Spinal Cord Injury Individuals Research Articles

Sensorimotor Time Delay Estimation by EMG Signal Processing in People Living with Spinal Cord Injury.

Neuro mechanical time delay is inevitable in the sensorimotor control of the body due to sensory, transmission, signal processing and muscle activation delays. In essence, time delay reduces stabilization efficiency, leading to system instability (e.g., falls). For this reason, estimation of time delay in patients such as people living with spinal cord injury (SCI) can help therapists and biomechanics to design more appropriate exercise or assistive technologies in the rehabilitation procedure. In this study, we aim to estimate the muscle onset activation in SCI people by four strategies on EMG data. Seven complete SCI individuals participated in this study, and they maintained their stability during seated balance after a mechanical perturbation exerting at the level of the third thoracic vertebra between the scapulas. EMG activity of eight upper limb muscles were recorded during the stability. Two strategies based on the simple filtering (first strategy) approach and TKEO technique (second strategy) in the time domain and two other approaches of cepstral analysis (third strategy) and power spectrum (fourth strategy) in the time-frequency domain were performed in order to estimate the muscle onset. The results demonstrated that the TKEO technique could efficiently remove the electrocardiogram (ECG) and motion artifacts compared with the simple classical filtering approach. However, the first and second strategies failed to find muscle onset in several trials, which shows the weakness of these two strategies. The time-frequency techniques (cepstral analysis and power spectrum) estimated longer activation onset compared with the other two strategies in the time domain, which we associate with lower-frequency movement in the maintaining of sitting stability. In addition, no correlation was found for the muscle activation sequence nor for the estimated delay value, which is most likely caused by motion redundancy and different stabilization strategies in each participant. The estimated time delay can be used in developing a sensory motor control model of the body. It not only can help therapists and biomechanics to understand the underlying mechanisms of body, but also can be useful in developing assistive technologies based on their stability mechanism.

Exoskeleton-Assisted Walking for Pulmonary and Exercise Performances of SCI Individuals.

To determine whether exoskeleton-assisted walking (EAW) improves pulmonary ventilation function, motor function and related body structure, and activities equivalently as the conventional exercise program for people with spinal cord injury (SCI). Forty participants (7 females and 33 males; age 37.1±12.0 years) with thoracic SCI were randomized into two groups and undertook 16 sessions of 50-60 min training (4 days/week). Participants in the EAW group received EAW trainings, such as assisted standing, walking, and climbing the stairs. The control group received a conventional exercise program. Outcomes were measured at baseline and upon completion of treatment. After trainings, the EAW group improved more than the control group in the forced vital capacity (FVC, 0.53 L [0.01-1.06 L]), predicted FVC% (19.59 [6.63-32.54]) and forced expiratory volume in 1s (0.61 L [0.15-1.07 L]), basic activities of daily living (BADL) (19.75 [10.88-28.62]), and distal femoral cartilage. Participants in the EAW group completed 6-minute walk test with median 17.3 meters while wearing the exoskeleton. There was no difference in trunk and lower extremity motor function, bone mineral density, and adverse events ( P > 0.05). In people with lower thoracic neurological level of SCI, EAW training has potential benefits to facilitate pulmonary ventilation function, walking, BADL and thickness of cartilage comparing to a conventional excise program. This study provided more evidence for using EAW in clinic, and partly proved EAW had equivalent effects as conventional exercise program, which may combine with conventional exercise program for reducing burden of therapists in the future.

Neuromodulation with transcutaneous spinal stimulation reveals different groups of motor profiles during robot-guided stepping in humans with incomplete spinal cord injury.

Neuromodulation via spinal stimulation has been investigated for improving motor function and reducing spasticity after spinal cord injury (SCI) in humans. Despite the reported heterogeneity of outcomes, few investigations have attempted to discern commonalities among individual responses to neuromodulation, especially the impact of stimulation frequencies. Here, we examined how exposure to continuous lumbosacral transcutaneous spinal stimulation (TSS) across a range of frequencies affects robotic torques and EMG patterns during stepping in a robotic gait orthosis on a motorized treadmill. We studied nine chronic motor-incomplete SCI individuals (8/1 AIS-C/D, 8 men) during robot-guided stepping with body-weight support without and with TSS applied at random frequencies between 1 and up to 100Hz at a constant, individually selected stimulation intensity below the common motor threshold for posterior root reflexes. The hip and knee robotic torques needed to maintain the predefined stepping trajectory and EMG in eight bilateral leg muscles were recorded. We calculated the standardized mean difference between the stimulation conditions grouped into frequency bins and the no stimulation condition to determine changes in the normalized torques and the average EMG envelopes. We found heterogeneous changes in robotic torques across individuals. Agglomerative clustering of robotic torques identified four groups wherein the patterns of changes differed in magnitude and direction depending mainly on the stimulation frequency and stance/swing phase. On one end of the spectrum, the changes in robotic torques were greater with increasing stimulation frequencies (four participants), which coincided with a decrease in EMG, mainly due to the reduction of clonogenic motor output in the lower leg muscles. On the other end, we found an inverted u-shape change in torque over the mid-frequency range along with an increase in EMG, reflecting the augmentation of gait-related physiological (two participants) or pathophysiological (one participant) output. We conclude that TSS during robot-guided stepping reveals different frequency-dependent motor profiles among individuals with chronic motor incomplete SCI. This suggests the need for a better understanding and characterization of motor control profiles in SCI when applying TSS as a therapeutic intervention for improving gait.

Cross-cultural translation, adaptation and validation of the consultation and relational empathy (Care) scale into Hindi among spinal cord injury population

BACKGROUND & OBJECTIVE: The treatment outcome is influenced by the relationship between health care providers and patients. So far, there is no validated tool/scale in Hindi which can be used in the Indian population to gather data on empathy and holistic care provided by the healthcare professionals during their consultation. The primary goal of the study is to translate and cross-culturally adapt the CARE scale to Hindi. Also, to determine its content validity and reliability so that further research can be done on the Hindi speaking Spinal Cord Injury population. METHODS: The study was conducted in three phases, namely Translation-Cultural Adaptation, Content Validity, & Reliability. The CARE measure was translated into Hindi and qualitative and quantitative content validation through the expert opinion and the content validity ratio (CVR) method was tested on a purposive sample of 30 spinal cord injury (SCI) individuals in two rehabilitation centres in New Delhi, India. Item analysis was conducted (on 50 SCI individuals) to determine internal consistency reliability. RESULTS: The Hindi CARE measure high has high internal consistency reliability (Cronbach’s alpha = 0.924). CVR and qualitative review done by the panels of experts validated the content of the CARE measure. CONCLUSION: The CARE measure- Hindi version is a validated and reliable tool to be used in Hindi speaking Spinal Cord Injury population context. Further work is required to establish test-retest reliability and studies on bigger sample size.

Associations Between Functioning Recovery, Employment, and Neighborhood Disadvantage in People With Spinal Cord Injury

Research Objectives To examine the association of neighborhood disadvantage and healthcare utilization, physical independence, mobility, social participation, and return to work (RTW) in individuals with spinal cord injury (SCI). Design A cohort study using the National Spinal Cord Injury (SCI) Model Systems Database linked with Area Deprivation Index (ADI) percentile scores from the Neighborhood Atlas by census block.Setting: Seventeen SCI Model Systems centers across the United States. Participants A total of 5094 individuals with traumatic SCI were discharged from rehabilitation programs between November 2011 and July 2020 and completed 1-year follow-up interviews. Interventions None. Main Outcome Measures One-year healthcare utilization, measured by whether participants rehospitalization, and physical independence, mobility, and social integration measured using the Craig Handicap Assessment and Reporting Technique (CHART). Multivariable logistic regression models were used to examine the associations. Results After adjusting for demographic, injury-related characteristics, and pre-injury comorbidity, neighborhood disadvantage was not associated with hospital readmission. However, compared with SCI individuals who live in the least disadvantaged neighborhood, those who live in the most disadvantaged neighborhood had a lower physical independence (need paid or unpaid assistant: OR[CI]= 1.52 [1.04-2.23]), mobility (day out of house: 0.38 [0.26 - 0.55]; night away from house: 0.44[0.36-0.62]), social integration (conversation with friends: 0.46 [0.33-0.63]; conversation with Stranger:0.57[0.41-0.80]), and RTW (0.18 [0.09-0.34]). Conclusions Neighborhood disadvantage was negatively associated with physical independence, mobility, social participant and RTW in individuals with SCI. Additional research is needed to identify potentially modifiable factors that may reduce inequalities in outcomes in the SCI population. Author(s) Disclosures no conflicts of interest in disclosures. To examine the association of neighborhood disadvantage and healthcare utilization, physical independence, mobility, social participation, and return to work (RTW) in individuals with spinal cord injury (SCI). A cohort study using the National Spinal Cord Injury (SCI) Model Systems Database linked with Area Deprivation Index (ADI) percentile scores from the Neighborhood Atlas by census block.Setting: Seventeen SCI Model Systems centers across the United States. A total of 5094 individuals with traumatic SCI were discharged from rehabilitation programs between November 2011 and July 2020 and completed 1-year follow-up interviews. None. One-year healthcare utilization, measured by whether participants rehospitalization, and physical independence, mobility, and social integration measured using the Craig Handicap Assessment and Reporting Technique (CHART). Multivariable logistic regression models were used to examine the associations. After adjusting for demographic, injury-related characteristics, and pre-injury comorbidity, neighborhood disadvantage was not associated with hospital readmission. However, compared with SCI individuals who live in the least disadvantaged neighborhood, those who live in the most disadvantaged neighborhood had a lower physical independence (need paid or unpaid assistant: OR[CI]= 1.52 [1.04-2.23]), mobility (day out of house: 0.38 [0.26 - 0.55]; night away from house: 0.44[0.36-0.62]), social integration (conversation with friends: 0.46 [0.33-0.63]; conversation with Stranger:0.57[0.41-0.80]), and RTW (0.18 [0.09-0.34]). Neighborhood disadvantage was negatively associated with physical independence, mobility, social participant and RTW in individuals with SCI. Additional research is needed to identify potentially modifiable factors that may reduce inequalities in outcomes in the SCI population.

Translation and validation into Portuguese of the international spinal cord injury pulmonary function basic data set.

Spinal cord injury (SCI) is a serious disabling syndrome, and the clinical picture depends on the level and extent of the injury. The International Spinal Cord Society (ISCoS) and the American Spinal Cord Association (ASIA) have developed instruments (Data Sets) to assess the various aspects of the SCI. In 2012, the International SCI Pulmonary Function Basic Data Set was elaborated. It is composed of four questions and spirometry for the collection of lung function basic data. The objective was to translate and validate the International SCI Pulmonary Function Basic Data Set to the Portuguese language. The entire methodology followed the recommendations of the ISCoS and ASIA. Two translations of the original version into Portuguese were performed, and after consensus among the translators, the Portuguese version was sent for back-translation. After back-translation and comparison with the original version, the final Portuguese version was obtained. For the second phase of the study, 30 SCI individuals were selected. Two interviewers applied the questionnaire in two distinct moments. All results presented constant, excellent, or perfectly concordant data, except for the third question in the inter-rater comparison, where the Kappa coefficient showed value reasonable in the first interview and good in the second. The translation into Brazilian Portuguese of the "International SCI Pulmonary Function Basic Data Set" created a valid and highly reliable instrument, like the original without linguistic and cultural disagreements that allow its use in the evaluation of patients with SCI in Brazil.

Predictors of One Year Pressure Injury Outcomes in Hospitalized Spinal Cord Injured Veterans

<h3>Research Objectives</h3> To investigate predictors of wound outcomes at 1 year of discharge of Veterans with spinal cord injury (SCI) hospitalized with one stage 3 or 4 pelvic pressure injury (PI). <h3>Design</h3> Retrospective medical record review between 1/1/2013-12/31/2018. <h3>Setting</h3> VA North Texas HealthCare System SCI unit. <h3>Participants</h3> Veterans with SCI admitted with one stage 3 or 4 pelvic PI. Traumatic and atraumatic SCI patients treated medically without flap surgery were included. <h3>Interventions</h3> Wound care. <h3>Main Outcome Measures</h3> Wound status at one year of discharge. A logistic model was built to select the significant predictors of wound healing outcomes. The area under the curve (AUC) was calculated using the leave-one-out cross validation method. P< 0.05 was considered statistically significant. <h3>Results</h3> A total of 62 hospitalizations were included for analyses: 33 healed, and 29 non-healed wounds. Three significant predictors of non-healed wound outcomes include: pressure mapping protocol during hospitalization, wound depth, and usage of alginates dressings. Two significant predictors of healed wound outcomes include: animal-based tissue and hydrocolloid dressings. The AUC of this logistic regression model is 79.98%. <h3>Conclusions</h3> The five wound outcome predictors are the depth of the wound, and clinical decision-making factors regarding seating and wound treatments. Pressure mapping protocol correlated with other variables that could not serve as a predictor by themselves including higher neurological level of injury and lack of manual pressure relief techniques. The clinical decision having a patient pressure mapped predicts that the wound may not heal at one year of discharge. The three wound treatment product predictors may represent characteristics of the wound. Further investigation on these clinical decision-making factors is warranted in utilizing treatment and healthcare recourses for SCI individuals hospitalized with PI. <h3>Author(s) Disclosures</h3> N/A.

Risk factors of AIS C incomplete cervical spinal cord injury for poor prognosis—The significance of anorectal evaluation

BackgroundAlthough the prognosis of incomplete cervical spinal cord injury (SCI) diagnosed as American Spinal Injury Association Impairment Scale grade C (AIS C) is generally favorable, some patients remain non-ambulatory. The present study explored the clinical factors associated with the non-ambulatory state of AIS C patients. MethodsThis study was a single-center retrospective observational study. Seventy-three participants with AIS C on admission were enrolled and divided into two groups according to ambulatory ability after one year. Prognostic factors of SCI were compared in ambulatory (A-group) and non-ambulatory participants (NA-group). Univariable and multivariable logistic regression analyses were performed on demographic information, medical history, mechanism of injury, presence of fracture, ASIA motor scores (MS) of the extremities, neurological findings, including an anorectal examination on admission, and imaging findings. ResultsForty-one patients were included in the A-group and 32 in the NA-group. Univariable analysis revealed that the following factors were related to poor outcomes (p < 0.05): older age, history of cerebrovascular disorder, impairment/absence of S4-5 sensory score, deep anal pressure (DAP) (−), voluntary anal contraction (VAC) (−), anorectal tone (−), anal wink reflex (−), and low MS of the upper and lower extremities. In the multivariable analysis using age, presence or absence of sacral abnormality, and history of cerebrovascular disorders (adjusted for these three factors), older age and presence of sacral abnormality on admission were independent risk factors for a non-ambulatory state at the 1-year follow-up. ConclusionsIncomplete AIS C SCI individuals with older age and/or impairment of anorectal examination could remain non-ambulatory at 1-year follow-up.

Low-intensity pulsed ultrasound partially reversed the deleterious effects of a severe spinal cord injury-induced bone loss and osteoporotic fracture healing in paraplegic rats.

To evaluate the effects of low-intensity pulsed ultrasound (LIPUS) on the quality of femoral fracture callus formation in rats with severe osteoporosis secondary to spinal cord injury (SCI). Forty-five male rats were equally divided into three groups: the Sham group underwent sham surgery for SCI followed by surgery for femoral fracture on day ten post-spine surgery; the SCI group sustained a complete transection of the spinal cord and a femoral fracture ten days post-SCI; and the SCI group treated with ultrasound (SCI + US), which also sustained a femoral fracture on day ten post-SCI, concomitant with daily application of LIPUS at the fracture site. At the non-fractured tibias, LIPUS counteracted the SCI-induced bone loss by normalizing the osteoblastic-related gene expression, decreasing resorptive area, increasing trabecular area, and decreasing RANK and RANK-L-positive areas, which resulted in higher cortical volume and stronger tibias. Likewise, LIPUS was effective at restoring bone fracture healing in SCI rats; by promoting endochondral ossification, increasing collagen deposition and OPG-positive-area, decreasing resorptive area, which led to higher density and improved microarchitecture, ultimately resulting in stronger fracture callus. At the tibias, LIPUS counteracted the SCI-induced bone loss effects by simultaneously increasing bone formation and decreasing bone resorption. We also evidenced the osteogenic effects of LIPUS at partially restoring the endochondral ossification during callus formation, leading to a newly formed tissue with improved microarchitecture and mechanical integrity. Therefore, LIPUS may be an efficient and non-invasive approach to prevent bone loss and osteoporotic fracture in SCI individuals.

O108 / #513 TARGETING MULTIPLE AUTONOMIC FUNCTIONS SIMULTANEOUSLY WITH SPINAL CORD EPIDURAL STIMULATION: TRACK 4: GENITOURINARY NEUROMODULATION / PELVIC PAIN / NEUROMODULATION IN PREGNANCY

Bladder distention has been identified as a primary trigger of autonomic dysreflexia (AD) in individuals with spinal cord injury (SCI) at cervical and upper thoracic levels (majority of population), with systolic blood pressure (SBP) rising more than 20 mmHg and remaining elevated with intolerable symptoms (pounding headache and/or chills, for example).The current study examined control of blood pressure during bladder filling with neuromodulation in SCI individuals previously implanted with a spinal cord epidural stimulation (scES) electrode array.

Feasibility and validity of the push-up test for synchronous and asynchronous strength tele-assessment in spinal cord injury individuals with paraplegia

Objectives: This study aimed to determine whether the synchronous and asynchronous push-up tele-assessment in individuals with spinal cord injury (SCI) is feasible and valid and to identify the relationship between the participants’ self-reported asynchronous strength tele-assessment and asynchronous push-up tele-assessment. Study design: Cross-sectional study Methods: Thirty-three men and women with SCI were included in this study. The participants were assessed using the one-maximum repetition test (1RM), the maximum repetitions with 60% of 1RM (MRT) of the bench press exercise, and synchronous and asynchronous push-up tele-assessment. The videos and the total repetitions performed were recorded. The primary outcomes were 1RM, MRT, synchronous push-up tele-assessment and asynchronous volume loads, and the participants’ self-reported asynchronous strength tele-assessment volume load. Results: The synchronous push-up tele-assessment and asynchronous volume loads presented significant correlations with 1RM (0.73 and 0.45, p < 0.001, respectively) and MRT volume loads (0.87 and 0.66, p < 0.001, respectively). The asynchronous push-up tele-assessment presented significant correlations with the synchronous version (intraclass correlation coefficient, ICC = 0.86; 95% CI: 0.72–0.93, p < 0.001) and participants’ self-reported asynchronous strength tele-assessment volume loads (ICC = 0.88; 95% CI: 0.75–0.94, p < 0.001). The difference between the synchronous push-up tele-assessment and asynchronous volume load means was 254.9 kg, and the interval around the differences was 1856.1 kg. The difference between asynchronous push-up tele-assessment and participants’ self-reported asynchronous strength tele-assessment means was −239.4 kg, and the interval around these was 1884.1 kg. Conclusion: The synchronous push-up tele-assessment is a feasible and valid way to assess the maximum resistance strength of individuals with SCI. Although the asynchronous push-up tele-assessment demonstrated excellent and significant correlations with the synchronous push-up tele-assessment and participants’ self-reported asynchronous strength tele-assessment, the test repetitions and the volume loads were underestimated by 15.5% (synchronous push-up tele-assessment vs. asynchronous) and overestimated by 17.3% (asynchronous push-up tele-assessment vs. participants’ self-reported asynchronous strength tele-assessment), and the effect sizes ranged from 0.19–0.38. The authors suggest emphasizing the criteria of repetition validity to reduce test error.

Evaluation of secondary complication awareness among individuals with spinal cord injury.

Secondary complications (SCs) are common and cause high morbidity and mortality in individuals with spinal cord injury (SCI). There is no information or a satisfactory scale of measurement for evaluating the opinions of individuals with SCI on whether they have sufficient knowledge about these complications. This study aimed to evaluate the opinions of individuals with SCI about whether they have sufficient information on SCI-related SCs. Demographic and clinical characteristics of 64 SCI individuals were recorded. A questionnaire was applied to evaluate the opinions of the participants and whether they have sufficient information about SCs before and after a multidisciplinary rehabilitation for SCI. A test was performed to measure the knowledge level at admission to the hospital and discharge. The mean value of the total questionnaire score, which was 6.2 at admission, increased to 7.91 at discharge ( P < 0.001). All subgroup scores of the questionnaire were higher at discharge than at admission (all P < 0.05). Total, neurogenic bladder, neurogenic bowel and spasticity test scores increased at discharge compared to admission (all P < 0.05). There is a relationship between the change in questionnaire scores and some demographic and injury characteristics. The opinions of the individuals with SCI on having sufficient information about SCs and their knowledge levels increased after a multidisciplinary rehabilitation program. Applying such a questionnaire and test at admission may have increased the awareness of the participants about SCs and contributed to a higher level of knowledge and opinion.

Functional recovery priorities and community rehabilitation service preferences of spinal cord injury individuals and caregivers of Chinese ethnicity and cultural background.

IntroductionSpinal cord injury (SCI) causes significant and permanent disability affecting motor, sensory and autonomic functions. We conducted a survey on the priorities of functional recovery and preferences for community rehabilitation services in a cohort of Chinese individuals with SCI as well as the primary caregivers. The study also investigated their views on advanced technology and research.MethodsAn online platform with a self-administered questionnaire was used to collect the opinions of clients that received services from an SCI follow-up clinic, a self-help association, or a non-government organization from 1 September−31 December 2021.ResultsEighty-seven subjects (74 individuals with SCI−48 tetraplegic, 26 paraplegic, and 13 caregivers) responded to the survey. Recovery of arm/hand function was given the highest priority among tetraplegics, followed by upper trunk/body strength and balance, and bladder/bowel function. Sexual function had a significant lower ranking than all priority areas except normal sensation (p < 0.05). Paraplegics viewed bladder/bowel function as the most important area of functional recovery, followed by walking movement, upper trunk/body strength and balance, elimination of chronic pain, and regaining normal sensation. There was no statistically significant difference among the top priority areas (p > 0.05). In contrast to previous studies done in Western populations, the study revealed that sexual function was ranked as the lowest by all 3 groups of respondents (tetraplegics, paraplegics, and caregivers). The majority of participants thought community rehabilitation services were inadequate. Most of the respondents were interested to try advanced technology which would facilitate their daily life and rehabilitation. About half of the individuals with SCI thought advance in technology and research could bring significant improvement in their quality of life in the coming 10 years.ConclusionThis survey is the first study specifically looking into the recovery and rehabilitation priorities of a Chinese population of individuals with SCI. This is also the first study to investigate the priorities of the primary caregivers of SCI individuals. The findings are useful as a reference for planning of future research and provision of rehabilitation services for the SCI community locally and in other parts of China.

Bioelectrical impedance vector analysis and body composition in cervical spinal cord injury: A pilot study.

IntroductionBody composition assessment in cervical spinal cord injury (c-SCI) individuals is important to monitor the fat free-mass (FFM) loss, due to immobilization, or gain, due to exercise practice. Single frequency bioelectrical impedance analysis (SF-BIA) is low in cost, simple and easy.ObjectivesThe aims of this study are: to evaluate the concordance between the FFM values obtained using dual X-ray absorptiometry (DXA) and the three SF-BIA previous predictive equations; and to test the applicability of the bioelectrical impedance vector analysis (BIVA).MethodsTwenty-three c-SCI males were divided into two groups: Physically active (PA; n = 13; at least 150 min/week) and non-active individuals (NPA) and were assessed by DXA and SF-BIA simultaneously.ResultsFFM values were similar between groups PA and NPA. Considering all participants, FFM values obtained by Kocina and Heyward (>11%) and Sun (<15.4%) predictive equations were different when compared to DXA (p < 0.01). However, Buchholz's et al. predictive equation showed FFM values similar to DXA, but presented poor concordance (<7%, p = 0.99; concordance coefficient = 0.85). BIVA showed consistency in ellipse distribution using FFM obtained using Buchholz et al. predictive equation.ConclusionsThe use of non-specific BIA equations can lead to misinterpretation in FFM values in male c-SCI individuals. Predictive equations for this group need to be developed.

Breaking Mental Barriers Promotes Recovery After Spinal Cord Injury.

Functional recovery after spinal cord injury (SCI) often proves difficult as physical and mental barriers bar survivors from enacting their designated rehabilitation programs. We recently demonstrated that adult mice administered gabapentinoids, clinically approved drugs prescribed to mitigate chronic neuropathic pain, recovered upper extremity function following cervical SCI. Given that rehabilitative training enhances neuronal plasticity and promotes motor recovery, we hypothesized that the combination of an aerobic-based rehabilitation regimen like treadmill training with gabapentin (GBP) administration will maximize recovery in SCI mice by strengthening synaptic connections along the sensorimotor axis. Whereas mice administered GBP recovered forelimb functions over the course of weeks and months following SCI, no additive forelimb recovery as the result of voluntary treadmill training was noted in these mice. To our surprise, we also failed to find an additive effect in mice administered vehicle. As motivation is crucial in rehabilitation interventions, we scored active engagement toward the rehabilitation protocol and found that mice administered GBP were consistently participating in the rehabilitation program. In contrast, mice administered vehicle exhibited a steep decline in participation, especially at chronic time points. Whereas neuroinflammatory gene expression profiles were comparable between experimental conditions, we discovered that mice administered GBP had increased hippocampal neurogenesis and exhibited less anxiety-like behavior after SCI. We also found that an external, social motivator effectively rescues participation in mice administered vehicle and promotes forelimb recovery after chronic SCI. Thus, not only does a clinically relevant treatment strategy preclude the deterioration of mental health after chronic SCI, but group intervention strategies may prove to be physically and emotionally beneficial for SCI individuals.

Impact of activity-based recovery training and desmopressin on spinal cord injury-induced polyuria in Wistar rats

Background: Activity-based recovery training (ABRT) reverses spinal cord injury (SCI) induced polyuria and alterations of biomarkers involved with fluid balance, including expression levels of kidney vasopressin 2 receptors. However, void volumes do not return to pre-injury baseline levels, indicating a combinatorial approach may be necessary. Objective/Design: In the current study, acute effects of a pharmacological intervention versus placebo were examined in male rats that had received 70 daily ABRT sessions. The treatment, desmopressin (DDAVP – synthetic analogue of arginine vasopressin), an antidiuretic therapy used for the management of bedwetting in children and central diabetes insipidus, has previously shown some promise in a few limited cohorts of SCI individuals having nocturnal polyuria. Results: A total of 70 sessions of ABRT over a 10-week timeframe again reduced the overproduction of urine, but not completely to pre-SCI baseline levels. DDAVP treatment maintained but did not further reduce the level of urine output in the ABRT group without continuous exercise, demonstrating either intervention/treatment alone is effective, despite no additive effect. Although intake did not change from pre-injury levels despite polyuria, DDAVP treatment also reduced drink volume. Conclusions: Further studies are needed as the mechanisms underlying changes in fluid and solute balance are likely multi-factorial involving a complex interaction between the neural (both central and peripheral) control of systems mediating thirst, urinary output, and cardiovascular regulation.

Stimulation Parameters Used During Repetitive Transcranial Magnetic Stimulation for Motor Recovery and Corticospinal Excitability Modulation in SCI: A Scoping Review.

There is a growing interest in non-invasive stimulation interventions as treatment strategies to improve functional outcomes and recovery after spinal cord injury (SCI). Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory intervention which has the potential to reinforce the residual spinal and supraspinal pathways and induce plasticity. Recent reviews have highlighted the therapeutic potential and the beneficial effects of rTMS on motor function, spasticity, and corticospinal excitability modulation in SCI individuals. For this scoping review, we focus on the stimulation parameters used in 20 rTMS protocols. We extracted the rTMS parameters from 16 published rTMS studies involving SCI individuals and were able to infer preliminary associations between specific parameters and the effects observed. Future investigations will need to consider timing, intervention duration and dosage (in terms of number of sessions and number of pulses) that may depend on the stage, the level, and the severity of the injury. There is a need for more real vs. sham rTMS studies, reporting similar designs with sufficient information for replication, to achieve a significant level of evidence regarding the use of rTMS in SCI.

Cognitive functions in individuals with spinal cord injury: Do symptoms of autonomic dysreflexia or orthostatic hypotension have an effect?

Aims: This study aimed to compare the cognitive functions of individuals with spinal cord injury (SCI) and age- and education level-matched healthy controls, and to compare the cognitive functions between individuals with T6 or rostral and T6 caudal injuries. Materials and Methods: This prospective and cross sectional study included 50 individuals with SCI and 47 age- and education level-matched healthy controls. The SCI individuals were divided into two groups as those with T6 or rostral (n = 20) and T6 caudal (n = 30) injuries. All participants underwent the Addenbrook Cognitive Examination-Revised (ACE-R) test to assess memory, attention and orientation, language, and verbal fluency. Results: The memory, verbal fluency, and language subgroups of the ACE-R were significantly higher in the control group than in the SCI group. Compared with the control group, memory, verbal fluency, and language subscores were significantly reduced in individuals with T6 or rostral injury, and memory and verbal fluency were in individuals with T6 caudal injury. However, there was no significant difference in any of the ACE-R subscores between individuals with T6 or rostral and T6 caudal injuries. Conclusion: Significant differences in certain parts of cognitive functioning were found in individuals with SCI compared with age- and education level-matched controls. However, no significant differences were noted in any parts of cognitive functioning between individuals with T6 or rostral and T6 caudal injuries. Although cognitive impairment is an important sequelae following SCI, autonomic dysfunctions appear to have no effect on cognitive impairments in this population.

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

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

Frequency of neuropathic pain and its effects on rehabilitation outcomes, balance function and quality of life among people with traumatic spinal cord injury.

Background & Objectives:Traumatic Spinal cord injury (SCI) is a devastating condition that results in life long disability. Impairments associated with traumatic SCI such as sensory, motor, and autonomic dysfunctions lead to an array of secondary SCI-specific complications. Neuropathic pain is one of the most common medical complications of traumatic SCI which significantly affects motor function and activities of daily living (ADL) in people with traumatic SCI. Neuropathic pain is one of the main factors for dependency, decreased quality of life (QOL), poor rehabilitation outcomes, and depression in traumatic SCI individuals. The main aim of the current study was to determine the frequency of neuropathic pain and its effects on rehabilitation outcomes, balance function, and QOL in people with traumatic SCI.Methods:A cross-sectional survey was carried out at PCP from March to August 2020. Overall, 123 participants were added to the study using a non-probability convenience sampling technique. Information was collected using an adapted, validated questionnaire. Both male and female traumatic SCI patients with age between 18-60 years who received at least two weeks of rehabilitation, 42 days after diagnosis of traumatic SCI were included in current study while patients with Acute SCI, SCI patients with any other condition which can affect neuropathic pain such as traumatic brain injury, diabetic neuropathy, amputation, etc. and progressive neurological diseases such as multiple sclerosis and Guillain barre syndromes were excluded. Patients who have received at least two weeks of rehabilitation, 42 days after diagnosis of traumatic SCI. Patients with traumatic SCI.Results:Overall, 123 traumatic SCI patients were included in the study. The majority of the (n=101, 82%) participants were male and 83 (67.5%) were from urban areas. Eighty-Seven (70.73%) participants had neuropathic pain. Neuropathic pain was significantly associated (P-value <0.005) with rehabilitation outcomes, balance function, and quality of life.Conclusion:It can be concluded that more than two-third of SCI patients suffer from neuropathic pain. Moreover, neuropathic pain is significantly associated with rehabilitation outcomes, balance function, and quality of life.