation. The use of predictive equations may lead to over-estimation of energy requirements. To avoid overfeeding we recommended measuring RMR using IC wherever possible. A further study with a larger sample size is needed due to the small number of subjects in our case-series. Development of a validated RMR equation in the SCI population is warranted.
Collapse
Affiliation(s)
- Samford Wong
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK,School of Health Science, University of London, London, UK,Correspondence to: Samford Wong, Department of Nutrition and Dietetics, National Spinal Injuries Centre, Stoke Mandeville Hospital, AylesburyHP21 8AL, UK; +44 (0)1296 315049.
| | - Paul Subong
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Allison Graham
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Ahmed Wail
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Fadel Derry
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Mofid Saif
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Maurizio Belci
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| |
Collapse
|
32
|
McRae J, Hayton J, Smith C. Speech and language therapy service provision in spinal injury units compared to major trauma centres in England: Are services matched? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:6-20. [PMID: 34510665 DOI: 10.1111/1460-6984.12671] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND National UK guidance makes recommendations for speech and language therapy staffing levels in critical care and rehabilitation settings. Traumatic spinal cord injury patients often require admission primarily to critical care services within a major trauma centre prior to transfer to a specialist spinal injury unit but may not receive similar levels of care. Dysphagia and communication difficulties are recognised features of cervical spinal cord injury; however, little is known about access to speech and language therapy services to provide rehabilitation and improve outcomes. AIMS The aim of this study was to compare the workforce and clinical practices of speech and language therapy services in eight spinal injury units and four major trauma centres in England through an online survey. METHODS & PROCEDURES An online survey was created with 26 multiple-choice questions across seven sub-sections, with options for free-text comments. These were sent to a named speech and language therapy contact at each of the specified units. Responses were uploaded into Excel for analyses, which included descriptive statistics and analysis of themes. OUTCOMES & RESULTS Responses were received from 92% (11/12) speech and language therapy services invited, which included seven out of eight spinal injury units and all four major trauma centres. No units met national staffing recommendations. Staff in spinal injury units provided an average of 27 h per week input to the unit compared to 80 h in a major trauma centre. Despite caseload variations, speech and language range of therapy involvement and prioritisation process were equivalent. Access to instrumental assessment varied, with less use of Fibreoptic Endoscopic Evaluation of Swallowing in spinal injury units despite its clinical value to the spinal cord injury caseload. CONCLUSIONS & IMPLICATIONS Speech and language therapy services delivering post-acute and long-term rehabilitation to spinal cord injury patients are limited by their resources and capacity, which restricts the level of therapy delivered to patients. This may have an impact on clinical outcomes for communication and swallowing impairments. Further evidence is needed of the interventions delivered by speech and language therapists and outcomes will be beneficial alongside benchmarking similar services. WHAT THIS PAPER ADDS What is already known on this subject In England, people who sustain a spinal cord injury are admitted to a major trauma centre prior to transfer to a specialist spinal injury unit. Dysphagia and communication impairments are recognised as a complication of cervical spinal cord injury and benefit from speech and language therapy intervention. National recommendations exist for staffing levels, expertise and competencies for speech and language therapists working in critical care and rehabilitation units. What this study adds This study identified variations in the levels of speech and language therapy staffing, seniority, service delivery and access to instrumental assessments for dysphagia between major trauma centres and spinal injury units. None of the services complied with national staffing recommendations. Clinical implications of this study Speech and language therapy services in spinal injury units are often available part-time or have limited access to diagnostic tools which limits the range and intensity of rehabilitation input available. This has clinical implications for outcomes for swallowing and communication as well as long-term consequences for integrating back into community.
Collapse
Affiliation(s)
- Jackie McRae
- Centre for Allied Health, Kingston University and St George's University of London, London, UK
- Acute Speech and Language Therapy Team, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jennifer Hayton
- MSc Speech and Language Sciences, University College London, London, UK
| | - Christina Smith
- Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| |
Collapse
|
33
|
Thietje R, Kowald B, Böthig R, Schulz AP, Northmann M, Rau Y, Hirschfeld S. Long-Term Survival and Causes of Death in Patients below the Age of 60 with Traumatic Spinal Cord Injury in Germany. J Clin Med 2021; 11:jcm11010026. [PMID: 35011766 PMCID: PMC8745560 DOI: 10.3390/jcm11010026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
To study the mortality, cause and risk indicators of death in German patients with traumatic spinal cord injury, patients with traumatic spinal cord injury admitted to Berufsgenossenschaftliches Trauma Hospital Hamburg between 1 January 1997 and 31 December 2018, aged between 16 and 60 with a minimal survival of one year after injury, were included. Further criteria were the absence of life-limiting comorbidities at the time of injury. 223 deceased patients with traumatic spinal cord injury were identified, investigated on and partly compared to the surviving subjects. We aimed to discover specific complications that were related to Spinal Cord Injury and responsible for a possibly limited life expectancy. Data collection was performed during in- and outpatient treatment. A statistical analysis was performed to compare groups. The post-injury life expectancy was 25.0 years with a significant correlation regarding the level of lesion and severity of injury. The leading causes of death were cardiovascular diseases and pneumonia. Bladder cancer was the most common fatal malignant tumor. The life expectancy of patients suffering from traumatic spinal cord injury is limited. The longer a patient survives after injury and the lower the level of lesion, the more likely an age-related cause of death becomes. Bladder cancer is significantly more frequent when compared to the overall distribution of tumor diseases in Germany.
Collapse
Affiliation(s)
- Roland Thietje
- Center for Spinal Injuries, BG Klinikum Hamburg, 21033 Hamburg, Germany; (B.K.); (R.B.); (A.P.S.); (M.N.); (S.H.)
- Correspondence:
| | - Birgitt Kowald
- Center for Spinal Injuries, BG Klinikum Hamburg, 21033 Hamburg, Germany; (B.K.); (R.B.); (A.P.S.); (M.N.); (S.H.)
| | - Ralf Böthig
- Center for Spinal Injuries, BG Klinikum Hamburg, 21033 Hamburg, Germany; (B.K.); (R.B.); (A.P.S.); (M.N.); (S.H.)
| | - Arndt P. Schulz
- Center for Spinal Injuries, BG Klinikum Hamburg, 21033 Hamburg, Germany; (B.K.); (R.B.); (A.P.S.); (M.N.); (S.H.)
- Department of Biomechanics and orthopedic Research, University Lübeck, 23538 Luebeck, Germany
| | - Markus Northmann
- Center for Spinal Injuries, BG Klinikum Hamburg, 21033 Hamburg, Germany; (B.K.); (R.B.); (A.P.S.); (M.N.); (S.H.)
| | - Yannick Rau
- Medical Faculty, University of Lübeck, 23538 Lübeck, Germany;
| | - Sven Hirschfeld
- Center for Spinal Injuries, BG Klinikum Hamburg, 21033 Hamburg, Germany; (B.K.); (R.B.); (A.P.S.); (M.N.); (S.H.)
| |
Collapse
|
34
|
Tomaschek R, Touhami D, Essig S, Gemperli A. Shared responsibility between general practitioners and highly specialized physicians in chronic spinal cord injury: Study protocol for a nationwide pragmatic nonrandomized interventional study. Contemp Clin Trials Commun 2021; 24:100873. [PMID: 34869940 PMCID: PMC8617342 DOI: 10.1016/j.conctc.2021.100873] [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: 05/11/2021] [Revised: 10/18/2021] [Accepted: 11/13/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction To improve the continuity of care for persons with spinal cord injury (SCI) living in peripheral areas, collaboration between general practitioners (GPs) and specialists is needed. This pragmatic non-randomized interventional study assesses feasibility and effectiveness of a new primary care model based on this collaboration. Methods The intervention is medical education on SCI related topics offered by specialists to GPs practicing in rural areas. Outcomes are assessed and analyzed in physicians and patients. Group allocation of persons with SCI follows intention-to-treat principle with intervention group being those in close proximity to a participating GP. Results It is expected that ten GPs and sixteen specialists will take part in the study's intervention. An average difference in “Doctor's opinion on collaboration questionnaire” score (mean 44; SD ± 12) from baseline after two years post-intervention in the group of participating GPs is hypothesized at P-value level <0.05; meanwhile, the control group remains at an average score of 56. Of persons with SCI (n = 395), 230 are expected to take part in the study at baseline. An average modified “Spinal Cord Injury-Secondary Conditions Scale” change in score from baseline to 24 months post intervention is expected to fall from 12.0 to 9.0 in the intervention group and to stay at 12.0 in the control group. Conclusion The study aims to improve patients' outcomes and providers’ experience with delivery of care for persons with SCI, as compared to current best practice. Trial registration ClinicalTrials.gov, NCT04071938. Registered August 28, 2018, https://www.clinicaltrials.gov/ct2/show/NCT04071938.
Collapse
Affiliation(s)
- Rebecca Tomaschek
- University of Lucerne, Department of Health Sciences and Medicine, Frohburgstrasse 3, 6002, Lucerne, Switzerland.,Center for Primary and Community Care, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Dima Touhami
- University of Lucerne, Department of Health Sciences and Medicine, Frohburgstrasse 3, 6002, Lucerne, Switzerland.,Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207, Nottwil, Switzerland
| | - Stefan Essig
- Center for Primary and Community Care, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Armin Gemperli
- University of Lucerne, Department of Health Sciences and Medicine, Frohburgstrasse 3, 6002, Lucerne, Switzerland.,Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207, Nottwil, Switzerland.,Center for Primary and Community Care, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| |
Collapse
|
35
|
DeVivo MJ, Chen Y, Wen H. Cause of Death Trends Among Persons With Spinal Cord Injury in the United States: 1960-2017. Arch Phys Med Rehabil 2021; 103:634-641. [PMID: 34800477 DOI: 10.1016/j.apmr.2021.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To identify trends in causes of death after spinal cord injury (SCI) that could enhance understanding of why life expectancy after SCI has not improved in the last 3 decades. DESIGN Cohort study. SETTING Twenty-nine SCI Model Systems and 3 Shriners Hospitals. PARTICIPANTS Individuals with traumatic SCI (N=49,266) enrolled in the SCI Collaborative Survival Study Database between 1973 and 2017. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Age-standardized cause-specific SCI mortality rates and 95% confidence intervals were calculated for 5 time intervals (1960-1979, 1980-1989, 1990-1999, 2000-2009, and 2010-2017). RESULTS A total of 17,249 deaths occurred in 797,226 person-years of follow-up. Since 2010, the highest mortality rate was for respiratory diseases, followed by heart disease, cancer, infective and parasitic diseases (primarily septicemia), and unintentional injuries. Mortality rates for respiratory diseases, cancer, stroke, urinary diseases, and digestive diseases, initially decreased significantly but remained relatively stable since 1980, whereas essentially no progress occurred for infective and parasitic diseases. Mortality rates for heart disease, pulmonary embolus, and suicide decreased significantly throughout the entire study period, but were offset by increases in mortality rates for endocrine (primarily diabetes), nutritional, and metabolic diseases, as well as unintentional injuries. From 2010 to 2017, the overall age-standardized mortality rate was 3 times higher for individuals with SCI than the general population, ranging from 27% higher for cancer to 9 times higher for infective and parasitic diseases. CONCLUSION Improving life expectancy after SCI will require: (1) reducing mortality rates from respiratory diseases and septicemia that have remained high, (2) reversing current trends in diabetes and unintentional injury deaths, and (3) continuing to reduce mortality from heart disease and other leading causes.
Collapse
Affiliation(s)
- Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
36
|
Alisseril S, Prakash NB, Chandy BR, Tharion G. Clinical Predictors of Vibrator-Assisted Ejaculation following Spinal Cord Injury: A Prospective Observational Study. J Neurosci Rural Pract 2021; 12:758-763. [PMID: 34737512 PMCID: PMC8558968 DOI: 10.1055/s-0041-1735819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction Infertility in men with spinal cord injury (SCI) occurs due to combination of factors like erectile dysfunction, ejaculatory failure, and semen abnormalities. Penile vibratory stimulation (PVS) is a known method of treatment for anejaculation. Predicting successful outcome of PVS depends on several clinical factors, which assess the intactness of the neural arc pertaining to the spinal ejaculation pattern generator. This study reports the clinical predictors for successful candidacy for a PVS trial in males with SCI. Methods Twenty-three males with SCI, satisfying the inclusion criteria, were recruited in this prospective observational study. Participants underwent two trials of PVS with single high-amplitude vibrator. The clinical predictors recorded were neurological level, superficial abdominal reflex, cremasteric reflex, bulbocavernosus reflex, plantar reflex, ankle jerk, knee jerk, lower abdominal sensation, and hip flexor response. In addition, somatic responses during PVS were recorded and corelated. Participants who had successful ejaculation were "responders" and the others were termed as "nonresponders." Binary logistic regression analysis of the clinical parameters was done to compare responders against nonresponders. Results Of the twenty-three males (mean age 33.2 ± 6.8 years) with paraplegia, all four persons with neurological level above T9 had successful ejaculation with PVS. Among all the clinical parameters in the study, presence of somatic responses showed statistical significance in predicting successful ejaculation ( p -value = 0.02). Conclusion This study reports that in men with SCI, along with the level of injury, somatic responses and other clinical reflexes, should be considered concurrently to predict the outcome of vibrator assisted ejaculation.
Collapse
Affiliation(s)
- Sivaram Alisseril
- Department of Physical Medicine and Rehabilitation, TD Medical College, Alappuzha, Kerala, India
| | - Navin B Prakash
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurological Sciences, Bengaluru, Karnataka, India
| | - Bobeena Rachel Chandy
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - George Tharion
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
37
|
An instrument for assessing quality of life in persons with neurogenic lower urinary tract dysfunction: validation of the German short-form Qualiveen questionnaire. Spinal Cord 2021; 60:306-311. [PMID: 34556820 DOI: 10.1038/s41393-021-00710-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective validation study. OBJECTIVES To validate and evaluate the measurement properties of the German Qualiveen short-form (SF) questionnaire in individuals with chronic neurogenic lower urinary tract dysfunction (NLUTD) resulting from spinal cord injury (SCI). SETTING Tertiary neuro-urologic referral center in Switzerland. METHODS Fifty individuals with chronic (>12 months) NLUTD resulting from SCI presenting for a urodynamic follow-up examination were enrolled to complete both the full version Qualiveen and the SF-Qualiveen questionnaires twice within three weeks. The criterion validity and test-retest reliability were evaluated by calculating the interclass correlation coefficients. Internal consistency was evaluated by calculating Cronbach's alpha. Finally, the cross-sectional construct validity was evaluated using Spearman's rank correlations between the scores of the two questionnaires for bladder evacuation, urinary continence, and urinary tract infection sub-groups. RESULTS The mean age of the evaluated individuals was 53 years. The median duration of NLUTD was 14.9 years. The SF-Qualiveen showed good to excellent criterion validity with correlation coefficients greater than 0.8. Internal consistency was good overall and in the domains "bother with limitations" as well as "feelings" (>0.75). However, internal consistency in the domains "frequency of limitations" and "fears" was moderate-poor (0.68-0.37). The test-retest reliability was excellent with correlation coefficients greater than 0.9. Finally, the cross-sectional construct validity ranged from moderate to excellent (0.60-0.97). CONCLUSIONS The German SF-Qualiveen has shown excellent reliability and validity and variable internal consistency. Its brevity will increase compliance, and we therefore recommend to include the SF-Qualiveen in urologic assessments.
Collapse
|
38
|
Leathem JM, Macht-Sliwinski M, Boak S, Courville A, Dearwater M, Gazi S, Scott A. Community exercise for individuals with spinal cord injury with inspiratory muscle training: A pilot study. J Spinal Cord Med 2021; 44:711-719. [PMID: 31525136 PMCID: PMC8477927 DOI: 10.1080/10790268.2019.1655200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Context/Objective: Respiratory disorders are a common cause of rehospitalization, and premature death in individuals with spinal cord injuries (SCI). Respiratory training combined with community exercise programs may be a method to reduce secondary complications in this population.Objective: The present study explores the inclusion of inspiratory muscle training (IMT) in an existing community exercise program.Design: Case series.Setting: Community.Participants: Participants (N = 6) completed the exercise program. Five were male and one was female; four reported incomplete injuries, and two reported complete injuries; four had cervical injuries, and two had thoracic injuries. The average age was 33 years (SD = 18.6) and time since injury was 7 years (SD = 4.0).Interventions: Participants completed an 8-week program, once-per-week for 4 h that included a circuit of resistance training, aerobic exercise, trunk stability, and education. IMT was completed as a home exercise program.Outcome Measures: Transfer test, T-shirt test, four-directional reach, four-directional trunk strength, weekly training diaries, and a subjective interview.Results: Twenty-eight training logs were collected. All measures improved: transfer test (mean = -14.62, SD = 7.00 s), T-shirt test (mean = -7.83, SD = 13.88 s), four-directional reach (mean = 3.75, SD = 8.06 in) and hand-held dynamometer (mean = 6.73, SD = 8.02 kg). Individuals reported a positive impact of the program.Conclusions: This pilot study demonstrated community exercise with IMT use may have positive impact on functional measures for people with SCI who are vulnerable to respiratory compromise. Continued education may increase successful health outcomes.Trial Registration: NCT03743077.
Collapse
Affiliation(s)
- Jessica M. Leathem
- Physical Therapist, JFK Medical Center, Johnson Rehabilitation Institute, Edison, New Jersey, USA,Correspondence to: Jessica M. Leathem, Physical Therapist, JFK Medical Center, Johnson Rehabilitation Institute, 65 James Street, Edison, NJ, 08820, USA.
| | - Martha Macht-Sliwinski
- CUMC, Program in Physical Therapy, Columbia University Medical Center, Columbia University,New York, New York, USA
| | - Sarah Boak
- UCHealth Physical Therapy and Rehabilitation Clinic, Lone Tree Medical Center, University of Colorado Hospital, Lone Tree, Colorado, USA
| | - Aubrey Courville
- Sentara Therapy Center, Careplex Hospital, Hampton, Virginia, USA
| | | | - Sneha Gazi
- EMH Physical Therapy, New York, New York, USA
| | - Allison Scott
- Green Bay Area School District in Green Bay, Peshtigo, Wisconsin, USA
| |
Collapse
|
39
|
Kaufman MR, Chang EI, Bauer T, Rossi K, Elkwood AI, Paulin E, Jarrahy R. Phrenic Nerve Reconstruction for Effective Surgical Treatment of Diaphragmatic Paralysis. Ann Plast Surg 2021; 87:310-315. [PMID: 34397519 DOI: 10.1097/sap.0000000000002896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Diaphragmatic paralysis due to phrenic nerve injury may cause orthopnea, exertional dyspnea, and sleep-disordered breathing. Phrenic nerve reconstruction may relieve symptoms and improve respiratory function. A retrospective review of 400 consecutive patients undergoing phrenic nerve reconstruction for diaphragmatic paralysis at 2 tertiary treatment centers was performed between 2007 and 2019. Symptomatic patients were identified, and the diagnosis was confirmed on radiographic evaluations. Assessment parameters included pulmonary spirometry (forced expiratory volume in 1 second and FVC), maximal inspiratory pressure, compound muscle action potentials, diaphragm thickness, chest fluoroscopy, and Short Form 36 Health Survey Questionnaire (SF-36) survey. There were 81 females and 319 males with an average age of 54 years (range, 19-79 years). The mean duration from diagnosis to surgery was 29 months (range, 1-320 months). The most common etiologies were acute or chronic injury (29%), interscalene nerve block (17%), and cardiothoracic surgery (15%). The mean improvements in forced expiratory volume in 1 second and FVC at 1 year were 10% (P < 0.01) and 8% (P < 0.05), respectively. At 2-year follow-up, the corresponding values were 22% (P < 0.05) and 18% (P < 0.05), respectively. Improvement on chest fluoroscopy was demonstrated in 63% and 71% of patients at 1 and 2-year follow-up, respectively. There was a 20% (P < 0.01) improvement in maximal inspiratory pressure, and compound muscle action potentials increased by 82% (P < 0.001). Diaphragm thickness demonstrated a 27% (P < 0.01) increase, and SF-36 revealed a 59% (P < 0.001) improvement in physical functioning. Symptomatic diaphragmatic paralysis should be considered for surgical treatment. Phrenic nerve reconstruction can achieve symptomatic relief and improve respiratory function. Increasing spirometry and improvements on Sniff from 1 to 2 years support incremental recovery with longer follow-up.
Collapse
Affiliation(s)
| | - Eric I Chang
- From the Institute for Advanced Reconstruction, Shrewsbury, NJ
| | - Thomas Bauer
- Department of Thoracic Surgery, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune City, NJ
| | - Kristie Rossi
- From the Institute for Advanced Reconstruction, Shrewsbury, NJ
| | | | - Ethan Paulin
- Department of Thoracic Surgery, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune City, NJ
| | - Reza Jarrahy
- Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, CA
| |
Collapse
|
40
|
Pizzolato C, Gunduz MA, Palipana D, Wu J, Grant G, Hall S, Dennison R, Zafonte RD, Lloyd DG, Teng YD. Non-invasive approaches to functional recovery after spinal cord injury: Therapeutic targets and multimodal device interventions. Exp Neurol 2021; 339:113612. [DOI: 10.1016/j.expneurol.2021.113612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
|
41
|
The challenges characterizing the lived experience of caregiving. A qualitative study in the field of spinal cord injury. Spinal Cord 2021; 59:493-503. [PMID: 33742117 PMCID: PMC8110474 DOI: 10.1038/s41393-021-00618-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/08/2022]
Abstract
Study design Qualitative exploratory study. Objectives To explore the lived experience of SCI caregivers, with a focus on the challenges of their role. Setting Caregivers of people with SCI living in the community in Switzerland. Methods Data were collected through semi-structured interviews. Thematic analysis was performed. Results The sample included 22 participants (16 women, 15 life partners) with a mean age of 61 years who had been caregivers for an average of 18 years. Caregiving in SCI seemed to be characterized by two phases. The first phase was relatively short and was central to becoming a caregiver; it was marked by challenges related to adjusting to the role of caregiver (e.g., dealing with shock, feeling unprepared). The second phase is lifelong and is characterized by a number of recurrent challenges related to balancing caregiving and personal life (e.g., having to prioritize caregiving over personal wishes, negotiating tasks and workload). Challenges related to lacking appropriate housing, facing financial uncertainty and dealing with bureaucracy were noted during both phases. Caregivers had to deal with these challenges to stay in step with life changes and newly emerging needs. Conclusions Informal caregivers have a major role in supporting people with SCI. But their needs are not static. Any strategy to empower them has to adapt to an evolving role characterized by multiple tasks and challenges. A functional relationship between caregivers and care recipients is based on the recognition of their individualities and the different phases of adaptation, which is also an enriching process.
Collapse
|
42
|
Lien WC, Wang WM, Wang F, Wang JD. Savings of loss-of-life expectancy and lifetime medical costs from prevention of spinal cord injuries: analysis of nationwide data followed for 17 years. Inj Prev 2021; 27:567-573. [PMID: 33483326 DOI: 10.1136/injuryprev-2020-043943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/27/2020] [Accepted: 01/03/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The objectives of this research were to determine the savings of loss-of-life expectancy (LE) and lifetime medical costs (LMC) from prevention of spinal cord injuries (SCI) in Taiwan. METHODS From the claims database of Taiwan National Health Insurance, we identified 6164 adult patients with newly diagnosed SCI with permanent functional disability from 2000 to 2015 and followed them until the end of 2016. We estimated survival function through the Kaplan-Meier method and extrapolated it to lifetime. RESULTS For the SCI cohort, the LE and loss-of-LE were 17.6 and 13.3 years, respectively, while those for SCI with coding of external causes (E-code) were 18.1 and 13.0 years, respectively. For the SCI cohort with E-code, the loss-of-LE of motor vehicle (MV)-related SCI was significantly higher than that of fall-related SCI. In young and middle-aged patients with SCI with E-code, the loss-of-LE of MV-related paraplegia was significantly higher than that of MV-related quadriplegia and fall-related SCI. With a 3% discount rate, the LMC for patients with SCI after diagnosis were US$82 772, while those for patients with SCI with E-code were US$81 473. The LMC and the cost per year for those living with quadriplegia were significantly higher than those for paraplegia in all age groups, possibly related to the higher frequencies of stroke, chronic lung disease and dementia. CONCLUSIONS We conclude that quadriplegia has a higher impact on medical costs than paraplegia, and MV-related SCI has a higher impact on loss-of-LE than fall-related SCI. We recommend comprehensive SCI prevention be established, including infrastructures of construction and transportation.
Collapse
Affiliation(s)
- Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Wei-Ming Wang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Fuhmei Wang
- Department of Economics, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan .,Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
43
|
Kriz J, Sediva K, Maly M. Causes of death after spinal cord injury in the Czech Republic. Spinal Cord 2021; 59:814-820. [PMID: 33446932 DOI: 10.1038/s41393-020-00593-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 01/02/2023]
Abstract
STUDY DESIGN A retrospective cohort study OBJECTIVES: To determine the causes of death in people with spinal cord injury (SCI) admitted to the Spinal Cord Unit (SCU) of the University Hospital Motol from 2004 to 2018. SETTING University Hospital Motol, Prague METHODS: From a cohort of people admitted to the SCU between 2004 and 2018, all deaths were identified based on the database of health insurance companies. The causes of death (ICD-10) were obtained from the Institute of Health Information and Statistics. The standardized mortality ratio (SMR) was calculated for most frequent causes of death. RESULTS During the study period, 990 patients with acute SCI were admitted to the SCU, out of which 183 (18.5%) died. Thirty-five people who had SCI due to cancer were excluded from the study. The leading cause of death in the remaining 148 people was pneumonia, followed by cardiac complications, pulmonary embolism, suicide, and urinary tract infection (UTI). In the group of the individuals who died within 1 year after SCI (N = 41), the main causes of death were pneumonia and pulmonary embolism (17.1% each). Among individuals who survived up to1 year after SCI (N = 107), the most common causes of death were pneumonia (14%) and pressure injuries (12.1%). The cause-specific SMRs were significantly increased for UTI, embolism, pneumonia, and suicide. CONCLUSION The frequent causes of death in our study group were pressure injuries and suicides. These findings are fundamental to the development and implementation of preventive programs to reduce mortality and increase life expectancy.
Collapse
Affiliation(s)
- Jiri Kriz
- Spinal Cord Unit, University Hospital Motol, Prague, Czech Republic.
| | - Kristyna Sediva
- Department of Rehabilitation and Sports Medicine, University Hospital Motol, Prague, Czech Republic
| | - Marek Maly
- Department of Biostatistics, National Institute of Public Health, Prague, Czech Republic
| |
Collapse
|
44
|
Ho C, Atchison K, Noonan VK, McKenzie N, Cadel L, Ganshorn H, Rivera JMB, Yousefi C, Guilcher SJT. Models of Care Delivery from Rehabilitation to Community for Spinal Cord Injury: A Scoping Review. J Neurotrauma 2021; 38:677-697. [PMID: 33191849 DOI: 10.1089/neu.2020.7396] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) is a chronic condition that results in high healthcare utilization and lifetime cost across the care continuum. In the absence of a standardized model of care delivery for SCI in western countries such as Canada, a scoping review of the literature was performed to identify and summarize existing international SCI models of care delivery. Four databases were searched using key words and subject headings for concepts such as: "spinal cord injury," "delivery of healthcare," "model of care," "patient care planning," and "care pathway." Title, abstract, and full text review were competed by two independent reviewers. A combined total of 46 peer-reviewed and gray literature articles were included. No single SCI model of care has been adopted across different countries internationally. However, optimal attributes of models of care were identified, including the importance of having multidisciplinary SCI specialty care providers along the continuum, provision of rural SCI services and outreach, integration of primary care, peer mentoring, and using a hub and spokes model of care. These findings inform the future development of an SCI model of care, which ideally would serve all geographical locations and span the continuum of care, improving the health status and quality of life of persons with SCI.
Collapse
Affiliation(s)
- Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kayla Atchison
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Nicole McKenzie
- Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Joanna Marie B Rivera
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Charlene Yousefi
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
45
|
Silva D, Sousa R, Salgado A. Hydrogels as delivery systems for spinal cord injury regeneration. Mater Today Bio 2021; 9:100093. [PMID: 33665602 PMCID: PMC7905359 DOI: 10.1016/j.mtbio.2021.100093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/04/2023] Open
Abstract
Spinal cord injury is extremely debilitating, both at physiological and psychological levels, changing completely the patient's lifestyle. The introduction of biomaterials has opened a new window to develop a therapeutic approach to induce regeneration after injury due to similarities with extracellular matrix. Particularly, hydrogels have the ability to support axonal growth and endogenous regeneration. Moreover, they can also act as potential matrixes in which to load and deliver therapeutic agents at injury site. In this review, we highlight some important characteristics to be considered when designing hydrogels as delivery systems (DS), such as rheology, mesh size, swelling, degradation, gelation temperature and surface charge. Additionally, affinity-based release systems, incorporation of nanoparticles, or ion-mediated interactions are also pondered. Overall, hydrogel DS aim to promote a sustained, controlled and prolonged release at injury site, allowing a targeted oriented action of the therapeutic agent that will be used.
Collapse
Affiliation(s)
- D. Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
- ICVS/3B's—PT Government Associate Laboratory, 4710-057/4805-017, Braga/Guimarães, Portugal
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, 4805-017, Guimarães, Portugal
| | - R.A. Sousa
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, 4805-017, Guimarães, Portugal
| | - A.J. Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
- ICVS/3B's—PT Government Associate Laboratory, 4710-057/4805-017, Braga/Guimarães, Portugal
| |
Collapse
|
46
|
Etiology-specific variation in survival following non-traumatic spinal cord injury: a causal inference approach using data from a population-based cohort. Spinal Cord 2020; 59:257-265. [PMID: 32948845 PMCID: PMC7943420 DOI: 10.1038/s41393-020-00554-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
Study design Observational, population-based cohort study. Objectives To evaluate the origin and contribution to excess of survival differences following non-traumatic spinal cord injury (NTSCI) using etiology as proxy for variation in underlying health condition. Setting Specialized rehabilitation centers in Switzerland. Methods Medical record data collected by the Swiss Spinal Cord Injury cohort (SwiSCI) study were linked with mortality information from the Swiss National Cohort. Considering contemporary theory and empirical evidence, a directed acyclic graph (DAG) was developed to formally evaluate causal differences among NTSCI etiologies, relative to traumatic SCI (TSCI). Statistical inference was contingent on hazard ratios (HRs) and marginal survival differences, derived using flexible parametric modeling. Results 3643 individuals (NTSCI = 1357; TSCI = 2286) diagnosed with SCI between 1990 and 2011 were included, contributing a cumulative 41,344 person-years and 1323 deaths. Test statistics confirmed DAG-dataset consistency. As compared to TSCI, mortality was elevated in all NTSCI etiological groups; malignant etiologies had the highest HRs (10; 95% CI, 8.0 to 14) followed by infection (2.6; 1.8 to 3.6) and vascular (2.5; 2.0 to 3.2) etiology groups. At the attained age of 55, the estimated reduction in survival among non-malignant etiologies was 9.4% (5.8 to 13) at 5 years and 17% (11 to 23) at 20 years. Conclusions Causal differences in survival among NTSCI etiological groups are likely a result of chronic variation in health conditions. This study supports the development of long-term interdisciplinary management and policy for individuals with NTSCI, specific to etiology.
Collapse
|
47
|
Nerve and Tendon Transfers After Spinal Cord Injuries in the Pediatric Population. Phys Med Rehabil Clin N Am 2020; 31:455-469. [DOI: 10.1016/j.pmr.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
48
|
Guilcher SJT, Hogan ME, McCormack D, Calzavara AJ, Hitzig SL, Patel T, Packer T, Guan Q, Lofters AK. Prescription medications dispensed following a nontraumatic spinal cord dysfunction: a retrospective population-based study in Ontario, Canada. Spinal Cord 2020; 59:132-140. [PMID: 32665709 DOI: 10.1038/s41393-020-0511-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To examine the prevalence of polypharmacy for individuals with nontraumatic spinal cord dysfunction (NTSCD) following inpatient rehabilitation and to determine associated risk factors. SETTING Ontario, Canada. METHODS Administrative data housed at ICES, Toronto, Ontario were used. Between 2004 and 2015, we investigated prescription medications dispensed over a 1-year period for persons following an NTSCD-related inpatient rehabilitation admission. Descriptive and analytical statistics were conducted. Using a robust Poisson multivariable regression model, relative risks related to polypharmacy (ten or more drug classes) were calculated. Main independent variables were sex, age, income quintile, and continuity of care with outpatient physician visits. RESULTS We identified 3468 persons with NTSCD during the observation window. The mean number of drug classes taken post-inpatient rehabilitation was 11.7 (SD = 6.0), with 4.0 different prescribers (SD = 2.5) and 1.8 unique pharmacies (SD = 1.0). Significant predictors for post-discharge polypharmacy were: being female, lower income, higher comorbidities prior to admission, lower Functional Independence Measure at discharge, previous number of medication classes dispensed in year prior to admission, and lower continuity of care with outpatient physician visits. The most common drugs dispensed post-inpatient rehabilitation were antihypertensives (70.0%), laxatives (61.6%), opioids (59.5%), and antibiotics (57.8%). CONCLUSION Similar to previous research with traumatic spinal cord injury, our results indicate that polypharmacy is prevalent among persons with NTSCD. Additional research examining medication therapy management for NTSCD is suggested.
Collapse
Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - Mary-Ellen Hogan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | | | | | - Sander L Hitzig
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tejal Patel
- Schlegel-University of Waterloo Research Institute of Aging, Waterloo, ON, Canada.,Waterloo Institute for Complexity and Innovation, Waterloo, ON, Canada.,University of Waterloo School of Pharmacy, Kitchener, ON, Canada
| | - Tanya Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada.,Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Qi Guan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aisha K Lofters
- ICES, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
| |
Collapse
|
49
|
Duffell LD, Donaldson NDN. A Comparison of FES and SCS for Neuroplastic Recovery After SCI: Historical Perspectives and Future Directions. Front Neurol 2020; 11:607. [PMID: 32714270 PMCID: PMC7344227 DOI: 10.3389/fneur.2020.00607] [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: 05/25/2020] [Indexed: 12/17/2022] Open
Abstract
There is increasing evidence that neuroplastic changes can occur even years after spinal cord injury, leading to reduced disability and better health which should reduce the cost of healthcare. In motor-incomplete spinal cord injury, recovery of leg function may occur if repetitive training causes afferent input to the lumbar spinal cord. The afferent input may be due to activity-based therapy without electrical stimulation but we present evidence that it is faster with electrical stimulation. This may be spinal cord stimulation or peripheral nerve stimulation. Recovery is faster if the stimulation is phasic and that the patient is trying to use their legs during the training. All the published studies are small, so all conclusions are provisional, but it appears that patients with more disability (AIS A and B) may need to continue using stimulation and for them, an implanted stimulator is likely to be convenient. Patients with less disability (AIS C and D) may make useful recovery and improve their quality of life from a course of therapy. This might be locomotion therapy but we argue that cycling with electrical stimulation, which uses biofeedback to encourage descending drive, causes rapid recovery and might be used with little supervision at home, making it much less expensive. Such an electrical therapy followed by conventional physiotherapy might be affordable for the many people living with chronic SCI. To put this in perspective, we present some information about what treatments are funded in the UK and the US.
Collapse
Affiliation(s)
- Lynsey D Duffell
- Implanted Devices Group, University College London, London, United Kingdom.,Aspire CREATe, University College London, London, United Kingdom
| | | |
Collapse
|
50
|
Peterson MD, Kamdar N, Chiodo A, Tate DG. Psychological Morbidity and Chronic Disease Among Adults With Traumatic Spinal Cord Injuries: A Longitudinal Cohort Study of Privately Insured Beneficiaries. Mayo Clin Proc 2020; 95:920-928. [PMID: 32299672 DOI: 10.1016/j.mayocp.2019.11.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/23/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the longitudinal incidence of psychological morbidities and multimorbidity and estimates of chronic diseases among adults with spinal cord injuries (SCIs) as compared with adults without SCIs. METHODS Privately insured beneficiaries who had medical coverage at any time between January 1, 2001, and December 31, 2017 were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for a traumatic SCI (n=6,847). RESULTS Adults with SCIs (n=6847) had a higher incidence of adjustment reaction (7.2% [n=493] vs 5.0% [n=42,862]), anxiety disorders (19.3% [n=1,322] vs 14.1% [n=120,872]), depressive disorders (29.3% [n=2,006] vs 9.3% [n=79,724]), alcohol dependence (2.4% [n=164] vs 1.0% [n=8,573]), drug dependence (2.3% [n=158] vs 0.8% [n=6,858]), psychogenic pain (1.0% [n=69] vs 0.2% [n=1,715]), dementia (6.5% [n=445] vs 1.5% [n=12,859]), insomnia (10.9% [n=746] vs 7.2% [n=61,722]), and psychological multimorbidity (37.4% [n=2,561] vs 23.9% [n=204,882]) as compared with adults without SCIs (n=857,245). The adjusted hazard ratios (HRs) of each psychological outcome were significantly higher for individuals with SCI and ranged from 1.18 (95% CI, 1.08-1.29) for anxiety disorders to 3.32 (95% CI, 1.93-5.71) for psychogenic pain. Adults with SCIs also had a significantly higher prevalence of all chronic diseases and chronic disease multimorbidity (51.1% vs 14.1%), except human immunodeficiency virus infection/AIDS. After propensity matching for age, education, race, sex, and chronic diseases (n=5884 matched pairs), there was still a significantly higher incidence of most psychological disorders and psychological multimorbidity among adults with SCIs. CONCLUSION Adults with traumatic SCIs experienced an increased incidence of psychological morbidities and multimorbidity as compared with adults without SCIs. Clinical efforts are needed to improve mental health screening and targeted interventions to reduce the risk for psychological disease onset in the traumatic SCI population.
Collapse
Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Anthony Chiodo
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| |
Collapse
|