Journal of Spinal Cord Medicine最新文献

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.

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.