Chronic Traumatic Spinal Cord Injury Research Articles

Relationships between self-reported prescription hydrocodone, oxycodone, and tramadol use and unintentional injuries among those with spinal cord injury.

Identify the relationships of three frequently used prescription opioids (hydrocodone, oxycodone, and tramadol) with unintentional injuries, including fall related and non-fall related injuries among adults with chronic, traumatic spinal cord injury (SCI). Cross-sectional cohort study. Community setting; Southeastern United States. Adult participants (N = 918) with chronic traumatic SCI were identified from a specialty hospital and state population-based registry, and completed a self-report assessment. N/A. Self-reported fall related and non-fall related unintentional injuries serious enough to receive medical care in a clinic, emergency room or hospital within the previous 12 months. Just over 20% of participants reported one or more unintentional injury in the past year, with an average of 2.16 among those with at least one. Overall, 9.6% reported fall related injuries. Only hydrocodone was associated with any past year unintentional injuries. Hydrocodone taken occasionally (no more than monthly) or regularly (weekly or daily) was related to 2.63 (95% CI =1.52, 4.56) or 2.03 (95% CI =1.15, 3.60) greater odds of having at least one unintentional injury in the past year, respectfully. Hydrocodone taken occasionally was also associated with past year non-fall related injuries (OR =2.20; 95% CI =1.12, 4.31). Each of the three opioids were significantly related to fall related injuries. Taking hydrocodone occasionally was associated with 2.39 greater odds of fall related injuries and occasional use was associated with 2.31 greater odds. Regular use of oxycodone was associated with 2.44 odds of a fall related injury (95% CI = 1.20, 4.98) and regular use of tramadol was associated with 2.59 greater odds of fall related injury (95% CI = 1.13, 5.90). Injury prevention efforts must consider the potential impact of opioid use, particularly hydrocodone. For preventing fall related injuries, each of the three opioids must be considered.

Poster (Knowledge Generation) ID 1985362

Objective To develop a lower extremity (LE) fragility fracture risk score estimation method among adults with chronic spinal cord injury (SCI). Methods Adults (≥18) with chronic traumatic SCI (n=90, C2-T12, AIS:A-D) participated in a 2-year prospective cohort study. We used a literature search and practice expertise to identify LE fracture predictors. Reference categories (i.e., risk score = 0) were: no prior fracture, 0-9 years post-injury, AIS-CD, no parental history of osteoporosis, and no opioid use. Using logistic regression coefficients, we calculated how far each category is from the base category and computed βi (Wij-WiREF) for each risk factor. In this model, B was the increase in risk associated with each year post injury. The point value for each fracture risk category was calculated by Pointsij=βi (Wij-WiREF)/B. The total points range from 0-21, and the probability of LE fracture is calculated for each point to determine the probability of developing a LE fracture using the formula: Results Most participants had an AIS-A impairment (60.0%), the mean time post-injury=15.23 years (SD=9.58). For the points system (0-17), prior fracture, years post-injury, AIS, Benzodiazepine use, Opioid use, and parental osteoporosis were defined risk factors. An individual’s risk profile can estimate LE fracture risk. A score of 11 equates to 20% or high fracture risk over a 5-year time period. Conclusion We describe our preliminary model to estimate LE fracture risk among those with chronic SCI. We plan to apply statistical and machine learning algorithms using Canadian RHSCIR data and US VHA data to validate the model, and increase the model’s predictability.

Soluble Nogo-Receptor-Fc decoy (AXER-204) in patients with chronic cervical spinal cord injury in the USA: a first-in-human and randomised clinical trial

Spinal cord injury (SCI) causes neural disconnection and persistent neurological deficits, so axon sprouting and plasticity might promote recovery. Soluble Nogo-Receptor-Fc decoy (AXER-204) blocks inhibitors of axon growth and promotes recovery of motor function after SCI in animals. This first-in-human and randomised trial sought to determine primarily the safety and pharmacokinetics of AXER-204 in individuals with chronic SCI, and secondarily its effect on recovery. We conducted a two-part study in adults (aged 18-65 years) with chronic (>1 year) cervical traumatic SCI at six rehabilitation centres in the USA. In part 1, AXER-204 was delivered open label as single intrathecal doses of 3 mg, 30 mg, 90 mg, or 200 mg, with primary outcomes of safety and pharmacokinetics. Part 2 was a randomised, parallel, double-blind comparison of six intrathecal doses of 200 mg AXER-204 over 104 days versus placebo. Participants were randomly allocated (1:1) by investigators using a central electronic system, stratified in blocks of four by American Spinal Injury Association Impairment Scale grade and receipt of AXER-204 in part 1. All investigators and patients were masked to treatment allocation until at least day 169. The part 2 primary objectives were safety and pharmacokinetics, with a key secondary objective to assess change in International Standards for Neurological Classification of SCI (ISNCSCI) Upper Extremity Motor Score (UEMS) at day 169 for all enrolled participants. This trial is registered with ClinicalTrials.gov, NCT03989440, and is completed. We treated 24 participants in part 1 (six per dose; 18 men, six women), and 27 participants in part 2 (13 placebo, 14 AXER-204; 23 men, four women), between June 20, 2019, and June 21, 2022. There were no deaths and no discontinuations from the study due to an adverse event in part 1 and 2. In part 2, treatment-related adverse events were of similar incidence in AXER-204 and placebo groups (ten [71%] vs nine [69%]). Headache was the most common treatment-related adverse event (five [21%] in part 1, 11 [41%] in part 2). In part 1, AXER-204 reached mean maximal CSF concentration 1 day after dosing with 200 mg of 412 000 ng/mL (SD 129 000), exceeding those concentrations that were efficacious in animal studies. In part 2, mean changes from baseline to day 169 in ISNCSCI UEMS were 1·5 (SD 3·3) for AXER-204 and 0·9 (2·3) for placebo (mean difference 0·54, 95% CI -1·48 to 2·55; p=0·59). This study delivers the first, to our knowledge, clinical trial of a rationally designed pharmacological treatment intended to promote neural repair in chronic SCI. AXER-204 appeared safe and reached target CSF concentrations; exploratory biomarker results were consistent with target engagement and synaptic stabilisation. Post-hoc subgroup analyses suggest that future trials could investigate efficacy in patients with moderately severe SCI without prior AXER-204 exposure. Wings for Life Foundation, National Institute of Neurological Disorders and Stroke, National Center for Advancing Translational Sciences, National Institute on Drug Abuse, and ReNetX Bio.

Effect of transcranial magnetic stimulation on functional outcome in patients with incomplete spinal cord injury: A randomized controlled study

Background. Incomplete spinal cord injury is a common disorder leading to sensory or motor function loss. Objective. This study aimed to investigate the effect of repetitive transcranial magnetic stimulation therapy (rTMS) on functional outcome in patients with incomplete spinal cord injury. Design. A prospective randomized controlled trial. Setting. Agouza Rehabilitation Hospital Out clinic. Methods. Forty male patients with chronic traumatic incomplete spinal cord injury aging from 25 to 45years. Patients were randomly divided into two equal groups (group A and group B).Group A was the study group that received rTMS in addition to designed physical therapy program including BWST training and Group B was the control group that received the same designed physical therapy program including BWST training. The functional gait was assessed using walking index for spinal cord injury (WISCI II) and gait speed was assessed using 10 m walk test. Measurements were performed before and after treatment and three months after end of the treatment as follow up. Results. There was a statistically significant improvement in WISCI II and 10m walk test at post treatment and follow up compared with that pre-treatment in study group (P < 0.05). There was no statistically significant improvement in all outcome variables at post treatment and follow up compared with that pretreatment in control group (P > 0.05).There was a statistically significant improvement in patients who received rTMS with BWST compared with patients received BWST only in WISCI II and 10 m walk test at post treatment (p = 0.01 and p = 0.001 respectively) compared to pre treatment. The gained effect was lost at follow up measurement compared to post treatment in WISCI II and the gained effect was maintained at follow up measurement compared to post treatment in 10m walk test score. Conclusion. It was proven that rTMS add a valuable effect for restoring function in patients with incomplete spinal cord injury, particularly in cases when the effect of BWST has reached a plateau.

Magnetic resonance spectroscopy investigation in the right human hippocampus following spinal cord injury.

Preclinical studies have shown that cognitive impairments following spinal cord injury (SCI), such as impaired spatial memory, are linked to inflammation, neurodegeneration, and reduced neurogenesis in the right hippocampus. This cross-sectional study aims to characterize metabolic and macrostructural changes in the right hippocampus and their association to cognitive function in traumatic SCI patients. Within this cross-sectional study, cognitive function was assessed in 28 chronic traumatic SCI patients and 18 age-, sex-, and education-matched healthy controls by a visuospatial and verbal memory test. A magnetic resonance spectroscopy (MRS) and structural MRI protocol was performed in the right hippocampus of both groups to quantify metabolic concentrations and hippocampal volume, respectively. Group comparisons investigated changes between SCI patients and healthy controls and correlation analyses investigated their relationship to memory performance. Memory performance was similar in SCI patients and healthy controls. The quality of the recorded MR spectra was excellent in comparison to the best-practice reports for the hippocampus. Metabolite concentrations and volume of the hippocampus measured based on MRS and MRI were not different between two groups. Memory performance in SCI patients and healthy controls was not correlated with metabolic or structural measures. This study suggests that the hippocampus may not be pathologically affected at a functional, metabolic, and macrostructural level in chronic SCI. This points toward the absence of significant and clinically relevant trauma-induced neurodegeneration in the hippocampus.

Cardio-centric hemodynamic management with and without adjuvant ethyl nitrite improves mean arterial pressure in rodents with chronic high-thoracic traumatic spinal cord injury

Objective: Traumatic spinal cord injury (SCI) causes an initial injury followed by a protracted phase of spinal cord tissue hypoxia. This tissue hypoxia contributes to secondary injury, leading to worse motor and cardio-autonomic outcomes in the chronic setting. No neuroprotective agents to mitigate secondary injury have been identified as efficacious in clinical trials. However, we have demonstrated that taking a cardio-centric approach to hemodynamic management following SCI by augmenting cardiac output and mean arterial pressure (MAP) with the b1-adrenoceptor agonist dobutamine (DOB), and further coupling DOB infusion with the inhalation of ethyl nitrite (ENO), an S-nitrosylating agent, is associated with improved spinal cord oxygenation in the acute phase post-SCI. Aim: To determine the influence of a cardio-centric approach to hemodynamic management with adjuvant ENO inhalation following SCI on long term outcomes. We hypothesized that treatment with DOB and ENO in the acute phase following SCI would mitigate secondary injury and improve cardiovascular outcomes in the chronic setting. Methods. A total of 34 male Wistar rats underwent a T3 contusion injury (300 kdyn) and were assigned into 4 treatment groups: control (n=6), ENO (n=6), DOB (n=12), and combined DOB and ENO (n=10). At 11-weeks post-SCI, a locomotor assessment was conducted using the Basso, Beattie and Bresnahan (BBB) locomotor rating scale. At 12-weeks post-SCI, rodents were anesthetized with intravenous urethane (2.44±0.50 g/kg) and instrumented with a solid-state pressure transducer in the carotid artery to measure MAP. Results. We observed a higher MAP in both DOB (113.6 ± 11.4 mmHg; p = 0.030) and ENO+DOB (116.7 ± 14.6 mmHg; p=0.013) treated groups when compared with controls (94.65 ± 11.62 mmHg). The MAP of ENO treated animals (91.6 ± 7.3 mmHg; P= 0.97) was not different from controls. No differences in BBB scores were found between DOB (15.17 ± 4.49), ENO+DOB (13.95 ± 3.86), ENO (12.5 ± 2.5) and control (11.8 ± 2.7)(P=0.29). Collectively, these data suggest that DOB treatment, alone or in combination with ENO, improves systemic hemodynamics in the chronic high-thoracic SCI setting US Department of Defense, ICORD Seed Grant, Craig H. Neilsen Foundation This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Riluzole for treating spasticity in patients with chronic traumatic spinal cord injury: Study protocol in the phase ib/iib adaptive multicenter randomized controlled RILUSCI trial.

Satisfactory treatment is often lacking for spasticity, a highly prevalent motor disorder in patients with spinal cord injury (SCI). Low concentrations of riluzole potently reduce the persistent sodium current, the post-SCI increase in which contributes to spasticity. The repurposing of this drug may therefore constitute a useful potential therapeutic option for relieving SCI patients suffering from chronic traumatic spasticity. RILUSCI is a phase 1b-2b trial designed to assess whether riluzole is a safe and biologically effective means of managing spasticity in adult patients with traumatic chronic SCI. In this multicenter double-blind trial, adults (aged 18-65 years) suffering from spasticity after SCI (target enrollment: 90 participants) will be randomly assigned to be given either a placebo or a recommended daily oral dose of riluzole for two weeks. The latter dose will be previously determined in phase 1b of the study by performing double-blind dose-finding tests using a Bayesian continuous reassessment method. The primary endpoint of the trial will be an improvement in the Modified Ashworth Score (MAS) or the Numerical Rating Score (NRS) quantifying spasticity. The secondary outcomes will be based on the safety and pharmacokinetics of riluzole as well as its impact on muscle spasms, pain, bladder dysfunction and quality of life. Analyses will be performed before, during and after the treatment and the placebo-controlled period. To the best of our knowledge, this clinical trial will be the first to document the safety and efficacy of riluzole as a means of reducing spasticity in patients with chronic SCI. The clinical trial, which is already in progress, was registered on the ClinicalTrials.gov website on August 9, 2016 under the registration number NCT02859792. Assistance Publique-Hôpitaux de Marseille.

Transcutaneous spinal stimulation in patients with intrathecal baclofen pump delivery system: A preliminary safety study.

To determine the effect of transcutaneous spinal stimulation (TSS) on an implanted intrathecal baclofen (ITB) pump in persons with traumatic spinal cord injury (SCI). Prospective clinical trial. Five individuals with chronic traumatic SCI, >18 years of age, and an anteriorly implanted Medtronic SynchroMed™ II ITB pump delivery system. Transcutaneous spinal stimulation trials with cathode at T11/12, with pump interrogation before, during and after stimulation. There was no evidence of any effect of the TSS in regards to disruption of the ITB pump delivery mechanism. Communication interference with the interrogator to the pump occurred often during stimulation for log transmission most likely secondary to the electromagnetic interference from the stimulation. One individual had elevated blood pressure at the end of the trial, suspected to be unrelated to the spinal stimulation. Based upon this pilot study, further TSS studies including persons with an implanted Medtronic SynchroMed™ II ITB pump can be considered when stimulating at the low thoracic spine, although communication with the programmer during the stimulation may be affected.

Training with noninvasive brain–machine interface, tactile feedback, and locomotion to enhance neurological recovery in individuals with complete paraplegia: a randomized pilot study

In recent years, our group and others have reported multiple cases of consistent neurological recovery in people with spinal cord injury (SCI) following a protocol that integrates locomotion training with brain machine interfaces (BMI). The primary objective of this pilot study was to compare the neurological outcomes (motor, tactile, nociception, proprioception, and vibration) in both an intensive assisted locomotion training (LOC) and a neurorehabilitation protocol integrating assisted locomotion with a noninvasive brain–machine interface (L + BMI), virtual reality, and tactile feedback. We also investigated whether individuals with chronic-complete SCI could learn to perform leg motor imagery. We ran a parallel two-arm randomized pilot study; the experiments took place in São Paulo, Brazil. Eight adults sensorimotor-complete (AIS A) (all male) with chronic (> 6 months) traumatic spinal SCI participated in the protocol that was organized in two blocks of 14 weeks of training and an 8-week follow-up. The participants were allocated to either the LOC group (n = 4) or L + BMI group (n = 4) using block randomization (blinded outcome assessment). We show three important results: (i) locomotion training alone can induce some level of neurological recovery in sensorimotor-complete SCI, and (ii) the recovery rate is enhanced when such locomotion training is associated with BMI and tactile feedback (∆Mean Lower Extremity Motor score improvement for LOC = + 2.5, L + B = + 3.5; ∆Pinprick score: LOC = + 3.75, L + B = + 4.75 and ∆Tactile score LOC = + 4.75, L + B = + 9.5). (iii) Furthermore, we report that the BMI classifier accuracy was significantly above the chance level for all participants in L + B group. Our study shows potential for sensory and motor improvement in individuals with chronic complete SCI following a protocol with BMIs and locomotion therapy. We report no dropouts nor adverse events in both subgroups participating in the study, opening the possibility for a more definitive clinical trial with a larger cohort of people with SCI.Trial registration: http://www.ensaiosclinicos.gov.br/ identifier RBR-2pb8gq.

Preclinical Development of a Therapy for Chronic Traumatic Spinal Cord Injury in Rats Using Human Wharton's Jelly Mesenchymal Stromal Cells: Proof of Concept and Regulatory Compliance.

(1) Background: the use of Mesenchymal Stromal Cells (MSC) in emerging therapies for spinal cord injury (SCI) hold the potential to improve functional recovery. However, the development of cell-based medicines is challenging and preclinical studies addressing quality, safety and efficacy must be conducted prior to clinical testing; (2) Methods: herein we present (i) the characterization of the quality attributes of MSC from the Wharton’s jelly (WJ) of the umbilical cord, (ii) safety of intrathecal infusion in a 3-month subchronic toxicity assessment study, and (iii) efficacy in a rat SCI model by controlled impaction (100 kdynes) after single (day 7 post-injury) and repeated dose of 1 × 106 MSC,WJ (days 7 and 14 post-injury) with 70-day monitoring by electrophysiological testing, motor function assessment and histology evaluation; (3) Results: no toxicity associated to MSC,WJ infusion was observed. Regarding efficacy, recovery of locomotion was promoted at early time points. Persistence of MSC,WJ was detected early after administration (day 2 post-injection) but not at days 14 and 63 post-injection. (4) Conclusions: the safety profile and signs of efficacy substantiate the suitability of the presented data for inclusion in the Investigational Medicinal Product Dossier for further consideration by the competent Regulatory Authority to proceed with clinical trials.

Correlations between percent body fat measured by dual-energy X-ray absorptiometry and anthropometric measurements in Thai persons with chronic traumatic spinal cord injury.

Cross-sectional study. To determine and compare the correlations of percent body fat (%BF) evaluated by dual-energy X-ray absorptiometry (DEXA) and anthropometric measurements including body mass index (BMI), skinfold thickness, waist circumference, hip circumference, and waist to hip ratio in Thai persons with chronic traumatic spinal cord injury (SCI). An SCI-specialized rehabilitation facility in a university hospital. Forty-six Thais with chronic traumatic SCI from a chronic SCI cohort of Maharaj Nakorn Chiang Mai Hospital were enrolled. Anthropometric measurements including weight, height, BMI, waist circumference, hip circumference, waist to hip ratio, and skinfold thickness of four sites (biceps, triceps, subscapular, and suprailiac) were measured. The estimated %BF was calculated using the Durnin-Womersley formula based on the sum of 4-site skinfold thickness. Data of %BF was evaluated by DEXA within 3 months before anthropometric measurements of each participant were obtained. The correlations between each anthropometric parameter and % BF from DEXA were determined by the Pearson correlation coefficient. The correlation of %BF between two methods, i.e., DEXA and estimation based on 4-site skinfold thickness, was strongly positive (r = 0.829; p < 0.001). The correlations between %BF from DEXA and hip circumference, BMI, and waist circumference were moderately positive (r = 0.697, 0.540, and 0.540, respectively; all p < 0.001). Better than the other anthropometric measurements, the estimation of %BF based on the 4-site skinfold using the Durnin-Womersley formula is a practical method for evaluating obesity in Thai people with chronic traumatic SCI.

The Laparoscopic Implantation of Neuroprosthesis Procedure Increases Leg Lean Mass in Individuals With Paraplegia Due To Traumatic Spinal Cord Injury

ObjectivesWe hypothesized that the laparoscopic implantation of neuroprosthesis (LION) procedure would significantly alter the body composition of patients with chronic traumatic spinal cord injury (SCI). The objectives were to determine the effect of the LION procedure on lean mass (LM), fatty mass (FM), and bone mineral content (BMC) in patients with SCI. Materials and MethodsFive consecutive patients underwent dual-energy x-ray absorptiometry scans before the LION procedure and at the one-year postoperative follow-up to determine changes in LM, FM, and BMC. Student paired t-test was used to determine significance. ResultsThe patients gained 2506 ± 565 g of LM in the legs (p < 0.001), which was an 18% total increase in leg LM. Total body LM was significantly increased by 3523 ± 1048 g (p < 0.003). FM was unaffected, whereas total BMC showed a small but significant increase of 99 ± 42 g (p = 0.009). ConclusionsThe LION procedure and subsequent neurostimulation procedures resulted in substantial increases in leg LM in patients with chronic traumatic SCI and paraplegia. A possible incremental effect on total BMC also was observed. Further studies are needed to confirm and expand these promising results.

Urinary system complications and long-term treatment compliance in chronic traumatic spinal cord injury patients with neurogenic lower urinary tract dysfunction.

Objectives The aim of this study was to evaluate upper and lower urinary tract complications and the compliance of long-term treatment in patients with spinal cord injury (SCI) by urodynamic examination. Patients and methods Between January 1997 and May 2007, a total of 89 patients with SCI (79 males, 19 females; mean age: 39.8±12.2 years; range, 19 to 72 years) who were admitted to physical medicine and rehabilitation clinic were retrospectively analyzed. Demographic, neurological, and urodynamic data of the patients with the diagnosis of neurogenic lower urinary tract dysfunction (NLUTD) in their initial urodynamic examination and without regular follow-up were recorded. Results The mean time to the first urodynamic examination was 8.6±5.4 months. Sixty-seven patients who had neurogenic detrusor overactivity (NDO) in their first urodynamic tests were recommended anticholinergics. Clean intermittent catheterization (CIC) was recommended after initial urodynamic examination in all patients. Thirty-nine patients of 67 who had NDO were taking medications, while 28 were not. In the patients who continued anticholinergic treatment, bladder capacity was found to statistically significantly increase, compared to the initial measurement values and detrusor pressures significantly decreased (p<0.001). The compliance rate with CIC and anticholinergic treatment was 79.8% and 58.2%, respectively. Sixteen of the patients had calculus in the urinary system. Forty-two patients had infections more than once a year and used antibiotics. Conclusion Neurogenic bladder should be evaluated at the beginning of SCI and, then, followed on a regular basis. Urodynamic tests should be performed immediately after spinal shock and can be repeated, as indicated.

Patient perspectives and self-rated knowledge of nerve transfer surgery for restoring upper limb function in spinal cord injury.

Nerve transfer surgery has the potential to restore upper limb function in patients with spinal cord injury (SCI); however, there has been limited exploration of patient perception of nerve transfer. To explore the perspectives of patients with chronic SCI (>2 years from injury) on nerve transfer surgery, and to determine if an educational intervention improved participants' perceived knowledge levels about the procedure. Mixed-methods study including qualitative semi-structured interviews and self-reported rating scales. Pre- and post-interviews were completed following an educational presentation. Two local SCI clinics. Ten patients with chronic traumatic SCI and neurological level of injury C3-C7 (motor complete or incomplete), recruited via snowball sampling (six male, four female). An educational slide presentation on nerve transfer concepts. The primary study outcome measure is the participants' responses to interview questions. The secondary study outcome measure is their self-reported knowledge levels of nerve transfer before and after education. Regaining upper limb function was a priority for all participants. Although most participants had heard of nerve transfer, none were offered it at the time of their SCI, and only two stated that they had any peers who had undergone the procedure. The educational module significantly increased self-rated scores on understanding of nerve transfer (p < .05). Although all participants were open to nerve transfer after the educational module, they described weighing different factors, including (1) potential for loss versus gain of function, (2) inadequate knowledge about nerve transfer, (3) recovery time, and (4) determining their eligibility for the surgery. These findings suggest that people with SCI have limited understanding of nerve transfer as a potential option and would benefit from educational opportunities to help them make informed decisions. This study may inform the development of patient resources to improve pre-surgical consultation and informed decision-making.

The Relationship of Secondary and Chronic Health Conditions With Emergency Department Visits and Related Hospitalizations Among People With Traumatic Spinal Cord Injury

ObjectiveIdentify the relationship of health conditions with self-reported emergency department (ED) visits and ED-related hospitalizations among people with traumatic spinal cord injury (SCI), while controlling for demographic, injury, and socioeconomic factors. DesignCross-sectional. SettingA regional SCI model system in the Southeastern United States. ParticipantsParticipants (N=648) were adults with chronic traumatic SCI at least 1 year postinjury who were identified through their Form II annual follow-up within the SCI Model Systems. InterventionsN/A. Main Outcome MeasuresSelf-reported ED visits and ED-related hospitalizations within the 12 months prior to the study. ResultsSeveral types of factors were significantly related to ED visits, with fewer related to ED hospitalizations. Men (odds ratio [OR]=1.58); those divorced, widowed, or separated (OR=1.57); and those with more severe SCI (C1-C4, or American Spinal Injury Association Impairment Scale A/B) had greater odds of having at least 1 ED visit; education and employment factors were not significant. Of health conditions, acute secondary health conditions including falls (OR=1.45), urinary tract infections (UTIs; OR=2.40), and pressure injuries (OR=1.58) were all associated with a greater odds of ED visits, whereas chronic health conditions were not. Being unemployed was associated with greater odds of an ED hospitalization (OR=1.79), as was having at least 1 UTI (OR=2.24) and at least 1 pressure injury (OR=2.37). ConclusionsThe current findings suggest acute secondary health conditions, particularly UTIs and pressure injuries, were much more highly related to ED visits and related hospitalizations compared to chronic health conditions (eg, diabetes, hypertension). Greater attention needs to be paid to fall, UTI, and pressure injury prevention to reduce the ED burden related to SCI.

The relationship between health behaviors and emergency department visits and hospitalizations after traumatic spinal cord injury.

Cross-sectional study. To identify demographic, injury, and behavioral predictors of emergency department (ED) visits and ED-related hospitalizations among individuals with chronic traumatic spinal cord injury (SCI). An academic medical center in the Southeastern United States. 4057 participants who were at least 18 years of age and 1 year post traumatic SCI with residual neurologic impairment were identified from three cohorts: a rehabilitation specialty hospital in the Southeastern USA and two SCI Surveillance System Registries, one in the Midwestern and one in the Southeastern USA. The participants completed a self-reported assessment on ED visits and ED hospitalizations (yes/no) in the past 12 months. Logistic regression models were used to examine the relationship between ED visits/hospitalizations and eight behavioral indicators, including body weight, healthy diet, drinking, smoking, non-medical substance usage, prescription medication usage, prescription medication misuse, and the planned exercise. During the study period, 41% of participants reported having at least one ED visit and 21% participants reported hospitalization after ED visit in the past 12 months. High frequency of prescription medication usage, prescription medication misuse, and lack of planned exercise were associated with greater odds of at least one ED visit and at least one ED-related hospitalization, while smoking was only associated with ED visits. Health care professionals should be aware that ED visit and related hospitalization prevalence remain high among people with chronic SCI, and there is significant need for intervention of managing risk behaviors and promoting healthy behaviors after SCI.

Flourishing after traumatic spinal cord injury: Results from a multimethod study.

Adverse outcomes after traumatic spinal cord injury (TSCI) are not ubiquitous; that is, it is possible to thrive in the years after injury. Accordingly, we examined both the association between various factors and psychological flourishing, or ideal mental health, after TSCI, as well as the characteristics of adults with average or higher levels of psychological flourishing in terms of personality, social support, and executive functioning. This study included two phases. In Phase 1, we collected information on demographic, health, and psychosocial variables from 449 adults with chronic TSCI using a mail survey. In Phase 2, we completed individual in-person assessments with a subset of 58 individuals from Phase 1 who had endorsed at least average levels of psychological flourishing and collected data using standardized measures of personality, social support, and executive functioning. Phase 1 data indicated that being married, viewing oneself favorably in comparison to others, and reporting better subjective health ratings were significantly associated with higher levels of psychological flourishing. Phase 2 data suggested that, as a cohort, participants tended to display a resilient personality profile, report high-average levels of social support, and perform grossly within normal limits on a measure of executive functioning. Our findings highlight factors associated with positive psychological outcomes after TSCI. A resilient personality profile, good social support, and unimpaired executive functioning capabilities appear to characterize adults who flourish with chronic TSCI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Construct validity of the enfranchisement scale of the community participation indicators

Objective: This study examined the construct validity of the Enfranchisement scale of the Community Participation Indicators. Design: We conducted a secondary analysis of data collected in a cross-sectional study of rehabilitation outcomes. Subjects: The parent study included 604 community-dwelling adults with chronic traumatic brain injury, stroke, or spinal cord injury. The sample had a mean age of 64.1 years, was two-thirds male, and included a high proportion of racial minorities (n = 250, 41.4%). Main measures: The Enfranchisement scale contains two subscales: the Control subscale and the Importance subscale. We examined correlations between each Enfranchisement subscale and measures of participation, environment, and impairments. The current analyses included cases with at least 80% of items completed on each subscale (Control subscale: n = 391; Importance subscale: n = 219). Missing values were imputed using multiple imputation. Results: The sample demonstrated high scores, indicating poor enfranchisement (Control subscale: M = 51.7; Importance subscale: M = 43.0). Both subscales were most strongly associated with measures of participation (Control subscale: r = 0.56; Importance subscale: r = 0.52), and least strongly associated with measures of cognition (Control subscale: r = 0.03; Importance subscale: r = 0.03). The Importance subscale was closely associated with depression (r = 0.54), and systems, services, and policies (r = 0.50). Both subscales were associated with social attitudes (Control subscale: r = 0.44; Importance subscale: r = 0.44) and social support (Control subscale: r = 0.49; Importance subscale: r = 0.41). Conclusions: We found evidence of convergent validity between the Enfranchisement scale and measures of participation, and discriminant validity between the Enfranchisement scale and measures of disability-related impairments. The analyses also revealed the importance of the environment to enfranchisement outcomes.

Relationships Between Functionality, Depression, and Anxiety With Community Integration and Quality of Life in Chronic Traumatic Spinal Cord Injury.

The aims of the study were (1) to identify relationships between functional and psychological aspects with community integration and quality of life assessments in people with chronic traumatic spinal cord injury and (2) to analyze clinical and demographic predictors of quality of life dimensions. This is an observational cohort study, and correlation coefficients were calculated between the Functional Independence Measure, the Hospital Anxiety and Depression Scale, the Community Integration Questionnaire, and the World Health Organization Quality of Life-BREF dimensions (physical [D1], psychological [D2], social [D3], and environmental [D4]). Quality of life predictors were identified using multiple linear regression analyses. Nine hundred seventy-five people with traumatic spinal cord injury assessed since 2007-2020 were included. The Community Integration Questionnaire home integration correlated strongly with the Functional Independence Measure self-care (r = 0.74) and transfers (r = 0.62) for participants with tetraplegia. The specific Hospital Anxiety and Depression Scale items (known as the anhedonia subscale) correlated strongly with D1 (r = -0.65), D2 (r = -0.69), D3 (r = -0.53), and D4 (r = -0.51) for participants with paraplegia and D1 (r = -0.53), D2 (r = -0.61), D3 (r = -0.47), and D4 (r = -0.53) for participants with tetraplegia. The Hospital Anxiety and Depression Scale-depression was the most relevant predictor of D1 (β = -0.61) and D2 (β = -0.76). The Functional Independence Measure transfers and self-care were strongly associated with the Community Integration Questionnaire home integration (in participants with tetraplegia). Anhedonia was strongly related to all four World Health Organization Quality of Life-BREF Scale dimensions, being the Hospital Anxiety and Depression Scale-depression the most relevant predictor of D1 and D2. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to (1) Determine the associations between functional and psychological measures with community integration domains and quality of life from a multidimensional perspective (physical, psychological, social, and environmental) in persons with chronic traumatic paraplegia or tetraplegia living in the community; (2) Identify long-term clinical and demographic predictors of specific quality of life dimensions (e.g., physical and psychological) in persons with paraplegia or tetraplegia living in the community; and (3) Illustrate the strength of the identified associations and the impact of the quality of life predictors to suggest possible specific aspects to be addressed by professionals in clinical practice. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Anatomical Increased/Decreased Changes in the Brain Area Following Individuals with Chronic Traumatic Complete Thoracic Spinal Cord Injury.

This study aimed to investigate anatomical changes in the brain following chronic complete traumatic thoracic spinal cord injury (ThSCI) using voxel-based morphometry (VBM). That is, it attempted to examine dynamic physical change following thoracic injury and the presence or absence of regions with decreased and increased changes in whole brain volume associated with change in the manner of how activities of daily living are performed. Twelve individuals with chronic traumatic complete ThSCI (age; 21-63 years, American Spinal Injury Association Impairment Scale; grade C-D) participated in this study. VBM was used to investigate the regions with increased volume and decreased volume in the brain in comparison with healthy control individuals. Decreases in volume were noted in areas associated with motor and somatosensory functions, including the right paracentral lobule (PCL)-the primary motor sensory area for lower limbs, left dorsal premotor cortex, and left superior parietal lobule (SPL). Furthermore, increased gray matter volume was noted in the primary sensorimotor area for fingers and arms, as well as in higher sensory areas. Following SCI both regions with increased volume and regions with decreased volume were present in the brain in accordance with changes in physical function. Using longitudinal observation, anatomical changes in the brain may be used to determine the rehabilitation effect by comparing present cases with cases with cervical SCI or cases with incomplete palsy.