A. Senthinathan, Mina Tadrous, Swaleh Hussain, B. C. Craven, Susan B. Jaglal, Rahim Moineddin, John Shepherd, Lauren Cadel, Vanessa K. Noonan, Sandra McKay, Karen Tu, S. Guilcher
The COVID-19 pandemic has significantly impacted healthcare utilization; however, research has not investigated the impact in the spinal cord injury/dysfunction (SCI/D) population in Canada. To examine healthcare utilization and delivery during the COVID-19 pandemic in individuals with SCI/D. A repeated-cross sectional retrospective longitudinal cohort study design was conducted using health administrative database in Ontario, Canada. In 5,754 individuals with SCI/D, healthcare utilization and delivery (in-person, and virtual) were determined at the 1) pre-pandemic (March 2015 to February 2020), 2) initial pandemic onset (March 2020-May 2020), and 3) pandemic (June 2020 to March 2022) phases. Autoregressive integrated moving average (ARIMA) modelling were conducted to determine pandemic impact on monthly healthcare utilization and delivery. The initial pandemic onset period had a significant reduction of 24% in physician (p=0.0081), 35% in specialist (p<0.0001), and 30% in urologist (p<0.0001) visits, compared to pre-pandemic levels, with a partial recovery as the pandemic progressed. In April 2020, compared to the pre-pandemic period, a significant increase (p<0.0001) for virtual visits for physician, specialist, urologist, and primary care was found. The initial pandemic onset period had a 46% decrease in ED visits (p=0.0764) and 58% decrease in hospital admissions (p=0.0011), compared to the pre-pandemic period. Healthcare utilization dropped in the initial pandemic onset period as physician, specialist, urologist, and ED visits, as well as hospitalization decreased significantly (p<0.05) versus pre-pandemic levels. Virtual visit increases compensated for in-person visit decreases as the pandemic progressed to allow for total visits to partially recover.
{"title":"Post Doc Competition (Health Services, Economics and Policy Change) ID 1985179","authors":"A. Senthinathan, Mina Tadrous, Swaleh Hussain, B. C. Craven, Susan B. Jaglal, Rahim Moineddin, John Shepherd, Lauren Cadel, Vanessa K. Noonan, Sandra McKay, Karen Tu, S. Guilcher","doi":"10.46292/sci23-1985179s","DOIUrl":"https://doi.org/10.46292/sci23-1985179s","url":null,"abstract":"The COVID-19 pandemic has significantly impacted healthcare utilization; however, research has not investigated the impact in the spinal cord injury/dysfunction (SCI/D) population in Canada. To examine healthcare utilization and delivery during the COVID-19 pandemic in individuals with SCI/D. A repeated-cross sectional retrospective longitudinal cohort study design was conducted using health administrative database in Ontario, Canada. In 5,754 individuals with SCI/D, healthcare utilization and delivery (in-person, and virtual) were determined at the 1) pre-pandemic (March 2015 to February 2020), 2) initial pandemic onset (March 2020-May 2020), and 3) pandemic (June 2020 to March 2022) phases. Autoregressive integrated moving average (ARIMA) modelling were conducted to determine pandemic impact on monthly healthcare utilization and delivery. The initial pandemic onset period had a significant reduction of 24% in physician (p=0.0081), 35% in specialist (p<0.0001), and 30% in urologist (p<0.0001) visits, compared to pre-pandemic levels, with a partial recovery as the pandemic progressed. In April 2020, compared to the pre-pandemic period, a significant increase (p<0.0001) for virtual visits for physician, specialist, urologist, and primary care was found. The initial pandemic onset period had a 46% decrease in ED visits (p=0.0764) and 58% decrease in hospital admissions (p=0.0011), compared to the pre-pandemic period. Healthcare utilization dropped in the initial pandemic onset period as physician, specialist, urologist, and ED visits, as well as hospitalization decreased significantly (p<0.05) versus pre-pandemic levels. Virtual visit increases compensated for in-person visit decreases as the pandemic progressed to allow for total visits to partially recover.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"4 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139344918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James Milligan, Joseph Lee, Allison Harrison, Kathleen MacGregor
The Centre for Family Medicine Primary Care Mobility Clinic has been active in developing collaborations at various institutions to further the overall research and clinical objectives of serving individuals with spinal cord injuries (SCI). From these initiatives, The Circulus SCI Primary Care Network (Circulus Network) was established to spark intentional collaborative research, education, training and service in primary care for individuals with SCI. The Circulus Network aims to bridge the gaps in primary care for individuals with SCI through research, education, increasing primary care resources, networking with various stakeholders and general advocacy. The Circulus Network is comprised of a Steering Committee and working groups that are representative of key stakeholders. These groups meet on a rotating monthly basis and are supported by a group process consultant. The Circulus Network informs best practice guidelines and improves knowledge translation by hosting quarterly interactive webinars on topics related to SCI and primary care as well as bi-annual Summits. Since 2021, The Circulus Network has hosted 9 webinars on SCI-related topics with good attendance by network participants. It also hosted a Summit in 2021 in which participants discussed priority planning topics and leveraged expertise to develop action steps. The Steering Committee is planning another Summit for February 2024. Using our extensive knowledge of primary care for individuals with SCI, we will continue to strengthen and develop the formalized network of patients, care partners, clinicians, researchers, and educators to support primary care of individuals with spinal cord injuries.
{"title":"Poster (Clinical/Best Practice Implementation) ID 2004606","authors":"James Milligan, Joseph Lee, Allison Harrison, Kathleen MacGregor","doi":"10.46292/sci23-2004606s","DOIUrl":"https://doi.org/10.46292/sci23-2004606s","url":null,"abstract":"The Centre for Family Medicine Primary Care Mobility Clinic has been active in developing collaborations at various institutions to further the overall research and clinical objectives of serving individuals with spinal cord injuries (SCI). From these initiatives, The Circulus SCI Primary Care Network (Circulus Network) was established to spark intentional collaborative research, education, training and service in primary care for individuals with SCI. The Circulus Network aims to bridge the gaps in primary care for individuals with SCI through research, education, increasing primary care resources, networking with various stakeholders and general advocacy. The Circulus Network is comprised of a Steering Committee and working groups that are representative of key stakeholders. These groups meet on a rotating monthly basis and are supported by a group process consultant. The Circulus Network informs best practice guidelines and improves knowledge translation by hosting quarterly interactive webinars on topics related to SCI and primary care as well as bi-annual Summits. Since 2021, The Circulus Network has hosted 9 webinars on SCI-related topics with good attendance by network participants. It also hosted a Summit in 2021 in which participants discussed priority planning topics and leveraged expertise to develop action steps. The Steering Committee is planning another Summit for February 2024. Using our extensive knowledge of primary care for individuals with SCI, we will continue to strengthen and develop the formalized network of patients, care partners, clinicians, researchers, and educators to support primary care of individuals with spinal cord injuries.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"62 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicole Cesca, Chantal Lin, Zeina Abu-Jurji, Aaron Wexler, Jonas Mark, S. McCullum, Rija Kamran, Brian Chan, Kristin E. Musselman
Rehabilitation after spinal cord injury (SCI) is a life-long process with individuals accessing care in a variety of settings, including centres without SCI-specific services (i.e., non-SCI-specialized centres). Activity-based Therapy (ABT) is a relatively new neurorestorative approach that involves intensive, task-specific movement practice below the level of injury. This study aimed to understand current knowledge, perceptions, and use of ABT by physical and occupational therapists at non-SCI-specialized centres. A qualitative exploratory study using semi-structured interviews was conducted. The Theoretical Domains Framework was used to develop an interview guide that queried therapists’ experiences providing SCI rehabilitation, perceptions of ABT and ABT implementation. Canadian therapists who worked with at least one SCI patient in the last 18 months and practiced at non-SCI-specialized centres participated. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description. Four physical and three occupational therapists from acute, inpatient, long-term care and outpatient settings participated. Three themes were determined: 1) Perceived challenges of working with SCI in non-SCI-specialized centres, 2) Current therapy techniques used and 3) Desire for ABT knowledge and implementation strategies specific to non-SCI-specialized centres. It was identified that participants were unknowingly incorporating some components of ABT in their practice. Participants emphasized challenges to ABT implementation, such as knowledge gaps, and expressed a keenness to learn more about ABT. Current implementation of ABT in non-SCI-specialized centres is limited, with a variety of challenges and therapist needs identified. Tailoring ABT education to therapists at non-SCI-specialized centres may increase implementation of ABT at these centres.
{"title":"Student Competition (Clinical/Best Practice Implementation) ID 1974598","authors":"Nicole Cesca, Chantal Lin, Zeina Abu-Jurji, Aaron Wexler, Jonas Mark, S. McCullum, Rija Kamran, Brian Chan, Kristin E. Musselman","doi":"10.46292/sci23-1974598s","DOIUrl":"https://doi.org/10.46292/sci23-1974598s","url":null,"abstract":"Rehabilitation after spinal cord injury (SCI) is a life-long process with individuals accessing care in a variety of settings, including centres without SCI-specific services (i.e., non-SCI-specialized centres). Activity-based Therapy (ABT) is a relatively new neurorestorative approach that involves intensive, task-specific movement practice below the level of injury. This study aimed to understand current knowledge, perceptions, and use of ABT by physical and occupational therapists at non-SCI-specialized centres. A qualitative exploratory study using semi-structured interviews was conducted. The Theoretical Domains Framework was used to develop an interview guide that queried therapists’ experiences providing SCI rehabilitation, perceptions of ABT and ABT implementation. Canadian therapists who worked with at least one SCI patient in the last 18 months and practiced at non-SCI-specialized centres participated. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description. Four physical and three occupational therapists from acute, inpatient, long-term care and outpatient settings participated. Three themes were determined: 1) Perceived challenges of working with SCI in non-SCI-specialized centres, 2) Current therapy techniques used and 3) Desire for ABT knowledge and implementation strategies specific to non-SCI-specialized centres. It was identified that participants were unknowingly incorporating some components of ABT in their practice. Participants emphasized challenges to ABT implementation, such as knowledge gaps, and expressed a keenness to learn more about ABT. Current implementation of ABT in non-SCI-specialized centres is limited, with a variety of challenges and therapist needs identified. Tailoring ABT education to therapists at non-SCI-specialized centres may increase implementation of ABT at these centres.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"95 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dilshan Abeywardane, Vivian K. Mushahwar, Kahir A. Rahemtulla
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins and is the third most common cardiovascular disease today. One of the causes of DVT is venous stasis. Current methods of DVT prevention include anticoagulants and mechanical prophylaxis. Anticoagulant use is contraindicated in individuals with bleeding risks and mechanical interventions are often cumbersome and uncomfortable. The overall goal of this project is to investigate a novel method for DVT prevention, termed intermittent electrical stimulation (IES). The current study investigated the effects of IES on healthy typical as well as post-stroke persons. Of the 32 participants, 22 were healthy subjects from Edmonton, and 10 were inpatient post-stroke subjects at the Glenrose Rehabilitation Hospital, Edmonton. A two-channel stimulator was used to administer IES through electrodes placed on the posterior and anterior sides of the leg and was applied in increasing stimulation amplitudes to the gastrocnemius muscle and the resulting plantar flexion force and changes in popliteal and femoral venous velocities were recorded for each stimulation respectively using B-mode ultrasound. IES-induced contractions produced significant increases in venous flow compared to baseline. Small contractions induced by comfortable levels of stimulation in typical and in post-stroke persons were sufficient to increase flow in the popliteal and femoral veins. The results indicate that IES can sufficiently increase venous flow to prevent venous stasis and is comfortable for end users. Incorporation of IES into a clinical device could provide a feasible and effective alternative for DVT prophylaxis.
{"title":"Student Competition (Technology Innovation) ID 1985239","authors":"Dilshan Abeywardane, Vivian K. Mushahwar, Kahir A. Rahemtulla","doi":"10.46292/sci23-1985239s","DOIUrl":"https://doi.org/10.46292/sci23-1985239s","url":null,"abstract":"Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins and is the third most common cardiovascular disease today. One of the causes of DVT is venous stasis. Current methods of DVT prevention include anticoagulants and mechanical prophylaxis. Anticoagulant use is contraindicated in individuals with bleeding risks and mechanical interventions are often cumbersome and uncomfortable. The overall goal of this project is to investigate a novel method for DVT prevention, termed intermittent electrical stimulation (IES). The current study investigated the effects of IES on healthy typical as well as post-stroke persons. Of the 32 participants, 22 were healthy subjects from Edmonton, and 10 were inpatient post-stroke subjects at the Glenrose Rehabilitation Hospital, Edmonton. A two-channel stimulator was used to administer IES through electrodes placed on the posterior and anterior sides of the leg and was applied in increasing stimulation amplitudes to the gastrocnemius muscle and the resulting plantar flexion force and changes in popliteal and femoral venous velocities were recorded for each stimulation respectively using B-mode ultrasound. IES-induced contractions produced significant increases in venous flow compared to baseline. Small contractions induced by comfortable levels of stimulation in typical and in post-stroke persons were sufficient to increase flow in the popliteal and femoral veins. The results indicate that IES can sufficiently increase venous flow to prevent venous stasis and is comfortable for end users. Incorporation of IES into a clinical device could provide a feasible and effective alternative for DVT prophylaxis.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"0 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Soroush Mirkiani, Neil Tyreman, Carly L O’Sullivan, Don Wilson, Amin Arefadib, Richard Fox, Philip Troyk, Vivian K. Mushahwar
Intraspinal microstimulation (ISMS) is a neuromodulation technique for restoring walking after spinal cord injury. The objective of this study was to fabricate a stretchable ISMS device suitable for pigs, a clinically-relevant animal model. Polyimide-insulated microwires (50µm, Pt-Ir, 80%/20%) were used for fabrication of electrodes. Their tips were de-insulated (∼0.15mm2) and sharpened using nanosecond and femtosecond UV lasers. Microcoils were fabricated from 25μm microwires (Pt-Ir, 80%/20%) to add stretchability to the lead wires. Sixteen microelectrode-leads were connected to a custom, wirelessly controlled stimulator using Medtronic extension cables (Model 37081). The implants were tested in seven domestic pigs and current pulse trains were delivered to various rostro-caudal regions of the lumbar spinal cord (1s, 40Hz, 50µA-300µA) to activate locomotor-related muscle synergies. The kinematics and isometric joint forces of the evoked hindlimb responses were recorded. Graded joint movements were evoked with increasing stimulus amplitude. Changes in the hip, knee, and ankle joints angles evoked by ISMS at 300µA were 17.9±1˚, 28.1±1˚, and 21.6±2˚, respectively. Isometric joint forces evoked by ISMS at 300µA were 12.21±0.91N, 7.4±0.71N, and 1.7±0.15N for knee extension, hip flexion, and ankle flexion, respectively. The movements evoked using the developed ISMS implant could generate full ranges of motion in the joints. The graded responses imply a near-physiological recruitment order of motoneurons, which is necessary for achieving long walking distances without muscle fatigue. The results show the capability of the developed ISMS device in generating movements in pigs, and the implants’ potential for future use in humans.
{"title":"Student Competition (Technology Innovation) ID 1984861","authors":"Soroush Mirkiani, Neil Tyreman, Carly L O’Sullivan, Don Wilson, Amin Arefadib, Richard Fox, Philip Troyk, Vivian K. Mushahwar","doi":"10.46292/sci23-1984861s","DOIUrl":"https://doi.org/10.46292/sci23-1984861s","url":null,"abstract":"Intraspinal microstimulation (ISMS) is a neuromodulation technique for restoring walking after spinal cord injury. The objective of this study was to fabricate a stretchable ISMS device suitable for pigs, a clinically-relevant animal model. Polyimide-insulated microwires (50µm, Pt-Ir, 80%/20%) were used for fabrication of electrodes. Their tips were de-insulated (∼0.15mm2) and sharpened using nanosecond and femtosecond UV lasers. Microcoils were fabricated from 25μm microwires (Pt-Ir, 80%/20%) to add stretchability to the lead wires. Sixteen microelectrode-leads were connected to a custom, wirelessly controlled stimulator using Medtronic extension cables (Model 37081). The implants were tested in seven domestic pigs and current pulse trains were delivered to various rostro-caudal regions of the lumbar spinal cord (1s, 40Hz, 50µA-300µA) to activate locomotor-related muscle synergies. The kinematics and isometric joint forces of the evoked hindlimb responses were recorded. Graded joint movements were evoked with increasing stimulus amplitude. Changes in the hip, knee, and ankle joints angles evoked by ISMS at 300µA were 17.9±1˚, 28.1±1˚, and 21.6±2˚, respectively. Isometric joint forces evoked by ISMS at 300µA were 12.21±0.91N, 7.4±0.71N, and 1.7±0.15N for knee extension, hip flexion, and ankle flexion, respectively. The movements evoked using the developed ISMS implant could generate full ranges of motion in the joints. The graded responses imply a near-physiological recruitment order of motoneurons, which is necessary for achieving long walking distances without muscle fatigue. The results show the capability of the developed ISMS device in generating movements in pigs, and the implants’ potential for future use in humans.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139347038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ujjoyinee Barua, Jeffery Holmes, E. Loh, R. Teasell, K. Sequeira, D. Wolfe, S. Mehta
Spinal cord injuries (SCI) have a devastating effect on individuals incurring this life-changing event; however, it can also affect those integrally involved in their care. Family caregivers often experience negative outcomes, including high levels of burden, leading to decreased psychological well-being. Cognitive behavioural therapy is the most evidence-based treatment to help people identify and modify thoughts and behaviours contributing to their mental health concerns. However, several resource limitations exist. Guided internet-delivered cognitive behaviour therapy (ICBT) offers an evidence-based and accessible approach to psychosocial service delivery. ICBT improved psychosocial outcomes, including depression among persons with chronic health conditions. However, the efficacy of ICBT has yet to be evaluated among these caregivers. We present the protocol of the Well-being Care Partners Program, a 10-week clinician-guided ICBT program tailored for SCI caregivers to improve their well-being. The program was developed through participatory action research involving seven expert members (i.e., clinicians, people with lived experiences). We aim to recruit 30 participants to pilot this program. Participants will complete measures at baseline, post-intervention, and three months post-intervention. The primary outcome will be feasibility assessed through acceptability and limited efficacy (i.e., depression, anxiety, caregiver burden) as suggested by Bowen’s feasibility framework. This is one of the first pilot trials to test the feasibility, acceptability, and efficacy of a guided ICBT program for SCI caregivers. ICBT is designed to deliver an evidence-based intervention to overcome face-to-face therapy barriers and reach a wider group of patients, including those who might experience difficulties accessing health care.
{"title":"Poster (Technology Innovation) ID 1970531","authors":"Ujjoyinee Barua, Jeffery Holmes, E. Loh, R. Teasell, K. Sequeira, D. Wolfe, S. Mehta","doi":"10.46292/sci23-1970531s","DOIUrl":"https://doi.org/10.46292/sci23-1970531s","url":null,"abstract":"Spinal cord injuries (SCI) have a devastating effect on individuals incurring this life-changing event; however, it can also affect those integrally involved in their care. Family caregivers often experience negative outcomes, including high levels of burden, leading to decreased psychological well-being. Cognitive behavioural therapy is the most evidence-based treatment to help people identify and modify thoughts and behaviours contributing to their mental health concerns. However, several resource limitations exist. Guided internet-delivered cognitive behaviour therapy (ICBT) offers an evidence-based and accessible approach to psychosocial service delivery. ICBT improved psychosocial outcomes, including depression among persons with chronic health conditions. However, the efficacy of ICBT has yet to be evaluated among these caregivers. We present the protocol of the Well-being Care Partners Program, a 10-week clinician-guided ICBT program tailored for SCI caregivers to improve their well-being. The program was developed through participatory action research involving seven expert members (i.e., clinicians, people with lived experiences). We aim to recruit 30 participants to pilot this program. Participants will complete measures at baseline, post-intervention, and three months post-intervention. The primary outcome will be feasibility assessed through acceptability and limited efficacy (i.e., depression, anxiety, caregiver burden) as suggested by Bowen’s feasibility framework. This is one of the first pilot trials to test the feasibility, acceptability, and efficacy of a guided ICBT program for SCI caregivers. ICBT is designed to deliver an evidence-based intervention to overcome face-to-face therapy barriers and reach a wider group of patients, including those who might experience difficulties accessing health care.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"130 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Brockie, C. Zhou, M. Movahed, J. Hong, M. G. Fehlings
Degenerative cervical myelopathy (DCM) is the most common form of spinal impairment worldwide and is caused by a series of degenerative changes that compress the spinal cord. DCM can be treated with surgical decompression (DEC), but recovery is impaired by secondary injury, such that 44% of patients who undergo DEC never regain lost function, and 9% experience persistent decline. The fractalkine receptor, CX3CR1, is expressed by monocyte-derived macrophages and CNS-resident microglia, where it mediates communication with neurons expressing its ligand, CX3CL1, and maintains phagocytic, migration, and injury response functions. The purpose of this study is to determine the role of fractalkine in degeneration and post-surgical injury. We hypothesize that CX3CR1 expression is elevated by DCM and DEC and that inhibiting it may attenuate inflammation and improve functional outcomes. To determine this, I am using a mouse model of C5-6 myelopathy in Cx3cr1-knockout and wildtype mice to produce functional degeneration and neuropathic pain across a 12-week period. Immunostaining of spinal tissue from myelo-pathic wildtype mice indicates upregulation of CX3CR1 throughout DCM and confirms this expression to be mediated by resident microglia. Inhibiting fractalkine signalling attenuates neuropathic pain across DCM progression. Following DEC, these benefits are reversed, and knockouts experience more pain up to 5 weeks post-surgery, suggesting a critical role for CX3CR1 in mediating secondary injury. My findings thus far indicate a significant role played by fractalkine signaling in DCM and DEC recovery and posit microglia as a target for therapeutic intervention.
{"title":"Student Competition (Knowledge Generation) ID 1987548","authors":"S. Brockie, C. Zhou, M. Movahed, J. Hong, M. G. Fehlings","doi":"10.46292/sci23-1987548s","DOIUrl":"https://doi.org/10.46292/sci23-1987548s","url":null,"abstract":"Degenerative cervical myelopathy (DCM) is the most common form of spinal impairment worldwide and is caused by a series of degenerative changes that compress the spinal cord. DCM can be treated with surgical decompression (DEC), but recovery is impaired by secondary injury, such that 44% of patients who undergo DEC never regain lost function, and 9% experience persistent decline. The fractalkine receptor, CX3CR1, is expressed by monocyte-derived macrophages and CNS-resident microglia, where it mediates communication with neurons expressing its ligand, CX3CL1, and maintains phagocytic, migration, and injury response functions. The purpose of this study is to determine the role of fractalkine in degeneration and post-surgical injury. We hypothesize that CX3CR1 expression is elevated by DCM and DEC and that inhibiting it may attenuate inflammation and improve functional outcomes. To determine this, I am using a mouse model of C5-6 myelopathy in Cx3cr1-knockout and wildtype mice to produce functional degeneration and neuropathic pain across a 12-week period. Immunostaining of spinal tissue from myelo-pathic wildtype mice indicates upregulation of CX3CR1 throughout DCM and confirms this expression to be mediated by resident microglia. Inhibiting fractalkine signalling attenuates neuropathic pain across DCM progression. Following DEC, these benefits are reversed, and knockouts experience more pain up to 5 weeks post-surgery, suggesting a critical role for CX3CR1 in mediating secondary injury. My findings thus far indicate a significant role played by fractalkine signaling in DCM and DEC recovery and posit microglia as a target for therapeutic intervention.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139344072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Tajali, Stephanie N. Iwasa, Sharmini Atputharaj, Vivian W. Sin, Naaz Kapadia, Kristin E. Musselman, Milos R. Popovic, Kei Masani
Functional electrical stimulation (FES) of paralyzed muscles can facilitate walking after spinal cord injury (SCI). To test the orthotic effects of different FES walking protocols on lower joint kinematics in individuals with incomplete SCI. Three adults with motor incomplete SCI participated in this study. Their lower extremity motor scores [LEMS (left, right)] were as follows: subject A: 25/25, subject B:15/25, subject C:9/23. They were asked to randomly complete four conditions of overground walking in a 4-meter walkway (6-10 times/condition) including no FES, and three bilateral FES walking protocols as follows: drop-foot (tibialis anterior stimulation), flexor withdrawal (common peroneal nerve stimulation), and multi-muscle stimulation (stimulation of quadriceps and gastrocnemius in the stance phase, and hamstring and tibialis anterior in the swing phase). The FES system obtained gait phase information from the two footswitches located under the individuals’ feet. Three-dimensional kinematic analysis was undertaken to measure minimum toe clearance (MTC), ankle, and hip range of motion (ROM) using a 100 Hz eight infrared camera (Vicon Motion Systems, Oxford, UK). The three FES-walking conditions significantly increased MTC compared to the no-FES condition in all participants. A significant decrease in ankle ROM was seen in the drop-foot (all subjects), multi-muscle (subjects A and C), and flexor withdrawal (subject A) stimulations. Hip ROM increased in the drop-foot (subjects B and C), flexor withdrawal (subject B), and multi-muscle (subject C) stimulations. Three FES-walking protocols induced positive kinematic changes (increased hip flexion and toe clearance) during walking in subjects with incomplete SCI.
{"title":"Post Doc Competition (Clinical/Best Practice Implementation) ID 1985647","authors":"S. Tajali, Stephanie N. Iwasa, Sharmini Atputharaj, Vivian W. Sin, Naaz Kapadia, Kristin E. Musselman, Milos R. Popovic, Kei Masani","doi":"10.46292/sci23-1985647s","DOIUrl":"https://doi.org/10.46292/sci23-1985647s","url":null,"abstract":"Functional electrical stimulation (FES) of paralyzed muscles can facilitate walking after spinal cord injury (SCI). To test the orthotic effects of different FES walking protocols on lower joint kinematics in individuals with incomplete SCI. Three adults with motor incomplete SCI participated in this study. Their lower extremity motor scores [LEMS (left, right)] were as follows: subject A: 25/25, subject B:15/25, subject C:9/23. They were asked to randomly complete four conditions of overground walking in a 4-meter walkway (6-10 times/condition) including no FES, and three bilateral FES walking protocols as follows: drop-foot (tibialis anterior stimulation), flexor withdrawal (common peroneal nerve stimulation), and multi-muscle stimulation (stimulation of quadriceps and gastrocnemius in the stance phase, and hamstring and tibialis anterior in the swing phase). The FES system obtained gait phase information from the two footswitches located under the individuals’ feet. Three-dimensional kinematic analysis was undertaken to measure minimum toe clearance (MTC), ankle, and hip range of motion (ROM) using a 100 Hz eight infrared camera (Vicon Motion Systems, Oxford, UK). The three FES-walking conditions significantly increased MTC compared to the no-FES condition in all participants. A significant decrease in ankle ROM was seen in the drop-foot (all subjects), multi-muscle (subjects A and C), and flexor withdrawal (subject A) stimulations. Hip ROM increased in the drop-foot (subjects B and C), flexor withdrawal (subject B), and multi-muscle (subject C) stimulations. Three FES-walking protocols induced positive kinematic changes (increased hip flexion and toe clearance) during walking in subjects with incomplete SCI.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139344726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deborah O. Okusanya, Jane A. Porter, Darren J. Mann, Zahra Karamzadeh, Sisuri G. Hemakumara, Trevor S. Barss, Vivian K. Mushahwar
When we walk, we swing our arms in rhythm with our legs due to neural connections in the spinal cord. Currently, rehabilitation protocols primarily focus on leg training to improve walking function. However, past research has highlighted the importance of engaging the arms in rehabilitative interventions through arm and leg cycling following an incomplete spinal cord injury (iSCI). The objective of this study is to determine if the application of non-invasive transcutaneous spinal cord stimulation (tSCS) paired with arm and leg cycling can improve walking for individuals with an iSCI. It is hypothesized that the addition of tSCS will activate previously inaccessible neural circuits within the spinal cord to produce significant improvements in walking capacity. Individuals with an iSCI underwent arm and leg cycling training that was assisted by functional electrical stimulation applied to the main extensor muscles of the leg. tSCS was applied over the cervical and lumbar regions of the spinal cord. Training consisted of 1 hour of cycling, 5 days/week for 12 weeks. A series of clinical and biomechanical assessments were performed to assess changes in functional mobility. Preliminary results in three participants showed increases in maximal walking speed on the 10-metre walk test, increases in walking endurance on the 6-minute walk test, and improved balance on the Berg Balance Scale. Preliminary biomechanical results suggested that the addition of tSCS may reduce left-right asymmetry. Arm and leg cycling paired with tSCS offers tremendous potential for improvements in walking function following an iSCI.
{"title":"Student Competition (Knowledge Generation) ID 1985159","authors":"Deborah O. Okusanya, Jane A. Porter, Darren J. Mann, Zahra Karamzadeh, Sisuri G. Hemakumara, Trevor S. Barss, Vivian K. Mushahwar","doi":"10.46292/sci23-1985159s","DOIUrl":"https://doi.org/10.46292/sci23-1985159s","url":null,"abstract":"When we walk, we swing our arms in rhythm with our legs due to neural connections in the spinal cord. Currently, rehabilitation protocols primarily focus on leg training to improve walking function. However, past research has highlighted the importance of engaging the arms in rehabilitative interventions through arm and leg cycling following an incomplete spinal cord injury (iSCI). The objective of this study is to determine if the application of non-invasive transcutaneous spinal cord stimulation (tSCS) paired with arm and leg cycling can improve walking for individuals with an iSCI. It is hypothesized that the addition of tSCS will activate previously inaccessible neural circuits within the spinal cord to produce significant improvements in walking capacity. Individuals with an iSCI underwent arm and leg cycling training that was assisted by functional electrical stimulation applied to the main extensor muscles of the leg. tSCS was applied over the cervical and lumbar regions of the spinal cord. Training consisted of 1 hour of cycling, 5 days/week for 12 weeks. A series of clinical and biomechanical assessments were performed to assess changes in functional mobility. Preliminary results in three participants showed increases in maximal walking speed on the 10-metre walk test, increases in walking endurance on the 6-minute walk test, and improved balance on the Berg Balance Scale. Preliminary biomechanical results suggested that the addition of tSCS may reduce left-right asymmetry. Arm and leg cycling paired with tSCS offers tremendous potential for improvements in walking function following an iSCI.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"60 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139345321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Chernesky, Anita Kaiser, Barry Munro, K. Walden, Heather Gainforth, Kristin E. Musselman
Teams with diverse perspectives and experiences have been increasingly recognized for their ability to identify key issues and utilize creativity and problem solving to plan and implement research and clinical initiatives that lead to greater impact. Yet, often we are unsure how to best engage individuals with differing expertise, such as those with lived experience, clinicians, healthcare administrators, engineers, researchers, funders and policy experts. After completing this workshop, participants will be able to: 1) Understand the principles and value of meaningfully engaging with a diverse team when conducting research or clinical projects, 2) Identify strategies that can facilitate the meaningful engagement of individuals with differing expertise, and 3) Create a plan of engagement for a research study or clinical initiative. A combination of lecture-based and case-based learning will be used to explain the guiding principles and best-practices for meaningful engagement and to discuss relevant resources, such as the North American Spinal Cord Injury (SCI) Consortium’s SCI Resource Advocacy Course and the Integrated Knowledge Translation Guiding Principles. Participants will be asked to apply these principles and practices to one of their own research or clinical initiatives through small group discussion. The Canadian Activity-Based Therapy (ABT) Community of Practice, which brings together diverse groups to address priorities for ABT research and clinical care, will be used as a case example during large group discussion. Not applicable. Through this workshop, participants will gain knowledge and strategies that can be applied to facilitate meaningful engagement in research and clinical initiatives.
{"title":"Workshop (Clinical/Best Practice Implementation) ID 1972517","authors":"John Chernesky, Anita Kaiser, Barry Munro, K. Walden, Heather Gainforth, Kristin E. Musselman","doi":"10.46292/sci23-1972517s","DOIUrl":"https://doi.org/10.46292/sci23-1972517s","url":null,"abstract":"Teams with diverse perspectives and experiences have been increasingly recognized for their ability to identify key issues and utilize creativity and problem solving to plan and implement research and clinical initiatives that lead to greater impact. Yet, often we are unsure how to best engage individuals with differing expertise, such as those with lived experience, clinicians, healthcare administrators, engineers, researchers, funders and policy experts. After completing this workshop, participants will be able to: 1) Understand the principles and value of meaningfully engaging with a diverse team when conducting research or clinical projects, 2) Identify strategies that can facilitate the meaningful engagement of individuals with differing expertise, and 3) Create a plan of engagement for a research study or clinical initiative. A combination of lecture-based and case-based learning will be used to explain the guiding principles and best-practices for meaningful engagement and to discuss relevant resources, such as the North American Spinal Cord Injury (SCI) Consortium’s SCI Resource Advocacy Course and the Integrated Knowledge Translation Guiding Principles. Participants will be asked to apply these principles and practices to one of their own research or clinical initiatives through small group discussion. The Canadian Activity-Based Therapy (ABT) Community of Practice, which brings together diverse groups to address priorities for ABT research and clinical care, will be used as a case example during large group discussion. Not applicable. Through this workshop, participants will gain knowledge and strategies that can be applied to facilitate meaningful engagement in research and clinical initiatives.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"47 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139345612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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