Spinal Injuries Unit Research Articles

Developing a fall prevention program in an inpatient spinal cord injury rehabilitation unit: A participatory action research study.

Spinal cord injury is a lifelong disability necessitating early management of falls during inpatient admissions. However, there is a paucity of research on fall prevention and management in Spinal cord injury rehabilitation. This study aimed at developing a fall prevention program in an inpatient rehabilitation Spinal cord injury unit. A participatory action research approach utilizing a before-and-after, mixed-method design was employed for this study. The study was performed at Rofaydeh Rehabilitation Hospital in Tehran, Iran, from 2021 to 2022. the study implemented Cohen's four-stage model, encompassing the design of a change program, action, observation and evaluation, and feedback stages. A purposeful sampling method was utilized to select 19 nurses and members of the rehabilitation team from the hospital, ensuring maximum diversity. Data collection involved semi-structured interviews, focus groups, and a checklist for fall prevention measures. Qualitative content analysis, alongside descriptive (frequency, mean, and standard deviation) and inferential statistics (paired t-tests and Chi-square tests), were employed for data analysis. The study adhered to COREQ guidelines. Falls were most common among patients aged fifty years or older (P = 0.026). Throughout the study period, men were more likely to experience falls than women (P = 0.01). Preventive interventions have led to significant improvements in indicators of patient monitoring and care, patient education, and environmental safety, as demonstrated by a paired-sample t-test (P<0.001). Moreover, factors contributing to patients' falls included "shortcomings in fall prevention policies" and "lack of knowledge and participation among patients and caregivers." Changes implemented in the Spinal Cord Injury unit involved enhancing interprofessional interactions, conducting educational workshops for patients and their companions, and identifying high-risk patients. These findings indicate a significant decrease in the incidence of falls following the intervention (P = 0.02). The study found that a multifaceted intervention can increase knowledge about fall risks and substantially reduce both falls and associated minor injuries.

Integrated oral care for patients with spinal cord injuries: perceptions of non-dental professionals

Purpose To understand the oral health attitudes, knowledge, and practices among non-dental professionals caring for patients with spinal cord injuries, as well as the barriers and facilitators to oral care across acute and rehabilitation hospital settings. Materials and Methods This study was a descriptive qualitative study. Nine focus groups with spinal cord injury clinicians from two Sydney hospitals were conducted (n = 35). A thematic analysis was undertaken. Results Four themes were constructed: understanding the impact of spinal cord injuries on oral health and wellbeing; limited support in the spinal cord injury unit to promote oral care; strategies that enable oral care promotion; and recommendations to expand scope in oral care and education. Although most clinicians considered oral health to be important there was a lack of guidelines to support standardised oral care practices. Barriers included lack of time, limited oral care resources, low priority and difficulty in accessing treatment. Staff were receptive to an integrated, multidisciplinary approach to oral care. Conclusion This Australian first study provides insight into spinal cord injury clinicians’ knowledge and practices of oral care. The findings will help guide future research in developing appropriate models of care to promote oral health among patients with spinal cord injuries.

On Professor Robert Lipschitz, MB, ChB, PhD(Med), FRCS(Edin) and the Spinal Cord Injury Service, Chris Hani Baragwanath Hospital, Soweto, Johannesburg, South Africa.

Professor Robert Lipschitz, MB, ChB, PhD(Med), FRCS(Edin) was a pioneer who established the Spinal Cord Injury Unit, at Chris Hani Baragwanath Hospital, Soweto, Johannesburg, South Africa. A brief description of his academic and clinical accomplishments is given.

Trends in spinal cancers: Primary & metastatic. An Irish epidemiological perspective

BackgroundThe incidence and histological type of spinal cancer is diverse. It is our role as physicians to explore the epidemiology of spinal cancers so that several projections can be made. Resource allocation, cost analyses, and the requirement of rehabilitation facilities all need to be considered.The objective of this paper is to provide an account of the acute spinal oncological admissions to the National Spinal Injuries Unit (NSIU) in both 2010 and 2020 with the hypothesis that upward trends will be noted. Only by exemplifying this trend, will it highlight the need to give spinal cancer the attention it deserves in the Republic of Ireland. MethodsAll patients who were to undergo spinal surgery for primary or metastatic spinal cancer in the Mater Misericordiae University Hospital (MMUH) in 2010 and 2020 were included in this retrospective cohort study. A list of medical record numbers (MRNs) for all patients who underwent spinal surgery in the MMUH were included. Data pertaining to patient demographics were noted. Results90 patients were included in this retrospective cohort study. 37 patients in 2010, had increased to 53 by 2020. Metastatic disease to the spine was still the most prominent reason for referral. The most common spinal region affected was the thoracic spine. Breast cancer was the most prevalent metastatic cancer to the spine in 2010. Lung cancer became the most prevalent by 2020. Posterior spinal fusion was the most frequent surgical procedure performed. The length of stay in higher care facilities decreased from 5.4 days in 2010, to 4 days in 2020. Decreased were also seen in the mean length of hospital stay, plummeting from 23.6 days in 2010, to 7.6 days in 2020. The same could not be said for the 30-day mortality rate, increasing from 5.4% in 2010, to 9.4% in 2020. ConclusionThe results of this study show a substantial rise in the incidence and prevalence of both primary and metastatic spinal disease here in Ireland. One can see clear improvements in operative technique, with less patients proceeding to higher levels of post-operative care, and earlier discharge times. This data can be used for future planning. The paper highlights the economic cost of spinal oncological care, but it also identifies key areas where preventative campaigns can be targeted.

Antimicrobial stewardship strategy implementation and impact in acute care spinal cord injury and disorder units

Context Antimicrobial Stewardship Programs (ASPs) are crucial to optimizing antibiotic use. ASPs are implemented in the Veterans Health Administration (VAs), but they do not target the needs of populations at high risk for resistant infections, such as spinal cord injury and disorder (SCI/D). Objective The goal of this study was to assess key ASP leader and SCI/D clinicians’ perceived level of implementation and impact of 33 Antimicrobial Stewardship (AS) strategies. Method SCI/D clinicians and ASP leaders across 24 VA facilities with SCI/D units were surveyed. Participants rated their perceived level of impact (“high”, “mild”, “low”) and perceived level of implementation (“not”, “partially”, “fully”) for 33 AS strategies in SCI/D units in VAs. Strategies were grouped into core elements which they support. We conducted a Fisher’s exact test to assess differences between respondent perceptions based on role (SCI/D clinicians versus ASP leaders). Results AS strategy implementation varied across VA facilities. Of the AS strategies, pre-authorization was perceived to be highly impactful (78%) and fully implemented (82%). SCI/D clinicians and ASP leaders rated AS strategies differently such that SCI/D clinicians were less aware of implementation of AS strategies related to reporting requirements; further, SCI/D clinicians rated strategies which guide treatment duration and which limit C. difficile antibiotic exposure as more impactful than ASP leaders. Ratings for facility-wide and SCI/D unit ratings did not significantly differ for impact or implementation. Conclusion Implementation practices varied across VA facilities. Future work should implement highly impactful AS strategies according to facility and unit needs.

The impact of COVID-19 and associated lockdowns on traumatic spinal cord injury incidence: a population based study

Study designNatural experimentObjectivesTo determine whether COVID-19 restrictions were associated with changes in the incidence of traumatic spinal cord injury (TSCI) in Scotland.SettingThe Queen Elizabeth National Spinal Injuries Unit (QENSIU), the sole provider of treatment for TSCI in Scotland.MethodsTime series analysis of all admissions for TSCI between 1st January 2015 and 31st August 2022.ResultsOver the 8-year study period, 745 patients were admitted to the QENSIU with a TSCI. Interrupted time series analysis showed that level 3 and 4 COVID-19 lockdown restrictions (the most severe levels) were associated with lower incidence of TSCI (RR 0.63, CI% CI 0.47, 0.82, p < 0.001). The associations were stronger in people aged over 45 (additive interaction p = 0.001), males (additive interaction p = 0.01) and non-tetraplegia (additive interaction p = 0.002). The incidence of TSCI due to deliberate self-harm was higher (0.41 versus 0.23 per month) during restrictions.ConclusionsOverall, TSCI incidence reduced in Scotland when lockdowns were implemented, presumably due to lower engagement in risky activities. The increase in TSCI due to deliberate self-harm may reflect increased mental health problems and social isolation and should be anticipated and targeted in future pandemics. The change in incidence during the COVID-19 pandemic may have an economic impact and see a temporary reduction in the burden on health and social care. The results of this study will be useful for resource planning in future pandemics.

“Be ready to learn”: a qualitative study of the patient perspective of falls and fall prevention following discharge from a spinal injuries unit

Purpose Falls following a spinal cord injury (SCI) can have physical and psychological consequences, although some risk of falls may be acceptable to enable participation in meaningful activity. The study aimed to explore the patients’ perspective of falls and fall prevention after discharge from a inpatient spinal injuries unit. Methods An interpretive descriptive approach guided the study. Semi structured interviews were conducted in the 6–12 months post discharge period. Thematic analysis was used to analyze the data and identify themes. Results Fifteen individuals with SCI, with a mean age of 57 years and varied fall experiences were included. Three themes were identified including: 1. Expectation of falling; 2. Learning from my own experience and the experience of others’ and 3. How to prevent falls. Learning from their own experience and the experience of others was highly valued by persons with SCI and influenced expectations of falls. A variety of strategies were used to prevent falls. Conclusions Strategies that include learning from others, include activities that are individual and provide skills in self-reflection may aid to make fall prevention meaningful.

Early and Intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): protocol of the process evaluation

IntroductionPeople with spinal cord injury receive physical rehabilitation to promote neurological recovery. Physical rehabilitation commences as soon as possible when a person is medically stable. One key component of physical...

Early and intensive motor training to enhance neurological recovery in people with spinal cord injury: trial protocol

Study designProtocol for a multi-centre randomised controlled trial (the SCI-MT trial).ObjectivesTo determine whether 10 weeks of intensive motor training enhances neurological recovery in people with recent spinal cord injury (SCI).SettingFifteen spinal injury units in Australia, Scotland, England, Italy, Netherlands, Norway, and Belgium.MethodsA pragmatic randomised controlled trial will be undertaken. Two hundred and twenty people with recent SCI (onset in the preceding 10 weeks, American Spinal Injuries Association Impairment Scale (AIS) A lesion with motor function more than three levels below the motor level on one or both sides, or an AIS C or D lesion) will be randomised to receive either usual care plus intensive motor training (12 h of motor training per week for 10 weeks) or usual care alone. The primary outcome is neurological recovery at 10 weeks, measured with the Total Motor Score from the International Standards for Neurological Classification of SCI. Secondary outcomes include global measures of motor function, ability to walk, quality of life, participants’ perceptions about ability to perform self-selected goals, length of hospital stay and participants’ impressions of therapeutic benefit at 10 weeks and 6 months. A cost-effectiveness study and process evaluation will be run alongside the trial. The first participant was randomised in June 2021 and the trial is due for completion in 2025.ConclusionsThe findings of the SCI-MT Trial will guide recommendations about the type and dose of inpatient therapy that optimises neurological recovery in people with SCI.Trial registrationACTRN12621000091808 (1.2.2021).

Minor microbial alterations after faecal diversion do not affect the healing process of anus-near pressure injuries in patients with spinal cord injury-results of a matched case-control study.

Retrospective matched case-control study including patients with spinal cord injury who presented with an anus-near pressure injury. Two groups were formed based on the presence of a diverting stoma. To evaluate the primary microbial colonisation and secondary infection of anus-near pressure injuries depending on the presence of a pre-existing diverting stoma and to investigate the effect on the wound healing. University hospital with a spinal cord injury unit. A total of 120 patients who had undergone surgery of an anus-near decubitus stage 3 or 4 were included in a matched-pair cohort study. Matching was realised according to age, gender, body mass index and general condition. The most common species in both groups was Staphylococcus spp.(45.0%). The only significantly different primary colonisation affected Escherichia coli, that was found in the stoma patients less often (18.3 and 43.3%, p < 0.01). A secondary microbial colonisation occurred in 15.8% and was equally distributed, except for Enterococcus spp. that was present in the stoma group only (6.7%, p < 0.05). The time to complete cure took longer in the stoma group (78.5 versus 57.0 days, p < 0.05) and was associated with a larger ulcer size (25 versus 16 cm2, p < 0.01). After correction for the ulcers' size, there was no association to outcome parameters such as overall success, healing time or adverse events. The presence of a diverting stoma alters the microbial flora of an anus-near decubitus slightly without impact on the healing process.

Long-term Outcomes Following Periprocedural and Spontaneous Spinal Cord Infarctions: A Population-Based Cohort Study.

Spinal cord infarction (SCInf) is a rare condition where consensus regarding diagnostic criteria is lacking and mis- or delayed diagnosis can be detrimental. The aim of this study was to describe baseline findings and predictors of long-term functional outcome in a population-based cohort of patients with SCInf. All adult patients (≥18 years) treated at the Spinal Cord Injury Unit of the study center, between 2006-2019, and discharged with a G95 diagnosis ("other and unspecified disease of the spinal cord") were screened for inclusion. The diagnostic criteria proposed by Zalewski et al. were retrospectively applied to evaluate the certainty of the SCInf diagnosis. 270 patients were screened and 57 were included in the study, of whom 30 had a spontaneous and 27 had a periprocedural SCInf. The median American Spinal Cord Injury Association Impairment Scale (AIS) on admission was C, which at median follow-up of 2.1 years had improved to D (p=0.002). Compared to periprocedural cases, spontaneous SCInf showed significantly better admission-AIS (median AIS D vs. B, p<0.001), fewer multilevel SCInf (27% vs. 59%, p=0.029), shorter hospital stay (median 22 vs. 44 days, p<0.001), as well as better AIS (median AIS D vs. C, p<0.001) and ambulatory status on long-term follow-up (66% vs. 1%, p<0.001). Regression analyses revealed that spontaneous SCInfs (OR=5.91 [1.92-18.1], p=0.002) and more favorable admission-AIS (OR=33.6 [7.72-146], p<0.001) were significant predictors of more favorable AIS at follow-up, with admission-AIS demonstrating independent predictive ability (OR=35.9 [8.05-160], p<0.001). SCInf is a rare neurological emergency lacking specific management guidelines. While the presumptive diagnosis is based on the typical presentation and clinical findings, T2-weighted and diffusion-weighted MRI were the most useful diagnostic tools in establishing a definitive diagnosis. Our data shows that spontaneous SCInf mostly affected a single spinal cord segment while periprocedural cases were more extensive, had poorer AIS on admission, poorer ambulatory function, and longer hospital stays. Regardless of the etiology, significant neurological improvements were seen at long-term follow-up, highlighting the importance of active rehabilitation.

Predictive factors of destination at discharge after spinal cord injury

IntroductionOne of the main goals of the rehabilitation of patients with spinal cord injury (SCI) is the reintegration of the individual to their family, social, and work setting. The objective of this study was to identify the factors that determine the discharge destination after a traumatic spinal cord injury. Material and methodsWe conducted a retrospective descriptive study of 305 patients with SCI who completed the rehabilitation treatment at the spinal injury unit of Hospital Insular de Gran Canaria between 2001 and 2018. ResultsDuring the study period, we observed an increase in the number of patients referred to long-term care centres, from 9.14% between 2001 and 2010 to 18.4% between 2011 and 2018 (P < .01). Of 20 variables that presented a significant association with destination at discharge in the univariate study, 7 presented a significant association in the multivariate study: age (OR: 1.05; 95% CI, 1.02–1.08), living with a partner (OR: 0.26; 95% CI, 0.09−0.76), residing on another island (OR: 3.57; 95% CI, 1.32–9.63), smoking (OR: 3.44; 95% CI, 1.26–9.44), diabetes (OR: 6.51; 95% CI, 1.46–29.02), history of psychiatric disorders (OR: 3.79; 95% CI, 1.31–10.93), and scores on the Spinal Cord Independence Measure-III (SCIM-III) (OR: 0.48; 95% CI, 0.33−0.69). ConclusionsOur findings identified advanced age, living on the island of Tenerife, not being married, smoking, type 2 diabetes mellitus, history of psychiatric disorders, and low SCIM-III scores as predictive factors of referral to a long-term care centre in patients with traumatic SCI in the Canary Islands.

Evaluation of the prognostic value of extra-parenchymal changes in traumatic spinal cord injury, assessed by magnetic resonance imaging

Objectives To analyze the relationship between neurological progression following traumatic spinal cord injury and Spinal Cord Compression (SCC) and Spinal Ligamentous Injury (LI) by magnetic resonance imaging. Design Retrospective observational study. Setting Spinal Cord Injury Unit (A Coruña, Spain). Participants Patients were admitted for traumatic spinal cord injury between January 2010 and December 2018 with a magnetic resonance imaging examination performed during the acute phase. Intervention Evaluation of SCC and LI by magnetic resonance imaging. Outcome measures Comparisons between neurological examination at admission and discharge were made, assessing ASIA Impairment Scale (AIS) grade and motor score. Results Data from 296 patients were collected. A relationship between SCC and LI and complete injuries were found (P < 0.001). Improvement of the AIS grade was observed in 31.6% of patients with SCC and 31.3% with LI versus 42.7% and 37.8% of subjects without these complications, respectively. Regarding motor score, patients with SCC had lower mean values at the beginning (46.9 ± 26.8 versus 61.1 ± 29.9 in the control group, P < 0.001), as well as less improvement when assessed by the percentage of change (35.1 ± 37.5% versus 49.4 ± 38.1% in the control group, P = 0.010). Similar results were obtained in cases with LI: mean motor score at admission was 45.9 ± 26.7 versus 54.9 ± 29.4 in the control group (P = 0.014) and the percentage of change was 28.5 ± 37.1% in comparison to 46.0 ± 37.5% (P = 0.001) in the controls. Conclusions There is a relationship between SCC and LI and complete spinal cord injury. This patient population has lower possibilities of improving their AIS grade and motor score.

P047 Rehabilitation-led management of sleep disordered breathing: adapting a model of care for a rehabilitation centre in Australia

Abstract Introduction Sleep disordered breathing (SDB) is highly prevalent in tetraplegia, yet most remain undiagnosed and untreated for the disorder. We have described the care models of three international SCI rehabilitation centres that are independently diagnosing and treating SDB, and distilled their common pathways into the SCISTAR (SCI Sleep disordered breathing Treatment &amp; Assessment in Rehabilitation) model. The aim of this project was to adapt the SCISTAR model to suit the Royal Rehab Spinal Injuries Unit, and to prepare for the implementation of this new model of care. Methods A clinical advisory group, consisting of researchers, rehabilitation and respiratory health professionals, met six times over eight months to: • identify the multidisciplinary SDB clinical team, • adapt the SCISTAR model, • develop parameters for safe clinical practice, • identify education needs, • identify and acquire the necessary equipment. Results The SDB clinical team consists of two rehabilitation consultants, two physiotherapists and four nurses. All patients with SCI will be assessed for SDB following admission. Assessments will include symptoms, spirometry and sniff nasal inspiratory pressure, and a Level 3 overnight sleep study (ResMed ApneaLink). Patients diagnosed with un-complicated SDB will be prescribed CPAP, which will be initiated and progressed on the ward. Screening for hypoventilation and predominant central sleep apnoea will occur throughout the pathway and if identified, patients will be referred to a specialist respiratory service. Comprehensive education and equipment has been provided. Conclusions The new care model is currently being piloted for 12 months. A comprehensive evaluation has been developed.

Falls on an inpatient rehabilitation spinal injuries unit: the characteristics, circumstances, and consequences

Study designRetrospective auditObjectivesTo describe the nature of falls and fallers in a spinal injuries unit (SIU) and identify factors associated with having more than one fall (recurrent fallers) and falls with physical or psychological consequences (consequential falls).SettingAn Australian inpatient rehabilitation SIU.MethodsData were retrospectively extracted from falls incident reports and electronic medical records over a 5-year period. Data were analysed descriptively to summarise participant and fall details. Univariate analyses identified candidate variables for further investigation in a multivariate model for recurrent fallers and consequential falls.ResultsOf the 566 persons admitted to the SIU, 132 (23%) participants experienced 207 falls over the 5 years. Of the fallers, 41 (31%) were recurrent fallers experiencing between 2 and 7 falls and 78 (59%) experienced a consequential fall. No significant variables were identified for recurrent fallers. For consequential falls, older age (OR = 1.038, 95% CI, 1.012 to 1.064, p = 0.004) and female gender (OR = 3.581, 95% CI, 1.269 to 10.103, p = 0.016) were significant, as well as falls that occurred on a Sunday (OR = 0.196, 95% CI, 0.061 to 0.630, p = 0.006). Falls while transferring were less likely to be consequential (OR = 4.100, 95% CI, 1.706 to 9.856, p = 0.002).ConclusionsNearly one quarter of SIU inpatients experienced a fall with almost a third of those who fell experiencing recurrent falls. Older age, female gender, and Sundays were risk factors for falls with consequence.

Prognostic value of early magnetic resonance imaging in the morbidity and mortality of traumatic spinal cord injury

ObjectiveTo assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC). DesignRetrospective study. SettingThird-level hospital, Spinal Cord Injury Unit and ICU. PatientsIndividuals with acute TSCI between 2010 and 2019. InterventionAnalysis of MRI performed in the first 72 h. Variables of interestAdmission to ICU and mortality. Results269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% ​​of single-level edema and 6.5% of multilevel edema (p = 0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p = 0.018).Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p = 0.020 and p = 0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p < 0.001 and p = 0.013). ConclusionsThe presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL.

Are micro enemas administered with a squeeze tube and a 5 cm-long nozzle as good or better than micro enemas administered with a 10 cm-long catheter attached to a syringe in people with a recent spinal cord injury? A non-inferiority, crossover randomised controlled trial

Study designDouble blind, non-inferiority crossover randomised controlled trial.ObjectivesTo determine if micro enemas administered with a squeeze-tube and a 5 cm-long nozzle (squeeze-tube method) are as good or better than micro enemas administered with a 10 cm-long catheter attached to a syringe (catheter method) in people with a recent spinal cord injury.SettingTwo inpatient spinal cord injury units located in Sydney, Australia.MethodsTwenty people admitted to hospital with recent spinal cord injury were randomly assigned to two treatment sequences; 4 weeks of micro enemas delivered by the squeeze-tube method followed by 4 weeks of micro enemas delivered by the catheter method, or vice versa. Each treatment sequence was 8 weeks with a crossover at the end of week 4. The primary outcome was time to complete bowel care. Secondary outcomes reflected faecal incontinence, quality of life, perception of treatment effectiveness and participant reported time to complete bowel care. The primary and secondary outcomes were measured by blinded assessors in week 4 and week 8. A non-inferiority margin of 10 min for time to complete bowel care was set a priori.ResultsThe mean between group difference (95% confidence interval) for the time to complete bowel care was −0.5 min (−2.8 to 1.8), where a negative value favours the catheter method. Results were similar for all secondary outcomes.ConclusionsMicro enemas delivered by the squeeze-tube method are as good or better than micro enemas delivered by the catheter method in people with a recent spinal cord injury.

Wheelchair Axle Position Effect on the Propulsion Performance of Persons With C7 Tetraplegia: A Repeated-Measures Study.

To assess the changes in speed, stroke frequency, acceleration, and shoulder range of motion (ROM) associated with different wheelchair axle positions in people with chronic C7 tetraplegia. This repeated-measures study was conducted at the Chronic Spinal Cord Injury Unit, FLENI Escobar, Argentina. The speed, stroke frequency, acceleration, and shoulder ROM during wheelchair propulsion were measured in nine participants with C7 spinal cord injury (SCI) in four different axle positions (forward and up, forward and down, backward and down, backward and up). Two strokes performed at maximum speed were analyzed on a smooth level vinyl floor in a motion analysis laboratory. Data were analyzed for significant statistical differences using the Friedman test and the Wilcoxon signed rank test. Our study showed significant differences in the speed with axle position 1 (1.57 m/s) versus 2 (1.55 m/s) and position 2 (1.55 m/s) versus 4 (1.52 m/s). The shoulder ROM showed a significant difference in the sagittal plane in position 2 (59.34 degrees) versus 3 (61.64 degrees), whereas the stroke frequency and the acceleration parameters showed no statistically significant differences with the different rear axle positions. Our study showed that modifying the rear axle position can improve the propulsion speed and produce changes in the shoulder ROM in the wheelchair propulsion of individuals with C7 SCI.

Dementia prevalence, a contextual factor associated with SARS-CoV-2 in veterans affairs community living centers.

BackgroundAlzheimer's disease and related dementias (ADRD) impact the diagnosis and infection control of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) in nursing homes (NH) by influencing the behavior of residents and their caregivers. Health system data show an association between ADRD and SARS‐CoV‐2. Whether this association is present in NH populations remains unknown. How increased SARS‐CoV‐2 risk among residents with ADRD impacts the greater NH population also remains unknown.MethodsThis retrospective cohort study used electronic health record data on Veterans residing in 133 Veterans Affairs Community Living Centers (CLC) and 15 spinal cord injury units from March 1, 2020 to December 13, 2020. We measured ADRD using diagnostic codes 12 months before an index SARS‐CoV‐2 test date for each resident. We used Poisson regression to determine the relative risk of SARS‐CoV‐2 for the highest quartile of facility ADRD prevalence versus the lowest, stratifying by individual ADRD status, and adjusting for covariates, with and without a random intercept to account for facility clustering.ResultsAcross the study period, 15,043 residents resided in CLCs, 1952 (13.0%) had SARS‐CoV‐2, and 8067 (53.6%) had ADRD. There was an estimated 60% increased risk of SARS‐CoV‐2 in facilities with highest dementia prevalence versus lowest (relative risk, 1.6 [95% confidence interval 0.95, 2.7]).ConclusionsCLC residents had a greater likelihood of SARS‐CoV‐2 infection in facilities with greater ADRD prevalence. Facility characteristics other than ADRD prevalence may account for this association.

More than Medals: A History of the Paralympics and Disability Sports in Postwar Japan by Dennis J. Frost

Reviewed by: More than Medals: A History of the Paralympics and Disability Sports in Postwar Japan by Dennis J. Frost Franziska Seraphim (bio) More than Medals: A History of the Paralympics and Disability Sports in Postwar Japan. By Dennis J. Frost. Cornell University Press, 2020. xiii, 311 pages. $39.95, cloth; $25.99, E-book. The Olympic Games are an unusually rich site for exploring the complex nature of our interconnected world from historical and interdisciplinary perspectives. Few icons of cultural internationalism reflect the changing interplay of geopolitical, economic, and sociocultural norms with so much affect, in large part because individual human bodies and souls bear out these dynamics. The rise of Asia as a locus in this historically Eurocentric internationalism—key moments being Tokyo 1964, Seoul 1988, Beijing 2008, Tokyo 2020, and Beijing 2022—has inspired a body of scholarly work on the value of sporting mega-events as diplomatic tools to renegotiate a range of power-political relations, domestic as well as international. The Beijing 2008 Summer Olympics served as a wonderful opportunity to read China's claims to international power through spectacle and the media more generally, as Tokyo 1964 once did for Japan.1 Since then, several edited volumes have taken an explicitly comparative approach to the Asian Olympics, still focused on narratives of nation in regional and international frames.2 But [End Page 445] as Tokyo 2020 took shape and then shifted to 2021 amidst the pandemic, academic research and public media combined in potent ways to place "health" at the center of a world more global than international: the mental health of athletes, public health in a time of pandemic, the environmental health of our planet. Taking seriously Tokyo's official motto "diversity and inclusion" and predating the pandemic, two special issues in the Asia-Pacific Journal in 2020 and the German Institute for Japanese Studies' timely edited volume Japan Through the Lens of the Tokyo Olympics, shift the focus to critical social, urban, and regional studies.3 From this vantage point, the history of the Olympics, and Tokyo 2020 in particular, reads like a century-long decline into unsustainability, with the International Olympic Committee (IOC) as its alarmingly reticent flagbearer. Dennis Frost has unearthed a parallel history of the Olympic movement that tells a surprisingly different story. Reading More Than Medals is to realize the astonishing disconnect between the Paralympics and the "ablebodied" Olympics, despite concerted efforts made recently to think the two together, for example in Routledge's 2020 Handbook of the Olympic and Paralympic Games.4 The story of the Paralympics is rooted not in cultural internationalism through elite competitive sports but in local efforts to address the medical and social challenges of rehabilitating and reintegrating an army of injured war veterans in societies recovering from World War II. In England as in Japan, medical doctors directing government rehabilitation programs at leading hospitals for people with severe spinal injuries innovated treatment through movement and activity and quickly recognized the power of competition. Ludwig Guttmann (1899–1980), director of the National Spinal Injuries Unit at the Ministry of Pensions Stoke Mandeville Hospital in Buckinghamshire, was instrumental in organizing the first Stoke Mandeville Games in 1948 and taking them to an international stage. The ninth International Stoke Mandeville Games borrowed the time and place of the 1960 Rome Olympics and is retrospectively recognized as the first Paralympic Games. His counterpart in Japan was Nakamura Yutaka [End Page 446] (1927–84), dean of the Orthopedic Department at Beppu National Hospital, ōita Prefecture, Kyushu, a wartime center of military training that had transitioned into a major center of veteran medical rehabilitation around its famous hot springs.5 Nakamura was a central figure in bringing about the first Paralympics organized as such, in Tokyo 1964, the Far East and South Pacific Games for the Disabled in 1975, and the annual International Wheelchair Marathon held in his native Ōita since 1981. Frost begins his Japan-centered history of international disability sports competitions with the question why Japan of all countries, where disability was safely kept out of sight and mind in the 1960s, ended up hosting the Paralympics in 1964 and went on to become an international...