Pub Date : 2024-01-01Epub Date: 2024-05-23DOI: 10.46292/sci23-00068
Alexander Mark Weber, Tom E Nightingale, Michael Jarrett, Amanda H X Lee, Olivia Lauren Campbell, Matthias Walter, Samuel J E Lucas, Aaron Phillips, Alexander Rauscher, Andrei V Krassioukov
Background: Spinal cord injuries (SCI) often result in cardiovascular issues, increasing the risk of stroke and cognitive deficits.
Objectives: This study assessed cerebrovascular reactivity (CVR) using functional magnetic resonance imaging (fMRI) during a hypercapnic challenge in SCI participants compared to noninjured controls.
Methods: Fourteen participants were analyzed (n = 8 with SCI [unless otherwise noted], median age = 44 years; n = 6 controls, median age = 33 years). CVR was calculated through fMRI signal changes.
Results: The results showed a longer CVR component (tau) in the grey matter of SCI participants (n = 7) compared to controls (median difference = 3.0 s; p < .05). Time since injury (TSI) correlated negatively with steady-state CVR in the grey matter and brainstem of SCI participants (RS = -0.81, p = .014; RS = -0.84, p = .009, respectively). Lower steady-state CVR in the brainstem of the SCI group (n = 7) correlated with lower diastolic blood pressure (RS = 0.76, p = .046). Higher frequency of hypotensive episodes (n = 7) was linked to lower CVR outcomes in the grey matter (RS = -0.86, p = .014) and brainstem (RS = -0.89, p = .007).
Conclusion: Preliminary findings suggest a difference in the dynamic CVR component, tau, between the SCI and noninjured control groups, potentially explaining the higher cerebrovascular health burden in SCI individuals. Exploratory associations indicate that longer TSI, lower diastolic blood pressure, and more hypotensive episodes may lead to poorer CVR outcomes. However, further research is necessary to establish causality and support these observations.
{"title":"Cerebrovascular Reactivity Following Spinal Cord Injury.","authors":"Alexander Mark Weber, Tom E Nightingale, Michael Jarrett, Amanda H X Lee, Olivia Lauren Campbell, Matthias Walter, Samuel J E Lucas, Aaron Phillips, Alexander Rauscher, Andrei V Krassioukov","doi":"10.46292/sci23-00068","DOIUrl":"10.46292/sci23-00068","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injuries (SCI) often result in cardiovascular issues, increasing the risk of stroke and cognitive deficits.</p><p><strong>Objectives: </strong>This study assessed cerebrovascular reactivity (CVR) using functional magnetic resonance imaging (fMRI) during a hypercapnic challenge in SCI participants compared to noninjured controls.</p><p><strong>Methods: </strong>Fourteen participants were analyzed (<i>n</i> = 8 with SCI [unless otherwise noted], median age = 44 years; <i>n</i> = 6 controls, median age = 33 years). CVR was calculated through fMRI signal changes.</p><p><strong>Results: </strong>The results showed a longer CVR component (tau) in the grey matter of SCI participants (<i>n</i> = 7) compared to controls (median difference = 3.0 s; <i>p</i> < .05). Time since injury (TSI) correlated negatively with steady-state CVR in the grey matter and brainstem of SCI participants (<i>R</i><sub>S</sub> = -0.81, <i>p</i> = .014; <i>R</i><sub>S</sub> = -0.84, <i>p</i> = .009, respectively). Lower steady-state CVR in the brainstem of the SCI group (<i>n</i> = 7) correlated with lower diastolic blood pressure (<i>R</i><sub>S</sub> = 0.76, <i>p</i> = .046). Higher frequency of hypotensive episodes (<i>n</i> = 7) was linked to lower CVR outcomes in the grey matter (<i>R</i><sub>S</sub> = -0.86, <i>p</i> = .014) and brainstem (<i>R</i><sub>S</sub> = -0.89, <i>p</i> = .007).</p><p><strong>Conclusion: </strong>Preliminary findings suggest a difference in the dynamic CVR component, tau, between the SCI and noninjured control groups, potentially explaining the higher cerebrovascular health burden in SCI individuals. Exploratory associations indicate that longer TSI, lower diastolic blood pressure, and more hypotensive episodes may lead to poorer CVR outcomes. However, further research is necessary to establish causality and support these observations.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 2","pages":"78-95"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11123610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155629","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}
Pub Date : 2024-01-01Epub Date: 2024-08-08DOI: 10.46292/sci23-00090
Antoine Dionne, Andréane Richard-Denis, Jean-Marc Mac-Thiong
Background: The proportion of patients with American Spinal Injury Association Impairment Scale (AIS) grade D traumatic spinal cord injuries (tSCI) is increasing. Although initial motor deficits can be relatively mild, some individuals fail to recover functional independence.
Objectives: This study aims to identify factors associated with failure to reach complete functional independence after AIS grade D tSCI.
Methods: An observational prospective cohort study was conducted at a level 1 trauma center specialized in SCI care. A prospective cohort of 121 individuals with an AIS-D tSCI was considered. The baseline characteristics, length of acute stay, need for inpatient rehabilitation, and 12-month functional status were assessed. Univariate and classification and regression tree (CART) analyses were performed to identify factors associated with reaching complete versus incomplete functional independence (defined as perfect total SCIM III score at 12-month follow-up).
Results: There were 69.3%, 83.3%, and 61.4% individuals reaching complete independence in self-care, respiration/sphincter management, and mobility, respectively. A total of 64 individuals (52%) reached complete functional independence in all three domains. In the CART analysis, we found that patients are more likely to achieve complete functional independence when they have a baseline motor score ≥83 (65% individuals) and if they present fewer medical comorbidities (70% individuals if Charlson Comorbidity Index [CCI] ≤4).
Conclusion: About half of individuals with AIS grade D tSCI can expect complete long-term functional independence. It is important to recognize early during acute care individuals with baseline motor score <83 or a high burden of comorbidities (CCI ≥5) to optimize their rehabilitation plan.
背景：美国脊髓损伤协会损伤量表（AIS）D级创伤性脊髓损伤（tSCI）患者的比例正在增加。虽然最初的运动障碍可能相对较轻，但有些患者无法恢复功能独立性：本研究旨在确定 AIS D 级创伤性脊髓损伤后未能达到完全功能独立的相关因素：在一家专门从事 SCI 护理的一级创伤中心开展了一项前瞻性队列观察研究。研究考虑了121名AIS-D级tSCI患者的前瞻性队列。研究人员对患者的基线特征、急性期住院时间、住院康复需求以及12个月的功能状态进行了评估。通过单变量和分类及回归树（CART）分析，确定达到完全或不完全功能独立（定义为随访12个月时SCIM III总分满分）的相关因素：在生活自理、呼吸/括约肌管理和行动能力方面，分别有69.3%、83.3%和61.4%的患者达到完全独立。共有 64 人（52%）在所有三个领域都达到了完全功能独立。在CART分析中，我们发现，如果患者的基线运动评分≥83分（65%的患者），且合并症较少（如果Charlson合并症指数[CCI]≤4，70%的患者），则更有可能实现完全功能独立：结论：约半数患有 AIS D 级 tSCI 的患者有望实现完全的长期功能独立。重要的是，在急性期护理过程中应及早识别基线运动评分为 D 级的患者。
{"title":"Predicting Complete versus Incomplete Long-Term Functional Independence after Acute AIS Grade D Spinal Cord Injury: A Prospective Cohort Study.","authors":"Antoine Dionne, Andréane Richard-Denis, Jean-Marc Mac-Thiong","doi":"10.46292/sci23-00090","DOIUrl":"10.46292/sci23-00090","url":null,"abstract":"<p><strong>Background: </strong>The proportion of patients with American Spinal Injury Association Impairment Scale (AIS) grade D traumatic spinal cord injuries (tSCI) is increasing. Although initial motor deficits can be relatively mild, some individuals fail to recover functional independence.</p><p><strong>Objectives: </strong>This study aims to identify factors associated with failure to reach complete functional independence after AIS grade D tSCI.</p><p><strong>Methods: </strong>An observational prospective cohort study was conducted at a level 1 trauma center specialized in SCI care. A prospective cohort of 121 individuals with an AIS-D tSCI was considered. The baseline characteristics, length of acute stay, need for inpatient rehabilitation, and 12-month functional status were assessed. Univariate and classification and regression tree (CART) analyses were performed to identify factors associated with reaching complete versus incomplete functional independence (defined as perfect total SCIM III score at 12-month follow-up).</p><p><strong>Results: </strong>There were 69.3%, 83.3%, and 61.4% individuals reaching complete independence in self-care, respiration/sphincter management, and mobility, respectively. A total of 64 individuals (52%) reached complete functional independence in all three domains. In the CART analysis, we found that patients are more likely to achieve complete functional independence when they have a baseline motor score ≥83 (65% individuals) and if they present fewer medical comorbidities (70% individuals if Charlson Comorbidity Index [CCI] ≤4).</p><p><strong>Conclusion: </strong>About half of individuals with AIS grade D tSCI can expect complete long-term functional independence. It is important to recognize early during acute care individuals with baseline motor score <83 or a high burden of comorbidities (CCI ≥5) to optimize their rehabilitation plan.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 3","pages":"50-58"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976854","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}
Pub Date : 2024-01-01Epub Date: 2024-08-08DOI: 10.46292/sci23-00052
Pallavi, Shambhovi Mitra, Anne E Palermo
Background: Respiratory complications are a leading cause of mortality post spinal cord injury (SCI). Along with breathing, respiratory muscles have a role in maintaining seated balance. Postinjury breathing influences respiratory muscle function. Preliminary evidence indicates a relation between respiratory muscle function and seated balance in people with chronic SCI dwelling in the community, but the relationship between balance and body habitus has not been explored.
Objectives: To explore the relationships among inspiratory muscle function, functional seated balance (FSB), and body habitus in people with SCI.
Methods: A convenience sample of inpatients with SCI (C5-T12) aged 18 to 60 years who were using a wheelchair was recruited from November 2022 to March 2023. Those with additional neurological disorders or respiratory support were excluded. Respiratory muscle function measures included maximal inspiratory pressure (MIP), sustained MIP (SMIP), and Fatigue Index Test (FIT). FSB was scored using the Function in Sitting Test (FIST). Body habitus was assessed using the axillary: umbilical (A:U) ratio. Spearman correlations explored the relationships.
Results: Thirty-eight of 42 screened participants were eligible and participated (male, 32). Levels of injury ranged from C5 to T12. The mean (SD) age and duration of injury of the sample was 25.61 (6.68) years and 31.03 (28.69) months, respectively. SMIP and FIT correlated significantly with FSB (rs= .441, p = .01, and rs= .434, p = .006, respectively). A significant correlation between SMIP and A:U ratio (rs= -.330, p = .043) was observed.
Conclusion: We observed a significant correlation between inspiratory pressure parameters and both functional seated balance and body habitus, adding to evidence on postural role of respiratory muscles.
{"title":"Functional Sitting Balance and Anthropometric Measures Are Related to Inspiratory Muscle Performance in People with Spinal Cord Injury.","authors":"Pallavi, Shambhovi Mitra, Anne E Palermo","doi":"10.46292/sci23-00052","DOIUrl":"10.46292/sci23-00052","url":null,"abstract":"<p><strong>Background: </strong>Respiratory complications are a leading cause of mortality post spinal cord injury (SCI). Along with breathing, respiratory muscles have a role in maintaining seated balance. Postinjury breathing influences respiratory muscle function. Preliminary evidence indicates a relation between respiratory muscle function and seated balance in people with chronic SCI dwelling in the community, but the relationship between balance and body habitus has not been explored.</p><p><strong>Objectives: </strong>To explore the relationships among inspiratory muscle function, functional seated balance (FSB), and body habitus in people with SCI.</p><p><strong>Methods: </strong>A convenience sample of inpatients with SCI (C5-T12) aged 18 to 60 years who were using a wheelchair was recruited from November 2022 to March 2023. Those with additional neurological disorders or respiratory support were excluded. Respiratory muscle function measures included maximal inspiratory pressure (MIP), sustained MIP (SMIP), and Fatigue Index Test (FIT). FSB was scored using the Function in Sitting Test (FIST). Body habitus was assessed using the axillary: umbilical (A:U) ratio. Spearman correlations explored the relationships.</p><p><strong>Results: </strong>Thirty-eight of 42 screened participants were eligible and participated (male, 32). Levels of injury ranged from C5 to T12. The mean (<i>SD</i>) age and duration of injury of the sample was 25.61 (6.68) years and 31.03 (28.69) months, respectively. SMIP and FIT correlated significantly with FSB (<i>r</i> <sub>s</sub>= .441, <i>p</i> = .01, and <i>r</i> <sub>s</sub>= .434, <i>p</i> = .006, respectively). A significant correlation between SMIP and A:U ratio (<i>r</i> <sub>s</sub>= -.330, <i>p</i> = .043) was observed.</p><p><strong>Conclusion: </strong>We observed a significant correlation between inspiratory pressure parameters and both functional seated balance and body habitus, adding to evidence on postural role of respiratory muscles.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 3","pages":"41-49"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976853","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}
M. Graco, Gerard Weber, K. Saravanan, Jacqueline Curran, Nicole Whitehead, J. Ross, Charito DelaCruz, Samritti Sood, Roxana E. Heriseanu, Ching Li Chai-Coetzer, David J. Berlowitz, David Joffe
Obstructive sleep apnea (OSA) is highly prevalent and poorly managed in spinal cord injury (SCI). Alternative management models are urgently needed to improve access to care. We previously described the unique models of three SCI rehabilitation centers that independently manage uncomplicated OSA. The primary objective was to adapt and implement a similar rehabilitation-led model of managing OSA in an SCI rehabilitation center in Australia. Secondary objectives were to identify the local barriers to implementation and develop and deliver tailored interventions to address them. A clinical advisory group comprised of rehabilitation clinicians, external respiratory clinicians, and researchers adapted and developed the care model. A theory-informed needs analysis was performed to identify local barriers to implementation. Tailored behavior change interventions were developed to address the barriers and prepare the center for implementation. Pathways for ambulatory assessments and treatments were developed, which included referral for specialist respiratory management of complicated cases. Roles were allocated to the team of rehabilitation doctors, physiotherapists, and nurses. The team initially lacked sufficient knowledge, skills, and confidence to deliver the OSA care model. To address this, comprehensive education and training were provided. Diagnostic and treatment equipment were acquired. The OSA care model was implemented in July 2022. This is the first time a rehabilitation-led model of managing OSA has been implemented in an SCI rehabilitation center in Australia. We describe a theory-informed method of adapting the model of care, assessing the barriers, and delivering interventions to overcome them. Results of the mixed-methods evaluation will be reported separately.
阻塞性睡眠呼吸暂停（OSA）在脊髓损伤（SCI）患者中发病率很高，但管理不善。亟需其他管理模式来改善护理服务。我们曾介绍过三家 SCI 康复中心独立管理无并发症 OSA 的独特模式。 我们的首要目标是在澳大利亚的一家 SCI 康复中心调整并实施类似的以康复为主导的 OSA 管理模式。次要目标是确定当地的实施障碍，并针对这些障碍制定和实施有针对性的干预措施。 由康复临床医生、外部呼吸临床医生和研究人员组成的临床咨询小组对护理模式进行了调整和开发。在理论指导下进行需求分析，以确定当地的实施障碍。针对这些障碍制定了量身定制的行为改变干预措施，并为中心的实施做好准备。 制定了门诊评估和治疗路径，其中包括复杂病例的呼吸专科转诊。由康复医生、物理治疗师和护士组成的团队被分配了职责。该团队最初缺乏足够的知识、技能和信心来实施 OSA 护理模式。为解决这一问题，我们提供了全面的教育和培训。还购置了诊断和治疗设备。OSA 护理模式于 2022 年 7 月开始实施。 这是澳大利亚 SCI 康复中心首次实施以康复为主导的 OSA 管理模式。我们介绍了一种以理论为指导的方法来调整护理模式、评估障碍并采取干预措施来克服这些障碍。混合方法评估的结果将另行报告。
{"title":"Management of Sleep-Disordered Breathing in a Spinal Cord Injury Rehabilitation Center: Model of Care Adaptation and Implementation","authors":"M. Graco, Gerard Weber, K. Saravanan, Jacqueline Curran, Nicole Whitehead, J. Ross, Charito DelaCruz, Samritti Sood, Roxana E. Heriseanu, Ching Li Chai-Coetzer, David J. Berlowitz, David Joffe","doi":"10.46292/sci23-00049","DOIUrl":"https://doi.org/10.46292/sci23-00049","url":null,"abstract":"\u0000 \u0000 Obstructive sleep apnea (OSA) is highly prevalent and poorly managed in spinal cord injury (SCI). Alternative management models are urgently needed to improve access to care. We previously described the unique models of three SCI rehabilitation centers that independently manage uncomplicated OSA.\u0000 \u0000 \u0000 \u0000 The primary objective was to adapt and implement a similar rehabilitation-led model of managing OSA in an SCI rehabilitation center in Australia. Secondary objectives were to identify the local barriers to implementation and develop and deliver tailored interventions to address them.\u0000 \u0000 \u0000 \u0000 A clinical advisory group comprised of rehabilitation clinicians, external respiratory clinicians, and researchers adapted and developed the care model. A theory-informed needs analysis was performed to identify local barriers to implementation. Tailored behavior change interventions were developed to address the barriers and prepare the center for implementation.\u0000 \u0000 \u0000 \u0000 Pathways for ambulatory assessments and treatments were developed, which included referral for specialist respiratory management of complicated cases. Roles were allocated to the team of rehabilitation doctors, physiotherapists, and nurses. The team initially lacked sufficient knowledge, skills, and confidence to deliver the OSA care model. To address this, comprehensive education and training were provided. Diagnostic and treatment equipment were acquired. The OSA care model was implemented in July 2022.\u0000 \u0000 \u0000 \u0000 This is the first time a rehabilitation-led model of managing OSA has been implemented in an SCI rehabilitation center in Australia. We describe a theory-informed method of adapting the model of care, assessing the barriers, and delivering interventions to overcome them. Results of the mixed-methods evaluation will be reported separately.\u0000","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"89 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138995219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Candy Tefertiller, S. Wojciehowski, Mitch Sevigny, J. Ketchum, Meghan Rozwod
To compare 1-year mobility outcomes of individuals with traumatic motor incomplete spinal cord injury (miSCI) who participated in standardized locomotor training (LT) within the first year of injury to those who did not. This retrospective case-control analysis conducted with six US rehabilitation hospitals used SCI Model Systems (SCIMS) data comparing 1-year postinjury outcomes between individuals with miSCI who participated in standardized LT to those who received usual care (UC). Participants were matched on age, gender, injury year, mode of mobility, and rehabilitation center. The primary outcome is the FIM Total Motor score. Other outcomes include the FIM Transfer Index, FIM Stairs, and self-reported independence with household mobility, community mobility, and stairs. LT participants reported significantly better FIM Total Motor (difference = 2.812, 95% confidence interval [CI] = 5.896, 17.282) and FIM Transfer Index scores (difference = 0.958, 95% CI = 0.993, 4.866). No significant between-group differences were found for FIM Stairs (difference = 0.713, 95% CI = -0.104, 1.530) or self-reported household mobility (odds ratio [OR] = 5.065, CI = 1.435, 17.884), community mobility (OR = 2.933, 95% CI = 0.868, 9.910), and stairs (OR = 5.817, 95% CI = 1.424, 23.756) after controlling for multiple comparisons. LT participants reported significantly greater improvements in primary and secondary measures of mobility and independence (FIM Total Motor score; FIM Transfer Index) compared to UC participants. Self-reported mobility outcomes were not significant between groups.
目的：比较创伤性运动性不完全性脊髓损伤（miSCI）患者在伤后第一年内参加标准化运动训练（LT）与未参加者的一年行动能力结果。 这项回顾性病例对照分析由美国六家康复医院利用 SCI 模型系统（SCIMS）数据进行，比较了参加标准化运动训练（LT）的 miSCI 患者与接受常规护理（UC）的患者在受伤后一年的疗效。参与者的年龄、性别、受伤年份、行动方式和康复中心均匹配。主要结果是 FIM 运动总分。其他结果包括 FIM 转移指数、FIM 楼梯以及自我报告的家庭行动独立性、社区行动独立性和楼梯独立性。 LT参与者的FIM运动总分（差异=2.812，95%置信区间[CI] = 5.896，17.282）和FIM转移指数得分（差异=0.958，95%置信区间[CI] = 0.993，4.866）均明显提高。在控制多重比较后，FIM 楼梯（差异 = 0.713，95% CI = -0.104，1.530）或自我报告的家庭移动能力（几率比 [OR] = 5.065，CI = 1.435，17.884）、社区移动能力（OR = 2.933，95% CI = 0.868，9.910）和楼梯（OR = 5.817，95% CI = 1.424，23.756）均未发现明显的组间差异。 与统合症参与者相比，LT参与者在活动能力和独立性的主要和次要测量指标（FIM运动总分；FIM转移指数）方面的改善幅度明显更大。自我报告的活动能力结果在组间无显著差异。
{"title":"Comparison of One-Year Postinjury Mobility Outcomes Between Locomotor Training and Usual Care After Motor Incomplete Spinal Cord Injury","authors":"Candy Tefertiller, S. Wojciehowski, Mitch Sevigny, J. Ketchum, Meghan Rozwod","doi":"10.46292/sci23-00013","DOIUrl":"https://doi.org/10.46292/sci23-00013","url":null,"abstract":"To compare 1-year mobility outcomes of individuals with traumatic motor incomplete spinal cord injury (miSCI) who participated in standardized locomotor training (LT) within the first year of injury to those who did not. This retrospective case-control analysis conducted with six US rehabilitation hospitals used SCI Model Systems (SCIMS) data comparing 1-year postinjury outcomes between individuals with miSCI who participated in standardized LT to those who received usual care (UC). Participants were matched on age, gender, injury year, mode of mobility, and rehabilitation center. The primary outcome is the FIM Total Motor score. Other outcomes include the FIM Transfer Index, FIM Stairs, and self-reported independence with household mobility, community mobility, and stairs. LT participants reported significantly better FIM Total Motor (difference = 2.812, 95% confidence interval [CI] = 5.896, 17.282) and FIM Transfer Index scores (difference = 0.958, 95% CI = 0.993, 4.866). No significant between-group differences were found for FIM Stairs (difference = 0.713, 95% CI = -0.104, 1.530) or self-reported household mobility (odds ratio [OR] = 5.065, CI = 1.435, 17.884), community mobility (OR = 2.933, 95% CI = 0.868, 9.910), and stairs (OR = 5.817, 95% CI = 1.424, 23.756) after controlling for multiple comparisons. LT participants reported significantly greater improvements in primary and secondary measures of mobility and independence (FIM Total Motor score; FIM Transfer Index) compared to UC participants. Self-reported mobility outcomes were not significant between groups.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139268837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dannae Arnold, Jaime Gillespie, Monica Bennett, Librada Callender, Seema Sikka, Rita Hamilton, Simon Driver, Chad Swank
Background After spinal cord injury (SCI), inpatient rehabilitation begins and continues through outpatient therapy. Overground exoskeleton gait training (OEGT) has been shown to be feasible in both settings, yet its use as an intervention across the continuum has not yet been reported. Objectives This study describes OEGT for patients with SCI across the continuum and its effects on clinical outcomes. Methods Medical records of patients with SCI who completed at least one OEGT session during inpatient and outpatient rehabilitation from 2018 to 2021 were retrospectively reviewed. Demographic data, Walking Index for Spinal Cord Injury-II (WISCI-II) scores, and OEGT session details (frequency, “walk” time, “up” time, and step count) were extracted. Results Eighteen patients [male (83%), White (61%), aged 37.4 ± 15 years, with tetraplegia (50%), American Spinal Injury Association Impairment Scale A (28%), B (22%), C (39%), D (11%)] completed OEGT sessions (motor complete, 18.2 ± 10.3; motor incomplete, 16.7 ± 7.7) over approximately 18 weeks (motor complete, 15.1 ± 6.4; motor incomplete, 19.0 ± 8.2). Patients demonstrated improved OEGT session tolerance on device metrics including “walk” time (motor complete, 7:51 ± 4:42 to 24:50 ± 9:35 minutes; motor incomplete, 12:16 ± 6:01 to 20:01 ± 08:05 minutes), “up” time (motor complete, 16:03 ± 7:41 to 29:49 ± 12:44 minutes; motor incomplete, 16:38 ± 4:51 to 23:06 ± 08:50 minutes), and step count (motor complete, 340 ± 295.9 to 840.2 ± 379.4; motor incomplete, 372.3 ± 225.2 to 713.2 ± 272). Across therapy settings, patients with motor complete SCI experienced improvement in WISCI-II scores from 0 ± 0 at inpatient admission to 3 ± 4.6 by outpatient discharge, whereas the motor incomplete group demonstrated a change of 0.2 ± 0.4 to 9.0 ± 6.4. Conclusion: Patients completed OEGT across the therapy continuum. Patients with motor incomplete SCI experienced clinically meaningful improvements in walking function.
背景脊髓损伤(SCI)后，住院康复开始并通过门诊治疗继续。地面外骨骼步态训练(OEGT)已被证明在这两种情况下都是可行的，但它作为一种连续干预的使用尚未有报道。目的:本研究描述了脊髓损伤患者的连续OEGT及其对临床结果的影响。方法回顾性分析2018年至2021年住院和门诊康复期间至少完成一次OEGT治疗的脊髓损伤患者的病历。提取了人口统计数据、脊髓损伤步行指数- ii (WISCI-II)评分和OEGT会话细节(频率、“步行”时间、“起身”时间和步数)。结果18例患者[男性(83%)，白人(61%)，年龄37.4±15岁，四肢瘫痪(50%)，美国脊髓损伤协会损伤量表A (28%)， B (22%)， C (39%)， D(11%)]完成了OEGT疗程(运动完成，18.2±10.3;电机不完整，16.7±7.7)在大约18周内完成(电机完整，15.1±6.4;电机不完整，19.0±8.2)。患者在设备指标上表现出改善的OEGT会话耐受性，包括“行走”时间(运动完成，7:51±4:42至24:50±9:35分钟;电机未完成，12:16±6:01至20:01±08:05分钟)，“启动”时间(电机完成，16:03±7:41至29:49±12:44分钟;电机未完成，16:38±4:51至23:06±08:50分钟)，步数(电机完成，340±295.9至840.2±379.4;电机不完整，372.3±225.2至713.2±272)。在整个治疗设置中，运动完全性脊髓损伤患者的WISCI-II评分从住院时的0±0提高到出院时的3±4.6，而运动不完全性脊髓损伤组的评分从0.2±0.4提高到9.0±6.4。结论:患者在整个治疗过程中完成了OEGT。运动不完全性脊髓损伤患者的行走功能有临床意义的改善。
{"title":"Clinical Delivery of Overground Exoskeleton Gait Training in Persons With Spinal Cord Injury Across the Continuum of Care: A Retrospective Analysis","authors":"Dannae Arnold, Jaime Gillespie, Monica Bennett, Librada Callender, Seema Sikka, Rita Hamilton, Simon Driver, Chad Swank","doi":"10.46292/sci23-00001","DOIUrl":"https://doi.org/10.46292/sci23-00001","url":null,"abstract":"Background After spinal cord injury (SCI), inpatient rehabilitation begins and continues through outpatient therapy. Overground exoskeleton gait training (OEGT) has been shown to be feasible in both settings, yet its use as an intervention across the continuum has not yet been reported. Objectives This study describes OEGT for patients with SCI across the continuum and its effects on clinical outcomes. Methods Medical records of patients with SCI who completed at least one OEGT session during inpatient and outpatient rehabilitation from 2018 to 2021 were retrospectively reviewed. Demographic data, Walking Index for Spinal Cord Injury-II (WISCI-II) scores, and OEGT session details (frequency, “walk” time, “up” time, and step count) were extracted. Results Eighteen patients [male (83%), White (61%), aged 37.4 ± 15 years, with tetraplegia (50%), American Spinal Injury Association Impairment Scale A (28%), B (22%), C (39%), D (11%)] completed OEGT sessions (motor complete, 18.2 ± 10.3; motor incomplete, 16.7 ± 7.7) over approximately 18 weeks (motor complete, 15.1 ± 6.4; motor incomplete, 19.0 ± 8.2). Patients demonstrated improved OEGT session tolerance on device metrics including “walk” time (motor complete, 7:51 ± 4:42 to 24:50 ± 9:35 minutes; motor incomplete, 12:16 ± 6:01 to 20:01 ± 08:05 minutes), “up” time (motor complete, 16:03 ± 7:41 to 29:49 ± 12:44 minutes; motor incomplete, 16:38 ± 4:51 to 23:06 ± 08:50 minutes), and step count (motor complete, 340 ± 295.9 to 840.2 ± 379.4; motor incomplete, 372.3 ± 225.2 to 713.2 ± 272). Across therapy settings, patients with motor complete SCI experienced improvement in WISCI-II scores from 0 ± 0 at inpatient admission to 3 ± 4.6 by outpatient discharge, whereas the motor incomplete group demonstrated a change of 0.2 ± 0.4 to 9.0 ± 6.4. Conclusion: Patients completed OEGT across the therapy continuum. Patients with motor incomplete SCI experienced clinically meaningful improvements in walking function.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"103 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135872449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ramtin Hakimjavadi, Shahin Basiratzadeh, Eugene K. Wai, Natalie Baddour, Stephen Kingwell, Wojtek Michalowski, Alexandra Stratton, Eve Tsai, Herna Viktor, Philippe Phan
Background Traumatic spinal cord injuries (TSCI) greatly affect the lives of patients and their families. Prognostication may improve treatment strategies, health care resource allocation, and counseling. Multivariable clinical prediction models (CPMs) for prognosis are tools that can estimate an absolute risk or probability that an outcome will occur. Objectives We sought to systematically review the existing literature on CPMs for TSCI and critically examine the predictor selection methods used. Methods We searched MEDLINE, PubMed, Embase, Scopus, and IEEE for English peer-reviewed studies and relevant references that developed multivariable CPMs to prognosticate patient-centered outcomes in adults with TSCI. Using narrative synthesis, we summarized the characteristics of the included studies and their CPMs, focusing on the predictor selection process. Results We screened 663 titles and abstracts; of these, 21 full-text studies (2009-2020) consisting of 33 distinct CPMs were included. The data analysis domain was most commonly at a high risk of bias when assessed for methodological quality. Model presentation formats were inconsistently included with published CPMs; only two studies followed established guidelines for transparent reporting of multivariable prediction models. Authors frequently cited previous literature for their initial selection of predictors, and stepwise selection was the most frequent predictor selection method during modelling. Conclusion Prediction modelling studies for TSCI serve clinicians who counsel patients, researchers aiming to risk-stratify participants for clinical trials, and patients coping with their injury. Poor methodological rigor in data analysis, inconsistent transparent reporting, and a lack of model presentation formats are vital areas for improvement in TSCI CPM research.
{"title":"Multivariable Prediction Models for Traumatic Spinal Cord Injury: A Systematic Review","authors":"Ramtin Hakimjavadi, Shahin Basiratzadeh, Eugene K. Wai, Natalie Baddour, Stephen Kingwell, Wojtek Michalowski, Alexandra Stratton, Eve Tsai, Herna Viktor, Philippe Phan","doi":"10.46292/sci23-00010","DOIUrl":"https://doi.org/10.46292/sci23-00010","url":null,"abstract":"Background Traumatic spinal cord injuries (TSCI) greatly affect the lives of patients and their families. Prognostication may improve treatment strategies, health care resource allocation, and counseling. Multivariable clinical prediction models (CPMs) for prognosis are tools that can estimate an absolute risk or probability that an outcome will occur. Objectives We sought to systematically review the existing literature on CPMs for TSCI and critically examine the predictor selection methods used. Methods We searched MEDLINE, PubMed, Embase, Scopus, and IEEE for English peer-reviewed studies and relevant references that developed multivariable CPMs to prognosticate patient-centered outcomes in adults with TSCI. Using narrative synthesis, we summarized the characteristics of the included studies and their CPMs, focusing on the predictor selection process. Results We screened 663 titles and abstracts; of these, 21 full-text studies (2009-2020) consisting of 33 distinct CPMs were included. The data analysis domain was most commonly at a high risk of bias when assessed for methodological quality. Model presentation formats were inconsistently included with published CPMs; only two studies followed established guidelines for transparent reporting of multivariable prediction models. Authors frequently cited previous literature for their initial selection of predictors, and stepwise selection was the most frequent predictor selection method during modelling. Conclusion Prediction modelling studies for TSCI serve clinicians who counsel patients, researchers aiming to risk-stratify participants for clinical trials, and patients coping with their injury. Poor methodological rigor in data analysis, inconsistent transparent reporting, and a lack of model presentation formats are vital areas for improvement in TSCI CPM research.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135471529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lauren Cadel, Stephanie R. Cimino, Glyneva Bradley-Ridout, S. L. Hitzig, Tanya L Packer, Lisa M McCarthy, Tejal Patel, Aisha K Lofters, Shoshana Hahn-Goldberg, Chester H Ho, S. Guilcher
Persons with traumatic spinal cord injury (SCI) are often experience polypharmacy, the use of multiple medications, to manage secondary complications and concurrent conditions. Despite the prevalence of polypharmacy and challenges associated with managing medications, there are few tools to support persons with SCI with medication self-management. The purpose of this scoping review was to identify and summarize what is reported in the literature on medication self-management interventions for adults with traumatic SCI. Articles were searched on electronic databases and grey literature. For inclusion, articles were required to include an adult population with a traumatic SCI and an intervention targeting medication management. They had to incorporate a component of self-management. Articles were independently screened and data were extracted and synthesized using descriptive approaches. Three studies were included in this scoping review. Interventions included a mobile app and two education-based interventions to address self-management of SCI, medication management, and pain management. None of the identified interventions addressed medication self-management comprehensively. Learning outcomes (perceived knowledge and confidence), behavioural outcomes (management strategies, data entry), and clinical outcomes (number of medications, pain scores, functional outcomes) were evaluated. Results of the interventions varied, but some positive outcomes were noted, with improvements in perceived knowledge and confidence and a reduction in the use of multiple pain medications. Overall, there are limited interventions targeting medication self-management for persons with SCI. There is an opportunity better support this population through the co-design and implementation of an intervention that comprehensively addresses self-management.
{"title":"Student Competition (Knowledge Generation) ID 1985151","authors":"Lauren Cadel, Stephanie R. Cimino, Glyneva Bradley-Ridout, S. L. Hitzig, Tanya L Packer, Lisa M McCarthy, Tejal Patel, Aisha K Lofters, Shoshana Hahn-Goldberg, Chester H Ho, S. Guilcher","doi":"10.46292/sci23-1985151s","DOIUrl":"https://doi.org/10.46292/sci23-1985151s","url":null,"abstract":"Persons with traumatic spinal cord injury (SCI) are often experience polypharmacy, the use of multiple medications, to manage secondary complications and concurrent conditions. Despite the prevalence of polypharmacy and challenges associated with managing medications, there are few tools to support persons with SCI with medication self-management. The purpose of this scoping review was to identify and summarize what is reported in the literature on medication self-management interventions for adults with traumatic SCI. Articles were searched on electronic databases and grey literature. For inclusion, articles were required to include an adult population with a traumatic SCI and an intervention targeting medication management. They had to incorporate a component of self-management. Articles were independently screened and data were extracted and synthesized using descriptive approaches. Three studies were included in this scoping review. Interventions included a mobile app and two education-based interventions to address self-management of SCI, medication management, and pain management. None of the identified interventions addressed medication self-management comprehensively. Learning outcomes (perceived knowledge and confidence), behavioural outcomes (management strategies, data entry), and clinical outcomes (number of medications, pain scores, functional outcomes) were evaluated. Results of the interventions varied, but some positive outcomes were noted, with improvements in perceived knowledge and confidence and a reduction in the use of multiple pain medications. Overall, there are limited interventions targeting medication self-management for persons with SCI. There is an opportunity better support this population through the co-design and implementation of an intervention that comprehensively addresses self-management.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"46 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anita Kaiser, Katherine Chan, James Sessford, S. McCullum, Peter Athanasopoulos, Chris Rice, Iona Macritchie, J. Zariffa, Kristin E. Musselman
Implementing activity-based therapy (ABT) across the continuum of care in Canada has proved challenging. The objective of this study was to understand and compare multi-group perspectives on the challenges that hinder implementation of ABT in Canada for people living with spinal cord injury or disease (SCI/D). Individuals from six key interest groups (i.e., researchers; persons living with SCI/D; administrators; physical and occupational therapists; community-based exercise trainers; and funders, advocates, and policy experts) who had knowledge of and/or experience with ABT were recruited to participate in focus group interviews that were held over web conferencing. Participants were asked about the barriers and facilitators to practicing ABT. Interview transcripts were analyzed using conventional content analysis followed by a comparative analysis across groups. Forty-eight individuals participated in interviews lasting 30-80 minutes. Six themes were identified: 1) Challenge of defining ABT and addressing gaps in knowledge/training. 2) Challenge of standardizing ABT. 3) Challenge of determining the optimal timing of ABT. 4) Challenge of defining, characterizing and achieving high dosage and intensity. 5) Challenge of funding ABT. 6) Challenge of measuring participation and performance in ABT. While all groups acknowledged these six challenges, therapists and community trainers viewed knowledge/training gaps and achieving high dosage and intensity as key challenges. Researchers and advocates emphasized funding as a key challenge. Participants highlighted the challenges that limit adoption of ABT into practice within hospital and community settings. Future research should explore avenues to address these challenges to support successful implementation of ABT in Canada.
{"title":"Student Competition (Knowledge Generation) ID 1975184","authors":"Anita Kaiser, Katherine Chan, James Sessford, S. McCullum, Peter Athanasopoulos, Chris Rice, Iona Macritchie, J. Zariffa, Kristin E. Musselman","doi":"10.46292/sci23-1975184s","DOIUrl":"https://doi.org/10.46292/sci23-1975184s","url":null,"abstract":"Implementing activity-based therapy (ABT) across the continuum of care in Canada has proved challenging. The objective of this study was to understand and compare multi-group perspectives on the challenges that hinder implementation of ABT in Canada for people living with spinal cord injury or disease (SCI/D). Individuals from six key interest groups (i.e., researchers; persons living with SCI/D; administrators; physical and occupational therapists; community-based exercise trainers; and funders, advocates, and policy experts) who had knowledge of and/or experience with ABT were recruited to participate in focus group interviews that were held over web conferencing. Participants were asked about the barriers and facilitators to practicing ABT. Interview transcripts were analyzed using conventional content analysis followed by a comparative analysis across groups. Forty-eight individuals participated in interviews lasting 30-80 minutes. Six themes were identified: 1) Challenge of defining ABT and addressing gaps in knowledge/training. 2) Challenge of standardizing ABT. 3) Challenge of determining the optimal timing of ABT. 4) Challenge of defining, characterizing and achieving high dosage and intensity. 5) Challenge of funding ABT. 6) Challenge of measuring participation and performance in ABT. While all groups acknowledged these six challenges, therapists and community trainers viewed knowledge/training gaps and achieving high dosage and intensity as key challenges. Researchers and advocates emphasized funding as a key challenge. Participants highlighted the challenges that limit adoption of ABT into practice within hospital and community settings. Future research should explore avenues to address these challenges to support successful implementation of ABT in Canada.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"54 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giuseppe Gazzellone, Sarah Lanteigne, Kimberley Gammage, Val A. Fajardo, David S. Ditor
Previous research has shown that an anti-inflammatory diet can reduce inflammation and improve health outcomes in individuals with neurological disability; however, long term dietary adherence has proven to be challenging. Accordingly, we have designed a 2-part consultation targeted at identified barriers for adherence to an anti-inflammatory diet in this population. This study aimed to determine the effects of the consultation on self-efficacy for adhering to an anti-inflammatory diet, as well as adherence and health outcomes one month post-intervention. Eleven individuals (10 female, age 51.5±12.6 years) with neurological disability (7 multiple sclerosis, 3 spinal cord injury, 1 muscular dystrophy; 20.5±10.6 years post-injury/diagnosis) participated. The intervention group (n=7) received recipes for an anti-inflammatory diet and the 2-part consultation, while controls (n=4) received the recipes only. The consultation consisted of a home-visit that included cooking and accessible kitchen equipment demonstrations, and an accompanied trip to the grocery store. Both task and barrier self-efficacy improved immediately following the consultation and tended to stay above baseline one month post-intervention. The consultation was also associated with increased dietary adherence one month post-intervention and decreased depressive symptoms as measured by the Centre for Epidemiological Studies Depression Scale (CES-D). Changes in dietary adherence (r=-0.61; p=0.045), and barrier self-efficacy (r=-0.77; p=0.009) were negatively correlated to changes in CES-D scores. A consultation targeted at barriers related to anti-inflammatory eating can improve self-efficacy for adherence as well as actual adherence and depressive symptomology one month later. Further follow-up studies to determine the persistence of these effects are warranted.
{"title":"Student Competition (Clinical/Best Practice Implementation) ID 1983939","authors":"Giuseppe Gazzellone, Sarah Lanteigne, Kimberley Gammage, Val A. Fajardo, David S. Ditor","doi":"10.46292/sci23-1983939s","DOIUrl":"https://doi.org/10.46292/sci23-1983939s","url":null,"abstract":"Previous research has shown that an anti-inflammatory diet can reduce inflammation and improve health outcomes in individuals with neurological disability; however, long term dietary adherence has proven to be challenging. Accordingly, we have designed a 2-part consultation targeted at identified barriers for adherence to an anti-inflammatory diet in this population. This study aimed to determine the effects of the consultation on self-efficacy for adhering to an anti-inflammatory diet, as well as adherence and health outcomes one month post-intervention. Eleven individuals (10 female, age 51.5±12.6 years) with neurological disability (7 multiple sclerosis, 3 spinal cord injury, 1 muscular dystrophy; 20.5±10.6 years post-injury/diagnosis) participated. The intervention group (n=7) received recipes for an anti-inflammatory diet and the 2-part consultation, while controls (n=4) received the recipes only. The consultation consisted of a home-visit that included cooking and accessible kitchen equipment demonstrations, and an accompanied trip to the grocery store. Both task and barrier self-efficacy improved immediately following the consultation and tended to stay above baseline one month post-intervention. The consultation was also associated with increased dietary adherence one month post-intervention and decreased depressive symptoms as measured by the Centre for Epidemiological Studies Depression Scale (CES-D). Changes in dietary adherence (r=-0.61; p=0.045), and barrier self-efficacy (r=-0.77; p=0.009) were negatively correlated to changes in CES-D scores. A consultation targeted at barriers related to anti-inflammatory eating can improve self-efficacy for adherence as well as actual adherence and depressive symptomology one month later. Further follow-up studies to determine the persistence of these effects are warranted.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"9 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139344131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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