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Delayed paraparesis after posterior spinal fusion for congenital scoliosis: a case report 先天性脊柱侧凸后路脊柱融合术后延迟性截瘫:病例报告
IF 1.2 Q4 Medicine Pub Date : 2024-04-17 DOI: 10.1038/s41394-024-00639-0
Shuhei Ohtsubo, Masayuki Ohashi, Toru Hirano, Hideki Tashi, Tatsuo Makino, Keitaro Minato, Yusuke Mitsuma, Hiroyuki Deguchi, Rintaro Hoshino, Nobuko Ohashi, Kenta Furutani, Hiroyuki Kawashima, Kei Watanabe

Introduction

Although multimodal intraoperative neuromonitoring (IONM), which has high sensitivity and specificity, is typically performed during spinal deformity surgery, neurological status may deteriorate with delay after surgical maneuvers. Here, we report a rare case of delayed postoperative neurological deficit (DPND) that was not detected by IONM during posterior spinal fusion (PSF) for congenital scoliosis.

Case presentation

A 14-year-old male presented with congenital scoliosis associated with T3 and T10 hemivertebrae. Preoperative Cobb angle of proximal thoracic (PT) and main thoracic (MT) curves were 50° and 41°, respectively. PSF (T1-L1) without hemivertebrectomy was performed, and the curves were corrected to 31° and 21° in the PT and MT curves, respectively, without any abnormal findings in IONM, blood pressure, or hemoglobin level. However, postoperative neurological examination revealed complete loss of motor function. A revision surgery, release of the curve correction by removing the rods, was immediately performed and muscle strength completely recovered on the first postoperative day. Five days postoperatively, PSF was achieved with less curve correction (36° in the PT curve and 26° in the MT curve), without postoperative neurological deficits.

Discussion

Possible mechanisms of DPND in our patient are spinal cord ischemia due to spinal cord traction caused by scoliosis correction and spinal cord kinking by the pedicle at the concave side. Understanding the possible mechanisms of intra- and postoperative neural injury is essential for appropriate intervention in each situation. Additionally, IONM should be continued to at least skin closure to detect DPND observed in our patient.

导言尽管多模态术中神经监测(IONM)具有很高的灵敏度和特异性,通常在脊柱畸形手术中进行,但手术操作延迟后神经状况可能会恶化。在此,我们报告了一例罕见的延迟性术后神经功能缺损(DPND)病例,该病例在先天性脊柱侧凸的后路脊柱融合术(PSF)中未被 IONM 检测到。术前胸椎近端(PT)和胸椎主弯(MT)的Cobb角分别为50°和41°。在未进行半椎体切除的情况下进行了PSF(T1-L1)手术,PT和MT曲线分别矫正为31°和21°,IONM、血压和血红蛋白水平均未发现异常。然而,术后神经系统检查发现,患者完全丧失了运动功能。立即进行了翻修手术,通过移除矫正杆解除了曲线矫正,术后第一天肌力就完全恢复了。术后五天,在较少的曲线矫正(PT曲线为36°,MT曲线为26°)的情况下实现了PSF,术后未出现神经功能缺损。讨论本例患者DPND的可能机制是脊柱侧凸矫正导致的脊髓牵引引起的脊髓缺血,以及凹侧椎弓根导致的脊髓扭转。了解术中和术后神经损伤的可能机制对于在各种情况下采取适当的干预措施至关重要。此外,IONM至少应持续到皮肤闭合,以检测在我们患者身上观察到的DPND。
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引用次数: 0
Bilateral tibial fractures associated with powered exoskeleton use in complete spinal cord injury – a case report & literature review 完全性脊髓损伤患者使用动力外骨骼导致的双侧胫骨骨折--病例报告和文献综述
IF 1.2 Q4 Medicine Pub Date : 2024-04-16 DOI: 10.1038/s41394-024-00635-4
John Mahon, Lily Nolan, David O’Sullivan, Mark Curtin, Aiden Devitt, Colin G. Murphy

Introduction

Powered robotic exoskeleton (PRE) physiotherapy programmes are a relatively novel frontier which allow patients with reduced mobility to engage in supported walking. Research is ongoing regarding their utility, risks, and benefits. This article describes the case of two fractures occurring in one patient using a PRE.

Case

We report the case of a 54 year old man who sustained bilateral tibial fractures while using a PRE, on a background of T10 AIS A SCI. The initial session was discontinued due to acute severe bilateral knee swelling after approximately 15 min. The patient attended their local hospital the following day, where radiographs demonstrated bilateral proximal tibial fractures. The patient was treated with manipulation under anaesthetic and long-leg casting for five weeks, at which point he was stepped down to hinged knee braces which were weaned gradually while he remained non-weight bearing for 12 weeks. The patient was investigated with DEXA scan and was diagnosed with osteoporosis. He was liaised with rheumatology services and bone protection was initiated. Fracture healing was achieved and weight-bearing precautions were discontinued, however this period of immobilisation led to significant spasticity. The patient was discharged from orthopaedic services, with ongoing rehabilitation and physiotherapy follow-up.

Conclusion

PRE assisted physiotherapy programmes are a promising concept in terms of rehabilitation and independence, however they are not without risk and it is important that both providers and patients are aware of this. Furthermore, SCI patients are at increased risk for osteoporosis and should be monitored and considered for bone protection.

导言:有动力机器人外骨骼(PRE)理疗计划是一个相对新颖的领域,它可以让行动不便的患者进行辅助行走。有关其效用、风险和益处的研究仍在进行中。我们报告了一名 54 岁男性患者的病例,他在使用 PRE 时发生了双侧胫骨骨折,其背景是 T10 AIS A SCI。最初的治疗在大约 15 分钟后因急性双侧膝关节严重肿胀而中断。第二天,患者到当地医院就诊,X 光片显示双侧胫骨近端骨折。患者在麻醉状态下接受了手法治疗,并进行了为期五周的长腿石膏固定,随后他被换上了铰链式膝关节支具,并在 12 周内一直保持不负重状态。患者接受了 DEXA 扫描检查,被诊断为骨质疏松症。他与风湿病部门取得了联系,并开始进行骨保护。骨折愈合后,患者停止了负重预防措施,但这段固定期导致了明显的痉挛。结论PRE辅助物理治疗计划在康复和独立性方面是一个很有前景的概念,但也不是没有风险,医疗服务提供者和患者都必须意识到这一点。此外,SCI 患者患骨质疏松症的风险增加,应进行监测并考虑保护骨骼。
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引用次数: 0
Acute spinal cord injury serum biomarkers in human and rat: a scoping systematic review 人类和大鼠急性脊髓损伤血清生物标志物:范围界定系统综述
IF 1.2 Q4 Medicine Pub Date : 2024-04-13 DOI: 10.1038/s41394-024-00636-3
Sina Shool, Saeed Rahmani, Mohammad Amin Habibi, Seyed Mohammad Piri, Mahmoud Lotfinia, Delara Jashnani, Sina Asaadi

Study design

Scoping systematic review.

Objectives

To summarize the available experimental clinical and animal studies for the identification of all CSF and serum-derived biochemical markers in human and rat SCI models.

Setting

Tehran, Iran.

Methods

In this scoping article, we systematically reviewed the electronic databases of PubMed, Scopus, WOS, and CENTRAL to retrieve current literature assessing the levels of different biomarkers in human and rat SCI models.

Results

A total of 19,589 articles were retrieved and 6897 duplicated titles were removed. The remaining 12,692 studies were screened by their title/abstract and 12,636 were removed. The remaining 56 were considered for full-text assessment, and 11 papers did not meet the criteria, and finally, 45 studies were included. 26 studies were human observational studies comprising 1630 patients, and 19 articles studied SCI models in rats, including 832 rats. Upon reviewing the literature, we encountered a remarkable heterogeneity in terms of selected biomarkers, timing, and method of measurement, studied models, extent, and mechanism of injury as well as outcome assessment measures.

Conclusions

The specific expression and distribution patterns of biomarkers in relation to spinal cord injury (SCI) phases, and their varied concentrations over time, suggest that cerebrospinal fluid (CSF) and blood biomarkers are effective measures for assessing the severity of SCI.

研究设计范围界定的系统性综述。目的总结现有的临床和动物实验研究,以确定人类和大鼠 SCI 模型中所有 CSF 和血清衍生生化标志物。方法在这篇范围界定的文章中,我们系统性地查阅了 PubMed、Scopus、WOS 和 CENTRAL 等电子数据库,以检索评估人类和大鼠 SCI 模型中不同生物标志物水平的现有文献。结果共检索到 19589 篇文章,删除了 6897 个重复的标题。根据标题/摘要筛选了剩余的 12,692 篇研究,删除了 12,636 篇。对剩余的 56 篇文章进行了全文评估,有 11 篇文章不符合标准,最终有 45 项研究被纳入其中。其中 26 项研究为人类观察性研究,包括 1630 名患者;19 篇文章研究了大鼠 SCI 模型,包括 832 只大鼠。结论 生物标志物在脊髓损伤(SCI)阶段的特异性表达和分布模式以及随时间变化的浓度表明,脑脊液(CSF)和血液中的生物标志物是评估 SCI 严重程度的有效指标。
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引用次数: 0
Trend differences in cervical spinal cord injuries before and after the coronavirus disease 2019 pandemic 2019 年冠状病毒病大流行前后颈椎脊髓损伤的趋势差异
IF 1.2 Q4 Medicine Pub Date : 2024-04-10 DOI: 10.1038/s41394-024-00633-6
Hirotaka Fukushima, Chikara Ushiku, Shoshi Akiyama, Shinji Saito, Hiroki Wakiya, Kenji Okuno, Mitsuru Saito

Study design

Cross-Sectional Study.

Objectives

To investigate the changes in the characteristics of cervical spinal cord injuries (CSCI) before and after the coronavirus disease 2019 (COVID-19) pandemic among patients transported to our hospital in Japan.

Setting

Hospital with an emergency center in Chiba, Japan.

Methods

Patients eligible for the study were those transported within 24 h of injury and diagnosed with cervical spinal cord injury between January 2018 and December 2021 at our hospital. Medical records were retrospectively examined to investigate the number and characteristics of patients with CSCI. The clinical variables of patients with CSCI were compared according to the time of admission as related to the COVID-19 pandemic: 2018-19 (before) or 2020-21 (after).

Results

The total number of patients with CSCI from 2018 to 2021 was 108, with 57 before the COVID-19 pandemic and 51 after the COVID-19 pandemic. The number of severe cases with an injury severity score (ISS) of >16 decreased after COVID-19 (p < 0.05). Falls on level surfaces were the most common cause of injury both before and after COVID-19. Although the ranking of traffic accidents decreased after COVID-19, among those, the number of bicycle injuries tended to increase.

Conclusions

The number of serious cases with an ISS > 16 decreased, presumably because of the decline in high-energy trauma due to the background decrease in the number of traffic accidents.

研究设计横断面研究.Objections To investigate the changes in the characteristics of cervical spinal cord injuries (CSCI) before and after the coronavirus disease 2019 (COVID-19) pandemic among patients transported to our hospital in Japan.SettingHospital with an emergency center in Chiba, Japan.MethodsPatients eligible to the study were those transported within 24 h of injury and diagnosed with cervical spinal cord injury between January 2018 and December 2021 at our hospital.研究方法符合研究条件的患者是在我院2018年1月至2021年12月期间受伤后24小时内转运并被诊断为颈脊髓损伤的患者。通过回顾性研究病历,调查了CSCI患者的数量和特征。根据与COVID-19大流行相关的入院时间:2018-19年(之前)或2020-21年(之后),对CSCI患者的临床变量进行比较。结果2018年至2021年的CSCI患者总数为108例,其中57例在COVID-19大流行之前,51例在COVID-19大流行之后。受伤严重程度评分(ISS)为>16的重症病例数量在COVID-19大流行后有所减少(p< 0.05)。在 COVID-19 之前和之后,在平地摔倒是最常见的受伤原因。虽然 COVID-19 后交通事故的排名有所下降,但其中自行车受伤的数量却呈上升趋势。结论 ISS 为 16 分的严重病例数量有所下降,这可能是由于交通事故数量下降导致高能量创伤减少。
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引用次数: 0
Robotic technology (ROBERT®) to enhance muscle strength in the hip flexor muscles following spinal cord injury: a feasibility study 机器人技术(ROBERT®)增强脊髓损伤后髋关节屈肌的肌肉力量:可行性研究
IF 1.2 Q4 Medicine Pub Date : 2024-04-10 DOI: 10.1038/s41394-024-00630-9
S. L. Sørensen, I. Poulsen, L. A. Harvey, F. Biering-Sørensen, J. F. Nielsen

Study design

Feasibility study.

Objective

To determine the feasibility of conducting a large trial designed to determine whether the ROBERT® can be used to increase the strength of the hip flexor muscles after spinal cord injury (SCI). The ROBERT® is a robotic device that provides assisted active movement while supporting the weight of the leg. Focus was on recruitment capability, suitability, and acceptability of the intervention and outcome measure.

Setting

Specialised SCI centre in Denmark.

Methods

All first-time admitted patients were screened to assess participant recruitment capability. Four people with SCI < 3 months tested a protocol consisting of 60 repetitions of hip flexion in supine conducted with the assistance of the ROBERT® three times a week for 4 weeks. Feasibility was assessed based on adherence to the protocol and completion rate and from the participants’ perspectives. Maximal voluntary contraction (MVC) was accessed at baseline and four weeks.

Results

The recruitment rate was 8% (7 months). The four participants completed 44 out of 48 sessions (92%). No adverse events occurred. One physiotherapist was required to set-up and supervise each session. The active exercise time varied from 7.5 to 17 min. The participants found the ROBERT® a good supplement to their usual rehabilitation. We were able to measure MVC in even very weak hip flexor muscles with a dynamometer MicroFET2 fixed to a frame.

Conclusion

The ROBERT® was feasible and acceptable. The participants perceived it as a supplement, not a replacement to usual physiotherapy. However, recruitment to the study was slow.

Trial registration

ClinicalTrials.gov NCT05558254. Registered 28th September 2022.

研究设计可行性研究。目的确定进行一项大型试验的可行性,该试验旨在确定是否可以使用 ROBERT® 增强脊髓损伤(SCI)后髋屈肌的力量。ROBERT®是一种机器人装置,可在支撑腿部重量的同时提供辅助主动运动。重点是干预和结果测量的招募能力、适用性和可接受性。方法对所有首次入院的患者进行筛选,以评估参与者的招募能力。四名患有 SCI < 3 个月的患者接受了一项方案测试,该方案包括在 ROBERT® 的辅助下进行 60 次仰卧屈髋,每周三次,持续 4 周。根据方案的依从性和完成率,并从参与者的角度对可行性进行了评估。结果招募率为 8%(7 个月)。四名参与者完成了 48 个疗程中的 44 个疗程(92%)。无不良事件发生。每次训练都需要一名物理治疗师进行设置和监督。主动锻炼时间从 7.5 分钟到 17 分钟不等。参与者认为 ROBERT® 是对其常规康复训练的良好补充。我们甚至可以使用固定在框架上的测力计 MicroFET2 来测量非常薄弱的髋屈肌的 MVC。参与者认为它是一种补充,而不是常规物理治疗的替代品。然而,该研究的招募工作进展缓慢。试验注册ClinicalTrials.gov NCT05558254。注册日期:2022 年 9 月 28 日。
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引用次数: 0
A rare case of spontaneous giant pneumorrachis presenting with cauda equina syndrome: a case report 一例罕见的自发性巨大气胸伴马尾综合征病例报告
IF 1.2 Q4 Medicine Pub Date : 2024-04-08 DOI: 10.1038/s41394-024-00631-8
Anuj Gupta, Mayukh Guha, Kuldeep Bansal

Introduction

Pneumorrachis is presence of air in the epidural space. It could be the result of trauma, barotrauma, iatrogenic or spontaneous. The pneumorrachis per se is an underdiagnosed entity as most of the patients are asymptomatic or have subclinical symptoms. The spontaneous occurrence of pneumorrachis has been reported in literature but giant spontaneous occurrence causing cauda equina syndrome has not been reported so far.

Case presentation

We report a case of 56-year-old male patient who came to our OPD on wheelchair with complains of difficulty in walking for 6 months with dribbling of urine for 2 months with on and off back pain. His perianal sensation was reduced with absent voluntary anal contraction. Imaging revealed giant air pockets in the spinal canal of L5-S1 extending upto L4-L5. It was managed surgically wherein laminectomy without fusion was done. The patient responded well to the treatment.

Discussion

There are many causes of pneumorrachis described in literature. Most of the cases of pneumorrachis are asymptomatic and incidentally diagnosed. With the improvement in radio-diagnostic modalities, the diagnosis of pneumorrachis can be easily established. When symptomatic, they can be managed conservatively. Those presenting with neurological deficit may require surgical intervention or other invasive intervention.

导言气瘘是指硬膜外腔存在空气。它可能是创伤、气压创伤、先天性或自发性的结果。由于大多数患者无症状或有亚临床症状,因此气胸本身的诊断率很低。我们报告了一例 56 岁的男性患者,他坐着轮椅来到我们的手术室,主诉行走困难 6 个月,滴尿 2 个月,伴有时有时无的背痛。他的肛周感觉减退,肛门不能自主收缩。影像学检查发现,L5-S1 的椎管内有巨大气囊,一直延伸到 L4-L5。患者接受了手术治疗,进行了无融合椎板切除术。讨论文献中描述的气瘘病因有很多。文献中描述了许多导致气胸的原因,大多数气胸病例都是无症状和偶然被诊断出来的。随着放射诊断方法的改进,肺脓肿的诊断可以很容易地确定。如果没有症状,可以采取保守治疗。而出现神经功能缺损的患者则可能需要进行手术或其他侵入性干预。
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引用次数: 0
A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer® Polyhexanide 0.02% 关于三名患者在注射 0.02% Uro-Tainer® 聚己内酯后出现顽固性自主神经反射障碍的病例报告
IF 1.2 Q4 Medicine Pub Date : 2024-04-05 DOI: 10.1038/s41394-024-00626-5
Louise C. Kelly, Joanne V. Glinsky, Lisa A. Harvey

Introduction

Historically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment.

Case presentation

These case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms.

Discussion

Catheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm.

This case report was prepared following the CARE Guidelines (supplementary file 1).

导言历史上,膀胱冲洗用于将治疗试剂直接灌入膀胱。这种做法已扩展到灌注解决导尿管问题(如结壳或形成生物膜)的溶液。这些产品似乎为长期使用导尿管的人提供了一种很有前景的策略。这些病例研究包括三名脊髓损伤 (SCI) 患者,他们在使用特定溶液冲洗导管时出现了严重的自主反射障碍 (AD)。讨论导尿管相关性尿路感染是 SCI 患者发病和死亡的一个重要原因。长期导尿管为机会性微生物提供了形成生物膜的载体,并创造了促进形成结石的环境,从而增加了慢性导尿管堵塞和尿路感染的风险。虽然使用这些溶液是为了降低这些风险,但它们也给易患 AD 的人带来了额外的风险。这些病例突出表明,在对某些 SCI 患者使用导尿管冲洗溶液时,需要明智地选择患者,并对不良事件进行临床监督和管理。本病例报告是根据 CARE 指南(补充文件 1)编写的。
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引用次数: 0
Facilitation of neurological recovery in a complete spinal cord injury with NeuroAiD: case report 用 NeuroAiD 促进完全性脊髓损伤患者的神经功能恢复:病例报告
IF 1.2 Q4 Medicine Pub Date : 2024-04-03 DOI: 10.1038/s41394-024-00632-7
Muhamad Faizal Zainudin, Salmah Anim Abu Hassan, Nyein Yin Khin

Introduction

NeuroAiD (MLC601 & MLC901)’s neuroprotective capabilities include limiting exaggerated calcium influx, decreasing excitotoxicity, reducing oxidative stress, and preventing glutamate-induced cell death. It has also been shown to facilitate synaptogenesis, neurogenesis, and neuroplasticity. However, its clinical efficacy has primarily been studied in the context of brain injuries, particularly stroke. NeuroAiD’s potential application in SCI remains largely untapped.

Case presentation

A 34-year-old male presented with C4 complete tetraplegia. Following surgical decompression and initial inpatient rehabilitation, he started consuming MLC901 two capsules three times daily at month 4 post injury for 6 months. He regained considerable neurological recovery following the supplementation. Apart from the improvement in the neurological level of injury, the patient exhibited motor recovery beyond the initial zone of partial preservation up to 24 months post injury.

Discussion

Our findings align with a recent animal study demonstrating MLC901’s potential to downregulate Vascular Endothelial Growth Factor (VEGF), a molecule known to increase vascular permeability and exacerbate tissue edema and infarction. In another animal study involving stroke-affected mice, MLC901 demonstrates the ability to promote neurological recovery by regulating the expression of proteins mediating angiogenesis, such as hypoxic inducible factor 1α, erythropoietin, angiopoietins 1 and 2, as well as VEGF. The anecdotal findings from this case report offer preliminary insights into NeuroAiD’s potential in facilitating recovery during post-acute and chronic phases of severe SCI, necessitating further exploration.

导言NeuroAiD(MLC601 & MLC901)的神经保护功能包括限制过多的钙离子流入、降低兴奋毒性、减少氧化应激和防止谷氨酸诱导的细胞死亡。此外,它还能促进突触生成、神经发生和神经可塑性。不过,其临床疗效主要是在脑损伤,尤其是中风的情况下进行研究的。NeuroAiD 在 SCI 中的潜在应用在很大程度上仍未得到开发。经过手术减压和最初的住院康复治疗后,他在伤后第 4 个月开始服用 MLC901,每次两粒,每天三次,共服用 6 个月。补充营养后,他的神经系统得到了相当程度的恢复。我们的研究结果与最近的一项动物研究结果一致,该研究表明 MLC901 有可能下调血管内皮生长因子 (VEGF),VEGF 是一种已知会增加血管通透性并加剧组织水肿和梗死的分子。在另一项涉及受中风影响的小鼠的动物研究中,MLC901 通过调节介导血管生成的蛋白质(如缺氧诱导因子 1α、促红细胞生成素、血管生成素 1 和 2 以及血管内皮生长因子)的表达,显示出促进神经系统恢复的能力。本病例报告中的轶事发现初步揭示了 NeuroAiD 在促进严重 SCI 急性期后和慢性期恢复方面的潜力,因此有必要进一步探讨。
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引用次数: 0
Exploring knowledge and implementation gaps of activity-based therapy in centers lacking specialized spinal cord injury services: understanding therapists' perspectives. 在缺乏脊髓损伤专业服务的中心探索活动疗法的知识和实施差距:了解治疗师的观点。
IF 1.2 Q4 Medicine Pub Date : 2024-03-21 DOI: 10.1038/s41394-024-00619-4
Nicole Cesca, Chantal Lin, Zeina Abu-Jurji, Aaron Wexler, Jonas Mark, Shane McCullum, Rija Kamran, Brian Chan, Kristin E Musselman

Study design: Qualitative exploratory OBJECTIVES: Rehabilitation following spinal cord injury (SCI) is a life-long process involving healthcare in a variety of settings, including facilities lacking SCI-specific services (i.e., non-SCI-specialized centers). Activity-based therapy (ABT) is a neurorestorative approach involving intensive, task-specific movement practice below the injury level. This study explored the existing knowledge, perceptions, and implementation of ABT among physical and occupational therapists working in non-SCI-specialized centers.

Setting: Canadian hospitals and community clinics DESIGN/METHODS: Semi-structured interviews were conducted with Canadian therapists who worked at non-SCI-specialized centers and treated at least one patient with SCI within the last 18 months. The Theoretical Domains Framework was used to develop interview questions that queried therapists' experiences in delivering SCI rehabilitation, their understanding of ABT and experience with its implementation. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description.

Results: Four physical therapists and three occupational therapists, from diverse settings (i.e., acute care, inpatient rehabilitation, long-term care, outpatient rehabilitation, rural outpatient clinic) participated. Three themes were identified: (1) Available knowledge, resources and therapy time in non-SCI-specialized centers challenge ABT implementation, (2) How current therapy practices in non-SCI-specialized centers align with ABT and (3) Desire for ABT knowledge. Although participants were not familiar with the term ABT, it was identified that they were unknowingly incorporating some components of ABT into their practice. Participants expressed a keenness to learn more about ABT.

Conclusion: Current knowledge and implementation of ABT in non-SCI-specialized centers is limited. Tailoring ABT education to therapists at non-SCI-specialized centers may increase ABT implementation.

研究设计:定性探索性 研究目的:脊髓损伤(SCI)后的康复是一个终身过程,涉及各种环境下的医疗保健,包括缺乏 SCI 专门服务的设施(即非 SCI 专门中心)。以活动为基础的疗法(ABT)是一种神经恢复方法,涉及损伤程度以下的强化、特定任务运动练习。本研究探讨了在非 SCI 专科中心工作的物理和职业治疗师对 ABT 的现有认识、看法和实施情况:加拿大医院和社区诊所 设计/方法:对在非 SCI 专科中心工作的加拿大治疗师进行了半结构化访谈,这些治疗师在过去 18 个月内至少治疗过一名 SCI 患者。理论领域框架被用来制定访谈问题,询问治疗师在提供 SCI 康复治疗方面的经验、他们对 ABT 的理解以及实施 ABT 的经验。对访谈进行了录音、逐字转录,并使用解释性描述进行分析:四位物理治疗师和三位职业治疗师参加了访谈,他们来自不同的环境(即急症护理、住院康复、长期护理、门诊康复、农村门诊诊所)。确定了三个主题:(1) 非 SCI 专科中心的可用知识、资源和治疗时间对 ABT 的实施构成挑战;(2) 非 SCI 专科中心当前的治疗实践如何与 ABT 保持一致;(3) 对 ABT 知识的渴望。尽管参与者对 ABT 一词并不熟悉,但发现他们在不知不觉中将 ABT 的某些内容融入了他们的实践中。参与者表示渴望了解更多有关 ABT 的知识:目前,非 SCI 专科中心对 ABT 的了解和实施都很有限。为非 SCI 专科中心的治疗师量身定制 ABT 教育可能会提高 ABT 的实施率。
{"title":"Exploring knowledge and implementation gaps of activity-based therapy in centers lacking specialized spinal cord injury services: understanding therapists' perspectives.","authors":"Nicole Cesca, Chantal Lin, Zeina Abu-Jurji, Aaron Wexler, Jonas Mark, Shane McCullum, Rija Kamran, Brian Chan, Kristin E Musselman","doi":"10.1038/s41394-024-00619-4","DOIUrl":"10.1038/s41394-024-00619-4","url":null,"abstract":"<p><strong>Study design: </strong>Qualitative exploratory OBJECTIVES: Rehabilitation following spinal cord injury (SCI) is a life-long process involving healthcare in a variety of settings, including facilities lacking SCI-specific services (i.e., non-SCI-specialized centers). Activity-based therapy (ABT) is a neurorestorative approach involving intensive, task-specific movement practice below the injury level. This study explored the existing knowledge, perceptions, and implementation of ABT among physical and occupational therapists working in non-SCI-specialized centers.</p><p><strong>Setting: </strong>Canadian hospitals and community clinics DESIGN/METHODS: Semi-structured interviews were conducted with Canadian therapists who worked at non-SCI-specialized centers and treated at least one patient with SCI within the last 18 months. The Theoretical Domains Framework was used to develop interview questions that queried therapists' experiences in delivering SCI rehabilitation, their understanding of ABT and experience with its implementation. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description.</p><p><strong>Results: </strong>Four physical therapists and three occupational therapists, from diverse settings (i.e., acute care, inpatient rehabilitation, long-term care, outpatient rehabilitation, rural outpatient clinic) participated. Three themes were identified: (1) Available knowledge, resources and therapy time in non-SCI-specialized centers challenge ABT implementation, (2) How current therapy practices in non-SCI-specialized centers align with ABT and (3) Desire for ABT knowledge. Although participants were not familiar with the term ABT, it was identified that they were unknowingly incorporating some components of ABT into their practice. Participants expressed a keenness to learn more about ABT.</p><p><strong>Conclusion: </strong>Current knowledge and implementation of ABT in non-SCI-specialized centers is limited. Tailoring ABT education to therapists at non-SCI-specialized centers may increase ABT implementation.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10957876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Priorities, needs and willingness of use of nerve stimulation devices for bladder and bowel function in people with spinal cord injury (SCI): an Australian survey. 脊髓损伤(SCI)患者使用神经刺激装置治疗膀胱和肠道功能的优先级、需求和意愿:澳大利亚调查。
IF 1.2 Q4 Medicine Pub Date : 2024-03-21 DOI: 10.1038/s41394-024-00628-3
Vanesa Bochkezanian, Kelsey J Henricksen, Benjamin J Lineburg, Louis A Myers-Macdonnell, Dennis Bourbeau, Kim D Anderson

Study design: Anonymous online survey OBJECTIVES: To investigate the priorities, needs and willingness to adopt nerve stimulation devices for managing neurogenic bladder and bowel function in people with spinal cord injury (SCI) living in Australia.

Setting: Online survey of people living with SCI in Australia.

Methods: This anonymous online survey used Qualtrics and was advertised via standard communication channels, such as advocacy groups representing the SCI community in Australia, social media, attending SCI sporting events and by word-of-mouth.

Results: Responses from 62 individuals (32% female, 68% male) were included. Bladder emptying through urethra without catheter was the highest priority for bladder function. Reducing time required for bowel routines and constipation were the top priorities regarding bowel function. The highest concern for internal/implanted devices was the 4% chance of device surgical removal, while wearing wires under the clothes was the main concern for external devices. 53% of respondents were willing to trial an implanted nerve stimulation device, while 70% would trial an external device to improve and gain independence in bladder and bowel function.

Conclusion: The findings of this study highlighted the potential role in which nerve stimulation can have in addressing bladder and bowel dysfunction in people with SCI, and have also identified that there was a need for Australian physiotherapists to evaluate their role in bladder and bowel dysfunction. Results from this study can help guide further research in nerve stimulation devices for bladder and bowel dysfunction in people with SCI.

Sponsorship: n/a.

研究设计:匿名在线调查 目的调查澳大利亚脊髓损伤(SCI)患者采用神经刺激设备管理神经源性膀胱和排便功能的优先事项、需求和意愿:对澳大利亚脊髓损伤(SCI)患者进行在线调查:这项匿名在线调查使用 Qualtrics,并通过标准沟通渠道进行宣传,如代表澳大利亚 SCI 社区的宣传团体、社交媒体、参加 SCI 体育赛事和口碑传播:共收到 62 人(32% 为女性,68% 为男性)的回复。不使用导尿管通过尿道排空膀胱是膀胱功能方面最优先考虑的问题。在排便功能方面,减少排便所需的时间和便秘是最优先考虑的问题。对于体内/植入式器械,受访者最担心的是 4% 的器械手术移除几率,而对于外置式器械,受访者最担心的是在衣服下穿电线。53%的受访者愿意试用植入式神经刺激装置,70%的受访者愿意试用外置装置来改善膀胱和排便功能并获得独立性:本研究结果强调了神经刺激在解决 SCI 患者膀胱和排便功能障碍方面的潜在作用,同时也指出澳大利亚物理治疗师有必要对其在膀胱和排便功能障碍方面的作用进行评估。这项研究的结果有助于指导进一步研究用于治疗 SCI 患者膀胱和排便功能障碍的神经刺激装置。
{"title":"Priorities, needs and willingness of use of nerve stimulation devices for bladder and bowel function in people with spinal cord injury (SCI): an Australian survey.","authors":"Vanesa Bochkezanian, Kelsey J Henricksen, Benjamin J Lineburg, Louis A Myers-Macdonnell, Dennis Bourbeau, Kim D Anderson","doi":"10.1038/s41394-024-00628-3","DOIUrl":"10.1038/s41394-024-00628-3","url":null,"abstract":"<p><strong>Study design: </strong>Anonymous online survey OBJECTIVES: To investigate the priorities, needs and willingness to adopt nerve stimulation devices for managing neurogenic bladder and bowel function in people with spinal cord injury (SCI) living in Australia.</p><p><strong>Setting: </strong>Online survey of people living with SCI in Australia.</p><p><strong>Methods: </strong>This anonymous online survey used Qualtrics and was advertised via standard communication channels, such as advocacy groups representing the SCI community in Australia, social media, attending SCI sporting events and by word-of-mouth.</p><p><strong>Results: </strong>Responses from 62 individuals (32% female, 68% male) were included. Bladder emptying through urethra without catheter was the highest priority for bladder function. Reducing time required for bowel routines and constipation were the top priorities regarding bowel function. The highest concern for internal/implanted devices was the 4% chance of device surgical removal, while wearing wires under the clothes was the main concern for external devices. 53% of respondents were willing to trial an implanted nerve stimulation device, while 70% would trial an external device to improve and gain independence in bladder and bowel function.</p><p><strong>Conclusion: </strong>The findings of this study highlighted the potential role in which nerve stimulation can have in addressing bladder and bowel dysfunction in people with SCI, and have also identified that there was a need for Australian physiotherapists to evaluate their role in bladder and bowel dysfunction. Results from this study can help guide further research in nerve stimulation devices for bladder and bowel dysfunction in people with SCI.</p><p><strong>Sponsorship: </strong>n/a.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10957911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Spinal Cord Series and Cases
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