Topics in Spinal Cord Injury Rehabilitation最新文献

{"title":"Evaluating Access to Neuropsychological Services for Individuals with Spina Bifida: Insights from the 2022 Provider Survey.","authors":"Lizabeth L Jordan, Rosalia Costello, Beatriz MacDonald, Amy Heffelfinger, Erin F Jones, T Andrew Zabel, Jennifer T Queally","doi":"10.46292/sci24-00023","DOIUrl":"10.46292/sci24-00023","url":null,"abstract":"<p><strong>Background: </strong>Many people with spina bifida (SB) have congenital brain malformations and receive neurosurgical intervention that can impact cognitive, behavioral, and emotional functioning. The Spina Bifida Association's (SBA) guidelines for care recommend that people with SB have neuropsychology evaluations to assess cognitive, behavioral, and emotional functioning throughout their lifespan; however, people with SB anecdotally report having trouble finding and accessing such care.</p><p><strong>Objectives: </strong>The goal of this study was to gain information about neuropsychology services available to people with SB and identify possible barriers to care.</p><p><strong>Methods: </strong>Neuropsychologists in the United States were invited to complete a practice-focused survey created by members of the Spina Bifida Neuropsychology Collaborative (SBNC). The survey was emailed to professional neuropsychology listservs and directly to providers at the SBA Clinic Care Partner and National Spina Bifida Patient Registry (NSBPR) sites.</p><p><strong>Results: </strong>Responses from 34 neuropsychologists (representing 22 sites, including 40% of SBA Clinic Care Partner sites and 67% of NSBPR sites) indicated that multilingual SB-focused neuropsychology services are available within all regions of the United States. Comprehensive, outpatient evaluations are common; however, integration of neuropsychology services into inpatient settings and multidisciplinary clinics is limited. Respondents report that waitlist time is the most frequent barrier to neuropsychology care, followed by cost/insurance/payor type, travel/transportation difficulties, and limited referrals.</p><p><strong>Conclusion: </strong>There are considerable gaps in the currently available array of US-based neuropsychology services for individuals with SB. Neuropsychologists and SB clinical programs are encouraged to strategically increase availability of neuropsychological services and expand care options.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 2","pages":"104-113"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530245","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":"Influence of Dietary Quality on Neurogenic Bowel Dysfunction in Individuals With Spinal Cord Injury.","authors":"Willemijn X M Faber, Janneke Nachtegaal, Janneke Stolwijk, Ben J M Witteman, Renate Winkels","doi":"10.46292/sci24-00055","DOIUrl":"10.46292/sci24-00055","url":null,"abstract":"<p><strong>Background: </strong>Neurogenic bowel dysfunction (NBD) occurs in up to 95% of individuals with spinal cord injury (SCI) and negatively impacts the quality of life. Although diet is an important component in the management of NBD, the relationship between diet quality and NBD is understudied in the SCI population.</p><p><strong>Objectives: </strong>To assess the diet quality of individuals with chronic SCI and explore possible relationships between diet quality, especially fiber, and symptoms of NBD, and to evaluate whether individuals with SCI themselves recognize relationships between dietary intake and NBD symptoms.</p><p><strong>Methods: </strong>Individuals with chronic SCI, recruited via their rehabilitation center, completed web-based questionnaires and 24-hour dietary recalls regarding the quality and intake of their diet and the severity of NBD. Ten individuals participated in interviews to explore their views on potential relationships between their diet and NBD.</p><p><strong>Results: </strong>Twenty-eight participants were recruited, of which ten were interviewed. All participants had symptoms of NBD of varying degrees and a low diet quality, but there was no difference between the NBD groups. The more severe NBD group had a lower intake of vegetables and a higher intake of salt. Almost half of the participants interviewed did not report experiencing an association between dietary intake and their NBD.</p><p><strong>Conclusions: </strong>A low diet quality was observed among individuals with chronic SCI, irrespective of their NBD symptoms. Many participants were unaware of a potential relationship between their diet and NBD. The sample size is insufficient to draw definitive conclusions; however, a potential hypothesis is that those with more severe NBD may consume not enough vegetables and too much salt. Further longitudinal prospective research is required to enhance nutritional guidelines for individuals with SCI and NBD.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":"42-51"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504703","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":"No Beneficial Effects of the Alfasigma VSL#3 Probiotic Treatment After Cervical Spinal Cord Injury in Rats.","authors":"Pamela J F Raposo, Antoinette T Nguyen, Emma K A Schmidt, Abel Torres Espin, Keith K Fenrich, David J Bennett, Karim Fouad","doi":"10.46292/sci24-00004","DOIUrl":"10.46292/sci24-00004","url":null,"abstract":"<p><strong>Background: </strong>The bidirectional communication between the gastrointestinal tract and the central nervous system appears to be linked to the intestinal microbiome. Research has shown that spinal cord injury (SCI) can disrupt the gut microbiome, leading to gut dysbiosis. These changes can have several negative impacts, such as exacerbated systemic inflammation and susceptibility to infection. Probiotics administered to mice with SCI have been shown to ameliorate gut dysbiosis, confer neuroprotection, and improve locomotor recovery. However, probiotics have also produced conflicting results, making potential claims regarding the application of probiotics as a therapeutic supplement ambiguous.</p><p><strong>Objectives: </strong>This study aimed to investigate the effects of a commercially available probiotic on recovery in a rat model of cervical SCI.</p><p><strong>Methods: </strong>Rats with cervical contusion SCI received probiotics over 7 days immediately after injury, and their recovery in motor, sensory, and cognitive tasks was compared to that of untreated animals.</p><p><strong>Results: </strong>Compared with a control group, the oral administration of probiotics influenced neither motor nor cognitive outcomes. We did observe a significantly different lesion size between the two groups, where the probiotic group had less spared tissue, despite a lack of differences in functional outcomes. In addition, probiotic treatment delayed gut microbiome composition recovery to baseline levels for up to 35 days postinjury (DPI). We found significantly higher proportions of <i>Lactobacillus</i> in the fecal matter of SCI-vehicle rats at 35 DPI, whereas <i>Streptococcus</i> was higher in SCI-probiotics fecal matter at 14 and 35 DPI, and <i>Bacillales</i> was higher in the latter group at 35 DPI.</p><p><strong>Conclusion: </strong>Taken together, our results do not support the application of the utilized probiotic cocktail as a dietary supplement for the treatment of cervical SCI-induced gut dysbiosis and secondary complications.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":"1-16"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504708","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":"Nutritional Intakes of People With Spinal Cord Injury Who Have Pressure Injuries in Hospital: A Secondary Analysis of a Randomized Controlled Trial.","authors":"Amy N Nevin, Kathleen Dwyer, Sridhar S Atresh, Angela Vivanti, Ingrid J Hickman, Merrilyn Banks","doi":"10.46292/sci24-00003","DOIUrl":"10.46292/sci24-00003","url":null,"abstract":"<p><strong>Background: </strong>People living with spinal cord injury (SCI) have one of the highest rates of pressure injury prevalence globally, yet the nutrition-related characteristics of this group are inadequately described.</p><p><strong>Objectives: </strong>This secondary analysis aimed to explore the nutritional status, dietary intakes, and healing outcomes of people with SCI who have pressure injuries in hospital.</p><p><strong>Methods: </strong>Participant demographics, pressure injury-related information, anthropometry, nutritional status (subjective global assessment), and nutrition interventions were recorded. Assessments of energy and protein intake (24-hour dietary recalls), comparison with evidence-based guideline recommendations, and pressure injury healing (surface area measurements) were collected weekly until one of these occurred: complete healing, hospital discharge, surgical repair, or day 28. Factors associated with overall healing were explored using Mann-Whitney <i>U</i> tests.</p><p><strong>Results: </strong>Twenty-six people (mean age, 51 ± 14 years; 81% male) were included. Most were well nourished (77%), receiving dietetic input (85%), and on high-protein, high-energy diets (92%). Between 50% and 90% were exceeding energy and protein recommendations at all time points, and there was a weak negative correlation between energy intake and healing (<i>r</i> = -0.430, <i>P</i> = .036). Reduced healing was observed among participants with severe pressure injuries (stage 4 or unstageable, size >5 cm², >1 pressure injury present) and in those exceeding energy and protein recommendations (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>People with SCI who have coexisting pressure injuries are at risk of excess intake that may be detrimental for pressure injury healing. Future studies examining the nutritional requirements of this population and the impact of both under- and overnutrition are critically needed to guide clinical care.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":"17-29"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504719","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 Novel Testing Battery for Preserved Autonomic Regulation Following Spinal Cord Injury and New Translationally Focused Data Representation.","authors":"Ryan Solinsky, Kathryn Burns, Jason W Hamner, Daniel D Veith, Wolfgang Singer, J Andrew Taylor","doi":"10.46292/sci24-00071","DOIUrl":"10.46292/sci24-00071","url":null,"abstract":"<p><strong>Background: </strong>Autonomic dysfunction is common after spinal cord injury (SCI). There are currently limited tools to comprehensively characterize its deficits. While individual established autonomic tests have a long history and sound scientific background, translating these autonomic testing results to inform clinical understanding is a major barrier.</p><p><strong>Objectives: </strong>To assess a strategic battery of autonomic tests to characterize and act as a biomarker of autonomic regulation for individuals with SCI and to develop a novel graphical representation of these data to facilitate understanding of autonomic dysfunction after SCI.</p><p><strong>Methods: </strong>We outline a battery of six laboratory autonomic tests that were curated to collectively describe the ability of individuals with SCI to inhibit and recruit sympathetic activity through the injured spinal cord. Heart rate/blood pressure variability, bolus phenylephrine, hand and foot cold pressor, Valsalva maneuver, and bladder pressor are herein described. Incorporating normative control data for 30 uninjured individuals completing this testing battery, we further demonstrate the utility of a composite biomarker, comparing these control results to 11 individuals with SCI.</p><p><strong>Results: </strong>Results demonstrate strong normality of data with testing psychometrics, suggesting stable reproducibility with repeat testing. Even in this preliminary sample of individuals with SCI, clear differences begin to emerge compared to uninjured norms. This illustrates the ability of this collective testing battery to characterize autonomic regulation after SCI. To aid in clinical translation, we further present a graphical representation, an <i>autonomic phenotype</i>, which serves as a snapshot of how normal or abnormal sympathetic inhibition and recruitment of activation may be after SCI.</p><p><strong>Conclusion: </strong>Utilizing these autonomic phenotypes, three example cases of individuals with SCI highlight evidence of varied degrees of autonomically complete SCI. Together, this represents a key advancement in our understanding of autonomic function after SCI.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 2","pages":"50-61"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530242","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":"Grocery Shopping and Eating Behaviors Differ Between Persons With and Without a Spinal Cord Injury.","authors":"Zachary J Donato, Adam S Levy, Alicia Sneij, Sherri L LaVela, Arthur S Berg, Lauren T Shapiro, Gary J Farkas","doi":"10.46292/sci24-00028","DOIUrl":"10.46292/sci24-00028","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) heightens the susceptibility to neurogenic obesity, which is driven by alterations in energy metabolism and suboptimal dietary habits after injury. Those with SCI may adjust their grocery shopping and eating behaviors, notably influencing overall health outcomes.</p><p><strong>Objectives: </strong>To assess differences in grocery shopping and eating behaviors between persons with and without (controls) SCI.</p><p><strong>Methods: </strong>In an online, cross-sectional study, adults with (<i>n</i> = 207) and without (<i>n</i> = 52) SCI completed a one-time survey that assessed grocery shopping behavior (shopping frequency and who completed the shopping) and eating behaviors, including the frequency of consuming alcoholic beverages, fast food, and preferences for fried food. Regression analyses were employed for group comparisons, controlling for relevant measures.</p><p><strong>Results: </strong>Compared to the controls, a smaller proportion of persons with SCI grocery shopped independently in person (<i>P</i> = .002), and a greater proportion relied on others to fulfill grocery needs (<i>P</i> = .008). Individuals with SCI demonstrated a reduced monthly frequency of overall (<i>P</i> = .019) and independent in-person grocery shopping than controls (<i>P</i> = .014). In contrast, the monthly frequency of grocery shopping through delivery and from their caregivers was similar (<i>P</i> > .05). Fried food and fast-food intake were comparable (<i>P</i> > .05), whereas alcoholic beverage consumption was lower in individuals with SCI than controls (<i>P</i> = .006).</p><p><strong>Conclusion: </strong>People with SCI reported obtaining groceries less often than controls, and a greater proportion relied on others, rather than themselves, to fulfill grocery needs. These findings highlight the influence of SCI on biobehavioral activities affecting neurogenic obesity, suggesting potential targets for interventions to enhance health outcomes post-SCI.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":"66-76"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504692","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 Effects of Functional Electrical Stimulation Cycling on Muscle Spasticity in Individuals With Spinal Cord Injury: A Systematic Review.","authors":"Stephanie K Couper, Moira Smith","doi":"10.46292/sci23-00048","DOIUrl":"10.46292/sci23-00048","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effects of functional electrical stimulation (FES) cycling on muscle spasticity in individuals with spinal cord injury (SCI) and provide recommendations for optimal FES cycling parameters to treat muscle spasticity.</p><p><strong>Method: </strong>In this systematic review, database searches of CINAHL, MEDLINE (Ovid), PEDro, PubMed, and Scopus were conducted to identify relevant studies published up to June 2023. Studies were screened for eligibility. Those that included an FES cycling intervention, an outcome measure of spasticity, and were available in full-text English were included. Two independent reviewers extracted the data and appraised the literature via the Crowe Critical Appraisal Tool (CCAT).</p><p><strong>Results: </strong>Of the 1782 studies identified, 16 satisfied the criteria for this review. Two-hundred and three participants were included, aged 7 to 80 years old. Ten studies identified a reduction in spasticity following FES cycling via objective or subjective outcome measures. Methodological quality was variable, with CCAT scores ranging from 19/40 (48%) to 35/40 (88%). National Health and Medical Research Council hierarchy levels ranged from II to IV.</p><p><strong>Conclusion: </strong>Evidence for the effectiveness of FES cycling to reduce muscle spasticity remains inconclusive. Long-term effects on spasticity were evident in moderate- to high-quality studies where FES cycling was conducted for 60 minutes, three times per week for 16 weeks. Additional research with larger sample sizes is warranted to confirm these findings. Further clarification of the optimal parameters of FES frequency, amplitude, and pulse width to reduce spasticity is required.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":"77-99"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504648","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":"Comparing the Accuracy of Standard Equations to Predict Glomerular Filtration Rate for Persons with Spinal Cord Injury: Which Is the \"Best Fit?\"","authors":"Nicholas Brown, Kathryn Struck, Terry Romo, Wouter Koek, Ashley Everett Garcia, Mark Fredrickson, Michelle Trbovich","doi":"10.46292/sci24-00001","DOIUrl":"10.46292/sci24-00001","url":null,"abstract":"<p><strong>Background: </strong>Patients with spinal cord injury (SCI) are at increased risk of renal insufficiency, so their renal function must regularly be monitored. Glomerular filtration rate (GFR) assessment is challenging as it requires measuring clearance of exogenous markers, which is impractical in most clinical settings. Thus, equations have been formulated to estimate GFR that utilize serum creatinine (Cr) or cystatin C (CysC).</p><p><strong>Objectives: </strong>Given loss of muscle mass after SCI, we hypothesized equations using CysC would be more accurate than those using Cr after SCI.</p><p><strong>Methods: </strong>Fifty-eight persons (51 male/7 female; age 22-87 years) with SCI level C2-L1/AIS A-D were enrolled. Serum CysC and Cr, 24-hour urine creatinine (24hrUCr) and 24-hour urine urea (24hrUurea) were collected. Average of the 24hrUCr clearance and 24hrUurea clearance was calculated (AvgCl_CrUr). Six GFR estimating equations were compared to AvgCl_CrUr. For each equation, mean bias (AvgCl_CrUr - eGFR) was calculated followed by the Pearson correlation calculation between AvgCl_CrUr and eGFR. In addition, the percentage of estimated values within 15%, 30%, and 50% of AvgCl_CrUr values are reported for each estimating equation.</p><p><strong>Results: </strong>2012 CKD-EPI CysC equation (bias 9.32 mg/dL, 95% CI, -1.23 to -17.41) was the most accurate predictor of GFR. This model accurately predicted GFR of 81%, 57%, and 33% within ±50%, ±30%, and ±15% of the AvgCl_CrUr, respectively. <b>Conclusion</b>: In persons with SCI, the CKD-EPI 2012 CysC equation, which uses cystatin C rather than creatinine, is the most accurate of the six equations tested in estimating GFR in persons with SCI.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 4","pages":"57-65"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773693","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":"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":"Predicting Complete versus Incomplete Long-Term Functional Independence after Acute AIS Grade D Spinal Cord Injury: A Prospective Cohort Study.","authors":"Antoine Dionne, Andréane Richard-Denis, Jean-Marc Mac-Thiong","doi":"10.46292/sci23-00090","DOIUrl":"10.46292/sci23-00090","url":null,"abstract":"<p><strong>Background: </strong>The proportion of patients with American Spinal Injury Association Impairment Scale (AIS) grade D traumatic spinal cord injuries (tSCI) is increasing. Although initial motor deficits can be relatively mild, some individuals fail to recover functional independence.</p><p><strong>Objectives: </strong>This study aims to identify factors associated with failure to reach complete functional independence after AIS grade D tSCI.</p><p><strong>Methods: </strong>An observational prospective cohort study was conducted at a level 1 trauma center specialized in SCI care. A prospective cohort of 121 individuals with an AIS-D tSCI was considered. The baseline characteristics, length of acute stay, need for inpatient rehabilitation, and 12-month functional status were assessed. Univariate and classification and regression tree (CART) analyses were performed to identify factors associated with reaching complete versus incomplete functional independence (defined as perfect total SCIM III score at 12-month follow-up).</p><p><strong>Results: </strong>There were 69.3%, 83.3%, and 61.4% individuals reaching complete independence in self-care, respiration/sphincter management, and mobility, respectively. A total of 64 individuals (52%) reached complete functional independence in all three domains. In the CART analysis, we found that patients are more likely to achieve complete functional independence when they have a baseline motor score ≥83 (65% individuals) and if they present fewer medical comorbidities (70% individuals if Charlson Comorbidity Index [CCI] ≤4).</p><p><strong>Conclusion: </strong>About half of individuals with AIS grade D tSCI can expect complete long-term functional independence. It is important to recognize early during acute care individuals with baseline motor score <83 or a high burden of comorbidities (CCI ≥5) to optimize their rehabilitation plan.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"30 3","pages":"50-58"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976854","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}