Spinal Cord Injury Health Research Articles

Telehealth High-Intensity Interval Exercise And Cardiometabolic Health In Spinal Cord Injury

Telehealth High-Intensity Interval Exercise And Cardiometabolic Health In Spinal Cord Injury

Telehealth high-intensity interval exercise and cardiometabolic health in spinal cord injury

BackgroundThe number of exercise trials examining cardiometabolic outcomes in spinal cord injury (SCI) is low, and prescribed exercise is often inconvenient for individuals with SCI to perform within their community. Individuals with SCI experience a myriad of barriers to exercise participation, which can include a lack of time, accessible or usable equipment and facilities, and transportation. Thus, it is imperative to identify effective modes of exercise that provide the greatest overall health benefits but do not require a significant time commitment. Low-volume high intensity interval training (HIIT) has demonstrated the same improvements in cardiometabolic health as moderate intensity exercise training (MIT), despite only requiring 20% of the total time commitment in adults without disabilities and more recently in individuals with SCI.ObjectivesThe primary purpose of this study is to integrate a 16 week home-based telehealth HIIT arm crank exercise training program in individuals with SCI and assess changes in cardiometabolic health.MethodsMen and women between the ages of 19 and 60 with a confirmed diagnosis of SCI between C7 and T12 will be recruited for this study. Participants will be randomized to 16 weeks of telehealth HIIT exercise two days per week or a no-exercise control group. Aerobic capacity, muscular strength, blood lipids, glucose tolerance, resting energy expenditure, blood pressure, and body composition will be assessed at baseline and 16 weeks post-training.DiscussionInactivity associated with SCI leads to chronic cardiometabolic health conditions. The majority of exercise interventions to date show that exercise is capable of increasing physical function, aerobic capacity, and muscle mass, and strength. Additionally, we have recently shown the ability of HIIT to improve blood lipid and glucose concentrations. Advances in telehealth exercise approaches have improved the capability to prescribe home-based exercise programs. Therefore, we hypothesize that the utilization of a home-based telehealth HIIT program will improve cardiometabolic health markers, yield high adherence (> 75%), and will be more enjoyable in individuals with SCI.Trial registrationTelehealth High-Intensity Interval Exercise and Cardiometabolic Health in Spinal Cord Injury NCT04940598

Utility of the World Health Organization Disability Assessment Schedule and the World Health Organization minimal generic set of domains of functioning and health in spinal cord injury.

To compare easy-to-use International Classification of Functioning, Disability and Health (ICF)-based measures of functioning with the level and severity of spinal cord injury. Cross-sectional study. Patients (n = 142) and their significant others completed the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire. A physician at the university hospital outpatient clinic assessed functioning with the 7-item World Health Organization (WHO) minimal generic set. The patient and proxy WHODAS sum score was rated severe with decreasing severity in groups with complete and partial tetraplegia and paraplegia, respectively. Working ability was rated most severely impaired in the tetraplegic groups. Between-group differences were also found in mobility, household tasks, and self-care. Mobility was found to be associated with lesion severity; life activities, participation and friendships with lesion level; and self-care and WHODAS sum score with both lesion severity and level. Depending on the level and severity of spinal cord injury, a moderate to strong correlation was found between the sum scores of the 2 tools, and mostly very strong correlations between patient and proxy assessments of functioning. Both generic ICF-based tools, despite their briefness, seemed to be useful as they were able to differentiate various levels and severities of spinal cord injury. We recommend using the 12-item WHODAS 2.0 when planning individualized services for patients with spinal cord injury.

Young people’s safety beliefs after a spinal cord injury health promotion and awareness presentation

Objective: Adolescence is presented as a vulnerable period for accidental injury, particularly spinal cord injury, given young people’s propensity for risky behaviours. School-based health promotion initiatives provide opportunities for education about the risks associated with dangerous behaviours. In this study, we aimed to describe young people’s safety beliefs before and after a school-based spinal cord health promotion and awareness presentation. The effect of selected demographic characteristics on safety beliefs was also examined. Design: A pre–post design was used to record group and time point differences on a range of specific safety beliefs before and after the presentation. Setting and method: The Spinal Education and Awareness Team (SEAT) from Spinal Life Australia conducted a health promotion and awareness presentation with 1,410 students aged 14–19 years across 13 secondary schools in Queensland, Australia. Presentations took place in regional, metropolitan and provincial city schools. A survey assessing basic demographic characteristics and specific risk behaviours was completed by students before and after the presentation. Results: T-tests and chi-square analyses were conducted to examine time point and group differences in relation to the SEAT presentation and to determine relative risks between subgroups of young people. A total of 705 pre-surveys (50%) and 735 post-surveys (52%) were analysed. Overall, reported beliefs were significantly safer post-presentation compared to pre-presentation (all t > 6.93, p < .001). Rural adolescent boys licensed to drive emerged as a particularly risky sub-group and were over three times (odds ratio [OR] = 3.35, 95% confidence interval [CI] = 1.34, 8.40) more likely than their metropolitan peers to hold less safe beliefs relating to spinal cord injury. Conclusion: Findings indicated that the health promotion and awareness presentation increased awareness of spinal cord injury risk behaviours overall and improved adolescent-related safety beliefs. Licensed adolescent boys from rural areas reported little change in awareness post-presentation, further highlighting the importance of targeted health promotion initiatives in rural areas. Extended research is required to further explore the belief–behaviour interaction in this at-risk population.

Lesión medular y uso de sustancias: una revisión sistemática

The objective of this study was to review recent findings about the prevalence of substance use (SU) and substance use disorders (SUD), and to discuss the related impact on health in spinal cord injury (SCI) population. For this purpose, computer-aided searches of MEDLINE (PubMed) and the Cochrane Library were conducted. From an initial pool of 59 articles, 52 met the inclusion criteria. Most of the studies referred to alcohol and tobacco and only a few studies reported on other substances. Study designs were mainly cross-sectional and descriptive, with scarce intervention and longitudinal studies. Although a high prevalence of post-injury SU has been documented among SCI patients, limited research exists on pre-injury SU and on longitudinal studies. Moreover, when exploring SUD, it has not been systematically studied in accordance with CIE or DSM criteria. Alcohol appears to be the most consumed substance among this population. Additionally, those patients with SU have shown poorer outcomes in different health indicators. Therefore, more insight is required to increase scientific knowledge in this field and to recommend tailored preventive interventions and research priorities in relation to this population.

The Effects of Combined Trunk and Gluteal Neuromuscular Electrical Stimulation on Posture and Tissue Health in Spinal Cord Injury

To investigate whether combined trunk and gluteal neuromuscular electrical stimulation (NMES) alters seated posture and improves pelvic tissue health in persons with a spinal cord injury. Intervention study; case series. Research laboratory, medical center. Seven persons with spinal cord injury recruited from a group of experienced implanted lower extremity NMES system users. Combined trunk and gluteal NMES in the sitting position. Five minutes of preintervention sitting was assessed, followed by 5 minutes of NMES application, and then 5 minutes of postintervention. Pelvic tissue health was evaluated by concurrently measuring transcutaneous oxygen tension (TcPO2) bilaterally over the ischia and the seating interface pressure (IP). TcPO2 data were binned into low (<10 mm Hg), medium (10-30 mm Hg), and high (>30 mm Hg) ranges, and the percentage time that TcPO2 was in each range was calculated. Ischial and sacral regions of interest were defined and the maximum region of interest and mean IP were determined, together with the maximum IP gradient for the entire contact area. Initial seating postures varied; 4 persons were initially sacral sitters. Tissue health responses to NMES were reviewed for sacral and nonsacral sitters. For sacral sitters, the sacral region IP and the maximum IP gradient tended to decrease during NMES and increased again after the intervention. Mean ischial TcPO2 increased during NMES and remained elevated after the intervention, increasing high TcPO2 percentage time for 50% of the sacral sitters both during and after the intervention. Nonsacral sitters showed few changes in tissue health as the result of the application of NMES. Trunk and gluteal stimulation acutely corrects anterior/posterior IP distribution, improving regional tissue health for sacral sitters. This correction requires constant application of NMES. The potential for positive changes in tissue health would be maximized by regular NMES use incorporating weight shifting.

Subjective health in spinal cord injury after outpatient healthcare follow-up.

To compare self-reported health, independence, and depression in two samples of people with spinal cord injury (SCI), one which receives regular, comprehensive outpatient health care follow-up and one that does not. Exploratory study of self-reported secondary conditions in 235 individuals with SCI who received health care follow-up using post hoc quasi-experimental comparisons with a group of 136 people with SCI who had no health care follow-up. Outpatients at a Veterans Affairs Health Care System SCI Center. The Check Your Health Instrument surveyed three self-report measures: overall health, independence, and depression. The Secondary Conditions Screening Instrument (SCSI) addressed 40 secondary conditions that may have been experienced in the prior year. Study participants who receive ongoing SCI health care reported higher subjective health, independence, and absence of depression scores compared to those that did not receive regular SCI health care follow-up. Results on the SCSI showed similar secondary conditions in the two groups, but higher frequency and severity in the no follow-up group. SCI outpatient health care follow-up is associated with higher subjective health, independence, and absence of depression.