scholarly journals Exploring adipogenic and myogenic circulatory biomarkers of recurrent pressure injury risk for persons with spinal cord injury

2020 ◽  
Vol 6 (1) ◽  
pp. 1-7
Author(s):  
Kath M Bogie ◽  
Katelyn Schwartz ◽  
Youjin Li ◽  
Shengxuan Wang ◽  
Wei Dai ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Repeated Measures ◽  
Injury Risk ◽  
Univariate Analysis ◽  
Model Development ◽  
Pyruvate Dehydrogenase Kinase ◽  
Cord Injury ◽  
Pressure Injury ◽  
Nonlinear Correlations

Purpose: To investigate linkages between circulatory adipogenic and myogenic biomarkers, gluteal intramuscular adipose tissue (IMAT), and pressure injury (PrI) history following spinal cord injury (SCI). Methods: This is an observational repeated-measures study of 30 individuals with SCI. Whole blood was collected regularly over 2-3 years. Circulatory adipogenic and myogenic gene expression was determined. IMAT was defined as above/below 15% (IMATd) or percentage (IMAT%). PrI history was defined as recurrent PrI (RPrI) or PrI number (nPrI). Model development used R packages (version 3.5.1). Univariate analysis screened for discriminating genes for downstream multivariate and combined models of averaged and longitudinal data for binary (RPrI/IMATd) and finer scales (nPrI/IMAT%). Results: For adipogenesis, Krüppel-like factor 4 was the top RPrI predictor together with resistin and cyclin D1, and sirtuin 2 was the top IMAT predictor. For myogenesis, the top RPrI predictor was dysferlin 2B, and pyruvate dehydrogenase kinase-4 was the top IMAT predictor together with dystrophin. Conclusion: Circulatory adipogenic and myogenic biomarkers have statistically significant relationships with PrI history and IMAT for persons with SCI. Biomarkers of interest may act synergistically or additively. Variable importance rankings can reveal nonlinear correlations among the predictors. Biomarkers of interest may act synergistically or additively, thus multiple genes may need to be included for prediction with finer distinction.

scholarly journals Individualized Clinical Practice Guidelines for Pressure Injury Management: Development of an Integrated Multi-Modal Biomedical Information Resource (Preprint)

2018 ◽  
Author(s):  
Kath M Bogie ◽  
Guo-Qiang Zhang ◽  
Steven K Roggenkamp ◽  
Ningzhou Zeng ◽  
Jacinta Seton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Practice ◽  
Injury Risk ◽  
Tissue Injury ◽  
Care Planning ◽  
Deep Tissue ◽  
Cord Injury ◽  
Pressure Injury

BACKGROUND Pressure ulcers (PU) and deep tissue injuries (DTI), collectively known as pressure injuries are serious complications causing staggering costs and human suffering with over 200 reported risk factors from many domains. Primary pressure injury prevention seeks to prevent the first incidence, while secondary PU/DTI prevention aims to decrease chronic recurrence. Clinical practice guidelines (CPG) combine evidence-based practice and expert opinion to aid clinicians in the goal of achieving best practices for primary and secondary prevention. The correction of all risk factors can be both overwhelming and impractical to implement in clinical practice. There is a need to develop practical clinical tools to prioritize the multiple recommendations of CPG, but there is limited guidance on how to prioritize based on individual cases. Bioinformatics platforms enable data management to support clinical decision support and user-interface development for complex clinical challenges such as pressure injury prevention care planning. OBJECTIVE The central hypothesis of the study is that the individual’s risk factor profile can provide the basis for adaptive, personalized care planning for PU prevention based on CPG prioritization. The study objective is to develop the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury (SCIPUD+) Resource to support personalized care planning for primary and secondary PU/DTI prevention. METHODS The study is employing a retrospective electronic health record (EHR) chart review of over 75 factors known to be relevant for pressure injury risk in individuals with a spinal cord injury (SCI) and routinely recorded in the EHR. We also perform tissue health assessments of a selected sub-group. A systems approach is being used to develop and validate the SCIPUD+ Resource incorporating the many risk factor domains associated with PU/DTI primary and secondary prevention, ranging from the individual’s environment to local tissue health. Our multiscale approach will leverage the strength of bioinformatics applied to an established national EHR system. A comprehensive model is being used to relate the primary outcome of interest (PU/DTI development) with over 75 PU/DTI risk factors using a retrospective chart review of 5000 individuals selected from the study cohort of more than 36,000 persons with SCI. A Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) is being developed to enable robust text-mining for data extraction from free-form notes. RESULTS The results from this study are pending. CONCLUSIONS PU/DTI remains a highly significant source of morbidity for individuals with SCI. Personalized interactive care plans may decrease both initial PU formation and readmission rates for high-risk individuals. The project is using established EHR data to build a comprehensive, structured model of environmental, social and clinical pressure injury risk factors. The comprehensive SCIPUD+ health care tool will be used to relate the primary outcome of interest (pressure injury development) with covariates including environmental, social, clinical, personal and tissue health profiles as well as possible interactions among some of these covariates. The study will result in a validated tool for personalized implementation of CPG recommendations and has great potential to change the standard of care for PrI clinical practice by enabling clinicians to provide personalized application of CPG priorities tailored to the needs of each at-risk individual with SCI. REGISTERED REPORT IDENTIFIER RR1-10.2196/10871

scholarly journals Biomarkers for recurrent pressure injury risk in persons with spinal cord injury

2019 ◽  
Vol 43 (5) ◽  
pp. 696-703 ◽  
Author(s):  
Katie Schwartz ◽  
M. Kristi Henzel ◽  
Mary Ann Richmond ◽  
Jennifer K. Zindle ◽  
Jacinta M. Seton ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Injury Risk ◽  
Cord Injury ◽  
Pressure Injury

Skin Self-Screening Camera for Veterans With Spinal Cord Injury

2017 ◽  
Author(s):  
Christine Olney ◽  
Jennifer Leestma ◽  
Andrew Hansen ◽  
John Ferguson ◽  
Mary Murphy Kruse ◽  
...  
Keyword(s):  
Spinal Cord ◽  
At Risk ◽  
Spinal Cord Injury ◽  
Adaptive Design ◽  
Mirror Image ◽  
Cord Injury ◽  
Skin Integrity ◽  
Pressure Injury ◽  
Risk Areas ◽  
Screening Device

Veterans with spinal cord injury (SCI) are at high risk for developing debilitating pressure injuries, particularly to their seated areas (e.g. coccyx, sacral and gluteal) [1]. To prevent development of a pressure injury the Veteran with SCI is encouraged to invoke multiple prevention strategies [2]. One recommended prevention strategy is to conduct twice daily skin self-screenings. Skin self-screening is usually conducted in the bed, prior to arising in the morning and prior to sleep in the evening. The current method to conduct skin self-screening utilizes a mirror at the end of a long handle. The Veteran with SCI examines at-risk areas for changes in their skin integrity such as discoloration, swelling, or changes in skin texture. This method can take up to 20 minutes to complete. In the event there is a change to skin integrity, the pressure injury prevention protocol advises the Veteran with SCI to off-load that particular area for at least 24 hours [3]. Further, he/she is advised to consult with their skin specialist if the area does not resolve to normal color or texture within that next 24 hour period. The consequences of ignoring an early stage pressure injury can be serious e.g. weeks to months of hospitalization attempting to heal the injury, tens to hundreds of thousands of dollars in healthcare costs, possible surgery to close the wound and possibly death [4]. Informal interviews with Veterans with SCI clarified and validated that conducting skin screening with the mirror could be very challenging due to barriers such as: not having a baseline image to compare to; the mirror image not being viewable to the user due to lack of user flexibility or body habitus; the mirror does not easily allow a complete view of all the at-risk areas; the user not being able to discern what he/she is actually viewing possibly due to mirror image distortion and limited visual acuity. The need for a better skin self-screening device was evidenced by the advanced pressure injuries Veterans presented to their healthcare providers. Finding a pressure injury in the early stages of development and intervening immediately, such as repositioning, can improve the trajectory of the injury [5]. Therefore the project goal was to offer a better tool for and improve the efficacy of skin self-screening for the Veterans with SCI. To overcome the identified barriers, our team of VA clinicians and engineers of the Minneapolis Adaptive Design & Engineering (MADE) program invented such a device at the Minneapolis VA. This paper presents the patient centered iterative process that was used to develop a skin self-screening device and the future directions for this technology.

scholarly journals Prevention and treatment of pressure sore following spinal cord injury

2020 ◽  
Vol 63 (10) ◽  
pp. 623-632
Author(s):  
Myeong Ok Kim
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Wound Care ◽  
Pressure Sore ◽  
Therapeutic Interventions ◽  
Advisory Panel ◽  
Pressure Sores ◽  
Cord Injury ◽  
Pressure Injury

Pressure sores or pressure injury is a serious complication of a spinal cord injury (SCI), representing a challenging problem for patients, their caregivers, and their physicians. Persons with SCI are vulnerable to pressure sores throughout their life. Pressure sores can potentially interfere with the physical, psychosocial, and overall quality of life. Outcomes directly depend on education and prevention along with conservative and surgical management. Therefore, it is very important to understand everything about pressure sores following SCI. This review covers epidemiology, cost, pathophysiology, risk factors, staging, evaluation tools, prevention, education, conservative wound care methods, surgical treatment, and future trends in wound healing related to post-SCI pressure sores. A change in nomenclature was adopted by the National Pressure Ulcer Advisory Panel in 2016, replacing “pressure ulcer”with “pressure injury.” New concepts of pressure injury staging, such as suspected deep tissue injuries and unstageable pressure injuries, were also introduced. A systematic evidence-based review of the prevention of and therapeutic interventions for pressure sores was also discussed.

scholarly journals Treatment and cost of pressure injury stage III or IV in four patients with spinal cord injury: the Basel Decubitus Concept

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Christine Meier ◽  
Stefan Boes ◽  
Armin Gemperli ◽  
Hans Peter Gmünder ◽  
Kamran Koligi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Stage Iii ◽  
Cord Injury ◽  
Pressure Injury

Poster 248: A Tunneling Pressure Injury with Direct Communication to the Hip Joint Diagnosed Via Fistulogram in a Patient with Spinal Cord Injury: A Case Report

PM&R ◽  
2018 ◽  
Vol 10 ◽  
pp. S82-S83
Author(s):  
George Chen ◽  
Amanda Farag ◽  
Steven B. Epstein ◽  
Cordelia H. Enyaosa ◽  
Keith Claffey ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Case Report ◽  
Hip Joint ◽  
Direct Communication ◽  
Cord Injury ◽  
Pressure Injury

scholarly journals Virtual reality improves embodiment and neuropathic pain caused by spinal cord injury

Neurology ◽  
2017 ◽  
Vol 89 (18) ◽  
pp. 1894-1903 ◽  
Author(s):  
Polona Pozeg ◽  
Estelle Palluel ◽  
Roberta Ronchi ◽  
Marco Solcà ◽  
Abdul-Wahab Al-Khodairy ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Virtual Reality ◽  
Neuropathic Pain ◽  
Repeated Measures ◽  
Visual Analogue Scale Pain ◽  
Body Ownership ◽  
Repeated Measures Design ◽  
Head Mounted Display ◽  
Cord Injury

Objective:To investigate changes in body ownership and chronic neuropathic pain in patients with spinal cord injury (SCI) using multisensory own body illusions and virtual reality (VR).Methods:Twenty patients with SCI with paraplegia and 20 healthy control participants (HC) participated in 2 factorial, randomized, repeated-measures design studies. In the virtual leg illusion (VLI), we applied asynchronous or synchronous visuotactile stimulation to the participant's back (either immediately above the lesion level or at the shoulder) and to the virtual legs as seen on a VR head-mounted display. We tested the effect of the VLI on the sense of leg ownership (questionnaires) and on perceived neuropathic pain (visual analogue scale pain ratings). We compared illusory leg ownership with illusory global body ownership (induced in the full body illusion [FBI]), by applying asynchronous or synchronous visuotactile stimulation to the participant's back and the back of a virtual body as seen on a head-mounted display.Results:Our data show that patients with SCI are less sensitive to multisensory stimulations inducing illusory leg ownership (as compared to HC) and that leg ownership decreased with time since SCI. In contrast, we found no differences between groups in global body ownership as tested in the FBI. VLI and FBI were both associated with mild analgesia that was only during the VLI specific for synchronous visuotactile stimulation and the lower back position.Conclusions:The present findings show that VR exposure using multisensory stimulation differently affected leg vs body ownership, and is associated with mild analgesia with potential for SCI neurorehabilitation protocols.

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