Topics in Spinal Cord Injury Rehabilitation最新文献

Background: Approximately 50% of spinal cord injuries (SCI) occur at the cervical level, resulting in significant loss of arm and hand function. Restoration of upper limb function is a high priority, and many opt for upper limb reconstructive surgeries to improve daily activities and psychological well-being.

Objectives: This retrospective multicenter study investigates whether demographic data (sex and age) and clinical characteristics (type of SCI and years since injury) are related to the outcome of upper limb reconstructive surgery.

Methods: Data were extracted from medical records of individuals with an SCI who underwent surgery in Sweden and New Zealand. Muscle strength (pinch, grip) and grasp ability were measured before surgery and at 6 or 12 months after surgery using standard methods. Statistical analyses included univariable and multivariable linear regression to assess the association between outcomes and predictors. Outcomes were available for 183 arms at follow-up, assessed through at least one of the response variables: grip strength, pinch strength, or grasp ability.

Results: The analyses demonstrated that by using regression models, we could explain 24% to 31% of the variation in pinch strength, grip strength, and grasp ability. The variables of sex, age, and level and severity of injury did explain a small but statistically significant proportion of the variance in pinch strength, grip strength, and grasp ability. Years after injury had no influence on the variation in outcome scores.

Conclusion: The findings suggest that demographic and injury-related factors partially explain the variation in functional outcomes after surgery, providing valuable insights for clinical decision-making and managing patient expectations.

Background: Neurogenic bowel dysfunction and neurogenic lower urinary tract dysfunction are often associated with spinal cord injury (SCI). In Brazil, studies and statistical data on these dysfunctions are scarce.

Objectives: To estimate the prevalence of neurogenic bowel dysfunction and neurogenic lower urinary tract dysfunction in Brazilians diagnosed with traumatic and nontraumatic SCI.

Methods: In this retrospective cross-sectional study, a form was used to collect sociodemographic and clinical data from medical records. The Mann-Whitney statistical tests were used for 2 independent samples, Pearson's chi-square test for categorical variables, and the Kruskal-Wallis test for more than 2 independent samples for quantitative variables. A logistic regression model was used to understand the factors associated with neurogenic bowel dysfunction.

Results: The sample comprised 1056 participants from all regions of Brazil. Of this sample, 60.90% had traumatic SCI, and 69.03% were male. The prevalence of neurogenic bowel dysfunction in the sample was 88%, and the prevalence of neurogenic lower urinary tract dysfunction was 90.6%. Participants with traumatic SCI are more affected by neurogenic bowel and lower urinary tract dysfunction than those with nontraumatic SCI.

Conclusion: Most people with SCI have neurogenic lower urinary tract and bowel alterations, especially those with traumatic SCI. Further studies are needed, and bowel and bladder reeducation programs should be provided in rehabilitation centers.

Background: Transcutaneous spinal cord stimulation (tSCS) has shown evidence of leveraging intact neural circuits to increase blood pressure (BP) in hypotensive people with chronic spinal cord injury (SCI).

Objectives: The primary aim is to determine the safety and feasibility of using tSCS to promote seated systolic BP (SBP) within a target range of 110-130 mm Hg and to mitigate the fall in BP with transition to an upright position in hypotensive participants during acute inpatient rehabilitation (AIR) following SCI.

Design/methods: Cathode placement on the spine will be randomized among 4 sites: T7/8, T9/10, T11/12, and L1/2. Mapping for other stimulation parameters includes waveform (monophasic, biphasic, pseudo-monophasic), frequency (30, 60, 120 Hz), use of a carrier frequency (0, 10 kHz), and stimulation amplitude (0-100 mA). Each mapping session will consist of 2 sit-up tests, one without stimulation followed by one with stimulation. During the sit-up test with stimulation, intensity will be slowly increased to 30 mA with continuous monitoring of BP, heart rate, pain, and symptoms of orthostatic hypotension (OH) and autonomic dysreflexia (AD). Once 30 mA is reached, brachial BP will be monitored for 5 minutes. If below the target SBP range, stimulation intensity will be increased in increments of 5 to 10 mA until one of the following occurs: (1) SBP is within the target range, (2) stimulation is intolerable, (3) 100 mA is reached, or (4) stimulation is delivered for 30 minutes. Safety and feasibility will be measured by assessing burn frequency, pain level, and symptoms of AD and OH along with scheduling compliance.

Background: Individuals with pediatric-onset spinal cord injury (SCI) represent a distinct group; management can be more complex than in adult-onset SCI. Changing medical needs, transfer of responsibility, and cognitive appraisals of disability may all impact life satisfaction in pediatric-onset SCI. Further, bladder/bowel management over many years may be time-consuming and socially disruptive. Cognitive appraisal of disability has been linked to life satisfaction and functioning in pediatric-onset SCI.

Objectives: This study examines associations between bladder/bowel accidents, bowel management, cognitive appraisals, and life satisfaction in pediatric-onset SCI.

Methods: Part of a larger study, 180 adults who sustained SCI age ≤18 and received treatment at a pediatric rehabilitation hospital system were interviewed. Participants were 55.6% male, 83.3% White, 38.6 years at interview, and 13.1 years at injury; 66.1% had complete injury, and 51.1% had paraplegia. Participants reported demographics/medical needs via semi-structured interview. Cognitive appraisals and life satisfaction were assessed using Appraisals of DisAbility Primary and Secondary Scale-Short Form and Satisfaction with Life Scale. Pairwise correlations with all constructs of interest and multivariable linear regressions using bowel program duration and cognitive appraisals as predictors of life satisfaction were conducted.

Results: Correlations align with literature suggesting associations between bladder accident frequency/bowel program duration and negative appraisals of disability (r = .17-.22, P < .05) and bowel program duration and reduced life satisfaction (r = -.29, P < .01). Increased bowel program duration is associated with reduced growth and resilience appraisals (r = .32, P < .001). Regressions indicate that increased bowel program duration and negative appraisals (fearful despondency, overwhelming disbelief, negative perceptions) are associated with reduced life satisfaction (R ² = .12-.24).

Conclusion: Findings suggest interventions targeting bowel management efficiency and cognitive appraisals may improve life satisfaction in this population.

Background: The International Classification of Functioning, Disability and Health (ICF) was developed by the World Health Organization as a standard language to describe biopsychosocial aspects of functioning, health, and health-related states. Different health professionals document functioning data from their professional perspective.

Objectives: The primary objective of this study was to utilize multidisciplinary electronic health records to identify the factors considered significant by different healthcare professional groups in documenting the functioning, disability, and health of individuals with spinal cord injury (SCI).

Methods: A random sample of 10 patients was selected from a larger cohort (n = 49) for analysis. Free text from electronic health records regarding subacute inpatient rehabilitation and an outpatient visit at the chronic stage was collected. Two researchers annotated the data to ICF codes. The study was a descriptive, longitudinal study using quantitative content analysis. Contextual analysis was used to compare the data between different health professionals and at different time points.

Results: In the 10-patient random sample, 447 health records were retrieved. The functioning data consisted of all ICF domains, with 9349 findings. Environmental factors were documented the most. Health professional groups had different patterns in the frequency of documented ICF categories in their documents, reflecting professionals' expertise in the multidisciplinary team. For example, occupational therapists highlighted activities and participation whereas psychologists emphasized body functions.

Conclusion: The findings of this study may facilitate the development of rehabilitation for persons with SCI and highlight the importance of multidisciplinary rehabilitation in complex medical conditions.

Objectives: To assess rates of potentially preventable hospitalizations (PPHs) among adults with spinal cord injury (SCI) living in South Carolina using prevention quality indicators (PQIs).

Methods: We assessed hospitalizations in nonfederal state hospitals between 2016 and 2018 for 2531 adults (>18 years old) with chronic (>1 year) traumatic SCI who were identified through a statewide population-based registry. PPHs were identified using the computer code, definitions, and framework for PQIs developed by the Agency for Healthcare Quality and Research (AHRQ). The rates of PPH, as measured by the 14 PQIs, were calculated for those living with SCI in South Carolina and were compared to state and national rates.

Results: The rates of PPH for those with SCI were significantly higher than the state rates for 3 conditions (chronic obstructive pulmonary disease/asthma, pneumonia, urinary tract infection) and 3 composite indicators. The state population rates were significantly higher than the national rates for all but one indicator. Among those with SCI, the PQI overall composite rate was 3303 per 100,000, compared to a state rate of 1503 and a national rate of 1301.

Conclusions: Compared to the general population, adults with chronic SCI experience more hospitalizations that could have been prevented with high-quality and routine ambulatory care. There is a need to better monitor and treat these ambulatory care sensitive conditions, to advance our understanding of the access to and receipt of quality healthcare, and to develop and implement targeted services to promote health and prevent hospitalizations.

Objectives: To examine intervention studies focused on developing independence readiness skills in individuals with spina bifida.

Methods: The scoping review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to identify intervention studies published from 2000 to 2024. Articles were included if they were an intervention study focused on preidentified domains of independence based on the Guidelines for the Care of People with Spina Bifida by the Spina Bifida Association. Title and abstract screening and full-text articles were completed by author dyads. Data extraction was completed in duplicate to ensure accuracy by separate raters. Inconsistencies were resolved through group consensus and item review.

Results: From 2542 unique references, 2028 were removed for not meeting inclusion criteria. Following full-text review, 38 studies were included in the final analysis. Only 5 studies utilized a rigorous randomized control trial study design. Intervention gaps targeting supported decision-making models and sexual health were noted. Interventions generally targeted school-age youth to older adults, with no studies focused on interventions for early childhood populations. Outcomes measurement varied widely across studies; future research will benefit from standardization of tools used to measure outcomes of interest.

Conclusion: Intervention studies focused on increasing independence skills for individuals with spina bifida are limited. For this growing area of research, comprehensive representation of understudied and underrepresented individuals within the spina bifida community, consideration of shared data elements across studies, and alignment of targeted domains of independence with stakeholder input must be central to future research efforts.

Spinal cord injury (SCI) and the associated autonomic dysfunction often lead to unique and severe blood pressure instability, including low resting blood pressure, orthostatic hypotension, postprandial hypotension, and transient episodic hypertension. Despite the high prevalence of these complications and the associated negative clinical outcomes, standardized protocols for measuring blood pressure stability in SCI clinical trials and research remain lacking. This guidelines article outlines best practices for measuring blood pressure stability in the SCI population. The guidelines were developed through a comprehensive literature review in combination with expert consensus to describe the techniques and necessary considerations when assessing blood pressure stability in individuals with SCI. We include detailed and rationalized protocols for assessing resting blood pressure, orthostatic hypotension, postprandial hypotension, and autonomic dysreflexia in individuals with SCI. An emphasis is placed on using validated and standardized tools, meticulous preparation, and practical and safe measurement techniques as well as careful consideration and mitigation of the myriad of confounding factors unique to the SCI population. We also advocate for integrating at-home monitoring and mobile health technologies to provide continuous, real-world data on blood pressure stability. Implementing best practice guidelines will enhance the accuracy and reliability of blood pressure assessments in SCI clinical settings and research, thereby facilitating the detection of cardiovascular dysfunction and ultimately improving patient outcomes. This comprehensive framework aims to advance our scientific understanding and clinical management of cardiovascular autonomic dysfunction after SCI, ultimately contributing to better health and quality of life for this population.

Objectives: To evaluate the content validity, construct validity, and test-retest reliability of a revised version of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury [LTPAQ-SCI(R)] that measures all four components of the spinal cord injury (SCI) exercise guidelines (i.e., exercise frequency, intensity, duration, and type).

Methods: Ten adults with SCI (6M/4F) were interviewed to develop the LTPAQ-SCI(R) and assess its content validity. Twenty-three adults with SCI (50 ± 14 years; 18M/5F) completed the LTPAQ-SCI(R), other self-report measures of aerobic leisure time physical activity (LTPA), moderate-to-vigorous LTPA (MVPA), and strength-training activities as well as cardiorespiratory fitness (i.e., peak oxygen consumption [V̇O_2peak]) and muscular strength tests.

Results: User interviews provided information to refine the questionnaire and support content validity. LTPAQ-SCI(R) measures of minutes per week of aerobic and strength-training LTPA shared large correlations with other self-report measures of aerobic LTPA, aerobic MVPA, and strength-training LTPA (r = 0.542 to 0.687, Ps < .01). LTPAQ-SCI(R) measures of minutes per week of aerobic LTPA and all LTPA (i.e., combined aerobic and strength-training LTPA) shared significant medium-sized positive correlations with relative V̇O_2peak (r = 0.393 and 0.406, respectively, Ps < .05). All variables measured by the LTPAQ-SCI(R) demonstrated good-to-excellent test-retest reliability (intraclass correlations = 0.854 to 1.000, Ps < .001).

Conclusion: This study provides preliminary evidence of the validity and reliability of the LTPAQ-SCI(R) as a measure of minutes per week of aerobic and strength-training LTPA in individuals with SCI. The LTPAQ-SCI(R) is recommended for use in community- and rehabilitation-based settings to collect epidemiological data on LTPA participation among individuals living with SCI.

Lower urinary tract symptoms (LUTS) are a frequent complaint after spinal cord injury and disease (SCI/D). As such, the majority of people with upper motor neuron SCI/D utilize medications for neurogenic detrusor overactivity (NDO), and overtreatment with systemic antimicrobials is common. Many people with SCI/D utilize urinary catheters for bladder management. These devices offer a conduit for delivery of targeted intravesical therapeutics for both NDO and LUTS (including those due to urinary tract infection [UTI]), which have the potential for greater efficacy due to higher concentration of therapeutics and fewer systemic side effects due to limited permeability of the uroepithelium. Specifically, intravesical therapeutics have the potential to prevent and treat UTI by altering uropathogen's access to the uroepithelium, washout of bacteria, uropathogen adherence, bladder ischemia, and other possible mechanisms of infection. This article presents intravesical therapeutic options for people with neurogenic lower urinary tract dysfunction (NLUTD) due to SCI/D, including bladder flushes and instillates of readily accessible medications and experimental agents (such as live biotherapeutics) in normal saline or sterile water. We propose that the intravesical approach to drug delivery is underutilized for people with NLUTD due to SCI/D and offers a valuable alternative to systemic medications.