Journal of Spinal Cord Medicine最新文献

Context: Veterans Health Administration (VHA) maintained a registry of identified and verified cases of US Veterans with spinal cord injuries and disorders (SCI/D) since 1994: VHA SCI/D Registry (VHA SCIDR). Data elements, capture, and storage methods varied over time.

Objective: Describe the consolidation and harmonization of historical VHA SCIDR data spanning three decades during its evolution to an automated platform and report population characteristics.

Methods: The VHA SCIDR captured data using four distinct acquisition methods over 28 years, including cases of Veterans with SCI/D receiving SCI/D System of Care services, via 25 SCI/D Centers and 122 Spoke Sites throughout the VHA healthcare system. Foundational elements of VHA SCIDR data capture methods, harmonization of data elements with the current automated algorithm, access protocol, and governance structure are described.

Results: From Fiscal Years (FYs) 1994 to 2022, VHA SCIDR identified 52,407 Veterans with traumatic or non-traumatic SCI/D, and 96.95% were male, 56.09% White, 16.57% were Black, 1.23% Asian and Pacific Islander, 0.75% Native American, and 25.36% unknown. Traumatic etiology comprised 53.39% of the sample, while 31.75% were non-traumatic, with 14.87% missing etiology classification. Injury category proportions were 5.19% high tetraplegia, 5.83% low tetraplegia, 5.85% high paraplegia, 7.53% low paraplegia, and 23.35% AIS D, with 52.25% missing or unable to be calculated.

Conclusions: VHA SCIDR is one of the three largest SCI/D registries in North America and is the case-identification platform for VHA SCI/D operations, program evaluation, and research studies. VHA SCIDR is connected to each Veteran's VHA healthcare data, facilitating big data research.

Objective: To investigate the factors influencing handgrip pressure (HGP) in typical children and adolescents and those with spina bifida (SB).

Methods: This cross-sectional study enrolled 126 typical participants and 58 with SB, aged 8-16 years, categorized into subgroups: typical children (typical prepubertal; n = 20), typical adolescents (typical pubertal and post-pubertal; n = 106), SB children (SB prepubertal; n = 11), and SB adolescents (SB pubertal and post-pubertal; n = 47). Data on sex, height (or wingspan), lean and fat body mass, and levels of physical activity and spinal cord injury were collected. Participants performed three maximal voluntary isometric contractions of HGP using a bulb dynamometer. Multiple linear regression analyses examined the relationship between variables and HGP.

Results: In typical children, decreases in height, fat and lean body mass were associated with decreased HGP. In typical adolescents, females exhibited higher HGP than males, and increases in lean body mass and height were positively associated with HGP; and sedentary individuals exhibited higher HGP compared to active counterparts. In SB adolescents, increases in fat and lean body mass were associated with higher HGP, and greater physical activity was associated with stronger HGP. Participants with sacral injury level showed higher HGP than those with thoracic injury level. No association was observed for SB children.

Conclusion: Except for SB children, various factors, mainly the lean body mass, significantly influenced the HGP in all groups. When the outcome is HGP, it is important to monitor body composition and physical activity in typical children and adolescents and those with SB.

Introduction: Specific management of people with spinal cord injury has allowed to improve their life expectancy. The objective of this study was to analyze if age was a factor affecting the healing time of surgery for pelvic pressure ulcers in patients with spinal cord injury.

Methods: Retrospective, monocentric study, enrolling all consecutive spinal cord injury participants admitted into a specialized Neurological Physical Medicine and Rehabilitation department for surgery for pelvic pressure ulcers during a 5-year period. Participants were divided into two groups, "Young group" patients aged between 18 and 64 years and "Senior group" patients over 65 years of age. Healing time was defined as the time required for complete closure, allowing mobilization of the lower limbs. Data related to the complication rate (dehiscence, hematoma, infection, flap necrosis), medical or psychiatric decompensation, length of stay and time to rehabilitation were collected.

Results: One hundred and fourteen participants were recruited, including 77 participants in the "Young group" and 37 in the "Senior group". In total, 131 pressure ulcers were operated. The median of the healing time was 46 [32.0;68.8] days, with a minimum of 20 days and a maximum of 694 days. Seven participants were considered as healing failures. There was no significant statistical difference between the two groups with 43 days [35.0;52.0] for the "Young group" and 56 days [40.0;80.0] for the "Senior group" (p = 0.44).

Discussion: This study demonstrated no significant difference in postoperative healing time of flaps for pelvic pressure ulcers between participant below and above 65 years of age.

Objectives: To investigate the occupational balance, caregiver burden, and factors affecting them in caregivers of individuals with spinal cord injuries in Iran.

Design: A cross-sectional study with multiple linear regression analyses to specify factors related to occupational balance and caregiver burden.

Settings: Community-dwelling individuals with spinal cord injury (SCI).

Participants: A convenience sample of 84 individuals with SCI.

Interventions: Not applicable.

Measures: The Occupational Balance Questionnaire-11, Caregiver Burden Scale (CBS), and Hospital Anxiety and Depression Scale (HADS) were used to assess the occupational balance, caregiver burden, and stress/anxiety levels of the caregivers, respectively. Functional independence, anxiety/depression levels, and the participants' ability for self-management were evaluated using the Barthel index, HADS, Partners In Health (PIH), and Patient Activation Measure (PAM), respectively.

Results: There was a positive and significant correlation between the self-management skills of the participants and their independence in daily activities with their caregivers' occupational balance. A negative and significant correlation was found between the individuals' self-management skills and their independence in daily activities with caregiver burden. In addition, a significant correlation existed between the anxiety and depression of the participants and their caregivers with occupational balance and caregiver burden. Finally, there was a negative and significant correlation between occupational balance and caregiver burden (P ≤ 0.05).

Conclusion: This study demonstrated that factors such as participants' self-management skills, their independence in daily activities, and the level of anxiety and depression in participants and caregivers affect the occupational balance and burden experienced by caregivers of individuals with SCIs.

Study design: Observational prospective multicenter study.

Objectives: The aim of this study is to evaluate the efficacy of bowel management and subjects' satisfaction by the Monitoring the Efficacy of Neurogenic Bowel Treatment On Response (MENTOR) tool and the impact of demographic and clinical factors on bowel management.

Methods: Consecutive patients with SCI were recruited by nine Italian Spinal Units. The MENTOR tool is a three-dimensional questionnaire assessing objective bowel score measures, patient's subjective perceptions, and "special attention symptoms"; the combination of these results defines the allocation of each subject into one of three categories reflecting the possible therapeutic recommendations (red for "recommend change", yellow for "further discussion", and green for "monitoring").

Results: We recruited 352 subjects with subacute or chronic SCI. The NBD average score was 11.7 ± 7.2 with 69.9% that expresses "good" or "adequate" satisfaction. 33.1% had one or more "special attention symptoms (SAS)". About the MENTOR tool color: 34.6% of the current treatment was adequate (green), 29.7% needed a revaluation (yellow), and 35% required a change (red). While in "green" patients the subjective perception coincided with the score, 24% of "yellow" patients and 34.4% of "red" patients answered they were well managed. None of the clinical or demographic characteristics was associated with patients' satisfaction or belonging to the three color zones.

Conclusions: Effective bowel management in subjects with SCI did not correlate with patient characteristics or satisfaction. Many patients have inappropriate bowel management despite their satisfaction and the chronicity of the injury. This disparity calls for a periodic assessment with an objective tool such as MENTOR to identify the individual that requires intervention.

Context/objectives: Adults with spinal cord injury in the UK do not currently have specialized access to SCI-informed community-based mental health support, despite their elevated risk of mental health decline. The lack of SCI-informed therapeutic support may increase the likelihood of mental health treatment failure. This study sought to qualitatively explore the experience of accessing, or attempting to access, generic (non-SCI-informed) mental health support when living with a spinal cord injury.

Design: Qualitative, exploratory study using thematic analysis.

Setting: Community-based sample in the UK.

Participants: Twenty people with spinal cord injury (10 female, 10 male) were recruited from a UK-based, SCI-specific support charity.

Interventions: Semi-structured interviews (mean length = 83 min, SD = 13.5 min).

Outcome measures: 9-item semi-structured interview schedule, addressing mental health service use.

Results: Three themes were identified: (1) Therapeutic timeliness; (2) A disconnect with standard services; and (3) Successful systems for support. The inpatient-to-outpatient transition represents a critical time window during which mental health is vulnerable to decline, requiring responsive access to mental health services throughout the lifespan. The lack of tailored, SCI-informed mental health services inhibits therapeutic engagement and limits perceived treatment outcomes.

Conclusions: Without SCI-informed care, generic mental health service referrals risk early termination of support and treatment disengagement. Mental health treatment withdrawal is initiated by both patients and their allocated healthcare professionals. This study demonstrates an evident need to develop programs for people with SCI to train as (peer) mental health practitioners, and to develop SCI-specific training modules for mental health care practitioners.

Objective: To assess a rule-based decision tree algorithm's performance for classifying and counting specific hip flexion repetitions in able-bodied people and to validate the algorithm's efficacy for people with spinal cord injury (SCI). Alternative placement of the accelerometer was tested.

Study design: A validation study.

Setting: Specialized SCI center in Denmark.

Methods: Ten able-bodied people and 10 people with SCI were recruited. All participants completed a 15-minute predefined protocol with the following movements: hip flexion in supine 90°, 45° and 20°, hip abduction, pelvic lift, transfer from supine to sitting, sit-to-stand, transfer to a wheelchair, pushed in a wheelchair, Motomed cycling, walking and steps in Nustep fitness trainer. All wore accelerometers on the thigh and a chest-mounted GoPro camera to establish ground truth.

Results: Confusion matrixes showed that able-bodied people's activities and specific hip movements can be classified and the number of repetitions counted with 0.86 accuracy. The algorithm's performance did not change substantially depending on the position of the accelerometer. For people with movement deficits caused by SCI, the accuracy lowered to 0.66 but could be improved to 0.79 for classifying and counting this population's activities/movements overall.

Conclusion: The algorithm tested could classify specific hip movements and other activities in the SCI population. This method using a single accelerometer may be applied in clinical trials for people with SCI to objectively assess the change in the number of repetitions over time of hip flexion movements, walking and sit-to-stand activities and to some extent hip abduction and pelvic lift.Trial registration: ClinicalTrials.gov NCT05558254. Registered 28th September 2022.

Context: Traumatic spinal cord injury (SCI) is characterized by damage in the spinal cord, which can result in a permanent or temporary disability and different degrees of paralysis, sensory loss, and bladder/bowel dysfunction. It represents an important cause of morbidity and mortality in the affected individuals. Based on the need to develop more effective treatments for SCI, authors have been investigating the effects of photobiomodulation (PBM) therapy on this injury.

Objective: In this context, the present study aimed to evaluate the long-term effect (follow-up) of PBM using a model of SCI in rats.

Results: For this, 33 rats were randomly divided into two experimental groups: the control group and the laser group, and sub-divided into two sub-groups (with two different periods of euthanasia post-injury, 4 and 8 weeks). PBM treatment was performed for 14 days (daily, 808 nm, continuous output, 30 mW, 0.028 cm², 1.07 W/cm², 1000 J/cm², 4 min and 42 secs). Animals were euthanized 4 and 8 weeks after the surgical procedure. For analysis, motor function and tactile sensitivity analysis were performed on days 1 and 7 post-surgery. Moreover, after euthanasia, samples were retrieved for histological and immunohistochemistry analysis. The results of the present study demonstrated that PBM improved function and motor behavior. Furthermore, irradiated animals demonstrated a decreased injury volume and decreased GFAP immunolabelling. These results suggest that PBM presented a long-term positive effect on the morphological aspects at the site of the injury and in the modulation of GFAP immunoexpression, which culminates in the improvement of the function behavior.

Conclusion: It may be suggested that PBM therapy in the parameters used, was able to modulate the inflammatory process, regulate the secondary lesion, decreasing cell apoptosis and edema in the earlier phases of recovery, which resulted in long-term positive effects (4 and 8 weeks). Further investigations are necessary to investigate the possible mechanisms that may explain the positive effects of PBM irradiation in SCI, which may contribute to a better understanding of the efficacy of PBM therapy and the development of more effective and safer treatments.