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Kumru H, Ros-Alsina A, García Alén L, Vidal J, Gerasimenko Y, Hernandez A, Wrigth M. Improvement in Motor and Walking Capacity during Multisegmental Transcutaneous Spinal Stimulation in Individuals with Incomplete Spinal Cord Injury. Int J Mol Sci 2024; 25:4480. [PMID: 38674065 PMCID: PMC11050444 DOI: 10.3390/ijms25084480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Transcutaneous multisegmental spinal cord stimulation (tSCS) has shown superior efficacy in modulating spinal locomotor circuits compared to single-site stimulation in individuals with spinal cord injury (SCI). Building on these findings, we hypothesized that administering a single session of tSCS at multiple spinal segments may yield greater enhancements in muscle strength and gait function during stimulation compared to tSCS at only one or two segments. In our study, tSCS was applied at single segments (C5, L1, and Coc1), two segments (C5-L1, C5-Coc1, and L1-Coc1), or multisegments (C5-L1-Coc1) in a randomized order. We evaluated the 6-m walking test (6MWT) and maximum voluntary contraction (MVC) and assessed the Hmax/Mmax ratio during stimulation in ten individuals with incomplete motor SCI. Our findings indicate that multisegmental tSCS improved walking time and reduced spinal cord excitability, as measured by the Hmax/Mmax ratio, similar to some single or two-site tSCS interventions. However, only multisegmental tSCS resulted in increased tibialis anterior (TA) muscle strength. These results suggest that multisegmental tSCS holds promise for enhancing walking capacity, increasing muscle strength, and altering spinal cord excitability in individuals with incomplete SCI.
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Affiliation(s)
- Hatice Kumru
- Fundación Institut Guttmann, Institut Universitari de NeurorehabilitacióAdscrit a la UAB, 08916 Badalona, Spain; (A.R.-A.); (L.G.A.); (J.V.); (A.H.); (M.W.)
- Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, 08916 Badalona, Spain
| | - Aina Ros-Alsina
- Fundación Institut Guttmann, Institut Universitari de NeurorehabilitacióAdscrit a la UAB, 08916 Badalona, Spain; (A.R.-A.); (L.G.A.); (J.V.); (A.H.); (M.W.)
| | - Loreto García Alén
- Fundación Institut Guttmann, Institut Universitari de NeurorehabilitacióAdscrit a la UAB, 08916 Badalona, Spain; (A.R.-A.); (L.G.A.); (J.V.); (A.H.); (M.W.)
- Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Joan Vidal
- Fundación Institut Guttmann, Institut Universitari de NeurorehabilitacióAdscrit a la UAB, 08916 Badalona, Spain; (A.R.-A.); (L.G.A.); (J.V.); (A.H.); (M.W.)
- Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, 08916 Badalona, Spain
| | - Yury Gerasimenko
- Pavlov Institute of Physiology, St. Petersburg 199034, Russia;
- Department of Physiology and Biophysics, University of Louisville, Louisville, KY 40292, USA
| | - Agusti Hernandez
- Fundación Institut Guttmann, Institut Universitari de NeurorehabilitacióAdscrit a la UAB, 08916 Badalona, Spain; (A.R.-A.); (L.G.A.); (J.V.); (A.H.); (M.W.)
- Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Mark Wrigth
- Fundación Institut Guttmann, Institut Universitari de NeurorehabilitacióAdscrit a la UAB, 08916 Badalona, Spain; (A.R.-A.); (L.G.A.); (J.V.); (A.H.); (M.W.)
- Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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Maresca G, Latella D, Formica C, Veneziani I, Ielo A, Quartarone A, Calabrò RS, De Cola MC. The Effects of Home Automation on Personal and Social Autonomies in Spinal Cord Injury Patients: A Pilot Study. J Clin Med 2024; 13:1275. [PMID: 38592129 PMCID: PMC10932432 DOI: 10.3390/jcm13051275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Spinal cord injury (SCI) is a severe and progressive neurological condition caused by trauma to the nervous system, resulting in lifelong disability and severe comorbidities. This condition imposes serious limitations on everyday life, interfering with patients' social lives and compromising their quality of life, psychological well-being, and daily living activities. Rehabilitation is essential to helping SCI patients gain more independence in their daily routines. Home automation (HA) systems provide personalized support to users, allowing them to manage various aspects of their living environment, promoting independence and well-being. This study aims to demonstrate the efficacy of an HA system in enhancing personal and social autonomies in SCI patients, resulting in improved cognitive function and reduced anxiety-depressive symptoms compared to traditional training. Methods: We enrolled 50 SCI patients undergoing neurorehabilitation at IRCCS Centro Neurolesi (Messina, Italy). These patients were randomly assigned to one of two groups: a control group (CG) and an experimental group (EG). The CG received traditional training, while the EG underwent HA training. We evaluated the patients before (T0) and after (T1) rehabilitation using various scales, including the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Anxiety (HRS-A), the 12-Item Short-Form Survey (SF-12), the Functional Independence Measure (FIM), Activities of Daily Living (ADL), Instrumental Activities of Daily Living Scale (IADL), and the EQ-5D-5L. Results: The effect of the experimental treatment showed an improvement in all patients test scores in the EG, especially regarding cognitive functions, mood disorders, activities of daily living, and quality of life. Conclusion: Our findings suggest that HA may be effective in improving daily autonomy and, in turn, alleviating mood disorders and enhancing psychological well-being.
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Affiliation(s)
- Giuseppa Maresca
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (G.M.); (D.L.); (A.I.); (A.Q.); (R.S.C.); (M.C.D.C.)
| | - Desirèe Latella
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (G.M.); (D.L.); (A.I.); (A.Q.); (R.S.C.); (M.C.D.C.)
| | - Caterina Formica
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (G.M.); (D.L.); (A.I.); (A.Q.); (R.S.C.); (M.C.D.C.)
| | - Isabella Veneziani
- Department of Nervous System and Behavioural Sciences, Psychology Section, University of Pavia, Piazza Botta 11, 27100 Pavia, Italy
| | - Augusto Ielo
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (G.M.); (D.L.); (A.I.); (A.Q.); (R.S.C.); (M.C.D.C.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (G.M.); (D.L.); (A.I.); (A.Q.); (R.S.C.); (M.C.D.C.)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (G.M.); (D.L.); (A.I.); (A.Q.); (R.S.C.); (M.C.D.C.)
| | - Maria Cristina De Cola
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (G.M.); (D.L.); (A.I.); (A.Q.); (R.S.C.); (M.C.D.C.)
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Conti A, Campagna S, Gianino MM, Mamo C, Onorati R, Albanesi B, Dimonte V, Borraccino A. Incidence and mortality of spinal cord injury from 2008 to 2020: a retrospective population-based cohort study in the Piedmont Region, Italy. Spinal Cord 2023; 61:99-105. [PMID: 35933474 PMCID: PMC9362101 DOI: 10.1038/s41393-022-00842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Retrospective population-based cohort study. OBJECTIVES To determine the incidence and mortality of spinal cord injuries (SCI) in the Piedmont Region of Northwestern Italy. SETTING Publicly-funded SCI rehabilitation centres in the Piedmont Region. METHODS Administrative databases were used to identify individuals at their first admission to a SCI rehabilitation centre from January 1st, 2008 to December 31st, 2020. Cases were stratified by age and aetiology (traumatic SCI, TSCI; non-traumatic SCI, NTSCI). Age- and aetiology-specific incidence rate and person-year mortality rates were calculated for each year. Case lethality was reported as deaths among prevalent cases for each year. RESULTS A total of 892 cases were identified (56.4% TSCI). The average annual crude incidence rate was 17.9 per million population, decreasing from 26.0 in 2008 to 10.8 in 2020. Young adults and the elderly represented the majority of TSCI and NTSCI cases, respectively. Of the 235 individuals who died during the study period, 58.3% had NTSCI. The mortality rate per 1000 person-years decreased from 16.3 in 2009 to 8.5 in 2020, while case lethality more than tripled (from 17.2 in 2009 to 57.1 in 2020). CONCLUSIONS We identified a decreasing trend in SCI incidence and mortality rates, with an increased case lethality over the study period, especially in NTSCI. Given these changes in the epidemiology of SCI, community services offered after rehabilitation should be strengthened to enhance their effectiveness and contribute to increased survival in this population.
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Affiliation(s)
- Alessio Conti
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Sara Campagna
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Maria Michela Gianino
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Carlo Mamo
- Epidemiology Unit, Local Health Unit TO3, Grugliasco (TO), Piedmont, Italy
| | - Roberta Onorati
- Epidemiology Unit, Local Health Unit TO3, Grugliasco (TO), Piedmont, Italy
| | - Beatrice Albanesi
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Alberto Borraccino
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy.
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Maggio MG, Naro A, De Luca R, Latella D, Balletta T, Caccamo L, Pioggia G, Bruschetta D, Calabrò RS. Body Representation in Patients with Severe Spinal Cord Injury: A Pilot Study on the Promising Role of Powered Exoskeleton for Gait Training. J Pers Med 2022; 12:jpm12040619. [PMID: 35455735 PMCID: PMC9030625 DOI: 10.3390/jpm12040619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with spinal cord injury (SCI) complain of changes in body representation, potentially leading to negative physical and psychological consequences. The purpose of our study is to evaluate the effects of robotic training with the Ekso-GT on body representation (BR) and on the quality of life in patients with SCI. The trial was designed as a pilot, assessor-blinded study. Forty-two inpatients with a diagnosis of SCI, classified as either American Spinal Cord Injury Association Impairment Scale (AIS), were enrolled in this study and randomized into either a control (CG: n = 21) or an experimental (EG: n = 21) group. Patients in the EG received rehabilitation training with the Ekso-GT device, whereas the CG patients were trained with conventional physical therapy (CPT), which consisted of physical and occupational therapy and psychological support. We considered as a primary outcome the modified Body Uneasiness Test (MBUT), focusing on three specific subscales on the patient’s perception of BR, i.e., the Global Severity Index (MBUT-GSI), which is an indicator of body suffering; the Positive Symptom Distress Index (MBUT-PSDI) that expresses an individual’s psychological distress; and the Lower Limb MBUT (MBUT-LL), which indicates the subject’s perception of their thighs/legs. The Short-Form-12 Health Status Questionnaire (SF12) and the Beck’s Depression Inventory (BDI) were used as secondary outcomes to evaluate the effect of the training on the quality of life and the psychological status. Non-parametric statistical analysis showed that the effect of the two treatments was significantly different on MBUT (BR), SF-12 (quality of life), and, partially, BDI (mood). Particularly, patients belonging to the EG achieved a major improvement in nearly all test scores compared to those in the CG. Our data suggest that the Ekso-GT training could be helpful in achieving positive changes in BR in patients with chronic SCI, especially in reducing psychological distress (PSDI) and thigh/leg perception (MBUT-LL) with an overall improvement in quality of life (SF-12).
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Affiliation(s)
- Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy;
| | - Antonino Naro
- AOU Policlinico “G. Martino”, 98125 Messina, Italy; (A.N.); (D.B.)
| | - Rosaria De Luca
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
| | - Desiree Latella
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
| | - Tina Balletta
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
| | - Lory Caccamo
- Neuropsychology Unit, University of Padua, 35121 Padua, Italy;
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98164 Messina, Italy;
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
- Correspondence: ; Tel.: +39-090-6012-3850
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Tederko P, Middleton J, Mycielski J, Joseph C, Pagliacci MC, Rapidi CA, Tarnacka B, Kujawa J. Relationship Between Level of Economic Development, Age, and Etiology of Spinal Cord Injury: A Cross-Sectional Survey From 22 Countries. Arch Phys Med Rehabil 2021; 102:1947-1958.e37. [PMID: 34119460 DOI: 10.1016/j.apmr.2021.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine relationships between age and spinal cord injury (SCI) and cause of SCI and how this depends on economic development. DESIGN Cross-sectional survey. SETTING Community, 22 countries representing all stages of economic development. PARTICIPANTS A total of 12,591 adults with SCI (N=12,591). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Interactions between age at injury and gross domestic product per capita based on purchasing power parity (GDP PPP) quartiles calculated with the application of logistic regression with the Maximum Likelihood estimator. Independence between SCI cause and age was assessed with the Wald test. RESULTS In persons with traumatic SCI, younger age was associated with a higher likelihood of injury in motor vehicle collisions, whereas older individuals had a greater chance of SCI due to falls. Associations between increased likelihood of high-energy traumatic SCI and younger age, low-energy traumatic SCI with older age, nontraumatic SCI with older age in persons injured in adulthood, and a higher prevalence of incomplete SCI lesions in individuals injured at an older age were revealed. Higher GDP PPP influenced positively the likelihood of low-energy SCI in older individuals and was negatively associated with the chance of sustaining SCI in motor vehicle collisions and the likelihood of having nontraumatic SCI at an older age. CONCLUSIONS SCI in older age is predominantly because of falls and nontraumatic injuries. Higher country income is associated with an increased proportion of SCI sustained later in life because of low-energy trauma involving cervical injury and a lower chance of being because of motor vehicle collisions. An increased prevalence of nontraumatic SCI in older individuals associated with lower country income may reflect a higher exposure to socially preventable conditions and lower access to or efficacy of health care. Future studies on etiology of SCI should make the distinction between low and high falls and overcome underrepresentation of older persons.
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Affiliation(s)
- Piotr Tederko
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jerzy Mycielski
- Department of Econometrics and Statistics, Faculty of Economics, University of Warsaw, Warsaw, Poland
| | - Conran Joseph
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | | | - Beata Tarnacka
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Kujawa
- Department of Medical Rehabilitation, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
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Chang F, Zhang Q, Xie H, Yang Y, Sun M, Wu A, Wu J, Chen G, Shen F, Li C, Lu J. Effects of a rehabilitation program for individuals with chronic spinal cord injury in Shanghai, China. BMC Health Serv Res 2020; 20:298. [PMID: 32293434 PMCID: PMC7158161 DOI: 10.1186/s12913-020-05181-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 04/01/2020] [Indexed: 12/15/2022] Open
Abstract
Background Specialized Institution-Based Rehabilitation (SIBR) is the cornerstone of care and treatment for individuals with spinal cord injury, but most people with chronic spinal cord injury (CSCI) living in China have no SIBR experience after acute care hospital discharge. In 2009, an SIBR facility was set up in Shanghai (China) to fill this important gap in care. The purpose of the study was to evaluate the effectiveness of an integrated rehabilitation training program among individuals with CSCI living in Shanghai. Methods A within-subject pre-posttest design was used to evaluate the SIBR. The sample included 455 individuals ≥1 year post-SCI, who were older than 18 years of age and were enrolled in a rehabilitation center in Shanghai, China, between 2013 and 2019. The data included individuals’ sociodemographic and injury characteristics, and twenty-three indicators were used as outcome measurements to evaluate basic life skills and their applications in family and social life. Multivariate linear regression was conducted to determine which factors might have influenced the effectiveness of the SIBR. Results All basic life skills and their applications in family and social life were improved, but with variations across socio-demographics. Female individuals with CSCI had better outcomes in basic life skills than did males. In terms of basic life skills and their applications in family and social life, individuals with a low level (thoracic or lumbosacral) of injury achieved more significant functional gains than those with a higher level (cervical). The baseline score was also a relevant factor in functional outcome. Conclusions Even for individuals with a long SCI history, SIBR training can improve basic life skills and the applications of those skills in family and social life settings.
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Affiliation(s)
- Fengshui Chang
- China Research Center on Disability, School of Public Health, Fudan University, Shanghai, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Haixia Xie
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Yuhui Yang
- China Research Center on Disability, School of Public Health, Fudan University, Shanghai, China
| | - Mei Sun
- China Research Center on Disability, School of Public Health, Fudan University, Shanghai, China
| | - Airong Wu
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Jinghua Wu
- Shanghai Disabled Persons' Federation, Shanghai, China
| | - Gang Chen
- China Research Center on Disability, School of Public Health, Fudan University, Shanghai, China
| | - Feng Shen
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Chengyue Li
- China Research Center on Disability, School of Public Health, Fudan University, Shanghai, China
| | - Jun Lu
- China Research Center on Disability, School of Public Health, Fudan University, Shanghai, China.
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Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome. Spinal Cord 2020; 58:768-777. [PMID: 31996778 DOI: 10.1038/s41393-020-0421-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 12/18/2022]
Abstract
STUDY DESIGN Multicenter prospective observational study of people with acute traumatic spinal cord injury (TSCI) admitted to rehabilitation. OBJECTIVES To update epidemiological characteristics of a TSCI Italian population and verify the impact of patient characteristics at admission on two outcomes: functional gain (SCIM III) and discharge destination. SETTING Thirty-one SCI centers for comprehensive rehabilitation in 13 Italian regions. METHODS All consecutive individuals admitted with acute TSCI were enrolled from October 1, 2013 to September 30, 2014; data were recorded on rehabilitation admission and discharge. Functional gain and discharge destination were identified as outcome measures and statistically analyzed with patient characteristics at admission to identify early outcome predictors. RESULTS Five hundred and ten individuals with TSCI met inclusion criteria; falls represented the most frequent etiology (45%). On admission, AIS A-B-C tetraplegia was reported in 35% of cases; AIS A-B-C paraplegia in 40%; AIS D paraplegia/tetraplegia in 25%. The majority were discharged home (72%). The mean (SD) SCIM gain was 38 ± 26 points. A predictive model was found for discharge setting: individuals with fall-related injuries, severe SCI (AIS A-B-C tetraplegia), tracheal cannula or indwelling catheter on admission, were less likely to be discharged home (OR 95% CI 0.15 [0.06, 0.35]). A model with a lower predictive power was found for SCIM gain, with lower score expected for females, older age, higher severity of SCI, a longer onset of injury admission interval (OAI), and mechanical ventilation on admission. CONCLUSIONS Prognostic factors in early rehabilitation are still hard to identify, making it difficult to correctly approach customized rehabilitation.
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Federici S, Artegiani F, Pigliautile M, Antonelli P, Diotallevi D, Ritacco I, Maschke R. Enhancing Psychological Sexual Health of People With Spinal Cord Injury and Their Partners in an Italian Unipolar Spinal Unit: A Pilot Data Study. Front Psychol 2019; 10:754. [PMID: 31024395 PMCID: PMC6459940 DOI: 10.3389/fpsyg.2019.00754] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/19/2019] [Indexed: 11/20/2022] Open
Abstract
Like the slogan of the American Consortium for Spinal Cord Medicine says, “No injury, no matter how serious, can take away your ability to have a relationship, experience love, and experience the attraction between two people.” However, people with spinal cord injury (SCI) have to fight with their own and societal attitudes and stereotypes that limit sexuality to the physiological functions of genitalia, phallocentric primacy of sexual pleasure, and sexual attractiveness of perfect bodies. The scope of the present study is to evaluate the impacts of a psychoeducational intervention in a personal growth group on the sexual life of seven people with SCI and four of their partners particularly their sexual interest and satisfaction, depression, and anxiety. Due to the small samples size, nonparametric statistical tests were used to compare pre- and post-outcome measures for all participants: patients and the partners group. Possible effects of gender were also considered. The effectiveness of the psychoeducational intervention was clearly apparent, showing a high effect size in improving sexual interest and satisfaction, and the opportunity and ability to enjoy sexuality. A reduction of anxiety was also observed for all participants, although it may not have been related to the psychoeducational intervention. Moreover, the intervention significantly improved the opportunity and ability to enjoy sexuality for the partner and patient group. No effect was found on depression. This was the first initiative in Italy aiming to address the sexual life and not only to cure the sexual dysfunction of people with SCI. The positive, clear evidence of the validity of the Love & Life project’s intervention bodes well for new psychoeducational initiatives that in Italy meet the sexual needs of people with SCI and their partners, providing adequate education and psychological support, involving partners, and creating a space to talk among peers.
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Affiliation(s)
- Stefano Federici
- Department of Philosophy, Social & Human Sciences and Education, University of Perugia, Perugia, Italy
| | | | - Martina Pigliautile
- Gerontology and Geriatrics Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Paolo Antonelli
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Innocenza Ritacco
- Unipolar Spinal Unit, Hospital Santa Maria della Misericordia, Perugia, Italy
| | - Renée Maschke
- Unipolar Spinal Unit, Hospital Santa Maria della Misericordia, Perugia, Italy
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Maresca G, Maggio MG, Buda A, La Rosa G, Manuli A, Bramanti P, De Luca R, Calabrò RS. A novel use of virtual reality in the treatment of cognitive and motor deficit in spinal cord injury: A case report. Medicine (Baltimore) 2018; 97:e13559. [PMID: 30558016 PMCID: PMC6320010 DOI: 10.1097/md.0000000000013559] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Aim of this study is to evaluate the cognitive and motor outcomes after a combined rehabilitative training using a standard cognitive approach and virtual reality (VR), in a patient with spinal cord injury (SCI). PATIENT'S CONCERNS A 60-year-old right-handed man, affected by incomplete cervical SCI, came to our observation for a moderate tetraparesis, mainly involving the left side, after about 6-months from the acute event. The neurological examination showed imbalance with upper limb incoordination, besides the paresis mainly involving the left side. At a neuropsychological evaluation, he presented important impairment in cognitive and behavioural status, with temporal and spatial disorientation, a reduction of attention and memory process, deficit of executive function and a severe depression of mood, which was not detected during the previous recovery. DIAGNOSIS Motor and cognitive deficits in SCI. INTERVENTIONS The patient was 1st submitted to standard cognitive training and traditional physiotherapy, and then to a combined therapeutic approach, in which virtual reality training was provided by means of the virtual reality rehabilitation system (VRRS, Khymeia, Italy). OUTCOMES After the combined therapeutic approach with the VRRS training, we observed a significant improvement in different cognitive domains, a notable reduction of anxiety and depressive symptoms, as well as motor performance, and balance improvement. LESSONS Virtual reality can be considered a promising tool for the rehabilitation of different neurological disorders, including patients with both motor and cognitive deficits following SCI.
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Reliability of the Italian version of the International Spinal Cord Injury Pain Basic Data Set. Spinal Cord 2018; 57:128-133. [DOI: 10.1038/s41393-018-0171-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 11/08/2022]
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Marquez MA, De Santis R, Ammendola V, Antonacci M, Santilli V, Berardi A, Valente D, Galeoto G. Cross-cultural adaptation and validation of the “Spinal Cord Injury-Falls Concern Scale” in the Italian population. Spinal Cord 2018; 56:712-718. [DOI: 10.1038/s41393-018-0070-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/10/2022]
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13
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Warren N, Walford K, Susilo A, New PW. Emotional Consequences of Delays in Spinal Rehabilitation Unit Admission or Discharge: A Qualitative Study on the Importance of Communication. Top Spinal Cord Inj Rehabil 2018; 24:54-62. [PMID: 29434461 DOI: 10.1310/sci17-00026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To explore the influence of health communications on the emotional consequences of delays in transfer from acute hospital into a spinal rehabilitation unit (SRU) or delays in discharge from SRU. Methods: Semi-structured interviews were conducted in this exploratory, thematic qualitative research design in an SRU, Melbourne, Australia. Results: Six patients experienced delay in admission to (n = 4) or discharge from (n = 3) the SRU, with one person experiencing both an admission and discharge delay. Median admission delay was 41.5 days, primarily related to bed availability and staffing issues. Participants experiencing a delay in transfer from the acute hospital reported feelings of uncertainty, frustration, disappointment, and concern due to a perception that their functional recovery was compromised because of delayed access to specialist rehabilitation. Psychological issues were less common than emotional responses. One participant spent some of the delay period waiting for admission to the SRU in a non-spinal rehabilitation unit and reported no concerns about his recovery. Median discharge delay was 27 days, largely due to a wait in obtaining funding for equipment. Emotional and psychological responses to delayed discharge, particularly frustration, appeared to be influenced by having a sense of control over the discharge process. Conclusion: Patients' experiences during the delay periods partially mitigated the emotional and psychological consequences of a delayed admission or discharge on their psychological well-being. Locus of control, where participants reported being able to effect some influence on their situation, appeared to moderate their emotional state. The findings suggest that clinicians can draw on the concept of control to better support patients through periods of delay.
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Affiliation(s)
- Narelle Warren
- School of Social Sciences and Psychology Department, Alfred Hospital, Monash University, Victoria, Australia
| | - Karin Walford
- School of Psychological Science, Monash University, Victoria, Australia
| | - Annisha Susilo
- School of Psychological Science, Monash University, Victoria, Australia
| | - Peter Wayne New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia
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Moon J, Yu J, Choi J, Kim M, Min K. Degree of Contribution of Motor and Sensory Scores to Predict Gait Ability in Patients With Incomplete Spinal Cord Injury. Ann Rehabil Med 2018; 41:969-978. [PMID: 29354573 PMCID: PMC5773440 DOI: 10.5535/arm.2017.41.6.969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/05/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To identify different contributions of motor and sensory variables for independent ambulation of patients with incomplete spinal cord injury (SCI), and reveal the most significant contributors among the variables. Methods The retrospective study included 30 patients with incomplete SCI and lesions were confirmed by magnetic resonance imaging. Motor and sensory scores were collected according to the International Standards for Neurological Classification of Spinal Cord Injury. The variables were analyzed by plotting ROC (receiver operating characteristic) curves to estimate their differential contributions for independent walking. The most significant functional determinant was identified through the subsequent logistic regression analysis. Results Motor and sensory scores were significantly different between the ambulators and non-ambulators. The majority was associated to the function of lower extremities. Calculation of area under ROC curves (AUC) revealed that strength of hip flexor (L2) (AUC=0.905, p<0.001) and knee extensor (L3) (AUC=0.820, p=0.006) contributed the greatest to independent walking. Also, hip flexor strength (L2) was the single most powerful predictor of ambulation by the logistic regression analysis (odds ratio=6.3, p=0.049), and the model fit well to the data. Conclusion The most important potential contributor for independent walking in patients with incomplete SCI is the muscle strength of hip flexors, followed by knee extensors compared with other sensory and motor variables.
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Affiliation(s)
- Jinkyoo Moon
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Junghoon Yu
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jaewoo Choi
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Scivoletto G, Torre M, Iosa M, Porto MR, Molinari M. Prediction Model for the Presence of Complications at Admission to Rehabilitation After Traumatic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2017; 24:151-156. [PMID: 29706759 DOI: 10.1310/sci17-00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Complications frequently occur in patients with spinal cord injury (SCI) during acute care or rehabilitation and have an impact on rehabilitation outcomes. Purpose: The aim of this study was to determine the occurrence and risk factors for complications in recently injured SCI patients. Methods: Two hundred fifty patients with traumatic injuries with and without complications were counted for the following dichotomous parameters: gender (male/female), associated lesions (presence/absence), surgery (yes/no), American Spinal Injury Association Impairment Scale (AIS) grade (A/other categories), lesion level (lumbar/other levels), and lesion-to-admission time (less than/longer than 1 month). The odds ratio (OR) and 95% confidence interval were computed for all the parameters that influenced the presence of complications at admission. These factors have been included in a binary logistic regression analysis (forward stepwise). Results: Complications at admission were observed in 104 patients (41.6%), especially for males, lesion-to-admission time longer than 1 month, presence of associated lesions, AIS grade A, and motor completeness, whereas lumbar lesions were associated with a reduced presence of complications at admission. In the regression analysis, 4 factors entered into the model: motor completeness, lesion-to-admission time, associated lesions, and gender. The final model explained 74% of the variance of data. Conclusions: Despite advances in the acute management of patients with SCI, the study unveiled a high percentage of patients with complications at admission to rehabilitation. The risk factors identified in the study allow determination of the population of subjects who are at higher risk of developing complications and need special management.
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Affiliation(s)
- Giorgio Scivoletto
- Spinal Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Monica Torre
- Spinal Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Maria Rosaria Porto
- Specialization School in Physical Medicine and Rehabilitation, Tor Vergata University, Rome, Italy
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Ferro S, Cecconi L, Bonavita J, Pagliacci MC, Biggeri A, Franceschini M. Incidence of traumatic spinal cord injury in Italy during 2013–2014: a population-based study. Spinal Cord 2017; 55:1103-1107. [DOI: 10.1038/sc.2017.88] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 11/09/2022]
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17
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Observational study of the effectiveness of spinal cord injury rehabilitation using the Spinal Cord Injury-Ability Realization Measurement Index. Spinal Cord 2015; 54:467-72. [PMID: 26369890 DOI: 10.1038/sc.2015.153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVES The objective of this study was to determine the rehabilitation potential and the extent to which it is realized in a cohort of spinal cord injury patients using the Spinal Cord Injury-Ability Realization Measurement Index (SCI-ARMI) and to study the clinical factors that influence this realization. SETTING Two spinal units in Italy. METHODS Consecutive patients were assessed at the end of an in-patient rehabilitation program using the Spinal Cord Independence Measure and the International Standards for Neurological Classification of Spinal Cord Injury. On the basis of these data and of the age and gender of the patients, we calculated the SCI-ARMI score. Regression analyses were performed to study the relationship between clinical factors and the extent to which rehabilitation potential is realized. RESULTS We examined the data for 306 patients. Most patients were discharged without having reached their rehabilitation potential, with an SCI-ARMI score <80%. SCI-ARMI scores at discharge were positively influenced by etiology and the lesion level and correlated negatively with lesion severity and the presence of complications during rehabilitation. CONCLUSION The SCI-ARMI is an effective tool that can be used to measure the achievement of rehabilitation potential in SCI patients and to identify groups of patients who are at risk of not meeting their rehabilitative potential.
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Time-series analysis of the barriers for admission into a spinal rehabilitation unit. Spinal Cord 2015; 54:126-31. [PMID: 26099216 DOI: 10.1038/sc.2015.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/17/2015] [Accepted: 05/25/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is a prospective open-cohort case series. OBJECTIVES The objective of this study was to assess changes over time in the duration of key acute hospital process barriers for patients with spinal cord damage (SCD) from admission until transfer into spinal rehabilitation unit (SRU) or other destinations. SETTING The study was conducted in Acute hospitals, Victoria, Australia (2006-2013). METHODS Duration of the following discrete sequential processes was measured: acute hospital admission until referral to SRU, referral until SRU assessment, SRU assessment until ready for SRU transfer and ready for transfer until SRU admission. Time-series analysis was performed using a generalised additive model (GAM). Seasonality of non-traumatic spinal cord dysfunction (SCDys) was examined. RESULTS GAM analysis shows that the waiting time for admission into SRU was significantly (P<0.001) longer for patients who were female, who had tetraplegia, who were motor complete, had a pelvic pressure ulcer and who were referred from another health network. Age had a non-linear effect on the duration of waiting for transfer from acute hospital to SRU and both the acute hospital and SRU length of stay (LOS). The duration patients spent waiting for SRU admission increased over the study period. There was an increase in the number of referrals over the study period and an increase in the number of patients accepted but not admitted into the SRU. There was no notable seasonal influence on the referral of patients with SCDys. CONCLUSIONS Time-series analysis provides additional insights into changes in the waiting times for SRU admission and the LOS in hospital for patients with SCD.
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Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit. Spinal Cord 2014; 53:358-62. [DOI: 10.1038/sc.2014.166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/20/2014] [Accepted: 08/27/2014] [Indexed: 11/08/2022]
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New PW. Reducing process barriers in acute hospital for spinal cord damage patients needing spinal rehabilitation unit admission. Spinal Cord 2014; 52:472-6. [DOI: 10.1038/sc.2014.59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 02/09/2014] [Accepted: 03/29/2014] [Indexed: 11/09/2022]
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Scivoletto G, Tamburella F, Laurenza L, Torre M, Molinari M. Who is going to walk? A review of the factors influencing walking recovery after spinal cord injury. Front Hum Neurosci 2014; 8:141. [PMID: 24659962 PMCID: PMC3952432 DOI: 10.3389/fnhum.2014.00141] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/26/2014] [Indexed: 12/11/2022] Open
Abstract
The recovery of walking function is considered of extreme relevance both by patients and physicians. Consequently, in the recent years, recovery of locomotion become a major objective of new pharmacological and rehabilitative interventions. In the last decade, several pharmacological treatment and rehabilitative approaches have been initiated to enhance locomotion capacity of SCI patients. Basic science advances in regeneration of the central nervous system hold promise of further neurological and functional recovery to be studied in clinical trials. Therefore, a precise knowledge of the natural course of walking recovery after SCI and of the factors affecting the prognosis for recovery has become mandatory. In the present work we reviewed the prognostic factors for walking recovery, with particular attention paid to the clinical ones (neurological examination at admission, age, etiology gender, time course of recovery). The prognostic value of some instrumental examinations has also been reviewed. Based on these factors we suggest that a reliable prognosis for walking recovery is possible. Instrumental examinations, in particular evoked potentials could be useful to improve the prognosis.
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Affiliation(s)
- Giorgio Scivoletto
- Spinal Cord Unit, IRCCS Fondazione S. Lucia Rome, Italy ; Clinical and Research Movement Analysis Lab, Fondazione S. Lucia Rome, Italy
| | - Federica Tamburella
- Spinal Cord Unit, IRCCS Fondazione S. Lucia Rome, Italy ; Clinical and Research Movement Analysis Lab, Fondazione S. Lucia Rome, Italy
| | | | - Monica Torre
- Spinal Cord Unit, IRCCS Fondazione S. Lucia Rome, Italy
| | - Marco Molinari
- Spinal Cord Unit, IRCCS Fondazione S. Lucia Rome, Italy ; Clinical and Research Movement Analysis Lab, Fondazione S. Lucia Rome, Italy
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22
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Scivoletto G, Farchi S, Laurenza L, Tamburella F, Molinari M. Impact of multiple injuries on functional and neurological outcomes of patients with spinal cord injury. Scand J Trauma Resusc Emerg Med 2013; 21:42. [PMID: 23718823 PMCID: PMC3669625 DOI: 10.1186/1757-7241-21-42] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/26/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The effects of multiple injuries on the neurological and functional outcomes of patients with traumatic spinal cord injury (SCI) are debated-some groups have shown that subjects with multiple injuries have the same neurological and functional outcomes of those without them, whereas others have found that SCI patients with associated traumatic brain injury have worse functional status at admission and discharge and longer rehabilitation stays than patients without brain injury. Thus, the aim of this study was to compare the outcomes of SCI subjects with or without multiple injuries. METHODS A total of 245 patients with a traumatic SCI during the first rehabilitation stay after the development of the lesion (202 males and 43 females; age 39.8 ± 17 years; lesion to admission time 51.1 ± 58 days) were examined on a referral basis. Patients were assessed using the following measures: American Spinal Injury Association standards, Barthel Index, Rivermead Mobility Index, and Walking Index for Spinal Cord Injury. The statistical analysis comprised Poisson regression models with relative risks and 95% confidence intervals, adjusted for the following confounders: age, sex, lesion level, and ASIA impairment scale (AIS) grade. Student's T test was used to compare the outcomes of patients divided by AIS impairment and lesion level. RESULTS SCI patients with and without multiple injuries differed significantly with regard to the level and completeness of the lesion. Overall, patients with multiple injuries had worse functional status at admission and discharge than monotraumatic subjects. However, when adjusted for neurological features, the populations had comparable functional and neurological status at admission and discharge and similar rates of complications and discharge destinations. The separate analysis per each level of lesion/AIS grade showed that in some groups, patients with multiple injuries had a significant longer length of stay or worse functional status at rehabilitation admission (but not at discharge) than their monotraumatic counterparts. CONCLUSIONS Multiple injuries do not affect the neurological or rehabilitative prognosis of spinal cord injuries. At discharge, patients with spinal cord injuries with and without multiple injuries achieved similar results with regard to neurological and functional improvement. Some groups of patients with multiple injuries had a longer length of stay.
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Affiliation(s)
- Giorgio Scivoletto
- Spinal Cord Unit, IRCCS S. Lucia Foundation, Rome, Italy
- Clinical and Research Movement Analysis (CaRMA) Lab, IRCCS S. Lucia Foundation, Rome, Italy
| | - Sara Farchi
- Public Health Agency of Lazio Region, Rome, Italy
| | | | - Federica Tamburella
- Spinal Cord Unit, IRCCS S. Lucia Foundation, Rome, Italy
- Clinical and Research Movement Analysis (CaRMA) Lab, IRCCS S. Lucia Foundation, Rome, Italy
| | - Marco Molinari
- Spinal Cord Unit, IRCCS S. Lucia Foundation, Rome, Italy
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Vervoordeldonk JJ, Post MWM, New P, Clin Epi M, Van Asbeck FWA. Rehabilitation of patients with nontraumatic spinal cord injury in the Netherlands: etiology, length of stay, and functional outcome. Top Spinal Cord Inj Rehabil 2013; 19:195-201. [PMID: 23960703 PMCID: PMC3743969 DOI: 10.1310/sci1903-195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with nontraumatic spinal cord injury (NTSCI) are different from patients with traumatic spinal cord injury. A better understanding of the characteristics of NTSCI and their influence on length of stay (LOS) and functional outcome might help professionals in planning rehabilitation and predicting outcomes in NTSCI. OBJECTIVE To describe personal and injury characteristics, etiology, LOS, and functional outcome after inpatient rehabilitation in patients with NTSCI. METHODS Retrospective single-center study including 124 patients who were discharged between 2006 and 2010 from their initial inpatient rehabilitation after onset of NTSCI. Information about personal and injury characteristics, LOS, and functional outcome was collected from medical files. Descriptive statistics were performed, and associations between etiology, LOS, and functional outcome were investigated. RESULTS Fifty percent of participants were male, and mean age was 54.9 years (SD 13.7). Most lesions were classified as American Spinal Injury Association Impairment Scale (AIS) D (68.8%) and paraplegic (76.6%). The most frequent etiologies were degeneration (25.8%), vascular disease (21.8%), benign tumor (16.1%), and malignant tumor (15.3%). Discharge destination was usually a private residence (84.6%). Median LOS in inpatient rehabilitation was 61.0 days (interquartile range [IQR], 38.3-111.8). Median functional status score was 47.5 (IQR, 30-70) at admission and 90 (IQR, 75-100) at discharge. Etiology was a significant predictor of LOS and functional status at admission and discharge, but not of functional improvement during inpatient rehabilitation. CONCLUSION Spinal degeneration, tumor, and vascular disease were the most common causes of NTSCI. All etiology groups improved during inpatient rehabilitation.
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Marinho AR, Flett HM, Craven C, Andrea Ottensmeyer C, Parsons D, Verrier MC. Walking-related outcomes for individuals with traumatic and non-traumatic spinal cord injury inform physical therapy practice. J Spinal Cord Med 2012; 35:371-81. [PMID: 23031174 PMCID: PMC3459566 DOI: 10.1179/2045772312y.0000000038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To describe and compare patient demographics, inpatient lengths of stay (LOS), and walking-related functional outcomes of individuals with spinal cord injuries (SCIs) of traumatic (TSCI) and non-traumatic (NTSCI) etiologies. To contrast these features between individuals who walked from those who did not walk at discharge from inpatient rehabilitation. DESIGN Prospective observational study; comparisons between TSCI and NTSCI, walkers and non-walkers. Information collected as a pilot project within a provincial SCI informatics strategy. SETTING Rehabilitation hospital specialized for SCIs. PARTICIPANTS Adults with NTSCI (n = 31) or TSCI (n = 59) admitted to inpatient rehabilitation, 2007-2009. OUTCOME MEASURES Lower-extremity motor scores (LEMS), spinal cord independence measure version III (SCIM-III) total and mobility subscores, functional independence measure (FIM), Length of Stay (LOS) at inpatient facilities. RESULTS Groups (NTSCI vs. TSCI) did not differ in the proportion of individuals that achieved "walker" status (SCIM-III mobility indoors (MI) score ≥ 3 at rehab discharge) (P = 0.41, 48.9% overall). Inpatient LOS at both acute care and rehabilitation facilities did not differ between groups; however, TSCI non-walkers had longer inpatient rehabilitation LOS than TSCI walkers. Among walkers, improvement was shown on all three mobility subscores of the SCIM-III between admission and discharge from rehabilitation; highest significance was shown on the SCIM-III MI. Walking status at discharge (SCIM-III MI) was most strongly correlated with LEMS at rehab admission (r = 0.71, P < 0.001). CONCLUSION Walking outcomes are comparable among individuals with NTSCI vs. TSCI admitted for specialized SCI rehabilitation. Routine use of SCIM-III mobility items for assessment of walking outcome is recommended for inpatient rehabilitation.
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Affiliation(s)
- Andresa R. Marinho
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | - Heather M. Flett
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | - Catharine Craven
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | | | - Daria Parsons
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | - Molly C. Verrier
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada,Correspondence to: Molly C. Verrier, Centre for Function and Well-Being, University of Toronto, 160-500 University Avenue, Toronto, ON, Canada M5G 1V7.
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Hagen EM, Rekand T, Gilhus NE, Grønning M. Traumatic spinal cord injuries--incidence, mechanisms and course. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:831-7. [PMID: 22511097 DOI: 10.4045/tidsskr.10.0859] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The primary purpose of this article is to provide an overview of demography, neurological level of injury, extent of lesion, incidence, prevalence, injury mechanisms as well as lethality and causes of death associated with traumatic spinal cord injuries. MATERIAL AND METHOD A literature search was carried out in PubMed, with the search words "traumatic spinal cord injury"/"traumatic spinal cord injuries" together with "epidemiology", and "spinal cord injury"/"spinal cord injuries" together with "epidemiology". RESULTS The reported annual incidence of traumatic spinal cord injuries varies from 2.3 per million in a study from Canada to 83 per million in Alaska. The prevalence is given as ranging from 236 per million in India to 1800 per million in the USA. The average age at the time of injury varies from 26.8 years in Turkey to 55.5 years in the USA. The ratio of men to women varies from 0.9 in Taiwan to 12.0 in Nigeria. The most frequent cause of injury is traffic accidents, followed by falls, violence and sports/leisure activity incidents. Patients with traumatic spinal cord injuries have a higher lethality than the normal population. The most frequent causes of death today are airway problems, heart disease and suicide. INTERPRETATION There are large geographical differences in reported incidence, prevalence and lethality. This is attributable to differences in definition, inclusion, classification and patient identification procedures in the various studies, together with geographical and cultural differences and differences in prehospital and hospital treatment.
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Occurrence and predictors of employment after traumatic spinal cord injury: the GISEM Study. Spinal Cord 2011; 50:238-42. [PMID: 22124342 DOI: 10.1038/sc.2011.131] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Multicenter, prospective study. OBJECTIVES To assess the occurrence and predictors of return to work after traumatic spinal cord injury (SCI). SETTING Italian rehabilitation centers. METHODS We evaluated patients previously included in the Italian Group for the Epidemiological Study of Spinal Cord Injuries study. A standardised telephone interview was used to collect data after a mean follow-up of 3.8 years. The main outcome measure was employment at the end of follow-up. RESULTS A total of 403 patients, 336 men and 67 women, with a mean age of 41.8±16.3 years, were included in the follow-up. In all, 42.1% of patients were employed at the moment of the interview, though 62% reported a worsening in their employment level. Predictors of employment were education (P<0.0001), bowel continence (P=0.02), independence in mobility (P=0.0004), ability to drive (P<0.0001), participating in the community (P=0.0001) and ability to live alone (P<0.0001) while age (P<0.0001), being married (P<0.0001), tetraplegia (P=0.03), occurrence of recent medical problems (P=0.002), re-hospitalization (P=0.02), presence of architectonic barriers (P=0.009) and having a public welfare subsidy (P<0.0001), predicted unemployment. On the basis of multivariate analysis, younger age, education, absence of tetraplegia, ability to drive, ability to live alone, previous employment were independent predictors of employment after SCI. Employment at follow-up was related to several indicators of quality of life. CONCLUSION Employment after SCI was rather frequent and was related to several patient characteristics and social factors. Specific interventions on the patient and on the social environment may favor employment after SCI and improve quality of life.
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Recovery following ischemic myelopathies and traumatic spinal cord lesions. Spinal Cord 2011; 49:897-902. [DOI: 10.1038/sc.2011.31] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kiekens C, Van Rie K, Peers K, Lysens R. Cost of Rehabilitation Care in Traumatic and Nontraumatic Spinal Cord Injury in a European Context. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1604-43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Idowu OK, Yinusa W, Gbadegesin SA, Adebule GT. Risk factors for pressure ulceration in a resource constrained spinal injury service. Spinal Cord 2011; 49:643-7. [PMID: 21221118 DOI: 10.1038/sc.2010.175] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Pressure ulceration and other complications constitute an encumbrance in the management of spinal cord injury in many services with limited resources in developing countries. These services undertake patients' care without adequate prehospital care, limited modern infrastructure and limited number of trained staff. OBJECTIVES To evaluate the associated risk factors for pressure ulceration in traumatic spinal cord injured managed in a resource constrained spinal injury unit in Lagos, Nigeria. A regional acute trauma and rehabilitation centre serving a population of >20 million. METHODS This is a prospective study in patients presenting with traumatic spinal cord injury between 1 October 2004 and 30 November 2006. The data collected include demographic characteristics, interval before admission in the unit, type of spinal cord injury and serum albumin. The incidence of pressure ulcers and the isolated organisms was recorded for patients who developed pressure ulcers on admission and during the period of stay in the unit. The length of hospital stay was also recorded for all the patients. RESULTS The overall incidence of pressure ulceration on admission was 57.1%. There was an average lengthening of hospital stay of 33.1 days in the group of patients with pressure ulceration compared to patients without pressure ulcers. The nutritional status on admission, interval before admission and the type of neurological injury were significant factors for the incidence of pressure ulcers. CONCLUSION The incidence of pressure ulceration was high, delay in admission and poor nutritional status may be significant factors in the incidence of pressure ulceration in spinal cord injury.
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Affiliation(s)
- O K Idowu
- Department of Orthopaedics and Trauma Surgery, National Orthopaedic Hospital, Igbobi, Yaba Lagos, Nigeria.
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Whiteneck G, Gassaway J, Dijkers M, Backus D, Charlifue S, Chen D, Hammond F, Hsieh CH, Smout RJ. The SCIRehab project: treatment time spent in SCI rehabilitation. Inpatient treatment time across disciplines in spinal cord injury rehabilitation. J Spinal Cord Med 2011; 34:133-48. [PMID: 21675353 PMCID: PMC3066504 DOI: 10.1179/107902611x12971826988011] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 08/30/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND/OBJECTIVE Length of stay (LOS) for rehabilitation treatment after spinal cord injury (SCI) has been documented extensively. However, there is almost no published research on the nature, extent, or intensity of the various treatments patients receive during their stay. This study aims at providing such information on a large sample of patients treated by specialty rehabilitation inpatient programs. METHODS Six hundred patients with traumatic SCI admitted to six rehabilitation centers were enrolled. Time spent on various therapeutic activities was documented by each rehabilitation clinician after each patient encounter. Patients were grouped by neurologic level and completeness of injury. Total time spent by each rehabilitation discipline over a patient's stay and total minutes of treatment per week were calculated. Ordinary least squares stepwise regression models were used to identify patient and injury characteristics associated with time spent in rehabilitation treatment overall and within each discipline. RESULTS Average LOS was 55 days (standard deviation 37), during which 180 (106) hours of treatment were received, or 24 (5) hours per week. Extensive variation was found in the amount of treatment received, between and within neurologic groups. Total hours of treatment provided throughout a patient's stay were primarily determined by LOS, which in turn was primarily predicted by medical acuity. Variation in minutes per week of treatment delivered by individual disciplines was predicted poorly by patient and injury characteristics. CONCLUSIONS Variations between and within SCI rehabilitation patient groups in LOS, minutes of treatment per week overall, and for each rehabilitation discipline are large. Variation in treatment intensity was not well explained by patient and injury characteristics. In accordance with practice-based evidence methodology, the next step in the SCIRehab study will be to determine which treatment interventions are related with positive outcomes (at 1 year post injury), after controlling for patient and injury differences.
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Affiliation(s)
- Gale Whiteneck
- Rocky Mountain Regional Spinal Injury System, Craig Hospital, Englewood, CO, USA
| | - Julie Gassaway
- Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
| | - Marcel Dijkers
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Deborah Backus
- Shepherd Center, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - Susan Charlifue
- Rocky Mountain Regional Spinal Injury System, Craig Hospital, Englewood, CO, USA
| | - David Chen
- Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Flora Hammond
- Carolinas Rehabilitation, Charlotte, NC, USA
- Indiana University, Indianapolis, IN, USA
| | - Ching-Hui Hsieh
- Center for Post-acute Studies, National Rehabilitation Hospital, Washington, DC, USA
| | - Randall J. Smout
- Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
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Effects of etiology on inpatient rehabilitation outcomes in 65- to 74-year-old patients with incomplete paraplegia from a nontraumatic spinal cord injury. PM R 2010; 2:504-13. [PMID: 20630437 DOI: 10.1016/j.pmrj.2010.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 02/17/2010] [Accepted: 03/05/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine differences in rehabilitation outcomes for older patients with a nontraumatic spinal cord injury (NT-SCI) for 5 etiologic diagnoses: degenerative spinal disease (DSD), malignant spinal tumor, benign spinal tumor, vascular ischemia, and spinal abscess. DESIGN Retrospective cohort study that used Medicare claims and assessment data. SETTING A total of 479 inpatient rehabilitation hospitals and units. PATIENTS A total of 1780 Medicare beneficiaries (65-74 years old) with incomplete paraplegia attributable to NT-SCI who were discharged from inpatient rehabilitation facilities from 2002 through 2005. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Length of stay, discharge Functional Independence Measure (FIM) instrument motor item and subscale scores, and discharge destination. RESULTS Demographic characteristics varied by etiology group. Mean +/- SD rehabilitation stays ranged from 13.3 +/- 7.7 days for DSD to 26.4 +/- 13.4 days for vascular ischemia. Adjusted data showed stays differed (P < .001) across etiology groups. Adjusted discharge mean self-care and mobility subscores revealed that patients with DSD and benign tumor were more independent (P < .001) than patients with a malignant tumor or spinal abscess. Patients with vascular ischemia were more dependent (P < .01) in mobility than the DSD and benign tumor groups. Etiologic differences (P < .01) in independence in discharge FIM modifiers for walking (FIM > or = 4), bladder (FIM > or = 6) and bowel management (FIM > or = 6) and bowel accidents/continence (FIM > or = 6), but not bladder accidents (FIM > or = 6), were present. The percent of patients discharged to a community residence ranged from 59.3% to 92.6%. Adjusted data showed that significantly larger percentages (P < .01) of patients in the DSD and malignant tumor groups than in the spinal abscess group were discharged to a community residence (versus nursing home). CONCLUSION There are etiologic differences in demographics, rehabilitation length of stay, functional outcomes, and discharge destination in elderly patients with NT-SCI.
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Traumatic and non-traumatic spinal cord lesions: an Italian comparison of neurological and functional outcomes. Spinal Cord 2010; 49:391-6. [PMID: 20603629 DOI: 10.1038/sc.2010.85] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To compare the rehabilitation outcomes of non-traumatic and traumatic spinal cord injury patients. SETTING Spinal cord unit of a rehabilitation hospital in Italy. PATIENTS AND METHODS In total, 380 patients at first rehabilitation stay after the lesion (144 traumatic patients and 236 non-traumatic patients; 244 men and 136 women; mean age 46.1±19.9 years; mean lesion to admission time 49.6±39.8 days). INTERVENTIONS Not applicable. MEASURES American Spinal Injury Association standards; Barthel index (BI), Rivermead mobility index and walking index for spinal cord injury. STATISTICAL ANALYSIS Poisson regression models with relative risks and 95% confidence intervals adjusted for the following confounders: age, sex, lesion level and Asia impairment. Models were stratified by age because a strong interaction between different variables and age was found. RESULTS Traumatic and non-traumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower BI score at admission and significantly better improvement in the BI score by discharge. The two populations were discharged with similar functional outcome. No significant differences were found with regard to the others outcomes. CONCLUSIONS In clinically stable patients, spinal cord injury etiology does not seem to affect the rehabilitative prognosis. At admission, traumatic patients show lower autonomy in daily life activities, probably because of the associated lesions that these patients often have. At discharge, traumatic and non-traumatic spinal cord lesion patients achieved similar results with regard to neurological and functional improvement.
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Invernizzi M, Carda S, Milani P, Mattana F, Fletzer D, Iolascon G, Gimigliano F, Cisari C. Development and validation of the Italian version of the Spinal Cord Independence Measure III. Disabil Rehabil 2010; 32:1194-203. [DOI: 10.3109/09638280903437246] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Divanoglou A, Westgren N, Bjelak S, Levi R. Medical conditions and outcomes at 1 year after acute traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study. Spinal Cord 2009; 48:470-6. [DOI: 10.1038/sc.2009.147] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Whiteneck G, Gassaway J, Dijkers M, Jha A. New approach to study the contents and outcomes of spinal cord injury rehabilitation: the SCIRehab Project. J Spinal Cord Med 2009; 32:251-9. [PMID: 19810627 PMCID: PMC2718827 DOI: 10.1080/10790268.2009.11760779] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Limited research evidence is available to show the effectiveness of the many specific interventions provided in spinal cord injury (SCI) rehabilitation; what is available typically focuses on effects of the full rehabilitation package but not specific therapy interventions, medical procedures, patient education, or counseling. Given the problems of conducting randomized controlled trials (RCTs) in rehabilitation, practice-based evidence (PBE) research has been suggested as an alternative methodology for identifying which rehabilitation interventions are associated most strongly with positive outcomes, after controlling for patient differences. Using the PBE research methodology, the SCIRehab project attempts to "open the black box" of acute SCI rehabilitation, provide detailed information on treatments delivered by all rehabilitation disciplines, and contribute to outcomes-based guidelines for clinical decision-making. METHODS The SCIRehab project includes 1,500 patients with acute SCI, consecutively admitted to 1 of 6 US inpatient rehabilitation facilities. Details of the rehabilitation process are captured by clinicians from multiple disciplines documenting their interventions in handheld personal digital assistants after sessions with their patients. Outcome data are abstracted from medical records (clinical outcomes data) and obtained from patient interviews at 6 and 12 months after injury. Extensive patient, injury, and other treatment characteristics are abstracted from medical records. SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. RESULTS SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. These findings are presented in a series of 9 articles. CONCLUSIONS To date, SCIRehab's major contribution is a system for categorizing specific contributions of each discipline and a technology for documenting that detail. After data collection is complete, future manuscripts will relate those process elements to outcomes. The SCIRehab Project is an important step toward establishing outcomes-based guidelines for SCI rehabilitation.
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Affiliation(s)
- Gale Whiteneck
- 1Craig Hospital, Englewood, Colorado; 2Institute for Clinical Outcomes Research, Salt Lake City, Utah; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
| | - Julie Gassaway
- 1Craig Hospital, Englewood, Colorado; 2Institute for Clinical Outcomes Research, Salt Lake City, Utah; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
| | - Marcel Dijkers
- 1Craig Hospital, Englewood, Colorado; 2Institute for Clinical Outcomes Research, Salt Lake City, Utah; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
| | - Amitabh Jha
- 1Craig Hospital, Englewood, Colorado; 2Institute for Clinical Outcomes Research, Salt Lake City, Utah; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
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Scivoletto G, Di Donna V. Prediction of walking recovery after spinal cord injury. Brain Res Bull 2009; 78:43-51. [PMID: 18639616 DOI: 10.1016/j.brainresbull.2008.06.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 05/28/2008] [Accepted: 06/04/2008] [Indexed: 12/11/2022]
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Scivoletto G, Cosentino E, Morganti B, Farchi S, Molinari M. Clinical prognostic factors for bladder function recovery of patients with spinal cord and cauda equina lesions. Disabil Rehabil 2008; 30:330-7. [PMID: 17852204 DOI: 10.1080/09638280701265596] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the relationship between lesion severity and other clinical factors and bladder function recovery. PATIENTS AND METHODS The charts of 269 patients with traumatic and non traumatic spinal cord lesion (SCL) were reviewed and the following information was recorded: lesion to admission time, injury variables, length of stay and neurological status. At five months, urological outcome was assessed by voiding modalities, and urodynamics according to International Continence Society. Logistic approach with univariate and multivariate analysis. RESULTS Both ASIA impairment at admission and age were significantly correlated with bladder function outcome. None of the patients with ASIA A impairment at admission reached volitional voiding at five months. ASIA B patients had a 90% lower probability of achieving good bladder control and ASIA C ones a 65% lower than ASIA D patients (p < 0.05). Older patients had a significant lower probability (60%) of achieving volitional voiding than younger ones (p < 0.05). Of the 121 patients with ASIA D impairment at discharge only 78 voided spontaneously and showed a higher frequency of cervical lesions and a lower frequency of detrusor-external sphincter dyssynergia. DISCUSSION AND CONCLUSION Bladder recovery in patients with complete SCL is limited. ASIA B patients showed a better neurological recovery and, concurrently, better bladder function recovery than ASIA A patients, thus demonstrating the importance of sensation preservation for recovery. Younger patients show better bladder recovery than older ones, probably because of different efficiency of spinal cord plasticity. Finally, patients with good neurological recovery may not achieve volitional voiding. Patients with bladder function recovery show a higher frequency of central cord and Brown-Sequard syndromes (with better prognosis) and a lower frequency of detrusor-sphincter dyssynergia.
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Affiliation(s)
- G Scivoletto
- Spinal Cord Unit, IRCCS Foundation S. Lucia, Rome, Italy.
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Inflammatory myelopathies and traumatic spinal cord lesions: comparison of functional and neurological outcomes. Phys Ther 2008; 88:471-84. [PMID: 18218824 DOI: 10.2522/ptj.20070049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Outcomes knowledge is essential to answer patients' questions regarding function, to plan the use of resources, and to evaluate treatments to enhance recovery. The purpose of this study was to compare the outcomes of patients with traumatic spinal cord injury (SCI) with those of patients with inflammatory spinal cord lesions (ISCLs). SUBJECTS AND METHODS The authors evaluated 181 subjects with traumatic SCI and 67 subjects with ISCLs. Using a matching cohorts procedure, 38 subjects were selected from each group. The measures used were the American Spinal Injury Association (ASIA) Impairment Scale (motor function), the Barthel Index (BI), the Rivermead Mobility Index (RMI), and the Walking Index for Spinal Cord Injury (WISCI). RESULTS The subjects in the ISCL group were older than those in the SCI group, with a longer interval from onset of lesion to rehabilitation admission and more incomplete lesions. In the matching cohorts, at admission, the traumatic SCI group had RMI and WISCI scores comparable to those of the ISCL group, but the traumatic SCI group had lower scores on the BI (greater dependence on assistance for activities of daily living). At discharge, the 2 groups had comparable functional outcomes. The neurological status of the 2 groups was comparable at admission and discharge. DISCUSSION AND CONCLUSION The results indicate that, at admission, patients with SCI have a greater physical dependence for assistance with activities of daily living than patients with ISCLs who have comparable neurological status. Such a difference depends on factors not related to the spinal cord lesion, such as the presence of associated lesions, the need to wear an orthotic device, or the sequelae of surgery. The outcomes of patients with SCI are determined more by factors such as lesion level and severity and age than by etiology. This finding could have implications for health care planning and rehabilitation research.
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Clinical factors that affect walking level and performance in chronic spinal cord lesion patients. Spine (Phila Pa 1976) 2008; 33:259-64. [PMID: 18303457 DOI: 10.1097/brs.0b013e3181626ab0] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observational Study. OBJECTIVE To evaluate the effects of neurologic and non-neurologic factors on walking level and performance in chronic spinal cord lesion (SCL) patients. SUMMARY OF BACKGROUND DATA Walking is one of the primary goals of patients after a SCL. Several studies have demonstrated that different neurologic and non-neurologic factors can affect walking level and performance. However, in SCL age and muscle strength have always been considered the major determinants of walking. METHODS Sixty-five patients with chronic SCL were included. Their demographic, neurologic status (ASIA standards), balance, and spasticity were recorded. Pearson and Spearman correlations were adopted to quantify the association between patients' characteristics and walking ability. The relationship between functional walking measures, Timed Up and Go, Six Minutes Walking Test (SMWT), Ten Meters Walking Test, and Walking Index for Spinal Cord Injury, and demographic and neurologic factors were measured by regression analyses. RESULTS Strength, balance, spasticity, and age were strictly correlated with walking level and walking performance. They also were the best predictors of walking features. CONCLUSION Results confirm the recognized importance of age and upper and lower extremity strengths for walking after a SCL. They also highlight the role of 2 other factors, i.e., balance and spasticity, seldom considered as thoroughly in SCL.
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Pagliacci MC, Franceschini M, Di Clemente B, Agosti M, Spizzichino L. A multicentre follow-up of clinical aspects of traumatic spinal cord injury. Spinal Cord 2006; 45:404-10. [PMID: 17102809 DOI: 10.1038/sj.sc.3101991] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective, multicentred follow-up (FU) observational study. OBJECTIVES Prospectively evaluate survival, complications, re-admissions and maintenance of clinical outcome in people experiencing traumatic spinal cord injury (SCI). SETTING Seven spinal units and 17 rehabilitation centres participating in the previous GISEM (ie Italian Group for the Epidemiological Study of Spinal Cord Injuries) study. METHOD A total of 511 persons with SCI, discharged between 1997 and 1999 after their first hospitalisation, were enrolled. A standardised questionnaire was administered via telephone. RESULTS Of the 608 persons originally enrolled, 36 died between discharge and follow-up (mean 3.8+/-0.64 years). Of the remainder, 403 completed telephone interviews, 72 refused to participate and 97 could not be contacted. More than half of the patients interviewed (53.6%) experienced at least one SCI-related clinical problem in the 6 months preceding interview; the most frequent being urological complications (53.7%). At least one re-admission was recorded in 56.8% of patients between discharge and FU interview. Of the patients interviewed, 70.5% reported bowel autonomy and 86% bladder management autonomy. On multivariate analysis, lack of bowel/bladder autonomy was the most common variable with a strong predicting value for mortality, occurrence of complications and re-admissions. CONCLUSION Re-admission and major complications seem common after SCI and should be considered when planning facilities. Failure to obtain bowel/bladder autonomy upon discharge from rehabilitation proved to be the most common predictive factor of poor outcome during the period between discharge and FU interview.
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Affiliation(s)
- M C Pagliacci
- Spinal Cord Injury Unit, Silvestrini Hospital, Perugia, Italy
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Biering-Sørensen F, Charlifue S, DeVivo M, Noonan V, Post M, Stripling T, Wing P. International Spinal Cord Injury Data Sets. Spinal Cord 2006; 44:530-4. [PMID: 16955072 DOI: 10.1038/sj.sc.3101930] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Discussion and development of final consensus. OBJECTIVE Present the background, purpose, and process for the International Spinal Cord Injury (SCI) Data Sets development. SETTING International. METHODS An international meeting on SCI data collection and analysis occurred at a workshop on May 2, 2002, before the combined meeting of the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) in Vancouver, British Columbia, Canada. At this meeting, a process was developed for selection of data elements to be included in International SCI Data Sets. RESULTS An overall structure and terminology has been developed following the format of the International Classification of Functioning, Disability and Health (ICF). This includes definitions of the Core Data Set, as well as Modules with Basic Questions or Data Sets and Expanded Data Sets. The Core Data Set has been developed and will be presented separately. Working groups for additional modules are being established as well as general guidelines for the development of the modules. CONCLUSION The presented format should help in developing data sets and modules within various topics related to SCI.
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Affiliation(s)
- F Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Crock HV, Yoshizawa H, Yamagishi M, Crock MC. Commentary on the prevention of paralysis after traumatic spinal cord injury in humans: the neglected factor—urgent restoration of spinal cord circulation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 14:910-4. [PMID: 15947996 DOI: 10.1007/s00586-005-0924-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2004] [Revised: 02/28/2005] [Accepted: 02/28/2005] [Indexed: 10/25/2022]
Abstract
Although advances in the management of spinal injuries during the past 60 years have led to greatly increased life expectancy for paralysed patients, most remain disabled. Around the world, spinal injury centres have become specialized rehabilitation units, where staff accepts the inevitability of persisting paralysis. In part, this pessimism has been based on incorrect information about the anatomy and function of the circulation of the spinal cord. Since the publication of accurate descriptions of the segmental nature of spinal vasculature, research and clinical data suggest that reversal or prevention of paralysis after spinal injury may be possible in many patients. These improved outcomes will depend on the recognition that urgent correction of cord blood supply in patients with traumatic spinal injury is critical to the long-term results of treatment. The creation of specialist spinal units within trauma centres for the urgent treatment of patients following spinal injury will require considerable logistical change, but has the potential to lead to a revolution in spinal care, driven by the knowledge that spinal cord function can often be saved.
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