Journal of Spinal Cord Medicine最新文献

Objective: To validate the Chinese version of the Community Integration Questionnaire-Revised (CIQ-R-C) for individuals with spinal cord injury.Design: Cross-sectional study.Setting: Shanghai Sunshine Rehabilitation Center.Participants: 317 adults with spinal cord injury in a rehabilitation center in Mainland China.Interventions: Not applicable.Methods: The CIQ-R-C (including an additional e-shopping item), global QoL, Zung Self-Rating Anxiety/Depression Scale (SAS/SDS), and Multidimensional Scale of Perceived Social Support (MSPSS) were administered. Reliability and validity analyses were conducted.Results: Good item-domain correlations were found for 15 of the 16-item original CIQ-R, except for item 10 (leisure alone or with others). Exploratory Factor Analysis supported a construct of the CIQ-R-C (excluding item 10) as made of four domains (CFI = 0.94; RMSEA = 0.06): home, social engagement, digital social networking, and traditional social networking. Good internal consistency and test-retest reliability were observed in the total and the home subscale of the CIQ-R-C. Satisfactory construct validity was shown by the correlation analysis among the CIQ-R-C Scale, SAS/SDS, global QoL, and MSPSS.Conclusion: The CIQ-R-C Scale is valid and reliable, and can be used to assess community integration of individuals with spinal cord injury in China.

Context/Objective: Providing accurate counseling on neurological recovery is crucial after traumatic spinal cord injury (TSCI). The early neurological changes that occur in the subacute phase of the injury (i.e. within 14 days of early decompressive surgery) have never been documented. The objective of this study was to assess peri-operative neurological improvements after acute TSCI and determine their relationship with long-term neurological outcomes, measured 6-12 months following the injury.Methods: A retrospective cohort study of 142 adult TSCI patients was conducted. Early peri-operative improvement was defined as improvement of at least 1 AIS grade between the pre-operative and follow-up (6-12 months post-TSCI) assessment. neurological improvement of at least 1 AIS grade.Results: Out of the 142 patients, 18 achieved a peri-operative improvement of at least 1 AIS grade. Presenting a pre-operative AIS grade B and having shorter surgical delays were the main factors associated with stronger odds of achieving this outcome. Out of the 140 patients who still had potential for improvement at the time of the post-operative assessment, 44 achieved late neurological recovery (improvement of at least 1 AIS grade between the post-operative assessment and follow-up). Patients who presented a perioperative improvement seemed more likely to achieve later neurological improvement as well, although this was not statistically significant.Conclusion: Our results suggest that it is important to assess early perioperative neurological changes within 14 days of surgery because it can provide beneficial insight on long-term neurological outcomes for some patients. In addition, earlier surgery may promote early neurological recovery.

Objective: To examine effects of a videoconferencing coach-guided expressive writing program on facilitating grief resolution in adults with spinal cord injury (SCI).Design: One group pretest - posttest design with a 1-month follow-up.Setting: Home-based videoconferencing.Participants: Twenty-four adults with SCI.Interventions: 10 weekly 1-hour videoconferencing sessions in which participants engaged in expressive writing guided by writing coaches, either individually or in small groups.Outcome Measures: Self-report questionnaires on measures of grief, emotional distress, depression, stress, trouble falling asleep, meaning and purpose, self-efficacy for managing chronic conditions, ability to participate in social roles and activities, and satisfaction with social roles and activities.Results: Immediately after completing the program, participants showed significant reductions in measures of severity of grief, trouble falling asleep, and trouble participating in social roles and activities and significant increases in self-efficacy for managing chronic conditions and satisfaction with social roles and activities. Participants maintained benefits at 1-month follow-up, showing significant reductions in measures of severity of grief, trouble falling asleep, and distress related to different difficulties and significant increases in feelings of meaning and purpose in life compared to their scores at pre-program. Post-hoc analysis showed that participants whose injury was sustained within 5 years of study enrollment had significant reductions in change scores of distress and trouble participating in social roles and activities compared to those whose injuries were sustained more than 5 years before the study began.Conclusion: The videoconferencing coach-guided expressive writing program helps adults with SCI reduce grief intensity and trouble falling asleep and produces a sustained effect. People who sustained a more recent injury seemed to gain more benefits from the program than those whose injuries occurred less recently.Trial Registration: NCT04721717.

Context: Hyperperfusion therapy, mean arterial blood pressure (MAP) > 85 mmHg, is a recommended treatment of blunt traumatic spinal cord injury (SCI). We hypothesized the first 24 h of MAP augmentation would be most influential on neurological outcomes.Design: This retrospective study from a level 1 urban trauma center dating 1/2017 to 12/2019 included all blunt traumatic spinal cord injured patients receiving hyperperfusion therapy. Patients were grouped as "No improvement" vs "Improvement" measured by change in American Spinal Injury Association (ASIA) score during their hospitalization. MAP values for the first 12, first 24 and last 72 h were compared between the two groups; P < 0.05 was significant.Results: After exclusions, 96 patients underwent hyperperfusion therapy for blunt traumatic SCI, 82 in the No Improvement and 14 in the Improvement group. Groups had similar treatment durations (95.6 and 96.7 h, P = 0.66) and ISS (20.5 and 23, P = 0.45). The area under the curve, calculation, to account for time less than goal and MAP difference from goal, in the No Improvement group was significantly higher (lower and more time below MAP goal) compared to the Improvement group for the first 12 h (40.3 v. 26.1 P = 0.03) with similar findings in the subsequent 12 h of treatment (13-24 h; 62.2 vs 43, P = 0.09). There was no difference between the groups in the subsequent 72 h (25-96 h; 156.4 vs 136.6, P = 0.57).Conclusions: Hyperperfusion to the spinal cord in the first 12 h correlated significantly with improved neurological outcome in SCI patients.

Objective: To investigate the association between sufficient energy intake and improvement in activities of daily living (ADL) after hospitalization in patients with cervical spinal cord injury (CSCI) undergoing post-acute rehabilitation.Design: Retrospective cohort study.Setting: Post-acute care hospital from September 2013 to December 2020.Participants: Patients with CSCI admitted to a post-acute care hospital for rehabilitation.Intervention: Not applicable.Outcome measure(s): Multiple regression analysis was performed to investigate the relationship of sufficient energy intake to Motor Functional Independence Measure (mFIM) gain, mFIM score at discharge, and body weight change during hospitalization.Results: In total, 116 patients (104 men and 12 women), median age: 55 (interquartile range [IQR] 41-65) years were included in the analysis. Then, 68 (58.6%) were in the energy-sufficient group, and 48 (41.4%) patients were classified under the energy-deficient group. The two groups did not significantly differ in terms of mFIM gain and mFIM score at discharge. The energy-sufficient group maintained body weight change during hospitalization than the energy-deficient group (0.6 [-2.0-2.0] vs. -1.9 [-4.0--0.3], P < 0.001). Multiple regression analysis showed no association between sufficient energy intake and outcomes.Conclusion: Sufficient energy intake within the first 3 days of admission did not affect ADL improvement during hospitalization in patients with a post-cute CSCI undergoing rehabilitation.

Objective: To identify differences in personal characteristics, health outcomes, and hospital utilization as a function of ambulatory status among adults with chronic SCI.Design: Prospective cohort study linked to state administrative billing data.Setting: Population-based SCI Registry from the Southeastern United States.Participants: 1,051 adults (>18 years old) with chronic (>1-year), traumatic SCI.Outcome Measures: The self-report assessment (SRA) included demographic, injury and disability characteristics, health status, psychological and behavioral factors, and participation and quality of life (QOL) variables. We linked cases to administrative billing data to assess hospital utilization, including Emergency Department (ED) visits and inpatient (IP) admissions (through the ED and direct IP) in non-federal state hospitals within the year following the SRA.Results: There were 706 ambulatory and 345 non-ambulatory participants. We found significant differences across all sets of factors and significant differences in hospital utilization metrics. Ambulatory adults had fewer ED visits (36% vs 44%), IP admissions through the ED (11% vs 25%) and IP only admissions (9% vs 19%) and spent fewer days in the hospital for both admissions through the ED (0.9 vs 4.6 days) and IP only admissions (0.7 vs 3.1 days). They also reported having fewer past year ED visits (44% vs 62%) and IP admissions (34% vs 52%).Conclusions: We identified differences in personal characteristics, ED visits and IP admissions between ambulatory and non-ambulatory adults with SCI, providing a better understanding of the characteristics of those with SCI. The findings suggest the need for separate analyses based on ambulatory status when assessing long-term health outcomes including hospital utilization.

Objective: We recently demonstrated that upper-body rowing exercise (UBROW) improved aerobic fitness in individuals with spinal cord injury (SCI), with no effect on traditional cardiometabolic risk factors. Here, we tested the hypothesis that the exercise-induced increase in aerobic fitness was maintained at 6-month (6M) follow-up.Design: Six-month follow-up.Setting: University/hospital.Participants: Seventeen wheelchair-dependent participants with SCI.Interventions: 12-week of exercise training (UBROW) or control (CON).Outcome Measures: Aerobic fitness (PO_peak and V̇O_2peak), body composition, blood pressure, and blood biomarkers of cardiometabolic risk were assessed at 6M follow-up and compared to baseline (BL) and immediately post-intervention (12-week). Minutes of mild, moderate, and heavy intensity leisure time physical activity (LTPA) were assessed by self-report.Results: Fourteen participants returned at 6M follow-up (CON, n = 6; UBROW, n = 8). In UBROW, PO_peak (median (Q1-Q3)) increased from BL (70 W (37-84)) to 12-week (77 W (58-109), P = 0.01) and 6M follow-up (81 W (51-96), P = 0.01), with no difference between 12-week and 6M follow-up (P = 0.21). Similarly, V̇O_2peak increased from BL (15.4 ml/kg/min (10.5-19.4)) to 12-week (16.6 ml/kg/min (12.8-21.3), P = 0.01) with no difference between 12-week and 6M follow-up (16.3 ml/kg/min (12.9-19.7), P = 0.74). No differences were found in CON for either PO_peak (P = 0.22) or V̇O_2peak (P = 0.27). There were no changes over time in traditional cardiometabolic risk factors or for minutes of different LTPA intensities.Conclusion: We demonstrate that improvements in aerobic fitness are maintained for at least six months after completion of a 12-week exercise intervention, supporting the use of periodic exercise interventions to boost aerobic fitness level in individuals with SCI.Trial registration: ClinicalTrials.gov identifier: NCT04390087..

Context: Sailing is a sport that can help in the rehabilitation of Spinal Cord Injury (SCI) patients and improve their quality of life. Teaching methodology in sailing has always been considered as complex, due to the great amount of uncertainty that this sport has.Purpose: To design a protocol for teaching adapted sailing in a simulated situation for people with SCI and to know the effect of the teaching protocol on learning, effort perception and heart rate.Method: Six adults were patients recruited at the National Hospital of Paraplegics of Toledo (Spain), aged between 31 and 54 years, who have passed the early subacute phase. Each subject underwent semi-immersive virtual reality sailing therapy for 40 min per session three times per week for six weeks, 18 sessions. A simulated adapted sailing initiation program VSail-Trainer® was used for the simulator therapy. During this session, the basic notions of sailing, wind direction, sheet trimming and control of the boat on different courses were explained. The variables assessed were: sailing learning, heart rate and effort perception.Results: The comparison of performance variables between pretest and posttest resulted differences in boat speed, heel and Velocity Made Good (VMG). These improvements in the performance variables are also reflected in the average times taken by the subjects to complete the regatta.Conclusion: The methodology used in this study can be used as a guide for learning the activity by new SCI patients in rehabilitation who want to get into sailing sport.

Objectives: Assess the occurrence of neuropathic pain in spinal cord injured persons (SCIP) and define the relationship between neuropathic pain with demographic and clinical characteristics in SCIPs.Methods: This Analytical cross-sectional study was conducted on 104 SCIPs treated at our tertiary care hospital. Initial clinical evaluation was done according to the American Spinal Injury Association (ASIA) impairment scale. A clinical evaluation was done. All subjects were screened with the Leeds Assessment of Neuropathic Symptoms, Signs (LANSS) and DN4 questionnaire for neuropathic pain. The Visual Analogue Scale (VAS) was used to measure the severity of neuropathic pain. Later two groups were created based on the presence and absence of neuropathic pain.Results: The mean age was 35.04 ± 13 years. Fifty-eight patients (55.8%) had a complete injury (ASIA grade A), 41 (39.4%) patients had an incomplete kind of injury (ASIA grade B-D) and 5(4.8%) patients had no deficits (ASIA grade E). Neuropathic pain was present in 77(74.0%) and absent in 27(26.0%) patients. Seventy-one patients (92.2%) experience neuropathic pain in the first year after traumatic SCI. Medicines were a common pain-relieving factor 64(83.1%).Conclusion: 74% of patients complained of neuropathic pain, indicating a significant complication. A comprehensive evaluation and treatment are necessary to address it while including variables like the completeness of injury, duration and timing.

Objective: Hip subluxation is a common complication in children with spinal cord injury. This study aimed to investigate the incidence and influencing factors of hip subluxation and discuss prevention strategies.Methods: Medical records of children with spinal cord injury were reviewed. The inclusion criteria were as follows: (1) the patient was younger than 18 years old when injured; (2) absence of traumatic or congenital pathological changes of the hip at the time of injury. The migration percentage and acetabular index were selected to evaluate hip stability and acetabulum development. Influencing factors of sex, age, injury duration, severity, level, and spasticity were analyzed.Results: A total of 146 children were enrolled. Twenty-eight children presented with hip subluxation and were significantly younger at the time of injury than those with normal hips (P = 0.002). The incidence of hip subluxation increased with the prolonged injury duration. Injury before age 6, complete injury, and flaccid lower extremities were significant influencing factors (P = 0.003, 0.004, and 0.015, respectively). The risk of hip subluxation decreased by 18% for every year older in injury age (P = 0.031) and decreased by 85% in children with spasticity (P = 0.018) than those without. However, the risk of hip subluxation in children with injury duration longer than 1 year was 7.1 times higher than those with shorter injury duration (P < 0.001).Conclusions: The incidence of hip subluxation in children with spinal cord injury increased with the injury duration. Younger children had immature hip development. Due to complete injury and flaccid muscle, lack of protection around the hip may lead to subluxation. Follow-up and prevention of hip subluxation need the joint effort of medical staff and families.