Topics in Spinal Cord Injury Rehabilitation最新文献

Background: Spinal cord injury (SCI) has been shown to impact vascular function and increase the risk of cardiovascular disease (CVD). However, data are limited regarding prognostic factors for identifying subclinical CVD risk in individuals with SCI.

Objectives: To identify maladaptive structural and functional changes to central and peripheral vasculature resulting from SCI and to assess the effect of SCI on these parameters relative to able-bodied comparators.

Methods: This review was prospectively registered. A systematic search was performed using PRISMA guidelines. Bias was assessed using the ROBINS-I and AHRQ tools. Studies reporting structural or functional changes to vasculature following SCI were included. Data on participant and injury characteristics, outcomes, and assessments used were extracted. Meta-analyses were conducted for adequately powered subgroups based on outcome type, measurement site, and level of injury.

Results: A total of 49 studies involving 1026 individuals with SCI and 941 able-bodied comparators were included. Most studies described injury level and severity using standardized impairment classifications. Subgroup analyses showed significantly reduced arterial diameter, compliance, endothelial function, blood flow volume, and high-density lipoprotein (HDL) cholesterol concentration among people with SCI compared to controls. Intima-media thickness, arterial stiffness, shear rate, and blood glucose and triglyceride concentrations were significantly greater for people with SCI compared to controls. Additional subgroup analyses were underpowered.

Conclusion: This review synthesizes the current literature reporting central and peripheral vasculature outcomes in people with SCI and able-bodied controls. Between-group differences were observed for several structural and functional vascular outcomes, which suggests that SCI has a significant impact on multiple subclinical CVD risk factors.

Objectives: To examine leisure-time physical activity (LTPA) volume in the Australian spinal cord injury (SCI) population while exploring its associations with sociodemographic and injury-related characteristics.

Methods: This study was a cross-sectional analysis of the Australian cohort of the International Spinal Cord Injury Survey. The study included 1579 participants aged 18 years or older with an SCI. Analyses included summary statistics, analysis of variance, and regression modelling.

Results: Approximately 58% (n = 863) of participants reported some participation in LTPA. The average (SD) total LTPA per week was 333 (318) minutes. Males, younger people, traumatically injured individuals, participants with less time since their injury, and those who required less assistance to ambulate reported between 50% and 200% more engagement in LTPA than their counterparts. Only 204 (13%) participants were compliant with the current SCI-specific physical activity guidelines for fitness improvement. Sociodemographic and injury-related characteristics explained a 2.9% variance for total LTPA, but the model was statistically insignificant.

Conclusion: Participation in LTPA in the Australian SCI population was low, and not enough activity was performed at intensities that elicit healthful change. These data add to the growing body of LTPA and physical activity data for the global SCI population. The trends of physical inactivity are globally consistent. Some sociodemographic variables and injury-related characteristics influence the volume and type of LTPA performed, but their effect is mild. Urgent attention is warranted to improve LTPA volume globally.

Despite considerable progress in spinal cord injury (SCI) research, there remains a pressing need for interventions that effectively restore neurological function after injury beyond that which occurs spontaneously. A major steppingstone towards the development of effective therapies for SCI is the ability to accurately predict recovery and identify individuals who are most likely to respond to intervention. Currently, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) remains the primary tool for assessing neurological impairment after injury. However, based on the inherent limitations of the ISNCSCI exam, accurate and sensitive biomarkers are required. Understanding the role of biomarkers in SCI is crucial for improving diagnosis, prognosis, and treatment strategies. In 2024, the Spinal Cord Outcome Partnership Endeavour (SCOPE) sponsored a precourse at the American Spinal Injuries Association (ASIA) meeting. The international panel discussed the scope, utility, and application of biomarkers in SCI clinical trials and clinical practice. This article summarizes key insights from this discussion, highlighting the value of various types of biomarkers, ranging from molecular and cellular markers to those reflecting neural circuits, systems, and movement. We also summarize the context of using different types of biomarkers and their application in research versus clinical practice. While there are currently no FDAqualified SCI biomarkers, the development of reliable biomarkers holds the potential to accelerate the pace of discovery and enable more precise approaches to treatment.

Background: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the most widely accepted system for characterizing sensorimotor impairments after spinal cord injury (SCI). There have been a number of ISNCSCI revisions, with the most recent edition published in 2019. Newer concepts, including the revised definitions of the zones of partial preservation (ZPPs) and documentation of non-SCI conditions, require training and practice for successful utilization. The International Standards Committee developed an ISNCSCI workbook of 26 practice cases, each with detailed explanations of the correct classification components. In this article, we present seven cases, which were selected from the workbook to reinforce the changes implemented in 2019.

Methods: Hypothetical ISNCSCI cases were created to illustrate important classification rules, definitions, and nuances. All cases were reviewed by members of the American Spinal Injury Association (ASIA) International Standards Committee, and if any discrepancies were identified, they were discussed until a consensus was reached. To confirm agreement, cases were also entered into online algorithms, which are compliant with the 2019 ISNCSCI revision. The seven cases in this article highlight newer classification concepts and include a discussion of key elements.

Cases: Each case reinforces the revised definitions of the ZPPs, such as the applicability of sensory ZPPs in all injuries without sensory sacral sparing and applicability of motor ZPPs in all injuries without voluntary anal contraction (VAC). Non-SCI-related impairments and their impact on the classification are reviewed in Cases 4-7.

Conclusion: The seven cases presented in this article feature key concepts from the 2019 ISNCSCI revision. These cases, as well as the full ISNCSCI workbook, can serve as valuable training tools to improve classification accuracy.

Background: In 2020, a first, expedited version of the International Standards for Neurological Classification of Spinal Cord Injury (E-ISNCSCI-V1) was proposed for determination of neurological level of injury (NLI) and American Spinal Injury Association Impairment Scale (AIS) classifications.

Objectives: This work describes assessment of E-ISNCSCI-V1 classification accuracy and the development and data-based validation of an ISNCSCI Item Reduction Algorithm (IIRA).

Methods: Classification accuracy for E-ISNCSCI-V1 examination shortcut options was assessed with automated analysis of 7026 full ISNCSCI examinations. Rules for the IIRA were iteratively adjusted to optimize the balance between omitting exam items and minimizing misclassification errors, and then it was validated through classification of 100 full ISNCSCI exams.

Results: If S1 findings are substituted for anorectal exam findings as proposed for E-ISNCSCI-V1, the error rate for AIS is 10%, with a high error rate (45%) for classifying true AIS B. The IIRA, which begins with full motor testing, followed by limited sensory testing required an average of 31% (42/134) of the full ISNCSCI exam items, with a 2% error rate for NLI and no AIS errors.

Conclusion: The previously proposed E-ISNCSCI-V1, which included an option to substitute S1 findings for anorectal exam findings, is not recommended due to AIS error rate. The IIRA provides a standardized option for a shortened examination classifying NLI and AIS with high accuracy. It will serve as a basis for version 2 of the E-ISNCSCI.

Background: Dietary interventions play a significant role in preventing and managing cardiometabolic diseases partly through their impact on the gut microbiome and circulating metabolites.

Objectives: To assess the impact of an 8-week low-carbohydrate, high-protein (LC/HP) diet on gut microbiome composition, function, and serum metabolome in individuals with spinal cord injury (SCI).

Methods: Twenty-four adults with chronic SCI were randomized into an LC/HP diet or a control group for 8 weeks. Stool and fasting serum samples were collected at baseline and week 8. The gut microbiome composition and metabolic potential were determined using metagenomic sequencing, while serum metabolome was assessed through untargeted liquid chromatography-tandem mass spectrometry. Statistical analyses focused on diet and time interaction effects, using R (version 4.1.0).

Results: A trend for increased alpha diversity (Gini-Simpson, P = .09) in the diet group indicated a more evenly distributed microbial community. Compared to the control group, several microbiome species (e.g., Fusicatenibacter saccharivorans, Eubacterium siraeum) that are implicated with better intestinal health and reduced inflammation increased, while other species (e.g., Hungatella hathewayi, Clostridium symbiosum) that are associated with colorectal cancer risk decreased in the diet group. Microbial metabolic pathways related to amino acid and purine nucleotides were altered. Increased tryptophan betaine and decreased 8-hydroxy-deoxyguanosine were observed in the serum in the diet group (P _interaction < .05), indicating compliance and reduced oxidative stress, respectively.

Conclusion: Adopting an LC/HP diet resulted in favorable gut microbiome and metabolome adaptations that may reduce the risk for cardiometabolic disease and colorectal cancer in individuals with SCI.

Objectives: To document, through a survey, perceptions of functional electrical stimulation (FES) from people with spinal cord injury (SCI) and carers, clinicians, and researchers (CCR).

Methods: Online questionnaires were completed in Australia and New Zealand from December 1, 2021 to August 31, 2022. Subgroups included people with SCI who have used FES, people with SCI who have not used FES, CCRs who have used FES, and CCRs who have not used FES. Frequencies and percentages of subgroup data were calculated for all questions. Open-ended responses were analyzed with inductive content analysis.

Results: Ninety-nine responses (70 people with SCI, 29 CCR) were analyzed. Out of the 99 responses, 47 people with SCI and 27 CCRs had used or currently use FES. Muscle strength was the most frequently reported benefit by people with SCI and CCRs who use(d) FES. Lack of training was the most frequently reported barrier to FES by people with SCI (85% of question responders) and CCRs (94%) who had used FES. People with SCI (95%) who had not used FES reported access as a barrier. The leading priorities for future research include improved ease of use for people with SCI (60% people with SCI) and clinical guidelines (48% CCR). Qualitative findings supported the quantitative findings.

Conclusion: This survey identified access as a barrier to FES and echoed benefits (strength) and barriers (training) reported in previous research. Ameliorating the barriers and investigating the areas of future research identified in this study will ultimately improve FES uptake in SCI rehabilitation.

Urinary tract infection (UTI) is the most common infection for people with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury/disease (SCI/D). While the current diagnostic pillars include symptoms, inflammation, and bacterial load, each is uniquely problematic when applied to NLUTD-related UTI. Authoritative guidelines have not taken into account the impact of bladder management on symptoms; baseline inflammation in the absence of symptoms limits usefulness of white blood count; and bacteriuria in the absence of symptoms and limitations of standard urine culture (SUC) limits utility of SUC-based determination of bacterial load. Newer approaches are being developed to better guide diagnosis and antibiotic use. These include the Urinary Symptom Questionnaires for Neurogenic Bladder for symptom measurement and decision-making around symptoms, novel inflammatory markers (urine NGAL, IL-1, and IL-8), and culture-independent microbial detection methods. Rapid antimicrobial susceptibility testing (AST) methods have been developed utilizing a number of different approaches, increasing the likelihood of point-of-care application in the future. Advancements in UTI diagnosis will include reconceptualization of "urine is sterile" to "eubiosis and dysbiosis," symptom complexes to aid decision-making, use of novel inflammatory markers, and less reliance on SUC with increased emphasis on culture-independent methods for bacterial identification, AST, and decision-making.

Background: Individuals with spinal cord injuries (SCI) experience depression at rates up to 5 times higher than the general population. Although research on hallucinogens for treating depression is growing, no studies have specifically focused on individuals with SCI.

Objectives: To identify factors associated with hallucinogen use and explore the relationship between hallucinogen use and psychosocial outcomes (i.e., depression and quality of life [QOL]) among individuals with SCI.

Methods: This exploratory, retrospective cross-sectional study design used data from 9976 participants in the Spinal Cord Injury Model Systems (SCIMS) National Database (NDB) between 2016 and 2021. The study outcomes were depression (Patient Health Questionnaire-9 [PHQ-9]) and QOL (Satisfaction with Life Scale [SWLS]). Hallucinogen use, measured by the WHO ASSIST 2, was dichotomized into some use versus no use.

Results: Overall, 65 participants (0.7%) reported some hallucinogen use in the prior 3 months. Multivariable logistic regression analysis showed that younger age, male sex, fall(s) in the previous year, and sleep disturbances were all associated with hallucinogen use. In multivariable linear regression, hallucinogen use was significantly associated with higher PHQ-9 scores (effect size [ES] 0.558) but was not significantly related to SWLS scores (ES 0.149).

Conclusion: This is the first study to identify demographic, injury, and psychosocial factors associated with hallucinogen use among individuals with SCI and to explore its relation to depression and QOL. These findings provide a foundation for future, fully powered studies aimed at determining the effect of hallucinogen use in the SCI population.

Objectives: To describe changes in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam in sublesional motor and sensory domains following short-term epidural electrical stimulation of lumbosacral spinal segments in individuals with spinal cord injury (SCI).

Methods: Twenty individuals with SCI underwent implantation of percutaneous epidural spinal cord stimulation followed by stimulation parameter optimization and 10-12 sessions of stimulation-enabled motor training. Pre-/postintervention ISNCSCI exams were compared to determine changes in motor/sensory scores for regions within 3 levels of the neurological level of injury (NLI) and caudal to this, with subanalyses per motor/sensory complete versus incomplete baseline status.

Results: Individuals with motor complete SCI gained 6% ± 3% of available motor points within 3 levels of NLI and 1% ± 0% of motor points caudal to this (P = .08). Motor incomplete individuals gained 9% ± 22% of available motor points within 3 levels of NLI and lost 4% ± 7% of motor points caudal to this (P = .63). Following stimulation, changes in motor scores with potential high functional impact occurred in 3 individuals (5 total muscle groups with conversion from baseline <3/5 strength to ≥3/5 at completion). Individuals with sensory complete SCI had fewer sensory gains within 3 levels of NLI (6%) compared to those with sensory incomplete SCI (30%, P = .02).

Discussion: Spinal cord stimulation after SCI rapidly induces changes in both motor and sensory domains that are retained after stimulation is removed. These changes primarily occur within 3 levels of the NLI and occur to a greater degree in those with incomplete SCI.