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Raguindin PF, Itodo OA, Eriks-Hoogland I, Muka T, Brach M, Stucki G, Stoyanov J, Glisic M. Does cardiometabolic risk profile differ among individuals with traumatic and non-traumatic spinal cord injury (SCI): the evidence from the multicenter SCI cohort in Switzerland (SwiSCI). Spinal Cord 2024; 62:387-395. [PMID: 38750255 PMCID: PMC11230898 DOI: 10.1038/s41393-024-00996-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 07/10/2024]
Abstract
STUDY DESIGN Longitudinal study. OBJECTIVE To explore whether individuals with traumatic spinal cord injury (TSCI) and non-traumatic SCI (NTSCI) experience different trajectories in changes of cardiometabolic disease (CMD) factors during initial rehabilitation stay. SETTING Multicenter Swiss Spinal Cord Injury Cohort (SwiSCI) study. METHODS Individuals without history of cardiovascular diseases were included. CMD factors and Framingham risk score (FRS) were compared between TSCI and NTSCI. Linear mixed models' analysis was employed to explore the trajectory in CMD factors changes over rehabilitation period and a multivariate linear regression analysis was used at discharge from inpatient rehabilitation to explore factors associated with CMD risk profile in TSCI and NTSCI. We performed age and sex-stratified analyses. RESULTS We analyzed 530 individuals with SCI (64% with TSCI and 36% NTSCI). The median age was 53 years (IQR:39-64) with 67.9% (n = 363) of the study cohort being male. The median rehabilitation duration was 4.4 months (IQR 2.4-6.4). At admission to rehabilitation, FRS (9.61 vs. 5.89) and prevalence of hypertension (33.16% vs. 13.62%), diabetes (13.68% vs. 4.06%), and obesity (79.05% vs. 66.67%) were higher in NTSCI as compared to TSCI, No difference was observed in cardiometabolic syndrome between the groups (around 40% in both groups). Overall, we observed longitudinal increases in total cholesterol, HDL-C and HDL/total cholesterol ratio, and a decrease in fasting glucose over the rehabilitation period. No differences in longitudinal changes in cardiovascular risk factors were observed between TSCI and NTSCI. CONCLUSIONS There was no deterioration in cardiometabolic risk factors over rehabilitation period, at discharge from initial rehabilitation stay. Both TSCI and NTSCI experienced high burden of cardiometabolic syndrome components with NTSCI experiencing more disadvantageous risk profile. The effectiveness of therapeutic and lifestyle/behavioral strategies to decrease burden of cardiometabolic disease and its components in early phase should be explored in future studies.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, 6005, Lucerne, Switzerland
| | - Oche Adam Itodo
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Inge Eriks-Hoogland
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, 6005, Lucerne, Switzerland
- Swiss Paraplegic Centre, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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Saengsuwan J, Ruangsuphaphichat A, Brockmann L, Sirasaporn P, Manimmanakorn N, Hunt KJ. Diurnal variation of heart rate variability in individuals with spinal cord injury. Biomed Eng Online 2024; 23:58. [PMID: 38902756 PMCID: PMC11188279 DOI: 10.1186/s12938-024-01256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Heart rate variability (HRV) may provide objective information about cardiogenic autonomic balance in individuals with spinal cord injury (SCI). The aim of this study was to characterize the diurnal variation of HRV in individuals with SCI at lesion level T6 and above and lesion level below T6. METHODS This was a retrospective analysis of a prior cross-sectional study. Individuals with chronic SCI underwent 24 h recording of the time between consecutive R waves (RR interval) to derive parameters of HRV as follows: standard deviation of all normal-to-normal R-R intervals (SDNN) and square root of the mean of the squared differences between successive R-R intervals (RMSSD) (time domain); and high frequency power (HF), low-frequency power (LF), very low frequency power (VLF), ultra-low frequency power (ULF) and total power (TP) (frequency domain). Changes in the magnitude of HRV outcomes over the 24 h period were investigated using a novel multi-component cosinor model constrained to the form of a three-harmonic Fourier series. RESULTS Participants were grouped as lesion level T6 and above (n = 22) or below T6 (n = 36). Most of them were male (n = 40, 69%) and the median age (interquartile range) was 50.5 (28) years. Both groups exhibited similar diurnal patterns in most HRV metrics. The lowest values occurred in the late afternoon (4-6 pm) and gradually increased, peaking around midnight to early morning (1-6 am). Exceptions included RMSSD, which peaked before midnight, and ULF, which showed a double peak pattern that peaked from 11 am to 1 pm and 4-6 am in participants with lesion level at T6 and above. The HRV values in participants with lesion level T6 and above were generally lower than participants with lesion level below T6, except for peak values of RMSSD, HF and LF. CONCLUSION This study demonstrated substantial diurnal variation of HRV in participants with SCI in both groups of participants. In clinical and research settings, diurnal variations in HRV must be taken into consideration.
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Affiliation(s)
- Jittima Saengsuwan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
- The Laboratory for Rehabilitation Engineering, Institute for Human Centred Engineering, Bern University of Applied Sciences, Biel, Switzerland.
| | | | - Lars Brockmann
- The Laboratory for Rehabilitation Engineering, Institute for Human Centred Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Patpiya Sirasaporn
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nuttaset Manimmanakorn
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kenneth J Hunt
- The Laboratory for Rehabilitation Engineering, Institute for Human Centred Engineering, Bern University of Applied Sciences, Biel, Switzerland
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Kurban D, Davidson RA, Smith KM, Carlson M, Joseph J, Elliott S, Noonan VK, Fallah N, Krassioukov AV. Construct validity of the international standards to document remaining autonomic function after spinal cord injury (ISAFSCI) (1st edition). Spinal Cord 2023; 61:644-651. [PMID: 37814014 DOI: 10.1038/s41393-023-00932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
STUDY DESIGN Observational study. OBJECTIVES To assess the construct validity of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) (2012 1st Edition). SETTING Two Canadian spinal cord injury (SCI) centers. METHODS Data were collected between 2011-2014. Assessments included the ISAFSCI, standardized measures of autonomic function and a clinical examination. Construct validity of ISAFSCI was assessed by testing a priori hypotheses on expected ISAFSCI responses to standard measures (convergent hypotheses) and clinical variables (clinical hypotheses). RESULTS Forty-nine participants with an average age of 45 ± 12 years were included, of which 42 (85.7%) were males, 37 (77.6%) had a neurological level of injury at or above T6, and 23 (46.9%) were assessed as having motor and sensory complete SCI. For the six General Autonomic Function component hypotheses, two hypotheses (1 clinical, 1 convergent) related to autonomic control of blood pressure and one clinical hypothesis for temperature regulation were statistically significant. In terms of the Lower Urinary Tract, Bowel and Sexual Function component of the ISAFSCI, all the hypotheses (5 convergent, 3 clinical) were statistically significant except for the hypotheses on female sexual items (2 convergent, 2 clinical), likely due to small sample size. CONCLUSION The construct validity of ISAFSCI (2012 1st Edition) for the General Autonomic Function component was considered to be weak while it was much stronger for the Lower Urinary Tract, Bowel and Sexual Function component based on a priori hypotheses. These results can inform future psychometric studies of the ISAFSCI (2021 2nd Edition).
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Affiliation(s)
| | - Ross A Davidson
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Karen M Smith
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, Canada
| | - Marie Carlson
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | | | - Stacy Elliott
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
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Dorton MC, Kramer JK, de Groot S, Post MWM, Claydon VE. Relationships between cardiovascular disease risk, neuropathic pain, mental health, and autonomic function in chronic spinal cord injury. Spinal Cord 2023; 61:548-555. [PMID: 37749189 DOI: 10.1038/s41393-023-00933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
STUDY DESIGN Multicentre, cross-sectional study. OBJECTIVES To determine if clinical measures of poor mental health (MH-) and neuropathic pain (NP) are related to increased CVD risk in individuals with chronic spinal cord injury (SCI), and further elucidate the relationships between CVD risk, autonomic function, NP, and MH-. SETTING Eight SCI rehabilitation centres in the Netherlands. METHODS Individuals (n = 257) with a traumatic, chronic (≥10 yrs) SCI, with age at injury between 18-35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. CVD risk was calculated using Framingham risk score. NP was inferred using The Douleur Neuropathique 4 clinical examination, and MH- was assessed using the five-item Mental Health Inventory questionnaire. Cardiovascular autonomic function was determined from peak heart rate during maximal exercise (HRpeak). RESULTS There was a high prevalence of both NP (39%) and MH- (45%) following SCI. MH- was significantly correlated with an adverse CVD risk profile (r = 0.174; p = 0.01), increased the odds of adverse 30-year CVD risk by 2.2 (CI 0.92-2.81, p = 0.02), and is an important variable in determining CVD risk (importance=0.74, p = 0.05). Females (p = 0.05) and those with a higher HRpeak (p = 0.046) tended to be more likely to have NP. CONCLUSIONS Clinical measures of MH-, but not NP, are important factors for increased CVD risk following SCI. NP tended to be more prevalent in those with more preserved cardiovascular autonomic function. The interrelationships between secondary consequences of SCI are complex and need further exploration.
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Affiliation(s)
- Matthew C Dorton
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - John K Kramer
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel W M Post
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and de Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
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Bosteder KD, Moore A, Weeks A, Dawkins JD, Trammell M, Driver S, Hamilton R, Swank C. Intensity of overground robotic exoskeleton training in two persons with motor-complete tetraplegia: a case series. Spinal Cord Ser Cases 2023; 9:24. [PMID: 37391401 PMCID: PMC10313748 DOI: 10.1038/s41394-023-00584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Participation in moderate-to-vigorous intensity physical activity (MVPA) is recommended to reduce chronic disease risk in individuals with tetraplegia. Assessing exercise intensity using traditional methods, such as heart rate, may be inaccurate in patients with motor-complete tetraplegia due to autonomic and neuromuscular dysfunction. Direct gas analysis may be more accurate. Overground robotic exoskeleton (ORE) training can be physiologically demanding. Yet, its utility as an aerobic exercise modality to facilitate MVPA in patients with chronic and acute motor-complete tetraplegia has not been explored. CASE PRESENTATION We present the results of two male participants with motor-complete tetraplegia who completed one ORE exercise session while intensity was assessed using a portable metabolic system and expressed in metabolic equivalents (METs). METs were calculated using a rolling 30-s average with 1 MET defined as 2.7 mL/kg/min and MVPA defined as MET ≥ 3.0. Participant A (28-year-old) with a chronic (12 yrs) spinal cord injury (C5, AIS A) completed 37.4 min of ORE exercise (28.9 min walking) achieving 1047 steps. Peak METs were 3.4 (average 2.3) with 3% of walk time spent in MVPA. Participant B (21-year-old) with an acute (2 months) spinal cord injury (C4, AIS A) completed 42.3 min of ORE exercise (40.5 min walking) achieving 1023 steps. Peak METs were 3.2 (average 2.6) with 12% of walk time spent in MVPA. Both participants tolerated activity well without observed adverse responses to activity. DISCUSSION ORE exercise may be an effective aerobic exercise modality that may increase participation in physical activity in patients with motor-complete tetraplegia.
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Affiliation(s)
- Katelyn D Bosteder
- Sports Therapy & Research Center, Baylor Scott & White Research Institute, Frisco, TX, USA.
| | - Ashlyn Moore
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | - Ariana Weeks
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | - Jonathan D Dawkins
- Sports Therapy & Research Center, Baylor Scott & White Research Institute, Frisco, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
| | - Molly Trammell
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
| | - Simon Driver
- Sports Therapy & Research Center, Baylor Scott & White Research Institute, Frisco, TX, USA
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Rita Hamilton
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
| | - Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
- Baylor Scott & White Research Institute, Dallas, TX, USA
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Respiratory Complications and Weaning Considerations for Patients with Spinal Cord Injuries: A Narrative Review. J Pers Med 2022; 13:jpm13010097. [PMID: 36675758 PMCID: PMC9861966 DOI: 10.3390/jpm13010097] [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: 12/05/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Respiratory complications following traumatic spinal cord injury are common and are associated with high morbidity and mortality. The inability to cough and clear secretions coupled with weakened respiratory and abdominal muscles commonly leads to respiratory failure, pulmonary edema, and pneumonia. Higher level and severity of the spinal cord injury, history of underlying lung pathology, history of smoking, and poor baseline health status are potential predictors for patients that will experience respiratory complications. For patients who may require prolonged intubation, early tracheostomy has been shown to lead to improved outcomes. Prediction models to aid clinicians with the decision and timing of tracheostomy have been shown to be successful but require larger validation studies in the future. Mechanical ventilation weaning strategies also require further investigation but should focus on a combination of optimizing ventilator setting, pulmonary toilet techniques, psychosocial well-being, and an aggressive bowel regimen.
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Salas-Monedero M, Lozano-Berrio V, Cazorla-Martínez MJ, Ceruelo-Abajo S, Gil-Agudo Á, Hernández-Sánchez S, Jiménez-Díaz JF, DelosReyes-Guzmán A. Is it Feasible to Use a Low-Cost Wearable Sensor for Heart Rate Monitoring within an Upper Limb Training in Spinal Cord Injured Patients?: A Pilot Study. Bioengineering (Basel) 2022; 9:bioengineering9120763. [PMID: 36550969 PMCID: PMC9774606 DOI: 10.3390/bioengineering9120763] [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: 10/28/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Cervical spinal cord injury (SCI) patients have impairment in the autonomic nervous system, reflected in the cardiovascular adaption level during the performance of upper limb (UL) activities carried out in the rehabilitation process. This adaption level could be measured from the heart rate (HR) by means of wearable technologies. Therefore, the objective was to analyze the feasibility of using Xiaomi Mi Band 5 wristband (XMB5) for HR monitoring in these patients during the performance of UL activities; (2) Methods: The HR measurements obtained from XMB5 were compared to those obtained by the professional medical equipment Nonin LifeSense II capnograph and pulse oximeter (NLII) in static and dynamic conditions. Then, four healthy people and four cervical SCI patients performed a UL training based on six experimental sessions; (3) Results: the correlation between the HR measurements from XMB5 and NLII devices was strong and positive in healthy people (r = 0.921 and r = 0.941 (p < 0.01) in the static and dynamic conditions, respectively). Then, XMB5 was used within the experimental sessions, and the HR oscillation range measured was significantly higher in healthy individuals than in patients; (4) Conclusions: The XMB5 seems to be feasible for measuring the HR in this biomedical application in SCI patients.
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Affiliation(s)
- Miriam Salas-Monedero
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
- International Doctoral School, Castilla La-Mancha University, 14507 Toledo, Spain
| | - Vicente Lozano-Berrio
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
| | | | - Silvia Ceruelo-Abajo
- Rehabilitation Department, Hospital Nacional de Parapléjicos (SESCAM), 14507 Toledo, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
- Rehabilitation Department, Hospital Nacional de Parapléjicos (SESCAM), 14507 Toledo, Spain
| | - Sonsoles Hernández-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sports Sciences, Castilla- La Mancha University, 14507 Toledo, Spain
| | - José-Fernando Jiménez-Díaz
- Performance and Sport Rehabilitation Laboratory, Faculty of Sports Sciences, Castilla- La Mancha University, 14507 Toledo, Spain
| | - Ana DelosReyes-Guzmán
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
- Correspondence:
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The Outcomes of Robotic Rehabilitation Assisted Devices Following Spinal Cord Injury and the Prevention of Secondary Associated Complications. Medicina (B Aires) 2022; 58:medicina58101447. [PMID: 36295607 PMCID: PMC9611825 DOI: 10.3390/medicina58101447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Spinal cord injuries (SCIs) have major consequences on the patient’s health and life. Voluntary muscle paralysis caused by spinal cord damage affects the patient’s independence. Following SCI, an irreversible motor and sensory deficit occurs (spasticity, muscle paralysis, atrophy, pain, gait disorders, pain). This pathology has implications on the whole organism: on the osteoarticular, muscular, cardiovascular, respiratory, gastrointestinal, genito-urinary, skin, metabolic disorders, and neuro-psychic systems. The rehabilitation process for a subject having SCIs can be considered complex, since the pathophysiological mechanism and biochemical modifications occurring at the level of spinal cord are not yet fully elucidated. This review aims at evaluating the impact of robotic-assisted rehabilitation in subjects who have suffered SCI, both in terms of regaining mobility as a major dysfunction in patients with SCI, but also in terms of improving overall fitness and cardiovascular function, respiratory function, as well as the gastrointestinal system, bone density and finally the psychosocial issues, based on multiple clinical trials, and pilot studies. The researched literature in the topic revealed that in order to increase the chances of neuro-motor recovery and to obtain satisfactory results, the combination of robotic therapy, a complex recovery treatment and specific medication is one of the best decisions. Furthermore, the use of these exoskeletons facilitates better/greater autonomy for patients, as well as optimal social integration.
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Raguindin PF, Stoyanov J, Eriks-Hoogland I, Stucki G, Jordan X, Schubert M, Franco OH, Muka T, Glisic M. Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from Swiss Spinal Cord Injury cohort (SwiSCI). PM R 2022. [PMID: 35648677 DOI: 10.1002/pmrj.12857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early screening is important in individuals with spinal cord injury (SCI) as they were deemed high-risk for cardiometabolic diseases. Few studies explored changes in cardiometabolic risk profile in the early phase of the injury. Thus, it remains unclear how early the cardiometabolic status deteriorates after injury. OBJECTIVE We determined the longitudinal changes in the cardiometabolic risk profile and examined the association between injury characteristics and cardiometabolic status in subacute SCI. SETTING Multicenter Swiss Spinal Cord Injury Cohort. PARTICIPANTS Adults with traumatic SCI without history of cardiovascular disease or type 2 diabetes. MAIN OUTCOME MEASURES Blood pressure (BP), lipid profile, fasting glucose, waist circumference (WC), weight, body mass index (BMI) and Framingham risk score (FRS) were compared across time and according to the injury characteristics. RESULTS We analyzed the data of 258 individuals with traumatic SCI (110 tetraplegia and 148 paraplegia, 122 motor complete and 136 incomplete). The median age was 50 years (IQR 32-60), with 76.36% (n=197) of the population being male. The median rehabilitation duration was 5.5 months (IQR 3.2-7.1). At admission to rehabilitation, fully-adjusted linear regression models showed higher baseline weight (β 0.06, 95% CI 0.005, 0.11), systolic BP (β 0.05, 95% CI 0.008, 0.09), diastolic BP (β 0.05 95% CI 0.004, 0.10), and triglycerides (β 0.27 95% CI 0.13, 0.42) in paraplegia than tetraplegia. Systolic BP, diastolic BP, HDL-C were higher in incomplete than complete injury. In our main analysis, we observed an increase in cholesterol and HDL-C and lipid ratio when comparing the beginning and end of rehabilitation. Individuals with paraplegia had a higher increase in BMI than tetraplegia, while no differences in other cardiometabolic risk factors were detected when comparing motor incomplete and complete injury. Trajectories of each participant showed that the majority of individuals with SCI decreased FRS score at follow-up compared to baseline and no significant changes in prevalence of cardiometabolic syndrome were observed. At discharge, one-third of study participants were classified as moderate to high risk of CVD, 64% were overweight, and 39.45% had cardiometabolic syndrome. CONCLUSION We observed a modest improvement in lipid profile and FRS during the first inpatient rehabilitation hospitalization. Injury characteristics, such as level and completeness, were not associated with changes in cardiometabolic risk factors in the subacute phase of the injury. Despite this, a significant proportion of study participants remained at risk of cardiometabolic disease at discharge, suggesting that early cardiometabolic preventive strategies may be initiated as early as during the first inpatient rehabilitation hospitalization. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | | | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | - Xavier Jordan
- Clinique Romande de Réadaptation, Avenue du Grand-Champsec 90, 1950 Sion, Switzerland
| | - Martin Schubert
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse 340, Zurich, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
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Evaluation of the Cardiometabolic Disorders after Spinal Cord Injury in Mice. BIOLOGY 2022; 11:biology11040495. [PMID: 35453695 PMCID: PMC9027794 DOI: 10.3390/biology11040495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/16/2022]
Abstract
Changes in cardiometabolic functions contribute to increased morbidity and mortality after chronic spinal cord injury. Despite many advancements in discovering SCI-induced pathologies, the cardiometabolic risks and divergences in severity-related responses have yet to be elucidated. Here, we examined the effects of SCI severity on functional recovery and cardiometabolic functions following moderate (50 kdyn) and severe (75 kdyn) contusions in the thoracic-8 (T8) vertebrae in mice using imaging, morphometric, and molecular analyses. Both severities reduced hindlimbs motor functions, body weight (g), and total body fat (%) at all-time points up to 20 weeks post-injury (PI), while only severe SCI reduced the total body lean (%). Severe SCI increased liver echogenicity starting from 12 weeks PI, with an increase in liver fibrosis in both moderate and severe SCI. Severe SCI mice showed a significant reduction in left ventricular internal diameters and LV volume at 20 weeks PI, associated with increased LV ejection fraction as well as cardiac fibrosis. These cardiometabolic dysfunctions were accompanied by changes in the inflammation profile, varying with the severity of the injury, but not in the lipid profile nor cardiac or hepatic tyrosine hydroxylase innervation changes, suggesting that systemic inflammation may be involved in these SCI-induced health complications.
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11
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Park JH, Kim HS, Jang SH, Hyun DJ, Park SI, Yoon J, Lim H, Kim MJ. Cardiorespiratory Responses to 10 Weeks of Exoskeleton-Assisted Overground Walking Training in Chronic Nonambulatory Patients with Spinal Cord Injury. SENSORS 2021; 21:s21155022. [PMID: 34372258 PMCID: PMC8347087 DOI: 10.3390/s21155022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022]
Abstract
Exercise intensity of exoskeleton-assisted walking in patients with spinal cord injury (SCI) has been reported as moderate. However, the cardiorespiratory responses to long-term exoskeleton-assisted walking have not been sufficiently investigated. We investigated the cardiorespiratory responses to 10 weeks of exoskeleton-assisted walking training in patients with SCI. Chronic nonambulatory patients with SCI were recruited from an outpatient clinic. Walking training with an exoskeleton was conducted three times per week for 10 weeks. Oxygen consumption and heart rate (HR) were measured during a 6-min walking test at pre-, mid-, and post-training. Exercise intensity was determined according to the metabolic equivalent of tasks (METs) for SCI and HR relative to the HR reserve (%HRR). Walking efficiency was calculated as oxygen consumption divided by walking speed. The exercise intensity according to the METs (both peak and average) corresponded to moderate physical activity and did not change after training. The %HRR demonstrated a moderate (peak %HRR) and light (average %HRR) exercise intensity level, and the average %HRR significantly decreased at post-training compared with mid-training (31.6 ± 8.9% to 24.3 ± 7.3%, p = 0.013). Walking efficiency progressively improved after training. Walking with an exoskeleton for 10 weeks may affect the cardiorespiratory system in chronic patients with SCI.
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Affiliation(s)
- Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri-si 11923, Korea; (J.H.P.); (S.H.J.)
| | - Hyeon Seong Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seoul 04763, Korea;
| | - Seong Ho Jang
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri-si 11923, Korea; (J.H.P.); (S.H.J.)
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seoul 04763, Korea;
| | - Dong Jin Hyun
- Robotics Lab, R&D Division of Hyundai Motor Company, 37 Cheoldobangmulgwan-ro, Uiwang-si 16082, Korea; (D.J.H.); (S.I.P.); (J.Y.); (H.L.)
| | - Sang In Park
- Robotics Lab, R&D Division of Hyundai Motor Company, 37 Cheoldobangmulgwan-ro, Uiwang-si 16082, Korea; (D.J.H.); (S.I.P.); (J.Y.); (H.L.)
| | - JuYoung Yoon
- Robotics Lab, R&D Division of Hyundai Motor Company, 37 Cheoldobangmulgwan-ro, Uiwang-si 16082, Korea; (D.J.H.); (S.I.P.); (J.Y.); (H.L.)
| | - Hyunseop Lim
- Robotics Lab, R&D Division of Hyundai Motor Company, 37 Cheoldobangmulgwan-ro, Uiwang-si 16082, Korea; (D.J.H.); (S.I.P.); (J.Y.); (H.L.)
| | - Mi Jung Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seoul 04763, Korea;
- Correspondence: ; Tel.: +82-2-2290-9353
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12
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Evaluation of cardiovascular disease risk in individuals with chronic spinal cord injury. Spinal Cord 2020; 59:716-729. [PMID: 33070157 DOI: 10.1038/s41393-020-00566-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN Multicentre, cross-sectional study. OBJECTIVES To identify which markers of obesity, injury characteristics and autonomic function variables are related to cardiovascular disease (CVD) risk after spinal cord injury (SCI), and establish cut-points for detection and risk management. SETTING Eight SCI rehabilitation centres in the Netherlands. METHODS Individuals (n = 257) with a traumatic, chronic (≥10 years) SCI, with age at injury between 18 and 35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. Three anthropometric measures were tested: body mass index (BMI); waist circumference (WC); and waist-to-height ratio (WHtR). Injury characteristics included: American Spinal Injury Association impairment scale (AIS); duration of injury (DOI); and neurological level of injury (LOI). Cardiovascular autonomic function was assessed from peak heart rate during maximal exercise (HRpeak). Systolic arterial pressure (SAP) and aerobic capacity (VO2peak) were also determined. CVD risk was calculated using the Framingham risk score (FRS). RESULTS All anthropometric variables were associated with FRS, with WC showing the strongest correlation (r = 0.41, p < 0.001) and greatest area under the curve (0.73) for 10-year CVD risk (%). WC, DOI, SAP, HRpeak, LOI, and VO2peak (variable importance: 0.81, 1.0, 0.98, 0.98, 0.66, 0.68, respectively) were important predictive variables for 10-year CVD risk in individuals with SCI. CONCLUSIONS We confirm that WC is a simple, practical measure of CVD risk, and along with DOI and markers of cardiovascular autonomic function, plays a role in the increased CVD risk following SCI.
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Barton TJ, Low DA, Bakker EA, Janssen T, de Groot S, van der Woude L, Thijssen DHJ. Traditional Cardiovascular Risk Factors Strongly Underestimate the 5-Year Occurrence of Cardiovascular Morbidity and Mortality in Spinal Cord Injured Individuals. Arch Phys Med Rehabil 2020; 102:27-34. [PMID: 32861666 DOI: 10.1016/j.apmr.2020.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/26/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore whether traditional models of cardiovascular disease (CVD) risk prediction correctly predict CVD events across a median 5.7-year follow-up period in individuals with spinal cord injury (SCI) and whether adding SCI-related characteristics (ie, lesion level) to the prediction model can improve the prognostic value. DESIGN Retrospective analysis of patient records. SETTING Observation at the start of active rehabilitation of participants in a multicenter cohort study, "Restoration of (Wheelchair) Mobility in SCI Rehabilitation," in the Netherlands. PARTICIPANTS Patients with SCI (N=200) The patients were 74% men, aged 40±14 years, and with an American Spinal Injury Association (ASIA) impairment score of A through D. Forty percent had tetraplegia, and 69% were motor complete. INTERVENTIONS Risk profiling/not applicable. MAIN OUTCOME MEASURES Survival status and cardiovascular morbidity and mortality qwere obtained from medical records. Five-year Framingham Risk Scores (FRS) and the FRS ability to predict events assessed using receiver operating characteristic (ROC) curves with corresponding areas under the curve (AUC) and 95% confidence intervals (CI). Kaplan-Meier curves and the log-rank test were used to assess the difference in clinical outcome between participants with an FRS score lower or higher than the median FRS score for the cohort. SCI-related factors associated with CVD events, ASIA impairment, motor completeness, level of injury, and sports participation before injury were explored using univariate and multivariate Cox proportional hazard regression. RESULTS The median 5-year FRS was 1.36%. Across a median follow-up period of 5.7 years, 39 developed a CVD event, including 10 fatalities. Although the FRS markedly underestimated the true occurrence of CVD events, the Kaplan-Meier curves and the log-rank test showed that the risk ratio for individuals with an FRS score less than the median FRS (eg, low risk) versus a score greater than the median FRS (high risk) was 3.2 (95% CI, 1.6-6.5; P=.001). Moreover, ROC with corresponding AUCs suggests acceptable accuracy of the FRS to identify individuals with increased risk for future CVD events (ROC AUC of 0.71; 95% CI, 0.62-0.82). Adding ASIA impairment (0.74; 95% CI, 0.66-0.82), motor impairment (0.74; 95% CI, 0.66-0.83), level of injury (0.72; 95% CI, 0.63-0.81), or active engagement in sport before injury (0.72; 95% CI, 0.63-0.88) to the FRS did not improve the level of discrimination. CONCLUSIONS Our 5.7-year retrospective study reveals that cardiovascular risk factors and risk models markedly underestimate the true risk for CVD events in individuals with SCI. Nonetheless, these markers successfully distinguish between SCI individuals at high versus low risk for future CVD events. Our data may have future clinical implications, both related to (cutoff values of) CVD risk factors, but also for (earlier) prescription of (non)pharmacologic strategies against CVD in SCI individuals.
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Affiliation(s)
- Thomas J Barton
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - David A Low
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Esmee A Bakker
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas Janssen
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Center of Human Movement Sciences; Groningen, the Netherlands
| | - Lucas van der Woude
- University of Groningen, University Medical Center Groningen, Center of Human Movement Sciences; Groningen, the Netherlands
| | - Dick H J Thijssen
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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14
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El-Kotob R, Craven BC, Mathur S, Ditor DS, Oh P, Miyatani M, Verrier MC. Assessing Heart Rate Variability As a Surrogate Measure of Cardiac Autonomic Function in Chronic Traumatic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 24:28-36. [PMID: 29434458 DOI: 10.1310/sci17-00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Although cardiac autonomic dysfunction is a contributing factor for cardiovascular disease development in individuals with a spinal cord injury (SCI), it remains poorly understood. Heart rate variability (HRV) analysis has the potential to non-invasively assess the cardiac autonomic nervous system. The study objectives are (a) to determine if there are differences in HRV measures across neurological level of impairment (NLI) and American Spinal Cord Injury Association Impairment Scale (AIS) subgroups, and (b) to determine if there is a relationship between HRV frequency measures (low frequency [LF] and high frequency [HF]) at rest. Methods: We conducted a secondary data analysis of a primary data set from a published cross-sectional study of electrocardiogram recordings of 56 subjects (44 men and 12 women, mean age ± SD = 46.75 ± 12.44 years) with a chronic traumatic SCI (C1-T12, AIS A-D, ≥2 years post injury). HRV was analyzed using time and frequency domain measures. Results: There were no significant HRV differences across NLI and AIS subgroups. The LF and HF indices were positively correlated in the entire sample (r = 0.708, p < .0001) and among impairment subgroups. Conclusion: No differences were observed in the HRV time and frequency measures when compared across NLI and AIS subgroups. The results were considered inconclusive, since possible explanations include inadequate sample size as well as other physiological considerations. A positive correlation was found between LF and HF when assessed at rest. The relationship between LF and HF may not necessarily represent a rebalanced autonomic nervous system, but it does question the utility of solely measuring LF:HF at rest in persons with chronic SCI.
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Affiliation(s)
- Rasha El-Kotob
- University Health Network, Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, Ontario, Canada.,Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B Catharine Craven
- University Health Network, Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, Ontario, Canada.,Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Mathur
- University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David S Ditor
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Paul Oh
- University Health Network, Toronto Rehabilitation Institute, Rumsey Centre, Toronto, Ontario, Canada.,Department of Medicine, Clinical Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Masae Miyatani
- University Health Network, Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, Ontario, Canada
| | - Mary C Verrier
- University Health Network, Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Socio-demographic and injury-related factors contributing to activity limitations and participation restrictions in people with spinal cord injury in Bangladesh. Spinal Cord 2017; 56:239-246. [DOI: 10.1038/s41393-017-0001-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 11/08/2022]
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16
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Affiliation(s)
- J Andrew Taylor
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02134, United States; Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA 02138, United States.
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17
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Inskip JA, Ravensbergen H(RJC, Sahota IS, Zawadzki C, McPhail LT, Borisoff JF, Claydon VE. Dynamic wheelchair seating positions impact cardiovascular function after spinal cord injury. PLoS One 2017; 12:e0180195. [PMID: 28666000 PMCID: PMC5493360 DOI: 10.1371/journal.pone.0180195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/12/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Innovative wheelchairs allow individuals to change position easily for comfort and social situations. While these wheelchairs are beneficial in multiple ways, the effects of position changes on blood pressure might exacerbate hypotension and cerebral hypoperfusion, particularly in those with spinal cord injury (SCI) who can have injury to autonomic nerves that regulate cardiovascular control. Conversely, cardiovascular benefits may be obtained with lowered seating. Here we investigate the effect of moderate changes in wheelchair position on orthostatic cardiovascular and cerebrovascular reflex control. METHODS Nineteen individuals with SCI and ten neurologically-intact controls were tested in supine and seated positions (neutral, lowered, and elevated) in the Elevation™ wheelchair. Participants with SCI were stratified into two groups by the severity of injury to cardiovascular autonomic pathways. Beat-to-beat blood pressure, heart rate and middle cerebral artery blood flow velocity (MCAv) were recorded non-invasively. RESULTS Supine blood pressure and MCAv were reduced in individuals with lesions to autonomic pathways, and declined further with standard seating compared to those with preserved autonomic control. Movement to the elevated position triggered pronounced blood pressure and MCAv falls in those with autonomic lesions, with minimum values significantly reduced compared to the seated and lowered positions. The cumulative duration spent below supine blood pressure was greatest in this group. Lowered seating bolstered blood pressure in those with lesions to autonomic pathways. CONCLUSIONS Integrity of the autonomic nervous system is an important variable that affects cardiovascular responses to orthostatic stress and should be considered when individuals with SCI or autonomic dysfunction are selecting wheelchairs. SPONSORSHIP This work was supported in part by the Heart and Stroke Foundation of British Columbia and the Yukon (V.E.C).
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Affiliation(s)
- Jessica A. Inskip
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Henrike (Rianne) J. C. Ravensbergen
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Inderjeet S. Sahota
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Christine Zawadzki
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lowell T. McPhail
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaimie F. Borisoff
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Institute of Technology (BCIT), Burnaby, British Columbia, Canada
| | - Victoria E. Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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Sarabadani Tafreshi A, Riener R, Klamroth-Marganska V. Distinctive Steady-State Heart Rate and Blood Pressure Responses to Passive Robotic Leg Exercise during Head-Up Tilt: A Pilot Study in Neurological Patients. Front Physiol 2017. [PMID: 28626427 PMCID: PMC5454056 DOI: 10.3389/fphys.2017.00327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Robot-assisted tilt table therapy was proposed for early rehabilitation and mobilization of patients after diseases such as stroke. A robot-assisted tilt table with integrated passive robotic leg exercise (PE) mechanism has the potential to prevent orthostatic hypotension usually provoked by verticalization. In a previous study with rather young healthy subjects [average age: 25.1 ± 2.6 years (standard deviation)], we found that PE effect on the cardiovascular system depends on the verticalization angle of the robot-assisted tilt table. In the current study, we investigated in an older population of neurological patients (a) whether they show the same PE effects as younger healthy population on the cardiovascular system at different tilt angles, (b) whether changing the PE frequency (i.e., stepping speed) influences the PE effect on the cardiovascular system, (c) whether PE could prevent orthostatic hypotension, and finally, (d) whether PE effect is consistent from day to day. Methods: Heart rate (HR), and systolic and diastolic blood pressures (sBP, dBP) in response to PE at two different tilt angles (α = 20°, 60°) with three different PE frequencies (i.e., 0, 24, and 48 steps per minute) of 10 neurological patients [average age: 68.4 ± 13.5 years (standard deviation)] were measured on 2 consecutive days. Linear mixed models were used to develop statistical models and analyze the repeated measurements. Results: The models show that: PE significantly increased sBP and dBP but had no significant effect on HR. (a) Similar to healthy subjects the effect of PE on sBP was dependent on the tilt angle with higher tilt angles resulting in a higher increase. Head-up tilting alone significantly increased HR and dBP but resulted in a non-significant drop in sBP. PE, in general, had a more additive effect on increasing BP. (b) The effect of PE was not influenced by its speed. (c) Neither during head-up tilt alone nor in combination with PE did participants experience orthostatic hypotension. (d) The measurement day was not a statistically significant factor regarding the effects of verticalization and PE on the cardiovascular response. Conclusion: We provide evidence that PE can increase steady-state values of sBP and dBP in neurological patients during head-up tilt. Similar to healthy subjects the effect on sBP depends on the verticalization angle of the robot-assisted tilt table. PE might have the potential to prevent orthostatic hypotension, but as the amount of drop in BP in response to head-up tilting was not leading to orthostatic hypotension in our patients, we could neither conclude nor reject such a preventive compensatory effect. Furthermore, we found that changing the PE speed does not influence the steady-state cardiovascular response.
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Affiliation(s)
- Amirehsan Sarabadani Tafreshi
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH ZurichZurich, Switzerland.,Reharobotics Group, Medical Faculty, Spinal Cord Injury Center, Balgrist University Hospital, University of ZurichZurich, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH ZurichZurich, Switzerland.,Reharobotics Group, Medical Faculty, Spinal Cord Injury Center, Balgrist University Hospital, University of ZurichZurich, Switzerland
| | - Verena Klamroth-Marganska
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH ZurichZurich, Switzerland.,Reharobotics Group, Medical Faculty, Spinal Cord Injury Center, Balgrist University Hospital, University of ZurichZurich, Switzerland
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Nooijen CF, Stam HJ, Sluis T, Valent L, Twisk J, van den Berg-Emons RJ. A behavioral intervention promoting physical activity in people with subacute spinal cord injury: secondary effects on health, social participation and quality of life. Clin Rehabil 2016; 31:772-780. [PMID: 27378787 DOI: 10.1177/0269215516657581] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess, for people with subacute spinal cord injury, if rehabilitation that is reinforced with the addition of a behavioral intervention to promote physical activity leads to a better health, participation and quality of life. DESIGN Randomized controlled trial. SETTING Rehabilitation centers. PARTICIPANTS A total of 39 participants analyzed (45 included), with subacute spinal cord injury in inpatient rehabilitation, dependent on a manual wheelchair (33% tetraplegia, 62% motor complete, 150 ±74 days postinjury). INTERVENTION A behavioral intervention promoting physical activity after discharge, involving 13 individual sessions delivered by a coach trained in motivational interviewing, beginning two months before and ending six months after discharge from inpatient rehabilitation. MAIN MEASURES Physical capacity as determined during a maximal exercise test, body mass index, blood pressure, fasting lipid profile, and social participation (IMPACT-S) and quality of life (SF-36) were determined using questionnaires. Measurements were performed two months before discharge, at discharge, and six and 12 months after discharge from inpatient rehabilitation. B represents the between-group difference. RESULTS Twelve months after discharge, significant intervention effects were found for diastolic blood pressure (B = -11.35 mmHg, 95% CI = -19.98 to -2.71), total cholesterol (B = -0.89 mmol/L, 95% CI = -1.59 to -0.20), low-density lipoprotein cholesterol (B = -0.63 mmol/L, 95% CI = -1.25 to -0.00) and participation (B = 9.91, 95% CI = 3.34 to 16.48). CONCLUSIONS A behavioral intervention promoting physical activity after discharge from inpatient rehabilitation improves social participation and seems to reduce risk factors for cardiovascular disease in people with subacute spinal cord injury.
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Affiliation(s)
- Carla Fj Nooijen
- 1 Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henk J Stam
- 1 Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tebbe Sluis
- 2 Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
| | - Linda Valent
- 3 Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Jos Twisk
- 4 Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.,5 Department of Health Sciences, VU University, Amsterdam, The Netherlands
| | - Rita Jg van den Berg-Emons
- 1 Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Machač S, Radvanský J, Kolář P, Kříž J. Cardiovascular response to peak voluntary exercise in males with cervical spinal cord injury. J Spinal Cord Med 2016; 39:412-20. [PMID: 26707873 PMCID: PMC5102295 DOI: 10.1080/10790268.2015.1126939] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
CONTEXT/OBJECTIVE Traumatic damage to the cervical spinal cord is usually associated with a disruption of the autonomic nervous system (ANS) and impaired cardiovascular control both during and following exercise. The magnitude of the cardiovascular dysfunction remains unclear. The aim of the current study was to compare cardiovascular responses to peak voluntary exercise in individuals with tetraplegia and able-bodied participants. DESIGN A case-control study. SUBJECTS Twenty males with cervical spinal cord injury (SCI) as the Tetra group and 27 able-bodied males as the Control group were included in the study. OUTCOME MEASURES Blood pressure (BP) response one minute after the peak exercise, peak heart rate (HRpeak), and peak oxygen consumption (VO2peak) on an arm crank ergometer were measured. In the second part of the study, 17 individuals of the Control group completed the Tetra group's workload protocol with the same parameters recorded. RESULTS There was no increase in BP in response to the exercise in the Tetra group. Able-bodied individuals exhibited significantly increased post-exercise systolic BP after the maximal graded exercise test (123±16%) and after completion of the Tetra group's workload protocol (114±11%) as compared to pre-exercise. The Tetra group VO2peak was 59% and the HRpeak was 73% of the Control group VO2peak and HRpeak, respectively. CONCLUSIONS BP did not increase following maximal arm crank exercise in males with a cervical SCI unlike the increases observed in the Control group. Some males in the Tetra group appeared to be at risk of severe hypotension following high intensity exercise, which can limit the ability to progressive increase and maintain high intensity exercise.
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Affiliation(s)
- Stanislav Machač
- Correspondence to: Stanislav Machač, Oddělení tělovýchovného lékařství, Klinika rehabilitace a tělovýchovného lékařství 2. LF UK a FN Motol, V Úvalu 84, 150 06, Praha 5, Czech Republic.
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21
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Goh MY, Millard MS, Wong ECK, Brown DJ, Frauman AG, O’Callaghan CJ. Diurnal blood pressure and urine production in acute spinal cord injury compared with controls. Spinal Cord 2016; 55:39-46. [DOI: 10.1038/sc.2016.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 05/22/2016] [Accepted: 05/28/2016] [Indexed: 01/26/2023]
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22
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Rianne Ravensbergen HJ, de Groot S, Post MW, Bongers-Janssen HM, van der Woude LH, Claydon VE. Is There an Association Between Markers of Cardiovascular Autonomic Dysfunction at Discharge From Rehabilitation and Participation 1 and 5 Years Later in Individuals With Spinal Cord Injury? Arch Phys Med Rehabil 2016; 97:1431-1439. [PMID: 27084265 DOI: 10.1016/j.apmr.2016.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 03/14/2016] [Accepted: 03/19/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether physical activity and participation 1 and 5 years after discharge are associated with measures of cardiovascular autonomic function: prevalence of hypotension and reduced peak heart rate at discharge from initial inpatient spinal cord injury (SCI) rehabilitation. DESIGN Prospective cohort study. SETTING Rehabilitation centers. PARTICIPANTS Individuals with SCI (N=146). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We recorded markers of cardiovascular autonomic dysfunction (resting blood pressure and peak heart rate) and personal and lesion characteristics at the time of discharge from rehabilitation. Parameters for participation (social health status dimension of the Sickness Impact Profile) and physical activity (Physical Activity Scale for Individuals with Physical Disabilities [PASIPD]) were measured 1 and 5 years after discharge. Effects of prevalence of cardiovascular autonomic dysfunction were analyzed using linear regression analysis while correcting for possible confounders. RESULTS We found no significant association between hypotension and social health status dimension of the Sickness Impact Profile or PASIPD, either at 1 or at 5 years after discharge. A significant association between peak heart rate and social health status dimension of the Sickness Impact Profile was found at 1 year after discharge, showing poorer participation in individuals with low peak heart rate (ie, cardiovascular autonomic dysfunction). The unadjusted relation between peak heart rate and the social health status dimension of the Sickness Impact Profile was significant at 5 years, but not when adjusted for confounders. We found associations between peak heart rate and PASIPD for both 1 and 5 years after discharge; however, these were not significant after correction for potential confounding factors. CONCLUSIONS Autonomic dysfunction after SCI is a crucial factor influencing quality of life. We found that cardiovascular autonomic impairment, assessed from low peak heart rate, was associated with reduced participation after 1 year. The results suggest that peak heart rate at discharge from rehabilitation after SCI should be used to identify those needing additional support to facilitate physical activity and participation after discharge.
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Affiliation(s)
- H J Rianne Ravensbergen
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada; International Collaboration On Repair Discoveries, Vancouver, BC, Canada; Research Institute MOVE Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands; Center for Human Movement Sciences Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcel W Post
- Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht, The Netherlands; Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Lucas H van der Woude
- Center for Human Movement Sciences Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada; International Collaboration On Repair Discoveries, Vancouver, BC, Canada.
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Evans N, Hartigan C, Kandilakis C, Pharo E, Clesson I. Acute Cardiorespiratory and Metabolic Responses During Exoskeleton-Assisted Walking Overground Among Persons with Chronic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2015; 21:122-32. [PMID: 26364281 DOI: 10.1310/sci2102-122] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lower extremity robotic exoskeleton technology is being developed with the promise of affording people with spinal cord injury (SCI) the opportunity to stand and walk. The mobility benefits of exoskeleton-assisted walking can be realized immediately, however the cardiorespiratory and metabolic benefits of this technology have not been thoroughly investigated. OBJECTIVE The purpose of this pilot study was to evaluate the acute cardiorespiratory and metabolic responses associated with exoskeleton-assisted walking overground and to determine the degree to which these responses change at differing walking speeds. METHODS Five subjects (4 male, 1 female) with chronic SCI (AIS A) volunteered for the study. Expired gases were collected during maximal graded exercise testing and two, 6-minute bouts of exoskeleton-assisted walking overground. Outcome measures included peak oxygen consumption (V̇O2peak), average oxygen consumption (V̇O2avg), peak heart rate (HRpeak), walking economy, metabolic equivalent of tasks for SCI (METssci), walk speed, and walk distance. RESULTS Significant differences were observed between walk-1 and walk-2 for walk speed, total walk distance, V̇O2avg, and METssci. Exoskeleton-assisted walking resulted in %V̇O2peak range of 51.5% to 63.2%. The metabolic cost of exoskeleton-assisted walking ranged from 3.5 to 4.3 METssci. CONCLUSIONS Persons with motor-complete SCI may be limited in their capacity to perform physical exercise to the extent needed to improve health and fitness. Based on preliminary data, cardiorespiratory and metabolic demands of exoskeleton-assisted walking are consistent with activities performed at a moderate intensity.
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Affiliation(s)
- Nicholas Evans
- Beyond Therapy, Shepherd Center, Atlanta, Georgia.,Hulse Spinal Cord Injury Laboratory, Shepherd Center, Atlanta, Georgia
| | - Clare Hartigan
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, Georgia
| | - Casey Kandilakis
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, Georgia
| | | | - Ismari Clesson
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, Georgia
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Hagen EM. Acute complications of spinal cord injuries. World J Orthop 2015; 6:17-23. [PMID: 25621207 PMCID: PMC4303786 DOI: 10.5312/wjo.v6.i1.17] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/24/2013] [Accepted: 05/28/2014] [Indexed: 02/06/2023] Open
Abstract
The aim of this paper is to give an overview of acute complications of spinal cord injury (SCI). Along with motor and sensory deficits, instabilities of the cardiovascular, thermoregulatory and broncho-pulmonary system are common after a SCI. Disturbances of the urinary and gastrointestinal systems are typical as well as sexual dysfunction. Frequent complications of cervical and high thoracic SCI are neurogenic shock, bradyarrhythmias, hypotension, ectopic beats, abnormal temperature control and disturbance of sweating, vasodilatation and autonomic dysreflexia. Autonomic dysreflexia is an abrupt, uncontrolled sympathetic response, elicited by stimuli below the level of injury. The symptoms may be mild like skin rash or slight headache, but can cause severe hypertension, cerebral haemorrhage and death. All personnel caring for the patient should be able to recognize the symptoms and be able to intervene promptly. Disturbance of respiratory function are frequent in tetraplegia and a primary cause of both short and long-term morbidity and mortality is pulmonary complications. Due to physical inactivity and altered haemostasis, patients with SCI have a higher risk of venous thromboembolism and pressure ulcers. Spasticity and pain are frequent complications which need to be addressed. The psychological stress associated with SCI may lead to anxiety and depression. Knowledge of possible complications during the acute phase is important because they may be life threatening and/ or may lead to prolonged rehabilitation.
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Sisto SA, Evans N. Activity and Fitness in Spinal Cord Injury: Review and Update. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0057-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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