Spinal Cord Series and Cases最新文献

{"title":"Quality of life after spinal cord injury: a qualitative interview-based study.","authors":"Vasilios Stenimahitis, Amina Guenna Holmgren, Maria Gharios, Victor Gabriel El-Hajj, Victor E Staartjes, Claes Hultling, Adrian Elmi-Terander, Erik Edström","doi":"10.1038/s41394-026-00735-3","DOIUrl":"https://doi.org/10.1038/s41394-026-00735-3","url":null,"abstract":"<p><strong>Study design: </strong>Qualitative, descriptive study of audio recorded, transcribed and analyzed data, based on individual semi-structured interviews using an interview guide.</p><p><strong>Objectives: </strong>To describe the subjective experience and quality of life (QoL) of individuals with spinal cord injury (SCI) and identify elements of importance in determining QoL.</p><p><strong>Setting: </strong>Swedish outpatient clinic.</p><p><strong>Methods: </strong>Individuals with SCI were recruited from a specialized SCI outpatient clinic, with eligibility limited to those who had attended at least one prior clinical follow-up. No interventions were applied. Data were collected through qualitative interviews, and the primary outcome measure was the identification of key themes influencing QoL following SCI, as perceived and reported by participants.</p><p><strong>Results: </strong>The interviews identified several key factors with perceived impact on the subjects' QoL including difficulties in managing everyday life, the desire to live an independent life, the significance of community and a sense of belonging, current life situation in relation to others and past experiences, and dealing with physical problems, and in particular pain, related to SCI.</p><p><strong>Conclusion: </strong>Participants highlighted independence, social connections, and managing SCI- related physical issues as crucial for their quality of life. They emphasized the community's role in helping individuals with SCI, live meaningful lives and pursue personal goals and aspirations.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"12 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The sense of well-being inventory (SWBI) and the brief adaptation to disability scale-revised (B-ADS-R): Italian translation, cultural adaptation and validation.","authors":"Giovanni Galeoto, Sara Cirinà, Anna Berardi, Rachele Simeon, Francescaroberta Panuccio, Barbara Lucia, Andrea Savona, Jeronimo González-Bernal, Jesús Ángel Seco-Calvo","doi":"10.1038/s41394-026-00734-4","DOIUrl":"10.1038/s41394-026-00734-4","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional, psychometric study OBJECTIVE: The Sense of Well-being Inventory (SWBI), Brief Adaptation to Disability Scale-Revised (B-ADS-R) are two of the major assessment tools used for HR-QoL assessment. The study aimed to translate, culturally adapt, and validate the SWBI and the B-ADS-R in Italian.</p><p><strong>Setting: </strong>Paraplegic Center of Ostia METHODS: The original scale was translated from English to Italian using international guidelines. The psychometric properties analyzed were: content and construct validity, Internal consistency, and stability. Construct validity was assessed measuring correlation between the assessment tools and Life Space Assessment (LSA), Caregiver Burden Scale (CBS), Manual Wheelchair Slalom Test (MWST), and Adaptation Manual Wheelchair Circuit (AMWC) scales.</p><p><strong>Results: </strong>The SWBI and the B-ADS-R translated and culturally adapted in Italian were administered to 72 people with Spinal Cord Injury. Both assessment tools resulted in high values of Cronbach's alpha (ranging from 0.72 to 0.95) and intraclass correlation coefficient. With regards to the content validity analysis interests correlations have been found between the B-ADS-R and the physical well-being subscale of the SWBI.</p><p><strong>Conclusion: </strong>The assessment tools analyzed provide rehabilitation professionals, especially those involved in vocational rehabilitation, with assessment measures beyond employment outcomes to improve the definition of success in rehabilitation related HR-QoL. The SWBI and the B-ADS-R help to provide a more valid picture of the individual's level of life satisfaction or HR-QoL.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"12 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early transanal irrigation in spinal cord injury-related neurogenic bowel dysfunction: preliminary insights.","authors":"Giuseppina Frasca, Luisa De Palma, Marisa Megna, Ilaria Rosso, Lorella Cocchini, Gianluca Medina, Gabriele Righi, Annalisa Baroni, Giulio Del Popolo, Astrid Bonaccorsi, Francesco Savoca, Angela Costa","doi":"10.1038/s41394-026-00733-5","DOIUrl":"10.1038/s41394-026-00733-5","url":null,"abstract":"<p><strong>Study design: </strong>Prospective, randomized, open-label, multicenter, parallel group study.</p><p><strong>Objectives: </strong>Neurogenic bowel dysfunction (NBD) is a common complication in spinal cord injury (SCI) patients, severely affecting quality of life. While transanal irrigation (TAI) has shown superior efficacy over conservative treatments (CT), its early adoption during the first hospitalization post-injury remains unexplored. This study aimed to compare early TAI initiation versus CT in managing NBD in SCI patients.</p><p><strong>Setting: </strong>This study involved four spinal units across Italy.</p><p><strong>Methods: </strong>SCI patients were randomized to receive TAI or CT during a four-week hospital stay, followed by continued treatment at home for 6 months. Bowel function, constipation, and continence were assessed using the Wexner scales, while quality of life was measured using the EQ-5D-5L and Spinal Cord Independence Measure (SCIM) questionnaires. Stool transit time and patient independence were also monitored.</p><p><strong>Results: </strong>Twenty-two patients were enrolled, with the TAI group showing significant improvements in constipation (Wexner score reduction from 13.43 ± 4.24 at baseline to 7.55 ± 2.38 and 8.80 ± 4.16 at 4 weeks and 6 months, p = 0.02) and a trend toward continence improvement. A significant increase in the total SCIM score was observed in the TAI group (p = 0.02), particularly in respiratory and sphincter management. Quality of life improved in both groups, with a notable enhancement in self-care activities for the TAI group (p = 0.006).</p><p><strong>Conclusions: </strong>These preliminary results suggest early TAI adoption improves bowel management, especially constipation, and enhances patient independence. Larger studies are needed to validate these findings and assess long-term benefits.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"12 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving hand function in chronic incomplete tetraplegia by high-PAS intervention with alternative equipment: a case report.","authors":"Anna Nätkynmäki, Macey Higdon, Janne Avela, Anastasia Shulga","doi":"10.1038/s41394-026-00731-7","DOIUrl":"10.1038/s41394-026-00731-7","url":null,"abstract":"<p><strong>Introduction: </strong>The reproducibility of a paired associative stimulation (high-PAS) protocol, shown to be beneficial for rehabilitation in incomplete spinal cord injury (SCI), was investigated in a different technical environment. Whereas previous studies relied on a specific technical setup for high-PAS, here the protocol was replicated using alternative devices. Differences in technical attributes could influence the replicability of specific output. As the necessary technology is available in many clinical and research settings, validating the protocol across device systems is important for broader implementation of high-PAS in SCI rehabilitation. In this case, a high-PAS protocol was administered over 6 consecutive weeks in a patient with severe chronic incomplete SCI.</p><p><strong>Case presentation: </strong>A 32-year-old male with chronic C5 American Spinal Injury Association Impairment Scale C tetraplegia participated in this study. Three muscle-nerve pairs from both upper extremities each received 20-min high-PAS, administered 22 times over 6 weeks. The patient was assessed by an experienced physiotherapist before high-PAS, immediately after it, and 1 month after. The intervention improved muscle strength, hand function, and daily task performance in both upper extremities.</p><p><strong>Discussion: </strong>This study sought to replicate high-PAS improvement of motor and functional scores in a patient with severe chronic incomplete SCI and demonstrated that the results can be successfully recapitulated by alternative devices. The improvement observed was consistent with previous studies and supports applicability in more versatile technical environments.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"12 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-of-life decisions in acute traumatic cervical spinal cord injury: a case series on caring through a biopsychosocial perspective and an interdisciplinary, shared decision making approach.","authors":"Lucia J Foxen-Snobl, Wouter A J Vints, Bas C T van Bussel, Toon F M Boselie, Charlotte C M van Laake-Geelen","doi":"10.1038/s41394-026-00732-6","DOIUrl":"10.1038/s41394-026-00732-6","url":null,"abstract":"<p><strong>Introduction: </strong>Health care advancements lead to increased survival after severe cervical spinal cord injury (cSCI). Already in the acute phase, the severity of the injury with its magnitude of expected medical complications and the devastating functional prognosis, can confront the patient and its medical team with pressing medical-ethical dilemmas regarding the (dis)continuation of treatment and/or end-of-life decisions.</p><p><strong>Case presentation: </strong>In this case series we discuss four patients with severe cSCI that were admitted to the Maastricht University Medical Center, the Netherlands, in 2024, and in whom questions regarding end-of-life decision arose within a couple of days. While the neurological presentations were very similar, the personal wishes, beliefs and psychosocial situations varied greatly. The process of shared decision making, with multiple meetings with the treatment team, the patients (when possible) and their significant others, lead to the formulation of personalized treatment plans regarding discontinuation of treatment and/or end-of-life decisions.</p><p><strong>Discussion: </strong>This case series shows that end-of-life decisions in patients with cSCI are complex and multifactorial. A biopsychosocial approach is needed to tailor a personalized treatment plan that includes medical, prognostic, personal and external factors. An interdisciplinary team that actively involves the patient and its significant others, facilitates the process of shared decision making, which may also have a beneficial effect on the grieving process for the people left behind.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"12 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bladder management for adults with spinal cord injury in the acute hospital setting: A retrospective study.","authors":"Emily Hon, Mengdong He, Lin Xu, Stephen Hampton, Kimberly Waddell","doi":"10.1038/s41394-026-00730-8","DOIUrl":"10.1038/s41394-026-00730-8","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>The purpose of this study was to describe bladder management during acute hospitalization for people with SCI and its association with length of hospitalization.</p><p><strong>Setting: </strong>Acute hospitals within a single academic health system in the United States of America.</p><p><strong>Methods: </strong>Data were extracted from the electronic health record for admissions between September 1, 2021, and September 30, 2023. Bladder management for all admissions was classified as either indwelling urinary catheter (IUC), clean intermittent catheterization (CIC), IUC and CIC, or no catheter. The relationship between bladder management, injury type, and length of stay was examined using a mixed effects linear regression model.</p><p><strong>Results: </strong>The final sample included 1169 unique patients and 1652 admissions. Half (49.7%) of admissions required no urinary catheter. The IUC-only group comprised 18.9% of admissions while CIC and the combined IUC and CIC groups comprised 15.7% of admissions. Most admissions (84.3%) included a single bladder management strategy. Up to 63.1% of the combined IUC and CIC group implemented a trial of CIC more than once during the admission. Both IUC and CIC management was associated with a significant increase in hospital stay of 10.7 days (95% CI [5.3, 16.1], P < 0.001) for those with a cervical injury.</p><p><strong>Conclusion: </strong>These results provide valuable information about existing care patterns that can guide future quality improvement initiatives to enhance bladder management early after SCI.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"12 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paired associative stimulation with a high-intensity cortical component and a high-frequency peripheral component in treatment of neuropathic pain after incomplete spinal cord injury - a pilot trial.","authors":"Kirsi Holopainen, Markus Pohjonen, Erika Kirveskari, Selja Vaalto, Jyrki P Mäkelä, Jari Arokoski, Anastasia Shulga","doi":"10.1038/s41394-026-00729-1","DOIUrl":"10.1038/s41394-026-00729-1","url":null,"abstract":"<p><strong>Study design: </strong>Prospective interventional sham-controlled pilot study.</p><p><strong>Objectives: </strong>To investigate the effect of motor-tract paired-associative stimulation consisting of high-intensity transcranial magnetic stimulation and high-frequency electric stimulation of peripheral nerves (high-PAS) on moderate-to-severe upper limb neuropathic pain in patients with incomplete spinal cord injury compared with sham treatment in the same patients.</p><p><strong>Setting: </strong>BioMag Laboratory, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.</p><p><strong>Methods: </strong>High-PAS was applied for 4 weeks to 5 patients with incomplete, non-traumatic SCI and chronic neuropathic pain in upper limb(s). Median, ulnar, and radial nerves of the more painful hand were stimulated. The same patients also received sham stimulation for 4 weeks. Pain was measured with Verbal Rating Scale weekly and with Brief Pain Inventory before and after both stimulation periods and after follow-up of 8 weeks.</p><p><strong>Results: </strong>Clinically significant relief in pain was not achieved with high-PAS or sham treatment.</p><p><strong>Conclusions: </strong>In this pilot study, clinically significant pain relief was not observed with high-PAS compared with sham treatment. Larger studies are needed to confirm these findings. Nevertheless, pain is not a contraindication for high-PAS in rehabilitation. The previously reported positive effect on milder neuropathic pain may be due to improved muscle activity, different pain types, or placebo effect. High-PAS targeting sensory tracts instead of motor tracts merits further investigation for pain treatment.</p><p><strong>Trial registration: </strong>clinicaltrials.gov, ID NCT05362422.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"12 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12957355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensive neurological and functional recovery in an incomplete tetraplegic patient following transverse myelitis/ acute disseminated encephalomyelitis (ADEM) with rehabilitation: a challenging journey of a 17-Year-Old Girl.","authors":"Akter Hossain, A Rouse","doi":"10.1038/s41394-026-00728-2","DOIUrl":"10.1038/s41394-026-00728-2","url":null,"abstract":"<p><strong>Study design: </strong>Single case report.</p><p><strong>Objective: </strong>We present a case of Tetraplegia due to Transverse Myelitis/ADEM with excellent rehabilitation outcome.</p><p><strong>Setting: </strong>National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, United Kingdom.</p><p><strong>Case report: </strong>An 8-year-old girl presented with a severe acute neurological decline, initially involving a chest infection, four-limb paralysis, and deteriorating consciousness, which required intubation and mechanical ventilation. She was diagnosed with Transverse Myelitis/Acute Disseminated Encephalomyelitis (ADEM). MRI imaging of the brain and spine revealed significant T2 signal changes in the brainstem, as well as in the cervical spine (C2-C5). Her rehabilitation focused on achieving independence in activities of daily living, with wheelchair assistance for mobility and support for transfer activities. This ongoing rehabilitation, conducted on both an inpatient and outpatient basis for a period of 8 years, led to remarkable progress. The patient showed significant neurological recovery, ultimately reaching an AIS-E classification, indicating complete recovery of motor and sensory function.</p><p><strong>Conclusion: </strong>Spinal injury resulting from Transverse Myelitis can lead to widespread paralysis; however, prompt diagnosis and early specialist rehabilitation are crucial in promoting functional recovery and improving outcomes for affected individuals. The suggested \"two-year\" window for recovery in the adult population would appear to be extended in the paediatric population.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"12 1","pages":"2"},"PeriodicalIF":0.9,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12891510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards accurate malnutrition identification in individuals with Spinal Cord Injury: a qualitative investigation.","authors":"Stephen J Keenan, Sophie I Gunter, Devni C Meewathurage, Katherine J Desneves","doi":"10.1038/s41394-026-00727-3","DOIUrl":"10.1038/s41394-026-00727-3","url":null,"abstract":"<p><strong>Study design: </strong>Exploratory qualitative descriptive study.</p><p><strong>Objectives: </strong>We aimed to explore how dietitians assess and diagnose malnutrition in individuals with spinal cord injury (SCI), limitations of current practice, and barriers to optimal practice, as well as improvements that could be made.</p><p><strong>Setting: </strong>Twelve dietitians working in hospital, rehabilitation, and community contexts across Australia, the United Kingdom, the United States, Norway, South Africa, and New Zealand.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted via Microsoft Teams between April and August 2024. Data were recorded, transcribed, and analysed thematically using Braun and Clarke's six-step thematic analysis method.</p><p><strong>Results: </strong>Participants primarily relied on generic screening tools due to institutional policy and ease of use. They expressed concerns about distinguishing obligatory post-injury weight changes from true undernutrition, and the minimal focus on overnutrition. Practical barriers to effective malnutrition identification included limited equipment access and staffing constraints, exacerbating screening challenges. Participants advocated for SCI-specific guidelines to improve diagnostic accuracy and reduce misclassification.</p><p><strong>Conclusions: </strong>Weight-centric approaches risk misclassifying malnutrition in SCI. Tailored frameworks that incorporate functional, clinical, and psychosocial factors are needed, alongside institutional support for successful implementation. Refined tools may standardise assessment and better address malnutrition's complex aetiology in SCI. Future research should explore and validate these approaches and evaluate their implementation in diverse SCI contexts.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"12 1","pages":"1"},"PeriodicalIF":0.9,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12823604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Haemoperitoneum in the setting of therapeutic anticoagulation and manual assisted cough for a patient with an acute cervical spinal cord injury and pulmonary embolus: a case report.","authors":"Zoe Bacolas, Jacqueline Ross, Thomas Phyland, Richard Clements, Thomas Rollinson","doi":"10.1038/s41394-025-00726-w","DOIUrl":"10.1038/s41394-025-00726-w","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory complications are the leading cause of morbidity and mortality in people with spinal cord injuries (SCI). Respiratory muscle weakness and altered mechanics occur in patients with cervical SCI, resulting in impaired airway clearance and low lung volumes. Respiratory physiotherapy includes cough augmentation techniques, such as manual assisted cough and/or mechanical insufflation-exsufflation (MI-E) to address these problems. Additionally, this population is at risk of pulmonary embolism, often receiving therapeutic anticoagulation.</p><p><strong>Case report: </strong>This case study presents a rare presentation of a large haemoperitoneum in a 22-year-old male with an acute C4 SCI, undergoing regular MI-E and manual assisted coughs whilst therapeutically anticoagulated with enoxaparin for multiple subsegmental pulmonary emboli. Additional contributing factors include higher dose therapeutic anticoagulation in the setting of elevated body mass index and a requirement for frequent, firm manual assisted coughs. Whilst no surgical intervention was required, the patient was admitted to the intensive care unit for close monitoring and received blood transfusions.</p><p><strong>Discussion: </strong>This report discusses the challenges encountered with managing respiratory compromise in patients with SCI, including the balance between therapeutic management of pulmonary emboli and the potentially under-appreciated risk of intra-abdominal haemorrhage with manual assisted coughs. This rare but serious complication highlights the need for careful risk-benefit analysis by clinicians providing respiratory physiotherapy in this patient population.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"11 1","pages":"31"},"PeriodicalIF":0.9,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12743054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}