Severe Spinal Cord Injury Research Articles

Developing a National Trauma Research Action Plan: Results from the Neurotrauma Research Panel Delphi Survey.

In 2016, the National Academies of Science, Engineering and Medicine called for the development of a National Trauma Research Action Plan. The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. Given the public health burden of injuries to the central nervous system, neurotrauma was one of 11 panels formed to address this recommendation with a gap analysis and generation of high-priority research questions. We recruited interdisciplinary experts to identify gaps in the neurotrauma literature, generate research questions, and prioritize those questions using a consensus-driven Delphi survey approach. We conducted four Delphi rounds in which participants generated key research questions and then prioritized the importance of the questions on a 9-point Likert scale. Consensus was defined as 60% or greater of panelists agreeing on the priority category. We then coded research questions using an National Trauma Research Action Plan taxonomy of 118 research concepts, which were consistent across all 11 panels. Twenty-eight neurotrauma experts generated 675 research questions. Of these, 364 (53.9%) reached consensus, and 56 were determined to be high priority (15.4%), 303 were deemed to be medium priority (83.2%), and 5 were low priority (1.4%). The research topics were stratified into three groups-severe traumatic brain injury (TBI), mild TBI (mTBI), and spinal cord injury. The number of high-priority questions for each subtopic was 46 for severe TBI (19.7%), 3 for mTBI (4.3%) and 7 for SCI (11.7%). This Delphi gap analysis of neurotrauma research identified 56 high-priority research questions. There are clear areas of focus for severe TBI, mTBI, and spinal cord injury that will help guide investigators in future neurotrauma research. Funding agencies should consider these gaps when they prioritize future research. Diagnostic Test or Criteria, Level IV.

Hypothermia as a potential remedy for canine and feline acute spinal cord injury: a review

Severe spinal cord injury (SCI) resulting in permanent sensory-motor and autonomic dysfunction caudal to a damaged spinal cord (SC) segment is a catastrophic event in human as well as in veterinary medicine. The situation of paraplegic/tetraplegic people or animals is further impaired by serious complications and often displays an image of permanent suffering. Therapeutic hypothermia (TH) has shown neuroprotective capacity in numerous experimental and several clinical studies or case reports. Hence, the method draws increasing attention of neuroscientists as well as health care workers. While systemic TH is a too complex procedure for veterinary practice, local application of TH with a reduced risk of the whole body temperature fluctuations and minimal side effects can become one of the therapeutic tools considered in the treatment of acute traumatic SCIs in bigger animals, especially when surgical decompression of spinal medulla and vertebral column reconstruction is indicated. Still, additional large prospective randomized studies are essential for the standardization of therapeutic protocols and the introduction of the method into therapeutic armamentarium in canine and feline spinal traumatology. The research strategy involved a PubMed, MEDLINE (Ovid), EMBASE (Ovid), and ISI Web of Science search from January 2000 to July 2021 using the terms “canine and feline spinal cord injuryˮ, “hypothermiaˮ, and “targeted temperature managementˮ in the English language literature; also references from selected studies were scanned and relevant articles included.

Acute, severe traumatic spinal cord injury: improving urinary bladder function by optimizing spinal cord perfusion.

The authors sought to investigate the effect of acute, severe traumatic spinal cord injury on the urinary bladder and the hypothesis that increasing the spinal cord perfusion pressure improves bladder function. In 13 adults with traumatic spinal cord injury (American Spinal Injury Association Impairment Scale grades A-C), a pressure probe and a microdialysis catheter were placed intradurally at the injury site. We varied the spinal cord perfusion pressure and performed filling cystometry. Patients were followed up for 12 months on average. The 13 patients had 63 fill cycles; 38 cycles had unfavorable urodynamics, i.e., dangerously low compliance (< 20 mL/cmH2O), detrusor overactivity, or dangerously high end-fill pressure (> 40 cmH2O). Unfavorable urodynamics correlated with periods of injury site hypoperfusion (spinal cord perfusion pressure < 60 mm Hg), hyperperfusion (spinal cord perfusion pressure > 100 mm Hg), tissue glucose < 3 mM, and tissue lactate to pyruvate ratio > 30. Increasing spinal cord perfusion pressure from 67.0 ± 2.3 mm Hg (average ± SE) to 92.1 ± 3.0 mm Hg significantly reduced, from 534 to 365 mL, the median bladder volume at which the desire to void was first experienced. All patients with dangerously low average initial bladder compliance (< 20 mL/cmH2O) maintained low compliance at follow-up, whereas all patients with high average initial bladder compliance (> 100 mL/cmH2O) maintained high compliance at follow-up. We conclude that unfavorable urodynamics develop within days of traumatic spinal cord injury, thus challenging the prevailing notion that the detrusor is initially acontractile. Urodynamic studies performed acutely identify patients with dangerously low bladder compliance likely to benefit from early intervention. At this early stage, bladder function is dynamic and is influenced by fluctuations in the physiology and metabolism at the injury site; therefore, optimizing spinal cord perfusion is likely to improve urological outcome in patients with acute severe traumatic spinal cord injury.

Clinical Validation of BCI-Controlled Wheelchairs in Subjects With Severe Spinal Cord Injury.

Brain-controlled wheelchairs are one of the most promising applications that can help people gain mobility after their normal interaction pathways have been compromised by neuromuscular diseases. The feasibility of using brain signals to control wheelchairs has been well demonstrated by healthy people in previous studies. However, most potential users of brain-controlled wheelchairs are people suffering from severe physical disabilities or who are in a "locked-in" state. To further validate the clinical practicability of our previously proposed P300-based brain-controlled wheelchair, in this study, 10 subjects with severe spinal cord injuries participated in three experiments and completed ten predefined tasks in each experiment. The average accuracy and information transfer rate (ITR) were 94.8% and 4.2 bits/min, respectively. Moreover, we evaluated the physiological and cognitive burdens experienced by these individuals before and after the experiments. There were no significant changes in vital signs during the experiment, indicating minimal physiological and cognitive burden. The patients' average systolic blood pressure before and after the experiment was 113±13.7 mmHg and 114±11.9 mmHg, respectively (P = 0.122). The patients' average heart rates before and after the experiment were 79±8.4/min and 79±8.2/min, respectively (P = 0.147). The average task load, measured by the National Aeronautics and Space Administration task load index, ranged from 10.0 to 25.5. The results suggest that the proposed P300-based brain-controlled wheelchair is safe and reliable; additionally, it does not significantly increase the patient's physical and mental task burden, demonstrating its potential value in clinical applications. Our study promotes the development of a more practical brain-controlled wheelchair system.

The Long-Term Efficacy Study of Multiple Allogeneic Canine Adipose Tissue-Derived Mesenchymal Stem Cells Transplantations Combined With Surgery in Four Dogs With Lumbosacral Spinal Cord Injury

Severe lumbosacral pain, paraparesis or paraplegia, and urinary incontinence are common but frustrating problems in dogs with lumbosacral spinal cord injury (SCI). The surgical interventions including stabilization and decompression may not restore satisfying neurological functions in severe SCI. Adipose tissue-derived mesenchymal stem cells (Ad-MSCs) show benefits in immunomodulation, anti-inflammation, and promotion of axonal growth and remyelination, and also display efficacy in several diseases in veterinary medicine. In this report, four dogs presented with fracture of sacrum vertebrae or fracture of seventh lumbar and lumbosacral displacement after road traffic accidents. The clinical signs include lumbosacral pain (4/4), paraparesis (3/4), paraplegia (1/4), and urinary incontinence (4/4). All dogs were treated by surgical decompression with or without stabilization 1 to 7 weeks after trauma. Allogeneic canine Ad-MSCs (cAd-MSCs) were injected locally on nerve roots through the surgical region in all dogs. One dose of intravenous transplantation and 4 doses of local transplantation were also performed within 8 weeks after the surgery separately. All dogs showed significant neurological improvements with normal ambulatory ability (4/4) and urinary control (3/4) 3 months after the surgery and the first cAd-MSCs transplantation. No side effect was related to multiple cAd-MSCs transplantations during 6 months monitoring in all dogs. In conclusion, multiple cAd-MSCs transplantations could be a recommended treatment combined with surgery in dogs with lumbosacral SCI.

K+/Cl- co-transporter-2 upmodulation: a multi-modal therapy to treat spinal cord injury.

K+/Cl- co-transporter-2 upmodulation: a multi-modal therapy to treat spinal cord injury.

Exoskeleton Training and Trans-Spinal Stimulation for Physical Activity Enhancement After Spinal Cord Injury (EXTra-SCI): An Exploratory Study.

After spinal cord injury (SCI) physical activity levels decrease drastically, leading to numerous secondary health complications. Exoskeleton-assisted walking (EAW) may be one way to improve physical activity for adults with SCI and potentially alleviate secondary health complications. The effects of EAW may be limited, however, since exoskeletons induce passive movement for users who cannot volitionally contribute to walking. Trans-spinal stimulation (TSS) has shown the potential to enable those with even the most severe SCI to actively contribute to movements during EAW. To explore the effects of EAW training on improving secondary health complications in persons with SCI, participants with chronic (n = 8) were enrolled in an EAW program 2–3 times per week for 12 weeks. Anthropometrics (seated and supine waist and abdominal circumferences (WC and AC), body composition assessment (dual exposure x-ray absorptiometry-derived body fat percent, lean mass and total mass for the total body, legs, and trunk), and peak oxygen consumption (VO2 during a 6-minute walk test [6MWT]) were assessed before and after 12 weeks of EAW training. A subset of participants (n = 3) completed EAW training with concurrent TSS, and neuromuscular activity of locomotor muscles was assessed during a 10-m walk test (10MWT) with and without TSS following 12 weeks of EAW training. Upon completion of 12 weeks of training, reductions from baseline (BL) were found in seated WC (−2.2%, P = 0.036), seated AC (−2.9%, P = 0.05), and supine AC (−3.9%, P = 0.017). Percent fat was also reduced from BL for the total body (−1.4%, P = 0.018), leg (−1.3%, P = 0.018), and trunk (−2%, P = 0.036) regions. No effects were found for peak VO2. The addition of TSS for three individuals yielded individualized responses but generally increased knee extensor activity during EAW. Two of three participants who received TSS were also able to initiate more steps without additional assistance from the exoskeleton during a 10MWT. In summary, 12 weeks of EAW training significantly attenuated markers of obesity relevant to cardiometabolic health in eight men with chronic SCI. Changes in VO2 and neuromuscular activity with vs. without TSS were highly individualized and yielded no overall group effects.

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.

Targeting the motor cortex to restore walking after incomplete spinal cord injury.

Targeting the motor cortex to restore walking after incomplete spinal cord injury.

Spinal Cord Transection In Xenopus laevis Tadpoles.

Spinal cord injury (SCI) is a permanent affliction, which affects the central nervous system (CNS) motor and sensory nerves, resulting in paralysis beneath the injury site. To date, there is no functional recovery therapy for SCI, and there is a lack of clarity regarding the many complexes and dynamic events occurring after SCI. Many non-mammalian organisms can regenerate after severe SCI, such as teleost fishes, urodele amphibians, and larval stages of anuran amphibians, including Xenopus laevis tadpoles. These are bona fide model organisms to study and understand the response to SCI and the mechanisms underlying successful regenerative processes. This type of research can lead to the identification of potential targets for SCI therapeutic intervention. This article describes how to perform Xenopus laevis tadpole spinal cord transection, including husbandry, surgery, postsurgery care, and functional test evaluation. This injury method can be applied for elucidating the different steps of spinal cord regeneration by studying the cellular, molecular, and genetic mechanisms, as well as histological and functional evolution after SCI and during spinal cord regeneration.

Long-Term Effects of Neural Precursor Cell Transplantation on Secondary Injury Processes and Functional Recovery after Severe Cervical Contusion-Compression Spinal Cord Injury.

Cervical spinal cord injury (SCI) remains a devastating event without adequate treatment options despite decades of research. In this context, the usefulness of common preclinical SCI models has been criticized. We, therefore, aimed to use a clinically relevant animal model of severe cervical SCI to assess the long-term effects of neural precursor cell (NPC) transplantation on secondary injury processes and functional recovery. To this end, we performed a clip contusion-compression injury at the C6 level in 40 female Wistar rats and a sham surgery in 10 female Wistar rats. NPCs, isolated from the subventricular zone of green fluorescent protein (GFP) expressing transgenic rat embryos, were transplanted ten days after the injury. Functional recovery was assessed weekly, and FluoroGold (FG) retrograde fiber-labeling, as well as manganese-enhanced magnetic resonance imaging (MEMRI), were performed prior to the sacrifice of the animals eight weeks after SCI. After cryosectioning of the spinal cords, immunofluorescence staining was conducted. Results were compared between the treatment groups (NPC, Vehicle, Sham) and statistically analyzed (p < 0.05 was considered significant). Despite the severity of the injury, leading to substantial morbidity and mortality during the experiment, long-term survival of the engrafted NPCs with a predominant differentiation into oligodendrocytes could be observed after eight weeks. While myelination of the injured spinal cord was not significantly improved, NPC treated animals showed a significant increase of intact perilesional motor neurons and preserved spinal tracts compared to untreated Vehicle animals. These findings were associated with enhanced preservation of intact spinal cord tissue. However, reactive astrogliosis and inflammation where not significantly reduced by the NPC-treatment. While differences in the Basso–Beattie–Bresnahan (BBB) score and the Gridwalk test remained insignificant, animals in the NPC group performed significantly better in the more objective CatWalk XT gait analysis, suggesting some beneficial effects of the engrafted NPCs on the functional recovery after severe cervical SCI.

Spinal cord imaging markers and recovery of standing with epidural stimulation in individuals with clinically motor complete spinal cord injury.

Spinal cord epidural stimulation (scES) is an intervention to restore motor function in those with severe spinal cord injury (SCI). Spinal cord lesion characteristics assessed via magnetic resonance imaging (MRI) may contribute to understand motor recovery. This study assessed relationships between standing ability with scES and spared spinal cord tissue characteristics at the lesion site. We hypothesized that the amount of lateral spared cord tissue would be related to independent extension in the ipsilateral lower limb. Eleven individuals with chronic, clinically motor complete SCI underwent spinal cord MRI, and were subsequently implanted with scES. Standing ability and lower limb activation patterns were assessed during an overground standing experiment with scES. This assessment occurred prior to any activity-based intervention with scES. Lesion hyperintensity was segmented from T2 axial images, and template-based analysis was used to estimate spared tissue in anterior, posterior, right, and left spinal cord regions. Regression analysis was used to assess relationships between imaging and standing outcomes. Total volume of spared tissue was related to left (p = 0.007), right (p = 0.005), and bilateral (p = 0.011) lower limb extension. Spared tissue in the left cord region was related to left lower limb extension (p = 0.019). A positive trend (p = 0.138) was also observed between right spared cord tissue and right lower limb extension. In this study, MRI measures of spared spinal cord tissue were significantly related to standing outcomes with scES. These preliminary results warrant future investigation of roles of supraspinal input and MRI-detected spared spinal cord tissue on lower limb motor responsiveness to scES.

Automated lever task with minimum antigravity movement for rats with cervical spinal cord injury

BackgroundAlthough there is currently no cure for paralysis due to spinal cord injury (SCI), the highest treatment priority is restoring arm and hand function for people with cervical SCI. Preclinical animal models provide an opportunity to test innovative treatments, but severe cervical injury models require significant time and effort to assess responses to novel interventions. Moreover, there is no behavioral task that can assess forelimb movement in rats with severe cervical SCI unable to perform antigravity movements. New methodWe developed a novel lever pressing task for rats with severe cervical SCI. We employed an automated adaptive algorithm to train animals using open-source software and commercially available hardware. We found that using the adaptive training required only 13.3 ± 2.5 training days to achieve behavioral proficiency. The lever press task could quantify immediate and long-term improvements in severely impaired forelimb function effectively. This behavior platform has potential to facilitate rehabilitative training and assess effects of therapeutic modalities following SCI. Comparison with existing methodsThere is no existing assessment aiming to quantify forelimb extension movement in rodents without function against gravity. We found that the new lever press task in the antigravity position could assess the severity of cervical SCI as well as the compensatory movement in the proximal forelimb less affected by the injury. ConclusionsThis study demonstrates that the new behavioral task is capable of tracking the functional changes with various therapies in rats with severe forelimb impairments in a cost- and time-efficient manner.

A DAMP-scavenging, IL-10-releasing hydrogel promotes neural regeneration and motor function recovery after spinal cord injury

Spinal cord injury (SCI) creates an inflammatory microenvironment characterized by damage-associated molecular patterns (DAMPs) and immune cell activation that exacerbate secondary damage and impair neurological recovery. Here we develop an immunoregulatory hydrogel scaffold for treating SCI that scavenges DAMPs and slowly releases the anti-inflammatory cytokine interleukin-10 (IL-10). We created this dual-functional scaffold by modifying a photocrosslinked gelatin hydrogel with the cationic, DAMP-binding polymer poly (amidoamine) and with IL-10, and compared the therapeutic activity of this scaffold with that of gelatin-only, gelatin + poly (amidoamine), and gelatin + IL-10 scaffolds in vitro and in vivo. In vitro, the dual-functional scaffold scavenged anionic DAMPs and exhibited sustained release of IL-10, reduced the proinflammatory responses of macrophages and microglia, and enhanced the neurogenic differentiation of neural stem cells. In a complete transection SCI mouse model, the injected dual-functional scaffold suppressed proinflammatory cytokine production, promoted the M2 macrophage/microglia phenotype, and led to neural regeneration and axon growth without scar formation to a greater extent than the single-function or control scaffolds. This DAMP-scavenging, IL-10-releasing scaffold provides a new strategy for promoting neural regeneration and motor function recovery following severe SCI.

Selective Myostatin Inhibition Spares Sublesional Muscle Mass and Myopenia-Related Dysfunction after Severe Spinal Cord Contusion in Mice.

Clinically relevant myopenia accompanies spinal cord injury (SCI), and compromises function, metabolism, body composition, and health. Myostatin, a transforming growth factor (TGF)β family member, is a key negative regulator of skeletal muscle mass. We investigated inhibition of myostatin signaling using systemic delivery of a highly selective monoclonal antibody - muSRK-015P (40 mg/kg) - that blocks release of active growth factor from the latent form of myostatin. Adult female mice (C57BL/6) were subjected to a severe SCI (65 kdyn) at T9 and were then immediately and 1 week later administered test articles: muSRK-015P (40 mg/kg) or control (vehicle or IgG). A sham control group (laminectomy only) was included. At euthanasia, (2 weeks post-SCI) muSRK-015P preserved whole body lean mass and sublesional gastrocnemius and soleus mass. muSRK-015P-treated mice with SCI also had significantly attenuated myofiber atrophy, lipid infiltration, and loss of slow-oxidative phenotype in soleus muscle. These outcomes were accompanied by significantly improved sublesional motor function and muscle force production at 1 and 2 weeks post-SCI. At 2 weeks post-SCI, lean mass was significantly decreased in SCI-IgG mice, but was not different in SCI-muSRK-015P mice than in sham controls. Total energy expenditure (kCal/day) at 2 weeks post-SCI was lower in SCI-immunoglobulin (Ig)G mice, but not different in SCI-muSRK-015P mice than in sham controls. We conclude that in a randomized, blinded, and controlled study in mice, myostatin inhibition using muSRK-015P had broad effects on physical, metabolic, and functional outcomes when compared with IgG control treated SCI animals. These findings may identify a useful, targeted therapeutic strategy for treating post-SCI myopenia and related sequelae in humans.

Bioactive scaffolds with enhanced supramolecular motion promote recovery from spinal cord injury.

The signaling of cells by scaffolds of synthetic molecules that mimic proteins is known to be effective in the regeneration of tissues. Here, we describe peptide amphiphile supramolecular polymers containing two distinct signals and test them in a mouse model of severe spinal cord injury. One signal activates the transmembrane receptor β1-integrin and a second one activates the basic fibroblast growth factor 2 receptor. By mutating the peptide sequence of the amphiphilic monomers in nonbioactive domains, we intensified the motions of molecules within scaffold fibrils. This resulted in notable differences in vascular growth, axonal regeneration, myelination, survival of motor neurons, reduced gliosis, and functional recovery. We hypothesize that the signaling of cells by ensembles of molecules could be optimized by tuning their internal motions.

Subclinical Hypoventilation in Dogs Undergoing Ventral Slot Decompressive Surgery for Cervical Myelopathy Due to Intervertebral Disc Herniation.

The objective of this prospective cohort study was to document the occurrence of post-operative hypoventilation in dogs undergoing decompressive ventral slot or hemilaminectomy for the treatment of intervertebral disc herniation (IVDH). Twenty dogs undergoing ventral slot surgery and 20 dogs undergoing hemilaminectomy surgery for the treatment of IVDH that presented to XX between 2017 and 2020 were enrolled. Dogs were anesthetized using a standard protocol. Blood gas samples were taken at up to 11 time points beginning during anesthetic recovery and continuing for a maximum of 72 h post-operatively. Dogs with cervical lesions that were non-ambulatory before surgery had more evidence of subclinical hypoventilation in the immediate peri-extubation period than dogs with less severe injuries or those undergoing hemilaminectomy surgery. We found no difference in the ventilation status in dogs undergoing cervical or thoracolumbar decompressive surgery for IVDH from 8 to 72 h post-operatively. Other markers of acid-base status indicated that subclinical hypoventilation within the peri-extubation period was transient and self-limiting. There was a moderate positive correlation between sedation scores and estimated PaCO2. These data suggest that dogs with severe cervical spinal cord injuries may be at risk for subclinical hypoventilation in the immediate peri-extubation period. Increased sedation may be correlated with decreased ventilatory status in dogs recovering from decompressive vertebral column surgery.

Change in mobility independence over 5 years for persons with chronic spinal cord injury

Objectives To evaluate change in mobility independence (MI) in community dwelling persons with spinal cord injury (SCI). Participants Community Survey. Design Cohort study. Rasch analysis was applied to the mobility subscale of the Spinal Cord Independence Measure – Self-Report data from years 2012 to 2017, resulting in a Rasch Mobility Independence Score (RMIS). We employed multilevel modeling to examine RMIS and its change over 5 years, adjusting for demographics and SCI severity; random forest regression was applied to determine the impact of modifiable factors (e.g. environmental factors, home-support) on its change. Results The analysis included 728 participants. The majority (≈85%) of participants demonstrated little or no change in RMIS from 2012 to 2017; however, a smaller proportion (15%) showed considerably large change of more than 10 on the 100-point scale. A mixed-effects model with random slopes and intercepts described the dataset very well (conditional R2 of 0.95) in terms of demographics and SCI severity. Age was the main predictor of change in RMIS. Considering SCI severity, change in RMIS was related to age for the subgroup with paraplegia, and to time since injury for the subgroup with tetraplegia. No impact of modifiable factors was found. Conclusion RMIS in persons with SCI changes over a period of 5 years, especially in elder patients with paraplegia and persons with incomplete tetraplegia with more than 15 years of time since injury. During routine follow-up change in mobility independence should be assessed in order to timely intervene and prevent mobility loss and participation limitations.

Epidural electrical stimulation to facilitate locomotor recovery after spinal cord injury.

Tonic or phasic electrical epidural stimulation of the lumbosacral region of the spinal cord facilitates locomotion and standing in a variety of preclinical models with severe spinal cord injury. However, the mechanisms of epidural electrical stimulation that facilitate sensorimotor functions remain largely unknown. This review aims to address how epidural electrical stimulation interacts with spinal sensorimotor circuits and discusses the limitations that currently restrict the clinical implementation of this promising therapeutic approach.

DOES THE LEVEL AND SEVERITY OF INJURY AFFECT PATIENT SATISFACTION IN PATIENTS WITH CHRONIC SPINAL CORD INJURY UNDERGOING INPATIENT REHABILITATION ?

OBJECTIVE: This study aimed to investigate whether the level of satisfaction differed regarding the level and severity of injury in patients with chronic spinal cord injury (SCI) treated on an in-patient setting and whether patients with different satisfaction levels had distinct functional independence and health related quality of life (HRQoL) measures.MATERIAL AND METHODS: The SCI level (cervical, thoracic, lumbosacral) of the patients was recorded, and the severity of SCI (incomplete,complete) was determined according to the American Spinal Cord Injury Association (ASIA) Impairment Scale. The degree of functional independence of the patients was determined using the Functional Independence Measure (FIM) motor score. HRQoL was assessed using the Short Form-36 (SF-36). Satisfaction was assessed using a questionnaire instituted to evaluate patient satisfaction. Satisfaction with the physician, nurse, physiotherapist, catering, cleaning service, technical equipment categories and the overall satisfaction were questioned and satisfaction levels were determined as ”very satisfied, satisfied, dissatisfied, very dissatisfied”.RESULTS: 84 patients with chronic SCI were included in this cross-sectional study. Regarding the level of SCI, 19 patients had cervical (mean age:36.3±14.5, 78.9% male), 52 had thoracic (mean age: 32.1±13.6, 61.5% male), 13 had lumbosacral SCI (mean age: 38.8±20, 61.5% male). Regarding the severity of SCI, 36 patients had complete (mean age: 34±13, 77.7% male), 48 had incomplete (mean age: 35±15, 56.2% male) injury. There was no significant difference between cervical, thoracic and lumbosacral SCI groups in satisfaction categories. However, when the groups were compared in regard to the severity of SCI, patients with incomplete SCI had higher rates for satisfaction with the physician and technical equipment (p=0.03 and p=0.02, respectively). No significant difference was found in the other categories. Regarding the overall satisfaction, there was no significant difference in HRQoL and functional independence of the patients grouped according to their satisfaction levels.CONCLUSIONS:Patients with incomplete SCI had higher satisfaction level with the physician and technical equipment. Although characteristics of injury are distinct, if the expectations are met similar satisfaction rates may be obtained in patients with chronic SCI. More comprehensive studies are needed in terms of other patient-related variables that affect patient satisfaction.