1
|
Moro V, Beccherle M, Scandola M, Aglioti SM. Massive body-brain disconnection consequent to spinal cord injuries drives profound changes in higher-order cognitive and emotional functions: A PRISMA scoping review. Neurosci Biobehav Rev 2023; 154:105395. [PMID: 37734697 DOI: 10.1016/j.neubiorev.2023.105395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
Spinal cord injury (SCI) leads to a massive disconnection between the brain and the body parts below the lesion level representing a unique opportunity to explore how the body influences a person's mental life. We performed a systematic scoping review of 59 studies on higher-order cognitive and emotional changes after SCI. The results suggest that fluid abilities (e.g. attention, executive functions) and emotional regulation (e.g. emotional reactivity and discrimination) are impaired in people with SCI, with progressive deterioration over time. Although not systematically explored, the factors that are directly (e.g. the severity and level of the lesion) and indirectly associated (e.g. blood pressure, sleeping disorders, medication) with the damage may play a role in these deficits. The inconsistency which was found in the results may derive from the various methods used and the heterogeneity of samples (i.e. the lesion completeness, the time interval since lesion onset). Future studies which are specifically controlled for methods, clinical and socio-cultural dimensions are needed to better understand the role of the body in cognition.
Collapse
Affiliation(s)
- Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy.
| | - Maddalena Beccherle
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy; Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy
| | - Salvatore Maria Aglioti
- Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy; Fondazione Santa Lucia IRCCS, Roma, Italy
| |
Collapse
|
2
|
Pfyffer D, Zimmermann S, Şimşek K, Kreis R, Freund P, Seif M. Magnetic resonance spectroscopy investigation in the right human hippocampus following spinal cord injury. Front Neurol 2023; 14:1120227. [PMID: 37251221 PMCID: PMC10213741 DOI: 10.3389/fneur.2023.1120227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/20/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Preclinical studies have shown that cognitive impairments following spinal cord injury (SCI), such as impaired spatial memory, are linked to inflammation, neurodegeneration, and reduced neurogenesis in the right hippocampus. This cross-sectional study aims to characterize metabolic and macrostructural changes in the right hippocampus and their association to cognitive function in traumatic SCI patients. Methods Within this cross-sectional study, cognitive function was assessed in 28 chronic traumatic SCI patients and 18 age-, sex-, and education-matched healthy controls by a visuospatial and verbal memory test. A magnetic resonance spectroscopy (MRS) and structural MRI protocol was performed in the right hippocampus of both groups to quantify metabolic concentrations and hippocampal volume, respectively. Group comparisons investigated changes between SCI patients and healthy controls and correlation analyses investigated their relationship to memory performance. Results Memory performance was similar in SCI patients and healthy controls. The quality of the recorded MR spectra was excellent in comparison to the best-practice reports for the hippocampus. Metabolite concentrations and volume of the hippocampus measured based on MRS and MRI were not different between two groups. Memory performance in SCI patients and healthy controls was not correlated with metabolic or structural measures. Conclusion This study suggests that the hippocampus may not be pathologically affected at a functional, metabolic, and macrostructural level in chronic SCI. This points toward the absence of significant and clinically relevant trauma-induced neurodegeneration in the hippocampus.
Collapse
Affiliation(s)
- Dario Pfyffer
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Sandra Zimmermann
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Kadir Şimşek
- Magnetic Resonance Methodology, Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Roland Kreis
- Magnetic Resonance Methodology, Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Maryam Seif
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| |
Collapse
|
3
|
Boakye M, Ball T, Dietz N, Sharma M, Angeli C, Rejc E, Kirshblum S, Forrest G, Arnold FW, Harkema S. Spinal cord epidural stimulation for motor and autonomic function recovery after chronic spinal cord injury: A case series and technical note. Surg Neurol Int 2023; 14:87. [PMID: 37025529 PMCID: PMC10070319 DOI: 10.25259/sni_1074_2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/14/2023] [Indexed: 03/19/2023] Open
Abstract
Background:
Traumatic spinal cord injury (tSCI) is a debilitating condition, leading to chronic morbidity and mortality. In recent peer-reviewed studies, spinal cord epidural stimulation (scES) enabled voluntary movement and return of over-ground walking in a small number of patients with motor complete SCI. Using the most extensive case series (n = 25) for chronic SCI, the present report describes our motor and cardiovascular and functional outcomes, surgical and training complication rates, quality of life (QOL) improvements, and patient satisfaction results after scES.
Methods:
This prospective study occurred at the University of Louisville from 2009 to 2020. scES interventions began 2–3 weeks after surgical implantation of the scES device. Perioperative complications were recorded as well as long-term complications during training and device related events. QOL outcomes and patient satisfaction were evaluated using the impairment domains model and a global patient satisfaction scale, respectively.
Results:
Twenty-five patients (80% male, mean age of 30.9 ± 9.4 years) with chronic motor complete tSCI underwent scES using an epidural paddle electrode and internal pulse generator. The interval from SCI to scES implantation was 5.9 ± 3.4 years. Two participants (8%) developed infections, and three additional patients required washouts (12%). All participants achieved voluntary movement after implantation. A total of 17 research participants (85%) reported that the procedure either met (n = 9) or exceeded (n = 8) their expectations, and 100% would undergo the operation again.
Conclusion:
scES in this series was safe and achieved numerous benefits on motor and cardiovascular regulation and improved patient-reported QOL in multiple domains, with a high degree of patient satisfaction. The multiple previously unreported benefits beyond improvements in motor function render scES a promising option for improving QOL after motor complete SCI. Further studies may quantify these other benefits and clarify scES’s role in SCI patients.
Collapse
Affiliation(s)
- Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Tyler Ball
- Department of Neurosurgery, Vanderbilt University, Nashville,
| | - Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Claudia Angeli
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Enrico Rejc
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| | - Steven Kirshblum
- Department of Physical Medicine Rehabilitation, Rutgers, Newark, New Jersey,
| | - Gail Forrest
- Department of Physical Medicine Rehabilitation, Rutgers, Newark, New Jersey,
| | - Forest W. Arnold
- Department of Infectious Diseases, University of Louisville, Louisville, United States
| | - Susan Harkema
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky,
| |
Collapse
|
4
|
Sandalic D, Arora M, Pozzato I, Simpson G, Middleton J, Craig A. A Narrative Review of Research on Adjustment to Spinal Cord Injury and Mental Health: Gaps, Future Directions, and Practice Recommendations. Psychol Res Behav Manag 2022; 15:1997-2010. [PMID: 35957761 PMCID: PMC9363004 DOI: 10.2147/prbm.s259712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022] Open
Abstract
Spinal cord injury (SCI) results in autonomic, motor, and sensory impairments that can compromise mental health. Guidelines directing the management of mental health following SCI presently address clinical anxiety, depression, post-traumatic stress, substance use disorders, and suicide. However, evidence suggests that perhaps as many as 70% of individuals with SCI do not develop a clinically diagnosable mental health disorder. Therefore, the authors contend that understanding non-clinical cognitive and psychological aspects of adjustment post-SCI is paramount and that the application of this knowledge to the formulation of adjustment-enhancing interventions is crucial. To assist with this endeavour, we examine existing mental health guidelines targeting SCI, and present a narrative review of research on the under-represented topics of adjustment, coping, grief, and resilience. We include mild cognitive impairment, which reflects a common factor that can compromise adjustment. Loss and stress trigger processes of adjustment, coping, grief, and resilience. SCI involves loss and stress triggering these processes, arguably without exception. Our study applied a narrative review methodology searching Google Scholar and PsychInfo databases for terms adjustment, coping, grief, resilience, and cognitive impairment. Qualitative studies and quantitative studies were selected to capture bottom-up and top-down perspectives. Reference lists of retrieved papers were searched as appropriate. Reviewed literature suggested that existing guidelines concerning mental health following SCI neglect positive processes of adjustment and suggest this neglect contributes to a deficits-based view of mental health following SCI. Research into "positive" or adjustment-enhancing processes is mostly cross-sectional, heterogenous, and poorly positioned to inform future guideline-development. Researchers should achieve consensus over the operationalisation of essential processes and overcome a fixation with "outcomes" to better inform management of mental health after SCI.
Collapse
Affiliation(s)
- Danielle Sandalic
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mohit Arora
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ilaria Pozzato
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Grahame Simpson
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - James Middleton
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ashley Craig
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Goraczko A, Zurek A, Lachowicz M, Kujawa K, Zurek G. The Relationship between Cognitive Performance and Quality of Life in Elite Athletes after Spinal Cord Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020948. [PMID: 35055769 PMCID: PMC8775381 DOI: 10.3390/ijerph19020948] [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: 11/24/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The present investigation was designed to determine cognitive performance and quality of life (QoL) in a group of elite athletes who sustained spinal cord injury (SCI). METHODS nine participants suffering a SCI participated in the study. Different cognitive functions were evaluated through the following tests: COWAT, Digit Span, Stroop color-word and QoL through the WHOQoL-BREF scale. RESULTS Generally, participants positively assessed their overall quality of life and health status. Although the tests conducted indicate reduced cognitive function among the athletes, it did not affect the reduction in QoL. Single correlations between the results of cognitive tests and QoL could be treated as coincidental. CONCLUSIONS Despite the observed decline in selected cognitive functions, the participants positively assessed their quality of life and physical health.Reduced cognitive functioning could be influenced by the impact of sleep-disordered breathing, pain, depressive disorders and medication. This indicates the need for an individualized approach to define the patient's deficits, needs and best care. Further studies with a larger group of participants are needed.
Collapse
Affiliation(s)
- Agata Goraczko
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland; (A.G.); (M.L.); (K.K.)
- Clinic of Neurorehabilitation, 54-519 Wroclaw, Poland
| | - Alina Zurek
- Institute of Psychology, University of Wroclaw, 50-527 Wroclaw, Poland;
| | - Maciej Lachowicz
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland; (A.G.); (M.L.); (K.K.)
| | - Katarzyna Kujawa
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland; (A.G.); (M.L.); (K.K.)
- Clinic of Neurorehabilitation, 54-519 Wroclaw, Poland
| | - Grzegorz Zurek
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland; (A.G.); (M.L.); (K.K.)
- Correspondence: ; Tel.: +48-600-081-799
| |
Collapse
|