Journal of Spinal Cord Medicine最新文献

Context: Emerging research suggests that individuals with a spinal cord injury (SCI) may be at a higher risk of developing cognitive impairment. Early detection of cognitive impairment is essential to improving quality of life and tailored rehabilitation. However, the true incidence of cognitive impairment in this group is unclear, largely due to the difficulty in administering cognitive assessment tools which often have elements that are dependent on hand function e.g. drawing and writing.

Design: We conducted three semi-structured focus groups with a total of 9 participants with the aim of gaining a better understanding of patient perspectives on subjective cognitive difficulties following their SCI.

Setting: Online focus groups.

Participants: 9 participants who have sustained a spinal cord injury.

Interventions: Focus groups were transcribed verbatim and analyzed using reflexive thematic analysis.

Outcome measures: Transcript were coded to identify patterns which were analyzed using reflexive thematic analysis to produce five overarching themes.

Results: People with SCI reported various levels of cognitive difficulties following their injury, and shared strategies that they have implemented to cope with these challenges. All participants expressed a lack of information or assessments on cognitive impairments, highlighting that the focus of their care has predominantly been about the physical aspects of their SCI. Additionally, they observed a difference in the approach to SCI management across different centers within the UK.

Conclusion: Patients with a SCI report cognitive issues following their injury but there is a lack of information or testing by healthcare professionals. Patients advocated for a more consistent and standardized approach, particularly since cognitive impairment can increase care needs and reduce engagement with rehabilitation.

Objective: Patients with spinal cord injuries/disorders (SCI/D) have one of the highest risks of developing pressure injuries, but surgical closure of these wounds has significant pre-operative and post-operative requirements with a high rate of complications. Limited data exists on the outcomes of stage IV pressure injuries that are not managed with surgical closure. Our objective was to review outcomes of patients with stage IV pressure injuries that close by secondary intention.

Design: Retrospective case series review Setting: Veterans Affairs hospital.

Methods: Records of veterans hospitalized on an SCI/D inpatient unit during March 2022 to June 2023 were reviewed to determine if patients were admitted with a stage IV pressure injury. These charts were then further reviewed to determine wound characteristics, medical and surgical management, and wound outcomes.

Results: Charts of twenty-three Veterans with a total of 25 pressure injuries were reviewed.

Conclusions: Ninety-two percent of stage IV pressure injuries improved with complete healing in 36%, though over half of these wounds had imaging concerning for osteomyelitis and required surgical debridement and/or antibiotics. Additionally, these wounds improved or closed though 91.30% were prescribed a progressive sitting program.

Objectives: Neurogenic heterotopic ossification (NHO) is extra-skeletal bone formation induced by neurologic conditions such as spinal cord injury (SCI) and traumatic brain injury (TBI). The definite treatment of established NHO is surgery and the most common complication of surgery is recurrence. This study compared three common postsurgical tertiary prevention strategies: radiotherapy, pharmacological treatment, and no additional intervention.

Materials and methods: Comprehensive searches on PubMed, Embase, Web of Science, and Cochrane Library were conducted until June 2023. Studies' quality was assessed using the MINORS tool, and the rate of NHO recurrence was pooled and compared through random-effects meta-analysis (Dersimonian-Laird). Inclusion criteria involved patients who underwent NHO removal surgery with subcategories based on recurrence prevention strategy: pharmacologic, radiotherapy, and no additional treatment.

Results: In total, 18 studies (n = 937 subjects) were included. Overall prevalence of recurrence (95% CI) was 12.40% (7.49%, 19.82%) with pharmacologic therapy at 9.34% (2.26%, 31.43%), radiotherapy at 15.71% (8.92%, 26.19%), and no additional treatment at 13.55% (6.73%, 25.39%). While no significant differences were observed among the interventions (P > 0.05), pharmacologic therapy exhibited a trend as the most effective method, followed by radiotherapy and no additional treatment.

Conclusion: This study found no significant differences in recurrence rates among treatment groups but noted fewer NHO recurrences with combined pharmacology and surgery in recent studies (after 2000), suggesting potential efficacy of postoperative pharmacotherapy for high-risk patients, though limitations like non-controlled studies and heterogeneity warrant caution.

Objectives: Electrical epidural stimulation (EES) or exoskeleton walking training (EWT) is beneficial to individuals with spinal cord injury (SCI). In this study, we aimed to evaluate the benefits of combining EES and EWT to manage trunk impairment in individuals with SCI.

Study design: Pre-post study.

Setting: A medical center.

Participants: Two participants with cervical SCI (C group) and two with thoracolumbar SCI (TL group) were recruited.

Intervention: Each participant underwent personalized EES and EWT rehabilitation for one month.

Outcome measures: The modified functional reach test (mFRT) was used for pre- and post-intervention assessments. Movement distance and velocity of the center of pressure (COP), and electromyography data (EMG) from the iliopsoas and erector spinae muscles were collected to assess trunk stability and movement function.

Results: The moving distance and velocity of the COP increased after one month of EES and EWT rehabilitation, with a significant rise in moving distance. In the subsequent stratification analysis, the moving distance of the C group increased significantly with or without EES (P = 0.046), but the increase in velocity was not significant. The TL group showed slight improvements in distance and velocity, both of which were not statistically significant.

Conclusions: The synergistic effect of EES and EWT may provide effective rehabilitation for individuals with SCI, particularly those with cervical SCI. This treatment helps them regain trunk stability and movement function within one month.Trial Registration: NCT05433064.

Study design: Retrospective data analysis of a population-based observational cohort. Setting: TSCI in British Columbia, Canada Participants: 3,433 TSCI patients included in the study.

Methods: Hospital records linked with administrative databases were utilized to measure in-hospital mortality, adverse event rate, and LOS between 2001 and 2021. Adverse events included all documented complications during hospital admission. Multivariable logistic regression and Cox proportional hazard models were used to identify factors associated with mortality, adverse events, and LOS.

Results: All cause in-hospital mortality was 6.4%. The average age of patients was 53.2 years (SD 19.7), 75.4% were males and 70% incurred a cervical spinal cord injury. Multivariable analysis demonstrated that patients 35 years old, multiple medical comorbidities, cervical injury, neurologically complete, high injury severity score (25), concomitant brain injury, lower socioeconomic status, and no surgical management were at higher risk for death. Factors associated with adverse events were similar with the exception of non-operative patients who had lower adverse events. Cox modeling for LOS demonstrated similar findings to mortality analysis.

Conclusions: This study found that spinal cord injury patients were more likely to have adverse outcomes with older age, cervical injury, multiple comorbidities, complete neurological injury, or higher severity initial traumatic injuries. This study identified risks associated with complications in TSCI, future research should address ways to improve outcomes in these targeted groups.

Context: A previously healthy 17-year-old female developed tetraplegia 2 weeks after influenza infection.

Findings: Imaging revealed vertical atlantoaxial subluxation with spinal cord compression. Conservative treatment failed; however, C1-C2 posterior fixation immediately improved symptoms.

Conclusion/clinical relevance: Early surgery should be considered when conservative treatment is ineffective in adolescent Grisel syndrome.

Introduction: Patients with spine injuries are at risk of acute kidney injury (AKI) through several mechanisms.

Objective: This study aims to assess the rate of severe AKI in a nationally representative sample of patients with spine injuries and determine whether SCI is an independent risk factor.

Methods: We conducted a cohort study utilizing the National Trauma Databank (NTDB) Patients included were 18 years or older with cervical or thoracic spine injuries (spine fractures and/or spinal cord injury) based on International Classification of Disease (ICD) codes from 2017 to 2022. Patients with pre-existing renal impairment were excluded. Logistic regression was used to determine the association between demographic and injury variables with incident AKI.

Results: 313,838 spinal injury patients were analyzed, of which 3,288 (1.05%) developed AKI. Patients with AKI were older (61 ± 19 vs. 55 ± 21 years, P < 0.001) and had more comorbidities. AKI was associated with higher Injury Severity Scores (23 ± 16 vs. 16 ± 12, P < 0.001) and increased blood product transfusions. After adjustment for confounders, SCI was independently associated with AKI (OR 1.41, 95% CI 1.28-1.55, P < 0.001). AKI patients experienced worse outcomes, including longer ICU stays, higher rates of withdrawal of care and unfavorable hospital dispositions (all P < 0.001).

Conclusion: AKI is associated with morbidity and mortality in patients with spine injuries. Comorbidities and more severe injuries, including the presence of SCI, are associated with AKI. More work is warranted to understand mechanisms of AKI in these patients.

Purpose: This study examined regional healthcare disparities' impact on the secondary fracture risk following spinal fractures, the likeliest secondary fracture types, and associated risk factors.

Materials and methods: Participants were selected from the Korean National Health Insurance Service Sample Cohort. Secondary fractures were hip, wrist, humerus, spine, ankle, and pelvis fractures six months after the spinal fracture. The medically vulnerable regions were defined using the PARC index. A Cox proportional hazards model was used to examine differences in the secondary fracture.

Results: A total of 1,135 and 2,426 of the participants lived in medically severely-vulnerable and moderately-vulnerable regions, respectively. Among patients who had spinal fractures, those residing in severely-vulnerable areas had 1.16 times higher risk of secondary fractures compared to those residing in medically non-vulnerable areas. Within 25-84 months after spinal surgery, patients in severely-vulnerable regions had 1.28 times higher secondary fracture risk.

Conclusions: Among patients with spinal fractures, those residing in medically vulnerable areas have a higher secondary fracture risk than those living in non-vulnerable areas. Policy measures are crucial for preventing secondary fractures in this population.

Context/objective: The purpose of this project was to expand the functionality of current seat interface pressure mapping (IPM) toward a novel integrated system that uses a mobile IPM application for wheelchair users partnered with a clinical IPM dashboard.

Methods: Guided by user-centered design, this mixed methods study aimed to understand and integrate user needs and preferences across three iterations of development with two stakeholder groups: (1) occupational and physical therapy (OT/PT) experts in spinal cord injury and disorder (SCI/D) care (n = 6) and (2) Veteran wheelchair users (WCUs) with SCI/D (n = 7). At each iterative stage, rapid qualitative analysis was used to summarize feedback and design inputs. Perception of usability was evaluated with the System Usability Scale (SUS) and User-Experience Questionnaire (UEQ). OT/PT feature preferences were assessed through polling during first focus group.

Results: Iteration I resulted in wireframes and models of designs for an IPM dashboard, mounting system for mobile IPM system, and smartwatch display options. Iteration II resulted in prototypes of an IPM dashboard, initial redesign of the mobile IPM app to include all-day IPM recording, automatic detection of pressure relief events and smartwatch functionality, and new hardware for IPM interface box. The final integrated IPM system was completed during Iteration III. OT/PTs indicated that aggregated and filtered views of IPM data could enhance patient communication, decision-making, and individualization of pressure management goals. Interface simplicity and automation minimize time and effort engaging with the system. Both stakeholder groups desired maximum control, flexibility, and efficiency in how they collect, access, and use the resulting IPM data. WCUs prefer a range of options for hardware access and use. SUS and UEQ scores were good to excellent across all subscales after three iterative rounds and both groups provided subjective approval of final products.

Conclusions: OT/PTs and WCUs with SCI/D perceived positive relative value and usability for using the newly integrated IPM system to objectively measure pressure and patterns of pressure management on the seating surface over time, evaluate seating equipment efficacy, and facilitate individualized care for managing pressure. Following this successful co-design of the integrated IPM system, real-world usability and information needs will be evaluated in the planned pre-implementation inpatient and outpatient pilot studies.

Context/objective: Due to paralysis in the lower limbs, individuals with spina bifida (SB) rely heavily on upper limb muscles for daily tasks and assisted locomotion. Therefore, reduced upper limb muscle performance may be a key limiting factor. The aim was to investigate differences in elbow muscles strength and fatigability between children and adolescents with SB and their healthy peers.

Design: Cross-sectional study.

Setting: Ribeirão Preto Medical School, University of São Paulo, Brazil.

Participants: Twenty-three youth with SB (SB, mean age 10.83 years) and 84 age-matched children and adolescents (Controls, mean age 12.17 years), of both sexes.

Outcome measures: Participants performed five maximum concentric elbow flexion and extension contractions (120°.s^-1) in an isokinetic dynamometer, to obtain maximal voluntary elbow flexor and extensor torque (MVT), which after was normalized to body weight (MVT-bw). After 10-min of rest, the participants performed a fatigue test with maximum concentric elbow flexion and extension contractions (120°.s^-1) until peak muscle torque (PT) dropped below 50% MVT. PT was recorded in each repetition and normalized to body weight (PT-bw) or maximum voluntary torque (PT-MVT). Simultaneously, surface-EMG was obtained in the biceps and triceps brachii muscles to evaluate changes in neuromuscular activation.

Results: SB showed lower MVT-bw for elbow flexors and extensors than Controls. The decline in PT-bw differed between groups for elbow flexors, where SB showed lower absolute decline rates (PT-bw) than Controls. No statistically significant differences were observed for any EMG variables.

Conclusion: SB did not exhibit increased fatigability in elbow flexors and extensors compared to Controls.