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Luu BL, Lewis RHC, Gandevia SC, Boswell-Ruys CL, Butler JE. The detection and sensory perception of inspiratory resistive loads in people with chronic tetraplegia. J Appl Physiol (1985) 2022; 133:1192-1201. [PMID: 36107987 DOI: 10.1152/japplphysiol.00064.2022] [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: 01/31/2023] Open
Abstract
This study investigated sensations of breathing following tetraplegia. Fifteen people with chronic tetraplegia and fifteen healthy able-bodied controls matched for age, sex, height, and weight participated. Sensations of breathing were quantified by determining the threshold for detecting an added resistance during inspiration. In a separate task, the perceived magnitudes of six suprathreshold resistive loads were determined with a modified Borg scale. The detection threshold of 0.34 cmH2O/L/s [standard deviation (SD) 0.14] in the tetraplegia group was higher than the 0.23 cmH2O/L/s (SD 0.10) threshold for able-bodied controls (P = 0.004). Both participant groups perceived larger loads to be more effortful, with the Borg effort rating increasing linearly with the peak inspiratory pressure generated at each load. The relationship between Borg effort rating and peak inspiratory pressure was steeper in participants with tetraplegia than in able-bodied controls (P = 0.001), but there was no difference when pressure was divided by maximal inspiratory pressure (P = 0.95). Despite a higher detection threshold, the findings suggest that the perceived magnitude of a suprathreshold inspiratory load is not impaired in chronic tetraplegia and that load magnitude perception is related to the maximal, and not absolute, inspiratory muscle force.NEW & NOTEWORTHY Sensations of breathing are thought to be impaired following chronic tetraplegia. The detection threshold for an added resistive load during inspiration was higher in people with tetraplegia than in healthy able-bodied participants. However, for inspiratory loads above the detection threshold, the perceived magnitude of a resistive load as a function of the peak inspiratory pressure was greater in tetraplegia. Load magnitude perception was comparable between participant groups when peak pressure was divided by maximal inspiratory pressure.
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Affiliation(s)
- Billy L Luu
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - R H Chaminda Lewis
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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Bajjig A, Cayetanot F, Taylor JA, Bodineau L, Vivodtzev I. Serotonin 1A Receptor Pharmacotherapy and Neuroplasticity in Spinal Cord Injury. Pharmaceuticals (Basel) 2022; 15:ph15040460. [PMID: 35455457 PMCID: PMC9025596 DOI: 10.3390/ph15040460] [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: 01/25/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022] Open
Abstract
Spinal cord injury is associated with damage in descending and ascending pathways between brainstem/cortex and spinal neurons, leading to loss in sensory-motor functions. This leads not only to locomotor reduction but also to important respiratory impairments, both reducing cardiorespiratory engagement, and increasing cardiovascular risk and mortality. Moreover, individuals with high-level injuries suffer from sleep-disordered breathing in a greater proportion than the general population. Although no current treatments exist to restore motor function in spinal cord injury (SCI), serotoninergic (5-HT) 1A receptor agonists appear as pharmacologic neuromodulators that could be important players in inducing functional improvements by increasing the activation of spared motoneurons. Indeed, single therapies of serotoninergic 1A (5-HT1A) agonists allow for acute and temporary recovery of locomotor function. Moreover, the 5-HT1A agonist could be even more promising when combined with other pharmacotherapies, exercise training, and/or spinal stimulation, rather than administered alone. In this review, we discuss previous and emerging evidence showing the value of the 5HT1A receptor agonist therapies for motor and respiratory limitations in SCI. Moreover, we provide mechanistic hypotheses and clinical impact for the potential benefit of 5-HT1A agonist pharmacology in inducing neuroplasticity and improving locomotor and respiratory functions in SCI.
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Affiliation(s)
- Afaf Bajjig
- Sorbonne Université, Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; (A.B.); (F.C.); (L.B.)
| | - Florence Cayetanot
- Sorbonne Université, Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; (A.B.); (F.C.); (L.B.)
| | - J. Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, MA 02139, USA;
| | - Laurence Bodineau
- Sorbonne Université, Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; (A.B.); (F.C.); (L.B.)
| | - Isabelle Vivodtzev
- Sorbonne Université, Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; (A.B.); (F.C.); (L.B.)
- Correspondence:
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Serotonin 1A agonist and cardiopulmonary improvements with whole-body exercise in acute, high-level spinal cord injury: a retrospective analysis. Eur J Appl Physiol 2020; 121:453-463. [PMID: 33099664 DOI: 10.1007/s00421-020-04536-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE High-level spinal cord injury (SCI) can result in spinal and supraspinal respiratory control deficits leading to insufficient ventilatory responses to exercise and training-related adaptations. We hypothesized a serotonin agonist, known to improve respiratory function in animal models, would improve adaptations to whole-body functional electrical stimulation (FES) exercise training in patients with acute high-level SCI. METHODS We identified 10 patients (< 2 years of injury with SCI from C4 to T3) in our program who had performed 6 months of FES-row training while on Buspirone (29 ± 17 mg/day) between 2012 and 2018. We also identified well-matched individuals who trained for six months but not on Buspirone (n = 11). A peak incremental FES-rowing exercise test and resting pulmonary function test had been performed before and after training. RESULTS Those on Buspirone demonstrated greater increases in peak oxygen consumption (VO2peak: + 0.24 ± 0.23 vs. + 0.10 ± 0.13 L/min, p = 0.08) and peak ventilation (VEpeak: + 6.5 ± 8.1 vs. - 0.7 ± 6.9 L/min, p < 0.05) compared to control. In addition, changes in VO2peak and VEpeak were correlated across all patients (r = 0.63, p < 0.01), but most strongly in those on Buspirone (r = 0.85, p < 0.01). Furthermore, changes in respiratory function correlated with increased peak tidal volume in the Buspirone group (r > 0.66, p < 0.05). CONCLUSION These results suggest Buspirone improves cardiorespiratory adaptations to FES-exercise training in individuals with acute, high-level SCI. The strong association between increases in ventilatory and aerobic capacities suggests improved respiratory function is a mechanism; however, controlled studies are needed to determine if this preliminary finding is reproducible.
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Garshick E, Mulroy S, Graves DE, Greenwald K, Horton JA, Morse LR. Active Lifestyle Is Associated With Reduced Dyspnea and Greater Life Satisfaction in Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97:1721-7. [PMID: 26951870 DOI: 10.1016/j.apmr.2016.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/25/2016] [Accepted: 02/13/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the relations between measures of activity with dyspnea and satisfaction with life in chronic spinal cord injury (SCI). DESIGN Cross-sectional survey. SETTING Five SCI centers. PARTICIPANTS Between July 2012 and March 2015, subjects (N=347) with traumatic SCI ≥1 year after injury who used a manual wheelchair or walked with or without an assistive device reported hours spent away from home or yard on the previous 3 days, sports participation, and planned exercise. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Satisfaction with Life Scale (SWLS) and dyspnea. Dyspnea was defined as shortness of breath when hurrying on the level or going up a slight hill, going slower than people the same age on the level because of breathlessness, or stopping for breath when going at your own pace, or after about 100yd (or after a few minutes) on the level. RESULTS Dyspnea prevalence was 30%. Adjusting for asthma or chronic obstructive pulmonary disease, mobility mode, race, and season, there was a significant linear trend between greater SWLS scores and quartiles of time spent away from the home or yard (P=.0002). SWLS score was greater if participating in organized sports (P=.01), although was not significantly greater with planned exercise (P=.093). Planned exercise was associated with a reduced odds ratio (OR) of dyspnea (.57; 95% confidence interval [CI], .34-.95; P=.032), but organized sports was not (P=.265). Dyspnea was not significantly increased in persons who spent the fewest hours outside their home or yard (≤7h) compared with people who spent the most hours outside their home or yard (>23h) (OR=1.69; 95% CI, 0.83-3.44; P=.145). CONCLUSIONS In SCI, a planned exercise program is associated with less dyspnea. An active lifestyle characterized by greater time spent away from home or yard and sports participation is associated with greater SWLS scores.
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Affiliation(s)
- Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Sara Mulroy
- Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Daniel E Graves
- Frazier Rehabilitation Institute, University of Louisville, Louisville, KY
| | - Karen Greenwald
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John A Horton
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Leslie R Morse
- Spaulding-Harvard Spinal Cord Injury Model System, Spaulding Rehabilitation Hospital, Boston, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
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Schilero GJ, Spungen AM, Bauman WA, Radulovic M, Lesser M. Pulmonary function and spinal cord injury. Respir Physiol Neurobiol 2009; 166:129-41. [PMID: 19442929 DOI: 10.1016/j.resp.2009.04.002] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 11/30/2022]
Abstract
Injury to the cervical and upper thoracic spinal cord disrupts function of inspiratory and expiratory muscles, as reflected by reduction in spirometric and lung volume parameters and static mouth pressures. In association, subjects with tetraplegia have decreased chest wall and lung compliance, increased abdominal wall compliance, and rib cage stiffness with paradoxical chest wall movements, all of which contribute to an increase in the work of breathing. Expiratory muscle function is more compromised than inspiratory muscle function among subjects with tetraplegia and high paraplegia, which can result in ineffective cough and propensity to mucus retention and atelectasis. Subjects with tetraplegia also demonstrate heightened vagal activity with reduction in baseline airway caliber, findings attributed to loss of sympathetic innervation to the lungs. Significant increase in airway caliber following inhalation of ipratropium bromide, an anticholinergic agent, suggests that reduction in airway caliber is not due to acquired airway fibrosis stemming from repeated infections or to abnormal hysteresis secondary to chronic inability of subjects to inhale to predicted total lung capacity. Reduced baseline airway caliber possibly explains why subjects with tetraplegia exhibit airway hyperresponsiveness to methacholine and ultrasonically nebulized distilled water. While it has been well demonstrated that bilateral phrenic nerve pacing or stimulation through intramuscular diaphragmatic electrodes improves inspiratory muscle function, it remains unclear if inspiratory muscle training improves pulmonary function. Recent findings suggest that expiratory muscle training, electrical stimulation of expiratory muscles and administration of a long-acting beta(2)-agonist (salmeterol) improve physiological parameters and cough. It is unknown if baseline bronchoconstriction in tetraplegia contributes to respiratory symptoms, of if the chronic administration of a bronchodilator reduces the work of breathing and/or improves respiratory symptoms. Less is known regarding the benefits of treatment of obstructive sleep apnea, despite evidence indicating that the prevalence of this condition in persons with tetraplegia is far greater than that encountered in able-bodied individuals.
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Affiliation(s)
- Gregory J Schilero
- Rehabilitation Research and Development Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, NY 10468, USA.
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Grandas NF, Jain NB, Denckla JB, Brown R, Tun CG, Gallagher ME, Garshick E. Dyspnea during daily activities in chronic spinal cord injury. Arch Phys Med Rehabil 2005; 86:1631-5. [PMID: 16084818 PMCID: PMC1361295 DOI: 10.1016/j.apmr.2005.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 12/07/2004] [Accepted: 02/07/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess factors associated with breathlessness in chronic spinal cord injury (SCI) during daily activities. DESIGN Cross-sectional survey. SETTINGS Veterans Affairs SCI service and the community. PARTICIPANTS Four hundred forty-one participants 1 or more years post-SCI, and without acute illness, were recruited between 1994 and 2003 and were categorized according to their ability to walk unassisted, walk with an aid, or to move about by either hand-propelled wheelchair or motorized wheelchair (MWC). INTERVENTIONS Assessment of injury extent, respiratory symptoms, cigarette smoking, comorbid medical conditions, and spirometry. MAIN OUTCOME MEASURES Breathlessness during talking, eating, or dressing. RESULTS Breathlessness was more common in MWC users (20/85 users, 24%) than in nonusers (20/356, 6%). The main activity associated with breathlessness in 15 MWC users was talking (18%). In MWC users, the risk of breathlessness was related to lifetime cigarette smoking (odds ratio [OR]=1.02; 95% confidence interval [CI], 1.00-1.03 per pack year), and reports of chronic cough (OR=7.8; 95% CI, 2.0-32.7), and wheeze (OR=3.5; 95% CI, 1.04-13.6). SCI level, percentage of predicted forced vital capacity and forced expiratory volume in 1 second, and maximal inspiratory pressures were not related to breathlessness. CONCLUSIONS Breathlessness during selected daily activities (most commonly talking) was greatest in SCI participants who were most impaired with regard to mobility and was associated with reports of coughing, wheezing, and cigarette smoking.
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Affiliation(s)
| | | | | | | | | | | | - Eric Garshick
- Reprint requests to Eric Garshick, MD, MOH, Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Pkwy, West Roxbury, MA 02132, e-mail: .
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Kelley A, Garshick E, Gross ER, Lieberman SL, Tun CG, Brown R. Spirometry testing standards in spinal cord injury. Chest 2003; 123:725-30. [PMID: 12628869 PMCID: PMC1896104 DOI: 10.1378/chest.123.3.725] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Because muscle paralysis makes it uncertain whether subjects with spinal cord injury (SCI) can perform spirometry in accordance with American Thoracic Society (ATS) standards, determinants of test failure were examined. DESIGN Cross-sectional study. SETTING Veterans Affairs (VA) medical center. PARTICIPANTS Veterans with SCI at VA Boston Healthcare System and nonveterans recruited by mail and advertisement. MEASUREMENTS AND RESULTS Two hundred thirty of 278 subjects (83%) were able to produce three expiratory efforts lasting > or = 6 s and without excessive back-extrapolated volume (EBEV). In 217 of 230 subjects (94%), FVC and FEV(1) were each reproducible in accordance with 1994 ATS standards. In the remaining 48 subjects, efforts with smooth and continuous volume-time tracings and acceptable flow-volume loops were identified. These subjects had a lower percentage of predicted FVC, FEV(1), and maximum expiratory and inspiratory pressures compared to the others, and a greater proportion had neurologically complete cervical injury (42% compared to 16%). In 19 subjects (40%), some expiratory efforts were not sustained maximally for > or = 6 s but had at least a 0.5-s plateau at residual volume (short efforts). In eight subjects (17%), some efforts were not short but had EBEV. In the remaining 21 subjects (44%), some efforts were short, some had EBEV, and some had both. If these efforts were not rejected, 262 of 278 subjects (94%) would have produced three acceptable efforts, and in 257 subjects (92%), the efforts were reproducible. CONCLUSIONS Subjects with SCI with the most impaired respiratory muscles and abnormal pulmonary function are able to perform spirometry reproducibly despite not meeting usual ATS acceptability standards. Exclusion of these subjects would lead to bias in studies of respiratory function in SCI. The modification of spirometry testing standards to include efforts with EBEV and with a 0.5-s plateau if < 6 s would reduce the potential for bias.
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Affiliation(s)
- Alyson Kelley
- Pulmonary and Critical Care Medicine Section, Medical Service, and Rehabilitation Medicine Service, VA Boston Healthcare System, West Roxbury, MA 02132, USA
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Stiens SA, Kirshblum SC, Groah SL, McKinley WO, Gittler MS. Spinal cord injury medicine. 4. Optimal participation in life after spinal cord injury: physical, psychosocial, and economic reintegration into the environment. Arch Phys Med Rehabil 2002; 83:S72-81, S90-8. [PMID: 11973700 DOI: 10.1053/apmr.2002.32178] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED This learner-directed module on spinal cord injury (SCI) presents a variety of perspectives of the process of personal and environmental adaptation for reintegration. Adaptation is unique to each person and does not predictably follow stages. Models used for understanding the process include biopsychosocial, ICIDH-2 (International Classification of Functioning, Disability and Health), and sector divisions of the environment. Home modification requires home (intermediate environment) evaluation and sociospatial behavioral mapping for planning and appropriation of remodeling in proportion to functional need and use. Options for access to the natural environment include specialized wheelchairs, climbing rigging, kayaks, and sail boats. Sports participation with adaptations is expanding and includes a larger variety of organizations and leagues. Economic needs are effectively anticipated with development of a life care plan. Procreative options to overcome infertility after SCI include vibratory stimulation for ejaculation, intravaginal insemination, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. Approaches to requests for withdrawal of life-sustaining care include depression screening, pain evaluation, and assistance in accomplishment of person centered goals. Overall, community reintegration after SCI is continually improving because of better acceptance, accessibility, and technology for building adaptations. OVERALL ARTICLE OBJECTIVES (a) To review models and theories of medical intervention and disablement and (b) to demonstrate their application in rehabilitation practice by designing unique treatment plans that meet patient person-centered goals.
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Affiliation(s)
- Steven A Stiens
- Department of Rehabilitation Medicine, University of Washington, SCI Unit VA Puget Sound Health Care System, Seattle, WA 98195, USA.
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