Topics in Spinal Cord Injury Rehabilitation最新文献

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

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

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

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

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

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.

Background: Spinal cord injury (SCI) heightens the susceptibility to neurogenic obesity, which is driven by alterations in energy metabolism and suboptimal dietary habits after injury. Those with SCI may adjust their grocery shopping and eating behaviors, notably influencing overall health outcomes.

Objectives: To assess differences in grocery shopping and eating behaviors between persons with and without (controls) SCI.

Methods: In an online, cross-sectional study, adults with (n = 207) and without (n = 52) SCI completed a one-time survey that assessed grocery shopping behavior (shopping frequency and who completed the shopping) and eating behaviors, including the frequency of consuming alcoholic beverages, fast food, and preferences for fried food. Regression analyses were employed for group comparisons, controlling for relevant measures.

Results: Compared to the controls, a smaller proportion of persons with SCI grocery shopped independently in person (P = .002), and a greater proportion relied on others to fulfill grocery needs (P = .008). Individuals with SCI demonstrated a reduced monthly frequency of overall (P = .019) and independent in-person grocery shopping than controls (P = .014). In contrast, the monthly frequency of grocery shopping through delivery and from their caregivers was similar (P > .05). Fried food and fast-food intake were comparable (P > .05), whereas alcoholic beverage consumption was lower in individuals with SCI than controls (P = .006).

Conclusion: People with SCI reported obtaining groceries less often than controls, and a greater proportion relied on others, rather than themselves, to fulfill grocery needs. These findings highlight the influence of SCI on biobehavioral activities affecting neurogenic obesity, suggesting potential targets for interventions to enhance health outcomes post-SCI.

Background: Autonomic dysfunction is common after spinal cord injury (SCI). There are currently limited tools to comprehensively characterize its deficits. While individual established autonomic tests have a long history and sound scientific background, translating these autonomic testing results to inform clinical understanding is a major barrier.

Objectives: To assess a strategic battery of autonomic tests to characterize and act as a biomarker of autonomic regulation for individuals with SCI and to develop a novel graphical representation of these data to facilitate understanding of autonomic dysfunction after SCI.

Methods: We outline a battery of six laboratory autonomic tests that were curated to collectively describe the ability of individuals with SCI to inhibit and recruit sympathetic activity through the injured spinal cord. Heart rate/blood pressure variability, bolus phenylephrine, hand and foot cold pressor, Valsalva maneuver, and bladder pressor are herein described. Incorporating normative control data for 30 uninjured individuals completing this testing battery, we further demonstrate the utility of a composite biomarker, comparing these control results to 11 individuals with SCI.

Results: Results demonstrate strong normality of data with testing psychometrics, suggesting stable reproducibility with repeat testing. Even in this preliminary sample of individuals with SCI, clear differences begin to emerge compared to uninjured norms. This illustrates the ability of this collective testing battery to characterize autonomic regulation after SCI. To aid in clinical translation, we further present a graphical representation, an autonomic phenotype, which serves as a snapshot of how normal or abnormal sympathetic inhibition and recruitment of activation may be after SCI.

Conclusion: Utilizing these autonomic phenotypes, three example cases of individuals with SCI highlight evidence of varied degrees of autonomically complete SCI. Together, this represents a key advancement in our understanding of autonomic function after SCI.

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.