Journal of Spinal Cord Medicine最新文献

Context: Clinical Practice Guidelines from the Consortium for Spinal Cord Injury (SCI) Medicine recommend daily self-screening of at-risk skin surfaces, but many Veterans with SCI describe challenges using the standard issue long-handled self-inspection mirror (LSIM).

Objective: The objective of this project was to compare the LSIM to a recently developed camera-based self-inspection system (CSIS). User feedback guided iterative engineering to improve and develop the new technology in preparation for transfer to industry.

Methods: Five Veterans with spinal cord injury (SCI) volunteered to compare use of a LSIM versus the CSIS to identify purposefully placed stickers with varying letters and colors over their high-risk skin surfaces while lying in bed. Each Veteran also responded to a series of interview questions and completed the QUEST 2.0 questionnaire on satisfaction with assistive technology.

Results: Veterans with SCI were able to correctly identify sticker letters and colors with significantly higher fidelity (P = .001 and P = .001 respectively) using the CSIS compared to using LSIM. Further the CSIS, was significantly (P = .004) preferred over the LSIM on the QUEST 2.0. The Cohen's D effect sizes for these paired comparisons were large (for color: 5.7, for sticker letter: 5.0 and QUEST 2.0: 2.6).

Conclusions: Improved visualization and satisfaction scores using the newly developed CSIS suggest that adoption of this new technology could improve the quality and acceptance of this skin screening strategy for persons with spinal cord injury.

Introduction: Spinal cord injury is a physiological disruption often caused by trauma, leading to severe physical and psychological effects, including irreversible impairment and disability. Cervical injuries, particularly between C1 and C8, are the most severe, potentially causing diaphragm paralysis and requiring mechanical ventilation. Reduced respiratory muscle strength not only affects respiratory function but also significantly impacts voice, speech, and communication, which are crucial for quality of life.

Objective: Conduct a systematic review of the literature on respiratory muscle training protocols in individuals with cervical spinal cord injury and evaluate the methodological quality of scientific publications.

Methods: Studies were searched by two independent researchers in the Regional Portal of the Virtual Health Library, EMBASE, SCOPUS and PubMed databases, using the descriptors: "respiratory muscle strength", "breathing training", and "cervical spinal cord injury", with no restriction on the time of publication. Studies containing respiratory muscle strength measurements and respiratory muscle training in people with cervical SCI were included and those that associated other techniques with functional respiratory training, such as electrical stimulation and other complementary techniques were excluded. The studies had the methodological quality (internal and external validity) classified by the PEDro scale (Physiotherapy Evidence Database).

Results: Nine studies were identified and considered valid based on the inclusion criteria. The protocols presented varied parameters. The session time ranged from 15 to 45 minutes, the number of sessions per day ranged from 1 to 2, the number of days per week ranged from 3 to 7, and the number of intervention weeks ranged from 4 to 10. Only three studies presented internal and external validity for respiratory muscle training programs.

Conclusion: This review identified that respiratory muscle training is an effective intervention to improve respiratory function in people with cervical SCI. However, due to the poor methodological quality of the studies, the effect size of the treatment, as well as the ideal dose and intensity, requires further investigation to better determine its overall effectiveness.

Objective: To identify the factors associated with home discharge in individuals with cervical spinal cord injuries (cSCI) according to age group.

Design: Cross-sectional study.

Setting: Hospital or rehabilitation centers specializing in spinal cord injuries in Japan.

Methods: The subjects were individuals with cSCI who were registered in the National Spinal Cord Injury Database between April 2000 and March 2019 and hospitalized for rehabilitation purposes. The subjects were stratified into three groups: 18-34 years old (young-aged group), 35-64 years old (middle-aged group), and 65 years and older (old-aged group). Logistic regression analysis was performed to identify the factors associated with home discharge in each age group.

Results: In the logistic regression analysis, the variables extracted as factors related to home discharge were: in the young-aged group, independence in bathing (odds ratio [OR]: 4.55), independence in toilet transfer (OR: 4.45), and high cervical (C1-C4) neurological level of injury (OR: 3.16). In the middle-aged group, living with others (OR: 3.36), independence in toilet transfer (OR: 5.74), and independence on stairs (OR: 3.58) were extracted. In the old-aged group, living with others (OR: 14.16), independence in bladder management (OR: 7.74), independence in locomotion (OR: 4.55), and good cognitive function (OR: 2.91) were extracted.

Conclusion: These results suggest that the factors associated with home discharge for individuals with cSCI have different characteristics in each age group. Additionally, factors common to all age groups, such as transfers and toileting, were identified. Appropriate support depending on the age group is necessary for home discharge.

Objective: To engage U.S. end users to (1) gather information on facilitators and barriers to awareness and adoption of the Canadian Spinal Cord Injury (SCI) Physical Activity (PA) guidelines; (2) inform potential adaptations to the presentation and messaging of the guidelines; and (3) develop recommendations for targeted dissemination strategies to promote awareness in the United States.

Design: Multi-method.

Setting: Working groups conducted remotely via Zoom and online surveys.

Participants: Individuals with lived SCI experience (n = 5), providers/clinical researchers (n = 7), and members of SCI professional or community organisations (n = 6).

Interventions: N/A.

Outcome measures: N/A.

Results: Participants highlighted the need for centralised, credible sources of information on PA. While participants generally viewed the guidelines as appropriate, useable, and acceptable, some questioned their credibility, as they were developed explicitly for Canadians with SCI rather than Americans. To enhance reach and effectiveness, participants suggested dissemination strategies that target specific audiences (i.e. level of functioning, level of injury, current level of PA). They also recommended collaborations with existing trusted community SCI organisations.

Conclusion: Findings underscore the need for accessible, centralised, and credible information sources on PA tailored to the needs of the SCI community. Findings also suggest that while the guidelines do not require redevelopment for a U.S. context, they do need customised presentation, such as removing Canadian symbols from the materials, to better suit U.S. audiences. Effective dissemination will benefit from targeted strategies that leverage trusted organisations to reach and engage specific groups, ultimately supporting greater guideline awareness, acceptance, and application across the SCI population.

Context: This study aimed to investigate the characteristics, diagnosis, and management of tuberculous longitudinally extensive transverse myelitis (TB-LETM), a rare manifestation of tuberculosis.

Findings: We analyzed two rare cases of TB-LETM and discussed their clinical manifestations and imaging findings in the context of the relevant literature. Patient 1, a 23-year-old female, presented with quadriplegia and dysuria, and spinal magnetic resonance imaging (MRI) revealed lesions extending from C1 to T3. Patient 2, an 18-year-old female, reported acute-onset numbness and weakness in both lower limbs, with MRI showing lesions from T1 to T4, along with multiple intracranial leptomeningeal enhancements. Both patients had elevated cerebrospinal fluid (CSF) cell counts and protein levels, and positive blood T-cell spot test (T-SPOT.TB), but no microbiological evidence of Mycobacterium tuberculosis was found. Diagnosis was based on clinical presentation, medical history, chest computed tomography (CT) findings, and CSF analysis. Over the past decade, 14 cases of TB-LETM have been reported. Common symptoms include fever, acute paralysis, sensory deficits in the lower limbs, and dysuria. Elevated CSF protein, lymphocytosis, and decreased glucose levels are essential for differentiating TB-LETM from autoimmune disorders.

Conclusion: Longitudinally extensive transverse myelitis (LETM), especially when involving the cervical and thoracic cords, should be considered a potential manifestation of tuberculosis infection. Analysis of cerebrospinal fluid, MRI findings, and T-SPOT testing can provide crucial diagnostic insights. A combination of anti-tuberculosis therapy and corticosteroids has proven clinically effective in managing this condition.

Context: Available diabetes risk calculators were developed for able-bodied individuals, but their metabolic profile is different from individuals with spinal cord injury.

Objectives: We aimed to develop a diabetes risk assessment tool specific to individuals with spinal cord injury.

Methods: We used national Veterans Affairs data to identify patients with at least a 2-year history of spinal cord injury and no prior history of diabetes with a Veterans Heath Affairs visit from 2005-2007, and followed the 11,054 individuals that met inclusion criteria for up to 17 years to assess diabetes development. We used least absolute shrinkage and selection operator (LASSO) Cox regression to develop prognostic diabetes prediction models and evaluated these models on discrimination and calibration.

Results: 2937 subjects developed diabetes during follow-up; median follow-up time was 8.7 years (IQR 3.3, 15.4). The first model selected 17 predictors and demonstrated median discrimination of 0.70 (IQR 0.69, 0.72) at 15 years. The second, more parsimonious model with 4 selected predictors demonstrated median discrimination of 0.69 (IQR 0.68, 0.71) at 15 years. Both models demonstrated good calibration across predicted risk, with better calibration in the 17-predictor model.

Conclusion: These spinal cord injury-specific risk calculators can be used by both patients and providers in assessing risk of diabetes development, and in shared decision making regarding surveillance and prevention.

Objective: The present study aims to investigate the effect and mechanism of heavy moxibustion (100 moxa-cone) at Sanyin point (the common point of Yin and kidney) on the function of neurogenic bladder (NB) dysfunction in rats with spinal cord injury (SCI).

Methods: Twenty-four male Sprague-Dawley rats were divided into four groups (n = 6): control, NB, NB + Moxibustion, and NB + Moxibustion + YS-49 (PI3 K agonist). The rats in control groups accepted a cut open of the skin, fascia, and muscle. The NB model was established using spinal cord transection. Fourteen days later, animals received heavy moxibustion at Sanyin point for three weeks or/and intraperitoneal administration of YS-49 (a PI3 K agonist). Basso, Beattie, and Bresnahan (BBB) scale, urodynamic parameters, bladder size, and weight were measured. The hematoxylin-eosin staining method was used to observe the histology of the bladder mucosa. Moreover, NB dysfunction after SCI could be restored by autophagy activation and autophagy is mediated by the PI3 K/Akt/mTOR pathway. Therefore, the expressions of autophagy factor (LC3 II/I and p62), PI3 K, and p-mTOR in the bladder mucosa were evaluated by western blotting.

Results: Heavy moxibustion treatment relieved the development of NB dysfunction in rats with SCI, with an increase in the bladder voiding efficiency and a decrease in afferent activity during storage in the moxibustion group compared with the NB group. The expression levels of LC3 II/I were markedly elevated by moxibustion, accompanied by a decrease in the levels of p62. YS-49 addition increased the PI3 K and p-mTOR expression which were down-regulated by moxibustion. Importantly, YS-49 reversed the effects of moxibustion on autophagy and bladder function.

Conclusion: Heavy moxibustion at Sanyin point exerted its effect on healing-impaired NB dysfunction in rats with SCI, possibly activating autophagy through the PI3 K/mTOR pathway.

Objective: To identify the prevalence and risk factors for low bone density (LBD) in young adults with spinal cord injury (SCI).Design: Retrospective cross-sectional study.Setting: National Rehabilitation Center in Seoul, Korea.Participants: SCI patients aged 20-49 years hospitalized from January 2010 to October 2021.Interventions: Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry of the lumbar spine, femoral neck, and total hip.Outcome Measures: Areal BMD, Z-score and T-score of each region and prevalence of LBD.Results: Osteopenia and osteoporosis were diagnosed in 451 (58.2%) and 156 (20.1%) of 775 patients, respectively. Among 181 patients within 3 months of onset, 105 (58%) and 20 (11%) were diagnosed with osteopenia and osteoporosis, respectively. Additionally, the percentage of LBD increased significantly as the time from injury increased. On multivariate analysis, the risk factors for LBD in patients with early SCI within 12 months of onset were female sex (odds ratio [OR] = 2.49; 95% confidence interval [CI], 1.34-4.46; p = 0.002), body mass index (OR = 0.86; 95% CI, 0.81-0.92; p < 0.001), and age (OR = 1.04; 95% CI, 1.01-1.07; p = 0.005). Alcohol or smoking history, etiology, neurological level, or completeness of injury, and the Korean version of the spinal cord independence measure-III score were not significantly correlated with LBD.Conclusions: The prevalence of osteopenia and osteoporosis is high in young adults with SCI. In addition, the diagnosis rate is high in the test performed at the initial stages after injury. Therefore, early bone health monitoring should be performed in young adults with SCI.

Study design: Retrospective data analysis study.

Objectives: To assess gait recovery rates in subjects with motor incomplete spinal cord injury (SCI) at the start of rehabilitation and to report their gait performance.

Setting: Tertiary inpatient Rehabilitation Center in Argentina.

Methods: The study analyzed data from 143 individuals with traumatic and non-traumatic SCI (AIS/ASIA Impairment Scale C and D) within 90 days of injury, all non-ambulatory upon admission. Gait status at discharge was evaluated using the 6-minute walk test and the Walking Index for Spinal Cord Injury II (WISCI II). Statistical evaluations utilized Pearson chi-square and Mann-Whitney U-tests. Approval was obtained from Fleni's Ethics Committee.

Results: Among the 65 patients with AIS C, 69% regained walking function, compared to 87% of the 74 patients with AIS D (p = 0.01). Walkers had a mean total motor score of 67 (±19) versus 51.7 (±25.5) for non-walkers (p = 0.002), and a total pinprick sensation score of 69.8 (± 27.5) vs. 49.5 (± 29) (p = 0.001). Additionally, 54% of AIS C and 86% of AIS D patients aged ≥ 50 regained walking ability; however, age-related differences were statistically significant only in AIS C group (p = 0,015). AIS D patients walked a mean of 249 meters (±134), while AIS C walked 207 meters (±128) (p = 0.07). The median WISCI II score between the two groups were not statistically significant.

Conclusions: Most patients with incomplete motor SCI who participated in inpatient rehabilitation regained walking, with motor score and pinprick sensation correlating to walking ability. Gait performance was comparable between AIS C and D.

Context: Veterans Health Administration (VHA) maintained a registry of identified and verified cases of US Veterans with spinal cord injuries and disorders (SCI/D) since 1994: VHA SCI/D Registry (VHA SCIDR). Data elements, capture, and storage methods varied over time.

Objective: Describe the consolidation and harmonization of historical VHA SCIDR data spanning three decades during its evolution to an automated platform and report population characteristics.

Methods: The VHA SCIDR captured data using four distinct acquisition methods over 28 years, including cases of Veterans with SCI/D receiving SCI/D System of Care services, via 25 SCI/D Centers and 122 Spoke Sites throughout the VHA healthcare system. Foundational elements of VHA SCIDR data capture methods, harmonization of data elements with the current automated algorithm, access protocol, and governance structure are described.

Results: From Fiscal Years (FYs) 1994 to 2022, VHA SCIDR identified 52,407 Veterans with traumatic or non-traumatic SCI/D, and 96.95% were male, 56.09% White, 16.57% were Black, 1.23% Asian and Pacific Islander, 0.75% Native American, and 25.36% unknown. Traumatic etiology comprised 53.39% of the sample, while 31.75% were non-traumatic, with 14.87% missing etiology classification. Injury category proportions were 5.19% high tetraplegia, 5.83% low tetraplegia, 5.85% high paraplegia, 7.53% low paraplegia, and 23.35% AIS D, with 52.25% missing or unable to be calculated.

Conclusions: VHA SCIDR is one of the three largest SCI/D registries in North America and is the case-identification platform for VHA SCI/D operations, program evaluation, and research studies. VHA SCIDR is connected to each Veteran's VHA healthcare data, facilitating big data research.