Long-standing Spinal Cord Injury Research Articles

Obesity in wheelchair users with long-standing spinal cord injury: prevalence and associations with time since injury and physical activity.

Secondary analysis of cross-sectional data from the ALLRISC cohort study. To investigate the prevalence of obesity and its association with time since injury (TSI) and physical activity (PA) in wheelchair users with long-standing (TSI > 10 years) spinal cord injury (SCI). Community, The Netherlands. Wheelchair users with SCI (N = 282) in TSI strata (10-19, 20-29, and ≥30 years) and divided in meeting SCI-specific exercise guidelines or not. Waist circumference (WC) and body mass index (BMI) were assessed. Participants were classified as being obese (WC > 102 cm for men, WC > 88 cm for women; BMI ≥ 25 kg/m2) or not. Logistic regression analyses were performed to investigate the associations between obesity and TSI and PA. Almost half of the participants (45-47%) were classified as obese. TSI was significantly associated with obesity, the odds of being obese were 1.4 higher when having a 10 years longer TSI. Furthermore, the odds of being obese were 2.0 lower for participants who were meeting the exercise guidelines. The prevalence of obesity is high in people with long-standing SCI. Those with a longer TSI and individuals who do not meet the exercise guidelines are more likely to be obese and need to be targeted for weight management interventions.

Adults Aging With Spinal Cord Injury: Prevalence and Associated Risk Factors for Diagnosis of Diabetes Mellitus

With the increased life expectancy, people aging with spinal cord injury (SCI) are more likely to experience chronic conditions, including diabetes mellitus (DM). The results of previous literature related to the prevalence of DM are mixed and risk factors associated with diagnosis of DM after SCI are not well defined. This study aims to investigate the prevalence of DM and explore associated risk factors for diagnosis of DM among adults aging with long-standing spinal cord injury in the United States. This is a secondary data analysis using the National Spinal Cord Injury Model Systems Database. Participants included 516 people age 45 and older who have been living with SCI for more than 10 years. The prevalence of DM in this sample was 13.2%. Multivariate logistic regression, controlling for confounding variables, was conducted to identify risk factors associated with DM diagnosis in this sample. The multivariate logistic regression model found that the participants who responded with less severe SCI measured by the ASIA impairment scale were less likely to be diagnosed with DM (OR=0.332, p=.017). Also, DM was found to be significantly associated with BMI (OR=1.043, p=.010) and age (OR=1.038, p= .010) respectively. Duration of disability was not significantly associated with DM. Future research is needed to validate these findings and identify other common risk factors for DM such as diet/nutrition. Further, exploration of the effect size of risk factors is also warranted. Such findings will inform interventions to aid prevention and early detection of DM.

Utilizing a Low-Carbohydrate/High-Protein Diet to Improve Metabolic Health in Individuals With Spinal Cord Injury

Abstract Objectives The purpose of this study is to determine if an 8-week low-carbohydrate/high-protein (LC/HP) dietary intervention will show improvements in clinically important metrics of metabolic function and body composition in individuals with spinal cord injury (SCI). Methods Twenty-one participants with long-standing SCI (≥3 years post-injury) (age: 45 ± 13 years) were randomly assigned to an 8-week iso-caloric high-protein/low-carbohydrate (HPLC) diet or their habitual control diets. Injury levels ranged between cervical vertebrate 4 to lumbar vertebrate 3. The HPLC diet included ∼30% total energy as protein (40% energy from carbohydrate) and participants were provided with all study meals if they were assigned to the HPLC group. Each participant underwent an oral glucose tolerance test (OGTT) and DXA scanning before and after the intervention after an overnight fast. Blood glucose and insulin during the OGTT were assessed, and their respective incremental areas under the curve were calculated, as well as Matsuda index, an indicator of insulin sensitivity. The blood lipid panel was analyzed using the fasting samples. A two-way repeated-measures ANOVA model was used to evaluate the main effect of diet, time, and their interaction. Results We observed no main effect of time, diet, and their interaction on the fasting concentrations of glucose, insulin, their respective concentrations at 120-minute during the OGTT, and areas under the curve, but a trend for decreased insulin AUC among participants in the HPLC group (P = 0.07). There is a trend for the diet by time interaction effect for the Matsuda index (P = 0.11). The Matsuda index quantitatively increased in the HPLC group while remained in the control group. In contrast, an interaction effect was observed for several outcomes. These outcomes were decreased in the HPLC group, and include total Cholesterol (−23.9mg/dL), LDL (−15.8 mg/dL), total body fat mass (−5%), and visceral fat mass (−11%) (P < 0.05 for all). Fat-free mass did not change over time. Conclusions Our results support that our HPLC diet can be safely adopted by individuals with SCI to achieve improvements in glucose metabolism and lipid profile and body composition. Funding Sources The study was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (#90SI5019).

Limited Association between the Total Healthy Eating Index-2015 Score and Cardiovascular Risk Factors in Individuals with Long-Standing Spinal Cord Injury: An Exploratory Study: An Exploratory Study

BackgroundThe healthy eating index-2015 (HEI-2015) reflects diet quality in reference to the 2015-2020 Dietary Guidelines for Americans (DGA). Little is known regarding its application in individuals with chronic spinal cord injury (SCI). ObjectiveTo explore the relationship between diet quality as assessed by the HEI-2015 and cardiovascular risk factors among individuals with chronic SCI. DesignThis is a cross-sectional analysis of baseline data collected from August 2017 through November 2019 for an interventional study that evaluates the effects of a high-protein/low-carbohydrate diet on cardiovascular risk factors in individuals with chronic SCI at the University of Alabama at Birmingham. Participants/settingTwenty-four free-living adults with SCI (mean age, 45 ± 12 y; 8F/16M, level of injury: nine cervical, 15 thoracic; mean duration of injury: 20 ± 13 y) were included. Main outcome measuresParticipants underwent a 2-hour oral glucose tolerance test (OGTT) and a dual-energy x-ray absorptiometry scan. Dietary intake was assessed by three, 24-hour multiple-pass dietary recalls to calculate the HEI-2015 using the simple HEI scoring algorithm method. Data analysisMultiple linear regression analyses were performed to predict indices of lipid metabolism and glucose homeostasis and C-reactive protein (CRP) from the HEI-2015. Principal component analysis was used to reduce the number of covariates (level of injury, sex, and body fat percentage). ResultsOn average, participants’ diets were of low quality (HEI-2015, 47.2 ± 10.8). The regression models for fasting glucose (FG), cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and CRP had moderate to large effect sizes (adjusted R2 ≥ 13%), suggesting good explanatory abilities of the predictors. Small or limited effect sizes were observed for glucose tolerance, fasting insulin, triglycerides, and Matsuda index (adjusted R2 < 13%). The HEI-2015 accounted for a moderate amount of variation in FG (partial omega-squared, ωP2 = 13%). Each 10-point HEI-2015 score increase was associated with a 3.3-mg/dL decrease in FG concentrations. The HEI-2015 accounted for a limited amount of variation in other indices (ωP2 < 5%). ConclusionsAmong participants with SCI, higher conformance to the 2015-2020 DGA was 1) moderately associated with better FG homeostasis; and 2) trivially associated with other cardiovascular risk factors. Because of the small sample size, these conclusions cannot be extrapolated beyond the study sample. Future larger studies are warranted to better understand the relationship between diet quality and cardiovascular disease risks in this population.

Housing adaptations and housing accessibility problems among older adults with long-standing spinal cord injury

Introduction Adults with spinal cord injuries are living longer than previously, and a majority are living in ordinary housing in the community. Housing accessibility is important for maintaining independent occupational performance for this population, but knowledge in this area is insufficient. We investigated housing adaptations and current accessibility problems among older adults with long-standing (&gt;10 years) spinal cord injuries. Method Data from home visits among 122 older adults with spinal cord injuries in Sweden were used. Housing adaptations and environmental barriers were descriptively analysed. Findings Kitchens, entrances, and hygiene areas were common locations for housing adaptations and environmental barriers that generated accessibility problems. The most common adaptations were ramps, wheelchair-accessible stovetops, and ceiling-lifts. Wall-mounted cupboards and high shelves (kitchen), inaccessible storage areas (outside the dwelling), and a lack of grab bars (hygiene area) generated the most accessibility problems. Conclusion Despite housing adaptations, there are considerable accessibility problems in the dwellings of older adults with long-standing spinal cord injuries in Sweden, indicating that long-term follow-up of the housing situation of this population is necessary. Focusing on accessible housing as a prerequisite for occupational performance is at the core of occupational therapy, deserving attention on the individual as well as the societal level.

Comparison of the gut microbiome composition among individuals with acute or long-standing spinal cord injury vs. able-bodied controls

Objective: Compare the gut microbiome composition among individuals with acute spinal cord injury (A-SCI), long-standing SCI (L-SCI), vs. able-bodied (AB) controls. Design: Cross-sectional study. Setting: The University of Alabama at Birmingham. Participants: Seven adults with A-SCI (36 ± 12 years, 2F/5M, C4-T10, and American Spinal Injury Association Impairment Scale [AIS] A–D), 25 with L-SCI (46 ± 13 years, 6F/19M, C4-L1, and AIS A–D), and 25 AB controls (42 ± 13 years, 9F/16M). Methods: Stool samples were collected after a median of 7 days and 18 years after injury in the A-SCI and L-SCI groups, respectively. Gut microbiome composition was analyzed using the 16S rRNA sequencing technique and QIIME software. The abundances of bacteria communities among groups were compared using the Kruskal–Wallis test adjusted for age. Results: Several alpha diversity indices were different among groups (Chao1, Observed species, and Phylogenetic Diversity), but not others (Shannon and Simpson). Beta diversity differed among each pair of groups (P < 0.05). A number of microbial communities were differentially abundant among the groups (P < 0.05). Conclusion: Our results revealed differences in the gut microbiome composition among groups. Compared to the AB controls, the SCI groups demonstrated microbiome profiles that shared features linked to metabolic syndrome, inflammation-related bowel disorders, depressive disorders, or antibiotics use, whereas the L-SCI group’s microbiome included features linked to reduced physical activity compared to the A-SCI and AB controls. Our results provided preliminary data and a scientific foundation for future studies investigating the impact of the gut microbiome composition on long-term health in individuals with SCI.

The Relationship Between Healthy Eating Index-2015 and Cardiometabolic Risk Factors in People with Long-Standing Spinal Cord Injury

Abstract Objectives The Healthy Eating Index (HEI)-2015 is a measure of diet quality in reference to the 2015 Dietary Guidelines for Americans. We examined the relationship between HEI-2015 and several indices of cardiometabolic risk factors among individuals with chronic spinal cord injury (SCI) (&amp;gt;3 years after injury). Methods Twenty-four participants without type 2 diabetes were included (45 ± 12 y, 8F/16 M, 9 Tetraplegia/15 Paraplegia, time since injury: 20 ± 13 y). All participants underwent a 2-hour oral glucose tolerance test (OGTT), a Dual-energy X-ray absorptiometry scan (DXA), and 3 24-hour multiple-pass dietary recalls. HEI-2015 was calculated using the dietary recall data. To build the regression model, firstly, principal component (PC) analysis was used to reduce the number of covariates from 3 (level of injury, gender, percentage body fat estimated from the DXA) to 2 PCs. Multiple linear regression analyses were run to predict indices of lipid metabolism and glucose homeostasis as well as C-reactive protein (CRP) from the HEI and the 2 PC scores. Results The average HEI-2015 score was lower for participants with SCI compared to the general American population (48 ± 11 vs. 59, P &amp;lt; 0.05). The regression models for fasting glucose (FG), Cholesterol, HDL, LDL, and CRP had moderate to large effect sizes (adjusted R2 &amp;gt; 13%), indicating good explanatory ability of the predictors. Small or limited effect sizes were observed for other models (glucose tolerance, fasting insulin, triaglycerides, and Matsuda index, adjusted R2 &amp;lt; 13% for all). Furthermore, the HEI accounted for a moderate amount of variation in FG as evidenced by partial Omega-squared of 13%. Each 10-point increase of the HEI was associated with a 3.3 mg/dL decrease in FG concentrations. However, HEI accounted for a limited amount of variations in other indices (ωP2 &amp;lt; 5% for all). Conclusions Our exploratory analyses suggest that HEI-2015 has limited effects on blood lipids and CRP but may be associated with lower FG concentrations in our sample group. Future larger studies are warranted to delineate the relationship between diet quality and cardiometabolic health outcomes in individuals with SCI. Funding Sources The National Institute on Disability, Independent Living, and Rehabilitation Research.

Gut Microbiome Composition Differs between Individuals with Acute and Long-standing traumatic Spinal Cord Injury

Gut Microbiome Composition Differs between Individuals with Acute and Long-standing traumatic Spinal Cord Injury

Experienced sitting-related problems and association with personal, lesion and wheelchair characteristics in persons with long-standing paraplegia and tetraplegia.

Cross-sectional study. To describe experienced sitting-related health and stability problems among persons with paraplegia (PP) or tetraplegia (TP) and to investigate associations with personal, lesion and wheelchair characteristics as well as satisfaction with sitting posture. Dutch community. A self-report questionnaire on seating was developed and completed by wheelchair-users living with Spinal Cord Injury (SCI) for ≥10 years (N = 264). Sitting-related problems and satisfaction with sitting posture were compared between participants with PP and TP using Chi-square and t-tests. Logistic regression analyses were performed to investigate associated characteristics. Reported sitting-related problems comprised: sitting to be tiring (regularly to always) (33%), sitting to be painful (28%), pressure ulcers in the last three months (29%), instability while sitting (8%) and instability during reaching (33%). Except for instability during reaching, no differences in occurrence of sitting-problems were found between lesion-group. Persons with TP were more dissatisfied with their sitting posture than persons with PP: 51% vs 36% (p = 0.022) and 51% and 47% respectively thought their sitting posture could be improved (p = 0.670). 'Experienced lack of support in the wheelchair' was associated with most sitting-problems. Pain and instability were associated with dissatisfaction with sitting posture. Sitting-related problems and dissatisfaction with sitting posture were frequently reported by persons with long-standing SCI. Sitting problems appeared to associate with lacking support in the wheelchair/seating. A comprehensive feedback from the wheelchair user and a stability check (reach task), as part of the wheelchair/seating-user fitting, may contribute to prevention of sitting-related problems.

Exercise self-efficacy is weakly related to engagement in physical activity in persons with long-standing spinal cord injury

Aims: Many people with a long-standing spinal cord injury have an inactive lifestyle. Although exercise self-efficacy is considered a key determinant of engaging in exercise, the relationship between exercise self-efficacy and physical activity remains unclear. Therefore, this study examines the relationship between exercise self-efficacy and the amount of physical activity in persons with long-standing spinal cord injury.Methods: This cross-sectional study included 268 individuals (aged 28–65 years) with spinal cord injury ≥ 10 years and using a wheelchair. Physical activity was measured with the Physical Activity Scale for Individuals with Physical Disabilities. Exercise self-efficacy was assessed with the Spinal cord injury Exercise Self-Efficacy Scale. Univariate and multivariable regression analyses were performed to test for the association between exercise self-efficacy and physical activity, controlling for supposed confounders.Results: Univariate regression analysis revealed that exercise self-efficacy was significantly related to the level of daily physical activity (β = 0.05; 95% CI 0.04–0.07; 15% explained variance; p < 0.001). In multivariable regression analysis exercise self-efficacy remained, explaining a significant additional amount of the variance (2%; p < 0.001) of physical activity.Conclusion: Exercise-self efficacy is a weak but independent explanatory factor of the level of physical activity among persons with long-standing spinal cord injury. Longitudinal trials are needed to study the impact of interventions targeting an increase of exercise self-efficacy on the amount of physical activity performed.Implications for rehabilitationPre-intervention levels of exercise-self-efficacy might mediate the effectiveness of interventions that aim at increasing physical activities in people with a long-standing spinal cord injury.Enhancing exercise-self efficacy may improve levels of physical activity, even in people with a long-standing spinal cord injury.When it comes to enhancing physical activity, efforts to enhance non-structured daily physical activities such as household activities and gardening might be as important as efforts to enhance sports and other physical exercise.

Computer and internet use among people with long-standing spinal cord injury: a cross-sectional survey in the Netherlands.

Cross-sectional survey OBJECTIVES: To describe computer and Internet use (other than for work or study) among people with long-standing spinal cord injury (SCI), examine associations between demographic and lesion characteristics and Internet use, and examine associations between Internet use and mental health, participation, and life satisfaction. Community, The Netherlands METHODS: Participants were 265 individuals living with SCI for at least 10 years, who were 18-35 at the onset of SCI, aged 28-65 at the time of the study and wheelchair-user. Scales for General and Health-related Internet use were developed. Nearly all (97.7%) participants had Internet access and 98.4% of those used it daily or weekly. Of those with tetraplegia, 47.4% had assistive devices for computer use. General Internet use, such as following news and online banking, was very frequent. Websites with information on general health or accessibility were typically visited a few times a year. Three-quarters never visited websites of other individuals with SCI or foreign websites with information on SCI. General Internet use was associated with male gender, younger age, and higher education. Participants with tetraplegia scored higher on Health-related Internet use compared to participants with paraplegia. Health-related Internet use was associated with worse participation, but not with the other psychosocial variables. Internet has become part of daily life of people with SCI in the Netherlands. However, only one association between Internet use and indicators of psychosocial functioning was found. Possible underuse of adaptive devices and of SCI-specific websites warrant further investigation.

What Lies Beneath: Why Some Pressure Injuries May Be Unpreventable for Individuals With Spinal Cord Injury

ObjectiveTo investigate intersections between pressure injury (PrI) history, muscle composition, and tissue health responses under physiologically relevant loading conditions for individuals with spinal cord injury (SCI). DesignRepeated measures study design with annual follow-up for up to 3 years. SettingTertiary care center. ParticipantsPersons with SCI (N=38). Exclusion criteria included having an open pelvic region PrI at the time of recruitment, presence of systemic disease, and/or known sensitivity to contrast. InterventionsNot applicable. Main Outcome MeasuresGluteal muscle composition, ischial interface pressures, tissue oxygenation. ResultsIschial region mean interface pressures are the same for individuals with or without a PrI history. Tissue oxygenation is lower during sitting for persons with a PrI history. Individuals with >15% gluteal intramuscular fat were statistically highly significantly (P<.001) more likely to have a history of severe or recurrent PrI. Intramuscular adipose tissue (IMAT) levels within the gluteal muscle may remain low over time or muscle tissue in the gluteal muscle region may be almost entirely replaced by IMAT. In the current study cohort, it was found that muscle composition also continues to change over time even for individuals with long-standing SCI. ConclusionsSoft-tissue compositional changes, specifically IMAT, provides a reliable indicator of PrI history and may provide a key to personalized PrI risk status for persons with SCI. The current findings confirm that interface pressure mapping alone is a limited indicator for PrI development.

Bowel Control Strategies Used by Veterans with Long-Standing Spinal Cord Injuries

Bowel Control Strategies Used by Veterans with Long-Standing Spinal Cord Injuries

Functional independence of persons with long-standing motor complete spinal cord injury in the Netherlands

Context/Objective: Since life expectancy of persons with spinal cord injury (SCI) has improved, it is relevant to know whether this group is able to maintain functional abilities many years after onset of SCI. Objectives of this study were (1) to examine associations between time since injury (TSI) and functional independence in persons with long-standing SCI and (2) to explore associations between functional independence and level of injury, comorbidities, mental health, waist circumference and secondary health conditions (SHCs).Design: TSI-stratified cross-sectional study. Strata were 10–19, 20–29 and 30+ years.Setting: Community.Participants: 226 persons with long-standing SCI. Inclusion criteria: motor complete SCI; age at injury 18–35 years; TSI ≥ 10 years; current age 28–65 years; wheelchair dependency.Interventions: Not applicable.Outcome measures: The Spinal Cord Independence Measure III (SCIM) was administered by a trained research assistant. Level of injury, comorbidities, mental health, waist circumference and SHCs were assessed by a rehabilitation physician.Results: Mean TSI was 23.6 (SD 9.1) years. No significant differences in SCIM scores were found between TSI strata. SCIM scores were lower for persons with tetraplegia, autonomic dysreflexia, hypotension, more than four SHCs and a high waist circumference. In linear regression analyses, TSI nor age was associated with the SCIM total score. Only level of injury (β = –0.7; P < .001) and waist circumference (β = –0.1; P = .042) were independent determinants (explained variance 55%).Conclusion: We found no association between TSI and functional independence in persons with long-standing motor complete SCI. This study confirms the possible effect of overweight on functional independence.

Strength and Step Activity After Eccentric Resistance Training in Those With Incomplete Spinal Cord Injuries.

Background: Individuals with spinal cord injuries (SCIs) often experience general weakness in the lower extremities that undermines daily step activity. Objective: To investigate the efficacy of eccentrically biased resistance training on lower extremity strength and physical activity of individuals with spinal injuries. Methods: Individuals with long-standing incomplete SCIs (N = 11) capable of completing a 10-meter walk assessment were included. All participants who completed the familiarization period finished the training. Individuals trained two times per week for 12 weeks on a lower body eccentric resistance training machine. It was hypothesized that the outcome variables (eccentric strength, isometric strength, and daily step physical activity) would improve as a result of the training intervention. Results: Eccentric strength [F(1.27, 12.71) = 8.42, MSE = 1738.35, H-F p = .009] and isometric strength [F(1.97, 19.77) = 7.10, MSE = 11.29, H-F p = .005] improved as a result of the training while daily step activity remained unchanged [F(2.00, 18.00) = 2.73, MSE = 216,836.78, H-F p = .092]. Conclusions: Eccentric resistance training improves eccentric and isometric strength. These physiological adaptations may translate to improved gait mechanics, but further study is required to identify this potential crossover effect.

A high-protein diet or combination exercise training to improve metabolic health in individuals with long-standing spinal cord injury: a pilot randomized study.

We compared the effects of an 8‐week iso‐caloric high‐protein (HP) diet versus a combined exercise regimen (Comb‐Ex) in individuals with long‐standing spinal cord injury (SCI). Effects on metabolic profiles, markers of inflammation, and signaling proteins associated with glucose transporter 4 (GLUT‐4) translocation in muscles were evaluated. Eleven participants with SCI completed the study (HP diet: n = 5; Comb‐Ex: n = 6; 46 ± 8 years; C5‐T12 levels; American Spinal Injury Association Impairment Scale A or B). The Comb‐Ex regimen included upper body resistance training (RT) and neuromuscular electrical stimulation‐induced‐RT for paralytic quadriceps muscles, interspersed with high‐intensity (80–90% VO2 peak) arm cranking exercises 3 days/week. The HP diet included ~30% total energy as protein (carbohydrate to protein ratio <1.5, ~30% energy from fat). Oral glucose tolerance tests and muscle biopsies of the vastus lateralis (VL) and deltoid muscles were performed before and after the trial. Fasting plasma glucose levels decreased in the Comb‐Ex (P < 0.05) group compared to the HP‐diet group. A decrease in areas under the curve for insulin and TNF‐α concentrations was observed for all participants regardless of group assignment (time effect, P < 0.05). Although both groups exhibited a quantitative increase in insulin sensitivity as measured by the Matsuda Index, the change was clinically meaningful only in the HP diet group (HP diet: pre, 4.6; post, 11.6 vs. Comb‐Ex: pre, 3.3; post, 4.6). No changes were observed in proteins associated with GLUT‐4 translocation in VL or deltoid muscles. Our results suggest that the HP‐diet and Comb‐Ex regimen may improve insulin sensitivity and decrease TNF‐α concentrations in individuals with SCI.

The Housing Enabler instrument: Assessing threats to reliability and validity

Introduction The Housing Enabler instrument, designed to measure housing accessibility, has not been used in samples with long-standing spinal cord injury. We aimed to investigate potential threats to the reliability and validity of the instrument when used among older adults with spinal cord injury. Method Cross-sectional data from the Swedish Aging with Spinal Cord Injury Study ( N = 123, injury levels C1–L5) were utilised. The potential effect on the reliability and content validity of the House Enabler was qualitatively considered and reviewed in an iterative evaluation procedure. To analyse the potential effect on construct validity, simulations adjusting accessibility problem scores for housing adaptations and use of mobility devices were conducted. Findings Considerable threats to the reliability and content validity of the Housing Enabler were identified. The simulated analysis of construct validity showed a modest overall effect on the accessibility problem scores, although this was substantial in some individuals. Conclusion Data collection and analyses of housing accessibility with the Housing Enabler in samples characterised by high frequencies of housing adaptations and/or use of mobility devices (such as powered wheelchairs) require particular attention. Further studies are needed to propose optimisation of the instrument for use in such contexts, followed by psychometric testing to maintain reliability and validity.

Rasch analysis of the University of Washington Self-Efficacy Scale short-form (UW-SES-6) in people with long-standing spinal cord injury.

Cross-sectional psychometric study. The University of Washington Self-Efficacy Scale (UW-SES) is a measure of self-efficacy regarding managing challenges related to multiple sclerosis or spinal cord injury (SCI) that can be used across disabling conditions. The objective of this study was to examine the psychometric properties of its short form, the UW-SES-6, using the Rasch model. Community, The Netherlands. Secondary analysis of data from the ALLRISC study. Participants were 261 individuals with a time since onset of SCI (TSI) for at least 10 years, 18-35 at the onset of SCI, and used a wheelchair in everyday life. Rasch analyses were conducted to examine stochastic ordering (fit), unidimensionality, local dependency, reliability, response scale structure, targeting, and item bias. Median age was 47.8 years (Inter-Quartile Range (IQR) 41.9-55), median TSI was 22 years (IQR 16.8-30.3), 73.6% were male, 90.4% had a traumatic SCI, 39.8% had tetraplegia, and 81.6% had motor complete SCI. After merging the middle three response categories of item 4, the UW-SES-6 showed satisfactory item fit without local dependence. The PSI was high (0.87). Comparison of the person and item threshold distributions showed satisfactory targeting of the UW-SES-6 to the study group. No differential item functioning was seen with respect to sex, age, level of education, level and completeness of lesion, and TSI. This study showed the UW-SES-6 to be a scale with sound psychometric properties that can be used as a quick and easy self-report measure of self-efficacy in people with SCI.

Participation restriction and assistance needs in people with spinal cord injuries of more than 40 year duration.

Prospective observational. Examine changes in participation restriction and assistance needs in a sample of people with long-standing spinal cord injuries (SCIs). Two British spinal centres. The sample consisted of British ageing with SCI study participants who were seen at baseline (1990 or 1993) and in the final follow-up (2010). Outcome measures were the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) and interview questions about assistance needs. Eighty-five Ageing study participants took part in 2010; their mean age was 67.65 years and the mean time since injury was 46.26 years. The mean CHART-SF physical independence subscore decreased from 97.44 in 1990 to 91.26 in 2010, mobility from 95.58 to 82.10, occupation from 86.82 to 64.49 and social integration from 96.29 to 88.68 (all p < 0.05). Increasing assistance needs were reported by 10.1% of participants in 1990, by 36.6% in 2010 (p < 0.05) and by 62.4% over the entire 20-year study period. Persons requiring more assistance were older and injured longer, had a more severe SCI and lower self-reported quality of life and life satisfaction (p < 0.05). In the multivariate logistic regression, the strongest predictor of needing more assistance was injury severity (p < 0.05). An increase in participation restriction and in assistance needs was reported over the 20 year follow-up in persons injured more than 40 years ago. SCI severity was the main risk factor for needing more assistance. Clinical awareness of how participation changes with age may help provide timely intervention and offset declines.

Paralytic and nonparalytic muscle adaptations to exercise training versus high-protein diet in individuals with long-standing spinal cord injury.

This study compares the effects of an 8-wk isocaloric high-protein (HP) diet versus a combination exercise (Comb-Ex) regimen on paralytic vastus lateralis (VL) and nonparalytic deltoid muscle in individuals with long-standing spinal cord injury (SCI). Fiber-type distribution, cross-sectional area (CSA), levels of translation initiation signaling proteins (Erk-1/2, Akt, p70S6K1, 4EBP1, RPS6, and FAK), and lean thigh mass were analyzed at baseline and after the 8-wk interventions. A total of 11 participants (C5-T12 levels, 21.8 ± 6.3 yr postinjury; 6 Comb-Ex and 5 HP diet) completed the study. Comb-Ex training occurred 3 days/wk and consisted of upper body resistance training (RT) in addition to neuromuscular electrical stimulation (NMES)-induced-RT for paralytic VL muscle. Strength training was combined with high-intensity arm-cranking exercises (1-min intervals at 85-90%, V̇o2peak) for improving cardiovascular endurance. For the HP diet intervention, protein and fat each comprised 30%, and carbohydrate comprised 40% of total energy. Clinical tests and muscle biopsies were performed 24 h before and after the last exercise or diet session. The Comb-Ex intervention increased Type IIa myofiber distribution and CSA in VL muscle and Type I and IIa myofiber CSA in deltoid muscle. In addition, Comb-Ex increased lean thigh mass, V̇o2peak, and upper body strength ( P < 0.05). These results suggest that exercise training is required to promote favorable changes in paralytic and nonparalytic muscles in individuals with long-standing SCI, and adequate dietary protein consumption alone may not be sufficient to ameliorate debilitating effects of paralysis. NEW & NOTEWORTHY This study is the first to directly compare the effects of an isocaloric high-protein diet and combination exercise training on clinical and molecular changes in paralytic and nonparalytic muscles of individuals with long-standing spinal cord injury. Our results demonstrated that muscle growth and fiber-type alterations can best be achieved when the paralyzed muscle is sufficiently loaded via neuromuscular electrical stimulation-induced resistance training.