Journal of Spinal Cord Medicine最新文献

Objective: To assess the incidence and possible risk factors for venous thromboembolism (VTE) in patients admitted to a SCI rehabilitation center.Design: Retrospective review.Setting: Acute neurorehabilitation hospital specializing in SCI.Methods: Records of 228 consecutive admissions were reviewed. All patients received screening four limb ultrasounds on admission. Charts were reviewed to determine whether VTE was diagnosed at the acute care hospital or in the rehabilitation center; either on admission screening or later in the rehabilitation stay. Charts were reviewed to identify potential risk factors for VTE as well as the incidence of bleeding complications in patients on full anticoagulation.Results: In this cohort, 115 deep venous thromboses (DVTs) were identified in the following settings: 27% in acute care [n = 31], 70% on admission to rehabilitation [n = 80], and 24% during the rehabilitation stay [n = 28]. Of those on therapeutic anticoagulation due to admission diagnosis of VTE [n = 63], 12.7% developed recurrent DVT and 9.5% had bleeding complications. Of those who were initiated and continued on therapeutic anticoagulation, there was zero incidence of PE. Risk factors for the development of VTE included age, body mass index (BMI), rehabilitation length of stay, injury etiology, spinal cord-related surgery, and history of inferior vena cava filter.Conclusions: DVT was identified in 70% of this cohort with screening ultrasound on admission to rehabilitation and of those initiated and continued on therapeutic anticoagulation, none developed PE, while 9.5% had bleeding complications. Given the findings of this study, prospective research in noninvasive vascular ultrasound screening for VTE should be considered.

Context: Adolescents and young adults (AYA) with spina bifida (SB) are more susceptible to obesity due to impaired mobility. There is limited access to physical activity for this population.Objective: The primary aim of this study was to evaluate the feasibility of a mobile health app in a weight management program for AYA with SB. This was determined by measuring program adherence, active use of the app (defined as ≥3 uses per week), and user rating of the Pt Pal™ mobile app. Secondary outcomes were changes in BMI, quality of life, and health behavior, and the number of active participants over time.Methods: Patients from the SB Clinic of a large metropolitan hospital between the ages of 11-21 years and overweight were invited to participate. The program consisted of group nutrition sessions and an individualized exercise plan using a mobile app with coaching. Outcome measures were program adherence, changes in BMI, and validated survey responses. Descriptive statistical analysis was performed.Results: Fifteen participants enrolled, and ten participants completed the program. Five of the ten participants attended the nutrition sessions. The number of active app users declined after the first week. Seventy percent of participants decreased their BMI. Most participants reported the program improved their ability to exercise regularly, eat a healthier diet and feel more self-confident. Peds QL™ psychosocial health domains increased postintervention. The YRBS showed increased physical activity and less sedentary time postintervention.Conclusions: This mobile app-based weight management program with coaching implemented may not be feasible for adoption in the general population of AYA with SB; however, it was well received by some, and further testing is needed to determine how to improve feasibility. This study provides useful information to guide future programs utilizing digital health and coaching.

Objective: To determine the associations between trauma variables, acute phase-related variables, and patient-level characteristics with functional recovery during the first-year post-discharge from inpatient rehabilitation facilities (IRF) for individuals with spinal cord injury (SCI).Design: Retrospective cohort analysis.Setting: Two SCI Model Centers in Pennsylvania, United States.Methods: We were able to link 378 individuals with traumatic SCI between the Pennsylvania Trauma Systems Outcomes Study and the National SCI Model Systems databases. Nineteen individuals with SCI were excluded due to missing data. We estimated functional recovery based on changes in functional independence measure (FIM) total motor score during the first-year post-discharge from IRF in 359 individuals with SCI, who did not have any missing data, using ordinary least squares regression (OLS).Results: After discharge from IRF the majority of individuals with SCI improved over the first-year post-injury. Individuals with cervical A-C (injury severity group) who were older had a slight decrease in motor FIM at 1-year post-injury. Regression analysis indicated that lower functional recovery was associated with being of Black and Hispanic race and ethnicity, higher injury severity group, occurrence of non-pulmonary infection during acute care, and longer length of stay at IRF (R² = 0.36).Conclusions: Patient-level characteristics, trauma variables, and acute phase-related variables were associated with functional recovery post-discharge from IRF. Further research is necessary to collect and assess post-rehabilitation and socio-economic factors that play a critical role in continued functional recovery in the community.

Neuromuscular electrical stimulation (NMES) is often used to activate muscles impaired after spinal cord injury to elicit functional activities or to facilitate exercise. However, in addition to the cost and availability of NMES and the inherent muscle fatigue that is associated with its use may limit its widespread utilization. Optimizing stimulation parameters during NMES-induced contractions could maximize force production with less fatigue.Purpose: To examine the interrelationship of pulse duration and pulse frequency on torque production and muscle fatigue in both impaired and non-impaired skeletal muscle of men and women.Methods: Individuals with [n = 14 (6 females), 38 ± 13 yr; 175 ± 11 cm; 76 ± 20 kg] and without [n = 14 (6 females), 29 ± 8 yr; 175 ± 9 cm; 74 ± 14 kg] spinal cord injury (SCI) participated. Muscle torque was recorded during a series of NMES-induced isometric muscle contractions using different combinations of pulse durations and frequencies. Additionally, two different muscle fatigue protocols (20 and 50 Hz/200µs) were utilized to elicit repeat isometric muscle contractions (1s on and 1s off × 3 min).Results: There was a statistically significant linear trend for pulse charge (the product of pulse frequency and pulse duration) on isometric torque production in participants without (p < 0.001, η²= 0.79), and in participants with SCI (p < 0.001, η²= 0.66), with higher total pulse charge generating higher torque values. Participants with SCI had significantly greater muscle fatigue for both muscle fatigue protocols (p < 0.05).Conclusions: NMES protocols should consider using longer pulse durations with lower frequencies to maximize force production for individuals with SCI. However, because mechanisms of muscle fatigue may be different for impaired muscle when compared to non-impaired muscle, further studies on protocols to offset fatigue are warranted.

Objectives: To evaluate the demographics, clinical characteristics, hospital course, and factors associated with outcomes in patients with spinal cord injury associated with vertebral fracture (SCI-VF).Design: Retrospective analysis of data collected from electronic health record.Setting: A large for-profit United States health care system.Participants: 2219 inpatients with SCI-VF between 2014 and 2020 identified using International Classification of Disease codes.Main Outcome Measure: In-hospital mortality, and disposition (home vs. no-home discharge) after hospitalization.Results: The mean age of patients admitted with a diagnosis of SCI-VF was 54.80 ± 20.85 years with 68.27% identified as male. The cervical spine was the most prevalent site of fracture, displaced vertebral fracture was the most common radiographic diagnosis, and the majority of injuries were classified as incomplete. 836 (37.67% of all 2219) patients were discharged home and had a shorter length of stay (7.56 ± 13.58 days) when compared to the average of the total study population (11.56 ± 19.2 days). The most common hospital-acquired complication (HAC) was falls (n = 259, 11.67%). Characteristics associated with in-hospital mortality in the 96 patients (6.94% of 1,383 patients with no-home discharge) included initial respiratory failure, ICU stay, increased medical comorbidity index value, insulin use, and presence of cardiovascular, pulmonary, and gastrointestinal HACs.Conclusions: A large observational study of patients with SCI-VF can add to the knowledge of SCI characteristics in the U.S. population. Recognizing the common hospital-acquired conditions and clinical characteristics associated with increased in-hospital mortality can be helpful to improve the care of patients with SCI-VF.

Objective: To discuss the efficacy of exoskeleton robotic training on ambulation recovery in patients with spinal cord injury (SCI).Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched systematically from their inception to April 2022 for studies on exoskeleton robotic training in patients with SCI. The language was restricted to English. The retrieved studies were screened to select eligible clinical trials. Meta-analysis was performed using Review Manager 5.4.Results: Eleven randomized clinical trials (RCTs) involving 456 participants were included in the meta-analysis. The results of the meta-analysis showed that exoskeleton robotic training was more effective in improving FIM [SMD = 0.58, 95%CI = (0.07, 1.10), P = 0.03], LEMS [MD = 4.64, 95%CI = (3.58, 5.70), P<0.05], MAS [MD = 0.76, 95%CI = (0.48, 1.03), P<0.05] and BBS [MD = -3.11, 95%CI =  (-12.59, 6.36), P<0.05] in patients with SCI, compared to conventional gait training(CGT). Subgroup analysis showed that the exoskeleton robotic could significantly improve the walking endurance and walking speed of patients with a duration of injury within 6 months. The sensitivity of inverted funnel plot analysis is low, suggesting that the analysis results of this study are relatively stable.Conclusion: Exoskeleton robotic training improves ambulation in patients with SCI, especially for patients with a course of injury within six months.

Context: Spinal cord injuries (SCIs) disrupt physiological functioning which can significantly impact sexuality. Those with SCI may rely heavily on Internet sexual health resources for many reasons. Evaluation of current internet health resources is warranted to identify the gaps in the literature.Objectives: The aim of this study was to conduct a purposive review of available Internet sexual health resources for those with SCI.Methods: A Google search was completed with search terms such as: "SCI and sexual functioning", "SCI and sexuality", "SCI and pregnancy" and "SCI and sexual pleasure". Resources were selected if they: (1) provided sexual health education to those with SCI; (2) were designed to increase skills-based learning or influence attitudes and beliefs; and (3) in English language. All identified resources were imported to NVivo 1.5.1 where a thematic content analysis was conducted.Results: The search resulted in 123 resources meeting the criteria. The most common themes included: Sexual functioning (in 83.7% of resources), Reproductive health (67.5%) and Impact of Secondary Complications (61.8%). The least common themes were Psychosocial (24.4%), Stigma (13.8%), and Quality of Life (12.2%). No information was coded for LGBTQ+.Discussion: Sexual health and SCI information focuses primarily on heterosexual males and specifically on sexual functioning. Resources addressing female sexuality were extremely limited and focused largely on reproduction. There was a complete absence of resource aimed to address LGBTQ+ people.Conclusion: The results demonstrate a need for Internet-based sexual health education resources to meet the needs of diverse individuals including women and gender non-conforming people.

Context: Spinal cord injury (SCI) presents significant challenges due to its debilitating nature and potential complications. While few medications have shown efficacy in improving neurological recovery, 4-Aminopyridine (4-AP), a voltage-gated potassium channel blocker, has been used clinically off-label to improve neurologic function in adults with spinal cord-related paralysis. However, evidence regarding its safety and effectiveness in the pediatric population remains scarce, as it is approved for use in older patients.Findings: This manuscript reports the case of a pediatric patient who sustained a traumatic cervical SCI. Initial neurological assessment indicated a C1 motor complete SCI. Surgical intervention for bullet removal and spinal fusion was carried out, followed by comprehensive inpatient rehabilitation.Conclusion/clinical relevance: 4-AP was introduced three months post-injury and was well-tolerated without obvious adverse effects. Notably, he exhibited neurological and functional improvement after four months of 4-AP use, though his improvement followed the expected trajectory of recovery. To date, this case represents the first case of 4-AP administration in a pediatric SCI patient, and therefore these findings contribute valuable clinical insight. By documenting the clinical trajectory of this case, this manuscript suggests 4-AP may be safe for use in pediatric patients.

Objective: To compare psychological factors and the number of painful sites between wheelchair basketball athletes (WBA) with and without shoulder pain and examine their associations with shoulder pain.

Design: A cross-sectional, case-control study.

Methods: Forty-three WBA participated. Shoulder pain was assessed with the Wheelchair User's Shoulder Pain Index (WUSPI), pain catastrophizing with the Pain Catastrophizing Scale (PCS), kinesiophobia by the Tampa Kinesiophobia Scale (TKS), self-efficacy with the General Self-Efficacy Scale (GSES), and the number of painful sites using the Nordic Musculoskeletal Questionnaire. Disability and sport-related data were collected. Spearman's correlation coefficients were calculated. Mann-Whitney U and independent samples t-tests were used for between-group comparisons.

Results: Athletes with shoulder pain (n = 21) had an increased number of painful sites (P < .050) and higher PCS (P = .003). The WUSPI exhibited moderate associations with the number of painful sites during the last year (rho = .581) and past seven days (rho = .602), and PCS (rho = .470), and a weak association with the TKS (rho = .333)(P < .050). The number of painful sites with disability exhibited moderate associations with PCS (rho = .427) and GSES (rho = -.473)(P < .050). WBA classification levels showed moderate associations with the WUSPI (rho = -.400) and the number of painful sites during the last year (rho = -.437), and a weak association with the number of painful sites during past seven days (rho = -.315)(P < .050). The PCS showed weak associations with the number of painful sites during the last year (rho = .365) and the past seven days (rho = .398)(P < .050).

Conclusions: Results suggest considering WBA classes, pain catastrophizing, self-efficacy and multisite pain in the pain management of WBA.