Topics in Spinal Cord Injury Rehabilitation最新文献

Background: Pediatric spinal cord disorders (SCD) are rare and devastating. However, evidence on the effect on musculoskeletal health management is limited.

Objectives: To investigate the relationships between SCD characteristics and musculoskeletal complications in children with SCD.

Methods: Medical records of patients admitted between January 2010 and December 2022 with SCD were retrospectively reviewed. Demographic data and the presence of hypercalcemia, fractures, scoliosis, hip dysplasia, spasticity, contractures, calcium, and vitamin D status were obtained (N = 100; male, 61%; median [IQR] age at diagnosis, 9 [9.5] years, range 0-17).

Results: Traumatic diagnoses represented 36% of patients. Incidence of scoliosis was 41%, hip dysplasia 12%, pathological fractures 9%, spasticity 32%, contractures 27%, hypercalcemia 20%, and vitamin D insufficiency 28% of total. Hypercalcemia was associated with male patients (odds ratio [OR] 4.07, 95% CI 1.03-16.06) and wheelchair users (OR 6.77, 95% CI 1.99-23.84). Nonambulant subjects were at increased risk of having scoliosis (OR 11.69, 95% CI 3.04-44.96), hip dysplasia (OR 55.64, 95% CI 5.59-553.41), contractures (OR 10.72, 95% CI 2.64-43.53), spasticity (OR 3.19, 95% CI 1.14-8.87), and presence of three or more musculoskeletal-related complications (OR 27.03, 95% CI 5.62-130.10).

Conclusion: Children with SCD are susceptible to many complications related to musculoskeletal health. This research provides comprehensive data on both traumatic and nontraumatic SCD disease etiologies in Victoria, Australia.

Background: Individuals with spinal cord injury (SCI) are at increased risk for insufficient 25(OH)D levels and associated adverse health outcomes, highlighting the need for vitamin D supplementation. However, the optimal dosing strategy for vitamin D supplementation in this population remains unclear.

Objectives: To evaluate the efficacy of medium-dose (MD) and high-dose (HD) vitamin D3 supplementation in raising 25(OH)D levels above the sufficiency threshold of 75 nmol/L in individuals with SCI.

Methods: A 12-month randomized, double-blind, placebo-controlled, superiority clinical trial was conducted in 42 individuals living with SCI for at least 3 years and who had insufficient 25(OH)D levels at baseline. Participants (7 female, 35 male; age 48 ± 10 years; 32 with paraplegia, 10 with tetraplegia) were randomly assigned to the placebo, MD intervention (24,000 IU D3 once every 4 weeks), or HD intervention (24,000 IU D3 once every 2 weeks) group. Baseline 25(OH)D levels (43 ± 16 nmol/L) did not differ between intervention groups (P = .8).

Results: Supplementation was well tolerated, and 25(OH)D levels remained well below the excess threshold. A dose-response effect on 25(OH)D levels was observed [F(2, 40) = 8.21, P < .001]. In the HD group, 46% of the participants reached sufficient levels. Participants having an incomplete lesion, higher baseline 25(OH)D levels, lower body mass index, supplementation during summer, autumn, or winter, or higher sun scores were more likely to reach sufficient 25(OH)D levels.

Conclusion: Vitamin D3 supplementation effectively increased 25(OH)D concentration to sufficient levels in participants with specific characteristics. Higher supplementation doses are needed to successfully increase 25(OH)D levels in all individuals with chronic SCI.

Background: Many people with spina bifida (SB) have congenital brain malformations and receive neurosurgical intervention that can impact cognitive, behavioral, and emotional functioning. The Spina Bifida Association's (SBA) guidelines for care recommend that people with SB have neuropsychology evaluations to assess cognitive, behavioral, and emotional functioning throughout their lifespan; however, people with SB anecdotally report having trouble finding and accessing such care.

Objectives: The goal of this study was to gain information about neuropsychology services available to people with SB and identify possible barriers to care.

Methods: Neuropsychologists in the United States were invited to complete a practice-focused survey created by members of the Spina Bifida Neuropsychology Collaborative (SBNC). The survey was emailed to professional neuropsychology listservs and directly to providers at the SBA Clinic Care Partner and National Spina Bifida Patient Registry (NSBPR) sites.

Results: Responses from 34 neuropsychologists (representing 22 sites, including 40% of SBA Clinic Care Partner sites and 67% of NSBPR sites) indicated that multilingual SB-focused neuropsychology services are available within all regions of the United States. Comprehensive, outpatient evaluations are common; however, integration of neuropsychology services into inpatient settings and multidisciplinary clinics is limited. Respondents report that waitlist time is the most frequent barrier to neuropsychology care, followed by cost/insurance/payor type, travel/transportation difficulties, and limited referrals.

Conclusion: There are considerable gaps in the currently available array of US-based neuropsychology services for individuals with SB. Neuropsychologists and SB clinical programs are encouraged to strategically increase availability of neuropsychological services and expand care options.

Background: Neuropathic pain after a spinal cord injury (SCI) is a common disorder whose management is highly complex. New therapies based on mirror neuron activation have been studied to address this problem.

Objectives: This systematic review aims to update the information about the effect of virtual walking (VW) systems on pain in people with complete or incomplete SCI.

Methods: Five databases (MEDLINE, Cochrane, Scopus, Embase, and PEDro) were consulted to find clinical trials on the topic. An Excel table was designed to collect all selected study data, including information about the design, objectives, samples, interventions, outcomes, and main results. PEDro scale was used to assess study quality.

Results: Ten studies were included in this systematic review. Six of them were clinical trials, and the methodological quality of the studies was moderate to high. The results of these trials support that VW reduces neuropathic pain in complete and incomplete SCI patients. This effect can be enhanced and maintained if combined with other therapies such as transcranial direct current stimulation.

Conclusion: Isolated VW is effective in reducing neuropathic pain in complete and incomplete SCI patients, and these effects are enhanced when combined with other therapies.

Objectives: To examine the association between incident traumatic spinal cord injury (TSCI) and the risk of Alzheimer's disease and related dementia (ADRD).

Methods: This is a longitudinal case-control study. We used 2012-2019 commercial insurance claims data from the Health Care Cost Institute (HCCI) and applied semi-parametric Cox survival models to compute hazard ratio (HR) for ADRD diagnosis comparing cases with incident TSCI with their controls without TSCI, adjusting for age, sex, a set of comorbid conditions, and any use of 6 classes of prescription medications. To reduce potential selection bias, we conducted a probability matching between cases (n = 251) and controls (n = 2480) using a 1:10 ratio without replacement based on age, sex, diagnosed chronic conditions, and index year of the TSCI diagnosis.

Results: Cases with incident TSCI had a higher HR of 2.39 (95% CI 1.19-4.80) for ADRD compared to their matched controls. Our sensitivity analysis of removing cases with traumatic brain injury at the index TSCI date or afterward did not change the results (HR 2.21, 95% CI 1.06-4.62).

Conclusion: Incident TSCI is associated with an increased risk of ADRD. Clinical guidelines for people with TSCI should consider the early and regular use of cognitive screening.

Background: Breastfeeding can be a vital component for maternal and infant health, but successful breastfeeding may be especially difficult for mothers with spinal cord injury (SCI). No reliable research on prevalence or complications associated with breastfeeding for mothers with SCI currently exists.

Methods: Our systematic review aimed to answer the following: (1) What are the breastfeeding rates in women after SCI? (2) What are the rates and nature of postpartum complications reported by women with SCI in conjunction with breastfeeding?

Results: Ten studies were included; the reported rates at which women with SCI were able to breastfeed varied widely, ranging from 11% to 100%. Generally speaking, women with higher-level SCI (above T6) were less likely to breastfeed and would breastfeed less frequently than women with lower-level SCI and less frequently than women without SCI. Complications reported included problems with the let-down reflex, autonomic dysreflexia, and a higher incidence of postpartum depression in women with SCI.

Conclusion: More research on mothers with SCI is needed, especially matched-control research comparing mothers with and without SCI on successful breastfeeding and associated complications.

Background: In the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), two approaches for determining motor levels (MLs) in not clinically testable myotomes (C2-C4, T2-L1, S2-S5) are described: one where the motor level follows the sensory level (MFSL) and another deriving motor function from sensory function (MFSF). Their results differ when (1) all key muscles of an upper (or upper and lower) extremity are scored as intact, (2) sensation is not normal in key muscle segments, and (3) a contiguous region of normal sensation starts at T2 (or S2).

Objectives: This work aims to characterize these cases and to discuss explanations.

Methods: We analyzed 1330 early and late ISNCSCI assessments of 665 individuals from EMSCI.

Results: Forty-nine (3.6% of all 2660 MLs) MFSL (63.3% T1, 36.7% S1) and MFSF MLs from 34 individuals differed without consequences on ASIA Impairment Scale (AIS) grades (4 AIS A, 1 AIS B, 29 AIS D). In 16 AIS D cases, all testable motor functions were intact, with a mean Spinal Cord Independence Measure (SCIM) total score of 95.67 ± 3.51 in 3 individuals with MFSL-ML T1 and 100 in 5 individuals with MFSL-ML S1. The MFSF-MLs are on average 9.63 ± 7.50 (T1: 12.16 ± 8.43; S1: 5.28 ± 1.36) segments caudal to the sensory level (SL).

Conclusion: We identified and characterized rare cases with an unusual sensory impairment pattern, which could be explained by an isolated damage of afferent spinal tracts or the presence of non-SCI conditions. Further investigations of these case are necessary for a more conclusive ML definition.

Background: The risk of symptomatic urinary tract infections (UTIs) after spinal cord injury/disease (SCI/D) is increased, and effective preventive measures are lacking.

Objectives: To evaluate the feasibility of a full-size trial on the efficacy of oral immunomodulation for the primary prevention of symptomatic UTIs in patients with SCI/D.

Methods: This was a randomized, placebo-controlled, quasi-blinded, monocentric feasibility trial enrolling patients with SCI/D during primary in-house rehabilitation. Participants received either a lyophilized Escherichia coli lysate (Uro-Vaxom®) or placebo for 90 days. During the intervention and a 3-month follow-up period, symptomatic UTIs and side effects were recorded. Upon trial completion, participants were asked to rate their trial experience.

Results: A total of 446 individuals with acute SCI/D were screened. Twenty-four out of 83 eligible candidates (28.9%) provided written informed consent, while 22 (26.5%) were randomized. The retention rate was high (90.9%) in both groups. Data of seven women and 13 men (40.8 ± 12.8 years) were analyzed. In the Uro-Vaxom group, two participants did not complete the treatment (adherence rate 80%). Six participants receiving Uro-Vaxom experienced symptomatic UTIs compared to nine participants in the placebo group. Six and four participants reported side effects in the Uro-Vaxom and placebo groups, respectively. Eighteen participants expressed willingness to participate again in a similar future trial.

Conclusion: The trial demonstrated strong retention and adherence rates with minimal participant burden. Consideration of broader inclusion criteria is suggested to improve the number of eligible patients and enhance participant recruitment.

Background: Neurogenic osteoporosis as a result of bone demineralization is a well-known complication after spinal cord injury (SCI). Bone demineralization is a result of the inevitable mechanical unloading of paralyzed limbs and decreased skeletal muscle activity.

Objectives: To determine the impact of a home-based electrical stimulation (ES)-induced exercise (Excs) protocol plus 2000 IU oral daily vitamin D (vit D) supplementation compared to passive movement training (PMT) plus 2000 IU oral daily vit D supplementation on bone microarchitectural properties as measured by magnetic resonance imaging (MRI), bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DXA), and biomarkers of bone formation and bone resorption in persons with chronic SCI.

Methods: Six men with motor complete SCI ranging from C8 to T10 were randomized into either 9 months of vit D+ES-Excs or vit D+PMT groups. The vit D+ES-Excs group underwent daily supplementation of vit D with 4.5 months of neuromuscular electrical stimulation-resistance training (NMES-RT) followed by 4.5 months of functional electrical stimulation (FES) rowing, twice weekly, using a home-based training approach. MRI, DXA, and blood biomarkers were captured at the beginning of the study (baseline), 4.5 months (post-intervention 1), and 9 months after training (post-intervention 2).

Results: The percentage changes indicated that 2 persons in the vit D+ES-Excs group showed decreases in trabecular spacing (28%) and increases in trabecular network (33%-49% at post-intervention 2). This was accompanied by attenuation of BMD loss at the pelvis (3.6%-7.7%), femoral necks (4.5%-8.4%), and knees (10.5%-18.7%). The vit D+ES-Excs group showed increases in leg (5.3%) to total body lean mass and decreases in biomarkers of bone resorption (7.0%-23.5%). Similar changes were not demonstrated following 9 months of vit D+PMT.

Conclusion: Home-based training with 9 months of vit D+ES exercise demonstrated the safety and practicability in mitigating deleterious changes in bone health in persons with chronic SCI. This is concomitant with increased leg lean mass and decreased circulating biomarkers of bone resorption in persons with SCI.

Background: People living with spinal cord injury (SCI) have one of the highest rates of pressure injury prevalence globally, yet the nutrition-related characteristics of this group are inadequately described.

Objectives: This secondary analysis aimed to explore the nutritional status, dietary intakes, and healing outcomes of people with SCI who have pressure injuries in hospital.

Methods: Participant demographics, pressure injury-related information, anthropometry, nutritional status (subjective global assessment), and nutrition interventions were recorded. Assessments of energy and protein intake (24-hour dietary recalls), comparison with evidence-based guideline recommendations, and pressure injury healing (surface area measurements) were collected weekly until one of these occurred: complete healing, hospital discharge, surgical repair, or day 28. Factors associated with overall healing were explored using Mann-Whitney U tests.

Results: Twenty-six people (mean age, 51 ± 14 years; 81% male) were included. Most were well nourished (77%), receiving dietetic input (85%), and on high-protein, high-energy diets (92%). Between 50% and 90% were exceeding energy and protein recommendations at all time points, and there was a weak negative correlation between energy intake and healing (r = -0.430, P = .036). Reduced healing was observed among participants with severe pressure injuries (stage 4 or unstageable, size >5 cm², >1 pressure injury present) and in those exceeding energy and protein recommendations (P < .05).

Conclusion: People with SCI who have coexisting pressure injuries are at risk of excess intake that may be detrimental for pressure injury healing. Future studies examining the nutritional requirements of this population and the impact of both under- and overnutrition are critically needed to guide clinical care.