Objectives: To compare acute cardiorespiratory responses during high intensity interval training (HIIT) and moderate intensity continuous training (MICT) on a recumbent handcycle in persons with spinal cord injury (PwSCI).
Methods: Eleven males and nine females with chronic SCI (T3 - L5), aged 23 (9) years, participated in this within-subject design. Based off peak power outputs from an incremental test to exhaustion, participants engaged in a HIIT and MICT session at matched workloads on a recumbent handcycle. Workloads (Joules), time, oxygen uptake (VO2), metabolic equivalent of task (MET), heart rate (HR), and energy expenditure (kcal) were recorded during HIIT and MICT.
Results: Total workload was similar across HIIT (87820 ± 24021 Joules) and MICT sessions (89044 ± 23696 Joules; p > .05). HIIT (20.00 [.03] minutes) was shorter in duration than MICT (23.20 [2.56]; p < .01). Average VO2 (20.96 ± 4.84 vs. 129.38 ± 19.13 mL/kg/min O2), MET (7.54 ± 2.00 vs. 6.21 ± 1.25), and HR (146.26 ± 13.80 vs. 129.38 ± 19.13 beats per minute) responses were significantly greater during HIIT than MICT (p < .01). Participants burned significantly more kilocalories during HIIT (128.08 ± 35.65) than MICT (118.93 ± 29.58; p < .01) and at a faster rate (6.40 ± 1.78 [HIIT] vs. 5.09 ± 1.14 [MICT] kcal/min; p < .01).
Conclusion: HIIT elicits greater increases in oxygen uptake and HR than MICT in PwSCI. In significantly less time, HIIT also burned more calories than MICT.
Regenerating the injured spinal cord is a substantial challenge with many obstacles that need to be overcome to achieve robust functional benefits. This abundance of hurdles can partly explain the limited success when applying regenerative intervention treatments in animal models and/or people. In this article, we elaborate on a few of these obstacles, starting with the applicability of animal models and how they compare to the clinical setting. We then discuss the requirement for combinatorial interventions and the associated problems in experimental design, including the addition of rehabilitative training. The article expands on differences in lesion sizes and locations between humans and common animal models, and how this difference can determine the success or failure of an intervention. An additional and frequently overlooked problem in the translation of interventions that applies beyond the field of neuroregeneration is the reporting bias and the lack of transparency in reporting findings. New data mandates are tackling this problem and will eventually result in a more balanced view of the field. Finally, we will discuss strategies to negotiate the challenging course of successful translation to facilitate successful translation of regeneration promoting interventions.
Background: Little is known about the impact of race/ethnicity on the clinical and neurological outcomes after acute traumatic spinal cord injury (tSCI).
Objectives: This study examined the influence of race/ethnicity on the individuals' survival and neurological recovery within the first year after tSCI.
Methods: The 306 cases enrolled in the First National Acute Spinal Cord Injury Study (NASCIS-1) were grouped as African American individuals (n = 84), non-Hispanic White individuals (n = 159), and other races/ethnicities that included Hispanic individuals (n = 60) and Asian individuals (n = 3). Outcome measures included survival and neurological recovery within the first year after tSCI. Data analyses were adjusted for major potential confounders.
Results: There were 39 females and 267 males with mean age of 31 years who mostly sustained cervical severe tSCI after motor vehicle accidents or falls. The three groups were comparable regarding sex distribution, level and severity of tSCI, level of consciousness at admission, and total received dose of methylprednisolone. African American individuals were significantly older than non-Hispanic White individuals (p = .0238). African American individuals and individuals of other races/ethnicities more often had a tSCI with open wound caused by missile and water-related accidents than non-Hispanic White individuals (p < .0001). Survival rates within the first year after tSCI were comparable among the three groups (p = .3191). Among the survivors, there were no significant differences among the three groups regarding motor and pinprick and light-touch sensory recovery (p > .0500).
Conclusions: The results of this study suggest that, while there were few differences among the racial/ethnical groups regarding the epidemiology of tSCI, race/ethnicity did not influence survival rate or neurological recovery within the first year post-tSCI.
Introduction: People with traumatic spinal cord injury (tSCI) experience lifelong physical and emotional health impacts, needing specialized care that is complex to navigate. The non-standardized care pathways used by different jurisdictions to address these needs lead to care inequities and poor health outcomes.
Purpose: To develop an evidence-based integrated tSCI Care Pathway, from time of injury to life in the community.
Methods and analysis: Eighty key partners engaged in planning, providing, and receiving tSCI care (1) identified existing guidelines, pathways, and care models; (2) created the tSCI Care Pathway with key elements or building blocks ("the what"), not specific recommendations ("the how") for each care stage (Acute, Rehabilitation, and Community), with elements highlighting the role of primary care and equity considerations on the pathway; (3) identified regional gaps in the tSCI Pathway and prioritized them for implementation; and (4) developed quality indicators.
Outcomes: The tSCI Pathway was drafted in overarching and detailed formats. For Acute Care, building blocks focused on appropriate assessment, initial management, and transition planning; for Rehabilitation, building blocks focused on access to specialized rehabilitation and assessment and planning of community needs; for Community, building blocks focused on follow-up, mechanisms for re-access, and holistic support for persons and families; and for equity considerations, building blocks focused on those at-risk or requiring complex supports. Team-based primary care and navigation supports were seen as crucial to reduce inequities.
Conclusion: This is the first comprehensive care pathway for tSCI. The Pathway is grounded in person-centred care, integrated care and services, and up-to-date clinical practice guidelines. The tSCI Care Pathway is flexible to regional realities and individual needs to ensure equitable care for all.
Background: Mounting empirical evidence suggests that, compared to women without disabilities, women with disabilities are more likely to experience interpersonal violence (IPV). However, there is extremely limited research attention on IPV against women with spinal cord injury (SCI), a particularly understudied and underserved population.
Objectives: To conduct the first known examination of lifetime IPV experience in women with SCI, to explore demographic and disability-related correlates of IPV, and to examine the health impacts of IPV.
Methods: The sample included 175 women with traumatic SCI from across the United States who enrolled in a randomized controlled trial of an online psychological health promotion intervention. The data, which included a brief measure of lifetime abuse, were collected as part of the baseline survey administered prior to randomization to the intervention or control conditions.
Results: The majority (55%) of the women described experiencing some abuse in their lifetime, with 43% reporting physical abuse, 32% reporting sexual abuse, and 23% reporting disability-related abuse. Sixteen percent of the women indicated that they had experienced all three (physical, sexual, disability) types of abuse. Few demographic and disability characteristics were related to overall lifetime IPV experience; however, disability characteristics were associated with disability-related IPV victimization. In addition, those with a history of IPV had poorer self-reported health and greater depression.
Conclusion: This study suggests that IPV is common among women with SCI. More research is needed to understand the prevalence, risk factors, and consequences of IPV against women with SCI to help inform policy and practice.
Objectives: To investigate the effects of salsalate on fasting and postprandial (PP) glycemic, lipidemic, and inflammatory responses in persons with tetraplegia.
Methods: This study was a randomized, double-blind, cross-over design. It was conducted at a university laboratory. Ten males aged 25 to 50 years with SCI at C5-8 levels for ≥1 year underwent 1 month of placebo and salsalate (4 g/day) treatment. Blood samples were drawn before and 4 hours after breakfast and lunch fast-food meal consumption.
Results: Descriptive statistics indicate that fasting and PP glucose values were reduced with salsalate (pre-post mean difference, 4 ± 5 mg/dL and 8 ± 8 mg/dL, respectively) but largely unchanged with placebo (0 ± 6 mg/dL and -0 ± 7 mg/dL, respectively). Insulin responses were generally reciprocal to glucose, however less pronounced. Fasting free fatty acids were significantly reduced with salsalate (191 ± 216 mg/dL, p = .021) but not placebo (-46 ± 116 mg/dL, p = .878). Results for triglycerides were similar (25 ± 34 mg/dL, p =.045, and 7 ± 29 mg/dL, p = .464). Fasting low-density lipoprotein (LDL) levels were higher after salsalate (-10 ± 12 mg/dL, p = .025) but not placebo (2 ± 9 mg/dL, p = .403) treatment. Inflammatory markers were largely unchanged.
Conclusion: In this pilot trial, descriptive values indicate that salsalate decreased fasting and PP glucose response to fast-food meal challenge at regular intervals in persons with tetraplegia. Positive effects were also seen for some lipid but not for inflammatory response markers. Given the relatively "healthy" metabolic profiles of the participants, it is possible that salsalate's effects may be greater and more consistent in people with less favorable metabolic milieus.
Background: Due in part to medical complications, adults with a pediatric onset spinal cord injury (SCI) are at higher risk of experiencing dissatisfaction with life and lower perceived physical health when compared to their peers with no disability. To support the prevention of medical complications, young people with SCI must successfully transition to adult health care. Health care transition (HCT) interventions can support young people with chronic conditions in their move to adult health care.
Objectives: To evaluate the feasibility and acceptability of a web-based HCT intervention codesigned with young people with SCI and parents/caregivers.
Methods: Semi-structured individual interviews were conducted online with young people with SCI and parents/caregivers who transitioned or were preparing for the transition from pediatric to adult health care. Interviews were also conducted with health care professionals. The interviews were analyzed using a hybrid deductive and inductive qualitative content analysis process. Feasibility and acceptability were measured using Bowen and colleagues' framework, which includes eight focus areas: acceptability, demand, implementation, practicality, adaption, integration, expansion, and limited efficacy.
Results: Overall, participants responded positively to the intervention and believed that it would be useful to young people with SCI and parents/caregivers. Two areas of Bowen et al.'s framework, implementation and integration, require further consideration in terms of how to embed the intervention into the current transition process.
Conclusion: This study found the HCT intervention to be an innovative approach to support young people with SCI and their parent/caregivers that demonstrates promise in the areas of feasibility and acceptability.
Background: The uncertain health care situations, such as that created by the COVID-19 pandemic, has limited hospital access and facilitated a paradigm shift in health care toward an increased demand for standard home visits and community-based rehabilitation services, including by ambulatory individuals with spinal cord injury (SCI).
Objectives: This 6-month prospective study explored the validity and reliability of a single-time sit-to-stand (STSTS) test when used by primary health care (PHC) providers, including a village health volunteer, caregiver, individual with SCI, and health professional.
Methods: Eighty-two participants were assessed for the STSTS using four arm placement conditions (arms on a walking device, arms on knees, arms free by the sides, and arms crossed over the chest) and standard measures, with prospective fall data follow-up over 6 months. Thirty participants involved in the reliability study were also assessed and reassessed for the ability to complete the STSTS conditions by PHC providers.
Results: Outcomes of the STSTS test, except the condition with arms on a walking device, could significantly discriminate lower extremity muscle strength (LEMS) and mobility of the participants (rpb = -0.58 to 0.69) with moderate concurrent validity. Outcomes of the tests without using the arms also showed moderate to almost-perfect reliability (kappa = 0.754-1.000) when assessed by PHC raters.
Conclusion: The findings suggest the use of an STSTS with arms free by the sides as a standard practical measure by PHC providers to reflect LEMS and mobility of ambulatory individuals with SCI in various clinical, community, and home-based settings.
Background: Individuals with paraplegia and coexisting trunk and postural control deficits rely on their upper extremities for function, which increases the risk of shoulder pain. A multifactorial etiology of shoulder pain includes "impingement" of the supraspinatus, infraspinatus, long head of the biceps tendons, and/or subacromial bursa resulting from anatomic abnormalities, intratendinous degeneration, and altered scapulothoracic kinematics and muscle activation. Targeting serratus anterior (SA) and lower trapezius (LT) activation during exercise, as part of a comprehensive plan, minimizes impingement risk by maintaining optimal shoulder alignment and kinematics during functional activities. To prevent excessive scapular upward translation, minimizing upper trapezius (UT) to SA and LT activation is also important.
Objectives: To determine which exercises (1) maximally activate SA and minimize UT:SA ratio and (2) maximally activate LT and minimize UT:LT ratio.
Methods: Kinematic and muscle activation data were captured from 10 individuals with paraplegia during four exercises: "T," scaption (sitting), dynamic hug, and SA punch (supine). Means and ratios were normalized by percent maximum voluntary isometric contraction (MVIC) for each muscle. One-way repeated measures analysis of variance determined significant differences in muscle activation between exercises.
Results: Exercises were rank ordered: (1) maximum SA activation: SA punch, scaption, dynamic hug, "T"; (2) maximum LT activation: "T," scaption, dynamic hug, SA punch; 3) minimum UT:SA ratio: SA punch, dynamic hug, scaption, "T"; and (4) minimum UT:LT ratio: SA punch, dynamic hug, "T," scaption. Exercise elicited statistically significant changes in percent MVIC and ratios. Post hoc analyses revealed multiple significant differences between exercises (p < .05).
Conclusion: SA punch produced the greatest SA activation and lowest ratios. Dynamic hug also produced optimal ratios, suggesting supine exercises minimize UT activation more effectively. To isolate SA activation, individuals with impaired trunk control may want to initiate strengthening exercises in supine. Participants maximally activated the LT, but they were not able to minimize UT while upright.
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