Journal of Spinal Cord Medicine最新文献

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.

Objective: This study aimed to evaluate the muscle activation responses of the deltoid (anterior (AD) and posterior (PD)) and brachioradialis (BRD) muscles in an adapted shuttle run test for Parabadminton (PBd).

Methods: Thirteen PBd athletes (WH1 = 4; WH2 = 9), performed an adapted shuttle run test under four experimental conditions (moderate (Mod) and intense (Int) effort; with (W) and without (Wout) racket use). The performance in the test was analyzed (cycles: the result of the adapted shuttle run test; frequency: Hz; and speed [m/s]). Non-normal data (Shapiro-Wilk) were analyzed using Friedman's ANOVA and Dunn's post-hoc test, with significance set at P < 0.05.

Results: The difference in muscle activation of the AD was significant between Mod-W vs. Int-W (69.11% vs. 97.96; P = 0.0357), and Int-W vs. Mod-Wout (97.96% vs. 67.23; P = 0.0480). For the PD there were differences between Mod-W vs. Int-Wout (154.40% vs. 250.35; P = 0.0143), and Mod-Wout vs. Int-Wout (183.85% vs. 250.35; P = 0.0029). For the BRD there were significant differences between Mod-W vs. Int-W (90.04% vs. 121.72; P = 0.0143), Mod-W vs. Int-Wout (91.12% vs. 123.00; P = 0.0375), Int-W vs. Mod-Wout (121.72% vs. 90.04; P = 0.0143), and between Mod-Wout vs. Int-Wout (90.04% vs. 123.00; P = 0.0375).

Conclusion: This study concludes that effort intensity is crucial for muscle activation of AD, PD, and BRD in PBd athletes, with greater recruitment observed in intense effort.

Context: Multiple surgical and non-surgical management options exist for treating central cord syndrome (CCS) patients. However, the final treatment decision is based on a patient's presentation and surgeon's choice.

Objectives: We aim to identify patient factors associated with decisions for surgical management versus non-surgical management of CCS and compare the outcomes of length of stay (LOS), patient disposition, readmission, complications, mortality, and total cost.

Methods: This retrospective analysis of the New York Statewide Planning and Research Cooperative System (SPARCS) database identified CCS patients from January 1, 2012, to December 31, 2021. Surgical treatments were determined using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. Chi-square, T-test, and multivariable regression were used to compare outcomes, with random intercepts and effects for facilities. P < 0.05 was considered significant.

Results: Of 2214 patients, 41.24% (n = 891) underwent surgery. The majority (46.88%, n = 1038) were aged 40-65, followed by 46.48% (n = 1029) older than 65. Compared to non-surgically managed patients, surgically treated patients had a lower 90-day readmission rate, but a significantly longer length of stay, likelihood of non-home discharge, and total charge and cost. Of surgical modalities, posterior cervical decompression had the shortest mean LOS, probability of readmission, probability of readmission, and lowest mean total charge.

Conclusion: Our study points toward surgery as having more favorable outcomes versus non-surgical management. The current study found that surgical management is associated with decreased probability of 90-day readmission and a non-significate decreased probability of mortality within 90 days of discharge.

Background: MAP augmentation is a guideline-recommended intervention in acute spinal cord injury (SCI), and vasopressin can be used to achieve mean arterial pressure (MAP) goals. Vasopressin could contribute to hyponatremia in SCI, but this relationship is poorly described.

Methods: This was a multicenter, retrospective, observational cohort of patients with acute SCI who received vasopressin only for MAP augmentation and developed hyponatremia. Patients were excluded if vasopressin was used for <6 h or for an alternative indication (e.g. shock states). The primary outcome was the probability hyponatremia was caused by vasopressin, determined using the Naranjo Adverse Drug Reaction Probability Scale.

Results: Twenty patients with SCI received vasopressin for MAP augmentation and 17 (85%) developed hyponatremia. Seventy percent of patients received an American Spinal Injury Association Impairment Scale (AIS) classification at admission: AIS A (42%), AIS B (50%), and AIS C (8%). MAP augmentation (mean goal of 87 (±7) mm Hg) was maintained for 5 (±2) days. The median Naranjo score was 7 (range 4-9), constituting a "probable" association of vasopressin with hyponatremia. Hyponatremia (Na <135 mEq/L) developed within 30 (±20) hours of vasopressin initiation, with a nadir at 129 (±4) mEq/L. Sodium declined by 8 mEq/L on average for every 24 h of vasopressin exposure. Hyponatremia resolved 12 (±9) hours after vasopressin discontinuation. Five patients were rechallenged with vasopressin and 4 (80%) re-developed hyponatremia.

Conclusion: Vasopressin used for MAP augmentation was associated with hyponatremia in patients with SCI who received it strictly for MAP augmentation and resolved after discontinuation. Providers should exercise caution when selecting vasopressin for MAP augmentation in acute SCI.

Background: Autonomic nervous system (ANS) dysfunction in individuals with spinal cord injury (SCI) may have an impact on Ureteric Jet Doppler Waveform (UJDW) types.

Objective: The aims of the study were (1) to determine UJDW types in individuals with SCI, (2) to evaluate the factors that affect these UJDW types, and (3) to examine the possible indirect effect of ANS dysfunction on these UJDW types.

Materials and methods: This cross-sectional study included twenty individuals with SCI (study group) and twenty-four healthy volunteers (control group). The appearance of UJDW forms and bladder wall thicknesses were collected by urinary Doppler ultrasound (USG) in both groups. Bladder pressure and abdominal pressure were recorded when the bladder was full after Doppler USG examination.

Results: The most common types of UJDW detected in participants with SCI were monophasic and biphasic wave patterns. When the study group and control groups were compared in terms of UJDW types, monophasic wave percentage median values were higher in the study group than in the control group (p = 0.001). The median values of the percentage of biphasic waves were higher in individuals with lesion level ≤ thoracic (T) 7 compared to individuals with lesion level ≥ T6 (p = 0.011). The monophasic wave form was not found at a higher rate in individuals with lesion level ≥ T6 level compared to the individuals with lesion level ≤ T7.

Conclusion: The findings of this study may suggest that the monophasic form is not evidence of ANS dysfunction in individuals with SCI.

Design: Retrospective Study.

Background: The incidence of traumatic brain injury (TBI) in patients with spinal cord injury (SCI) is well documented. However, the incidence of SCI specifically in patients with closed head injury (CHI) is understudied. SCI and CHI are underdiagnosed, and this can be complicated history. Facilities are often focused on patients' primary issues, and with polytrauma patients' cognitive impairment, SCI can be missed. Thus, this study aimed to determine the incidence of SCI in patients with CHI.

Methods and materials: This retrospective study used Pennsylvania Trauma Systems Foundation database to identify patients with SCI among those with CHI (2010 through 2020 end) and described the patient demographics; incidence per year; frequencies of the various causes and types of injuries; and the underlying CHI in terms of frequencies of diagnosis and severity. The frequencies of various diagnoses associated with SCI, neurologic level of injury, severity and the associated vertebral fractures, and in-hospital mortality were also described.

Results: Among patients with CHI, 2.6% were found to have SCI. Patients mostly affected were male (73.5%), Caucasian (78.4%), and a mean age (SD, range) of 46.3 (15.5, 19-70) years. Blunt injury, predominantly in the form of motor vehicle collisions (55.7%) and falls (34.6%) constituted the main causes. Cervical spine was most affected (76.2%), with C1-C4 region comprising the most injuries (39%), followed by thoracic spine (26.4%). Vertebral Fracture (VF) was noted in 47.1%; C5-C7 was the most fractured region (28.9%). VF levels matched SCI levels in 52-70%. Complete SCI was diagnosed in 18.6% of patients. The mean duration of stay in hospital was 11 days (range 0-262). In-hospital mortality was noted in 8.2% of patients.

Conclusion: The CHI should not necessarily be severe to have a suspicion of SCI. The clinical findings of SCI in CHI mostly follow the pattern in dual diagnosis of TBI/SCI, such as frequent involvement of cervical spine with less involvement of the thoracic and lumbar sections of the spine. An appropriate clinical suspicion to screen and follow management protocols for SCI is recommended for the best patient care.

Context/objective: Oral hygiene is crucial for basic health by preventing systemic diseases. People with spinal cord injuries (SCI) in previous studies identified cost, physical barriers (such as chair lifts), and dental fear as barriers to dental care. Our study observes whether Veterans with SCI are receiving appropriate dental care, and if not, to identify the barriers.

Design: Cross-sectional survey during their annual exam, inpatient stays, or outpatient visits.

Setting: Clement J. Zablockie Veterans Affairs Medical Center Spinal Cord Injury/Disorders Program.

Participants: 188 Veterans with SCI (n = 188).

Results: 157 (83.5%) Veterans reported having received dental care since their SCI. Most reported receiving post-SCI dental care at a non-VA clinic (63.3%) and at least annually (63.3%). Some of these Veterans reported being unable to receive dental care since their SCI (23.4%) and identified barriers: lack of insurance (60.0%), money (30.0%), physical obstacles (6.7%), and "other" reasons (10.0%). Veterans who were white (black OR 0.518, CI 0.157-1.709; other OR 0.181, CI 0.053-0.620), had dental insurance (OR 5.778, CI 1.258-26.547), and/or had VA dental care eligibility (OR 4.782, CI 1.516-15.085) were more likely to have received dental care since SCI. However, most did not report having insurance (70.9%) or VA eligibility for dental care (63.1%).

Conclusions: Sex, age and level of injury were not related to dental care access, but race, insurance, and VA care eligibility were. Similar to the general population, finances were the most-reported barrier to dental care. Prioritizing early intervention, financial aid, and preventive measures can enhance the health of Veterans with SCIs.

Context: Sufficient vitamin D levels (serum 25(OH)D>75 nmol/L) have been associated with secondary health conditions and functional outcomes in individuals with chronic spinal cord injury (SCI). This study evaluated the effects of vitamin D3 supplementation on these outcomes.

Design: Randomized, placebo-controlled, double-blind clinical trial.

Setting: Specialized SCI center.

Participants: Participants included 42 individuals living with SCI for at least three years and exhibiting insufficient 25(OH)D levels at baseline (seven females, 35 males, mean age 48±10 years, 10 with tetraplegia, 32 with paraplegia).

Interventions: Participants were randomly assigned to receive placebo, medium-dose (24'000 IU every four weeks), or high-dose (24'000 IU every two weeks) vitamin D3 supplementation for 12 months.

Outcome measures: For 12 months, the following parameters were evaluated at three-month intervals: 25(OH)D levels; occurrence of urinary tract infections, pressure injuries, falls, and pain; handgrip strength; functional independence; levels of fatigue, anxiety, and depression.

Results: Of the participants who received supplementation, 33% achieved sufficient 25(OH)D levels. Pain was reported by 79% of participants during the study, while falls (57%), urinary tract infections (55%), and pressure injuries (21%) were reported less frequently. Vitamin D3 supplementation demonstrated no measurable effect on any of the investigated parameters (all P-values ≥ 0.19).

Conclusion: Vitamin D3 supplementation resulted in sufficient 25(OH)D levels in only a minority of participants, which may account for the absence of effects on secondary outcomes relevant to SCI. Future studies should investigate the efficacy of higher supplementation doses, particularly for individuals with clinically relevant levels of the respective outcomes.Trial registration: The study was registered at ClinicalTrials.gov (registration ID: NCT04652544).

Objectives: This study aimed to investigate the relationship between spinal alignment and trunk muscle strength, sitting balance and functionality in individuals with spinal cord injury.

Methods: This study included 46 individuals with spinal cord injury (SCI) at T7 or below (AIS A or B) (mean age: 38.93 ± 14.43). Spinal alignment in a sitting posture was assessed using the DIERS Formetric Functional Spine and Posture Analysis System, while trunk muscle strength was measured with the DIERS Myoline Isometric Muscle Force Analysis System. Trunk balance was evaluated using the Trunk Control Test (TCT), Function in Sitting Test (FIST), and Modified Functional Reach Test (mFRT). Functional ability and independence were assessed with the Spinal Cord Independence Measure (SCIM-III).

Results: The analysis of the relationship between spinal alignment and trunk isometric muscle strength revealed a moderate positive correlation between trunk extensor strength and trunk length (r_s = -0.502) and a moderate negative correlation with vertebral rotation (+max) (r_s = -0.555). Also, a moderate negative correlation was found between trunk flexor strength and vertebral rotation (+max) (r_s = -0.480). No correlation was found between the spinal alignment and balance and functionality.

Conclusions: This study shows that trunk extensor strength is significantly associated with spinal alignment parameters, such as vertebral rotation and trunk length, in individuals with spinal cord injury. However, no relationship was found between spinal alignment and sitting balance or functional performance. These results suggest that combining postural assessment and trunk strengthening in rehabilitation may help improve posture and mobility.