Journal of Spinal Cord Medicine最新文献

Context: Falling is common after spinal cord injury (SCI). Falls can cause a fear of falling and reduced participation in activities. Interventions that target falls self-efficacy may change fall-related behaviors, such as reduced participation.

Objective: The primary objective was to investigate the impact of a photovoice intervention on falls self-efficacy in individuals with chronic SCI. The secondary objectives were to examine the effects of photovoice on participation, quality of life, fear of falling and falls.

Methods;: Convergent mixed methods study with 34 adults with chronic SCI; 17 used a wheelchair (WC) and 17 ambulated (AM). The six-week, virtual photovoice intervention focused on fall prevention and consisted of photo-assignments, individual interviews and group meetings facilitated by a peer mentor. The primary measures were questionnaires of falls self-efficacy and falling concern. The secondary measures included questionnaires of participation, quality of life and fear of falling, and number of falls. Quantitative data were compared over time for WC and AM groups separately with a repeated measures ANOVA or Friedman's test. Semi-structured interviews and thematic analysis were used to collect and analyze qualitative data. A joint display merged quantitative and qualitative findings.

Results: Scores did not change over time for both groups (p≥0.109) with the exception of participation. The AM group's participation scores were significantly improved three months post-intervention (p≤0.028). Overall, divergence between quantitative and qualitative data was observed, with some participants describing improvements in self-efficacy and quality of life.

Conclusions: A photovoice intervention focused on fall prevention may benefit ambulatory individuals with chronic SCI.Trial registration: ClinicalTrials.gov identifier: NCT04864262.

Background: Between January 2020 and December 2023, the United States reported over 103 million COVID-19 cases and 1.1 million related deaths. Veterans with spinal cord injuries and disorders (VSCI/D) are particularly vulnerable due to chronic health conditions and comorbidities, which increases COVID-19 infection and mortality risk from exposure to others who they depend on for care. This manuscript highlights factors associated with COVID-19 vaccine uptake in VSCI/D.

Objective: This study aimed to explore Veteran demographic and clinical factors associated with COVID-19 test positivity, vaccine uptake, and COVID-19-related mortality among VSCI/D in the 2-year period following the start of the pandemic.

Methods: This observational cohort study used the Veterans Health Administration's (VHA) Spinal Cord Injuries and Disorders Registry to identify VSCI/D alive on March 20, 2020. Outcome measures included COVID-19 test positivity, vaccine uptake, and mortality within 30 days of a positive test over a 2-year period.

Results: Among 17,522 VSCI/D, 12% had a positive COVID-19 test at least once in the two-year period following March 20, 2020, 73% received at least one COVID-19 vaccine dose in the 2-year period, and 47% received at least three doses. COVID-related mortality occurred in 67 (0.4%; 67/17,522) VSCI/D in the first year of the pandemic and 46 in the second year (0.6% two-year mortality; 113/17,522).

Conclusion: Less than half of VSCI/D received three COVID-19 vaccine doses, suggesting opportunities for quality improvement efforts. Peer support services may help improve vaccine uptake among VSCI/D in the future.

Context: Self-management (SM) is essential for individuals with spinal cord injury (SCI) to manage complex health needs and maintain autonomy post-rehabilitation. While early research focused on medical aspects, recent studies increasingly explore psychosocial and contextual challenges. However, the evolution of SCI SM research and its alignment with real-world implementation remains understudied.

Objective: To map two decades of SCI SM research, describing design, topic, population and setting trends, and synthesizing evidence on day-to-day SM practices and unmet needs.

Methods: Applying Arksey & O'Malley's scoping framework, JBI guidance and PRISMA-ScR standards, we searched PubMed, ScienceDirect, CINAHL, Scopus and Cochrane Library. Trend analyses summarized study characteristics; thematic synthesis integrated reported experiences of everyday SM.

Results: Sixty-one articles (51 studies) met inclusion criteria, mostly published between 2019-2025. Findings reveal methodological diversification, with growing qualitative and mixed-methods research alongside quantitative designs. Studies increasingly span inpatient and community settings, reflecting emphasis on early SM skill development. Three thematic dimensions are identified: Individual factors (knowledge, psychological well-being, integration of SM into daily life), Interpersonal and societal influences (patient-provider relationships, societal contexts), and Technological integration (enhancement of SM outcomes, usability and feasibility). While medical management dominates, emotional and role management remain comparatively under-examined.

Conclusions: SCI SM research is expanding in scope but remains uneven in supporting practical implementation. This review highlights the need for interventions that go beyond behavior change to address everyday adaptation, contextual barriers, and sustained SM skills. More longitudinal and participatory research is needed to ensure SM strategies match the lived realities of individuals with SCI.

Context: The psychosocial consequences of a Spinal Cord Injury or Disorder (SCI/D) can include increased loneliness. However, differences in the measurement of loneliness confound the available evidence.

Objectives: To compare levels of loneliness between adults with a SCI/D and the general population (Touch Test data) using the UCLA Loneliness Scale (any version). A secondary aim was to explore potential subgroups vulnerable to loneliness.

Methods: Observational studies examining loneliness in SCI/D were identified via CINAHL, PubMed, PsycINFO, MEDLINE, Embase, Web of Science (up until 9th Sept 2025), Google Scholar (first 100 results), and targeted citation searching. Standardized mean group differences (Hedges' g) were pooled using random effects modelling and the methodological quality of included studies evaluated (QualSyst tool). Study characteristics and bivariate correlations of loneliness in SCI/D were additionally examined.

Results: Thirteen observational studies (N = 3029 adults with SCI/D) were included in the analysis. Average UCLA scores (revised Version 3, 20-item and 3-item) for the pooled SCI/D sample and the general population were comparable, with both groups reporting moderate levels of loneliness (g_w = .01; CI: -.43 to .46, P = .951). Individual effect estimates among the SCI/D studies were, however, characterized by imprecision and heterogeneity. Associations between loneliness, demographic and SCI/D characteristics were inconsistent although those who were lonely did report adverse health and social outcomes.

Conclusions: The underlying personal, social and environmental factors which contribute to loneliness in SCI/D should be monitored and addressed. Ongoing research is also needed to develop a more culturally nuanced understanding of loneliness in disability. Protocol registration: https://osf.io/s6723/.

Context/objective: spinal cord injury (SCI) is a debilitating condition that can lead to severe motor deficits. This study aimed to evaluate the therapeutic effects of hederagenin, a Chinese herbal medicinal ingredient, on motor recovery and the inflammatory response in rat models of SCI.

Design: We used the Allen weight-drop technique to create a Sprague-Dawley rat model of spinal cord injury. We then administered hederagenin (10 mg/kg) via intraperitoneal injection for 28 consecutive days.

Setting: Third-class first-class hospital.

Outcome measures: The Basso-Beattie-Bresnahan (BBB) scores were evaluated. Histological analyses were performed via hematoxylin and eosin staining. The levels of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) in SCI rat spinal cord tissues were evaluated by immumohistochemical staining. Microglial activation markers (Iba-1) and M2 phenotypic markers (CD206) were assessed by Immunofluorescence staining. PPAR-γ in rats were assessed by western blotting (WB).

Results: The Basso-Beattie-Bresnahan (BBB) scoring system assessed locomotor function, and revealed significant improvements in BBB score in hederagenin-treated rats starting from the fifth day post-surgery. We also found elevated levels of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) in the spinal cord tissues of SCI rats, which significantly decreased after hederagenin Treatment. We also analyzed Microglial activation markers were analyzed, including Iba-1. Our results showed increased expression of CD206 in response to hederagenin, indicating that it promotes M2 polarization and reduces microglial activation. Additionally, hederagenin increased the expression of peroxisome proliferator-activated receptor-γ (PPAR-γ) in rats with SCI. However, the PPAR-γ inhibitor GW966 reversed the above roles of hederagenin.

Conclusion: Our results indicate that hederagenin not only aids in the recovery of motor function in SCI rats but also diminishes inflammation while fostering neuroprotection via the modulation of microglial activity. This effect may be linked to the activation of the PPAR-γ signaling pathway. These results provide compelling evidence for the potential of hederagenin as a therapeutic agent for SCI and warrant further investigation into its clinical applications in neuroregeneration and inflammation modulation.

Aim: The aim of this study was to determine intermittent catheterization (IC) adherence, the reasons for discontinuation, and the frequency of urinary tract infections (UTIs) in individuals with neurogenic bladder dysfunction secondary to spinal cord injury.

Methods: This cross-sectional study was conducted with 237 patients with spinal cord injury who were either currently performing or had previously performed IC at a tertiary-level rehabilitation center. Sociodemographic and clinical characteristics of the patients were collected using a descriptive information form and the Functional Independence Measure.

Results: IC was continued by 89.9% of the study participants, and discontinued by 10.1%. Higher adherence was observed in male patients and those with complete injuries (P < 0.05). Of those who continued IC, the rates of "use of bladder/sphincter relaxants in the last four weeks" and "use of antibiotics/antiseptics for UTI in the past year" were significantly higher compared to those who discontinued IC (P < 0.05). The most common reasons for discontinuation were individual decision (33.3%) and physician recommendation (29.2%). Patients who stopped IC preferred voiding (normal or reflex) (58.3%), indwelling catheterization (25%), or the use of diapers/pads (16.7%). The majority of patients who discontinued IC did so within the first year of use.

Conclusion: The decision to continue IC is influenced by individual, clinical, and environmental factors. These findings highlight the necessity of personalized education, follow-up, and support programs to enhance long-term adherence to IC.

Objective: To conduct a meta-analysis of the literature to summarize the risk factors for pulmonary infection in patients with cervical spinal cord injury.

Methods: Computer-based searches were performed in CNKI, CBM, Wanfang Database, VIP Series Databases, The Cochrane Library, WOS, PubMed, Springer Link, EBSCO, MEDLINE and other databases. The time frame was from January 1, 2000 to April 1, 2025. Case-control studies and cohort studies related publications were searched according to subject terms and free words. According to inclusion and exclusion criteria, 7 publications were identified, and finally meta-analysis was performed on them by Review Manager 5.3 software.

Results: Seven publications met the inclusion criteria, with a total of 912 cases and 742 controls. The results of meta-analysis showed that the risk factors for pulmonary infection in patients with cervical spinal cord injury were: American Spinal Injury Association (ASIA) Impairment Scale (AIS) - AIS A and AIS B (OR: 3.90, 95% CI: 2.74-5.53), high-level injury (OR: 2.73, 95% CI: 1.69-4.40), hormone shock therapy (OR: 4.14, 95% CI: 2.58-6.62), smoking history (OR = 2.34, 95% CI: 1.54-3.55), operation time (P < 0.00001, I² = 96%), hypoalbuminemia (P < 0.00001, I² = 96%), and age (P < 0.00001, I² = 95%).

Conclusion: AIS A and B, high-level injury, hormone shock therapy and smoking history are risk factors for pulmonary infection in patients with cervical spinal cord injury. Controlling the above factors can effectively reduce the incidence of pulmonary infection in patients with cervical spinal cord injury.

Background and aims: Potential ameliorative effects of melatonin and dexpanthenol alone or in combination were investigated by neurological, histopathological, biochemical, and molecular means in an experimental spinal cord injury model in rats.

Methods and results: Forty-two Sprague Dawley female rats were equally divided into six groups as control (C), sham (S), spinal cord injury (SCI), spinal cord injury with dexpanthenol application (SCI+Dex), spinal cord injury with melatonin application (SCI+Mel), and spinal cord injury with dexpanthenol and melatonin application (SCI+Dex+Mel). In neurochemical analysis, mean Modified Tarlov Scale measurement was significantly better in the SCI+Dex and SCI+Dex+Mel groups as compared to the SCI group at the last measurement point. In biochemical analysis, tissue levels of GSH, SOD, MDA, and XO increased significantly in the SCI group compared to the control. However, no changes were detected among the groups in gene expression levels of XO, SOD, NF-κB, and CASP3. Histopathological examination revealed severe neuronal degeneration in the SCI group, while the severity of the lesions decreased in the Mel and/or Dex given groups.

Conclusion: Overall, the results indicated that Dex+Mel application may have an ameliorative effect on neuroprotection especially at the later stages of spinal cord injury.

Context: Spinal Cord Injuries (SCI) greatly affect physical independence, especially in older Veterans. While the Functional Independence Measure (FIM) is widely used in rehabilitation, it lacks consideration of SCI-specific needs such as ventilation, wheelchair use, and bowel/bladder management. The Spinal Cord Independence Measure-Version III (SCIM-III) was developed to address these gaps, but its effectiveness has not been studied in the veteran population, which is typically older, predominantly male, and has higher comorbidity rates. This study examined the concurrent validity, responsiveness, and predictive value of FIM and SCIM-III for length of stay (LOS) and discharge destinations in older Veterans with SCI.

Methods: This retrospective cohort study used data from an acute rehabilitation program (March 2021-May 2023) and included 33 adults (≥18 years) with a recent SCI (≤1 year) and a minimum one-week admission. Collected data included demographics, AIS level, injury type/duration, length of stay, and discharge destination.

Results: The SCIM-III demonstrated acceptable concurrent validity with the FIM, and both the FIM and SCIM-III were responsive to change. Neither measure was a significant predictor of discharge outcome. The SCIM-III admission score significantly predicted LOS, whereas the FIM admission total score did not significantly predict LOS.

Conclusion: SCIM-III demonstrates acceptable concurrent validity and responsiveness to change when compared with FIM. Only the SCIM-III admission scores predicted LOS. These initial findings suggest the utility of the SCIM-III for improving clinical care and discharge planning among Veterans.

Background: spinal cord injury (SCI) results in permanent disability and secondary complications, requiring long-term healthcare management. Globally, individuals with SCI face barriers to healthcare access; in Lebanon, data on these challenges are limited.

Objective: To assess healthcare and rehabilitation accessibility for individuals with SCI in Lebanon, focusing on facility accessibility, service utilization, coverage, patient satisfaction, and community reintegration.

Methods: A cross-sectional survey was conducted with 70 individuals with SCI receiving outpatient care in Lebanese rehabilitation and medical centers (January-March 2025). Data included sociodemographic and clinical profiles, facility accessibility audits, healthcare access and use, and patient satisfaction.

Results: Participants' mean age was 42.1 ± 14.9 years; 64.3% were male. Physical barriers were prevalent, with over 90% of Obstetrics & Gynecology and 85% of Family and Physical Medicine clinics lacking accessible imaging and restrooms. Only 53.3% had partial health coverage, and 59.2% cited unaffordability as the main barrier to care. All received rehabilitation, mostly physical therapy (93.5%), while access to occupational and psychological therapies was limited (29% each). Though satisfaction was high, 51.6% lacked post-rehabilitation follow-up. Major reintegration challenges included inaccessible public spaces (38.6%) and financial hardship (25.7%).

Conclusion: Significant physical, financial, and systemic barriers hinder healthcare and rehabilitation access for individuals with SCI in Lebanon. Coordinated efforts are needed to improve infrastructure, insurance coverage, and continuity of care, enhancing outcomes and community inclusion for this population.