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}
Triti Khorasheh, Lucie Langford, Mariza Croosfernando, Dawn Richards, B. C. Craven
The engagement of people with lived experience (PLEX) of spinal cord injury/disease (SCI/D) in rehabilitation research can lead to relevant questions and improved data collection, interpretation, knowledge translation, and research impact. We describe the process to create a toolkit which elaborates the roles that PLEX can play in rehabilitation research to ensure engagement is authentic and effective. Five separate working groups were convened to each focus on a specific role of PLEX: research team member, peer reviewer, knowledge translator, decision-maker, and fundraising ambassador. The roles of PLEX in research, relevant training tools, and indicators to measure engagement were explored through 17 virtual meetings with 45 scientists, research staff, learners, and PLEX. Menti-meter and Survey Monkey were used to select training tools via consensus. A summative meeting was held with all participants to achieve consensus regarding the role descriptions. Meeting transcripts and survey data informed iterations of the materials prior to achieving consensus. The Toolkit contains five role descriptions for PLEX as well as example activities, training requirements for scientists and PLEX, and specific indicators for each role. The Toolkit includes several best practice considerations and three practical tools for researchers to plan engagement, facilitate compensation, and implement/evaluate engagement. The Toolkit can be used by researchers and research organizations to develop, implement, and evaluate engagement plans with PLEX in SCI/D rehabilitation research. This Toolkit can be used to transform the SCI/D rehabilitation research and advocacy agenda, and contribute to more relevant research with a greater impact.
{"title":"Poster (Clinical/Best Practice Implementation) ID 1985364","authors":"Triti Khorasheh, Lucie Langford, Mariza Croosfernando, Dawn Richards, B. C. Craven","doi":"10.46292/sci23-1985364s","DOIUrl":"https://doi.org/10.46292/sci23-1985364s","url":null,"abstract":"The engagement of people with lived experience (PLEX) of spinal cord injury/disease (SCI/D) in rehabilitation research can lead to relevant questions and improved data collection, interpretation, knowledge translation, and research impact. We describe the process to create a toolkit which elaborates the roles that PLEX can play in rehabilitation research to ensure engagement is authentic and effective. Five separate working groups were convened to each focus on a specific role of PLEX: research team member, peer reviewer, knowledge translator, decision-maker, and fundraising ambassador. The roles of PLEX in research, relevant training tools, and indicators to measure engagement were explored through 17 virtual meetings with 45 scientists, research staff, learners, and PLEX. Menti-meter and Survey Monkey were used to select training tools via consensus. A summative meeting was held with all participants to achieve consensus regarding the role descriptions. Meeting transcripts and survey data informed iterations of the materials prior to achieving consensus. The Toolkit contains five role descriptions for PLEX as well as example activities, training requirements for scientists and PLEX, and specific indicators for each role. The Toolkit includes several best practice considerations and three practical tools for researchers to plan engagement, facilitate compensation, and implement/evaluate engagement. The Toolkit can be used by researchers and research organizations to develop, implement, and evaluate engagement plans with PLEX in SCI/D rehabilitation research. This Toolkit can be used to transform the SCI/D rehabilitation research and advocacy agenda, and contribute to more relevant research with a greater impact.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346150","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}
Darren J. Mann, Jane A. Porter, Deborah O. Okusanya, Justin Lee, Zahra Karamzadeh, Monique Yuan, Trevor S. Barss, Vivian K. Mushahwar
Functional electrical stimulation (FES)-assisted arm and leg (A&L) cycling is an effective rehabilitative intervention for improving walking following an incomplete spinal cord injury (SCI). The goal of this study was to assess the potential benefits of combining transcutaneous spinal cord stimulation (tSCS) with A&L cycling to potentially improve functional mobility and activities of daily living for persons living with motor complete SCI. This is a case study of a participant with AIS B SCI. The participant has been undergoing FES-assisted A&L cycling training combined with cervical and lumbar tSCS (1 hr/day, 5 days/week) for 37 weeks. Assessments were performed pre-training and every 6 weeks thereafter and include the International Standards for Neurological Classification of SCI (ISNCSCI), time able to stand while assisted, and training load of each exercise session. Although there were no changes in the ISNCSCI scores, the duration of assisted standing increased from 10s per-training to 33.5s at 36 weeks post-training. Interestingly, the addition of tSCS enhanced standing duration to 38.5s. Moreover, the total power output exerted by the participant consistently increased over time. This study provides, for the first time, evidence that FES-assisted A&L cycling paired with non-invasive tSCS can be safely completed after severe SCI and leads to improvements in training load and assisted standing. Additional assessments will be incorporated to further identify improvements in function and quality of life. Future work will assess the benefits of using epidural spinal cord stimulation combined with A&L cycling after motor complete SCI.
{"title":"Student Competition (Knowledge Generation) ID 1985170","authors":"Darren J. Mann, Jane A. Porter, Deborah O. Okusanya, Justin Lee, Zahra Karamzadeh, Monique Yuan, Trevor S. Barss, Vivian K. Mushahwar","doi":"10.46292/sci23-1985170s","DOIUrl":"https://doi.org/10.46292/sci23-1985170s","url":null,"abstract":"Functional electrical stimulation (FES)-assisted arm and leg (A&L) cycling is an effective rehabilitative intervention for improving walking following an incomplete spinal cord injury (SCI). The goal of this study was to assess the potential benefits of combining transcutaneous spinal cord stimulation (tSCS) with A&L cycling to potentially improve functional mobility and activities of daily living for persons living with motor complete SCI. This is a case study of a participant with AIS B SCI. The participant has been undergoing FES-assisted A&L cycling training combined with cervical and lumbar tSCS (1 hr/day, 5 days/week) for 37 weeks. Assessments were performed pre-training and every 6 weeks thereafter and include the International Standards for Neurological Classification of SCI (ISNCSCI), time able to stand while assisted, and training load of each exercise session. Although there were no changes in the ISNCSCI scores, the duration of assisted standing increased from 10s per-training to 33.5s at 36 weeks post-training. Interestingly, the addition of tSCS enhanced standing duration to 38.5s. Moreover, the total power output exerted by the participant consistently increased over time. This study provides, for the first time, evidence that FES-assisted A&L cycling paired with non-invasive tSCS can be safely completed after severe SCI and leads to improvements in training load and assisted standing. Additional assessments will be incorporated to further identify improvements in function and quality of life. Future work will assess the benefits of using epidural spinal cord stimulation combined with A&L cycling after motor complete SCI.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"10 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346575","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}
Exercising after spinal cord injury (SCI) is necessary to prevent or reduce secondary complications such as obesity, cardiovascular disease, or type II diabetes. The effects of SCI on muscle and autonomic functions determine type, duration, and intensity of exercise capacity. Although SCI exercise guidelines exist, achieving these recommendations requires a comprehensive understanding of how muscle and autonomic function affect a person’s exercise capability. Therefore, we reviewed the effect of SCI level on muscle and sympathetic function during exercise for those living with SCI to better develop strategies to achieve these guidelines. A literature review of exercise, muscle control and SCI was performed to identify muscles innervated by each level and how key sympathetic tissues and organs required for exercise are affected by SCI. We identified spinal levels responsible for increasing heart rate, cardiovascular smooth muscle contraction, inducing sweat and activating adrenal glands since these are essential in maintaining high intensity and long duration exercise. We translated the information into a comprehensive user-friendly poster. A comprehensive graphical poster was developed for those living with SCI to understand and identify how their level of SCI affects their muscle and sympathetic function needed for optimal exercise and to meet exercise guidelines. This infographic fills a void since this type of ‘person-centred’ information is lacking in the SCI and exercise field. The knowledge acquired through this infographic could further guide training practices and exercise modifications to increase exercise capacity and quality of life for those living with SCI.
{"title":"Student Competition (Knowledge Generation) ID 1985154","authors":"Juanita Garcia, Kristine Cowley","doi":"10.46292/sci23-1985154s","DOIUrl":"https://doi.org/10.46292/sci23-1985154s","url":null,"abstract":"Exercising after spinal cord injury (SCI) is necessary to prevent or reduce secondary complications such as obesity, cardiovascular disease, or type II diabetes. The effects of SCI on muscle and autonomic functions determine type, duration, and intensity of exercise capacity. Although SCI exercise guidelines exist, achieving these recommendations requires a comprehensive understanding of how muscle and autonomic function affect a person’s exercise capability. Therefore, we reviewed the effect of SCI level on muscle and sympathetic function during exercise for those living with SCI to better develop strategies to achieve these guidelines. A literature review of exercise, muscle control and SCI was performed to identify muscles innervated by each level and how key sympathetic tissues and organs required for exercise are affected by SCI. We identified spinal levels responsible for increasing heart rate, cardiovascular smooth muscle contraction, inducing sweat and activating adrenal glands since these are essential in maintaining high intensity and long duration exercise. We translated the information into a comprehensive user-friendly poster. A comprehensive graphical poster was developed for those living with SCI to understand and identify how their level of SCI affects their muscle and sympathetic function needed for optimal exercise and to meet exercise guidelines. This infographic fills a void since this type of ‘person-centred’ information is lacking in the SCI and exercise field. The knowledge acquired through this infographic could further guide training practices and exercise modifications to increase exercise capacity and quality of life for those living with SCI.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"76 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343679","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}
Drug-induced myelopathy has been reported widely for heroin use, but less frequently for amphetamines or fentanyl. Hyperglycemia-induced acute myelopathy has not previously been described. We present a case of toxic/metabolic myelopathy secondary to the aforementioned results in a patient presenting for tertiary inpatient rehabilitation. A 28-year-old man with Type 1 Diabetes without complications and polysubstance use (fentanyl and crystal methamphetamine) presented to hospital with quadriparesis and anesthesia. Patient reported he fell down a flight of stairs while using substances and remained on the ground for hours-days as he was acutely paralyzed when he awoke. Initial examination demonstrated a C5 motor level. Pan-CT demonstrated no intracranial or spinous abnormalities. MRI with gadolinium showed cord edema from C1-T4 and patchy enhancement from C4-C7 without cord compression. Diffusion restriction and hemorrhagic transformation were later seen in C4-C7. Initial blood glucose was 66 with no serum ketones. Serum toxicology was negative and urine toxicology was positive for amphetamines and fentanyl. Autoimmune and infectious workups were negative. He received 5 days of pulse steroids and 7 sessions of plasmapheresis with minimal functional or neurological improvement. He was admitted to rehabilitation as a C5 AIS-B and did not exhibit further improvement in motor or sensory function over 3 months of active inpatient rehab. Given the pattern of cord enhancement with hemorrhagic transformation, this injury most likely represents acute myelitis induced by hyperglycemia and amphetamines/fentanyl. To our knowledge, this is the first case report where hyperglycemia may have contributed to acute myelopathy.
{"title":"Student Competition (Knowledge Generation) ID 1984525","authors":"Nicholas Sequeira, B. C. Craven","doi":"10.46292/sci23-1984525s","DOIUrl":"https://doi.org/10.46292/sci23-1984525s","url":null,"abstract":"Drug-induced myelopathy has been reported widely for heroin use, but less frequently for amphetamines or fentanyl. Hyperglycemia-induced acute myelopathy has not previously been described. We present a case of toxic/metabolic myelopathy secondary to the aforementioned results in a patient presenting for tertiary inpatient rehabilitation. A 28-year-old man with Type 1 Diabetes without complications and polysubstance use (fentanyl and crystal methamphetamine) presented to hospital with quadriparesis and anesthesia. Patient reported he fell down a flight of stairs while using substances and remained on the ground for hours-days as he was acutely paralyzed when he awoke. Initial examination demonstrated a C5 motor level. Pan-CT demonstrated no intracranial or spinous abnormalities. MRI with gadolinium showed cord edema from C1-T4 and patchy enhancement from C4-C7 without cord compression. Diffusion restriction and hemorrhagic transformation were later seen in C4-C7. Initial blood glucose was 66 with no serum ketones. Serum toxicology was negative and urine toxicology was positive for amphetamines and fentanyl. Autoimmune and infectious workups were negative. He received 5 days of pulse steroids and 7 sessions of plasmapheresis with minimal functional or neurological improvement. He was admitted to rehabilitation as a C5 AIS-B and did not exhibit further improvement in motor or sensory function over 3 months of active inpatient rehab. Given the pattern of cord enhancement with hemorrhagic transformation, this injury most likely represents acute myelitis induced by hyperglycemia and amphetamines/fentanyl. To our knowledge, this is the first case report where hyperglycemia may have contributed to acute myelopathy.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"3 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343877","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}
Monitoring skin integrity is a critical issue for patients with spinal cord injury. Damage to the skin can go unnoticed due to sensory loss or diminution and can result in pressure injuries or wounds that can be difficult to heal. A team of inpatient clinicians and people with lived experience worked together to create a ‘SkIn-fo-Graphic’ that would be used to teach all new inpatients how to do a full body skin check. A full picture of the body, contributed by Spinal Cord Injury Ontario (SCIO), was marked with the names of specific bony prominences and areas which should be viewed daily to ensure a skin check is complete. Staff at our Centre modified the graphic and created step-by-step instructions. Patients provided feedback on terminology and placement of words/ arrows for clarity. Further refinement was completed by SCIO and clinical staff to create the final tool and instructions. A graphic was developed iteratively by a community organization, physicians, allied health professionals and patients to provide a tool with instructions that can be used by both clinical staff (to teach daily skin check) and patients (as a reference for doing their own checks). A QR Code link was also created to directly link patients to more in-depth skin education on the community partner website. Engaging all stakeholders in the development of a key tool for instruction of skin check in patients with spinal cord injury is important to ensure complete clarity and utility.
对于脊髓损伤患者来说，监测皮肤完整性是一个至关重要的问题。由于感觉缺失或减弱，皮肤损伤可能会被忽视，并可能导致难以愈合的压力伤或伤口。一个由住院临床医生和有生活经验者组成的团队共同制作了一张 "SkIn-fo-Graphic"，用于教所有新住院病人如何进行全身皮肤检查。 由安大略省脊髓损伤协会（SCIO）提供的人体全图上标注了特定骨骼突起和部位的名称，这些部位应每天查看，以确保皮肤检查完整。我们中心的员工对图形进行了修改，并制作了分步说明。患者就术语和字词/箭头的位置提供了反馈意见，以提高清晰度。SCIO 和临床工作人员进一步完善了最终的工具和说明。 一个社区组织、医生、专职医疗人员和患者反复开发了一个图形，以提供一个带有说明的工具，供临床工作人员（教授日常皮肤检查）和患者（作为自己进行检查时的参考）使用。还创建了一个 QR 码链接，直接将患者链接到社区合作伙伴网站上更深入的皮肤教育。 让所有利益相关者都参与到脊髓损伤患者皮肤检查关键工具的开发中，对于确保工具的清晰度和实用性非常重要。
{"title":"Poster (Clinical/Best Practice Implementation) ID 1984775","authors":"Andrea Chase, Vidya Sreenivasan, Dorothyann Curran, Monica Robichaud, Lorraine Maddigan, Tory Bowman","doi":"10.46292/sci23-1984775s","DOIUrl":"https://doi.org/10.46292/sci23-1984775s","url":null,"abstract":"Monitoring skin integrity is a critical issue for patients with spinal cord injury. Damage to the skin can go unnoticed due to sensory loss or diminution and can result in pressure injuries or wounds that can be difficult to heal. A team of inpatient clinicians and people with lived experience worked together to create a ‘SkIn-fo-Graphic’ that would be used to teach all new inpatients how to do a full body skin check. A full picture of the body, contributed by Spinal Cord Injury Ontario (SCIO), was marked with the names of specific bony prominences and areas which should be viewed daily to ensure a skin check is complete. Staff at our Centre modified the graphic and created step-by-step instructions. Patients provided feedback on terminology and placement of words/ arrows for clarity. Further refinement was completed by SCIO and clinical staff to create the final tool and instructions. A graphic was developed iteratively by a community organization, physicians, allied health professionals and patients to provide a tool with instructions that can be used by both clinical staff (to teach daily skin check) and patients (as a reference for doing their own checks). A QR Code link was also created to directly link patients to more in-depth skin education on the community partner website. Engaging all stakeholders in the development of a key tool for instruction of skin check in patients with spinal cord injury is important to ensure complete clarity and utility.","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":"139345097","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}
Shajaky Parameswaran, Thomas P. Walden, Louise Brisbois, B. C. Craven
Following a traumatic spinal cord injury (tSCI), patients prioritize being able to manage their bowels independently. A reduction of independence can impact an individual’s quality of life. The current study investigates the relationships between sphincter control, level of independence and quality of life. We hypothesized that sphincter control would relate strongly to levels of independence and quality of life. Adults with tSCI who consented to participate in the Rick Hansen Spinal Cord Injury Registry at the Lyndhurst Rehabilitation Centre completed community follow-up interviews from 2014-2021. Data was collected at baseline, year 1, 2 and 5 (n = 330). Descriptive data and neurological level of injury (NLI) were collected, along with the Life Satisfaction Questionnaire (LiSAT-11), 36-item Short Form Survey Quality of Life measures (SF-36v2) and the Spinal Cord Independence Measure III (SCIM). Separate analyses were conducted for NLI C1-T10 (upper motor neuron [UMN] [n=280]), and T11-S5 (lower motor neuron [LMN] [n=50]). Associations between sphincter management and life satisfaction were calculated using Spearman’s correlation coefficient, adjusted for age and sex. SCIM had a moderate, yet significant relationship with LiSAT-11 (r2=0.48, p<0.001) for LMN, but no relationship for UMN (r2= 0.17, p<0.001). A weak relationship was observed between SCIM and SF-36v2 for LMN (r2=0.30, p=0.014) but no relationship for UMN (r2=0.01, p=0.59). Sphincter management scores after rehabilitation discharge are not a strong predictor of life satisfaction following tSCI suggesting that a multifaceted approach is required to assess an individuals’ quality of life post tSCI.
{"title":"Student Competition (Knowledge Generation) ID 1984770","authors":"Shajaky Parameswaran, Thomas P. Walden, Louise Brisbois, B. C. Craven","doi":"10.46292/sci23-1984770s","DOIUrl":"https://doi.org/10.46292/sci23-1984770s","url":null,"abstract":"Following a traumatic spinal cord injury (tSCI), patients prioritize being able to manage their bowels independently. A reduction of independence can impact an individual’s quality of life. The current study investigates the relationships between sphincter control, level of independence and quality of life. We hypothesized that sphincter control would relate strongly to levels of independence and quality of life. Adults with tSCI who consented to participate in the Rick Hansen Spinal Cord Injury Registry at the Lyndhurst Rehabilitation Centre completed community follow-up interviews from 2014-2021. Data was collected at baseline, year 1, 2 and 5 (n = 330). Descriptive data and neurological level of injury (NLI) were collected, along with the Life Satisfaction Questionnaire (LiSAT-11), 36-item Short Form Survey Quality of Life measures (SF-36v2) and the Spinal Cord Independence Measure III (SCIM). Separate analyses were conducted for NLI C1-T10 (upper motor neuron [UMN] [n=280]), and T11-S5 (lower motor neuron [LMN] [n=50]). Associations between sphincter management and life satisfaction were calculated using Spearman’s correlation coefficient, adjusted for age and sex. SCIM had a moderate, yet significant relationship with LiSAT-11 (r2=0.48, p<0.001) for LMN, but no relationship for UMN (r2= 0.17, p<0.001). A weak relationship was observed between SCIM and SF-36v2 for LMN (r2=0.30, p=0.014) but no relationship for UMN (r2=0.01, p=0.59). Sphincter management scores after rehabilitation discharge are not a strong predictor of life satisfaction following tSCI suggesting that a multifaceted approach is required to assess an individuals’ quality of life post tSCI.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"9 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139345683","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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