Field Of Spinal Cord Injury Research Articles

Quality reporting of carotid intima-media thickness methodology; Current state of the science in the field of spinal cord injury

Objectives: Carotid intima-media thickness (cIMT) may be used increasingly as a cardiovascular disease (CVD) screening tool in individuals with spinal cord injury (SCI) as other routine invasive diagnostic tests are often unfeasible. However, variation in cIMT acquisition and analysis methods is an issue in the current published literature. The growth of the field is dependent on cIMT quality acquisition and analysis to ensure accurate reporting of CVD risk. The purpose of this study is to evaluate the quality of the reported methodology used to collect cIMT values in SCI.Methods: Data from 12 studies, which measured cIMT in individuals with SCI, were identified from the Medline, Embase and CINAHL databases. The quality of the reported methodologies was scored based on adherence to cIMT methodological guidelines abstracted from two consensus papers.Results: Five studies were scored as ‘moderate quality’ in methodological reporting, having specified 9 to 11 of 15 quality reporting criterion. The remaining seven studies were scored as ‘low quality’, having reported less than 9 of 15 quality reporting criterion. No study had methodological reporting that was scored as ‘high quality’. The overall reporting of quality methodology was poor in the published SCI literature.Conclusions: A greater adherence to current methodological guidelines is needed to advance the field of cIMT in SCI. Further research is necessary to refine cIMT acquisition and analysis guidelines to aid authors designing research and journals in screening manuscripts for publication.

Mevalonate Cascade and Small Rho GTPase in Spinal Cord Injury.

The mevalonate pathway has been extensively studied for its involvement in cholesterol synthesis. Inhibition of this pathway using statins (3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors; HMGR inhibitors) is the primarily selected method due to its cholesterol-lowering effect, making statins the most commonly used (86-94%) cholesterol-lowering drugs in adults. This pathway has several other by-products that are affected by statins including GTPase molecules (guanine triphosphate-binding kinases), such as Rho/Rho-associated coiled kinase (ROCK) kinases, that are implicated in other diseases, including those of the central nervous system (CNS). These molecules control several aspects of neural cell life including axonal growth, cellular migration, and cell death, and therefore, are of increasing interest in the field of spinal cord injury (SCI). Limited regeneration capacity of nerve fibers in adult CNS has been considered the main obstacle for finding a SCI cure. Over the past two decades, the identity of inhibitory factors for regeneration has been widely investigated. It is well-established that the Rho/ROCK kinase system is specifically activated by the components of damaged spinal cord tissue, including oligodendrocytes and myelin, as well as extracellular matrix. This has led many groups to hypothesize that statin therapy may in fact enhance the current neurorestorative approaches. In this mini-review, a summary of SCI pathophysiology is discussed and the current literature targeting the regeneration obstacles in SCI are reviewed, with special attention to recent publications of the past decade. In addition, we focus on the current literature involving the use of pharmacological and molecular inhibitors of small GTPase molecules for treatment of neurotrauma. Inhibiting these molecules has been shown to increase neuroprotection, enhance axonal regeneration, and facilitate the implementation of cell replacement therapies. Based upon available literature, the need for clinical trials involving targeted inhibition of GTPase molecules remains strong. Some of these drugs are widely used for other diseases, and therefore re-purposing their application for neurotrauma can be fasttracked. These approaches can potentially modify the inhibitory environment of nervous tissue to allow the spontaneous repair capacity of injured tissue.

Autoregressive transitional ordinal model to test for treatment effect in neurological trials with complex endpoints.

BackgroundA number of potential therapeutic approaches for neurological disorders have failed to provide convincing evidence of efficacy, prompting pharmaceutical and health companies to discontinue their involvement in drug development. Limitations in the statistical analysis of complex endpoints have very likely had a negative impact on the translational process.MethodsWe propose a transitional ordinal model with an autoregressive component to overcome previous limitations in the analysis of Upper Extremity Motor Scores, a relevant endpoint in the field of Spinal Cord Injury. Statistical power and clinical interpretation of estimated treatment effects of the proposed model were compared to routinely employed approaches in a large simulation study of two-arm randomized clinical trials. A revisitation of a key historical trial provides further comparison between the different analysis approaches.ResultsThe proposed model outperformed all other approaches in virtually all simulation settings, achieving on average 14 % higher statistical power than the respective second-best performing approach (range: -1 %, +34 %). Only the transitional model allows treatment effect estimates to be interpreted as conditional odds ratios, providing clear interpretation and visualization.ConclusionThe proposed model takes into account the complex ordinal nature of the endpoint under investigation and explicitly accounts for relevant prognostic factors such as lesion level and baseline information. Superior statistical power, combined with clear clinical interpretation of estimated treatment effects and widespread availability in commercial software, are strong arguments for clinicians and trial scientists to adopt, and further extend, the proposed approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-016-0251-y) contains supplementary material, which is available to authorized users.

Elevated Serum Insulin-Like Growth Factor 1 Levels in Patients with Neurological Remission after Traumatic Spinal Cord Injury.

After traumatic spinal cord injury, an acute phase triggered by trauma is followed by a subacute phase involving inflammatory processes. We previously demonstrated that peripheral serum cytokine expression changes depend on neurological outcome after spinal cord injury. In a subsequent intermediate phase, repair and remodeling takes place under the mediation of growth factors such as Insulin-like Growth Factor 1 (IGF-1). IGF-1 is a promising growth factor which is thought to act as a neuroprotective agent. Since previous findings were taken from animal studies, our aim was to investigate this hypothesis in humans based on peripheral blood serum. Forty-five patients after traumatic spinal cord injury were investigated over a period of three months after trauma. Blood samples were taken according to a fixed schema and IGF-1 levels were determined. Clinical data including AIS scores at admission to the hospital and at discharge were collected and compared with IGF-1 levels. In our study, we could observe distinct patterns in the expression of IGF-1 in peripheral blood serum after traumatic spinal cord injury regardless of the degree of plegia. All patients showed a marked increase of levels seven days after injury. IGF-1 serum levels were significantly different from initial measurements at four and nine hours and seven and 14 days after injury, as well as one, two and three months after injury. We did not detect a significant correlation between fracture and the IGF-1 serum level nor between the quantity of operations performed after trauma and the IGF-1 serum level. Patients with clinically documented neurological remission showed consistently higher IGF-1 levels than patients without neurological remission. This data could be the base for the establishment of animal models for further and much needed research in the field of spinal cord injury.

The energy expenditure of people with spinal cord injury whilst walking compared to an able-bodied population.

BackgroundIn the field of spinal cord injury (SCI) research there is an emphasis on the ability to ambulate.PurposeTo determine the ambulation energy expenditure (EE) and factors that affect ambulation EE in SCI participants compared to able-bodied participants.MethodsThis was a cross-sectional study. Participants were recruited from seven SCI rehabilitation units within the Johannesburg area. The following were used: demographic questionnaire to capture participants’ characteristics, modified Ashworth scale for spasticity; goniometer for range of movement (ROM); American Spinal Injury Association (ASIA) scale for patient classification; accelerometer for EE and the six-minute walk test (6MWT) for endurance. Characteristics of the study participants were summarised using descriptive statistics. Data were analysed as follows: two-sample t-test for comparison between the able-bodied and SCI sample and Pearson product moment correlations for relationship between identified factors and EE.ResultsParticipants comprised 45 in the SCI group and 21 in the able-bodied group. The mean energy expenditure per metre (EE/m) for the SCI participants was 0.33 (± 0.29) calories compared to 0.08 (± 0.02) calories for the able-bodied participants. A decrease in walking velocity resulted in an increase in EE. For SCI participants, every decrease in degree of hip flexion ROM resulted in a 0.003 increase in EE/m walked. A unit decrease in velocity resulted in an increase of 0.41 in EE/m walked. Energy expenditure per metre decreased from ASIA A to ASIA D. Crutch walking utilised 0.34 calories per metre less energy than walking frames (p = 0.03).ConclusionBased on this study’s findings, factors to consider in order to maximise energy efficiency whilst walking are maintaining hip flexion ROM and optimising velocity of walking.

Chondroitinase gene therapy improves upper limb function following cervical contusion injury

Chondroitin sulphate proteoglycans (CSPGs) are known to be important contributors to the intensely inhibitory environment that prevents tissue repair and regeneration following spinal cord injury. The bacterial enzyme chondroitinase ABC (ChABC) degrades these inhibitory molecules and has repeatedly been shown to promote functional recovery in a number of spinal cord injury models. However, when used to treat more traumatic and clinically relevant spinal contusion injuries, findings with the ChABC enzyme have been inconsistent. We recently demonstrated that delivery of mammalian-compatible ChABC via gene therapy led to sustained and widespread digestion of CSPGs, resulting in significant functional repair of a moderate thoracic contusion injury in adult rats. Here we demonstrate that chondroitinase gene therapy significantly enhances upper limb function following cervical contusion injury, with improved forelimb ladder performance and grip strength as well as increased spinal conduction through the injury site and reduced lesion pathology. This is an important addition to our previous findings as improving upper limb function is a top priority for spinal injured patients. Additionally great importance is placed on replication in the spinal cord injury field. That chondroitinase gene therapy has now been shown to be efficacious in contusion models at either thoracic or cervical level is an important step in the further development of this promising therapeutic strategy towards the clinic.

Aromatic L-amino acid decarboxylase cells in the spinal cord: a potential origin of monoamines.

Monoamine neurotransmitters include catecholamines and indoleamines. The most common catecholamines are dopamine (DA), noradrenaline (NA) and adrenaline, which are produced from phenylalanine and tyrosine; whereas the most common indoleamine is serotonin (5-hydroxytrypta mine, 5-HT), which is produced from 5-hydroxytryptophan (5-HTP). In the central nervous system, monoamine neurotransmitters come from specific monoaminergic neurons that occur in a variety of brain regions. In the mammalian spinal cord the different monoamine neurotransmitters, which are important modulators of both sensory and motor functions, are commonly believed to originate in different supraspinal brain regions. For example, 5-HT is produced by neurons in the caudal brain stem raphe nuclei, which include the raphe magnus, raphe obscurus, raphe pallidus, ventral lateral medulla and the area postrema; DA is mainly from the hypothalamic A11 region; and NA is mainly from the locus coeruleus. Traditionally, it has been held that monoamine neurotransmitters cannot be produced in the spinal cord itself. However, following spinal cord transection, some 2–15% of the normal complement of 5-HT and about 5% of the normal complement of NA remain in the spinal cord below the lesion (Magnusson, 1973; Schmidt and Jordan, 2002) although the data about the existence of residual DA are inconsistent to date. For decades, neuroscientists – especially those in the field of spinal cord injury (SCI) research – have been frustrated in their efforts to determine the origins of these small amounts of monoamines. Recently, accumulating evidence has suggested that one possible origin might be the intraspinal monoaminergic neurons. Indeed, some intraspinal 5-HT, tyrosine hydroxylase (TH) and DA β-hydroxylase neurons have been found in mammalian spinal cord (Mouchet et al., 1986; Neuton and Hamill, 1988). However, intraspinal monoaminergic neurons are both very few in number and sparsely distributed. For example, the entire rat spinal cord contains only 3–9 5-HT cells, which occur mainly in regions below the cervical spinal level (Neuton and Hamill, 1988); intraspinal DA cells occur mainly at cervical and sacral levels; and intraspinal NA cells occur mainly in cervical segments (Mouchet et al., 1986). Considering these facts, it seems quite improbable that, following complete spinal transection, intraspinal monoaminergic neurons are the sole source of residual monoamines caudal to the lesion. Then what are the other possible sources? Recent findings by our group (Wienecke et al., 2014) and Bennett's group (Li et al., 2014) point to the aromatic L-amino acid decarboxylase (AADC) cells in the spinal cord.

Cell Therapy Augments Functional Recovery Subsequent to Spinal Cord Injury under Experimental Conditions.

The spinal cord injury leads to enervation of normal tissue homeostasis ultimately leading to paralysis. Until now there is no proper cure for the treatment of spinal cord injury. Recently, cell therapy in animal spinal cord injury models has shown some progress of recovery. At present, clinical trials are under progress to evaluate the efficacy of cell transplantation for the treatment of spinal cord injury. Different types of cells such as pluripotent stem cells derived neural cells, mesenchymal stromal cells, neural stem cells, glial cells are being tested in various spinal cord injury models. In this review we highlight both the advances and lacuna in the field of spinal cord injury by discussing epidemiology, pathophysiology, molecular mechanism, and various cell therapy strategies employed in preclinical and clinical injury models and finally we discuss the limitations and ethical issues involved in cell therapy approach for treating spinal cord injury.

Model for bridging the translational "valleys of death" in spinal cord injury research

Model for bridging the translational "valleys of death" in spinal cord injury research Bill Barrable,1 Nancy Thorogood,1 Vanessa Noonan,1,2 Jocelyn Tomkinson,1 Phalgun Joshi,1 Ken Stephenson,1 John Barclay,1 Katharina Kovacs Burns3 1Rick Hansen Institute, 2Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, 3Health Sciences Council, University of Alberta, Edmonton, AB, Canada Abstract: To improve health care outcomes with cost-effective treatments and prevention initiatives, basic health research must be translated into clinical application and studied during implementation, a process commonly referred to as translational research. It is estimated that only 14% of health-related scientific discoveries enter into medical practice and that it takes an average of 17 years for them to do so. The transition from basic research to clinical knowledge and from clinical knowledge to practice or implementation is so fraught with obstacles that these transitions are often referred to as “valleys of death”. The Rick Hansen Institute has developed a unique praxis model for translational research in the field of spinal cord injury (SCI). The praxis model involves three components. The first is a coordinated program strategy of cure, care, consumer engagement, and commercialization. The second is a knowledge cycle that consists of four phases, ie, environmental scanning, knowledge generation and synthesis, knowledge validation, and implementation. The third is the provision of relevant resources and infrastructure to overcome obstacles in the “valleys of death”, ie, funding, clinical research operations, informatics, clinical research and best practice implementation, consumer engagement, collaborative networks, and strategic partnerships. This model, which is to be independently evaluated in 2018 to determine its strengths and limitations, has been used to advance treatments for pressure ulcers in SCI. The Rick Hansen Institute has developed an innovative solution to move knowledge into action by bridging the “valleys of death” in the research continuum, with the intention of improving health outcomes for people with SCI and decreasing the financial impact on the health care system. This model may be generalizable to other health conditions and the lessons learned in developing the praxis model may assist other organizations dealing with similar translational research challenges. Keywords: spinal cord injuries, clinical outcomes, translational research, implementation, knowledge mobilization, praxis model

Nerve Transfers to Restore upper Extremity Function: A Paradigm Shift.

Nerve Transfers to Restore upper Extremity Function: A Paradigm Shift.

Repairing the injured spinal cord: sprouting versus regeneration. Is this a realistic match?

Repairing the injured spinal cord: sprouting versus regeneration. Is this a realistic match?

Designing interactivity on consumer health websites: PARAFORUM for spinal cord injury

ObjectiveThis paper addresses the issue of interactivity on health consumer websites powered by health organizations, by presenting the design of PARAFORUM, an interactive website in the field of spinal cord injury (SCI). MethodsThe design of PARAFORUM is based on different streams of research in online health communication, web-based communities, open innovation communities and formative evaluation with stakeholders. ResultsPARAFORUM implements a model of diversified interactivity based on individuals with SCI and their families, health professionals, and researchers sharing their expertise in SCI. In addition to traditional health professional/researcher-to-consumer and peer-to-peer interactions, through PARAFORUM consumers, health professionals and researchers can co-design ideas for the enhancement of practice and research on SCI. ConclusionThere is the need to reflect on the conceptualization and operationalization of interactivity on consumer health websites. Interactions between different users can make these websites important platforms for promoting self-management of chronic conditions, organizational innovation, and participatory research. Practice implicationsInteractivity on consumer health websites is a main resource for health communication. Health organizations are invited to build interactive websites, by considering, however, that the exploitation of interactivity require users’ collaboration, processes and standards for managing content, creating and translating knowledge, and conducting internet-based studies.

P260 A Model For Bridging The Translational Valley Of Death In Spinal Cord Injury

BackgroundDespite the amount of funding that supports basic research, few research discoveries achieve their potential. The transition from bench-to-bedside research is so fraught with obstacles that it is referred to...

Validation and cross-cultural adaptation of the Persian version of Craig Handicap Assessment and Reporting Technique (CHART) short form

Objective: To test the psychometric specifications of the Persian version of the Craig Handicap Assessment and Reporting Technique (CHART) short form in an Iranian population. Design: Cross-sectional study. Subjects: Fifty-two individuals with a mean age of 49.3 years (SD 7.9, minimum 38 years and maximum 80 years), who had chronic spinal cord lesions, were included in this study. Most of them were paraplegic (88.5%) and unemployed (76.9%). Methods: Reliability (internal consistency) of the measure was examined by applying Cronbach’s alpha. In addition, validity (construct) was tested by Pearson’s correlation. Results: Overall, the internal consistency of the questionnaire was found to be satisfactory (Cronbach’s alpha 0.613). Regarding construct validity, the minimum and maximum significant correlations were among Physical Component Summery and Cognitive Independence (r = 0.267, p < 0.05), Vitality and Social Integration (r = −0.429, p < 0.01) respectively. Conclusion: By analyzing data regarding the psychometric specifications of the Persian version of CHART, we can conclude that this version is a valid, reliable and unique measure that can be used for spinal cord–injured individuals. As demonstrated in our preliminary study, it is easy to be filled out and is not confusing.Implications for RehabilitationThe Persian version of the CHART has been successfully validated.It can be used by those working specifically in the field of spinal cord injury and also more generally.It will enable both initial assessment and follow-up for people in Persian-speaking areas of the world.

Perceptions of patients with spinal cord injury on future research in South India

PurposeThe purpose of this paper is to evaluate the perceptions of research priorities as expressed by people with spinal cord injury (SCI).Design/methodology/approachA descriptive study based on feedback from patients, rehabilitated following SCI was conducted in order to explore their felt needs for further research. A questionnaire was sent to 225 people who were rehabilitated following SCI. They were asked to indicate three priorities for further research on disability related issues. The questionnaire had a list of issues on different facets of disability following SCI. In total, 62 patients responded to the questionnaire.FindingsResearch on urinary incontinence was stated to have the highest priority among these different groups according to their age, marital status, duration of disability, and employment status. Rehabilitated patients of all age groups, irrespective of marital or employment status or duration of disability, indicated that further research is to be done on urinary incontinence.Research limitations/implicationsA similar study among groups in a larger population would add further information.Practical implicationsPractitioners should address these expressed needs of the persons with SCI in the community.Social implicationsThese expressed needs will increase awareness among the team involved in the management of SCI in the community thus fill the gap between research and practice.Originality/valueResearch focussing on various problems associated with spinal cord injury have been carried out globally. On most of the occasions, the perceptions of the affected people regarding research areas are seldom obtained. This research would guide future directions of rehabilitation research in the field of spinal cord injury.

Methodology of systematic reviews and recommendations.

Although research in the field of spinal cord injury (SCI) is a relatively new endeavor, a remarkable number of papers focused on this subspecialty have been published in a broad variety of journals over the last two decades. A multidisciplinary group of experts, including clinical epidemiologists, neurosurgical and orthopedic spine surgeons, basic scientists, rehabilitation specialists, intensivists, and allied health professionals (nursing and physical therapy) was assembled through the Spinal Cord Injury Solutions Network to summarize the existing literature focusing on 12 key topics related to acute traumatic SCI, which have not been recently reviewed. The objective was to develop evidence-based recommendations to help translate current science into clinical practice and to identify new directions for research. For each topic one to three specific questions were formulated by consensus through the expert panel. A systematic review of the literature was performed to determine the current evidence for the specific questions. A primary literature search was performed using MEDLINE, CINAHL, EMBASE, and Cochrane databases. A secondary search strategy incorporated additional articles referenced in significant publications (i.e., meta-analysis, systematic and nonsystematic review articles). Two reviewers independently reviewed the titles and abstracts yielded by this comprehensive search and subsequently selected articles based on the predetermined inclusion and inclusion criteria. Data were extracted for population into evidentiary tables. Selected articles were rated for level of evidence and methodological quality, information that was also included in evidentiary tables. Disagreements were resolved by a third reviewer or consensus-based discussion. Based on the evidence compiled, answers to the targeted questions were formulated and recommendations generated by consensus-based discussion and anonymized voting using Delphi methodology. A level of consensus of 80% or higher was considered to represent strong agreement.

The bright side of the glial scar in CNS repair

Following CNS injury, in an apparently counterintuitive response, scar tissue formation inhibits axonal growth, imposing a major barrier to regeneration. Accordingly, scar-modulating treatments have become a leading therapeutic goal in the field of spinal cord injury. However, increasing evidence suggests a beneficial role for this scar tissue as part of the endogenous local immune regulation and repair process. How can these opposing effects be reconciled? Perhaps it is all a matter of timing.

The Bors Award: Legacy of Ernest H. J. “Pappy” Bors, MD

After World War II, military hospitals in the US were inundated with veterans paralyzed by spinal cord injury. Their complications spanned specialties and subspecialties including pulmonary medicine, orthopedics, neurology, urology, dermatology, surgery and some yet to be developed. Care was hindered by a health care delivery structure based on specialty and a lack of cohesive approach to their complex medical and social problems. Not only did the structure need overhauling, clinicians were needed to care for these “hopeless cripples” and research was needed to find ways to address their many needs in a climate of little support and even less recognition. Even the patients, hardened warriors, often bitter, with no hope for recovery, needed to be convinced that there was a better way. Only a dedicated, aggressive and persistent professional could hope to make any headway in such a difficult situation. In 1944, Ernest H.J. Bors, MD, joined the staff of Hammond General Army Hospital. As assistant chief of urology, Dr Bors was urology consultant to the hospital's Spinal Cord Injury Care Section (1,2). Caring for these most needy veterans inspired him to develop a comprehensive way to oversee all of their needs. Not only did Dr Bors become the foremost expert on neurourology in spinal cord injury, he developed a holistic multidisciplinary approach that formed the foundation for modern SCI centers. His success with his SCI ward attracted the attention of the War Department, which opened the first SCI Center in the nation at Birmingham General Army Hospital (now the Long Beach VA Hospital), and placed Dr Bors in charge. Soon he had 220 patients under his care and disciplinary problems that further complicated the administrative, medical and surgical issues involved in managing this large, innovative unit. The frustrations and responsibilities sometimes overwhelmed Dr Bors, who was known for his crusty, ‘tough love' demeanor. But his equally tough patients, eventually numbering more than 2,500, recognized his underlying deep love and dedication and called their champion, “Pappy”. They called themselves the S.O.B.s (Survivors of Birmingham) and in 1970, more than 700 of them turned out for Pappy Bors' retirement party in Los Angeles—a fitting tribute to a true pioneer in the field of spinal cord injury. Since 1994, the Journal of Spinal Cord Medicine has offered an annual award in Pappy's honor—The Ernest Bors Award for Scientific Development, because throughout a career spent fighting for basic resources while caring for thousands of patients many considered ‘hopeless cases', Dr Bors made research and publication a priority. “You learn at the bedside,” he said, and from there, he devised better ways to manage SCI complications by developing protocols for treatment and rehabilitation. He shared his innovative techniques in more than 140 scientific papers and in a major textbook, co-authored by Estin Comarr, MD, Neurological Urology, Physiology of Micturition, Its Neurological Disorders and Sequelae. More than 35 years later, this remains the authoritative text in this field. The Bors Award memorializes this pioneer who “carried the torch of care and research and opened the way for better care” of all individuals with SCI (3) by recognizing the achievement of young investigators and supporting their ongoing efforts. The winning authors represent the spectrum of spinal cord injury research (see box). The guidelines for the Bors Award are published in each issue. Entries are judged by a panel of editors convened by the Editor. The winner is invited to present the paper at the annual conference and receives recognition and a cash prize. The Editorial Board encourages students, fellows and residents to share in the legacy of Dr Bors by seeking answers to problems faced by individuals with SCI and sharing their findings with the readers of the Journal of Spinal Cord Medicine.

Focusing on the evidence in spinal cord injury

Lisa Harvey is a highly respected researcher and clinician working in the field of spinal cord injury in Sydney. She has published extensively in the area of spinal cord injury and its physiotherapy management. Dr Harvey has wide-ranging teaching experience across all levels of the profession and provides significant professional leadership to the spinal cord injury community, not just to physiotherapists, but also to other clinical specialties. She is extremely well qualified to write a text of this sort and the fruits of her labours are a great addition to the material currently available. The text reflects more accurately than earlier publications the way we practise as spinal physiotherapists working with patients with spinal cord injury. This guide brings a contemporary and evidence-based edge to writing in this field. The book provides the student, and physiotherapists of all experience levels, with a wealth of information. As an experienced clinician there was much in this text which I found stimulating and informative. The breadth of the content is extensive. I found the section on commonly used assessment scales extremely useful both as a clinician and researcher. The sections on respiratory management, skin care, bowel and bladder function, and sexuality are complemented by extensive descriptions of wheelchair and transfer skills with useful illustrations. Upper limb and

Poster 43: Spinal Cord Injury Rehabilitation: An Evidence-Based Review

Objective: To conduct a systematic review of the published research examining the strengths and weaknesses of various interventions used within the field of spinal cord injury (SCI) rehabilitation. Data Source: 4 databases—Medline and PubMed, CINAHL, Embase, and PsycINFO—were searched for articles addressing all interventions used within the SCI population. Methodologic quality was assessed using either the PEDro or the Downs and Black assessment tool. Study Selection: Included were randomized controlled trials (RCTs), non-RCTs, cohort, case-control, case series, pre-post- and postinterventional studies, and, if necessary, case studies.