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Crozes F, Delpierre C, Costa N. Mapping the costs and socioeconomic characteristics involved in traumatic brain injuries: a scoping review. J Rehabil Med 2024; 56:jrm18311. [PMID: 39101675 PMCID: PMC11318505 DOI: 10.2340/jrm.v56.18311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 06/26/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVE To identify the articles in the existing literature that analyse healthcare costs according to the socioeconomic position (pre- or post-injury) for traumatic brain injury survivors. Secondary aims were to describe the types of costs and socioeconomic characteristics and to determine whether socioeconomic characteristics affect the risk of traumatic brain injury or whether the consequences of trauma alter living conditions post-injury. METHODS This scoping review followed the methods proposed by Arksey and O'Malley. The literature search was performed in 5 databases. RESULTS Twenty-two articles were included, published between 1988 and 2023. Only 2 articles (9%) followed the guidelines for economic evaluation of healthcare programmes and 2 articles (9%) evaluated socioeconomic position "completely" with 3 main individual measures of socioeconomic characteristics (i.e., education, income, and occupation). The relationship between costs and socioeconomic characteristics could vary in 2 ways in traumatic brain injury: socioeconomic disadvantage was mostly associated with higher healthcare costs, and the cost of healthcare reduced the survivors' living conditions. CONCLUSION This work highlights the need for a detailed and methodologically sound assessment of the relationship between socioeconomic characteristics and the costs associated with trauma. Modelling the care pathways of traumatic brain injury would make it possible to identify populations at risk of poor recovery or deterioration following a TBI, and to develop specific care pathways. The aim is to build more appropriate, effective, and equitable care programmes.
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Affiliation(s)
- Fanny Crozes
- Health economic Unit, University Hospital center of Toulouse, Toulouse, France; EQUITY research team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France; Institute of Nursing Training, Toulouse University Hospital, Toulouse, France.
| | - Cyrille Delpierre
- EQUITY research team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
| | - Nadège Costa
- Health economic Unit, University Hospital center of Toulouse, Toulouse, France; EQUITY research team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
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Alhabeeb AY, Konbaz F, Aleissa S, Alhamed GS, Alhowaish TS, Alhamadh MS, Masuadi E, Abalkhail M, AlHelal F, Bourghli A. Returning to Work After Traumatic Spine Fractures: Current Status in a Military Hospital. Mil Med 2024; 189:e1690-e1695. [PMID: 38343205 PMCID: PMC11221555 DOI: 10.1093/milmed/usae012] [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: 06/25/2023] [Revised: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION The consequences of traumatic spine fracture (TSF) are complex and have a major burden on patients' social life and financial status. In this study, we aimed to investigate the return to work (RTW) after surgically treated TSFs, develop eventual predictors of delayed or failure to RTW, and assess narcotics use following such injuries. METHODS This was a single-center retrospective cohort study that was performed in a tertiary care center. TSF patients who required surgical intervention from 2016 to 2021 were enrolled. Demographic, operative, and complication data, as well as narcotics use, were recorded. RTW was modeled using multivariate logistic regression analysis. RESULTS Within the 173 patients with TSF, male patients accounted for 82.7%, and motor vehicle accidents were the most common mechanism of injury (80.2%). Neurologically intact patients represented 59%. Only 38.15% returned to work after their injury. Majority of the patients didn't use narcotics more than 1 week after discharge (93.1%). High surgical blood loss, operation time, and hospital length of stay were significantly associated with not returning to work. In multivariant regression analysis, every increase of 100 ml of surgical blood loss was found to decrease the chance of RTW by 25% (P = 0.04). Furthermore, every increase of one hour in operation time decreases the chance of RTW by 31% (P = 0.03). CONCLUSION RTW is an important aspect that needs to be taken into consideration by health care providers. We found that age and high surgery time, blood loss, and hospital stay are significantly impacting patients' RTW after operated TSF.
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Affiliation(s)
- Abdulrahman Yousef Alhabeeb
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Faisal Konbaz
- Department of Spine Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Sami Aleissa
- Department of orthopedic surgery, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Ghada S Alhamed
- Department of orthopedic surgery, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Thamer S Alhowaish
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Moustafa S Alhamadh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Emad Masuadi
- College of Medicine and Health science, United Arab Emirates University, United Arab Emirates
| | - Majed Abalkhail
- Department of orthopedic surgery, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Fahad AlHelal
- Department of orthopedic surgery, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Anouar Bourghli
- Department of Spine Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
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Chhabra HS, Phadke V, Manghwani J, El-Sharkawi M, Butler JS, Benneker LM, Vialle E, Hazenbiller O, Bransford R. An Assessment of the World's Contribution to Spine Trauma Care: A Bibliometric Analysis of Classifications and Surgical Management; An AO Spine Knowledge Forum Trauma Initiative. Global Spine J 2024; 14:1061-1069. [PMID: 37849275 PMCID: PMC11192134 DOI: 10.1177/21925682231205104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
STUDY DESIGN Bibliometric analysis. OBJECTIVES An analysis of the literature related to the assessment and management of spinal trauma was undertaken to allow the identification of top contributors, collaborations and research trends. METHODS A search to identify original articles published in English between 2011 and 2020 was done using specific keywords in the Web of Science database. After screening, the top 300 most cited articles were analyzed using Biblioshiny R software. RESULTS The highest number of contributions were from the Thomas Jefferson University, USA, University of Toronto and University of British Columbia, Canada. The top 3 most prolific authors were Vaccaro AR, Arabi B, and Oner FC. The USA and Canada were among the top contributing countries; Switzerland and Brazil had most multiple country co-authored articles. The most relevant journals were the European Spine Journal, Spine and Spine Journal. Three of the 5 most cited articles were about classification systems of fractures. The keyword analysis included clusters for different spinal regions, spinal cord injury, classification agreement and reliability studies, imaging related studies, surgical techniques and outcomes. CONCLUSIONS The study identified the most impactful authors and affiliations, and determined the journals where most impactful research is published in the field. Study also compared the productivity and collaborations across countries. The study highlighted the impact of development of new classification systems, and identified research trends including instrumentation, fixation and decompression techniques, epidemiology and recovery after spinal trauma.
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Affiliation(s)
- Harvinder Singh Chhabra
- Chief of Spine Service and Medical Director, Indian Spinal Injuries Centre, New Delhi, India
| | - Vandana Phadke
- Clinical Research Department, Indian Spinal Injuries Centre, New Delhi, India
| | - Jitesh Manghwani
- Consultant Spine Surgeon and Robotic Spine Surgeon, Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | - Mohammad El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Assiut University Medical School Assiut, Asyut, Egypt
| | - Joseph S. Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Mater Private Hospital, Dublin, Ireland
| | | | - Emiliano Vialle
- Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil
| | - Olesja Hazenbiller
- AO Network Clinical Research, AO Spine, AO Foundation, Davos, Switzerland
| | - Richard Bransford
- Department of Orthopaedics and Sport Medicine, Harborview Medical Center, Seattle, WA, USA
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Mueller NN, Kim Y, Ocoko MYM, Dernelle P, Kale I, Patwa S, Hermoso AC, Chirra D, Capadona JR, Hess-Dunning A. Effects of Micromachining on Anti-oxidant Elution from a Mechanically-Adaptive Polymer. JOURNAL OF MICROMECHANICS AND MICROENGINEERING : STRUCTURES, DEVICES, AND SYSTEMS 2024; 34:10.1088/1361-6439/ad27f7. [PMID: 38586082 PMCID: PMC10996452 DOI: 10.1088/1361-6439/ad27f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Intracortical microelectrodes (IMEs) can be used to restore motor and sensory function as a part of brain-computer interfaces in individuals with neuromusculoskeletal disorders. However, the neuroinflammatory response to IMEs can result in their premature failure, leading to reduced therapeutic efficacy. Mechanically-adaptive, resveratrol-eluting (MARE) neural probes target two mechanisms believed to contribute to the neuroinflammatory response by reducing the mechanical mismatch between the brain tissue and device, as well as locally delivering an antioxidant therapeutic. To create the mechanically-adaptive substrate, a dispersion, casting, and evaporation method is used, followed by a microfabrication process to integrate functional recording electrodes on the material. Resveratrol release experiments were completed to generate a resveratrol release profile and demonstrated that the MARE probes are capable of long-term controlled release. Additionally, our results showed that resveratrol can be degraded by laser-micromachining, an important consideration for future device fabrication. Finally, the electrodes were shown to have a suitable impedance for single-unit neural recording and could record single units in vivo.
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Affiliation(s)
- Natalie N Mueller
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Youjoung Kim
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Mali Ya Mungu Ocoko
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Peter Dernelle
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Ishani Kale
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Simran Patwa
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Anna Clarissa Hermoso
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Deeksha Chirra
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Jeffrey R Capadona
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Allison Hess-Dunning
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
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Raso J, Kamalapathy P, Solomon E, Driskill E, Kurker K, Joshi A, Hassanzadeh H. Increased Time to Fixation After Traumatic Spinal Cord Injury Influenced by Race and Insurance Status. Global Spine J 2024:21925682231225175. [PMID: 38317534 DOI: 10.1177/21925682231225175] [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: 02/07/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES Although the optimal timing of surgical intervention for traumatic spinal cord injury (TSCI) is controversial, early intervention has been recognized as being beneficial in several studies. The objective of this study was to evaluate the socioeconomic factors that may delay time to surgical fixation in the management of TSCI. METHODS The present study utilized the Trauma Quality Improvement Program (TQIP) dataset to identify patients aged greater than 18 undergoing spinal fusion for TSCI from 2007-2016. Patients were divided into subgroups based on race and insurance types. Multivariable linear regression was used to compare time to procedure based on race and payer type while adjusting for demographic and injury-specific factors. Significance was set at P < .05. RESULTS Using multivariable analysis, Hispanic and Black patients were associated with significantly increased time to fixation of 12.1 h (95% CI 5.5-18.7, P < .001), and 20.1 h (95% CI 12.1-28.1, P < .001), respectively compared to White patients. Other cohorts based on racial status did not have significantly different times to fixation (P > .05). Medicaid was associated with an increased time to fixation compared to private insurance (11.6 h, 95% CI 3.9-19.2, P = .003). CONCLUSIONS Black and Hispanic race and Medicaid were associated with statistically significant increases in time to fixation following TSCI, potentially compromising quality of patient care and resulting in poorer outcomes. More research is needed to elucidate this relationship and ensure equitable care is being delivered.
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Affiliation(s)
- Jon Raso
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eric Solomon
- Department of Orthopaedic Surgery, Johns Hopkins University, Bethesda, MD, USA
| | | | - Kristina Kurker
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aditya Joshi
- Department of Orthopaedic Surgery, Johns Hopkins University, Bethesda, MD, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, Johns Hopkins University, Bethesda, MD, USA
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Celeste-Villalvir A, Kovic C, Argüelles F. The Intersectional Impact of Disability and Immigration on Health: A Health Needs Assessment of Immigrants Living With Spinal Cord Injury in Houston, Texas. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:209-218. [PMID: 36670517 DOI: 10.1177/2752535x221132445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Immigrants with spinal cord injury (SCI) experience challenges with co-morbidities and lack of access to medical supplies and equipment. Much of the current disability and SCI literature does not include Latinx immigrants with SCI. To address this gap in knowledge, the present study explores the intersectional impact of disability and immigration on health as well as the health status and health needs of immigrants living with SCI. METHODS This community-partnered study is a secondary analysis of needs assessment data collected in February 2019 with 24 of the members of Living Hope Wheelchair Association, a nonprofit organization serving Latinx immigrants living with SCI in Houston, Texas. RESULTS Participants shared challenges with accessing healthcare, comorbidities, mental illness, transportation, and discrimination by healthcare professionals. They also shared difficulties accessing medical supplies, medical equipment, and the need for adaptations in their homes and vehicles. CONCLUSION The findings corroborate those of previous studies with people with SCI, but highlights additional layers of marginalization and challenges faced by immigrants living with SCI. More research is needed to understand the health needs and health status of this population, including their access to care and management of chronic diseases such as diabetes and heart disease. Findings support the need for public health and immigration policies to promote inclusion and equitable access to services as well as improve the health and quality of life of immigrants.
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Affiliation(s)
- Alane Celeste-Villalvir
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
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Crispo JAG, Liu LJW, Noonan VK, Thorogood NP, Kwon BK, Dvorak MF, Thibault D, Willis AW, Cragg JJ. Nationwide emergency department visits for pediatric traumatic spinal cord injury in the United States, 2016-2020. Front Neurol 2023; 14:1264589. [PMID: 38020637 PMCID: PMC10667469 DOI: 10.3389/fneur.2023.1264589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Traumatic spinal cord injury (tSCI) is a debilitating neurological condition resulting in lifelong disability for many individuals. The primary objectives of our study were to describe national trends in incident emergency department (ED) visits for tSCI among children (less than 21 years) in the United States, and to determine the proportion of visits that resulted in immediate hospitalization each year, including stratified by age and sex. Secondary objectives were to examine associations between select characteristics and hospitalization following tSCI, as well as to assess sports-related tSCIs over time, including by individual sport and geographic region. Methods We used the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample to identify ED visits among children between January 2016 and December 2020 for incident tSCI. Diagnosis codes were used to identify tSCI and sports-related injury etiologies. Census Bureau data were used to approximate annual rates of pediatric ED visits for tSCI per 100,000 children. Unconditional logistic regression modeling assessed whether select factors were associated with hospital admission. Results We found that the annual ED visit rate for tSCI remained relatively stable between 2016 and 2020, with approximately 2,200 new all-cause pediatric ED visits for tSCI annually. Roughly 70% of ED visits for tSCI resulted in hospitalization; most ED visits for tSCI were by older children (15-20 years) and males, who were also more often admitted to the hospital. Notable secondary findings included: (a) compared with older children (15-20 years), younger children (10-14 years) were less likely to be hospitalized immediately following an ED visit for tSCI; (b) patient sex and race were not associated with hospital admission; and (c) American tackle football was the leading cause of sports-related ED visits for tSCI among children. Our findings also suggest that the proportion of sports-related tSCI ED visits may have increased in recent years. Discussion Future research should further examine trends in the underlying etiologies of pediatric tSCI, while assessing the effectiveness of new and existing interventions aimed at tSCI prevention.
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Affiliation(s)
- James A. G. Crispo
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Human Sciences Division, NOSM University, Sudbury, ON, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Lisa J. W. Liu
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Vanessa K. Noonan
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Nancy P. Thorogood
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Brian K. Kwon
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Marcel F. Dvorak
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Dylan Thibault
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Allison W. Willis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Jacquelyn J. Cragg
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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Warner FM, Tong B, McDougall J, Martin Ginis KA, Rabchevsky AG, Cragg JJ, Kramer JL. Perspectives on Data Sharing in Persons With Spinal Cord Injury. Neurotrauma Rep 2023; 4:781-789. [PMID: 38028277 PMCID: PMC10659015 DOI: 10.1089/neur.2023.0035] [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] [Indexed: 12/01/2023] Open
Abstract
Open data sharing of clinical research aims to improve transparency and support novel scientific discoveries. There are also risks, including participant identification and the potential for stigmatization. The perspectives of persons participating in research are needed to inform open data-sharing policies. The aim of the current study was to determine perspectives on data sharing in persons with spinal cord injury (SCI), including risks and benefits, and types of data people are most willing to share. A secondary aim was to examine predictors of willingness to share data. Persons with SCIs in the United States and Canada completed a survey developed and disseminated through various channels, including our community partner, the North American Spinal Cord Injury Consortium. The study collected data from 232 participants, with 52.2% from Canada and 42.2% from the United States, and the majority completed the survey in English. Most participants had previously participated in research and had been living with an SCI for ≥5 years. Overall, most participants reported that the potential benefits of data sharing outweighed the negatives, with persons with SCI seen as the most trustworthy partners for data sharing. The highest levels of concern were that information could be stolen and companies might use the information for marketing purposes. Persons with SCI were generally supportive of data sharing for research purposes. Clinical trials should consider including a statement on open data sharing in informed consents to better acknowledge the contribution of research participants in future studies.
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Affiliation(s)
- Freda M. Warner
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessie McDougall
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathleen A. Martin Ginis
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Kelowna, British Columbia, Canada
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
| | - Alexander G. Rabchevsky
- Department of Physiology and Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky, Lexington, Kentucky, USA
| | - Jacquelyn J. Cragg
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - John L.K. Kramer
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Medvediev VV, Oleksenko NP, Pichkur LD, Verbovska SA, Savosko SI, Draguntsova NG, Lontkovskyi YA, Vaslovych VV, Tsymbalyuk VI. Implantation Effect of a Fibrin Matrix Associated with Mesenchymal Wharton’s Jelly Stromal Cells on the Course of an Experimental Spinal Cord Injury. CYTOL GENET+ 2023. [DOI: 10.3103/s0095452723010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Sterner RC, Sterner RM. Immune response following traumatic spinal cord injury: Pathophysiology and therapies. Front Immunol 2023; 13:1084101. [PMID: 36685598 PMCID: PMC9853461 DOI: 10.3389/fimmu.2022.1084101] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Traumatic spinal cord injury (SCI) is a devastating condition that is often associated with significant loss of function and/or permanent disability. The pathophysiology of SCI is complex and occurs in two phases. First, the mechanical damage from the trauma causes immediate acute cell dysfunction and cell death. Then, secondary mechanisms of injury further propagate the cell dysfunction and cell death over the course of days, weeks, or even months. Among the secondary injury mechanisms, inflammation has been shown to be a key determinant of the secondary injury severity and significantly worsens cell death and functional outcomes. Thus, in addition to surgical management of SCI, selectively targeting the immune response following SCI could substantially decrease the progression of secondary injury and improve patient outcomes. In order to develop such therapies, a detailed molecular understanding of the timing of the immune response following SCI is necessary. Recently, several studies have mapped the cytokine/chemokine and cell proliferation patterns following SCI. In this review, we examine the immune response underlying the pathophysiology of SCI and assess both current and future therapies including pharmaceutical therapies, stem cell therapy, and the exciting potential of extracellular vesicle therapy.
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Affiliation(s)
- Robert C. Sterner
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Rosalie M. Sterner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States,*Correspondence: Rosalie M. Sterner,
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Ray S, Al-Sammarraie N, Mahmood M. Neuroprotective role of Noggin in spinal cord injury. Neural Regen Res 2023; 18:492-496. [DOI: 10.4103/1673-5374.350190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hagan MJ, Pertsch NJ, Leary OP, Ganga A, Sastry R, Xi K, Zheng B, Behar M, Camara-Quintana JQ, Niu T, Sullivan PZ, Abinader JF, Telfeian AE, Gokaslan ZL, Oyelese AA, Fridley JS. Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 12:100186. [PMID: 36479003 PMCID: PMC9720595 DOI: 10.1016/j.xnsj.2022.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/04/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Discharge to acute rehabilitation is strongly correlated with functional recovery after traumatic injury, including spinal cord injury (SCI). However, services such as acute care rehabilitation and Skilled Nursing Facilities (SNF) are expensive. Our objective was to understand if high-cost, resource-intensive post-discharge rehabilitation or alternative care facilities are utilized at disparate rates across socioeconomic groups after SCI. METHODS We performed a cohort analysis using the National Trauma Data Bank® tabulated from 2012-2016. Eligible patients had a diagnosis of cervical or thoracic spine fracture with spinal cord injury (SCI) and were treated surgically. We evaluated associations of sociodemographic and psychosocial variables with non-home discharge (e.g., discharge to SNF, other healthcare facility, or intermediate care facility) via multivariable logistic regression while correcting for injury severity and hospital characteristics. RESULTS We identified 3933 eligible patients. Patients who were older, male (OR=1.29 95% Confidence Interval [1.07-1.56], p=.007), insured by Medicare (OR=1.45 [1.08-1.96], p=.015), diagnosed with a major psychiatric disorder (OR=1.40 [1.03-1.90], p=.034), had a higher Injury Severity Score (OR=5.21 [2.96-9.18], p<.001) or a lower Glasgow Coma Score (3-8 points, OR=2.78 [1.81-4.27], p<.001) had a higher chance of a non-home discharge. The only sociodemographic variable associated with lower likelihood of utilizing additional healthcare facilities following discharge was uninsured status (OR=0.47 [0.37-0.60], p<.001). CONCLUSIONS Uninsured patients are less likely to be discharged to acute rehabilitation or alternative healthcare facilities following surgical management of SCI. High out-of-pocket costs for uninsured patients in the United States may deter utilization of these services.
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Affiliation(s)
- Matthew J. Hagan
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Nathan J. Pertsch
- Department of Neurosurgery, Rush University Medical Center, 600 S. Paulina St, Chicago, IL 60612, USA
| | - Owen P. Leary
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Arjun Ganga
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Rahul Sastry
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Kevin Xi
- Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA
| | - Bryan Zheng
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Mark Behar
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Joaquin Q. Camara-Quintana
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Tianyi Niu
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Patricia Zadnik Sullivan
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Jose Fernandez Abinader
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Albert E. Telfeian
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Ziya L. Gokaslan
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Adetokunbo A. Oyelese
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Jared S. Fridley
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
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Copley PC, Tadross D, Salloum N, Woodfield J, Edlmann E, Poon M, Khan S, Brennan PM. A systematic review identifying outcome measures used in evaluating adults sustaining cervical spine fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3365-3377. [PMID: 36063214 DOI: 10.1007/s00586-022-07369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the outcome measures used in studies investigating cervical spine fractures in adults, with or without associated spinal cord injury, to inform development of a core outcome set. METHODS Medline, Embase and Scopus were searched for relevant studies until May 28, 2022, without a historic limit on study date. Study characteristics, population characteristics and outcomes reported were extracted and analyzed. RESULTS Our literature search identified 536 studies that met criteria for inclusion, involving 393,266 patients. Most studies were single center (87.3%), retrospective studies (88.9%) and involved a median of 40 patients (range 6-167,278). Treatments assessed included: surgery (55.2%), conservative (6.2%), halo immobilization (4.9%), or a mixture (33.2%). Median study duration was 84 months (range 3-564 months); the timing of clinical and/or radiological follow-up assessment after injury was reported in 56.7%. There was significant heterogeneity in outcomes used, with 79 different reported outcomes measures. Differences in use were identified between smaller/larger, retro-/prospective and single/multicenter cohorts. Over time, the use of radiological outcomes has declined with greater emphasis on patient-reported outcome measures (PROMs). Studies of conservative management were more likely to detail PROMs and mortality, whereas surgical studies reported Frankel/ASIA grade, radiological fusion, complication rates, duration of hospital stay and re-operation rates more frequently. In studies assessing the elderly population (> 65 years), use of PROMs, mortality, hospital stay and discharge destination were more common, whereas fusion was reported less often. Response rates for outcome assessments were lower in studies assessing elderly patients, and studies using PROMs. CONCLUSIONS We have classified the various outcome measures used for patients with cervical spine fractures based on the COMET outcome taxonomy. We also described the contexts in which different outcomes are more commonly employed to help guide decision-making when designing future research endeavors.
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Affiliation(s)
- Phillip C Copley
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK.
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
- Department of Clinical Neurosciences, Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK.
| | - Daniel Tadross
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nadia Salloum
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Julie Woodfield
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ellie Edlmann
- Southwest Neurosurgical Centre, Derriford Hospital, Plymouth, UK
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Michael Poon
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sadaquate Khan
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Paul M Brennan
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
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Pham TL, Miao J, Singh H, Lee MB, Cage TA. Systemic sclerosis-associated compressive cervical calcinosis: intersection of degenerative spine instability, lesional spinal cord compression, and traumatic spinal cord injury. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22302. [PMID: 36461834 PMCID: PMC9552677 DOI: 10.3171/case22302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tumoral calcinosis, mass-like calcium deposition into the soft tissues, is an uncommon manifestation of the systemic sclerosis subtype of scleroderma. When this process affects the spinal epidural space, it can cause canal narrowing and place the spinal cord at significant risk of injury. OBSERVATIONS Here a 62-year-old female with systemic sclerosis and no previous evidence of spinal cord compromise who developed acute spinal cord injury and quadriparesis after a mechanical fall is described. She was found to have a large dorsal epidural calcified mass compressing her cervical spinal cord. She underwent medical management for acute spinal cord compression as well as surgical management for acute spinal cord injury and degenerative spine disease. Her case illustrates a rare etiology of simultaneous degenerative spine instability and lesional spinal cord compression with acute spinal cord injury. LESSONS Tumor calcinosis leading to acute spinal cord injury in the setting of systemic sclerosis is an uncommon but critical entity to recognize in patients with scleroderma and may require the physician to use a combination of medical and surgical management strategies from each of these categories of spine pathology.
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Affiliation(s)
- Thu Lan Pham
- Division of Neurosurgery, Santa Clara Valley Medical Center, San Jose, California
| | - Jingya Miao
- Division of Neurosurgery, Santa Clara Valley Medical Center, San Jose, California
| | - Harminder Singh
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and ,Division of Neurosurgery, Santa Clara Valley Medical Center, San Jose, California
| | - Marco B. Lee
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and ,Division of Neurosurgery, Santa Clara Valley Medical Center, San Jose, California
| | - Tene A. Cage
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and ,Division of Neurosurgery, Santa Clara Valley Medical Center, San Jose, California
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15
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Boehl G, Raguindin PF, Valido E, Bertolo A, Itodo OA, Minder B, Lampart P, Scheel-Sailer A, Leichtle A, Glisic M, Stoyanov J. Endocrinological and inflammatory markers in individuals with spinal cord injury: A systematic review and meta-analysis. Rev Endocr Metab Disord 2022; 23:1035-1050. [PMID: 35978214 PMCID: PMC9515048 DOI: 10.1007/s11154-022-09742-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 10/25/2022]
Abstract
Spinal cord injury (SCI) can lead to dramatic physiological changes which can be a factor in developing secondary health conditions and might be reflected in biomarker changes in this elevated risk group. We focused specifically on the endocrine and inflammation profile differences between SCI and able-bodied individuals (ABI). Our aim was to determine the differences in inflammatory markers and endocrine profiles between SCI and ABI. We systematically searched 4 electronic databases for relevant studies. Human observational (cross-sectional, cohort, case-control) studies that compared biomarkers of interest between SCI and ABI population were included. Weighted mean difference between SCI and ABI was calculated using random-effects models. Heterogeneity was computed using I2 statistic and chi-squared test. Study quality was evaluated through the Newcastle-Ottawa Scale. The search strategy yielded a total of 2,603 studies from which 256 articles were selected for full-text assessment. Sixty-two studies were included in the meta-analysis. SCI individuals had higher levels of pro-inflammatory C-reactive protein and IL-6 than ABI. Creatinine and 25-hydroxyvitamin D3 levels were lower in SCI than ABI. Total testosterone levels and IGF-1 were also found to be lower, while cortisol and leptin levels were higher in SCI when compared to ABI. Accordingly, meta-regression, subgroup analysis, and leave-one-out analysis were performed, however, they were only able to partially explain the high levels of heterogeneity. Individuals with SCI show higher levels of inflammatory markers and present significant endocrinological changes when compared to ABI. Moreover, higher incidence of obesity, diabetes, osteoporosis, and hypogonadism in SCI individuals, together with decreased creatinine levels reflect some of the readily measurable aspects of the phenotype changes in the SCI group. These findings need to be considered in anticipating medically related complications and personalizing SCI medical care.
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Affiliation(s)
| | - Peter Francis Raguindin
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Ezra Valido
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Alessandro Bertolo
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Orthopedic Surgery, University of Bern, Bern Inselspital, Bern, Switzerland
| | - Oche Adam Itodo
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Public Health & Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | | | | | - Alexander Leichtle
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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16
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Budd MA, Gater DR, Channell I. Psychosocial Consequences of Spinal Cord Injury: A Narrative Review. J Pers Med 2022; 12:jpm12071178. [PMID: 35887675 PMCID: PMC9320050 DOI: 10.3390/jpm12071178] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Consequences of a spinal cord injury (SCI) entail much more than damage to the spinal cord. The lives of people with SCI, along with those around them, experience profound long-lasting changes in nearly every life domain. SCI is a physical (biological) injury that is inextricably combined with various psychological and social consequences. The objective of this review is to present psychosocial challenges following SCI through the biopsychosocial model, beginning with acknowledgement of the larger societal effects of ableism and stigma before addressing the many unique psychosocial aspects of living with SCI. Included in this review are qualitative studies and systematic reviews on current psychosocial outcomes and consequences. This paper attempts to structure this information by dividing it into the following sections: relationships and family; changes in finances and employment; issues related to the person’s living situation; community reintegration; factors associated with mood and coping (e.g., depression, anxiety, substance use, and PTSD); self-harm behaviors (ranging from nonadherence to suicide); effects of traumatic brain injury; considerations regarding sexual health; aging with SCI; and concludes with a brief discussion about post-traumatic growth. Cultivating an understanding of the unique and interrelated psychosocial consequences of people living with SCI may help mitigate the psychosocial aftermath and serve as a reminder to providers to maintain a person-centered approach to care.
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Affiliation(s)
- Maggi A. Budd
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Isabella Channell
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Mental Health Counseling and Behavioral Medicine Graduate Program, Boston University School of Medicine, Boston, MA 02128, USA
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De Almeida TF, Borges LHB, Dantas AFODA. Development of an IoT Electrostimulator with Closed-Loop Control. SENSORS (BASEL, SWITZERLAND) 2022; 22:3551. [PMID: 35591243 PMCID: PMC9104803 DOI: 10.3390/s22093551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023]
Abstract
The most used approach in the motor rehabilitation of spinal cord injury is functional electrical stimulation. However, current devices do not provide real-time feedback, work in the closed-loop, and became remotely operable. In this scenario, this paper presents the development of an open access 4-channel IoT electrostimulator device with an inertial sensor. The electrostimulator circuit was designed with four modules: Boost Converter, H-bridge, Inertial Measurement Unit, and Processing Module. The firmware was implemented in the processing module to manage the modules to perform closed-loop stimulation (using PID controller). To perform the proof of concept of the device, a closed loop test was performed to control the ankle joint, performing the movements of dorsiflexion, plantar flexion, inversion, and eversion. The designed hardware allowed one to freely change the boost converter voltage and modulate the signal with 200 μs of pulse duration and 50 Hz of period in a safe and stable way. Furthermore, the controller was able to move the ankle joint in all desired directions following the reference values and respecting the imposed constraints. In general, the developed hardware was able to safely control a closed-loop joint.
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Affiliation(s)
| | | | - André Felipe Oliveira de Azevedo Dantas
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Av. Alberto Santos Dumont, 1560, Zona Rural, Macaiba 59280-000, RN, Brazil; (T.F.D.A.); (L.H.B.B.)
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18
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Tracy BM, Hoover E, Jones N, Hinrichs MJ, Gelbard RB. The Effect of Physiatry Involvement for Patients With Acute Traumatic Spinal Cord Injury at a Level 1 Trauma Center. Top Spinal Cord Inj Rehabil 2022; 28:76-83. [PMID: 36457359 PMCID: PMC9678214 DOI: 10.46292/sci21-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective To explore the impact of physiatry on acute traumatic spinal cord injury (ATSCI) outcomes using a propensity score matching (PSM) analysis. Methods We retrospectively reviewed all patients with ATSCI at a level 1 trauma center from 2018 to 2019. In a 1:1 fashion, we matched patients who were evaluated by physiatry to those who were not. Our PSM analysis controlled for patient demographics, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), comorbidities, mechanism, and presence of a traumatic brain injury (TBI). Outcomes included complications, discharge disposition, and 30-day mortality. Survival analysis was performed using Kaplan-Meier plots. Results A total of 102 patients (physiatry 51; no physiatry 51) were matched. Median age was 38 (28-55) years, and median ISS was 25.5 (17-35); 82.4% (n = 84) were male, and 77.5% (n = 79) were bluntly injured. Rates of in-hospital complications were similar between groups. Physiatry involvement was associated with increased odds of discharge to inpatient rehabilitation (odds ratio, 4.6; 95% CI, 2-11.6; p < .001). There was a significant survival benefit seen with physiatry involvement at 30 days (92.6% vs. 78.6%, p = .004) that correlated with a decreased risk of mortality (hazard ratio, 0.2; 95% CI, 0.03-0.7; p = .01). Conclusion Incorporating physiatry into the management of patients with ATSCI is associated with improved survival and greater odds of discharge to rehabilitation. In this population, physiatry should be incorporated into the trauma care team to optimize patient outcomes.
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Affiliation(s)
- Brett M Tracy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Erin Hoover
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nikki Jones
- Department of Surgery, Morehouse School of Medicine at Grady Memorial Hospital, Atlanta, Georgia
| | - Mark J Hinrichs
- Department of Rehabilitation Medicine, Emory University School of Medicine at Grady Memorial Hospital, Atlanta, Georgia
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Fry A, Chan HW, Harel N, Spielman L, Escalon M, Putrino D. Evaluating the clinical benefit of brain-computer interfaces for control of a personal computer. J Neural Eng 2022; 19. [PMID: 35325875 DOI: 10.1088/1741-2552/ac60ca] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/24/2022] [Indexed: 11/11/2022]
Abstract
Brain-computer interfaces (BCIs) enabling the control of a personal computer could provide myriad benefits to individuals with disabilities including paralysis. However, to realize this potential, these BCIs must gain regulatory approval and be made clinically available beyond research participation. Therefore, a transition from engineering-oriented to clinically oriented outcome measures will be required in the evaluation of BCIs. This review examined how to assess the clinical benefit of BCIs for the control of a personal computer. We report that: 1) a variety of different patient-reported outcome measures can be used to evaluate improvements in how a patient feels, and we offer some considerations that should guide instrument selection. 2) Activities of daily living can be assessed to demonstrate improvements in how a patient functions, however, new instruments that are sensitive to increases in functional independence via the ability to perform digital tasks may be needed. 3) Benefits to how a patient survives has not previously been evaluated, but establishing patient-initiated communication channels using BCIs might facilitate quantifiable improvements in health outcomes.
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Affiliation(s)
- Adam Fry
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
| | - Ho Wing Chan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
| | - Noam Harel
- James J Peters VA Medical Center, 130 W Kingsbridge Rd, New York, New York, 10468, UNITED STATES
| | - Lisa Spielman
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
| | - Miguel Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
| | - David Putrino
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
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20
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Inhibition of Bruton Tyrosine Kinase Reduces Neuroimmune Cascade and Promotes Recovery after Spinal Cord Injury. Int J Mol Sci 2021; 23:ijms23010355. [PMID: 35008785 PMCID: PMC8745213 DOI: 10.3390/ijms23010355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Microglia/astrocyte and B cell neuroimmune responses are major contributors to the neurological deficits after traumatic spinal cord injury (SCI). Bruton tyrosine kinase (BTK) activation mechanistically links these neuroimmune mechanisms. Our objective is to use Ibrutinib, an FDA-approved BTK inhibitor, to inhibit the neuroimmune cascade thereby improving locomotor recovery after SCI. Rat models of contusive SCI, Western blot, immunofluorescence staining imaging, flow cytometry analysis, histological staining, and behavioral assessment were used to evaluate BTK activity, neuroimmune cascades, and functional outcomes. Both BTK expression and phosphorylation were increased at the lesion site at 2, 7, 14, and 28 days after SCI. Ibrutinib treatment (6 mg/kg/day, IP, starting 3 h post-injury for 7 or 14 days) reduced BTK activation and total BTK levels, attenuated the injury-induced elevations in Iba1, GFAP, CD138, and IgG at 7 or 14 days post-injury without reduction in CD45RA B cells, improved locomotor function (BBB scores), and resulted in a significant reduction in lesion volume and significant improvement in tissue-sparing 11 weeks post-injury. These results indicate that Ibrutinib exhibits neuroprotective effects by blocking excessive neuroimmune responses through BTK-mediated microglia/astroglial activation and B cell/antibody response in rat models of SCI. These data identify BTK as a potential therapeutic target for SCI.
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21
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Miguel CA, Noya-Riobó MV, Mazzone GL, Villar MJ, Coronel MF. Antioxidant, anti-inflammatory and neuroprotective actions of resveratrol after experimental nervous system insults. Special focus on the molecular mechanisms involved. Neurochem Int 2021; 150:105188. [PMID: 34536545 DOI: 10.1016/j.neuint.2021.105188] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/11/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022]
Abstract
After different types of acute central nervous system insults, including stroke, subarachnoid haemorrhage and traumatic brain and spinal cord injuries, secondary damage plays a central role in the induction of cell death, neurodegeneration and functional deficits. Interestingly, secondary cell death presents an attractive target for clinical intervention because the temporal lag between injury and cell loss provides a potential window for effective treatment. While primary injuries are the direct result of the precipitating insult, secondary damage involves the activation of pathological cascades through which endogenous factors can exacerbate initial tissue damage. Secondary processes, usually interactive and overlapping, include oxidative stress, neuroinflammation and dysregulation of autophagy, ultimately leading to cell death. Resveratrol, a natural stilbene present at relatively high concentrations in grape skin and red wine, exerts a wide range of beneficial health effects. Within the central nervous system, in addition to its inherent free radical scavenging role, resveratrol increases endogenous cellular antioxidant defences thus modulating multiple synergistic pathways responsible for its antioxidant, anti-inflammatory and anti-apoptotic properties. During the last years, a growing body of in vitro and in vivo evidence has been built, indicating that resveratrol can induce a neuroprotective state and attenuate functional deficits when administered acutely after an experimental injury to the central nervous system. In this review, we summarize the most recent findings on the molecular pathways involved in the neuroprotective effects of this multi target polyphenol, and discuss its neuroprotective potential after brain or spinal cord injuries.
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Affiliation(s)
- C A Miguel
- Laboratorio de Dolor en Cáncer, Instituto de Investigaciones en Medicina Traslacional CONICET - Universidad Austral, Av. Pte. Perón 1500, B1629AHJ, Pilar, Buenos Aires, Argentina
| | - M V Noya-Riobó
- Laboratorio de Dolor en Cáncer, Instituto de Investigaciones en Medicina Traslacional CONICET - Universidad Austral, Av. Pte. Perón 1500, B1629AHJ, Pilar, Buenos Aires, Argentina
| | - G L Mazzone
- Laboratorio de Dolor en Cáncer, Instituto de Investigaciones en Medicina Traslacional CONICET - Universidad Austral, Av. Pte. Perón 1500, B1629AHJ, Pilar, Buenos Aires, Argentina; Facultad de Ciencias Biomédicas, Universidad Austral, Av. Pte. Perón 1500, B1629AHJ, Pilar, Buenos Aires, Argentina
| | - M J Villar
- Laboratorio de Dolor en Cáncer, Instituto de Investigaciones en Medicina Traslacional CONICET - Universidad Austral, Av. Pte. Perón 1500, B1629AHJ, Pilar, Buenos Aires, Argentina; Facultad de Ciencias Biomédicas, Universidad Austral, Av. Pte. Perón 1500, B1629AHJ, Pilar, Buenos Aires, Argentina
| | - M F Coronel
- Laboratorio de Dolor en Cáncer, Instituto de Investigaciones en Medicina Traslacional CONICET - Universidad Austral, Av. Pte. Perón 1500, B1629AHJ, Pilar, Buenos Aires, Argentina; Facultad de Ciencias Biomédicas, Universidad Austral, Av. Pte. Perón 1500, B1629AHJ, Pilar, Buenos Aires, Argentina.
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22
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Li Y, Wei B, Zhong Y, Feng H, Wu H. A bibliometric analysis of global research on spinal cord injury: 1999-2019. Spinal Cord 2021; 60:281-287. [PMID: 34497380 DOI: 10.1038/s41393-021-00691-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Bibliometric review. OBJECTIVE The spatial structure of the global spinal cord injury (SCI) research field has not been summarized or analyzed. The objective of this study was to understand the current status and global trends of SCI research, and provide scholars knowledge to integrate into their plans for future research. SETTING Not applicable. METHODS The Web of Science database was searched for articles related to SCI published between 1999 and 2019. Metrics based on publication data, including publication counts, H indices, countries, institutions, authors, and journals were extracted. Co-citation analysis, collaboration analysis, and co-occurrence analysis of keywords were conducted using CiteSpace. RESULTS The search identified a total of 41,012 articles related to SCI. Overall, the number of publications increased annually. The United States was the top ranked country by publication count, H index, and citation count. Harvard University and the University of Toronto made the most contributions. M.G. Fehlings was the top ranked author. Spinal Cord published the largest number of articles, and was the most frequently cited journal. The top 5 ranked keywords that appeared most frequently were spinal cord injury, functional recovery, adult rat rehabilitation, and paraplegia. Twelve major clusters of keywords and 15 clusters of co-cited references were generated. CONCLUSIONS This study comprehensively analyzed and summarized the trends in SCI research during the past 20 years. Findings should provide scholars information on the countries, institutions, authors, and journals that are active in the field of SCI research, and a knowledge base for future projects.
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Affiliation(s)
- Yongbo Li
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China
| | - Baixing Wei
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China
| | - Yihan Zhong
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China
| | - Hao Feng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China
| | - Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China.
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23
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Chio JCT, Xu KJ, Popovich P, David S, Fehlings MG. Neuroimmunological therapies for treating spinal cord injury: Evidence and future perspectives. Exp Neurol 2021; 341:113704. [PMID: 33745920 DOI: 10.1016/j.expneurol.2021.113704] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
Spinal cord injury (SCI) has a complex pathophysiology. Following the initial physical trauma to the spinal cord, which may cause vascular disruption, hemorrhage, mechanical injury to neural structures and necrosis, a series of biomolecular cascades is triggered to evoke secondary injury. Neuroinflammation plays a major role in the secondary injury after traumatic SCI. To date, the administration of systemic immunosuppressive medications, in particular methylprednisolone sodium succinate, has been the primary pharmacological treatment. This medication is given as a complement to surgical decompression of the spinal cord and maintenance of spinal cord perfusion through hemodynamic augmentation. However, the impact of neuroinflammation is complex with harmful and beneficial effects. The use of systemic immunosuppressants is further complicated by the natural onset of post-injury immunosuppression, which many patients with SCI develop. It has been hypothesized that immunomodulation to attenuate detrimental aspects of neuroinflammation after SCI, while avoiding systemic immunosuppression, may be a superior approach. To accomplish this, a detailed understanding of neuroinflammation and the systemic immune responses after SCI is required. Our review will strive to achieve this goal by first giving an overview of SCI from a clinical and basic science context. The role that neuroinflammation plays in the pathophysiology of SCI will be discussed. Next, the positive and negative attributes of the innate and adaptive immune systems in neuroinflammation after SCI will be described. With this background established, the currently existing immunosuppressive and immunomodulatory therapies for treating SCI will be explored. We will conclude with a summary of topics that can be explored by neuroimmunology research. These concepts will be complemented by points to be considered by neuroscientists developing therapies for SCI and other injuries to the central nervous system.
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Affiliation(s)
- Jonathon Chon Teng Chio
- Division of Translational and Experimental Neuroscience, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - Katherine Jiaxi Xu
- Human Biology Program, University of Toronto, Wetmore Hall, 300 Huron St., Room 105, Toronto, Ontario M5S 3J6, Canada.
| | - Phillip Popovich
- Department of Neuroscience, Belford Center for Spinal Cord Injury, Center for Brain and Spinal Cord Repair, The Neurological Institute, The Ohio State University, Wexner Medical Center, 410 W. 10(th) Ave., Columbus 43210, USA.
| | - Samuel David
- Centre for Research in Neuroscience and BRaIN Program, The Research Institute of the McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada.
| | - Michael G Fehlings
- Division of Translational and Experimental Neuroscience, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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24
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McRae J, Smith C, Emmanuel A, Beeke S. The experiences of individuals with cervical spinal cord injury and their family during post-injury care in non-specialised and specialised units in UK. BMC Health Serv Res 2020; 20:783. [PMID: 32831066 PMCID: PMC7443811 DOI: 10.1186/s12913-020-05659-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with acute cervical spinal cord injury require specialised interventions to ensure optimal clinical outcomes especially for respiratory, swallowing and communication impairments. This study explores the experiences of post-injury care for individuals with cervical spinal cord injury and their family members during admissions in specialised and non-specialised units in the United Kingdom. METHODS Semi-structured interviews were undertaken with individuals with a cervical spinal cord injury and their family member, focussing on the experience of care across units. Eight people with spinal cord injury levels from C2 to C6, were interviewed in their current care settings. Six participants had family members present to support them. Interviews were audio-recorded and transcribed with data inputted into NVivo for thematic analysis. RESULTS The study identified six themes from the participant interviews that highlighted different experiences of care in non-specialised and specialised settings. A number of these were related to challenges with the system, whilst others were about the personal journey of recovery. The themes were titled as: adjustment, transitions, "the golden opportunity", "when you can't eat", communication, and "in the hands of the nurses and doctors". CONCLUSIONS Whilst participants reported being well cared for in non-specialised units, they felt that they did not receive specialist care and this delayed their rehabilitation. Participants were dependent on healthcare professionals for information and care and at times lost hope for recovery. Staff in non-specialised units require training and guidance to help provide support for those with dysphagia and communication difficulties, as well as reassurance to patients and families whilst they wait for transfer to specialised units.
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Affiliation(s)
- Jackie McRae
- Faculty of Health, Social Care and Education, Kingston and St Georges University of London, London, UK
| | - Christina Smith
- Division of Psychology and Language Science, University College London, London, WC1N 1PF UK
| | - Anton Emmanuel
- Division of Medicine, University College London, London, WC1E 6JF UK
| | - Suzanne Beeke
- Division of Psychology and Language Science, University College London, London, WC1N 1PF UK
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