Merna Seliman, Julianne W. Y. Hong, Stephanie Marrocco, Erica Lo, K. Walden, Andrea Chase, Jean François Lemay, Sarah Donkers, D. Wolfe
Rehabilitation approaches after Spinal Cord Injury (SCI) differ across rehabilitation centres and between therapists. Differences may be influenced by factors such as therapeutic approaches, equipment availability, training provided for therapists, or demographics of admitted patients. A measure of physical function that is widely used within Canadian rehabilitation centres is the Standing and Walking Assessment Tool (SWAT). It is not clear what factors or therapeutic approaches lead to optimal standing and walking outcomes in the SCI population. To explore the perspectives of physio-therapists on factors that affect standing and walking outcomes in inpatient SCI rehabilitation. Three focus groups were conducted with nine physiotherapists representing seven inpatient rehabilitation centres across Canada to provide their perspectives on current practices and to gain in-depth insights into centre-specific factors that may influence standing and walking outcomes. Thematic analysis was used to analyze the focus group data. Thematic analysis revealed that high treatment intensity and frequency are needed for optimal standing and walking outcomes. Physiotherapists emphasized that appropriate length of stay was essential to deliver an effective treatment plan. They noted, however, that there is pressure to discharge patients quickly leading to shorter length of stays and a perceived compromise in outcomes. Physiotherapists emphasized the importance of building rapport with patients, creating an exciting therapeutic environment, and the availability of enough staff for optimal recovery. The findings of this qualitative study will inform the implementation and development of opportunities to optimize standing and walking outcomes across rehabilitation centres in Canada.
{"title":"Poster (Knowledge Generation) ID 1985172","authors":"Merna Seliman, Julianne W. Y. Hong, Stephanie Marrocco, Erica Lo, K. Walden, Andrea Chase, Jean François Lemay, Sarah Donkers, D. Wolfe","doi":"10.46292/sci23-1985172s","DOIUrl":"https://doi.org/10.46292/sci23-1985172s","url":null,"abstract":"Rehabilitation approaches after Spinal Cord Injury (SCI) differ across rehabilitation centres and between therapists. Differences may be influenced by factors such as therapeutic approaches, equipment availability, training provided for therapists, or demographics of admitted patients. A measure of physical function that is widely used within Canadian rehabilitation centres is the Standing and Walking Assessment Tool (SWAT). It is not clear what factors or therapeutic approaches lead to optimal standing and walking outcomes in the SCI population. To explore the perspectives of physio-therapists on factors that affect standing and walking outcomes in inpatient SCI rehabilitation. Three focus groups were conducted with nine physiotherapists representing seven inpatient rehabilitation centres across Canada to provide their perspectives on current practices and to gain in-depth insights into centre-specific factors that may influence standing and walking outcomes. Thematic analysis was used to analyze the focus group data. Thematic analysis revealed that high treatment intensity and frequency are needed for optimal standing and walking outcomes. Physiotherapists emphasized that appropriate length of stay was essential to deliver an effective treatment plan. They noted, however, that there is pressure to discharge patients quickly leading to shorter length of stays and a perceived compromise in outcomes. Physiotherapists emphasized the importance of building rapport with patients, creating an exciting therapeutic environment, and the availability of enough staff for optimal recovery. The findings of this qualitative study will inform the implementation and development of opportunities to optimize standing and walking outcomes across rehabilitation centres in Canada.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"231 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343746","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}
Merna Seliman, Charlie Giurleo, Stacy Elliott, Marie Carlson, A. Kras-Dupuis, D. Wolfe, Kate McBride
Sexual health is an important component of overall health. Yet, sexuality is often neglected in rehabilitation. Studies indicate that typically clinicians do not address the sexual health concerns of patients because of lack of adequate training, comfort, and knowledge in this area. The purpose of this initiative was to develop and implement an e-learning module to address the current gap in rehabilitation practice. In 2021, an interdisciplinary team of rehab clinicians worked with an Instructional Designer based at Parkwood Institute to develop e-Learning modules aimed to introduce rehab teams to sexual health rehab and application to practice. The modules were launched at Parkwood Institute in January 2022 and were compulsory education for all rehabilitation staff in Spinal Cord, Acquired Brain Injury and Stroke programs. They were subsequently launched more broadly at Vancouver Coastal Health in March 2022. Surveys were conducted to assess the impact of the modules on clinical application. To date,186/209 (89%) of rehabilitation staff at Parkwood Institute and a total of 55 clinicians from Vancouver Coastal Health have completed the modules. Preliminary results show improvement in confidence, knowledge, and ability to address the sexual health needs of rehabilitation patients. The e-Learning modules help fill the current practice gap and facilitate sustainability of sexual health practice in clinical settings. Accessible educational opportunities such as the e-modules are valuable tools in enhancing self-efficacy of staff when addressing sexual health concerns of patients.
{"title":"Poster (Clinical/Best Practice Implementation) ID 1985003","authors":"Merna Seliman, Charlie Giurleo, Stacy Elliott, Marie Carlson, A. Kras-Dupuis, D. Wolfe, Kate McBride","doi":"10.46292/sci23-1985003s","DOIUrl":"https://doi.org/10.46292/sci23-1985003s","url":null,"abstract":"Sexual health is an important component of overall health. Yet, sexuality is often neglected in rehabilitation. Studies indicate that typically clinicians do not address the sexual health concerns of patients because of lack of adequate training, comfort, and knowledge in this area. The purpose of this initiative was to develop and implement an e-learning module to address the current gap in rehabilitation practice. In 2021, an interdisciplinary team of rehab clinicians worked with an Instructional Designer based at Parkwood Institute to develop e-Learning modules aimed to introduce rehab teams to sexual health rehab and application to practice. The modules were launched at Parkwood Institute in January 2022 and were compulsory education for all rehabilitation staff in Spinal Cord, Acquired Brain Injury and Stroke programs. They were subsequently launched more broadly at Vancouver Coastal Health in March 2022. Surveys were conducted to assess the impact of the modules on clinical application. To date,186/209 (89%) of rehabilitation staff at Parkwood Institute and a total of 55 clinicians from Vancouver Coastal Health have completed the modules. Preliminary results show improvement in confidence, knowledge, and ability to address the sexual health needs of rehabilitation patients. The e-Learning modules help fill the current practice gap and facilitate sustainability of sexual health practice in clinical settings. Accessible educational opportunities such as the e-modules are valuable tools in enhancing self-efficacy of staff when addressing sexual health concerns of patients.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"33 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346129","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}
Sleep disorders are more common among individuals living with spinal cord injury and spinal cord disease (SCI/D) than among non-disabled people. Upon completion of this workshop, attendees will (1) understand the pathophysiology, diagnosis, classification, clinical consequences and management of the most common sleep disorders in non-disabled people; (2) recognise the current knowledge, knowledge gaps, and recently research-generated knowledge on sleep disorders in individuals living with SCI/D; and (3) appreciate the use of an educational tool to raise awareness on sleep disorders among individuals with SCI/D. This workshop will include two 20-minute lectures with illustrative cases followed by open discussion on the following topics: (i) pathophysiology, diagnosis, classification, clinical consequences and management of the most common sleep disorders in non-disabled people; and (ii) the current knowledge, knowledge gaps, and recently research-generated knowledge on sleep disorders in individuals living with SCI/D. Finally, an example of educational tool on sleep for individuals living with SCI/D will be presented. Untreated sleep disorders can have significant short-term and long-term consequences. Early diagnosis and timely treatment is key in the prevention or mitigation of consequences of sleep disorders. Proper management of sleep disorders can have psychosocial and functional impacts on the lives of individuals with SCI/D; it may also mitigate other secondary medical conditions after SCI/D. Finally, there is a pressing need to raise awareness of this issue among individuals living with SCI/D and healthcare professionals. Sleep disorders are common and understudied in the SCI/D population. Early diagnosis and proper treatment is key to improve the lives of individuals with SCI/D and, likely, reduce other secondary medical conditions from SCI/D. Raising awareness on sleep disorders among individuals with SCI/D is needed.
{"title":"Workshop (Clinical/Best Practice Implementation) ID 2000430","authors":"Julio C Furlan, Mitsue S. Aibe, M. Boulos","doi":"10.46292/sci23-2000430s","DOIUrl":"https://doi.org/10.46292/sci23-2000430s","url":null,"abstract":"Sleep disorders are more common among individuals living with spinal cord injury and spinal cord disease (SCI/D) than among non-disabled people. Upon completion of this workshop, attendees will (1) understand the pathophysiology, diagnosis, classification, clinical consequences and management of the most common sleep disorders in non-disabled people; (2) recognise the current knowledge, knowledge gaps, and recently research-generated knowledge on sleep disorders in individuals living with SCI/D; and (3) appreciate the use of an educational tool to raise awareness on sleep disorders among individuals with SCI/D. This workshop will include two 20-minute lectures with illustrative cases followed by open discussion on the following topics: (i) pathophysiology, diagnosis, classification, clinical consequences and management of the most common sleep disorders in non-disabled people; and (ii) the current knowledge, knowledge gaps, and recently research-generated knowledge on sleep disorders in individuals living with SCI/D. Finally, an example of educational tool on sleep for individuals living with SCI/D will be presented. Untreated sleep disorders can have significant short-term and long-term consequences. Early diagnosis and timely treatment is key in the prevention or mitigation of consequences of sleep disorders. Proper management of sleep disorders can have psychosocial and functional impacts on the lives of individuals with SCI/D; it may also mitigate other secondary medical conditions after SCI/D. Finally, there is a pressing need to raise awareness of this issue among individuals living with SCI/D and healthcare professionals. Sleep disorders are common and understudied in the SCI/D population. Early diagnosis and proper treatment is key to improve the lives of individuals with SCI/D and, likely, reduce other secondary medical conditions from SCI/D. Raising awareness on sleep disorders among individuals with SCI/D is needed.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"100 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346596","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}
This study examined the effects of concomitant TBI on injury epidemiology, management and outcomes of individuals with traumatic SCI. A propensity-score matched cohort study compared a SCI+TBI group (n=1018) with a SCI-only group (n=3687), which were matched on a 1:1 ratio by age, sex, severity and level of SCI, and Charlson Comorbidity Index. TBI was defined as a Glasgow coma score of <15 at admission. Both groups were compared regarding injury epidemiology (mechanism, ethnicity, GCS, other injuries), management (mechanical ventilation, traction, Methylprednisone, surgery, time to decompression), and post-SCI outcomes (length of stay [LOS], International Standards for Neurological Classification of SCI [ISNCSCI] motor subscore, Functional Independence Measure, discharge destination, spasticity and pain at discharge). Overall, being white (OR=5.332, p=0.0265) was associated with having TBI, while having other body injuries (OR=0.095, p=0.0065) was associated with the SCI-only group. Odds of dying in a hospital were 2.442 times larger for the TBI+SCI group. The TBI+SCI group had longer acute-care LOS. Both groups had similar rehabilitation LOS. Odds of being discharged to nursing homes/long-term care facilities were 1.949 times higher for TBI+SCI individuals. Concomitant TBI did not influence change in ISNCSCI motor subscore from initial admission to final discharge. Odds of individuals with pain was 1.52 times higher for the TBI+SCI group. Occurrence of spasticity was similar between the groups. This study highlights discrepancies between the TBI+SCI and SCI-only groups regarding injury epidemiology, survival, discharge disposition, and pain. Both groups experienced similar access to treatment services, motor recovery, and spasticity. These data were presented in the 2022 Annual Meeting of the American Neurological Association, which has a different attendance audience.
{"title":"Poster (Clinical/Best Practice Implementation) ID 1969157","authors":"Julio C Furlan, Di Wang","doi":"10.46292/sci23-1969157s","DOIUrl":"https://doi.org/10.46292/sci23-1969157s","url":null,"abstract":"This study examined the effects of concomitant TBI on injury epidemiology, management and outcomes of individuals with traumatic SCI. A propensity-score matched cohort study compared a SCI+TBI group (n=1018) with a SCI-only group (n=3687), which were matched on a 1:1 ratio by age, sex, severity and level of SCI, and Charlson Comorbidity Index. TBI was defined as a Glasgow coma score of <15 at admission. Both groups were compared regarding injury epidemiology (mechanism, ethnicity, GCS, other injuries), management (mechanical ventilation, traction, Methylprednisone, surgery, time to decompression), and post-SCI outcomes (length of stay [LOS], International Standards for Neurological Classification of SCI [ISNCSCI] motor subscore, Functional Independence Measure, discharge destination, spasticity and pain at discharge). Overall, being white (OR=5.332, p=0.0265) was associated with having TBI, while having other body injuries (OR=0.095, p=0.0065) was associated with the SCI-only group. Odds of dying in a hospital were 2.442 times larger for the TBI+SCI group. The TBI+SCI group had longer acute-care LOS. Both groups had similar rehabilitation LOS. Odds of being discharged to nursing homes/long-term care facilities were 1.949 times higher for TBI+SCI individuals. Concomitant TBI did not influence change in ISNCSCI motor subscore from initial admission to final discharge. Odds of individuals with pain was 1.52 times higher for the TBI+SCI group. Occurrence of spasticity was similar between the groups. This study highlights discrepancies between the TBI+SCI and SCI-only groups regarding injury epidemiology, survival, discharge disposition, and pain. Both groups experienced similar access to treatment services, motor recovery, and spasticity. These data were presented in the 2022 Annual Meeting of the American Neurological Association, which has a different attendance audience.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"51 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346632","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}
This study examined the influence of race/ethnicity on the individuals’ survival and neurological recovery within the first year after tSCI. This retrospective cohort study included all 306 cases enrolled in the NASCIS-1, who were grouped into (a) African Americans (n=84), (b) non-Hispanic whites (n=159), and (c) other races/ethnicities that included Hispanics (n=60) and Asians (n=3). Outcome measures included survival and neurological recovery (as assessed using the NASCIS motor, and pinprick and light-touch sensory scores) within the first year post-tSCI. Data analyses of neurological recovery were adjusted for major potential confounders. There were 39 females and 267 males with a mean age of 31 years who mostly sustained cervical severe tSCI after vehicular accidents or falls. The three groups were comparable regarding sex distribution, level and severity of tSCI, level of consciousness at admission, and total received dose of methylprednisolone. However, African Americans were significantly older than non-Hispanic white individuals (P=0.0238). African Americans and individuals of other races/ethnicities had tSCI with open wounds caused by missile and water-related accidents more often than non-Hispanic white individuals (P<0.0001). However, survival rates within the first year post-tSCI were statistically comparable among the three groups (P=0.3191). Among the survivors, there was no statistically significant difference among the three groups regarding motor, and pinprick and light-touch sensory recovery (P>0.0500). The results of this study suggest that the epidemiology of tSCI might vary depending upon the individual’s race/ethnicity. Nevertheless, race/ethnicity did not influence survival rate or neurological recovery within first year post-tSCI.
{"title":"Poster (Clinical/Best Practice Implementation) ID 1969155","authors":"Julio C Furlan","doi":"10.46292/sci23-1969155s","DOIUrl":"https://doi.org/10.46292/sci23-1969155s","url":null,"abstract":"This study examined the influence of race/ethnicity on the individuals’ survival and neurological recovery within the first year after tSCI. This retrospective cohort study included all 306 cases enrolled in the NASCIS-1, who were grouped into (a) African Americans (n=84), (b) non-Hispanic whites (n=159), and (c) other races/ethnicities that included Hispanics (n=60) and Asians (n=3). Outcome measures included survival and neurological recovery (as assessed using the NASCIS motor, and pinprick and light-touch sensory scores) within the first year post-tSCI. Data analyses of neurological recovery were adjusted for major potential confounders. There were 39 females and 267 males with a mean age of 31 years who mostly sustained cervical severe tSCI after vehicular accidents or falls. The three groups were comparable regarding sex distribution, level and severity of tSCI, level of consciousness at admission, and total received dose of methylprednisolone. However, African Americans were significantly older than non-Hispanic white individuals (P=0.0238). African Americans and individuals of other races/ethnicities had tSCI with open wounds caused by missile and water-related accidents more often than non-Hispanic white individuals (P<0.0001). However, survival rates within the first year post-tSCI were statistically comparable among the three groups (P=0.3191). Among the survivors, there was no statistically significant difference among the three groups regarding motor, and pinprick and light-touch sensory recovery (P>0.0500). The results of this study suggest that the epidemiology of tSCI might vary depending upon the individual’s race/ethnicity. Nevertheless, race/ethnicity did not influence survival rate or neurological recovery within first year post-tSCI.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"233 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346827","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}
According to the WHO nearly one billion people worldwide live with some form of disability and one fifth of those have significant difficulty functioning as a result. Climate change is a reality and the impacts on healthcare and the care of our communities is significant. From food and water supply, housing emergency preparedness and safety to the effects on our health, climate change has a disproportionate impact on persons with disabilities. The purpose of this workshop is to provide attendees with a review of the issues that climate change has created for persons with disabilities with a focus on traumatic and non-traumatic spinal cord injury. We will then move to a group discussion on what we can do individually and as health systems to address these challenges and make sure the rights and safety of persons with disabilities are protected as we navigate our world with Climate Change. We will use powerpoint slides, polls and group discussion to explore this topic. This workshop will further educate SCI experts nationally/internationally and collect their thoughts and ideas on climate impact on persons with disabilities. Our hope is that this information will help inform a more formal position statement from the CSCIRA.
{"title":"Workshop (Health Services, Economics and Policy Change) ID 2012040","authors":"Christine Short, Colleen O’Connell","doi":"10.46292/sci23-2012040s","DOIUrl":"https://doi.org/10.46292/sci23-2012040s","url":null,"abstract":"According to the WHO nearly one billion people worldwide live with some form of disability and one fifth of those have significant difficulty functioning as a result. Climate change is a reality and the impacts on healthcare and the care of our communities is significant. From food and water supply, housing emergency preparedness and safety to the effects on our health, climate change has a disproportionate impact on persons with disabilities. The purpose of this workshop is to provide attendees with a review of the issues that climate change has created for persons with disabilities with a focus on traumatic and non-traumatic spinal cord injury. We will then move to a group discussion on what we can do individually and as health systems to address these challenges and make sure the rights and safety of persons with disabilities are protected as we navigate our world with Climate Change. We will use powerpoint slides, polls and group discussion to explore this topic. This workshop will further educate SCI experts nationally/internationally and collect their thoughts and ideas on climate impact on persons with disabilities. Our hope is that this information will help inform a more formal position statement from the CSCIRA.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"28 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343532","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}
Julio C Furlan, M. G. Fehlings, James Milligan, Sukhvinder Kalsi-Ryan
This workshop aims to overview degenerative cervical myelopathy (DCM), which is the most common cause of non-traumatic spinal cord injury across the world. DCM is estimated to affect approximately 1 in 50 adults; however, < 10% receive a diagnosis, and lifelong disability remains a common outcome. Upon completion of this workshop, attendees will (1) understand the diagnostic criteria and investigations for DCM and avoid misdiagnosis in the primary care level; (2) recognise the indications and role of surgical treatment; (3) comprehend the impact of prehabilitation and rehabilitation; (4) understand the alternatives for non-operative management of DCM; and (5) appreciate the importance of raising awareness of this disease. This workshop will review the diagnostic criteria and investigations for individuals with different degrees of DCM, the current clinical practice guidelines for management of DCM with focus on the role of surgical decompression of spinal cord, the role of prehabilitation and rehabilitation, current non-operative options for patients with DCM, and some initiatives focused on raising awareness of this disease. This workshop will include lectures (10-15 minutes each) with illustrative cases followed by open discussion on the following topics: (i) diagnosis, misdiagnosis and investigations in DCM; (ii) surgical management of DCM; (iii) prehabilitation and rehabilitation in DCM; and (iv) non-operative management of DCM. Although DCM is the most common cause of non-traumatic spinal cord disease, there is a need for the development of a tailored and multi-disciplinary care framework for management of DCM, which would improve patients’ outcomes. Greater awareness of DCM among healthcare professionals is urged to avoid misdiagnosis and mitigate the long-term consequences of this disease.
{"title":"Workshop (Clinical/Best Practice Implementation) ID 2000428","authors":"Julio C Furlan, M. G. Fehlings, James Milligan, Sukhvinder Kalsi-Ryan","doi":"10.46292/sci23-2000428s","DOIUrl":"https://doi.org/10.46292/sci23-2000428s","url":null,"abstract":"This workshop aims to overview degenerative cervical myelopathy (DCM), which is the most common cause of non-traumatic spinal cord injury across the world. DCM is estimated to affect approximately 1 in 50 adults; however, < 10% receive a diagnosis, and lifelong disability remains a common outcome. Upon completion of this workshop, attendees will (1) understand the diagnostic criteria and investigations for DCM and avoid misdiagnosis in the primary care level; (2) recognise the indications and role of surgical treatment; (3) comprehend the impact of prehabilitation and rehabilitation; (4) understand the alternatives for non-operative management of DCM; and (5) appreciate the importance of raising awareness of this disease. This workshop will review the diagnostic criteria and investigations for individuals with different degrees of DCM, the current clinical practice guidelines for management of DCM with focus on the role of surgical decompression of spinal cord, the role of prehabilitation and rehabilitation, current non-operative options for patients with DCM, and some initiatives focused on raising awareness of this disease. This workshop will include lectures (10-15 minutes each) with illustrative cases followed by open discussion on the following topics: (i) diagnosis, misdiagnosis and investigations in DCM; (ii) surgical management of DCM; (iii) prehabilitation and rehabilitation in DCM; and (iv) non-operative management of DCM. Although DCM is the most common cause of non-traumatic spinal cord disease, there is a need for the development of a tailored and multi-disciplinary care framework for management of DCM, which would improve patients’ outcomes. Greater awareness of DCM among healthcare professionals is urged to avoid misdiagnosis and mitigate the long-term consequences of this disease.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"167 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139344031","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}
This ongoing cross-sectional study aims to examine the potential association between moderate-to-severe sleep apnea and severe cardiovascular dysfunction after spinal cord injury (SCI). This cross-sectional study included participants who were newly diagnosed with sleep apnea using a home-based/hospital unattended sleep screening test that quantifies the apnea-hypopnea index (AHI). Episodes of AD were defined as a sudden increase in systolic blood pressure (BP) of at least 20 mmHg. We exclude episodes of AD during sleep that were caused by triggers other than apnea or hypopnea. This study included English-speaking adults with subacute or chronic (≥1 month after SCI onset), cervical or high-thoracic (T6 or more cranial), complete or incomplete SCI, who reported clinical symptoms and/or signs suggestive of sleep apnea. This study included 45 individuals (14 females and 31 males; age range: 20 to 84 years, mean age: 57.0 years) with motor complete (n=22) or incomplete SCI at cervical (n=38) or high thoracic levels. Time since SCI varied from 1.5 months to 52 years. Their mean apnea-hypopnea index (AHI) was 16.0 events/hour (AHI range: 0.8 to 51.7 events/hour). Higher AHI was significantly correlated with more frequent silent episodes of AD (Rsqr=0.220, p=0.001) during sleep. The AHI was not associated with systolic BP (p=0.903), diastolic BP (p=0.639), mean arterial pressure (p=0.714), and heart rate (p=0.669) during sleep. The results of this cross-sectional study suggest that more severe sleep apnea is associated with frequent silent episodes of AD during sleep among individuals living with cervical or high-thoracic SCI.
{"title":"Poster (Knowledge Generation) ID 1969160","authors":"Julio C Furlan, E. Loh, M. Boulos","doi":"10.46292/sci23-1969160s","DOIUrl":"https://doi.org/10.46292/sci23-1969160s","url":null,"abstract":"This ongoing cross-sectional study aims to examine the potential association between moderate-to-severe sleep apnea and severe cardiovascular dysfunction after spinal cord injury (SCI). This cross-sectional study included participants who were newly diagnosed with sleep apnea using a home-based/hospital unattended sleep screening test that quantifies the apnea-hypopnea index (AHI). Episodes of AD were defined as a sudden increase in systolic blood pressure (BP) of at least 20 mmHg. We exclude episodes of AD during sleep that were caused by triggers other than apnea or hypopnea. This study included English-speaking adults with subacute or chronic (≥1 month after SCI onset), cervical or high-thoracic (T6 or more cranial), complete or incomplete SCI, who reported clinical symptoms and/or signs suggestive of sleep apnea. This study included 45 individuals (14 females and 31 males; age range: 20 to 84 years, mean age: 57.0 years) with motor complete (n=22) or incomplete SCI at cervical (n=38) or high thoracic levels. Time since SCI varied from 1.5 months to 52 years. Their mean apnea-hypopnea index (AHI) was 16.0 events/hour (AHI range: 0.8 to 51.7 events/hour). Higher AHI was significantly correlated with more frequent silent episodes of AD (Rsqr=0.220, p=0.001) during sleep. The AHI was not associated with systolic BP (p=0.903), diastolic BP (p=0.639), mean arterial pressure (p=0.714), and heart rate (p=0.669) during sleep. The results of this cross-sectional study suggest that more severe sleep apnea is associated with frequent silent episodes of AD during sleep among individuals living with cervical or high-thoracic 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":"139344696","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}
Lauren Cadel, S. L. Hitzig, Lisa M McCarthy, Shoshana Hahn-Goldberg, Tanya L Packer, Chester H Ho, Aisha K Lofters, Tejal Patel, Stephanie R. Cimino, S. Guilcher
Adults with spinal cord injury/dysfunction (SCI/D) are commonly prescribed multiple medications to manage secondary complications. Significant challenges managing medications have been highlighted, with the need for more support with medication self-management. The objective of this study is to co-develop a toolkit to assist with medication self-management for persons with SCI/D. Adults with SCI/D, caregivers, and healthcare providers will participate in the three steps of concept mapping – brainstorming, sorting and rating, and mapping to identify key components of the toolkit. Participants will generate statements about what should be incorporated into a toolkit to help persons with SCI/D manage their medications. Participants will rate the final list of statements on importance and feasibility and sort the statements into thematic piles. A visual map will be developed by a subset of participants, representing the thematic piles. To date, participants have generated over 500 statements. Ideas generated around the content of the toolkit focus on information about: pharmacological and non-pharmacological options for managing secondary complications, side effects, communicating with providers, and medication access. Ideas specific to the delivery of the toolkit focus on: ensuring an individualized approach, accessibility, and the use of visuals. Statements will be synthesized for sorting and rating and mapping. Subsequent phases of this research will refine the toolkit through interviews and input from our working group. A mixed methods pilot evaluation will then be conducted to assess the feasibility, acceptability, and appropriateness of the toolkit, as well medication knowledge, self-efficacy, and quality of life.
{"title":"Student Competition (Knowledge Generation) ID 1985014","authors":"Lauren Cadel, S. L. Hitzig, Lisa M McCarthy, Shoshana Hahn-Goldberg, Tanya L Packer, Chester H Ho, Aisha K Lofters, Tejal Patel, Stephanie R. Cimino, S. Guilcher","doi":"10.46292/sci23-1985014s","DOIUrl":"https://doi.org/10.46292/sci23-1985014s","url":null,"abstract":"Adults with spinal cord injury/dysfunction (SCI/D) are commonly prescribed multiple medications to manage secondary complications. Significant challenges managing medications have been highlighted, with the need for more support with medication self-management. The objective of this study is to co-develop a toolkit to assist with medication self-management for persons with SCI/D. Adults with SCI/D, caregivers, and healthcare providers will participate in the three steps of concept mapping – brainstorming, sorting and rating, and mapping to identify key components of the toolkit. Participants will generate statements about what should be incorporated into a toolkit to help persons with SCI/D manage their medications. Participants will rate the final list of statements on importance and feasibility and sort the statements into thematic piles. A visual map will be developed by a subset of participants, representing the thematic piles. To date, participants have generated over 500 statements. Ideas generated around the content of the toolkit focus on information about: pharmacological and non-pharmacological options for managing secondary complications, side effects, communicating with providers, and medication access. Ideas specific to the delivery of the toolkit focus on: ensuring an individualized approach, accessibility, and the use of visuals. Statements will be synthesized for sorting and rating and mapping. Subsequent phases of this research will refine the toolkit through interviews and input from our working group. A mixed methods pilot evaluation will then be conducted to assess the feasibility, acceptability, and appropriateness of the toolkit, as well medication knowledge, self-efficacy, and quality of life.","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":"139346078","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}
Sisuri G. Hemakumara, Zahra Karamzadeh, Darren J. Mann, Trevor S. Barss, Vivian K. Mushahwar
Transcutaneous spinal cord stimulation (tSCS) facilitates spinal networks involving motor function. The purpose of this study is to compare the effect of stimulators used and amplitude of tSCS, applied at the cervical region of the spinal cord, on propriospinal modulation of lower limbs. Corticospinal and spinal reflex excitability were assessed with lower limb motor evoked potentials (MEPs), and Hoffman (H-) reflexes, respectively. Neurologically intact participants (n=6) were recruited. Two stimulators (NeoStim-5 and DS8R) were used, and different tSCS amplitudes at threshold (thresh) and maximum tolerance (max) were applied. The effect of tSCS on the amplitude of the H-reflex evoked in the soleus muscle was assessed, as well as the effect of cervical tSCS on MEPs evoked in the tibialis anterior muscle. Participants completed five conditions including: 1) Control (no stimulation) 2) DS8R Thresh 3) DS8R Max 4) NeoStim-5 Thresh 5) NeoStim-5 Max. At the same tSCS amplitude, the participants subjectively tolerated the NeoStim-5 better than the DS8R. The maximum tolerated amplitude for NeoStim-5 was higher than that of the DS8R, for all participants. Preliminary analysis suggests changes in tSCS amplitude delivered, do not appear to have an effect on the H-reflex and MEP in this small sample of participants. Preliminary findings indicate that different stimulators produce different sensations at the same tSCS amplitudes. Changes in stimulator amplitudes do not appear to have an effect on the electrophysiological outcome on propriospinal modulation. This study sets the basis for understanding mechanisms of tSCS, including cutaneous activation.
{"title":"Student Competition (Knowledge Generation) ID 1985185","authors":"Sisuri G. Hemakumara, Zahra Karamzadeh, Darren J. Mann, Trevor S. Barss, Vivian K. Mushahwar","doi":"10.46292/sci23-1985185s","DOIUrl":"https://doi.org/10.46292/sci23-1985185s","url":null,"abstract":"Transcutaneous spinal cord stimulation (tSCS) facilitates spinal networks involving motor function. The purpose of this study is to compare the effect of stimulators used and amplitude of tSCS, applied at the cervical region of the spinal cord, on propriospinal modulation of lower limbs. Corticospinal and spinal reflex excitability were assessed with lower limb motor evoked potentials (MEPs), and Hoffman (H-) reflexes, respectively. Neurologically intact participants (n=6) were recruited. Two stimulators (NeoStim-5 and DS8R) were used, and different tSCS amplitudes at threshold (thresh) and maximum tolerance (max) were applied. The effect of tSCS on the amplitude of the H-reflex evoked in the soleus muscle was assessed, as well as the effect of cervical tSCS on MEPs evoked in the tibialis anterior muscle. Participants completed five conditions including: 1) Control (no stimulation) 2) DS8R Thresh 3) DS8R Max 4) NeoStim-5 Thresh 5) NeoStim-5 Max. At the same tSCS amplitude, the participants subjectively tolerated the NeoStim-5 better than the DS8R. The maximum tolerated amplitude for NeoStim-5 was higher than that of the DS8R, for all participants. Preliminary analysis suggests changes in tSCS amplitude delivered, do not appear to have an effect on the H-reflex and MEP in this small sample of participants. Preliminary findings indicate that different stimulators produce different sensations at the same tSCS amplitudes. Changes in stimulator amplitudes do not appear to have an effect on the electrophysiological outcome on propriospinal modulation. This study sets the basis for understanding mechanisms of tSCS, including cutaneous activation.","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":"139346106","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：