Secondary Medical Complications Research Articles

Obsessive-compulsive disorder with compulsive exercise leading to intensive care treatment in an adolescent male: a case report.

Obsessive-compulsive disorder (OCD) and eating disorders (ED) are compulsive disorders with overlapping symptoms. However, weight loss and over-exercise causing secondary medical complications are rarely seen in OCD. We report the case of a 15-year-old male who presented with atypical symptoms of OCD leading to severe medical compromise. Covid-19 related team sport restrictions led to compulsive exercise associated with intrusive thoughts. The onset of stress fractures limited exercise ability,prompting compensatory food restriction. Bradycardia, hypothermia and hypoglycaemia resulted from severe malnourishment and weight loss in the context of OCD. His weight was 85.8% of ideal body weight on admission, reflective of a weight 10-15 kg lower than his premorbid weight. During admission, he developed exercise-induced rhabdomyolysis with significantly elevated creatinine kinase and required intensive care unit treatment. Psychotropic medication included lamotrigine, olanzapine and high dose fluoxetine alongside cognitive-behavioural therapy. Medical stabilisation and weight restoration allowed discharge to an outpatient Child and Adolescent Mental Health Service. This atypical case of OCD highlights the potentially life-threatening risks associated with excessive exercise and malnutrition. This paper highlights the complexities of treatment in a patient who cannot adhere to bed rest and the differential diagnoses of anorexia nervosa, orthorexia nervosa and exercise addiction.

Health status and disability in persons with spinal cord injuries in South Africa and Kenya

Background: There is a lack of understanding regarding the nature of disabilities and functioning limitations associated with spinal cord injuries (SCI) in developing economies given limited healthcare resources.Aim: Our purpose was to assess and compare SCI-related disability among individuals with SCI in South Africa and Kenya to inform rehabilitation service planning.Settings: Two hundred individuals from South Africa and 90 from Kenya with SCI took part in this cross-sectional survey study, examining the comprehensive functioning of individuals with long-term SCI.Methods: This study utilised the International SCI (InSCI) Community Survey questionnaire. Subsections of the questionnaire were used to investigate the differences in the period-prevalence of secondary medical conditions, activity limitations and participation restrictions in persons with SCI.Results: In both countries, sexual dysfunction (55% – 57%), pain (48% – 49%), spasticity (41% – 42%) and bladder dysfunction (27% – 60%) emerged as the predominant secondary medical complications, with sexual dysfunction and pain showing overlap. There was no notable superiority in terms of treatment rates for secondary medical conditions between countries; however, exceptions were found. Both countries experienced similar overlaps in prevalent activity limitations and participation restrictions, including standing unsupported, using the toilet, bladder and bowel impairments, using public transport and reaching destinations. However, the Kenyan cohort showed significantly higher prevalence rates compared to the South African cohort for challenges related to carrying out daily routines, getting to destinations and using public transportation, while maintaining intimate relationships was more prevalent in South Africa.Conclusion: This study provides insight into the similarities and differences in both the nature and prevalence of disability in two developing economies. It appears that universal functioning patterns after SCI exist in the two countries, and a further need emerged to examine these functioning problems on other major life areas.Contribution: While some functioning problems could be addressed through healthcare and rehabilitation alone, others will require improved coordination and a whole-of-government approach, namely issues related to participation, community integration and inclusion.

Valsalva maneuver pressure recovery time is prolonged following spinal cord injury with correlations to autonomically-influenced secondary complications.

This work's purpose was to quantify rapid sympathetic activation in individuals with spinal cord injury (SCI), and to identify associated correlations with symptoms of orthostatic hypotension and common autonomically mediated secondary medical complications. This work was a cross-sectional study of individuals with SCI and uninjured individuals. Symptoms of orthostatic hypotension were recorded using the Composite Autonomic Symptom Score (COMPASS)-31 and Autonomic Dysfunction following SCI (ADFSCI) survey. Histories of secondary complications of SCI were gathered. Rapid sympathetic activation was assessed using pressure recovery time of Valsalva maneuver. Stepwise multiple linear regression models identified contributions to secondary medical complication burden. In total, 48 individuals (24 with SCI, 24 uninjured) underwent testing, with symptoms of orthostatic hypotension higher in those with SCI (COMPASS-31, 3.3 versus 0.6, p < 0.01; ADFSCI, 21.2 versus. 3.2, p < 0.01). Pressure recovery time was prolonged after SCI (7.0s versus. 1.7s, p < 0.01), though poorly correlated with orthostatic symptom severity. Neurological level of injury after SCI influenced pressure recovery time, with higher injury levels associated with more prolonged time. Stepwise multiple linear regression models identified pressure recovery time as the primary explanation for variance in number of urinary tract infections (34%), histories of hospitalizations (12%), and cumulative secondary medical complication burden (24%). In all conditions except time for bowel program, pressure recovery time outperformed current clinical tools for assessing such risk. SCI is associated with impaired rapid sympathetic activation, demonstrated here by prolonged pressure recovery time. Prolonged pressure recovery time after SCI predicts higher risk for autonomically mediated secondary complications, serving as a viable index for more "autonomically complete" injury.

Sexual Activity in Adults with Pediatric-Onset Spinal Cord Injury: Injury, Demographic, and Lifestyle Factors.

Sexual development is a complex process of understanding oneself as a sexual being. Youth with spinal cord injury (SCI) navigate the typical phases of sexual development along with the physical and psychological sequelae of an SCI. As youth with SCI progress from adolescence to emerging adulthood, sexual activity-physical intimacy and sexual intercourse-is an important milestone. The aims of the study were to (1) describe frequency of physical intimacy among adults with pediatric-onset SCI and (2) identify injury, demographic, and lifestyle factors that predict frequency of physical intimacy. Adults with pediatric-onset SCI who were former patients within a North American pediatric hospital system (N = 277) completed a structured telephone interview that included medical and sociodemographic information and standardized measures of psychological functioning. Participants rated physical intimacy and sexual intercourse frequency on a 5-point Likert scale, with a response of monthly, weekly, or daily classified as regular frequency and never or yearly as irregular frequency. Bivariate and multivariate analyses were conducted with physical intimacy frequency as the primary outcome. Of the participants, 55% engaged in physical intimacy and 49% engaged in sexual intercourse with regular frequency. In logistic regression analyses, living independently of parents, being married, and higher perceived social integration increased likelihood of regular frequency of physical intimacy. Injury severity and secondary medical complications were not significant independent predictors of frequency of physical intimacy. Half of adults with pediatric-onset SCI engage in regular physical intimacy; this is below the estimates for the general population. Psychosocial factors are stronger contributors to physical intimacy frequency than SCI-related factors. Health care providers and researchers should focus on barriers to social integration and development of social relationships as factors that influence physical intimacy in this population.

Autonomic impairment is not explained by neurological level of injury or motor-sensory completeness.

Cross-sectional study. Determine how well common clinical assessments of level and completeness of injury are correlated with symptoms of autonomic blood pressure instability and secondary medical complications after spinal cord injury (SCI). Academic medical center, United States. Eighty-two individuals with (n = 48) and without (n = 34) SCI had symptoms of autonomic blood pressure instability quantified with the Autonomic Dysfunction Following SCI (ADFSCI) survey. Health histories quantified the secondary medical complications through number of urinary tract infections and hospitalizations in the past year, time to complete bowel program, and lifetime pressure injuries. Regression models were completed to identify strengths of associated correlations. ADFSCI scores were significantly higher in individuals with SCI than controls. Neurological level of injury and ASIA impairment scale were both minimally correlated to symptoms of autonomic blood pressure instability, accounting for only 11.5% of variability in regression models. Secondary medical complications had similar, minimal correlations to level and motor/sensory completeness of SCI (R2 = 0.07 and R2 = 0.03 respectively). Contrasting this, symptoms of blood pressure instability on ADFSCI far outperformed the common clinical motor/sensory bedside exam, with moderately strong correlations to the ranked number of secondary medical complications after SCI (R2 = 0.31). Neurological level of injury and motor/sensory completeness provided limited insights into which individuals with SCI would have blood pressure instability or secondary medical complications. Interestingly, symptoms of blood pressure instability outperform the clinical motor/sensory bedside exam, with higher correlations to secondary medical complications after SCI.

Data-Driven Smart Living Lab to Promote Participation in Rehabilitation Exercises and Sports Programs for People with Disabilities in Local Communities

Patients discharged from hospitals after an inpatient course of medical treatment for any ailment or traumatic injury that results in disabling conditions and are rendered mobility impaired require ongoing systematic sports and exercise programs to maintain healthy lifestyles. Under such circumstances, a rehabilitation exercise and sports center, accessible throughout local communities, is critical for promoting beneficial living and community participation for these individuals with disabilities. An innovative data-driven system equipped with state-of-the-art smart and digital equipment, set up in architecturally barrier-free infrastructures, is essential for these individuals to promote health maintenance and overcome secondary medical complications following an acute inpatient hospitalization or suboptimal rehabilitation. A federally funded collaborative research and development (R&D) program proposes to build a multi-ministerial data-driven system of exercise programs using a smart digital living lab as a platform to provide pilot services in physical education and counseling with exercise and sports programs for this patient population. We describe the social and critical aspects of rehabilitating such a population of patients by presenting a full study protocol. A modified sub-dataset of the previously generated 280-item full dataset is applied using a data-collecting system-"The Elephant"-as an example of how data acquisition will be achieved to assess the effects of lifestyle rehabilitative exercise programs for people with disabilities.

Anterior Spinal Cord Ischemia due to an Acute Aortic Intramural Type B Hematoma

Anterior Spinal Cord Ischemia due to an Acute Aortic Intramural Type B Hematoma

Increased mortality following Guillain-Barré syndrome: A population-based cohort study.

Guillain-Barré syndrome (GBS) may be fatal in the acute phase but also affect long-term prognosis due to irreversible sequelae and secondary medical complications. We determined the short-term, intermediate, and long-term mortality of GBS compared to the general population. Individual-level data from nationwide registries were linked in this matched cohort study of all first-time hospital-diagnosed GBS patients in Denmark between 1987 and 2016 and 10 individuals from the general population, matched on age, sex, and index date. We used Cox regression analysis to calculate matched mortality hazard ratios (HRs) following GBS, assessing short-term (0-6months), intermediate (>6months-4years), and long-term (>4years) mortality. We identified 2414 patients with GBS and 23,909 matched individuals from the general population. Short-term mortality was 4.8% (95% confidence interval [CI] = 4.0-5.8) and 0.8% (95% CI = 0.7-0.9) for GBS patients and general population members, respectively, resulting in an HR of 6.6 (95% CI = 4.0-5.8). Intermediate mortality was 7.6% (95% CI = 6.5-8.9), compared with 5.8% (95% CI = 5.5-6.1) for general population members, corresponding to an HR of 1.5 (95% CI = 1.3-1.8). After the first 4years, long-term mortality showed similar results for GBS patients and general population members (HR = 1.1, 95% CI = 0.9-1.2). During the first 6months after GBS hospital admission, GBS was associated with a 6.6-fold increased mortality as compared with the background population of the same age. Mortality remained increased for approximately 4years following GBS, and then leveled off to a similar long-term mortality rate.

Comparative study between operative and conservative treatment in cases of spinal cord injury: An analytical, case control and prospective study in a tertiary care hospital of Bihar

Introduction: Spinal cord injury (SCI) following trauma is a functional, psychological and socioeconomic disorder, results in serious secondary medical complications with increased morbidity and mortality. In most of the cases it leads to increased hospitalization, loss of employment and decreased quality of life. Aims & Objectives: To observe and compare the outcome of conservative and operative methods of treatment in patients of traumatic paraplegia due to spinal cord injury. Materials and Methods: This was an analytical, case control, prospective study. Twenty-one consecutive patients of spinal cord and spinal column injuries of age between 10 to 60 years and both the gender were included. Using Thoracolumbar Injury Classification and Severity Score (TLISS) they were divided into conservative group (n=13, TLISS score ?3 and 4) and operative group (n=8, TLISS score ?5). Follow up was done on 3rd week, 12th week, 24th week and 36th weeks of treatment. Results: Most of the patients in this study were in 31-40 years, male, from rural area, injured due to fall from height. Out of 13 patients treated conservatively, 7 had excellent, 4 had good, and 2 had bad outcome according to clinical and radiological findings at the end of follow up months. There was no significant difference in sensory control, motor control, bladder/bowel voluntary control and complications among patients undergone conservative and operative treatment. But the radiological findings for deformity correction was significantly higher among patients undergone operative treatment with respect to conservative treatment. Conclusions: In this study operative management of spinal cord injury was more efficacious, more compliant but had similar co-morbidity with respect to conservative management. But on the basis of treatment cost and complications conservative management is mostly preferred in rural areas. Keywords: Traumatic paraplegia, Thoracolumbar injury severity score (TLISS), Plaster jacket

Mortality and secondary complications four years after traumatic spinal cord injury in Cape Town, South Africa.

A prospective, regional, population-based study. (1) Determine the mortality rate and factors associated with it 4 years after a TSCI and (2) The point prevalence of secondary medical complications of survivors at 4 years. Communities of the Cape metropolitan area, South Africa. All persons (n = 145) sustaining a TSCI from 15 September 2013 to 14 September 2014 were eligible for follow-up at 4 years. Participants were contacted after 4 years. The next of kin, via verbal autopsy, was used to establish cause of death. Those who were alive at 4 years were asked to indicate any secondary medical complications. Logistic regression techniques were used to identify independently associated risk indicators for death and development of secondary complications, respectively. Of the initial 145 persons, 87 were included and accounted for. Of these, 21 (24%) had died, 55 (63%) were alive and completed the survey, and 11 (13%) were classified as alive but did not submit the survey. The main cause of death reported was septicaemia (n = 7; 33%), followed by unknown natural causes (n = 7; 33%), then pressure injuries (n = 5; 24%). Out of the 55 persons alive, 89% had at least one medical complication at the time of enquiry, while more than 50% experienced 6 or more complications. The most common complications were pain (80%), muscle spasms (76%), sleeping problems (56%), and bladder dysfunction (44%). Almost one-quarter of persons with TSCI have died 4 years after injury. Also, secondary complications were found to be highly prevalent at 4 years. This information could be used to develop secondary complications prevention programmes to reduce premature deaths. This study was funded by the Medical Research Council of South Africa within the Research Capacity Development Initiative.

Development, validation and feasibility study of a remote basic skills assessment for wheelchair service providers

Aim The purpose of this study was to develop, validate and conduct a feasibility study of three remote basic skills assessment modalities for wheelchair service providers (WSP) including an online case study quiz (m1), an in-person skills assessment (m2) and a video conference skills assessment (m3). Methods We conducted a literature review; developed and validated 3 basic skills assessments; and conducted a feasibility study of each modality. Results The literature review revealed that a validated remote basic skills assessment for WSP that reflects all World Health Organization (WHO) 8 wheelchair service provision steps did not exist. We recruited a total of 12 participants for the feasibility study. Two participants dropped out of the study prior to completing a second testing modality. Related to test performance, the results show that our first hypothesis was rejected because only m1 mean score was comparable to the International Society of Wheelchair Professionals (ISWP) Basic Knowledge Test (SD = 0.44). This is in contrast with the Wilcoxon signed-rank test results that show a statistically significant difference between these two modalities. We are therefore not confident that the knowledge test was an appropriate comparison to m1 skills assessment. Hypothesis two was not rejected. The feasibility results reveal 86% success. Conclusion M1, 2 and 3 have the potential to serve as remote basic skills assessments. However, according to both test performance and feasibility criteria, we believe that m2 has the highest potential to be included in certification processes for basic wheelchair service providers, like the one offered by ISWP. IMPLICATIONS FOR REHABILITATION A universal remote basic skills assessment that can be accessed across the globe, especially in remote locations where a skilled and experienced provider is not available, is needed. Such test can be an asset to training or professional organisations like ISWP as a way to test WSP competency or to warrant certification. WSP clinical knowledge and skills are essential for the prescription of an appropriate wheelchair to avoid physical harm, abandonment of the device and unnecessary expenses. Properly prescribed wheelchairs allow people with impaired mobility to gain increased ability to perform ADLs, participate in communities, and reduce secondary medical complications such as upper limb repetitive strain injuries, pain, and/or pressure sores.

Neuropsychological functioning in survivors of childhood medulloblastoma/CNS-PNET: The role of secondary medical complications

Objective To investigate the long-term cognitive consequences of malignant pediatric brain tumor and its treatment, and factors explaining variability in cognitive functioning among survivors. Method: A geographical cohort of survivors of pediatric medulloblastoma (MB) and supratentorial primitive neuroectodermal tumor (CNS-PNET), treated between 1974 and 2013, was invited to participate. Of the 63 surviving patients, 50 (79%) consented to participation. The participants were tested with a battery of neuropsychological tests covering a wide age range. Verbal cognition, nonverbal cognition, processing speed, attention, memory, executive functioning, and manual dexterity were assessed. The participants were between 5:5 and 51:11 years of age at time of assessment. Assessments took place on average 19 years after primary tumor resective surgery. Results: One participant had a severe intellectual disability. For the rest, IQ varied from 52 to 125, with a mean score of 88.0 (SD 19.7). Twenty-eight (56%) of the participants had full-scale IQ scores in the age-average range or above. Gender, age at operation, time since operation, the presence of secondary medical complications, and treatment variables explained 46% of the variability in IQ scores, F(4,44) = 9.5, p<.001. The presence of endocrine insufficiency in combination with either epilepsy and/or hydrocephalus was associated with lowered IQ, lowered processing speed, and memory impairments. Conclusion: Patients treated for childhood MB and CNS-PNET have a lifelong risk of medical sequelae, including impaired cognitive functioning. This study adds to the literature by demonstrating the importance of following neuropsychological functioning closely, especially processing speed, learning, and memory, in survivors who have multiple secondary medical complications.

Assessment of the Patient With Intracerebral Hemorrhage: A Review of the Literature.

Spontaneous nontraumatic intracerebral hemorrhage is associated with high morbidity and mortality. Given the risk of rapid neurological deterioration, early identification with rapid neuroimaging is vital. Predictors of outcome, such as spot sign and intracerebral hemorrhage score, can help guide management goals. Management should be aimed at prevention of hematoma expansion, treatment of increased intracranial pressure, and prevention of secondary brain injury and medical complications.

Employment After Spinal Cord Injury

This review focuses on employment after spinal cord injury (SCI) and highlights recent evidence-based models of vocational rehabilitation. Employment rates among people with SCI remain much lower than the general population. Benefits of employment for persons with SCI include improved quality of life, enhanced independence, reduced depression, improved social integration, greater life satisfaction, better health, and longevity. When striving to work after SCI, there are facilitators to be exploited (e.g., education, transportation, assistive technology) and barriers that need management (e.g., secondary medical complications). Individualized placement and support (IPS) and vocational resource facilitation (VRF) are examples of new evidence-based models of vocational rehabilitation that integrate vocational services with clinical care in order to better help persons with SCI find competitive employment in the community. If people with SCI do not return to work soon after their injury, then it may take more time for them to reach their full vocational potential.

The Effect of the Interactive Mobile Health and Rehabilitation System on Health and Psychosocial Outcomes in Spinal Cord Injury: Randomized Controlled Trial.

BackgroundIndividuals with spinal cord injury (SCI) are at risk for secondary medical complications, such as urinary tract infections (UTIs) and pressure injuries, that could potentially be mitigated through improved self-management techniques. The Interactive Mobile Health and Rehabilitation (iMHere) mobile health (mHealth) system was developed to support self-management for individuals with disabilities.ObjectiveThe main objective of this study was to determine if the use of iMHere would be associated with improved health outcomes over a 9-month period. A secondary objective was to determine if the use of iMHere would be associated with improved psychosocial outcomes. Phone usage, app usage, and training time data were also collected to analyze trends in iMHere use.MethodsOverall, 38 participants with SCI were randomized into either the intervention group who used the iMHere system and received standard care or the control group who received standard care without any technology intervention. Health outcomes were recorded for the year before entry into the study and during the 9 months of the study. Participants completed surveys at baseline and every 3 months to measure psychosocial outcomes.ResultsThe intervention group had a statistically significant reduction in UTIs (0.47 events per person; P=.03; number needed to treat=2.11). Although no psychosocial outcomes changed significantly, there was a nonsignificant trend toward a reduction in mood symptoms in the intervention group compared with the control group meeting the threshold for clinical significance. Approximately 34 min per participant per month were needed on average to manage the system and provide technical support through this mHealth system.ConclusionsThe use of the iMHere mHealth system may be a valuable tool in the prevention of UTIs or reductions in depressive symptoms. Given these findings, iMHere has potential scalability for larger populations.Trial RegistrationClinicalTrials.gov NCT02592291; https://clinicaltrials.gov/ct2/show/NCT02592291.

Secondary medical complications after traumatic spinal cord injury in Stockholm, Sweden: Towards developing prevention strategies

(i) To determine the prevalence of secondary complications after traumatic spinal cord injury during acute care and rehabilitation; (ii) to investigate whether associations exist between level and completeness of injury and the development of common complications; and (iii) to assess whether associations exist between secondary complications and return-to-work 1 year after injury. A prospective, population-based study, including all newly-injured persons with traumatic spinal cord injury for an 18-month period. The International Spinal Cord Injury Core Data Set was used to capture injury characteristics, as well as associated injuries and neurological severity. All secondary medical complications (e.g. pressure injuries, pulmonary embolism, pneumonia, urinary tract infection) were screened for during acute care and rehabilitation. Inferential statistics were carried out. Out of the 45 persons undergoing acute care, the 3 most common complications were urinary tract infections (47%), pneumonia (22%) and neuropathic pain (18%). Of the 31 persons who received rehabilitation, the most common complications were urinary tract infections (42%), neuropathic pain (42%), and spasticity (35%). A significant association was found between injury level and development of neuropathic pain during rehabilitation. Although a specialized system for spinal cord injury management is available in Sweden, secondary complications are still common. These findings could be used to inform the development of strategies for prevention of secondary complications.

A Muscle Synergy-Inspired Control Design to Coordinate Functional Electrical Stimulation and a Powered Exoskeleton: Artificial Generation of Synergies to Reduce Input Dimensionality

Mobility disorders caused by spinal cord injury (SCI), stroke, or progressive neurological diseases such as multiple sclerosis and amyotrophic lateral sclerosis, lead to a deterioration in quality of life. Resulting sequelae, such as pressure ulcers, depression, and urinary infections, require constant medical care throughout a patient's lifetime. Evidence has shown that, following an injury or a disease, individuals who use rehabilitative interventions to restore walking and standing functions experience fewer secondary medical complications than do wheelchair users [1]. Two such rehabilitative interventions include functional electrical stimulation (FES) and powered exoskeletons. These technologies have the potential to mitigate secondary health complications, lower medical expenses, and achieve independent ambulation in individuals following an SCI.

Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications.

ObjectivesInadequate glycemic control amongst patients with Type 2 diabetes mellitus (T2DM) indicates a major public health problem and a significant risk factor for the progression and complications caused by diabetes. Glycemic control is the main therapeutic objective for the prevention of organ damage and other complications arising from diabetes.MethodsThis was a retrospective observational study of T2DM patients with complications, who were aged 40 years and older. The study was conducted retrospectively on medical records (in-patient and out-patient) obtained from a South Indian teaching hospital, Manipal, India. The patients included in the study had fasting blood sugar, postprandial blood sugar and HbA1c measured at least twice during follow-ups the previous year. Patients’ HbA1c levels were categorized into good control ≤7% (≤53mmol/mol), and poor control >7% (>53mmol/mol), and patients’ characteristics were analyzed.ResultsA total of 657 patients were included in the study. The mean age was 59.67 (SD = 9.617) years, with 152 (23.1%) females and 505 (76.9%) males, and 514 (78.2%) patients had poor glycemic control. Most of the patients were on insulin mono-therapy [n = 271 (42.1%)], about a third of the patients were on combination therapy that included an oral hypoglycemic agent and insulin [n = 236 (36.6%)]. Patients with a history of more than 10 years of diabetes [n = 293 (44.6%)], had a family history of diabetes [n = 256 (39%)] and obesity [n = 95 (14.5%)], all had poor glycemic control.ConclusionThis present study indicated a significant association of gender (female), age, high-density lipoprotein level, duration of diabetes and type of medication, with poor glycemic control in T2DM patients that had secondary medical complications.

A retrospective pilot study on patients who deteriorated while admitted to a neurovascular ward

The purpose of this pilot study was to collect information on the circumstances of care for neuroscience inpatients who were referred to a rapid response team for recognised deterioration, and to explore the appropriateness of the tools used to collect that information. A quantitative descriptive study design was employed to retrospectively review 30 patient charts from a quaternary centre in Canada. Two nurse reviewers independently collected the data and non-inferential statistics were analysed to provide a broad picture of the characteristics of patients who had deteriorated. The underlying cause of deterioration for the majority of patients was not the result of neurological sequelae, but rather due to secondary medical complications. Aspiration pneumonia was the leading medical complication, followed by sepsis. Patients with central nervous system lesions are at significant risk of aspiration pneumonia, an often-overlooked secondary complication, which requires vigilance in the neuroscience nurse in order to prevent. The tools used to collect this information will require further refining to be useful for a larger, prospective study.

Inflammatory Stress Effects on Health and Function After Spinal Cord Injury.

Background: Injury to the spinal cord produces immediate, adaptive inflammatory responses that can exacerbate the initial injury and lead to secondary damage. Thus far, researchers and clinicians have focused on modulating acute inflammation to preserve sensorimotor function. However, this singular approach risks overlooking how chronic inflammation negatively impacts the broader health of persons with a spinal cord injury (SCI). Objective: The aim of this monograph was to discuss interrelated processes causing persistent inflammatory stress after SCI, along with associated health risks. We review archetypal factors that contribute to a chronic inflammatory state, including response to injury, acute infection, and autonomic dysreflexia. Secondary complications producing and exacerbating inflammation are also discussed, including pain, depression, obesity, and injury to the integumentary and skeletal systems. Finally, we discuss the role of bacteria and the gut microbiome in this process and then conclude with a discussion on how a pro-inflammatory phenotype promotes an elevated risk for cardiovascular disease after injury. Conclusions: Effectively managing chronic inflammation should be a high priority for clinicians and researchers who seek to improve the health and life quality of persons with SCI. Chronic inflammation worsens secondary medical complications and amplifies the risk for cardiometabolic disorders after injury, directly impacting both the quality of life and mortality risk after SCI. Inflammation can worsen pain and depression and even hinder neurological recovery. It is, therefore, imperative that countermeasures to chronic inflammation are routinely considered from the point of initial injury and proceeding throughout the lifespan of the individual with SCI.