Mohammadreza Amiri, Suban Kangatharan, Louise Brisbois, Farnoosh Farahani, Natavan Khasiyeva, Meredith Burley, Sheila Casemore, Margaret Murphy, Stacy-Ann Walker, B. C. Craven
Heart disease is the most common cause of death after spinal cord injury or disease (SCI/D), with Cardiometabolic Disease (CMD) risk a primary contributor. 1) To report the frequency of Physical Activity guideline adherence; 2) To report the frequency of serum lipid screening recall and their recollection of the result interpretation; among adults living with SCI/D in the community. A Kinesiologist collected the SCI-High outcome data via in person or phone 1:1 interviews, and chart abstraction among UHN outpatients. A Provincial Intake Coordinator collected data via phone interview among outpatients affiliated with SCI Ontario. Survey responses were scored using Reachlite’s optical character recognition software. Descriptive statistics characterize the participant’s age, sex, impairment characteristics, and adherence to physical activity guidelines and the frequency of lipid screening/interpretation recall. Best practice education materials were used to increase future PA guideline adherence, prompt lipid screening, and healthy food choices. Adult outpatients (n=127, 67% male), mean age 61 years, and 55% paraplegic consented to participate. In total, 48% (60/126) of outpatients reported engaging in some form of aerobic exercise; of whom 50% (30/60) of these individuals were meeting current PA guidelines. About 51% of outpatients recalled lipid screening within the last year, 33% indicated they had not had an assessment. Clinical interpretation of lipid values was recalled by 71% (53/75) of outpatients. Physical activity guideline adherence and routine lipid assessments are integral to CMD risk modification – substantial education resources and recall aids may help to modify CMD risk after SCI/D.
{"title":"Poster (Clinical/Best Practice Implementation) ID 1984972","authors":"Mohammadreza Amiri, Suban Kangatharan, Louise Brisbois, Farnoosh Farahani, Natavan Khasiyeva, Meredith Burley, Sheila Casemore, Margaret Murphy, Stacy-Ann Walker, B. C. Craven","doi":"10.46292/sci23-1984972s","DOIUrl":"https://doi.org/10.46292/sci23-1984972s","url":null,"abstract":"Heart disease is the most common cause of death after spinal cord injury or disease (SCI/D), with Cardiometabolic Disease (CMD) risk a primary contributor. 1) To report the frequency of Physical Activity guideline adherence; 2) To report the frequency of serum lipid screening recall and their recollection of the result interpretation; among adults living with SCI/D in the community. A Kinesiologist collected the SCI-High outcome data via in person or phone 1:1 interviews, and chart abstraction among UHN outpatients. A Provincial Intake Coordinator collected data via phone interview among outpatients affiliated with SCI Ontario. Survey responses were scored using Reachlite’s optical character recognition software. Descriptive statistics characterize the participant’s age, sex, impairment characteristics, and adherence to physical activity guidelines and the frequency of lipid screening/interpretation recall. Best practice education materials were used to increase future PA guideline adherence, prompt lipid screening, and healthy food choices. Adult outpatients (n=127, 67% male), mean age 61 years, and 55% paraplegic consented to participate. In total, 48% (60/126) of outpatients reported engaging in some form of aerobic exercise; of whom 50% (30/60) of these individuals were meeting current PA guidelines. About 51% of outpatients recalled lipid screening within the last year, 33% indicated they had not had an assessment. Clinical interpretation of lipid values was recalled by 71% (53/75) of outpatients. Physical activity guideline adherence and routine lipid assessments are integral to CMD risk modification – substantial education resources and recall aids may help to modify CMD risk after SCI/D.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139344019","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}
Carly L O’Sullivan, Neil Tyreman, Rofyontsa F. Shanti, Wilbur A. O’Steen, Soroush Mirkiani, Maxwell Boakye, Dena R. Howland, Vivian K. Mushahwar
Spinal cord injury (SCI) affects locomotion and quality of life. Two spinal cord stimulation approaches are currently under investigation for restoring standing and walking following SCI: epidural spinal cord stimulation (ESCS) and intraspinal microstimulation (ISMS). In ESCS, electrodes are placed on the dura mater and in ISMS, ultrafine wires are inserted into the cord. These modalities likely activate the locomotor regions in the ventral horn through different pathways. The goal of this study is to examine the difference in the distribution of neuronal activation and the type of neurons activated by ESCS and ISMS. The first step was to establish the needed immunohistochemical (IHC) staining protocols. Domestic pigs were divided into naïve (n=2) and positive control (n=1) groups. The naïve control animals were anesthetized for 5 hrs. The positive control animal was anesthetized for 2 hrs and injected with hypertonic saline in hindlimb muscles. The animals were then euthanized, and the spinal cord removed for IHC analysis. Antibodies against cFos, a maker of neuronal activation, and NeuN, a neuronal marker were used. Preliminary results indicate that ESCS activates neurons in the dorsal horn with scattered activation in the intermediate and ventral regions. ISMS primarily activates neurons in the intermediate and ventral regions where locomotor-related networks reside. To the best of our knowledge, this is the first time the type and sites of activation of ESCS and ISMS are investigated. This will provide a foundational understanding of the mechanism of action of these stimulation modalities.
{"title":"Student Competition (Knowledge Generation) ID 1985158","authors":"Carly L O’Sullivan, Neil Tyreman, Rofyontsa F. Shanti, Wilbur A. O’Steen, Soroush Mirkiani, Maxwell Boakye, Dena R. Howland, Vivian K. Mushahwar","doi":"10.46292/sci23-1985158s","DOIUrl":"https://doi.org/10.46292/sci23-1985158s","url":null,"abstract":"Spinal cord injury (SCI) affects locomotion and quality of life. Two spinal cord stimulation approaches are currently under investigation for restoring standing and walking following SCI: epidural spinal cord stimulation (ESCS) and intraspinal microstimulation (ISMS). In ESCS, electrodes are placed on the dura mater and in ISMS, ultrafine wires are inserted into the cord. These modalities likely activate the locomotor regions in the ventral horn through different pathways. The goal of this study is to examine the difference in the distribution of neuronal activation and the type of neurons activated by ESCS and ISMS. The first step was to establish the needed immunohistochemical (IHC) staining protocols. Domestic pigs were divided into naïve (n=2) and positive control (n=1) groups. The naïve control animals were anesthetized for 5 hrs. The positive control animal was anesthetized for 2 hrs and injected with hypertonic saline in hindlimb muscles. The animals were then euthanized, and the spinal cord removed for IHC analysis. Antibodies against cFos, a maker of neuronal activation, and NeuN, a neuronal marker were used. Preliminary results indicate that ESCS activates neurons in the dorsal horn with scattered activation in the intermediate and ventral regions. ISMS primarily activates neurons in the intermediate and ventral regions where locomotor-related networks reside. To the best of our knowledge, this is the first time the type and sites of activation of ESCS and ISMS are investigated. This will provide a foundational understanding of the mechanism of action of these stimulation modalities.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139344085","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}
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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
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