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}
N. Punjani, Sighild Lemarchant, Svetlana Altamentova, J. Chio, Jian Wang, Yann Godfrin, M. G. Fehlings
NX210c is a 12-amino acid peptide derived from conserved thrombospondin type 1 repeat sequences in the subcommissural organ-spondin, which has a unique multifunctional mechanism of action to ameliorate outcomes following neurological injuries. The aim of this study was to evaluate the efficacy of NX210c to promote functional recovery and tissue repair in a cervical traumatic spinal cord injury (SCI) model. Adult female Wistar rats were subjected to a C6/C7 clip compression-contusion injury and treated once daily with intraperitoneal injections of NX210c (8 mg/kg) or its vehicle for 8 weeks, beginning 4 hours (h) or 8h post-injury (n=16-17/group), with concurrent neurobehavioural tests. Earlier NX210c administration at 4h increased forelimb grip strength (p<0.05) and improved several static and dynamic aspects of locomotion including regularity index and base of support of the forelimbs (CatWalk) (p<0.05). Delaying initial administration of NX210c to 8h, promoted weight gain, accelerated bladder control recovery from 14 to 9 days post-injury, and improved trunk balance (inclined plane) as early as one-week post-injury (p<0.05). 94% of NX210c-treated rats compared to 75% of vehicle controls observed weight support at the delayed initial injection timepoint. Histology (n=6/group) demonstrated greater white matter preservation and reduced cavity size at the injury epicenter, and higher neuronal soma counts caudally, with NX210c starting 8h post-injury compared to the vehicle (p<0.05). NX210c targets various aspects of SCI, improving motor function, bladder control, white matter preservation, and neuronal counts, with more benefits observed at the later initial injection timepoint.
{"title":"Student Competition (Knowledge Generation) ID 1987946","authors":"N. Punjani, Sighild Lemarchant, Svetlana Altamentova, J. Chio, Jian Wang, Yann Godfrin, M. G. Fehlings","doi":"10.46292/sci23-1987946s","DOIUrl":"https://doi.org/10.46292/sci23-1987946s","url":null,"abstract":"NX210c is a 12-amino acid peptide derived from conserved thrombospondin type 1 repeat sequences in the subcommissural organ-spondin, which has a unique multifunctional mechanism of action to ameliorate outcomes following neurological injuries. The aim of this study was to evaluate the efficacy of NX210c to promote functional recovery and tissue repair in a cervical traumatic spinal cord injury (SCI) model. Adult female Wistar rats were subjected to a C6/C7 clip compression-contusion injury and treated once daily with intraperitoneal injections of NX210c (8 mg/kg) or its vehicle for 8 weeks, beginning 4 hours (h) or 8h post-injury (n=16-17/group), with concurrent neurobehavioural tests. Earlier NX210c administration at 4h increased forelimb grip strength (p<0.05) and improved several static and dynamic aspects of locomotion including regularity index and base of support of the forelimbs (CatWalk) (p<0.05). Delaying initial administration of NX210c to 8h, promoted weight gain, accelerated bladder control recovery from 14 to 9 days post-injury, and improved trunk balance (inclined plane) as early as one-week post-injury (p<0.05). 94% of NX210c-treated rats compared to 75% of vehicle controls observed weight support at the delayed initial injection timepoint. Histology (n=6/group) demonstrated greater white matter preservation and reduced cavity size at the injury epicenter, and higher neuronal soma counts caudally, with NX210c starting 8h post-injury compared to the vehicle (p<0.05). NX210c targets various aspects of SCI, improving motor function, bladder control, white matter preservation, and neuronal counts, with more benefits observed at the later initial injection timepoint.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"7 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346601","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}
Kristine Cowley, Peter Athanasopoulos, Chester Ho, Jacquie D. Ripat, Hope Jervis Rademeyer, Peter Warkentin, John Gregory
Spinal cord injury (SCI) affects every aspect of a person’s bodily functions. As such, for a person to survive and strive in the community after SCI, both a comprehensive and effective rehabilitation program, as well as life-sustaining healthcare (i.e., SCI-specific medical services, equipment, and supplies) is needed. Although Canada has a publicly funded universal healthcare system, provinces have flexibility in determining how rehabilitation is delivered and in defining ‘essential’ healthcare. This workshop will consist of two lectures on current standards of care in acute SCI rehabilitation and provision of life-sustaining SCI healthcare services, equipment, and supplies in Canada, followed by an initial overview of standards in other comparable countries and discussion of next steps for developing equity and consistency in Canada for SCI rehabilitation and provision of SCI-related healthcare needs. Upon completion of this workshop, attendees will understand:
{"title":"Workshop (Clinical/Best Practice Implementation) ID 2002364","authors":"Kristine Cowley, Peter Athanasopoulos, Chester Ho, Jacquie D. Ripat, Hope Jervis Rademeyer, Peter Warkentin, John Gregory","doi":"10.46292/sci23-2002364s","DOIUrl":"https://doi.org/10.46292/sci23-2002364s","url":null,"abstract":"Spinal cord injury (SCI) affects every aspect of a person’s bodily functions. As such, for a person to survive and strive in the community after SCI, both a comprehensive and effective rehabilitation program, as well as life-sustaining healthcare (i.e., SCI-specific medical services, equipment, and supplies) is needed. Although Canada has a publicly funded universal healthcare system, provinces have flexibility in determining how rehabilitation is delivered and in defining ‘essential’ healthcare. This workshop will consist of two lectures on current standards of care in acute SCI rehabilitation and provision of life-sustaining SCI healthcare services, equipment, and supplies in Canada, followed by an initial overview of standards in other comparable countries and discussion of next steps for developing equity and consistency in Canada for SCI rehabilitation and provision of SCI-related healthcare needs. Upon completion of this workshop, attendees will understand:","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"192 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346660","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}
P. Eftekhar, Dr. Cathy Craven, Sukhvinder Kalsy-Ryan
It is essential that individuals with spinal cord injury set their goals prior to their peripheral nerve transfer (PNT) surgery. Goal setting is a significant factor in pre-operative planning and is one way in which we can track performance and outcomes for these patients. To describe goal types identified by patients managed in the PNT-SCI rehab program at Lyndhurst-UHN. Cite and report the COPM outcomes in the domains of Self-care and Productivity. A retrospective case series was conducted (n=14), charts were reviewed for type of goals and patient’s perception of goal attainment using COPM for a case series of three patients with tetraplegia who received PNT-SCI surgery and comprehensive rehabilitation. The changes in COPM are reported from baseline to 12 months post-surgery. Each patient identified three goals pre-surgery; their goals and the COPM were used to measure change over time. Ninety two percent of the identified goals were in the area of Self Care, and 8% were in the Productivity areas. Two of the patients who received PNT-SCI rehabilitation had an increase of 1 on the COPM, while one individual regressed by 2 points. That individual did not receive comprehensive rehabilitation. It is known that recovery after PNT-SCI surgery can take 24 or more months. We reported COPM change scores at 12 months post surgery. The MCID is two points for COPM, ideally over 24 months we will see MCID of three or higher.
{"title":"Poster (Clinical/Best Practice Implementation) ID 1998248","authors":"P. Eftekhar, Dr. Cathy Craven, Sukhvinder Kalsy-Ryan","doi":"10.46292/sci23-1998248s","DOIUrl":"https://doi.org/10.46292/sci23-1998248s","url":null,"abstract":"It is essential that individuals with spinal cord injury set their goals prior to their peripheral nerve transfer (PNT) surgery. Goal setting is a significant factor in pre-operative planning and is one way in which we can track performance and outcomes for these patients. To describe goal types identified by patients managed in the PNT-SCI rehab program at Lyndhurst-UHN. Cite and report the COPM outcomes in the domains of Self-care and Productivity. A retrospective case series was conducted (n=14), charts were reviewed for type of goals and patient’s perception of goal attainment using COPM for a case series of three patients with tetraplegia who received PNT-SCI surgery and comprehensive rehabilitation. The changes in COPM are reported from baseline to 12 months post-surgery. Each patient identified three goals pre-surgery; their goals and the COPM were used to measure change over time. Ninety two percent of the identified goals were in the area of Self Care, and 8% were in the Productivity areas. Two of the patients who received PNT-SCI rehabilitation had an increase of 1 on the COPM, while one individual regressed by 2 points. That individual did not receive comprehensive rehabilitation. It is known that recovery after PNT-SCI surgery can take 24 or more months. We reported COPM change scores at 12 months post surgery. The MCID is two points for COPM, ideally over 24 months we will see MCID of three or higher.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"17 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346683","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}
Philemon Tsang, Wagner H. Souza, Thomas P. Walden, M. Miyatani, Cathy Craven
Heart Disease is the leading cause of death after spinal cord injury (SCI). Individuals with paraplegia develop hypertension and elevated arterial stiffness prior to their age matched peers. Overground exoskeleton training is becoming an increasingly prevalent form of exercise. In the general population, exercise training has been shown to reduce arterial stiffness. Recent RCT failed to show changes in arterial stiffness with arm ergometry or body weight supported treadmill training. The aim of this project is to determine the effect of Exoskeleton Exercise on changing arterial stiffness. The study setting will take place at a rehabilitation facility. The study will involve 34 sessions over the span of approximately 18-20 weeks. The key intervention utilized in the investigation will be an Overground EksoNR gait and balance training program. The primary outcome measure will be carotid-femoral pulse wave velocity (cfPWV) and secondary measures will include heart rate (HR), blood pressure (BP), waist circumference (WC), and oxygen saturation (SpO2). Statistical Analysis will involve mean changes at baseline, midway, and end of study. The 34-session (2x/week for ∼18 weeks) rehabilitation protocol will focus on using the EksoNR for overground gait and balance activities. For measurement of cfPWV, two transcutaneous Doppler flowmeters will be used at the common carotid and femoral artery. To calculate cfPWV, the distance travelled by the pulse is divided by the average pulse transit time (PTT). The 18-week Exoskeleton Program would improve arterial stiffness (cfPWV) in individuals with chronic incomplete SCI/D.
{"title":"Post-Doc Competition (Knowledge Generation) ID 1985177","authors":"Philemon Tsang, Wagner H. Souza, Thomas P. Walden, M. Miyatani, Cathy Craven","doi":"10.46292/sci23-1985177s","DOIUrl":"https://doi.org/10.46292/sci23-1985177s","url":null,"abstract":"Heart Disease is the leading cause of death after spinal cord injury (SCI). Individuals with paraplegia develop hypertension and elevated arterial stiffness prior to their age matched peers. Overground exoskeleton training is becoming an increasingly prevalent form of exercise. In the general population, exercise training has been shown to reduce arterial stiffness. Recent RCT failed to show changes in arterial stiffness with arm ergometry or body weight supported treadmill training. The aim of this project is to determine the effect of Exoskeleton Exercise on changing arterial stiffness. The study setting will take place at a rehabilitation facility. The study will involve 34 sessions over the span of approximately 18-20 weeks. The key intervention utilized in the investigation will be an Overground EksoNR gait and balance training program. The primary outcome measure will be carotid-femoral pulse wave velocity (cfPWV) and secondary measures will include heart rate (HR), blood pressure (BP), waist circumference (WC), and oxygen saturation (SpO2). Statistical Analysis will involve mean changes at baseline, midway, and end of study. The 34-session (2x/week for ∼18 weeks) rehabilitation protocol will focus on using the EksoNR for overground gait and balance activities. For measurement of cfPWV, two transcutaneous Doppler flowmeters will be used at the common carotid and femoral artery. To calculate cfPWV, the distance travelled by the pulse is divided by the average pulse transit time (PTT). The 18-week Exoskeleton Program would improve arterial stiffness (cfPWV) in individuals with chronic incomplete SCI/D.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346832","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}
ISMS entails implanting micro-electrodes into the spinal cord to produce synergistic activations of the legs. To date, ISMS has produced in-place stepping in cats with complete spinal cord injury (SCI) (Saigal et al, 2004), and long distances of over ground walking in anesthetized cats (Holinski et al, 2016). The goal of this project is to develop an intervention for restoring overground walking capacity for persons experiencing paralysis due to SCI, by investigating the potential of ISMS to enable long-distance overground walking in cats with chronic SCI. Experiments will be performed in eight adult cats with chronic complete SCI. The control strategy will include timed transitions between different phases of the step cycle, which will be modified using feedback from force plates and gyroscopes. The biomechanics of walking (speed of walking, stride length, left-right symmetry, inter-joint coordination) and muscle activation patterns will be recorded and analyzed. The stride-to-stride regularity of walking, amount of weight-bearing, and level of spasticity before, during, and after ISMS will be assessed. We expect that ISMS will produce long distances of walking (>500 m) in cats with SCI. The biomechanical features of walking will be similar to those in neurologically-intact cats. This project is a critical step towards demonstrating the viability of ISMS as a means for restoring functional walking after severe SCI. If successful, ISMS and the control strategies developed may in the future change the lives of many people living with SCI, giving them the capability to walk independently.
{"title":"Student Competition (Technology Innovation) ID 1985155","authors":"Amin Arefadib, Pouria Faridi, Soroush Mirkiani, Ashley Dalrymple, Vivian K. Mushahwar","doi":"10.46292/sci23-1985155s","DOIUrl":"https://doi.org/10.46292/sci23-1985155s","url":null,"abstract":"ISMS entails implanting micro-electrodes into the spinal cord to produce synergistic activations of the legs. To date, ISMS has produced in-place stepping in cats with complete spinal cord injury (SCI) (Saigal et al, 2004), and long distances of over ground walking in anesthetized cats (Holinski et al, 2016). The goal of this project is to develop an intervention for restoring overground walking capacity for persons experiencing paralysis due to SCI, by investigating the potential of ISMS to enable long-distance overground walking in cats with chronic SCI. Experiments will be performed in eight adult cats with chronic complete SCI. The control strategy will include timed transitions between different phases of the step cycle, which will be modified using feedback from force plates and gyroscopes. The biomechanics of walking (speed of walking, stride length, left-right symmetry, inter-joint coordination) and muscle activation patterns will be recorded and analyzed. The stride-to-stride regularity of walking, amount of weight-bearing, and level of spasticity before, during, and after ISMS will be assessed. We expect that ISMS will produce long distances of walking (>500 m) in cats with SCI. The biomechanical features of walking will be similar to those in neurologically-intact cats. This project is a critical step towards demonstrating the viability of ISMS as a means for restoring functional walking after severe SCI. If successful, ISMS and the control strategies developed may in the future change the lives of many people living with SCI, giving them the capability to walk independently.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"21 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346891","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 Mobility Clinic strives to provide high quality primary care to persons living with spinal cord injury or other health conditions that affect mobility. The Mobility Clinic Resource Abilities Council (MC RAC) was established to serve in an advisory capacity, making recommendations on matters that impact the experience of patients with physical disabilities and their support persons at the Mobility Clinic. MC RAC provides feedback on, and ideas for initiatives and programs that support and enhance the model of person-centred care. It also advances collaborative patient engagement and person-centred care principles and practices within primary care for persons with physical disabilities Members include individuals with lived experience with physical disability, their support persons, and Mobility Clinic staff. The council was established August 2022 and meets virtually once per month for approximately 90 minutes. MC RAC has successfully met nine times and has provided feedback on the following topics: Breast & Cervical Cancer screening Initiative for People with Physical Disabilities, Mobility Clinic website development, building pathways for advocacy with the KW4 OHT, Circulus Network webinar topics, Mobility Clinic organization and clinical flow. Feedback to be implemented into Mobility Clinic activities. Patient and support persons involvement in decision-making processes improve care experiences and contribute to better health outcomes for patients. We will continue to work and develop our patient advisory council to better support the Mobility Clinic’s patients and their support persons.
{"title":"Poster (Clinical/Best Practice Implementation) ID 2004605","authors":"James Milligan, Joseph Lee, Allison Harrison, Kathleen MacGregor","doi":"10.46292/sci23-2004605s","DOIUrl":"https://doi.org/10.46292/sci23-2004605s","url":null,"abstract":"The Centre for Family Medicine Mobility Clinic strives to provide high quality primary care to persons living with spinal cord injury or other health conditions that affect mobility. The Mobility Clinic Resource Abilities Council (MC RAC) was established to serve in an advisory capacity, making recommendations on matters that impact the experience of patients with physical disabilities and their support persons at the Mobility Clinic. MC RAC provides feedback on, and ideas for initiatives and programs that support and enhance the model of person-centred care. It also advances collaborative patient engagement and person-centred care principles and practices within primary care for persons with physical disabilities Members include individuals with lived experience with physical disability, their support persons, and Mobility Clinic staff. The council was established August 2022 and meets virtually once per month for approximately 90 minutes. MC RAC has successfully met nine times and has provided feedback on the following topics: Breast & Cervical Cancer screening Initiative for People with Physical Disabilities, Mobility Clinic website development, building pathways for advocacy with the KW4 OHT, Circulus Network webinar topics, Mobility Clinic organization and clinical flow. Feedback to be implemented into Mobility Clinic activities. Patient and support persons involvement in decision-making processes improve care experiences and contribute to better health outcomes for patients. We will continue to work and develop our patient advisory council to better support the Mobility Clinic’s patients and their support persons.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"42 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343405","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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