Journal of Spinal Cord Medicine最新文献

Context/objective: Non-invasive neuromodulation may be an effective treatment for stimulating motor and functional recovery of the upper extremities after spinal cord injury (SCI). We aimed to investigate the effects of combining repetitive transcranial magnetic stimulation (rTMS) with robotic therapy. We compared upper extremity function in patients who received rTMS and robot therapy to those who received sham rTMS and robot therapy.

Design: Randomized controlled trial.

Setting: Rehabilitation center.

Participants: Thirty patients with SCI were randomized into two groups: an intervention group (IG) receiving rTMS plus robotic therapy and a control group (CG) receiving sham rTMS with robotic therapy.

Interventions: The IG received 15 sessions of combined rTMS and robotic therapy over 5 weeks (3 sessions per week), while the CG received sham rTMS with robotic therapy.

Outcome measures: Functional assessments pre- and post-intervention included the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), grip strength, pain levels, the modified Ashworth scale (MAS), and the Korean version of the Spinal Cord Independence Measure III (KSCIM-III).

Results: Both groups showed significant post-treatment improvements in GRASSP domains (Strength, Sensation, Quantitative Prehension), with no significant intergroup differences. Grip strength, pain, and MAS scores improved in both groups without significant differences. In KSCIM-III, the IG showed significant gains in feeding and grooming, while the CG significantly improved in wheelchair-to-toilet/tub transfers.

Conclusions: This study suggests that combining rTMS with upper extremity robotic therapy may have potential benefits for upper extremity function in patients with SCI. However, the addition of rTMS did not demonstrate clear superiority over robotic therapy alone. Further research with larger cohorts and optimized protocols is warranted to clarify its therapeutic value.Trial registration: Clinical Research Information Service, Republic of Korea identifier: KCT0004443.

Context: Frailty has emerged as a key determinant of surgical outcomes, surpassing chronological age and comorbidity indices in prognostic value. The Risk Analysis Index (RAI), a multidomain frailty assessment tool, has shown strong predictive utility in spine surgery. Recent analyses specifically evaluated RAI in urgent surgical intervention for acute traumatic spinal cord injury (SCI), where timely outcome prediction is critical.Findings: In 10,000 SCI patients, frailty demonstrated a graded association with adverse 30-day outcomes. Mortality increased from 1.5% in robust individuals (RAI 0-20) to 11.8% in very frail patients (RAI >41), paralleled by increased non-home discharge and complications. The RAI consistently outperformed the modified frailty index (mFI-5), achieving c-statistics >0.72 for mortality and discharge outcomes. These results align with broader spine surgery literature, where the RAI has demonstrated superior discrimination compared to mFI-5 across elective cases, degenerative conditions, spinal deformity, and tumor surgery. Predictive strength reflects incorporation of functional and nutritional domains, which comorbidity-based indices miss. Importantly, RAI-based analyses have identified high-risk subsets even in lower-risk cohorts, such as anterior cervical discectomy, underscoring its generalizability.Conclusion/Clinical Relevance: The RAI reliably predicts short-term outcomes after SCI and across diverse spine surgery populations, outperforming simpler frailty measures. Its integration into neurosurgical assessment enables more accurate risk stratification, informs perioperative management, and supports shared decision-making. Routine use of the RAI may guide multidisciplinary optimization and resource allocation, and future interventions targeting frail patients may leverage its predictive capacity to improve outcomes.

Objectives: In all patients, LFAS To explore the effect of low frequency antidromic stimulation (LFAS) of the pelvic somatic serves on intestinal peristalsis and heart rate in individuals with chronic spinal cord ird injury and spasticity.

Setting: Hospital in Zürich, Switzerland.

Methods: Ten consecutive patients underwent laparoscopic implantation of neuroprosthesis to sciatic/femoral nerves - the LION procedure: 5 patients with Thoracic (T) SCI AIS A, 1 patient T4 AIS C, 1 patient C3 AIS A, and 3 patients with cervical injury (AIS B/C). At the end of the implantation, intestinal peristalsis observed laparoscopically was recorded before and after starting with LFAS at 10 Hz. On the first postoperative day, heart rates before and after the beginning of the same LFAS were checked. Statistical analyses were performed using a paired Student's t-test.

Results: LFAS Of the pelvic somatic nerves induced strong peristalsis in the small bowel and ascending/transverse colon without affecting the urinary bladder or descending colon/rectum, and a significant slowing of the heart rate in 8 patients with an overall reduction from 96.3 bpm (bpm) (P < 0.01).

Conclusions: This case series study reports on the effect of continuous antidromic pelvic neuromodulation (CAPN) on extraspinal somatic and autonomic pathways in chronic SCI. The discussion poses a novel hypothesis about the effect of CAPN on spinal pathways and activation of corticospinal pathways and neuroplasticity via the Renshaw cells. A rationale is provided for CAPN-induced activation of the vagus nerve (VN) and the existence of anastomotic pathways between the lumbosacral somatic nerves and the VN, and the capability of an activation of the motor functions of the VN. A second hypothesis is posed for the activation of cortico-vagal plasticity that may improve recovery after complete SCI by combining CAPN with neuromodulation of the VN.Trial registration NCT03441256.

Study design: Case report.

Objectives: Pressure ulcers (PUs) affect many spinal cord-injured individuals and can result in serious life-threatening complications including infections and gangrene. Treatment is lengthy and extremely expensive due to recurrent and prolonged hospitalization and multiple surgeries. Consequently, for both medical and economic reasons, intensive efforts in prophylaxis and new effective therapeutic options are mandatory. This report presents the positive effects of pelvic nerve stimulation on the healing of gluteal and heel PUs.

Setting: Hospital in Zürich/CH.

Methods: Five patients with spinal cord injuries with PUs underwent continuous low-frequency electrostimulation (10 Hz) of the sciatic and femoral nerves by means of laparoscopic implantation of a neuroprosthesis via the LION procedure. This procedure is primarily performed in persons with chronic spinal cord injuries to facilitate voluntary electrically assisted walking function. Evaluations included quadriceps muscle thickness, regional skin temperature, and subjective healing reports. Evaluations were conducted at baseline and after three months of stimulation.

Results: The LION procedure significantly increased the healing process of gluteal (n = 3) and heel (n = 2) PUs in 5 patients. Besides cutaneous vasodilation, there was a significant increase in gluteal/legs muscle mass on both sides. All ulcers completely healed within three months.

Conclusions: Pelvic somatic nerve stimulation showed promise as a treatment for pressure ulcers in patients with spinal cord injuries by enabling gluteal pressure relief, peripheral vasodilation, and muscle building.

Context: Individuals with spinal cord injury or disease (SCI/D) face significant barriers to physical activity, leading to high rates of sedentary behavior and related health complications. Structured Para sport programs in rehabilitation settings have emerged as a strategy to promote activity, improve outcomes, and support long-term health.

Objective: To investigate the relationship between Para sport systematization levels (PSL) and adherence to physical activity guidelines, physical fitness, and shoulder pain among manual wheelchair users with SCI/D in a rehabilitation hospital.

Design: Cross-sectional study. Setting: Rehabilitation hospital. Participants: 114 SCI/D participants stratified by three PSL levels (1-3). Outcomes measures: Physical activity adherence, fitness status, and shoulder pain prevalence were compared across groups using guideline-based criteria and regression models.

Results: PSL3 demonstrated greater adherence to physical activity guidelines (84.6%) and higher physical fitness levels (50.0%) compared to PSL1 and PSL2. Adherence to activity recommendations was approximately seven times higher in PSL3 than in PSL1, and five times higher than in PSL2. Shoulder pain prevalence was lowest in PSL3 (15.4%), in contrast to higher rates observed in PSL1 (30.0%) and PSL2 (24.1%). Logistic regression analyses revealed significant associations between PSL and physical fitness (P < 0.01). No significant associations were identified between shoulder pain and adherence to physical activity.

Conclusion: Structured Para sport programs within rehabilitation hospitals enhance physical activity participation may reduce shoulder pain prevalence. The PSL was a stronger predictor of adherence than demographic or clinical factors, supporting the integration of PSL programs as a cost-effective, health-promoting strategy in SCI/D rehabilitation.

Objective: Spinal tumors are the leading cause of acute SCI. Little is known about the care pathway and outcomes of patients with SCI due to NESCC. This paper aims to compare the burden of care of patients with TSCI vs. SCI caused by neoplastic epidural spinal cord compression (NESCC).

Design: Retrospective cohort study.

Setting: Level-1 trauma center in Montreal, Canada.

Participants: of 441 consecutive patients with TSCI, or NESCC.

Methods: Sociodemographic variables and injury characteristics were collected. The rates of pneumonia, urinary tract infection, pressure injury, and the length of stay in the acute care before discharge were compared between patients with NTSCI vs. TSCI. Multivariable analyzes were then performed to determine if the etiology of SCI was independently associated with the outcomes above.

Results: Of the 441 patients recruited, 124 presented with NESCC and 317 with TSCI. Individuals with NESCC were less likely be male, were older, had more comorbidities and were more likely to present incomplete paraplegia. In addition, they had lower rates of pneumonia (8.1% vs. 19.2%; P = 0.004), UTI (10.5% vs. 20.5%; P = 0.013), and shorter average acute length of stay (21.7 ± 18.4 vs. 28.3 ± 20.2; P = 0.002), while the rates of pressure injuries were similar. At the multivariable level, a NTSCI was associated with lower odds of urinary tract infection (OR = 0.235; P = 0.013) and shorter LOS (=-0.189; P = 0.004).

Conclusion: Despite being older and presenting more comorbidities, patients with NESCC have lower rates of acute complications and shorter length of stays in the acute hospitalization, regardless of the severity of the initial injury.

Purpose: to investigating the effectiveness of a Mindfulness-Based Stress Reduction (MBSR) intervention on resilience, quality of life (QoL), and individual independence in individuals with spinal cord injury (SCI).

Materials & methods: In this randomized clinical trial, 56 individuals with SCI were recruited through convenience sampling and randomly assigned to intervention and control groups. The intervention group received six weekly face-to-face MBSR sessions, while the control group continued with their routine home care. Patients completed assessments at three time points: baseline, immediately post-intervention, and one-month post-intervention. The assessments included demographic information, the spinal cord injury Quality of Life Questionnaire (SCIQL-23), Spinal Cord Independence Measure III (SCIM III), and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10-P). Data were analyzed using inferential statistics, including independent t-tests and repeated measures ANOVA, with SPSS version 26.

Results: The MBSR intervention significantly improved resilience and QoL in the intervention group at both post-intervention time points compared to baseline (P < 0.05). Resilience scores increased by approximately 4 points, and QoL scores improved by around 3 points. No significant changes were observed in the control group (P ≥ 0.05). However, no significant improvements in individual independence were detected either between or within groups after the intervention (P ≥ 0.05).

Conclusion: MBSR, a simple, nurse-led, and non-invasive intervention, significantly enhanced resilience and QoL in individuals with SCI. These findings highlight the value of psychological interventions in improving mental well-being in this population. Nonetheless, the lack of improvement in individual independence suggests the need for further research to explore this outcome more thoroughly.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20220813055673N1.

Objective: This study aimed to compare shoulder jerk magnitudes during level and floor transfers and evaluate the impact the head-hips technique on shoulder mechanics in full-time wheelchair users (WCUs). From an ergonomics perspective, elevated magnitudes in jerk are associated with overuse injuries. In other aspects of wheelchair biomechanics, such as propulsion kinematics, increased jerk at the shoulders during manual propulsion has been predictive of shoulder pain. Exploratorily, this study aimed to evaluate the influence of sex, weight, and physical activity on shoulder jerk.

Design: Cross-sectional study. Setting: University-based laboratory in Champaign, USA. Participants: A convenient sample of full-time WCUs that could perform independent level and floor transfers were recruited for participation. Outcome Measures: Using Mann-Whitney U test, data was stratified based on transfer type and sex to determine if differences existed in shoulder jerk magnitudes across stratifications. Spearman's correlation was conducted to assess relationships between shoulder jerk, body weight, physical activity, and trunk flexion (i.e. head-hips technique).

Results: Peak and average shoulder jerk magnitudes were significantly greater during floor transfers compared to level transfers. Trunk flexion was negatively correlated to peak shoulder jerk and weight during level transfers. Physical activity was negatively correlated to average shoulder jerk during level transfers. Females experienced reduced shoulder jerk compared to males during level transfers.

Conclusion: The use of head-hips technique and the higher levels of chronic physical activity may play a role in protecting the shoulders during transfer-related activities. Floor transfers may pose risks to shoulder health for WCUs that should be limited when possible. Clinicians should emphasize the importance of the head-hips technique and fitness for maintaining long-term shoulder health in WCUs.

Context: Large language models (LLMs), such as ChatGPT and DeepSeek, are increasingly used by patients for medical information about their health condition. While several studies have explored ChatGPT's performance in spinal cord injury (SCI)-related queries, no direct comparison between GPT-4o and DeepSeek-V3 has been conducted in this context.

Methods: The five most-searched SCI-related topics comprising of forty-eight questions were generated based on top Google Trends search terms. Responses were generated using GPT-4o and DeepSeek-V3, with three outputs per question. A total of two hundred and eighty-eight responses were independently evaluated by three Rehabilitation Physicians using the S.C.O.R.E. framework, which evaluates five domains: Safety, Consensus with Guidelines, Objectivity, Reproducibility, and Explainability on a 5-point Likert scale. Paired t-tests were used to compare model performance.

Results: Both models achieved high ratings for Safety and Consensus with Guidelines. DeepSeek-V3 scored slightly but significantly higher in Objectivity (P = 0.014), Reproducibility (P = 0.007), and Explainability (P < 0.001). No significant differences were found in Safety or Consensus with Guidelines. Qualitative review highlighted more consistent and contextually rich answers from DeepSeek-V3.

Conclusion: While both GPT-4o and DeepSeek-V3 are generally safe and informative tools for SCI patient education, DeepSeek-V3 demonstrated slightly superior performance in delivering consistent, objective, and well-explained responses. LLMs may serve as useful adjuncts in SCI patient education, but ongoing evaluation and clinician oversight remains essential.

Study design: A retrospective study with a crossover design.

Objectives: Maintaining mean arterial pressure (MAP) is crucial in the early management of SCI, yet the role of oral midodrine in this setting remains unclear. This study evaluates whether midodrine facilitates IV vasopressor weaning within 24 hours of initiation.

Setting: The study was conducted at a Level 1 trauma center.

Methods: A cohort of 28 patients was analyzed. MAP levels and IV vasopressor dosages were recorded 24 hours before and after midodrine initiation. The primary outcome was reduced IV vasopressor use while maintaining MAP targets.

Results: Midodrine was started on average 4.0±1.9 days after initiation of intravenous vasopressor therapy. Twenty-two individuals (78.6%) received less intravenous vasopressors during the 24-hour period after initiation of midodrine. Mean MAP remained similar 24 hours before vs. after initiation of midodrine (90.4±3.3 vs. 88.6±5.1 mm Hg). Earlier introduction of midodrine was significantly related to more rapid weaning and reduced total duration of intravenous vasopressor therapy.

Conclusions: Initiating oral midodrine in the ICU within 7 days of a traumatic SCI resulted in a rapid decrease in intravenous vasopressor requirements in close to 80% of people while maintaining MAP targets, therefore supporting the potential of midodrine to accelerate the weaning of intravenous vasopressors.