Journal of Spinal Cord Medicine最新文献

Objectives: To investigate the safety and feasibility of repeated transcutaneous spinal direct current stimulation (tsDCS) as priming strategy during exoskeleton-assisted locomotor training in individuals with SCI and evaluate potential neurophysiologic and functional gait changes.

Study design: Case series experimental design.

Setting: Research laboratory at a post-acute rehabilitation hospital.

Participants: Four participants with chronic incomplete SCI.

Interventions: Four participants with chronic incomplete SCI received three weeks of training consisting of two types of interventions after baseline (A): 20-minute tsDCS (anode or cathode) applied over the spinous processes of T10 followed by 20-minute exoskeleton-assisted locomotor training (B, B1, B2) and 20-minute exoskeleton-assisted locomotor training (C, C1, C2). Each phase consisted of five consecutive intervention sessions. Two participants underwent sequence A-B1-C-B2 and two sequence A-C1-B-C2. Soleus Hoffmann Reflex (H-reflex) and gait speed (10-m walk test) were assessed on the first and fifth days of training for each training type.

Outcome measures: Adverse skin reactions or other events, H-reflex (Hmax/Mmax ratio), and gait speed (10-m walk test).

Results: No adverse events occurred. All participants tolerated tsDCS with no negative effects on their skin. Participants demonstrated varied responses in their H/M ratios after tsDCS followed by exoskeleton-assisted locomotor training as well as after exoskeleton-assisted locomotor training. No consistent pattern can be identified in this case series. Three participants showed an increase in gait speed after tsDCS combined with exoskeleton-assisted locomotor training.

Conclusions: Noninvasive repeated spinal stimulation can safely be used in individuals with incomplete SCI. Further large-scale research is necessary to determine the efficacy of tsDCS for priming the spinal cord in facilitating recovery of gait in individuals with SCI.

Objectives: To determine rates of opioid and concomitant antidepressant, anticonvulsant and benzodiazepine dispensing in the post-discharge period, after acute spinal cord injury (SCI).

Design: Single-center prospective cohort study with 12-month linked pharmaceutical data.

Setting: Community pharmaceutical dispensing.

Participants: Patients ≥18 who were diagnosed with a SCI between March 2017 and March 2018.

Outcome measures: Rates of dispensing of opioid and concomitant antidepressant, anticonvulsant and benzodiazepine medications in the 12-month post-discharge from a specialist inpatient Spinal Injuries Unit.

Results: Sixty-eight participants volunteered for the study. Of the medications dispensed in the 12-months after discharge, 16% were opioids, which were supplied to 56% of participants. Forty-six percent of participants had concurrent dispensing of at least one other medication class of interest (antidepressants, anticonvulsants, or benzodiazepines). Participants with opioids prescribed at discharge were 6.5 times more likely to have been dispensed opioids in the 12-months following discharge compared to those who did not have opioids listed at discharge (OR = 6.5, 95% CI = 2.2, 19.0, P < .001).

Conclusions: Longer-term opioid prescribing plus concomitant analgesia and sleep medications in the post-acute period after SCI were common. Chronic opioid use and the polypharmacy observed is concerning, given the potential for dependence, tolerance and increased drug interactions and associated adverse effects. Both issues point to the need for clear discharge instructions for primary care prescribers and regular monitoring to manage pharmacotherapy therapeutic benefits and risks alongside non-medication therapies.

Design: Retrospective observational study.

Objective: To analyze changes in mood states during the acute phase of inpatient rehabilitation for spinal cord injury (SCI) and the factors associated with worse mood states and less improvement.

Setting: Spinal unit in Italy.

Participants: The study included people with SCI admitted between 2014 and 2019 and treated for psychological problems with a focus on 'emotion processing' and 'emotional adjustment'. The sample included 170 patients (71.8% male, mean age 47.1 ± 16, range 17-78), 46.5% with tetraplegia and 50% with comorbidities.

Outcome measures: The Profile of Mood States (POMS) questionnaire was used to assess mood states at baseline and at the end of treatment. Multiple linear regression models were used to identify factors associated with changes in mood states during treatment.

Results: At baseline, patients with distress related to SCI diagnosis reported lower levels of vigor, whereas those with distressing life events reported higher levels of anger and confusion-bewilderment. POMS subscales improved significantly by at least 4 points. ASIA Impairment Scale (AIS) C score, living with family of origin, comorbidities and critical events during hospitalization were associated with greater improvements, whereas higher education was associated with less improvement in depressive mood. In tetraplegic patients, higher improvements in depressive mood were associated with greater independence at discharge, whereas in patients with paraplegia, higher improvements in anxiety and vitality were associated with better mobility.

Conclusion: Our results indicate that mood states improved in people with SCI receiving a psychological treatment. Socio-demographic and SCI-related characteristics associated with a greater effect of psychological treatment should be considered in order to tailor the intervention.

Study design: Retrospective data analysis study.

Objectives: To assess gait recovery rates in subjects with motor incomplete spinal cord injury (SCI) at the start of rehabilitation and to report their gait performance.

Setting: Tertiary inpatient Rehabilitation Center in Argentina.

Methods: The study analyzed data from 143 individuals with traumatic and non-traumatic SCI (AIS/ASIA Impairment Scale C and D) within 90 days of injury, all non-ambulatory upon admission. Gait status at discharge was evaluated using the 6-minute walk test and the Walking Index for Spinal Cord Injury II (WISCI II). Statistical evaluations utilized Pearson chi-square and Mann-Whitney U-tests. Approval was obtained from Fleni's Ethics Committee.

Results: Among the 65 patients with AIS C, 69% regained walking function, compared to 87% of the 74 patients with AIS D (p = 0.01). Walkers had a mean total motor score of 67 (±19) versus 51.7 (±25.5) for non-walkers (p = 0.002), and a total pinprick sensation score of 69.8 (± 27.5) vs. 49.5 (± 29) (p = 0.001). Additionally, 54% of AIS C and 86% of AIS D patients aged ≥ 50 regained walking ability; however, age-related differences were statistically significant only in AIS C group (p = 0,015). AIS D patients walked a mean of 249 meters (±134), while AIS C walked 207 meters (±128) (p = 0.07). The median WISCI II score between the two groups were not statistically significant.

Conclusions: Most patients with incomplete motor SCI who participated in inpatient rehabilitation regained walking, with motor score and pinprick sensation correlating to walking ability. Gait performance was comparable between AIS C and D.

Context/objective: In-person hypnotic cognitive therapy (HYP-CT) is a promising treatment for chronic spinal cord injury-related pain. We describe the effects of HYP-CT delivered via Zoom (Z-HYP-CT) and compare the effects to historical controls who received hypnosis, cognitive therapy, or HYP-CT in-person.

Design: Open pilot trial of HYP-CT versus historical controls.

Setting: Telehealth study that recruited people with chronic SCI.

Participants: Adults with moderate to severe chronic SCI-related pain.

Interventions: Four weekly sessions of HYP-CT delivered via Zoom.

Outcome measures: The primary outcome was average pain intensity on a 0-10 numerical rating scale measured at end of treatment (4 weeks) and 12 weeks. Secondary outcomes included pain interference, depression, sleep, pain catastrophizing, and pain self-efficacy.

Results: 23 individuals with SCI-related pain participated in the open trial and were compared to 21 historical controls. Average age was 54 years, 70% were male, and the majority were White. The participants were 11.6-13.1 years post-SCI and average pain intensity was 4.8-5.4/10. After Z-HYP-CT mixed-effects linear regressions showed that pain intensity was significantly less at 4 weeks (-1.28, P < .0001) and 12 weeks (-1.50, P < .0001) relative to baseline. Pain interference, depression, and pain catastrophizing also decreased significantly at both time points. There were no significant differences between the effects of Z-HYP-CT versus historical controls on any outcome variable.

Conclusion: HYP-CT delivered via telehealth was associated with reduced pain intensity and other benefits that were comparable to the effect achieved by in-person historical controls. The effects of Z-HYP-CT should be evaluated using a randomized controlled design.

Context: Emerging data suggests that patients with a spinal cord injury (SCI) have a higher risk of developing cognitive impairment. The true incidence of cognitive impairment in this group is unclear due to the difficulty in administering commonly used assessment tools, which are dependent on functional abilities e.g. drawing and writing.

Methods: A 16-question online survey, that aims to understand current practices on the assessment of cognition and the limitations of currently available tools, was sent via a Research Network Group to British Association of Spinal Cord Injury Specialists (BASCIS) registered clinicians at each of the 12 Spinal Injuries Centers in the UK and Ireland.

Results: 41 responses from 11 different SCI centers, with most from clinicians who have worked with SCI patients for over 10 years. 68% felt that there was a higher incidence of cognitive impairment in those with an SCI. However, 15% reported not using tools to screen for cognitive impairment, primarily due to lack of time, lack of guidelines, and physical disabilities affecting the ability to complete tests. When used, the most commonly utilized tools were those that rely on intact hand function.

Conclusions: Clinicians report a higher incidence of cognitive impairment in those with an SCI. However, currently used tools are not always appropriate, and patients with impaired hand function may be under-represented or undiagnosed. Further work is needed for a more standardized assessment tool to ensure that these patients receive appropriate diagnosis and management, particularly since cognitive impairment in this group can increase care needs and reduce engagement with rehabilitation.

Context/objective: The objective of this study was to examine the implications of shelter-in-place (SIP) during the COVID-19 pandemic on secondary health conditions (SHC), loneliness, social isolation, social connectedness, anxiety, and positive affect and well-being (PAWB) among community-dwelling adults with spinal cord injury (SCI).

Design: An online exploratory cross-sectional descriptive design.

Participants: 131 community-dwelling adults with SCI.

Outcome measures: UCLA Loneliness Scale, SCI-QOL - Anxiety and PAWB.

Results: Respondents were approximately 33 years old, mostly male and Caucasian. More than half reported being married, living with their spouse in a home with modifications, or living in a household of three or more people. More than half reported experiencing more pain during SIP but not experiencing more of any other SHC than before SIP. On average, participants experienced a moderate level of loneliness, severe anxiety, and higher levels of PAWB during SIP.

Conclusion: Respondents reported that they experienced more pain, loneliness, and anxiety while at the same time reporting higher PAWB. Future research should focus on understanding the nuances of the seemingly counterintuitive relationship described here to develop better ways to support community-dwelling adults with SCI during public health emergencies and SIP.

Context: Neurogenic bladder is one of the major complications of spinal cord injury (SCI). Due to inadequate, ill-timed intervention, it can be lethal and lead to chronic case of renal calculus, renal failure or recurrent urinary tract infections. Intermittent theta burst stimulation (iTBS) is a patterned, non-invasive transcranial magnetic stimulation procedure that can improve the functional status of patients with SCI by manipulating cortico-spinal plasticity. Trans spinal magnetic stimulation has shown transient improvement in establishing voluntary urination and specific bladder parameters in patients with incomplete SCI (iSCI). The present case report evaluates the effect of motor cortical iTBS combined with a customized exercise regime on neurogenic lower urinary tract symptoms in a patient with incomplete dorsal spinal cord injury.

Findings: This is a case of a patient with iSCI who sustaining a stabbing injury. Initial neurological assessment indicated a D5/6 hemi transection. Surgical intervention was followed by cortical iTBS administration for 2 weeks, adjunct to comprehensive rehabilitation for 6 weeks. Urodynamics studies were evaluated for bladder function and neurogenic bladder symptom score (NBSS). We found an improvement in bladder parameters (capacity, compliance, postvoid residual volume, detrusor pressure and bladder indices) linear to the NBSS score, indicating a reduction in neurogenic symptoms.

Conclusion/clinical relevance: iTBS combined with bladder rehabilitation, can be a promising, effective treatment strategy in improving bladder dyssynergia and lower urinary tract dysfunction in patients with incomplete SCI.Trial registration: Clinical Trials Registry India identifier: CTRI/2023/08/056.

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.

Objectives: To study the feasibility of a Water Specific Therapy (WST) program in subjects with incomplete spinal cord injury (iSCI) and <6 months since injury. Secondary: To analyze the impact on balance and gait.

Design: Pilot study with single-subject repeated-measures.

Setting: Rehabilitation center.

Participants: Twelve individuals with subacute (≤6 months) motor iSCI (T1-L5).

Intervention: WST program comprising 18 sessions, 40-minute-long, including warm up, balance training, aerobic exercises, and cool-down, monitored via the Rating of Perceived Effort scale.

Outcome measures: Feasibility was assessed through adherence to treatment, safety and attrition rate. Self-perceived improvement (balance, gait, and lower limb strength) and difficulties encountered by physical therapists were also evaluated. Secondary outcomes included the Berg Balance Scale (BBS), Timed Up and Go test, 10-meter walk test (10-MWT), 6-minute walk test (6-MWT), and Walking Index for Spinal Cord Injury II (WISCI-II).

Results: Adherence to treatment reached 83%, with only two unrelated dropouts. No adverse effects were recorded, deeming the treatment safe. Self-perceived improvements were noted by 88.9% of subjects, with moderate and substantial gains in the three reported variables. Physiotherapists referred difficulties in reaching intensity targets, prompting program adaptations. Statistical significance (P < 0.05) was reached in BBS, 10-MWT, 6-MWT and WISCI-II outcomes.

Conclusion: WST is a feasible, safe, well-accepted method for treating subacute iSCI, potentially enhancing gait and balance in these subjects. Individualized program adaptations may be required. Controlled studies are warranted to determine it is effectiveness.Trial registration: ClinicalTrials.gov identifier: NCT03962218..