China Rehabilitation Research Center Research Articles

Development and Validation of a Nomogram for Predicting Heterotopic Ossification Following Spinal Cord Injury

ObjectiveHeterotopic ossification (HO) following spinal cord injury (SCI) can severely compromise patient mobility and quality of life. Precise identification of SCI patients at an elevated risk for HO is crucial for implementing early clinical interventions. While the literature presents diverse correlations between HO onset and purported risk factors, the development of a predictive model to quantify these risks is likely to bolster preventive approaches. This study is designed to develop and validate a nomogram-based predictive model that estimates the likelihood of HO in SCI patients, utilizing recognized risk factors to expedite clinical decision-making processes. MethodsWe recruited a total of 145 patients with SCI and presenting with HO who were hospitalized at the China Rehabilitation Research Center, Beijing Boai Hospital, from June 2016 to December 2022. Additionally, 337 patients with SCI without HO were included as controls. Comprehensive data were collected for all study participants, and subsequently, the dataset was randomly partitioned into training and validation groups. Using Least Absolute Shrinkage and Selection Operator regression, variables were meticulously screened during the pretreatment phase to formulate the predictive model. The efficacy of the model was then assessed using metrics including receiver-operating characteristic (ROC) analysis, calibration assessment, and decision curve analysis. ResultsThe final prediction model incorporated age, sex, complete spinal cord injury status, spasm occurrence, and presence of deep vein thrombosis (DVT). Notably, the model exhibited commendable performance in both the training and validation groups, as evidenced by areas under the ROC curve (AUCs) of 0.756 and 0.738, respectively. These values surpassed the AUCs obtained for single variables, namely age (0.636), sex (0.589), complete spinal cord injury (0.681), spasm occurrence (0.563), and DVT presence (0.590). Furthermore, the calibration curve illustrated a congruence between the predicted and actual outcomes, indicating the high accuracy of the model. The decision curve analysis indicated substantial net benefits associated with the application of the model, thereby underscoring its practical utility. ConclusionsHO following SCI correlates with several identifiable risk factors, including male gender, youthful age, complete SCI, spasm occurrence and DVT. Our predictive model effectively estimates the likelihood of HO development by leveraging these factors, assisting physicians in identifying patients at high risk. Subsequently, correct positioning to prevent spasm-related deformities and educating healthcare providers on safe lower limb mobilization techniques are crucial to minimize muscle injury risks from rapid iliopsoas muscle extension. Additionally, the importance of early DVT prevention through routine screening and anticoagulation is emphasized to further reduce the incidence of HO.

Long-term trends and risk factors of tracheostomy and decannulation in patients with cervical spinal cord Injury.

Retrospective study. To investigate the risk factors of tracheostomy and decannulation after cervical spinal cord injury (CSCI) and their epidemiological changes over the past 8 years in Beijing Bo'ai Hospital, China Rehabilitation Research Center (CRRC), China. Beijing Bo'ai Hospital, CRRC. We reviewed 8 years of patient data (2013.1.1 to 2020.12.31) at CRRC, focusing on those hospitalized and diagnosed with CSCI. We analyzed changes in demographic and clinical data's trends. Logistic regression analysis was used to determine factors impacting tracheostomy and decannulation. Finally, 1641 CSCI patients met the inclusion criteria. Over the past 8 years, the proportion of tracheostomized patients with CSCI was 16.3%, and the proportion of successfully decannulated of tracheostomized patients with TCSCI was 77.9%. We found that Traumatic (OR = 1.8, 95% CI = 1.06, 3.22; p = 0.046), Motor level of injury (C5-C8) (OR = 0.32, 95% CI = -1.91,-0.34; p = 0.005), AIS = A/B/C (OR = 22.7/11.1/4.2, 95% CI = 12.16,42.26/5.74,21.56/2.23,7.89; p < 0.001/p < 0.001/p < 0.001), age > 56 (OR = 1.6, 95% CI = 1.04, 2.32; p = 0.031) were the risk factors for tracheostomy. By analyzing the risk factors of decannulation failure in tracheostomized patients with TCSCI through multivariable logistic regression, statistically significant differences were found in age > 45 (OR = 4.1, 95% CI = 1.44, 11.81; p = 0.008), complete injury (OR = 2.7, 95% CI = 1.26, 5.95; p = 0.011), facet dislocation (OR = 2.8, 95% CI = 1.13,7.07; p = 0.027). Recent years have witnessed shifts in the epidemiological characteristics of CSCI. Identifying the factors influencing tracheostomy and decannulation in CSCI can aid in improving patient prognosis.

Clinical characteristics and proposed mechanism of pediatric spinal cord injury resulting from backbend practice.

Pediatric spinal cord injury without radiographic abnormality (SCIWORA) caused by backbend practice is increasing. This study proposed an underlying 'combined injury mechanism' related to the spinal cord and femoral nerve overstretching. Pediatric patients diagnosed with backbend-associated SCIWORA at the China Rehabilitation Research Center during 2017-2021 were recruited. Clinical and imaging data were collected, and each patient's clinical course and prognosis were determined. Healthy dancers were recruited to simulate the backbend, obtain images, and estimate the spinal cord and femoral nerve stretch ratio. A model for the 'combined injury mechanism' was established using 4-week-old SD rats. Forty-two SCIWORA female patients with an average age of 6 (SD 1) years and an average hospitalization time of 91 (SD 43) days were assessed. The primary initial symptom was pain in the back and/or lower extremities (33, 79%). The average time from injury onset to severe paralysis was 2.0 (SD 0.6) hours. Most patients had complete paraplegia (32, 76%), and neurological levels were distributed mainly in thoracic segments (38, 91%). Patients with elicited tendon reflexes on admission tended to have an incomplete spinal cord injury (p = 0.001) and improved motor recovery (p = 0.018). After one year, the most common complications were scoliosis (31, 74%) and abnormal hips (14, 33%). Injury of the caudal spinal cord torn by nerve roots was confirmed by surgical exploration in a case. The thoracic spinal cord and femoral nerves were overstretched by 148.8 ± 3.6% and111.7 ± 4.0%, respectively, in a full backbend posture. The 'combined injury mechanism' was partially replicated in the animal model. Spinal overstretch and transient dislocation are considered the primary mechanisms by which SCIWORA occurs in children. Overstretching the femoral nerve aggravates spinal cord injuries caused by backbend practice.

Exploring the Feasibility of Machine Learning to Predict Risk Stratification Within 3 Months in Chest Pain Patients with Suspected NSTE-ACS

ObjectiveWe aimed to assess the feasibility and superiority of machine learning (ML) methods to predict the risk of Major Adverse Cardiovascular Events (MACEs) in chest pain patients with NSTE-ACS. MethodsEnrolled chest pain patients were from two centers, Beijing Anzhen Emergency Chest Pain Center Beijing Bo’ai Hospital, China Rehabilitation Research Center. Five classifiers were used to develop ML models. Accuracy, Precision, Recall, F-Measure and AUC were used to assess the model performance and prediction effect compared with HEART risk scoring system. Ultimately, ML model constructed by Naïve Bayes was employed to predict the occurrence of MACEs. ResultsAccording to learning metrics, ML models constructed by different classifiers were superior over HEART (History, ECG, Age, Risk factors, & Troponin) scoring system when predicting acute myocardial infarction (AMI) and all-cause death. However, according to ROC curves and AUC, ML model constructed by different classifiers performed better than HEART scoring system only in prediction for AMI. Among the five ML algorithms, Linear support vector machine (SVC), Naïve Bayes and Logistic regression classifiers stood out with all Accuracy, Precision, Recall and F-Measure from 0.8 to 1.0 for predicting any event, AMI, revascularization and all-cause death (vs. HEART ≤ 0.78), with AUC from 0.88 to 0.98 for predicting any event, AMI and revascularization (vs. HEART ≤ 0.85). ML model developed by Naïve Bayes predicted that suspected acute coronary syndrome (ACS), abnormal electrocardiogram (ECG), elevated hs-cTn I, sex and smoking were risk factors of MACEs. ConclusionCompared with HEART risk scoring system, the superiority of ML method was demonstrated when employing Linear SVC classifier, Naïve Bayes and Logistic. ML method could be a promising method to predict MACEs in chest pain patients with NSTE-ACS.

Prediction of motor function in patients with traumatic brain injury using genetic algorithms modified back propagation neural network: A data-based study.

Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. In this study, the characteristics of the patients, who were admitted to the China Rehabilitation Research Center, were elucidated in the TBI database, and a prediction model based on the Fugl-Meyer assessment scale (FMA) was established using this database. A retrospective analysis of 463 TBI patients, who were hospitalized from June 2016 to June 2020, was performed. The data of the patients used for this study included the age and gender of the patients, course of TBI, complications, and concurrent dysfunctions, which were assessed using FMA and other measures. The information was collected at the time of admission to the hospital and 1 month after hospitalization. After 1 month, a prediction model, based on the correlation analyses and a 1-layer genetic algorithms modified back propagation (GA-BP) neural network with 175 patients, was established to predict the FMA. The correlations between the predicted and actual values of 58 patients (prediction set) were described. Most of the TBI patients, included in this study, had severe conditions (70%). The main causes of the TBI were car accidents (56.59%), while the most common complication and dysfunctions were hydrocephalus (46.44%) and cognitive and motor dysfunction (65.23 and 63.50%), respectively. A total of 233 patients were used in the prediction model, studying the 11 prognostic factors, such as gender, course of the disease, epilepsy, and hydrocephalus. The correlation between the predicted and the actual value of 58 patients was R 2 = 0.95. The genetic algorithms modified back propagation neural network can predict motor function in patients with traumatic brain injury, which can be used as a reference for risk and prognosis assessment and guide clinical decision-making.

The trends in sports-related spinal cord injury in China.

Retrospective epidemiological study. To determine the characteristics of sports-related spinal cord injury (SCI) in China and assess changes in the trend of these injuries that may impact policy making. China Rehabilitation Research Center (CRRC), Beijing. Of the 2448 SCI cases reviewed, 6.7% (n = 164) were caused by sport- and recreation-related accidents. They were admitted to the CRRC between January 1, 2013 and December 31, 2019. We collected data on age, sex, etiology, the neurological level of injury, the American Spinal Injury Association (ASIA) Impairment Scale (AIS) scores on admission, and the neurological recovery results at discharge. Dancing (58.6%), followed by water sports (14.7%) and taekwondo (4.2%) were the leading etiologies. Of the SCIs caused by dancing, 27.1% of the individuals had incomplete injury, and of these, 57.7% showed improved neurological function. However, 72.9% had complete injury, and these individuals did not show any improvement in neurological function. Individuals with dance-related SCIs graded as A and D according to the AIS, showed no significant improvement in their motor function scores at the time of discharge. While the scores of those graded B and C increased significantly, there were no significant differences in the light touch and pin touch scores. The etiology of sports-related SCI in China has changed dramatically, with dancing replacing water sports as the primary cause of SCIs. Individuals with dance-related SCIs have a poor prognosis. In China, prevention of dance-related SCIs has become a priority.

Clinical efficacy of idebenone in stroke patients with mild cognitive impairment, and its effect on regional homogeneity of resting-state functional magnetic resonance imaging of the brain

Purpose: To evaluate the clinical efficacy of Idebenone in stroke patients with mild cognitive impairment, and its effect on regional homogeneity (ReHo) of resting-state functional magnetic resonance imaging (rs-fMRI) of the brain.&#x0D; Methods: One hundred and twenty stroke patients with mild cognitive impairment who were admitted to the Department of Neurology of the China Rehabilitation Research Center Beijing Boai Hospital from January 2018 to January 2020 were enrolled in this study. The patients were randomly divided into control group and study group. Control group was treated with nimodipine, while the study group received a combination of nimodipine and idebenone.&#x0D; Results: Clinical efficacy was higher in the study group than in the control group (p &lt; 0.05). Scores on Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), and activity of daily living scale (ADL) were significantly elevated (p &lt; 0.05) in both groups after treatment, but scores for MoCA and ADL were significantly higher in the study group than in the control group (p &lt; 0.05). After 6 months of treatment, there were significantly more patients with improved clinical dementia rating (CDR)in the study group than in the control group (p &lt; 0.05).&#x0D; Conclusion: The use of idebenone and nimodipine for treatment of stroke patients with cognitive dysfunction leads to significant improvement in clinical outcomes, and enhancement of cognitive function and quality of life, due to improved brain function in the precuneus. However, the mechanism involved in the combination therapy-induced enhancement of cognitive function requires further investigation.&#x0D; Keywords: Stroke; Cognitive dysfunction; Resting-state functional magnetic resonance imaging of brain; Regional homogeneity; Quality of life

Effect of Aquatic Treadmill Training on Patients with Hemiplegia after Stroke

<bold>Objective</bold> To observe the effect of aquatic treadmill training on resting muscle thickness of the affected side and walking functions of patients with hemiplegia after stroke. <bold>Methods</bold> A total of 40 patients with hemiplegia after stroke hospitalized in the China Rehabilitation Research Center from March 2021 to October 2021, were divided randomly into control group and experiment group according to the random series generated by SPSS 26.0 software, with 20 patients in each group. Both groups received conventional rehabilitation treatment (basic movement training, motor function facilitation, dynamic standing balance training, walking training, etc.), 30 minutes a time, once a day, five days a week, lasting for four weeks. In addition to the conventional rehabilitation treatment, the control group received gait training with the overhead track system and the experiment group received aquatic treadmill training. Both groups were treated for 20 minutes a day, five days a week, lasting for four weeks. Before and after treatment, a full digital handheld color ultrasound diagnostic instrument was used to measure the muscle thickness of obliquus externus abdominis (EO）, internal abdominal oblique (IO), transverse abdominal (TrA), rectus femoris (RF), tibialis anterior (TA) and medial gastrocnemius (MG). GaitWatch 3D gait analysis and sports training system was used to measure velocity, swing time asymmetry ratio and step length asymmetry ratio. <bold>Results</bold> 1) Muscle thickness: compared with that before treatment, the thickness of RF and TA muscles in the control group increased significantly after treatment; the thickness of EO, IO, TrA, RF and TA muscles of the experiment group increased significantly after treatment, the difference was statistically significant (<italic>P</italic>&lt;0.05). Compared with the control group, there was significant increases in thickness of EO, IO, RF and TA muscles in the experiment group (<italic>P</italic>&lt;0.05). 2) Gait velocity, swing time asymmetry ratio, step length asymmetry ratio: compared with that before treatment, gait velocity of both groups after treatment increased significantly, and step length asymmetry ratio decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). <bold>Conclusion</bold> The aquatic treadmill training can improve the affected side muscle thickness, gait velocity and step length asymmetry ratio of patients with hemiplegia after stroke, and is recommended for clinical application.

The Effect of Vocal Intonation Therapy on Vocal Dysfunction in Patients With Cervical Spinal Cord Injury: A Randomized Control Trial.

In this study, the vocal intonation therapy (VIT) was compared with the standard respiratory therapy for people suffering from respiratory dysfunction as a result of cervical spinal cord injury (CSCI) to observe its effect on vocal quality. Thirty patients with vocal dysfunction after CSCI with the injury time of more than 3 months were screened for inclusion in the trial, and 18 patients completed the 12-weeks, each participant had 60 sessions in total in the clinical trial. All patients were allocated to the intervention group or the control group. The intervention group received VIT training and the control group received respiratory phonation therapy. Both groups were trained by professional therapists, and the training time was 30 min/day, 5 days/week, for 60 sessions for each group in a total of 12 weeks. In the Baseline (T0), mid-intervention period (after 6 weeks, T1), and after intervention (after 12 weeks, T2), the vocal quality of the two groups of patients was tested with a computer-aided real-time audio analyzer 2.1.6 (Adobe Systems, United States) for Sing-SPL (p < 0.0001), Speech-SPL (p < 0.0001), SNL (p < 0.0001), and F0 (p < 0.0001) of the intervention group were significantly improved compared with the control group. In comparing the spectrometry analysis of vocal quality for the 2 groups of participants, there was a significant difference in the results of Sing-SPL and Speech-SPL acoustic analysis in the intervention group of patients at T2 (after 12 weeks) compared to the control group. Vocal intonation therapy—music therapy can improve the speech sound quality of cervical CSCI patients and provide CSCI patients with a practical, highly operable treatment that has both functional training effects and can bring a pleasant experience that can be promoted in the medical field. This study was approved by the Ethics Committee of China Rehabilitation Research Center (CRRC) (approval No. 2019-83-1) on May 20th, 2019. It was registered with the National Health Security Information Platform, medical research registration, and filing information system (Registration No. MR-11-21-011802) on January 28th, 2021.

Analysis of Correlation between Serum Inflammatory Factors and Cognitive Function, Language, and Memory in Alzheimer's Disease and Its Clinical Significance.

Objective A case-control study was conducted to explore the correlation between serum inflammatory factor monitoring and cognitive function, language, and memory ability of Alzheimer's disease (AD) and its clinical significance. Methods Thirty-six patients with AD treated from April 2019 to August 2021 in our hospital were enrolled as the study subjects (AD group), and 30 healthy volunteers from the physical examination center and the AD group with the same sex, age, education, and no complaints of memory loss were enrolled as the control group. Montreal Cognitive Assessment (MoCA) and AD Rating Scale-Cognitive (ADAS-cog) were employed to assess the cognitive function of AD and the control group. The Chinese Standard aphasia Test of China Rehabilitation Research Center (CRRCAE) was employed to assess the language function of AD and NC population. The World Health Organization-University of California, Los Angeles Auditory Word Learning Test (WHO-UCLAAV-LT) scale was employed to evaluate the memory function of AD group and control group. The levels of inflammatory factors in serum of the AD group and control group were detected by enzyme-linked immunosorbent assay (ELISA). The serum inflammatory factors levels were compared between the AD group and the control group, and the correlation between the level of serum inflammatory factors and cognitive function, language, and memory ability in the AD group was analyzed. Results In terms of the demographic data of the two groups, there exhibited no significant difference in gender, age, education level, and other general data (P > 0.05). In terms of cognitive function, MoCA scores were remarkably lower compared to the AD group. In the comparison of memory ability, the scores of long-term delayed recognition, delayed memory, and instantaneous memory in the AD group were remarkably lower (P < 0.05). In the comparison of language ability, the scores of listening comprehension, reading, and naming in the AD group exhibited remarkably lower (P < 0.05). With regard to the levels of serum inflammatory factors, the levels of serum interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and CCL-12 in AD group were remarkably higher, while the level of TNF-β in the AD group was lower compared to the control group. Furthermore, there exhibited no significant correlation between the levels of serum IL-4, IL-6, IL-10, TNF-α, CCL-2, and the total scores, MoCA, and ADAS-cog, but there exhibited a positive relationship between the level of serum TNF-β and the score of MoCA scale. The correlations between IL-4, IL-6, IL-10, TNF-α, TNF-β, CCL-2, and the scores of long-term delayed recognition, delayed memory, and instantaneous memory were analyzed in the AD group. The serum levels of IL-4, IL-6, IL-10, TNF-α, CCL-2, and TNF-β were not remarkably correlated with the scores of long-term delayed recognition, delayed memory, and instantaneous memory. The correlations between IL-4, IL-6, IL-10, TNF-α, TNF-β, CCL-2, and the scores of listening comprehension, reading, and naming were analyzed in the AD group, but with no significant correlation between the serum levels of IL-4, IL-6, IL-10, CCL-2, TNF-α, and TNF-β and the scores of listening comprehension, reading, and naming. Conclusion Compared with the control group, the levels of serum IL-4, IL-6, IL-10, TNF-α, and CCL-2 in patients with AD exhibited remarkably higher, while the level of serum TNF-β exhibited remarkably lower. The level of serum TNF-β was remarkably correlated with cognitive function in patients with AD, which may reflect the severity of cognitive impairment in patients with AD.

Clinical value of nutritional risk scores in patients with sepsis associated acute renal injury

To investigate the clinical value of nutritional indexes including body mass index (BMI), albumin (ALB), nutrition risk screening 2002 (NRS 2002) and the nutrition risk in critically ill score (NUTRIC) in 28-day prognosis of patients with sepsis related acute kidney injury (AKI). A prospective cohort study was conducted. Patients with sepsis treated in the emergency intensive care unit (EICU) of China Rehabilitation Research Center from December 1, 2018 to December 1, 2020 were observed for 7 days. Patients with sepsis related AKI were enrolled in this study. The gender, age, BMI, basic diseases, shock, number of affected organs, length of hospital stay, ALB, mechanical ventilation (MV) and vasoactive drug use, sequential organ failure score (SOFA), rapid sequential organ failure score (qSOFA) and acute physiology and chronic health evaluation II (APACHE II) were recorded. The NRS 2002 score and NUTRIC score were calculated. Cox regression model was used to analyze the risk factors of 28-day mortality in patients with sepsis related AKI. The receiver operator characteristic curves (ROC curves) were drawn and the areas under the ROC curves (AUC) were calculated, and the value of BMI, ALB, NRS 2002 score and NUTRIC score was analyzed to predict 28-day mortality in patients with sepsis related AKI. Kaplan Meier survival curves were used to analyze the effects of NRS 2002 score and NUTRIC score stratification on the 28 day prognosis of patients with sepsis related AKI. A total of 140 patients with sepsis related AKI were enrolled, including 73 survival patients and 67 died patients within 28 days. The 28-day mortality was 47.9% (67/140). BMI in the survival group was significantly higher than that in the death group [kg/m2: 22.0 (19.5, 25.6) vs. 20.7 (17.3, 23.9), P < 0.05], and NRS 2002 score and NUTRIC score were significantly lower than those in the death group [NRS 2002 score: 5 (4, 6) vs. 7 (6, 7), NUTRIC score: 6 (5, 7) vs. 7 (6, 9), both P < 0.05]. The ALB of the survival group was slightly higher than that of the death group, but the difference was not statistically significant. Cox regression analysis showed that NRS 2002 score and NUTRIC score were independent risk factors for 28-day death in patients with sepsis related AKI. ROC curve analysis showed that NUTRIC score had the strongest predictive ability for 28-day death [AUC = 0.785, 95% confidence interval (95%CI) was 0.708-0.850], followed by NRS 2002 score (AUC = 0.728, 95%CI was 0.647-0.800), but there was no significant difference between them. Compared with NRS 2002 score, the predictive ability of BMI and ALB was poor. Kaplan-Meier curve analysis showed that the prognosis of patients with NRS 2002 score≥5 was significantly worse than that of patients with NRS 2002 score < 5 (28-day cumulative survival rate: 42.1% vs. 75.6%, Log-Rank test: χ2 = 11.884, P = 0.001), and the prognosis of patients with NUTRIC score ≥ 6 was significantly worse than that of patients with NUTRIC score < 6 (28-day cumulative survival rate: 40.4% vs. 86.1%, Log-Rank test: χ2 = 19.026, P = 0.000). Patients with sepsis related AKI have high nutritional risk. Both NRS 2002 score and NUTRIC score have good predictive value for the prognosis of patients with sepsis related AKI, while BMI and ALB have low predictive value. Due to the complex calculation of NUTRIC score, NRS 2002 score may be more suitable for emergency department.

Study on the relationship between 25-hydroxyvitamin D level and rehabilitation of stroke patients.

To analyse the relationship between 25-hydroxyvitamin D (25(OH)D) level and rehabilitation in stroke patients. 100 stroke patients hospitalized in the Neurorehabilitation Department of China Rehabilitation Research Center from November 2019 to April 2020 were selected as the research subjects. And set up a case group. 50 subjects who underwent outpatient physical examination in China Rehabilitation Research Center in the same period were selected as the control group. The differences of biochemical and bone metabolism indexes such as serum 25(OH)D, blood lipid, liver and kidney function between the two groups were analysed. We took rehabilitation efficacy as the dependent variable, Pearson correlation analysis and multivariate logistic regression analysis were performed to analyse the indicators affecting rehabilitation efficacy. The average level of 25(OH)D in the case group was significantly lower than that in the control group ( p < 0.05). The rehabilitation efficacy was significantly positively correlated with 25(OH)D level ( p < 0.003) and significantly negatively correlated with duration of disease ( p < 0.01) and NIHSS score ( p < 0.05). The increase in 25(OH)D is a protective factor for non-occurrence of cerebral infarction, and the increase in the 25(OH)D level is conducive to the prognosis of cerebral infarction.

Establishment and evaluation of clinical diagnostic scoring system for septic cardiomyopathy

To establish a clinical diagnostic scoring system for septic cardiomyopathy (SCM) and evaluate its diagnostic efficacy. A prospective cohort study was performed. Patients with sepsis and septic shock admitted to the department of emergency of China Rehabilitation Research Center were enrolled from January 2019 to December 2020. The baseline information, medical history, heart rate (HR), mean arterial pressure (MAP), body temperature and respiratory rate (RR) on admission were recorded. Laboratory indexes such as white blood cell count (WBC), hypersensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and blood lactic acid (Lac) were measured. Transthoracic echocardiography was conducted within 24 hours and on the 7th after admission. Sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II), and nutritional risk screening 2002 scale (NRS2002) were also assessed. The patients were divided into two groups according to whether SCM occurred or not. The risk factors of SCM were screened by univariate and multivariate Logistic regression. The cut-off value of continuous index was determined by receiver operator characteristic curve (ROC curve) and discretized concerning clinical data. The regression coefficient β was used to establish the corresponding score, and the clinical diagnostic score system of SCM was established. The diagnostic value of the model was evaluated by ROC curve. In total, 147 patients were enrolled in the study and the incidence of SCM was 28.6% (42/147). Univariate Logistic regression analysis showed the risk factors of SCM included: (1) continuous indicators: age, NT-proBNP, RR, MAP, Lac, NRS2002, SOFA, APACHE II; (2) discrete indicators: shock, use of vasoactive drugs, history of coronary heart disease, acute kidney injury (AKI). Multivariate Logistic regression analysis after discretization of above continuous index showed that age ≥ 87 years old, NT-proBNP ≥ 3 000 ng/L, RR ≥ 30 times/min, Lac ≥ 3 mmol/L and SOFA ≥ 10 points were independent risk factors for SCM [age ≥ 87 years: odds ratio (OR) = 3.491, 95% confidence interval (95%CI) was 1.371-8.893, P = 0.009; NT-proBNP ≥ 3 000 ng/L: OR = 2.708, 95%CI was 1.093-6.711, P = 0.031; RR ≥ 30 times/min: OR = 3.404, 95%CI was 1.356-8.541, P = 0.009; Lac ≥ 3 mmol/L: OR = 3.572, 95%CI was 1.460-8.739, P = 0.005; SOFA ≥ 10 points: OR = 8.693, 95%CI was 2.541-29.742, P = 0.001]. The clinical diagnostic score system of SCM was established successfully, which was composed of age ≥ 87 years old (1 point), NT-proBNP ≥ 3 000 ng/L (1 point), RR ≥ 30 times/min (1 point), Lac ≥ 3.0 mmol/L (1 point), SOFA ≥ 10 points (2 points), and the total score was 6 points. ROC curve analysis showed the cut-off value of the scoring system for diagnosing SCM was 3 points, the area under ROC curve (AUC) was 0.833, 95%CI was 0.755-0.910, P < 0.001, with the sensitivity of 71.4%, and specificity of 86.7%. The clinical diagnostic scoring system has good diagnostic efficacy for SCM and contributes to early identification of SCM for clinicians.

Effect of vocal respiratory training on respiratory function and respiratory neural plasticity in patients with cervical spinal cord injury: a randomized controlled trial.

In previous studies, researchers have used singing to treat respiratory function in patients with spinal cord injury. However, few studies have examined the way in which vocal training affects respiratory neural plasticity in patients with spinal cord injury. Vocal respiratory training (VRT) is a type of vocal muscle-related treatment that is often a component of music therapy (MT) and focuses on strengthening respiratory muscles and improving lung function. In this randomized controlled study, we analyzed the therapeutic effects of VRT on respiratory dysfunction at 3 months after cervical spinal cord injury. Of an initial group of 37 patients, 26 completed the music therapy intervention, which comprised five 30-minute sessions per week for 12 weeks. The intervention group (n = 13) received VRT training delivered by professional certified music therapists. The control group (n = 13) received respiratory physical therapy delivered by professional physical therapists. Compared with the control group, we observed a substantial increase in respiratory function in the intervention group after the 12-week intervention. Further, the nerve fiber bundles in the respiratory center in the medulla exhibited a trend towards increased diversification, with an increased number, path length, thickness, and density of nerve fiber bundles. These findings provide strong evidence for the effect of music therapeutic VRT on neural plasticity. This study was approved by the Ethics Committee of China Rehabilitation Research Center (approval No. 2020-013-1) on April 1, 2020, and was registered with the Chinese Clinical Trial Registry (registration No. ChiCTR2000037871) on September 2, 2020.

Effectiveness of Melodic Intonation Therapy in Chinese Mandarin on Non-fluent Aphasia in Patients After Stroke: A Randomized Control Trial.

Melodic intonation therapy (MIT) positively impacts the speech function of patients suffering from aphasia and strokes. Fixed-pitch melodies and phrases formulated in MIT provide the key to the target language to open the language pathway. This randomized controlled trial compared the effects of music therapy-based MIT and speech therapy on patients with non-fluent aphasia. The former is more effective in the recovery of language function in patients with aphasia. Forty-two participants were enrolled in the study, and 40 patients were registered. The participants were randomly assigned to two groups: the intervention group (n = 20; 16 males, 4 females; 52.90 ± 9.08 years), which received MIT, and the control group (n = 20; 15 males, 5 females; 54.05 ± 10.81 years), which received speech therapy. The intervention group received MIT treatment for 30 min/day, five times a week for 8 weeks, and the control group received identical sessions of speech therapy for 30 min/day, five times a week for 8 weeks. Each participant of the group was assessed by a Boston Diagnostic Aphasia Examination (BDAE) at the baseline (t1, before the start of the experiment), and after 8 weeks (t2, the experiment was finished). The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were also measured on the time points. The best medical care of the two groups is the same. Two-way ANOVA analysis of variance was used only for data detection. In the spontaneous speech (information), the listening comprehension (right or wrong, word recognition, and sequential order) and repetitions of the intervention group were significantly higher than the control group in terms of the cumulative effect of time and the difference between groups after 8 weeks. The intervention group has a significant time effect in fluency, but the results after 8 weeks were not significantly different from those in the control group. In terms of naming, the intervention group was much better than the control group in spontaneous naming. Regarding object naming, reaction naming, and sentence completing, the intervention group showed a strong time accumulation effect. Still, the results after 8 weeks were not significantly different from those in the control group. These results indicate that, compared with speech therapy, MIT based on music therapy is a more effective musical activity and is effective and valuable for the recovery of speech function in patients with non-fluent aphasia. As a more professional non-traumatic treatment method, MIT conducted by qualified music therapists requires deeper cooperation between doctors and music therapists to improve rehabilitating patients with aphasia. The Ethics Committee of the China Rehabilitation Research Center approved this study (Approval No. 2020-013-1 on April 1, 2020) and was registered with the Chinese Clinical Trial Registry (Registration number: Clinical Trials ChiCTR2000037871) on September 3, 2020.

Traumatic spinal cord injury caused by low falls and high falls: a comparative study

BackgroundQuite a few traumatic spinal cord injuries (TSCI) were caused by falls. However, the comparison of different causes of TSCI or the epidemiological characteristics of TSCI caused by falls of different heights are rare. This study investigated the epidemiological characteristics of TSCI caused by falls and conducted a comparison between low falls and high falls.MethodData from cases with TSCI admitted to China Rehabilitation Research Center from 2010 to 2019 were collected, including age, gender, occupation, cause, neurological level, and severity of the injury in admission, combined injuries, complications, and rehabilitation length of stay. Mann-Whitney U and chi-square (χ2) tests were used to assess the differences between two groups at a statistical significance level of 0.05.ResultA total of 1858 TSCI cases were included and 41.7% were caused by falls, 11.4% by low falls and 30.3% by high falls, respectively. Patients with fall-induced TSCI were older and had a shorter rehabilitation length of stay than those with non-fall-induced TSCI. Patients with high fall-induced TSCI were younger and more likely to suffer from paraplegia, severer injuries, and combined injuries, and had longer time from injury to rehabilitation and rehabilitation length of stay, compared with patients with low fall-induced TSCI.ConclusionFalls is the leading causes of TSCI and high fall is becoming more common. Attention not only should be paid to high falls for the severe injury and longer hospitalization, but also low falls due to the higher neurological level of the injury and the aging of population in China.

Positive effects of music therapist's selected auditory stimulation on the autonomic nervous system of patients with disorder of consciousness: a randomized controlled trial.

The current randomized controlled trial was performed at the China Rehabilitation Science Institute, China to test the hypothesis that musical auditory stimulation has positive effects on the autonomic nervous system of patients with disorder of consciousness. Although past studies have recommended that patients with disorder of consciousness listen to patient-preferred music, this practice is not universally accepted by researchers. Twenty patients with severe disorder of consciousness listened to either therapist-selected (n = 10, 6 males and 4 females; 43.33 ± 18.76 years old) or patient-preferred (n = 10, 5 males and 5 females, 48.83 ± 18.79 years old) musical therapy, 30 minutes/day, 5 times/week for 6 weeks. The results showed no obvious differences in heart rate variability-related parameters including heart rate, standard deviation of normal-to-normal R-R intervals, and the root-mean-square of successive heartbeat interval differences of successive heartbeat intervals between the two groups of patients. However, percentage of differences exceeding 50 ms between adjacent normal number of intervals, low-frequency power/high-frequency power, high-frequency power norm, low-frequency power norm, and total power were higher in patients receiving therapist-selected music than in patients receiving their own preferred music. In contrast, this relationship was reversed for the high-frequency power and very-low-frequency band. These results suggest that compared with preferred musical stimulation, therapist-selected musical stimulation resulted in higher interactive activity of the autonomic nervous system. Therefore, therapist-selected musical stimulation should be used to arouse the autonomic nervous system of patients with disorder of consciousness. This study was approved by the Institutional Ethics Committee of China Rehabilitation Research Center, China (approval No. 2018-022-1) on March 12, 2018 and registered with the Chinese Clinical Trial Registry (registration number ChiCTR1800017809) on August 15, 2018.

The changing demographics of traumatic spinal cord injury in Beijing, China: a single-centre report of 2448 cases over 7 years.

Retrospective study. To investigate the epidemiological changes in persons with traumatic spinal cord injury (TSCI) over the past 7 years in Beijing Bo'ai Hospital, China Rehabilitation Research Center, China. Beijing Bo'ai Hospital, China Rehabilitation Research Center (CRRC). A database containing the records of all persons treated with SCI from 1 January 2013 to 31 December 2019 was reviewed. Variables including demographic and clinical data were analysed. Comparisons were made with data previously published in 2002. During the study period, 2448 persons with recent TSCI were included in the analysis. The mean age at the time of injury increased from 38.1 years to 40.2 years (P = 0.025). The percentage of elderly persons increased (8.8-14.6%, P = 0.036) and was higher than that in 2002. The percentage of retirees increased. Transport related injuries were the leading cause of injury and the percentage of TSCI due to low falls increased 6%. Low falls were the most common cause for elderly persons (y ≥ 60) and were even higher for elderly women. Persons with cervical injuries increased compared to the 2002-data (44.1% vs 4.9%). The percentage of persons with incomplete SCI increased significantly over the study duration. Persons with TSCI are becoming older, and the percentage of elderly persons is increasing year by year. These changes are likely due to a combination of population ageing in the region and changes in aetiology, with corresponding changes including an increase in persons with cervical TSCI and persons with incomplete injury.

Effectiveness of oral motor respiratory exercise and vocal intonation therapy on respiratory function and vocal quality in patients with spinal cord injury: a randomized controlled trial.

Singing, as a method of combining respiratory function exercise and vocal intonation therapy, provides a new direction for respiratory function exercise in patients with spinal cord injury. This randomized controlled trial investigated the effects of oral motor respiratory exercise and vocal intonation therapy on respiratory function and vocal quality in patients with spinal cord injury. Among 31 included patients with spinal cord injury, 18 completed the treatment. These 18 patients were randomly assigned to undergo music therapy (intervention group, 30 min/d, 5 times a week, for a total of 12 weeks; n = 9, 7 males and 2 females; 30.33 ± 11.74 years old) or normal respiratory training (control group, n = 9; 8 males and 1 female; 34.78 ± 11.13 years old). Both patient groups received routine treatment concurrently. Before and at 6 and 12 weeks after intervention, a standard respiratory function test, a voice test, the St. George's Respiratory Questionnaire, and a quality of life questionnaire were administered. The results showed that the inspiratory capacity, forced expiratory volume in 1 second, forced vital capacity, maximal mid-expiratory flow rate, sing-loud pressure level, and sustained note length were significantly increased in the intervention group compared with the control group. The St. George's Respiratory Questionnaire and quality of life results of patients in the intervention group were significantly superior to those in the control group. These findings suggest that oral motor respiratory exercise and vocal intonation therapy, as respiratory training methods in music therapy, are effective and valuable for improving respiratory dysfunction and vocal quality in patients with spinal cord injury. This study was approved by the Ethics Committee of China Rehabilitation Research Center (approval No. 2019-78-1) on May 27, 2019 and was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1900026922) on October 26, 2019.

Epidemiological features of traumatic spinal cord injury in Beijing, China

Objective: To describe epidemiological features of traumatic spinal cord injury (TSCI) and to conduct a comparison with data from 2002. Design: Retrospective research. Setting: China Rehabilitation Research Center (CRRC), Beijing. Methods: Five hundred and ninety patients with TSCI were admitted to the CRRC from 1st January 2011 to 31st December 2019. We collected data on sex, age, marital status, etiology, occupation, neurological level of injury, and the American Spinal Injury Association Impairment Scale on admission, time of injury and treatment. Results: Statistically significant differences were observed between data from 2002 and the present results (P < 0.001). The mean age of patients with TSCI was 46.3 ± 15.5 years, and the male/female ratio was 4.73:1. The incidence of TSCI increased gradually with age and peaked in the 40–49 age group. The most common occupation was worker (28.6%), followed by office clerk (16.8%) and retired (15.4%). Fall from heights (30.8%), followed by traffic accidents (27.6%) and low falls (25.1%), were the leading etiologies of TSCI. A majority of patients (54.9%) had cervical injuries, 91.9% underwent surgical treatment, and the lowest number of injuries were recorded during winter (19.6%). Conclusion: According to the changes in the epidemiological characteristics of TSCI, preventative strategies should be readjusted. We should pay more attention to the risk of low falls of the elderly. The authors recommend that stricter regulatory practices and safety measures should be developed alongside infrastructure improvements to reduce, and perhaps prevent TSCI.