1
|
Kurban D, Davidson RA, Smith KM, Carlson M, Joseph J, Elliott S, Noonan VK, Fallah N, Krassioukov AV. Construct validity of the international standards to document remaining autonomic function after spinal cord injury (ISAFSCI) (1st edition). Spinal Cord 2023; 61:644-651. [PMID: 37814014 DOI: 10.1038/s41393-023-00932-z] [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: 04/20/2022] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
STUDY DESIGN Observational study. OBJECTIVES To assess the construct validity of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) (2012 1st Edition). SETTING Two Canadian spinal cord injury (SCI) centers. METHODS Data were collected between 2011-2014. Assessments included the ISAFSCI, standardized measures of autonomic function and a clinical examination. Construct validity of ISAFSCI was assessed by testing a priori hypotheses on expected ISAFSCI responses to standard measures (convergent hypotheses) and clinical variables (clinical hypotheses). RESULTS Forty-nine participants with an average age of 45 ± 12 years were included, of which 42 (85.7%) were males, 37 (77.6%) had a neurological level of injury at or above T6, and 23 (46.9%) were assessed as having motor and sensory complete SCI. For the six General Autonomic Function component hypotheses, two hypotheses (1 clinical, 1 convergent) related to autonomic control of blood pressure and one clinical hypothesis for temperature regulation were statistically significant. In terms of the Lower Urinary Tract, Bowel and Sexual Function component of the ISAFSCI, all the hypotheses (5 convergent, 3 clinical) were statistically significant except for the hypotheses on female sexual items (2 convergent, 2 clinical), likely due to small sample size. CONCLUSION The construct validity of ISAFSCI (2012 1st Edition) for the General Autonomic Function component was considered to be weak while it was much stronger for the Lower Urinary Tract, Bowel and Sexual Function component based on a priori hypotheses. These results can inform future psychometric studies of the ISAFSCI (2021 2nd Edition).
Collapse
Affiliation(s)
| | - Ross A Davidson
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Karen M Smith
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, Canada
| | - Marie Carlson
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | | | - Stacy Elliott
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
2
|
Wilson JR, Doty S, Petitt JC, El-Abtah M, Francis JJ, Sharpe MG, Kelly ML, Anderson KD. Feasibility of gabapentin as an intervention for neurorecovery after an acute spinal cord injury: Protocol. Front Neurol 2022; 13:1033386. [PMID: 36419530 PMCID: PMC9676350 DOI: 10.3389/fneur.2022.1033386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction This protocol is describing the first ever prospective, mock-efficacy, dose exploration trial design testing the feasibility of administering gabapentin in the acute setting as an intervention for neurorecovery. Gabapentin is an FDA-approved medication for treating seizures and postherpetic neuralgia and is used broadly off-label for neuropathic pain management for many conditions, including spinal cord injury. Emerging data suggests that when given early after spinal cord injury onset and in low-medium doses, gabapentin may have properties that promote recovery of neurological function. The objective of this trial is to assess the feasibility of conducting an efficacy trial in which gabapentin is started early after injury, is restricted in its dose, and is not used for pain management. Methods and analysis Forty-two people aged 18 years or older with any level and any severity of spinal cord injury induced by a trauma will be enrolled, randomized, and have the first dose of study medication by 120 h post-injury onset. Participants will be randomly assigned to one of three groups: 600, 1,800 mg/day gabapentin, or placebo. Study medication will be given for a 90-day duration. Blinded assessments will be obtained at 7 days post-injury (baseline), 30 days post-injury (interim), after the 90-day treatment duration/approximately 3 months post-injury (end of treatment), and at 6 months post-injury (end of study). The key analysis parameters will evaluate feasibility of recruitment of target population, delivery of drug treatment protocol, maintenance of blinding, and retention of participants. Discussion Outputs from this trial will inform research and clinical practice on the effects of manipulating gabapentin for non-pain management purposes in the acute setting and will guide the development of a properly powered efficacy trial of gabapentin as an intervention for neurorecovery in spinal cord injury. Ethics and dissemination The study was approved by the MetroHealth Institutional Review Board (IRB21-00609) and registered at clinicaltrials.gov prior to enrolling any participants. Dissemination will include peer-reviewed publications, presentations at professional conferences and in the community, and through other healthcare and public venues. Clinical trial registration www.ClinicalTrials.gov, identifier: NCT05302999; protocol version 1.1 approved 05/23/2022. Trial funding National Institute on Disability, Independent Living and Rehabilitation Research.
Collapse
Affiliation(s)
- James R. Wilson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, United States
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Samuel Doty
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Jordan C. Petitt
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Mohamed El-Abtah
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - John J. Francis
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Megan G. Sharpe
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Michael L. Kelly
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- MetroHealth Medical Center, MetroHealth System, Cleveland, OH, United States
| | - Kim D. Anderson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, United States
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- *Correspondence: Kim D. Anderson
| |
Collapse
|
3
|
Xing H, Liu N, Krassioukov AV, Biering-Sørensen F. How to learn the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) content: Self-study through booklet is not enough. J Spinal Cord Med 2022; 45:874-881. [PMID: 33960871 PMCID: PMC9662037 DOI: 10.1080/10790268.2021.1918978] [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: 10/21/2022] Open
Abstract
OBJECTIVE To investigate the baseline knowledge of autonomic functions and specifically the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) among medical students and to present the effective methods in learning of the ISAFSCI. DESIGN Interventional training session. SETTING A tertiary hospital. PARTICIPANTS 37 medical students. INTERVENTIONS Before training, a self-rating questionnaire including 24 concepts extracted from the ISAFSCI was administrated to the students. Then students were divided into two groups. One group (N = 19) had a one-hour ISAFSCI booklet self-study (BSS), while the other group (N = 18) received a one-hour lecture-based learning (LBL) about the ISAFSCI. After BSS/LBL, all students were examined by a 15-question written test on the knowledge of ISAFSCI. MAIN OUTCOME MEASURES Baseline knowledge self-rating questionnaire before training and comparison of post-training performance on the written test between the BSS and LBL groups. RESULTS Before training, students were familiar with only 8 out of the 24 concepts within the questionnaire (demonstrating baseline knowledge rate beyond 50%). Significant difference in post-training performance (P<0.05) between BBS and LBL groups was noted for 5 of 15 items tested, including hypohydrosis, broncho-pulmonary system, lower urinary tract function, bowel function and female sexual function. All questions except the one regarding hypohydrosis were answered with greater than 80% accuracy by LBL group. CONCLUSION Use of ISAFSCI booklet alone for self-study by medical students is not sufficient to obtain bassline knowledge of autonomic discussions after SCI. It is recommended that formal lecture or presentation should be used to improve the effectiveness of learning the ISAFSCI for medical students.
Collapse
Affiliation(s)
- Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, People’s Republic of China,Correspondence to: Nan Liu, Department of Rehabilitation Medicine, Peking University Third Hospital, No. 49 North Garden Road, Beijing100191, People’s Republic of China.
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, GF Strong Rehabilitation Center, Vancouver, Canada
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
What should be clarified when learning the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) among medical students. Spinal Cord Ser Cases 2021; 7:68. [PMID: 34333517 DOI: 10.1038/s41394-021-00431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/08/2022] Open
|
5
|
Wecht JM, Krassioukov AV, Alexander M, Handrakis JP, McKenna SL, Kennelly M, Trbovich M, Biering-Sorensen F, Burns S, Elliott SL, Graves D, Hamer J, Krogh K, Linsenmeyer TA, Liu N, Hagen EM, Phillips AA, Previnaire JG, Rodriguez GM, Slocum C, Wilson JR. International Standards to document Autonomic Function following SCI (ISAFSCI): Second Edition. Top Spinal Cord Inj Rehabil 2021; 27:23-49. [PMID: 34108833 DOI: 10.46292/sci2702-23] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jill M Wecht
- James J Peters VA Medical Center, Bronx, NY.,Bronx Veterans Medical Research Foundation, Bronx, NY.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD) and Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia.,Spinal Cord Program, GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.,President, American Spinal Injury Association (ASIA)
| | - Maralee Alexander
- Sustain Our Abilities, Birmingham, AL.,University of Alabama at Birmingham School of Medicine, Birmingham, AL.,Spaulding Rehabilitation Hospital, Charlestown, MA
| | - John P Handrakis
- James J Peters VA Medical Center, Bronx, NY.,Bronx Veterans Medical Research Foundation, Bronx, NY.,New York Institute of Technology, Department of Physical Therapy, School of Health Professions, Old Westbury, NY
| | - Stephen L McKenna
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA.,Department of Neurosurgery, Stanford University, Stanford, CA
| | - Michael Kennelly
- James J Peters VA Medical Center, Bronx, NY.,Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY.,International Collaboration on Repair Discoveries (ICORD) and Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia
| | - Michele Trbovich
- South Texas Veterans Health Care System, San Antonio, TX.,Department of Rehabilitation Medicine, University of Texas Health San Antonio
| | - Fin Biering-Sorensen
- Department for Spinal Cord Injuries, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Stephen Burns
- Spinal Cord Injury Service, VA Puget Sound Health Care System, Seattle, WA.,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Stacy L Elliott
- International Collaboration on Repair Discoveries (ICORD) and Division of Sexual Medicine, Departments of Psychiatry and Urologic Sciences, Faculty of Medicine, University of British Columbia
| | - Daniel Graves
- College of Rehabilitation Sciences, Department of Rehabilitation Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA
| | | | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Todd A Linsenmeyer
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery ( Division of Urology), Rutgers New Jersey Medical School, Newark, NJ.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Ellen Merete Hagen
- National Hospital for Neurology and Neurosurgery, Queens Square, UCLH, London, UK.,Institute of Neurology, University College London, London, UK
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Hotchkiss Brain Institute, University of Calgary.,Cardiovascular Institute, Cumming School of Medicine, University of Calgary
| | | | - Gianna M Rodriguez
- Physical Medicine and Rehabilitation Department, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Chloe Slocum
- Spaulding Rehabilitation Hospital, Charlestown, MA.,Harvard Medical School Department of Physical Medicine and Rehabilitation, Boston, MA
| | - James R Wilson
- Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute, Cleveland, OH.,Department of Physical Medicine and Rehabilitation, Case Western Reserve University-SOM, Cleveland, OH
| |
Collapse
|
6
|
Abstract
STUDY DESIGN This was a prospective cohort study. OBJECTIVE The objective of this study was to design and test a novel spine neurological examination adapted for telemedicine. SUMMARY OF BACKGROUND DATA Telemedicine is a rapidly evolving technology associated with numerous potential benefits for health care, especially in the modern era of value-based care. To date, no studies have assessed whether. METHODS Twenty-one healthy controls and 20 patients with cervical or lumbar spinal disease (D) were prospectively enrolled. Each patient underwent a telemedicine neurological examination as well as a traditional in-person neurological examination administered by a fellowship trained spine surgeon and a physiatrist. Both the telemedicine and in-person tests consisted of motor, sensory, and special test components. Scores were compared via univariate analysis and secondary qualitative outcomes, including responses from a satisfaction survey, were obtained upon completion of the trial. RESULTS Of the 20 patients in the D group, 9 patients had cervical disease and 11 patients had lumbar disease. Comparing healthy control with the D group, there were no significant differences with respect to all motor scores, most sensory scores, and all special tests. There was a high rate of satisfaction among the cohort with 92.7% of participants feeling "very satisfied" with the overall experience. CONCLUSIONS This study presents the development of a viable neurological spine examination adapted for telemedicine. The findings in this study suggest that patients have comparable motor, sensory, and special test scores with telemedicine as with a traditional in-person examination administered by an experienced clinician, as well as reporting a high rate of satisfaction among participants. To our knowledge, this is the first telemedicine neurological examination for spine surgery. Further studies are warranted to validate these findings.
Collapse
|
7
|
Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management. Semin Neurol 2020; 40:550-559. [PMID: 32906175 DOI: 10.1055/s-0040-1713885] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Spinal cord injury (SCI) disrupts autonomic circuits and impairs synchronistic functioning of the autonomic nervous system, leading to inadequate cardiovascular regulation. Individuals with SCI, particularly at or above the sixth thoracic vertebral level (T6), often have impaired regulation of sympathetic vasoconstriction of the peripheral vasculature and the splanchnic circulation, and diminished control of heart rate and cardiac output. In addition, impaired descending sympathetic control results in changes in circulating levels of plasma catecholamines, which can have a profound effect on cardiovascular function. Although individuals with lesions below T6 often have normal resting blood pressures, there is evidence of increases in resting heart rate and inadequate cardiovascular response to autonomic provocations such as the head-up tilt and cold face tests. This manuscript reviews the prevalence of cardiovascular disorders given the level, duration and severity of SCI, the clinical presentation, diagnostic workup, short- and long-term consequences, and empirical evidence supporting management strategies to treat cardiovascular dysfunction following a SCI.
Collapse
|
8
|
Alexander M, Carr C, Alexander J, Chen Y, McLain A. Assessing the ability of the Sacral Autonomic Standards to document bladder and bowel function based upon the Asia Impairment Scale. Spinal Cord Ser Cases 2019; 5:85. [PMID: 31700683 PMCID: PMC6821794 DOI: 10.1038/s41394-019-0228-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 12/30/2022] Open
Abstract
Study design Retrospective review of data. Objective To determine if there is a relationship between the Asia Impairment Scale (AIS) and the bladder and bowel components of the International Standards to Document Remaining Autonomic Function after SCI (ISAFSCI). Setting University-Based Academic Rehabilitation Program. Methods Retrospective cross-sectional study assessing International Standards for Neurologic Classification After SCI (ISNCSCI) examination along with bladder and bowel components of the ISAFSCI. Results Subjects with AIS A injuries were statistically less likely to have history of bladder control and bowel control per investigator determination and bladder sensation via self-report versus patients categorized with AIS B injuries. Self-reported history of bowel sensation and control of voiding were more likely in subjects with C, D, or E injuries than with B injuries. Bowel and bladder control as determined by investigator and bladder and bowel sensation and control as self-reported were all statistically less likely in persons with AIS A injuries versus CDE. Conclusions This retrospective study provides initial data regarding components of the bladder and bowel sections of the sacral ISAFSCI and AIS. Further prospective research is needed to further characterize the relationship between retention of bladder and bowel sensation and function and the AIS. We suggest that incorporation of the sacral components of the ISAFSCI into the ISNCSCI may be beneficial to obtain further information about retention of sacral function with specific patterns of injury.
Collapse
Affiliation(s)
- Marca Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | - Conley Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | | | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | - Amie McLain
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| |
Collapse
|
9
|
Sarafis ZK, Monga AK, Phillips AA, Krassioukov AV. Is Technology for Orthostatic Hypotension Ready for Primetime? PM R 2019; 10:S249-S263. [PMID: 30269810 DOI: 10.1016/j.pmrj.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/29/2023]
Abstract
Spinal cord injury (SCI) often results in the devastating loss of motor, sensory, and autonomic function. After SCI, the interruption of descending sympathoexcitatory pathways disrupts supraspinal control of blood pressure (BP). A common clinical consequence of cardiovascular dysfunction after SCI is orthostatic hypotension (OH), a debilitating condition characterized by rapid profound decreases in BP when assuming an upright posture. OH can result in a diverse array of insidious and pernicious health consequences. Acute effects of OH include decreased cardiac filling, cerebral hypoperfusion, and associated presyncopal symptoms such as lightheadedness and dizziness. Over the long term, repetitive exposure to OH is associated with a drastically increased prevalence of heart attack and stroke, which are leading causes of death in those with SCI. Current recommendations for managing BP after SCI primarily include pharmacologic interventions with prolonged time to effect. Because most episodes of OH occur in less than 3 minutes, this delay in action often renders most pharmacologic interventions ineffective. New innovative technologies such as epidural and transcutaneous spinal cord stimulation are being explored to solve this problem. It might be possible to electrically stimulate sympathetic circuitry caudal to the injury and elicit rapid modulation of BP to manage OH. This review describes autonomic control of the cardiovascular system before injury, resulting cardiovascular consequences after SCI such as OH, and the clinical assessment tools for evaluating autonomic dysfunction after SCI. In addition, current approaches for clinically managing OH are outlined, and new promising interventions are described for managing this condition.
Collapse
Affiliation(s)
- Zoe K Sarafis
- ICORD-BSCC, University of British Columbia, Vancouver, BC, Canada(∗)
| | - Aaron K Monga
- ICORD-BSCC, University of British Columbia, Vancouver, BC, Canada(†)
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada(‡)
| | - Andrei V Krassioukov
- ICORD-BSCC; Experimental Medicine Program; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia; GF Strong Rehabilitation Center, Vancouver Coastal Health; 818 West 10th Avenue, Vancouver, BC, Canada, V5Z1M9(§).
| |
Collapse
|
10
|
Stoffel JT, Van der Aa F, Wittmann D, Yande S, Elliott S. Fertility and sexuality in the spinal cord injury patient. World J Urol 2018; 36:1577-1585. [PMID: 29948051 DOI: 10.1007/s00345-018-2347-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/17/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND After a spinal cord injury, patients have different perceptions of sexuality, sexual function, and potential for fertility. These changes can greatly impact quality of life over a lifetime. PURPOSE The purpose of this workgroup was to identify common evidence based or expert opinion themes and recommendations regarding treatment of sexuality, sexual function and fertility in the spinal cord injury population. METHODS As part of the SIU-ICUD joint consultation of Urologic Management of the Spinal Cord Injury (SCI), a workgroup and comprehensive literature search of English language manuscripts regarding fertility and sexuality in the spinal cord injury patient were formed. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for levels of evidence (LOEs) and grades of recommendation (GORs). RESULTS Genital arousal, ejaculation, and orgasm are significantly impacted after spinal cord injury in both male and female SCI patients. This may have a more significant impact on potential for fertility in male spinal cord injury patients, particularly regarding ability of generate erection, semen quantity and quality. Female patients should be consulted that pregnancy is still possible after injury and a woman should expect resumption of normal reproductive function. As a result, sexual health teaching should be continued in women despite injury. Pregnancy in a SCI may cause complications such as autonomic dysreflexia, so this group should be carefully followed during pregnancy. CONCLUSIONS By understanding physiologic changes after injury, patients and care teams can work together to achieve goals and maximize sexual quality of life after the injury.
Collapse
Affiliation(s)
| | | | - D Wittmann
- University of Michigan, Ann Arbor, MI, USA
| | - S Yande
- Ruby Hall Clinic, Pune, India
| | - S Elliott
- University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
11
|
Dong C, Zhu P, Xie Z, Fan Z, Dong Z. Reinnervation of the rectum with transfer of the genital branch of the genitofemoral nerve to the pelvic nerve in rats. J Neurosurg Spine 2018; 28:562-567. [PMID: 29451438 DOI: 10.3171/2017.8.spine17696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study was to determine the feasibility of rectum reinnervation with transfer of a primarily genitofemoral nerve to the pelvic nerve in the rat.METHODSThirty-six male rats were randomly divided into 3 groups: rats in the nerve transfer group (n = 12) were subjected to rectal denervation and then bilateral genitofemoral nerve–pelvic nerve transfer; rats in the nerve resection group (n = 12) underwent rectum denervation without nerve transfer; and rats in the control group (n = 12) underwent sham surgery. Rectum denervation was achieved by transection of the L-6 spinal nerves, the spinal nerves below L-6, and the pelvic nerve. Four months postoperatively, retrograde nerve tracing, regenerative nerve morphological examination, and rectal manometry assessment were performed.RESULTSRegenerative nerve morphological examination showed good axonal regeneration after genitofemoral nerve transfer. Nerve stimulation induced increased rectal pressures in 10 of 12 rats in the nerve transfer group. The mean rectal pressure in this group was 54.9 ± 7.1 mm Hg, which is higher than the mean value in the nerve resection group (5.5 ± 2.0 mm Hg) but lower than that in the control group (70.6 ± 8.5 mm Hg) (p < 0.05). The appearance of FluoroGold-labeled neurons in the L-1 and L-2 spinal cord segments in the nerve transfer group confirmed the formation of new neural pathways.CONCLUSIONSThe results have demonstrated that genitofemoral nerve–pelvic nerve transfer can achieve nerve regeneration. In this animal model, the authors were able to reinnervate the rectum by nerve transfer.
Collapse
Affiliation(s)
| | - Ping Zhu
- 2Nephrology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People’s Hospital, Yichang, Hubei, China
| | - Zonglan Xie
- 2Nephrology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People’s Hospital, Yichang, Hubei, China
| | | | | |
Collapse
|
12
|
Walter M, Krassioukov AV. Autonomic Nervous System in Paralympic Athletes with Spinal Cord Injury. Phys Med Rehabil Clin N Am 2018; 29:245-266. [PMID: 29627087 DOI: 10.1016/j.pmr.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Individuals sustaining a spinal cord injury (SCI) frequently suffer from sensorimotor and autonomic impairment. Damage to the autonomic nervous system results in cardiovascular, respiratory, bladder, bowel, and sexual dysfunctions, as well as temperature dysregulation. These complications not only impede quality of life, but also affect athletic performance of individuals with SCI. This article summarizes existing evidence on how damage to the spinal cord affects the autonomic nervous system and impacts the performance in athletes with SCI. Also discussed are frequently used performance-enhancing strategies, with a special focus on their legal aspect and implication on the athletes' health.
Collapse
Affiliation(s)
- Matthias Walter
- Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - Andrei V Krassioukov
- Division of Physical Medicine and Rehabilitation, Department of Medicine, International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, University of British Columbia, GF Strong Rehabilitation Centre, Vancouver Coastal Health, 818 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada.
| |
Collapse
|
13
|
Goetz LL, Emmanuel A, Krogh K. International standards to document remaining autonomic Function in persons with SCI and neurogenic bowel dysfunction: Illustrative cases. Spinal Cord Ser Cases 2018; 4:1. [PMID: 29423306 PMCID: PMC5802388 DOI: 10.1038/s41394-017-0030-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Neurogenic bowel dysfunction (NBD) is a highly prevalent problem after spinal cord injury, with potential for significant impact on health and quality of life. The international standards to document remaining autonomic function after SCI were developed to standardize communication between professionals regarding neurogenic bowel and other autonomic function after SCI. To improve understanding of the bowel subsection, illustrative cases are presented. CASE PRESENTATION Three cases are presented which illustrate differences in presentation and scoring of the elements in the data set based upon varying injury severity and location. DISCUSSION Determination of neurologic level of injury is insufficient for assessment of autonomic function and there is no direct method of assessment. Hence, surrogate makers are needed. The bowel subsection of the International standards to document remaining autonomic function in persons with SCI is an easy-to-use tool for this purpose.
Collapse
Affiliation(s)
- Lance L. Goetz
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VA Medical Center and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA USA
| | - Anton Emmanuel
- GI Physiology Unit, University College Hospital, London, UK
| | - Klaus Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
14
|
Abstract
Spinal cord injury results in physiologic adaptations affecting heat production (reduced muscle mass) and heat dissipation (blood redistribution and reduced sweating capacity below the level of lesion). However, it is the balance between these factors which determines whether heat balance is achieved. Core temperature estimates are generally consistent with those for the able-bodied, with cooler values reported in some instances. More notable differences are demonstrated through cooler lower-body skin temperatures at rest and a loss of anticipatory control during exposure to heat and cold when compared to the able-bodied. During exercise in cool conditions persons with paraplegia demonstrate similar body temperature responses as for the able-bodied but retain heat during recovery. Persons with tetraplegia demonstrate continual increases in core temperature and thus thermal imbalance along with greater heat retention. During exercise in the heat, athletes with paraplegia appear to be able to regulate body temperature to a similar extent as the able-bodied. Those with tetraplegia again show thermal imbalance but to a much greater extent than in the cold. Future work should focus upon specific sweating responses and adaptations following spinal cord injury, the effects of completeness of lesion, perceptual responses to environmental challenges, and how these translate to undertaking activities of daily living.
Collapse
Affiliation(s)
- Mike J Price
- School of Life Sciences, Coventry University, Coventry, United Kingdom.
| | - Michelle Trbovich
- Spinal Cord Injury Unit, San Antonio Veterans Hospital, San Antonio, TX, United States
| |
Collapse
|
15
|
Lee AHX, Phillips AA, Squair JW, Barak OF, Coombs GB, Ainslie PN, Sarafis ZK, Mijacika T, Vucina D, Dujic Z, Krassioukov AV. Alarming blood pressure changes during routine bladder emptying in a woman with cervical spinal cord injury. Spinal Cord Ser Cases 2017; 3:17101. [PMID: 29423304 PMCID: PMC5798923 DOI: 10.1038/s41394-017-0022-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Many individuals with high-level spinal cord injury (SCI) experience secondary conditions such as autonomic dysreflexia (AD), which is a potentially life-threatening condition comprising transient episodes of hypertension up to 300 mmHg. AD may be accompanied by symptoms and signs such as headache, flushing, and sweating. Delay in AD recognition and management is associated with increased incidence of cardiovascular events and disease. As it is commonly triggered by bladder distension, AD continues to be a major concern for individuals living with SCI, both on a daily basis and in the long-term. CASE PRESENTATION A 58-year-old woman with C3 AIS B SCI presented with low resting blood pressure (BP) at 100/64 mmHg. She reported frequent episodes of AD that were most commonly attributed to urinary bladder filling. During our testing session, her systolic BP rose to 130 mmHg, at which point her care aide stepped in to utilize the Credé maneuver, which was part of her daily routine for bladder emptying. Application of suprapubic pressure further elevated her systolic BP to 230 mmHg. Throughout the episode of AD, the participant experienced a pounding headache and erythema above the LOI. DISCUSSION Clinical guidelines for bladder management after SCI recommend avoiding the Credé maneuver due to potential complications such as hernia or bruising. This current case report demonstrates the additional risk of inducing AD and dangerously high BP elevation.
Collapse
Affiliation(s)
- Amanda H. X. Lee
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC V1Y 1T3 Canada
- Department of Experimental Medicine, Faculty of Medicine, University of British Columbia Vancouver, Vancouver, BC V6T 1Z4 Canada
| | - Aaron A. Phillips
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC V1Y 1T3 Canada
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4 Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Jordan W. Squair
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC V1Y 1T3 Canada
- MD/PhD Training Program, Faculty of Medicine, University of British Columbia Vancouver, Vancouver, BC V6T 1Z4 Canada
| | - Otto F. Barak
- University of Novi Sad School of Medicine, Novi Sad, Serbia
| | - Geoff B. Coombs
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC V1V 1V7 Canada
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Kelowna, BC V1V 1V7 Canada
| | - Philip N. Ainslie
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC V1V 1V7 Canada
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Kelowna, BC V1V 1V7 Canada
| | - Zoe K. Sarafis
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC V1Y 1T3 Canada
| | - Tanja Mijacika
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska, Split Croatia
| | - Diana Vucina
- Department of Neurology, Clinical Hospital Center Split, Spinciceva, Split Croatia
| | - Zeljko Dujic
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska, Split Croatia
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC V1Y 1T3 Canada
- Department of Experimental Medicine, Faculty of Medicine, University of British Columbia Vancouver, Vancouver, BC V6T 1Z4 Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC Canada
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC V1V 1V7 Canada
| |
Collapse
|
16
|
Alexander M, Wecht J, Krassioukov A. Pulse article: Survey on the current usage of the International Standards for the Assessment of Autonomic Function after Spinal Cord Injury (ISAFSCI). Spinal Cord Ser Cases 2017; 3:17100. [PMID: 29423303 DOI: 10.1038/s41394-017-0025-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/27/2017] [Accepted: 10/03/2017] [Indexed: 11/09/2022] Open
Abstract
Study design Online questionnaire. Objectives To identify the awareness, and current use, of the International Standards for the Assessment of Autonomic Function after SCI (ISAFSCI) and suggest necessary revisions. Setting An international collaboration of committee members. Methods A survey was drafted and consensus achieved among members of the International Standards Committee of the ASIA. The questionnaire was posted on SurveyMonkey for 2 months. A survey link was posted on the ASIA and ISCoS websites, and committee members circulated the survey to colleagues with the goal of obtaining a wide-spread international response. Results A total of 173 providers responded. About half (n = 84) of the respondents used the standards in some form. Forty-four percent (n = 72) felt they knew the difference between the standards and the data sets. Among 135 responses on the usefulness of the ISAFSCI, the bladder, bowel, and sexual function sections, and the heart rate, respiratory rate, blood pressure, and sudomotor sections for use in patients with tetraplegia were reported as most useful. Comments revealed that respondents would like more explanation regarding specific definitions of components of the standards, how/when to use the ISAFSCI, and how the ISAFSCI may assist in clinical care. Conclusion The ISAFSCI is used by a subset of SCI clinicians. Some find the standards useful, while others are unaware of the utility of the ISAFSCI to prevent morbidity and assist in documentation of autonomic recovery post SCI. Further clarification regarding the definition of various disorders, and how and why to use the ISAFSCI in the SCI population, is needed.
Collapse
Affiliation(s)
- Marcalee Alexander
- 1Birmingham VA Medical Center, Birmingham, AL 35233 USA.,2University of Alabama at Birmingham Department of Physical Medicine and Rehabilitation, Birmingham, AL 35294 USA.,3Harvard Medical School Department of Physical Medicine and Rehabilitation, Boston, MA 02115 USA
| | - Jill Wecht
- 4National Center for the Medical Consequences of SCI: James J Peters VA Medical Center, Bronx, NY 10468 USA.,5Department of Medicine and Rehabilitation Medicine, The Icahn School of Medicine, Mount Sinai, New York, NY 10029 USA
| | - Andrei Krassioukov
- 6International Collaboration On Repair Discoveries, Vancouver, BC V6T 1Z4 Canada.,7University of British Columbia, Vancouver, BC V6T 1Z4 Canada
| | | |
Collapse
|