Long duration spinal cord injury: Perceptions of functional change over time

Background: Guidelines regarding asymptomatic bacteriuria (ASB) have consistently recommended against screening and treatment in most circumstances. However, screening of patients with spinal cord injury (SCI) is common practice and in some cases is a formal protocol at the organizational level. A previous study found that more than one-third of patients with ASB detected on routine screening cultures performed at annual visits in 2012 received antibiotics. However, the role of antibiotic stewardship has become more prominent over the last decade. We hypothesized that diagnostic and therapeutic stewardship efforts may be impacting the practice of annual urine-culture screening for SCI patients. We evaluated urine culture screening and treatment rates over a 10-year period. Methods: Patients with SCI seen in the VA Boston HCS for an annual exam in 2018 were eligible for inclusion and formed the baseline cohort for this study. Annual visits for the cohort over a 10-year period (January 1, 2009–December 31, 2018) were included in the analysis. Electronic data collection and manual chart review were utilized to capture outcomes of interest including urine culture, antibiotic prescriptions and indication within 15 days, and documentation of urinary or infectious symptoms. The main outcomes were (1) rate of urine cultures performed ±3 days of the visit, (2) rate of antibiotic treatment in asymptomatic patients, and (3) trend over time of urine culturing and treating. The χ2 test for trend was used to compare rates over time. Results: In total, 1,962 annual visits were made by the 344 unique patients over the 10-year period and were available for analysis. Among these, 639 (32.6%) visits had a urine culture performed within 3 days. The proportion of visits with a collected culture decreased from (109 of 127) 85.8% of visits in 2009 to (65 of 338) 19.2% of visits in 2018, P ≤ .001 (Fig. 1). In the treatment analysis, 39 visits were excluded for active symptoms, concern for uncontrolled infection, or prophylaxis as antibiotic indication. Among 600 remaining screening cultures, 328 had a bacterial pathogen or >100,000 mixed colonies consistent with ASB. Overall, 51 patients (17%) received antimicrobials. The rate of antibiotic treatment for ASB did not significantly decrease over time pP = 0.79 (Fig. 2). Conclusions: Over a 10-year period of annual SCI visits, the proportion of visits with a urine culture performed as routine screening significantly and consistently decreased. However, the rate of treatment for positive urine cultures remained consistent. These data support targeted diagnostic stewardship in this population to reduce unnecessary antibiotic use.Funding: NoneDisclosures: None

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Long term outcome of functional independence and quality of life after traumatic SCI in Germany

Spinal Cord ◽

10.1038/s41393-021-00659-9 ◽

2021 ◽

Author(s):

Florian Möller ◽

Rüdiger Rupp ◽

Norbert Weidner ◽

Christoph Gutenbrunner ◽

Yorck B. Kalke ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Functional Independence ◽

Term Outcome ◽

Long Term Outcome ◽

Cord Injury ◽

Over Time

Abstract Study design Multicenter observational study. Objective To describe the long-term outcome of functional independence and quality of life (QoL) for individuals with traumatic and ischemic SCI beyond the first year after injury. Setting A multicenter study in Germany. Methods Participants of the European multicenter study about spinal cord injury (EMSCI) of three German SCI centers were included and followed over time by the German spinal cord injury cohort study (GerSCI). Individuals’ most recent spinal cord independence measure (SCIM) scores assessed by a clinician were followed up by a self-report (SCIM-SR) and correlated to selected items of the WHO short survey of quality of life (WHO-QoL-BREF). Results Data for 359 individuals were obtained. The average time passed the last clinical SCIM examination was 81.47 (SD 51.70) months. In total, 187 of the 359 received questionnaires contained a completely evaluable SCIM-SR. SCIM scores remained stable with the exception of reported management of bladder and bowel resulting in a slight decrease of SCIM-SR of −2.45 points (SD 16.81). SCIM-SR scores showed a significant correlation with the selected items of the WHO-QoL-BREF (p < 0.01) with moderate to strong influence. Conclusion SCIM score stability over time suggests a successful transfer of acquired independence skills obtained during primary rehabilitation into the community setting paralleled by positively related QoL measurements but bladder and bowel management may need special attention.

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Physical therapy is targeted and adjusted over time for the rehabilitation of locomotor function in acute spinal cord injury interventions in physical and sports therapy

Spinal Cord ◽

10.1038/s41393-017-0007-5 ◽

2017 ◽

Vol 56 (2) ◽

pp. 158-167 ◽

Cited By ~ 5

Author(s):

Martina Franz ◽

Lea Richner ◽

Markus Wirz ◽

Anne von Reumont ◽

Ulla Bergner ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Physical Therapy ◽

Acute Spinal Cord Injury ◽

Locomotor Function ◽

Cord Injury ◽

Over Time

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Community integration in spinal cord injury of long duration

Neurorehabilitation ◽

10.3233/nre-2004-19203 ◽

2004 ◽

Vol 19 (2) ◽

pp. 91-101 ◽

Cited By ~ 49

Author(s):

Susan Charlifue ◽

Kenneth Gerhart

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Community Integration ◽

Long Duration ◽

Cord Injury

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Spinal Cord Injury due to Tumour or Metastasis in Aragón, Northeastern Spain (1991–2008): Incidence, Time Trends, and Neurological Function

BioMed Research International ◽

10.1155/2017/2478197 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Maayken Elizabeth Louise van den Berg ◽

Juan M. Castellote ◽

Jose Ignacio Mayordomo ◽

Ignacio Mahillo-Fernandez ◽

Jesus de Pedro-Cuesta

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Population Distribution ◽

Primary Tumour ◽

Temporal Trends ◽

Health Resources ◽

The Elderly ◽

Incidence Rates ◽

Cord Injury ◽

Over Time

Purpose. Understanding the presentation of spinal cord injury (SCI) due to tumours considering population distribution and temporal trends is key to managing SCI health services. This study quantified incidence rates, function scores, and trends of SCI due to tumour or metastasis over an 18-year time period in a defined region in Spain. Methods. A retrospective cohort study included in-and outpatients with nontraumatic SCI due to tumour or metastasis admitted to a metropolitan hospital in Spain between 1991 and 2008. Main outcome measures were crude and age- and sex-adjusted incidence rates, tumour location and type, distribution by spinal level, neurological level of injury, and impairment ASIA scores. Results. Primary tumour or metastasis accounted for 32.5% of nontraumatic SCI with an incidence rate of 4.1 per million population. Increasing rates with age and over time were observed. Major pathology groups were intradural-extramedullary masses from which meningiomas and neurinomas accounted for 40%. Lesions were mostly incomplete with predominant ASIA Grade D. Conclusions. Increasing incidence rates of tumour-related SCI over time in the middle-aged and the elderly suggest a growing need for neurooncology health resources in the future.

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Finger somatotopy is preserved after tetraplegia but deteriorates over time

eLife ◽

10.7554/elife.67713 ◽

2021 ◽

Vol 10 ◽

Author(s):

Sanne Kikkert ◽

Dario Pfyffer ◽

Michaela Verling ◽

Patrick Freund ◽

Nicole Wenderoth

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Observational Study ◽

Sensorimotor Cortex ◽

Structural Mri ◽

Finger Movement ◽

Functional Connections ◽

Cord Injury ◽

Primary Sensorimotor Cortex ◽

Over Time

Previous studies showed reorganised and/or altered activity in the primary sensorimotor cortex after a spinal cord injury (SCI), suggested to reflect abnormal processing. However, little is known about whether somatotopically-specific representations can be activated despite reduced or absent afferent hand inputs. In this observational study we used functional MRI and an (attempted) finger movement task in tetraplegic patients to characterise the somatotopic hand layout in primary somatosensory cortex. We further used structural MRI to assess spared spinal tissue bridges. We found that somatotopic hand representations can be activated through attempted finger movements in absence of sensory and motor hand functioning, and no spared spinal tissue bridges. Such preserved hand somatotopy could be exploited by rehabilitation approaches that aim to establish new hand-brain functional connections after SCI (e.g., neuroprosthetics). However, over years since SCI the hand representation somatotopy deteriorated, suggesting that somatotopic hand representations are more easily targeted within the first years after SCI.

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Long-term spinal cord injury: Functional changes over time

Archives of Physical Medicine and Rehabilitation ◽

10.1016/0003-9993(93)90057-h ◽

1993 ◽

Vol 74 (10) ◽

pp. 1030-1034 ◽

Cited By ~ 135

Author(s):

Kenneth A. Gerhart ◽

Ebba Bergstrom ◽

Susan W. Charlifue ◽

Robert R. Menter ◽

Gale G. Whiteneck

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Functional Changes ◽

Cord Injury ◽

Changes Over Time ◽

Over Time

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Classification challenges of the 2019 revised International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)

Spinal Cord ◽

10.1038/s41393-021-00648-y ◽

2021 ◽

Author(s):

Steven Kirshblum ◽

Mary Schmidt Read ◽

Rüdiger Rupp

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

International Standards ◽

Correct Classification ◽

International Expert ◽

Cord Injury ◽

Over Time

Abstract Study design Retrospective review of ISNCSCI datasets. Objectives To discuss the correct classification of ISNCSCI datasets considered as challenging. Setting International expert collaboration. Methods The International Standards Committee of the American Spinal Injury Association (ASIA) receives challenging case scenarios regarding the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI). Among those cases received, sample cases representing different categories of typical classification difficulties were identified by members of the International Standards committee. Results From the cases received, five sample cases were identified as representative for publication. These cases are related to the correct classification in the presence of non-SCI related conditions, the determination of motor zones of partial preservation in regions with no myotomes to test, the classification of the ASIA Impairment Scale in patients with substantial motor function below the motor level but no sacral sparing, the inclusion of non-key muscle functions in the classification of sensory incomplete individuals, and the correct classification of individuals with an amputation. Conclusion Presenting cases with challenging classifications, along with responses and explanations, will serve spinal cord injury professionals to better understand and utilize the ISNCSCI classification. As the ISNCSCI endorsed by ASIA and the International Spinal Cord Society (ISCoS) evolves over time, such resources are important to clarify inquiries from the spinal cord injury community and to understand the rationale for revisions.

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