Journal of Spinal Cord Medicine最新文献

Context: Emerging data suggests that patients with a spinal cord injury (SCI) have a higher risk of developing cognitive impairment. The true incidence of cognitive impairment in this group is unclear due to the difficulty in administering commonly used assessment tools, which are dependent on functional abilities e.g. drawing and writing.

Methods: A 16-question online survey, that aims to understand current practices on the assessment of cognition and the limitations of currently available tools, was sent via a Research Network Group to British Association of Spinal Cord Injury Specialists (BASCIS) registered clinicians at each of the 12 Spinal Injuries Centers in the UK and Ireland.

Results: 41 responses from 11 different SCI centers, with most from clinicians who have worked with SCI patients for over 10 years. 68% felt that there was a higher incidence of cognitive impairment in those with an SCI. However, 15% reported not using tools to screen for cognitive impairment, primarily due to lack of time, lack of guidelines, and physical disabilities affecting the ability to complete tests. When used, the most commonly utilized tools were those that rely on intact hand function.

Conclusions: Clinicians report a higher incidence of cognitive impairment in those with an SCI. However, currently used tools are not always appropriate, and patients with impaired hand function may be under-represented or undiagnosed. Further work is needed for a more standardized assessment tool to ensure that these patients receive appropriate diagnosis and management, particularly since cognitive impairment in this group can increase care needs and reduce engagement with rehabilitation.

Context/objective: The objective of this study was to examine the implications of shelter-in-place (SIP) during the COVID-19 pandemic on secondary health conditions (SHC), loneliness, social isolation, social connectedness, anxiety, and positive affect and well-being (PAWB) among community-dwelling adults with spinal cord injury (SCI).

Design: An online exploratory cross-sectional descriptive design.

Participants: 131 community-dwelling adults with SCI.

Outcome measures: UCLA Loneliness Scale, SCI-QOL - Anxiety and PAWB.

Results: Respondents were approximately 33 years old, mostly male and Caucasian. More than half reported being married, living with their spouse in a home with modifications, or living in a household of three or more people. More than half reported experiencing more pain during SIP but not experiencing more of any other SHC than before SIP. On average, participants experienced a moderate level of loneliness, severe anxiety, and higher levels of PAWB during SIP.

Conclusion: Respondents reported that they experienced more pain, loneliness, and anxiety while at the same time reporting higher PAWB. Future research should focus on understanding the nuances of the seemingly counterintuitive relationship described here to develop better ways to support community-dwelling adults with SCI during public health emergencies and SIP.

Context: Healthcare institutions acknowledge the value of diverse workforces for enhancing programs and meeting the varied needs of individuals with Spinal Cord Injury. This survey conducted at the 2023 Academy of Spinal Cord Injury Professions (ASCIP) conference assesses healthcare professionals' views on workplace Diversity, Equity, and Inclusion (DEI) and their support for integrating related educational content in future events.

Methods: : The survey was distributed digitally to ASCIP attendees, ensuring anonymity and voluntary participation. It aimed to collect data on demographic backgrounds, perceptions of DEI at work, and the relevance of educational topics regarding Inclusion, Diversity, Equity, and Access (IDEA) for upcoming conference agendas.

Results: : Seventy percent of respondents felt able to achieve success and express their genuine feelings in the workplace, with their opinions valued. While economic disparities were often discussed (56%) in relation to patient care, other aspects like religion, cultural racism, racial inequalities, and LGBTQ + issues were less frequently addressed. Approximately 55% reported that their organizations had recently started or were initiating DEI efforts.

Conclusions: : There is a clear need for inclusive work environments and patient care that values the diverse intersectionality of the community served. Strong support exists for further educational initiatives on IDEA concepts, highlighting a significant opportunity to enhance early-stage DEI programs in healthcare settings.

Context: Intensive walking practice often demands capabilities that go beyond the limits for both patients and therapists. As a solution, robot-assisted exoskeletons have been developed to deliver efficient rehabilitation sessions.

Objective: The primary aim was to evaluate the effect of adding exoskeleton training, the FreeGait®, to conventional treatment on walking status in patients with motor incomplete spinal cord injury. The secondary aim was to assess its impact on mobility, functional independence, and health-related quality of life.

Methods: This study compared exoskeleton gait training with conventional therapy (RBCT) versus conventional therapy alone (CT). Fourteen participants with motor incomplete spinal cord injury were included, with seven in each group. Both groups had 40-minute conventional therapy sessions 5 days a week. Additionally, the RBCT performed exoskeleton walking and balance exercises 3 days a week. The WISCI II (primary outcome), 10MWT, gait speed, TUG, BBS, SCIM III, and WHOQOL-BREF were used for evaluation (see text for acronyms).

Results: Walking status and mobility-related measures showed significant improvements in the RBCT (p < 0.05), whereas no significant differences were observed in the CT (p > 0.05). There was a significant difference in the physical health domain of the WHOQOL-BREF only in the RBCT. However, no significant differences were found in the WHOQOL-BREF total score in both groups (p > 0.05). Furthermore, no significant difference was observed between the groups in terms of change (p > 0.05).

Conclusions: Gait training with the new exoskeleton combined with conventional therapy, positively contributes to walking status, mobility, and functional independence.Trial registration: ClinicalTrials.gov identifier: NCT06137456.

Background: Spinal cord injuries (SCIs) are major sources of socioeconomic burdens and are still rising globally. SCIs also cause several personal sufferings in both physical and psychological aspects. Individuals' reactions following a traumatic incident can vary based on the severity and nature of the damage, as well as their psychological dispositions. Locus of control (an individual's belief in his/her ability to control the outcome of events surrounding them) is an important factor in determining individuals' quality of life (QoL) in the aftermath of an incident.

Methods: We conducted a cross-sectional study to investigate the association between locus of control and general health in patients with lumbar SCI. This study was carried out on 108 patients with lumbar SCI using the Rotter's Locus of Control Scale and the General Health questionnaires, as well as demographic data.

Results: Patients with an internal locus of control had a significantly better general health score than those with an external locus of control (32 vs. 38.5; P < 0.0001). There was a moderate positive correlation between general health and locus of control score (R = 0.575; P < 0.0001). Also, employed patients had a significantly more internal locus of control score compared to unemployed patients (7 vs. 8; P = 0.004).

Conclusion: Scores of locus of control and general health are significantly correlated, and internal locus of control could lead to better general mental health in patients with lumbar SCI. Although there is a need for more studies with better study designs to approve of this association, the results of this study emphasize the importance of interventions targeting locus of control, improving socio-economic conditions, and rehabilitation measures in improving the general health of these patients.

Context/objective: Pressure injury (PrI) recurrence is common among persons with spinal cord injury and disorders (SCI/D) who undergo reconstructive flap surgery for pelvic stage 4 PrI (S4PrI). This paper describes the development and implementation of the Minneapolis Spinal Cord Optimization, Rehabilitation and Empowerment (SCORE), a preoperative interdisciplinary tool for risk assessment and mitigation, and reports its effect on the one-year flap failure rate (significant breakdown).

Design: Retrospective review.

Setting: Minneapolis Veterans Affairs Health Care System (MVAHCS) SCI/D Center, a tertiary care center.

Participants: 141 Veterans with SCI/D and pelvic S4PrI underwent 204 interdisciplinary assessments for flap surgery.

Interventions: The Minneapolis SCORE was developed by the MVAHCS SCI/D Center and first implemented in 2012. The eight domains of the tool and continuous improvements in tool implementation for risk assessment and mitigation are described.

Outcome measures: Per-year incidence rate of flap failures within one year of surgery from 2009 to 2019.

Results: 48.3% (28/58) of S4PrI assessments during 2009-2011 (pre-SCORE) led to flap surgery the same year, increasing to 59.6% (87/146) of assessments after SCORE implementation during 2012-2019. The one-year flap failure rate abruptly decreased from 40.5% (15/37) of the 2009-2012 surgeries to 7.7% (6/78) of the 2013-2019 surgeries (P < .0001). Characteristics of patients by time period, operative status, and flap outcome are presented.

Conclusion: After an initial learning curve in tool implementation and subsequent tool refinement, the use of the Minneapolis SCORE before flap surgeries was associated with improved flap integrity at one year. Successful use of the tool requires collaborative problem-solving between the patient and interdisciplinary team.

Context: Breast and cervical cancer are among the most common types of cancer, with breast cancer being a leading cause of death in females. Participation in preventive cancer screening is thought to be lower for females with spinal cord injury (SCI) compared to the general population, which could lead to late diagnosis and increased mortality.

Objective: To summarize evidence on the prevalence of breast and cervical cancer, adherence to cancer screening recommendations, and factors influencing participation in preventive programs among females with SCI.

Methods: Systematic searches were conducted in PubMed, Embase, a guideline repository, and two SCI-specific websites for articles published between 1990 and 2023. The risk of bias was assessed using different critical appraisal tools. Fixed-effects meta-analysis estimated differences in adherence to mammography and Pap testing recommendations between females with and without SCI. Prospero registration: CRD42023481362.

Results: We identified 15 studies, mainly from high-income countries, with a cumulative study population of 9,565 people. No studies evaluated cervical or breast cancer prevalence in females with SCI. Meta-analysis found females with SCI had 1.4 times the odds of not having a recent mammogram and 1.8 times the odds of not having a recent pap test, compared to females without SCI. Barriers included environmental, attitudinal, financial, and informal factors.

Conclusion: There is no information on the prevalence of cervical or breast cancer in females with SCI. Participation in breast and cervical cancer screening is lower among females with SCI. Physical inaccessibility of health care and lack of provider knowledge were the main barriers.

Context: Despite being important for health and wellbeing, people with a disability engage in tourism significantly less than people who are non-disabled. It is important to understand why this is occurring so that we can set an agenda toward accessible tourism.

Objective: To understand the tourism experiences and needs of people living with spinal cord injury.

Methods: Seven databases were searched for papers related to tourism engagement by people with a spinal cord injury. Included papers were published in English from 2000 and included gray material. Qualitative and quantitative papers were charted separately, with the key findings extracted.

Results: The search identified 3513 papers, duplicates were removed, 2192 papers were screened at title and abstract, 90 papers screened at full text, and 31 papers were included in the final synthesis. Fifty-eight percent of the papers explored American tourism, and 45% were articles in a spinal cord injury magazine. Collectively, the studies, conference papers, and magazine articles highlighted environmental and personal factors that support or hinder engagement in tourism, the impacts on the experience, and recommendations.

Conclusion: People with a spinal cord injury want to engage in tourism, however environmental and personal factors create challenges that prevent engagement. Advocacy efforts and consumer partnering are required to support disability education and improve accessible tourism. The limited amount of high-quality research highlights a gap in our knowledge and minimizes the trustworthiness and transferability of the findings from this scoping review.

Context: A previously healthy 40-year-old woman experienced a sudden complete tetraplegia (C8, AIS-A).

Findings: MRI revealed a C6/C7 disc herniation surrounded by an epidural haematoma.

Conclusion/clinical relevance: Physicians must recognize acute, non-traumatic disc herniation as a potential cause of spinal cord injury, urging prompt diagnosis and intervention.