scholarly journals Development of priorities for a Canadian strategy to advance activity-based therapies after spinal cord injury

Spinal Cord ◽  
2021 ◽  
Author(s):  
Kristin E. Musselman ◽  
Kristen Walden ◽  
Vanessa K. Noonan ◽  
Hope Jervis-Rademeyer ◽  
Nancy Thorogood ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Stroke Rehabilitation ◽  
Participatory Design ◽  
Best Practice ◽  
Optimal Timing ◽  
Activity Levels ◽  
Cord Injury ◽  
Healthcare Administrators ◽  
Psychosocial Benefits

Abstract Study Design Participatory design. Objectives Activity-based therapies (ABT) have physical and psychosocial benefits for individuals with spinal cord injury (SCI). A Canadian ABT summit was held to: (1) identify methods used in stroke rehabilitation that may be appropriate for SCI; (2) understand the current state of ABT activities in Canada; and (3) identify priorities for ABT research and care for the next five years. Setting Stakeholder-engaged meeting at a tertiary rehabilitation hospital. Methods Thirty-nine stakeholders, including individuals with SCI, frontline clinicians, healthcare administrators, researchers, funders and health policy experts, attended. Two participants were note-takers. Priority identification occurred through input from stakeholder groups, followed by individual voting. Conventional content analysis was used to synthesize the information in the meeting notes. Results The strengths of ABT in stroke rehabilitation included clear and clinically feasible definitions, measurements and interventions, and recognized requirements for implementation (e.g. behavior change, partnerships). Knowledge gaps concerning ABT activities in Canada were identified for acute and community settings, non-traumatic populations, and the interventions, equipment and standardized measures (i.e. upper limb, activity levels) used. Five priorities for ABT across the continuum of care were identified: (1) Identify current ABT activities; (2) Create a network to facilitate dialog; (3) Track engagement in ABT activities; (4) Develop and implement best practice recommendations; and (5) Study optimal timing, methods, and dose of ABT. Working groups were formed to address priorities 1–3. Conclusions The priorities will guide SCI research and care activities in Canada over the next five years. Sponsorship Praxis Spinal Cord Institute.

Experimental spinal cord trauma: a review of mechanically induced spinal cord injury in rat models

2017 ◽  
Vol 28 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Dauda Abdullahi ◽  
Azlina Ahmad Annuar ◽  
Masro Mohamad ◽  
Izzuddin Aziz ◽  
Junedah Sanusi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cord Compression ◽  
Acute Injury ◽  
Optimal Timing ◽  
Spinal Cord Trauma ◽  
Rat Models ◽  
Human Spinal Cord ◽  
Cord Injury ◽  
Transient Force

AbstractIt has been shown that animal spinal cord compression (using methods such as clips, balloons, spinal cord strapping, or calibrated forceps) mimics the persistent spinal canal occlusion that is common in human spinal cord injury (SCI). These methods can be used to investigate the effects of compression or to know the optimal timing of decompression (as duration of compression can affect the outcome of pathology) in acute SCI. Compression models involve prolonged cord compression and are distinct from contusion models, which apply only transient force to inflict an acute injury to the spinal cord. While the use of forceps to compress the spinal cord is a common choice due to it being inexpensive, it has not been critically assessed against the other methods to determine whether it is the best method to use. To date, there is no available review specifically focused on the current compression methods of inducing SCI in rats; thus, we performed a systematic and comprehensive publication search to identify studies on experimental spinalization in rat models, and this review discusses the advantages and limitations of each method.

A Prospective Study on Physical Activity Levels After Spinal Cord Injury During Inpatient Rehabilitation and the Year After Discharge

2008 ◽  
Vol 89 (11) ◽  
pp. 2094-2101 ◽  
Author(s):  
Rita J. van den Berg-Emons ◽  
Johannes B. Bussmann ◽  
Janneke A. Haisma ◽  
Tebbe A. Sluis ◽  
Lucas H. van der Woude ◽  
...  
Keyword(s):  
Physical Activity ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Prospective Study ◽  
Inpatient Rehabilitation ◽  
Activity Levels ◽  
Cord Injury ◽  
Physical Activity Levels ◽  
A Prospective Study

scholarly journals FES Bike Race preparation to Cybathlon 2016 by EMA team: a short case report

2017 ◽  
Vol 27 (4) ◽  
Author(s):  
Juliana Araujo Guimarães ◽  
Lucas Oliveira da Fonseca ◽  
Ana Carolina De Sousa ◽  
Miguel Eduardo Gutierrez Paredes ◽  
George Andrew Brindeiro ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Left Knee ◽  
Activity Levels ◽  
Controlled System ◽  
Video Footage ◽  
Cord Injury ◽  
Automation And Control ◽  
Complete Spinal Cord Injury ◽  
And Control

FES-assisted cycling has been recommended to people struggling to emerge from a disability to more functioning life after spinal cord injury. Recommendations issued by a gowing number of scientific papershas promised toimprove body composition and physical activity levels, as well as to controlinvoluntary muscle response; favoring activity and participation which break new grounds in expanding locomotion, leisure and occupational options for people with paraplegia and tetraplegia. In this report we described our experience to select and prepare a pilot to compete in the FES Bike Race modality at Cybathlon 2016 in Kloten (Zurick). He was a man, 38 years old, with a complete spinal cord injury, level T9, three years of injury. He took part in a two preparation phases lasting respectively 18 and 12 weeks each: (1st) pre-FES-cycling and a (2nd) FES-cycling. The 1st phase aimed to explore electrical stimulation response in the quadricps, hamstrings and gluteus muscles; searching for a standard muscular recruitment enable to propel the pedals of a trike. Following, in the 2nd phase, stationary to mobile FES-cycling was performed at the same time the development of the automation and control systems were being incorporated in the trike. We adapted a commercial tadpole trycicle anda pilot controlled system. Although we had planned a three session by week protocol, for reasons of term and time to finish the trike development and be prepared to compete, in the last two weeks before the Cybatlhon an intense level of exercise was maintained. After the race, we noticedinflammatory signs on the left knee which later revealed a patella fracture. The video footage analysis confirmed ithappened during the race’s first lap.

Urodynamics in patients with spinal cord injury: A clinical review and best practice paper by a working group of The International Continence Society Urodynamics Committee

2017 ◽  
Vol 37 (2) ◽  
pp. 581-591 ◽  
Author(s):  
Brigitte Schurch ◽  
Valerio Iacovelli ◽  
Marcio A. Averbeck ◽  
Stefano Carda ◽  
Waleed Altaweel ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Review ◽  
Working Group ◽  
Best Practice ◽  
International Continence Society ◽  
Cord Injury

scholarly journals A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury: Introduction, Rationale, and Scope

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 84S-94S ◽  
Author(s):  
Michael G. Fehlings ◽  
Lindsay A. Tetreault ◽  
Jefferson R. Wilson ◽  
Brian K. Kwon ◽  
Anthony S. Burns ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Traumatic Event ◽  
Sodium Succinate ◽  
Well Being ◽  
Acute Spinal Cord Injury ◽  
Optimal Timing ◽  
Past Century ◽  
Cord Injury

Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient’s physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of magnetic resonance imaging, and the type and timing of rehabilitation. This lack of consensus has prevented the standardization of care across treatment centers and among the various disciplines that encounter patients with SCI. The objective of this guideline is to form evidence-based recommendations for these areas of controversy and outline how to best manage patients with SCI. The ultimate goal of these guidelines is to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care and encouraging clinicians to make evidence-informed decisions.

scholarly journals Timing of tracheostomy in acute traumatic spinal cord injury: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Sarah Foran ◽  
Shaurya Taran ◽  
JM Singh ◽  
Demetrios James Kutsogiannis ◽  
Victoria McCredie
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Hospital Length Of Stay ◽  
Optimal Timing ◽  
Early Tracheostomy ◽  
Methodologic Quality ◽  
Cord Injury

Abstract Background Patients with acute traumatic cervical or high thoracic level spinal cord injury (SCI) typically require mechanical ventilation (MV) during their acute admission. Placement of a tracheostomy is preferred when prolonged weaning from MV is anticipated. However, the optimal timing of tracheostomy placement in patients with acute traumatic SCI remains uncertain. We systematically reviewed the literature to determine the effects of early versus late tracheostomy or prolonged intubation in patients with acute traumatic SCI on important clinical outcomes.Methods Six databases were searched from their inception to January 2020. Conference abstracts from relevant proceedings and the gray literature were searched to identify additional studies. Data was obtained by two independent reviewers to ensure accuracy and completeness. The quality of observational studies was evaluated using the Newcastle Ottawa Scale (NOS).Results Seventeen studies (2,804 patients) met selection criteria, 14 of which were published after 2009. Meta-analysis showed that early tracheostomy was not associated with decreased short-term mortality (risk ratio [RR] 0.84; 95% confidence interval [CI] 0.39 to 1.79; p = 0.65; n = 2,072), but was associated with a reduction in MV duration (mean difference [MD] 13.1 days; 95% CI -6.70 to -21.11; p = 0.0002; n = 855), intensive care unit (ICU) length of stay (MD -10.20 days; 95% CI -4.66 to -15.74; p = 0.0003; n = 855), and hospital length of stay (MD -7.39 days; 95% CI -3.74 to -11.03; p < 0.0001; n = 423). Early tracheostomy was also associated with a decreased incidence of ventilator-associated pneumonia (VAP) and tracheostomy-related complications (RR 0.86; 95% CI 0.75 to 0.98; p = 0.08; n = 2,043 and RR 0.08; 95% CI -0.01 to -0.15; p = 0.02; n = 812 respectively). The majority of studies ranked as good methodologic quality on the NOS. Conclusions Early tracheostomy in patients with acute traumatic SCI may reduce duration of mechanical ventilation, length of ICU stay, and length of hospital stay. Current studies highlight the lack of high-level evidence to guide the optimal timing of tracheostomy in acute traumatic SCI. Future research should seek to understand whether early tracheostomy improves patient comfort, decreases duration of sedation and improves long-term outcomes.PROSPERO registration number: CRD42020162488

scholarly journals Window of opportunity for surgical decompression in patients with acute traumatic cervical spinal cord injury

2020 ◽  
Vol 32 (5) ◽  
pp. 633-641 ◽  
Author(s):  
Marko Jug ◽  
Nataša Kejžar ◽  
Matej Cimerman ◽  
Fajko F. Bajrović
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Neurological Recovery ◽  
Optimal Timing ◽  
Neurological Improvement ◽  
Severity Of Injury ◽  
Cord Injury

OBJECTIVEThe objective of this prospective study was to determine the optimal timing for surgical decompression (SD) in patients with acute traumatic cervical spinal cord injury (tSCI) within the first 24 hours of injury.METHODSIn successive patients with fracture and/or dislocation of the subaxial cervical spine and American Spinal Injury Association Impairment Scale (AIS) grades A–C, receiver operating characteristic curve analysis was used to determine the optimal timing for SD within the first 24 hours of cervical tSCI to obtain a neurological recovery of at least two AIS grades. Multivariate logistic regression was used to model significant neurological recovery with time to SD, degree of spinal canal compromise (SCC), and severity of injury.RESULTSIn this cohort of 64 patients, the optimal timing for SD to obtain a significant neurological improvement was within 4 hours of injury (95% confidence interval 4–9 hours). Increasing the delay from injury to SD or the degree of SCC significantly reduced the likelihood of significant neurological improvement. Due to the strong correlation with SCC, the severity of injury was a marginally significant predictor of neurological recovery.CONCLUSIONSThese findings indicate that in patients with acute cervical tSCI and AIS grades A–C, the optimal timing for SD is within the first 4–9 hours of injury, depending on the degree of SCC and the severity of injury. Further studies are required to better understand the interrelationships among the timing of SD, injury severity, and degree of SCC in these patients.

The development of an outcome measures toolkit for spinal cord injury rehabilitation

2017 ◽  
Vol 84 (2) ◽  
pp. 119-129 ◽  
Author(s):  
Christie W. L. Chan ◽  
William C. Miller ◽  
Matthew Querée ◽  
Vanessa K. Noonan ◽  
Dalton L. Wolfe ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Practice ◽  
Outcome Measures ◽  
Best Practice ◽  
Outcome Measure ◽  
Medical Condition ◽  
Measurement Properties ◽  
Injury Rehabilitation ◽  
Cord Injury

Background. Spinal cord injury (SCI) is a complex medical condition that can be difficult to monitor. Purpose. This study aimed to establish a common set of validated outcome measures specifically for SCI clinical practice. Method. In a three-round online Delphi process, experts in SCI care across Canada suggested and ranked outcome measures for clinical practice. The facilitators provided feedback between rounds and determined if consensus (at least 75% agreement) was reached on a single outcome measure per clinical area. Findings. One hundred and forty-eight outcome measures were initially considered for inclusion. After three rounds, consensus was reached for 23 out of 30 clinical areas. In the remaining seven, more than one outcome measure was recommended. The final toolkit comprises 33 outcome measures with sufficient measurement properties for use with a SCI population. Implications. An outcome measures toolkit validated specifically for SCI should lead to improved identification of best practice and enable clinicians to monitor client progress effectively.

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