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Bloom O, Bryce TN, Botticello AL, Galea M, Delgado AD, Dyson-Hudson TA, Zanca JM, Spungen A. Health impacts reported in the Spinal Cord Injury COVID-19 Pandemic Experience Survey (SCI-CPES). J Spinal Cord Med 2023:1-10. [PMID: 37769141 DOI: 10.1080/10790268.2023.2260959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
CONTEXT In people with spinal cord injury (SCI), infections are a leading cause of death, and there is a high prevalence of diabetes mellitus, obesity, and hypertension, which are all comorbidities associated with worse outcomes after COVID-19 infection. OBJECTIVE To characterize self-reported health impacts of COVID-19 on people with SCI related to exposure to virus, diagnosis, symptoms, complications of infection, and vaccination. METHODS The Spinal Cord Injury COVID-19 Pandemic Experience Survey (SCI-CPES) study was administered to ask people with SCI about their health and other experiences during the COVID-19 pandemic. RESULTS 223 community-living people with SCI (male = 71%; age = 52±15 years [mean±SD]; paraplegia = 55%) completed the SCI-CPES. Comorbidities first identified in the general population as associated with poor outcomes after COVID-19 infection were commonly reported in this SCI sample: hypertension (30%) and diabetes (13%). 23.5% of respondents reported a known infection exposure from someone who visited (13.5%) or lived in their home (10%). During the study, which included a timeframe when testing was either unavailable or scarce, 61% of respondents were tested for COVID-19; 14% tested or were presumed positive. Fever, fatigue, and chills were the most common symptoms reported. Of the 152 respondents surveyed after COVID-19 vaccines became available, 82% reported being vaccinated. Race and age were significantly associated with positive vaccination status: most (78%) individuals who were vaccinated identified as Non-Hispanic White and were older than those who reported being unvaccinated (57±14 vs. 43±13 years, mean±SD). CONCLUSIONS Self-reported COVID-19 symptoms were relatively uncommon and not severe in this sample of people with SCI. Potential confounders and limitations include responder, recruitment and self-reporting biases and changing pandemic conditions. Future studies on this topic should query social distancing and other behavioral strategies. Large retrospective chart review studies may provide additional data on incidence and prevalence of COVID-19 infections, symptoms, and severities in the SCI population.
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Affiliation(s)
- Ona Bloom
- The Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Physical Medicine and Rehabilitation, Northwell Health, Manhasset, New York, USA
| | - Thomas N Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Amanda L Botticello
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marinella Galea
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Spinal Cord Injury and Disorders Service and Spinal Cord Damage Research Center, James J Peters VA Medical Center, Bronx, New York, USA
| | - Andrew D Delgado
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jeanne M Zanca
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ann Spungen
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Spinal Cord Injury and Disorders Service and Spinal Cord Damage Research Center, James J Peters VA Medical Center, Bronx, New York, USA
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Graham ZA, Siedlik JA, Toro CA, Harlow L, Cardozo CP. Boldine Alters Serum Lipidomic Signatures after Acute Spinal Cord Transection in Male Mice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6591. [PMID: 37623175 PMCID: PMC10454893 DOI: 10.3390/ijerph20166591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
Traumatic spinal cord injury (SCI) results in wide-ranging cellular and systemic dysfunction in the acute and chronic time frames after the injury. Chronic SCI has well-described secondary medical consequences while acute SCI has unique metabolic challenges as a result of physical trauma, in-patient recovery and other post-operative outcomes. Here, we used high resolution mass spectrometry approaches to describe the circulating lipidomic and metabolomic signatures using blood serum from mice 7 d after a complete SCI. Additionally, we probed whether the aporphine alkaloid, boldine, was able to prevent SCI-induced changes observed using these 'omics platforms'. We found that SCI resulted in large-scale changes to the circulating lipidome but minimal changes in the metabolome, with boldine able to reverse or attenuate SCI-induced changes in the abundance of 50 lipids. Multiomic integration using xMWAS demonstrated unique network structures and community memberships across the groups.
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Affiliation(s)
- Zachary A. Graham
- Research Service, Birmingham VA Health Care System, Birmingham, AL 35233, USA
- Healthspan, Resilience & Performance, Florida Institute for Human and Machine Cognition, Pensacola, FL 32502, USA
- Department of Cell, Developmental, and Integrative Biology, University of Alabama-Birmingham, Birmingham, AL 35294, USA
| | - Jacob A. Siedlik
- Department of Exercise Science and Pre-Health Professions, Creighton University, Omaha, NE 68178, USA;
- School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Carlos A. Toro
- Spinal Cord Damage Research Center, Bronx, NY 10468, USA; (C.A.T.); (L.H.); (C.P.C.)
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lauren Harlow
- Spinal Cord Damage Research Center, Bronx, NY 10468, USA; (C.A.T.); (L.H.); (C.P.C.)
| | - Christopher P. Cardozo
- Spinal Cord Damage Research Center, Bronx, NY 10468, USA; (C.A.T.); (L.H.); (C.P.C.)
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Medical Service, James J. Peters VA Medical Center, Bronx, NY 10468, USA
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Fodor R, Voiță-Mekeres F, Cheregi CD, Indrieș M, Noor H, Pop NO, Marian P, Platona RI, Lascu CF, Marcu OA. Epidemiological Study on Spinal Cord Injuries in a Hospital from North-West of Romania. PHARMACOPHORE 2023. [DOI: 10.51847/ht5jip60uc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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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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Bloom O, Tracey KJ, Pavlov VA. Exploring the vagus nerve and the inflammatory reflex for therapeutic benefit in chronic spinal cord injury. Curr Opin Neurol 2022; 35:249-257. [PMID: 35102123 PMCID: PMC9258775 DOI: 10.1097/wco.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe features and implications of chronic systemic inflammation in individuals with spinal cord injury (SCI) and to summarize the growing therapeutic possibilities to explore the vagus nerve-mediated inflammatory reflex in this context. RECENT FINDINGS The discovery of the inflammatory reflex provides a rationale to explore neuromodulation modalities, that is, electrical vagus nerve stimulation and pharmacological cholinergic modalities to regulate inflammation after SCI. SUMMARY Inflammation in individuals with SCI may negatively impact functional recovery and medical consequences after SCI. Exploring the potential of the vagus nerve-based inflammatory reflex to restore autonomic regulation and control inflammation may provide a novel approach for functional improvement in SCI.
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Affiliation(s)
- Ona Bloom
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset
- Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
| | - Kevin J. Tracey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset
- Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
| | - Valentin A. Pavlov
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset
- Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
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Chronic physical health conditions following injury: a comparison of prevalence and risk in people with orthopaedic major trauma and other types of injury. Arch Phys Med Rehabil 2022; 103:1738-1748. [DOI: 10.1016/j.apmr.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022]
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Systemic inflammation in traumatic spinal cord injury. Exp Neurol 2019; 325:113143. [PMID: 31843491 DOI: 10.1016/j.expneurol.2019.113143] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 01/08/2023]
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Sabharwal S. Addressing cardiometabolic risk in adults with spinal cord injury: acting now despite knowledge gaps. Spinal Cord Ser Cases 2019; 5:96. [PMID: 31798971 PMCID: PMC6881335 DOI: 10.1038/s41394-019-0241-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 12/14/2022] Open
Abstract
This perspective advocates for the adoption of recently published clinical practice guidelines on identifying and managing cardiometabolic risk after spinal cord injury (SCI). It makes the case for acting now, with the knowledge that we currently have, while continuing to address knowledge gaps with high-quality research studies in this area. Cardiovascular disease is a leading cause of death in people with SCI. Cardiometabolic disease (CMD) and risks are more likely to be overlooked after SCI. Unique SCI-related considerations impact both assessment and management of cardiometabolic risk. Risk factors and components of CMD including obesity, impaired glucose tolerance/insulin resistance, dyslipidemia, and hypertension should be evaluated and managed to optimize the cardiometabolic health of this population. While it would be optimal to base all care on high-quality evidence-based research, its absence should not be an excuse for inaction. Applying what is currently known and filling the research gaps with empirical recommendations based on clinical rationale and expert consensus is both appropriate and necessary till more definitive SCI-specific evidence becomes available.
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Affiliation(s)
- S. Sabharwal
- VA Boston Health Care System, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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9
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Sachdeva R, Gao F, Chan CCH, Krassioukov AV. Cognitive function after spinal cord injury: A systematic review. Neurology 2018; 91:611-621. [PMID: 30158159 DOI: 10.1212/wnl.0000000000006244] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/06/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To systematically examine the incidence of cognitive impairment in individuals with spinal cord injury (SCI), as well as identify potential contributing and confounding factors. METHODS Studies quantitatively reporting cognitive ability after spinal cord injury were searched electronically via Medline, CINAHL, Embase, and PsycINFO. Manual screening for references within articles was also performed. A total of 2,481 studies were screened and a total of 70 were included in this review, 21 reporting cognitive function after SCI compared to an able-bodied control group and 49 with no able-bodied controls. Studies were analyzed for the incidence of impairment and the interactions with concomitant traumatic brain injury, psychological or somatic complaints, decentralized cardiovascular control, sleep apnea, neurologic level of injury, and age. RESULTS There is a high volume of evidence reporting substantial cognitive impairment in individuals with SCI. Potential co-contributors include concomitant brain injury, psychological or somatic comorbidities, decentralized cardiovascular control, and sleep apnea. Cognitive functioning was negatively correlated with age. No clear agreement was found for the incidence of cognitive impairment or its association with level of injury. CONCLUSION Current evidence suggests that individuals with SCI should be examined and addressed for cognitive impairment. Future studies aimed at identifying potential secondary causative factors should employ stringent controls for co-occurring brain trauma since it appears to be a major contributor and confounder to impaired cognition.
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Affiliation(s)
- Rahul Sachdeva
- From the International Collaboration on Repair Discoveries (ICORD) (R.S., A.V.K.) and Department of Medicine, Division of Physical Medicine and Rehabilitation (R.S., A.V.K.), University of British Columbia, Vancouver, Canada; Department of Spinal and Neural Functional Reconstruction (F.G.), China Rehabilitation Research Center, Beijing, China; Faculty of Rehabilitation Medicine (F.G.), Capital Medical University, Beijing, China; and Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences (C.C.H.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Feng Gao
- From the International Collaboration on Repair Discoveries (ICORD) (R.S., A.V.K.) and Department of Medicine, Division of Physical Medicine and Rehabilitation (R.S., A.V.K.), University of British Columbia, Vancouver, Canada; Department of Spinal and Neural Functional Reconstruction (F.G.), China Rehabilitation Research Center, Beijing, China; Faculty of Rehabilitation Medicine (F.G.), Capital Medical University, Beijing, China; and Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences (C.C.H.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Chetwyn C H Chan
- From the International Collaboration on Repair Discoveries (ICORD) (R.S., A.V.K.) and Department of Medicine, Division of Physical Medicine and Rehabilitation (R.S., A.V.K.), University of British Columbia, Vancouver, Canada; Department of Spinal and Neural Functional Reconstruction (F.G.), China Rehabilitation Research Center, Beijing, China; Faculty of Rehabilitation Medicine (F.G.), Capital Medical University, Beijing, China; and Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences (C.C.H.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Andrei V Krassioukov
- From the International Collaboration on Repair Discoveries (ICORD) (R.S., A.V.K.) and Department of Medicine, Division of Physical Medicine and Rehabilitation (R.S., A.V.K.), University of British Columbia, Vancouver, Canada; Department of Spinal and Neural Functional Reconstruction (F.G.), China Rehabilitation Research Center, Beijing, China; Faculty of Rehabilitation Medicine (F.G.), Capital Medical University, Beijing, China; and Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences (C.C.H.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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Walter JS, Posluszny J, Dieter R, Dieter RS, Sayers S, Iamsakul K, Staunton C, Thomas D, Rabbat M, Singh S. Stimulation of abdominal and upper thoracic muscles with surface electrodes for respiration and cough: Acute studies in adult canines. J Spinal Cord Med 2018; 41:326-336. [PMID: 28614985 PMCID: PMC6055958 DOI: 10.1080/10790268.2017.1335447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To optimize maximal respiratory responses with surface stimulation over abdominal and upper thorax muscles and using a 12-Channel Neuroprosthetic Platform. METHODS Following instrumentation, six anesthetized adult canines were hyperventilated sufficiently to produce respiratory apnea. Six abdominal tests optimized electrode arrangements and stimulation parameters using bipolar sets of 4.5 cm square electrodes. Tests in the upper thorax optimized electrode locations, and forelimb moment was limited to slight-to-moderate. During combined muscle stimulation tests, the upper thoracic was followed immediately by abdominal stimulation. Finally, a model of glottal closure for cough was conducted with the goal of increased peak expiratory flow. RESULTS Optimized stimulation of abdominal muscles included three sets of bilateral surface electrodes located 4.5 cm dorsal to the lateral line and from the 8th intercostal space to caudal to the 13th rib, 80 or 100 mA current, and 50 Hz stimulation frequency. The maximal expired volume was 343 ± 23 ml (n=3). Optimized upper thorax stimulation included a single bilateral set of electrodes located over the 2nd interspace, 60 to 80 mA, and 50 Hz. The maximal inspired volume was 304 ± 54 ml (n=4). Sequential stimulation of the two muscles increased the volume to 600 ± 152 ml (n=2), and the glottal closure maneuver increased the flow. CONCLUSIONS Studies in an adult canine model identified optimal surface stimulation methods for upper thorax and abdominal muscles to induce sufficient volumes for ventilation and cough. Further study with this neuroprosthetic platform is warranted.
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Affiliation(s)
- James S. Walter
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Urology Departments, Loyola University, Stritch School of Medicine, Maywood, Illinois, USA,Correspondence to: James S. Walter, Edward Hines Jr. VA Hospital (151), 5000 South 5th Avenue, Hines, IL 60141, USA.
| | - Joseph Posluszny
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Surgery Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Raymond Dieter
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Robert S. Dieter
- Cardiology Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Cardiology Departments, Loyola University, Stritch School of Medicine, Maywood, Illinois, USA
| | - Scott Sayers
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Thoracic and Cardiovascular Surgery Departments, Loyola University, Stritch School of Medicine, Maywood, Illinois, USA
| | | | | | - Donald Thomas
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Surgery Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Mark Rabbat
- Cardiology Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA,Cardiology Departments, Loyola University, Stritch School of Medicine, Maywood, Illinois, USA
| | - Sanjay Singh
- Research Services, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
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Vriz O, Bertin N, Ius A, Bizzarini E, Bossone E, Antonini-Canterin F. Carotid Artery Stiffness and Development of Hypertension in People with Paraplegia and No Overt Cardiovascular Disease: A 7-year Follow-up Study. J Cardiovasc Echogr 2017; 27:132-140. [PMID: 29142811 PMCID: PMC5672685 DOI: 10.4103/jcecho.jcecho_43_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objectives The aim of this study was to compare arterial stiffness between people with paraplegia and able-bodied persons (ABPs) and to assess cardiovascular markers that may be predictive of the development of arterial hypertension in people with spinal cord injury (SCI). Setting This study was conducted at rehabilitation Hospital, Udine (Italy). Methods Fifty-seven patients with SCI were prospectively enrolled and compared with 88 healthy ABPs. All patients underwent comprehensive transthoracic echocardiography, and one-point left common carotid artery (CCA) color-Doppler study for arterial stiffness. Results Patients with SCI had significantly lower body mass index (BMI) and diastolic blood pressure (BP) compared with ABPs, and significantly higher carotid stiffness values (and lower arterial compliance) (P < 0.05) after adjustment for age, sex, BMI, physical activity, and heart rate. The SCI patients had lower values of the right ventricular function parameters (tricuspid annular plane systolic excursion and right Sm; P < 0.0001), increased wall thickness, and impaired diastolic function. At 7-year follow-up, 10.5% of SCI patients showed high BP; they were significantly heavier with a tendency toward increased abdominal obesity after adjustment for age and systolic BP. BMI was found to be an independent predictor of the development of hypertension. Conclusions Patients with posttraumatic chronic SCI and no overt cardiovascular disease exhibit higher CCA stiffness along with the left and right ventricular involvement, compared with ABPs. People with paraplegia who develop arterial hypertension show increased CCA stiffness mediated by obesity. Lifestyle modifications and weight control should be promoted in all patients with SCI, even at a very early stage.
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Affiliation(s)
- Olga Vriz
- Department of Cardiology and Emergency, San Antonio Hospital, San Daniele Del Friuli, Udine, Italy
| | - Nicole Bertin
- Department of Cardiology and Emergency, San Antonio Hospital, San Daniele Del Friuli, Udine, Italy
| | - Arianna Ius
- Department of Cardiology and Emergency, San Antonio Hospital, San Daniele Del Friuli, Udine, Italy
| | | | - Eduardo Bossone
- Heart Department, Division of Cardiology, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, Italy
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Abstract
OBJECTIVE To describe the initial benefits of a structured group exercise program on exercise frequency and intensity, perceived health, pain, mood, and television watching habits. DESIGN Pre-test/post-test. PARTICIPANTS/METHODS Eighty-nine persons with SCI participated voluntarily in a no-cost, twice weekly physical therapy group exercise class over 3 months. Forty-five persons completed pre- and post-participation interviews on exercise frequency and intensity, perceived health, pain, mood, sleep, and television watching habits. RESULTS Mean participant age of the respondents was 43.82 years. 49% had AIS C or D injuries, 24% had AIS A,B paraplegia, 9% had AIS A,B C1-C4 and 18% had AIS A,B C5-C8. 75.6% of participants were male and 84.4% had a traumatic etiology as the cause of their SCI. There was a significant improvement in days of strenuous and moderate exercise as well as health state. There was an average decrease in pain scores, depression scores, number of hours spent watching television, and days/week of mild exercise. CONCLUSION Participation in structured, small group exercise as a component of a wellness program after SCI shows promise for improving regular exercise participation and health state, but benefits may also occur across other areas of health and function including mood, pain, and hours spent watching television. Further follow-up is needed to determine whether improvements can be maintained after program completion and across all neurological levels.
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Affiliation(s)
- Deborah A. Crane
- Correspondence to: Deborah A. Crane, Department of Rehabilitation Medicine, University of Washington/Harborview Medical Center, 325 9th Avenue, Box 359740, Seattle, WA 98104, USA.
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Navarrete-Opazo A, Cuitiño P, Salas I. Effectiveness of dietary supplements in spinal cord injury subjects. Disabil Health J 2016; 10:183-197. [PMID: 28065420 DOI: 10.1016/j.dhjo.2016.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/04/2016] [Accepted: 12/11/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) consume more dietary supplements than the general population. However, there is limited information regarding the clinical effectiveness of dietary supplements in SCI population. OBJECTIVE To systematically review the effectiveness of dietary supplements for the prevention or treatment of health-related conditions associated with SCI. METHODS Randomized or non-randomized controlled clinical trials were selected, comparing the effect of any dose and form of a dietary supplement (defined by the Dietary Supplement Health and Education Act), with either no treatment, placebo, or other medication. Data Sources included the Cochrane Database, DARE, LILACS, CINAHL, EMBASE, MEDLINE, OTSeeker, PEDro, PsycINFO, SpeechBITE, ScienceDirect, Scopus, clinicaltrials.gov, Google Scholar, and OpenGrey. Two reviewers independently classified articles from January 1970 through October 2015, and 18 articles were selected. RESULTS Due to the heterogeneity of outcome measures across studies, a meta-analysis was not conducted. However, high-quality evidence showed that cranberry supplementation is not effective for prevention of urinary tract infections (UTIs) in SCI. Moderate-quality evidence supported a beneficial effect of vitamin D, alpha-lipoic acid, and omega-3 supplementation, although replication of results is needed. There were conflicting results for the effect of creatine supplementation on improvement of motor outcomes. Low-quality evidence does not permit assessment of the effectiveness of melatonin, whey protein, vitamin C, and Chinese herb in SCI. CONCLUSIONS There is sufficient data suggesting that cranberry supplementation is ineffective for prevention of UTIs in individuals with SCI. There is insufficient data to support or refute the use of any other dietary supplement in individuals with SCI.
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Affiliation(s)
- Angela Navarrete-Opazo
- Children's Hospital of Wisconsin, Milwaukee, WI, USA; Chile Teleton Institute, Santiago, Chile.
| | | | - Inés Salas
- Chile Teleton Institute, Santiago, Chile
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14
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[Anesthesiological approach for patients with spinal cord injuries]. Anaesthesist 2016; 65:553-70. [PMID: 27371543 DOI: 10.1007/s00101-016-0193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Spinal cord injuries (SCI) are serious medical conditions, which are associated with severe and potentially fatal risks and complications depending on the location and extent of injury. Traffic accidents, falls and recreational activities are the leading causes for traumatic SCI (TSCI) worldwide whereas non-traumatic spinal cord injuries (NTSCI) are mostly due to tumors and congenital diseases. As chronification of the injuries progresses other organ systems are affected including anatomical changes, the respiratory and cardiovascular systems and endocrinological pathways. All these effects have to be considered in the anesthesiological management of patients with SCI. Autonomic dysreflexia (AD) is the most dangerous and life-threatening complication in patients with chronic SCI above T6 that results from an overstimulation of sympathetic reflex circuits in the upper thoracic spine and can be fatal. This article summarizes the specific pathophysiology of SCI and how AD can be avoided as well as also providing anesthetists with strategies for perioperative and intensive care management of patients with SCI.
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Adriaansen JJE, Douma-Haan Y, van Asbeck FWA, van Koppenhagen CF, de Groot S, Smit CA, Visser-Meily JMA, Post MWM. Prevalence of hypertension and associated risk factors in people with long-term spinal cord injury living in the Netherlands. Disabil Rehabil 2016; 39:919-927. [PMID: 27157316 DOI: 10.3109/09638288.2016.1172349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To describe the prevalence of hypertension and associated risk factors in people with long-term spinal cord injury (SCI) and to compare the prevalence of high blood pressure and/or the use of antihypertensive drugs with the prevalence in the Dutch general population. METHOD Multicentre cross-sectional study (N = 282). Hypertension was defined as a systolic blood pressure (SBP) of ≥140 mmHg and/or a diastolic blood pressure (DBP) of ≥90 mmHg after ≥2 blood pressure measurements during ≥2 doctor visits. High blood pressure was defined as a single measurement of a SBP of ≥140 mmHg and/or a DBP of ≥90 mmHg. RESULTS The prevalence of hypertension was 21.5%. Significant predictors were: lesion level below C8 (T1-T6: OR =6.4, T7-L5: OR =10.1), history of hypercholesterolemia (OR =4.8), longer time since injury (OR =1.1), higher age (OR =1.1). The prevalence of high blood pressure and/or the use of antihypertensive drugs was higher in men (T1-T6 lesion: 48%; T7-L5 lesion: 57%) and women (T1-T6 lesion: 48%; T7-L5 lesion: 25%) with a SCI below C8 compared to Dutch able-bodied men (31%) and women (18%). CONCLUSION High blood pressure is common in people with SCI. Screening for hypertension during annual checkups is recommended, especially in those with a SCI below C8. Implications for Rehabilitation High blood pressure is common in people with long-term SCI living in the Netherlands and its prevalence is higher in both men and women with a spinal cord lesion level below C8 compared with the age-matched Dutch general population. It is recommended to screen for hypertension during annual checkups in people with SCI, especially in those with a higher risk of developing hypertension, e.g. those with a spinal cord lesion level below C8 and an age of ≥45 years or a time since injury of ≥20 years. When a high blood pressure is measured in people with SCI, they should receive a further assessment of the blood pressure according to the available guidelines for the general population, including ambulatory 24 h-blood pressure monitoring.
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Affiliation(s)
- Jacinthe J E Adriaansen
- a Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht , Utrecht , The Netherlands
| | - Yvonne Douma-Haan
- a Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht , Utrecht , The Netherlands
| | - Floris W A van Asbeck
- a Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht , Utrecht , The Netherlands
| | - Casper F van Koppenhagen
- a Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht , Utrecht , The Netherlands.,b Spinal Cord Injury Department , De Hoogstraat Rehabilitation , Utrecht , The Netherlands
| | - Sonja de Groot
- c Amsterdam Rehabilitation Research Center
- Reade , Amsterdam , The Netherlands.,d University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences , Groningen , The Netherlands
| | - Christof A Smit
- c Amsterdam Rehabilitation Research Center
- Reade , Amsterdam , The Netherlands
| | | | - Johanna M A Visser-Meily
- a Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht , Utrecht , The Netherlands
| | - Marcel W M Post
- a Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht , Utrecht , The Netherlands.,e University of Groningen, University Medical Center Groningen, Center for Rehabilitation , Department of Rehabilitation Medicine , Groningen , The Netherlands
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Shobeiri F, Jenabi E, Poorolajal J, Hazavehei SMM. The Association between Body Mass Index and Hot Flash in Midlife Women: A Meta-analysis. J Menopausal Med 2016; 22:14-9. [PMID: 27152309 PMCID: PMC4854655 DOI: 10.6118/jmm.2016.22.1.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/24/2015] [Accepted: 12/18/2015] [Indexed: 11/08/2022] Open
Abstract
Objectives The association between body mass index (BMI) and hot flash risk has not been specifically clarifies yet. This meta-analysis was, therefore, conducted to estimate the association between overweight and obesity and hot flash risk. Methods We searched PubMed, Web of Science, and Scopus for observational studies addressing the association between BMI and hot flash until August 2015. Data were independently extracted and analyzed using 95% odds ratio (OR), and confidence intervals (CI) based on the random-effects models. Results We identified 2,244 references and conducted seven studies with 4,219 participants. The association between hot flash and overweight was estimated 1.13 (95% CI: 0.97-1.32) and that of obesity was estimated 1.79 (95% CI: 1.52-2.11). No evidence of heterogeneity and publication bias was observed. Conclusion This meta-analysis demonstrated that, though not to a great extent, obesity does increase the risk of hot flash. The findings from this meta-analysis indicated that obesity is associated with an increased risk of hot flash. Further large prospective cohort studies are required to provide convincing evidence as to whether or not BMI is associated with an increased risk of hot flashes.
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Affiliation(s)
- Fatemeh Shobeiri
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ensiyeh Jenabi
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Modeling of Noncommunicable Diseases Research Center, Department of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyyed Mohammad Mahdi Hazavehei
- Research Center for Health Sciences, Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Respiratory Training Improves Blood Pressure Regulation in Individuals With Chronic Spinal Cord Injury. Arch Phys Med Rehabil 2015; 97:964-73. [PMID: 26718236 DOI: 10.1016/j.apmr.2015.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the effects of respiratory motor training (RMT) on pulmonary function and orthostatic stress-mediated cardiovascular and autonomic responses in individuals with chronic spinal cord injury (SCI). DESIGN Before-after intervention case-controlled clinical study. SETTING SCI research center and outpatient rehabilitation unit. PARTICIPANTS A sample of (N=21) individuals with chronic SCI ranging from C3 to T2 diagnosed with orthostatic hypotension (OH) (n=11) and healthy, noninjured controls (n=10). INTERVENTIONS A total of 21±2 sessions of pressure threshold inspiratory-expiratory RMT performed 5d/wk during a 1-month period. MAIN OUTCOME MEASURES Standard pulmonary function test: forced vital capacity, forced expiratory volume in one second, maximal inspiratory pressure, maximal expiratory pressure, beat-to-beat arterial blood pressure, heart rate, and respiratory rate were acquired during the orthostatic sit-up stress test before and after the RMT program. RESULTS Completion of RMT intervention abolished OH in 7 of 11 individuals. Forced vital capacity, low-frequency component of power spectral density of blood pressure and heart rate oscillations, baroreflex effectiveness, and cross-correlations between blood pressure, heart rate, and respiratory rate during the orthostatic challenge were significantly improved, approaching levels observed in noninjured individuals. These findings indicate increased sympathetic activation and baroreflex effectiveness in association with improved respiratory-cardiovascular interactions in response to the sudden decrease in blood pressure. CONCLUSIONS Respiratory training increases respiratory capacity and improves orthostatic stress-mediated respiratory, cardiovascular, and autonomic responses, suggesting that this intervention can be an efficacious therapy for managing OH after SCI.
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Radulovic M, Anand P, Korsten MA, Gong B. Targeting Ion Channels: An Important Therapeutic Implication in Gastrointestinal Dysmotility in Patients With Spinal Cord Injury. J Neurogastroenterol Motil 2015; 21:494-502. [PMID: 26424038 PMCID: PMC4622131 DOI: 10.5056/jnm15061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/10/2015] [Accepted: 07/06/2015] [Indexed: 01/04/2023] Open
Abstract
Gastrointestinal (GI) dysmotility is a severe, and common complication in patients with spinal cord injury (SCI). Current therapeutic methods using acetylcholine analogs or laxative agents have unwanted side effects, besides often fail to have desired effect. Various ion channels such as ATP-sensitive potassium (KATP) channel, calcium ions (Ca2+)-activated potassium ions (K+) channels, voltage-sensitive Ca2+ channels and chloride ion (Cl−) channels are abundantly expressed in GI tissues, and play an important role in regulating GI motility. The release of neurotransmitters from the enteric nerve terminal, innervating GI interstitial cells of Cajal (ICC), and smooth muscle cells (SMC), causes inactivation of K+ and Cl− channels, increasing Ca2+ influx into cytoplasm, resulting in membrane depolarization and smooth muscle contraction. Thus, agents directly regulating ion channels activity either in ICC or in SMC may affect GI peristalsis and would be potential therapeutic target for the treatment of GI dysmotility with SCI.
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Affiliation(s)
- Miroslav Radulovic
- Department of Medicine Icahn School of Medicine at Mount Sinai, New York, NY, USA.,National Center of Excellence for the Medical Consequences of SCI, James J Peters Veteran Affairs Medical Center, Bronx, NY, USA
| | - Preeti Anand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark A Korsten
- Department of Medicine Icahn School of Medicine at Mount Sinai, New York, NY, USA.,National Center of Excellence for the Medical Consequences of SCI, James J Peters Veteran Affairs Medical Center, Bronx, NY, USA
| | - Bing Gong
- Department of Medicine Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lifetime prevalence of chronic health conditions among persons with spinal cord injury. Arch Phys Med Rehabil 2014; 96:673-9. [PMID: 25497516 DOI: 10.1016/j.apmr.2014.11.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess lifetime prevalence of 7 chronic health conditions (CHCs) among a cohort of adults with chronic traumatic spinal cord injury (SCI). DESIGN Cross-sectional. SETTING Rehabilitation hospital. PARTICIPANTS Adults with SCI who were ≥18 years of age, were ≥1 year postinjury, and had residual neurologic effects impeding full recovery (n=1678). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES CHCs were measured using questions from the Behavioral Risk Factor Surveillance System for diabetes (not including gestational), heart attack (also called a myocardial infarction), angina or coronary artery disease, stroke, hypertension (not including during pregnancy), high blood cholesterol, or cancer. RESULTS Of participants, 49.5% reported having at least 1 CHC, with 23.2% reporting ≥2 CHCs. The most frequently reported CHC was high cholesterol (29.3%) followed by hypertension (28.7%) and diabetes (11.8%). Although the prevalence of CHCs significantly increased with increasing age, only hypertension and cancer were significantly associated with years postinjury. Four CHCs (diabetes, coronary artery disease, hypertension, high cholesterol) were significantly related to mobility status as measured by injury level and ambulatory status. However, after controlling for age, years postinjury, sex, and race, mobility status became nonsignificant in relation to coronary artery disease, but it remained significantly associated with diabetes, hypertension, and high cholesterol. CONCLUSIONS Clinicians should be aware of the risk of CHCs in persons with SCI and should screen for these conditions and regular maintenance activities related to SCI.
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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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Associations between abdominal visceral fat and surrogate measures of obesity in Japanese men with spinal cord injury. Spinal Cord 2014; 52:836-41. [DOI: 10.1038/sc.2014.162] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 07/16/2014] [Accepted: 08/18/2014] [Indexed: 02/07/2023]
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Sorenson MR. Body composition of women and men with complete motor paraplegia. J Spinal Cord Med 2014; 37:366-7. [PMID: 25079617 PMCID: PMC4116717 DOI: 10.1179/2045772314y.0000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Matthew R. Sorenson
- Correspondence to: Matthew R. Sorenson, School of Nursing, DePaul University College of Science and Health, 1 E. Jackson, Chicago, IL 60604, USA.
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Ragnarsson KT. G. Heiner sell distingushed lecture: american spinal injury association (Asia) 40th anniversary: beginnings, accomplishments and future challenges. Top Spinal Cord Inj Rehabil 2013; 19:153-71. [PMID: 23960700 DOI: 10.1310/sci1903-153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Kristjan T Ragnarsson
- Lucy G. Moses Professor and Chairman, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York , New York
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