Thomas P. Walden, Shajaky Parameswaran, Louise Brisbois, B. C. Craven
Individuals with a neurologic level of injury (NLI) C1-T10 have an UMN bowel and propensity for external anal sphincter spasm and need chemical/mechanical stimuli to evacuate their bowels versus those with an NLI T11-S5 and LMN bowel whom have a patulous sphincter and complete manual bowel disimpaction. We describe the associations between independence in sphincter control for 5 years following discharge among individuals with traumatic SCI (tSCI). Adults with tSCI (n=113, 80 men) whom completed baseline, 1, 2, and 5-year community follow-up interviews (2014-2021) were included. Responses to the Spinal Cord Independence Measure (SCIM-III) Sphincter Control and Respiration subscores were extracted. Participants were separated into UMN and LMN groups. A linear mixed model determined longitudinal differences in SCIM subscores. NLI and follow-up time points were assigned as fixed effects, age a random effect, and sex as a covariate. Observed differences were compared to the minimal clinically importance difference (MCID) in SCIM-III subscores. The mean difference in SCIM-III subscores was 4.85 between the UMN and LMN bowel groups, with UMN group scoring lower at all-time points (p≤0.017). The mean group difference was equal to the MCID, constituting a substantial meaningful difference. No differences in SCIM subscores were noted across time (p≥0.9), regardless of NLI or bowel impairment. Self-reported sphincter control remains stable for 5 years post-injury, emphasizing the need to maximizing bowel independence before discharge. Individuals with UMN bowel have lower sphincter control scores than individuals with a LMN bowel.
{"title":"Post Doc Competition (Knowledge Generation) ID 1987817","authors":"Thomas P. Walden, Shajaky Parameswaran, Louise Brisbois, B. C. Craven","doi":"10.46292/sci23-1987817s","DOIUrl":"https://doi.org/10.46292/sci23-1987817s","url":null,"abstract":"Individuals with a neurologic level of injury (NLI) C1-T10 have an UMN bowel and propensity for external anal sphincter spasm and need chemical/mechanical stimuli to evacuate their bowels versus those with an NLI T11-S5 and LMN bowel whom have a patulous sphincter and complete manual bowel disimpaction. We describe the associations between independence in sphincter control for 5 years following discharge among individuals with traumatic SCI (tSCI). Adults with tSCI (n=113, 80 men) whom completed baseline, 1, 2, and 5-year community follow-up interviews (2014-2021) were included. Responses to the Spinal Cord Independence Measure (SCIM-III) Sphincter Control and Respiration subscores were extracted. Participants were separated into UMN and LMN groups. A linear mixed model determined longitudinal differences in SCIM subscores. NLI and follow-up time points were assigned as fixed effects, age a random effect, and sex as a covariate. Observed differences were compared to the minimal clinically importance difference (MCID) in SCIM-III subscores. The mean difference in SCIM-III subscores was 4.85 between the UMN and LMN bowel groups, with UMN group scoring lower at all-time points (p≤0.017). The mean group difference was equal to the MCID, constituting a substantial meaningful difference. No differences in SCIM subscores were noted across time (p≥0.9), regardless of NLI or bowel impairment. Self-reported sphincter control remains stable for 5 years post-injury, emphasizing the need to maximizing bowel independence before discharge. Individuals with UMN bowel have lower sphincter control scores than individuals with a LMN bowel.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"123 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139344464","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}
Shannon Rockall, James Hektner, Scott Donia, John Chernesky, Vanessa K. Noonan
Persons with lived experience of SCI (PLEX) living in rural areas have difficulty accessing optimal care and are required to travel long distances to access specialized services. Clinicians not affiliated with specialized urban centres recognize that developing knowledge and skills specific to SCI will improve care outcomes. Praxis has conducted multiple workshops on SCI topics throughout the BC Interior Health Region to improve clinician knowledge about SCI. Topics include pressure injuries, autonomic dysreflexia, specialized equipment, bowel and bladder, etc. Utilizing evidence-based information and PLEX experiences, these workshops have increased clinician confidence when working with clients with SCI. This interactive workshop explores the development and implementation of the sessions, from the perspectives of a clinician, a PLEX, and a knowledge exchange expert. The goals of this workshop are to: This workshop demonstrates the benefit of SCI knowledge exchange for clinicians working in rural areas. Furthermore, it highlights key factors in developing these workshops, and provides an opportunity to connect with other rural SCI initiatives and networks aimed at enhancing the care and well-being of PLEX.
{"title":"Workshop (Clinical/Best Practice Implementation) ID 1998666","authors":"Shannon Rockall, James Hektner, Scott Donia, John Chernesky, Vanessa K. Noonan","doi":"10.46292/sci23-1998666s","DOIUrl":"https://doi.org/10.46292/sci23-1998666s","url":null,"abstract":"Persons with lived experience of SCI (PLEX) living in rural areas have difficulty accessing optimal care and are required to travel long distances to access specialized services. Clinicians not affiliated with specialized urban centres recognize that developing knowledge and skills specific to SCI will improve care outcomes. Praxis has conducted multiple workshops on SCI topics throughout the BC Interior Health Region to improve clinician knowledge about SCI. Topics include pressure injuries, autonomic dysreflexia, specialized equipment, bowel and bladder, etc. Utilizing evidence-based information and PLEX experiences, these workshops have increased clinician confidence when working with clients with SCI. This interactive workshop explores the development and implementation of the sessions, from the perspectives of a clinician, a PLEX, and a knowledge exchange expert. The goals of this workshop are to: This workshop demonstrates the benefit of SCI knowledge exchange for clinicians working in rural areas. Furthermore, it highlights key factors in developing these workshops, and provides an opportunity to connect with other rural SCI initiatives and networks aimed at enhancing the care and well-being of PLEX.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"12 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343834","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, S. L. Hitzig, James Milligan, Peter Athanasopoulos, M. Boulos
We studied the feasibility of a home-based screening sleep test (HBSST), the validity of four questionnaires used to screen for sleep-related breathing disorders (SRBDs), and the potential association between SRBD and clinical features in individuals with spinal cord injury (SCI). Adults with subacute/chronic (>1 month post-injury) SCI were recruited for the cross-sectional study and qualitative analysis. Feasibility of the HBSST was objectively evaluated and participants shared their experience. We also examined the validity of the Berlin, STOP, Medical Outcomes Study Sleep Scale [MOS-SS], and STOP-Bang screening questionnaires. We investigated the association between the degree of SRBD and three features (i.e., neck circumference, body mass index [BMI] and oropharynx opening as assessed using the Modified Mallampati classification [MMC]). There were 13 females and 18 males with ages varying from 20 to 86 years (mean age: 54.7 years) with motor complete (n=8) or incomplete SCI at cervical (n=21) or thoraco-lumbar levels. Time since SCI varied from 1.5 to 474 months. Overall, 28 individuals completed the HBSST and endorsed its feasibility. Mean apnea-hypopnea index (AHI) was 17.3 events/hour (range: 0.5-83.7). AHI was significantly correlated with Berlin (p=0.036) and STOP-Bang scores (p=0.009). There was no significant correlation between AHI and MOS-SS (p=0.348) or STOP (p=0.165). AHI was not associated with neck circumference (p=0.614), BMI (p=0.958), or MMC (p=0.335). Our results suggest that HBSST is a feasible screening method, and Berlin and STOP-Bang are valid screening questionnaires for the SCI population. AHI was not correlated with BMI, neck circumference, or MMC.
{"title":"Poster (Health Services, Economics and Policy Change) ID 1969166","authors":"Julio C Furlan, S. L. Hitzig, James Milligan, Peter Athanasopoulos, M. Boulos","doi":"10.46292/sci23-1969166s","DOIUrl":"https://doi.org/10.46292/sci23-1969166s","url":null,"abstract":"We studied the feasibility of a home-based screening sleep test (HBSST), the validity of four questionnaires used to screen for sleep-related breathing disorders (SRBDs), and the potential association between SRBD and clinical features in individuals with spinal cord injury (SCI). Adults with subacute/chronic (>1 month post-injury) SCI were recruited for the cross-sectional study and qualitative analysis. Feasibility of the HBSST was objectively evaluated and participants shared their experience. We also examined the validity of the Berlin, STOP, Medical Outcomes Study Sleep Scale [MOS-SS], and STOP-Bang screening questionnaires. We investigated the association between the degree of SRBD and three features (i.e., neck circumference, body mass index [BMI] and oropharynx opening as assessed using the Modified Mallampati classification [MMC]). There were 13 females and 18 males with ages varying from 20 to 86 years (mean age: 54.7 years) with motor complete (n=8) or incomplete SCI at cervical (n=21) or thoraco-lumbar levels. Time since SCI varied from 1.5 to 474 months. Overall, 28 individuals completed the HBSST and endorsed its feasibility. Mean apnea-hypopnea index (AHI) was 17.3 events/hour (range: 0.5-83.7). AHI was significantly correlated with Berlin (p=0.036) and STOP-Bang scores (p=0.009). There was no significant correlation between AHI and MOS-SS (p=0.348) or STOP (p=0.165). AHI was not associated with neck circumference (p=0.614), BMI (p=0.958), or MMC (p=0.335). Our results suggest that HBSST is a feasible screening method, and Berlin and STOP-Bang are valid screening questionnaires for the SCI population. AHI was not correlated with BMI, neck circumference, or MMC.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"287 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343893","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}
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":"48 1","pages":""},"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":"49 1","pages":""},"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":"4 1","pages":""},"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":"62 1","pages":""},"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":"95 1","pages":""},"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":"0 1","pages":""},"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":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"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}
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