Spinal Cord Series and Cases最新文献

Study design: Retrospective observational study.

Objective: The study aims to evaluate the effects of early transfer of individuals with traumatic spinal cord injuries to a specialist spinal injury centre, focusing on the duration of hospital and intensive care stays, as well as the incidence of medical complications.

Setting: Regional Spinal Injuries Centre, UK.

Patients and methods: All patients with traumatic SCI admitted over a 4-year period to our Regional Spinal Injury Centre were included in this study. A total of 104 patients were divided into 2 groups: those referred within 48 h (34 patients) and those referred later after the injury but within 2 months of injury (70 patients). There were no differences in the number of patients with tetraplegia or paraplegia or in the average age or sex between the two groups. there is no significant difference in the incidence of associated injuries between the 2 groups.

Results: Patients who were transferred early stayed less in the ICU than did those who were transferred late (9 and 25 days, respectively; p < 0.05). The percentage of patients requiring ICU stay was also significantly lower (from 41-9%; p < 0.001); 24% of patients in the early group had medical complications, while 45% of patients in the delayed group had these complications (p < 0.05). The average length of hospital stay ( ± SD), including rehabilitation, in the early admission group was 121 (86.9) days, while that in the delayed admission group was 188 (84.9) days (p < 0.0001).

Conclusion: Earlier admission of traumatic SCI patients to a spinal injury centre is associated with shorter acute care period, shorter total hospital stay and reduced preventable complications.

Study design: A validity study.

Objectives: To assess the content validity of the Lower Extremity Motor Activity Log (LE-MAL) for assessing spontaneous lower-extremity use in individuals with spinal cord injury/disease (SCI/D). Additionally, the remote application of the LE-MAL was tested.

Setting: Community-based video calls (SCIR-Group/UDESC, Brazil).

Methods: The content validity study was conducted based on COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). A panel of end-users composed of individuals with SCI/D and rehabilitation professionals was interviewed about the relevance, comprehensiveness, and comprehensibility of the LE-MAL items by video call. The content validity ratio (CVR) was calculated for each item, and the content validity index (CVI) was calculated for the overall instrument. The items were considered to have adequate content validity if CVR ≥ 0.54 and the instrument to have adequate content validity if CVI > 0.80. Data on the percentage of individuals able to complete the instrument and the time taken to do so were used in the remote application feasibility analysis.

Results: Twenty-six participants were interviewed, 13 individuals with SCI/D and 13 rehabilitation professionals. All items obtained a CVR ≥ 0.54, and the CVI was 0.95. All participants completed the LE-MAL remotely, with a median time of 21 min.

Conclusions: The LE-MAL presents adequate content validity for evaluating the spontaneous use of the lower extremities during mobility activities in real world settings among individuals with incomplete SCI/D. Additionally, LE-MAL is feasible for remote application via video calls.

Study design: Cross-sectional study OBJECTIVES: Spinal cord disorders (SCD) in children are rare, but effects on body composition and functional outcomes can be significant. Little is known about bone health and pediatric SCD experiences. We therefore aimed to describe bone health and body composition following pediatric SCD, and characterize the condition based on the International Classification of Functioning, Disability and Health (ICF) Framework.

Setting: The Royal Children's Hospital, Melbourne, Australia METHODS: Ten participants with SCD were recruited into a study exploring musculoskeletal outcomes. Whole-body dual x-ray absorptiometry (DXA) scans for musculoskeletal and body composition analysis, and pain, activity, and participation questionnaires were administered.

Results: Body composition measured by DXA revealed lean tissue indices were decreased, and fat tissue indices were increased for all participants compared to age-matched controls. The centiles (mean ± SD) for Lean Mass Index and Appendicular Lean Mass Index for the whole cohort were 14 ± 25 and 8 ± 13, respectively, while the total cohort Fat Mass Index and Trunk/Appendicular Fat Mass Ratio centiles were 61 ± 31 and 69 ± 34, respectively. Bone mineral density levels at the spine were unchanged but decreased at the hip for all participants (Mean Z-score: -2.2 ± 1.0). Weight-bearing status influenced functional outcomes, with weight-bearing children tending to report higher levels of pain, activity and participation than non-weight-bearing children.

Conclusions: We report novel body composition data and functional outcomes in children with SCD. This study provides a useful overview of the experiences of children with SCD at the Royal Children's Hospital, but larger scale studies are needed to generalize the results.

Study design: Cross-sectional descriptive survey.

Objectives: To assess participation levels, types of leisure-time activities, and barriers to engagement among people with spinal cord injury (SCI), and to identify demographic and functional factors influencing participation.

Setting: Western Denmark.

Methods: Between September and November 2023, adults with SCI were invited to complete a digital survey. Inclusion criteria were any level of SCI. Data collected included demographic and injury-related characteristics, types and frequency of leisure-time activities, social context, and perceived participation barriers. Analyses involved descriptive statistics, prevalence proportions, and prevalence proportion ratios.

Results: Of 1259 eligible persons, 479 completed the survey. Participants engaged in a median of three different leisure-time activities over the past year. In the previous four weeks, 19% reported participating in leisure activities less than once per week. Participation in non-social and social activities less than once per week was reported by 44 and 37%, respectively. Lower participation was more common among persons with shorter educational attainment and reduced mobility at 100 meters. Most activities were self-organized or provided by commercial providers. The most commonly reported barriers were physical limitations, time constraints, and activity suitability.

Conclusions: Participation in leisure-time activities among people with SCI varies widely. In this study, social engagement, education level, and mobility were observed to be related to patterns of participation. Addressing physical, contextual, and logistical barriers through tailored interventions may enhance leisure-time engagement and support more holistic rehabilitation outcomes.

Study design: Concurrent mixed methods case series.

Objectives: To examine the feasibility and effect of a peer-facilitated, remote handcycling sport program on physical, psychological, and social health of individuals with spinal cord injury or disease (SCI/D) aged ≥50 years.

Setting: Participants' homes.

Methods: Manual wheelchair users aged ≥50 years with chronic SCI/D were eligible. Participants completed remote, group-based handcycling at moderate-vigorous intensity twice weekly for 12 weeks, co-led by a physiotherapist and peer with SCI/D. Handcycling duration was progressively increased to 45 min. Outcome measures were completed at three timepoints (pre-, post-, 12 weeks post-training). True change was assessed using the two-standard deviation band method for the Spinal Cord Independence Measure, Moorong Self-Efficacy Scale, Exercise Self-Efficacy Scale (ESES), Positive Affect and Well-Being Scale, and Multidimensional Scale of Perceived Social Support, and minimal detectable change for the 6 min Push Test (6MPT). Semi-structured interviews were analyzed using thematic analysis.

Results: Five participants enrolled; four completed the program and one was withdrawn following fractures unrelated to program. Overall, divergence was observed when comparing quantitative and qualitative findings. Interview data revealed participants perceived physical, psychological, and social health improvements, but there was minimal change in quantitative scores. A few instances of convergence were noted; e.g., immediately post-intervention, SP01 experienced improvement in 6MPT distance, which corroborated SP01's perceived physical health improvements. At 12-week follow-up, SP03 experienced reduction in ESES score, which aligned with SP03's reports of skin issues limiting sport.

Conclusions: Remote handcycling provided some health benefits for participants with SCI/D aged ≥50 years.

Study design: Qualitative design.

Aim: The aim of the study was to (i) determine the perspectives of therapists and people with spinal cord injury (SCI) on our recently developed Australian and New Zealand Clinical Practice Guidelines for the physiotherapy management of people with SCI, and (ii) understand the barriers and facilitators to the rollout of the Guidelines and identify implementation strategies to support their uptake.

Setting: Hospital and community SCI services, Australia.

Methods: Twenty-one therapists and 10 people with SCI were interviewed one-on-one or within focus groups. The interviews captured perspectives of therapists and people with SCI on the Guidelines as well as barriers and facilitators to the rollout of the Guidelines. The interviews with therapists were guided by the Theoretical Domains Framework (TDF). All interviews were transcribed and thematically coded. Barriers and facilitators were then linked to the COM-B model (Capability, Opportunity, Motivation - Behaviour) to identify implementation strategies.

Results: The barriers to implementation of the Guidelines identified by therapists were lack of knowledge and skill, lack of resources and challenges associated with working within large organisations. Facilitators to the uptake of the Guidelines were providing education, skill training, Guideline champions, awareness, and two-way communication between patient and therapist. Fourteen implementation strategies were identified.

Conclusion: Both therapists and people with SCI thought the Guidelines were a useful tool to improve the quality of care provided to people with SCI across various health settings. Facilitators identified in this study are being used to guide current implementation projects to enhance the uptake of the Guidelines.

Study design: Cross-sectional study OBJECTIVES: Spinal cord disorders (SCD) in children are uncommon, but for those affected the musculoskeletal effects can be severe. Little is known about bone health and pediatric SCD experiences in Australia. We aimed to describe bone and muscle development following pediatric SCD.

Setting: The Royal Children's Hospital, Melbourne, Australia METHODS: Ten participants with SCD were recruited and underwent peripheral quantitative computed tomography (pQCT) scans and blood tests to observe bone health biochemistry.

Results: Z-scores (mean ± SD) for trabecular density at the 4% tibial site were lower in non-weightbearing children compared to weightbearing children (-6.5 ± 1.5 vs. -2.4 ± 1.5, Total cohort: -5.0 ± 2.6). At the 66% site, muscle cross-sectional area (-4.7 ± 2.2 vs. -1.1 ± 1.7, Total cohort: -3.1 ± 2.7), strength strain index (-3.4 ± 1.3 vs. -1.0 ± 0.4, Total cohort: -2.5 ± 1.6) and total bone cross-sectional area (-2.4 ± 0.8 vs. 0.4 ± 1.7, Total cohort: -1.2 ± 1.9) were also lower in non-weightbearing children. Radial Z-scores revealed reduced total bone area at the 4% site (-3.5 ± 2.1) and strength strain index at the 65% site (-1.3 ± 1.8) in all participants. Serum testing revealed alkaline phosphatase was reduced in three participants, one of whom was also deficient in phosphate and 25-Hydroxyvitamin D.

Conclusions: Weightbearing status influenced multiple outcomes including trabecular density, muscle cross-sectional area and bone strength in the tibia.

Introduction: Robotic Exoskeleton-assisted gait training is an emerging approach in spinal cord injury (SCI) rehabilitation. This case report evaluates the effectiveness of Powered-Robotic exoskeleton-based gait training in an individual with chronic paraplegia.

Case presentation: A 31-year-old male with T12 SCI due to fall underwent a four-week structured rehabilitation program incorporating powered robotic exoskeleton training (Exo-Rehabilitation) alongside conventional therapy. The patient participated in 15 sessions over four weeks of intervention, with progressive gait training phases, transition from assisted weight-bearing to independent crutch-assisted walking. Functional, neurological and psychological outcomes were assessed pre and post intervention. Clinical measures include, Function in sitting test (FIST), Walking Index for Spinal cord injury (WISCI-II), ISNSCI lower extremity motor scores (LEMS), Spinal Cord Independence measure (SCIM III), 6-min walk test (6MWT) and Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0). Patient reported outcomes and attendance were also recorded. The patient demonstrated better, sitting balance, and functional mobility, with enhanced psychological well-being and adherence to rehabilitation.

Discussion: Robotic Exoskeleton-assisted gait training may be safe and a feasible approach to improve mobility, balance, and functional independence in SCI patients. Robotic overground exoskeleton-based gait training may represent a significant step forward in bridging the gap between conventional therapy and advanced technology, offering new hope for functional recovery and independence in individuals with Chronic SCI.

Study design: Retrospective single-centre study on spinal cord injury/disease (SCI/D) persons with spasticity, treated with muscle flaps reconstruction for pressure injury (PI) between July 2013 and January 2022.

Objectives: PI is a common complication in SCI/D. Neuro-muscular (NM) blockade with botulinum toxin-A (BTX) and intrathecal baclofen were used to treat associated spasticity in the reconstruction with muscle flaps, because spasms can lead to flap detachment and failure of the reconstruction, and compared with drug treatment alone or no drug.

Setting: Tertiary Rehabilitation Hospital for SCI/D in Italy.

Methods: Data were extracted from medical records. The characteristics of the sample were summarized using absolute and percentage frequencies, median and interquartile range or mean ± standard deviation, as appropriate. Characteristics and outcomes of PI were reported using the PI as the unit of analysis. Categorical variables were compared between groups with and without BTX-NM blockade using the chi-squared test and continuous variables were compared using Mann-Whitney's test. Statistical analyses were carried out using Stata, version 18.0 (StataCorp LLC, 2023).

Results: In this study of 46 persons with 54 PIs, the treatment of spasticity consisted of medication, BTX-NM blockade and intrathecal baclofen. The use of BTX-NM was associated with a significantly lower minor complication rate (13.4% vs 59%, p = 0.003) and a significantly shorter time to complete recovery (44 vs 58 days, p = 0.006).

Conclusion: BTX-NM can be used to prevent muscle spasms and may lead to better outcomes by reducing the minor complication rates and time to recovery.

Introduction: Spinal cord injury (SCI) is a life-changing experience which can result in a substantial range of psychological challenges. Although anxiety is elevated following SCI, evidence suggests that it is underreported and underdiagnosed, with consequences for long-term physical and mental health. In the UK, Cognitive Behavioural Therapy (CBT) is recommended as the first-line intervention for anxiety. However, people with SCI often face additional and complex challenges, which can limit the efficacy of protocol-delivered CBT. Pre-injury vulnerabilities can compound psychological challenges by influencing primary and secondary appraisals and perceived manageability of injury, resulting in poorer mental health and rehabilitation outcomes.

Case presentation: A transdiagnostic treatment intervention using a SCI-specific adjustment model alongside CBT and Coping Effectiveness Training (CET) of an adult with post-injury anxiety and adjustment difficulties (as measured by the GAD-7 and the ADAPSS), and history of depression (as measured by the PHQ-9). Individual psychological treatment for anxiety maintenance cycles, low mood and reduction of threat appraisals are reported, alongside multidisciplinary collaboration to enhance engagement. Outcomes included improved symptoms of anxiety, reduction of loss appraisals and development of resilience appraisals.

Discussion: Case studies of psychological treatment are sparse within the SCI literature. This case provides a detailed application of one of the most recognised psychological treatment modalities - CBT - and its integration with CET within an adjustment model for SCI. This study also highlights the importance of providing psychological support, psychoeducation and self-management strategies for all individuals with SCI, that is not dependent upon the degree of psychological morbidity.