Spinal Cord Injury Experience Research Articles

Secondary health conditions in people with spinal cord injury in South Africa: Prevalence and associated factors.

People with spinal cord injury (SCI) experience preventable secondary health conditions (SHCs) that worsen the disability, reduce the quality of life and affect health and wellbeing. There is limited information on the prevalence of SHCs and the associated factors to inform planning and practice in South Africa (SA). To identify the prevalence of SHCs and the associated factors in people with SCI. We conducted a retrospective review of patients' medical records at a tertiary academic hospital and a rehabilitation hospital in Gauteng Province, SA. Data collected included demographic data, injury profile, SHCs and associated factors. Data were summarised using descriptive statistics of frequency and percentages. Fisher's exact test was used to determine the association between SHCs and sociodemographic and clinical variables. The Mann-Whitney U-test was used to determine the associated risk factors for SHCs. Multinomial regression was used to determine the predictors of the frequency of SHCs. A total of 425 records were reviewed, 68.0% of patients were male, and the median (interquartile range) age was 45 (35 - 56) years. The majority (93.7%) of the patients had SHCs, and 78% had ≥2 SHCs. Significant predictors of having >3 SHCs were the duration of SCI (p=0.01), site of injury in the upper (p=0.03) and lower (p=0.01) thoracic spine, being unemployed (p=0.04), and public hospital income classification (H0 = social grant/unemployed, H1 = earning ZAR0 - 70000 per annum single income/ZAR0 - 100000 per annum household income, and Road Accident Fund; p=0.03, p=0.03 and p=0.01, respectively). Secondary health conditions were prevalent among patients with SCI. People with SCI experience multimorbidity that requires multiple management strategies. These findings point to the need for prevention strategies to minimise the occurrence of SHCs.

A qualitative interview study on how people with incomplete spinal cord injury experience high-intensity walking exercise

Study designQualitative, in-depth research interviews.ObjectiveTo provide new insight into how people with a recent incomplete spinal cord injury (SCI) experience high-intensity walking exercise after discharge from subacute inpatient rehabilitation.SettingInformants for this interview study participated in a previous randomized controlled trial (RCT) that was conducted at Sunnaas Rehabilitation Hospital, Norway.MethodsFour individual face-to-face interviews were conducted with the participants in natural setting. The interviews were analyzed through systematic text condensation and discussed in the context of experiences of bodily changes.ResultsFour themes emerged that described positive but also challenging bodily experiences related to performing high-intensity walking exercise: “Expectations and motivation”—reasons for participating, “Challenging bodily changes”—impacts on walking ability, “Adaptation strategies”—achieving the high-intensity target level, and “Integrating exercise into a new daily life”—combining participation, new body and new life.ConclusionsThis study indicates the importance of participating in a specific exercise program at discharge from subacute inpatient rehabilitation for ambulant people with SCI. However, high-intensity walking exercise may be too demanding to perform during this time period. The insights from the study provide new knowledge that can contribute to improving clinical rehabilitation practice.

Novel Clinimetric Toolset to Quantify the Stability of Blood Pressure and Its Application to Evaluate Cardiovascular Function After Spinal Cord Injury

Profound dysfunction of the cardiovascular system occurs after spinal cord injury (SCI), which is a leading cause of mortality in this population. Most individuals with chronic SCI experience transient episodes of hypotensive and hypertensive blood pressure in response to daily life activities. There are currently limited tools available to evaluate the stability of blood pressure with respect to a reference range. The aim of this study was to develop a clinimetric toolset for accurately quantifying stability of the blood pressure measurements and taking into consideration the complex dynamics of blood pressure variability among individuals with SCI. The proposed toolset is based on distribution of the blood pressure data points within and outside of the clinically recommended range. This toolset consists of six outcome measures including 1) total deviation of the 90% of the blood pressure data points from the center of the target range (115 mmHg); 2) The area under the cumulative distribution curve starting from the percentage of blood pressure measurements within the range, and the percentage of values within symmetrically expanded boundary ranges, above and below the target range; 3) the slope of the cumulative distribution curve that is calculated by fitting an exponential cumulative distribution function and the natural logarithm of its rate parameter; 4) its x- and 5) y-axis intercepts; and 6) the fitting error. These outcome measures were validated using blood pressure measurements recorded during cardiovascular perturbation tests and prolonged monitoring period from individuals with chronic SCI and non-injured controls. The statistical analysis based on the effect size and intra-class correlation coefficient, demonstrated that the proposed outcome measures fulfill reliability, responsiveness and discrimination criteria. The novel methodology proposed in this study is reliable and effective for evaluating the stability of continuous blood pressure in individuals with chronic spinal cord injury.

Functional electrical stimulation cycling in patients with chronic spinal cord injury: a pilot study

Objective To examine the therapeutic value of lower extremity functional electrical stimulation (FES) - evoked cycling on functional independence, health status, gait parameters, pulmonary functions, and biochemical values in patients with chronic complete/incomplete spinal cord injury (SCI). Materials and Methods Fifteen patients with SCI (duration of more than 6 months) who were able to stand up and walk with long leg braces or assistive devices and had stable neurological status and trunk balance undertook FES cycling for 6 weeks (three times per week). The main outcomes were: Functional Independence Measure (FIM), Nottingham Health Profile (NHP), 6-minute walk test (6MWT), and 20-meter walk test (20MWT). Secondary outcomes include measurements of pulmonary function tests and biochemical values. All parameters were evaluated at the beginning and end of the program. Results Improvements were seen in motor and total scores of FIM (p = 0.007), physical mobility subscale of NHP (p = 0.011), 6MWT (p = 0.001), and 20MWT (p = 0.011). In pulmonary functions, only forced vital capacity (FVC) levels demonstrated a significant increase compared with baseline (p = 0.011). Biochemical values reached no significant level. Conclusion The results of this study showed that the FES cycling exercise program improves motor and total FIM scores, gait parameters, and FVC values of pulmonary functions in patients with chronic SCI experience. The FES cycle might be a valuable and well-tolerated intervention in clinical rehabilitation.

Prolonged exposure therapy for PTSD among spinal cord injury survivors: Study protocol for a randomized controlled trial

The National Spinal Cord Injury Statistical Center estimates 294,000 people in the US live with a spinal cord injury (SCI), with approximately 17,810 new cases each year. Although the physical outcomes associated with SCI have been widely studied, the psychological consequences of sustaining a SCI remain largely unexplored. Scant research has focused on posttraumatic stress disorder (PTSD) in this population, despite prevalence estimates suggesting that up to 60% of individuals with SCI experience PTSD post-injury, compared to only 7% of the general US population. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. However, no trauma focused exposure-based therapy for PTSD (e.g. PE) has not yet been tested in a SCI population. Thus, we aim to conduct the first test of an evidence-based intervention for PTSD among patients with SCI. Adults with SCI and PTSD (N = 60) will be randomly assigned to either: (1) 12-sessions of PE (2–3 sessions per week) or (2) a treatment as usual (TAU) control group who will receive the standard inpatient rehabilitation care for SCI patients. Primary outcomes will be assessed at 0, 6, 10, and 32 weeks.

Problems people with spinal cord injury experience accessing help with bowel care when hospitalised outside a specialist spinal injury service.

To examine the nature of problems experienced by people with spinal cord injury (SCI) when accessing help to maintain recommended bowel regimes while hospitalised outside a specialist spinal injury service. Bowel dysfunction is one particularly undesirable aspect of life with a SCI, with constipation and incontinence common. Descriptive qualitative. Accounts of problems encountered in hospitals in New South Wales Australia collected during interviews with 11 people living with SCI and 12 responses provided by spinal clinicians via an online survey were subjected to thematic analysis. The COREQ guidelines were followed for reporting. There were similarities across data collected from both sources. Individuals with SCI described instances where their bowel care needs did not fit with the pace and processes in acute hospitals. The clinician data pointed to a failure of healthcare professionals to assist people with SCI to maintain bowel care regimes recommended by specialist spinal services. Both groups described times when bowel care received was unreliable and fragmented, along with reports of staff who were unwilling and/or unable to provide the assistance required. Many and varied physical and psychosocial repercussions for individuals were associated with these system failures. In some instances, rather than restoring health, being admitted to hospital represented a significant health risk. A failure of hospital systems to meet the bowel care needs of people with SCI when hospitalised outside a specialist spinal unit was identified. System and individual factors contributed to these problems, hence addressing them requires both system and individual responses. If this problem is left unaddressed, the health and quality of life of people with SCI will continue to be compromised. Nursing scope of practice needs to be clarified and communicated to nurses outside specialist spinal injury units in relation to their role in maintaining bowel care regimes recommended for their patients by spinal specialists, and nurses need to ensure they possess the skills required. To allocate the time needed to provide this care, individual nurses need the support of the whole nursing team, including managers who are prepared to arrange additional staff when needed.

69742 miR-338-5p as a Biomarker of Neuropathic Pain After Spinal Cord Injury

ABSTRACT IMPACT: Identification of microRNA (miRNA) associated with neuropathic pain after spinal cord injury (SCI) will elucidate underlying epigenetic mechanisms contributing to its development and identify targets for intervention to optimize treatment strategies and outcomes. OBJECTIVES/GOALS: Approximately 70% of individuals with SCI experience neuropathic pain, which is refractory to pharmacologic intervention, and can reduce overall health and wellbeing. This study aims to identify predictive miRNA biomarkers of neuropathic pain after SCI to identify targets for the development of efficacious interventions. METHODS/STUDY POPULATION: Blood samples and clinical outcome measures were collected from adult participants with SCI with neuropathic pain (n = 28) and without neuropathic pain (n = 15). The sample population consisted of a mean age of 39 (SD = 12.12), 8 female (20%), with 13 classified as acute SCI (within 3 months post injury) and 30 as chronic SCI (> 3 years post injury). Pain presence, type, and intensity were assessed with the International Spinal Cord Injury Basic Pain Dataset (ISCIBPDS). Serum miRNA sequencing counts were produced from blood samples. Fold change and independent t-tests assessed differential expression between those with and without neuropathic pain, and those with chronic or acute SCI. Linear regression was performed to explore the relationship between miRNA expression and ISCIBPDS pain intensity ratings. RESULTS/ANTICIPATED RESULTS: In individuals with SCI, significant downregulation of expression of miR-338-5p was present in those with neuropathic pain compared to those without neuropathic pain (fold change = 0.81, p = 0.04). A significant relationship between expression of miR-338-5p and highest reported neuropathic pain intensity on the ISCIBPDS was identified (R2 = 0.15, F = 7.32, p < 0.01). Covariates of sex, age, and years post injury were not found to significantly influence the relationship between miRNA expression and ISCIBPDS intensity ratings. No significant differences in miR-338-5p expression were identified between participants with acute and chronic SCI, or with nociceptive pain ratings, demonstrating specificity of the relationship between miR-338-5p differential expression with pain of a neuropathic nature. DISCUSSION/SIGNIFICANCE OF FINDINGS: These findings, along with validated targets of miR-338-5p in the NF-KB neuroinflammatory signaling pathway, suggest that miR-338-5p may serve a neuroprotective role in modulating neuroinflammation, and that its downregulation may result in maladaptive neuroplastic mechanisms contributing to the development of neuropathic pain after SCI.

Investigating proactive balance control in individuals with incomplete spinal cord injury while walking on a known slippery surface

BackgroundUp to 83 % of individuals with incomplete spinal cord injury (iSCI) experience ≥ 1 fall/year. Individuals with iSCI employ more cautious walking strategies than able-bodied (AB) individuals during normal walking. Whether individuals with iSCI can use proactive balance strategies to adapt to expected slip perturbations/reduce slip severity while walking has not been previously assessed. Methods19 individuals with iSCI (AIS D; 14 males; 61 ± 18 years) and 17 AB individuals (13 males; 61 ± 18 years) completed 3 walking conditions: normal walking trials, an unexpected slip trial, and expected slip trials. Steel rollers induced a slip in the antero-posterior (AP) direction. Outcome variables included step length, center of mass velocity, foot-floor angle, AP margin of stability, and maximum post-slip velocity (PSV). ResultsThe iSCI group used a greater magnitude of cautious strategies (i.e. walking slower with shorter, flatter steps) than AB individuals in all conditions. However, the lack of significant interaction effects indicate that the proactive adaptations compared to normal walking (i.e. walking slower with shorter, flatter steps, and a more anterior xCOM-position) were similar between the two groups (AB & iSCI). Both groups showed a similar rate of adaptation (after just 1 slip) and these feedforward changes were maintained throughout the remaining slip trials which was effective at reducing maximum PSV. ConclusionsIndividuals with iSCI use proactive balance strategies to adapt to a known slippery surface in a similar manner to AB individuals both in terms of the proportion and timing of adaptation.

Excruciating Care: Experiences of Care Transition from Hospital to Home among the Family Caregivers of Patients with Spinal Cord Injury

Background: Transition of patients with spinal cord injury (SCI) from hospital to home often involves a shift in caregiving responsibility from health-care providers to family caregivers. Poor care transition may lead to poor care-related outcomes. Objectives: The aim of this study was to explore experiences of care transition from hospital to home among the family caregivers of patients with SCI. Methods: This qualitative study was conducted in 2018–2019. Participants were 17 family caregivers of patients with SCI who were purposively recruited from two specialty SCI care centers in Iran. In-depth semi-structured interviews were held for data collection. Interviews were audio-recorded, transcribed, and analyzed using conventional content analysis. Results: The following four main categories were developed during data analysis: lack of knowledge (with two subcategories), excruciating care (with two subcategories), emotional burden of caregiving (with three subcategories), and need for support (with two subcategories). The nine subcategories of these main categories were lack of medical and care-related information, seeking for information, heavy burden of daily caregiving, need for providing professional care at home, feelings of sadness and sorrow, feeling of insufficiency, restriction of life, limited support by family members and relatives, and limited financial support by the government. Conclusion: Family caregivers of patients with SCI experience many challenges and problems during care transition from hospital to home, which can affect the quality of their care services for their patients. Therefore, they need ongoing support throughout the process of care.

Anthropometric Prediction of Visceral Adiposity in Persons With Spinal Cord Injury.

Over two-thirds of persons with spinal cord injury (SCI) experience neurogenic obesity-induced cardiometabolic syndrome (CMS) and other chronic comorbidities. Obesity is likely to impede social and recreational activities, impact quality of life, and impose additional socioeconomic burdens on persons with SCI. Advances in imaging technology facilitate the mapping of adiposity and its association with the cardiometabolic profile after SCI. Central adiposity or central obesity is characterized by increased waist (WC) and abdominal circumferences (AC) as well as visceral adipose tissue (VAT). A number of studies, while relying on expensive imaging techniques, have reported direct associations of both central obesity and VAT in imposing significant health risks after SCI. The mechanistic role of central obesity on cardiometabolic heath in persons with SCI has yet to be identified, despite the knowledge that it has been designated as an independent risk factor for cardiometabolic dysfunction and premature mortality in other clinical populations. In persons with SCI, the distribution of adipose tissue has been suggested to be a function of sex, level of injury, and age. To date, there is no SCI-specific WC or AC cutoff value to provide anthropometric prediction of VAT and diagnostic capability of persons at risk for central obesity, CMS, and cardiovascular disease after SCI. The purpose of the current review is to summarize the factors contributing to visceral adiposity in persons with SCI and to develop an SCI-specific anthropometric prediction equation for this population. Furthermore, a proposed WC cutoff will be discussed as a surrogate index for central obesity, CMS, and cardiovascular disorders after SCI.

Pain and its impact on functioning and disability in manual wheelchair users with spinal cord injury: a protocol for a mixed-methods study

IntroductionApproximately 80% of people with spinal cord injury experience clinically significant chronic pain. Pain (whether musculoskeletal or neuropathic) is consistently rated as one of the most difficult problems to manage...

The relationship between the hand pattern used during fast wheelchair propulsion and shoulder pain development

Up to 84% of manual wheelchair users (MWCU) with spinal cord injury experience shoulder pain, which is correlated with shoulder adductor weakness in this population. Modeling studies have shown weak shoulder adductors lead to compensations from the deltoid and rotator cuff muscles during propulsion, which may lead to altered propulsion mechanics. However, the role recovery phase hand pattern has in pain development is unclear, as each hand pattern is associated with unique mechanics and different levels of muscle demand. Previous research found no correlation between hand pattern and shoulder pain at self-selected speeds. However, fast propulsion may exacerbate poor mechanics caused by shoulder muscle weakness, which may reveal those at risk for pain development. The present study evaluated whether the hand pattern used during fast wheelchair propulsion is correlated with shoulder pain. We also assessed whether shoulder adductor strength was correlated with hand pattern. Fast propulsion data from two subsets of MWCU were analyzed at three time points (baseline, 18 months, 36 months). All participants were pain-free at baseline. Subset 1 compared individuals who remained pain-free to those who developed shoulder pain. Subset 2 compared individuals with chronic pain at follow-up to those whose pain resolved over time. The hand pattern used was not different between groups in either subset. However, more over-rim patterns were correlated with lower adductor strength in Subset 1. These results suggest that although the hand pattern used during fast propulsion is not correlated with shoulder pain, more over-rim hand patterns may indicate weaker shoulder adductors.

Incidence of urinary tract infection following initiation of intermittent catheterization among patients with recent spinal cord injury in Germany and the Netherlands

Objective: To assess incidence of urinary tract infection (UTI) among patients with recent spinal cord injury (SCI) who initiated intermittent catheterization (IC). Design: Retrospective chart review. Setting: Two European SCI rehabilitation centers. Participants: Seventy-three consecutive patients with recent SCI who initiated IC. Outcome measures: Incidence of UTI, using six different definitions, each based on microbiology ± symptomatology ± mention of UTI . Rates were expressed in terms of numbers of UTIs per 100 patient-months (PMs). Attention was focused on first-noted UTI during the three-month follow-up, as assessed with each of the six definitions. Results: Fifty-eight percent of patients (n = 33) met ≥1 definitions for UTI during follow-up (rate: 31.5 UTIs per 100 PMs), ranging from 14% (5.3 per 100 PMs; definition requiring bacteriuria, pyuria, and presence of symptoms) to 45% (22.7 per 100 PMs; definition requiring “mention of UTI”). Ten cases were identified using the definition that required bacteriuria, pyuria, and symptoms, whereas definitions that required bacteriuria and either pyuria or symptoms resulted in the identification of 20–25 cases. Median time to UTI ranged from 42 days (“mention of UTI”) to 81 days (definition requiring bacteriuria and ≥100 leukocytes/mm3). Conclusion: Depending on definition, 14% to 45% of patients with recent SCI experience UTI within three months of initiating IC. Definitions requiring bacteriuria and either pyuria or symptoms consistently identified about twice as many cases as those that required all three conditions. Standardizing definitions may help improve detection, treatment, and prevention of UTI within this vulnerable population.

Users with spinal cord injury experience of robotic Locomotor exoskeletons: a qualitative study of the benefits, limitations, and recommendations

BackgroundPersons with spinal cord injury (SCI) may experience both psychological and physiological benefits from robotic locomotor exoskeleton use, and knowledgeable users may have valuable perspectives to inform future development. The objective of this study is to gain insight into the experiences, perspectives, concerns, and suggestions on the use of robotic locomotor exoskeletons by civilians and veterans living with SCI.MethodsParticipants reported their demographic characteristics and the extent of robotic exoskeleton use in an online survey. Then, 28 experienced robotic locomotor exoskeleton users participated in focus groups held at three regional hospitals that specialize in rehabilitation for persons with SCI. We used a qualitative description approach analysis to analyze the data, and included thematic analysis.ResultsParticipants expressed that robotic exoskeletons were useful in therapy settings but, in their current form, were not practical for activities of daily living due to device limitations. Participants detailed the psychological benefits of being eye-level with their non-disabled peers and family members, and some reported physiologic improvements in areas such as bowel and bladder function. Participants detailed barriers of increased fatigue, spasticity, and spasms and expressed dissatisfaction with the devices due to an inability to use them independently and safely. Participants provided suggestions to manufacturers for technology improvements.ConclusionsThe varied opinions and insights of robotic locomotor exoskeletons users with SCI add to our knowledge of device benefits and limitations.

Crippling Christian Theology as I Power My Wheelchair Out the Door

This article draws on the author’s experience of spinal cord injury to reflect on theological method and central elements of Christian theology. It uses disability theory to unmask the ablest ideology that too often frames church hierarchies and that marginalizes and excludes people with disability and others who are different, notably LGBTQI people of faith. From this perspective, it provides a critical reading of the traditional threefold Christian gospel of perfect creation, fall, and redemption as renewed perfection, arguing that vulnerability, pain, and disability are not a consequence of the fall, but the product of the creative generativity of nature. It tentatively reimagines atonement theory and redemption as a reversal of unjust marginalization (transformative grace for those who experience and perpetrate evil). Finally it considers the transformation of the soul by reference to a disability aesthetic and the truth, goodness, and beauty of God and the diverse creation. It elevates disability as beautiful and desirable, a creative gift of infinite difference.

Characteristics of activity-based therapy interventions for people living with spinal cord injury or disease across the continuum of care: a scoping review protocol

IntroductionIndividuals living with spinal cord injury and disease (SCI/D) experience sensory and motor impairments below their neurological level of injury. Activity-based therapies (ABT) are interventions that provide activation of the...

Relationship between pain, fatigue, and physical activity levels during a technology-based physical activity intervention

Objective: The majority of individuals with spinal cord injury (SCI) experience chronic pain. Chronic pain can be difficult to manage because of variability in the underlying pain mechanisms. More insight regarding the relationship between pain and physical activity (PA) is necessary to understand pain responses during PA. The objective of this study is to explore possible relationships between PA levels and secondary conditions including pain and fatigue. Design: Prospective cohort analysis of a pilot study. Setting: Community. Participants: Twenty individuals with SCI took part in the study, and sixteen completed the study. Interventions: Mobile-health (mHealth) based PA intervention for two-months during the three-month study. Outcome measures: Chronic Pain Grade Scale (CPGS) questionnaire, The Wheelchair User’s Shoulder Pain Index (WUSPI), Fatigue Severity Scale (FSS), and PA levels measured by the mHealth system. Results: A positive linear relationship was found between light-intensity PA and task-specific pain. However, the relationship between moderate-intensity PA and pain interference was best represented by a curvilinear relationship (polynomial regression of second order). Light-intensity PA showed positive, linear correlation with fatigue at baseline. Moderate-intensity PA was not associated with fatigue during any phase of the study. Conclusion: Our results indicated that PA was associated with chronic pain, and the relationship differed based on intensity and amount of PA performed. Further research is necessary to refine PA recommendations for individuals with SCI who experience chronic pain. Trial registration: ClinicalTrials.gov identifier: NCT03773692.

Improving Grasp Function After Spinal Cord Injury With a Soft Robotic Glove.

People with tetraplegia resulting from spinal cord injury experience debilitating hand impairments that may lead to lifelong dependence on others to perform activities of daily living. Wearable robotic devices that actively support hand function during daily living tasks could bring great benefits to this population. In this work, the performance of a textile-based soft robotic glove controlled by the user with a button was evaluated in thirteen participants with tetraplegia. Performance outcomes included activities of daily living using the Jebsen Taylor Hand Function Test, active range of motion of the fingers, and grasp strength for power and pinch grasps. In the Jebsen Test, participants showed significant improvements in performance of activities of daily living with glove assistance, completing a median of 50% more tasks than in their baseline attempt without the glove. Significant improvements were also found for power and pinch grasp forces and active range of motion of the fingers with the glove assistance. Participants with lower baseline motor function received greater benefits from glove assistance. This work demonstrates the effectiveness of a user-controlled textile-based soft robotic glove to improve activity of daily living abilities in individuals with hand impairments resulting from spinal cord injury.

Factors that influence the risk of falling after spinal cord injury: a qualitative photo-elicitation study with individuals that use a wheelchair as their primary means of mobility

IntroductionFalls are a concern for wheelchair users with spinal cord injury (SCI). Falls can negatively impact the physical and psychological well-being of fallers. To date, the perspectives of wheelchair users...

Spinal cord injury providers’ perspectives on managing sublesional osteoporosis

Objective: Persons with spinal cord injuries (SCI) experience rapid sublesional bone loss following injury (1, 3). Evidence on preventing/managing osteoporosis in SCI is lacking. This project examined how providers manage bone loss in SCI. Design: Telephone interviews with SCI providers. Setting: VA SCI centers and clinics. Participants: Veterans Administration SCI centers and clinics were categorized on their average number of dual-energy X-ray absorptiometry (DXA) scans (FY2014-2016). Twelve SCI providers from high and low DXA-ordering sites were interviewed. Questions included osteoporosis screening/diagnosis, prevention/treatment strategies, secondary causes of osteoporosis, and osteoporotic fracture complications. Interviews were audio-recorded, transcribed, and analyzed. Results: Providers described a lack of standardized guidelines for managing osteoporosis in SCI. They most often screened for osteoporosis using DXA when: (1) considering use of a new device or activity, (2) for patients with a history of fracture. Some providers assumed that non-ambulatory SCI patients already have osteoporosis so infrequently ordered DXAs. Assessment of secondary causes of osteoporosis was uncommon. Fracture prevention strategies identified included weight-bearing and engaging in activities like adaptive sports. Vitamin D and calcium were frequently prescribed as a result of deficiencies identified during lab testing. Providers seldom prescribed FDA-approved medications for osteoporosis. Post-fracture complications encountered included nonunion/malunion and compartment syndrome. Providers indicated that patients often experienced psychological stress, anxiety and depression following fractures. Conclusion: Providers described a lack of evidence for screening and management of patients with SCI and osteoporosis. Future efforts should include developing evidence-informed guidelines to aid providers in osteoporosis management.