Topics in Spinal Cord Injury Rehabilitation最新文献

Background: The bidirectional communication between the gastrointestinal tract and the central nervous system appears to be linked to the intestinal microbiome. Research has shown that spinal cord injury (SCI) can disrupt the gut microbiome, leading to gut dysbiosis. These changes can have several negative impacts, such as exacerbated systemic inflammation and susceptibility to infection. Probiotics administered to mice with SCI have been shown to ameliorate gut dysbiosis, confer neuroprotection, and improve locomotor recovery. However, probiotics have also produced conflicting results, making potential claims regarding the application of probiotics as a therapeutic supplement ambiguous.

Objectives: This study aimed to investigate the effects of a commercially available probiotic on recovery in a rat model of cervical SCI.

Methods: Rats with cervical contusion SCI received probiotics over 7 days immediately after injury, and their recovery in motor, sensory, and cognitive tasks was compared to that of untreated animals.

Results: Compared with a control group, the oral administration of probiotics influenced neither motor nor cognitive outcomes. We did observe a significantly different lesion size between the two groups, where the probiotic group had less spared tissue, despite a lack of differences in functional outcomes. In addition, probiotic treatment delayed gut microbiome composition recovery to baseline levels for up to 35 days postinjury (DPI). We found significantly higher proportions of Lactobacillus in the fecal matter of SCI-vehicle rats at 35 DPI, whereas Streptococcus was higher in SCI-probiotics fecal matter at 14 and 35 DPI, and Bacillales was higher in the latter group at 35 DPI.

Conclusion: Taken together, our results do not support the application of the utilized probiotic cocktail as a dietary supplement for the treatment of cervical SCI-induced gut dysbiosis and secondary complications.

Background: Neurogenic bowel dysfunction (NBD) occurs in up to 95% of individuals with spinal cord injury (SCI) and negatively impacts the quality of life. Although diet is an important component in the management of NBD, the relationship between diet quality and NBD is understudied in the SCI population.

Objectives: To assess the diet quality of individuals with chronic SCI and explore possible relationships between diet quality, especially fiber, and symptoms of NBD, and to evaluate whether individuals with SCI themselves recognize relationships between dietary intake and NBD symptoms.

Methods: Individuals with chronic SCI, recruited via their rehabilitation center, completed web-based questionnaires and 24-hour dietary recalls regarding the quality and intake of their diet and the severity of NBD. Ten individuals participated in interviews to explore their views on potential relationships between their diet and NBD.

Results: Twenty-eight participants were recruited, of which ten were interviewed. All participants had symptoms of NBD of varying degrees and a low diet quality, but there was no difference between the NBD groups. The more severe NBD group had a lower intake of vegetables and a higher intake of salt. Almost half of the participants interviewed did not report experiencing an association between dietary intake and their NBD.

Conclusions: A low diet quality was observed among individuals with chronic SCI, irrespective of their NBD symptoms. Many participants were unaware of a potential relationship between their diet and NBD. The sample size is insufficient to draw definitive conclusions; however, a potential hypothesis is that those with more severe NBD may consume not enough vegetables and too much salt. Further longitudinal prospective research is required to enhance nutritional guidelines for individuals with SCI and NBD.

Objectives: To determine the effectiveness of a mandibular advancement device (MAD) in individuals with spinal cord injury (SCI) who suffer from obstructive sleep apnea (OSA) syndrome, and to identify potential predictive factors of response to MAD.

Methods: Forty individuals (34 men and 6 women) with an apnea-hypopnea index (AHI) of more than 15 were included in the MAD uncontrolled clinical trial. The outcomes were evaluated through polygraphic examination before therapy and after 1 and 6 months. Subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]) and quality of life (WHOQOL-BREF) were assessed at baseline and after 6 months. Throughout the study, side effects were continuously monitored.

Results: Thirty-five individuals completed the study. The mean AHI decreased from 35.7 ± 15.6 to 18.5 ± 10.6 at 6 months (P < .0001). ESS improved from 9.3 ± 5.2 to 6.8 ± 3.5 (P = .0001), while no significant change was observed in WHOQOL-BREF scores. Participants with severe (AHI >30) OSA had shorter time since injury and higher body mass index (BMI) than those with moderate OSA (AHI 15-30). According to the criterion for treatment success of at least 50% improvement in AHI, MADs were effective in 48.6% of participants. Younger age and lower WHOQOL-BREF scores were the only factors significantly associated with treatment success.

Conclusion: MADs appear to be an effective treatment for both moderate and severe OSA in people with SCI. They may be a suitable alternative for individuals who decline or are unable to tolerate continuous positive airway pressure therapy.

Background: Experiencing a spinal cord injury (SCI) entails profound biopsychosocial challenges. In this context, patient-provider communication is of critical importance. Yet, the unique complexities of SCI make effective communication particularly difficult.

Objectives: This scoping review aims to provide a comprehensive overview of existing research on patient-provider communication in SCI, providing insights in the focus, the methodology, and the findings of current research and identifying research gaps.

Methods: The search was conducted on CINAHL, PubMed, PsycInfo, Cochrane, Web of Science, and Science Direct. Results of the included studies were thematically analyzed.

Results: A total of 30 studies were included. Current research focuses on verbal communication and the communication function of information delivery. Most studies are cross-sectional qualitative studies, involving either patients or health care providers (HCPs). HCP communication skills, individual patient preferences, and interprofessional communication were the most frequently found influencing factors of patient-provider communication. Identified outcomes of patient-provider communication included higher engagement and satisfaction in patients and enhanced work satisfaction and reduced stress for HCPs.

Discussion: Despite the importance of communication in SCI, significant gaps remain. Studies have largely neglected key areas such as partnership-building, digital and written communication, and interventional research. Given the central role of communication in SCI rehabilitation, these gaps are particularly concerning and demand attention.

Conclusion: This review reinforces the necessity for tailored, person-centered communication strategies that address the unique complexities of SCI rehabilitation. It calls for more comprehensive research to develop communication interventions that benefit both patients and HCPs, with a strong focus on long-term effects.

Objectives: To investigate incidence, conversion, neurological characteristics, and age-dependent functional independence of individuals with initial spinal cord injury (SCI) recovering to American Spinal Injury Association Impairment Scale (AIS) E, meaning normal sensory and motor functions according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).

Methods: We analyzed 12,221 EMSCI (European Multicenter Study about Spinal Cord Injury) ISNCSCI datasets from 5 time points over the first year after SCI of 4286 individuals (age: 48.7 ± 19 years; 23% female; 92% traumatic, 8% ischemic).

Results: Sixty-five of 82 individuals with at least one AIS E exam had an initial assessment within 6 weeks after injury with neurological level of injury peaking at C4 (16.9%) and L2 (15.4%), predominantly AIS grade D (89.2%), and mean total sensory/motor scores reaching 89.4% of their maximum. First AIS E conversion was detected at a median of 171 (interquartile range 274) days after injury. A change point analysis of Spinal Cord Independence Measure (SCIM) III assessments at the time of conversion of 75 AIS E individuals demonstrates a decline of full functional independence with age particularly over 70 years (<40, 76.9%; 40-70, 42.9%; >70, 14.3%).

Conclusion: The current AIS E definition insufficiently reflects the reality experienced by older people without deficits in the ISNCSCI, as functional impairments remain predominantly in mobility-related activities. To detect whether these deficits are related to comorbidities attributable to aging rather than remnant deficits of SCI, functional assessments such as the SCIM should be performed in an age-matched non-SCI control group.

Objectives: To describe the performance of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination in individuals with traumatic spinal cord injury (TSCI) and nontraumatic spinal cord injury (NTSCI) across Canadian acute and rehabilitation facilities, evaluating timing, completeness, and classification accuracy.

Methods: Using the Rick Hansen Spinal Cord Injury Registry (2015-2022), participants were analyzed across 6 cohorts: (A) TSCI-acute-admission (n = 4461), (B) TSCI-acute-discharge (n = 972), (C) TSCI-rehabilitation-admission (n = 2673), (D) TSCI-rehabilitation-discharge (n = 2316), (E) NTSCI-rehabilitation-admission (n = 728), and (F) NTSCI-rehabilitation-discharge (n = 619). ISNCSCI data included performed (yes/no), timing (≤72 hours, ≤7 days, and >7 days of admission/discharge), completeness, missing items, and worksheet used (yes/no). Classification accuracy between the clinician-determined and algorithm-generated ASIA Impairment Scale and neurological level of injury classification was evaluated. Descriptive and bivariate statistics were used to analyze cohorts.

Results: Overall, 70% of participants had at least one examination performed, with 76% performed ≤72 hours, 91% ≤7 days, and 9% >7 days. However, 45% were partially complete, primarily missing sensory scores and rectal components ≤7 days. Comparison of TSCI and NTSCI during rehabilitation showed that NTSCI cohorts had significantly more exams at admission and fewer at discharge, with more complete exams. Moreover, age at injury, injury type, mechanism, severity, length of stay, and pain influenced examination performance.

Conclusion: This study highlights the need for greater consistency in ISNCSCI examination performance and identifies patient-level barriers to completion. Determining the most effective standardized approach for ISNCSCI use across SCI care, addressing modifiable human/organizational factors, and ensuring comprehensive clinical training will improve the quality of this assessment.

Background: In the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), motor levels are inferred from sensory levels for high cervical, thoracic, and low sacral injuries, as key muscles are only assessed in upper and lower extremities. This is known as the "motor follows sensory level" rule.

Objectives: To develop regression models for estimating motor scores from sensory scores in segments without clinically testable key muscles and to validate the consensus-based "motor follows sensory level" approach.

Methods: A total of 6940 ISNCSCI examinations from the European Multicenter Study about Spinal Cord Injury were reviewed. Multiple linear and random forest regression models were trained on scores in clinically testable segments to predict motor from sensory scores of the same spinal segment and side. Models based on ipsilateral light touch or pinprick scores alone, as well as all bilateral sensory scores, were also evaluated. Predicted motor scores were used to recalculate motor levels for the segments without clinically testable key muscles and compared to the true motor levels.

Results: The ipsilateral regression models showed minimal differences (R ² 0.64-0.65; RMSE 1.34). Normal motor scores were predicted only for normal sensory function; in the linear model, this was captured by the equation: motor score = 0.18 + 1.22 * light touch score + 0.96 * pinprick score. Model-based motor levels were shifted caudally 0.18 segments (linear regression) and 0.32 segments (random forest regression).

Conclusion: As models predict normal motor function only for normal sensory scores, predicted motor levels deviate only marginally, supporting the "motor follows sensory level" rule.

Background: Mouse models of traumatic spinal cord injury (SCI) are used to understand pathophysiology and test potential interventions. Experimental injury parameters, deficits on functional tasks, and histology are used to assess severity and recovery. Blood biomarkers may be a promising additional metric to assess severity and detect efficacy of interventions, but they have not been examined previously in mouse spinal cord injury (SCI).

Objectives: To examine blood biomarkers in mouse SCI.

Methods: We measured plasma levels of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) longitudinally following a thoracic contusion SCI in adolescent (3 month old) and aged (18 month old) male and female C57Bl6/J mice. Biomarkers were also assessed in comparably aged uninjured animals.

Results: Three-month-old animals exhibited elevated plasma NfL and GFAP 1 month after injury. NfL levels decreased from 1 to 2 months post injury but remained elevated from baseline, while GFAP levels remained high. Adolescent males exhibited higher NfL levels than females post injury. In aged animals, NfL was comparably elevated at 1 and 2 months post injury. In aged females, GFAP was elevated at 1 and 2 months after injury, while levels in males did not increase from baseline until 2 months after injury. Values from uninjured animals show plasma NfL and GFAP increase with age in absence of injury.

Conclusion: In a mouse SCI model, plasma NfL and GFAP are elevated chronically after injury. Sex and age at injury may affect biomarker trajectories, which may indicate underlying pathology relevant to treatment and recovery. Establishing the trajectory of NfL and GFAP after experimental injury may help to standardize injury paradigms, assess recovery, and detect efficacy of interventions.

Background: The impact of concomitant traumatic brain injury (TBI) and spinal cord injury (SCI) on the development of problematic chronic pain has never been studied. We hypothesized that concomitant TBI increases the rates of problematic chronic pain outcomes in SCI individuals.

Objectives: To examine the association between concomitant TBI-SCI (as opposed to isolated TBI or SCI) and the development of problematic chronic pain outcomes, including referral to a specialized pain clinic or long-term usage of opioids or other chronic pain medications.

Methods: A retrospective observational cohort study on 18,861 neurotrauma patients from prospective governmental populational databases from the province of Quebec, Canada (population ∼8 million) was conducted. The main independent variable was the nature of neurotrauma sustained at the time of the accident: TBI only versus SCI only versus concomitant TBI-SCI. Problematic chronic pain was defined as (1) receiving a formal diagnosis of chronic pain, (2) using significant amounts of opioids, or (3) receiving a referral to a chronic pain clinic.

Results: Out of the all the included patients, 16,472 (87%) had TBI only, 1528 had TSCI only (8.1%), and 861 (4.6%) had concomitant TBI-SCI diagnosis. At the group level, patients with concomitant TBI-SCI presented markedly higher use of opioid/chronic pain medication than patients with SCI or TBI only (15.3% vs. 8.5% vs. 0.5%; P < .001). At the multivariate level, the nature of neurotrauma sustained remained significantly associated with all 3 outcomes that were used to define problematic chronic pain. Finally, a synergistic effect between SCI and TBI was confirmed for the development of chronic use of opioids and other pain medications (odds ratio [OR] 1.92; P < .001).

Conclusion: This study supports a synergistic effect of TBI and SCI for the development of chronic use of opioids and other pain medications. Clinicians should be aware of potential underlying TBI in SCI patients in order to address potential chronic pain issues after neurotrauma.

Background: Emerging neuromodulation approaches, including epidural electrical stimulation (EES), offer hope for restoration of function following chronic spinal cord injury (SCI). However, integrating neuromodulation therapies into clinical procedures is challenging due to the unique needs of the SCI population.

Objectives: The purpose of this study was to understand the experiences of participants during a first-in-human trial of perilesional EES aimed at restoring sensorimotor function.

Methods: We report participants' experiences by describing their clinical care, experiences during experimental neuromodulation sessions, and perspectives on the utility of a perilesional EES system. Three participants with chronic thoracic SCI participated in semistructured interviews after completing a 14-day inpatient experimental protocol, which included stimulation mapping, lower extremity motor control experiments, and treadmill stepping. Interview data were analyzed using an applied thematic analysis approach. Nine key themes addressed 4 major topic areas: clinical experiences, experiences during laboratory experiments, experiences as a research participant, and perceived value of perilesional EES.

Results: All participants noted the potential for EES to enhance functional recovery, though their postoperative experiences related to clinical care, postoperative pain, and disruptions to routine care differed. Insights gained from qualitative analyses highlighted challenges and opportunities for improving postsurgical care and refining application of EES technology. Further, these results inform recommendations for neuromodulation trials in the SCI community to help mitigate postoperative complications and improve study participant experiences.

Conclusion: Key recommendations include being proactive regarding potential postsurgical complications, educating clinical staff regarding common SCI comorbidities, and customizing experimental protocols to align with the priorities and clinical needs of each participant.