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Martinache F, Foudhaïli A, Vigué B. Early rehabilitation after spinal cord injury: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00294. [PMID: 38602049 DOI: 10.11124/jbies-22-00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The objective of this scoping review is to identify the timings and types of early rehabilitation after spinal cord injuries (SCI) that are documented in the literature, as well as identify possible research gaps in this field. INTRODUCTION Preclinical and clinical studies support the idea that early rehabilitation may be beneficial for patients with acute SCI. However, the timing and types of rehabilitation that should and could be used in the acute stage are still unclear. The first step towards such knowledge is to extensively review what is documented in the literature. INCLUSION CRITERIA This review will consider all papers focusing on early rehabilitation after SCI in adult humans or animals (<3 months post-SCI for humans and other primates and <3 weeks post-SCI for other animals). Interventions in the included papers must aim at sensorimotor or functional improvement and take place in a hospital or a rehabilitation center if they target human subjects. METHODS MEDLINE (PubMed), Scopus, Embase (Embase.com), PEDro, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PROSPERO, ClinicalTrials.gov, and gray literature sources will be searched for eligible articles. This review will include published and unpublished experimental and observational studies, research protocols, conference abstracts, systematic reviews, and guidelines. No language or date limits will be applied. Two independent reviewers will perform study selection and data extraction, and the results will be presented according to the SCI type and severity. REVIEW REGISTRATION Open Science Framework https://osf.io/q45er.
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Affiliation(s)
- Florence Martinache
- Université Paris-Saclay, CIAMS, 91405, Orsay, France
- Techno Concept, Manosque, France
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
| | - Adéla Foudhaïli
- Département de Médecine Physique et Réadaptation, AP-HP, CHU Lariboisiére, F-75010, Paris, France
- Université Paris Cité, Inserm, MASCOT, F-75010 Paris, France
- Université Paris Cité, Institut des Sciences du Sport-Santé de Paris, F-75015 Paris, France
| | - Bernard Vigué
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
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Behnammoghadam M, Alimohammadi N, Riazi A, Eghbali-Babadi M, Rezvani M. Care needs of adults with spinal trauma in the prehospital and hospital setting from the perspective of patient care team: A qualitative research. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:83. [PMID: 38720688 PMCID: PMC11078458 DOI: 10.4103/jehp.jehp_282_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND Appropriate care of patients with definite spinal cord injury or at risk of it in the prehospital and hospital stages requires comprehensive planning in the health system. It is also the requirement of any successful program to explain the needs from the perspective of its stakeholders. Thus, this study aimed to discover the care needs of adults with spinal trauma in prehospital and hospital settings from the perspective of the patient care team. MATERIALS AND METHODS This qualitative study was conducted with the participation of urban and rural prehospital emergency personnel and emergency departments of educational and therapeutic hospitals affiliated to Isfahan, Tehran, Shiraz, Kermanshah, Ahvaz, and Yasuj Universities of Medical Sciences, through conducting 36 in-depth semi-structured interviews from September to December 2021. Using purposive sampling method, the participants were selected considering the maximum variation. The data saturation was reached after conducting interviews and group discussions with 36 subjects. Data were analyzed using conventional content analysis approach. Lundman and Graneheim approach were used for the study rigour. Data were simultaneously analyzed using MAXQDA software version 10. RESULT During the data analysis, two themes of prehospital care with two main categories (emergency care and management of secondary complications of spinal trauma) and hospital care with two main categories (emergency care and management of secondary complications of spinal trauma) emerged. CONCLUSION Emergency care and management of secondary complications of spinal cord injury in the prehospital and hospital stages can affect treatment results, improve quality of life, and reduce mortality rate, secondary injuries, and healthcare costs. Thus, identification of the care needs of the adults with spinal trauma from the perspective of the patient care team can help the authorities to plan appropriate interventions.
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Affiliation(s)
- Mohammad Behnammoghadam
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrollah Alimohammadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Riazi
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Eghbali-Babadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, Neurosciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Irrgang S, Himmelhaus S, Allek K, Debecker I, Gemperli A, Kynast K, von Reumont A, Scheel-Sailer A. Assessments and interventions on body functions, structures and activity to prepare adults with acute spinal cord injury or disease for participation: a scoping review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1272682. [PMID: 38601217 PMCID: PMC11004486 DOI: 10.3389/fresc.2024.1272682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
Introduction In the acute phase after a spinal cord injury or disease (SCI/D), various therapeutic assessments and interventions are applied with the goal of restoring structures, preventing complications and preparing the patient as best as possible for further activity and finally participation. The goal was to identify and evaluate the available evidence on assessments and interventions for body functions and structures to prepare adults with acute spinal cord SCI/D for activity and participation during the first 14 days. Methods A scoping review was conducted. The search was performed on June 19, 2023 using the databases PubMed, PEDro, Cochrane library and Embase. These were screened for studies including patients with acute SCI/D and physiotherapeutic or occupational therapy assessments and interventions. Only studies in English or German published between 2012 and 2023 were included. Results Twelve publications met the inclusion criteria, namely three systematic reviews, two randomized controlled trials, two observational studies and five clinical practice guidelines. Assessments as the Spinal Cord Independence Measure, as well as exercises such as daily passive mobilization of body structures against contractures were used in the entire population, while others were only applied in subgroups of SCI/D such as the Graded Redefined Assessment of Strength, Sensation and Prehension or functional electrical stimulation with and without additional movements. The methodological quality of the studies found varied greatly from good to very poor. Discussion Heterogeneity in research design and study population as well as lack of high-quality studies do not cover the standard of clinical management in the acute phase and further comprehensive research is needed.
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Affiliation(s)
- Sophie Irrgang
- Health Services and Clinical Care Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sandra Himmelhaus
- Health Services and Clinical Care Group, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Kirstin Allek
- Spinal Cord Injury Center, Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - Armin Gemperli
- Health Services and Clinical Care Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Karen Kynast
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne von Reumont
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Anke Scheel-Sailer
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Center, Nottwil, Switzerland
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Gray N, Shaikh J, Cowley A, Goosey-Tolfrey V, Logan P, Quraishi N, Booth V. The effect of early mobilisation (< 14 days) on pathophysiological and functional outcomes in animals with induced spinal cord injury: a systematic review with meta-analysis. BMC Neurosci 2024; 25:20. [PMID: 38528450 DOI: 10.1186/s12868-024-00862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/11/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION The optimum time to mobilise (standing, walking) following spinal cord injury (SCI) is unknown but may have implications for patient outcomes. There are no high-quality experimental studies that examine this issue, with a paucity of guidance for clinicians. Pre-clinical studies lead research in this field and can contribute to knowledge and support future clinical practice. OBJECTIVE to evaluate the effect of early compared to no mobilisation on pathophysiological and functional outcomes in animals with induced SCI. METHODS A systematic review with meta-analysis was conducted by searching pre-clinical literature in MEDLINE (PubMed), Embase (Ovid), Web of Science, OpenGrey, and EThOS (June 2023). Studies were included of any research method giving numerical results comparing pathophysiological and functional outcomes in rats and mice mobilised within 14-days of induced SCI to those that did not mobilise. Data were synthesised using random-effects meta-analyses. The quality of the evidence was assessed using the CAMARADES checklist. The certainty of findings was reported using the GRADE approach. This study is registered on PROSPERO (CRD42023437494). RESULTS Seventeen studies met the inclusion criteria. Outcomes found that Brain Derived Neurotrophic Factor levels were greater in those that initiated mobilisation within 14-days of SCI compared to the groups that did not. Mobilisation initiated within 14-days of SCI was also associated with statistically significant functional gains: (Basso, Beattie and Bresnahan locomotor rating score (BBB) = 2.13(0-21), CI 1.43, 2.84, Ladder Rung Walking Task = - 12.38(0-100), CI 20.01, - 4.76). Meta-analysis identified the greatest functional gains when mobilisation was initiated within 3 days of SCI (BBB = 3.00, CI 2.31-3.69, p < 0.001), or when delivered at low intensity (BBB = 2.88, CI 2.03-3.70, p < 0.001). Confidence in the findings from this review was low to moderate due to the risk of bias and mixed methodological quality. CONCLUSION Mobilisation instigated within 14-days of injury, may be an effective way of improving functional outcomes in animal models following SCI, with delays potentially detrimental to recovery. Outcomes from this study support further research in this field to guide future clinical practice.
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Affiliation(s)
- Natalie Gray
- School of Medicine, University of Nottingham, Nottingham, UK.
| | - Junaid Shaikh
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Alison Cowley
- School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Vicky Goosey-Tolfrey
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Nasir Quraishi
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Vicky Booth
- School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Tetreault LA, Kwon BK, Evaniew N, Alvi MA, Skelly AC, Fehlings MG. A Clinical Practice Guideline on the Timing of Surgical Decompression and Hemodynamic Management of Acute Spinal Cord Injury and the Prevention, Diagnosis, and Management of Intraoperative Spinal Cord Injury: Introduction, Rationale, and Scope. Global Spine J 2024; 14:10S-24S. [PMID: 38632715 PMCID: PMC10964894 DOI: 10.1177/21925682231183969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
STUDY DESIGN Protocol for the development of clinical practice guidelines following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. OBJECTIVES Acute SCI or intraoperative SCI (ISCI) can have devastating physical and psychological consequences for patients and their families. The treatment of SCI has dramatically evolved over the last century as a result of preclinical and clinical research that has addressed important knowledge gaps, including injury mechanisms, disease pathophysiology, medical management, and the role of surgery. In an acute setting, clinicians are faced with critical decisions on how to optimize neurological recovery in patients with SCI that include the role and timing of surgical decompression and the best strategies for hemodynamic management. The lack of consensus surrounding these treatments has prevented standardization of care across centers and has created uncertainty with respect to how to best manage patients with SCI. ISCI is a feared complication that can occur in the best of hands. Unfortunately, there are no systematic reviews or clinical practice guidelines to assist spine surgeons in the assessment and management of ISCI in adult patients undergoing spinal surgery. Given these limitations, it is the objective of this initiative to develop evidence-based recommendations that will inform the management of both SCI and ISCI. This protocol describes the rationale for developing clinical practice guidelines on (i) the timing of surgical decompression in acute SCI; (ii) the hemodynamic management of acute SCI; and (iii) the prevention, identification, and management of ISCI in patients undergoing surgery for spine-related pathology. METHODS Systematic reviews were conducted according to PRISMA standards in order to summarize the current body of evidence and inform the guideline development process. The guideline development process followed the approach proposed by the GRADE working group. Separate multidisciplinary, international groups were created to perform the systematic reviews and formulate the guidelines. All potential conflicts of interest were vetted in advance. The sponsors exerted no influence over the editorial process or the development of the guidelines. RESULTS This process resulted in both systematic reviews and clinical practice guidelines/care pathways related to the role and timing of surgery in acute SCI; the optimal hemodynamic management of acute SCI; and the prevention, diagnosis and management of ISCI. CONCLUSIONS The ultimate goal of this clinical practice guideline initiative was to develop evidence-based recommendations for important areas of controversy in SCI and ISCI in hopes of improving neurological outcomes, reducing morbidity, and standardizing care across settings. Throughout this process, critical knowledge gaps and future directions were also defined.
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Affiliation(s)
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Nathan Evaniew
- McCaig Institute for Bone and Joint Health, Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Michael G Fehlings
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Morooka Y, Kunisawa Y, Okubo Y, Araki S, Takakura Y. Effects of early mobilization within 48 hours of injury in patients with incomplete cervical spinal cord injury. J Spinal Cord Med 2024:1-9. [PMID: 38265416 DOI: 10.1080/10790268.2024.2304919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To investigate the effects of early mobilization within 48 h of injury on motor function and walking ability in patients with incomplete cervical spinal cord injury (SCI). DESIGN A retrospective observational study. SETTING Intensive care unit or high care unit of a university hospital emergency center. PARTICIPANTS Of 224 patients with SCI having American Spinal Injury Association impairment scale grades C and D, 158 consecutive patients hospitalized for at least 3 weeks after injury were included. INTERVENTIONS Patients were categorized into two groups: an early mobilization group in which patients were mobilized within 48 h of injury and a delayed mobilization group in which they were mobilized after 48 h of injury. OUTCOME MEASURES The upper extremity motor score (UEMS), lower extremity motor score (LEMS), and Walking Index for Spinal Cord Injury II (WISCI II) were compared using propensity score matching analysis. RESULTS Of the 158 patients who met the eligibility criteria, 32 were matched between the groups. There was a significant difference in the change in LEMS from the initial assessment to the assessment 2 weeks postoperatively in the early mobilization group (median 9 points vs. 3 points, p < 0.05). There were no significant differences in UEMS or WISCI II. CONCLUSION Early mobilization within 48 h may improve lower extremity motor function in patients with acute incomplete cervical SCI.
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Affiliation(s)
- Yusuke Morooka
- Faculty of Health, Department of Physical Therapy, Saitama Medical University, Saitama, Japan
| | - Yosuke Kunisawa
- Faculty of Health, Department of Physical Therapy, Saitama Medical University, Saitama, Japan
| | - Yuya Okubo
- Saitama Medical Center, Department of Rehabilitation, Kawagoe, Japan
| | - Shinta Araki
- Saitama Medical Center, Department of Rehabilitation, Kawagoe, Japan
| | - Yasuyuki Takakura
- Faculty of Health, Department of Physical Therapy, Saitama Medical University, Saitama, Japan
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Babu H, Sriraman S, Karthikbabu S, Sophia P, Kumar SNS. Factors Influencing Social and Community Participation of People with Spinal Cord Injury in Karnataka, India. Indian J Community Med 2024; 49:52-55. [PMID: 38425982 PMCID: PMC10900467 DOI: 10.4103/ijcm.ijcm_421_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/18/2023] [Indexed: 03/02/2024] Open
Abstract
Background Social and community participation are major indicators to assess the adequacy of treatment and rehabilitation in patients with spinal cord injury (SCI). This study examined the relationship between functional independence, level of disability, and social and community participation among people with SCI in India. Materials and Method In this cross sectional study, 110 persons with SCI, aged 18 years and above participated in a community setting, in Karnataka, India. Spinal Cord Independence Measure Version III-self-reporting (SCIM III-SR), Craig Handicap Assessment and Reporting Technique (CHART), and WHO Disability Assessment Schedule 2.0 (WHODAS) were the clinical outcome measures. Spearman's correlation and stepwise multiple linear regression were done to determine association and identify the factors determining the community participation of people with SCI. Results CHART physical independence had a positive correlation with SCIM self-care (R = 0.446) and SCIM mobility (r = 0.434). CHART cognitive independence (R = -0.38) and CHART mobility (R = -0.396) had a weak correlation with WHODAS. SCIM self-care and SCIM mobility (R2 = 0.34) were determinants of CHART cognitive independence. SCIM respiratory and sphincter management and SCIM self-care (R2 = 0.327) were determinants of CHART mobility. Conclusion Self-care and mobility of people with SCI determine their ability to successfully reintegrate into the community, warranting a comprehensive community rehabilitation program.
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Affiliation(s)
- Heavenna Babu
- Physiotherapist and Public Health Researcher, Ontario, Canada
| | - Sheetal Sriraman
- Pediatric Resident, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Suruliraj Karthikbabu
- Principal and Professor, KMCH College of Physiotherapy, Dr. NGP Research and Educational Trust, Coimbatore, The Tamilnadu Dr. MGR University, Chennai, India
| | - P. Sophia
- Occupational Therapist, Baptist Hospital, Bengaluru, Karnataka, India
| | - Senthil N. S. Kumar
- Chief Executive Officer, The Association of People with Disability (APD-India), Bengaluru, Karnataka, India
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Furlan JC. Concomitant traumatic brain injury as a determinant of survival, and neurological and functional outcomes after traumatic spinal cord injury: A retrospective cohort study. PM R 2023. [PMID: 38151464 DOI: 10.1002/pmrj.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/22/2023] [Accepted: 11/02/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Although concomitant traumatic brain injury (TBI) is not infrequently associated with spinal cord injury (SCI), there is relatively scarce information about the effects of concomitant TBI on outcomes after SCI. OBJECTIVE To assess the impact of concomitant mild-to-moderate TBI on survival, and neurological and functional outcomes within the first year after acute traumatic SCI. DESIGN Retrospective cohort study. SETTING Acute spine trauma centers in the United States. PARTICIPANTS This study includes all individuals who were enrolled into the Third National Spinal Cord Injury Study (NASCIS-3). The study population was classified into SCI + TBI group and SCI-alone group. TBI was defined as a Glasgow Coma Scale score <15 on admission. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Both groups were compared regarding their survival and neurological outcomes (ie, NASCIS motor, sensory and pain scores) and functional outcome (ie, Functional Independence Measure score) within the first year following SCI. Data analyses were adjusted for major potential confounders. RESULTS There were 413 individuals in the SCI-alone group and 86 individuals in the SCI + TBI group (17.2%). Both groups were comparable regarding gender distribution (p = .621). However, the SCI + TBI group was older (p < .001), had a higher proportion of complete (p = .006) and cervical SCI (p = .003), and had a higher blood alcohol level (p < .001) than the SCI-alone group. The SCI + TBI group did not significantly differ from the SCI-alone group regarding survival within the first year after SCI (p = .768). Among the survivors, concomitant mild-to-moderate TBI did not significantly affect neurological and functional outcomes at 1 year after SCI in the multiple regression analyses after adjusting for major potential confounders. CONCLUSIONS The results of this study suggest that concomitant mild-to-moderate TBI did not have a significant impact on survival, neurological recovery, and functional outcomes at 1 year after SCI, even though there were some epidemiological differences between SCI-alone and SCI + TBI groups.
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Affiliation(s)
- Julio C Furlan
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Chen S, Li G, Li F, Wang G, Wang Q. A dynamic nomogram for predicting the probability of irreversible neurological dysfunction after cervical spinal cord injury: research based on clinical features and MRI data. BMC Musculoskelet Disord 2023; 24:459. [PMID: 37277760 DOI: 10.1186/s12891-023-06570-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Irreversible neurological dysfunction (IND) is an adverse event after cervical spinal cord injury (CSCI). However, there is still a shortage of objective criteria for the early prediction of neurological function. We aimed to screen independent predictors of IND and use these findings to construct a nomogram that could predict the development of neurological function in CSCI patients. METHODS Patients with CSCI attending the Affiliated Hospital of Southwest Medical University between January 2014 and March 2021 were included in this study. We divided the patients into two groups: reversible neurological dysfunction (RND) and IND. The independent predictors of IND in CSCI patients were screened using the regularization technique to construct a nomogram, which was finally converted into an online calculator. Concordance index (C-index), calibration curves analysis and decision curve analysis (DCA) evaluated the model's discrimination, calibration, and clinical applicability. We tested the nomogram in an external validation cohort and performed internal validation using the bootstrap method. RESULTS We enrolled 193 individuals with CSCI in this study, including IND (n = 75) and RND (n = 118). Six features, including age, American spinal injury association Impairment Scale (AIS) grade, signal of spinal cord (SC), maximum canal compromise (MCC), intramedullary lesion length (IMLL), and specialized institution-based rehabilitation (SIBR), were included in the model. The C-index of 0.882 from the training set and its externally validated value of 0.827 demonstrated the model's prediction accuracy. Meanwhile, the model has satisfactory actual consistency and clinical applicability, verified in the calibration curve and DCA. CONCLUSION We constructed a prediction model based on six clinical and MRI features that can be used to assess the probability of developing IND in patients with CSCI.
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Affiliation(s)
- Si Chen
- Department of Orthopaedics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Guangzhou Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Sichuan, 646000, China
| | - Feng Li
- Department of Orthopaedics, The Affiliated Chengdu 363 Hospital of Southwest Medical University, Chengdu, China
| | - Gaoju Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Sichuan, 646000, China
| | - Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Sichuan, 646000, China.
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Hejrati N, Pedro K, Alvi MA, Quddusi A, Fehlings MG. Degenerative cervical myelopathy: Where have we been? Where are we now? Where are we going? Acta Neurochir (Wien) 2023; 165:1105-1119. [PMID: 37004568 DOI: 10.1007/s00701-023-05558-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/06/2023] [Indexed: 04/04/2023]
Abstract
Degenerative cervical myelopathy (DCM), a recently coined term, encompasses a group of age-related and genetically associated pathologies that affect the cervical spine, including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament (OPLL). Given the significant contribution of DCM to global disease and disability, there are worldwide efforts to promote research and innovation in this area. An AO Spine effort termed 'RECODE-DCM' was initiated to create an international multistakeholder consensus group, involving patients, caregivers, physicians and researchers, to focus on launching actionable discourse on DCM. In order to improve the management, treatment and results for DCM, the RECODE-DCM consensus group recently identified ten priority areas for translational research. The current article summarizes recent advancements in the field of DCM. We first discuss the comprehensive definition recently refined by the RECODE-DCM group, including steps taken to arrive at this definition and the supporting rationale. We then provide an overview of the recent advancements in our understanding of the pathophysiology of DCM and modalities to clinically assess and diagnose DCM. A focus will be set on advanced imaging techniques that may offer the opportunity to improve characterization and diagnosis of DCM. A summary of treatment modalities, including surgical and nonoperative options, is then provided along with future neuroprotective and neuroregenerative strategies. This review concludes with final remarks pertaining to the genetics involved in DCM and the opportunity to leverage this knowledge toward a personalized medicine approach.
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Affiliation(s)
- Nader Hejrati
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Karlo Pedro
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ayesha Quddusi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada.
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Liu A, Qiu NH, Zhong XR, Fang X, Liao JJ, Zhang ZP, Zheng PF, Hu YY, Hu KH, Xiong YH, Lu LJ, Xi XH, Wu Q, Bao YZ. Dynamic evaluation of the cervical spine by kinematic MRI in patients with cervical spinal cord injury without fracture and dislocation. J Orthop Surg Res 2023; 18:249. [PMID: 36973814 PMCID: PMC10044375 DOI: 10.1186/s13018-023-03745-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The pattern of changes in the cervical spine and the spinal cord and their dynamic characteristics in patients with cervical spinal cord injury without fracture and dislocation remain unclear. This study aimed to evaluate the dynamic changes in the cervical spine and spinal cord from C2/3 to C7/T1 in different positions by using kinematic magnetic resonance imaging in patients with cervical spinal cord injury without fracture and dislocation. This study was approved by the ethics committee of Yuebei People's Hospital. METHODS Using median sagittal T2-weighted images for 16 patients with cervical spinal cord injury without fracture and dislocation who underwent cervical kinematic MRI, the anterior space available for the cord, spinal cord diameter, posterior space available for the cord from C2/3 to C7/T1, and Muhle's grade were determined. The spinal canal diameter was calculated by adding the anterior space available for the cord, spinal cord diameter, and posterior space available for the cord. RESULTS The anterior space available for the cord, posterior space available for the cord, and spinal canal diameters at C2/3 and C7/T1 were significantly higher than those from C3/4 to C6/7. Muhle's grades at C2/3 and C7/T1 were significantly lower than those at the other levels. Spinal canal diameter was lower in extension than in the neutral and flexion positions. In the operated segments, significantly lesser space was available for the cord (anterior space available for the cord + posterior space available for the cord), and the spinal cord diameter/spinal canal diameter ratio was higher than those in the C2/3, C7/T1, and non-operated segments. CONCLUSION Kinematic MRI demonstrated dynamic pathoanatomical changes, such as canal stenosis in different positions, in patients with cervical spinal cord injury without fracture and dislocation. The injured segment had a small canal diameter, high Muhle's grade, low space available for the cord, and high spinal cord diameter/spinal canal diameter ratio.
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Affiliation(s)
- Ao Liu
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Nan-Hai Qiu
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Xue-Ren Zhong
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Xiang Fang
- Department of Spine Surgery, Shaoguan First People's Hospital, Shaoguan City, 512026, Guangdong, China
| | - Jun-Jian Liao
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Zhi-Peng Zhang
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Pei-Feng Zheng
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Yong-Yu Hu
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Kong-He Hu
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Ying-Hui Xiong
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Lin-Jun Lu
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Xin-Hua Xi
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China
| | - Qiang Wu
- Department of Spine Surgery, Shaoguan First People's Hospital, Shaoguan City, 512026, Guangdong, China
| | - Yong-Zheng Bao
- Department of Spine Surgery, Yuebei People's Hospital, Guangdong Medical University, Shaoguan City, 512026, Guangdong, China.
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12
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Defi IR, Hamam NR, Biben V, Al Barqi NC. Improving functional outcomes and quality of life in an elderly woman with sarcopenia and spinal Tuberculosis: A case report. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1076010. [PMID: 36817719 PMCID: PMC9935826 DOI: 10.3389/fresc.2023.1076010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023]
Abstract
Background Indonesia is the world's second-largest contributor to TB patients. According to prevalence by age, the elderly have the most diagnosed TB. In Indonesia, TB spondylitis affects approximately 5% of TB cases and is a common cause of non-traumatic spinal cord injury (NTSCI). Spinal cord injury (SCI) is a growing public health concern, particularly among the elderly, as many of its populations have sarcopenia. Due to the complete absence of voluntary muscle contraction, SCI is followed by a rapid loss of skeletal muscle mass. SCI has several physical, psychological, social, and economic consequences. Case presentation A 68-years-old woman presented with weakness and numbness of all four limbs. She also had sarcopenia, malnutrition, and dependency on activities of daily living (ADL). In addition, the patient was at a risk of SCI complications. Magnetic resonance imaging (MRI) showed destruction of the vertebral bodies at the level of the 5th and 6th cervical area, tuberculous abscesses of the paravertebral and longus colli muscles. The patient underwent debridement and spinal stabilization. However, the patient was at a risk of developing SCI complications. In these patients, the Physical Rehabilitation and Medicine (PRM) strategy focuses on improving medical conditions, including preventing secondary complications, promoting neurological recovery, and optimizing function. Conclusion This case highlights the importance of PRM intervention in assessing functional disorders in the elderly to improve their quality of life (QOL).
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Affiliation(s)
- Irma Ruslina Defi
- Physical Medicine and Rehabilitation Department, Hasan Sadikin General Hospital, Faculty of Medicine Padjadjaran University, Bandung, Indonesia,Correspondence: Irma Ruslina Defi
| | - Nur Rusyidah Hamam
- Physical Medicine and Rehabilitation Department, Hasan Sadikin General Hospital, Faculty of Medicine Padjadjaran University, Bandung, Indonesia
| | - Vitriana Biben
- Physical Medicine and Rehabilitation Department, Hasan Sadikin General Hospital, Faculty of Medicine Padjadjaran University, Bandung, Indonesia
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13
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Nunnerley JL, Glinsky JV, Dunn JA, Stavric VA, Haber A, Denis S, Ben M, Chen LW, Harvey LA. Developing spinal cord injury physiotherapy clinical practice guidelines: a qualitative study to determine how physiotherapists and people living with spinal cord injury use evidence. Spinal Cord 2023; 61:160-168. [PMID: 36513762 PMCID: PMC9746570 DOI: 10.1038/s41393-022-00867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/04/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Abstract
STUDY DESIGN Generic qualitative design. OBJECTIVES Australian and New Zealand SCI physiotherapists are developing clinical practice guidelines for the physiotherapy management of people living with spinal cord injury. To guide the development of the guidelines it was important to understand how physiotherapists and people living with spinal cord injury use evidence to choose interventions and the potential barriers and facilitators to the uptake of the clinical practice guidelines. SETTING Spinal Cord Injury Centres in Sydney, Australia and New Zealand. METHODS Focus groups and interviews with physiotherapists and people living with spinal cord injury were recorded, transcribed, and subjected to thematic analysis. RESULTS A total of 75 participants took part in the study, 45 physiotherapists and 30 people living with spinal cord injury. Three main themes were identified from the data: (1) Types and sources of evidence that influence treatment choices, (2) the many factors determining treatment choices, and (3) ways in which clinical practice guidelines could influence treatment. CONCLUSIONS Clinical practice guidelines have the potential to reduce the barriers identified by physiotherapists in accessing and interpreting research evidence on interventions for people living with spinal cord injury. Supported implementation of guidelines is required to demonstrate their benefit and encourage physiotherapists to factor in evidence when balancing the multiple factors influencing choice of physiotherapy intervention.
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Affiliation(s)
- Joanne L Nunnerley
- Burwood Academy, Christchurch, New Zealand. .,University of Otago, Christchurch, New Zealand.
| | - Joanne V Glinsky
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia
| | | | | | | | - Sophie Denis
- Prince of Wales Hospital, Sydney, NSW, Australia
| | | | - Lydia W Chen
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lisa A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia
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14
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Lambrechts MJ, D’Antonio ND, Karamian BA, Kanhere AP, Dees A, Wiafe BM, Canseco JA, Woods BI, Kaye ID, Rihn J, Kurd M, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Does displacement of cervical and thoracolumbar dislocation-translation injuries predict spinal cord injury or recovery? J Neurosurg Spine 2022; 37:821-827. [PMID: 35962960 DOI: 10.3171/2022.6.spine22435] [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: 04/25/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE For patients with cervical and thoracolumbar AO Spine type C injuries, the authors sought to 1) identify whether preoperative vertebral column translation is predictive of a complete spinal cord injury (SCI) and 2) identify whether preoperative or postoperative vertebral column translation is predictive of neurological improvement after surgical decompression. METHODS All patients who underwent operative treatment for cervical and thoracolumbar AO Spine type C injuries at the authors' institution between 2006 and 2021 were identified. CT and MRI were utilized to measure vertebral column translation in millimeters prior to and after surgery. A receiver operating characteristic (ROC) curve was generated to predict the probability of sustaining a complete SCI on the basis of the amount of preoperative vertebral column translation. ROC curves were then used to predict the probability of neurological recovery on the basis of preoperative and postoperative vertebral column translation. RESULTS ROC analysis of 67 patients identified 6.10 mm (area under the curve [AUC] 0.77, 95% CI 0.650-0.892) of preoperative vertebral column translation as predictive of complete SCI. Additionally, ROC curve analysis found that 10.4 mm (AUC 0.654, 95% CI 0.421-0.887) of preoperative vertebral column translation was strongly predictive of no postoperative neurological improvement. Residual postoperative vertebral column translation after fracture reduction and instrumentation had no predictive value on neurological recovery (AUC 0.408, 95% CI 0.195-0.622). CONCLUSIONS For patients with cervical and thoracolumbar AO Spine type C injuries, the amount of preoperative vertebral column translation is highly predictive of complete SCI and the likelihood of postoperative neurological recovery.
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Affiliation(s)
- Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nicholas D. D’Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Arun P. Kanhere
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Azra Dees
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Bright M. Wiafe
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Barrett I. Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - I. David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jeffrey Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mark Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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15
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Hohl K, Smith AC, Macaluso R, Giffhorn M, Prokup S, O’Dell DR, Kleinschmidt L, Elliott JM, Jayaraman A. Muscle adaptations in acute SCI following overground exoskeleton + FES training: A pilot study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:963771. [PMID: 36311207 PMCID: PMC9608781 DOI: 10.3389/fresc.2022.963771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the combined effects of robotic exoskeleton and functional electrical stimulation (FES) training on muscle composition during over-ground gait training in persons with acute spinal cord injury (SCI). Design Randomized crossover pilot study. Setting Inpatient-rehabilitation Hospital. Participants Six individuals with acute SCI. Intervention Participants were randomized to either receive training with the Ekso® Bionics exoskeleton combined with FES in addition to standard-of-care or standard-of-care alone. Outcome measures The main outcome measures for the study were quantified using magnetic resonance imaging (MRI), specifically, lower extremity muscle volume and intramuscular adipose tissue (IMAT). Static balance and fall risk were assessed using the Berg Balance Scale. Results Significant improvements were observed in muscle volume in the exoskeleton intervention group when compared to only standard-of-care (p < 0.001). There was no significant difference between the groups in IMAT even though the intervention group saw a reduction in IMAT that trended towards statistical significance (p = 0.07). Static balance improved in both groups, with greater improvements seen in the intervention group. Conclusions Early intervention with robotic exoskeleton may contribute to improved muscle function measured using MRI in individuals with acute SCI.
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Affiliation(s)
- Kristen Hohl
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Rebecca Macaluso
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Matthew Giffhorn
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Sara Prokup
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Denise R. O’Dell
- Department of Physical Therapy, University of Kentucky College of Health Sciences, Lexington, KY, United States
| | - Lina Kleinschmidt
- Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jim M. Elliott
- Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Northern Sydney Local Health District, The Kolling Institute and Faculty of Medicine and Health, The University of Sydney, St. Leonards, NSW, Australia
| | - Arun Jayaraman
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States,Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Physical Medicine / Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Correspondence: Arun Jayaraman
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16
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Acute Traumatic Spinal Cord Injury. Adv Emerg Nurs J 2022; 44:272-280. [DOI: 10.1097/tme.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Tabarestani TQ, Lewis NE, Kelly-Hedrick M, Zhang N, Cellini BR, Marrotte EJ, Williamson T, Wang H, Laskowitz DT, Faw TD, Abd-El-Barr MM. Surgical Considerations to Improve Recovery in Acute Spinal Cord Injury. Neurospine 2022; 19:689-702. [PMID: 36203295 PMCID: PMC9537855 DOI: 10.14245/ns.2244616.308] [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: 07/01/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022] Open
Abstract
Acute traumatic spinal cord injury (SCI) can be a devastating and costly event for individuals, their families, and the health system as a whole. Prognosis is heavily dependent on the physical extent of the injury and the severity of neurological dysfunction. If not treated urgently, individuals can suffer exacerbated secondary injury cascades that may increase tissue injury and limit recovery. Initial recognition and rapid treatment of acute SCI are vital to limiting secondary injury, reducing morbidity, and providing the best chance of functional recovery. This article aims to review the pathophysiology of SCI and the most up-to-date management of the acute traumatic SCI, specifically examining the modern approaches to surgical treatments along with the ethical limitations of research in this field.
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Affiliation(s)
| | - Nicholle E. Lewis
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Nina Zhang
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Brianna R. Cellini
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Eric J. Marrotte
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA,Center for Bioethics, Harvard Medical School, Boston, MA, USA
| | - Haichen Wang
- Department of Neurology, Duke University, Durham, NC, USA
| | | | - Timothy D. Faw
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA,Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
| | - Muhammad M. Abd-El-Barr
- Department of Neurosurgery, Duke University, Durham, NC, USA,Corresponding Author Muhammad M. Abd-El-Barr Department of Neurosurgery, Duke University Medical Center 2840, Room 5335 5th Floor, Orange Zone, Duke South, Durham, NC 27710, USA
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18
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Lewis NE, Tabarestani TQ, Cellini BR, Zhang N, Marrotte EJ, Wang H, Laskowitz DT, Abd-El-Barr MM, Faw TD. Effect of Acute Physical Interventions on Pathophysiology and Recovery After Spinal Cord Injury: A Comprehensive Review of the Literature. Neurospine 2022; 19:671-686. [PMID: 36203293 PMCID: PMC9537860 DOI: 10.14245/ns.2244476.238] [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: 06/01/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022] Open
Abstract
Physical rehabilitation is essential for enhancing recovery in individuals with spinal cord injury (SCI); however, aside from early surgical intervention and hemodynamic management, there are no proven interventions for promoting recovery in the acute phase. In general, early rehabilitation is considered beneficial, but optimal parameters and potential contraindications for implementing rehabilitation at very early time points are unclear. Moreover, clinical trials to date are limited to studies initiating rehabilitation 2 weeks after injury and later. To address these gaps, this article reviews the preclinical literature on physical interventions initiated within the first 8 days postinjury. Effects of early rehabilitation on molecular and structural nervous system changes, behavioral function, and body systems are considered. Most studies utilized treadmill or cycle training as the primary intervention. Treadmill training initiated within the first 3 days and terminated by 1 week after injury worsened autonomic function, inflammation, and locomotor outcomes, while swim training during this period increased microvascular dysfunction. In contrast, lower-intensity rehabilitation such as reach training, ladder training, or voluntary wheel or ball training showed benefits when implemented during the first 3 days. Rehabilitation initiated at 4 days postinjury was also associated with enhanced motor recovery. Cycling appears to have the greatest risk-benefit ratio; however, the effects of cycle training in the first 3 days were not investigated. Overall, research suggests that lower intensity or voluntary rehabilitation during the hyperacute phase is more appropriate until at least 4 days postinjury, at which point higher-intensity activity becomes safer and more beneficial for recovery.
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Affiliation(s)
- Nicholle E. Lewis
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Brianna R. Cellini
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Nina Zhang
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Eric J. Marrotte
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Haichen Wang
- Department of Neurology, Duke University, Durham, NC, USA
| | | | | | - Timothy D. Faw
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA,Duke Institute for Brain Sciences, Duke University, Durham, NC, USA,Corresponding Author Timothy D. Faw Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, 311 Research Drive, Durham, NC 21170, USA
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19
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Panisset MG, El-Ansary D, Dunlop SA, Marshall R, Clark J, Churilov L, Galea MP. Factors influencing thigh muscle volume change with cycling exercises in acute spinal cord injury - a secondary analysis of a randomized controlled trial. J Spinal Cord Med 2022; 45:510-521. [PMID: 32970970 PMCID: PMC9246176 DOI: 10.1080/10790268.2020.1815480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective: To conduct a per-protocol analysis on thigh muscle volume outcomes from the Spinal Cord Injury and Physical Activity (SCIPA) Switch-On Trial.Design: Secondary analysis from an assessor-blind randomized, controlled trial.Setting: Four acute/sub-acute hospitals in Australia and New Zealand.Participants: 24 adults (1 female) within four weeks of motor complete or incomplete spinal cord injury (SCI)Intervention: Functional electrical stimulation-assisted cycling (FESC) or passive cycling (PC) 4x/week for 12 weeks.Outcome Measures: Whole thigh and muscle group volumes calculated from manually segmented MR images.Results: 19/24 participants completed ≥ twelve weeks of the intervention. Five participants experienced hypertrophy (4 FESC; 1 PC) and eight attenuation of atrophy (<20% volume loss) (3 FESC; 5 PC) in thigh muscle volume. Six participants were non-responders, exhibiting atrophy >20% (3 FESC; 3 PC). Mean (SD) change for FESC was -2.3% (25.3%) and PC was -14.0% (12.3%). After controlling for baseline muscle volumes, a strong significant correlation was found between mean weekly exercise frequency and quadriceps and hamstring volumes (r=6.25, P=0.006), regardless of mode. Average watts was highly correlated to quadriceps volumes only (r=5.92, P=0.01), while total number of sessions was strongly correlated with hamstring volumes only (r=5.91, P=0.01).Conclusion: This per-protocol analysis of FESC and PC early after SCI reports a partial response in 42% and a beneficial response in 25% of patients who completed 12 weeks intervention, regardless of mode. Strong correlations show a dose-response according to exercise frequency. Characteristics of non-responders are discussed to inform clinical decision-making.
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Affiliation(s)
- Maya G. Panisset
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Australia,Correspondence to: Maya G. Panisset, Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC3052, Australia; Ph: (+61) 0405 027 127.
| | - Doa El-Ansary
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorne, Australia,Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Sarah Alison Dunlop
- School of Biological Sciences, The University of Western Australia, Perth, Australia
| | - Ruth Marshall
- Hampstead Rehabilitation Centre, Northfield, Australia
| | - Jillian Clark
- Hampstead Rehabilitation Centre, Lightsview, Australia
| | | | - Mary P. Galea
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Australia
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20
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Mutepfa AR, Hardy JG, Adams CF. Electroactive Scaffolds to Improve Neural Stem Cell Therapy for Spinal Cord Injury. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:693438. [PMID: 35274106 PMCID: PMC8902299 DOI: 10.3389/fmedt.2022.693438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
Spinal cord injury (SCI) is a serious condition caused by damage to the spinal cord through trauma or disease, often with permanent debilitating effects. Globally, the prevalence of SCI is estimated between 40 to 80 cases per million people per year. Patients with SCI can experience devastating health and socioeconomic consequences from paralysis, which is a loss of motor, sensory and autonomic nerve function below the level of the injury that often accompanies SCI. SCI carries a high mortality and increased risk of premature death due to secondary complications. The health, social and economic consequences of SCI are significant, and therefore elucidation of the complex molecular processes that occur in SCI and development of novel effective treatments is critical. Despite advances in medicine for the SCI patient such as surgery and anaesthesiology, imaging, rehabilitation and drug discovery, there have been no definitive findings toward complete functional neurologic recovery. However, the advent of neural stem cell therapy and the engineering of functionalized biomaterials to facilitate cell transplantation and promote regeneration of damaged spinal cord tissue presents a potential avenue to advance SCI research. This review will explore this emerging field and identify new lines of research.
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Affiliation(s)
- Anthea R. Mutepfa
- Neural Tissue Engineering Keele, School of Life Sciences, Keele University, Keele, United Kingdom
| | - John G. Hardy
- Department of Chemistry, Lancaster University, Lancaster, United Kingdom
- Materials Science Institute, Lancaster University, Lancaster, United Kingdom
- *Correspondence: John G. Hardy
| | - Christopher F. Adams
- Neural Tissue Engineering Keele, School of Life Sciences, Keele University, Keele, United Kingdom
- Christopher F. Adams
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21
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Boerger TF, Hyngstrom AS, Furlan JC, Kalsi-Ryan S, Curt A, Kwon BK, Kurpad SN, Fehlings MG, Harrop JS, Aarabi B, Rahimi-Movaghar V, Guest JD, Wilson JR, Davies BM, Kotter MRN, Koljonen PA. Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity? Global Spine J 2022; 12:97S-108S. [PMID: 35174735 PMCID: PMC8859699 DOI: 10.1177/21925682211050925] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies. METHODS Literature search. RESULTS In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed. CONCLUSIONS We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.
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Affiliation(s)
- Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Julio C. Furlan
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Armin Curt
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Brian K. Kwon
- Department of Orthopedics, Vancouver Spine Surgery Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | | | - Paul A. Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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22
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Furlan JC. Effects of age on survival and neurological recovery of individuals following acute traumatic spinal cord injury. Spinal Cord 2021; 60:81-89. [PMID: 34635785 DOI: 10.1038/s41393-021-00719-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To evaluate the effects of older age at the time of injury on the individuals' survival and neurological recovery within the first year after acute traumatic spinal cord injury (tSCI). SETTING United States. METHODS This study included all participants enrolled into the First National Acute Spinal Cord Injury Study (NASCIS-1). Outcome measures included survival and neurological recovery (as assessed using the NASCIS motor and sensory scores) within the first year after tSCI. Data analyses of neurological recovery were adjusted for major potential confounders. RESULTS The study included 39 females and 267 males with overall mean age of 31 years who mostly sustained cervical severe tSCI after motor vehicle accidents or falls. Survival rates among older individuals are significantly lower than among younger individuals within the first year following tSCI (p < 0.0001). Among who survived the first year of tSCI, there were no statistically significant difference between older survivors and younger survivors regarding motor and sensory recovery in the multiple regression analyses adjusted for major potential confounders. CONCLUSIONS The results of this retrospective study suggest that older age at the injury onset is associated with lower survival rate within the first year following tSCI. However, older individuals have similar potential to recover from their initial neurological impairment to younger individuals after tSCI. The results of this study combined to the recent literature underline the need for multidisciplinary team approach to the management of the elderly with acute SCI is essential to maximize their recovery.
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Affiliation(s)
- Julio C Furlan
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. .,KITE Research Institute, University Health Network, Toronto, ON, Canada. .,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada. .,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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23
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Mousa AH, Agha Mohammad S, Rezk HM, Muzaffar KH, Alshanberi AM, Ansari SA. Nanoparticles in traumatic spinal cord injury: therapy and diagnosis. F1000Res 2021. [DOI: 10.12688/f1000research.55472.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nanotechnology has been previously employed for constructing drug delivery vehicles, biosensors, solar cells, lubricants and as antimicrobial agents. The advancement in synthesis procedure makes it possible to formulate nanoparticles (NPs) with precise control over physico-chemical and optical properties that are desired for specific clinical or biological applications. The surface modification technology has further added impetus to the specific applications of NPs by providing them with desirable characteristics. Hence, nanotechnology is of paramount importance in numerous biomedical and industrial applications due to their biocompatibility and stability even in harsh environments. Traumatic spinal cord injuries (TSCIs) are one of the major traumatic injuries that are commonly associated with severe consequences to the patient that may reach to the point of paralysis. Several processes occurring at a biochemical level which exacerbate the injury may be targeted using nanotechnology. This review discusses possible nanotechnology-based approaches for the diagnosis and therapy of TSCI, which have a bright future in clinical practice.
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24
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Jaja BNR, Badhiwala J, Guest J, Harrop J, Shaffrey C, Boakye M, Kurpad S, Grossman R, Toups E, Geisler F, Kwon B, Aarabi B, Kotter M, Fehlings MG, Wilson JR. Trajectory-Based Classification of Recovery in Sensorimotor Complete Traumatic Cervical Spinal Cord Injury. Neurology 2021; 96:e2736-e2748. [PMID: 33849991 DOI: 10.1212/wnl.0000000000012028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that sensorimotor complete traumatic cervical spinal cord injury (SCI) is a heterogenous clinical entity comprising several subpopulations that follow fundamentally different trajectories of neurologic recovery. METHODS We analyzed demographic and injury data from 655 patients who were pooled from 4 prospective longitudinal multicenter studies. Group-based trajectory modeling was applied to model neurologic recovery trajectories over the initial 12 months postinjury and to identify predictors of recovery trajectories. Neurologic outcomes included upper extremity motor score, total motor scores, and American Spinal Injury Association Impairment Scale (AIS) grade improvement. RESULTS The analysis identified 3 distinct trajectories of neurologic recovery. These clinical courses included (1) marginal recovery trajectory, characterized by minimal or no improvement in motor strength or change in AIS grade status (remained grade A); (2) moderate recovery trajectory, characterized by low baseline motor scores that improved approximately 13 points or AIS conversion of 1 grade point; (3) good recovery trajectory, characterized by baseline motor scores in the upper quartile that improved to near maximum values within 3 months of injury. Patients following the moderate or good recovery trajectories were younger, had more caudally located injuries, had a higher degree of preserved motor and sensory function at baseline examination, and exhibited a greater extent of motor and sensory function in the zone of partial preservation. CONCLUSION Cervical complete SCI can be classified into one of 3 distinct subpopulations with fundamentally different trajectories of neurologic recovery. This study defines unique clinical phenotypes based on potential for recovery, rather than baseline severity of injury alone. This approach may prove beneficial in clinical prognostication and in the design and interpretation of clinical trials in SCI.
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Affiliation(s)
- Blessing N R Jaja
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Jetan Badhiwala
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - James Guest
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - James Harrop
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Chris Shaffrey
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Max Boakye
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Shekar Kurpad
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Robert Grossman
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Elizabeth Toups
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Fred Geisler
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Brian Kwon
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Bizhan Aarabi
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Mark Kotter
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Michael G Fehlings
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Jefferson R Wilson
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK.
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Kelch A, Harro C. Physical Therapy Interventions in a Patient with Nontraumatic Incomplete Spinal Cord Injury Secondary to Metastatic Lung Cancer: A Case Report. Physiother Theory Pract 2021; 38:2230-2240. [PMID: 33998952 DOI: 10.1080/09593985.2021.1923094] [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: 10/21/2022]
Abstract
Background and Introduction: Individuals with dual cancer and spinal cord injury diagnoses present unique challenges to rehabilitation teams. This case report describes the modification of a physical therapy plan of care for an individual with incomplete spinal cord injury (iSCI) resulting from metastatic lung cancer who underwent adjunctive cancer treatment.Case Description: A 61-year-woman with small cell lung cancer and T5 iSCI presenting to inpatient rehabilitation (IPR) to address function limitations from iSCI following metastatic epidural tumor resection.Intervention: Interventions focused on task-specific training of mobility skills with modifications made to address cancer-related fatigue, promote energy conservation, and prioritize functional skills for home discharge given anticipated disease progression.Outcomes: IPR length of stay was 31 days. Functional Independence Measure (FIM) total score increased from 52/133 at admissions to 106/133 at discharge. Spinal Cord Independence Measure - III (SCIM-III) total score increased from 31/100 to 55/100. Functional Assessment of Chronic Illness Therapy-Fatigue Subscale score increased from 21/52 to 41/52 reflecting reduced fatigue level compared to admission. These gains facilitated discharge home with family support.Conclusion: Physical therapy plan of care required consideration of dual diagnosis, cancer-related fatigue, and patient-centered goals. Participation in IPR positively affected quality of life and ability to return home with family.
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Affiliation(s)
- Amanda Kelch
- Vortex Physical Therapy and Balance, San Jose, CA, USA
| | - Cathy Harro
- Grand Valley State University, College of Health Professions, Department ofPhysical Therapy, Cook-DeVos Center for Health Sciences, Grand Rapids MI, USA.,Neurological Physical Therapy Residency Program, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
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Zhu F, Liu Y, Zeng L, Wang Y, Kong X, Yao S, Chen K, Jing X, Yang L, Guo X. Evaluating the Severity and Prognosis of Acute Traumatic Cervical Spinal Cord Injury: A Novel Classification Using Diffusion Tensor Imaging and Diffusion Tensor Tractography. Spine (Phila Pa 1976) 2021; 46:687-694. [PMID: 33395024 DOI: 10.1097/brs.0000000000003923] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational cohort study. OBJECTIVE We explored the relationship between diffusion tensor imaging (DTI) parameters and prognosis in patients with acute traumatic cervical spinal cord injury (ATCSCI). SUMMARY OF BACKGROUND DATA DTI has been used to diagnose spinal cord injury; nevertheless, its role remains controversial. METHODS We analyzed retrospectively 24 patients with ATCSCI who were examined using conventional T2-weighted imaging and DTI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were recorded at the injured site. Diffusion tensor tractography (DTT) was used to measure the spinal cord white matter fiber volume (MWFV). American Spinal Injury Association (ASIA) grades were recorded. Correlations between DTI parameters and ASIA scores were evaluated using Spearman correlation coefficients. RESULTS FA values at injured sites were significantly lower than those of the control group, whereas ADC values in injured and control groups were not significantly different. DTT revealed that ATCSCI could be divided into four types: Type A1-complete rupture of spinal cord white matter fiber (MWF); Type A2-partial rupture of MWF; Type B-most MWF retained with severe compression or abnormal fiber conduction direction; and Type C-MWF basically complete with slight compression. Preoperative physical examinations revealed complete injury (ASIA A) in patients with A1 (n = 4) and A2 (n = 4). The ASIA grades or scores of A2 were improved to varying degrees, whereas there was no significant improvement in A1. FA values and MWFV of ASIA B, C, and D were significantly higher than those of ASIA A. FA and MWFV were correlated with ASIA motor score preoperatively and at final follow-up. CONCLUSION We propose a classification for the severity of ATCSCI based on DTI and DTT that may explain why some patients with ASIA A recover, whereas others do not.Level of Evidence: 4.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Liu
- Department of Radiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lian Zeng
- Department of Orthopedics, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yulong Wang
- Department of Orthopedics, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Yao
- Department of Orthopedics, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaifang Chen
- Department of Orthopedics, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xirui Jing
- Department of Orthopedics, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lian Yang
- Department of Radiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaodong Guo
- Department of Orthopedics, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Clinical Benefit of Rehabilitation Training in Spinal Cord Injury: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2021; 46:E398-E410. [PMID: 33620185 DOI: 10.1097/brs.0000000000003789] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE This study was performed to evaluate the effects of different rehabilitation interventions in spinal cord injury. SUMMARY OF BACKGROUND DATA Several activity-based interventions have been widely applied in spinal cord injury in the past, but the effects of these rehabilitation exercises are controversial. METHODS Publications were searched from databases (PubMed, Embase, Cochrane, the database of the U.S. National Institutes of Health and World Health Organization International Clinical Trials Registry Platform) using the searching terms like spinal cord injury, transcranial magnetic stimulation, functional electrical stimulation, activity-based therapy, and robotic-assisted locomotor training. Randomized controlled trials and controlled trials were included. The primary outcomes included functional upper/lower extremity independence, walking capacity, spasticity, and life quality of individuals with spinal cord injury. Meta-analysis was performed using Revman 5.0 software. RESULTS Thirty-one articles were included. Meta-analysis showed that transcranial magnetic stimulation improved walking speed (95% confidence interval [CI] 0.01, 0.16) and lower extremity function (95% CI 1.55, 7.27); functional electrical stimulation significantly increased upper extremity independence (95% CI 0.37, 5.48). Robotic-assisted treadmill training improved lower extremity function (95% CI 3.44, 6.56) compared with related controls. CONCLUSION Activity-based intervention like transcranial magnetic stimulation, functional electrical stimulation, and robotic-assisted treadmill training are effective in improving function in individuals with spinal cord injury.Level of Evidence: 1.
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Sobreira M, Almeida MP, Gomes A, Lucas M, Oliveira A, Marques A. Minimal Clinically Important Differences for Measures of Pain, Lung Function, Fatigue, and Functionality in Spinal Cord Injury. Phys Ther 2021; 101:6039321. [PMID: 33336700 DOI: 10.1093/ptj/pzaa210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/26/2020] [Accepted: 10/29/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to determine the minimal clinically important differences (MCIDs) for the numerical pain rating scale (NPRS), peak cough flow (PCF), peak expiratory flow (PEF), fatigue severity scale (FSS), and London chest activities of daily living scale (LCADL) in patients with spinal cord injuries (SCIs) after rehabilitation. METHODS Inpatients with SCI from 2 rehabilitation centers participating in a daily rehabilitation program were recruited. The NPRS, PCF, PEF, FSS, and LCADL were collected at baseline and discharge. The global rating of change scale was performed at discharge. MCIDs were calculated using anchor (linear regression, mean change, and receiver operating characteristic curves) and distribution-based methods (0.5 times the baseline SD, standard error of measurement, 1.96 times standard error of measurement, and minimal detectable change) and pooled using arithmetic weighted mean. RESULTS Sixty inpatients with SCI (36 males; 54.5 [15.9] years) participated. On average their rehabilitation program lasted 7.3 (1.7) weeks. Pooled MCID estimates were 1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL. CONCLUSION Established MCIDs for NPRS, PCF, PEF, FSS, and LCADL will help health professionals to interpret results and guide rehabilitation interventions in patients with SCI. IMPACT Health professionals and researchers may now use -1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL to interpret if changes in pain, cough intensity, expiratory flow, fatigue and activities of daily living after rehabilitation of patients with SCI have been clinically relevant.
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Affiliation(s)
- Margarida Sobreira
- Medicine and Rehabilitation Centre of Alcoitão, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Miguel P Almeida
- Rehabilitation Centre of the North, Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal.,Institute of Biomedicine, Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Ana Gomes
- Rehabilitation Centre of the North, Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal
| | - Marlene Lucas
- Medicine and Rehabilitation Centre of Alcoitão, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Ana Oliveira
- Institute of Biomedicine, Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Agras do Crasto, Building 30, 3810-193, Aveiro, Portugal
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Rodríguez-Fernández A, Lobo-Prat J, Font-Llagunes JM. Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments. J Neuroeng Rehabil 2021; 18:22. [PMID: 33526065 PMCID: PMC7852187 DOI: 10.1186/s12984-021-00815-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/12/2021] [Indexed: 02/08/2023] Open
Abstract
Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.
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Affiliation(s)
- Antonio Rodríguez-Fernández
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Center for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028, Barcelona, Spain. .,Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.
| | - Joan Lobo-Prat
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Center for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,ABLE Human Motion, Diagonal 647, 08028, Barcelona, Spain.,Institut de Robòtica i Informàtica Industrial, CSIC-UPC, Llorens i Artigas 4-6, 08028, Barcelona, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Center for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,ABLE Human Motion, Diagonal 647, 08028, Barcelona, Spain
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Furlan JC. Effects on Outcomes of Hyperglycemia in the Hyperacute Stage after Acute Traumatic Spinal Cord Injury. Neurotrauma Rep 2021; 2:14-24. [PMID: 34223544 PMCID: PMC8240828 DOI: 10.1089/neur.2020.0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hyperglycemia has adverse effects on neuronal recovery after brain injury, but its effects after spinal cord injury (SCI) are understudied. This retrospective cohort study examined the potential effects on outcomes of hyperglycemia in the hyperacute stage after acute traumatic SCI. This study included all individuals enrolled in the National Acute Spinal Cord Injury Study 3 (NASCIS-3). Glycemic levels at 24 h, at 48 h, and at day 7 after acute SCI were examined as potential determinants of survival, neurological outcomes (using NASCIS motor, sensory, and pain scores), and functional outcome (using the Functional Independence Measure [FIM]) within the first year post-SCI. Hyperglycemia was defined using two thresholds (140 mg/dL and 180 mg/dL). Study subjects were 76 females and 423 males with an overall mean age of 36 years who sustained mostly cervical SCI due to motor vehicle accidents or falls. Hyperglycemia diagnosed at day 7 post-injury was associated with significantly greater mortality rates post-SCI. Among the survivors, hyperglycemia during the hyperacute stage was not significantly correlated with neurological recovery post-SCI. Hyperglycemia persistent until day 7 was significantly correlated with lower functional scores post-SCI. These results suggest that hyperglycemia at day 7 is correlated with greater mortality rates within the first year post-SCI. Although hyperglycemia during the hyperacute stage was not associated with neurological recovery, hyperglycemia at day 7 may adversely affect functional recovery within the first year post-SCI. Future investigations are needed to determine the optimal glycemic target in the management of patients with SCI.
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Affiliation(s)
- Julio C. Furlan
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Patsakos EM, Craven BC, Kua A, Cheng CL, Eng J, Ho C, Noonan VK, Querée M, Bayley MT. Evaluation of the quality of published SCI clinical practice guidelines using the AGREE II instrument: Results from Can-SCIP expert panel. J Spinal Cord Med 2021; 44:S69-S78. [PMID: 34779735 PMCID: PMC8604538 DOI: 10.1080/10790268.2021.1961053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is a complex condition with substantial adverse personal, social and economic impacts necessitating evidence-based inter-professional care. To date, limited studies have assessed the quality of clinical practice guidelines (CPGs) within SCI. The aim of this study is to evaluate the quality of the development process and methodological rigour of published SCI CPGs across the care continuum from pre-hospital to community-based care. METHODS Electronic health databases and indexes were searched to identify English or French language CPGs within SCI published within the last nine years with specific evidence-based recommendations applicable to the Canadian health care setting. Eligible CPGs were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS A total of forty-one CPGs that met the inclusion criteria were appraised by at least four raters. There was high variability in quality. Twenty-seven CPGs achieved a good rigour of development domain score of >70%. Other standardized mean domain scores were scope and purpose (85.32%), stakeholder involvement (65.03%), clarity of presentation (84.81%), applicability (55.55%) and editorial independence (75.83%). The agreement between appraisers (intraclass correlation coefficient) was high (intraclass correlation coefficient > 0.80). CONCLUSION There is a paucity of CPGs that address community-based specialized rehabilitation and community reintegration. Furthermore, many CPGs only focus on a single impairment at one time point in the care continuum. As SCI is a complex condition that results in multimorbidity and requires health monitoring and intervention across the lifespan, a rigorously developed CPG that addresses high-quality, interprofessional comprehensive care is needed.
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Affiliation(s)
- Eleni M. Patsakos
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ailene Kua
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Christiana l. Cheng
- Praxis Spinal Cord Institute, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, British Columbia, Canada
| | - Janice Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Alberta, Canada
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, British Columbia, Canada
| | - Matthew Querée
- Department of Physiotherapy, Faculty of Medicine, University of British Columbia, GF Strong Rehabilitation Centre, British Columbia, Canada
| | - Mark T. Bayley
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - the Can-SCIP Guideline Expert Panel
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Praxis Spinal Cord Institute, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Alberta, Canada
- Department of Physiotherapy, Faculty of Medicine, University of British Columbia, GF Strong Rehabilitation Centre, British Columbia, Canada
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Guo X, Feng Y, Sun T, Feng S, Tang J, Chen L, Cao X, Lin H, He X, Li M, Zhang Z, Yin G, Mei X, Huang H. Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version). JOURNAL OF NEURORESTORATOLOGY 2021. [DOI: 10.26599/jnr.2021.9040003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Treatment of spinal cord injury (SCI) remains challenging. Considering the rapid developments in neurorestorative therapies for SCI, we have revised and updated the Clinical Therapeutic Guidelines for Neurorestoration in Spinal Cord Injury (2016 Chinese version) of the Chinese Association of Neurorestoratology (Preparatory) and China Committee of International Association of Neurorestoratology. Treatment of SCI is a systematic multimodal process that aims to improve survival and restore neurological function. These guidelines cover real-world comprehensive neurorestorative management of acute, subacute, and chronic SCI and include assessment and diagnosis, pre-hospital first aid, treatment, rehabilitation, and complication management.
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Wang YL, Zhu FZ, Zeng L, Telemacque D, Saleem Alshorman JA, Zhou JG, Xiong ZK, Sun TF, Qu YZ, Yao S, Sun TS, Feng SQ, Guo XD. Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19. Chin J Traumatol 2020; 23:196-201. [PMID: 32674856 PMCID: PMC7298513 DOI: 10.1016/j.cjtee.2020.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 02/04/2023] Open
Abstract
Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.
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Affiliation(s)
- Yu-Long Wang
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Feng-Zhao Zhu
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lian Zeng
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Dionne Telemacque
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jamal Ahmad Saleem Alshorman
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jin-Ge Zhou
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ze-Kang Xiong
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ting-Fang Sun
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yan-Zhen Qu
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Sheng Yao
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Tian-Sheng Sun
- Department of Orthopedics, The Seventh Medical Center of People's Liberation Army, Army General Hospital, Beijing 100700, China
| | - Shi-Qing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - Xiao-Dong Guo
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Group of Spinal Injury and Functional Reconstruction, Neural Regeneration and Repair Committee, Chinese Research Hospital Association
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Orthopedics, The Seventh Medical Center of People's Liberation Army, Army General Hospital, Beijing 100700, China
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - Spinal Cord Basic Research Group, Spinal Cord Committee of Chinese Society of Rehabilitation Medicine
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Orthopedics, The Seventh Medical Center of People's Liberation Army, Army General Hospital, Beijing 100700, China
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - Spinal Cord Injury and Rehabilitation Group, Chinese Association Of Rehabilitation Medicine
- Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Orthopedics, The Seventh Medical Center of People's Liberation Army, Army General Hospital, Beijing 100700, China
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
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Dionne TP, Lenker JA, Hennessy P, Sullivan JE. Use of Electrical Stimulation for People With Spinal Cord Injury: A Survey of Occupational Therapy Practitioners. Am J Occup Ther 2020; 74:7403205110p1-7403205110p7. [PMID: 32365317 DOI: 10.5014/ajot.2020.035584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE When working with clients who have experienced spinal cord injury (SCI), occupational therapy practitioners can face challenges in achieving desired results during functional activity when using electrical stimulation (ES) interventions. In an effort to understand current practice, a survey study was conducted. OBJECTIVE For people with SCI, ES elicits positive physiological effects; however, no implementation guidelines exist for upper extremity application of ES for this population. Therefore, we surveyed occupational therapy practitioners about their use of ES with clients who have cervical-level SCI. DESIGN A 33-item, 20-min online survey was used. PARTICIPANTS AND SETTING We queried 57 occupational therapy practitioners with active caseloads in regional rehabilitation centers specializing in SCI, both outpatient and inpatient. RESULTS For clients with SCI, occupational therapy practitioners used ES most often for grasp-and-release, reaching, and grip or pinch activities using a broad range of parameter settings. Among respondents, 43% did not use a specific treatment protocol; 27% used research evidence to guide selection of parameters. CONCLUSIONS AND RELEVANCE Findings suggest that ES treatment parameters are not uniformly applied, introducing potential unknown effects on client outcomes and undermining treatment fidelity. WHAT THIS ARTICLE ADDS Our survey of occupational therapy practitioners regarding their practice and use of ES interventions with this population revealed variation in application of ES treatment parameters. Understanding different treatment approaches and justification used when applying ES to clients with SCI is an important first step in unifying and promoting best practice and maximizing patient outcomes.
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Affiliation(s)
- Timothy P Dionne
- Timothy P. Dionne, PhD, OTR/L, is Assistant Professor, Occupational Therapy Graduate Program, School of Medicine, The University of New Mexico, Albuquerque;
| | - James A Lenker
- James A. Lenker, PhD, OTR/L, FAOTA, is Associate Professor, Department of Rehabilitation Science, University at Buffalo, Buffalo, NY
| | - Patrick Hennessy
- Patrick Hennessy, PT, MPT, NCS, is Clinical Knowledge Broker, Infinity Rehab, Wilsonville, OR
| | - Jane E Sullivan
- Jane E. Sullivan, PT, DHS, MS, is Professor, Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago
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Mateo S, Di Marco J, Cucherat M, Gueyffier F, Rode G. Inconclusive efficacy of intervention on upper-limb function after tetraplegia: A systematic review and meta-analysis. Ann Phys Rehabil Med 2020; 63:230-240. [DOI: 10.1016/j.rehab.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/21/2019] [Accepted: 05/06/2019] [Indexed: 01/01/2023]
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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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Shanmuganathan K, Zhuo J, Bodanapally UK, Kuladeep S, Aarabi B, Adams J, Miller C, Gullapallie RP, Menakar J. Comparison of Acute Diffusion Tensor Imaging and Conventional Magnetic Resonance Parameters in Predicting Long-Term Outcome after Blunt Cervical Spinal Cord Injury. J Neurotrauma 2020; 37:458-465. [DOI: 10.1089/neu.2019.6394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | - Jiachen Zhuo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Uttam K. Bodanapally
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sudini Kuladeep
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jason Adams
- Department of Rehabilitation Services, University of Maryland School of Medicine, Baltimore, Maryland
| | - Catriona Miller
- Aeromedical Research Department, U.S. Air Force School of Aerospace Medicine, Center for the Sustainment of Trauma and Readiness Skills, Baltimore, Maryland
| | - Rao P. Gullapallie
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jay Menakar
- R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
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Jiang F, Wilson JRF, Badhiwala JH, Santaguida C, Weber MH, Wilson JR, Fehlings MG. Quality and Safety Improvement in Spine Surgery. Global Spine J 2020; 10:17S-28S. [PMID: 31934516 PMCID: PMC6947676 DOI: 10.1177/2192568219839699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Review article. OBJECTIVES A narrative review of the literature on the current advances and limitations in quality and safety improvement initiatives in spine surgery. METHODS A comprehensive literature search was performed using Ovid MEDLINE focusing on 3 preidentified concepts: (1) quality and safety improvement, (2) reporting of outcomes and adverse events, and (3) prediction model and practice guidelines. The search was conducted under appropriate subject headings and using relevant text words. Articles were screened, and manuscripts relevant to this discussion were included in the narrative review. RESULTS Quality and safety improvement remains a major research focus attracting investigators from the global spine community. Multiple databases and registries have been developed for the purpose of generating data and monitoring the progress of quality and safety improvement initiatives. The development of various prediction models and clinical practice guidelines has helped shape the care of spine patients in the modern era. With the reported success of exemplary programs initiated by the Northwestern and Seattle Spine Team, other quality and safety improvement initiatives are anticipated to follow. However, despite these advancements, the reporting metrics for outcomes and adverse events remain heterogeneous in the literature. CONCLUSION Constant surveillance and continuous improvement of the quality and safety of spine treatments is imperative in modern health care. Although great advancement has been made, issues with reporting outcomes and adverse events persist, and improvement in this regard is certainly needed.
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Affiliation(s)
- Fan Jiang
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | - Jamie R. F. Wilson
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | - Jetan H. Badhiwala
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,St Michael’s Hospital, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T2S8, Canada.
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Afshari FT, Choi D, Russo A. Controversies regarding mobilisation and rehabilitation following acute spinal cord injury. Br J Neurosurg 2019; 34:123-126. [DOI: 10.1080/02688697.2019.1708268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Fardad T. Afshari
- Department of Neurosurgery, Birmingham University Hospital, Birmingham, UK
| | - David Choi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation, London, UK
| | - Antonino Russo
- Department of Neurosurgery, Birmingham University Hospital, Birmingham, UK
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Badhiwala JH, Ahuja CS, Fehlings MG. Time is spine: a review of translational advances in spinal cord injury. J Neurosurg Spine 2019; 30:1-18. [PMID: 30611186 DOI: 10.3171/2018.9.spine18682] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/28/2018] [Indexed: 11/06/2022]
Abstract
Acute traumatic spinal cord injury (SCI) is a devastating event with far-reaching physical, emotional, and economic consequences for patients, families, and society at large. Timely delivery of specialized care has reduced mortality; however, long-term neurological recovery continues to be limited. In recent years, a number of exciting neuroprotective and regenerative strategies have emerged and have come under active investigation in clinical trials, and several more are coming down the translational pipeline. Among ongoing trials are RISCIS (riluzole), INSPIRE (Neuro-Spinal Scaffold), MASC (minocycline), and SPRING (VX-210). Microstructural MRI techniques have improved our ability to image the injured spinal cord at high resolution. This innovation, combined with serum and cerebrospinal fluid (CSF) analysis, holds the promise of providing a quantitative biomarker readout of spinal cord neural tissue injury, which may improve prognostication and facilitate stratification of patients for enrollment into clinical trials. Given evidence of the effectiveness of early surgical decompression and growing recognition of the concept that "time is spine," infrastructural changes at a systems level are being implemented in many regions around the world to provide a streamlined process for transfer of patients with acute SCI to a specialized unit. With the continued aging of the population, central cord syndrome is soon expected to become the most common form of acute traumatic SCI; characterization of the pathophysiology, natural history, and optimal treatment of these injuries is hence a key public health priority. Collaborative international efforts have led to the development of clinical practice guidelines for traumatic SCI based on robust evaluation of current evidence. The current article provides an in-depth review of progress in SCI, covering the above areas.
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Affiliation(s)
- Jetan H Badhiwala
- 1Division of Neurosurgery, Department of Surgery, and.,2Institute of Medical Science, University of Toronto; and
| | - Christopher S Ahuja
- 1Division of Neurosurgery, Department of Surgery, and.,2Institute of Medical Science, University of Toronto; and.,3Department of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael G Fehlings
- 1Division of Neurosurgery, Department of Surgery, and.,2Institute of Medical Science, University of Toronto; and.,3Department of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Ko CC, Tu TH, Chen YT, Wu JC, Huang WC, Cheng H. Monkey Recovery from Spinal Cord Hemisection: Nerve Repair Strategies for Rhesus Macaques. World Neurosurg 2019; 129:e343-e351. [PMID: 31132502 DOI: 10.1016/j.wneu.2019.05.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Repair of spinal cord injury (SCI) using peripheral nerve graft (PNG) and acidic fibroblast growth factor (aFGF) has shown promising results in rats and a few human patients, but not in nonhuman primates. The aim of this study was to verify the effective use of PNG and aFGF for repairing incomplete SCI in nonhuman primates. METHODS Six adult rhesus macaques received spinal cord hemisection at T8 level and were grouped into repair and control groups (n = 3 in each). Animals in the repair group underwent nerve repair with autologous PNG plus aFGF immediately after lesioning. The control group received exactly the same operation for lesioning but no treatment. Postoperative behavioral evaluations, electrophysiologic tests (including motor and somatosensory evoked potentials), and magnetic resonance imaging were performed and compared between the 2 groups as well as histologic examination of the spinal cord cephalic to, at, and caudal to the lesion site after sacrifice. RESULTS Animals in the repair group had better motor function in the lower limbs at every observed time point and demonstrated more improvement on electrophysiologic examinations than the control group. The repair group had smaller areas of myelomalacia on magnetic resonance imaging around the lesion compared with the control group, suggesting diminished inflammatory responses with the repair strategy. CONCLUSIONS PNG plus aFGF for SCI in nonhuman primates yielded improvements in clinical behavior, electrophysiologic tests, and magnetic resonance imaging. This study suggests that the repair strategy is feasible and effective for nonhuman primate SCI. Further investigations are warranted to corroborate its effectiveness for clinical application.
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Affiliation(s)
- Chin-Chu Ko
- Jhong Jheng Spine & Orthopedic Hospital, Kaohsiung, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsung-Hsi Tu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, Taiwan
| | - Ya-Tzu Chen
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Wen-Cheng Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Henrich Cheng
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Tetreault L, Nater A, Garwood P, Badhiwala JH, Wilson JR, Fehlings MG. Development and Implementation of Clinical Practice Guidelines: An Update and Synthesis of the Literature With a Focus in Application to Spinal Conditions. Global Spine J 2019; 9:53S-64S. [PMID: 31157146 PMCID: PMC6512193 DOI: 10.1177/2192568219831689] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Review. OBJECTIVES The objectives of this review are to (a) summarize the role of clinical practice guidelines (CPGs), (b) outline the methodology involved in formulating CPGs, (c) provide an illustration of these principles using a CPG developed for degenerative cervical myelopathy, and (d) highlight the importance of knowledge translation. METHODS A review of the literature was conducted to summarize current standards in CPG development and implementation. RESULTS CPGs are systematically developed statements intended to affect decisions made by health care providers, policy makers, and patients. The main objectives of CPGs are to synthesize and translate evidence into recommendations, optimize patient outcomes, standardize care, and facilitate shared decision making among physicians, patients, and their caregivers. The main steps involved in the development of CPGs include defining the clinical problem, assembling a multidisciplinary guideline development group and systematic review team, conducting a systematic review of the literature, translating the evidence to recommendations, critically appraising the CPG and updating the document when new studies arise. The final step in developing a CPG is to implement it into clinical practice; this step requires an assessment of the barriers to implementation and the formulation of effective dissemination strategies. CONCLUSION CPGs are an important component in the teaching and practice of medicine and are available for a wide spectrum of diseases. CPGs, however, can only be used to influence clinical practice if the recommendations are informed by a systematic review of the literature and developed using rigorous methodology. The opportunity to transform clinical management of spinal conditions is an attractive outcome of the application of high-quality CPGs.
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Affiliation(s)
- Lindsay Tetreault
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University College Cork, Cork, Ireland
| | - Anick Nater
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Jetan H. Badhiwala
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Michael G. Fehlings
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Samartzis D, Germscheid NM, Fehlings MG, Fisher CG, de Kleuver M, Öner FC, Yoon ST, Vialle LR. AOSpine Knowledge Forums: Research in Motion. Global Spine J 2019; 9:5S-7S. [PMID: 31157147 PMCID: PMC6512198 DOI: 10.1177/2192568219845647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Luiz R. Vialle
- Pontificia Universidade Catolica do Paraná, Curitiba, Brazil
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Jagadevan M, Mohanakrishnan B, Murugesan S, Sharma D, Agarwal NK, Fletcher J, Balasubramanian V. Progression to ambulation following lower limb fractures in an individual with a spinal cord injury: a case report. Spinal Cord Ser Cases 2019; 5:26. [PMID: 31240121 PMCID: PMC6461996 DOI: 10.1038/s41394-019-0171-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction Patients with spinal cord injury (SCI) and concomitant lower limb fractures are a challenge to rehabilitate. Conventionally, postural orientation is an important milestone in the rehabilitative process. We propose an alternative strategy in achieving goals in individuals with an SCI with concomitant injuries that preclude weight bearing below the knee. Case presentation A 16-year-old girl sustained a burst fracture of L1 in conjunction with bilateral ankle fractures. During rehabilitation, the calcaneal fracture on the left and tibial plafond fracture on the right prevented her progression in conventional rehabilitation. An alternative strategy "K-ing" (Kneel Standing/Kneel Walking) was adopted to facilitate truncal activation without loading the ankle joints. This was found to be helpful in obtaining upright posture stability without hampering her recovery of associated ankle injuries. Discussion "K-ing" strategy can be useful and presents a simple alternative in the presence of associated ankle injuries. It also avoids complications associated with bedrest when there is delay in initiation of ambulation.
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Affiliation(s)
- Mohanakrishnan Jagadevan
- Department of Ortho Surgery, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Bhanumathy Mohanakrishnan
- Department of Ortho Surgery, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Salaja Murugesan
- Department of Ortho Surgery, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Deep Sharma
- Department of Ortho Surgery, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Navin Kumar Agarwal
- Department of Physical Medicine and Rehabilitation, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jebaraj Fletcher
- Department of Physical Medicine and Rehabilitation, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vengatesan Balasubramanian
- Department of Physical Medicine and Rehabilitation, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
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Spotlight on Neurotrauma Research in Canada's Leading Academic Centers. J Neurotrauma 2018; 35:1986-2004. [PMID: 30074875 DOI: 10.1089/neu.2018.29017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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