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Stevanovic S, Dalmao-Fernandez A, Mohamed D, Nyman TA, Kostovski E, Iversen PO, Savikj M, Nikolic N, Rustan AC, Thoresen GH, Kase ET. Time-dependent reduction in oxidative capacity among cultured myotubes from spinal cord injured individuals. Acta Physiol (Oxf) 2024; 240:e14156. [PMID: 38711362 DOI: 10.1111/apha.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/27/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Skeletal muscle adapts in reaction to contractile activity to efficiently utilize energy substrates, primarily glucose and free fatty acids (FA). Inactivity leads to atrophy and a change in energy utilization in individuals with spinal cord injury (SCI). The present study aimed to characterize possible inactivity-related differences in the energy metabolism between skeletal muscle cells cultured from satellite cells isolated 1- and 12-months post-SCI. METHODS To characterize inactivity-related disturbances in spinal cord injury, we studied skeletal muscle cells isolated from SCI subjects. Cell cultures were established from biopsy samples from musculus vastus lateralis from subjects with SCI 1 and 12 months after the injury. The myoblasts were proliferated and differentiated into myotubes before fatty acid and glucose metabolism were assessed and gene and protein expressions were measured. RESULTS The results showed that glucose uptake was increased, while oleic acid oxidation was reduced at 12 months compared to 1 month. mRNA expressions of PPARGC1α, the master regulator of mitochondrial biogenesis, and MYH2, a determinant of muscle fiber type, were significantly reduced at 12 months. Proteomic analysis showed reduced expression of several mitochondrial proteins. CONCLUSION In conclusion, skeletal muscle cells isolated from immobilized subjects 12 months compared to 1 month after SCI showed reduced fatty acid metabolism and reduced expression of mitochondrial proteins, indicating an increased loss of oxidative capacity with time after injury.
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Affiliation(s)
- Stanislava Stevanovic
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Andrea Dalmao-Fernandez
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Derya Mohamed
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Tuula A Nyman
- Department of Immunology, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Emil Kostovski
- Vestre Viken Hospital Trust, Drammen, Norway
- Manifestsenteret, Røyken, Norway
| | - Per Ole Iversen
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway
- Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - Mladen Savikj
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Natasa Nikolic
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Arild C Rustan
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - G Hege Thoresen
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eili T Kase
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
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Chen DY, Di X, Karunakaran KD, Sun H, Pal S, Biswal BB. Delayed cerebrovascular reactivity in individuals with spinal cord injury in the right inferior parietal lobe: a breath-hold functional near-infrared spectroscopy study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.03.24307819. [PMID: 38883754 PMCID: PMC11177928 DOI: 10.1101/2024.06.03.24307819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Cerebrovascular reactivity (CVR) reflects the ability of blood vessels to dilate or constrict in response to a vasoactive stimulus, and allows researchers to assess the brain's vascular health. Individuals with spinal cord injury (SCI) are at an increased risk for autonomic dysfunction in addition to cognitive impairments, which have been linked to a decline in CVR; however, there is currently a lack of brain-imaging studies that investigate how CVR is altered after SCI. In this study, we used a breath-holding hypercapnic stimulus and functional near-infrared spectroscopy (fNIRS) to investigate CVR alterations in individuals with SCI (n = 20, 14M, 6F, mean age = 46.3 ± 10.2 years) as compared to age- and sex-matched able-bodied (AB) controls (n = 25, 19M, 6F, mean age = 43.2 ± 12.28 years). CVR was evaluated by its amplitude and delay components separately by using principal component analysis and cross-correlation analysis, respectively. We observed significantly delayed CVR in the right inferior parietal lobe in individuals with SCI compared to AB controls (linear mixed-effects model, fixed-effects estimate = 6.565, Satterthwaite's t-test, t = 2.663, p = 0.008), while the amplitude of CVR was not significantly different. The average CVR delay in the SCI group in the right inferior parietal lobe was 14.21 s (sd: 6.60 s), and for the AB group, the average delay in the right inferior parietal lobe was 7.08 s (sd: 7.39 s). CVR delays were also associated with the duration since injury in individuals with SCI, in which a longer duration since injury was associated with a shortened delay in CVR in the right inferior parietal region (Pearson's r-correlation, r = -0.59, p = 0.04). This study shows that fNIRS can be used to quantify changes in CVR in individuals with SCI, and may be further used in rehabilitative settings to monitor the cerebrovascular health of individuals with SCI.
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Affiliation(s)
- Donna Y. Chen
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, US
- Rutgers Biomedical and Health Sciences, Rutgers School of Graduate Studies, Newark, NJ, US
| | - Xin Di
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, US
| | | | - Hai Sun
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, US
| | - Saikat Pal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, US
- Electrical and Computer Engineering Department, New Jersey Institute of Technology, Newark, NJ, US
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, US
| | - Bharat B. Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, US
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Meade MA, Yin Z, Lin P, Kamdar N, Rodriguez G, McKee M, Peterson MD. Type 2 Diabetes Increases the Risk of Serious and Life-Threatening Conditions Among Adults With Traumatic Spinal Cord Injury. Mayo Clin Proc Innov Qual Outcomes 2023; 7:452-461. [PMID: 37818139 PMCID: PMC10562090 DOI: 10.1016/j.mayocpiqo.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Objective To compare the incidence of and adjusted hazards for serious and life-threatening morbidities among adults with traumatic spinal cord injury (TSCI) with and without type 2 diabetes (T2D). Participants and Methods A retrospective longitudinal cohort study was conducted from September 1, 2022 to February 2, 2023, among privately insured beneficiaries if they had an International Classification of Diseases, 9th Revision or 10th Revision, Clinical Modification diagnostic code for TSCI (n=9081). Incidence estimates of serious and life-threatening morbidities, and more common secondary and long-term health conditions, were compared at 5 years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for serious and life-threatening morbidities. Results Adults living with TSCI and T2D had a higher incidence of all of the morbidities assessed as compared with nondiabetic adults with TSCI. Fully adjusted survival models reported that adults with TSCI and T2D had a greater hazard for most of the serious and life-threatening conditions assessed, including sepsis (hazard ratio [HR]: 1.65), myocardial infarction (HR: 1.63), osteomyelitis (HR: 1.9), and stroke or transient ischemic attack (HR: 1.59). Rates for comorbid and secondary conditions were higher for individuals with TSCI and T2D, such as pressure sores, urinary tract infections, and depression, even after controlling for sociodemographic and comorbid conditions. Conclusion Adults living with TSCI and T2D have a significantly higher incidence of and risk of developing serious and life-threatening morbidities as compared with nondiabetic adults with TSCI.
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Affiliation(s)
- Michelle A. Meade
- Department of Physical Medicine and Rehabilitation, University of Michigan Health, University of Michigan, Ann Arbor
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Zhe Yin
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
| | - Neil Kamdar
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Obstetrics and Gynecology, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan Health, University of Michigan, Ann Arbor
| | - Gianna Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan Health, University of Michigan, Ann Arbor
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
| | - Michael McKee
- Department of Physical Medicine and Rehabilitation, University of Michigan Health, University of Michigan, Ann Arbor
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan Health, University of Michigan, Ann Arbor
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
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Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case-control study. Spinal Cord 2023; 61:260-268. [PMID: 36797477 DOI: 10.1038/s41393-023-00879-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 01/06/2023] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
STUDY DESIGN This is a retrospective case-control study. OBJECTIVES To identify predictors of lower extremity (LE) long bone fracture-related amputation in persons with traumatic spinal cord injury (tSCI). SETTING US Veterans Health Administration facilities (2005-2015). METHODS Fracture-amputation sets in Veterans with tSCI were considered for inclusion if medical coding indicated a LE amputation within 365 days following an incident LE fracture. The authors adjudicated each fracture-amputation set by electronic health record review. Controls with incident LE fracture and no subsequent amputation were matched 1:1 with fracture-amputation sets on site and date of fracture (±30 days). Multivariable conditional logistic regression determined odds ratios (OR) and 95% confidence intervals (CI) for potential predictors (motor-complete injury; diabetes mellitus (DM); peripheral vascular disease (PVD); smoking; primary (within 30 days) nonsurgical fracture management; pressure injury and/or infection), controlling for age and race. RESULTS Forty fracture-amputation sets from 37 Veterans with LE amputations and 40 unique controls were identified. DM (OR = 26; 95% CI, 1.7-382), PVD (OR = 30; 95% CI, 2.5-371), and primary nonsurgical management (OR = 40; 95% CI, 1.5-1,116) were independent predictors of LE fracture-related amputation. CONCLUSIONS Early and aggressive strategies to prevent DM and PVD in tSCI are needed, as these comorbidities are associated with increased odds of LE fracture-related amputation. Nonsurgical fracture management increased the odds of LE amputation by at least 50%. Further large, prospective studies of fracture management in tSCI are needed to confirm our findings. Physicians and patients should consider the potential increased risk of amputation associated with non-operative management of LE fractures in shared decision making.
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Maher JL, Whitmarsh C, Smith P, Taylor H, Fard A, Bilzon J. Feasibility study of high-intensity interval training to reduce cardiometabolic disease risks in individuals with acute spinal cord injury. BMJ Open 2023; 13:e068507. [PMID: 36737096 PMCID: PMC9900054 DOI: 10.1136/bmjopen-2022-068507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Individuals ageing with spinal cord injury (SCI) experience an accelerated trajectory of diseases and disorders, such as cardiovascular disease and diabetes, that resemble those experienced with ageing alone. Currently, an evidence-based approach toward managing this problem does not exist and therefore the purpose of this study is to determine the feasibility of conducting a high-intensity exercise intervention in individuals with acute (<6 months postinjury) SCI to improve cardiometabolic health. METHODS AND ANALYSIS We will conduct a single-centre, two parallel-arm, randomised feasibility study of a high-intensity interval training (HIIT) intervention in individuals with acute SCI. We will enrol 40 individuals (20 intervention, 20 control) with acute SCI attending inpatient rehabilitation at Salisbury District Hospital. Participants will be randomly allocated to the intervention group (HIIT) or control group for 18 weeks. Both groups will participate in standard care throughout the duration of the study. The HIIT group only will also perform supervised HIIT exercise on an arm cycle ergometer three times per week. Over the course of the intervention, most participants will be discharged from the hospital, and at this time, an arm cycle ergometer will be installed in their home and the intervention will transition into outpatient care. We will assess cardiorespiratory fitness, glycaemic control, lipid profile and body habitus as well as qualitative assessments of acceptability at weeks 0, 9 and 18 with the primary outcome being the feasibility of a full Randomised Controlled Trial (RCT). ETHICS AND DISSEMINATION This study will inform a longer-term, definitive, multicentre RCT to establish the impact of this exercise intervention in maintaining the cardiometabolic health of patients during the acute phase following SCI. Results will be disseminated in different formats including peer-reviewed journal articles, conference presentations and internet media, to a wide audience including clinicians, researchers and individuals with SCI. TRIAL REGISTRATION NUMBER ISRCTN57514022.
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Affiliation(s)
| | - Catherine Whitmarsh
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Paula Smith
- Department of Psychology, University of Bath, Bath, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Aram Fard
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
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Petrie MA, Kimball AL, Shields RK. Acute Low Force Electrically Induced Exercise Modulates Post Prandial Glycemic Markers in People with Spinal Cord Injury. J Funct Morphol Kinesiol 2022; 7:jfmk7040089. [PMID: 36278750 PMCID: PMC9624321 DOI: 10.3390/jfmk7040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Regular exercise involves daily muscle contractions helping metabolize up to 70% of daily ingested glucose. Skeletal muscle increases glucose uptake through two distinct pathways: insulin signaling pathway and muscle contraction mediated AMPK pathway. People with paralysis are unable to contract their muscles which atrophy, transform into insulin resistant glycolytic muscle, and develop osteoporosis. Our goal is to determine if low force electrically induced exercise (LFE) will modulate the post prandial insulin and glucose response in people with and without spinal cord injury (SCI). 18 people with SCI and 23 without SCI (Non-SCI) participated in an assessment of metabolic biomarkers during passive sitting (CTL) and a bout of LFE delivered to the quadriceps/hamstring muscle groups after a glucose challenge. Baseline fasting insulin (p = 0.003) and lactate (p = 0.033) levels were higher in people with SCI, but glucose levels (p = 0.888) were similar compared to the non-SCI population. After 1-h of muscle contractions using LFE, heart rate increased (p < 0.001), capillary glucose decreased (p = 0.004), insulin decreased (p < 0.001), and lactate increased (p = 0.001) in the SCI population. These findings support that LFE attenuates certain metabolic blood biomarkers during a glucose challenge and may offer a lifestyle strategy to regulate metabolic responses after eating among people with SCI.
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7
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Goldsmith JA, Holman ME, Puri P, Khalil RE, Ennasr AN, Gorgey AS. The interaction of macronutrients and body composition among individuals with chronic spinal cord injury. Br J Nutr 2022; 129:1-12. [PMID: 35738897 PMCID: PMC9789189 DOI: 10.1017/s0007114522001830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Changes in body composition and dietary intake occur following spinal cord injury (SCI). The Geometric Framework for Nutrition (GFN) is a tool that allows the examination of the complex relationships between multiple nutrition factors and health parameters within a single model. This study aimed to utilize the GFN to examine the associations between self-reported macronutrient intakes and body composition in persons with chronic SCI. Forty-eight individuals with chronic SCI were recruited. Participants completed and returned 3- or 5-day self-reported dietary recall sheets. Dietary intake of macronutrients (fats, proteins, and carbohydrates) were analysed. Anthropometric measures (circumferences), dual-energy x-ray absorptiometry (DXA), and magnetic resonance imaging (MRI) were used to assess whlole-body composition. Associations between all circumference measures and carbohydrates were observed. Among MRI measures, only significant associations between subcutaneous adipose tissue and protein x carbohydrate as well as carbohydrates alone were identified. Carbohydrates were negatively associated with several measures of fat mass as measured by DXA. Overall, carbohydrates appear to play an important role in body composition among individuals with SCI. Higher carbohydrate intake was associated with lower fat mass. Additional research is needed to determine how carbohydrate intake influences body composition and cardiometabolic health after SCI.
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Affiliation(s)
- Jacob A. Goldsmith
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
| | - Matthew E. Holman
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Puneet Puri
- Internal Medicine Hepatology, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
| | - Refka E. Khalil
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
| | - Areej N. Ennasr
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA
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Azurdia D, Acuña SM, Narasaki-Jara M, Furtado O, Jung T. Effects of Virtual Reality-Based Aerobic Exercise on Perceptions of Pain and Fatigue in Individuals with Spinal Cord Injury. Games Health J 2022; 11:236-241. [PMID: 35704919 DOI: 10.1089/g4h.2021.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Virtual reality (VR) has become an effective alternative to promote exercise. However, limited studies have investigated the effect of VR on pain and fatigue in individuals with spinal cord injury (SCI). Objective: The purpose of this study was to investigate the effects of using VR during exercise on pain and fatigue in individuals with SCI. This study employed a concurrent nested mixed-methods design. Materials and Methods: Eleven individuals with SCI completed a 6-minute exercise test using arm ergometry with and without VR. Pain and fatigue questionnaire data were collected using Pain Self Efficacy Questionnaire, the Fatigue Severity Scale, and the Fatigue Assessment Scale. Qualitative data were collected after the VR session. Results: Participants experienced less pain and fatigue during VR exercise than during non-VR exercise. Qualitative data were consistent with the questionnaire results. Conclusion: Clinicians should consider the use of VR in reducing pain and fatigue.
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Affiliation(s)
- Daniel Azurdia
- Department of Cardiac Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephan Manuel Acuña
- Human Movement and Neurophysiology Lab, Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma, USA
| | - Mai Narasaki-Jara
- Department of Kinesiology and Health Promotion, California State Polytechnic University, Pomona, California, USA
| | - Ovande Furtado
- Department of Kinesiology, California State University, Northridge, California, USA
| | - Taeyou Jung
- The Center of Achievement, Department of Kinesiology, California State University, Northridge, California, USA
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Mahmoudi E, Lin P, Ratakonda S, Khan A, Kamdar N, Peterson MD. Preventative Services Use and Risk Reduction for Potentially Preventative Hospitalizations among People with Traumatic Spinal Cord Injury. Arch Phys Med Rehabil 2022; 103:1255-1262. [PMID: 35691712 DOI: 10.1016/j.apmr.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/11/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the risk of potentially preventable hospitalizations (PPHs) for adults (18 years or older) with traumatic spinal cord injury (TSCI) to identify the most common types of preventable hospitalizations and their associative risk factors. DESIGN Cohort study. SETTING Using 2007-2017 U.S. claims data from the Optum Clinformatics Data Mart, we identified adults (18 years or older) with diagnosis of TSCI (n=5380). Adults without TSCI diagnosis were included as controls (n=1,074,729). Using age and sex, we matched individuals with and without TSCI (n=5173) with propensity scores to address potential selection bias. Generalized linear regression was applied to examine the risk of TSCI on PPHs. Models were adjusted for age; sex; race and ethnicity; Elixhauser comorbidity count; any cardiometabolic, psychological, and musculoskeletal chronic conditions; U.S. Census Division; socioeconomic variables; and use of certain preventative care services. Adjusted odds ratios were compared within a 4-year follow-up period. PARTICIPANTS Adults with and without TSCI (N=5,173). INTERVENTION Not applicable. MAIN OUTCOMES MEASURES Any PPH and specific PPHs RESULTS: Adults with TSCI had higher risk for any PPH (odds ratio [OR], 1.67; 95% CI,1.20-2.32), as well as PPHs because of urinary tract infection (UTI) (OR, 3.78; 95% CI, 2.47-5.79), hypertension (OR, 3.77; 95% CI, 1.54-9.21), diabetes long-term complications (OR, 2.54; 95% CI, 1.34-4.80), and pneumonia (OR, 1.71; 95% CI. 1.21-2.41). Annual wellness visit was associated with reduced PPH risk compared with cases and controls without annual wellness visit (OR, 0.57; 95% CI, 0.46-0.71) and among people with TSCI (OR, 0.69; 95% CI, 0.55-0.86) compared with cases without annual wellness visit. CONCLUSIONS Adults with TSCI are at a heightened risk for PPH. They are also more susceptible to certain PPHs such as UTIs, pneumonia, and heart failure. Encouraging the use of preventative or health-promoting services, especially for respiratory and urinary outcomes, may reduce PPHs among adults with TSCI.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Samantha Ratakonda
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Anam Khan
- School of Public Health, University of Michigan, Ann Arbor, MI; Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Mark D Peterson
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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10
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Wahl U, Hirsch T. A systematic review of cardiovascular risk factors in patients with traumatic spinal cord injury. VASA 2021; 51:46-55. [PMID: 34852665 DOI: 10.1024/0301-1526/a000981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: The main risk factors for cardiac events, and particularly for the development of atherosclerosis, are diabetes mellitus, arterial hypertension, dyslipidemia and smoking. Patients with a traumatic spinal cord injury (SCI) may present with autonomic nervous system dysfunction depending on their level of spinal cord injury. Studies have found a rise in cardiovascular mortality. A systematic review was conducted that focused on this patient group's predisposition to vascular risk. Methods: We performed a PubMed and Cochrane database search. After applying specific search criteria, 42 articles were included in our analysis out of a total of 10,784 matches. The articles were selected with the aim of establishing cardiovascular risk factors in patients with traumatic spinal cord injury. Results: Patients with SCI are at an increased risk for peripheral artery disease even in the absence of cardiovascular risk factors. Major vascular changes to the arteries of patients with SCI include: a reduction in lumen size, increased vessel wall tension, higher vascular stiffness, an impaired reactive hyperemic response, and a lack of reduced vascular resistance. The findings for carotid atherosclerosis were inconclusive. This group of patients also has a higher disposition for diabetes mellitus, lipid metabolism disorders and coronary artery disease. Paraplegics are more likely to suffer from dyslipidemia, obesity and PAD, while tetraplegics are more likely to have diabetes mellitus. Conclusions: Patients with SCI are more likely to have cardiovascular risk factors and have cardiovascular disease compared to the normal population. Peripheral circulatory disorders are particularly common. Patients with SCI are now considered to be a new risk group for cardiovascular disease; however, large epidemiological studies are needed to verify in more detail the cardiovascular risk profile of this patient group.
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Affiliation(s)
- Uwe Wahl
- Department of Internal Medicine, BG Hospital Bergmannstrost Halle, Halle/Saale, Germany
| | - Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Vein Competence Centre, Halle/Saale, Germany
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11
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Huang H, Xue J, Zheng J, Tian H, Fang Y, Wang W, Wang G, Hou D, Lin J. Bioinformatic analysis of the gene expression profile in muscle atrophy after spinal cord injury. Sci Rep 2021; 11:21903. [PMID: 34754020 PMCID: PMC8578571 DOI: 10.1038/s41598-021-01302-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/26/2021] [Indexed: 01/13/2023] Open
Abstract
Spinal cord injury (SCI) is often accompanied by muscle atrophy; however, its underlying mechanisms remain unclear. Here, the molecular mechanisms of muscle atrophy following SCI were investigated. The GSE45550 gene expression profile of control (before SCI) and experimental (14 days following SCI) groups, consisting of Sprague–Dawley rat soleus muscle (n = 6 per group), was downloaded from the Gene Expression Omnibus database, and then differentially expressed gene (DEG) identification and Gene Ontology, pathway, pathway network, and gene signal network analyses were performed. A total of 925 differentially expressed genes, 149 biological processes, and 55 pathways were screened. In the pathway network analysis, the 10 most important pathways were citrate cycle (TCA cycle), pyruvate metabolism, MAPK signalling pathway, fatty acid degradation, propanoate metabolism, apoptosis, focal adhesion, synthesis and degradation of ketone bodies, Wnt signalling, and cancer pathways. In the gene signal network analysis, the 10 most important genes were Acat1, Acadvl, Acaa2, Hadhb, Acss1, Oxct1, Hadha, Hadh, Acaca, and Cpt1b. Thus, we screened the key genes and pathways that may be involved in muscle atrophy after SCI and provided support for finding valuable markers for this disease.
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Affiliation(s)
- Hui Huang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Jinju Xue
- Department of Geriatrics, Affiliated Haikou Hospital, Central South University Xiangya School of Medicine, Haikou, 570208, Hainan, China
| | - Jiaxuan Zheng
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Haiquan Tian
- Department of Orthopaedic Surgery, The Second People's Hospital of Changzhi, Changzhi, 046000, Shanxi, China
| | - Yehan Fang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Wei Wang
- Department of Emergency, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Guangji Wang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Dan Hou
- Department of Neurology, Affiliated Haikou Hospital, Central South University Xiangya School of Medicine, Haikou, 570208, Hainan, China.
| | - Jianping Lin
- Department of Joint Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China.
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12
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Petrie MA, Taylor EB, Suneja M, Shields RK. Genomic and Epigenomic Evaluation of Electrically Induced Exercise in People With Spinal Cord Injury: Application to Precision Rehabilitation. Phys Ther 2021; 102:6413907. [PMID: 34718779 PMCID: PMC8754383 DOI: 10.1093/ptj/pzab243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Physical therapists develop patient-centered exercise prescriptions to help overcome the physical, emotional, psychosocial, and environmental stressors that undermine a person's health. Optimally prescribing muscle activity for people with disability, such as a spinal cord injury, is challenging because of their loss of volitional movement control and the deterioration of their underlying skeletal systems. This report summarizes spinal cord injury-specific factors that should be considered in patient-centered, precision prescription of muscle activity for people with spinal cord injury. This report also presents a muscle genomic and epigenomic analysis to examine the regulation of the proliferator-activated receptor γ coactivator 1α (PGC-1α) (oxidative) and myostatin (hypertrophy) signaling pathways in skeletal muscle during low-frequency (lower-force) electrically induced exercise versus higher-frequency (higher-force) electrically induced exercise under constant muscle recruitment (intensity). METHODS Seventeen people with spinal cord injury participated in 1 or more unilateral electrically induced exercise sessions using a lower-force (1-, 3-, or 5-Hz) or higher-force (20-Hz) protocol. Three hours after the exercise session, percutaneous muscle biopsies were performed on exercised and nonexercised muscles for genomic and epigenomic analysis. RESULTS We found that low-frequency (low-force) electrically induced exercise significantly increased the expression of PGC-1α and decreased the expression of myostatin, consistent with the expression changes observed with high-frequency (higher-force) electrically induced exercise. Further, we found that low-frequency (lower-force) electrically induced exercise significantly demethylated, or epigenetically promoted, the PGC-1α signaling pathway. A global epigenetic analysis showed that >70 pathways were regulated with low-frequency (lower-force) electrically induced exercise. CONCLUSION These novel results support the notion that low-frequency (low-force) electrically induced exercise may offer a more precise rehabilitation strategy for people with chronic paralysis and severe osteoporosis. Future clinical trials are warranted to explore whether low-frequency (lower-force) electrically induced exercise training affects the overall health of people with chronic spinal cord injury.
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Affiliation(s)
- Michael A Petrie
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Eric B Taylor
- Department of Biochemistry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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13
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Morse LR, Field-Fote EC, Contreras-Vidal J, Noble-Haeusslein LJ, Rodreick M, Shields RK, Sofroniew M, Wudlick R, Zanca JM. Meeting Proceedings for SCI 2020: Launching a Decade of Disruption in Spinal Cord Injury Research. J Neurotrauma 2021; 38:1251-1266. [PMID: 33353467 DOI: 10.1089/neu.2020.7174] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The spinal cord injury (SCI) research community has experienced great advances in discovery research, technology development, and promising clinical interventions in the past decade. To build upon these advances and maximize the benefit to persons with SCI, the National Institutes of Health (NIH) hosted a conference February 12-13, 2019 titled "SCI 2020: Launching a Decade of Disruption in Spinal Cord Injury Research." The purpose of the conference was to bring together a broad range of stakeholders, including researchers, clinicians and healthcare professionals, persons with SCI, industry partners, regulators, and funding agency representatives to break down existing communication silos. Invited speakers were asked to summarize the state of the science, assess areas of technological and community readiness, and build collaborations that could change the trajectory of research and clinical options for people with SCI. In this report, we summarize the state of the science in each of five key domains and identify the gaps in the scientific literature that need to be addressed to move the field forward.
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Affiliation(s)
- Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Edelle C Field-Fote
- Shepherd Center, Atlanta, Georgia, USA.,Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jose Contreras-Vidal
- Laboratory for Non-Invasive Brain Machine Interfaces, NSF IUCRC BRAIN, Cullen College of Engineering, University of Houston, Houston, Texas, USA
| | - Linda J Noble-Haeusslein
- Departments of Neurology and Psychology and the Institute of Neuroscience, University of Texas at Austin, Austin, Texas, USA
| | | | - Richard K Shields
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Michael Sofroniew
- Department of Neurobiology, University of California, Los Angeles, California, USA
| | - Robert Wudlick
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Jeanne M Zanca
- Spinal Cord Injury Research, Kessler Foundation, West Orange, New Jersey, USA.,Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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14
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Health provider identified barriers and facilitators to weight management for individuals with spinal cord injury. Spinal Cord 2021; 59:1061-1071. [PMID: 33564116 PMCID: PMC8349924 DOI: 10.1038/s41393-021-00614-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/20/2022]
Abstract
Study Design: Qualitative descriptive study using semi-structured interviews Objective: The purpose of this study was to examine the barriers and facilitators of weight management in individuals with spinal cord injury (SCI) from the perspective of SCI health care providers. Setting: Veterans Health Administration and Midwest Regional SCI Care Systems Methods: Health care providers (n=25) who care for individuals with SCI completed semi-structured interviews. Thematic analysis methodology was used to identify emergent themes around barriers and facilitators to weight management in SCI. Results: Sixteen subthemes emerged for barriers and 7 subthemes emerged for facilitators for weight management in SCI. Barriers included individual-level factors (e.g., physical ability/mobility limitations, lack of interest, psychological obstacles, lack of knowledge, poor dietary strategies), socio-environmental factors (e.g., challenges with family support, lack of access to weight management resources, dependency on others, difficulties obtaining weight measurement), and organizational factors (e.g., lack of integration/ inconsistent weight management support from healthcare systems, pushing calorie intake early post-injury). Facilitators included individual-level factors (e.g., motivation, education/knowledge, participation in exercise and physical activity) and socio-environmental factors (e.g., positive support network, access to/use of healthy dietary strategies, access to exercise facilities/adaptive equipment, participating in weight management with others). Conclusions: Healthcare providers identified individual-level, socio-environmental, and organizational barriers and facilitators that influence weight management efforts in individuals with SCI. Future weight management resources and programs should consider addressing common barriers identified by healthcare providers, individuals with SCI, and their caregivers, and develop strategies to promote facilitators to enhance weight management in this population.
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15
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Nash MS, Gater DR. Cardiometabolic Disease and Dysfunction Following Spinal Cord Injury. Phys Med Rehabil Clin N Am 2020; 31:415-436. [DOI: 10.1016/j.pmr.2020.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Petrie MA, Sharma A, Taylor EB, Suneja M, Shields RK. Impact of short- and long-term electrically induced muscle exercise on gene signaling pathways, gene expression, and PGC1a methylation in men with spinal cord injury. Physiol Genomics 2019; 52:71-80. [PMID: 31869286 DOI: 10.1152/physiolgenomics.00064.2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Exercise attenuates the development of chronic noncommunicable diseases (NCDs). Gene signaling pathway analysis offers an opportunity to discover if electrically induced muscle exercise regulates key pathways among people living with spinal cord injury (SCI). We examined short-term and long-term durations of electrically induced skeletal muscle exercise on complex gene signaling pathways, specific gene regulation, and epigenetic tagging of PGC1a, a major transcription factor in skeletal muscle of men with SCI. After short- or long-term electrically induced exercise training, participants underwent biopsies of the trained and untrained muscles. RNA was hybridized to an exon microarray and analyzed by a gene set enrichment analysis. We discovered that long-term exercise training regulated the Reactome gene sets for metabolism (38 gene sets), cell cycle (36 gene sets), disease (27 gene sets), gene expression and transcription (22 gene sets), organelle biogenesis (4 gene sets), cellular response to stimuli (8 gene sets), immune system (8 gene sets), vesicle-mediated transport (4 gene sets), and transport of small molecules (3 gene sets). Specific gene expression included: oxidative catabolism of glucose including PDHB (P < 0.001), PDHX (P < 0.001), MPC1 (P < 0.009), and MPC2 (P < 0.007); Oxidative phosphorylation genes including SDHA (P < 0.006), SDHB (P < 0.001), NDUFB1 (P < 0.002), NDUFA2 (P < 0.001); transcription genes including PGC1α (P < 0.030) and PRKAB2 (P < 0.011); hypertrophy gene MSTN (P < 0.001); and the myokine generating FNDC5 gene (P < 0.008). Long-term electrically induced exercise demethylated the major transcription factor PGC1a. Taken together, these findings support that long-term electrically induced muscle activity regulates key pathways associated with muscle health and systemic metabolism.
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Affiliation(s)
- Michael A Petrie
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Arpit Sharma
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa.,Department of Biochemistry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Eric B Taylor
- Department of Biochemistry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Richard K Shields
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
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17
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Wiest MJ, West C, Ditor D, Furlan JC, Miyatani M, Farahani F, Alavinia SM, Oh PI, Bayley MT, Craven BC. Development of Cardiometabolic Health indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2019; 42:166-175. [PMID: 31573456 PMCID: PMC6781462 DOI: 10.1080/10790268.2019.1613322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context: Spinal cord injury or disease (SCI/D) leads to unchanged low-density lipoprotein and cholesterol, very low high-density lipoprotein a form of dyslipidemia and physical inactivity which combine to increase risk of morbidity and mortality from cardiometabolic disease. Herein, we describe the selection of structure, process and outcome indicators for adults in the first 18 months post-SCI/D rehabilitation admission. Methods: A Pan-Canadian Cardiometabolic Health Working Group was formed to develop a construct definition. Cardiometabolic risk factors were summarized in a Driver diagram. Release of the Paralyzed Veterans of America "Identification and Management of Cardiometabolic Risk after Spinal Cord Injury" and the International Scientific Exercise Guidelines: "Evidence-based scientific exercise guidelines for adults with spinal cord injury", informed the group's focus on prevention strategies to advance this Domain of rehabilitation admission. Results: The structure indicator identifies during rehabilitation the presence of appropriate time and resources for physical exercise prescription. Process indicators are lipid profile assessment at rehabilitation admission and documented exercise prescriptions prior to discharge. The outcome indicators track patient's knowledge retention regarding exercise prescription at discharge, current exercise adherence and lipid status 18 months after rehabilitation discharge. Conclusion: Routine national implementation of these indicators at the specified time points will enhance efforts to detect dyslipidemia and assure routine participation in endurance exercise. These indicators align with international initiatives to improve cardiometabolic health through interventions targeting modifiable risk factors specifically endurance exercising and optimal lipid profiles, crucial to augmenting cardiometabolic health after SCI/D.
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Affiliation(s)
- Matheus J. Wiest
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Christopher West
- Cell & Physiological Sciences, Southern Medical Program, University of British Columbia, Kelowna, British Columbia, Canada,ICORD, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Ditor
- Faculty of Applied Health Science, Brock University, St. Catharines, Ontario, Canada
| | - Julio C. Furlan
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Masae Miyatani
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul I. Oh
- Cardiac Prevention and Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, Neural Engineering & Therapeutic Team, KITE Toronto Rehabilitation Institute, University Health Network 520 Sutherland Drive, Toronto, ON M4G 3V9, Canada; Ph: (416) 597-3422 (ext: 6122).
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18
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Nash MS, Groah SL, Gater DR, Dyson-Hudson TA, Lieberman JA, Myers J, Sabharwal S, Taylor AJ. Identification and Management of Cardiometabolic Risk after Spinal Cord Injury. J Spinal Cord Med 2019; 42:643-677. [PMID: 31180274 PMCID: PMC6758611 DOI: 10.1080/10790268.2018.1511401] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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19
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Amanat M, Vaccaro AR, Salehi M, Rahimi-Movaghar V. Neurological conditions associated with spinal cord injury. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.100245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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20
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Nash MS, Bilzon JLJ. Guideline Approaches for Cardioendocrine Disease Surveillance and Treatment Following Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:264-276. [PMID: 30546969 PMCID: PMC6267529 DOI: 10.1007/s40141-018-0203-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Persons with spinal cord injuries (SCI) commonly experience individual risks and coalesced health hazards of the cardiometabolic syndrome (CMS). This review will examinethe role of exercise and nutritional intervention as countermeasures to these disease risks. RECENT FINDINGS The CMS hazards of overweight/obesity, insulin resistance, hypertension, and dyslipidemia are strongly associated with physical deconditioning and are common after SCI. Both the CMS diagnosis and physical deconditioning worsen the prognosis for all-cause cardiovascular disease occurring early after SCI. Evidence supports a therapeutic role for physical activity after SCI as an effective countermeasure to these risks and often represents the first-line approach to CMS abatement. This evidence is supported by authoritative systematic reviews and associated guidelines that recommend specific activities, frequencies, and activities of work. In many cases, the most effective exercise programming uses more intense periods of work with limited rest. As SCI is also associated with poor dietary habits, including excessive energy intake and saturated fat consumption, more comprehensive lifestyle management incorporating both exercise and nutrition represents a preferred approach for overall health management. SUMMARY Irrespective of the interventional strategy, improved surveillance of the population for CMS risks and encouraged incorporation of exercise and nutritional management according to recent population-specific guidelines will most likely play an important role in the preservation of activity, optimal health, and independence throughout the lifespan.
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Affiliation(s)
- Mark S. Nash
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL USA
- Departments of Neurological Surgery and Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL USA
| | - James L. J. Bilzon
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL USA
- Department for Health, University of Bath, Bath, Somerset UK
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21
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Bigford G, Nash MS. Nutritional Health Considerations for Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 23:188-206. [PMID: 29339895 DOI: 10.1310/sci2303-188] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic spinal cord injury (SCI) often results in morbidity and mortality due to all-cause cardiovascular disease (CVD) and comorbid endocrine disorders. Several component risk factors for CVD, described as the cardiometabolic syndrome (CMS), are prevalent in SCI, with the individual risks of obesity and insulin resistance known to advance the disease prognosis to a greater extent than other established risks. Notably, adiposity and insulin resistance are attributed in large part to a commonly observed maladaptive dietary/nutritional profile. Although there are no evidence-based nutritional guidelines to address the CMS risk in SCI, contemporary treatment strategies advocate more comprehensive lifestyle management that includes sustained nutritional guidance as a necessary component for overall health management. This monograph describes factors in SCI that contribute to CMS risks, the current nutritional profile and its contribution to CMS risks, and effective treatment strategies including the adaptability of the Diabetes Prevention Program (DPP) to SCI. Establishing appropriate nutritional guidelines and recommendations will play an important role in addressing the CMS risks in SCI and preserving optimal long-term health.
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Affiliation(s)
- Gregory Bigford
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida.,The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Mark S Nash
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida.,Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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22
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Nash MS, Groah SL, Gater DR, Dyson-Hudson TA, Lieberman JA, Myers J, Sabharwal S, Taylor AJ. Identification and Management of Cardiometabolic Risk after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2018; 24:379-423. [PMID: 30459501 PMCID: PMC6241225 DOI: 10.1310/sci2404-379] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mark S Nash
- Departments of Neurological Surgery and Physical Medicine & Rehabilitation, Applied Physiology Research Laboratory, The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Suzanne L Groah
- Paralysis Rehabilitation and Recovery Program, Spinal Cord Injury Research, MedStar National Rehabilitation Hospital, Washington, DC
- Rehabilitation Medicine, Georgetown University Hospital, Washington, DC
| | - David R Gater
- Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Trevor A Dyson-Hudson
- Spinal Injury Research and Outcomes Assessment Research, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jesse A Lieberman
- Carolinas Rehabilitation and Carolinas Medical Center, Charlotte, North Carolina
| | - Jonathan Myers
- Department of Medicine, Stanford University, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Sunil Sabharwal
- VA Boston Health Care System, Boston, Massachusetts
- VA Spinal Cord Injuries and Disorders System of Care, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Allen J Taylor
- MedStar Georgetown University Hospital, MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC
- Uniformed University of the Health Sciences, Bethesda, Maryland
- Georgetown University, Washington, DC
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23
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Lieberman JA, McClelland JW, Goff DC, Racine E, Dulin MF, Bauman WA, Niemeier J, Hirsch MA, Norton HJ, Moore CG. Nutrition education for cardiovascular disease prevention in individuals with spinal cord injuries: study protocol for a randomized controlled trial. Trials 2017; 18:584. [PMID: 29202852 PMCID: PMC5716386 DOI: 10.1186/s13063-017-2263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022] Open
Abstract
Background Individuals with chronic spinal cord injuries (SCIs) have an increased prevalence of cardiovascular disease (CVD) and associated risk factors compared with age-matched control subjects. Exercise has been shown to improve selected CVD risk factors in individuals with SCI, but using nutrition education as an intervention has not been evaluated in this population. This paper describes our research plan for evaluating the effect of nutrition education on individuals with SCI. In the present study, called Eat Smart, Live Better, we are using a randomized controlled design to test an intervention adapted from an existing evidence-based program that showed a positive effect on nutrition knowledge and behavior of older adults from the general population. There will be an inpatient group (n = 100) and a community group (n = 100). The aims of our study are to compare the intervention and control groups for (1) changes in nutritional behavior, nutritional knowledge, and dietary quality by participants in the program; (2) levels of adiposity and metabolic CVD risk factors at 12-month follow-up; and (3) differential effects among individuals with SCI in the acute rehabilitation setting and those living in the community. Methods/design This is a randomized controlled trial of nutrition education. The treatment groups receive six nutrition education sessions. The control groups receive the one “standard of care” nutrition lecture that is required by the Commission on Accreditation of Rehabilitation Facilities. Treatment groups include both an inpatient group, comprising patients who have been admitted to an acute rehabilitation facility because of their recent SCI, and an outpatient group, consisting of community-dwelling adults who are at least 1 year after their SCI. A total of 200 participants will be randomized 1:1 to the intervention or control group, stratified by location (acute rehabilitation facility or community dwelling). Discussion To our knowledge, this will be the first reported study of nutrition education in individuals with SCI. The low cost and feasibility of the intervention, if shown to improve nutritional behavior, suggests that it could be implemented in rehabilitation facilities across the country. This has the potential of lowering the burden of CVD and CVD risk factors in this high-risk population. Trial registration ClinicalTrials.gov, NCT02368405. Registered on February 10, 2015.
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Affiliation(s)
- Jesse A Lieberman
- Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA.
| | | | - David C Goff
- National, Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Suite 8030, Bethesda, MD, 20892, USA
| | - Elizabeth Racine
- University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
| | - Michael F Dulin
- University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
| | - William A Bauman
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
| | - Janet Niemeier
- Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Mark A Hirsch
- Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - H James Norton
- Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Charity G Moore
- Center for Outcomes Research and Evaluation, Carolinas HealthCare System, 1540 Garden Terrace Road, Charlotte, NC, 28203, USA
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24
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Willingham TB, McCully KK. In Vivo Assessment of Mitochondrial Dysfunction in Clinical Populations Using Near-Infrared Spectroscopy. Front Physiol 2017; 8:689. [PMID: 28959210 PMCID: PMC5603672 DOI: 10.3389/fphys.2017.00689] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/28/2017] [Indexed: 12/13/2022] Open
Abstract
The ability to sustain submaximal exercise is largely dependent on the oxidative capacity of mitochondria within skeletal muscle, and impairments in oxidative metabolism have been implicated in many neurologic and cardiovascular pathologies. Here we review studies which have demonstrated the utility of Near-infrared spectroscopy (NIRS) as a method of evaluating of skeletal muscle mitochondrial dysfunction in clinical human populations. NIRS has been previously used to noninvasively measure tissue oxygen saturation, but recent studies have demonstrated the utility of NIRS as a method of evaluating skeletal muscle oxidative capacity using post-exercise recovery kinetics of oxygen metabolism. In comparison to historical methods of measuring muscle metabolic dysfunction in vivo, NIRS provides a more versatile and economical method of evaluating mitochondrial oxidative capacity in humans. These advantages generate great potential for the clinical applicability of NIRS as a means of evaluating muscle dysfunction in clinical populations.
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Affiliation(s)
| | - Kevin K McCully
- Department of Kinesiology, University of GeorgiaAthens, GA, United States
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25
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Woelfel JR, Kimball AL, Yen CL, Shields RK. Low-Force Muscle Activity Regulates Energy Expenditure after Spinal Cord Injury. Med Sci Sports Exerc 2017; 49:870-878. [PMID: 28009786 DOI: 10.1249/mss.0000000000001187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Reduced physical activity is a primary risk factor for increased morbidity and mortality. People with spinal cord injury (SCI) have reduced activity for a lifetime, as they cannot volitionally activate affected skeletal muscles. We explored whether low-force and low-frequency stimulation is a viable strategy to enhance systemic energy expenditure in people with SCI. PURPOSE This study aimed to determine the effects of low stimulation frequency (1 and 3 Hz) and stimulation intensity (50 and 100 mA) on energy expenditure in people with SCI. We also examined the relationship between body mass index and visceral adipose tissue on energy expenditure during low-frequency stimulation. METHODS Ten individuals with complete SCI underwent oxygen consumption monitoring during electrical activation of the quadriceps and hamstrings at 1 and 3 Hz and at 50 and 100 mA. We calculated the difference in energy expenditure between stimulation and rest and estimated the number of days that would be necessary to burn 1 lb of body fat (3500 kcal) for each stimulation protocol (1 vs 3 Hz). RESULTS Both training frequencies induced a significant increase in oxygen consumption above a resting baseline level (P < 0.05). Energy expenditure positively correlated with stimulus intensity (muscle recruitment) and negatively correlated with adiposity (reflecting the insulating properties of adipose tissue). We estimated that 1 lb of body fat could be burned more quickly with 1 Hz training (58 d) as compared with 3 Hz training (87 d) if an identical number of pulses were delivered. CONCLUSION Low-frequency stimulation increased energy expenditure per pulse and may be a feasible option to subsidize physical activity to improve metabolic status after SCI.
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Affiliation(s)
- Jessica R Woelfel
- 1Carver College of Medicine, University of Iowa, Iowa City, IA; and 2Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA
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Alterations in autonomic cerebrovascular control after spinal cord injury. Auton Neurosci 2017; 209:43-50. [PMID: 28416148 PMCID: PMC6432623 DOI: 10.1016/j.autneu.2017.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 04/02/2017] [Accepted: 04/03/2017] [Indexed: 11/24/2022]
Abstract
Among chronic cardiovascular and metabolic sequelae of spinal cord injury (SCI) is an up-to four-fold increase in the risk of ischemic and hemorrhagic stroke, suggesting that individuals with SCI cannot maintain stable cerebral perfusion. In able-bodied individuals, the cerebral vasculature is able to regulate cerebral perfusion in response to swings in arterial pressure (cerebral autoregulation), blood gases (cerebral vasoreactivity), and neural metabolic demand (neurovascular coupling). This ability depends, at least partly, on intact autonomic function, but high thoracic and cervical spinal cord injuries result in disruption of sympathetic and parasympathetic cerebrovascular control. In addition, alterations in autonomic and/or vascular function secondary to paralysis and physical inactivity can impact cerebrovascular function independent of the disruption of autonomic control due to injury. Thus, it is conceivable that SCI results in cerebrovascular dysfunction that may underlie an elevated risk of stroke in this population, and that rehabilitation strategies targeting this dysfunction may alleviate the long-term risk of adverse cerebrovascular events. However, despite this potential direct link between SCI and the risk of stroke, studies exploring this relationship are surprisingly scarce, and the few available studies provide equivocal results. The focus of this review is to provide an integrated overview of the available data on alterations in cerebral vascular function after SCI in humans, and to provide suggestions for future research.
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Smith DL, Yarar-Fisher C. Contributors to Metabolic Disease Risk Following Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016; 4:190-199. [PMID: 29276654 PMCID: PMC5737009 DOI: 10.1007/s40141-016-0124-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Spinal cord injury (SCI) induced changes in neurological function have significant impact on the metabolism and subsequent metabolic-related disease risk in injured individuals. This metabolic-related disease risk relationship is differential depending on the anatomic level and severity of the injury, with high level anatomic injuries contributing a greater risk of glucose and lipid dysregulation resulting in type 2 diabetes and cardiovascular disease risk elevation. Although alterations in body composition, particularly excess adiposity and its anatomical distribution in the visceral depot or ectopic location in non-adipose organs, is known to significantly contribute to metabolic disease risk, changes in fat mass and fat-free mass do not fully account for this elevated disease risk in subjects with SCI. There are other negative adaptations in body composition including reductions in skeletal muscle mass and alterations in muscle fiber type, in addition to significant reduction in physical activity, that contribute to a decline in metabolic rate and increased metabolic disease risk following SCI. Recent studies in adult humans suggest cold- and diet-induced thermogenesis through brown adipose tissue metabolism may be important for energy balance and substrate metabolism, and particularly sensitive to sympathetic nervous signaling. Considering the alterations that occur in the autonomic nervous system (SNS) (sympathetic and parasympathetic) following a SCI, significant dysfunction of brown adipose function is expected. This review will highlight metabolic alterations following SCI and integrate findings from brown adipose tissue studies as potential new areas of research to pursue.
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Affiliation(s)
- Daniel L. Smith
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham AL, 35294 USA
- Nathan Shock Center of Excellence in the Basic Biology of Aging, University of Alabama at Birmingham, Birmingham AL, 35294 USA
- Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham AL, 35294 USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham AL, 35294 USA
| | - Ceren Yarar-Fisher
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham AL, 35294 USA
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham AL, 35294 USA
- Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham AL, 35294 USA
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Nash MS, Tractenberg RE, Mendez AJ, David M, Ljungberg IH, Tinsley EA, Burns-Drecq PA, Betancourt LF, Groah SL. Cardiometabolic Syndrome in People With Spinal Cord Injury/Disease: Guideline-Derived and Nonguideline Risk Components in a Pooled Sample. Arch Phys Med Rehabil 2016; 97:1696-705. [PMID: 27465752 DOI: 10.1016/j.apmr.2016.07.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/14/2016] [Accepted: 07/16/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess cardiometabolic syndrome (CMS) risk definitions in spinal cord injury/disease (SCI/D). DESIGN Cross-sectional analysis of a pooled sample. SETTING Two SCI/D academic medical and rehabilitation centers. PARTICIPANTS Baseline data from subjects in 7 clinical studies were pooled; not all variables were collected in all studies; therefore, participant numbers varied from 119 to 389. The pooled sample included men (79%) and women (21%) with SCI/D >1 year at spinal cord levels spanning C3-T2 (American Spinal Injury Association Impairment Scale [AIS] grades A-D). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We computed the prevalence of CMS using the American Heart Association/National Heart, Lung, and Blood Institute guideline (CMS diagnosis as sum of risks ≥3 method) for the following risk components: overweight/obesity, insulin resistance, hypertension, and dyslipidemia. We compared this prevalence with the risk calculated from 2 routinely used nonguideline CMS risk assessments: (1) key cut scores identifying insulin resistance derived from the homeostatic model 2 (HOMA2) method or quantitative insulin sensitivity check index (QUICKI), and (2) a cardioendocrine risk ratio based on an inflammation (C-reactive protein [CRP])-adjusted total cholesterol/high-density lipoprotein cholesterol ratio. RESULTS After adjustment for multiple comparisons, injury level and AIS grade were unrelated to CMS or risk factors. Of the participants, 13% and 32.1% had CMS when using the sum of risks or HOMA2/QUICKI model, respectively. Overweight/obesity and (pre)hypertension were highly prevalent (83% and 62.1%, respectively), with risk for overweight/obesity being significantly associated with CMS diagnosis (sum of risks, χ(2)=10.105; adjusted P=.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (χ(2)2=21.23, adjusted P<.001). Of the subjects, 76.4% were at moderate to high risk from elevated CRP, which was significantly associated with CMS determination (both methods; sum of risks, χ(2)2=10.198; adjusted P=.048 and HOMA2/QUICKI, χ(2)2=10.532; adjusted P=.04). CONCLUSIONS As expected, guideline-derived CMS risk factors were prevalent in individuals with SCI/D. Overweight/obesity, hypertension, and elevated CRP were common in SCI/D and, because they may compound risks associated with CMS, should be considered population-specific risk determinants. Heightened surveillance for risk, and adoption of healthy living recommendations specifically directed toward weight reduction, hypertension management, and inflammation control, should be incorporated as a priority for disease prevention and management.
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Affiliation(s)
- Mark S Nash
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; Department of Physical Medicine and Rehabilitation, and Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
| | - Rochelle E Tractenberg
- Collaborative for Research on Outcomes and Metrics, Georgetown University Medical Center, Washington, DC; Department of Neurology, Georgetown University Medical Center, Washington, DC; Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC; Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Armando J Mendez
- Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; Diabetes Research Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Maya David
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | | | | | - Patricia A Burns-Drecq
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Luisa F Betancourt
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
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Kang Q, Chen G, Lu J, Yu H. Health Disparities by Type of Disability: Health Examination Results of Adults (18-64 Years) with Disabilities in Shanghai, China. PLoS One 2016; 11:e0155700. [PMID: 27196419 PMCID: PMC4873126 DOI: 10.1371/journal.pone.0155700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 05/03/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS There have been few studies on the disparities within the population with disabilities, especially in China. The aim of this study was to evaluate the differences in some health conditions among people with different types of disabilities in Shanghai. METHODS This study was conducted using data from the Shanghai Disabled Persons' Rehabilitation Comprehensive Information Platform. The records of 31,082 persons with disabilities who had undergone professional health examination were analyzed, and the prevalence and number of five diseases and five risk factors were examined. Logistic regression was used to explore disparities from two perspectives: 1) basic differences, unadjusted for other factors, and 2) differences after adjusting for key demographic covariates. A p-value < 0.05 was considered significant. RESULTS Individuals with visual disability had a high rate of refractive error (60.0%), and averaged 1.75 diseases of interest, which was the highest value among all disability types. The mean number of risk factors we measured was greatest (1.96) in the population with mental disability. There were significant differences (p < 0.05) between the hearing and speech impairment group and the other groups with respect to most health outcomes, except chronic pharyngitis, hepatic cysts, and high blood pressure. CONCLUSION Significant differences of selected health outcomes between groups with different types of disabilities remained after controlling for key demographic indicators. Further research is needed to explore the relationships between health conditions and disability types.
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Affiliation(s)
- Qi Kang
- School of Public Health, Fudan University, Shanghai 200032, P. R. China
| | - Gang Chen
- School of Public Health, Fudan University, Shanghai 200032, P. R. China
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, P. R. China
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai 200032, P. R. China
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, P. R. China
| | - Huijiong Yu
- Department of Rehabilitation, Shanghai Disabled Persons’ Federation, Shanghai 200126, P. R. China
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BARROS FILHO TARCÍSIOELOYPESSOA, ARAUJO FERNANDOFLORESDE, HIGINO LUCASDAPAZ, MARCON RAPHAELMARTUS, CRISTANTE ALEXANDREFOGAÇA. THE EFFECT OF MONOSIALOGANGLYOSIDE (GM-1) ADMINISTRATION IN SPINAL CORD INJURY. ACTA ORTOPEDICA BRASILEIRA 2016; 24:123-6. [PMID: 27217811 PMCID: PMC4863858 DOI: 10.1590/1413-785220162403160032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect of monosialoganglioside (GM-1) in spinal cord trauma patients seen in our service who have not been treated with methylprednisolone. METHODS Thirty patients with acute spinal cord trauma were randomly divided into two groups. In Group 1, patients received 200 mg GM-1 in the initial assessment and thereafter received 100 mg intravenous per day for 30 days and Group 2 (control) received saline. Patients were evaluated periodically (at 6 weeks, 6 months, one year and two years), using a standardized neurological assessment of the American Spinal Injury Association / International Spinal Cord Society. RESULTS The comparative statistical analysis of motor indices, sensitive indices for pain and touch according to the standardization of ASIA / ISCOS showed that the assessments at 6 weeks, 6 months and 2 years, GM-Group 1 patients had higher rates than the control group regarding sensitivity to pain and touch, with no statistically significant difference from the motor index. CONCLUSION The functional assessment showed improvement in the sensitive indices of patients treated with GM1 after post-traumatic spinal cord injury compared to patients who received placebo. Level of Evidence IV, Prospective Case Studies Series.
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Transcriptional Pathways Associated with Skeletal Muscle Changes after Spinal Cord Injury and Treadmill Locomotor Training. BIOMED RESEARCH INTERNATIONAL 2015; 2015:387090. [PMID: 26380273 PMCID: PMC4561307 DOI: 10.1155/2015/387090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/19/2015] [Indexed: 01/06/2023]
Abstract
The genetic and molecular events associated with changes in muscle mass and
function after SCI and after the implementation of candidate therapeutic
approaches are still not completely known. The overall objective of this study was
to identify key molecular pathways activated with muscle remodeling after SCI
and locomotor training. We implemented treadmill training in a well-characterized
rat model of moderate SCI and performed genome wide expression profiling on
soleus muscles at multiple time points: 3, 8, and 14 days after SCI. We found that the
activity of the protein ubiquitination and mitochondrial function related pathways
was altered with SCI and corrected with treadmill training. The BMP pathway was
differentially activated with early treadmill training as shown by Ingenuity
Pathway Analysis. The expression of several muscle mass regulators was
modulated by treadmill training, including Fst, Jun, Bmpr2, Actr2b, and Smad3. In
addition, key players in fatty acids metabolism (Lpl and Fabp3) responded to
both SCI induced inactivity and reloading with training. The decrease in Smad3 and Fst early after the initiation of treadmill training was confirmed by RT-PCR. Our data suggest that TGFβ/Smad3 signaling may be mainly involved in the decrease in muscle mass observed with SCI, while the BMP pathway was activated with treadmill training.
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Grubišić V, Parpura V. Diversity in the utilization of glucose and lactate in synthetic mammalian myotubes generated by engineered configurations of MyoD and E12 in otherwise non-differentiation growth conditions. Biomaterials 2014; 43:50-60. [PMID: 25591961 DOI: 10.1016/j.biomaterials.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/03/2014] [Indexed: 12/21/2022]
Abstract
We previously used the expression of various combinations and configurations of MyoD and E12, two basic helix-loop-helix transcription factors (TF), to produce populations of myotubes assuming distinct morphology, myofibrillar development and Ca2+ dynamics, from mammalian C2C12 myoblasts in non-differentiation growth conditions. Here, we assessed the synthetically generated myotubes in terms of energetics, otherwise necessary to sustain their mechanical output as bio-actuators. We found that the myotubes exhibit changed expression of key regulators for the uptake and utilization of two major cellular fuels, glucose and lactate. Furthermore, while lactate transport was uniformly slowed in all the populations of myotubes, glucose uptake and utilization were modified by particular TF configuration. Our approach allows the production of a class of biomaterials with predetermined energetics that could be applied in biorobotics, where fuel of choice could be used, and also in reparative medicine where, for example, particular population of myotubes could be additionally employed as glucose sinks to mitigate effects of secondary metabolic syndrome.
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Affiliation(s)
- Vladimir Grubišić
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Vladimir Parpura
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA; Department of Biotechnology, University of Rijeka, 51000 Rijeka, Croatia.
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Lieberman J, Goff D, Hammond F, Schreiner P, Norton HJ, Dulin M, Zhou X, Steffen L. Dietary intake and adherence to the 2010 Dietary Guidelines for Americans among individuals with chronic spinal cord injury: a pilot study. J Spinal Cord Med 2014; 37:751-7. [PMID: 24621049 PMCID: PMC4231963 DOI: 10.1179/2045772313y.0000000180] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To investigate dietary intake and adherence to the 2010 Dietary Guidelines for Americans in individuals with chronic spinal cord injury (SCI) and able-bodied individuals. DESIGN A pilot study of dietary intake among a sample of individuals with SCI >1 year ago from a single site compared with able-bodied individuals. PARTICIPANTS/METHODS One hundred black or white adults aged 38-55 years old with SCI >1 year and 100 age-, sex-, and race-matched adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary intake was assessed by the CARDIA dietary history. Linear regression analysis was used to compare dietary intake between the subjects with SCI and those enrolled in the CARDIA study. Further, adherence to the 2010 Dietary Guidelines for dairy, fruits, and vegetables, and whole-grain foods was assessed. RESULTS Compared with CARDIA participants, participants with SCI consumed fewer daily servings of dairy (2.10 vs. 5.0, P < 0.001), fruit (2.01 vs. 3.64, P = 0.002), and whole grain foods (1.20 vs. 2.44 P = 0.007). For each food group, fewer participants with SCI met the recommended servings compared with the CARDIA participants. Specifically, the participants with SCI and in CARDIA who met the guidelines were, respectively: dairy, 22% vs. 54% (P < 0.001), fruits and vegetables 39% vs. 70% (P = 0.001), and whole-grain foods 8% vs. 69.6% (P = 0.001). CONCLUSIONS Compared with able-bodied individuals, SCI participants consumed fewer daily servings of fruit, dairy, and whole grain foods than proposed by the 2010 Dietary Guideline recommendations. Nutrition education for this population may be warranted.
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Affiliation(s)
- Jesse Lieberman
- Carolinas Rehabilitation/Carolinas Medical Center, Charlotte, NC, USA
| | - David Goff
- Colorado School of Public Health, Aurora, CO, USA
| | - Flora Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Pamela Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - H. James Norton
- Carolinas Rehabilitation/Carolinas Medical Center, Charlotte, NC, USA
| | - Michael Dulin
- Carolinas Rehabilitation/Carolinas Medical Center, Charlotte, NC, USA
| | - Xia Zhou
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Lyn Steffen
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
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Lai YJ, Lin CL, Chang YJ, Lin MC, Lee ST, Sung FC, Lee WY, Kao CH. Spinal cord injury increases the risk of type 2 diabetes: a population-based cohort study. Spine J 2014; 14:1957-64. [PMID: 24361350 DOI: 10.1016/j.spinee.2013.12.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 11/22/2013] [Accepted: 12/13/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies on the risk and prevalence of diabetes among spinal cord injury (SCI) patients are limited and controversial. PURPOSE To compare the risk and incidence rate (IR) of Type 2 diabetes in SCI and non-SCI patients. STUDY DESIGN This is a population-based retrospective cohort study. PATIENT SAMPLE Data from Taiwan's National Health Insurance Research Database for the period 1997 to 2010 were analyzed. Patients aged 20 years and older newly identified with SCIs during this period were included in the SCI cohort. A non-SCI comparison cohort was randomly selected from National Health Insurance beneficiaries and matched with the SCI cohort based on age, sex, and index date. OUTCOME MEASURES Both cohorts were followed until the first of the following occurred: the diagnosis of Type 2 diabetes (International Classification of Disease, Ninth Revision, Clinical Modification codes 250), withdrawal from the insurance system, the end of 2010, or death. METHODS A Cox proportional hazards regression analysis was used to estimate the risk of developing diabetes. RESULTS Taiwan possesses an older SCI population, with a mean age of 51.6 years. The IR for diabetes in patients with and without SCIs was 22.1 per 10,000 person-years and 17.2 per 10,000 person-years, respectively. The adjusted hazard ratio (HR) for diabetes was 1.33 times higher in patients with SCIs than in those without SCIs. In patients with SCIs, men (adjusted HR=1.23, 95% confidence interval (CI)=1.04-1.44), older people (adjusted HR=4.26 in patients older than 65 years, 95% CI=3.16-5.74), patients with comorbidity (adjusted HR=1.36, 95% CI=1.14-1.62), and patients with a complete thoracic SCI (T-spine injury) (adjusted HR=2.13, 95% CI=0.95-4.79) were more likely to be diagnosed with diabetes than other patient subgroups. CONCLUSIONS Our findings may facilitate the prioritizing of preventive health strategies and planning of long-term care for SCI patients.
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Affiliation(s)
- Yun-Ju Lai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, No.1, Rongguang Rd, Puli Township, Nantou County 545, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan
| | - Yen-Jung Chang
- Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, No.1, Yida Rd, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan
| | - Shih-Tan Lee
- Department of Family Medicine, Puli Branch of Taichung Veterans General Hospital, No.1, Rongguang Rd, Puli Township, Nantou County 545, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan; Department of Public Health, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan
| | - Wen-Yuan Lee
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan; China Medical University Hospital Taipei Branch, No. 360, Sec. 2, Neihu Rd. Neihu District, Taipei, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan.
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Decrease of PPARδ in Type-1-Like Diabetic Rat for Higher Mortality after Spinal Cord Injury. PPAR Res 2014; 2014:456386. [PMID: 24817882 PMCID: PMC4003751 DOI: 10.1155/2014/456386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 12/24/2022] Open
Abstract
Changes in the peroxisome proliferator-activated receptors-δ (PPARδ) expression in rats after spinal cord injury (SCI) have been previously reported. Diabetic animals show a higher mortality after SCI. However, the relationship between the progress of diabetes and PPARδ in SCI remains unknown. In the present study, we used compressive SCI in streptozotocin-(STZ-) induced diabetic rats. GW0742, a PPARδ agonist, was used to evaluate its merit in STZ rats after SCI. Changes in PPARδ expression were detected by Western blot. Survival rates were also estimated. A lower expression of PPARδ in spinal cords of STZ-diabetic rats was observed. In addition, the survival times in two-week induction diabetes were longer than those in eight-week induction group, which is consistent with the expression of PPARδ in the spinal cord. Moreover, GW0742 significantly increased the survival time of STZ rats. Furthermore, their motor function and pain response were attenuated by GSK0660, a selective PPARδ antagonist, but were enhanced by GW0742. In conclusion, the data suggest that higher mortality rate in STZ-diabetic rats with SCI is associated with the decrease of PPARδ expression. Thus, change of PPARδ expression with the progress of diabetes seems responsible for the higher mortality rate after SCI.
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Lieberman J, Goff D, Hammond F, Schreiner P, James Norton H, Dulin M, Zhou X, Steffen L. Dietary intake relative to cardiovascular disease risk factors in individuals with chronic spinal cord injury: a pilot study. Top Spinal Cord Inj Rehabil 2014; 20:127-36. [PMID: 25477735 PMCID: PMC4252172 DOI: 10.1310/sci2002-127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The relationship between cardiovascular disease (CVD) risk factors and dietary intake is unknown among individuals with spinal cord injury (SCI). OBJECTIVE To investigate the relationship between consumption of selected food groups (dairy, whole grains, fruits, vegetables, and meat) and CVD risk factors in individuals with chronic SCI. METHODS A cross-sectional substudy of individuals with SCI to assess CVD risk factors and dietary intake in comparison with age-, gender-, and race-matched able-bodied individuals enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary history, blood pressure, waist circumference (WC), fasting blood glucose, high-sensitivity C-reactive protein (hs-CRP), lipids, glucose, and insulin data were collected from 100 SCI participants who were 38 to 55 years old with SCI >1 year and compared to 100 matched control participants from the CARDIA study. RESULTS Statistically significant differences between SCI and CARDIA participants were identified in WC (39.2 vs 36.2 in.; P < .001) and high-density lipoprotein cholesterol (HDL-C; 39.2 vs 47.5 mg/dL; P < .001). Blood pressure, total cholesterol, triglycerides, glucose, insulin, and hs-CRP were similar between SCI and CARDIA participants. No significant relation between CVD risk factors and selected food groups was seen in the SCI participants. CONCLUSION SCI participants had adverse WC and HDL-C compared to controls. This study did not identify a relationship between consumption of selected food groups and CVD risk factors.
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Affiliation(s)
- Jesse Lieberman
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, North Carolina
| | - David Goff
- Colorado School of Public Health, Denver, Colorado
| | - Flora Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana
| | - Pamela Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - H. James Norton
- Department of Biostatistics, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael Dulin
- Department of Family Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Xia Zhou
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - Lyn Steffen
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
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Cragg JJ, Noonan VK, Dvorak M, Krassioukov A, Mancini GBJ, Borisoff JF. Spinal cord injury and type 2 diabetes: results from a population health survey. Neurology 2013; 81:1864-8. [PMID: 24153440 DOI: 10.1212/01.wnl.0000436074.98534.6e] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the association between spinal cord injury (SCI) and type 2 diabetes in a large representative sample and to determine whether an association exists irrespective of known risk factors for type 2 diabetes. METHODS Data were obtained on 60,678 respondents to the Statistics Canada 2010 Cycle of the cross-sectional Canadian Community Health Survey. Multivariable logistic regression, incorporating adjustment for confounders and probability weights to account for the Canadian Community Health Survey sampling method, was conducted to quantify this association. RESULTS After adjustment for both sex and age, SCI was associated with a significant increased odds of type 2 diabetes (adjusted odds ratio = 1.66, 95% confidence interval 1.16-2.36). These heightened odds persisted after additional adjustment for smoking status, hypertension status, body mass index, daily physical activity, alcohol intake, and daily consumption of fruits and vegetables (fully adjusted odds ratio = 2.45, 95% confidence interval 1.34-4.47). CONCLUSIONS There is a strong association between SCI and type 2 diabetes, which is not explained by known risk factors for type 2 diabetes.
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Affiliation(s)
- Jacquelyn J Cragg
- From the School of Population and Public Health, Faculty of Medicine (J.J.C.), International Collaboration on Repair Discoveries (J.J.C., A.K., J.F.B.), Division of Spine, Department of Orthopaedics (M.D.), Department of Medicine, Division of Physical Medicine and Rehabilitation (A.K.), and Cardiovascular Imaging Research Core Laboratory, Division of Cardiology, Department of Medicine (G.B.J.M.), University of British Columbia, Vancouver; Rick Hansen Institute (V.K.N.), Vancouver; Acute Spine Program (M.D.), Vancouver General Hospital; GF Strong Rehabilitation Centre (A.K.), Vancouver Health Authority, Vancouver; and British Columbia Institute of Technology (J.F.B.), Burnaby, Canada
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Rowland M, Peterson-Besse J, Dobbertin K, Walsh ES, Horner-Johnson W. Health outcome disparities among subgroups of people with disabilities: a scoping review. Disabil Health J 2013; 7:136-50. [PMID: 24680042 DOI: 10.1016/j.dhjo.2013.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 08/12/2013] [Accepted: 09/16/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND A growing body of research has found that people with disabilities experience lower health status and an excess burden of disease relative to the general US population. However, the population of people with disabilities is quite diverse. Thus, it is important to understand health differences between subgroups of people with disabilities in order to most effectively target interventions to address disparities. An initial step in this process is reviewing and synthesizing available research addressing these subgroup differences. OBJECTIVES To conduct a scoping review of literature to describe recent research activity that has examined health outcome disparities within populations of people with disabilities. METHODS We searched for relevant articles in MEDLINE, PsycINFO, and CINAHL databases. Three staff independently reviewed abstracts according to inclusion criteria. Two authors then independently extracted data from each included article. RESULTS For many of the health outcomes of interest, there was no published literature in relation to key disparity factors (e.g. race, income) within the population of people with disabilities. The health outcomes most frequently examined were diabetes and heart disease. The most frequently examined disparity factors were the type of disabling condition and gender. CONCLUSIONS There are significant gaps in available research. Building a body of research that identifies disparities and potentially vulnerable subgroups may improve understanding of the causes of disparities and contribute to efforts to improve quality of life and health outcomes for individuals with disabilities.
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Affiliation(s)
- Maya Rowland
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Emily S Walsh
- Oregon Evidence-based Practice Center, Scientific Resource Center, AHRQ Effective Health Care Program, USA
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Selassie A, Snipe L, Focht KL, Welldaregay W. Baseline prevalence of heart diseases, hypertension, diabetes, and obesity in persons with acute traumatic spinal cord injury: potential threats in the recovery trajectory. Top Spinal Cord Inj Rehabil 2013; 19:172-82. [PMID: 23960701 DOI: 10.1310/sci1903-172] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic diseases impede the recovery trajectory of acutely injured persons with traumatic spinal cord injury (TSCI). This study compares the odds of prevalent heart disease, hypertension, diabetes mellitus, and obesity between persons with TSCI and persons with lower extremity fractures (LEF) who were discharged from acute care facilities. METHODS 1,776 patients with acute TSCI (cases) and 1,780 randomly selected patients with LEF (controls) discharged from January 1, 1998, through December 31, 2009, from all nonfederal hospitals were identified. Data extracted from uniform billing files were compared between cases and controls in a multivariable logistic regression model controlling for sociodemographic and clinical covariables. RESULTS Thirty percent of patients with acute TSCI had at least 1 of 4 conditions compared with 18% of patients with LEF (P < .0001). Persons with acute TSCI were 4 times more likely (odds ratio [OR], 4.05; 95% CI, 1.65-9.97) to have obesity, 2.7 times more likely to have heart disease (P < .001), 2 times more likely to have hypertension (P < .001), and 1.7 times more likely to have diabetes (P = .044) at the onset of TSCI. Disproportionately more Blacks than Whites have TSCI and chronic diseases. CONCLUSION This study suggests that there is an increased burden of cardiovascular and cardiometabolic diseases among persons with acute TSCI compared with LEF trauma controls. Unattended comorbid conditions will affect quality of life and the recovery process. This warrants continuous monitoring and management of chronic diseases during the rehabilitation process.
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Affiliation(s)
- Anbesaw Selassie
- Department of Biostatistics and Epidemiology, Medical University of South Carolina , Charleston
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Cragg JJ, Noonan VK, Krassioukov A, Borisoff J. Cardiovascular disease and spinal cord injury: results from a national population health survey. Neurology 2013; 81:723-8. [PMID: 23884034 DOI: 10.1212/wnl.0b013e3182a1aa68] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the association between cardiovascular disease (CVD) and spinal cord injury (SCI) in a large representative sample. METHODS Data were compiled from more than 60,000 individuals from the 2010 cycle of the cross-sectional Canadian Community Health Survey (CCHS). Multivariable logistic regression analysis was conducted to examine this relationship, adjusting for confounders and using probability weighting to account for the CCHS sampling method. RESULTS After adjusting for age and sex, SCI was associated with a significant increased odds of heart disease (adjusted odds ratio [OR] = 2.72, 95% confidence interval [CI] 1.94-3.82) and stroke (adjusted OR = 3.72, 95% CI 2.22-6.23). CONCLUSIONS These remarkably heightened odds highlight the exigent need for targeted interventions and prevention strategies addressing modifiable risk factors for CVD in individuals with SCI.
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Affiliation(s)
- Jacquelyn J Cragg
- School of Population and Public Health, Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver Canada.
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Ryan TE, Erickson ML, Young HJ, McCully KK. Case report: endurance electrical stimulation training improves skeletal muscle oxidative capacity in chronic spinal cord injury. Arch Phys Med Rehabil 2013; 94:2559-2561. [PMID: 23816924 DOI: 10.1016/j.apmr.2013.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe the use of a novel neuromuscular electrical stimulation (NMES) endurance exercise protocol and its effects on skeletal muscle oxidative capacity. DESIGN Case report, pre/post intervention. SETTING University-based trial. PARTICIPANT A 39-year-old man who suffered a motor complete spinal cord injury (C5-6, ASIA Impairment Scale grade A). INTERVENTION Twenty-four weeks of endurance NMES that consisted of progressive increases in the twitch frequency, duration of sessions, and sessions per week. MAIN OUTCOME MEASURE Mitochondrial capacity was measured, in vivo, as the rate of recovery of muscle oxygen consumption using near-infrared spectroscopy. RESULTS The rate of recovery of muscle oxygen consumption increased approximately 3-fold from 0.52 to 1.43, 1.46, and 1.40/min measured on 3 separate occasions during week 12 of training, and 1.57/min after 24 weeks of NMES endurance training. CONCLUSION The findings of this study suggest that NMES endurance training using twitches can increase mitochondrial capacity to comparable levels measured in nonparalyzed muscles of sedentary able-bodied controls.
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Affiliation(s)
- Terence E Ryan
- Department of Kinesiology, University of Georgia, Athens, GA.
| | | | - Hui-Ju Young
- Department of Kinesiology, University of Georgia, Athens, GA
| | - Kevin K McCully
- Department of Kinesiology, University of Georgia, Athens, GA
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Barry W, St Andre JR, Evans CT, Sabharwal S, Miskevics S, Weaver FM, Smith BM. Hypertension and antihypertensive treatment in veterans with spinal cord injury and disorders. Spinal Cord 2012; 51:109-15. [DOI: 10.1038/sc.2012.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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LaVela SL, Evans CT, Prohaska TR, Miskevics S, Ganesh SP, Weaver FM. Males Aging With a Spinal Cord Injury: Prevalence of Cardiovascular and Metabolic Conditions. Arch Phys Med Rehabil 2012; 93:90-5. [DOI: 10.1016/j.apmr.2011.07.201] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 10/14/2022]
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Secondary health conditions in individuals aging with SCI: Terminology, concepts and analytic approaches. Spinal Cord 2011; 50:373-8. [DOI: 10.1038/sc.2011.150] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gélis A, Stéfan A, Colin D, Albert T, Gault D, Goossens D, Perrouin-Verbe B, Fattal C, Pelissier J, Coudeyre E. Therapeutic education in persons with spinal cord injury: A review of the literature. Ann Phys Rehabil Med 2011; 54:189-210. [DOI: 10.1016/j.rehab.2011.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 03/13/2011] [Accepted: 03/17/2011] [Indexed: 11/24/2022]
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McCully KK, Mulcahy TK, Ryan TE, Zhao Q. Skeletal muscle metabolism in individuals with spinal cord injury. J Appl Physiol (1985) 2011; 111:143-8. [PMID: 21512153 DOI: 10.1152/japplphysiol.00094.2011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
With increasing survival rates in people with spinal cord injuries (SCI), detection and prevention of metabolic and cardiovascular disease have become increasingly important. Few studies have evaluated in vivo mitochondrial function in paralyzed skeletal muscle. The purpose of this study was to compare oxidative muscle metabolism using the rate of phosphocreatine (PCr) resynthesis measured by magnetic resonance spectroscopy (MRS) in people with SCI and able-bodied (AB) controls. Eight subjects with complete SCI (American Spinal Injury Association Impairment Scale A, levels T3-T12, injury duration 2-13 years) were compared with 12 AB controls. T1-weighted (1)H MR images of the thigh were taken to identify skeletal muscle. Phosphorous MRS was performed with a 13 × 13-cm(2) surface coil placed on the right vastus lateralis in a 3 Tesla clinical MRI scanner. PCr resynthesis was measured after electrical stimulation for 60 s at 4 Hz in SCI and AB and in AB subjects after 39 s of voluntary isometric contractions. Resting metabolites were not different between SCI and AB, except for an elevated phosphodiester peak. PCr recovery was slower in AB subjects using electrical stimulation compared with voluntary exercise (28.4 ± 6.1 vs. 41.5 ± 4.3 s; P < 0.05). PCr recovery rates and calculated muscle maximum oxidative capacity in SCI were both 52% of electrically stimulated AB (P < 0.001). In vivo oxidative metabolism was reduced in paralyzed muscle to a similar extent as seen in people with mitochondrial myopathies and heart failure.
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Affiliation(s)
- Kevin K McCully
- Department of Kinesiology, University of Georgia, 330 River Rd., Athens, GA 30602, USA.
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Souza FID, Barros Filho TEP, Cristante AF. Avaliação do emprego do GM1 após lesão medular experimental em ratos. COLUNA/COLUMNA 2011. [DOI: 10.1590/s1808-18512011000400011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a eficácia do GM1, administrado por via intraperitoneal, após lesão medular experimental em ratos. MÉTODOS: Foram utilizados 20 ratos da raça Wistar machos, adultos jovens, com média de idade de 20 semanas, pesando em torno de 350 g, divididos em dois grupos de 10 animais. No grupo 1 foi administrado apenas soro fisiológico por via intraperitoneal. Ao grupo 2, administraram-se 30 mg/kg de GM1 diariamente por essa mesma via. As lesões foram produzidas seguindo-se o protocolo internacional MASCIS (Multicenter Animal Spinal Cord Injury Study), com o sistema NYImpactor. Os animais foram avaliados funcionalmente pela escala BBB nos dias 14, 28 e 42 após a lesão. O potencial evocado foi realizado em todos os animais, no 42º dia após o trauma. RESULTADOS: Utilizou-se um modelo de variância de dois fatores (ANOVA) e o teste t de Student. As avaliações funcionais e por meio de potencial evocado não demonstraram diferença estatisticamente significante entre os dois grupos. CONCLUSÃO: O emprego de GM1 intraperitoneal não demonstrou resultados satisfatórios após lesão medular experimental.
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Findley PA, Banerjea R, Sambamoorthi U. Excess mortality associated with mental illness and substance use disorders among veteran clinic users with spinal cord injury. Disabil Rehabil 2010; 33:1608-15. [PMID: 21184627 DOI: 10.3109/09638288.2010.540294] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Among veterans with traumatic spinal cord injury (SCI) or disease aetiologies, examine the association between diagnosed mental illness (MI) and substance use disorders (SUD) on mortality after controlling for demographic and socioeconomic factors, SCI severity, injury duration and chronic physical illnesses. METHOD Longitudinal analysis of Veteran Health Administration(VHA) administrative data and Medicare claims for FY 1999-2004 matched with Spinal Cord Dysfunction-Registry (SCD-R) of VHA clinic users (N = 8334) with SCI. SCI was identified through SCD-R; individual MIs (anxiety, bipolar, depressive disorders, psychoses, post-traumatic disorder and schizophrenia) and SUDs (tobacco, alcohol and/or drug) were identified through ICD-9-CM codes. Cox-proportional hazards regressions were used to examine association between MI and SUD and time to death in years. RESULTS Among veterans with SCI, 17% died by the end of FY 2004. Veterans with psychosis (35%), depression (22%) and alcohol and/or drug use (20%) had significantly higher rates of mortality compared to those without these diagnoses. After adjusting for other independent variables in the study, hazards ratios for psychosis was 1.47 (95%CI = 1.24, 1.75), for alcohol and/or drug use was 1.30 (95% CI = 1.11, 1.53). CONCLUSIONS Some types of MI and SUD were associated with excess mortality among veterans with SCI. Care for MI and SUD needs to be routinely integrated into SCI management. Future research is needed to determine whether depression and SUD treatment provides opportunity to improve survival.
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Affiliation(s)
- Patricia A Findley
- Department of Veterans Affairs New Jersey Healthcare System, Center for Health Care Knowledge Management, East Orange, NJ, USA.
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Teo SHJ, Sew S, Backman C, Forwell S, Lee WK, Chan PL, Dean E. Health of people with spinal cord injury in Singapore: implications for rehabilitation planning and implementation. Disabil Rehabil 2010; 33:1460-74. [PMID: 21091048 DOI: 10.3109/09638288.2010.533812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study aimed to provide a broad overview of the health of people with spinal cord injury (SCI) in Singapore, so as to highlight areas of potential need. These areas could then guide future research and rehabilitation programme development. METHODS Demographic data, injury information and information about SCI-related secondary impairments, chronic conditions and their associated risk factors, medical and hospital utilisation, participation (Craig Handicap Assessment and Reporting Technique) and life satisfaction (Satisfaction with Life Scale) were collected via interviews from people living with traumatic SCI. RESULTS On average, participants (50 men and 5 women) were aged 48.3 ± 16.54 years and had had their SCIs for 5 years. -75% with tetraplegia. The most prevalent SCI-related secondary impairments were pain, spasms, bladder problems, bowel problems and oedema. Chronic conditions and their associated risk factors were prevalent. Participation and life satisfaction scores were lower than those reported for similar populations cross-culturally. CONCLUSION The study revealed several health areas that may be affecting the overall health of people with SCI in Singapore. By focusing on community reintegration and health promotion, physiotherapists and other rehabilitation professionals may augment health outcomes and improve the quality of life of this population in Singapore.
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Affiliation(s)
- Sock Hui Joy Teo
- Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore.
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