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Taman M, Abdulrazeq H, Chuck C, Sastry RA, Ali R, Chen CC, Malik AN, Sullivan PLZ, Oyelese A, Gokaslan ZL, Fridley JS. Vasopressor Use in Acute Spinal Cord Injury: Current Evidence and Clinical Implications. J Clin Med 2025; 14:902. [PMID: 39941573 PMCID: PMC11818478 DOI: 10.3390/jcm14030902] [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: 11/07/2024] [Revised: 01/23/2025] [Accepted: 01/28/2025] [Indexed: 02/16/2025] Open
Abstract
Acute spinal cord injury (SCI) often results in severe neurologic deficits, with hemodynamic instability contributing to secondary ischemic damage. Beyond surgical decompression, maintaining adequate mean arterial pressure (MAP) is key to enhancing spinal cord perfusion and oxygenation. Vasopressor therapy is frequently used to achieve hemodynamic stability, but optimal MAP targets and vasopressor selection remain controversial. This review explores updated guidelines and current evidence regarding MAP management and the use of vasopressors in SCI, focusing on their impact on spinal cord perfusion and neurologic outcomes. Recent studies highlight the role of durotomy in directly improving spinal cord perfusion pressure (SCPP) by reducing intraspinal pressure (ISP), offering a complementary mechanical intervention as part of pharmacologic therapies. Recent guidelines suggest an MAP range of 75-80 mmHg as a lower limit and 90-95 mmHg as an upper limit for 3-7 days post-injury, highlighting the need for personalized hemodynamic management. Norepinephrine is commonly preferred due to its balanced effects on peripheral vascular resistance and spinal cord perfusion pressure (SCPP), though dopamine, phenylephrine, and dobutamine each offer unique hemodynamic profiles suited to specific clinical scenarios. Despite their benefits, vasopressors carry significant risks, including arrhythmias and potential myocardial strain, necessitating careful selection based on individual patient factors. Further research is needed to refine vasopressor use and establish evidence-based protocols that optimize neurologic recovery, alongside continued exploration of SCPP as a potential therapeutic target.
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Affiliation(s)
- Mazen Taman
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Amiri M, Alavinia M, Farahani F, Khasiyeva N, Burley M, Kangatharan S, Craven BC. Urban-Rural Disparities in Community Participation after Spinal Cord Injury in Ontario. Healthcare (Basel) 2024; 12:2089. [PMID: 39451503 PMCID: PMC11507304 DOI: 10.3390/healthcare12202089] [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: 08/31/2024] [Revised: 10/05/2024] [Accepted: 10/08/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Personal, social, and environmental factors may influence self-efficacy and social reintegration among people living with spinal cord injury or disease (SCI/D) in urban and rural areas. Novel data collection methods have the potential to characterize community participation (CP) in diverse settings. OBJECTIVES The objectives were (1) to describe and compare self-reported community participation (Reintegration to Normal Living Index (RNLI) and Moorong Self-Efficacy Scale (MSES)) levels of individuals with SCI/D living in urban or rural Ontario, Canada; and (2) to determine the accuracy of an artificial intelligence (AI) optical mark recognition tool for extracting data from CP surveys conducted among participants after transitioning from inpatient rehabilitation to home and residing in the community. METHODS We partnered with SCI Ontario staff to collect MSES and RNLI survey data from adults with motor complete (e.g., AIS A-B) and incomplete (AIS C-D) SCI/D living in urban or rural Ontario, Canada, between January and October 2022. The Rurality Index of Ontario (RIO) from the postal code determined urban or rural residency. Optical mark recognition (OMR) software was used for survey data extraction. A Research Associate validated the extracted survey responses. Descriptive statistics, correlation analysis, and non-parametric statistics were used to describe the participants, their impairments, and their reported CP levels across urban and rural settings. RESULTS Eighty-five individuals with SCI/D (mean age 53.7 years, 36.5% female) completed the survey. Most of the participants resided in major urban areas (69.4%) and had traumatic injuries (64.7%). The mean total MSES score for Ontarians with SCI/D was 87.96 (95% confidence interval [CI]: 84.45, 91.47), while the mean total RNLI score for the same individuals was 75.61 (95% CI: 71.85, 79.37). Among the MSES domains, the lowest score was observed in response to sexual satisfaction (mean: 4.012, 95% CI: 3.527, 4.497), while the lowest RNLI domain item score was associated with the ability to travel out of town (mean: 5.965, 95% CI: 5.252, 6.678). Individuals with incomplete injuries in rural areas reported lower MSES and RNLI scores than those with complete motor injuries, whereas no significant differences were found in MSES and RNLI scores among urban residents based on impairment. These findings suggest that, depending on the environmental context (e.g., rural vs. urban areas), AIS categories may influence the perception of CP among people living with SCI/D. The OMR tool had 97.4% accuracy in extracting data from the surveys. CONCLUSIONS The CP (MSES and RNLI) scores reported by individuals with SCI/D differ based on their living setting. In rural Ontario, individuals with greater functional ability reported lower CP than their counterparts living in urban settings. Although CP remains a challenge, the needs of individuals with motor incomplete SCI/D and heterogeneous levels of mobility residing in rural areas require exploration and targeted interventions. The OMR tool facilitates accurate data extraction from surveys across settings.
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Affiliation(s)
- Mohammadreza Amiri
- Centre for the Business and Economics of Health, The University of Queensland, St. Lucia, QLD 4072, Australia;
- KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada; (M.A.); (F.F.); (S.K.)
| | - Mohammad Alavinia
- KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada; (M.A.); (F.F.); (S.K.)
| | - Farnoosh Farahani
- KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada; (M.A.); (F.F.); (S.K.)
| | - Natavan Khasiyeva
- Spinal Cord Injury Ontario, Toronto, ON M4G 3V9, Canada; (N.K.); (M.B.)
| | - Meredith Burley
- Spinal Cord Injury Ontario, Toronto, ON M4G 3V9, Canada; (N.K.); (M.B.)
| | - Suban Kangatharan
- KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada; (M.A.); (F.F.); (S.K.)
| | - Beverley Catharine Craven
- KITE Research Institute, University Health Network, Toronto, ON M5G 2A2, Canada; (M.A.); (F.F.); (S.K.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON M5S 1B2, Canada
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Maoneo I, Beltchika A, Ketani T, Kasereka L, Akilimali P, Ntsambi G. Traumatic and Non-traumatic Radiculomedullary Compressions: A Comparative Analysis. Cureus 2024; 16:e71352. [PMID: 39478772 PMCID: PMC11522942 DOI: 10.7759/cureus.71352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2024] [Indexed: 11/02/2024] Open
Abstract
Background Radiculomedullary lesions represent a significant public health issue, with their epidemiological, clinical, and therapeutic characteristics varying depending on whether they are of traumatic or non-traumatic origin. The aim of this study was to compare clinical, therapeutic, and postoperative aspects between traumatic radiculomedullary lesions (TRML) and non-traumatic radiculomedullary lesions (NTRML). Methods This was a prospective cohort study conducted from 2020 to 2023 involving patients suffering from radiculomedullary lesions operated at the Department of Neurosurgery, University Teaching Hospital of Kinshasa. In addition to socio-demographic characteristics, the two patient groups - traumatic and non-traumatic - were compared based on clinical, therapeutic, and postoperative aspects using the American Spinal Injury Association (ASIA) and Spinal Cord Independence Measures (SCIM III) scores. Results We included 153 patients, with 73 traumatic cases (47.7%) and 80 non-traumatic cases (52.3%). TRMLs were predominantly caused by road traffic accidents (34%) and falls (11%), while NTRMLs were mainly due to disc herniations (22.2%) and tuberculosis (13.7%). The mean age for TRMLs was 35.4 ±12.8 years with a sex ratio of 3.5, compared to 50.7±15.9 years and a sex ratio of 1.1 for NTRMLs. TRMLs were more frequently located in the cervical region (32.8%) and the thoracolumbar junction (40%), whereas NTRMLs predominantly affected the thoracic (22.5%) and lumbar (63.7%) regions. Patients with NTRMLs had more incomplete lesions (98.7%) and better SCIM III scores at admission compared to TRMLs (p ˂ 0.001). TRMLs had more complete deficits 42 (57.3%) vs 1 (1.3%). Both groups significantly improved their ASIA and SCIM III scores postoperatively (p ˂ 0.001) but in a similar manner (Diff-in-diff: ASIA, p=0.955; SCIM, p=0.967). TRMLs developed more complications than NTRMLs (p˂0,001). Only five patients (11.6%) with ASIA A progressed to higher grades, and all remained dependent (SCIM III score ˂50). The average hospital stay was 89.2 ±74.2 days for TRMLs and 57.5±52.9 days for NTRMLs (p˂0.001). Conclusion This study revealed that TRMLs frequently affect young male individuals and are often located in the cervical region and thoracolumbar junction. In contrast, NTRMLs affect older individuals without gender preference and are usually found in the thoracic and lumbar regions. TRMLs often lead to complete deficits, pressure sores, urinary infections, and longer hospital stays compared to NTRMLs. Both patient groups showed significant postoperative improvement with no significant difference between them. However, patients with complete deficits showed less improvement in both groups.
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Affiliation(s)
- Israël Maoneo
- Neurosurgery, University of Kisangani, Kisangani, COD
| | | | - Teddy Ketani
- Neurosurgery, University of Kinshasa, Kinshasa, COD
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Alito A, Filardi V, Famà F, Bruschetta D, Ruggeri C, Basile G, Stancanelli L, D'Amico C, Bianconi S, Tisano A. Traumatic and non-traumatic spinal cord injury: Demographic characteristics, neurological and functional outcomes. A 7-year single centre experience. J Orthop 2021; 28:62-66. [PMID: 34880567 PMCID: PMC8627899 DOI: 10.1016/j.jor.2021.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/03/2021] [Accepted: 11/17/2021] [Indexed: 01/10/2023] Open
Abstract
Objective The aim of this study is to evaluate demographic and clinical characteristics of a population affected by traumatic and non-traumatic spinal cord injury (SCI) and to analyze functional outcomes after rehabilitation. Methods This study involved 112 SCI patients (75 male and 37 female) admitted at the Neurorehabilitation Unit of the University Hospital of Messina. The neurological outcomes were evaluated according to the American Spinal Injury Association Impairment Scale (AIS) and by using length of stay, Functional Independence Measure (FIM) and Barthel Index (BI). Results NT-SCI patients were significantly older, numerous (75,89%) and affected by greater lesions when admitted, than T-SCI ones. Most of lesions were incomplete (93%) and associated with paraplegia (71%). FIM and BI outcomes are similar in both groups, even if T-SCI patients showed greater improvement when discharged. No significant differences were found in the length of stay. The most common complication in non-traumatic SCI group was urinary tract infection and this was observed in 25 patients (29,41%). Linear regression models explained 26% of the variance of LOS and 38% of the variance of functional outcome. Functional status on admission was the strongest determinant of LOS and completeness of the lesion was the strongest determinant of functional outcome. Etiology (traumatic versus non-traumatic) was a weak independent determinant of LOS but was not an independent determinant of functional outcome. Conclusion SCI patient's rehabilitation should be carried out by taking into account etiology of the injury. It is important to consider this information while developing the targets and planning of the rehabilitation program. In particular, older age negatively influence the degree of disability on admission and the entity of functional recovery in both populations. Non-traumatic lesions could have minor benefits after rehabilitation therapy if compared with traumatic ones.
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Affiliation(s)
- A. Alito
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - V. Filardi
- D.A. Research and Internationalization, University of Messina, Via Consolato Del Mare 41, 98121, Messina, Italy,Corresponding author.
| | - F. Famà
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
| | - D. Bruschetta
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
| | - C. Ruggeri
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - G. Basile
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
| | - L. Stancanelli
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - C. D'Amico
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - S. Bianconi
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - A. Tisano
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
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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: 0.6] [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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Sturt R, Hill B, Holland A, New PW, Bevans C. Validation of a clinical prediction rule for ambulation outcome after non-traumatic spinal cord injury. Spinal Cord 2019; 58:609-615. [DOI: 10.1038/s41393-019-0386-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/20/2019] [Accepted: 11/03/2019] [Indexed: 11/09/2022]
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Gupta A, Kumar SN, Taly AB. Urodynamic profile in acute transverse myelitis patients: Its correlation with neurological outcome. J Neurosci Rural Pract 2019; 8:44-48. [PMID: 28149080 PMCID: PMC5225720 DOI: 10.4103/0976-3147.193547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: The objective of this study was to observe urodynamic profile of acute transverse myelitis (ATM) patients and its correlation with neurological outcome. Patients and Methods: This prospective study was conducted in the neurorehabilitation unit of a tertiary university research hospital from July 2012 to June 2014. Forty-three patients (19 men) with ATM with bladder dysfunction, admitted in the rehabilitation unit, were included in this study. Urodynamic study (UDS) was performed in all the patients. Their neurological status was assessed using ASIA impairment scale and functional status was assessed using spinal cord independence measure. Bladder management was based on UDS findings. Results: In total, 17 patients had tetraplegia and 26 had paraplegia. Thirty-six patients (83.7%) had complaints of increased frequency and urgency of urine with 26 patients reported at least one episode of urge incontinence. Seven patients reported obstructive urinary complaints in the form of straining to void with 13 patients reported both urgency and straining to void and 3 also had stress incontinence. Thirty-seven (86.1%) patients had neurogenic overactive detrusor with or without sphincter dyssynergia and five patients had acontractile detrusor on UDS. No definitive pattern was observed between neurological status and bladder characteristics. All patients showed significant neurological and functional recovery with inpatient rehabilitation (P < 0.05 and P < 0.001, respectively). Conclusions: The problem of neurogenic bladder dysfunction is integral to ATM. Bladder management in these patients should be based on UDS findings. Bladder characteristics have no definitive pattern consistent with the neurological status.
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Affiliation(s)
- Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sushruth Nagesh Kumar
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arun B Taly
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India; Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Gupta S, Jaiswal A, Norman K, DePaul V. Heterogeneity and Its Impact on Rehabilitation Outcomes and Interventions for Community Reintegration in People With Spinal Cord Injuries: An Integrative Review. Top Spinal Cord Inj Rehabil 2019; 25:164-185. [PMID: 31068748 DOI: 10.1310/sci2502-164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Various injury characteristics such as cause, level, severity, and time since injury divide individuals with spinal cord injury (SCI) into many subgroups. The heterogeneity among individuals' injuries and personal characteristics has significant implications for SCI rehabilitation practice, specifically directed toward community reintegration, which is a key goal of rehabilitation interventions for people with disabilities. Purpose: This study aims to summarize the evidence on attributes that make the SCI population heterogeneous, the impact of these attributes on community reintegration, and the implications of heterogeneity for rehabilitation interventions directed toward optimizing community reintegration. Methods: We used an integrative review approach to conduct this study. MEDLINE, PubMed, CINAHL, EMBASE, Google Scholar, and PsycINFO were searched from inception until May 2017. Out of 670 articles retrieved, 49 provided evidence on the impact of various attributes that make SCI heterogeneous on rehabilitation outcomes related to community reintegration. Results: An array of injury-related, personal, social, and environmental factors are associated with various rehabilitation outcomes that affect community reintegration of people with SCI. There is level 1 evidence that social support, self-efficacy, and self-esteem facilitate community reintegration among people with SCI while there is level 5 evidence that presence of psychological or medical complications decreases it. There is lack of clarity on the impact of injury-related factors on community reintegration. Conclusion: This integrative review found that social support and individuals' self-efficacy can improve community reintegration of people with SCI. However, evidence regarding the impact of injury characteristics on community reintegration is still underdeveloped. Approaches directed at community reintegration should involve components of psychosocial, physical, and vocational rehabilitation while considering personal and societal aspects of an individual's life.
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Affiliation(s)
- Shikha Gupta
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Atul Jaiswal
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Kathleen Norman
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Pattanakuhar S, Kammuang-Lue P, Kovindha A, Komaratat N, Mahachai R, Chotiyarnwong C. Is admission to an SCI specialized rehabilitation facility associated with better functional outcomes? Analysis of data from the Thai Spinal Cord Injury Registry. Spinal Cord 2019; 57:684-691. [PMID: 30842632 DOI: 10.1038/s41393-019-0267-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective cohort study of the Thai Spinal Cord Injury Registry. OBJECTIVE To determine whether being admitted to a spinal cord injury (SCI) specialized rehabilitation facility (SSRF) is associated with better functional outcomes. SETTING Four rehabilitation facilities in Thailand; one a SSRF and the others non-SSRFs. METHODS Data from the one SSRF and three non-SSRFs were extracted from the Thai Spinal Cord Injury Registry. Multivariate regression analysis was used to exclude the effect of confounding factors and prove the independent association of SSRF admission with respect to Spinal Cord Independence Measurement (SCIM) at discharge. RESULTS Among the 234 new SCI inpatients enrolled, 167 persons (71%) had been admitted to the SSRF. The SSRF had a greater proportion of persons with AIS A, B, C tetraplegia and people with AIS D, whereas the non-SSRFs had a higher proportion of patients with AIS A, B or C paraplegia. Patients discharged from the SSRF demonstrated a greater SCIM score improvement than those from the non-SSRFs (24.1 vs 17.0; p = 0.003). By using multivariate regression analysis controlling for age, time from injury to rehabilitation, severity of injury and SCIM score on admission, SSRF admission was found to be an independent predictive factor of SCIM score improvement at discharge (p = 0.008). CONCLUSION Admission to an SSRF is associated with better rehabilitation outcomes. This finding supports the importance of SSRF access to improve the functional outcome of patients with SCI.
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Affiliation(s)
- Sintip Pattanakuhar
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Pratchayapon Kammuang-Lue
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichana Kovindha
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Rungarun Mahachai
- Department of Rehabilitation Medicine, Ratchaburi Hospital, Ratchaburi, Thailand
| | - Chayaporn Chotiyarnwong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Guilcher SJT, Voth J, Ho C, Noonan VK, McKenzie N, Thorogood NP, Craven BC, Cronin S, Jaglal SB. Characteristics of Non-traumatic Spinal Cord Dysfunction in Canada Using Administrative Health Data. Top Spinal Cord Inj Rehabil 2018; 23:343-352. [PMID: 29339910 DOI: 10.1310/sci2304-343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: There is a paucity of studies using administrative health data to examine the epidemiology, health care utilization, and outcomes for non-traumatic spinal cord dysfunction (NTSCD). Objective: The purpose of this study is to characterize discrete NTSCD cohorts using decision algorithms with Canadian health administrative databases. Method: Data were provided by the Canadian Institute for Health Information that included all acute care hospital, day surgery, ambulatory, and inpatient rehabilitation records of patients with neurological impairment between April 1, 2004 and March 31, 2011. Diagnostic codes for neurological impairment and NTSCD etiology were used to identify cases and classify 3 NTSCD groups (most likely, probable, and possible). Logistic regression identified factors related to inpatient rehabilitation admission within 7 days of discharge among the preferred group. Results: The most likely NTSCD group (n = 6,362) was significantly older and had a greater proportion of women and individuals with cauda equina lesions compared to the other 2 NTSCD groups (probable [n = 2,777] and possible [n = 11,179]; ps < .001). Factors associated with the likelihood of an inpatient rehabilitation admission included being older (odds ratio [OR], 1.01; 95% CI, 1.00-1.01), being female (OR, 1.18; 95% CI, 1.06-1.32), having paraplegia diagnosis compared to cauda equina (OR, 1.24; 95% CI, 1.09-1.41), residing in an urban area compared to a rural area (OR, 1.34; 95% CI, 1.13-1.58), having degenerative etiology compared to other (OR, 1.59; 95% CI, 1.41-1.80), and having an MRI on record compared to not (OR = 1.57; 95% CI, 1.39-1.76). Conclusion: Administrative data allow for ongoing surveillance of a population in a relatively cost-effective manner. Advancing our knowledge of NTSCD epidemiology, health outcomes, and system performance can inform policy and system planning.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jennifer Voth
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Nicole McKenzie
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - B Catharine Craven
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Shawna Cronin
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Ontario, Canada
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New PW, Eriks-Hoogland I, Scivoletto G, Reeves RK, Townson A, Marshall R, Rathore FA. Important Clinical Rehabilitation Principles Unique to People with Non-traumatic Spinal Cord Dysfunction. Top Spinal Cord Inj Rehabil 2018; 23:299-312. [PMID: 29339906 DOI: 10.1310/sci2304-299] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Non-traumatic spinal cord dysfunction (SCDys) is caused by a large range of heterogeneous etiologies. Although most aspects of rehabilitation for traumatic spinal cord injury and SCDys are the same, people with SCDys have some unique rehabilitation issues. Purpose: This article presents an overview of important clinical rehabilitation principles unique to SCDys. Methods: Electronic literature search conducted (January 2017) using MEDLINE and Embase (1990-2016) databases for publications regarding SCDys. The focus of the literature search was on identifying publications that present suggestions regarding the clinical rehabilitation of SCDys. Results: The electronic search of MEDLINE and Embase identified no relevant publications, and the publications included were from the authors' libraries. A number of important clinical rehabilitation principles unique to people with SCDys were identified, including classification issues, general rehabilitation issues, etiology-specific issues, and a role for the rehabilitation physician as a diagnostic clinician. The classification issues were regarding the etiology of SCDys and the International Standards for Neurological Classification of Spinal Cord Injury. The general rehabilitation issues were predicting survival, improvement, and rehabilitation outcomes; admission to spinal rehabilitation units, including selection decision issues; participation in rehabilitation; and secondary health conditions. The etiology-specific issues were for SCDys due to spinal cord degeneration, tumors, and infections. Conclusions: Although there are special considerations regarding the rehabilitation of people with SCDys, such as the potential for progression of the underlying condition, functional improvement is typically significant with adequate planning of rehabilitation programs and special attention regarding the clinical condition of patients with SCDys.
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Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Service, Department of Rehabilitation, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | | | - Giorgio Scivoletto
- Spinal Unit, IRCCS Fondazione S. Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Ronald K Reeves
- Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Andrea Townson
- GF Strong Rehab Centre, British Columbia, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, Northfield, South Australia, Australia.,Discipline of Orthopaedics and Trauma, School of Medicine, Faculty of Health Science, University of Adelaide, South Australia, Australia
| | - Farooq A Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi, Pakistan.,Department of Rehabilitation Medicine, Bahria University Medical and Dental College, Bahria University, Karachi, Pakistan
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Observational study of the effectiveness of spinal cord injury rehabilitation using the Spinal Cord Injury-Ability Realization Measurement Index. Spinal Cord 2015; 54:467-72. [PMID: 26369890 DOI: 10.1038/sc.2015.153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVES The objective of this study was to determine the rehabilitation potential and the extent to which it is realized in a cohort of spinal cord injury patients using the Spinal Cord Injury-Ability Realization Measurement Index (SCI-ARMI) and to study the clinical factors that influence this realization. SETTING Two spinal units in Italy. METHODS Consecutive patients were assessed at the end of an in-patient rehabilitation program using the Spinal Cord Independence Measure and the International Standards for Neurological Classification of Spinal Cord Injury. On the basis of these data and of the age and gender of the patients, we calculated the SCI-ARMI score. Regression analyses were performed to study the relationship between clinical factors and the extent to which rehabilitation potential is realized. RESULTS We examined the data for 306 patients. Most patients were discharged without having reached their rehabilitation potential, with an SCI-ARMI score <80%. SCI-ARMI scores at discharge were positively influenced by etiology and the lesion level and correlated negatively with lesion severity and the presence of complications during rehabilitation. CONCLUSION The SCI-ARMI is an effective tool that can be used to measure the achievement of rehabilitation potential in SCI patients and to identify groups of patients who are at risk of not meeting their rehabilitative potential.
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Barakat N, Gorman MP, Benson L, Becerra L, Borsook D. Pain and spinal cord imaging measures in children with demyelinating disease. NEUROIMAGE-CLINICAL 2015; 9:338-47. [PMID: 26509120 PMCID: PMC4588416 DOI: 10.1016/j.nicl.2015.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/19/2015] [Accepted: 08/28/2015] [Indexed: 12/15/2022]
Abstract
Pain is a significant problem in diseases affecting the spinal cord, including demyelinating disease. To date, studies have examined the reliability of clinical measures for assessing and classifying the severity of spinal cord injury (SCI) and also to evaluate SCI-related pain. Most of this research has focused on adult populations and patients with traumatic injuries. Little research exists regarding pediatric spinal cord demyelinating disease. One reason for this is the lack of reliable and useful approaches to measuring spinal cord changes since currently used diagnostic imaging has limited specificity for quantitative measures of demyelination. No single imaging technique demonstrates sufficiently high sensitivity or specificity to myelin, and strong correlation with clinical measures. However, recent advances in diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) measures are considered promising in providing increasingly useful and specific information on spinal cord damage. Findings from these quantitative imaging modalities correlate with the extent of demyelination and remyelination. These techniques may be of potential use for defining the evolution of the disease state, how it may affect specific spinal cord pathways, and contribute to the management of pediatric demyelination syndromes. Since pain is a major presenting symptom in patients with transverse myelitis, the disease is an ideal model to evaluate imaging methods to define these regional changes within the spinal cord. In this review we summarize (1) pediatric demyelinating conditions affecting the spinal cord; (2) their distinguishing features; and (3) current diagnostic and classification methods with particular focus on pain pathways. We also focus on concepts that are essential in developing strategies for the detection, monitoring, treatment and repair of pediatric myelitis.
Pain is a major presenting symptom in children with myelitis. Currently used imaging has limited sensitivity to myelin content. We provide a summary on pediatric demyelinating conditions. We review pain involvement and pathways affected by demyelination. We review imaging modalities for the diagnosis and monitoring of myelitis.
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Affiliation(s)
- Nadia Barakat
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Lino Becerra
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA ; Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA ; Department of Radiology, Boston Children's Hospital, Boston, MA, USA
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Menon N, Gupta A, Khanna M, Taly AB. Ambulation following spinal cord injury and its correlates. Ann Indian Acad Neurol 2015; 18:167-70. [PMID: 26019413 PMCID: PMC4445191 DOI: 10.4103/0972-2327.150605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/13/2014] [Accepted: 12/16/2014] [Indexed: 12/25/2022] Open
Abstract
Objectives: To assess walking ability of spinal cord injury (SCI) patients and observe its correlation with functional and neurological outcomes. Patients and Methods: The present prospective, observational study was conducted in a tertiary research hospital in India with 66 patients (46 males) between January 2012 and December 2013. Mean age was 32.62 ± 11.85 years (range 16-65 years), mean duration of injury was 85.3 ± 97.6 days (range 14-365 days) and mean length of stay in the rehabilitation unit was 38.08 ± 21.66 days (range 14-97 days) in the study. Walking Index for spinal cord injury (WISCI II) was used to assess ambulation of the SCI patients. Functional recovery was assessed using Barthel Index (BI) and Spinal Cord Independence Measures (SCIM). Neurological recovery was assessed using ASIA impairment scale (AIS). We tried to correlate ambulatory ability of the patients with functional and neurological recovery. Results: Ambulatory ability of the patients improved significantly using WISCI II (P < 0.001) when admission and discharge scores were compared (1.4 ± 3.5 vs 7.6 ± 6.03). Similarly, functional (BI: 31.7 ± 20.5 vs 58.4 ± 23.7 and SCIM: 29.9 ± 15.1 vs 56.2 ± 20.6) and neurological recovery were found to be very significant (P < 0.001) when admission vs discharge scores were compared. Improvement in WISCI II scores was significantly correlated with improvement in neurological (using AIS scores) and functional status (using BI and SCIM scores) (P < 0.001). Conclusions: Significant improvement was seen in WISCI II, BI, and SCIM scores after in-patient rehabilitation. Improvement in WISCI II scores also significantly correlated with functional and neurological recovery.
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Affiliation(s)
- Nitin Menon
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Arun B Taly
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Neurology, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Nas K, Karakoç M, Aydın A, Öneş K. Rehabilitation in spinal infection diseases. World J Orthop 2015; 6:1-7. [PMID: 25621205 PMCID: PMC4303778 DOI: 10.5312/wjo.v6.i1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/29/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Spinal cord infections were the diseases defined by Hypocrite yet the absence of modern medicine and there was not a real protocol in rehabilitation although there were many aspects in surgical treatment options. The patients whether surgically or conservatively treated had a lot of neurological, motor, and sensory disturbances. Our clinic has quite experience from our previous researchs. Unfortunately, serious spinal cord infections are still present in our region. In these patients the basic rehabilitation approaches during early, pre-operation, post-operation period and in the home environment will provide significant contributions to improve the patients’ sensory and motor skills, develop the balance and proriocaption, increase the independence of patients in daily living activities and minimize the assistance of other people. There is limited information in the literature related with the nature of the rehabilitation programmes to be applied for patients with spinal infections. The aim of this review is to share our clinic experience and summarise the publications about spinal infection rehabilitation. There are very few studies about the rehabilitation of spinal infections. There are still not enough studies about planning and performing rehabilitation programs in these patients. Therefore, a comprehensive rehabilitation programme during the hospitalisation and home periods is emphasised in order to provide optimal management and prevent further disability.
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Milicevic S, Piscevic V, Bukumiric Z, Nikolic AK, Sekulic A, Corac A, Babovic R, Jankovic S. Analysis of the factors influencing functional outcomes in patients with spinal cord injury. J Phys Ther Sci 2014; 26:67-71. [PMID: 24567678 PMCID: PMC3927044 DOI: 10.1589/jpts.26.67] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/04/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The extent of functional independence ultimately achieved by an individual patient will be influenced by a variety of medical and non-medical factors. [Subjects and Methods] this study included 419 patients with spinal cord lesions treated in the Clinic for Rehabilitation "Dr M. Zotovic", Belgrade, Serbia, from January 2000 to December 2009. The patients were divided in two groups according to achievement of increase in Functional Independence Measure (FIM) score of more than 13 at discharge compared to admission. A variety of clinical variables were followed in both groups. [Results] one hundred twenty-one patients (28.9%) showed improvements in FIM score of ≤13, while 298 (71.1%) patients showed an increases in FIM score of >13 at discharge compared to admission. Better functional recovery was observed in patients with non-traumatic spinal cord lesions, lower neurological levels of the lesion (OR = 6.07), and in patients treated surgically, but the level of the spinal cord lesion was the most influential factor affecting outcome. [Conclusion] the patients with spinal cord lesions should not only be grouped by traumatic and non-traumatic lesions only, but also sub-categorized, according to the etiology, level of injury and treatment method.
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Affiliation(s)
| | | | - Zoran Bukumiric
- Medical Faculty in Belgrade, Institute of Medical Statistics and Informatics, Serbia
| | | | | | - Aleksandar Corac
- Medical Faculty Pristina, Department of Preventive Medicine, Serbia
| | - Rade Babovic
- Clinic for Rehabilitation "Dr M. Zotovic", Serbia
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Cragg JJ, Noonan VK, Dvorak M, Krassioukov A, Mancini GBJ, Borisoff JF. Spinal cord injury and type 2 diabetes: results from a population health survey. Neurology 2013; 81:1864-8. [PMID: 24153440 DOI: 10.1212/01.wnl.0000436074.98534.6e] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the association between spinal cord injury (SCI) and type 2 diabetes in a large representative sample and to determine whether an association exists irrespective of known risk factors for type 2 diabetes. METHODS Data were obtained on 60,678 respondents to the Statistics Canada 2010 Cycle of the cross-sectional Canadian Community Health Survey. Multivariable logistic regression, incorporating adjustment for confounders and probability weights to account for the Canadian Community Health Survey sampling method, was conducted to quantify this association. RESULTS After adjustment for both sex and age, SCI was associated with a significant increased odds of type 2 diabetes (adjusted odds ratio = 1.66, 95% confidence interval 1.16-2.36). These heightened odds persisted after additional adjustment for smoking status, hypertension status, body mass index, daily physical activity, alcohol intake, and daily consumption of fruits and vegetables (fully adjusted odds ratio = 2.45, 95% confidence interval 1.34-4.47). CONCLUSIONS There is a strong association between SCI and type 2 diabetes, which is not explained by known risk factors for type 2 diabetes.
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Affiliation(s)
- Jacquelyn J Cragg
- From the School of Population and Public Health, Faculty of Medicine (J.J.C.), International Collaboration on Repair Discoveries (J.J.C., A.K., J.F.B.), Division of Spine, Department of Orthopaedics (M.D.), Department of Medicine, Division of Physical Medicine and Rehabilitation (A.K.), and Cardiovascular Imaging Research Core Laboratory, Division of Cardiology, Department of Medicine (G.B.J.M.), University of British Columbia, Vancouver; Rick Hansen Institute (V.K.N.), Vancouver; Acute Spine Program (M.D.), Vancouver General Hospital; GF Strong Rehabilitation Centre (A.K.), Vancouver Health Authority, Vancouver; and British Columbia Institute of Technology (J.F.B.), Burnaby, Canada
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Kennedy P, Chessell ZJ. Traumatic versus non-traumatic spinal cord injuries: are there differential rehabilitation outcomes? Spinal Cord 2013; 51:579-83. [DOI: 10.1038/sc.2013.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/12/2013] [Accepted: 03/17/2013] [Indexed: 11/09/2022]
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Marinho AR, Flett HM, Craven C, Andrea Ottensmeyer C, Parsons D, Verrier MC. Walking-related outcomes for individuals with traumatic and non-traumatic spinal cord injury inform physical therapy practice. J Spinal Cord Med 2012; 35:371-81. [PMID: 23031174 PMCID: PMC3459566 DOI: 10.1179/2045772312y.0000000038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To describe and compare patient demographics, inpatient lengths of stay (LOS), and walking-related functional outcomes of individuals with spinal cord injuries (SCIs) of traumatic (TSCI) and non-traumatic (NTSCI) etiologies. To contrast these features between individuals who walked from those who did not walk at discharge from inpatient rehabilitation. DESIGN Prospective observational study; comparisons between TSCI and NTSCI, walkers and non-walkers. Information collected as a pilot project within a provincial SCI informatics strategy. SETTING Rehabilitation hospital specialized for SCIs. PARTICIPANTS Adults with NTSCI (n = 31) or TSCI (n = 59) admitted to inpatient rehabilitation, 2007-2009. OUTCOME MEASURES Lower-extremity motor scores (LEMS), spinal cord independence measure version III (SCIM-III) total and mobility subscores, functional independence measure (FIM), Length of Stay (LOS) at inpatient facilities. RESULTS Groups (NTSCI vs. TSCI) did not differ in the proportion of individuals that achieved "walker" status (SCIM-III mobility indoors (MI) score ≥ 3 at rehab discharge) (P = 0.41, 48.9% overall). Inpatient LOS at both acute care and rehabilitation facilities did not differ between groups; however, TSCI non-walkers had longer inpatient rehabilitation LOS than TSCI walkers. Among walkers, improvement was shown on all three mobility subscores of the SCIM-III between admission and discharge from rehabilitation; highest significance was shown on the SCIM-III MI. Walking status at discharge (SCIM-III MI) was most strongly correlated with LEMS at rehab admission (r = 0.71, P < 0.001). CONCLUSION Walking outcomes are comparable among individuals with NTSCI vs. TSCI admitted for specialized SCI rehabilitation. Routine use of SCIM-III mobility items for assessment of walking outcome is recommended for inpatient rehabilitation.
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Affiliation(s)
- Andresa R. Marinho
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | - Heather M. Flett
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | - Catharine Craven
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | | | - Daria Parsons
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | - Molly C. Verrier
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada,Correspondence to: Molly C. Verrier, Centre for Function and Well-Being, University of Toronto, 160-500 University Avenue, Toronto, ON, Canada M5G 1V7.
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Patel S, Alavi Y, Lindfield R, Kuper H. The impact of rehabilitative services in the lives of adults and children with disabilities, in low-income and middle-income countries: an assessment of the quality of the evidence. Disabil Rehabil 2012; 35:703-12. [DOI: 10.3109/09638288.2012.705949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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New PW, Townson A, Scivoletto G, Post MWM, Eriks-Hoogland I, Gupta A, Smith É, Reeves RK, Gill ZA. International comparison of the organisation of rehabilitation services and systems of care for patients with spinal cord injury. Spinal Cord 2012; 51:33-9. [DOI: 10.1038/sc.2012.82] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Benito-Penalva J, Edwards DJ, Opisso E, Cortes M, Lopez-Blazquez R, Murillo N, Costa U, Tormos JM, Vidal-Samsó J, Valls-Solé J, Medina J. Gait training in human spinal cord injury using electromechanical systems: effect of device type and patient characteristics. Arch Phys Med Rehabil 2011; 93:404-12. [PMID: 22209475 DOI: 10.1016/j.apmr.2011.08.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 08/14/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the clinical improvements in spinal cord injury (SCI) patients associated with intensive gait training using electromechanical systems according to patient characteristics. DESIGN Prospective longitudinal study. SETTING Inpatient SCI rehabilitation center. PARTICIPANTS Adults with SCI (n=130). INTERVENTION Patients received locomotor training with 2 different electromechanical devices, 5 days per week for 8 weeks. MAIN OUTCOME MEASURES Lower-extremity motor score, Walking Index for Spinal Cord Injury, and 10-meter walking test data were collected at the baseline, midpoint, and end of the program. Patients were stratified according to the American Spinal Injury Association (ASIA) category, time since injury, and injury etiology. A subgroup of traumatic ASIA grade C and D patients were compared with data obtained from the European Multicenter Study about Human Spinal Cord Injury (EM-SCI). RESULTS One hundred and five patients completed the program. Significant gains in lower-limb motor function and gait were observed for both types of electromechanical device systems, to a similar degree. The greatest rate of improvement was shown in the motor incomplete SCI patients, and for patients <6 months postinjury. The positive response associated with training was not affected by injury etiology, age, sex, or lesion level. The trajectory of improvement was significantly enhanced relative to patients receiving the conventional standard of care without electromechanical systems (EM-SCI). CONCLUSIONS The use of electromechanical systems for intensive gait training in SCI is associated with a marked improvement in lower-limb motor function and gait across a diverse range of patients and is most evident in motor incomplete patients, and for patients who begin the regimen early in the recovery process.
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Affiliation(s)
- Jesús Benito-Penalva
- Department of Spinal Cord Injury, Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain.
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St. Andre J, Smith B, Stroupe K, Burns S, Evans C, Ripley D, Li K, Huo Z, Hogan T, Weaver F. A Comparison of Costs and Health Care Utilization for Veterans with Traumatic and Nontraumatic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1604-27] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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SCIM III is reliable and valid in a separate analysis for traumatic spinal cord lesions. Spinal Cord 2010; 49:292-6. [DOI: 10.1038/sc.2010.111] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Traumatic and non-traumatic spinal cord lesions: an Italian comparison of neurological and functional outcomes. Spinal Cord 2010; 49:391-6. [PMID: 20603629 DOI: 10.1038/sc.2010.85] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To compare the rehabilitation outcomes of non-traumatic and traumatic spinal cord injury patients. SETTING Spinal cord unit of a rehabilitation hospital in Italy. PATIENTS AND METHODS In total, 380 patients at first rehabilitation stay after the lesion (144 traumatic patients and 236 non-traumatic patients; 244 men and 136 women; mean age 46.1±19.9 years; mean lesion to admission time 49.6±39.8 days). INTERVENTIONS Not applicable. MEASURES American Spinal Injury Association standards; Barthel index (BI), Rivermead mobility index and walking index for spinal cord injury. STATISTICAL ANALYSIS Poisson regression models with relative risks and 95% confidence intervals adjusted for the following confounders: age, sex, lesion level and Asia impairment. Models were stratified by age because a strong interaction between different variables and age was found. RESULTS Traumatic and non-traumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower BI score at admission and significantly better improvement in the BI score by discharge. The two populations were discharged with similar functional outcome. No significant differences were found with regard to the others outcomes. CONCLUSIONS In clinically stable patients, spinal cord injury etiology does not seem to affect the rehabilitative prognosis. At admission, traumatic patients show lower autonomy in daily life activities, probably because of the associated lesions that these patients often have. At discharge, traumatic and non-traumatic spinal cord lesion patients achieved similar results with regard to neurological and functional improvement.
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New PW, Simmonds F, Stevermuer T. A population-based study comparing traumatic spinal cord injury and non-traumatic spinal cord injury using a national rehabilitation database. Spinal Cord 2010; 49:397-403. [DOI: 10.1038/sc.2010.77] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study. Spinal Cord 2009; 48:45-50. [PMID: 19546877 DOI: 10.1038/sc.2009.78] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort design. OBJECTIVES To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation. SETTING Ontario, Canada. METHODS Inpatient stays (2003-2006) were identified from the National Rehabilitation Registry System. Exclusions were: in-hospital mortality; discharge after 31 March 2006; death within 1 year after discharge. Multivariate logistic regression analyses were used to determine factors predicting high utilization. RESULTS NTSCI cases (n=1002) were greater than TSCI (n=560). NTSCIs were older (mean=61.6, s.d.=15.8) with more co-morbidities, paraplegic (39.5%) and female (P<0.001). NTSCI had higher FIM admission and discharge scores but lower change scores. Mean number of physician visits for NTSCI and TSCI were 31.2 (median=24) and 29.7 (median=22), with no significant differences in mean specialist visits (NTSCI 16.5: TSCI 17.0). Factors predicting 30 or more physician visits included age 60 years or above (OR=1.5; 95% CI=1.2-1.9), urban living (OR=1.59; 95% CI=1.12-2.22) and lowest quartile (18-88) discharge FIM (OR=1.8; 95% CI=1.4-2.3). Charlson score of 3 or more (OR=2.1; 95% CI=1.3-3.2), urban living (OR=1.92; 95% CI=1.3-2.86) and lowest quartile discharge FIM (OR=1.5; 95% CI=1.2-2.0) were associated with 20 or more specialist visits. Factors for high ED use were: rurality (OR=1.5; 95% CI=1.1-2.1), low income (OR=1.4; 95% CI=1.1-1.9) and low (18-88) discharge FIM (OR=1.7; 95% CI=1.3-2.2). CONCLUSION Both demonstrated significant health care utilization requiring attention to health care needs; particularly for those living in rural settings, with low income and/or low functional ability.
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Non-traumatic spinal cord lesions: epidemiology, complications, neurological and functional outcome of rehabilitation. Spinal Cord 2008; 47:307-11. [PMID: 18936767 DOI: 10.1038/sc.2008.123] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Prospective cross-sectional study. OBJECTIVE To study epidemiology, complication, neurological and functional outcome in non-traumatic spinal cord lesions (NTSCL) after inpatient rehabilitation. SETTING Neurological rehabilitation unit of a tertiary research hospital. METHODS Sixty-four patients (M/F=28:36) with NTSCL admitted from June 2005 to January 2008 for multidisciplinary rehabilitation. Epidemiology, medical complications during stay in rehabilitation, admission and discharge--Barthel Index (BI) and American Spinal Injury Association (ASIA) impairment scale for functional and neurological recovery, respectively, were recorded and analyzed. RESULTS NTSCL constituted 60% (64 of 106) of the total SCL patients admitted for rehabilitation during the same period. Female patients outnumbered males (56.25%) in the study. Mean age, duration of illness and duration of stay in rehabilitation were 30.64+/-13.67 years (6-57), 7.09+/-9.15 months (1-48) and 55.75+/-40.91 days (14-193), respectively. The ratio of paraplegia and quadriplegia was 2:1. Forty-four patients (68.75%) had incomplete cord lesion according to the ASIA impairment scale. Spinal tumors (26.6%) were found to be the most common etiology, followed by Pott's spine (25%) and transverse myelitis (22%). Urinary tract infection was found to be the most common complication (50%), followed by spasticity (35.93%) and urinary incontinence (31.25%). The mean BI scores showed significant (P=0.000) functional recovery during rehabilitation using paired Student's t-test. The ASIA impairment scale showed significant neurological recovery (P=0.001) using the Wilcoxon non-parametric test. CONCLUSIONS NTSCL constitute a significant proportion of overall SCL. Female population, paraplegia and incomplete cord lesions are more common among NTSCL in this study. Patients with NTSCL recover significantly both neurologically and functionally with rehabilitation intervention.
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