Spinal Cord Series and Cases最新文献

Study design: Exploratory qualitative descriptive study.

Objectives: We aimed to explore how dietitians assess and diagnose malnutrition in individuals with spinal cord injury (SCI), limitations of current practice, and barriers to optimal practice, as well as improvements that could be made.

Setting: Twelve dietitians working in hospital, rehabilitation, and community contexts across Australia, the United Kingdom, the United States, Norway, South Africa, and New Zealand.

Methods: Semi-structured interviews were conducted via Microsoft Teams between April and August 2024. Data were recorded, transcribed, and analysed thematically using Braun and Clarke's six-step thematic analysis method.

Results: Participants primarily relied on generic screening tools due to institutional policy and ease of use. They expressed concerns about distinguishing obligatory post-injury weight changes from true undernutrition, and the minimal focus on overnutrition. Practical barriers to effective malnutrition identification included limited equipment access and staffing constraints, exacerbating screening challenges. Participants advocated for SCI-specific guidelines to improve diagnostic accuracy and reduce misclassification.

Conclusions: Weight-centric approaches risk misclassifying malnutrition in SCI. Tailored frameworks that incorporate functional, clinical, and psychosocial factors are needed, alongside institutional support for successful implementation. Refined tools may standardise assessment and better address malnutrition's complex aetiology in SCI. Future research should explore and validate these approaches and evaluate their implementation in diverse SCI contexts.

Introduction: Respiratory complications are the leading cause of morbidity and mortality in people with spinal cord injuries (SCI). Respiratory muscle weakness and altered mechanics occur in patients with cervical SCI, resulting in impaired airway clearance and low lung volumes. Respiratory physiotherapy includes cough augmentation techniques, such as manual assisted cough and/or mechanical insufflation-exsufflation (MI-E) to address these problems. Additionally, this population is at risk of pulmonary embolism, often receiving therapeutic anticoagulation.

Case report: This case study presents a rare presentation of a large haemoperitoneum in a 22-year-old male with an acute C4 SCI, undergoing regular MI-E and manual assisted coughs whilst therapeutically anticoagulated with enoxaparin for multiple subsegmental pulmonary emboli. Additional contributing factors include higher dose therapeutic anticoagulation in the setting of elevated body mass index and a requirement for frequent, firm manual assisted coughs. Whilst no surgical intervention was required, the patient was admitted to the intensive care unit for close monitoring and received blood transfusions.

Discussion: This report discusses the challenges encountered with managing respiratory compromise in patients with SCI, including the balance between therapeutic management of pulmonary emboli and the potentially under-appreciated risk of intra-abdominal haemorrhage with manual assisted coughs. This rare but serious complication highlights the need for careful risk-benefit analysis by clinicians providing respiratory physiotherapy in this patient population.

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.