Topics in Spinal Cord Injury Rehabilitation最新文献

Background: Individuals with spinal cord injury (SCI) at or above T6 face increased cardiovascular disease (CVD) risks due to altered autonomic control and physical inactivity. Arm cycle ergometry training (ACET) or body weight-supported treadmill training (BWSTT) may improve cardiovascular health, but the impact on cardiac structure and function remains unclear.

Objectives: The study aimed to compare the impact of two exercise interventions on cardiac measures in individuals with chronic SCI.

Methods: Participants with motor-complete SCI (C4-T6, American Spinal Injury Association Impairment Scale [AIS] grade A or B) were randomly assigned to perform 72 ACET or BWSTT sessions. Left ventricular (LV) echocardiography assessments were performed pre and post training. Data were analyzed using a two-way repeated measures analysis of variance and effect sizes (Cohen's d).

Results: Twelve participants underwent analysis (6 per group), revealing significant Group (ACET, BWSTT) x Time (pre, post) interactions for global circumferential systolic and diastolic strain rate (SR) and early diastolic filling velocity (P ≤ .018; Cohen's d > .8/ -.8). Within-group post hoc testing demonstrated a significant decrease in global circumferential systolic SR (P < .001, d = -4.00) and a significant increase in global circumferential diastolic SR (P = .025, d = 2.48) following ACET, with no significant differences following BWSTT. Although there were no statistically significant within-group post hoc changes (P > .58) for diastolic filling, there was a large effect size favoring ACET (d = 1.11).

Conclusion: This exploratory study suggests that ACET alters LV mechanics and potentially diastolic function in a cohort of individuals with chronic, cervical or upper thoracic, motor-complete SCI. Conversely, no significant changes were observed following BWSTT. These findings indicate that ACET can improve cardiac function relative to BWSTT in individuals with SCI, though further studies are warranted.

Introduction: Alterations to bone metabolism deteriorations in bone density and architecture after spinal cord injury (SCI) are complex and multifactorial: mechanical unloading, impaired osteoblast activity, altered hormone levels, and regional blood flow combine to increase lower extremity fracture incidence and mortality. Bone biomarkers are vital to detect disease, identify candidate therapies, monitor therapy effectiveness, and quantify fracture risk.

Objectives: This study aimed to synthesize available literature on serum and plasma bone biomarkers in both animal and human SCI models and to generate consensus regarding their appropriateness for use across the translational continuum.

Methods: A systematic search was conducted; 4731 studies were excluded, yielding 125 studies for data extraction. Data were reviewed by an interdisciplinary panel of experts. Through a modified e-Delphi process, consensus statements were iteratively developed regarding the appropriateness of 14 serum bone biomarkers in human and animal models and across the translational continuum.

Results: The consensus process highlighted challenges in interpreting animal and human models, emphasizing the need for methodological rigor and standardized biomarker reporting. Consideration of diurnal variations in biomarkers and model selection (transection vs. clip) underscored the complexity of SCI research. Limitations included defining "adult" rodents and lack of data on sex-related differences in biomarkers and their interpretation, given most human data were obtained from males and animal data from females.

Conclusion: The consensus statements provide guidance, address gaps in reporting and interpretation of biomarkers, promote use of standardized protocols and assay kits, and emphasize interdisciplinary approaches to advancing scientific discovery and facilitating knowledge translation.

Objectives: The objective of the study is to develop the International Spinal Cord Injury (SCI) Fracture History Extended Data Set within the framework of the International SCI Data Sets to permit consistent collection and reporting of fracture history in the SCI population.

Methods: The International SCI Fracture History Extended Data Set has been developed by a working group. The initial data set was open for 2 months for discussion and was revised based on suggestions from members of the International SCI Data Sets Committee, the International Spinal Cord Society (ISCoS) Executive and Scientific Committees, American Spinal Injury Association (ASIA) Board, other interested organizations, societies, and individual reviewers. The data set was also posted for 2 months for comments on ISCoS's and ASIA's websites.

Results: The final data set contains questions on fractures after SCI. Because the information may be collected at any time, the date of data collection is important to capture relative to the time lapsed after SCI. The data set includes information on fracture history (location, etiology, treatment, complications for each fracture event), osteoporosis treatment (current and past use), bone measures by quantitative computed tomography (6 variables), and body composition (7 variables). The complete instructions for data collection and the data sheet itself are freely available on the ISCoS website (https://cdn.ymaws.com/www.iscos.org.uk/resource/resmgr/fracture/iscieds_fracture_1.pdf).

Conclusion: The data set proposes to collect information on bone loss, other factors potentially predictive of fracture risk, and fracture in persons with SCI to guide clinical management and future research activities.

Background: In May 2021, the second edition of International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) was published.

Objectives: To transcreate the 2021 ISAFSCI (2nd ed.) to German and to assess its feasibility in the subacute phase following spinal cord injury/disease (SCI/D).

Methods: Transcreation to German was performed by an interdisciplinary team of native English and German speakers. We screened individuals with SCI/D for eligibility (i.e., age ≥18 years; >3 months following SCI/D) between August 2021 and January 2022. To minimize the time for the assessment, we first interviewed participants in a supine position before conducting the clinical examination. We assessed participants thrice within 14 days using a randomized sequence of assessors, and we assessed SCI/D according to the International Standards for Classification of Spinal Cord Injury (ISNCSCI) grading of the SCI/D, including the American Spinal Injury Association Impairment Scale (AIS). Time of ISAFSCI assessments (median and quartiles) and its completeness (%) were calculated.

Results: Twelve participants (3 females; median age 42 years [Q1: 31, Q3: 54]) were enrolled and assessed thrice. Severity and level of injury were either sensorimotor complete (AIS A, 9) or incomplete (AIS C, 3) SCI/D and tetraplegia (n = 5) or paraplegia (n = 7), respectively. Median time to complete an assessment was 39 minutes (Q1: 32, Q3: 46).

Conclusion: The German version of the ISAFSCI second edition is feasible to perform in a subacute cohort. However, given the subacute stage following SCI, certain limitations must be acknowledged. Many participants have not yet engaged in sexual activity, which limits the evaluation of sexual function.

Background: Complicated urinary tract infection (cUTI) is prevalent among people with spinal cord injury and disease (SCI/D). Diagnostic guidelines are neither consistent nor evidence based.

Objectives: To establish consensus around symptoms-based diagnostic and decision-making criteria for cUTI for SCI/D.

Methods: A representative sample of clinicians from PM&R, infectious disease, urology, and primary care within the United States (phase 1) and internationally (phase 2) participated in this study. Phase 1 involved focus groups and interviews to refine a decision-making paradigm for cUTI based on reliable and validated Urinary Symptom Questionnaires for Neurogenic Bladder (USQNBs: intermittent catheterization, indwelling catheterization, and voider versions). The phase 2 international Delphi survey on cUTI diagnostic criteria reflected phase 1 results. These criteria feature 6 "profiles": combinations of symptom number and types with associated likelihood of cUTI for each USQNB (18 total decisions).

Results: Analyses of the phase 1 transcripts (n = 32) led to the Delphi design. Across the United States and internationally, 24 responses were obtained on the complete Delphi, with 48 responses on the USQNB for intermittent catheterization only. We achieved the a priori target 80% consensus on 13 of 18 decisions. The remaining 5 decisions reached 62.2% to 77.8% agreement. Changes were made based on respondent suggestions to clarify decisions and slightly modify risk descriptors. One hundred percent consensus among subject matter experts from 9 collaborating SCI model systems centers was achieved for the revisions.

Conclusion: This is the first international and empirical initiative to establish cUTI symptoms-based guidelines for cUTI in SCI/D. These guidelines provide a coherent and evidence-based approach to decision making based on symptoms for clinicians and patients.

Background: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) have been refined through the years and continue to evolve with advances in the field. The International Standards Committee of the American Spinal Injury Association (ASIA) is responsible for maintaining, continually reviewing, and updating the ISNCSCI. Questions from spinal cord injury (SCI) professionals are frequently submitted to ASIA for review by the International Standards Committee.

Methods: Of the questions submitted to the International Standards Committee, 5 were selected for this article, as they relate to common areas of confusion, address challenging classification concepts, and have not previously been described. Representative cases were also created to reinforce classification rules and the committee's recommendations.

Cases: The 5 questions/cases address ISNCSCI classification in the setting of (1) AIS E grade, (2) tendon transfer, (3) spinal cord stimulation, (4) nontraumatic SCI (ntSCI) etiology, and (5) AIS D grade (vs. AIS B) based on the presence of non-key muscle function. Each case includes a detailed review of the correct classification components and thorough discussion of the impact the corresponding question has on the classification.

Conclusion: The International Standards Committee provides answers to questions about ISNCSCI classification. The scenarios presented in this article address important classification rules and challenging concepts that have not previously been described. This article can serve as a useful reference when similar cases are encountered in clinical and research settings.

Objectives: The aim of this study was to determine whether circulating concentrations of activation- and apoptosis-derived endothelial cell-derived microvesicles (EMVs) differ between adults after subacute (time since injury ≤6 months) and chronic (time since injury >12 months) spinal cord injury (SCI).

Methods: Peripheral blood was collected from 43 adults (age range 18-71 years): 12 non-injured adults (9 male/3 female), 16 adults with subacute cervical and high thoracic (C2-T3) motor complete injuries (13 male/3 female; time since injury 1-3 months), and 15 adults with chronic cervical and high thoracic (C1-T2) motor complete injuries (14 male/1 female; time since injury 12-52 months). EMVs were defined by markers of endothelial origin either by activation (CD62e⁺) or apoptosis (CD31⁺/CD42b^-) by flow cytometry. Activation-derived but not apoptosis-derived EMVs were significantly higher (P < .05) in adults with chronic SCI (median [IQR], 139 [83-181] EMVs/μL) compared with adults with subacute SCI (median [IQR], 99 [83-104] EMVs/μL) and non-injured adults (median [IQR], 74 [51-104] EMVs/μL). In contrast, apoptosis-derived but not activation-derived EMVs were significantly higher (P < .05) in adults with subacute SCI (mean ± SD, 77 ± 17 EMVs/μL) compared with adults with chronic SCI (mean ± SD, 55 ± 19 EMVs/μL) and non-injured adults (mean ± SD, 52 ± 25 EMVs/μL). Differential expression of circulating EMVs in adults with SCI during the subacute and chronic phase of injury may represent a biomarker of the vascular environment associated with each condition. Our findings suggest that the vascular phenotype is markedly different in subacute compared with the chronic SCI and provide insight into endothelial function after SCI.

Objectives: To determine the interrater reliability between an automated and manual measure of lesion damage following spinal cord injury (SCI) using T2-weighted magnetic resonance images (MRI).

Methods: Twenty-one MRIs were collected from patients who had completed rehabilitation at Craig Hospital. Manual measurements of midsagittal tissue bridges were conducted by an experienced rater using OsiriX (Pixmeo Sarl, Geneva, Switzerland), and automated measures were taken using the SCIsegV2 automated function through the Spinal Cord Toolbox (SCT). Manual and automated measurements were compared using intraclass correlation coefficients (ICC). Percentage agreement and Cohen's kappa statistic were calculated to compare detection of midsagittal tissue bridges.

Results: ICCs between the manual and automated measures were excellent (ICC 0.94, 95% CI 0.84-0.97, P < .001, for ventral tissue bridges; ICC 0.99, 95% CI 0.97-0.99, P < .001, for dorsal tissue bridges). Percentage agreement between raters was 90.8% for ventral, dorsal, and any midsagittal tissue bridge. Cohen's kappa for the detection of tissue bridges showed substantial agreement between the two raters for ventral, dorsal, and any tissue bridges (0.81, P < .001; 0.79, P < .001; and 0.81, P < .001, respectively).

Conclusion: Measurements of midsagittal tissue bridges between manual and automated raters are reliable. Automated measurements may help to expedite research related to midsagittal tissue bridges and functional outcomes for individuals with SCI.

Background: One in two individuals with spinal cord injury (SCI) experiences postprandial hypotension (PPH), a decline (>20 mm Hg) in systolic blood pressure (SBP) within 2 hours after eating. Consuming meals with a low glycemic index (GI) could prevent or lessen PPH.

Objectives: To determine the effect of a low-GI diet on PPH and postprandial glucose and insulin in individuals with chronic SCI (>1 year postinjury).

Methods: Eleven participants (6 males, 5 females; age 43 ± 11 years) with chronic SCI (C4-C7, 7; T4-T12, 4) took part in a randomized crossover study (low GI vs. high GI). On each occasion, BP, glucose, and insulin were measured in the fasted state and for 2 hours after consuming a breakfast meal (60% carbohydrate, 28% fat, 12% protein) in laboratory-controlled conditions. Participants wore an ambulatory BP monitor and continuous glucose monitor for 3 days at home, and consumed study meals that were macronutrient-matched across conditions.

Results: The maximum decrease in systolic blood pressure (SBP) following the laboratory-controlled breakfast meals tended to be lower in the low-GI (14 ± 12 mm Hg) compared to the high-GI (24 ± 25 mm Hg) diet (d = 0.52, P = .056). Serum glucose (P < .01) and insulin (P = .026) concentrations were lower at 30 minutes in the low-GI diet. In the home setting, peak glucose concentrations were lower after lunch (P = .011) and dinner (P < .01) in the low-GI diet.

Conclusion: A low-GI meal may be an effective solution to reduce the magnitude of PPH and peak glucose concentrations in individuals with chronic SCI.

Background: Spasticity is common in spinal cord injury (SCI) and multiple sclerosis (MS), and it can manifest as repeated, rhythmic muscle contractions called clonus. The spontaneous nature of clonus can disrupt independent performance of activities of daily living and negatively impact overall health and quality of life.

Objectives: To quantify biomarkers of clonus and explore management of clonus in individuals with SCI or progressive MS using epidural spinal cord stimulation (ES) or dorsal root stimulation (DRS).

Methods: Four male participants were included in this case series study: 3 with SCI and 1 with MS. All participants underwent temporary percutaneous ES lead placement over the dorsolateral thoracolumbar region of the spinal cord. Participants with SCI were also implanted with DRS leads at the L4 dorsal root. Clonus was elicited mechanically at the ankle while recording electromyography of the soleus muscle synchronized to direct spinal cord field potential recordings from ES and DRS percutaneous leads.

Results: Clonus was evident as a prominent band (5-8 Hz) in recordings from ES leads, DRS leads, soleus muscle, and accelerometry. In 4 participants, percutaneous spinal stimulation reduced median clonus duration and cycle count. Clonus was immediately suppressed upon activation of spinal cord stimulation, and the suppression persisted even when clonus was reinitiated after turning off the stimulation.

Conclusion: The use of objective biomarkers, including spinal cord potentials, to quantify clonus in real time combined with the immediate and reversible effects of stimulation highlight the potential of neuromodulation as a therapeutic tool for managing clonus. These data demonstrate preliminary efficacy of ES and DRS for clonus monitoring and treatment in 4 participants.