Journal of Spinal Cord Medicine最新文献

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.

Context: Spasticity is characterized by muscle hypertonia due to a velocity-dependent increase in tonic stretch reflexes, mostly related to hyperactive spinal reflexes. After spinal cord injury, the impact of noxious stimuli on autonomic dysreflexia is well documented. It is admitted in clinical practice that sublesional noxious stimuli can also increase spasticity. However, this has never been reported in the literature. In this single case study, we describe the impact of a noxious stimulus (bladder stone) on the spasticity of lower limbs in a male with spinal cord injury, using quantitative gait analysis before and after stone removal.

Findings: : Clinical evaluation was performed on the subject before and after bladder lithiasis removal, by two physiotherapists using ASIA score and the Modified Ashworth scale. Quantitative gait analyses were compared before and 3 months after lithiasis resection.Regarding gait kinematics, there was a reduction of the right knee recurvatum, and of the successive increases of flexion (double bump) of flexion in the swing phase. In the stance phase, the right ankle maximum dorsiflexion increased. In the swing phase, the double bump of ankle dorsiflexion disappeared. Surface electromyography showed a reduction of the triceps surae hypertonia, especially in the right gastrocnemius muscle at the swing.

Conclusion: We propose that lithiasis created a noxious stimulus regarding the S2, S3 and S4 metamers with a diffusion of the spinal reflex to the metamers S1, S2, S3 and S4. This highlights a potential causal link between an intravesical noxious stimulus and an increase in the subject's spasticity, through a disinhibited spinal nociceptive reflex.

Context: Paralysis of the expiratory muscles in cervical and high thoracic spinal cord injury (SCI) results in an impaired ability to clear airway secretions effectively and increases the risk of atelectasis and respiratory tract infections (RTI). Spinal cord stimulation (SCS) applied via the Cough Stimulation System (CSS) has been shown to restore an effective cough mechanism in subjects with SCI. In this study, we evaluated the specific impact of use of the CSS by one study participant with SCI, subsequent discontinuation of usage, and then re-institution of this modality. Airway pressure generation (P) and peak expiratory airflow rate (F) achieved with CSS and clinical assessment questionnaires were assessed.

Findings: With the CSS, this subject was able to generate P and F rates of 103 cmH₂O and 7.1 l/s, respectively, with associated significant clinical benefits, including, much greater ease in raising secretions and reduction in the incidence of RTIs. However, following a 2-year period of regular use, the CSS became non-functional and a 2-year period elapsed before it could be replaced. During this time, he again experienced great difficulty managing airway secretions and an increased frequency of RTIs. Re-institution of the CSS system resulted in the restoration of an effective cough mechanism and similar clinical benefits.

Conclusion/clinical relevance: This report demonstrates the very high degree of the clinical utility of the CSS as it had made a substantial beneficial impact on this participant's respiratory status and life quality.

Objective: To evaluate outcomes and perceptions of participating in a pilot spinal cord injury (SCI) specific community-based self-management program.Design: A program evaluation conducted through the review of retrospective data.Setting: An outpatient vocational rehabilitation service in Singapore.Participants: Adults with SCI who completed a self-management intervention.Intervention: A self-management educational program was delivered by healthcare professionals with involvement of peer mentors. Up to six self-selected topics were covered using a multi-modal teaching approach.Outcome Measures: Retrospective data collected at baseline, post-intervention, and three-month follow-up were analyzed. Outcome measures included the University of Washington Self-Efficacy scale (UW-SES), SCI Secondary Conditions Scale (SCI-SCS), Community Integration Questionnaire (CIQ), and employment. Post-program survey findings were also reviewed.Results: Data from fifteen participants revealed positive changes over time for the UW-SES (η² = .27), SCI-SCS (η² = .21), and CIQ (η² = .23). Self-efficacy scores increased from baseline to post-intervention with a large effect size (Hedge's g = 0.89), and from baseline to follow-up with a medium effect size (Hedge's g = 0.50). Participants reported overall perceived benefit and satisfaction with the program's design and relevance. They valued access to useful information, effective instructional methods, program customization, and participant empowerment and affirmation. Suggestions for program refinement included: more peer support, psycho-emotional support, and continued program adaptability and accessibility.Conclusion: A SCI-specific community-based self-management program was associated with short-term improvements in self-efficacy and was well-received. Further research is required to determine its effectiveness, essential program features that promote successful outcomes, and cost-effectiveness of program implementation.

Context/Objective: Depression is the most common psychological comorbidity associated with spinal cord injury (SCI) and affects healthcare utilization and costs. This study aimed to use an International Classification of Disease (ICD) and prescription drug-based depression phenotypes to classify people with SCI, and to evaluate the prevalence of those phenotypes, associated risk factors, and healthcare utilization.Design: Retrospective Observational StudySetting: Marketscan Database (2000-2019)Participants: Individuals with SCI were classified into six ICD-9/10, and prescription drugs defined phenotypes: Major Depressive Disorder (MDD), Other Depression (OthDep), Antidepressants for Other Psychiatric Conditions (PsychRx), Antidepressants for non-psychiatric condition (NoPsychRx), Other Non-depression Psychiatric conditions only (NonDepPsych), and No Depression (NoDep). Except for the latter, all the other groups were referred to as "depressed phenotypes". Data were screened for 24 months pre- and 24 months post-injury depression.Interventions: NoneOutcome Measures: Healthcare utilization and paymentsResults: There were 9,291 patients with SCI classified as follows: 16% MDD, 11% OthDep, 13% PsychRx, 13% NonPsychRx, 14% NonDepPsych, 33% NoDep. Compared with the NoDep group, the MDD group was younger (54 vs. 57 years old), predominantly female (55% vs. 42%), with Medicaid coverage (42% vs. 12%), had increased comorbidities (69% vs. 54%), had fewer traumatic injuries (51% vs. 54%) and had higher chronic 12-month pre-SCI opioid use (19% vs. 9%) (all P < 0.0001). Classification into a depressed phenotype before SCI was found to be significantly associated with depression phenotype post-SCI, as evidenced by those who experienced a negative change (37%) vs. a positive change (15%, P < 0.0001). Patients in the MDD cohort had higher healthcare utilization and associated payments at 12 and 24 months after SCI.Conclusion: Increasing awareness of psychiatric history and MDD risk factors may improve identifying and managing higher-risk patients with SCI, ultimately optimizing their post-injury healthcare utilization and cost. This method of classifying depression phenotypes provides a simple and practical way to obtain this information by screening through pre-injury medical records.

Background: The Trunk Assessment Scale for Spinal Cord Injury (TASS) and the Trunk Control Test for individuals with a Spinal Cord Injury (TCT-SCI) are highly reliable assessment tools for evaluating the trunk function of individuals with SCIs. However, the potential differences in the validity of these two scales are unclear.Objectives: To evaluate the criterion validity of the TASS and the construct validity of the TASS and TCT-SCI.Participants and Methods: We evaluated 30 individuals with SCIs (age 63.8 ± 10.7 yrs, 17 with tetraplegia). To evaluate criterion validity, we calculated Spearman's rho between the TASS and the gold standard (the TCT-SCI). To determine construct validity, we used the following hypothesis testing approaches: (i) calculating Spearman's rho between each scale and the upper and lower extremity motor scores (UEMS, LEMS), the Walking Index for SCI-II (WISCI-II), and the motor score of the Functional Independence Measure (mFIM); and (ii) determining the cut-off point for identifying ambulators with SCIs (≥ 3 points on item 12 of Spinal Cord Independent Measure III) by a receiver operating characteristics analysis.Results: A moderate correlation was confirmed between the TASS and the TCT-SCI (r = 0.68). Construct validity was supported by six of the eight prior hypotheses. The cut-off points for identifying ambulators with SCIs were 26 points (TASS) and 18 points (TCT-SCI).Conclusion: Our results indicate that the contents of the TASS and the TCT-SCI might reflect the epidemiological characteristics of the populations in which they were developed.