Spinal Cord Injured Patients Research Articles

Nocturia and obstructive sleep apnea in spinal cord injured patients - a cohort study.

To describe the prevalence of nocturia and obstructive sleep apnea (OSA) in a cohort of spinal cord injury (SCI) patients and to describe their association. Additionally, to assess clinical and urodynamic data explaining nocturia and to evaluate the effect of OSA management with continuous positive airway pressure (CPAP). Retrospective analysis of data from patients with SCI followed in a tertiary care rehabilitation center with a specialized sleep and neuro-urology units. All adult SCI patients who underwent urodynamic assessment before polysomnography (PSG) between 2015 and 2023 were eligible. Subjective (nocturia) and objective data (urodynamic data, polysomnography, CPAP built-in software) were collated from the Handisom database (database register no. 20200224113128) and the medical records of SCI patients. Statistical testing used Mann-Whitney test for non-parametric variables, Fisher's exact test for contingency analysis and the Spearman correlation test to assess correlations. A p-value < 0.05 was considered significant. Statistical analyses were performed using GraphPad Prism v9. 173 patients (131 males, 42 females) were included. The majority of patients were paraplegic (n = 111 (64,2%)) and had complete lesions (n = 75 (43,4%)). A total of 100 patients had nocturia (57,5%). The prevalence of OSA (Apnea Hypopnea Index (AHI) ≥ 15/h) in the studied population was 61,9%. No correlation was found between nocturia and OSA. A significant difference was observed between patients with and without nocturia in terms of the presence of neurogenic detrusor overactivity (p = 0,049), volume at the first detrusor contraction (p = 0,004) and the bladder functional capacity (p < 0,001). Nocturia and OSA are highly prevalent in patients with SCI, but no statistical association was found between these two disorders. A prospective study focusing on nocturnal polyuria will be needed to assess the impact of OSA on lower urinary tract symptoms in SCI patients.

Effective treatment of pressure ulcers with the NPWT in spinal cord injured patients - final results of the case series.

Effective treatment of pressure ulcers with the NPWT in spinal cord injured patients - final results of the case series.

Physiotherapy in the functional capacity of patients with spinal cord injury: evidence of professional performance in the last 10 years

Objective: To identify, through a systematic literature review, the role of Neurofunctional Physiotherapy in assessing the functional capacity of spinal cord injured patients. Methods: The search was coordinated in the SciELO, PubMed, LILACS databases and on the Google Academic platform, selecting articles published in Portuguese, English and Spanish between 2011 and 2021. The PRISMA methodology model was followed and the PEDro scale was used to analyze the articles found. The following instruments were considered and accepted in the review: Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM), Modified Ashworth Scale, Walking Index for Spinal Cord Injury II (WISCI II), Medical Outcomes Study 36 - Item Short - Form Health Survey (SF-36), Berg Balance Scale, Barthel Index and American Spinal Injury Association (ASIA). Results: The score obtained by the PEDro scale ranged from 0 to 10, it was noted that among the studies included in the review, the average obtained was approximately 6.42. Conclusion: Health care for patients with spinal cord trauma is a process for reintegration into the community, as well as a means of providing an emotional boost in order to stimulate the search for and confidence in achieving a satisfactory functional recovery. The articles investigated show the effectiveness of Neurofunctional Physiotherapy in these patients. The number of visits the patient receives seems to be relevant; the more visits the better for their recovery. Keywords: Spinal cord injury; physiotherapy; international classification of functioning; scale; assessment; functional status.

Isolated continent cystostomy on neurologic native bladder: Functional results

IntroductionContinent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement. MethodsMonocentric, retrospective study of patients who underwent CCUD surgery in a neuro-urological context. Mitrofanoff's, Monti's or Casale's channels were performed. Patients selected had an underactive, stable, or stabilized bladder under adjuvant therapy with proper cystomanometric capacity. Prior or concomitant enterocystoplasty were excluded. Failure was defined as the occurrence of clinical leakage whatever it is through urinary stomal, or urethral. Urodynamic parameters were also reported. ResultsThirty-one patients underwent surgery. Nine women had a concomitant bladder neck sling and 1 urethral closure. The mean follow-up was 7 years. 8/31 (26%) had stomal leakage and 9 urethral leakage (29%). Five spinal cord injured patients (n=14) had stomal leakage (36%) and 6 urethral leakage (43%). Of the 25 postoperative urodynamic parameters, cystomanometric bladder capacity was 419mL (vs. 514mL) and 2 additional patients had de novo NDO (9 vs. 7). DiscussionThe morbidity of augmentation enterocystoplasty is weighed against the presence of a well-controlled bladder preoperatively. Our study shows the appearance of leakage in some patients despite a well-balanced bladder, a decrease in mean cystomanometric capacity and an increase in the rate of NDO postoperatively. Good selection criteria for an isolated CCUD should be carefully revised and defined. Level of evidenceGrade C - retrospective study.

Attempted movement classification of spinal cord injured patients using hybrid CNN‐LSTM networks

AbstractIndividuals who are suffering from the most severe of motor disabilities can improve their quality of life by controlling and directing mechanical and electronic devices. As for Spinal Cord Injured (SCI) patients', attempted hand movements can be classified using electroencephalography (EEG). The research aims to develop a hybrid CNN‐LSTM (Convolutional Neural Network—Long Short Term Memory) architecture for multichannel EEG signal classification. It is a challenging task to classify real‐world multichannel EEG data from SCI patients. The proposed research preprocessed the EEG data to improve the signal‐to‐noise ratio and arranged for them to extract additional information from the data. The preprocessing step includes filtering, downsampling, and artifact removal, while the postprocessing step includes time‐frequency representation and spatial information encoding. A hybrid CNN‐LSTM is used for feature extraction and classification. The proposed method has been implemented on a dataset consisting of 5 different classes of attempted hand movements from 10 SCI patients. The average classification accuracy of 92.36% is achieved for 5‐class classification. To check the global validity of the proposed network, the BCI competition IV data is classified by the proposed method and has found 92.70% overall accuracy.

CLINICAL AND FUNCTIONAL EVALUATION OF WRISTS AND HANDS OF SPINAL CORD INJURED PATIENTS.

The inability of the spinal cord to propagate sensory and motor stimuli as a result of the disruption of the nerve tracts is called spinal cord injury. This study analyzes clinically and radiologically the hands and wrists of spinal cord injured patients, evaluating their motor and sensitive functionality, in order to determine if these patients are more likely to develop degenerative alterations. 14 patients (8 paraplegics and 6 tetraplegics) were evaluated, undergoing anamnesis and clinical examination - a scale of muscular strength (MRC - Medical Research Council) and the amplitude measurement of the movement with a manual goniometer (ROM), were used for objective evaluation - and x-ray exams. The results were compared with pre-existing data from other studies. When asked, only one of the 14 observed patients complained about constant wrist pain, described as level 3 (weak to moderate), based on the visual analog scale (VAS). The motor evaluation, MRC and ROM divided the group of patients into two subgroups: paraplegic and tetraplegic patients. The x-ray analysis showed, based on Kellgren and Lawrence classification, that all exam images fit grades 1 or 2 of osteoarthritis and osteoarthrosis. In conclusion, spinal cord injured patients showed none or minimal clinical and radiological signs of osteoarthritis on hands or wrists. Overall, the hands and wrists of spinal cord-injured patients behave similarly to noninjured patients. Level of Evidence III; Retrospective Comparative Study.

Polysomnography in patients with spinal cord injury who underwent robotic assisted gait training

IntroductionObstructive sleep apnea in spinal cord injured (SCI) patients is an important but underestimated clinical problem. Spinal cord injury weakens the muscles responsible for breathing, resulting in a reduction in lung capacity. Training of respiratory muscles may present an effective method of increasing respiratory muscle strength and lung volume.AimThe aim of study was to evaluate the effectiveness of robot-assisted gait training (RAGT) in 34 patients with SCI in sleep-disordered breathing (SDB) reduction.Material and methodsWe conducted a control trail to compare RAGT (exoskeleton EKSO-GT or Locomat Pro) with conventional gait training using conventional physiotherapy with dynamic parapodium. We included patients with SCI (above T8 level of injury) recruited between 3 months and 2 years post injury. Polysomnographic studies were performed before and after the completion of the 7-week rehabilitation program. Patients were divided into 2 groups above and up 40 years old.Results and discussionThe comparison of all polysomnographic parameters before and after rehabilitation with RAGT revealed the decline in all polysomnographic parameters (the apnea-hypopnea index – AHI; score reached statistically significant value – &lt;i&gt;P&lt;/i&gt; &lt; 0.02). In comparison in patients aged up to 40 years with conventional gait rehabilitation the number of apnoea’s and shortness of breath during sleep even increased: the AHI index increased after rehabilitation from 1.7 to 3.2 values.ConclusionsRAGT therapy should be considered as a therapeutic option for SDB reduction in patients after SCI. Additionally, the study identified the need to conduct further studies on larger groups of patients.

Effects of a Gait Training Program on Spinal Cord Injury Patients: A Single-Group Prospective Cohort Study

Introduction: Spinal cord injury is defined as the pathological process produced by any etiology affecting the spinal cord, which may alter motor, sensory, and/or autonomic function below the level of the lesion. The complexity of the neurological deficit and, therefore, the resulting clinical picture depends on the level of the lesion, the extent, and the affectation of the white or gray substance. This injury can totally or partially affect the ability to walk, and its highest priority with respect to mobility is to restore the ability to walk. All of which make the improvement of the methods used in their rehabilitation a top priority for health systems. Objective: The main objective of this study was to evaluate the effect of a gait training program for patients with spinal cord injuries. Material and Methods: A single-group, prospective cohort study was developed following the Strengthening the Reporting of Observational Studies in Epidemiology Guidelines (STROBE) at the International Center for Neurological Restoration of Siboney Playa (Havana, Cuba) from May 2020 to July 2021 with a sample of 30 patients by accidental or deliberate non-probabilistic sampling that met the expected inclusion criteria, who underwent a physical rehabilitation program for 8 weeks of work. Results: Statistically significant changes were observed in the overall course, by sex, by topographic level of lesion, and by functional class. Conclusions: The gait training program used produced significant changes in thoracic spinal cord injured patients regardless of the level of injury, sex, or functional class of the patient.

Bridging the bone gap: a prospective study protocol on osteoporosis risk in Portuguese patients with spinal cord injury

Spinal Cord Injury is associated with a decrease in bone mineral density and consequently an increased risk of fragility fractures. This prospective study protocol, aims to investigate the risk factors and prevalence of osteoporosis in a Portuguese population of spinal cord injured patients. By analyzing a range of variables, including not only personal and family history, lifestyle factors, and injury severity, but also bone mineral density and biochemical markers of bone resorption, the research seeks to enhance our understanding of osteoporosis in spinal cord injury patients and improve preventive measures. The effectiveness of pharmacological interventions is greater when started soon after the injury, therefore, prompt diagnosis and treatment of osteoporosis are essential to prevent the complications associated with this condition, particularly osteoporotic fractures.

The good or the bad: an overview ofautoantibodies in traumatic spinal cord injury.

Infections remain the most common cause of death after traumatic spinal cord injury, likely due to a developing immune deficiency syndrome. This, together with a somewhat contradictory development of autoimmunity in many patients, are two major components of the maladaptive systemic immune response. Although the local non-resolving inflammation in the lesioned spinal cord may lead to an antibody formation against autoantigens of the injured spinal cord tissue, there are also natural (pre-existing) autoantibodies independent of the injury. The way in which these autoantibodies with different origins affect the neuronal and functional outcome of spinal cord-injured patients is still controversial.

Heterogeneity of Functional Improvement in Patients with Spinal Tetraplegia: a Retrospective Observational Longitudinal Study

INTRODUCTION. The prevalence of severe spine and spinal cord injuries worldwide is increasing, while the structure and nature of recovery of lost functions remain poorly understood.&#x0D; AIM. To study the variability of functional activities during continued rehabilitation to distinguish pure rehabilitation goals&#x0D; MATERIAL AND METHODS. 190 patients with C4D1 tetraplegia 1860 years old whose were under clinical and functional follow up over a period for 57 years after spinal cord injury were examined. They were examed using the motor section of the FIM scale (FIMm), the VLT scale. The rehabilitation program was standardized and based on the National Clinical Guidelines for physical rehabilitation in spinal cord injured patients.&#x0D; RESULTS. At admission, the age of the patients was 31 (24.0; 43.0) years, the proportion of patients with DU C4C6 was 117 (62 %), with complete damage types A and B was 134 (70 %) patients, men 151 (79 %). Functional improvement was 19 (12.0; 28.0) points on the VLT scale; 14 (5.0; 21.0) points on the FIMm scale over the entire observation period, and was predominantly noted in the first rehabilitation cycle. The proportion of patients completely independent increased on FIMm activities: eating by 25 %, dressing the upper body by 33 %, dressing the lower body by 20 %, self-care domain by +34 %, wheelchair transfer by 21 %, walking by 5 %, and the proportion of patients completely dependent decreased: eating by 9 %, upper dressing by 13 %, lower dressing by 12 %, self-care domain by 7 %, wheelchair transfer by 21 %, wheelchair mobility by 11 %, and walking by 4.5 %. Changes on the VLT scale domains were balance domain 14 %, 1 finger 18 %, hand 26 %, and manipulation 11 %. The gain in food intake activity (FIM) was higher in patients with DU C6C8 (4050 %) and incomplete motor damage (43 %), on the VLT scale domains similar to C6C8 (1218 %), and incomplete motor damage (20 %).&#x0D; CONCLUSION. The most significant functional recovery occurred in self-care and transfer activities, as well as hand and pinch grasping.

Movement analysis in spinal cord injuries : Assistance in clinical decision making

For motor incomplete spinal cord injured patients, improvement of walking function is an important aim in the rehabilitation program. In specialized treatment centers, the 6‑minute walking test, the 10-meter walking test or the timed-up-and-go test are used as an assessment tool to determine walking ability, but these tests are not able to assess the quality of gait. Marker-based movement analysis can be used as areliable method to evaluate the gait pattern. This allows an objective assessment of gait quality over time or can be used to support therapy planning. The benefit of such an analysis is presented by means of two case studies.

The spinal cord injury-induced immune deficiency syndrome: results of the SCIentinel study.

Infections are prevalent after spinal cord injury (SCI), constitute the main cause of death and are a rehabilitation confounder associated with impaired recovery. We hypothesize that SCI causes an acquired lesion-dependent (neurogenic) immune suppression as an underlying mechanism to facilitate infections. The international prospective multicentre cohort study (SCIentinel; protocol registration DRKS00000122; n = 111 patients) was designed to distinguish neurogenic from general trauma-related effects on the immune system. Therefore, SCI patient groups differing by neurological level, i.e. high SCI [thoracic (Th)4 or higher]; low SCI (Th5 or lower) and severity (complete SCI; incomplete SCI), were compared with a reference group of vertebral fracture (VF) patients without SCI. The primary outcome was quantitative monocytic Human Leukocyte Antigen-DR expression (mHLA-DR, synonym MHC II), a validated marker for immune suppression in critically ill patients associated with infection susceptibility. mHLA-DR was assessed from Day 1 to 10 weeks after injury by applying standardized flow cytometry procedures. Secondary outcomes were leucocyte subpopulation counts, serum immunoglobulin levels and clinically defined infections. Linear mixed models with multiple imputation were applied to evaluate group differences of logarithmic-transformed parameters. Mean quantitative mHLA-DR [ln (antibodies/cell)] levels at the primary end point 84 h after injury indicated an immune suppressive state below the normative values of 9.62 in all groups, which further differed in its dimension by neurological level: high SCI [8.95 (98.3% confidence interval, CI: 8.63; 9.26), n = 41], low SCI [9.05 (98.3% CI: 8.73; 9.36), n = 29], and VF without SCI [9.25 (98.3% CI: 8.97; 9.53), n = 41, P = 0.003]. Post hoc analysis accounting for SCI severity revealed the strongest mHLA-DR decrease [8.79 (95% CI: 8.50; 9.08)] in the complete, high SCI group, further demonstrating delayed mHLA-DR recovery [9.08 (95% CI: 8.82; 9.38)] and showing a difference from the VF controls of -0.43 (95% CI: -0.66; -0.20) at 14 days. Complete, high SCI patients also revealed constantly lower serum immunoglobulin G [-0.27 (95% CI: -0.45; -0.10)] and immunoglobulin A [-0.25 (95% CI: -0.49; -0.01)] levels [ln (g/l × 1000)] up to 10 weeks after injury. Low mHLA-DR levels in the range of borderline immunoparalysis (below 9.21) were positively associated with the occurrence and earlier onset of infections, which is consistent with results from studies on stroke or major surgery. Spinal cord injured patients can acquire a secondary, neurogenic immune deficiency syndrome characterized by reduced mHLA-DR expression and relative hypogammaglobulinaemia (combined cellular and humoral immune deficiency). mHLA-DR expression provides a basis to stratify infection-risk in patients with SCI.

Penile gangrene caused by inflation of balloon of indwelling urethral catheter in urethra in a spinal cord-injured patient.

Penile gangrene caused by inflation of balloon of indwelling urethral catheter in urethra in a spinal cord-injured patient.

Spinal inhibitory interneurons: regulators of coordination during locomotor activity.

Since the early 1900's it has been known that a neural network, situated entirely within the spinal cord, is capable of generating the movements required for coordinated locomotion in limbed vertebrates. Due the number of interneurons in the spinal cord, and the extent to which neurons with the same function are intermingled with others that have divergent functions, the components of this neural circuit (now referred to as the locomotor central pattern generator-CPG) have long proven to be difficult to identify. Over the past 20 years a molecular approach has been incorporated to study the locomotor CPG. This approach has resulted in new information regarding the identity of its component interneurons, and their specific role during locomotor activity. In this mini review the role of the inhibitory interneuronal populations that have been shown to be involved in locomotor activity are described, and their specific role in securing left-right, and flexor extensor alternation is outlined. Understanding how these interneuronal populations are activated, modulated, and interact with one another will help us understand how locomotor behavior is produced. In addition, a deeper understanding of the structure and mechanism of function of the locomotor CPG has the potential to assist those developing strategies aimed at enhancing recovery of motor function in spinal cord injured patients.

DETERMINATION OF THE BENEFITS AND COMPLICATIONS OF CLEAN INTERMITTENT CATHETERIZATION TO SPINAL CORD INJURED PATIENTS

Introduction: Intermittent catheterization (IC) is the best method for bladder emptying in patients with spinal cord lesions who are suffering from neurogenic bladder dysfunction. The aim of the study was to determine the benefits of using clean intermittent catheters for patients with spinal cord injury at regular intervals daily to empty the bladder and identify the complications from its use. Methods: A quantitative descriptive design study was done at Ibn Al-Kuff hospital for spinal cord injuries in Baghdad city, including (60) male spinal cord injured patients from the 14th of February 2021 to the 20th of April 2022. A non-probability (purposive) sample of (60) male spinal cord-injured (SCI) patients with paraplegia and tetraplegia were selected. A questionnaire format was used, which consisted of three major parts with a total (of 26) items. Results: The present study included (60) male paraplegic and tetraplegic patients, half of them in the age group between (18-27) years old, and 33 (55%) of them were single. The majority24 (40%) of the study sample were primary school graduates. Furthermore, 24 (40%) were employees before they were injured. Concerning the clinical characteristics of patients, the study indicates that (48 (80%) of the sample were paraplegic patients, 41(68.3%) were complete paralysis and 55(91.7%) of them the cause of injury was Traumatic SCI. Furthermore, 51(85%) of them use selfclean intermittent catheterization; concerning the number of daily catheterizations, 33(55%) of them used it from 7- and more daily, while 34(56.7%) of them, the time between the catheter and the next was each two hours. Concerning the urinary complication occurs during the last 3 months associated with intermittent catheterization, 22(36.7%) of the sample had (UTIs). Conclusion: The current study has demonstrated that the practices of spinal cord injury patients about clean intermittent catheters were acceptable and regular, and it was beneficial to them, as it reduced complications, especially urinary tract infections, noting the need to increase the time between each interval of catheterization to (4-6) hours for each period.

Dr. Xiao-Ming Xu: A True Gentleman and Scholar in the Field of Spinal Cord Injury and Schwann Cell Biology.

Dr. Xiao-Ming Xu: A True Gentleman and Scholar in the Field of Spinal Cord Injury and Schwann Cell Biology.

HAL Training in Spinal Cord Injured Patients: A Narrative Review of 10 Years Experience

To provide a summary and overview of the use of Hybrid Assistive Limb in spinal cord injured patients over the past 10 years. A review of the literature was performed via Web of Science and PubMed using the search terms “Hybrid assistive limb” or “HAL“ or “wearable robot“ or “exoskeleton” and “SCI” or “spinal cord injury” by two of the authors. Relevant articles were then studied in full text. Our review of the literature found 21 articles that met the inclusion criteria of this narrative review including 344 participants. Articles were sorted into two general categories: (1) clinical trials, and (2) single-case or two-case reports. The vast majority of patients improved functionally, showing increased walking distances, walking speeds, and endurance. In addition, a variety of other advances were described, such as temporary decrease in spasticity, improvement in bladder and bowel management, pain reduction, and change in muscle activity. Even though there is no uniform application of HAL training in people living with SCI the current study situation suggests that many patients could benefit from this innovative training within their means.

Clinical Guidelines of Patient-Centered Bladder Management of Neurogenic Lower Urinary Tract Dysfunction due to Chronic Spinal Cord Injury - Part 2

Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.

Clinical Guidelines of Patient-Centered Bladder Management of Neurogenic Lower Urinary Tract Dysfunction Due to Chronic Spinal Cord Injury – Part 3

This article reports the current evidence and expert opinions on patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among chronic spinal cord injured (SCI) patients in Taiwan. The main problems with SCI-NLUTD are failure to store, empty, or both. The management of SCI-NLUTD should be prioritized as follows: (a) preservation of renal function, (b) freedom from urinary tract infection, (c) efficient bladder emptying, (d) freedom from indwelling catheters, (e) patient agreement with management, and (f) avoidance of medication after proper management. The management of NLUTD in SCI patients must be based on urodynamic findings rather than neurologic evaluation inferences. It is important to identify high-risk patients to prevent renal functional deterioration in those with chronic SCI-NLUTD. Urodynamic studies should be performed on patients with SCI on a regular basis, and any urological complications should be adequately treated. When surgery is required, less invasive and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. The most important aspect of treatment is to improve the quality of life in SCI patients with NLUTD. Annual active surveillance of bladder and renal function is required to avoid renal function deterioration and urological complications, particularly in high-risk SCI patients.