Journal of Spinal Cord Medicine最新文献

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.

Background: The necessary and optimal physical activity for individuals with spinal cord injury remains unclear, and the development of interventions adapted to the needs of individuals with spinal cord injury is inadequate.

Objective: To investigate the implications and health-related outcomes of different levels of physical activity on individuals with spinal cord injuries.

Methods: The participants comprised 67 individuals, aged 18-65 years, with spinal cord injuries, who resided in Japan. Participants' demographic information was obtained, and their activities of daily living independence, physical activity level, mental health status, lifestyle, and social capital were assessed using online questionnaires. Participants were divided into three groups, based on their level of physical activity. Outcome measures were compared among the participants for different PA levels using one-way ANOVA. And, Pearson's product-moment correlation coefficient was used to examine the relationships between different levels of PA and the other outcome measures.

Results: A one-way analysis of variance demonstrated a significant interaction between sports time, exercise time, the International Physical Activity Questionnaire-Short Form score, and Health-Related Social Capital among the groups. Participants with low activity correlated negatively with sports time and health practice index, and positively with exercise time and psychological distress. Participants with moderate activity also showed a positive correlation with exercise time and distress.

Conclusions: The differences observed in the sports time emphasize the potential benefits of higher physical activity levels among individuals with spinal cord injuries and the existence of challenges associated with different levels of physical activity.

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.

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.

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.

Context: Reduced muscle strength and function are common after spinal cord injury (SCI). While low-load blood flow restriction exercise (BFRE) enhances muscle strength in healthy and clinical populations, its safety and feasibility in individuals with SCI remain underexplored.

Objectives: To investigate the feasibility and safety of low-load BFRE in individuals with incomplete SCI.

Study design: Case series.

Setting: SCI rehabilitation center.

Participants: Six participants with motor incomplete SCI were enrolled in the study.

Intervention: A two-week BFRE intervention for the lower limbs was conducted twice weekly at 40% total arterial occlusion pressure, using 30-40% of 1-repetition maximum loads.

Outcome measures: Feasibility measures, specifically recruitment and eligibility rates and intervention acceptability, were collected. Blood pressure (BP) responses and specific coagulation markers for deep vein thrombosis (DVT) were assessed as safety measures.

Results: Recruitment and eligibility rates were 2.8% and 6.6% for individuals admitted for first-time rehabilitation (subacute SCI) and 8.3% and 13.9% for 4-week readmission rehabilitation stays (chronic SCI), respectively. Intervention acceptability was high, characterized by 95.8% training adherence and low-to-moderate self-reported pain levels. BP responses and changes in C-reactive protein, Fibrinogen, and D-dimer during the intervention remained within clinically acceptable levels.

Conclusion: BFRE was feasible in an SCI rehabilitation setting despite a low recruitment rate. BFRE imposed no heightened risk of DVT or severe BP fluctuations in the present case series. Additionally, no severe adverse events occurred, and only mild complaints were reported. More extensive safety considerations warrant larger-scale exploration.

Trial registration: ClinicalTrials.gov identifier: NCT03690700.

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.

Introduction: Traumatic spinal cord injuries (TSCIs) are associated with high morbidity rates that can affect motor, sensory, and autonomic function. SCIs commonly result from sports, motor vehicle accidents, and other blunt traumas.

Objective: To determine risk factors for in-hospital mortality, in-hospital complications, and increased length of stay (LOS) following TSCI.

Methods: Data from the United States (US) National Trauma Data Bank (NTDB) from 2017 to 2021 was collected and used to assess risk factors for increased in-hospital mortality, complications, and hospital length of stay. Univariable analysis was completed on the 2017-2018 data. Variable importance was calculated, and a logistic regression was performed using the most important variables. Internal and external validation was completed using a testing cohort and 2020-2021 data.

Results: Spinal fusion was associated with decreased mortality but increased complications and LOS. Increased age and injury severity score was associated with increased mortality, complications, and LOS, while the emergency department Glasgow Coma Score was inversely related to all outcomes. Each model had moderate to high prediction ability based on internal area under the curves (AUCs) ranging from 0.757 to 0.899 and external AUCs between 0.744 and 0.884.

Conclusion: Understanding the factors that contribute to poorer outcomes following TSCI can help inform physicians of best treatment practices and patient prognosis. We highlighted five risk factors that correlate with short-term patient outcomes. Future research will further explore how treatment can impact both short - and long-term outcomes.

Context: Current guidelines recommend four weeks of stress ulcer prophylaxis following traumatic spinal cord injury.

Objectives: Assess the current literature on the incidence, timing, and risk factors for gastrointestinal bleeding/clinically important gastrointestinal bleeding in the acute setting following a traumatic spinal cord injury and whether the use of stress ulcer prophylaxis has been shown to reduce the rates of gastrointestinal bleeding.

Methods: A systematic review was performed in PubMed, Embase, Web of Science, and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results: A total of 24 articles met the inclusion/exclusion criteria. The average rate of gastrointestinal bleeding among all studies was 5.5% (95% CI = 5.4-5.6%; n = 26,576). The average rate of clinically important gastrointestinal bleeding was 1.8% (95% CI = 1.79-1.82%; n = 3,857). The mean time since injury to when gastrointestinal bleeding occurred ranged from 5 to 22.5 days. For clinically important gastrointestinal bleeding the average time was 16 days or less. Those with cervical injuries had a higher incidence of clinically important gastrointestinal bleeding compared to those with non-cervical injuries (2.7% vs. 0.7%). No study found any difference in the use of stress ulcer prophylaxis in participants with or without gastrointestinal bleeding.

Conclusions: The overall incidence of clinically important gastrointestinal bleeding among studies was found to be low. Individuals with non-cervical injury were not found to be at high risk of clinically important gastrointestinal bleeding. There was also insufficient evidence to indicate that use of stress ulcer prophylaxis reduces the rate of gastrointestinal bleeding in those with traumatic spinal cord injury.

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.