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Trbovich M, Wu Y, Koek W, Wecht J, Kellogg D. Elucidating mechanisms of attenuated skin vasodilation during passive heat stress in persons with spinal cord injury. J Spinal Cord Med 2024; 47:765-774. [PMID: 37158753 PMCID: PMC11378667 DOI: 10.1080/10790268.2023.2203535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE Persons with spinal cord injury (SCI) are unable to efficiently dissipate heat via thermoregulatory vasodilation as efficiently as able-bodied persons during whole body passive heat stress (PHS). Skin blood flow (SkBF) is controlled by dual sympathetic vasomotor systems: noradrenergic vasoconstrictor (VC) nerves and cholinergic vasodilator (VD) nerves. Thus, impaired vasodilation could result from inappropriate increases in noradrenergic VC tone that compete with cholinergic vasodilation or diminished cholinergic tone. To address this issue, we used bretylium (BR) which selectively blocks neural release of norepinephrine, thereby reducing noradrenergic VC tone. If impaired vasodilation during PHS is due to inappropriate increase in VC tone, BR treatment will improve SkBF responses during PHS. DESIGN Prospective interventional trial. SETTING laboratory. PARTICIPANTS 22 veterans with SCI. INTERVENTIONS Skin surface areas with previously defined intact vs. impaired thermoregulatory vasodilation were treated with BR iontophoresis with a nearby untreated site serving as control/CON. Participants underwent PHS until core temperature rose 1°C. OUTCOME MEASURES Laser doppler flowmeters measured SkBF over BR and CON sites in areas with impaired and intact thermoregulatory vasodilation. Cutaneous vascular conductance (CVC) was calculated for all sites. Peak-PHS CVC was normalized to baseline (BL): (CVC peak-PHS/CVC BL) to quantify SkBF change. RESULTS CVC rise in BR sites was significantly less than CON sites in areas with intact (P = 0.03) and impaired (P = 0.04) thermoregulatory vasodilation. CONCLUSION Cutaneous blockade of neural release of noradrenergic neurotransmitters affecting vasoconstriction did not enhance thermoregulatory vasodilation during PHS in persons with SCI; rather BR attenuated the response. Cutaneous blockade of neural release of noradrenergic neurotransmitters affecting vasoconstriction did not restore cutaneous active vasodilation during PHS in persons with SCI.
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Affiliation(s)
- Michelle Trbovich
- Department of Rehabilitation Medicine, University of Texas Health Science Center, San Antonio
- South Texas Veteran's Health Care System, San Antonio, Texas, USA
| | - Yubo Wu
- South Texas Veteran's Health Care System, San Antonio, Texas, USA
| | - Wouker Koek
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, USA
| | - Jill Wecht
- James J Peters Department of Veteran's Affairs Medical Center, Bronx, New York, USA
| | - Dean Kellogg
- South Texas Veteran's Health Care System, San Antonio, Texas, USA
- Geriatric Research Education and Clinical Center and Dept of Medicine, University of Texas Health Science Center, San Antonio, USA
- Department of Medicine, University of TX Health Science Center, San Antonio, USA
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Sisodiya SM, Gulcebi MI, Fortunato F, Mills JD, Haynes E, Bramon E, Chadwick P, Ciccarelli O, David AS, De Meyer K, Fox NC, Davan Wetton J, Koltzenburg M, Kullmann DM, Kurian MA, Manji H, Maslin MA, Matharu M, Montgomery H, Romanello M, Werring DJ, Zhang L, Friston KJ, Hanna MG. Climate change and disorders of the nervous system. Lancet Neurol 2024; 23:636-648. [PMID: 38760101 DOI: 10.1016/s1474-4422(24)00087-5] [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: 11/17/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 05/19/2024]
Abstract
Anthropogenic climate change is affecting people's health, including those with neurological and psychiatric diseases. Currently, making inferences about the effect of climate change on neurological and psychiatric diseases is challenging because of an overall sparsity of data, differing study methods, paucity of detail regarding disease subtypes, little consideration of the effect of individual and population genetics, and widely differing geographical locations with the potential for regional influences. However, evidence suggests that the incidence, prevalence, and severity of many nervous system conditions (eg, stroke, neurological infections, and some mental health disorders) can be affected by climate change. The data show broad and complex adverse effects, especially of temperature extremes to which people are unaccustomed and wide diurnal temperature fluctuations. Protective measures might be possible through local forecasting. Few studies project the future effects of climate change on brain health, hindering policy developments. Robust studies on the threats from changing climate for people who have, or are at risk of developing, disorders of the nervous system are urgently needed.
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Affiliation(s)
- Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK.
| | - Medine I Gulcebi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Francesco Fortunato
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - James D Mills
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Ethan Haynes
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Elvira Bramon
- Division of Psychiatry, University College London, London, UK
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK; National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Anthony S David
- Division of Psychiatry, University College London, London, UK
| | - Kris De Meyer
- UCL Climate Action Unit, University College London, London, UK
| | - Nick C Fox
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK; Department of the UK Dementia Research Institute, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Martin Koltzenburg
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Dimitri M Kullmann
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manju A Kurian
- Department of Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Hadi Manji
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Mark A Maslin
- Department of Geography, University College London, London, UK; Natural History Museum of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, UCL and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Hugh Montgomery
- Department of Medicine, University College London, London, UK
| | - Marina Romanello
- Institute for Global Health, University College London, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lisa Zhang
- Centre for Behaviour Change, University College London, London, UK
| | - Karl J Friston
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Michael G Hanna
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK; MRC International Centre for Genomic Medicine in Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
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Vasquez LO, Lee I, Bart J, Barton CR, Chui J, Tascione O, Kumar NS, Cirnigliaro CM, Lombard AT, Kirshblum SC, Bauman WA, Handrakis JP. Self-reported effects of warm seasonal temperatures in persons with spinal cord injury. J Spinal Cord Med 2024; 47:395-403. [PMID: 37010833 PMCID: PMC11044722 DOI: 10.1080/10790268.2023.2194962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Spinal cord injury (SCI) interrupts motor, sensory, and autonomic pathways, impairing mobility and increasing heat storage during warm seasonal temperatures due to compromised autonomic control of vasodilation and sweating and recognition of body temperature. Thus, persons with SCI are more vulnerable to hyperthermia and its adverse effects. However, information regarding how persons with SCI perceive warmer seasons and whether thermal discomfort during warmer seasons restricts routine activities remains anecdotal. DESIGN Cross-sectional, self-report surveys. SETTING VA Medical Center and Kessler Institute for Rehabilitation. PARTICIPANTS Three groups of 50 participants each: tetraplegia, paraplegia, and matched non-SCI controls. OUTCOME MEASURES Tetraplegia, paraplegia, and control groups responded "yes" or "no" when asked whether warm seasonal temperatures adversely affected comfort or participation in routine activities. RESULTS The percentage of responses differed among tetraplegia, paraplegia, and control groups when asked if they required ≥20 min to cool down once overheated (44 vs. 20 vs. 12%; X2 = 14.7, P < 0.001), whether heat-related discomfort limited their ability to go outside (62 vs. 34 vs. 32%; X2 = 11.5, P = 0.003), if they needed to use a water-mister because of the heat (70 vs. 44 vs. 42%; X2 = 9.8, P = 0.008), and if heat-related discomfort limited participation in social activities (40 vs. 20 vs. 16%; X2 = 8.7, P = 0.01). CONCLUSION Warmer seasonal temperatures had a greater negative impact on reported comfort and daily activities of persons with SCI than non-SCI controls. Those with tetraplegia were most adversely affected. Our findings warrant increasing awareness and identifying interventions to address the vulnerability of persons with SCI to hyperthermia.
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Affiliation(s)
- Luis Ortiz Vasquez
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Ingrid Lee
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Jessica Bart
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York, USA
| | - Christian R. Barton
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York, USA
| | - Jennifer Chui
- Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Oriana Tascione
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Nina S. Kumar
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Christopher M. Cirnigliaro
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Alex T. Lombard
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Steven C. Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - William A. Bauman
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John P. Handrakis
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York, USA
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Moro V, Beccherle M, Scandola M, Aglioti SM. Massive body-brain disconnection consequent to spinal cord injuries drives profound changes in higher-order cognitive and emotional functions: A PRISMA scoping review. Neurosci Biobehav Rev 2023; 154:105395. [PMID: 37734697 DOI: 10.1016/j.neubiorev.2023.105395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
Spinal cord injury (SCI) leads to a massive disconnection between the brain and the body parts below the lesion level representing a unique opportunity to explore how the body influences a person's mental life. We performed a systematic scoping review of 59 studies on higher-order cognitive and emotional changes after SCI. The results suggest that fluid abilities (e.g. attention, executive functions) and emotional regulation (e.g. emotional reactivity and discrimination) are impaired in people with SCI, with progressive deterioration over time. Although not systematically explored, the factors that are directly (e.g. the severity and level of the lesion) and indirectly associated (e.g. blood pressure, sleeping disorders, medication) with the damage may play a role in these deficits. The inconsistency which was found in the results may derive from the various methods used and the heterogeneity of samples (i.e. the lesion completeness, the time interval since lesion onset). Future studies which are specifically controlled for methods, clinical and socio-cultural dimensions are needed to better understand the role of the body in cognition.
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Affiliation(s)
- Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy.
| | - Maddalena Beccherle
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy; Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy
| | - Salvatore Maria Aglioti
- Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy; Fondazione Santa Lucia IRCCS, Roma, Italy
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5
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Trbovich M, Wu B, Koek W, Wecht J, Kellogg D. Are Thermoregulatory Sweating and Active Vasodilation in Skin Controlled by Separate Nerves During Passive Heat Stress in Persons With Spinal Cord Injury? Top Spinal Cord Inj Rehabil 2022; 28:84-95. [PMID: 36457358 PMCID: PMC9678215 DOI: 10.46292/sci21-00063] [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] [Indexed: 01/26/2023]
Abstract
Background Sudomotor responses (SR) and active vasodilation (AVD) are the primary means of heat dissipation during passive heat stress (PHS). It is unknown if they are controlled by a single or separate set of nerves. Older qualitative studies suggest that persons with spinal cord injury (SCI) have discordant areas of sweating and vasodilation. Objectives To test the hypothesis that neural control of SR and AVD is through separate nerves by measuring SR and vasodilation in persons with SCI to determine if these areas are concordant or discordant. Methods Nine persons with tetraplegia, 13 with paraplegia, and nine able-bodied controls underwent PHS (core temperature rise 1°C) twice. Initially, the starch iodine test measured SR post-PHS in skin surface areas surrounding the level of injury. Subsequently, laser Doppler imagery scans measured vasodilation pre- and post-PHS in areas with and without SR. Percent change in red blood cell (RBC) flux was compared in areas with and without SR. Results Persons with tetraplegia were anhidrotic on all areas; however, the same areas demonstrated minimal RBC flux change significantly less than equivalent able-bodied skin surface areas. In persons with paraplegia, areas of intact SR correlated with areas of RBC flux change quantitatively comparable to able-bodied persons. In anhidrotic areas, RBC flux change was significantly less than areas with SR and likely resulted from non-AVD mechanisms. Conclusion In persons with SCI under PHS, areas with intact SR and AVD are concordant, suggesting these two aspects of thermoregulation are controlled by a single set of nerves.
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Affiliation(s)
- Michelle Trbovich
- Department of Rehabilitation Medicine, University of Texas Health Science Center, San Antonio Audie L. Murphy Memorial Veterans Affairs Hospital, San Antonio, Texas
- South Texas Veteran’s Health Care System, San Antonio, Texas
| | - Beth Wu
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
| | - Wouker Koek
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas
| | - Jill Wecht
- James J Peters Department of Veterans Affairs Medical Center, Bronx, New York
| | - Dean Kellogg
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
- Geriatric Research Education and Clinical Center and Dept of Medicine, University of Texas Health Science Center, San Antonio, Texas
- South Texas Veteran’s Health Care System, San Antonio, Texas
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Flett S, Garcia J, Cowley KC. Spinal electrical stimulation to improve sympathetic autonomic functions needed for movement and exercise after spinal cord injury: a scoping clinical review. J Neurophysiol 2022; 128:649-670. [PMID: 35894427 DOI: 10.1152/jn.00205.2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spinal cord injury (SCI) results in sensory, motor and autonomic dysfunction. Obesity, cardiovascular and metabolic diseases are highly prevalent after SCI. Although inadequate voluntary activation of skeletal muscle contributes, it is absent or inadequate activation of thoracic spinal sympathetic neural circuitry and sub-optimal activation of homeostatic (cardiovascular, temperature) and metabolic support systems that truly limits exercise capacity, particularly for those with cervical SCI. Thus, when electrical spinal cord stimulation (SCS) studies aimed at improving motor functions began mentioning effects on exercise-related autonomic functions, a potential new area of clinical application appeared. To survey this new area of potential benefit, we performed a systematic scoping review of clinical SCS studies involving these spinally mediated autonomic functions. Nineteen studies were included, 8 used transcutaneous and 11 used epidural SCS. Improvements in BP at rest or in response to orthostatic challenge were investigated most systematically, whereas reports of improved temperature regulation, whole body metabolism and peak exercise performance were mainly anecdotal. Effective stimulation locations and parameters varied between studies, suggesting multiple stimulation parameters and rostrocaudal spinal locations may influence the same sympathetic function. Brainstem and spinal neural mechanisms providing excitatory drive to sympathetic neurons that activate homeostatic and metabolic tissues that provide support for movement and exercise and their integration with locomotor neural circuitry are discussed. A unifying conceptual framework for the integrated neural control of locomotor and sympathetic function is presented which may inform future research needed to take full advantage of SCS for improving these spinally mediated autonomic functions.
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Affiliation(s)
- Sarah Flett
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Juanita Garcia
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristine C Cowley
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Kumar NS, Bart J, Barton C, Graham ML, Leung PP, Tittley TD, Lee I, Bang C, Bauman WA, Handrakis JP. Core Temperature Lability Predicts Sympathetic Interruption and Cognitive Performance during Heat Exposure in Persons with Spinal Cord Injuries. J Neurotrauma 2021; 38:2141-2150. [PMID: 33882698 DOI: 10.1089/neu.2020.7598] [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: 11/12/2022] Open
Abstract
Among persons with high spinal cord injury (Hi-SCI: > T5), changes in core body temperature (Tcore) and cognitive performance during heat exposure appear related to degree of sympathetic interruption. Twenty men with Hi-SCI (C4-T4, American Spinal Injury Association Impairment Scale [AIS] A-B) and 19 matched, able-bodied controls were acclimated to 27°C baseline (BL) before exposure to 35°C heat challenge (HC). Two groups, differentiated by increase in Tcore during HC, were identified: high responders (HR-SCI: ΔTcore ≥0.5°C; n = 13, C4-T2) and low responders (LR-SCI: ΔTcore <0.5°C; n = 7, C4-T4). Tcore, distal skin temperatures (Tskavg), and distal microvascular perfusion (LDFboth feet) were measured, as were indices of sympathetic integrity, mean arterial pressure (MAP), and extremity sweat rate (SRavg). Cognitive performance was assessed at BL and post-HC, using the Stroop Color and Word and Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span tests. At BL, Tcore of the HR-SCI group (36.6 ± 0.4°C) was lower than that for the LR-SCI (37.1 ± 0.3°C; p = 0.011) and control groups (37.3 ± 0.3°C; p < 0.001). After HC, Tcore was not different among groups. MAP of the HR-SCI group (70.9 ± 9.8 mm Hg) was lower than that of the LR-SCI (81.8 ± 7.0 mm Hg; p = 0.048) and control groups (89.9 ± 9.9 mm Hg; p < 0.001). SRavg increased more in the control group (77.0 ± 52.5 nL/cm2/min) than in the HR-SCI group (15.5 ± 22.0 nL/cm2/min; p = 0.001). Only the HR-SCI group had significant increases in T-Scores of Stroop Word (7.5 ± 4.4; p < 0.001), WAIS-IV Digit Span Sequence (1.9 ± 1.8; p = 0.002), and WAIS-IV Digit Span Total (1.4 ± 1.6; p = 0.008). Persons with SCI who responded to HC with a greater change in Tcore demonstrated evidence of greater sympathetic interruption and had an associated improvement in cognitive performance.
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Affiliation(s)
- Nina S Kumar
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury and James J. Peters VA Medical Center, Bronx, New York, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jessica Bart
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury and James J. Peters VA Medical Center, Bronx, New York, USA
- New York Institute of Technology, Department of Physical Therapy, Old Westbury, New York, USA
| | - Christian Barton
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury and James J. Peters VA Medical Center, Bronx, New York, USA
- New York Institute of Technology, Department of Physical Therapy, Old Westbury, New York, USA
| | - Marin L Graham
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury and James J. Peters VA Medical Center, Bronx, New York, USA
- New York Institute of Technology, Department of Physical Therapy, Old Westbury, New York, USA
| | - Patricia P Leung
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury and James J. Peters VA Medical Center, Bronx, New York, USA
- New York Institute of Technology, Department of Physical Therapy, Old Westbury, New York, USA
| | - Tishina D Tittley
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury and James J. Peters VA Medical Center, Bronx, New York, USA
| | - Ingrid Lee
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury and James J. Peters VA Medical Center, Bronx, New York, USA
| | - Charlene Bang
- Medical Service, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Medicine and The Icahn School of Medicine at Mount Sinai, New York, New York
| | - William A Bauman
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury and James J. Peters VA Medical Center, Bronx, New York, USA
- Medical Service, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Medicine and The Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - John P Handrakis
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury and James J. Peters VA Medical Center, Bronx, New York, USA
- New York Institute of Technology, Department of Physical Therapy, Old Westbury, New York, USA
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8
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Chiaravalloti ND, Weber E, Wylie G, Dyson-Hudson T, Wecht JM. The impact of level of injury on patterns of cognitive dysfunction in individuals with spinal cord injury. J Spinal Cord Med 2020; 43:633-641. [PMID: 31859606 PMCID: PMC7534192 DOI: 10.1080/10790268.2019.1696076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context: While it is well recognized that physical and physiological changes are more prominent in individuals with higher neurologic levels of spinal cord injury (SCI), the impact of level of lesion on cognition is less clear. Design: Cross-sectional, 3-group. Setting: Non-profit rehabilitation research foundation. Participants: 59 individuals with SCI (30 with tetraplegia, 29 with paraplegia) and 30 age-matched healthy controls (HC). Interventions: None. Outcome Measures: Neuropsychological tests in the domains of attention, working memory, processing speed, executive control, and learning and memory. Results: Results indicated significantly lower test performance in individuals with paraplegia on new learning and memory testing compared to HC. In contrast, compared to HC the group with tetraplegia, showed a significantly impaired performance on a processing speed task, and both the tetraplegia and the paraplegia groups were similarly impaired on a verbal fluency measure. SCI groups did not differ on any cognitive measure. Conclusion: Individuals with SCI may display different patterns of cognitive performance based on their level of injury.
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Affiliation(s)
- Nancy D. Chiaravalloti
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - Erica Weber
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - Glenn Wylie
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - Trevor Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - Jill M. Wecht
- VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York, USA
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Rehabilitation Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
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Trbovich MB, Handrakis JP, Kumar NS, Price MJ. Impact of passive heat stress on persons with spinal cord injury: Implications for Olympic spectators. Temperature (Austin) 2019; 7:114-128. [PMID: 33015240 PMCID: PMC7518736 DOI: 10.1080/23328940.2019.1631730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 01/26/2023] Open
Abstract
Environmental heat stress can negatively impact health, work capacity, and athletic performance and potentially to lead to life-threatening consequences if not mitigated. With the upcoming Toyko Olympic games to be held during anticipated warm ambient temperatures (up to 29°C), and with spectators potentially spending long durations of time outdoors, certain populations of persons with impaired thermoregulatory capacity will be at higher risk of heat-related illness from passive heat stress. Persons with spinal cord injury (SCI) are one of these groups as a result of a decentralized sympathetic nervous system, which leaves them with impairment in convective and evaporative cooling via vasodilation and sweating, respectively. This review summarizes (1) thermoregulatory physiological responses of persons with SCI under passive heat stress: the effect of level and completeness of injury; (2) the impact of passive heat stress on quality of life (QOL), outdoor participation, behavioral thermoregulation, and cognition; (3) recommendations and education for clinicians providing health care for persons with SCI; and (4) suggestions of future directions for exploring the gaps in the literature on passive heat stress in persons with SCI. This article aims to equip consumers with SCI and health-care professionals with the most up-to-date knowledge on passive heat stress responses in persons with SCI, so that their attendance at the Olympic games can be done with maximal safety and enjoyment.
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Affiliation(s)
- Michelle B. Trbovich
- Department of Rehabilitation Medicine, UT Health Science Center at San Antonio, San Antonio, TX, USA
- Spinal cord injury center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - John P. Handrakis
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, NY, USA
- New York Institute of Technology, Department of Physical Therapy, School of Health Professions, Old Westbury, NY, USA
| | - Nina S. Kumar
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, NY, USA
| | - Mike J. Price
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Chiaravalloti ND, Weber E, Wylie G, Dyson-Hudson T, Wecht JM. Patterns of cognitive deficits in persons with spinal cord injury as compared with both age-matched and older individuals without spinal cord injury. J Spinal Cord Med 2018; 43:88-97. [PMID: 30508409 PMCID: PMC7006756 DOI: 10.1080/10790268.2018.1543103] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Context/Objective: Cognitive deficits can impact as many as 60% of individuals with spinal cord injury (SCI). In an effort to identify the nature of cognitive deficits in SCI, we examined neuropsychological test performance in individuals with SCI, age matched healthy controls and older healthy controls.Design: Participants completed a motor-free neuropsychological test battery assessing attention, working memory, information processing speed, new learning /memory and executive control.Setting: Outpatient rehabilitation research facility.Participants: Participants included 60 individuals with chronic spinal cord injury [SCI; 32 with paraplegia (T2-T12) and 28 with tetraplegia (C3-T1)], 30 age-matched healthy controls (AMHC; 30-40 years old) and 20 older healthy controls (OHC; 50-60 years old).Outcome Measures: Wechsler Intelligence Scale - 3rd edition (WAIS-III) Digit Span and Letter-Number Sequencing; Symbol Digit Modalities Test (SDMT) - oral version; California Verbal Learning Test-II; Paced Auditory Serial Addition Test (PASAT); Wechsler Abbreviated Scale of Intelligence (WASI); Delis-Kaplan Executive Function System; Verbal Fluency subtest.Results: Significant differences were noted between the SCI and AMHC groups on measures of information processing speed, new learning and memory, and verbal fluency. No significant differences were noted between the groups on tests of attention or working memory.Conclusion: The current study documented differences in specific realms of cognitive functioning between a chronic SCI sample and AMHC. Implications for cognitive rehabilitation and overall quality of life are discussed. Additional research is needed utilizing a more comprehensive battery of motor-free neuropsychological tests that avoid the confound of upper limb motor limitations on cognitive performance.
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Affiliation(s)
- Nancy D. Chiaravalloti
- Kessler Foundation, Traumatic Brain Injury Research, West Orange, New Jersey, USA,Kessler Foundation, Neuropsychology & Neuroscience Research, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation Medical School, Rutgers-NJ, Newark, New Jersey, USA,Correspondence to: Nancy D. Chiaravalloti, PhD, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ 07936, (973) 324–8440.
| | - Erica Weber
- Kessler Foundation, Traumatic Brain Injury Research, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation Medical School, Rutgers-NJ, Newark, New Jersey, USA
| | - Glenn Wylie
- Kessler Foundation, Neuropsychology & Neuroscience Research, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation Medical School, Rutgers-NJ, Newark, New Jersey, USA,VA War Related Illness and Injury Study Center, East Orange, New Jersey, USA
| | - Trevor Dyson-Hudson
- Department of Physical Medicine and Rehabilitation Medical School, Rutgers-NJ, Newark, New Jersey, USA,Kessler Foundation, Spinal Cord Injury Research, West Orange, New Jersey, USA
| | - Jill M. Wecht
- VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York, USA,Department of Medicine and Rehabilitation Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
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