Healthcare Library Current Awareness Bulletin – Spinal Cord Injuries

Objective: While there are specific recommendations for pressure relieving cushions when seated in a wheelchair, there is a paucity of information regarding prescribed wheelchair cushions for persons with spinal cord injury (SCI) when traveling and not in their wheelchair seat. A questionnaire was designed to ascertain if individuals with SCI who are primarily wheelchair users utilize a prescribed wheelchair cushion when traveling in a motor vehicle (MV) or on a commercial airliner, as not utilizing one may be a causative factor in developing pressure ulcers.Design and setting: Survey design in an outpatient SCI rehabilitation setting.Participants: Full-time wheelchair users, with chronic (>1 year) SCI.Results: Forty-two participants completed the survey, with a mean age of 39 years old and time post-injury of 10.4 years. All subjects used a prescribed wheelchair cushion when seated in their wheelchair. Twentyseven subjects reported transferring to a MV seat (59.5% of sample), with 25 (92.6%) reporting not using a prescribed wheelchair cushion when sitting directly on the MV seat. For subjects who traveled on an airplane (n = 23-54.8%), 19 (82.6%) reported that they do not sit on a prescribed specialty cushion.Conclusion: Persons with chronic SCI, who are primary wheelchair users, utilize prescribed wheelchair cushions when sitting in their wheelchair, but most do not utilize a prescribed wheelchair cushion when seated in a MV (if they transfer out of their chair) or on a airplane seat. Studies to determine the pressures over the bony prominences on their travel surfaces may need to be undertaken to see whether the pressures are appropriate, as they may be a source of skin breakdown. Publication type: Journal: Review Source: EMBASE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 3. Title: Activity-based therapy for recovery of walking in chronic spinal cord injury: results from a secondary analysis to determine responsiveness to therapy. Citation: Archives of Physical Medicine & Rehabilitation, December 2014, vol./is. 95/12(2247-52), 0003-9993;1532821X (2014 Dec) Author(s): Jones ML, Evans N, Tefertiller C, Backus D, Sweatman M, Tansey K, Morrison S Language: English Abstract: OBJECTIVE: To gain insight into who is likely to benefit from activity-based therapy (ABT), as assessed by secondary analysis of data obtained from a clinical trial.DESIGN: Secondary analysis of results from a randomized controlled trial with delayed treatment design.SETTING: Outpatient program in a private, nonprofit rehabilitation hospital.PARTICIPANTS: Volunteer sample of adults (N=38; 27 men; 11 women; age, 22-63y) with chronic (>12mo postinjury), motor-incomplete (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade C or D) spinal cord injury (SCI).INTERVENTIONS: A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression.MAIN OUTCOME MEASURES: Walking speed and endurance (10-meter walk test and 6-minute walk test) and functional ambulation (timed Up and Go test).RESULTS: This secondary analysis identified likely responders to ABT on the basis of injury characteristics: AIS classification, time since injury, and initial walking ability. Training effects were the most clinically significant in AIS grade D participants with injuries <3 years in duration. This information, along with information about preliminary responsiveness to therapy (gains after 12wk), can help predict the degree of recovery likely from participation in an ABT program.CONCLUSIONS: ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, not everyone with goals of walking recovery will benefit. Individuals with SCI should be advised of the time, effort, and resources required to undertake ABT. Practitioners are encouraged to use the findings from this trial to assist prospective participants in establishing realistic expectations for recovery. Copyright 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. Publication type: Journal Article Source: MEDLINE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 4. Title: Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: results from a randomized clinical trial. Citation: Archives of Physical Medicine & Rehabilitation, December 2014, vol./is. 95/12(2239-2246.e2), 00039993;1532-821X (2014 Dec) Author(s): Jones ML, Evans N, Tefertiller C, Backus D, Sweatman M, Tansey K, Morrison S Language: English Abstract: OBJECTIVE: To examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation.DESIGN: Randomized controlled trial with delayed treatment design.SETTING: Outpatient program in a private, nonprofit rehabilitation hospital.PARTICIPANTS: Volunteer sample of adults (N=48; 37 men and 11 women; age, 18-66y) with chronic (>12mo postinjury), motorincomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI).INTERVENTIONS: A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and taskspecific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression.MAIN OUTCOME MEASURES: Neurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check).RESULTS: Significant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1+6.3 vs 0.9+5.0; P=.024] and lower extremity motor score [4.2+5.2 vs -0.6+4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096+0.14m/s vs 0.027+0.10m/s; P=.036) and 6-minute walk test total distance (35.97+48.2m vs 3.0+25.5m; P=.002).CONCLUSIONS: ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motorincomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits. Copyright 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. Publication type: Journal Article Source: MEDLINE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 5. Title: An acute growth factor treatment that preserves function after spinal cord contusion injury Citation: Journal of Neurotrauma, November 2014, vol./is. 31/21(1807-1813), 0897-7151;1557-9042 (01 Nov 2014) Author(s): Chehrehasa F., Cobcroft M., Young Y.W., Mackay-Sim A., Goss B. Language: English Abstract: Inflammation of the spinal cord after traumatic spinal cord injury (SCI) leads to destruction of healthy tissue. This "secondary degeneration" is more damaging than the initial physical damage and is the major contributor to permanent loss of functions. In our previous study, we showed that combined delivery of two growth factors, vascular endothelial growth factor and platelet-derived growth factor, significantly reduced secondary degeneration after hemisection injury of the spinal cord in the rat. Growth factor treatment reduced the size of the lesion cavity at 30 days, compared to control animals, and further reduced the cavity at 90 days in treated animals, whereas in control animals the lesion cavity continued to increase in size. Growth factor treatment also reduced astrogliosis and reduced macroglia/macrophage activation around the injury site. Treatment with individual growth factors alone had similar effects to control treatments. The present study investigated whether growth factor treatment would improve locomotor behavior after spinal contusion injury, a more relevant pre-clinical model of SCI. The growth factors were delivered for the first 7 days to the injury site by osmotic minipump. Locomotor behavior was monitored at 1-28 days after injury using the Basso, Beattie and Bresnahan (BBB) score and at 30 days using automated gait analysis. Treated animals had BBB scores of 18; control animals scored 10. Treated animals had significantly reduced lesion cavities and reduced macroglia/macrophage activation around the injury site. We conclude that growth factor treatment preserved spinal cord tissues after contusion injury, thereby allowing functional recovery. This treatment has the potential to significantly reduce the severity of human spinal cord injuries. Publication type: Journal: Review Source: EMBASE 6. Title: Anti-apoptotic signal transduction mechanism of electroacupuncture in acute spinal cord injury. Citation: Acupuncture in Medicine, December 2014, vol./is. 32/6(463-71), 0964-5284;1759-9873 (2014 Dec) Author(s): Renfu Q, Rongliang C, Mengxuan D, Liang Z, Jinwei X, Zongbao Y, Disheng Y Language: English Abstract: Spinal cord injury (SCI) can be caused by a variety of pathogenic factors. In China, acupuncture is widely used to treat SCI. We previously found that acupuncture can reduce apoptosis and promote repair after SCI. However, the antiapoptotic mechanisms by which acupuncture exerts its effects on SCI remain unclear. Our aim was to investigate the role of the PI3K/Akt and extracellular signal-regulated kinases (ERK)1/2 signalling pathways in acupuncture treatment of acute SCI. Eighty pure-bred New Zealand rabbits were randomly divided into the following five groups (n=16 per group): control; model; elongated needle electroacupuncture (EA); EA+LY294002; and EA+PD98059. We established a spinal cord contusion model of SCI in all experimental groups except controls, in which only a laminectomy was performed. After SCI, three of the groups received EA once daily for 3 days. One hour before SCI, the two drug groups received LY294002 (Akt inhibitor; 10 mug, 20 muL) or PD98059 (ERK inhibitor; 3 mug, 20 muL) via intrathecal injection. At 48 h after SCI, animals were killed and spinal cord tissue samples were collected for transferase dUTP nick end labelling (TUNEL) assays, immunohistochemistry and western blot assays. EA significantly increased p-Akt and p-ERK1/2 expression, reduced cytochrome c and caspase-3 expression and inhibited neuronal apoptosis in the injured spinal cord segment. The opposite effects were seen after using Akt and ERK inhibitors. Acupuncture promotes the repair of SCI, possibly by activation of the PI3K/Akt and ERK1/2 signalling pathways and by inhibition of the mitochondrial apoptotic pathway. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rightslicensing/permissions. Publication type: Journal Article Source: MEDLINE Full text: Available ProQuest at Acupuncture in Medicine Full text: Available ProQuest at Acupuncture in Medicine 7. Title: Associations with chest illness and mortality in chronic spinal cord injury Citation: Journal of Spinal Cord Medicine, 2014, vol./is. 37/6(662-669), 1079-0268;2045-7723 (2014) Author(s): Danilack V.A., Stolzmann K.L., Gagnon D.R., Brown R., Tun C.G., Morse L.R., Garshick E. Language: English Abstract: Outcome measures: Logistic regression assessing relationships with chest illness at baseline and Cox regression assessing the relationship between chest illness and mortality.Objective: Identify factors associated with chest illness and describe the relationship between chest illness and mortality in chronic spinal cord injury (SCI).Design: Cross-sectional survey assessing chest illness and a prospective assessment of mortality.Methods: Between 1994 and 2005, 430 persons with chronic SCI (mean + SD), 52.0 + 14.9 years old, and >4 years post SCI (20.5 + 12.5 years) underwent spirometry, completed a health questionnaire, and reported any chest illness resulting in time off work, indoors, or in bed in the preceding 3 years. Deaths through 2007 were identified.Results: Chest illness was reported by 139 persons (32.3%). Personal characteristics associated with chest illness were current smoking (odds ratio =2.15; 95% confidence interval =1.25-3.70 per each pack per day increase), chronic obstructive pulmonary disease (COPD) (3.52; 1.79-6.92), and heart disease (2.18; 1.14-4.16). Adjusting for age, subjects reporting previous chest illness had a non-significantly increased hazard ratio (HR) for mortality (1.30; 0.88-1.91). In a multivariable model, independent predictors of mortality were greater age, SCI level and completeness of injury, diabetes, a lower %-predicted forced expiratory volume in 1 second, heart disease, and smoking history. Adjusting for these covariates, the effect of a previous chest illness on mortality was attenuated (HR = 1.15; 0.771.73).Conclusion: In chronic SCI, chest illness in the preceding 3 years was not an independent risk factor for mortality and was not associated with level and completeness of SCI, but was associated with current smoking, physician-diagnosed COPD, and heart disease history. Publication type: Journal: Review Source: EMBASE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 8. Title: Bone mass in individuals with chronic spinal cord injury: associations with activity-based therapy, neurologic and functional status, a retrospective study. Citation: Archives of Physical Medicine & Rehabilitation, December 2014, vol./is. 95/12(2342-9), 0003-9993;1532821X (2014 Dec) Author(s): Hammond ER, Metcalf HM, McDonald JW, Sadowsky CL Language: English Abstract: OBJECTIVE: To describe the prevalence of osteoporosis and its association with functional electrical stimulation (FES) use in individuals with spinal cord injury (SCI)-related paralysis.DESIGN: Retrospective crosssectional evaluation.SETTING: Clinic.PARTICIPANTS: Consecutive persons with SCI (N=364; 115 women, 249 men) aged between 18 and 80 years who underwent dual-energy x-ray absorptiometry (DXA) examinations.INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURE: Prevalence of osteoporosis defined as DXA T score <-2.5.RESULTS: The prevalence of osteoporosis was 34.9% (n=127). Use of FES was associated with 31.2% prevalence of osteoporosis compared with 39.5% among persons not using FES. In multivariate adjusted logistic regression analysis, FES use was associated with 42% decreased odds of osteoporosis after adjusting for sex, age, body mass index, type and duration of injury, Lower Extremity Motor Scores, ambulation, previous bone fractures, and use of calcium, vitamin D, and anticonvulsant; (adjusted odds ratio [OR]=.58; 95% confidence interval [CI], .35-.99; P=.039). Duration of injury >1 year was associated with a 3-fold increase in odds of osteoporosis compared with individuals with injury <1 year; (adjusted OR=3.02; 95% CI, 1.60-5.68; P=.001).CONCLUSIONS: FES cycling ergometry may be associated with a decreased loss of bone mass after paralysis. Further prospective examination of the role of FES in preserving bone mass will improve our understanding of this association. Copyright 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. Publication type: Journal Article Source: MEDLINE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 9. Title: Cell therapy for spinal cord injuries: What is really going on? Citation: Neuroscientist, December 2014, vol./is. 20/6(623-638), 1073-8584;1089-4098 (20 Dec 2014) Author(s): Granger N., Franklin R.J.M., Jeffery N.D. Language: English Abstract: During the last two decades, many experiments have examined the ability of cell transplants to ameliorate the loss of function after spinal cord injuries, with the hope of developing interventions to benefit patients. Although many reports suggest positive effects, there is growing concern over the quality of the available preclinical data. It is therefore important to ask whether this worldwide investigative process is close to defining a cell transplant protocol that could be translated into human patients with a realistic chance of success. This review systematically examines the strength of the preclinical evidence and outlines mechanisms by which transplanted cells may mediate their effects in spinal cord injuries. First, we examined changes in voluntary movements in the forelimb associated with cell transplants after partial cervical lesions. Second, we examined the efficacy of transplanted cells to restore electrophysiological conduction across a complete thoracic lesion. We postulated that cell therapies found to be successful in both models could reasonably have potential to treat human patients. We conclude that although there are data to support a beneficial effect of cell transplantation, most reports provide only weak evidence because of deficits in experimental design. The mechanisms by which transplanted cells mediate their functional effects remain unclear. Publication type: Journal: Review Source: EMBASE 10. Title: Chronic bacterial prostatitis in men with spinal cord injury. Citation: World Journal of Urology, December 2014, vol./is. 32/6(1579-85), 0724-4983;1433-8726 (2014 Dec) Author(s): Krebs J, Bartel P, Pannek J Language: English Abstract: PURPOSE: Recurrent urinary tract infections (UTI) are a major problem affecting spinal cord injury (SCI) patients and may stem from chronic bacterial prostatitis. We have therefore investigated the presence of chronic bacterial prostatitis and its role in the development of recurrent symptomatic UTI in SCI men.METHODS: This study is a prospective cross-sectional investigation of bacterial prostatitis in SCI men in a single SCI rehabilitation center. In 50 men with chronic SCI presenting for a routine urologic examination, urine samples before and after prostate massage were taken for microbiologic investigation and white blood cell counting. Furthermore, patient characteristics, bladder diary details, and the annual rate of symptomatic UTI were collected retrospectively.RESULTS: No participant reported current symptoms of UTI or prostatitis. In most men (39/50, 78 %), the microbiologic analysis of the post-massage urine sample revealed growth of pathogenic bacteria. The majority of these men (32/39, 82 %) also presented with mostly (27/39, 69 %) the same pathogenic bacteria in the pre-massage sample. There was no significant (p = 0.48) difference in the number of symptomatic UTI in men with a positive postmassage culture compared with those with a negative culture. No significant (p = 0.67) difference in the frequency distribution of positive versus negative post-massage cultures was detected between men with recurrent and sporadic UTI.CONCLUSIONS: Most SCI men are affected by asymptomatic bacterial prostatitis; however, bacterial prostatitis does not play a major role in the development of recurrent UTI. The indication for antibiotic treatment of chronic bacterial prostatitis in asymptomatic SCI men with recurrent UTI is questionable. Publication type: Journal Article Source: MEDLINE 11. Title: Cortical reorganization after spinal cord injury: Always for good? Citation: Neuroscience, December 2014, vol./is. 283/(78-94), 0306-4522;1873-7544 (December 06, 2014) Author(s): Moxon K.A., Oliviero A., Aguilar J., Foffani G. Language: English Abstract: Plasticity constitutes the basis of behavioral changes as a result of experience. It refers to neural network shaping and re-shaping at the global level and to synaptic contacts remodeling at the local level, either during learning or memory encoding, or as a result of acute or chronic pathological conditions. 'Plastic' brain reorganization after central nervous system lesions has a pivotal role in the recovery and rehabilitation of sensory and motor dysfunction, but can also be "maladaptive". Moreover, it is clear that brain reorganization is not a "static" phenomenon but rather a very dynamic process. Spinal cord injury immediately initiates a change in brain state and starts cortical reorganization. In the long term, the impact of injury with or without accompanying therapy on the brain is a complex balance between supraspinal reorganization and spinal recovery. The degree of cortical reorganization after spinal cord injury is highly variable, and can range from no reorganization (i.e. "silencing") to massive cortical remapping. This variability critically depends on the species, the age of the animal when the injury occurs, the time after the injury has occurred, and the behavioral activity and possible therapy regimes after the injury. We will briefly discuss these dependencies, trying to highlight their translational value. Overall, it is not only necessary to better understand how the brain can reorganize after injury with or without therapy, it is also necessary to clarify when and why brain reorganization can be either "good" or "bad" in terms of its clinical consequences. This information is critical in order to develop and optimize cost-effective therapies to maximize functional recovery while minimizing maladaptive states after spinal cord injury. Publication type: Journal: Review Source: EMBASE 12. Title: Effect of tilt and recline on ischial and coccygeal interface pressures in people with spinal cord injury. Citation: American Journal of Physical Medicine & Rehabilitation, December 2014, vol./is. 93/12(1019-30), 08949115;1537-7385 (2014 Dec) Author(s): Chen Y, Wang J, Lung CW, Yang TD, Crane BA, Jan YK Language: English Abstract: OBJECTIVE: Clinicians commonly recommend that power wheelchair users with spinal cord injury perform wheelchair tilt and recline maneuvers to redistribute seating loads away from the ischial tuberosities. However, ischial pressure reduction may be accompanied by coccygeal pressure increases. Although the coccyx is among the most common sites of pressure ulcers, few studies have reported coccygeal interface pressure. The purpose of this study was to investigate both ischial and coccygeal interface pressures in response to changes in wheelchair tilt and recline angles.DESIGN: Thirteen power wheelchair users were recruited into this study. Six combinations of wheelchair tilt (15, 25, and 35 degrees) and recline (10 and 30 degrees, corresponding to traditional recline conventions of 100 and 120 degrees, respectively) angles were tested in random order. Each combination was tested with 5 mins of upright sitting, 5 mins of tilt and recline, as well as 5 mins of maximal pressure relief recovery. Peak pressure indices were calculated at the ischial and coccygeal sites.RESULTS: Ischial pressures monotonically decreased in response to increasing combinations of tilt and recline. Increments of 15 degrees of tilt did not produce significant differences under either recline angle, whereas increments of 25 degrees of tilt produced significant differences under both recline angles. Coccygeal pressures increased in response to the four smallest (of six) combinations of tilt and recline, whereas they decreased in response to the largest two combinations.CONCLUSIONS: Ischial pressures seemed to be redistributed to the coccyx in response to the four smallest angle combinations and redistributed to the back support in response to the two largest angle combinations. Future work should confirm this pressure redistribution to the back support and determine the back support locations of redistribution. Publication type: Journal Article Source: MEDLINE Full text: Available American journal of physical medicine & rehabilitation / Association of Academic Physiatrists at American Journal of Physical Medicine and Rehabilitation 13. Title: Effects of spinal cord injury on body composition and metabolic profile Part I Citation: Journal of Spinal Cord Medicine, 2014, vol./is. 37/6(693-702), 1079-0268;2045-7723 (2014) Author(s): Gorgey A.S., Dolbow D.R., Dolbow J.D., Khalil R.K., Castillo C., Gater D.R. Language: English Abstract: Several body composition and metabolic-associated disorders such as glucose intolerance, insulin resistance, and lipid abnormalities occur prematurely after spinal cord injury (SCI) and at a higher prevalence compared to able-bodied populations. Within a few weeks to months of the injury, there is a significant decrease in total lean mass, particularly lower extremity muscle mass and an accompanying increase in fat mass. The infiltration of fat in intramuscular and visceral sites is associated with abnormal metabolic profiles. The current review will summarize the major changes in body composition and metabolic profiles that can lead to comorbidities such as type 2 diabetes mellitus and cardiovascular diseases after SCI. It is crucial for healthcare specialists to be aware of the magnitude of these changes. Such awareness may lead to earlier recognition and treatment of metabolic abnormalities that may reduce the co-morbidities seen over the lifetime of persons living with SCI. Publication type: Journal: Review Source: EMBASE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 14. Title: Exercise equipment preferences among adults with spinal cord injury. Citation: Spinal Cord, December 2014, vol./is. 52/12(874-9), 1362-4393;1476-5624 (2014 Dec) Author(s): Pelletier CA, Ditor DS, Latimer-Cheung AE, Warburton DE, Hicks AL Language: English Abstract: STUDY DESIGN: Cross-sectional.OBJECTIVES: To evaluate exercise equipment preferences and compare cardiometabolic demand for passive hybrid and arm-only exercise among adults with paraplegia (PP) and those with tetraplegia (TP).SETTING: Four community exercise programmes.METHODS: Thirty-six adults (mean age: 41.1+12.1 years) with chronic (11.4+10.7 years post injury) TP (C3-C8; n=17) or PP (T3-T12; n=19) were recruited. Participants completed 20 min of submaximal aerobic exercise at moderate to vigorous intensity on four types of aerobic exercise equipment: arm cycle ergometer (ACE), arm glider (AG), arm-leg recumbent stepper (ALRS), and arm-leg cycle ergometer (ALCE). Participants also completed 3 sets of 10 repetitions of resistance exercise using wall pulleys (WP) and weight stack (WS) equipment. A questionnaire was administered to evaluate equipment preference. Heart rate (HR) and oxygen uptake (VO2) were measured in a subset of participants (n=9) during submaximal aerobic exercise.RESULTS: Arm-only exercise modes were perceived as being safer than passive hybrid exercise modes. There were no differences in perceived enjoyment between equipment types and groups. There were significant group but not equipment differences in HR (TP: 101.4 bpm; PP: 124.9 bpm) and VO2 (TP: 6.5ml*kg(-1)*min(-1); PP: 10.5mL*kg(-1)*min(-1)) during submaximal aerobic exercise.CONCLUSION: In this cross-community assessment of exercise equipment preferences after spinal cord injury (SCI), arm-only exercise modes were perceived as safer than hybrid exercise modes and there were no differences between equipment types in physiological responses. Publication type: Journal Article Source: MEDLINE Full text: Available Nature Publishing Group at Spinal Cord 15. Title: Feasibility of using training cases from International Spinal Cord Injury Core Data Set for testing of International Standards for Neurological Classification of Spinal Cord Injury items. Citation: Spinal Cord, December 2014, vol./is. 52/12(919-22), 1362-4393;1476-5624 (2014 Dec) Author(s): Liu N, Hu ZW, Zhou MW, Biering-Sorensen F Language: English Abstract: STUDY DESIGN: Descriptive comparison analysis.OBJECTIVE: To evaluate whether five training cases of International Spinal Cord Injury Core Data Set (ISCICDS) are appropriate for testing the facts within the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and could thus be used for testing its training effectiveness.METHODS: The authors reviewed the five training cases from the ISCICDS and determined the sensory level (SL), motor level (ML) and American Spinal Injury Association Impairment Scale (AIS) for the training cases. The key points from the training cases were compared with our interpretation of the key aspects of the ISNCSCI.RESULTS: For determining SL, three principles of ML, sacral sparing, complete injury, classification of AIS A, B, C and D, determining motor incomplete status through sparing of motor function more than three levels below the ML, there are corresponding case scenarios in ISCICDS. However, no case scenario shows classification of AIS E and the use of voluntary anal sphincter contraction for determination of motor incomplete status. Neurological level of injury could be deduced from the SL and ML. Finally, none of the cases include information about zone of partial preservation, STUDY DESIGN: Descriptive comparison analysis.OBJECTIVE: To evaluate whether five training cases of International Spinal Cord Injury Core Data Set (ISCICDS) are appropriate for testing the facts within the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and could thus be used for testing its training effectiveness.METHODS: The authors reviewed the five training cases from the ISCICDS and determined the sensory level (SL), motor level (ML) and American Spinal Injury Association Impairment Scale (AIS) for the training cases. The key points from the training cases were compared with our interpretation of the key aspects of the ISNCSCI.RESULTS: For determining SL, three principles of ML, sacral sparing, complete injury, classification of AIS A, B, C and D, determining motor incomplete status through sparing of motor function more than three levels below the ML, there are corresponding case scenarios in ISCICDS. However, no case scenario shows classification of AIS E and the use of voluntary anal sphincter contraction for determination of motor incomplete status. Neurological level of injury could be deduced from the SL and ML. Finally, none of the cases include information about zone of partial preservation, sensory score or motor score.CONCLUSION: Majority of the facts related to SL, ML and AIS are included in the five training cases of ISCICDS. Thus, using these training cases, it is feasible to test the above facts within the ISNCSCI. It is suggested that the missing fact should be included in an update of the training cases. Publication type: Journal Article Source: MEDLINE Full text: Available Nature Publishing Group at Spinal Cord 16. Title: Grieving my broken body: an autoethnographic account of spinal cord injury as an experience of grief. Citation: Disability & Rehabilitation, 2014, vol./is. 36/21(1823-9), 0963-8288;1464-5165 (2014) Author(s): Clifton S Language: English Abstract: PURPOSE: For good reason, the trajectory of contemporary research and therapy into rehabilitation following spinal cord injury (SCI) has moved away from focusing on the pathology of depression, to highlight the contribution of resiliency, optimism, and hope to long-term well-being. This article complements this literature, exploring the analogous links between the losses of SCI and the experiences of the grief that accompanies the death of a loved one.METHOD: The article uses autoethnography, drawing on the authors' writing about his own experiences as a C5 (incomplete) quadriplegic, to identify a correlation between the stages/symptoms of grief and the journey of rehabilitating from an SCI.RESULTS: The article highlights the "wild" and ambiguous reality of adjusting to an SCI, and so challenges the dualist tendency to assume that people are either resilient or weak, successful or unsuccessful in their recovery. It recognises that adjusting to an SCI involves complex swings in emotion--sadness, anger, and melancholy, alongside hope and determination.CONCLUSION: Drawing on strategies of grief therapy, the article suggests that constructing and reconstructing the story of one's own life is essential to learning to accept and live with an SCI.IMPLICATIONS FOR REHABILITATION: Since the losses accompanying SCI are analogous to grief, grief therapy strategies that recognise the complex and ambiguous nature of recovery can be part of rehabilitation. Therapy should encourage people to construct and reconstruct narratives--life stories--that help them mourn their loss and make sense of their new lives. The loss of an SCI is especially potent following return to the community, so storied therapy should continue beyond the period of the in-house rehabilitation. Publication type: Journal Article Source: MEDLINE 17. Title: Impact of pressure ulcers on individuals living with a spinal cord injury. Citation: Archives of Physical Medicine & Rehabilitation, December 2014, vol./is. 95/12(2312-9), 0003-9993;1532821X (2014 Dec) Author(s): Lala D, Dumont FS, Leblond J, Houghton PE, Noreau L Language: English Abstract: OBJECTIVE: To describe the impact of pressure ulcers on the ability to participate in daily and community activities, health care utilization, and overall quality of life in individuals living with spinal cord injury (SCI).DESIGN: Cross-sectional study.SETTING: Nationwide survey.PARTICIPANTS: Participants (N=1137) with traumatic SCI who were >1 year postinjury and living in the community were recruited. Of these, 381 (33.5%, 95% confidence interval, 30.8%-36.3%) had a pressure ulcer over the last 12 months.INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Measures developed for the Rick Hansen Spinal Cord Injury Registry Community Follow-up Survey Version 2.0.RESULTS: Of the 381 individuals with pressure ulcers, 65.3% reported that their pressure ulcer reduced their activity to some extent or more. Pressure ulcers reduced the ability of individuals with SCI to participate in 19 of 26 community and daily activities. Individuals with 1 or 2 pressure ulcers were more dissatisfied with their ability to participate in their main activity than those without pressure ulcers (P=.0077). Pressure ulcers were also associated with a significantly higher number of consultations with family doctors, nurses, occupational therapists, and wound care nurses/specialists (P<.05).CONCLUSIONS: Pressure ulcers have a significant impact on the daily life of individuals with SCI. Our findings highlight the importance of implementing pressure ulcer prevention and management programs for this high-risk population and require the attention of all SCI-related health care professionals. Copyright 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. Publication type: Journal Article Source: MEDLINE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 18. Title: Influence of different rehabilitation therapy models on patient outcomes: Hand function therapy in individuals with incomplete SCI Citation: Journal of Spinal Cord Medicine, 2014, vol./is. 37/6(734-743), 1079-0268;2045-7723 (2014) Author(s): Kapadia N.M., Bagher S., Popovic M.R. Language: English Abstract: Outcome measures: We analyzed the functional independence measure (FIM) and the spinal cord independence measure (SCIM) self-care sub-scores.Results: The mean change scores on the FIM self-care sub-score for the COT1, COT2, and FES + COT groups were 12.8, 10, and 20.1 points, respectively. Similarly, the mean change scores on the SCIM self-care sub-score for the COT1, COT2, and FES + COT groups were, 2.6, 3.16, and 10.2 points, respectively.Conclusion: Increased rehabilitation intensity alone may not always be beneficial. The type of intervention plays a significant role in determining functional changes. In this instance, receiving one (COT1) or two (COT2) doses of COT resulted in similar outcomes, however, FES + COT therapy yielded much better outcomes compared to COT1 and COT2 interventions.Objectives: The primary objective was to compare the benefits of single (COT1) versus double (COT2) dose of conventional occupational therapy (COT) in improving voluntary hand function in individuals with incomplete, sub-acute C3-C7 spinal cord injury (SCI). The secondary objective was to compare these two interventions versus functional electrical stimulation therapy plus COT (FES + COT).Design: Retrospective analysis.Setting: Inpatient spinal cord rehabilitation center, Toronto. Participants: Individuals with traumatic incomplete sub-acute SCI.Interventions: Data from Phases I and II (ClinicalTrials.gov ID NCT00221117) randomized control trials were pooled together for the purpose of this study. Participants in the COT1 group received 45 hours of therapy, the COT2 group received 80 hours of therapy, and the FES + COT group received 40 hours of COT therapy +40 hours of FES therapy. Publication type: Journal: Article Source: EMBASE Full text: Available The journal of spinal cord medicine at Journal of Spinal Cord Medicine, The 19. Title: Inter-rater reliability of modified modified ashworth scale in the assessment of plantar flexor muscle spasticity in patients with spinal cord injury. Citation: Physiotherapy Research International, December 2014, vol./is. 19/4(231-7), 1358-2267;1471-2865 (2014 Dec) Author(s): Mishra C, Ganesh GS Language: English Abstract: INTRODUCTION: Spasticity occurs in disorders of the central nervous system such as stroke, spinal cord injury (SCI), multiple sclerosis and traumatic brain injury. The recently developed clinical measurement for the measurement of spasticity is the Modified Modified Ashworth Scale (MMAS) PURPOSE OF STUDY: The purpose of this study is to determine the inter-rater reliability of the MMAS in the assessment of plantar flexor spasticity in patients with SCI.METHODOLOGY: Thirty-eight subjects (32 males and six females, mean age 31.9+12.6years) were recruited for the study. Excluded from the study were patients with contracture in the lower limb and where passive movements were contraindicated.PROCEDURE: Each patient was assessed by two raters in a single session. After the performance of the procedure by the first assessor and rating of the patient's muscle tone with the MMAS, the same procedure was repeated by the second assessor after 1hour. The evaluation was carried out in side-lying position. The extent of agreement was analysed by non-weighted Cohen kappa.RESULTS: The agreement between the raters was good (soleus k: 0.75, SE=0 .084, p<0.0001, gastrocnemius k:0.70, SE=0.105, p<0.0001).CONCLUSION: The MMAS has good inter-rater reliability in the assessment of plantar flexor muscle spasticity in patients with SCI. Copyright 2014 John Wiley & Sons, Ltd. Copyright 2014 John Wiley & Sons, Ltd. Publication type: Journal Article INTRODUCTION: Spasticity occurs in disorders of the central nervous system such as stroke, spinal cord injury (SCI), multiple sclerosis and traumatic brain injury. The recently developed clinical measurement for the measurement of spasticity is the Modified Modified Ashworth Scale (MMAS) PURPOSE OF STUDY: The purpose of this study is to determine the inter-rater reliability of the MMAS in the assessment of plantar flexor spasticity in patients with SCI.METHODOLOGY: Thirty-eight subjects (32 males and six females, mean age 31.9+12.6years) were recruited for the study. Excluded from the study were patients with contracture in the lower limb and where passive movements were contraindicated.PROCEDURE: Each patient was assessed by two raters in a single session. After the performance of the procedure by the first assessor and rating of the patient's muscle tone with the MMAS, the same procedure was repeated by the second assessor after 1hour. The evaluation was carried out in side-lying position. The extent of agreement was analysed by non-weighted Cohen kappa.RESULTS: The agreement between the raters was good (soleus k: 0.75, SE=0 .084, p<0.0001, gastrocnemius k:0.70, SE=0.105, p<0.0001).CONCLUSION: The MMAS has good inter-rater reliability in the assessment of plantar flexor muscle spasticity in patients with SCI. Copyright 2014 John Wiley & Sons, Ltd. Copyright 2014 John Wiley & Sons, Ltd. Publication type: Journal Article