Spinal Cord Series and Cases最新文献

Introduction: Shoulder pain mostly due to high biomechanical load of the anterior-shoulder musculature is prevalent among manual wheelchair users with spinal cord injury or disorder (SCI/D). This case study showcases a novel pull-function attachment to the wheelchair that reverses the propulsion motion by pulling rather than pushing the wheelchair. Additionally, the study reports its preliminary usability and impact on shoulder pain.

Case presentation: Four individuals with SCI/D (median age: 33; 1 female) used the novel pull-function attachment to the manual wheelchair for six weeks. Usability (System Usability Scale; ranging from 1 = 'strongly disagree' to 5 = 'strongly agree') and daily usage time were assessed. Shoulder pain intensity was explored before and after the six weeks using the Wheelchair User's Shoulder Pain Index. Median usability scores were ≥3.0 for 5/6 items, indicating high usability of the assistive technology. Shoulder pain intensity was reduced in all participants at the post-test (median change: -6.3), with the change in shoulder pain exceeding the minimal detectable change for 2/3 participants.

Discussion: The results of this case study suggest high usability of the pull-function attachment to the wheelchair. The decreases in shoulder pain intensity reported following six weeks of use were noticeable and may have clinical relevance. This novel assistive technology that enables forward propulsion by pulling rather than pushing the wheelchair may therefore have the potential to reduce shoulder pain in manual wheelchair users with SCI/D.

Study design: Multi-phase root cause analysis (RCA) OBJECTIVES: Determine the root cause of why veterans developed a novel CAPrI following the completion of the CAPP-FIT intervention from the providers and veterans' perspectives.

Setting: A Midwest Veteran Health Administration (VHA) facility SCI clinic.

Methods: RCA using Five Why's method and chronology mapping for veterans with spinal cord injury who developed a novel community-acquired pressure injury (CAPrI) following use of a decision support tool to prevent CAPrIs, called the Community Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT). Data sources include the electronic health record and veteran responses to the CAPP-FIT.

Results: Key themes emerged describing differing provider/veteran perspectives and barriers that led to the development of a novel CAPrI. Themes included (1) disagreement in level of care needed due to complexity of needs or differing priorities; (2) focus on education and treatment over prevention; (3) barriers in accessing VHA care; and (4) veteran and informal resource engagement.

Conclusion: CAPrI's develop quickly, and some can be prevented. Improving the speed that veterans gain access to critical services (e.g., caregiver and specialists), as well as improving communication at the system level (i.e., across VHA facilities and to private facilities) can decrease the risk of CAPrI's.

Study design: A retrospective study.

Objectives: Neurological deficits occur in 1/3 of spinal infection cases. Non-specific symptoms can lead to delays in diagnosis. This study reviews outcomes and the timeliness of diagnosis in patients with spinal infection who sustained subsequent spinal cord impairment.

Setting: All 40 patients admitted to The Princess Royal Spinal Injuries Centre, Sheffield, UK, between 2016-2018 for rehabilitation for spinal cord impairment secondary to spinal infection.

Results: The average age was 58.6 years (31-85; SD 13.1) with 24 (60%) being male. 36 (90%) had native infections and 3 (7.5%) were acquired post-operatively (1 (2.5%) unknown). 7 patients had been intravenous drug users (17.5%). 50% (20) had previously sought medical attention for the same symptoms. There were long intervals to suspected diagnosis and to MRI (range 0-30 days). 15 (37.5%) patients deteriorated neurologically following admission to hospital; 8 were taking antibiotics at the time of deterioration. None of the patients had normal C-reactive protein levels at presentation. 7 (17.5%) sustained complete spinal cord impairment. 27 (67.5%) were discharged as wheelchair users.

Conclusions: Whilst the majority of patients responded to rehabilitation interventions, they were left with residual life changing disabilities. Among those requiring rehabilitation, delays in diagnosis appear to frequently occur pre-hospital. This could be attributed to a low index of suspicion in the community. Some deteriorated neurologically despite antibiotics. Close neurological monitoring of those suspected or confirmed to have a diagnosis of spinal infection is appropriate. There should be a low threshold for the use of inflammatory markers when investigating back pain.

Study design: Methodological Research Design.

Objectives: To establish the content validity, internal consistency reliability & test-retest reliability of the SCI-FCS for individuals with SCI in Delhi, India.

Setting: Indian Spinal Injuries Centre, India.

Methods: A panel of 13 experts validated the content of the 16-item scale using both qualitative and quantitative methods. The scale was then piloted with 43 manual wheelchair users with SCI. Internal consistency was assessed through item analysis, and 20 participants were retested after one week to evaluate test-retest reliability.

Results: All items met the minimum Content Validity Ratio (CVR) of 0.54 required for 13 experts, ensuring their retention. The scale demonstrated a strong internal consistency (Cronbach's alpha = 0.865) and good test-retest reliability (ICC = 0.785).

Conclusion: The SCI-FCS is a valid and reliable tool to assess the fall concerns in manual wheelchair users with SCI in Delhi, India. It can help rehabilitation professionals evaluate the effectiveness of fall prevention interventions.

Sponsorship: None.

Introduction: Traumatic spinal cord injury (SCI) tetraplegics are at an increased risk of deep venous thrombosis (DVT) due to immobility and altered hemostasis. Inflammatory bowel diseases such as ulcerative colitis (UC) face an elevated risk of thrombotic events due to chronic inflammation, in addition to the risk of diarrhea and bleeding. The case report underscores the potentially additive prothrombotic effects of ulcerative colitis and tetraplegia.

Case presentation: A 53-year-old male with UC and traumatic R C3 L C4 sensory, R C3 L C5 motor ASIA impairment C tetraplegia, developed a below the knee DVT during inpatient rehabilitation, despite DVT prophylaxis. Due to potential risk of progression, interventions ultimately included serial ultrasound examinations, IVC filter, and anticoagulation. However, due to bleeding complications, anticoagulation was discontinued, followed by worsening of DVT to the bilateral lower extremities which advanced above the knees. Subsequently, the patient developed clostridium difficile infection, further exacerbating his ulcerative colitis. Bowel program was impacted, and treatment was provided for both clostridium difficile and ulcerative colitis.

Discussion: Both UC and traumatic SCI increase have risk of thrombosis. UC exacerbations and bleeding pose challenges in the treatment of DVT. The need to discontinue anticoagulation due to bleeding risk led to a significant progression of the DVT. SCI bowel program required careful adjustments in the setting of an UC exacerbation, likely triggered by clostridium difficile infection.

Study design: A development and reliability study.

Objectives: To develop an assessment tool designed to categorize the care needs of inpatients with Spinal Cord Injuries.

Setting: Spinal Cord Injury Centre of Western Denmark.

Methods: Inspired by previous tools, NCA-SCI was refined through an iterative process with experienced clinicians. Content validity was established via consensus meetings and focus group interviews, resulting in 17 items across five categories: no/minor assistance, moderate assistance, severe nursing assistance, and unstable situations needing extensive nursing care. Face validity was ensured through iterative clinical feedback, and reliability was tested with four nurses scoring 36 patients.

Results: Content validity and feedback led to a comprehensive, practical tool. Inter-rater reliability showed 81.4% agreement (Kappa = 0.69), while intra-rater reliability had 78.9% agreement (Kappa = 0.65), indicating moderate reliability.

Conclusion: The NCA-SCI assesses nursing care needs in SCI rehabilitation, offering a practical tool with moderate reliability. The development of the NCA-SCI led to an easily usable tool for planning and coordinating daily care at a highly specialized unit.

Study design: A systematic review.

Objectives: Tuberculous myelitis, an uncommon disorder, often manifests as transverse myelopathy. The majority of the literature comprises isolated case reports, necessitating a systematic review for better understanding and management.

Setting: Uttar Pradesh India.

Methods: Our review followed PRISMA guidelines, searching PubMed, Scopus, Embase, and Google Scholar with no language constraints. Quality assessment of reports was based on selection, ascertainment, causality, and reporting. Data synthesis was qualitative with categorical and continuous data representation.

Results: We analyzed 34 reports describing 39 individuals. The majority (85%) had a duration of illness of one month or less. Upper motor neuron paraparesis was the most common neurological manifestation (69.2%), followed by areflexic paraparesis (15.3%). Paradoxical reactions occurred in 20.5% of cases. Microbiological confirmation was achievable in approximately 77% of cases. Neuroimaging abnormalities were present in 41% of cases, and chest imaging abnormalities in 53.9%. Longitudinally-extensive hyperintensities in cervical and thoracic regions were common spinal imaging abnormalities. Central nervous system tuberculosis was confirmed in 47.7% of cases, while pulmonary and disseminated tuberculosis were each found in 25.6%. Improvement was noted in 87.2% of cases, while 10.3% did not improve or died.

Conclusion: Tuberculous myelitis, is a distinct spinal cord disease. Most cases had microbiological confirmation, and the majority showed improvement with treatment.

Introduction: Loss of appetite is a neglected condition in individuals with spinal cord injury, often assessed as an emotional issue, without considering the autonomic dysfunctions that decrease gastric afferents, altering hunger perception, to the same extent as it causes autonomic dysreflexia, neurogenic bladder, and neurogenic bowel related to the interruption of information flow between effector organs and the brain. The objective of the report the side effect of appetite from the robotic exoskeleton for lower limbs with direct ground weight unloading.

Case presentation: A 30-year-old man with a complete SCI (T8, AIS A) and no appetite perception since the injury experienced an unexpected recovery of appetite during exoskeleton-assisted walking therapy. Appetite improvement occurred after two sessions and coincided with the onset of walking in the exoskeleton.

Discussion: The recovery of appetite during exoskeleton-assisted walking could be linked to autonomic and visceral afferent improvements. However, this observation is exploratory, and other factors, such as mood enhancement from experiencing walking, may have contributed. Further studies are needed to investigate these mechanisms.

Introduction: Individuals with spinal cord injury (SCI) experience alterations in metabolism that result in increased central obesity, insulin resistance, and dyslipidemia placing them at elevated risk for developing cardiometabolic disease (CMD). Increased exercise and dietary modifications are the primary interventions for preventing CMD. However, people with SCI face unique challenges that prevent them from increasing their physical activity and easily modifying their nutritional intake. Tirzepatide is a medication that has been approved by the Food and Drug Administration to be used in conjunction with lifestyle changes to treat obesity in adults with type 2 diabetes mellitus.

Case presentation: A male in his 40's with C6 American Spinal Injury Association Impairment Scale B SCI 15 years prior with a body mass index of 32 presented to his primary care provider for treatment of obesity. He previously worked with multiple dietitians and increased his physical activity to lose weight. Despite these interventions, he was unable to reduce his weight. He was started on tirzepatide. After 3 months of treatment, he lost 31 pounds and saw improvements in his lipid profile. The only adverse effect reported was heartburn.

Discussion: The metabolic dysfunction associated with SCI and barriers to adequate exercise for weight loss place individuals with SCI at increased risk for obesity and developing CMD. Tirzepatide may be an effective adjunct therapy to lifestyle interventions to help prevent CMD in those with SCI. Further research is indicated to examine the long-term efficacy, benefits, and adverse effects that may be associated with tirzepatide.

Study design: Cross-sectional explorative observational study.

Setting: The China Rehabilitation Research Center is one of the centers for spinal cord injury in China, and this study investigates the Chinese part of spinal cord injury.

Objective: To observe the changes of fecal short-chain fatty acids (SCFA) in patients with traumatic spinal cord injury (TSCI) compared with normal controls.

Methods: Thirty-eight patients with TSCI who were hospitalized in Beijing Boai Hospital of China Rehabilitation Research Center from April, 2017 to October, 2018 were recruited. Basic data such as age, gender, neurological level, etiology, and defecation method were recorded, and neurogenic bowel dysfunction score (NBD) was assessed. Twenty-one healthy subjects from the staffs of Beijing Bo'ai Hospital were recruited as the control group. Fresh stool samples were collected and gas chromatography-mass spectrometry (GC-MS) was used to determine the contents of caproic acid, isovaleric acid, isobutyric acid, valeric acid, butyric acid, propionic acid and acetic acid in feces of TSCI patients and controls. The Mann-Whitney U test was used to compare SCFA levels between the two groups.

Results: Compared with healthy controls, the levels of isovaleric acid and isobutyric acid in the feces of TSCI patients increased, while the levels of butyric acid and acetic acid decreased, and the differences were statistically significant (P < 0.05).

Conclusion: The fecal content of propionic acid and butyric acid decreased while that of isobutyric acid and isoamyl acid increased in patients with chronic TSCI.