Spinal Cord Injury Diseases Research Articles

Complex Electrical Stimulation Systems in Motor Function Rehabilitation after Spinal Cord Injury

Spinal cord injury (SCI) is an existing incurable disease that brings great pain and life obstacles to patients. Spinal cord electrical stimulation is an effective means to alleviate spinal cord injury. However, its complicated mechanism of action is still unclear. This article aims to summarize several different spinal cord electrical stimulation methods, analyze the stimulation effect, and briefly describe the current understanding of its origin and mechanism of action. In recent years, several application cases of the electrical stimulation system of stimulation methods have confirmed its positive effects in spinal cord injury diseases and provided new perspectives for the improvement of spinal cord injury. Finally, the possible development direction and corresponding challenges of spinal cord electrical stimulation in the future are proposed.

Development of employment indicators to advance the quality of spinal cord injury rehabilitation care: SCI-High Project

Context Employment and Return to Work (RTW) rates following spinal cord injury/disease (SCI/D) are low due to individual and impairments characteristics, secondary health conditions, social and environmental barriers, prior work experience, workplace supports and resources, and physical or psychosocial work demands. To improve RTW, the SCI-High Project team developed a set of Employment structure, process, and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods A pan-Canadian Working Group of diverse stakeholders: (1) defined the Employment construct; (2) conducted a systematic search of available outcomes measures; (3) constructed a Driver diagram summarizing factors associated with employment. Subsequent facilitated meetings allowed for the creation of structure and process indicators, and the selection of outcome indicators. Results The structure indicator is the proportion of SCI/D rehabilitation programs with an employment resource center. The process indicator is the proportion of SCI/D rehabilitation inpatients who receive an employment assessment during inpatient rehabilitation. The intermediary and final outcome measures are the Readiness for Return-to-Work Scale (RRTW) and Work Productivity and Activity Impairment (WPAI). Scale A of the RRTW for those who are unemployed and Scale B of RRTW and WPAI will be used for those who are employed. Conclusion This framework of Employment indicators intends to support the RTW needs of persons with SCI/D by ensuring that rehabilitation professionals provide opportunities to explore RTW within the first 18 months after rehab admission. Increased employment rates have the potential to enhance the wellbeing, health, and longevity of individuals with SCI/D.

Development of community participation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Context Community participation following spinal cord injury/disease (SCI/D) can be challenging due to associated primary impairments and secondary health conditions as well as difficulties navigating both the built and social-emotional environment. To improve the quality of SCI/D rehabilitation care to optimize community participation, the SCI-High Project developed a set of structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods A pan-Canadian Working Group of diverse stakeholders: (1) defined the community participation construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with community participation; and (4) prepared a process map. Facilitated meetings allowed selection and review of a set of structure, process and outcome indicators. Results The structure indicator is the proportion of SCI/D rehabilitation programs with availability of transition living setting/independent living unit. The process indicators are the proportion of SCI/D rehabilitation inpatients who experienced: (a) a therapeutic community outing prior to rehabilitation discharge; and, (b) those who received a pass to go home for the weekend. The intermediary and final outcome measures are the Moorong Self-Efficacy Scale and the Reintegration to Normal Living Index. Conclusion The proposed indicators have the potential to inform whether inpatient rehabilitation for persons with SCI/D can improve self-efficacy and lead to high levels of community participation post-rehabilitation discharge.

The effects of epidural stimulation on individuals living with spinal cord injury or disease: a scoping review

Background Spinal cord injury/disease (SCI/D) impacts sensory, motor and autonomic function. Epidural stimulation (ES) has the potential to improve function across many domains. Objective To synthesize the effects of ES on functional goals for individuals with SCI/D. Methods Seven biomedical databases were searched. Inclusion criteria required (1) ES as the primary intervention, (2) human participants with SCI/D, (3) pre-post measure of an orthotic and/or therapeutic effect, and (4) original data. Data extracted were participant characteristics, ES and exercise parameters, outcome measures, complications, orthotic and/or therapeutic effects. Data were synthesized descriptively according to functional goal. Critical appraisal was completed using the Downs and Black modified checklist. Results Included studies were case studies or case-series (n = 24), or pre-post interventions (n = 23). One study was a case-control. Research quality was poor to fair. There were mixed results of ES on bladder and sexual function, and standing in participants with SCI/D. Effects of ES included improved bowel function, increased cardiorespiratory and cardiometabolic function, pain reduction, decreased spasms and spasticity, and, when combined with repetitive movement training, improved gait parameters. In the one study focused on the upper extremity, grip strength improved. Conclusions ES shows promise as an intervention to improve functional goals after SCI/D with a focus on locomotion.

Bladder management, severity of injury and period of latency: a descriptive study on 135 patients with spinal cord injury and bladder cancer.

Study designLongitudinal study.ObjectivesTo describe the severity of spinal cord injury/disease (SCI/D), type and management of neurogenic lower urinary tract dysfunction, tumor characteristics, and bladder cancer latency period in SCI/D patients.SettingSpinal cord injury centers in Germany, Austria, and Switzerland.MethodsData of SCI/D patients diagnosed with bladder cancer were collected between Jan 2012–Dec 2019 in the course of annual surveys in the neuro-urological departments of all 28 centers. Demographic and paralysis-specific data, data on the type and management of neurogenic lower urinary tract dysfunction, and histopathological tumor characteristics were collected.ResultsRegarding histopathological tumor characteristics, no significant differences were found in 135 individuals with SCI/D when stratified for bladder management without chronic catheterization, SCI/D severity, and ASIA classification. The mean latency period between the onset of SCI/D and the diagnosis of bladder cancer was significantly longer in patients with catheter-free emptying methods compared to patients with intermittent catheterization, and in patients with LMNL (Lower Motor Neuron Lesion) compared to patients with UMNL (Upper Motor Neuron Lesion).ConclusionsUrinary bladder carcinomas are late events in the long-term course of SCI/D. Follow-up and approaches to screening must therefore be intensified with increasing duration of long-term SCI.

Exploring exercise participation and the usability of the adaptive rower and arm crank ergometer through wheelchair users’ perspectives

Purpose Arm crank ergometry and adaptive rowing are existing exercise options for wheelchairs users, but not commonly available. This study was conducted to explore exercise participation of wheelchair users, as well as the usability of the adaptive rowing ergometer (aROW) and arm crank ergometer (ACE). Methods This mixed-methods study used a concurrent triangulation design. Following completion of both exercise sessions (5 min each), participants (n = 14) with spinal cord injury/disease (SCI/D) completed the System Usability Scale (SUS), and a semi-structured interview. Participants were asked about the use of both exercise modalities, and general exercise participation. SUS data were analyzed using a paired sample t-test and qualitative data were analyzed through conventional content analysis. Results Wheelchair users exercised for improved physical and mental health, as well as for functional independence, and community participation; however, lack of accessible equipment was a prominent barrier. Both the aROW and ACE have high usability, but the aROW was perceived as more enjoyable and effective for cardiovascular exercise. Conclusions The implementation of the aROW into community gyms has the potential to help close the existing gap in inclusive equipment and may help people with disabilities to be more fully included in their community and lead healthier lives. Implications for rehabilitation Wheelchair users perceive exercise as a meaningful activity that enhances physical health and risk of disease, functional independence, community participation, and overall social and emotional health. The adapted rowing machine was perceived as highly usable and was felt to be more enjoyable and effective for cardiovascular exercise compared to traditional arm crank ergometers. The adaptive rower provides an additional accessible equipment option for wheelchair users to obtain effective cardiovascular exercise. More available equipment may increase community participation and promote inclusion for wheelchair users.

COVID-19 and spinal cord injury and disease: results of an international survey as the pandemic progresses.

Study designAn online survey.ObjectivesTo follow-up with and re-query the international spinal cord community’s response to the Coronavirus Disease 2019 (COVID-19) pandemic by revisiting questions posed in a previous survey and investigating new lines of inquiry.SettingAn international collaboration of authors and participants.MethodsTwo identical surveys (one in English and one in Spanish) were distributed via the internet. Responses from both surveys were pooled and analyzed for demographic and response data.ResultsThree hundred and sixty-six respondents were gathered from multiple continents and regions. The majority (63.1%) were rehabilitation physicians and only 12.1% had patients with spinal cord injury/disease (SCI/D) that they knew had COVID-19. Participants reported that the COVID-19 pandemic had caused limited access to clinician and support services and worsening medical complications. Nearly 40% of inpatient clinicians reported that “some or all” of their facilities’ beds were being used by medical and surgical patients, rather than by individuals requiring inpatient rehabilitation. Respondents reported a 25.1% increase in use of telemedicine during the pandemic (35% used it before; 60.1% during), though over 60% felt the technology incompletely met their patients’ needs.ConclusionThe COVID-19 pandemic has negatively impacted the ability of individuals with SCI/D to obtain their “usual level of care.“ Moving forward into a potential “second wave” of COVID-19, patient advocacy and efforts to secure access to thorough and accessible care are essential.

Can clinical and urodynamic parameters predict the occurrence of neutralizing antibodies in therapy failure of intradetrusor onabotulinumtoxin A injections in patients with spinal cord injury?

BackgroundThe aim of the study was to clarify whether clinical and/or urodynamic parameters could be used to infer the probability of neutralizing antibody (NAb) formation as a possible cause of therapy failure (non-response, NR) in patients with neurogenic detrusor overactivity (NDO) due to acquired spinal cord injury/disease (SCI/D) treated with intradetrusor botulinum neurotoxin A (BoNT-A) injections.MethodsA retrospective chart review was performed of all patients with SCI/D who underwent both intradetrusor onabotulinumtoxin A injections and the determination of neutralizing antibodies against BoNT-A between January 1, 2002, and December 31, 2018. NR was defined as urodynamically confirmed persistent or reappearing NDO.ResultsA total of 2700 BoNT-A injections in 414 patients were ascertained. In 69 patients with primary NR after the first BoNT-A injection (n = 6) or with secondary NR after more than one BoNT-A injection (n = 63), an antibody analysis was performed. Antibody examination showed 36 (52.2%) negative, 5 (7.2%) borderline and 14 (each 20.3%) each of positive and highly positive values. Subgroup analysis indicated a correlation between NAb formation and the duration of BoNT-A therapy (p = 0.015), the mean number of BoNT-A injections (p = 0.011) and the time interval between BoNT-A applications (< 7 months, p = 0.022). Urodynamic data analysis indicate significant differences with cut-off values of MCC (< 225 ml, p = 0.038) and MDP (> 45 cmH2O, p = 0.040). However, in the regression analysis models, the predictive value for the occurrence of NAb was too low (MCC: ROC AUC 0.62, MDP: ROC AUC 0.52) to distinguish with sufficient certainty between NAb-positive and NAb-negative NR patients.ConclusionsDespite significant correlations, clinical and urodynamic parameters are only partially suitable for predicting antibody formation against BoNT-A.

The use of a mobile educational tool on pressure injury education for individuals living with spinal cord injury/disease: a qualitative research study

Background As many as 30–60% of individuals living with spinal cord injury/disease (SCI/D) experience at least one pressure injury (PI) in their lifetime. Best practice guidelines in SCI/D rehabilitation emphasize the importance of providing education regarding PI prevention and management for individuals living with SCI/D. Mobile educational applications can be used for PI education however there is limited research on the user-experiences of mobile educational applications about PIs for individuals living with SCI/D. Objectives The purpose of this study was to explore the experiences of individuals living with SCI/D on the use of Pressure Ulcer Target (PUT), a mobile educational app for PI prevention and management. Methods/Overview Nine participants living with SCI/D used PUT over two weeks. Individual semi-structured interviews were conducted to explore the participants’ perceptions regarding the utility, aesthetics and ease of use of PUT and suggested modifications. A conventional content analysis was used to identify themes and categories from the data. Results User-experiences with PUT fell into four themes: (1) Strengths and weakness; (2) Target population; (3) Key concepts and messages; and (4) Recommendations for improvement. Conclusions PUT serves as a review of previously acquired PI knowledge and should be introduced early in rehabilitation to motivate users to prevent PIs. Future studies exploring healthcare professionals’ perspectives of PUT are warranted. Implications for rehabilitation PUT aids individuals living with SCI/D in the community to review PI prevention and management strategies that they learned as inpatients. The use of pictures to deliver patient education regarding PI prevention and management through a mHealth app is recommended. PUT should be introduced early in rehabilitation to motivate users to prevent PIs.

Clinical guideline for perioperative management of acute spinal cord injury

The incidence of acute spinal cord injury is increasing year by year, but there still lacks clinical guideline for perioperative management. In order to provide a standardized management for the perioperative period of acute spinal cord injury, the specialists from Spinal Disease Prevention and Control Group, Spinal Cord Injury Disease Prevention Society of Chinese Preventive Medicine Committee and Basic Research Group, Spinal Cord Committee of Chinese Society of Rehabilitation Medicine have developed a guideline after retrieval of domestic and foreign literature, discussion and voting on the basis of practical and scientific principles. This guideline focuses on 12 perioperative management issues of acute spinal cord injury, involving admission evaluation, admission diagnosis, complications management, preoperative preparation, surgical indication, timing selection, surgical mode selection, complications management, pain management, drug treatment, rapid rehabilitation and nursing care. Based on evidence-based medicine, the aim of this guideline is to provide scientific advices for perioperative management after acute spinal cord injury so as to effectively improve the surgical treatment and prognosis of spinal cord injury. Key words: Spinal cord injuries; Perioperative care; Practice guideline

Spinal cord injury with neurogenic lower urinary tract dysfunction as a potential risk factor for bladder carcinoma

Life expectancy for people with spinal cord injury/disease (SCI/D) is increasing, due to modern advances in treatment methods and in neuro-urology. However, with the increased life expectancy the risk of developing urinary bladder cancer is gaining importance. How is this patient group different from the general population? Single-centre retrospective evaluation of consecutive patient data with spinal cord injury and proven urinary bladder cancer. Between January 1st 1998 and March 31st 2017, 32 (3 female, 29 male) out of a total of 6432 patients with SCI/D were diagnosed with bladder cancer.The average age at bladder cancer diagnosis was 54.5 years, which is well below the average for bladder cancer cases in the general population (male: 74, female: 75).Twenty-seven patients suffered from urodynamically confirmed neurogenic detrusor overactivity, while five patients (all male) had detrusor acontractility.The median latency period between the onset of SCI/D and tumor diagnosis was 29.5 years. Temporary indwelling catheterisation was found in four patients for only 1.61 % of the overall latency period of all patients.The majority of the patients (n = 27) had transitional cell carcinoma, while five had squamous cell carcinoma. Of the 32 patients, 25 (78 %) had muscle invasive bladder cancer at ≥ T2 at the time of diagnosis. Regarding tumour grading, 23 out of 32 patients showed a histologically poorly differentiated G3 carcinoma; two patients each had G2 and G1 tumours repectively (no information on tumour grading was available in five patients).The median survival for all patients was 11.5 months. The prognosis of patients with squamous cell carcinoma was even worse; 4 out of 5 died within 7 months (median 4 months). The significantly younger age at onset and the frequency of invasive, poorly differentiated tumour at diagnosis indicate that SCI/D influences both bladder cancer risk and prognosis significantly. The latency period between paralysis and tumour disease seems to be a decisive risk parameter.The type of neurogenic bladder dysfunction and the form of bladder drainage do not appear to influence the risk. Long-term indwelling catheter drainage played only a minor role in the investigated patients.Early detection of bladder cancer in patients with spinal cord injury remains a challenge.

Peer-led, transformative learning approaches increase classroom engagement in care self-management classes during inpatient rehabilitation of individuals with spinal cord injury

Objective: Evaluate effects of revised education classes on classroom engagement during inpatient rehabilitation for individuals with spinal cord injury/disease (SCI/D).Design: Multiple-baseline, quasi-experimental design with video recorded engagement observations during conventional and revised education classes; visual and statistical analysis of difference in positive engagement responses observed in classes using each approach.Participants/Setting: 81 patients (72% male, 73% white, mean age 36 SD 15.6) admitted for SCI/D inpatient rehabilitation in a non-profit rehabilitation hospital, who attended one or more of 33 care self-management education classes that were video recorded. All study activities were approved by the host facility institutional review board.Intervention: Conventional nurse-led self-management classes were replaced with revised peer-led classes incorporating approaches to promote transformative learning. Revised classes were introduced across three subject areas in a step-wise fashion over 15 weeks.Outcome Measure: Positive engagement responses (asking questions, participating in discussion, gesturing, raising hand, or otherwise noting approval) were documented from video recordings of 14 conventional and 19 revised education classes.Results: Significantly higher average (per patient per class) positive engagement responses were observed in the revised compared to conventional classes (p=0.008).Conclusion: Redesigning SCI inpatient rehabilitation care self-management classes to promote transformative learning increased patient engagement. Additional research is needed to examine longer term outcomes and replicability in other settings.

Effects of Peer Mentoring on Self-Efficacy and Hospital Readmission After Inpatient Rehabilitation of Individuals With Spinal Cord Injury: A Randomized Controlled Trial

ObjectiveTo investigate the effect of intensive peer mentoring on patient-reported outcomes of self-efficacy and unplanned hospital readmissions for persons with spinal cord injury/disease (SCI/D) within the first 6 months after discharge from inpatient rehabilitation. DesignRandomized controlled trial. SettingNonprofit inpatient rehabilitation hospital specializing in care of persons with SCI/D and brain injury. ParticipantsPatients (N=158) admitted to the SCI/D rehabilitation program whose discharge location was a community setting. Participants (51% with paraplegia and 49% with tetraplegia) were 73% white and 77% men, with a mean age of 38 years. InterventionsParticipants in the experimental group received initial consult/introduction with a peer support program liaison and were assigned a peer mentor, who met with the participant weekly throughout the inpatient stay and made weekly contact by phone, e-mail, or in person for 90 days postdischarge. Participants also were encouraged to participate in regularly scheduled peer support activities. Nonexperimental group participants were introduced to peer support and provided services only on request. Main Outcome MeasuresGeneral Self-efficacy Scale (adapted to SCI/D), project-developed community integration self-efficacy scale, and patient-reported unplanned rehospitalizations. ResultsGrowth rate for self-efficacy in the first 6 months postdischarge was significantly higher for experimental group participants than nonexperimental group participants. Experimental group participants also had significantly fewer unplanned hospital days. ConclusionsThis study provides evidence that individuals receiving intensive peer mentoring during and after rehabilitation for SCI/D demonstrate greater gains in self-efficacy over time and have fewer days of unplanned rehospitalization in the first 180 days postdischarge. More research is needed to examine the long-term effects of this intervention on health care utilization and the relation between improved health and patient-reported quality of life outcomes.

Cardiometabolic Syndrome in People With Spinal Cord Injury/Disease: Guideline-Derived and Nonguideline Risk Components in a Pooled Sample

ObjectiveTo assess cardiometabolic syndrome (CMS) risk definitions in spinal cord injury/disease (SCI/D). DesignCross-sectional analysis of a pooled sample. SettingTwo SCI/D academic medical and rehabilitation centers. ParticipantsBaseline data from subjects in 7 clinical studies were pooled; not all variables were collected in all studies; therefore, participant numbers varied from 119 to 389. The pooled sample included men (79%) and women (21%) with SCI/D >1 year at spinal cord levels spanning C3-T2 (American Spinal Injury Association Impairment Scale [AIS] grades A–D). InterventionsNot applicable. Main Outcome MeasuresWe computed the prevalence of CMS using the American Heart Association/National Heart, Lung, and Blood Institute guideline (CMS diagnosis as sum of risks ≥3 method) for the following risk components: overweight/obesity, insulin resistance, hypertension, and dyslipidemia. We compared this prevalence with the risk calculated from 2 routinely used nonguideline CMS risk assessments: (1) key cut scores identifying insulin resistance derived from the homeostatic model 2 (HOMA2) method or quantitative insulin sensitivity check index (QUICKI), and (2) a cardioendocrine risk ratio based on an inflammation (C-reactive protein [CRP])–adjusted total cholesterol/high-density lipoprotein cholesterol ratio. ResultsAfter adjustment for multiple comparisons, injury level and AIS grade were unrelated to CMS or risk factors. Of the participants, 13% and 32.1% had CMS when using the sum of risks or HOMA2/QUICKI model, respectively. Overweight/obesity and (pre)hypertension were highly prevalent (83% and 62.1%, respectively), with risk for overweight/obesity being significantly associated with CMS diagnosis (sum of risks, χ2=10.105; adjusted P=.008). Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model (χ22=21.23, adjusted P<.001). Of the subjects, 76.4% were at moderate to high risk from elevated CRP, which was significantly associated with CMS determination (both methods; sum of risks, χ22=10.198; adjusted P=.048 and HOMA2/QUICKI, χ22=10.532; adjusted P=.04). ConclusionsAs expected, guideline-derived CMS risk factors were prevalent in individuals with SCI/D. Overweight/obesity, hypertension, and elevated CRP were common in SCI/D and, because they may compound risks associated with CMS, should be considered population-specific risk determinants. Heightened surveillance for risk, and adoption of healthy living recommendations specifically directed toward weight reduction, hypertension management, and inflammation control, should be incorporated as a priority for disease prevention and management.

Comorbidities and Age Related Conditions among Persons with Spinal Cord Injury/Disease (SCI/D)

To investigate the prevalence of comorbid conditions and age related conditions among those aging with spinal cord injury and disease. To compare these data to current Medicare data on adults over 65 and those with disabilities. To determine the association of age and time since injury or disease onset to these rates of prevalence.

Flexible ureteroscopic laser lithotripsy for upper urinary tract stone disease in patients with spinal cord injury.

The objective of this study is to present the outcomes of flexible ureteroscopic laser lithotripsy (URS) for upper urinary tract stone disease in spinal cord injury (SCI) patients performed by a single surgeon. A retrospective analysis was performed for SCI patients treated with flexible URS for proximal ureter and kidney stone disease by a single surgeon between 2003 and 2013. Patient characteristics, operative outcomes, metabolic evaluation, and stone analyses were assessed in detail. A total of 27 URS procedures were performed for urolithiasis in 21 renal units of 19 patients. The mean age was 52.1 ± 15.6 years (16-72) and mean BMI was 29.2 ± 7.3 kg/m(2) (20-45.7). Etiology of SCI was trauma (n: 10), multiple sclerosis (n: 6), cerebrovascular accident (n: 1), or undetermined (n: 2). The mean stone size was 15.9 ± 8.6 (6-40) mm. In the 27 URS procedures, stones were located in the ureter (n: 5), the kidney (n: 14), and both areas (n: 8). Mean hospitalization time was 2.0 ± 2.4 (0-10) days. Postoperative complications were observed in 6 cases (22.2%). Three major complications included urosepsis (n: 1) and respiratory failure (n: 2), that were observed postoperatively and required admission to the intensive care unit. The 2 minor complications were hypotension, fever and UTI, and required medical treatment. Fourteen (66.6%) of the 21 renal units were stone free. Calcium phosphate carbonate (n: 9) and struvite (n: 5) were the primary stone compositions detected. Hypocitraturia (n: 6), hypercalciuria (n: 5), hypernaturia (n: 5), hyperoxaluria (n: 4), and hyperuricosuria (n: 1) were common abnormalities in 24-h urine analysis. Ureteroscopic laser lithotripsy can be an effective treatment modality for SCI patients with upper urinary tract calculi.

The influence of age on functional recovery of adults with spinal cord injury or disease after inpatient rehabilitative care: a pilot study

The impact of age on functional recovery after spinal cord injury/disease (SCI/D) is still unclear. Given this, we sought to examine the potential influence of patient's age on functional recovery following SCI/D. This retrospective cohort study included consecutive adults with SCI/D admitted to a tertiary rehabilitation center from January 2003 to April 2004. The main outcome was functional recovery during inpatient rehabilitation. Functional recovery was assessed using the Spinal Cord Independence Measure (SCIM) and Functional Independence Measure (FIM). FIM and SCIM mean admission scores were subtracted from mean discharge scores and compared to thresholds for minimal clinically important differences. Potential confounders included gender, mechanism of SCI/D, level, and severity of SCI/D. There were 30 patients (11 females, 19 males; ages 30-83 years) with traumatic (n = 11) or non-traumatic SCI/D (n = 19). Mean baseline SCIM and FIM scores were 55.1 ± 4.3 and 82.7 ± 3.6, respectively. After a mean follow-up time of 71 days, patients achieved a mean SCIM of 70.6 ± 4.2 and mean FIM score of 107.3 ± 2.8. SCIM scores were not associated with age in the analyses either using univariate analysis (p = 0.137) or regression analysis (p = 0.215). FIM scores were not associated with age either using univariate analysis (p = 0.266) or regression analysis (p = 0.551). Our results indicate that age is not associated with functional recovery after rehabilitation for SCI/D. Clinicians and allied health professionals should have a greater awareness of the potential of adult patients with SCI/D to achieve functional recovery regardless of age.

Increased risk of acute coronary syndrome after spinal cord injury: A nationwide 10-year follow-up cohort study

Thallium scintillation tests and computerized tomography analyses of coronary artery calcification have revealed a higher prevalence of asymptomatic coronary artery disease in spinal cord injury (SCI) patients [1–4]. Acute coronary syndrome (ACS) is one of the most common causes of death in patients with cardiovascular disease. 50% of patients diagnosed with a myocardial infarction experienced silent ischemia and did not exhibit any classic ACS symptoms [5]. However, the incidence and characteristics of ACS in SCI patients have not been reported and it is uncertain whether they are actually at a higher risk for ACS.

Lessons for spinal cord injury rehabilitation taken from adult developmental psychology: 2011 Essie Morgan Lecture

Background/objectiveDevelopmental phases affect how individuals cope with and challenge threats to self-concept, health and functioning. Understanding prominent models of adult psychological development can help spinal cord injury/disease (SCI/D) rehabilitation professionals facilitate positive change and growth.DesignAuthor's theoretical model informed by literature review and personal experience.SettingVeterans administration (VA) medical center interdisciplinary outpatient clinic providing primary and specialty care to veterans with spinal cord injuries and disorders.ConclusionThreats to life expectations, health, well-being, identity, and other aspects of self create crises that can result in psychopathology or psychological growth. SCI/D can present multiple threats across the lifespan. For example, self-image, ability to perform various activities, ability to feel attractive, and even life itself may be challenged by SCI/D or its complications. Threats may be perceived at the time of injury or onset of symptoms. Also, as the injured body declines further over time, complications can cause significant temporary or permanent functional decline. Individuals interpret each of these threats in the context of current developmental needs. How people cope is influenced by developmental factors and personality traits. An integrated model of adult psychological development based on the works of Erikson, Gutmann, and Baltes is related to the literature on coping with SCI/D. This model provides insights that interdisciplinary rehabilitation teams may use to facilitate personal growth, optimal functioning, and physical health as adults with SCI negotiate normal developmental challenges throughout their lifetimes.

Nontraumatic Spinal Cord Injury/Disease: Etiologies and Outcomes

The pathogenesis of nontraumatic spinal cord injury/disease (SCI/D) includes vertebral spondylosis, cancerous and infectious-related compression, vascular ischemia, multiple sclerosis, inflammatory disease, motor neuron disease, radiation myelopathy, syringomyelia, paraneoplastic syndrome, and vitamin B12 deficiency. The incidence, demographics, clinical presentations, and outcomes for the nontraumatic SCI/D population have not been as thoroughly studied in persons with SCI as in persons with traumatic etiology. A better understanding of these issues will assist in the medical management, rehabilitation, and longterm follow-up for these individuals.