Topics in Spinal Cord Injury Rehabilitation最新文献

{"title":"Cerebrovascular Reactivity Following Spinal Cord Injury.","authors":"Alexander Mark Weber, Tom E Nightingale, Michael Jarrett, Amanda H X Lee, Olivia Lauren Campbell, Matthias Walter, Samuel J E Lucas, Aaron Phillips, Alexander Rauscher, Andrei V Krassioukov","doi":"10.46292/sci23-00068","DOIUrl":"10.46292/sci23-00068","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injuries (SCI) often result in cardiovascular issues, increasing the risk of stroke and cognitive deficits.</p><p><strong>Objectives: </strong>This study assessed cerebrovascular reactivity (CVR) using functional magnetic resonance imaging (fMRI) during a hypercapnic challenge in SCI participants compared to noninjured controls.</p><p><strong>Methods: </strong>Fourteen participants were analyzed (<i>n</i> = 8 with SCI [unless otherwise noted], median age = 44 years; <i>n</i> = 6 controls, median age = 33 years). CVR was calculated through fMRI signal changes.</p><p><strong>Results: </strong>The results showed a longer CVR component (tau) in the grey matter of SCI participants (<i>n</i> = 7) compared to controls (median difference = 3.0 s; <i>p</i> < .05). Time since injury (TSI) correlated negatively with steady-state CVR in the grey matter and brainstem of SCI participants (<i>R</i>_S = -0.81, <i>p</i> = .014; <i>R</i>_S = -0.84, <i>p</i> = .009, respectively). Lower steady-state CVR in the brainstem of the SCI group (<i>n</i> = 7) correlated with lower diastolic blood pressure (<i>R</i>_S = 0.76, <i>p</i> = .046). Higher frequency of hypotensive episodes (<i>n</i> = 7) was linked to lower CVR outcomes in the grey matter (<i>R</i>_S = -0.86, <i>p</i> = .014) and brainstem (<i>R</i>_S = -0.89, <i>p</i> = .007).</p><p><strong>Conclusion: </strong>Preliminary findings suggest a difference in the dynamic CVR component, tau, between the SCI and noninjured control groups, potentially explaining the higher cerebrovascular health burden in SCI individuals. Exploratory associations indicate that longer TSI, lower diastolic blood pressure, and more hypotensive episodes may lead to poorer CVR outcomes. However, further research is necessary to establish causality and support these observations.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 2","pages":"78-95"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11123610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155629","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":"Prevalence and Impact of Fractures in Persons with Spinal Cord Injuries: A Population-Based Study Comparing Fracture Rates between Individuals with Traumatic and Nontraumatic Spinal Cord Injury.","authors":"Christina Ziebart, Susan Jaglal, Sara Guilcher, Lavina Matai, Ping Li, Cathy Craven","doi":"10.46292/sci24-00029","DOIUrl":"https://doi.org/10.46292/sci24-00029","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal complications are one of the most common reasons for a patient with a spinal cord injury (SCI) to be rehospitalized. Bone loss due to immobilization and changes in metabolic processes because of the SCI lead to an increased risk of fractures.</p><p><strong>Objective: </strong>To evaluate the prevalence and demographic characteristics of people living with an SCI who had a secondary fracture.</p><p><strong>Methods: </strong>We used population health administrative data from Ontario, Canada, in individuals with either traumatic (TSCI) or nontraumatic SCI (NTSCI). Records of duplicate cases, missing unique patient identifier numbers, individuals not eligible for provincial health insurance, and age <18 years were excluded. Only records of fractures treated in the emergency department or acute care hospital were included. Descriptive statistics were used to summarize data, using counts and percentages that described the numbers and proportions of fractures by type disaggregated by sex, age groups, and type of SCI.</p><p><strong>Results: </strong>A total of 14,168 unique records were identified with 4486 as TSCI and 9682 as NTSCI between April 1, 2004 and March 31, 2020 and were followed up to March 31, 2021. Overall, 11% of the cohort had a subsequent fracture with no difference between TSCI and NTSCI. Hip fractures accounted for 21% of the fractures, wrists accounted for 12%, spine 11%, and tibia 11%. The average time to the first subsequent fracture after the SCI was 3.97 (<i>SD</i> 3.4) years.</p><p><strong>Conclusion: </strong>Monitoring and management of fracture risk needs attention in the first 2 years, with a focus on NTSCI.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 4","pages":"1-13"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773403","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":"Effects of 30-Day Midodrine Administration, Compared to Placebo, on Blood Pressure, Cerebral Blood Flow Velocity, and Cognitive Performance in Persons with SCI.","authors":"Caitlyn G Peters, Joseph P Weir, Nancy D Chiaravalloti, Trevor A Dyson-Hudson, Steven C Kirshblum, Jill M Wecht","doi":"10.46292/sci23-00038","DOIUrl":"10.46292/sci23-00038","url":null,"abstract":"<p><strong>Background: </strong>Individuals with spinal cord injury (SCI) at and above T6 experience impaired descending cortical control of the autonomic nervous system, which predisposes them to blood pressure (BP) disorders including persistent hypotension.</p><p><strong>Objectives: </strong>The primary aim of this investigation was to determine the effects of midodrine, 10 mg, administered daily over a 30-day period in the home environment, compared to placebo, on laboratory assessments of BP, cerebral blood flow velocity (CBFv), and cognitive performance in hypotensive individuals with chronic SCI.</p><p><strong>Methods: </strong>This prospective, randomized, placebo-controlled, double-blind, crossover trial was conducted in 15 individuals with tetraplegia. In the first 30-day period, five participants were randomized to midodrine and 10 were randomized to placebo; participants were then crossed over to the second 30-day period following a 14-day washout. Laboratory assessments of BP, CBFv, and cognitive performance were measured before and after each of the two study arms.</p><p><strong>Results: </strong>Systolic BP (SBP) was significantly increased following midodrine administration compared to placebo (116 ± 23 mm Hg vs 94 ± 16 mm Hg; <i>p</i> = .002). In addition, diastolic CBFv was increased after midodrine administration compared to placebo (31.0 ± 11.2 vs 25.6 ± 9.1 cm/s; <i>p</i> = .04). However, there were no significant drug by time interaction effects for systolic or mean CBFv (<i>p</i> > .172) and cognitive performance (<i>p</i> = .689).</p><p><strong>Conclusion: </strong>The results suggest significant increases in SBP and diastolic CBFv without appreciable effects on cognition after 30 days of midodrine administration. Further investigation is needed to identify effective antihypotensive treatment options that not only normalize BP but also improve CBFv and cognition.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 4","pages":"45-56"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773719","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":"Functional Sitting Balance and Anthropometric Measures Are Related to Inspiratory Muscle Performance in People with Spinal Cord Injury.","authors":"Pallavi, Shambhovi Mitra, Anne E Palermo","doi":"10.46292/sci23-00052","DOIUrl":"10.46292/sci23-00052","url":null,"abstract":"<p><strong>Background: </strong>Respiratory complications are a leading cause of mortality post spinal cord injury (SCI). Along with breathing, respiratory muscles have a role in maintaining seated balance. Postinjury breathing influences respiratory muscle function. Preliminary evidence indicates a relation between respiratory muscle function and seated balance in people with chronic SCI dwelling in the community, but the relationship between balance and body habitus has not been explored.</p><p><strong>Objectives: </strong>To explore the relationships among inspiratory muscle function, functional seated balance (FSB), and body habitus in people with SCI.</p><p><strong>Methods: </strong>A convenience sample of inpatients with SCI (C5-T12) aged 18 to 60 years who were using a wheelchair was recruited from November 2022 to March 2023. Those with additional neurological disorders or respiratory support were excluded. Respiratory muscle function measures included maximal inspiratory pressure (MIP), sustained MIP (SMIP), and Fatigue Index Test (FIT). FSB was scored using the Function in Sitting Test (FIST). Body habitus was assessed using the axillary: umbilical (A:U) ratio. Spearman correlations explored the relationships.</p><p><strong>Results: </strong>Thirty-eight of 42 screened participants were eligible and participated (male, 32). Levels of injury ranged from C5 to T12. The mean (<i>SD</i>) age and duration of injury of the sample was 25.61 (6.68) years and 31.03 (28.69) months, respectively. SMIP and FIT correlated significantly with FSB (<i>r</i> _s= .441, <i>p</i> = .01, and <i>r</i> _s= .434, <i>p</i> = .006, respectively). A significant correlation between SMIP and A:U ratio (<i>r</i> _s= -.330, <i>p</i> = .043) was observed.</p><p><strong>Conclusion: </strong>We observed a significant correlation between inspiratory pressure parameters and both functional seated balance and body habitus, adding to evidence on postural role of respiratory muscles.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 3","pages":"41-49"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976853","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":"Trabecular Bone Score in Individuals with Chronic Spinal Cord Injury: A Cross-Sectional Study.","authors":"Matteo Ponzano, Lindsie Blencowe, Lora M Giangregorio, B Catharine Craven","doi":"10.46292/sci24-00014","DOIUrl":"https://doi.org/10.46292/sci24-00014","url":null,"abstract":"<p><strong>Objectives: </strong>To describe lumbar spine (LS) trabecular bone score (TBS) values after SCI, and to explore the differences in fractures risk assessment between FRAX® and TBS-adjusted FRAX® in individuals living with chronic SCI.</p><p><strong>Methods: </strong>Baseline dual-energy x-ray absorptiometry (DXA) scans from an established cohort were acquired using a Hologic Discovery QDR 4500. TBS measurements were performed using the TBS iNsight^TM software version 2.1.2.0. A Welch's t-test was performed to explore differences in TBS, FRAX®, and TBS-adjusted FRAX® between men and women, between participants ≤49 years and ≥50 years, and between subgroups with and without history of fracture and with complete and incomplete injury.</p><p><strong>Results: </strong>We analyzed 37 scans; the mean TBS was 1.336 ± 0.107. The mean 10-year fracture risk was 8.8% ± 11.4% for major osteoporotic fracture and 4.0% ± 10.8% for hip fracture according to FRAX®, and 6.6% ± 2.8% for major osteoporotic fracture and 2.8% ± 6.7% for hip fractures according to TBS-adjusted FRAX®. The 10-year fracture risk for major osteoporotic fractures was higher in individuals with a prior fragility fracture compared to those without, according to FRAX® (<i>p</i> = .033) and TBS-adjusted FRAX® (<i>p</i> = .001).</p><p><strong>Conclusion: </strong>Over a half of our sample presented a partially degraded bone microarchitecture based on TBS. TBS was not different between people with motor complete and motor incomplete injury or with and without prior fragility fracture. Future studies are needed to define the clinical relevance of TBS and TBS-adjusted FRAX® in people with chronic SCI.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 4","pages":"14-23"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773478","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":"25-Hydroxyvitamin D Levels and Vitamin D3 Supplementation During Postacute Spinal Cord Injury Rehabilitation.","authors":"Anneke Hertig-Godeschalk, Clara O Sailer, Claudio Perret, Dirk Lehnick, Anke Scheel-Sailer, Joelle L Flueck","doi":"10.46292/sci24-00024","DOIUrl":"10.46292/sci24-00024","url":null,"abstract":"<p><strong>Background: </strong>Insufficient 25-hydroxyvitamin D [25(OH)D] levels are associated with falls, fractures, and worse overall health outcomes. We evaluated 25(OH)D levels in individuals with spinal cord injury or disorder (SCI/D) during postacute rehabilitation who received vitamin D3 supplementation according to routine clinical practice. Associations with clinical outcomes were also assessed.</p><p><strong>Methods: </strong>This prospective observational cohort study included individuals aged 18 to 85 years with newly acquired SCI/D admitted for inpatient rehabilitation to a specialized center. The following parameters were collected monthly from admission to discharge as part of the clinical routine: serum 25(OH)D, vitamin D3 supplementation, pressure injuries, bed rest, and falls. 25(OH)D levels were categorized as insufficient (≤75 nmol/L) or sufficient (>75 nmol/L). Descriptive statistics and group comparisons were performed.</p><p><strong>Results: </strong>Eighty-seven patients (25 [29%] females, median age 53 [IQR 39-67] years) were included and followed for 186 (163-205) days. The proportion of patients with a sufficient 25(OH)D level increased from 8% (95% CI, 3-16) to 61% (95% CI, 50-71) (<i>p</i> < .001). Ninety-two percent of patients received vitamin D3 (1100 [1000-2000] IU/day). No differences in 25(OH)D levels or supplementation doses were found for the occurrence of pressure injuries, bed rest, or falls.</p><p><strong>Conclusion: </strong>This is the first study to examine 25(OH)D levels and vitamin D3 supplementation during postacute SCI/D rehabilitation. Insufficient 25(OH)D levels were prevalent throughout rehabilitation. For some patients, the doses of vitamin D3 used in current clinical practice may be too low to achieve sufficient 25(OH)D levels. Regular monitoring of 25(OH)D levels and individualized supplementation strategies are warranted.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 4","pages":"24-34"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773662","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":"A Literature Review of Nutrition Knowledge Measurement Items Used in Persons Living with Spinal Cord Injuries and Disorders.","authors":"Cara Ray, Gary J Farkas, Lorena Reyes, Alex W K Wong, Allen W Heinemann, Dan Eisenberg, Jennifer Burns, Sherri L LaVela","doi":"10.46292/sci23-00066","DOIUrl":"https://doi.org/10.46292/sci23-00066","url":null,"abstract":"<p><strong>Objectives: </strong>To identify and describe diet and nutrition knowledge measurement tools/items used among adults with spinal cord injuries and disorders (SCI/D).</p><p><strong>Methods: </strong>Conducted a literature search for publications measuring diet/nutrition knowledge using items or tools in persons with SCI/D. Eligible articles were published in 1992-2022, in English, and assessed SCI/D participants' nutrition knowledge. Articles were reviewed for study design, questionnaire validation, sample characteristics, item content, and whether nutrition knowledge was general or SCI/D-specific.</p><p><strong>Results: </strong>Of 48 articles examined, five were included in the review. None of the nutrition knowledge questionnaires were validated in persons with SCI/D. Only one study assessed nutrition knowledge in nonathletes with chronic SCI/D, and this study excluded individuals with tetraplegia. The other studies either solely recruited athletes (<i>n</i> = 2; one included participants with amputation) or individuals with acute SCI/D (<i>n</i> = 2). Common item topics included calories/energy, sources of micronutrients and macronutrients and their effects on the body, and nutrition literacy. One questionnaire included non-SCI/D-specific nutrition items for persons with disabilities. Only one (unvalidated) questionnaire contained SCI-specific nutrition knowledge items, which only assessed whether more energy, fiber, and water are needed following acute SCI/D.</p><p><strong>Conclusion: </strong>Studies that assess nutrition knowledge among persons with SCI/D are rare and are typically observational or cross-sectional, with limited information on important SCI/D subgroups. Items relevant to unique needs of persons with SCI/D are sparse. A validated questionnaire that measures knowledge of SCI-specific nutrition, that is relevant to this population, and that can be parceled out by subgroup is needed.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 4","pages":"66-79"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773668","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":"Management of Sleep-Disordered Breathing in a Spinal Cord Injury Rehabilitation Center: Model of Care Adaptation and Implementation","authors":"M. Graco, Gerard Weber, K. Saravanan, Jacqueline Curran, Nicole Whitehead, J. Ross, Charito DelaCruz, Samritti Sood, Roxana E. Heriseanu, Ching Li Chai-Coetzer, David J. Berlowitz, David Joffe","doi":"10.46292/sci23-00049","DOIUrl":"https://doi.org/10.46292/sci23-00049","url":null,"abstract":"\u0000 \u0000 Obstructive sleep apnea (OSA) is highly prevalent and poorly managed in spinal cord injury (SCI). Alternative management models are urgently needed to improve access to care. We previously described the unique models of three SCI rehabilitation centers that independently manage uncomplicated OSA.\u0000 \u0000 \u0000 \u0000 The primary objective was to adapt and implement a similar rehabilitation-led model of managing OSA in an SCI rehabilitation center in Australia. Secondary objectives were to identify the local barriers to implementation and develop and deliver tailored interventions to address them.\u0000 \u0000 \u0000 \u0000 A clinical advisory group comprised of rehabilitation clinicians, external respiratory clinicians, and researchers adapted and developed the care model. A theory-informed needs analysis was performed to identify local barriers to implementation. Tailored behavior change interventions were developed to address the barriers and prepare the center for implementation.\u0000 \u0000 \u0000 \u0000 Pathways for ambulatory assessments and treatments were developed, which included referral for specialist respiratory management of complicated cases. Roles were allocated to the team of rehabilitation doctors, physiotherapists, and nurses. The team initially lacked sufficient knowledge, skills, and confidence to deliver the OSA care model. To address this, comprehensive education and training were provided. Diagnostic and treatment equipment were acquired. The OSA care model was implemented in July 2022.\u0000 \u0000 \u0000 \u0000 This is the first time a rehabilitation-led model of managing OSA has been implemented in an SCI rehabilitation center in Australia. We describe a theory-informed method of adapting the model of care, assessing the barriers, and delivering interventions to overcome them. Results of the mixed-methods evaluation will be reported separately.\u0000","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"89 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138995219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of One-Year Postinjury Mobility Outcomes Between Locomotor Training and Usual Care After Motor Incomplete Spinal Cord Injury","authors":"Candy Tefertiller, S. Wojciehowski, Mitch Sevigny, J. Ketchum, Meghan Rozwod","doi":"10.46292/sci23-00013","DOIUrl":"https://doi.org/10.46292/sci23-00013","url":null,"abstract":"To compare 1-year mobility outcomes of individuals with traumatic motor incomplete spinal cord injury (miSCI) who participated in standardized locomotor training (LT) within the first year of injury to those who did not. This retrospective case-control analysis conducted with six US rehabilitation hospitals used SCI Model Systems (SCIMS) data comparing 1-year postinjury outcomes between individuals with miSCI who participated in standardized LT to those who received usual care (UC). Participants were matched on age, gender, injury year, mode of mobility, and rehabilitation center. The primary outcome is the FIM Total Motor score. Other outcomes include the FIM Transfer Index, FIM Stairs, and self-reported independence with household mobility, community mobility, and stairs. LT participants reported significantly better FIM Total Motor (difference = 2.812, 95% confidence interval [CI] = 5.896, 17.282) and FIM Transfer Index scores (difference = 0.958, 95% CI = 0.993, 4.866). No significant between-group differences were found for FIM Stairs (difference = 0.713, 95% CI = -0.104, 1.530) or self-reported household mobility (odds ratio [OR] = 5.065, CI = 1.435, 17.884), community mobility (OR = 2.933, 95% CI = 0.868, 9.910), and stairs (OR = 5.817, 95% CI = 1.424, 23.756) after controlling for multiple comparisons. LT participants reported significantly greater improvements in primary and secondary measures of mobility and independence (FIM Total Motor score; FIM Transfer Index) compared to UC participants. Self-reported mobility outcomes were not significant between groups.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139268837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Delivery of Overground Exoskeleton Gait Training in Persons With Spinal Cord Injury Across the Continuum of Care: A Retrospective Analysis","authors":"Dannae Arnold, Jaime Gillespie, Monica Bennett, Librada Callender, Seema Sikka, Rita Hamilton, Simon Driver, Chad Swank","doi":"10.46292/sci23-00001","DOIUrl":"https://doi.org/10.46292/sci23-00001","url":null,"abstract":"Background After spinal cord injury (SCI), inpatient rehabilitation begins and continues through outpatient therapy. Overground exoskeleton gait training (OEGT) has been shown to be feasible in both settings, yet its use as an intervention across the continuum has not yet been reported. Objectives This study describes OEGT for patients with SCI across the continuum and its effects on clinical outcomes. Methods Medical records of patients with SCI who completed at least one OEGT session during inpatient and outpatient rehabilitation from 2018 to 2021 were retrospectively reviewed. Demographic data, Walking Index for Spinal Cord Injury-II (WISCI-II) scores, and OEGT session details (frequency, “walk” time, “up” time, and step count) were extracted. Results Eighteen patients [male (83%), White (61%), aged 37.4 ± 15 years, with tetraplegia (50%), American Spinal Injury Association Impairment Scale A (28%), B (22%), C (39%), D (11%)] completed OEGT sessions (motor complete, 18.2 ± 10.3; motor incomplete, 16.7 ± 7.7) over approximately 18 weeks (motor complete, 15.1 ± 6.4; motor incomplete, 19.0 ± 8.2). Patients demonstrated improved OEGT session tolerance on device metrics including “walk” time (motor complete, 7:51 ± 4:42 to 24:50 ± 9:35 minutes; motor incomplete, 12:16 ± 6:01 to 20:01 ± 08:05 minutes), “up” time (motor complete, 16:03 ± 7:41 to 29:49 ± 12:44 minutes; motor incomplete, 16:38 ± 4:51 to 23:06 ± 08:50 minutes), and step count (motor complete, 340 ± 295.9 to 840.2 ± 379.4; motor incomplete, 372.3 ± 225.2 to 713.2 ± 272). Across therapy settings, patients with motor complete SCI experienced improvement in WISCI-II scores from 0 ± 0 at inpatient admission to 3 ± 4.6 by outpatient discharge, whereas the motor incomplete group demonstrated a change of 0.2 ± 0.4 to 9.0 ± 6.4. Conclusion: Patients completed OEGT across the therapy continuum. Patients with motor incomplete SCI experienced clinically meaningful improvements in walking function.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"103 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135872449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}