Complication Of Spinal Cord Injury Research Articles

Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry.

Clean intermittent catheterization (CIC) is recommended for bladder management after spinal cord injury (SCI) since it has the lowest complication rate. However, transitions from CIC to other less optimal strategies, such as indwelling catheters (IDCs) are common. In individuals with SCI who stopped CIC, we sought to determine how individual characteristics affect the bladder-related quality of life (QoL) and the reasons for CIC cessation. The Neurogenic Bladder Research Group registry is an observational study, evaluating neurogenic bladder-related QoL after SCI. From 1479 participants, those using IDC or urinary conduit were asked if they had ever performed CIC, for how long, and why they stopped CIC. Multivariable regression, among participants discontinuing CIC, established associations between demographics, injury characteristics, and SCI complications with bladder-related QoL. There were 176 participants who had discontinued CIC; 66 (38%) were paraplegic and 110 (63%) were male. The most common reasons for CIC cessation among all participants were inconvenience, urinary leakage, and too many urine infections. Paraplegic participants who discontinued CIC had higher mean age, better fine motor scores, and lower educational attainment and employment. Multivariable regression revealed years since SCI was associated with worse bladder symptoms (neurogenic bladder symptom score), ≥4 urinary tract infections (UTIs) in a year was associated with worse satisfaction and feelings about bladder symptoms (SCI-QoL difficulties), while tetraplegia was associated better satisfaction and feelings about bladder symptoms (SCI-QoL difficulties). Tetraplegics who have discontinued CIC have an improved QoL compared with paraplegics. SCI individuals who have discontinued CIC and have recurrent UTIs have worse QoL.

Management of pain in individuals with spinal cord injury: Guideline of the German-Speaking Medical Society for Spinal Cord Injury.

Introduction: Pain is a prominent complication in spinal cord injury (SCI). It can either occur as a direct or as an indirect consequence of SCI and it often heavily influences the quality of life of affected individuals. In SCI, nociceptive and neuropathic pain can equally emerge at the same time above or below the level of injury. Thus, classification and grading of pain is frequently difficult. Effective treatment of SCI-related pain in general and of neuropathic pain in particular is challenging. Current treatment options are sparse and their evidence is considered to be limited. Considering these aspects, a clinical practice guideline was developed as basis for an optimized, comprehensive and standardized pain management in SCI-related pain.Methods: The German-Speaking Medical Society for Spinal Cord Injury (Deutschsprachige Medizinische Gesellschaft für Paraplegiologie – DMGP) developed a clinical practice guideline that received consensus from seven further German-speaking medical societies and one patient organization. The evidence base from clinical trials and meta-analyses was summarized and subjected to a structured consensus-process in accordance with the regulations of the Association of Scientific Medical Societies in Germany (AWMF) and the methodological requirements of the “German instrument for methodological guideline appraisal”.Results: This consensus-based guideline (S2k classification according to the AWMF guidance manual and rules) resulted in seven on-topic statements and 17 specific recommendations relevant to the classification, assessment and therapy of pain directly or indirectly caused by SCI. Recommended therapeutic approaches comprise pharmacological (e.g. nonsteroidal anti-inflammatory drugs or anticonvulsants) and non-pharmacological (e.g. physical activity or psychotherapeutic techniques) strategies for both nociceptive and neuropathic pain.Discussion: Assessment of SCI-related pain is standardized and respective methods in terms of examination, classification and grading of pain are already in use and validated in German language. In contrast, valid, evidence-based and efficient therapeutic options are limited and ask for further clinical studies, ideally randomized controlled trials and meta-analyses.

Does Reduced Blood Flow Affect the Rate of Muscle Loss in Rats Post Spinal Cord Injury

Muscle atrophy is a major sequela occurring after spinal cord injury (SCI) that results from disuse. Additionally, other secondary complications of SCI (e.g., alterations in muscle blood flow) may contribute to muscle loss. PURPOSE: To determine the time course of muscle blood flow changes in relation to muscle atrophy in a rodent severe contusion SCI model. METHODS: Sixty-three 4-months-old (skeletally-mature) male Sprague-Dawley rats received SHAM surgery (T9 laminectomy) or severe (250 kdyne) contusion SCI using a computer-guided impactor. At 1-, 2-, and 4-weeks (wk) post-surgery, an intravenous catheter was implanted into the tail vein of SHAM and SCI animals. Colored microspheres (15μm diameter) were then infused into the circulation, allowing for the measurement of regional blood flow (ml/min/g tissue mass). Subsequently, the animals were euthanized and the mass of the dissected right and left soleus, gastrocnemius, and plantaris were taken. Concentrations of the colored microspheres within each muscle were determined via spectrophotometry, following chemical digestion of the muscle. Muscle blood flow calculations were then averaged across the contralateral hindlimbs for the aforementioned muscles. SCI vs SHAM comparisons were made at each time point using independent samples t-tests and Pearson’s correlation coefficients. RESULTS: SCI animals exhibited 23-41% lower soleus mass, 17-27% lower gastrocnemius mass, and 16-29% lower plantaris mass vs SHAM, at all time points (p<0.001). Soleus and gastrocnemius blood flow (corrected for tissue mass, ml/min/g) was 51% lower (p<0.001) and 25% lower (p<0.05) after SCI, respectfully, at 1-wk only. Additionally, a positive relationship between soleus mass and blood flow (corrected for mass) was identified at 1-wk (r= 0.687, p<0.01). No significant alterations in plantaris blood flow were identified at any time point. CONCLUSION: Hindlimb muscle atrophy and reduced muscle blood flow occurred within 1-wk of severe contusion SCI. Thereafter, muscle blood renormalized in comparison with SHAM animals. Further research is needed to determine whether the reductions in muscle blood flow occurring after SCI contribute to muscle loss and/or whether prevention of blood flow deficits preserves muscle mass.

The relationship of seasonality and the increase in urinary tract infections among hospitalized patients with spinal cord injury.

Urinary tract infection (UTI) is the most frequent complication in patients who have spinal cord injury (SCI). The occurrence rate of UTI in this type of hospitalized patients was correlated to seasonality, age, and gender. Patients hospitalized during the 4-year study period with underlying SCI were identified from Taiwan's National Health Insurance Research Database. Patients with a discharge diagnosis of UTI were identified as those with SCI and UTI; they were divided into the following four age groups: <18 years, 18 to 44 years, 45 to 64 years, and ≥65 years. The gender, monthly number of cases, major complication rate, seasonal differences, and odds ratios (ORs) of associated factors were analyzed. Data of 30 149 hospitalized patients diagnosed with SCI were retrieved. SCI and UTI were diagnosed in 3405 (11.3%) patients, of them 2296 were males (67.4%) and 1109 were females (32.6%). The UTI occurrence rate in hospitalized SCI patients was higher in males (11.8%) than in females (10.4%) (OR: 1.24; 95% CI: 1.15-1.34); it was highest in the ≥65-year-old age group (12.8%) and lowest in the <18-year-old age group (5.8%) (OR: 2.51; 95% CI: 1.83-3.44). The UTI occurrence rate varied from 7% to 18%, and it was highest in the summer (13.0% ± 2.6%) and lowest in the winter (10.2% ± 1.9%) (OR: 1.27; 95% CI: 1.15-1.40). Acute pyelonephritis was the most common complication in SCI and UTI cases. The mean occurrence rate of UTI in hospitalized SCI patients was 11.3%; it was higher in males, in patients aged ≥65 years, and in the summer. Therefore, physicians should pay attention to the occurrence of UTI in aged male patients with SCI, especially in the summer.

Osteoporosis prophylaxis in acute SCI.

Osteoporosis is a serious complication of spinal cord injury that is associated with increased fracture rates. Diagnosis and management of osteoporosis is limited by the lack of rigorous, well powered clinical trials with fracture as a primary outcome. Due to a lack of evidence-based guidelines, clinical practice varies greatly. This Point-counterpoint series address prophylaxis of osteoporosis in acute SCI.

Facilitators and Barriers for Implementing an Internet Clinic for the Treatment of Pressure Injuries.

Background:Pressure injuries (PIs) represent a frequent, often preventable, secondary complication of spinal cord injury (SCI) with serious consequences to health, societal participation, and quality of life. Specialized knowledge and service delivery related to treatment and prevention are typically located within major health centers.Introduction:For persons with SCI living at home, it can be challenging to access specialized PI care. A telehealth approach could help mitigate this challenge. This multisite pilot investigation assessed the feasibility of integrating information technologies within the management of PIs.Materials and Methods:Each study site formed a specialized interdisciplinary care team that identified components of their standard clinical care pathway and examined how they could be integrated with study technologies. A monitoring system was utilized to enable patients and caregivers to exchange clinical information with the care team.Results:Clinician and patient focus groups were completed to identify facilitators and barriers for long-term implementation. Findings demonstrate that this method of service delivery is feasible but requires further development.Discussion:This model of care requires refinement to address technological, regulatory, and clinician acceptance barriers; however, increased access to these services has the potential for improving PI healing or prevention rates in comparison with those not able to access specialized services.Conclusions:This project demonstrates that PI treatment services can be delivered effectively through the internet. Future trials can investigate efficacy and cost-effectiveness of this model of care to inform sustained implementation.

Astaxanthin attenuates neuroinflammation contributed to the neuropathic pain and motor dysfunction following compression spinal cord injury

Spinal cord injury (SCI) is a debilitating condition in which inflammatory responses in the secondary phase of injury leads to long lasting sensory-motor dysfunction. The medicinal therapy of SCI complications is still a clinical challenge. Understanding the molecular pathways underlying the progress of damage will help to find new therapeutic candidates. Astaxanthin (AST) is a ketocarotenoid which has shown anti-inflammatory effects in models of traumatic brain injury. In the present study, we examined its potential in the elimination of SCI damage through glutamatergic-phospo p38 mitogen-activated protein kinase (p-p38MAPK) signaling pathway. Inflammatory response, histopathological changes and sensory-motor function were also investigated in a severe compression model of SCI in male rats.The results of acetone drop and inclined plane tests indicated the promising role of AST in improving sensory and motor function of SCI rats. AST decreased the expression of n-methyl-d-aspartate receptor subunit 2B (NR2B) and p-p38MAPK as inflammatory signaling mediators as well as tumor necrosis factor-α (TNF-α) as an inflammatory cytokine, following compression SCI. The histopathological study culminated in preserved white mater and motor neurons beyond the injury level in rostral and caudal parts. The results show the potential of AST to inhibit glutamate-initiated signaling pathway and inflammatory reactions in the secondary phase of SCI, and suggest it as a promising candidate to enhance functional recovery after SCI.

Managing Spasticity in a Pregnant Woman with Spinal Cord Injury: a Review

This paper aims to review the available treatment options for spasticity management that can be used for pregnant women with spinal cord injury (SCI). There are extensive reviews exploring the approach to care for the parturient with SCI. These often include a discussion on common medications used and their potential impact on pregnancy and lactation. However, there are no specific guidelines on managing spasticity in pregnancy. Existing review articles show a low level of evidence for commonly utilized physical interventions in spasticity management. There are several case reports on the use of intrathecal baclofen and focal injections with botulinum neurotoxin during pregnancy. The approach to management should recognize the interaction of pregnancy with secondary complications of SCI. Treatment decisions should be based on severity of spasticity, patient goals, and education of potential risks and benefits of different options with regard to pregnancy, lactation, maternal, and fetal outcomes.

Assessment of knowledge and practice & identification of barriers towards pressure ulcer care and prevention among nursing professional

Despite advances in health care, pressure ulcers (PrU) remain one of the most common and serious complications of spinal cord injury (SCI). Prevention of hospital-acquired PrU is an essential prerequisite for early reintegration of SCI patients into the society. Therein, lays the importance of awareness and knowledge about the prevention and management of PrU amongst nurses. The aim of this study was to assess nurses's knowledge of PU management to identify lacunas in implementation of PrU prevention strategies. It was a cross-sectional study. The participants completed a structured performa and Pressure Ulcer Knowledge Test (PUKT), which comprised of 47-items to examine the knowledge on PrU prevention, staging and wound description. A cutoff score of 90% of participants answering an item correctly was used to gauge “adequate” knowledge. Total 240 nurses participated in this study, out of which 87% were female, mean age 42.5 ± 10.49(yrs), more than 50% subjects had work experience of > 20 years. Mean total correct response was 59.01 ± 17.75 and to questions related to ulcer, wound and prevention was 56.19 ± 23.54, 52.98 ± 22.13, and 61.09 ± 18.09, respectively. A satisfactory percentage had adequate knowledge of prevention of PrU. However very poor response was observed to certain questions with only 7(2.92%) answering correctly about the use of Heel protectors and only 37(16.25%) aware about the role of eschar in ulcer healing. The mean PUKT score was < 60% for 41% of the participants. Nursing professionals involved in active care of patients performed significantly better in all the aspects of knowledge test. University training followed by In-service training was the source of education on PrU. Lack of resources and training (25%) & shortage of staff (23%) were the frequently cited barriers to carrying out PrU risk assessment, documentation and prevention. Our study identified deficits in PrU knowledge and areas where nurses would benefit from focused education strategies.

Personal, family and societal educational needs assessment of individuals with spinal cord injury in Iran.

Objectives:To explore individuals’ perception of the personal, family and societal educational needs following a spinal cord injury (SCI).Methods:Sixty-one patients who sustained a traumatic SCI between March 2015 and June 2016 referred to Brain and Spinal Cord Injury Research Center (BASIR) were included in a cross sectional study and completed an online survey containing open-and closed-ended questions, in Iran. Participants’ responses were analyzed i using a qualitative approach with a thematic analysis.Results:Following a thematic analysis of the patient’s perceived educational needs, 3 themes and 14 subthemes were identified. The 3 themes included personal, family, and societal educational perceived needs. Within personal educational needs, there were 7 subthemes which included personal independence and transportation, financial independence, life skills modification, knowledge about SCI, prevention of SCI complications, relationships and sexual function, and psychological adjustments. Among family educational needs, the 3 subthemes were caregiver skills and communication, first aid and emergency skills, and emotional and psychological support. For societal educational needs, the 4 subthemes described were social integration, interpersonal communication skills, SCI awareness and injury prevention, sympathize while avoiding pity.Conclusion:According to our findings, people with SCI have various needs that need to be addressed. Educational support should be a part of a comprehensive rehabilitation program and geared towards addressing the patients’ personal and family needs, while educating the community about SCI in order to allow for reintegration into society.

Treatment of spasticity in spinal cord injury with botulinum toxin

Context: Spasticity is one of the most frequent complications in spinal cord injury (SCI), and is routinely managed with oral pharmacologic therapy. Botulinum toxin (BT) is not accepted as a treatment for spasticity in SCI in Spain but may be used in certain cases of focal distribution.Objective: To report the results with BT for treatment of spasticity in SCI.Design and Setting: Descriptive retrospective study conducted at a specialist SCI rehabilitation center in Spain, covering patients first treated from 2012 through 2014, and successfully followed up for a minimum of 1 year. Data were collected on the following variables: demographic and SCI characteristics (level and grade); nature of spasticity, e.g. tone, distribution, spasms, articular involvement and pain; function; application of BT; tolerance and adverse reactions.Results: The study covered 90 patients, predominantly male with incomplete injuries. Improvement in tone as measured by the modified Ashworth scale was a mean of 1.17 points. Goniometric improvement was achieved in 65.6% and improvement in pain in 38.9% of cases. There were no adverse side-effects.Patients with focal spasticity showed a significantly greater improvement in tone (P < 0.0001). The earlier the BT injection, the greater the improvement in goniometric performance (P < 0.006) and pain (P < 0.033), with the best results being obtained within the first 6 months of clinical course. ASIA D injuries showed a greater improvement in tone (P < 0.0001).Conclusions: BT can be both an effective treatment for focal spasticity in SCI and a good coadjuvant for oral treatments in generalized spasticity.

Treatment of Complications of Spinal Cord Injuries

Treatment of Complications of Spinal Cord Injuries

Effectiveness of 4-Aminopyridine for the Management of Spasticity in Spinal Cord Injury: A Systematic Review.

Background: Spasticity is a common secondary complication of spinal cord injury (SCI), which can severely impact functional independence and quality of life. 4-Aminopyridine (4-AP) is a potassium channel blocker that has been studied as an intervention for spasticity in individuals with SCI. Objective: To conduct a systematic review of the available evidence regarding the effectiveness of 4-AP for the management of spasticity in individuals with SCI. Methods: A comprehensive literature search was conducted on five electronic databases for articles published in English up to January 2017. Studies were included if (1) the sample size was three or more subjects, (2) the population was ≥50% SCI, (3) the subjects were ≥18 years old, (4) the treatment was 4-AP via any route, and (5) spasticity was assessed before and after the intervention. Subject characteristics, study design, intervention protocol, assessment methods, side effects, adverse events, and outcomes were extracted from selected studies. Randomized controlled trials (RCTs) were evaluated for methodological quality using the Physiotherapy Evidence Database (PEDro) tool. Levels of evidence were assigned using a modified Sackett scale. Results: Nine studies met inclusion criteria with a pooled sample size of 591 subjects. Six studies were RCTs (PEDro = 6-10, Level 1 evidence) and three studies were pre-post tests (Level 4 evidence). There was a wide range in duration, severity, and level of SCI across subjects. Oral 4-AP was investigated in five studies; one study reported significant improvements on the Ashworth Scale (AS), while the remaining four studies found no improvement. Three studies found no significant improvements on the Spasm Frequency Scale. Intravenous 4-AP was investigated in three studies; no significant improvements were found on the AS or in the Reflex Score. Intrathecal 4-AP was investigated in one study, which did not find significant improvements on the AS. Conclusion: There is weak evidence supporting the effectiveness of 4-AP in reducing spasticity post SCI. Future research should utilize contemporary measures of spasticity and address methodological limitations such as small sample sizes.

Activity gains after upper limb surgery for spasticity in patients with spinal cord injury.

IV.

Improving Sperm Viability After Spinal Cord Injury Using Hyperbaric Therapy

Infertility is one of many complications of spinal cord injury (SCI) in male patients, who are often at the peak of their reproductive life. This study evaluated effects of hyperbaric therapy (HT) on quality of sperm of rats with SCI and correlated the findings with histologic analysis of the testicles. This experimental study comprised 18 rats that were submitted to SCI with a MASCIS Impactor and randomly allocated to either a HT or a control group. Testicular biopsies were performed on the first and 28th day of the study; 4 parameters were evaluated: concentration of sperm per mL, number of round cells per field, number of inflammatory cells per field (peroxidase [Endtz] test), and sperm viability (hypo-osmotic swelling test). There was no difference in sperm concentration between the HT group (P= 0.41) and control group (P= 0.74) during 28 days. From day 1 to day 28, sperm viability decreased twice as much in the control group (P= 0.001) compared with the HT group (P= 0.017). There was no difference between the groups in mean sperm concentration and number of round and inflammatory cells. On the first day, there was no difference in sperm viability between groups. There was a significantly higher (P=0.001) percentage of viable sperm in the HT group (86.8 ± 5.6) compared with the control group (48.8 ± 21.8) on day28. SCI increased the number of round and inflammatory cells and diminished sperm viability in both groups. HT promoted greater sperm viability in rats with SCI.

Spinal Kord Hasarlarında Üretral Komplikasyonlar

Spinal Kord Hasarlarında Üretral Komplikasyonlar

Biomarkers screening and related functions identification for spinal cord injury based on guilt-by-association

Objective: The aim was to research Spinal Cord Injury (SCI) related genes and functions for postoperative recovery and complications and prevention. Methods: E-GEOD-18179 was used to screen Differently Expressed Genes (DEGs) between SCI samples and controls. Adjacency matrix was constructed as gene co-expression network. Sub-network was identified based on spearman correlation coefficient. Assortativity coefficient was calculated to represent the relationship among nodes. Gene Ontology (GO) functional enrichment was processed and guilt-byassociation was undertaken. Results: Total 129 DEGs were obtained and Adjacency matrix with 129 × 129 genes was constructed. There into, TYROBP and MIA were with weight of 0.9695. Total 129 genes were enriched in 127 GO terms, such as molecular function and catalytic activity. K terms and related AUC values were obtained. The guilt-by-association node degrees AUCs were generated. In addition, the optimal list genes were obtained, such as JUN and PTK2B. Finally, optimal GO terms were obtained, such as regulation of signal transduction, positive regulation of macromolecule metabolic process and cellular component organization. Conclusion: Screened genes including JUN, PTK2B, CCND1 and ADAM8 might be potential genes for SCI postoperative recovery and complications and prevention.

The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study

Secondary complications of spinal cord injury (SCI) are a burden to affected individuals and the rest of society. There is limited evidence of the economic burden or cost of complications in SCI populations in Canada, however, which is necessary for comparative economic analyses and decision analytic modeling of possible solutions to these common health problems. Comparative economic analyses can inform resource allocation decisions, but the outputs are only as good as the inputs. In this article, new evidence of the excess or incremental costs of urinary tract infection (UTI) and pressure ulceration (PU) in acute traumatic SCI from an exploratory case series analysis of admissions to a Level I specialized Canadian spine facility (2008-2013) is presented. Participants in a national SCI registry were case-control matched (1:1) on the predicted probability of experiencing UTI or PU during initial acute SCI admission. The excess costs of UTI and PU are estimated as the mean of the differences in total direct acute SCI admission costs (length of stay, accommodation, nursing, pharmacy) from the perspective of the admitting facility between participants matched or paired on demographic and SCI characteristics. Even relatively minor UTI and PU, respectively, added an average of $7,790 (standard deviation [SD] $6,267) and $18,758 (SD $27,574) to the direct cost of acute SCI admission in 2013 Canadian dollars (CAD). This case series analysis established evidence of the excess costs of UTI and PU in acute SCI admissions, which will support decision-informing analyses in SCI.

Tune the cord into right chords—activating a “paralyzed” immune system by silencing thoracic interneuron

Spinal cord injury (SCI) results in devastating impairment of motor function. An under-appreciated yet equally important complication in chronic SCI is infection. The increased risk of infection in patients living with SCI has traditionally been attributed to motor-paralysis such as dysphagia or neurogenic bladder resulting in pneumonia or urinary tract infection. However, a condition known as SCI-induced immune depression syndrome is thought to decrease adaptive and innate immunity, leading to increased susceptibility to infections (1). A study by Ueno et al ., seeks to elucidate the cellular mechanism of this phenomenon (2).

Latent Structural Analysis of Health Outcomes in People Living With Spinal Cord Injury

ObjectiveTo develop a latent structural model of health outcomes in people with spinal cord injury (SCI) that accounts for the measurement of underlying factors and their association with demographic and injury-related exogenous variables. DesignCross-sectional study. SettingSpecialty hospital and medical university. ParticipantsParticipants with traumatic SCI (N=1871) of at least 1-year duration. InterventionsNot applicable. Main Outcome MeasuresExploratory factor analysis was used to identify latent health outcome structures. Several key exogenous variables were also linked with the latent health outcome factors. ResultsSix latent health outcome factors were identified by the exploratory factor analysis with excellent model fit (root mean square error of approximation=.040). These latent factors included (1) global health problems; (2) chronic disease; (3) acute treatments; (4) symptoms of SCI complications, (5) pressure ulcers; and (6) subsequent injuries. Sex, race/ethnicity, age, years since injury, and injury severity were all significantly associated with at least 1 latent health outcome factor, which indicates that these latent health outcomes varied as a function of the exogenous variables. ConclusionsThis study improved our understanding of the structure of health outcomes, and utilization of latent health outcome factors provides more stable and comprehensive composite scores than does utilization of a single observed health outcome indicator.