Journal of Spinal Cord Medicine最新文献

Context: Sailing is a sport that can help in the rehabilitation of Spinal Cord Injury (SCI) patients and improve their quality of life. Teaching methodology in sailing has always been considered as complex, due to the great amount of uncertainty that this sport has.Purpose: To design a protocol for teaching adapted sailing in a simulated situation for people with SCI and to know the effect of the teaching protocol on learning, effort perception and heart rate.Method: Six adults were patients recruited at the National Hospital of Paraplegics of Toledo (Spain), aged between 31 and 54 years, who have passed the early subacute phase. Each subject underwent semi-immersive virtual reality sailing therapy for 40 min per session three times per week for six weeks, 18 sessions. A simulated adapted sailing initiation program VSail-Trainer® was used for the simulator therapy. During this session, the basic notions of sailing, wind direction, sheet trimming and control of the boat on different courses were explained. The variables assessed were: sailing learning, heart rate and effort perception.Results: The comparison of performance variables between pretest and posttest resulted differences in boat speed, heel and Velocity Made Good (VMG). These improvements in the performance variables are also reflected in the average times taken by the subjects to complete the regatta.Conclusion: The methodology used in this study can be used as a guide for learning the activity by new SCI patients in rehabilitation who want to get into sailing sport.

Objectives: Assess the occurrence of neuropathic pain in spinal cord injured persons (SCIP) and define the relationship between neuropathic pain with demographic and clinical characteristics in SCIPs.Methods: This Analytical cross-sectional study was conducted on 104 SCIPs treated at our tertiary care hospital. Initial clinical evaluation was done according to the American Spinal Injury Association (ASIA) impairment scale. A clinical evaluation was done. All subjects were screened with the Leeds Assessment of Neuropathic Symptoms, Signs (LANSS) and DN4 questionnaire for neuropathic pain. The Visual Analogue Scale (VAS) was used to measure the severity of neuropathic pain. Later two groups were created based on the presence and absence of neuropathic pain.Results: The mean age was 35.04 ± 13 years. Fifty-eight patients (55.8%) had a complete injury (ASIA grade A), 41 (39.4%) patients had an incomplete kind of injury (ASIA grade B-D) and 5(4.8%) patients had no deficits (ASIA grade E). Neuropathic pain was present in 77(74.0%) and absent in 27(26.0%) patients. Seventy-one patients (92.2%) experience neuropathic pain in the first year after traumatic SCI. Medicines were a common pain-relieving factor 64(83.1%).Conclusion: 74% of patients complained of neuropathic pain, indicating a significant complication. A comprehensive evaluation and treatment are necessary to address it while including variables like the completeness of injury, duration and timing.

Objective: Hip subluxation is a common complication in children with spinal cord injury. This study aimed to investigate the incidence and influencing factors of hip subluxation and discuss prevention strategies.Methods: Medical records of children with spinal cord injury were reviewed. The inclusion criteria were as follows: (1) the patient was younger than 18 years old when injured; (2) absence of traumatic or congenital pathological changes of the hip at the time of injury. The migration percentage and acetabular index were selected to evaluate hip stability and acetabulum development. Influencing factors of sex, age, injury duration, severity, level, and spasticity were analyzed.Results: A total of 146 children were enrolled. Twenty-eight children presented with hip subluxation and were significantly younger at the time of injury than those with normal hips (P = 0.002). The incidence of hip subluxation increased with the prolonged injury duration. Injury before age 6, complete injury, and flaccid lower extremities were significant influencing factors (P = 0.003, 0.004, and 0.015, respectively). The risk of hip subluxation decreased by 18% for every year older in injury age (P = 0.031) and decreased by 85% in children with spasticity (P = 0.018) than those without. However, the risk of hip subluxation in children with injury duration longer than 1 year was 7.1 times higher than those with shorter injury duration (P < 0.001).Conclusions: The incidence of hip subluxation in children with spinal cord injury increased with the injury duration. Younger children had immature hip development. Due to complete injury and flaccid muscle, lack of protection around the hip may lead to subluxation. Follow-up and prevention of hip subluxation need the joint effort of medical staff and families.

Objective: To assess the incidence and possible risk factors for venous thromboembolism (VTE) in patients admitted to a SCI rehabilitation center.Design: Retrospective review.Setting: Acute neurorehabilitation hospital specializing in SCI.Methods: Records of 228 consecutive admissions were reviewed. All patients received screening four limb ultrasounds on admission. Charts were reviewed to determine whether VTE was diagnosed at the acute care hospital or in the rehabilitation center; either on admission screening or later in the rehabilitation stay. Charts were reviewed to identify potential risk factors for VTE as well as the incidence of bleeding complications in patients on full anticoagulation.Results: In this cohort, 115 deep venous thromboses (DVTs) were identified in the following settings: 27% in acute care [n = 31], 70% on admission to rehabilitation [n = 80], and 24% during the rehabilitation stay [n = 28]. Of those on therapeutic anticoagulation due to admission diagnosis of VTE [n = 63], 12.7% developed recurrent DVT and 9.5% had bleeding complications. Of those who were initiated and continued on therapeutic anticoagulation, there was zero incidence of PE. Risk factors for the development of VTE included age, body mass index (BMI), rehabilitation length of stay, injury etiology, spinal cord-related surgery, and history of inferior vena cava filter.Conclusions: DVT was identified in 70% of this cohort with screening ultrasound on admission to rehabilitation and of those initiated and continued on therapeutic anticoagulation, none developed PE, while 9.5% had bleeding complications. Given the findings of this study, prospective research in noninvasive vascular ultrasound screening for VTE should be considered.

Context: Adolescents and young adults (AYA) with spina bifida (SB) are more susceptible to obesity due to impaired mobility. There is limited access to physical activity for this population.Objective: The primary aim of this study was to evaluate the feasibility of a mobile health app in a weight management program for AYA with SB. This was determined by measuring program adherence, active use of the app (defined as ≥3 uses per week), and user rating of the Pt Pal™ mobile app. Secondary outcomes were changes in BMI, quality of life, and health behavior, and the number of active participants over time.Methods: Patients from the SB Clinic of a large metropolitan hospital between the ages of 11-21 years and overweight were invited to participate. The program consisted of group nutrition sessions and an individualized exercise plan using a mobile app with coaching. Outcome measures were program adherence, changes in BMI, and validated survey responses. Descriptive statistical analysis was performed.Results: Fifteen participants enrolled, and ten participants completed the program. Five of the ten participants attended the nutrition sessions. The number of active app users declined after the first week. Seventy percent of participants decreased their BMI. Most participants reported the program improved their ability to exercise regularly, eat a healthier diet and feel more self-confident. Peds QL™ psychosocial health domains increased postintervention. The YRBS showed increased physical activity and less sedentary time postintervention.Conclusions: This mobile app-based weight management program with coaching implemented may not be feasible for adoption in the general population of AYA with SB; however, it was well received by some, and further testing is needed to determine how to improve feasibility. This study provides useful information to guide future programs utilizing digital health and coaching.

Objective: To determine the associations between trauma variables, acute phase-related variables, and patient-level characteristics with functional recovery during the first-year post-discharge from inpatient rehabilitation facilities (IRF) for individuals with spinal cord injury (SCI).Design: Retrospective cohort analysis.Setting: Two SCI Model Centers in Pennsylvania, United States.Methods: We were able to link 378 individuals with traumatic SCI between the Pennsylvania Trauma Systems Outcomes Study and the National SCI Model Systems databases. Nineteen individuals with SCI were excluded due to missing data. We estimated functional recovery based on changes in functional independence measure (FIM) total motor score during the first-year post-discharge from IRF in 359 individuals with SCI, who did not have any missing data, using ordinary least squares regression (OLS).Results: After discharge from IRF the majority of individuals with SCI improved over the first-year post-injury. Individuals with cervical A-C (injury severity group) who were older had a slight decrease in motor FIM at 1-year post-injury. Regression analysis indicated that lower functional recovery was associated with being of Black and Hispanic race and ethnicity, higher injury severity group, occurrence of non-pulmonary infection during acute care, and longer length of stay at IRF (R² = 0.36).Conclusions: Patient-level characteristics, trauma variables, and acute phase-related variables were associated with functional recovery post-discharge from IRF. Further research is necessary to collect and assess post-rehabilitation and socio-economic factors that play a critical role in continued functional recovery in the community.

Neuromuscular electrical stimulation (NMES) is often used to activate muscles impaired after spinal cord injury to elicit functional activities or to facilitate exercise. However, in addition to the cost and availability of NMES and the inherent muscle fatigue that is associated with its use may limit its widespread utilization. Optimizing stimulation parameters during NMES-induced contractions could maximize force production with less fatigue.Purpose: To examine the interrelationship of pulse duration and pulse frequency on torque production and muscle fatigue in both impaired and non-impaired skeletal muscle of men and women.Methods: Individuals with [n = 14 (6 females), 38 ± 13 yr; 175 ± 11 cm; 76 ± 20 kg] and without [n = 14 (6 females), 29 ± 8 yr; 175 ± 9 cm; 74 ± 14 kg] spinal cord injury (SCI) participated. Muscle torque was recorded during a series of NMES-induced isometric muscle contractions using different combinations of pulse durations and frequencies. Additionally, two different muscle fatigue protocols (20 and 50 Hz/200µs) were utilized to elicit repeat isometric muscle contractions (1s on and 1s off × 3 min).Results: There was a statistically significant linear trend for pulse charge (the product of pulse frequency and pulse duration) on isometric torque production in participants without (p < 0.001, η²= 0.79), and in participants with SCI (p < 0.001, η²= 0.66), with higher total pulse charge generating higher torque values. Participants with SCI had significantly greater muscle fatigue for both muscle fatigue protocols (p < 0.05).Conclusions: NMES protocols should consider using longer pulse durations with lower frequencies to maximize force production for individuals with SCI. However, because mechanisms of muscle fatigue may be different for impaired muscle when compared to non-impaired muscle, further studies on protocols to offset fatigue are warranted.

Objectives: To evaluate the demographics, clinical characteristics, hospital course, and factors associated with outcomes in patients with spinal cord injury associated with vertebral fracture (SCI-VF).Design: Retrospective analysis of data collected from electronic health record.Setting: A large for-profit United States health care system.Participants: 2219 inpatients with SCI-VF between 2014 and 2020 identified using International Classification of Disease codes.Main Outcome Measure: In-hospital mortality, and disposition (home vs. no-home discharge) after hospitalization.Results: The mean age of patients admitted with a diagnosis of SCI-VF was 54.80 ± 20.85 years with 68.27% identified as male. The cervical spine was the most prevalent site of fracture, displaced vertebral fracture was the most common radiographic diagnosis, and the majority of injuries were classified as incomplete. 836 (37.67% of all 2219) patients were discharged home and had a shorter length of stay (7.56 ± 13.58 days) when compared to the average of the total study population (11.56 ± 19.2 days). The most common hospital-acquired complication (HAC) was falls (n = 259, 11.67%). Characteristics associated with in-hospital mortality in the 96 patients (6.94% of 1,383 patients with no-home discharge) included initial respiratory failure, ICU stay, increased medical comorbidity index value, insulin use, and presence of cardiovascular, pulmonary, and gastrointestinal HACs.Conclusions: A large observational study of patients with SCI-VF can add to the knowledge of SCI characteristics in the U.S. population. Recognizing the common hospital-acquired conditions and clinical characteristics associated with increased in-hospital mortality can be helpful to improve the care of patients with SCI-VF.

Objective: To discuss the efficacy of exoskeleton robotic training on ambulation recovery in patients with spinal cord injury (SCI).Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched systematically from their inception to April 2022 for studies on exoskeleton robotic training in patients with SCI. The language was restricted to English. The retrieved studies were screened to select eligible clinical trials. Meta-analysis was performed using Review Manager 5.4.Results: Eleven randomized clinical trials (RCTs) involving 456 participants were included in the meta-analysis. The results of the meta-analysis showed that exoskeleton robotic training was more effective in improving FIM [SMD = 0.58, 95%CI = (0.07, 1.10), P = 0.03], LEMS [MD = 4.64, 95%CI = (3.58, 5.70), P<0.05], MAS [MD = 0.76, 95%CI = (0.48, 1.03), P<0.05] and BBS [MD = -3.11, 95%CI =  (-12.59, 6.36), P<0.05] in patients with SCI, compared to conventional gait training(CGT). Subgroup analysis showed that the exoskeleton robotic could significantly improve the walking endurance and walking speed of patients with a duration of injury within 6 months. The sensitivity of inverted funnel plot analysis is low, suggesting that the analysis results of this study are relatively stable.Conclusion: Exoskeleton robotic training improves ambulation in patients with SCI, especially for patients with a course of injury within six months.