Journal of Spinal Cord Medicine最新文献

Context: Spinal Cord Injuries (SCI) greatly affect physical independence, especially in older Veterans. While the Functional Independence Measure (FIM) is widely used in rehabilitation, it lacks consideration of SCI-specific needs such as ventilation, wheelchair use, and bowel/bladder management. The Spinal Cord Independence Measure-Version III (SCIM-III) was developed to address these gaps, but its effectiveness has not been studied in the veteran population, which is typically older, predominantly male, and has higher comorbidity rates. This study examined the concurrent validity, responsiveness, and predictive value of FIM and SCIM-III for length of stay (LOS) and discharge destinations in older Veterans with SCI.

Methods: This retrospective cohort study used data from an acute rehabilitation program (March 2021-May 2023) and included 33 adults (≥18 years) with a recent SCI (≤1 year) and a minimum one-week admission. Collected data included demographics, AIS level, injury type/duration, length of stay, and discharge destination.

Results: The SCIM-III demonstrated acceptable concurrent validity with the FIM, and both the FIM and SCIM-III were responsive to change. Neither measure was a significant predictor of discharge outcome. The SCIM-III admission score significantly predicted LOS, whereas the FIM admission total score did not significantly predict LOS.

Conclusion: SCIM-III demonstrates acceptable concurrent validity and responsiveness to change when compared with FIM. Only the SCIM-III admission scores predicted LOS. These initial findings suggest the utility of the SCIM-III for improving clinical care and discharge planning among Veterans.

Background: spinal cord injury (SCI) results in permanent disability and secondary complications, requiring long-term healthcare management. Globally, individuals with SCI face barriers to healthcare access; in Lebanon, data on these challenges are limited.

Objective: To assess healthcare and rehabilitation accessibility for individuals with SCI in Lebanon, focusing on facility accessibility, service utilization, coverage, patient satisfaction, and community reintegration.

Methods: A cross-sectional survey was conducted with 70 individuals with SCI receiving outpatient care in Lebanese rehabilitation and medical centers (January-March 2025). Data included sociodemographic and clinical profiles, facility accessibility audits, healthcare access and use, and patient satisfaction.

Results: Participants' mean age was 42.1 ± 14.9 years; 64.3% were male. Physical barriers were prevalent, with over 90% of Obstetrics & Gynecology and 85% of Family and Physical Medicine clinics lacking accessible imaging and restrooms. Only 53.3% had partial health coverage, and 59.2% cited unaffordability as the main barrier to care. All received rehabilitation, mostly physical therapy (93.5%), while access to occupational and psychological therapies was limited (29% each). Though satisfaction was high, 51.6% lacked post-rehabilitation follow-up. Major reintegration challenges included inaccessible public spaces (38.6%) and financial hardship (25.7%).

Conclusion: Significant physical, financial, and systemic barriers hinder healthcare and rehabilitation access for individuals with SCI in Lebanon. Coordinated efforts are needed to improve infrastructure, insurance coverage, and continuity of care, enhancing outcomes and community inclusion for this population.

Context: Pressure injuries remain highly prevalent in the spinal cord injury and Disorder (SCI/D) population, despite evidence that supports preventive behaviors such as daily self-skin inspection. Long-handled mirrors are issued as standard of care in the Veterans Health Administration (VHA) but are of little utility when the patient has impaired mobility. VHA researchers sought to test a skin inspection tool (now known as the Habit Camera™) which has features intended to overcome the need for excessive trunk rotation and excellent coordination. Pictures can be captured, edited, and uploaded for communication to healthcare practitioners. Gaps still exist regarding the feasibility of use in daily life. The purpose of this report is to explore patterns influencing feasibility of use during pilot field testing of the first commercially available version of the Habit Camera.

Methods: We employed a user-centered design with Veterans with SCI/D. Participants tested the Habit Camera for four weeks. Semi-structured interviews were conducted at the start, and completion of the 4-week period. Interviews were recorded and field notes collected. Data were analyzed using a rapid qualitative assessment.

Results: Five Veterans with SCI/D participated. The following were identified as influencing feasibility of the Habit Camera for skin inspection: design features, learning skills for use, and technical proficiency.

Conclusions: Interactions may occur between identified factors influencing feasibility of a device for skin inspection, with a potential overarching influence of motivation and caregiver support. This work highlights the need to measure these factors when assessing the feasibility of new devices and technologies.

Context/objective: Venous thromboembolism (VTE) poses significant risks in persons with traumatic spinal cord injury (tSCI) during the acute and sub-acute post-injury phases. This study examines VTE prophylaxis, surveillance, and treatment practices in the inpatient rehabilitation setting.

Design: Cross-sectional.

Setting: Online.

Participants: SCI providers at Spinal Cord Injury Model Systems (SCIMS).

Interventions: Survey via REDCap based upon a case scenario.

Outcome measures: The primary aim of the study was to examine current practices related to the screening and prevention of deep vein thrombosis (DVT), as well as the monitoring and treatment of both DVT and pulmonary embolism (PE).

Results: Among 47 providers surveyed about management of a patient with C6 ASIA Impairment Scale (AIS) A tetraplegia 10 days post-injury, 53.2% order routine admission duplex scans (40.0% of those providers obtain scans of both upper and lower limbs). Low molecular weight heparin (LMWH) is the preferred agent for VTE prophylaxis (91%), most commonly enoxaparin 40 mg daily, followed by 30 mg twice daily. Approximately one-third of respondents continue prophylaxis for 8 weeks, another third for 12 weeks, and the remainder varied based on individual circumstances. For proximal DVT treatment, 61.1% prescribe a LMWH followed by a direct oral anticoagulant (DOAC), and 30.6% use a DOAC alone, with the majority of providers treating for 3 months.

Conclusion: This survey highlights diverse practices amongst tSCI providers regarding diagnostic testing, VTE prophylaxis, and treatment approaches for persons with tSCI in SCIMS centers. The variability underscores the need for high-quality research and updated, SCI-specific clinical guidelines.

Objective: This study investigates intrathecal baclofen (ITB) therapy referral timing, dosing patterns, and complications in individuals with spinal cord injury (SCI).

Study design: Retrospective chart review.

Setting: Outpatient clinic.

Methods: A total of 147 adults with SCI and spasticity who underwent ITB trials or therapy at our center between July 2013 and July 2023 were included. Data were collected to assess ITB trial outcomes, referral patterns, dosing trends, and ITB-related complications.

Results: Of the 147 patients, 89% had traumatic SCI, 11% had nontraumatic SCI, and 79% were male, with a median age of 28 years (IQR: 21-44). The median Modified Ashworth Scale (MAS) score at referral was 3 (IQR: 3-3), and the Penn Spasm Frequency Scale (PSFS) score was 3 (IQR: 2-3). Nontraumatic SCI required higher median ITB doses than traumatic SCI (458 mcg vs. 300 mcg, p = 0.04). Additionally, individuals with AIS D required significantly lower doses (p < 0.001). The ITB-related complication rate was 27%, with pump site infections (13%) and catheter malfunctions (9%) being the most common. Despite complications, 82% of affected patients underwent successful pump re-implantation or catheter replacement.

Conclusion: Most ITB recipients are younger individuals with severe spasticity at referral. Dosing patterns vary by etiology and severity of injury. While ITB is effective, long-term monitoring is essential to mitigate ITB-related infections and catheter complications. Further research is needed to study risk factors for complications and evaluate long-term outcomes.

Context: Painful tonic spasms (PTS) are a common symptom in patients with neuromyelitis optica spectrum disease (NMOSD). Antiepileptic drugs (AEDs) such as carbamazepine serve as first-line therapeutic agents for PTS. However, hypersensitivity reactions to carbamazepine may occur in some patients, necessitating alternative treatment regimens. Currently, clinical reports on the efficacy of the newer-generation AED topiramate for PTS remain limited.Findings: In this case report, we described a 38-year-old Chinese woman with a 2-year history of NMOSD who developed episodic spasms and pain in the limbs. Unfortunately, adverse reactions occurred after the administration of carbamazepine, and she was tried on topiramate as an alternative therapy. About 2 months after treatment, she experienced significant relief of symptoms without adverse events.Conclusion: Our case report highlights that topiramate can be used as an alternative therapy for PTS in NMOSD patients who had cannot tolerate carbamazepine.

Objectives: To determine rates of opioid and concomitant antidepressant, anticonvulsant and benzodiazepine dispensing in the post-discharge period, after acute spinal cord injury (SCI).

Design: Single-center prospective cohort study with 12-month linked pharmaceutical data.

Setting: Community pharmaceutical dispensing.

Participants: Patients ≥18 who were diagnosed with a SCI between March 2017 and March 2018.

Outcome measures: Rates of dispensing of opioid and concomitant antidepressant, anticonvulsant and benzodiazepine medications in the 12-month post-discharge from a specialist inpatient Spinal Injuries Unit.

Results: Sixty-eight participants volunteered for the study. Of the medications dispensed in the 12-months after discharge, 16% were opioids, which were supplied to 56% of participants. Forty-six percent of participants had concurrent dispensing of at least one other medication class of interest (antidepressants, anticonvulsants, or benzodiazepines). Participants with opioids prescribed at discharge were 6.5 times more likely to have been dispensed opioids in the 12-months following discharge compared to those who did not have opioids listed at discharge (OR = 6.5, 95% CI = 2.2, 19.0, P < .001).

Conclusions: Longer-term opioid prescribing plus concomitant analgesia and sleep medications in the post-acute period after SCI were common. Chronic opioid use and the polypharmacy observed is concerning, given the potential for dependence, tolerance and increased drug interactions and associated adverse effects. Both issues point to the need for clear discharge instructions for primary care prescribers and regular monitoring to manage pharmacotherapy therapeutic benefits and risks alongside non-medication therapies.

Design: Retrospective observational study.

Objective: To analyze changes in mood states during the acute phase of inpatient rehabilitation for spinal cord injury (SCI) and the factors associated with worse mood states and less improvement.

Setting: Spinal unit in Italy.

Participants: The study included people with SCI admitted between 2014 and 2019 and treated for psychological problems with a focus on 'emotion processing' and 'emotional adjustment'. The sample included 170 patients (71.8% male, mean age 47.1 ± 16, range 17-78), 46.5% with tetraplegia and 50% with comorbidities.

Outcome measures: The Profile of Mood States (POMS) questionnaire was used to assess mood states at baseline and at the end of treatment. Multiple linear regression models were used to identify factors associated with changes in mood states during treatment.

Results: At baseline, patients with distress related to SCI diagnosis reported lower levels of vigor, whereas those with distressing life events reported higher levels of anger and confusion-bewilderment. POMS subscales improved significantly by at least 4 points. ASIA Impairment Scale (AIS) C score, living with family of origin, comorbidities and critical events during hospitalization were associated with greater improvements, whereas higher education was associated with less improvement in depressive mood. In tetraplegic patients, higher improvements in depressive mood were associated with greater independence at discharge, whereas in patients with paraplegia, higher improvements in anxiety and vitality were associated with better mobility.

Conclusion: Our results indicate that mood states improved in people with SCI receiving a psychological treatment. Socio-demographic and SCI-related characteristics associated with a greater effect of psychological treatment should be considered in order to tailor the intervention.

Objectives: To investigate the safety and feasibility of repeated transcutaneous spinal direct current stimulation (tsDCS) as priming strategy during exoskeleton-assisted locomotor training in individuals with SCI and evaluate potential neurophysiologic and functional gait changes.

Study design: Case series experimental design.

Setting: Research laboratory at a post-acute rehabilitation hospital.

Participants: Four participants with chronic incomplete SCI.

Interventions: Four participants with chronic incomplete SCI received three weeks of training consisting of two types of interventions after baseline (A): 20-minute tsDCS (anode or cathode) applied over the spinous processes of T10 followed by 20-minute exoskeleton-assisted locomotor training (B, B1, B2) and 20-minute exoskeleton-assisted locomotor training (C, C1, C2). Each phase consisted of five consecutive intervention sessions. Two participants underwent sequence A-B1-C-B2 and two sequence A-C1-B-C2. Soleus Hoffmann Reflex (H-reflex) and gait speed (10-m walk test) were assessed on the first and fifth days of training for each training type.

Outcome measures: Adverse skin reactions or other events, H-reflex (Hmax/Mmax ratio), and gait speed (10-m walk test).

Results: No adverse events occurred. All participants tolerated tsDCS with no negative effects on their skin. Participants demonstrated varied responses in their H/M ratios after tsDCS followed by exoskeleton-assisted locomotor training as well as after exoskeleton-assisted locomotor training. No consistent pattern can be identified in this case series. Three participants showed an increase in gait speed after tsDCS combined with exoskeleton-assisted locomotor training.

Conclusions: Noninvasive repeated spinal stimulation can safely be used in individuals with incomplete SCI. Further large-scale research is necessary to determine the efficacy of tsDCS for priming the spinal cord in facilitating recovery of gait in individuals with SCI.

Study design: Retrospective data analysis study.

Objectives: To assess gait recovery rates in subjects with motor incomplete spinal cord injury (SCI) at the start of rehabilitation and to report their gait performance.

Setting: Tertiary inpatient Rehabilitation Center in Argentina.

Methods: The study analyzed data from 143 individuals with traumatic and non-traumatic SCI (AIS/ASIA Impairment Scale C and D) within 90 days of injury, all non-ambulatory upon admission. Gait status at discharge was evaluated using the 6-minute walk test and the Walking Index for Spinal Cord Injury II (WISCI II). Statistical evaluations utilized Pearson chi-square and Mann-Whitney U-tests. Approval was obtained from Fleni's Ethics Committee.

Results: Among the 65 patients with AIS C, 69% regained walking function, compared to 87% of the 74 patients with AIS D (p = 0.01). Walkers had a mean total motor score of 67 (±19) versus 51.7 (±25.5) for non-walkers (p = 0.002), and a total pinprick sensation score of 69.8 (± 27.5) vs. 49.5 (± 29) (p = 0.001). Additionally, 54% of AIS C and 86% of AIS D patients aged ≥ 50 regained walking ability; however, age-related differences were statistically significant only in AIS C group (p = 0,015). AIS D patients walked a mean of 249 meters (±134), while AIS C walked 207 meters (±128) (p = 0.07). The median WISCI II score between the two groups were not statistically significant.

Conclusions: Most patients with incomplete motor SCI who participated in inpatient rehabilitation regained walking, with motor score and pinprick sensation correlating to walking ability. Gait performance was comparable between AIS C and D.