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Xie Y, Zhang L, Guo S, Peng R, Gong H, Yang M. Changes in respiratory structure and function after traumatic cervical spinal cord injury: observations from spinal cord and brain. Front Neurol 2023; 14:1251833. [PMID: 37869136 PMCID: PMC10587692 DOI: 10.3389/fneur.2023.1251833] [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] [Received: 07/02/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Respiratory difficulties and mortality following severe cervical spinal cord injury (CSCI) result primarily from malfunctions of respiratory pathways and the paralyzed diaphragm. Nonetheless, individuals with CSCI can experience partial recovery of respiratory function through respiratory neuroplasticity. For decades, researchers have revealed the potential mechanism of respiratory nerve plasticity after CSCI, and have made progress in tissue healing and functional recovery. While most existing studies on respiratory plasticity after spinal cord injuries have focused on the cervical spinal cord, there is a paucity of research on respiratory-related brain structures following such injuries. Given the interconnectedness of the spinal cord and the brain, traumatic changes to the former can also impact the latter. Consequently, are there other potential therapeutic targets to consider? This review introduces the anatomy and physiology of typical respiratory centers, explores alterations in respiratory function following spinal cord injuries, and delves into the structural foundations of modified respiratory function in patients with CSCI. Additionally, we propose that magnetic resonance neuroimaging holds promise in the study of respiratory function post-CSCI. By studying respiratory plasticity in the brain and spinal cord after CSCI, we hope to guide future clinical work.
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Affiliation(s)
- Yongqi Xie
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Liang Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Shuang Guo
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Rehabilitation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Run Peng
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Huiming Gong
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Mingliang Yang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
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Guízar-Sahagún G, Grijalva I, Franco-Bourland RE, Madrazo I. Aging with spinal cord injury: A narrative review of consequences and challenges. Ageing Res Rev 2023; 90:102020. [PMID: 37487887 DOI: 10.1016/j.arr.2023.102020] [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: 03/29/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
Given the increase in life expectancy, aging with a pre-existing spinal cord injury (SCI) is becoming more common. This condition is challenging as compromised health status and functional independence can worsen. We aimed to provide an updated overview of the consequences of aging with SCI, highlighting the main challenges facing this population in a narrative review of the current literature we retrieved from the PubMed database from 2000 to 2022 on any aspect related to aging in persons with SCI. Here we address adverse circumstances that increase disability and hinder an active lifestyle, such as progressive physical deterioration, secondary health conditions, limitations in personal activity, changes in family and social support structures, aging of caregivers, and depletion of economic resources. Favorable changes are also observed, including psychosocial adjustments that improve quality of life. Additionally, various interventions are discussed to promote well-being, health, and social participation. Due to the relevance of this issue, people with SCI and all those who take care of them must have up-to-date information to carry out the necessary measures to promote healthy aging in a more inclusive social environment.
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Affiliation(s)
- Gabriel Guízar-Sahagún
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico.
| | - Israel Grijalva
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
| | - Rebecca E Franco-Bourland
- Department of Biochemistry, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 289 Calzada México-Xochimilco, Mexico City, Mexico
| | - Ignacio Madrazo
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
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Rosales-Antequera C, Viscor G, Araneda OF. Inflammation and Oxidative Stress as Common Mechanisms of Pulmonary, Autonomic and Musculoskeletal Dysfunction after Spinal Cord Injury. BIOLOGY 2022; 11:biology11040550. [PMID: 35453749 PMCID: PMC9032591 DOI: 10.3390/biology11040550] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/19/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary When a spinal cord injury occurs, the neurons that regulate our voluntary movements, those involved in environment and somatic perception and those that regulate vegetative functions are affected. Once neuronal damage is established, the cells of other tissues are also affected in their functions, altering the interaction between organs and altering the proper functioning of the organism. Multiple studies in animal models, as well as in humans, have recognized as factors involved in organ damage the imbalance between the formation of highly reactive molecules called pro-oxidants and defensive mechanisms called antioxidants. Closely associated with this phenomenon, the inflammatory response is also pathologically activated. In this narrative review, we have analyzed the information involving these pathological processes at the level of the lung, the autonomic nervous system and the skeletal musculature after spinal cord injury. Knowing the abnormal functioning mechanisms that occur after a spinal cord injury not only offers a better understanding of the organic events but also offers future possibilities for therapeutic interventions that may benefit the thousands of patients suffering this pathology. Abstract One of the etiopathogenic factors frequently associated with generalized organ damage after spinal cord injury corresponds to the imbalance of the redox state and inflammation, particularly of the respiratory, autonomic and musculoskeletal systems. Our goal in this review was to gain a better understanding of this phenomenon by reviewing both animal and human studies. At the respiratory level, the presence of tissue damage is notable in situations that require increased ventilation due to lower thoracic distensibility and alveolar inflammation caused by higher levels of leptin as a result of increased fatty tissue. Increased airway reactivity, due to loss of sympathetic innervation, and levels of nitric oxide in exhaled air that are similar to those seen in asthmatic patients have also been reported. In addition, the loss of autonomic control efficiency leads to an uncontrolled release of catecholamines and glucocorticoids that induce immunosuppression, as well as a predisposition to autoimmune reactions. Simultaneously, blood pressure regulation is altered with vascular damage and atherogenesis associated with oxidative damage. At the muscular level, chronically elevated levels of prooxidants and lipoperoxidation associated with myofibrillar atrophy are described, with no reduction or reversibility of this process through antioxidant supplementation.
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Affiliation(s)
- Cristián Rosales-Antequera
- Physical Medicine and Rehabilitation Unit, Clínica Universidad de los Andes, Santiago 8320000, Chile;
- Integrative Laboratory of Biomechanics and Physiology of Effort, LIBFE, School of Kinesiology, Faculty of Medicine, Universidad de los Andes, Santiago 8320000, Chile
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain;
| | - Oscar F. Araneda
- Integrative Laboratory of Biomechanics and Physiology of Effort, LIBFE, School of Kinesiology, Faculty of Medicine, Universidad de los Andes, Santiago 8320000, Chile
- Correspondence:
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Lee KZ, Liou LM, Vinit S, Ren MY. Rostral-caudal effect of cervical magnetic stimulation on the diaphragm motor evoked potential following cervical spinal cord contusion in the rat. J Neurotrauma 2021; 39:683-700. [PMID: 34937419 DOI: 10.1089/neu.2021.0403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The present study was designed to investigate the rostro-caudal effect of spinal magnetic stimulation on diaphragmatic motor-evoked potentials following cervical spinal cord injury. The diaphragm electromyogram was recorded in rats that received a laminectomy or a left mid-cervical contusion at the acute (1 day), subchronic (2 weeks), or chronic (8 weeks) injured stages. The center of a figure-eight coil was placed at 30 mm lateral to bregma on the left side, and the effect of magnetic stimulation was evaluated by stimulating the rostral, middle, and caudal cervical regions in spontaneously breathing rats. The results demonstrated that cervical magnetic stimulation induced intensity-dependent motor-evoked potentials in the bilateral diaphragm in both uninjured and contused rats; however, the left diaphragm exhibited a higher amplitude and earlier onset than the right diaphragm. Moreover, the intensity-response curve was shifted upward in the rostral-to-caudal direction of magnetic stimulation, suggesting that caudal cervical magnetic stimulation produced more robust diaphragmatic motor-evoked potentials compared to rostral cervical magnetic stimulation. Interestingly, the diaphragmatic motor-evoked potentials were similar between uninjured and contused rats during cervical magnetic stimulation despite weaker inspiratory diaphragmatic activity in contused rats. Additionally, in contused animals but not uninjured animals, diaphragmatic motor-evoked potential amplitude were greater at the chronic stage than during earlier injured stages. These results demonstrated that cervical magnetic stimulation can excite the residual phrenic motor circuit to activate the diaphragm in the presence of a significant lesion in the cervical spinal cord. These findings indicate that this non-invasive approach is effective for modulating diaphragmatic excitability following cervical spinal cord injury.
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Affiliation(s)
- Kun-Ze Lee
- National Sun Yat-sen University, 34874, Biological Sciences, Kaohsiung, Taiwan;
| | - Li-Min Liou
- Kaohsiung Medical University Hospital, 89234, Neurology, Kaohsiung, Taiwan;
| | - Stéphane Vinit
- Université Paris-Saclay, 27048, UFR des Sciences de la Santé Simone Veil, Saint-Aubin, Île-de-France, France;
| | - Ming-Yue Ren
- National Sun Yat-sen University, 34874, Biological Sciences, Kaohsiung, Taiwan;
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Hsu YE, Chen SC, Geng JH, Wu DW, Wu PY, Huang JC. Obesity-Related Indices Are Associated with Longitudinal Changes in Lung Function: A Large Taiwanese Population Follow-Up Study. Nutrients 2021; 13:nu13114055. [PMID: 34836307 PMCID: PMC8624262 DOI: 10.3390/nu13114055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 12/14/2022] Open
Abstract
The global pandemic of obesity and the increasing incidence of chronic respiratory diseases are growing health concerns. The association between obesity and pulmonary function is uncertain. Therefore, this study aimed to explore associations between changes in lung function and obesity-related indices in a large longitudinal study. A total of 9059 participants with no personal histories of asthma, smoking, bronchitis, or emphysema were enrolled from the Taiwan Biobank and followed for 4 years. Lung function was assessed using spirometry measurements including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Changes in FEV1/FVC (∆FEV1/FVC) between baseline and follow-up were calculated. The following obesity-related indices were studied: lipid accumulation product (LAP), body roundness index (BRI), conicity index (CI), body adiposity index (BAI), abdominal volume index (AVI), body mass index (BMI), waist–hip ratio (WHR), and waist-to-height ratio (WHtR). In multivariable analysis, the subjects with high BMI (p < 0.001), WHR (p < 0.001), WHtR (p < 0.001), LAP (p = 0.002), BRI (p < 0.001), CI (p = 0.005), BAI (p < 0.001), and AVI (p < 0.001) were significantly associated with a high baseline FEV1/FVC. After 4 years of follow-up, the subjects with high BMI (p < 0.001), WHR (p < 0.001), WHtR (p < 0.001), LAP (p = 0.001), BRI (p < 0.001), CI (p = 0.002), BAI (p < 0.001), and AVI (p < 0.001) were significantly associated with a low △FEV1/FVC. High obesity-related index values were associated with better baseline lung function and a rapid decrease in lung function at follow-up.
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Affiliation(s)
- Yu-En Hsu
- Department of Post Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (S.-C.C.); (D.-W.W.); (P.-Y.W.)
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jiun-Hung Geng
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan;
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Da-Wei Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (S.-C.C.); (D.-W.W.); (P.-Y.W.)
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Pei-Yu Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (S.-C.C.); (D.-W.W.); (P.-Y.W.)
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jiun-Chi Huang
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (S.-C.C.); (D.-W.W.); (P.-Y.W.)
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-803-6783-3440
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van Diemen T, Verberne DPJ, Koomen PSJ, Bongers-Janssen HMH, van Nes IJW. Interdisciplinary follow-up clinic for people with spinal cord injury: a retrospective study of a carousel model. Spinal Cord Ser Cases 2021; 7:86. [PMID: 34580276 DOI: 10.1038/s41394-021-00451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Explorative retrospective cohort study. OBJECTIVE Secondary health conditions (SHCs) are common in people with spinal cord injury (SCI). To date, little is known about the effectiveness of long-term follow-up care in preventing SHCs. The objective of this study was to explore the therapeutic content of an interdisciplinary follow-up clinic by retrospective analyses of provided recommendations and collected data concerning SHCs. SETTING Rehabilitation center Sint Maartenskliniek, The Netherlands. METHODS All people with SCI, who visited one or more outpatient interdisciplinary follow-up clinics between January 2012 and October 2020 were included in this study. Treatment information was retrieved from their medical records. RESULTS The 264 participants of the follow-up clinic received, after their first visit, an average of 3.9 recommendations regarding SHCs. Most recommendations were preventive in nature (43%), and were related to physical SHCs (61%). Most recommendations were followed by the participants (34% out of 40% that could be determined) and half of the underlying problems were solved (31% out of 62%). The bodyweight and respiratory function remained stable over time. CONCLUSION Participants of the interdisciplinary follow-up clinics received extensive recommendations on a variety of subjects, which most likely, reflects the interdisciplinary approach. Recommendations were followed-up to a large extent, resulting in solving half of the underlying SHCs. This way, worse SHCs were prevented by the recommendations. This findings, together with the stability of respiratory function and bodyweight, suggests the added value of the interdisciplinary follow-up clinic to usual care. More prospective research is necessary to investigate the (cost-)effectiveness.
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Affiliation(s)
- Tijn van Diemen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - Daan P J Verberne
- Department of Neurorehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Patrick S J Koomen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Ilse J W van Nes
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
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Effects of Respiratory Muscle Training on Baroreflex Sensitivity, Respiratory Function, and Serum Oxidative Stress in Acute Cervical Spinal Cord Injury. J Pers Med 2021; 11:jpm11050377. [PMID: 34062971 PMCID: PMC8147917 DOI: 10.3390/jpm11050377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background: respiratory complications are a leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). We examined the effects of respiratory muscle training (RMT) in patients with acute cervical SCI. Methods: this prospective trial enrolled 44 adults with acute cervical SCI, of which twenty received RMT and twenty-four did not receive RMT. Respiratory function, cardiovascular autonomic function, and reactive oxidative species (ROS) were compared. The experimental group received 40-min high-intensity home-based RMT 7 days per week for 10 weeks. The control group received a sham intervention for a similar period. The primary outcomes were the effects of RMT on pulmonary and cardiovascular autonomic function, and ROS production in individuals with acute cervical SCI. Results: significant differences between the two groups in cardiovascular autonomic function and the heart rate response to deep breathing (p = 0.017) were found at the 6-month follow-up. After RMT, the maximal inspiratory pressure (p = 0.042) and thiobarbituric acid-reactive substances (TBARS) (p = 0.006) improved significantly, while there was no significant difference in the maximal expiratory pressure. Significant differences between the two groups in tidal volume (p = 0.005) and the rapid shallow breathing index (p = 0.031) were found at 6 months. Notably, the SF-36 (both the physical (PCS) and mental (MCS) component summaries) in the RMT group had decreased significantly at the 6-month follow-up, whereas the clinical scores did not differ significantly (p = 0.333) after RMT therapy. Conclusions: High-intensity home-based RMT can improve pulmonary function and endurance and reduce breathing difficulties in patients with respiratory muscle weakness after injury. It is recommended for rehabilitation after spinal cord injury.
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Reyes MRL, Elmo MJ, Menachem B, Granda SM. A Primary Care Provider's Guide to Managing Respiratory Health in Subacute and Chronic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:116-122. [PMID: 32760190 DOI: 10.46292/sci2602-116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Respiratory complications following spinal cord injury (SCI) have remained the leading cause of death across the lifespan and are one of the most common reasons for hospitalization. Complications from altered respiratory physiology after SCI include atelectasis, pneumonia, venous thromboembolic disease, and sleep-disordered breathing. The risk for complications is greater with higher SCI levels and severity, and mortality from pneumonia is heightened compared to the general population. Optimal primary care for individuals with SCI includes appropriate surveillance for SCI-specific respiratory disease, key preventive care including promotion of influenza immunization and respiratory muscle training, and early identification and treatment of pneumonia with institution of aggressive secretion management strategies. The respiratory physiology and specific management of respiratory complications after SCI is reviewed.
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Affiliation(s)
- Maria Regina L Reyes
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Mary Jo Elmo
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Brandon Menachem
- Department of Internal Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
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Argetsinger LC, Singh G, Bickel SG, Calvery ML, Behrman AL. Spinal cord injury in infancy: activity-based therapy impact on health, function, and quality of life in chronic injury. Spinal Cord Ser Cases 2020; 6:13. [PMID: 32157078 PMCID: PMC7064539 DOI: 10.1038/s41394-020-0261-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Spinal cord injury (SCI) in infancy magnifies the complexity of a devastating diagnosis. Children injured so young have high incidences of scoliosis, hip dysplasia, and respiratory complications leading to poor health and outcomes. We report the medical history, progression of rehabilitation, usual care and activity-based therapy, and outcomes for a child injured in infancy. Activity-based therapy (ABT) aims to activate the neuromuscular system above and below the lesion through daily, task-specific training to improve the neuromuscular capacity, and outcomes for children with acquired SCI. Case presentation A 3-month-old infant suffered a cervical SCI from a surgical complication with resultant tetraplegia. Until age 3, her medical complications included scoliosis, kyphosis, and pneumonia. Even with extensive physical and occupational therapy, she was fully dependent on caregivers for mobility and unable to roll, come to sit, sit, stand or walk. She initiated ABT at ~3 years old, participating for 8 months. The child’s overall neuromuscular capacity improved significantly, especially for head and trunk control, contributing to major advances in respiratory health, novel engagement with her environment, and improved physical abilities. Discussion From injury during infancy until 3 years old, this child’s health, abilities, and complications were consistent with the predicted path of early-onset SCI. Due to her age at injury, severity and chronicity of injury, she demonstrated unexpected, meaningful changes in her neuromuscular capacity during and post-ABT associated with improved health, function and quality of life for herself and her caregivers.
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Affiliation(s)
- Laura C Argetsinger
- Frazier Rehab Institute, Pediatric NeuroRecovery Program, Louisville, KY, USA
| | - Goutam Singh
- Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Scott G Bickel
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | | | - Andrea L Behrman
- Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY, USA. .,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA. .,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA.
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Walia P, Goldstein RL, Teylan M, Lazzari AA, Hart JE, Tun CG, Garshick E. Associations between vitamin D, adiposity, and respiratory symptoms in chronic spinal cord injury. J Spinal Cord Med 2018; 41:667-675. [PMID: 28992807 PMCID: PMC6217502 DOI: 10.1080/10790268.2017.1374020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Context/Objective Persons with chronic spinal cord injury (SCI) have an increased risk of respiratory-related morbidity and mortality and chronic respiratory symptoms are clinical markers of future respiratory disease. Therefore, we sought to assess potentially modifiable factors associated with respiratory symptoms, with a focus on circulating vitamin D and measures of body fat. Design Cross-sectional study. Setting Veterans Affairs Medical Center. Participants Three hundred forty-three participants (282 men and 61 women) with chronic SCI participating in an epidemiologic study to assess factors influencing respiratory health recruited from VA Boston and the community. Methods Participants provided a blood sample, completed a respiratory health questionnaire, and underwent dual x-ray absorptiometry (DXA) to assess % body fat. Logistic regression was used to assess cross-sectional associations between respiratory symptoms and plasma vitamin D and measures of body fat with adjustment for a number of potential confounders. Outcome Measures Chronic cough, chronic phlegm, any wheeze, persistent wheeze. Results After adjustment for a number of confounders (including smoking), participants with greater %-android, gynoid, trunk, or total body fat had increased odds ratios for any wheeze and suggestive associations with persistent wheeze, but not with chronic cough or phlegm. Vitamin D levels were not associated with any of the respiratory symptoms. Conclusion Increased body fat, but not vitamin D, was associated with wheeze in chronic SCI independent of a number of covariates.
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Affiliation(s)
- Palak Walia
- Research and Development Service, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Rebekah L. Goldstein
- Research and Development Service, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Merilee Teylan
- Research and Development Service, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Antonio A. Lazzari
- Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carlos G. Tun
- Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Eric Garshick
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA,Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, Massachusetts, USA,Correspondence to: Eric Garshick, MD, VA Boston Health Care System, West Roxbury, MA, USA.
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Chan LW, Griebling TL, Arnold EP, Chu PS, New PW, Wagg A. Special considerations in the urological management of the older spinal cord injury patient. World J Urol 2018; 36:1603-1611. [PMID: 30003376 DOI: 10.1007/s00345-018-2326-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This paper reports the key findings of Committee 8 of the Joint SIU-ICUD Consultation on Urologic Management of the Spinal Cord Injured Patient and address issues pertaining to the older person with a SCI and the time-related changes relevant to their urological, gastrointestinal and functional management. METHODS A literature review using the Pubmed and Ovid search engines was performed examining pertinent literature regarding SCI in the older patient. RESULTS There is a rising incidence of both traumatic and non-traumatic spinal cord injury (SCI) in older people and improvements in healthcare and nutrition mean patients with SCI are living longer. Outcomes after a SCI in the older person are a sum of the effects of injury and its management compounded by specific effects of ageing and the emergence of unrelated comorbidities. Changes in health, comorbidities, cognition and dexterity with ageing have an impact on function and are important considerations in the management of the older patient with SCI. Treatment decisions are thus increasingly complex due to the need to take into account these changes and accompanying polypharmacy. For the person living with a SCI, changes in circumstances (social and financial) have an impact on quality of life and influence management and support strategies. CONCLUSIONS Older patients with SCI face additional challenges both in the acute setting and with ageing. Clinicians should take into account comorbid conditions, mental health, physical function, cognition and social support in making management decisions. With the global ageing population, health services planning will need to allow for increase in resources required to care for older patients with SCI.
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Affiliation(s)
- Lewis W Chan
- Department of Urology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia.
| | - Tomas L Griebling
- Department of Urology and The Landon Center on Aging, The University of Kansas School of Medicine, Kansas City, USA
| | - Edwin P Arnold
- Department of Surgery, Otago University, Christchurch, New Zealand
| | - Peggy S Chu
- Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong Special Administrative Region, China
| | - Peter W New
- Alfred Health and Epworth-Monash Rehabilitation Medicine Unit, Caulfield Hospital, Spinal Rehabilitation Service, Monash University, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Canada
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Respiratory functional and motor control deficits in children with spinal cord injury. Respir Physiol Neurobiol 2017; 247:174-180. [PMID: 29107737 DOI: 10.1016/j.resp.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 12/18/2022]
Abstract
Children with spinal cord injury (SCI) are at high risk for developing complications due to respiratory motor control deficits. However, underlying mechanisms of these abnormalities with respect to age, development, and injury characteristics are unclear. To evaluate the effect of SCI and age on respiratory motor control in children with SCI, we compared pulmonary function and respiratory motor control outcome measures in healthy typically developing (TD) children to age-matched children with chronic SCI. We hypothesized that the deficits in respiratory functional performance in children with SCI are due to the abnormal and age-dependent respiratory muscle activation patterns. Fourteen TD (age 7±2 yrs., Mean±SD) and twelve children with SCI (age 6±1 yrs.) were evaluated by assessing Forced Vital Capacity (FVC); Forced Expiratory Volume in 1sec (FEV1); and respiratory electromyographic activity during maximum inspiratory and maximum expiratory airway pressure measurements (PImax and PEmax). The results indicate a significant reduction (p<.01) of FVC, FEV1 and PEmax values in children with SCI compared to TD controls. During PEmax assessment, children with SCI produced significantly decreased (p<.01) activation of respiratory muscles below the neurological level of injury (rectus abdominous and external oblique muscles). In addition, children with SCI had significantly increased (p<.05) compensatory muscle activation above the level of injury (upper trapezius muscle). In the TD group, age, height, and weight significantly (p<.05) contributed towards increase in FVC and FEV1. In children with SCI, only age was significantly (p<.05) correlated with FVC and FEV1 values. These findings indicate the degree of SCI-induced respiratory functional and motor control deficits in children are age-dependent.
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13
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Garshick E, Walia P, Goldstein RL, Teylan M, Lazzari AA, Tun CG, Hart JE. Plasma Leptin and Reduced FEV 1 and FVC in Chronic Spinal Cord Injury. PM R 2017; 10:276-285. [PMID: 28827209 DOI: 10.1016/j.pmrj.2017.08.437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/28/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adipose tissue produces leptin, which is pro-inflammatory, and adiponectin, which has anti-inflammatory properties. Participants with chronic spinal cord injury (SCI) have increased body fat and are at increased risk for respiratory illness. OBJECTIVE To assess the associations between leptin and adiponectin with pulmonary function in a chronic SCI cohort. DESIGN Cross-sectional study. SETTING Veterans Affairs Medical Center. PARTICIPANTS A total of 285 participants (237 men and 48 women) with chronic SCI with mean (standard deviation) injury duration 17.8 (13.2) years from the VA Boston and the community participating in an epidemiologic study assessing factors associated with respiratory health. METHODS Participants (24.6% cervical American Spinal Injury Association Impairment Scale (AIS) level A, B, and C; 33.6% other AIS A, B, and C; 41.8% AIS D) provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma leptin and adiponectin with spirometric measures of pulmonary function adjusted for age, race, gender, and height. Level and severity of SCI, mobility mode, body mass index, smoking, chronic obstructive pulmonary disease, asthma, chest injury history, laboratory batch, and other potential confounders were also considered. MAIN OUTCOME MEASUREMENTS forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC. RESULTS There was a statistically significant inverse relationship between plasma leptin assessed in quartiles or as a continuous covariate with FEV1 and FVC. In fully adjusted models, each interquartile range (16,214 pg/mL) increase in leptin was associated with a significant decrease in FEV1 (-93.1 mL; 95% confidence interval = -166.2, -20.0) and decrease in FVC (-130.7 mL; 95% confidence interval = -219.4, -42.0). There were no significant associations between leptin and FEV1/FVC or between plasma adiponectin with FEV1, FVC, or FEV1/FVC. CONCLUSION Plasma leptin in individuals with chronic SCI is inversely associated with FEV1 and FVC, independently of SCI level and severity and other covariates. This finding suggests that plasma leptin may contribute to reduced pulmonary function in chronic SCI. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Palak Walia
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rebekah L Goldstein
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Merilee Teylan
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Antonio A Lazzari
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Carlos G Tun
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jaime E Hart
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
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14
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Legg Ditterline BE, Aslan SC, Randall DC, Harkema SJ, Castillo C, Ovechkin AV. Effects of Respiratory Training on Heart Rate Variability and Baroreflex Sensitivity in Individuals With Chronic Spinal Cord Injury. Arch Phys Med Rehabil 2017; 99:423-432. [PMID: 28802811 DOI: 10.1016/j.apmr.2017.06.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the effects of pressure threshold respiratory training (RT) on heart rate variability and baroreflex sensitivity in persons with chronic spinal cord injury (SCI). DESIGN Before-after intervention case-controlled clinical study. SETTING SCI research center and outpatient rehabilitation unit. PARTICIPANTS Participants (N=44) consisted of persons with chronic SCI ranging from C2 to T11 who participated in RT (n=24), and untrained control subjects with chronic SCI ranging from C2 to T9 (n=20). INTERVENTIONS A total of 21±2 RT sessions performed 5 days a week during a 4-week period using a combination of pressure threshold inspiratory and expiratory devices. MAIN OUTCOME MEASURES Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and beat-to-beat arterial blood pressure and heart rate changes during the 5-second-long maximum expiratory pressure maneuver (5s MEP) and the sit-up orthostatic stress test, acquired before and after the RT program. RESULTS In contrast to the untrained controls, individuals in the RT group experienced significantly increased FVC and FEV1 (both P<.01) in association with improved quality of sleep, cough, and speech. Sympathetically (phase II) and parasympathetically (phase IV) mediated baroreflex sensitivity both significantly (P<.05) increased during the 5s MEP. During the orthostatic stress test, improved autonomic control over heart rate was associated with significantly increased sympathetic and parasympathetic modulation (low- and high-frequency change: P<.01 and P<.05, respectively). CONCLUSIONS Inspiratory-expiratory pressure threshold RT is a promising technique to positively affect both respiratory and cardiovascular dysregulation observed in persons with chronic SCI.
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Affiliation(s)
- Bonnie E Legg Ditterline
- Department of Physiology, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Sevda C Aslan
- Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - David C Randall
- Department of Physiology, University of Kentucky, Lexington, KY
| | - Susan J Harkema
- Department of Physiology, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Camilo Castillo
- Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Alexander V Ovechkin
- Department of Physiology, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY.
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15
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Köseoğlu BF, Safer VB, Öken Ö, Akselim S. Cardiovascular disease risk in people with spinal cord injury: is there a possible association between reduced lung function and increased risk of diabetes and hypertension? Spinal Cord 2016; 55:87-93. [PMID: 27377303 DOI: 10.1038/sc.2016.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/09/2016] [Accepted: 05/28/2016] [Indexed: 12/25/2022]
Abstract
STUDY DESIGN Retrospective, descriptive study of medical files 253 patients with chronic traumatic spinal cord injury (SCI). OBJECTIVES To determine the frequency of cardiovascular disease (CVD) risk factors in SCI people, to estimate CVD risk in this population according to the Framingham Risk Score (FRS) and to determine whether reduced lung function parameters are significant predictors of diabetes mellitus (DM) and hypertension. SETTING Academic Rehabilitation Hospital. METHODS Demographic and clinical records of the patients and lung function parameters were obtained. RESULTS The FRS could not be calculated in 26 (10.3%) patients because this tool is designed for adults aged 20 years and older. According to the FRS guideline, ~6.7% of the SCI patients had high risk, 5.9% of them had intermediate risk and 77.1% of the study group had low risk for CVD. Regression analysis showed that impaired lung function parameters (FEV1, FVC and MVV) were significant predictors for the future development of hypertension (odds ratio (OR): 0.483 (0.258-0.903 95% confidence interval (CI)), OR: 0.549 (0.319-0.946 95% CI) and OR: 0.981 (0.965-0.998 95% CI), respectively) and DM (OR: 0.335 (0.140-0.801 95% CI), OR: 0.391 (0.183-0.839 95% CI) and OR: 0.970 (0.947-0.993 95% CI), respectively) in the SCI population. CONCLUSION This study showed that there might be a significant relationship between reduced lung function and the risk of DM and hypertension in people with SCI. Therefore, systematic measurement of these parameters should be performed in the routine clinical follow-up of SCI patients. Once reduced lung parameters are determined, the higher risk for developing hypertension and DM should be considered.
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Affiliation(s)
- B F Köseoğlu
- Department of Physical Medicine and Rehabilitation, Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - V B Safer
- Department of Physical Medicine and Rehabilitation, Ministry of Health, Istanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ö Öken
- Department of Physical Medicine and Rehabilitation, Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - S Akselim
- Department of Physical Medicine and Rehabilitation, Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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Hart JE, Morse L, Tun CG, Brown R, Garshick E. Cross-sectional associations of pulmonary function with systemic inflammation and oxidative stress in individuals with chronic spinal cord injury. J Spinal Cord Med 2016; 39:344-52. [PMID: 26180939 PMCID: PMC5073753 DOI: 10.1179/2045772315y.0000000045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT/OBJECTIVE Systemic inflammation, and to a lesser extent oxidative stress, have been associated with reduced pulmonary function. Our objective was to evaluate the associations between biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6)) and novel makers of global oxidative stress (fluorescent oxidation products (FLOx)) with spirometric and lung volume measures in individuals with chronic spinal cord injury (SCI). DESIGN Cross-sectional study. SETTING Veterans Affairs Medical Center. PARTICIPANTS One-hundred thirty-seven men with chronic SCI participating in an epidemiologic study. METHODS Participants provided a blood sample, completed health questionnaires, and underwent pulmonary function testing, including helium dilution measurement of functional residual capacity (FRC). General linear models were used to model associations between increasing quartiles of inflammation or oxidative stress with each outcome measure, after adjustment for a number of potential confounders. OUTCOME MEASURES Percent-predicted forced vital capacity in one second (FEV1), percent-predicted forced vital capacity (FVC), FEV1/FVC, percent-predicted residual volume (RV), percent-predicted FRC, and percent-predicted total lung capacity (TLC). RESULTS After adjustment for a number of confounders, participants with higher levels of CRP and IL-6 had lower percent-predicted FEV1 and FVC measurements. There were no clear patterns of association with any of the oxidative stress biomarkers or other outcome measures. CONCLUSION Increased systemic inflammation was associated with reductions in FEV1 and FVC independent of a number of covariates. Although the mechanism is uncertain, these results suggest that reductions in pulmonary function in SCI are associated with systemic inflammation.
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Affiliation(s)
- Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Leslie Morse
- Spaulding-Harvard SCI Model System, Spaulding Rehabilitation Hospital and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA
| | - Carlos G. Tun
- Rehabilitation Medicine Service, VA Boston Healthcare System, West Roxbury, MA, USA
| | - Robert Brown
- Pulmonary and Critical Care Medicine Unit and Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Eric Garshick
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,Pulmonary and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, West Roxbury, MA, USA,Correspondence to: Eric Garshick, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA, 02132 USA.
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17
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Long-term change in respiratory function following spinal cord injury. Spinal Cord 2016; 54:714-9. [PMID: 26754472 DOI: 10.1038/sc.2015.233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES To model the effect of time since injury on longitudinal respiratory function measures in spinal cord injured-individuals and to investigate the effect of patient characteristics. SETTING A total of 173 people who sustained a spinal cord injury between 1966 and April 2013 and who had previously participated in research or who underwent clinically indicated outpatient respiratory function tests at the Austin Hospital in Melbourne, Australia, were included in the study. At least two measurements over time were available for analysis in 59 patients. METHODS Longitudinal data analysis was performed using generalised linear regression models to determine changes in respiratory function following spinal cord injury from immediately post injury to many years later. Secondly, we explored whether injury severity, age, gender and body mass index (BMI) at injury altered the time-dependent change in respiratory function. RESULTS The generalised linear regression model showed no significant change (P=0.276) in respiratory function measured in (forced) vital capacity ((F)VC) after the spinal cord injury. However, significant (P<0.05) differences in respiratory function over time were found when categorising age and BMI. CONCLUSION This clinical cohort with long-term, repeated measurements of respiratory function showed no significant overall change in respiratory function over 23 years. However, a decline in respiratory function over time was observed in subgroups of individuals older than 30 years at the onset of injury and in those with a BMI>30 kg m(-2).
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18
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Gómez Garrido A, León Espitia AM, Montesinos Magraner L, Ramirez Galceran L, Soler Canudes E, González Viejo MA. [Spanish validation of the International Spinal Cord Injury Pulmonary Function Basic Data Set questionnaire for the study of the repercussion of spinal cord injury in the respiratory system]. Med Clin (Barc) 2015; 145:477-81. [PMID: 26055634 DOI: 10.1016/j.medcli.2015.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 04/04/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE The dysfunction of the respiratory system and the breathing complications in persons with injured spinal cord has an effect on the morbidity and the mortality of the disease. The objectives were: 1) to translate to Spanish and validate the questionnaire of international consensus: International Spinal Cord Injury Pulmonary Function Basic Data Set, and 2) to determine the influence of chronic spinal cord injury in the respiratory system in terms of respiratory functionalism. MATERIALS AND METHOD Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. We tested the reliability of that questionnaire. We conducted a descriptive transversal study to determine the degree of involvement of the respiratory system in spinal cord injury. RESULTS A percentage of 91.9 did not have any respiratory pathology before spinal cord injury and 54.8% of patients smoked. A percentage of 27.4 of patients presented breathing complications one year after the injury. Results of the respiratory function tests were: FVC 67%, FEV1 72% and PEF 70%. Concordance and reliability were 98%. CONCLUSION The Spanish version of the questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory involvement in spinal cord injury.
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Affiliation(s)
- Alba Gómez Garrido
- Unidad de Rehabilitación Cardiorrespiratoria, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España.
| | - Ana María León Espitia
- Unidad de Rehabilitación Cardiorrespiratoria, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Lluïsa Montesinos Magraner
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Lucrecia Ramirez Galceran
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Emilia Soler Canudes
- Unidad de Rehabilitación Cardiorrespiratoria, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Miguel Angel González Viejo
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
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Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial. Phys Ther 2014; 94:1709-19. [PMID: 25082923 DOI: 10.2522/ptj.20140079] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND People with spinal cord injury (SCI) may benefit from resistive inspiratory muscle training (RIMT). Current evidence is weak, and little is known about the effect on functional outcomes and long-term effects. OBJECTIVE The purpose of this study was to assess immediate and long-term effects of RIMT in people with SCI. DESIGN This was a single-blinded randomized controlled trial. SETTING The study was conducted at 4 specialized SCI units in the Netherlands. PATIENTS The study participants were 40 people with SCI (15 with motor complete tetraplegia, 16 with incomplete tetraplegia, 8 with motor complete paraplegia, and 1 with incomplete paraplegia) who had impaired pulmonary function and were admitted for initial inpatient rehabilitation. INTERVENTION Study participants were randomized to an RIMT group or a control group. All participants received usual rehabilitation care. In addition, participants in the intervention group performed RIMT with a threshold trainer. MEASUREMENTS Measurements were performed at baseline, after 8 weeks of intervention, 8 weeks later, and 1 year after discharge from inpatient rehabilitation. Primary outcome measures were: respiratory muscle function, lung volumes and flows, and perceived respiratory function. Secondary outcome measures concerned patient functioning, which included health-related quality of life, limitations in daily life due to respiratory problems, and respiratory complications. RESULTS During the intervention period, maximum inspiratory pressure (MIP) improved more in the RIMT group than in the control group (11.7 cm H2O, 95% confidence interval=4.3 to 19.0). At follow-up, this effect was no longer significant. No effect on other primary or secondary outcome measures was found except for an immediate effect on mental health. LIMITATIONS The sample size was insufficient to study effects on respiratory complications. CONCLUSIONS Resistive inspiratory muscle training has a positive short-term effect on inspiratory muscle function in people with SCI who have impaired pulmonary function during inpatient rehabilitation.
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20
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Terson de Paleville DGL, Sayenko DG, Aslan SC, Folz RJ, McKay WB, Ovechkin AV. Respiratory motor function in seated and supine positions in individuals with chronic spinal cord injury. Respir Physiol Neurobiol 2014; 203:9-14. [PMID: 25169115 DOI: 10.1016/j.resp.2014.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022]
Abstract
This case-controlled clinical study was undertaken to investigate to what extent pulmonary function in individuals with chronic spinal cord injury (SCI) is affected by posture. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) were obtained from 27 individuals with chronic motor-complete (n=13, complete group) and motor-incomplete (n=14, incomplete group) C2-T12 SCI in both seated and supine positions. Seated-to-supine changes in spirometrical (FVC and FEV1) and airway pressure (PImax and PEmax) outcome measures had different dynamics when compared in complete and incomplete groups. Patients with motor-complete SCI had tendency to increase spirometrical outcomes in supine position showing significant increase in FVC (p=.007), whereas patients in incomplete group exhibited decrease in these values with significant decreases in FEV1 (p=.002). At the same time, the airway pressure values were decreased in supine position in both groups with significant decrease in PEmax (p=.031) in complete group and significant decrease in PImax (p=.042) in incomplete group. In addition, seated-to-supine percent change of PImax was strongly correlated with neurological level of motor-complete SCI (ρ=-.77, p=.002). These results indicate that postural effects on respiratory performance in patients with SCI can depend on severity and neurological level of SCI, and that these effects differ depending on respiratory tasks. Further studies with adequate sample size are needed to investigate these effects in clinically specific groups and to study the mechanisms of such effects on specific respiratory outcome measures.
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Affiliation(s)
| | - Dimitry G Sayenko
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Sevda C Aslan
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Rodney J Folz
- Department of Medicine: Division of Pulmonary, Critical Care and Sleep Disorders, University of Louisville, Louisville, KY, USA
| | - William B McKay
- Hulse Spinal Cord Injury Laboratory, Shepherd Center, Atlanta, GA, USA
| | - Alexander V Ovechkin
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA.
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A center's experience: pulmonary function in spinal cord injury. Lung 2014; 192:339-46. [PMID: 24723067 DOI: 10.1007/s00408-014-9575-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/10/2014] [Indexed: 01/24/2023]
Abstract
Traumatic spinal cord injury (SCI) is associated with significant psychological and physical challenges. A multidisciplinary approach to management is essential to ensure recovery during the acute phase, and comprehensive rehabilitative strategies are necessary to foster independence and quality of life throughout the chronic phase of injury. Complications that beset these individuals are often a unique consequence of SCI, and knowledge of the effects of SCI upon organ systems is essential for appropriate management. According to the National SCI Statistical Center (NSCISC), as of 2010 there were an estimated 265,000 persons living with SCI in the United States, with approximately 12,000 incidence cases annually. Although life expectancy for newly injured individuals with SCI is markedly reduced, persons with chronic SCI are expected to live about as long as individuals without SCI; however, longevity varies inversely with level of injury. Since 2005, 56 % of persons with SCI are tetraplegic, and due to paralysis of respiratory muscles, these individuals may be especially prone to pulmonary complications, which remain a major cause of mortality among persons with chronic SCI. We at the VA Rehabilitation Research and Development Center of Excellence for the Medical Consequences of SCI at the James J. Peters VA Medical Center have devoted more than 25 years to the study of secondary medical conditions that complicate SCI. Herein, we review pulmonary research at the Center, both our past and future endeavors, which form an integral part of our multidisciplinary approach toward achieving a greater understanding of and improving care for veterans with SCI.
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Tester NJ, Fuller DD, Fromm JS, Spiess MR, Behrman AL, Mateika JH. Long-term facilitation of ventilation in humans with chronic spinal cord injury. Am J Respir Crit Care Med 2014; 189:57-65. [PMID: 24224903 DOI: 10.1164/rccm.201305-0848oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Intermittent stimulation of the respiratory system with hypoxia causes persistent increases in respiratory motor output (i.e., long-term facilitation) in animals with spinal cord injury. This paradigm, therefore, has been touted as a potential respiratory rehabilitation strategy. OBJECTIVES To determine whether acute (daily) exposure to intermittent hypoxia can also evoke long-term facilitation of ventilation after chronic spinal cord injury in humans, and whether repeated daily exposure to intermittent hypoxia enhances the magnitude of this response. METHODS Eight individuals with incomplete spinal cord injury (>1 yr; cervical [n = 6], thoracic [n = 2]) were exposed to intermittent hypoxia (eight 2-min intervals of 8% oxygen) for 10 days. During all exposures, end-tidal carbon dioxide levels were maintained, on average, 2 mm Hg above resting values. Minute ventilation, tidal volume, and breathing frequency were measured before (baseline), during, and 30 minutes after intermittent hypoxia. Sham protocols consisted of exposure to room air and were administered to a subset of the participants (n = 4). MEASUREMENTS AND MAIN RESULTS Minute ventilation increased significantly for 30 minutes after acute exposure to intermittent hypoxia (P < 0.001), but not after sham exposure. However, the magnitude of ventilatory long-term facilitation was not enhanced over 10 days of intermittent hypoxia exposures. CONCLUSIONS Ventilatory long-term facilitation can be evoked by brief periods of hypoxia in humans with chronic spinal cord injury. Thus, intermittent hypoxia may represent a strategy for inducing respiratory neuroplasticity after declines in respiratory function that are related to neurological impairment. Clinical trial registered with www.clinicaltrials.gov (NCT01272011).
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Affiliation(s)
- Nicole J Tester
- 1 Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida
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Terson de Paleville DGL, McKay WB, Folz RJ, Ovechkin AV. Respiratory motor control disrupted by spinal cord injury: mechanisms, evaluation, and restoration. Transl Stroke Res 2013; 2:463-73. [PMID: 22408690 DOI: 10.1007/s12975-011-0114-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pulmonary complications associated with persistent respiratory muscle weakness, paralysis, and spasticity are among the most important problems faced by patients with spinal cord injury when lack of muscle strength and disorganization of reciprocal respiratory muscle control lead to breathing insufficiency. This review describes the mechanisms of the respiratory motor control and its change in individuals with spinal cord injury, methods by which respiratory function is measured, and rehabilitative treatment used to restore respiratory function in those who have experienced such injury.
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Affiliation(s)
- Daniela G L Terson de Paleville
- Exercise Physiology, University of Louisville, Louisville, KY, USA. Physiology and Biophysics, University of Louisville, Louisville, KY, USA
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Postma K, Haisma JA, de Groot S, Hopman MT, Bergen MP, Stam HJ, Bussmann JB. Changes in Pulmonary Function During the Early Years After Inpatient Rehabilitation in Persons With Spinal Cord Injury: A Prospective Cohort Study. Arch Phys Med Rehabil 2013; 94:1540-6. [DOI: 10.1016/j.apmr.2013.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/22/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
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Aslan SC, Chopra MK, McKay WB, Folz RJ, Ovechkin AV. Evaluation of respiratory muscle activation using respiratory motor control assessment (RMCA) in individuals with chronic spinal cord injury. J Vis Exp 2013:50178. [PMID: 23912611 PMCID: PMC3740445 DOI: 10.3791/50178] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
During breathing, activation of respiratory muscles is coordinated by integrated input from the brain, brainstem, and spinal cord. When this coordination is disrupted by spinal cord injury (SCI), control of respiratory muscles innervated below the injury level is compromised leading to respiratory muscle dysfunction and pulmonary complications. These conditions are among the leading causes of death in patients with SCI. Standard pulmonary function tests that assess respiratory motor function include spirometrical and maximum airway pressure outcomes: Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), Maximal Inspiratory Pressure (PImax) and Maximal Expiratory Pressure (PEmax). These values provide indirect measurements of respiratory muscle performance(6). In clinical practice and research, a surface electromyography (sEMG) recorded from respiratory muscles can be used to assess respiratory motor function and help to diagnose neuromuscular pathology. However, variability in the sEMG amplitude inhibits efforts to develop objective and direct measures of respiratory motor function. Based on a multi-muscle sEMG approach to characterize motor control of limb muscles, known as the voluntary response index (VRI), we developed an analytical tool to characterize respiratory motor control directly from sEMG data recorded from multiple respiratory muscles during the voluntary respiratory tasks. We have termed this the Respiratory Motor Control Assessment (RMCA). This vector analysis method quantifies the amount and distribution of activity across muscles and presents it in the form of an index that relates the degree to which sEMG output within a test-subject resembles that from a group of healthy (non-injured) controls. The resulting index value has been shown to have high face validity, sensitivity and specificity. We showed previously that the RMCA outcomes significantly correlate with levels of SCI and pulmonary function measures. We are presenting here the method to quantitatively compare post-spinal cord injury respiratory multi-muscle activation patterns to those of healthy individuals.
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Affiliation(s)
- Sevda C Aslan
- Department of Neurological Surgery, University of Louisville, Louisville, USA
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Aarabi B, Harrop JS, Tator CH, Alexander M, Dettori JR, Grossman RG, Fehlings MG, Mirvis SE, Shanmuganathan K, Zacherl KM, Burau KD, Frankowski RF, Toups E, Shaffrey CI, Guest JD, Harkema SJ, Habashi NM, Andrews P, Johnson MM, Rosner MK. Predictors of pulmonary complications in blunt traumatic spinal cord injury. J Neurosurg Spine 2013; 17:38-45. [PMID: 22985369 DOI: 10.3171/2012.4.aospine1295] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECT Pulmonary complications are the most common acute systemic adverse events following spinal cord injury (SCI), and contribute to morbidity, mortality, and increased length of hospital stay (LOS). Identification of factors associated with pulmonary complications would be of value in prevention and acute care management. Predictors of pulmonary complications after SCI and their effect on neurological recovery were prospectively studied between 2005 and 2009 at the 9 hospitals in the North American Clinical Trials Network (NACTN). METHODS The authors sought to address 2 specific aims: 1) define and analyze the predictors of moderate and severe pulmonary complications following SCI; and 2) investigate whether pulmonary complications negatively affected the American Spinal Injury Association (ASIA) Impairment Scale conversion rate of patients with SCI. The NACTN registry of the demographic data, neurological findings, imaging studies, and acute hospitalization duration of patients with SCI was used to analyze the incidence and severity of pulmonary complications in 109 patients with early MR imaging and long-term follow-up (mean 9.5 months). Univariate and Bayesian logistic regression analyses were used to analyze the data. RESULTS In this study, 86 patients were male, and the mean age was 43 years. The causes of injury were motor vehicle accidents and falls in 80 patients. The SCI segmental level was in the cervical, thoracic, and conus medullaris regions in 87, 14, and 8 patients, respectively. Sixty-four patients were neurologically motor complete at the time of admission. The authors encountered 87 complications in 51 patients: ventilator-dependent respiratory failure (26); pneumonia (25); pleural effusion (17); acute lung injury (6); lobar collapse (4); pneumothorax (4); pulmonary embolism (2); hemothorax (2), and mucus plug (1). Univariate analysis indicated associations between pulmonary complications and younger age, sports injuries, ASIA Impairment Scale grade, ascending neurological level, and lesion length on the MRI studies at admission. Bayesian logistic regression indicated a significant relationship between pulmonary complications and ASIA Impairment Scale Grades A (p = 0.0002) and B (p = 0.04) at admission. Pulmonary complications did not affect long-term conversion of ASIA Impairment Scale grades. CONCLUSIONS The ASIA Impairment Scale grade was the fundamental clinical entity predicting pulmonary complications. Although pulmonary complications significantly increased LOS, they did not increase mortality rates and did not adversely affect the rate of conversion to a better ASIA Impairment Scale grade in patients with SCI. Maximum canal compromise, maximum spinal cord compression, and Acute Physiology and Chronic Health Evaluation-II score had no relationship to pulmonary complications.
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Affiliation(s)
- Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Abstract
OBJECTIVES To develop the International Spinal Cord Injury (SCI) Pulmonary Function Basic Data Set within the framework of the International SCI Data Sets in order to facilitate consistent collection and reporting of basic bronchopulmonary findings in the SCI population. SETTING International. METHODS The SCI Pulmonary Function Data Set was developed by an international working group. The initial data set document was revised on the basis of suggestions from members of the Executive Committee of the International SCI Standards and Data Sets, the International Spinal Cord Society (ISCoS) Executive and Scientific Committees, American Spinal Injury Association (ASIA) Board, other interested organizations and societies and individual reviewers. In addition, the data set was posted for 2 months on ISCoS and ASIA websites for comments. RESULTS The final International SCI Pulmonary Function Data Set contains questions on the pulmonary conditions diagnosed before spinal cord lesion,if available, to be obtained only once; smoking history; pulmonary complications and conditions after the spinal cord lesion, which may be collected at any time. These data include information on pneumonia, asthma, chronic obstructive pulmonary disease and sleep apnea. Current utilization of ventilator assistance including mechanical ventilation, diaphragmatic pacing, phrenic nerve stimulation and Bi-level positive airway pressure can be reported, as well as results from pulmonary function testing includes: forced vital capacity, forced expiratory volume in one second and peak expiratory flow. The complete instructions for data collection and the data sheet itself are freely available on the website of ISCoS (http://www.iscos.org.uk).
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Bauman WA, Korsten MA, Radulovic M, Schilero GJ, Wecht JM, Spungen AM. 31st g. Heiner sell lectureship: secondary medical consequences of spinal cord injury. Top Spinal Cord Inj Rehabil 2012; 18:354-78. [PMID: 23459498 PMCID: PMC3584784 DOI: 10.1310/sci1804-354] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Persons with spinal cord injury (SCI) have secondary medical consequences of paralysis and/or the consequences of extreme inactivity. The metabolic changes that result from reduced activity include insulin resistance with carbohydrate disorders and dyslipidemia. A higher prevalence of coronary artery calcification was found in persons with SCI than that in matched able-bodied controls. A depression in anabolic hormones, circulating testosterone and growth hormone, has been described. Adverse soft tissue body composition changes of increased adiposity and reduced skeletal muscle are appreciated. Immobilization is the cause for sublesional disuse osteoporosis with an associated increased risk of fragility fracture. Bowel dysmotility affects all segments of the gastrointestinal tract, with an interest in better defining and addressing gastroesophageal reflux disease and difficulty with evacuation. Developing and testing more effective approaches to cleanse the bowel for elective colonoscopy are being evaluated. The extent of respiratory dysfunction depends on the level and completeness of SCI. Individuals with higher spinal lesions have both restrictive and obstructive airway disease. Pharmacological approaches and expiratory muscle training are being studied as interventions to improve pulmonary function and cough strength with the objective of reducing pulmonary complications. Persons with spinal lesions above the 6th thoracic level lack both cardiac and peripheral vascular mechanisms to maintain blood pressure, and they are frequently hypotensive, with even worse hypotension with upright posture. Persistent and/or orthostatic hypotension may predispose those with SCI to cognitive impairments. The safety and efficacy of anti-hypotensive agents to normalize blood pressure in persons with higher level cord lesions is being investigated.
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Affiliation(s)
- William A Bauman
- VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York ; Medical Service, James J. Peters VA Medical Center , Bronx, New York ; Department of Medicine, The Mount Sinai School of Medicine , New York, New York ; Department of Rehabilitation Medicine, The Mount Sinai School of Medicine , New York, New York
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Tollefsen E, Fondenes O. Respiratoriske komplikasjoner ved ryggmargsskader. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1111-4. [DOI: 10.4045/tidsskr.10.0922] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Garshick E, Stolzmann KL, Gagnon DR, Morse LR, Brown R. Systemic inflammation and reduced pulmonary function in chronic spinal cord injury. PM R 2011; 3:433-9. [PMID: 21570031 PMCID: PMC3141080 DOI: 10.1016/j.pmrj.2011.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 02/07/2011] [Accepted: 02/10/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the relationship between systemic inflammation and pulmonary function in persons with chronic spinal cord injury (SCI). DESIGN Cross-sectional study. SETTING Veterans Affairs Medical Center. PARTICIPANTS Fifty-nine men with chronic SCI participating in a prior epidemiologic study. METHODS Standardized assessment of pulmonary function and measurement of plasma C-reactive protein (CRP) and interleukin-6 (IL-6). MAIN OUTCOME MEASUREMENTS Forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC). RESULTS Persons with the highest values of IL-6 had the lowest %-predicted FEV(1) and FVC. There was a significant inverse linear trend between quartile of IL-6 and %-predicted FEV(1) (P < .001) and FVC (P < .006), unadjusted and adjusted for SCI level and completeness of injury, obstructive lung disease history, smoking, and body mass index (P = .010-.039). Although not as strong as for IL-6, there also were similar trends for %-predicted FEV(1) and FVC with CRP. CONCLUSIONS In chronic SCI, higher levels of IL-6 and CRP were associated with a lower FEV(1) and FVC, independent of level and completeness of injury. These results suggest that the reduction of pulmonary function after SCI is related not only to neuromuscular impairment but also to factors that promote systemic inflammation.
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Affiliation(s)
- Eric Garshick
- Pulmonary and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA.
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Lee PN, Fry JS. Systematic review of the evidence relating FEV1 decline to giving up smoking. BMC Med 2010; 8:84. [PMID: 21156048 PMCID: PMC3017006 DOI: 10.1186/1741-7015-8-84] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/14/2010] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The rate of forced expiratory volume in 1 second (FEV1) decline ("beta") is a marker of chronic obstructive pulmonary disease risk. The reduction in beta after quitting smoking is an upper limit for the reduction achievable from switching to novel nicotine delivery products. We review available evidence to estimate this reduction and quantify the relationship of smoking to beta. METHODS Studies were identified, in healthy individuals or patients with respiratory disease, that provided data on beta over at least 2 years of follow-up, separately for those who gave up smoking and other smoking groups. Publications to June 2010 were considered. Independent beta estimates were derived for four main smoking groups: never smokers, ex-smokers (before baseline), quitters (during follow-up) and continuing smokers. Unweighted and inverse variance-weighted regression analyses compared betas in the smoking groups, and in continuing smokers by amount smoked, and estimated whether beta or beta differences between smoking groups varied by age, sex and other factors. RESULTS Forty-seven studies had relevant data, 28 for both sexes and 19 for males. Sixteen studies started before 1970. Mean follow-up was 11 years. On the basis of weighted analysis of 303 betas for the four smoking groups, never smokers had a beta 10.8 mL/yr (95% confidence interval (CI), 8.9 to 12.8) less than continuing smokers. Betas for ex-smokers were 12.4 mL/yr (95% CI, 10.1 to 14.7) less than for continuing smokers, and for quitters, 8.5 mL/yr (95% CI, 5.6 to 11.4) less. These betas were similar to that for never smokers. In continuing smokers, beta increased 0.33 mL/yr per cigarette/day. Beta differences between continuing smokers and those who gave up were greater in patients with respiratory disease or with reduced baseline lung function, but were not clearly related to age or sex. CONCLUSION The available data have numerous limitations, but clearly show that continuing smokers have a beta that is dose-related and over 10 mL/yr greater than in never smokers, ex-smokers or quitters. The greater decline in those with respiratory disease or reduced lung function is consistent with some smokers having a more rapid rate of FEV1 decline. These results help in designing studies comparing continuing smokers of conventional cigarettes and switchers to novel products.
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Affiliation(s)
- Peter N Lee
- PN Lee Statistics and Computing Ltd, Surrey, UK.
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Ovechkin A, Vitaz T, de Paleville DT, Aslan S, McKay W. Evaluation of respiratory muscle activation in individuals with chronic spinal cord injury. Respir Physiol Neurobiol 2010; 173:171-8. [DOI: 10.1016/j.resp.2010.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 07/27/2010] [Accepted: 07/30/2010] [Indexed: 11/24/2022]
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Olsén MF, Romberg K. Reliability of the Respiratory Movement Measuring Instrument, RMMI. Clin Physiol Funct Imaging 2010; 30:349-353. [PMID: 20584032 DOI: 10.1111/j.1475-097x.2010.00951.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A new instrument to measure breathing movements, Respiratory Movement Measuring Instrument (RMMI), has been developed. There is still a lack of knowledge about the reliability of the instrument. OBJECTIVES The aim was to investigate reliability of the RMMI. METHODS In this trial, RMMI (ReMo Inc. Keldnaholt, Reykjavik, Iceland) was used. Inter- and intrarater reliability was performed on 30 volunteers who were tested three times in the supine position. Two of the tests were performed by one of the authors and the third test by the other. Intrasubject reliability was tested on 10 volunteers 12 times randomly during 1 h. Intra-instrument reliability was performed by measuring 12 solid surfaces where the instrument was placed horizontally against a couch or vertically against a chair. RESULTS Intra-rater reliability: The correlations were moderate to strong (r = 0.54-0.94) except for the left lower thoracic position r = 0.35. Inter-rater reliability: The correlations were strong (r = 0.71-0.99) except for the left lower thoracic position r = 0.35. The strongest correlations were seen on the tests on abdominal breathing movements. Intra subject reliability: The over-all difference within and between the participants and test was non-significant (P = 0.98). The average difference between the tests was 1.4 mm. Intra instrument: The differences between the measurements were small (mean 0.15 mm). The over-all difference was non-significant (P = 0.79). CONCLUSION The RMMI is a reliable instrument and usable in both clinical practice and research.
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Affiliation(s)
- Monika Fagevik Olsén
- The Departments of Occupational and Physical Therapy, Sahlgrenska Academy, Gothenburg University.,Department of physical therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Romberg
- Department of physical therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Schilero GJ, Spungen AM, Bauman WA, Radulovic M, Lesser M. Pulmonary function and spinal cord injury. Respir Physiol Neurobiol 2009; 166:129-41. [PMID: 19442929 DOI: 10.1016/j.resp.2009.04.002] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 11/30/2022]
Abstract
Injury to the cervical and upper thoracic spinal cord disrupts function of inspiratory and expiratory muscles, as reflected by reduction in spirometric and lung volume parameters and static mouth pressures. In association, subjects with tetraplegia have decreased chest wall and lung compliance, increased abdominal wall compliance, and rib cage stiffness with paradoxical chest wall movements, all of which contribute to an increase in the work of breathing. Expiratory muscle function is more compromised than inspiratory muscle function among subjects with tetraplegia and high paraplegia, which can result in ineffective cough and propensity to mucus retention and atelectasis. Subjects with tetraplegia also demonstrate heightened vagal activity with reduction in baseline airway caliber, findings attributed to loss of sympathetic innervation to the lungs. Significant increase in airway caliber following inhalation of ipratropium bromide, an anticholinergic agent, suggests that reduction in airway caliber is not due to acquired airway fibrosis stemming from repeated infections or to abnormal hysteresis secondary to chronic inability of subjects to inhale to predicted total lung capacity. Reduced baseline airway caliber possibly explains why subjects with tetraplegia exhibit airway hyperresponsiveness to methacholine and ultrasonically nebulized distilled water. While it has been well demonstrated that bilateral phrenic nerve pacing or stimulation through intramuscular diaphragmatic electrodes improves inspiratory muscle function, it remains unclear if inspiratory muscle training improves pulmonary function. Recent findings suggest that expiratory muscle training, electrical stimulation of expiratory muscles and administration of a long-acting beta(2)-agonist (salmeterol) improve physiological parameters and cough. It is unknown if baseline bronchoconstriction in tetraplegia contributes to respiratory symptoms, of if the chronic administration of a bronchodilator reduces the work of breathing and/or improves respiratory symptoms. Less is known regarding the benefits of treatment of obstructive sleep apnea, despite evidence indicating that the prevalence of this condition in persons with tetraplegia is far greater than that encountered in able-bodied individuals.
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Affiliation(s)
- Gregory J Schilero
- Rehabilitation Research and Development Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, NY 10468, USA.
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