Journal of Spinal Cord Medicine最新文献

Study design: Retrospective non-controlled intervention study.

Objectives: To assess indications, feasibility, safety and efficacy of dorsal rhizotomy at the level of conus medullaris (conus deafferentation - CDAF) in individuals with spinal cord injury/disease (SCI/D).

Setting: Two specialized tertiary German centers for spinal cord injuries.

Methods: In addition to a detailed description of the surgical procedure (including two technical variants: hemilaminectomy and osteoplastic laminotomy), an analysis of the surgical reports on intra- and postoperative complications and an evaluation of the pre- and postoperative paraplegiologic and neuro-urologic parameters of SCI/D patients with CDAF are presented.

Results: A total of 30 patients, 6 of them women, 22 with complete, 8 with incomplete SCI/D underwent CDAF. The most common indications were therapy-refractory detrusor overactivity, spasticity of the lower limbs and autonomic dysreflexia, usually with several simultaneous indications.Except for one antibiotic-treated wound infection, no severe CDAF-associated complications were documented. Urodynamic parameters (maximum detrusor pressure, maximum cystometric capacity) improved significantly (p < .001). In addition, all clinical targets (autonomic dysreflexia, spasticity triggered by bladder and bowel dysfunction, recurrent urinary tract infections, urinary incontinence) were also significantly improved.Quality of life (SCI-QoL-BDS) was significantly improved (p < .001) from 10 (IQR 6-16) to 17 (IQR 9.75-21), while neurogenic bowel dysfunction (NBD) score did not significantly change.

Conclusions: The present study identified different indications for the use of CDAF that can be performed safely and efficiently with very few intraoperative and postoperative complications. We see a high potential in this method for the improvement of the paraplegiological and neuro-urological therapy spectrum.

Context: Autonomic dysreflexia (AD), a lethal condition of which patients with spinal cord injury (SCI) are at risk, is under-identified in these patient populations. Research literature is limited on AD-related educational resources provided to patients with SCI.

Objective: The American Medical Association and National Institutes of Health recommend healthcare material be written in a sixth- to eighth-grade reading level for patients. In this study, the authors compared the readability of AD-related materials provided to patients with SCI through Commission on Accreditation of Rehabilitation Facilities (CARF)-accredited websites versus those obtained via Google search.

Methods: Online, free materials were obtained from CARF-accredited institutions. These data were compared with top Google search results for the term "autonomic dysreflexia." Materials were assessed using 4 different validated readability scales. The average reading grade level was recorded for each readability index between the two groups.

Results: For CARF-accredited institutions (n = 21), the mean readability score was at a 10th grade level. For Google search (n = 84), the mean readability score was at a 13th grade level. Further analysis demonstrated a statistically significant difference between the readability of the CARF-accredited and non-accredited websites (P < 0.01). One-way ANOVA demonstrated no significant differences among the four readability calculators for CARF-accredited sites and, separately, for Google websites.

Conclusion: Online information provided to patients with SCI on AD through CARF-accredited institutions is two- to four-reading grade levels higher than recommended. Efforts should be made to modify the readability of CARF-accredited and non-academic website materials to improve patient education.

Context: Meditation and mindfulness practices offer promising non-pharmacological alternatives for individuals with spinal cord injury (SCI) to improve their health and well-being, but integrating such practices into daily routines can be challenging.

Objectives: This survey study aims to identify motivators and barriers to engagement with meditation and mindfulness interventions among individuals with SCI.

Methods: A cross-sectional survey was conducted among adults with SCI (N = 94) from a single large acute rehabilitation center in the United States.

Results: Results from the survey showed a strong interest in meditation among individuals with SCI, with nearly half reporting current engagement in meditation practices at least once a week. Motivations for starting meditation varied, including relaxation, curiosity, and improving mental well-being, such as reducing anxiety, stress, and depression. The preferred modes of meditation delivery included app-guided and virtual individual sessions. Specific barriers to meditation were identified, such as the inability to stop thoughts, a lack of knowledge about meditation, and uncertainty about correct practice techniques. Physician discussions about meditation with participants were infrequent.

Conclusion: Overall, the study provides valuable insights into the meditation practices and preferences of individuals with SCI, highlighting opportunities and challenges for promoting meditation engagement and enhancing well-being in this population. Limitations of the study include limited generalizability, reliance on self-reported measures, and lack of assessment of potential confounding variables. Future research efforts should focus on developing and evaluating interventions that address the barriers and promote the uptake of meditation practices in this population.

Objectives: This study serves a methodological reference and provides epidemiological profile for Ecuador's first population-based survey on spinal cord injury.

Methods: We determined sample size and eligibility using data from the National Council for Disability Equality. The survey was developed with translation, cultural adaptation, and pilot testing. In collaboration with the National Federation of People with Physical Disabilities of Ecuador, data were collected. Participants were classified by SCI etiology and severity to describe the cohort profile. Additionally, incidence and mortality rates from 2017 to 2022 were estimated using hospital discharge data.

Results: The survey involved 633 individuals, with a final cohort of 521 eligible participants, 75.2% of whom were male. The mean age was 45 years. Traumatic SCIs constituted 83.4% of cases, with 80.8% being paraplegic. The median age at onset was 27 years, and participants had lived with the injury for a median of 14 years. Traffic accidents were the leading cause of traumatic injuries (36.1%), followed by violence (16.6%) and work accidents (15.9%). Nontraumatic injuries primarily resulted from spinal degeneration (31.4%) and infections (29.1%). Traumatic injuries were more common in younger males, while nontraumatic injuries were more frequent among older females. Annually, Ecuador sees 516 new SCI cases, equating to three cases per 100,000 people, with a hospital mortality rate during the acute period of 3%.

Conclusion: This study presents the first national epidemiological profile of SCI in Ecuador, showing that injuries predominantly affect young individuals, primarily due to traffic accidents. The findings highlight areas for intervention and provide valuable insights into data collection and rehabilitation strategies for future research.

Study design: Diagnostic Study.

Objectives: Early prognosis for recovery in traumatic cervical spinal cord injury resulting in tetraplegia may further guide rehabilitation and surgical interventions. This study assesses the feasibility and potential of using stimulated manual motor testing (SMMT) and needle electromyography (EMG) to predict gains in strength during acute inpatient rehabilitation.

Setting: Single academic inpatient rehabilitation facility (IRF).

Methods: Muscles with weak strength (manual motor test (MMT) <3) were assessed for lower motor neuron (LMN) integrity by SMMT using surface electrodes. Muscles without clinical strength (MMT=0) using SMMT and EMG. Correlations and prognostic models assessed the association and prediction of these measures with improvement in MMT values over 4 weeks.

Results: The missing data rate for SMMT and motor unit action potential (MUAP) testing was 9.5% and 24%, respectively. Wilcoxon Rank Sum tests of 4-week MMT changes with MUAP presence (P = 3.89×10^-6) and SMMT improvement (P = 0.0156) were statistically significant, but the Spearman Rank Correlation Coefficient of changes in SMMT with MMT changes was not (P = 0.817). The receiver operating characteristic (ROC) Area Under the Curve (AUC) for combined MUAP and SMMT predictors of MMT improvement was 0.732, with an optimal sensitivity of 41.9% (95% CI 25.8% to 58.1%) and specificity of 90.3% (95% CI 84.5% to 96.1%). This model was superior to univariate models.

Conclusions: With pragmatic compromises in test administration to reduce attrition, measuring the presence of voluntary MUAP and improvement in SMMT during acute rehabilitation retains value in predicting motor improvement in 4 weeks.

Objectives: This study aims to elucidate the relationship between red blood cell (RBC) count and D-dimer levels in patients with spinal cord injury, with the goal of identifying potential therapeutic targets for minimizing D-dimer levels.

Study design: An observational, retrospective, cross-sectional, single center study.

Setting: Individuals with SCI (576 cases) admitted to a rehabilitation medicine department.

Outcome measures: After exclusions, we divided the participants (n = 308) into two groups based on their D-dimer levels: Group 1 (≤0.5  mg/L, n = 64) and Group 2 (>0.5  mg/L, n = 244). Key variables such as deep vein thrombosis (DVT), anticoagulant therapy, pulmonary infection, injury characteristics, and hematological parameters were analyzed for their association with RBC counts and D-dimer levels.

Results: DVT and anticoagulant therapy emerged as significant covariates. A comprehensive analysis identified a negative linear correlation between RBC counts and D-dimer levels, markedly more pronounced in Group 2. For every 1.00 × 10¹²/L increase in RBC, D-dimer levels decreased by 1.93  mg/L in Group 2, compared to a 0.02  mg/L decrease in Group 1.

Conclusions: Higher RBC counts might be associated with lower D-dimer levels in patients with SCI, especially in those with higher initial D-dimer levels. This association highlights a potential therapeutic focus on managing RBC counts to decrease D-dimer level, which may mitigate the risk of DVT formation in patients with SCI.

Design: Retrospective observational study.

Objective: To analyze changes in mood states during the acute phase of inpatient rehabilitation for spinal cord injury (SCI) and the factors associated with worse mood states and less improvement.

Setting: Spinal unit in Italy.

Participants: The study included people with SCI admitted between 2014 and 2019 and treated for psychological problems with a focus on 'emotion processing' and 'emotional adjustment'. The sample included 170 patients (71.8% male, mean age 47.1 ± 16, range 17-78), 46.5% with tetraplegia and 50% with comorbidities.

Outcome measures: The Profile of Mood States (POMS) questionnaire was used to assess mood states at baseline and at the end of treatment. Multiple linear regression models were used to identify factors associated with changes in mood states during treatment.

Results: At baseline, patients with distress related to SCI diagnosis reported lower levels of vigor, whereas those with distressing life events reported higher levels of anger and confusion-bewilderment. POMS subscales improved significantly by at least 4 points. ASIA Impairment Scale (AIS) C score, living with family of origin, comorbidities and critical events during hospitalization were associated with greater improvements, whereas higher education was associated with less improvement in depressive mood. In tetraplegic patients, higher improvements in depressive mood were associated with greater independence at discharge, whereas in patients with paraplegia, higher improvements in anxiety and vitality were associated with better mobility.

Conclusion: Our results indicate that mood states improved in people with SCI receiving a psychological treatment. Socio-demographic and SCI-related characteristics associated with a greater effect of psychological treatment should be considered in order to tailor the intervention.

Objectives: To determine rates of opioid and concomitant antidepressant, anticonvulsant and benzodiazepine dispensing in the post-discharge period, after acute spinal cord injury (SCI).

Design: Single-center prospective cohort study with 12-month linked pharmaceutical data.

Setting: Community pharmaceutical dispensing.

Participants: Patients ≥18 who were diagnosed with a SCI between March 2017 and March 2018.

Outcome measures: Rates of dispensing of opioid and concomitant antidepressant, anticonvulsant and benzodiazepine medications in the 12-month post-discharge from a specialist inpatient Spinal Injuries Unit.

Results: Sixty-eight participants volunteered for the study. Of the medications dispensed in the 12-months after discharge, 16% were opioids, which were supplied to 56% of participants. Forty-six percent of participants had concurrent dispensing of at least one other medication class of interest (antidepressants, anticonvulsants, or benzodiazepines). Participants with opioids prescribed at discharge were 6.5 times more likely to have been dispensed opioids in the 12-months following discharge compared to those who did not have opioids listed at discharge (OR = 6.5, 95% CI = 2.2, 19.0, P < .001).

Conclusions: Longer-term opioid prescribing plus concomitant analgesia and sleep medications in the post-acute period after SCI were common. Chronic opioid use and the polypharmacy observed is concerning, given the potential for dependence, tolerance and increased drug interactions and associated adverse effects. Both issues point to the need for clear discharge instructions for primary care prescribers and regular monitoring to manage pharmacotherapy therapeutic benefits and risks alongside non-medication therapies.

Context: Transcutaneous spinal stimulation (TSS), applied to the cervical spine, is able to improve voluntary upper extremity strength and function in individuals with cervical spinal cord injury (SCI). While most respond and improve in the presence of TSS, others do not respond as favorably. Midsagittal tissue bridges, adjacent to the lesion, can be observed and measured using T₂-weighted magnetic resonance imaging (MRI), and both ventral and dorsal tissue bridges are associated with recovery following SCI. Tissue bridges may also be important for responding to neuromodulation such as TSS. The purpose of this case series was to explore potential relationships between the presence of tissue bridges and responsiveness to TSS for recovery of upper extremity strength and function in research participants with cervical-level SCI.

Methods: This study involved six research participants who completed a clinical trial of rehabilitation paired with TSS to improve upper extremity strength and function. Ventral and dorsal midsagittal tissue bridges were quantified using T₂-weighted MRI.

Results: Three participants classified as both strength and function responders showed presence of ventral tissue bridges, while the three strength-only responders did not. The same was found for dorsal tissue bridges, except for one strength-only responder that had a dorsal tissue bridge.

Conclusions: The findings of this case series shed light onto the potential importance of midsagittal tissue bridges - a proxy for spared sensorimotor tracts - for responsiveness to TSS for upper extremity recovery following SCI.

Objective: We investigated the construct validity, responsiveness, and interpretability of the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) to determine its usefulness in measuring the functional level of gait.

Patients and methods: This was a prospective observational study following the checklist of the Consensus-Based Standards for Selecting Health Measurement Instruments. The SCI-FAI consists of three items: Gait Parameter, Assistive Devices, and Temporal. We recruited 55 patients diagnosed with a spinal cord injury (SCI) in the subacute or chronic phase from Ibaraki Prefectural University of Health Sciences Hospital. Construct validity was clarified by hypothesis testing and the rate of hypothesis verification. We divided responsiveness into subacute and chronic groups and determined the correlation between the changes in the two timepoints of the SCI-FAI and 6-minute walk test. Interpretability involved the calculation of cutoff values for indoor and outdoor walking.

Results: Construct validity was confirmed for 12 of the 15 hypotheses, indicating high construct validity. In the subacute group, Gait Parameter and Assistive Devices showed moderate responsiveness. Interpretability showed that the Gait Parameter was perfect in 19 of the 20 subjects who did not need a walking aid when walking. The cutoff value for Gait Parameter for indoor walking was 17.5 points (AUC 0.91) and that for Assistive Devices was 9.5 points (AUC 0.88). The cutoff values for outdoor walking were Gait Parameter 18.5 points (AUC 0.96) and Assistive Devices 10.5 points (AUC 0.94).

Conclusion: Our results demonstrated that the SCI-FAI has adequate construct validity, moderate responsiveness in SCI patients in the subacute phase, and interpretability in the gait assessment of individuals with SCIs. Gait Parameter is likely to show a ceiling effect for people with SCIs who can walk without using an upper-limb walking aid.