Journal of Spinal Cord Medicine最新文献

Objectives: Assess pateint-reported effects of transcutaneous spinal cord stimulation (tSCS) on spasticity after multiple treatment.

Design: An uncontrolled prospective case series study.

Setting: A rehabilitation hospital.

Participants: A convenience sample of hospitalized adults with spinal cord injury (SCI) and lower-body spasticity limiting physical function and/or reducing quality of life (i.e. pain, sleep disturbance).

Interventions: Participants received 30 minutes of tSCS (continuous, asymmetrical, biphasic rectangular impulses, 100 Hz) applied for 3-6 consecutive days using NeuroTrac multiTENS® (http://quintet.no). Two electrodes were placed paravertebrally at Th11-Th12 level and two on lower abdomen.

Outcome measures: Penn`s Spasm Frequency and Severity Scales were used for quantifying spasticity, Numeric Rating Scales (NRS 0-10) for perceived impact of spasticity on one chosen activity of a daily living, sleep-disturbance, and pain in trunk/lower limbs due to spasticity. The outcome measures were completed through interviews conducted before the first treatment, and immediately after the last treatment.

Results: Seventeen people participated; injury levels C6-T12, AIS A-D, and mean age 51 years (SD 14). Fourteen participants reported a clinical important improvement in ADL performance, sleep disturbance and/or a decrease in pain due to spasticity (≥ two points on NRS). Minimal change was reported on Penn`s Spasm frequency and Severity Scales. No adverse events were observed.

Conclusions: The majority of the participants perceived clinically relevant improvements on at least one patient-reported outcome measure, and no adverse events were reported. This is a simple and a non-invasive treatment that may have a potential of reducing the troublesome effects of spasticity.

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: To confirm the structural validity of the Trunk Assessment Scale for Spinal Cord Injury (TASS).

Participants and methods: We evaluated 104 Japanese individuals with a spinal cord injury (SCI) (age 63.5 ± 12.2 years; 64 with tetraplegia) with the TASS 1-3 times. We conducted a Rasch analysis to assess the TASS' unidimensionality, fit statistics, category probability curve, ceiling/floor effects, local independence, reliability, and difference item function (DIF).

Results: The TASS was observed to be a unidimensional and highly reproducible scale of item difficulty hierarchy that sufficiently identifies the superiority of the examinee's ability. The TASS was easy for the participants of this study. One TASS item was a misfit based on the infit and outfit mean square; another item also showed a DIF contrast for age. Several items were found to require a synthesis or modification of the content. The TASS showed a floor effect, and most of the non-scorers were individuals with a complete SCI.

Conclusion: Our findings clarify the structural validity of the TASS, and our analyses revealed that the TASS includes an unfitness item and was less challenging for individuals with SCIs. The improvements suggested by these results provide important information for modifying the TASS to a more useful instrument.

Context: Motor deficits are among the most common consequences of incomplete spinal cord injury (SCI). These impairments can affect patients' levels of functioning and quality of life. Combined robotic therapy and non-invasive brain stimulation (NIBS) have been used to improve motor impairments in patients with corticospinal tract lesions.

Objectives: To examine the effects of combined robotic therapy and NIBS on motor function post incomplete SCI.

Methods: PubMed, SCOPUS, MEDLINE, PEDro, Web of Science, REHABDATA, CINAHL, and EMBASE were searched from inception until July 2023. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate the selected studies quality.

Results: Of 557 studies, five randomized trials (n = 122), with 25% of participants being females, were included in this review. The PEDro scores ranged from eight to nine, with a median score of nine. There were variations in treatment protocols and outcome measures, resulting in heterogeneous findings. The findings showed revealed evidence for the impacts of combined robotic therapy and NIBS on motor function in individuals with incomplete SCI.

Conclusions: Combined robotic training and NIBS may be safe for individuals with incomplete SCI. The existing evidence concerning its effects on motor outcomes in individuals with SCI is limited. Further experimental studies are needed to understand the effects of combined robotic training and NIBS on motor impairments in SCI populations.

Objective: To determine the effect of vitamin D supplementation on changes in body composition associated with musculoskeletal health status in patients with chronic SCI and vitamin D deficiency as a response to age.

Design: Prospective drug-intervention study.

Setting: Department of rehabilitation medicine, Veterans Health Service Medical Center.

Participants: Seventeen patients with vitamin D insufficiency/deficiency (<30 ng/mL) and chronic SCI were divided into two groups: groups A <65 years (n = 8) and B ≥65 years of age (n = 9).

Interventions: Both groups received 800 IU/day cholecalciferol for 12 weeks.

Outcome measures: We used blood samples to evaluate metabolites related to vitamin D, testosterone (T), lipid profiles, and sex hormone-binding globulin (SHBG). Bioelectrical impedance analysis (BIA) was used to evaluate body composition.

Results: Group A had significantly better baseline clinical characteristics for all BIA measurements. SHGB was significantly higher in Group B (P = 0.003) and albumin was significantly higher in Group A (P = 0.000). When comparing pre- to post-treatment, Group A showed a significant improvement in T (P = 0.042), total cholesterol (P = 0.035), and triglyceride (P = 0.025) levels, whereas Group B significantly increased vitamin D (P = 0.038) and protein mass (PM) (P = 0.034) levels.

Conclusion: This study suggested that addressing vitamin D deficiency in patients with SCI had different effects in young and older adults, with both groups showing positive changes in body composition. Particularly, the increase in PM on BIA measurements in elderly patients at high risk of sarcopenia was encouraging.