Incidence and clinical correlates of increased serum creatine kinase levels in persons with spinal cord injury

BACKGROUND: Elevated plasma levels of creatine kinase (CPK) are found in various neuromuscular conditions as a result of muscle damage and necrosis. Elevated CPK has also been described in elite wheelchair athletes and in able-bodied individuals after strenuous exercise. METHODS: The incidence of elevated CPK in individuals with spinal cord injury (SCI) has not been well established. We reviewed laboratory data from 581 individuals with chronic SCI. RESULTS: Most individuals with SCI (73.3%) had CPK values within 95% confidence intervals for able-bodied individuals. The highest levels were seen in African Americans (21% had CPK values > 95 confidence intervals for able-bodied individuals). Significant associations between CPK and the following independent variables were identified: impairment group, gender, duration of injury, body mass index, and ethnic group. Multiple regression analysis revealed significant correlations between CPK and oxygen consumption (beta .37, P < .01) in 32 individuals who performed the exercise test. CONCLUSIONS: These findings are important for clinicians evaluating symptoms of fatigue and myopathy in individuals with SCI.     

Cardiovascular response to peak voluntary exercise in males with cervical spinal cord injury

Context/Objective: Traumatic damage to the cervical spinal cord is usually associated with a disruption of the autonomic nervous system (ANS) and impaired cardiovascular control both during and following exercise. The magnitude of the cardiovascular dysfunction remains unclear. The aim of the current study was to compare cardiovascular responses to peak voluntary exercise in individuals with tetraplegia and able-bodied participants.

Design: A case-control study.

Subjects: Twenty males with cervical spinal cord injury (SCI) as the Tetra group and 27 able-bodied males as the Control group were included in the study.

Outcome Measures: Blood pressure (BP) response one minute after the peak exercise, peak heart rate (HR_peak), and peak oxygen consumption (VO_2peak) on an arm crank ergometer were measured. In the second part of the study, 17 individuals of the Control group completed the Tetra group's workload protocol with the same parameters recorded.

Results: There was no increase in BP in response to the exercise in the Tetra group. Able-bodied individuals exhibited significantly increased post-exercise systolic BP after the maximal graded exercise test (123±16%) and after completion of the Tetra group's workload protocol (114±11%) as compared to pre-exercise. The Tetra group VO_2peak was 59% and the HR_peak was 73% of the Control group VO_2peak and HR_peak, respectively.

Conclusions: BP did not increase following maximal arm crank exercise in males with a cervical SCI unlike the increases observed in the Control group. Some males in the Tetra group appeared to be at risk of severe hypotension following high intensity exercise, which can limit the ability to progressive increase and maintain high intensity exercise.     

Low-Frequency Fatigue in Individuals With Spinal Cord Injury

Abstract

Background/Objective: This study examined magnitude and recovery of low-frequency fatigue (LFF) in the quadriceps after electrically stimulated contractions in spinal cord-injured (SCI) and able-bodied subjects.

Subjects: Nine SCI (ASIA A-C, levels C5-T9, injured 13.6 ± 12.2 years) and 9 sedentary able-bodied subjects completed this study.

Methods: Fatigue was evoked in 1 thigh, and the nonfatigued leg served as a control. The fatigue test for able-bodied subjects lasted 15 minutes. For SCI, stimulation was adjusted so that the relative drop in force was matched to the able-bodied group. Force was assessed at 20 (P20) and 100 Hz (PI 00), and the ratio of P20/P100 was used to evaluate LFF in thighs immediately after, at 10, 20, and 60 minutes, and at 2, 4, 6, and 24 hours after a fatigue test.

Results: The magnitude of LFF (up to 1 hour after fatigue) was not different between able-bodied and patients with SCI. However, recovery of LFF over 24 hours was greater in able-bodied compared with patients with SCI in both the experimental (P < 0.001) and control legs (P < 0.001). The able-bodied group showed a gradual recovery of LFF over time in the experimental leg, whereas the SCI group did not.

Conclusions: These results show that individuals with SCI are more susceptible to LFF than able-bodied subjects. In SCI, simply assessing LFF produced considerable LFF and accounted for a substantial portion of the response. We propose that muscle injury is causing the dramatic LFF in SCI, and future studies are needed to test whether “fatigue” in SCI is actually confounded by the effects of muscle injury.     

Measuring Hand Intrinsic Muscle Strength: Normal Values and Interrater Reliability

Abstract

Background: The intrinsic musdes of the hand are of interest in spinal cord injury (SCI) and other myelopathies, because they are innervated by the most caudal cord segments innervating the upper limb. ln addition, abnormalities of the peripheral nervous system, such as peripheral nerve entrapments, often affect hand intrinsic musde strength of SCI patients. Therefore, measuring hand intrinsic strength may allow for early diagnosis of neurologic dedine.

Methods: A method was developed for measuring strength of hand intrinsic musdes with a handheld myometer. With the use of a handheld myometer, this study examined the distribution of strength measurements for second-digit abductors, fifth-digit abductors, and thumb opposers in able-bodied participants and in individuals with weakness. The quantitative measurements were compared with manual musde test scores and interrater reliability is described for these hand intrinsic strength measurements. Thirty-one able-bodied individuals participated (17 men, 14 women; mean age = 37.7 years) . ln addition, 24, patients with SCI participated (23 men, 1 woman; mean age = 53.5 years; 9 with paraplegia and 14 with tetraplegia as a primary diagnosis). The Bland-Altman method was used to test for interrater reliability.

Results: Mean strength of able-bodied participants was 5.0 kg for second-digit abduction, 3.1 kg for fifth-digit abduction, and 5.0 kg for thumb opposition, and the lower Iimits of normal were 3 .0, 1 .8, and 3.4 kg, respectively. The 95th percentile of interrater differences were 2 9.3% for second-digit abduction, 38.5% for fifth-digit abduction, and 43.7% for thumb opposition.

Condusion: Abnormal hand intrinsic strength should be suspected if values are lower than the 5th percentile values listed above or if strength change exceeds the 95th percentile for interrater differences shown above. These quantitative hand strength measurements may allow for earlier diagnosis of secondary neurologic complications and may aid in monitaring neurologic recovery in persons with SCI.     

Acute Effects Of Locomotor Training on Overground Walking Speed and H-Reflex Modulation in Individuals with Incomplete Spinal Cord Injury

Abstract

Objective: The purpose of this study was to assess the effect of a single bout of a locomotor-training paradigm on overground walking speed and H-reflex modulation of individuals with incomplete spinal cord injury (SCI).

Methods: Self-selected and maximum walking speeds and soleus H-reflexes (H/M ratios) during standing and stance and swing phases of walking (self-selected velocity) were obtained from 4 individuals with American Spinal Injury Association impairment classification D. Data were collected immediately before and after a single bout of locomotor training with body weight support on a treadmill. The pretraining H/M ratios of the SCI subjects were also compared with values from 4 able-bodied subjects who did not receive the intervention. Maximum H/M ratios while standing and during midstance and midswing phases of overground walking were considerably greater in the SCI subjects than in the control subjects.

Results: After the single bout of training, self-selected and maximum overground walking speeds of the subjects with SCI increased by 26% and 25%, respectively. Furthermore, H-reflexes were significantly more depressed in the SCI subjects during overground walking (28% less during stance, 34% less during swing).

Conclusions: Although preliminary, these findings indicate that a single bout of locomotor training produced immediate increases in walking velocity and acute neurophysiologic changes in individuals with incomplete SCI.     

Clinical Assessment and Management of Obesity in Individuals With Spinal Cord Injury: A Review

Background: Diagnosing and managing obesity in individuals with spinal cord injury (SCI) remain challenging.

Methods: Literature on the epidemiology, impact, and management of obesity in individuals with SCI was reviewed.

Findings: Although nearly 66% of individuals with SCI are either overweight or obese, little guidance is available to measure and monitor obesity in the clinical setting. The use of anthropometric indices and specific cut points available for able-bodied persons is limited by the body composition changes that follow SCI. Indices of upper body obesity warrant examination in SCI because they provide an index of central obesity, which is more closely linked to some obesity-related conditions than is overall obesity. Investigations into the sequelae of excess body fat and its distribution are also needed in SCI because past research in this area has been inconclusive. Although limited, evidence regarding obesity interventions in SCI may be promising.

Conclusions: The best anthropometric tool to define obesity in the clinical setting remains unknown. SCI-specific assessment tools and a better understanding of the sequelae of excess body weight will lead to better targeting of prevention and treatment efforts. More research is needed on the individual components of a weight management program unique to SCI. Until then, providers are urged to use a team approach and draw on existing resources and applicable research in able-bodied individuals to facilitate weight management in individuals with SCI.     

Invited Review Carbohydrate And Lipid Metabolism In Chronic Spinal Cord Injury

Abstract

Background: Abnormalities of carbohydrate and lipid metabolism are more common in the spinal cord injury (SCI) population than in the able-bodied population. This is an important consideration in the long-term care of individuals with SCI.

Design: Literature review.

Findings: When compared with the able-bodied population, people with SCI are more likely to have oral carbohydrate intolerance, insulin resistance, elevated low-density lipoprotein cholesterol, and reduced high-density lipoprotein cholesterol, associated with increased prevalences of diabetes mellitus and cardiovascular disease.

Conclusions: Because of increased risk factors for diabetes mellitus and heart disease in individuals with SCI, modifiable risk factors should be addressed, eg, obesity, inactivity, dietary factors, and smoking. To reduce mortality and morbidity associated with these risk factors, periodic screening for carbohydrate and lipid abnormalities is recommended, with appropriate therapeutic interventions.     

Pulse Wave Velocity for Assessment of Arterial Stiffness Among People With Spinal Cord Injury: A Pilot Study

Background/Objective: The most significant complication and leading cause of death for people with spinal cord injury (SCI) is coronary artery disease (CAD). It has been confirmed that aortic pulse wave velocity (PVW) is an emerging CAD predictor among able-bodied individuals. No prior study has described PWV values among people with SCI. The objective of this study was to compare aortic (the common carotid to femoral artery) PWV, arm (the brachial to radial artery) PVW, and leg (the femoral to posterior tibial artery) PVW in people with SCI (SCI group) to able-bodied controls (non-SCI group).

Methods: Participants included 12 men with SCI and 9 non-SCI controls matched for age, sex, height, and weight. Participants with a history of CAD or current metabolic syndrome were excluded. Aortic, arm, and leg PVW was measured using the echo Doppler method.

Results: Aortic PVW (mean ± SD) in the SCI group (1,274 ± 369 cm/s) was significantly higher (P < 0.05) than in the non-SCI group (948 ± 110 cm/s). There were no significant between-group differences in mean arm PVW (SCI: 1,152 ± 193 cm/s, non-SCI: 1,237 ± 193 cm/s) or mean leg PVW (SCI: 1,096 ± 1 73 cm/s, non-SCI: 994 ±178 cm/s) values.

Conclusions: Aortic PVW was higher among the SCI group compared with the non-SCI group. The higher mean aortic PVW values among the SCI group compared with the non-SCI group indicated a higher risk of CAD among people with SCI in the absence of metabolic syndrome.     

A Pilot Study of Factors Associated With Falls in Individuals With Incomplete Spinal Cord Injury

Abstract

Background/Objective: To determine factors associated with falls among a sample of ambulatory individuals with incomplete spinal cord injury (SCI).

Study Design: Cross-sectional mail survey.

Methods: A survey instrument of participant characteristics and fall-related variables was developed using relevant items from existing measures and was mailed to 221 individuals with incomplete SCI, who were identified from records of a large specialty hospital in the southeastern United States. Of the 221 prospective participants, 119 completed the questionnaire (54%). Multivariable logistic regression models were used to determine factors that were independently associated with having had a fall in the past year.

Results: After adjusting for covariates, having fallen in the past year was significantly (P < 0.05) associated with greater numbers of medical conditions (odds ratio [OR] = 1.3; 95% confidence interval [Cl] = 1.0-1.7), having arthritis (OR = 3.4, 95% Cl = 1.2-9.6), experiencing dizziness (OR = 5.6, 95% Cl = 1.1-27.7), greater numbers of days with poor physical health (OR = 1.1; 95% Cl = 1.0-1.3), and the restriction of community activities because of fear of falling (OR = 1.5, 95% Cl = 1.1-2.1). The multivariable models also showed that the odds of having fallen were significantly lower among those with better current perceived physical health (OR = 0.5; 95% Cl = 0.3-0.9), those with better perceived health compared to a year ago (OR = 0.4; 95% Cl = 0.2-0.8), individuals who exercised more frequently (OR = 0.2; 95% Cl = 0.1-0.7), and those who used a walker (OR = 0.3; 95% CI = 0.1-0.9).

Conclusions: Results suggest that interventions that address exercise frequency, walker use, and dizziness have promise for reducing falls for individuals with incomplete SCI.     

Cardiac arrhythmias associated with spinal cord injury

Abstract

Context/Objectives

To review the current literature to reveal the incidence of cardiac arrhythmias and its relation to spinal cord injury (SCI).

Methods

Data source: MEDLINE database, 304 hits, and 32 articles were found to be relevant. The relevant articles all met the inclusion criteria: (1) contained original data (2) on cardiac arrhythmias (3) in humans with (4) traumatic SCI.

Results

In the acute phase of SCI (1–14 days after injury) more cranial as well as more severe injuries seemed to increase the incidence of bradycardia. Articles not covering the first 14 days after injury, thus describing the chronic phase of SCI, showed that individuals with SCI did not have a higher incidence of cardiac arrhythmias compared with able-bodied controls. Furthermore, their heart rate did not differ significantly. Penile vibro-stimulation was the procedure investigated most likely to cause bradycardia, which in turn was associated with episodes of autonomic dysreflexia. The incidence of bradycardia was found to be 17–77% for individuals with cervical SCI. For individuals with thoracolumbar SCI, the incidence was 0–13%.

Conclusion

Bradycardia was commonly seen in the acute stage after SCI as well as during procedures such as penile vibro-stimulation and tracheal suction. These episodes of bradycardia were seen more often in individuals with cervical injuries. Longitudinal studies with continuous electrocardiogram recordings are needed to uncover the true relation between cardiac arrhythmias and SCI.     

Circulating angiogenic biomolecules at rest and in response to upper-limb exercise in individuals with spinal cord injury

Abstract

Objective

Individuals with spinal cord injury (SCI) show structural and functional vascular maladaptations and muscle loss in their lower limbs. Angiogenic biomolecules play important roles in physiological and pathological angiogenesis, and are implicated in the maintenance of muscle mass. This study examined the responses of angiogenic molecules during upper-limb aerobic exercise in patients with SCI and in able-bodied (AB) individuals.

Methods

Eight SCI patients with thoracic lesions (T₆–T₁₂, ASIA A) and eight AB individuals performed an arm-cranking exercise for 30 minutes at 60% of their VO_2max. Plasma concentrations of vascular endothelial growth factor (VEGF-A₁₆₅), VEGF receptor 1 (sVEGFr-1), VEGF receptor 2 (sVEGFr-2), metalloproteinase 2 (MMP-2), and endostatin were measured at rest, after exercise, and at 1.5 and 3.0 hours during recovery.

Results

The two-way analysis of variance showed non-significant main effects of “group” and significant main effects of “time/exercise” for all angiogenic biomolecules examined (P < 0.01–0.001). The arm-cranking exercise significantly increased plasma concentrations of VEGF, sVEGFr-1, sVEGFr-2, MMP-2, and endostatin in both groups (P < 0.001–0.01). The magnitude of the increase was similar in both patients with SCI and AB individuals, as shown by the non-significant group × time interaction for all angiogenic parameters.

Conclusions

Upper-limb exercise (arm-cranking for 30 minutes at 60% of VO_2max) is a sufficient stimulus to trigger a coordinated circulating angiogenic response in patients with SCI. The response of angiogenic molecules to upper-limb aerobic exercise in SCI appears relatively similar to that observed in AB individuals.     

Dietary intake and adherence to the 2010 Dietary Guidelines for Americans among individuals with chronic spinal cord injury: A pilot study

Abstract

Objective

To investigate dietary intake and adherence to the 2010 Dietary Guidelines for Americans in individuals with chronic spinal cord injury (SCI) and able-bodied individuals.

Design

A pilot study of dietary intake among a sample of individuals with SCI >1 year ago from a single site compared with able-bodied individuals.

Participants/methods

One hundred black or white adults aged 38–55 years old with SCI >1 year and 100 age-, sex-, and race-matched adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary intake was assessed by the CARDIA dietary history. Linear regression analysis was used to compare dietary intake between the subjects with SCI and those enrolled in the CARDIA study. Further, adherence to the 2010 Dietary Guidelines for dairy, fruits, and vegetables, and whole-grain foods was assessed.

Results

Compared with CARDIA participants, participants with SCI consumed fewer daily servings of dairy (2.10 vs. 5.0, P < 0.001), fruit (2.01 vs. 3.64, P = 0.002), and whole grain foods (1.20 vs. 2.44 P = 0.007). For each food group, fewer participants with SCI met the recommended servings compared with the CARDIA participants. Specifically, the participants with SCI and in CARDIA who met the guidelines were, respectively: dairy, 22% vs. 54% (P < 0.001), fruits and vegetables 39% vs. 70% (P = 0.001), and whole-grain foods 8% vs. 69.6% (P = 0.001).

Conclusions

Compared with able-bodied individuals, SCI participants consumed fewer daily servings of fruit, dairy, and whole grain foods than proposed by the 2010 Dietary Guideline recommendations. Nutrition education for this population may be warranted.     

Lipid profiles are influenced by arm cranking exercise and training in individuals with spinal cord injury

STUDY DESIGN: A prospective, two-group comparative intervention study. OBJECTIVE: To determine the acute and training effects of arm cranking exercise on blood lipid profiles in wheel chair bound individuals with spinal cord injury (SCI) and normal able-bodied subjects. SETTING: Faculty of Science, School of Sport and Exercise Science, Liverpool John Moores University, England. METHODS: Total cholesterol, triglyceride and high-density lipoprotein cholesterol (HDL-C) at rest and in response to arm cranking exercise before and after 12 weeks of training were compared between individuals with SCI (N = 5) and able-bodied subjects (N = 7). Following the determination of peak oxygen consumption (VO2peak), all subjects performed a submaximal arm cranking exercise at an intensity corresponding to 60-65% VO2peak for 30 min. Venous blood samples were obtained before and after submaximal exercise and measured for total cholesterol, triglycerides and HDL-C concentrations. These lipid parameters were remeasured in all subjects at rest and in response to the same submaximal arm cranking exercise after 12 weeks of individually supervised arm cranking training programme. RESULTS: Before training, the resting mean value of triglyceride in individuals with SCI was significantly (P < 0.05) higher than that found in able-bodied persons. Acute arm cranking exercise did not change total cholesterol or triglyceride concentrations in either the SCI or the able-bodied groups. However, HDL-C increased significantly following exercise in the able-bodied subjects. Following training, the resting mean value of total cholesterol in the group with SCI was significantly (P < 0.05) higher compared with able-bodied individuals. Furthermore, the resting and post submaximal arm cranking exercise mean values of total cholesterol in the able-bodied group, but not in the group with SCI, were significantly lower than those observed before training. While the resting mean value of HDL-C before training in the group with SCI was lower than that found in the able-bodied, this difference did not reach the designated level of significance (P > 0.05). Submaximal arm cranking exercise was followed by a significant increase in HDL-C only in the able-bodied individuals. Compared to pretraining, the resting and post arm cranking exercise levels of HDL-C in the group with SCI increased significantly (P < 0.05) after training. CONCLUSION: It is concluded that acute arm cranking exercise and training in individuals with SCI is associated with favourable effects on HDL-C, whereas total cholesterols and triglycerides were not altered. The mechanism responsible for the increase in HDL-C with training in individuals with SCI is not known, but it is likely to be related to increased activity of cholesterol transport enzymes lipoprotein lipase and acyltransferase.     

Physical exercise improves arterial stiffness after spinal cord injury

Abstract

Objective/background

Aortic pulse wave velocity (PWV), the gold-standard assessment of central arterial stiffness, has prognostic value for cardiovascular disease risk in able-bodied individuals. The aim of this study was to compare aortic PWV in athletes and non-athletes with spinal cord injury (SCI).

Design

Cross-sectional comparison.

Methods

Aortic PWV was assessed in 20 individuals with motor-complete, chronic SCI (C2–T5; 18 ± 8 years post-injury) using applanation tonometry at the carotid and femoral arterial sites. Ten elite hand-cyclists were matched for sex to 10 non-athletes; age and time since injury were comparable between the groups. Heart rate and discrete brachial blood pressure measurements were collected throughout testing.

Outcome measures

Aortic PWV, blood pressure, heart rate.

Results

Aortic PWV was significantly lower in athletes vs. non-athletes (6.9 ± 1.0 vs. 8.7 ± 2.5 m/second, P = 0.044). There were no significant between-group differences in resting supine mean arterial blood pressure (91 ± 19 vs. 81 ± 10 mmHg) and heart rate (60 ± 10 vs. 58 ± 6 b.p.m.).

Conclusion

Athletes with SCI exhibited improved central arterial stiffness compared to non-athletes, which is in agreement with the previous able-bodied literature. This finding implies that chronic exercise training may improve arterial health and potentially lower cardiovascular disease risk in the SCI population.     

SCI Article & Abstract Review

Abstract

Background/Objective: Differences in soft-tissue stiffness may provide for a quantitative assessment and detection technique for pressure ulcers or deep-tissue injury. An ultrasound indentation system may provide a relatively convenient, simple, and noninvasive method for quantitative measurement of changes in soft- tissue stiffness in vivo.

Methods: The Tissue Ultrasound Palpation System (TUPS) was used to quantitatively measure changes in soft-tissue stiffness at different anatomical locations within and between able-bodied persons and individuals with chronic spinal cord injury (SCI). The stiffness of soft tissue was measured at the ischial tuberosity, greater trochanter, posterior midthigh, and biceps brachii. Additionally, soft-tissue thickness and soft-tissue deformation were also measured.

Results: Significant differences in soft-tissue stiffness were observed within the various anatomical locations tested, in both the able-bodied and SCI groups. Differences in soft-tissue stiffness were also observed between the 2 groups. Participants with SCI had significantly softer tissue in their buttock-thigh area.

Conclusions: TUPS is a clinically feasible technology that can reliably and effectively detect changes in soft-tissue stiffness. The study has provided a better understanding of the tissue mechanical response to external loading, specifically in the SCI population, suggesting the use of tissue stiffness as a parameter to detect and assess pressure-related soft-tissue injury.     

Motor Vehicle Mismatch-Related Spinal Injury

Abstract

Background/Objective: Motor vehicle collision (MVC)-related spinal cord injury (SCI) is the mostprevalent etiology of SCI. Few studies have defined SCI risk factors. Vehicle mismatch occurs in 2-vehicleMVCs in which there are significant differences in vehicle weight, stiffness, and height. This study examinedSCI risk and vehicle mismatch.

Methods: A matched case-control study using the 1995 to 2003 National Automotive Sampling System(NASS). Study subjects were identified from 2-vehicle MVCs. Cases were occupants who had suffereda cervical, thoracic, or lumbar SCI. Odds ratios (ORs) and 95% confidence intervals (Cis) were calculated.

Results: There were 101,682 cases of SCI matched to 805,091 controls. Occupants of passenger vehiclesinvolved in MVCs with a light truck or van (LTV) were at increased risk for SCI (OR= 1.87, 95% Cl= 1.07-3.24) and this risk was greatest for thoracic SCI (OR= 5.09, 95% Cl= 2.33-11.13). In addition, occupants ofL TVs involved in MVCs with passenger vehicles were at significant increased risk for cervical (OR= 1. 39) andlumbar (OR= 2.65) SCI; and occupants of LTVs involved in MVCs with other LTVs were at increased risk ofany SCI (OR= 2.02, 95% Cl= 1.52-2.69). For these subjects, significant increased risks were seen for all spineregions: cervical (OR= 1.41), thoracic (OR= 2.86), and lumbar (OR= 2.38).

Conclusions: The results of this study suggest that occupants of passenger vehicles are at increased SCI riskwhen involved in 2-vehicle MVCs with L TVs; and that occupants of L TVs are at increased SCI risk, regardless     

Resting energy expenditure in male athletes with a spinal cord injury

Objective: To investigate whether there are differences in the resting energy expenditure (REE) and body composition of athletes with a spinal cord injury (SCI) compared to active able-bodied controls.

Design: In this cross sectional study, male athletes with a SCI were compared to active able-bodied controls matched for age, stretch stature and body mass. In addition, the accuracy of standard REE prediction equations in estimating REE was assessed.

Participants: Seven male wheelchair athletes with a SCI and six matched active able-bodied controls volunteered to participate.

Outcome measures: REE was measured using indirect calorimetry and estimated using population-specific prediction equations. Body composition (lean tissue mass, fat mass and bone mineral content) was measured by dual energy X-ray absorptiometry (DXA).

Results: While absolute and adjusted REE in the athletes with SCI was lower than controls, this difference was not significant (P?=?0.259). When adjusted for lean tissue mass (LTM), REE was significantly higher (P?=?0.038) in the athletes with SCI compared to the controls (146 ± 29kJ/kg LTM vs. 125 ± 8kJ/kg LTM). LTM was significantly lower in the athletes with SCI (44.35 ± 6.98?kg) compared to the able-bodied controls (56.02 ± 4.93?kg; P < 0.01). The differences between predicted and measured REE in the athletes with SCI were not statistically significant (except for the Owen equation), however there was no significant correlation between the measures.

Conclusion: This suggests that existing prediction equations used to estimate energy requirements may require modification for athletes with SCI.     

Healthcare facility-onset,healthcare facility-associated Clostridioides difficile infection in Veterans with spinal cord injury and disorder

Abstract

Objective: To describe the burden and risk of healthcare facility-onset, healthcare facility-associated (HO-HCFA) Clostridioides difficile infection (CDI) in Veterans with spinal cord injury and disorder (SCI/D).

Design: Retrospective, longitudinal cohort study from October 1, 2001–September 30, 2010.

Setting: Ninety-four acute care Veterans Affairs facilities.

Participants: Patients with SCI/D.

Outcomes: Incidence rate of HO-HCFA CDI.

Methods: Rates of CDI were determined, and crude unadjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated. Multivariable Poisson random-effects regression analyses were used to assess factors independently associated with the rate of CDI.

Results: 1,409 cases of HO-HCFA CDI were identified. CDI rates in 2002 were 13.9/10,000 person-days and decreased to 5.5/10,000 person-days by 2010. Multivariable regression analyses found that antibiotic (IRR?=?18.79, 95% CI 14.09-25.07) and proton-pump inhibitor (PPI) or H2 blocker use (IRR?=?7.71, 95% CI 5.47-10.86) were both independently associated with HO-HCFA CDI. Exposure to both medications demonstrated a synergistic risk (IRR?=?37.55, 95% CI 28.39-49.67). Older age, Northeast region, and invasive respiratory procedure in the prior 30 days were also independent risk factors, while longer SCI duration and care at a SCI center were protective.

Conclusion: Although decreasing, CDI rates in patients with SCI/D remain high. Targeted antimicrobial stewardship and pharmacy interventions that reduce antibiotic and PPI/H2 blocker use could have profound benefits in decreasing HO-HCFA CDI in this high-risk population.     

Platform Presentations 1–36

Abstract

Objective

Stiffness and viscosity represent passive resistances to joint motion related with the structural properties of the joint tissue and of the musculotendinous complex. Both parameters can be affected in patients with spinal cord injury (SCI). The purpose of this study was to measure passive knee stiffness and viscosity in patients with SCI with paraplegia and healthy subjects using Wartenberg pendulum test.

Design

Non-experimental, cross-sectional, case–control design.

Setting

An outpatient physical therapy clinic, University of social welfare and Rehabilitation Science, Iran.

Patients

A sample of convenience sample of 30 subjects participated in the study. Subjects were categorized into two groups: individuals with paraplegic SCI (n = 15, age: 34.60 ± 9.18 years) and 15 able-bodied individuals as control group (n = 15, age: 30.66 ± 11.13 years).

Interventions

Not applicable.

Main measures

Passive pendulum test of Wartenberg was used to measure passive viscous-elastic parameters of the knee (stiffness, viscosity) in all subjects.

Results

Statistical analysis (independent t-test) revealed significant difference in the joint stiffness between healthy subjects and those with paraplegic SCI (P = 0.01). However, no significant difference was found in the viscosity between two groups (P = 0.17). Except for first peak flexion angle, all other displacement kinematic parameters exhibited no statistically significant difference between normal subjects and subjects with SCI.

Conclusions

Patients with SCI have significantly greater joint stiffness compared to able-bodied subjects.     

Examining implicit bias of physicians who care for individuals with spinal cord injury: A pilot study and future directions

Abstract

Context

Despite evidence that healthcare providers have implicit biases that can impact clinical interactions and decisions, implicit bias among physicians caring for individuals with spinal cord injury (SCI) has not been examined.

Objective

Conduct a pilot study to examine implicit racial bias of SCI physicians and its association with functioning and wellbeing for individuals with SCI.

Design

Combined data from cross-sectional surveys of individuals with SCI and their SCI physicians.

Setting

Four national SCI Model Systems sites.

Participants

Individuals with SCI (N = 162) and their SCI physicians (N = 14).

Outcome measures

SCI physicians completed online surveys measuring implicit racial (pro-white/anti-black) bias. Individuals with SCI completed questionnaires assessing mobility, physical independence, occupational functioning, social integration, self-reported health, depression, and life satisfaction. We used multilevel regression analyses to examine the associations of physician bias and outcomes of individuals with SCI.

Results

Physicians had a mean bias score of 0.62 (SD = 0.35), indicating a strong pro-white/anti-black bias. Greater physician bias was associated with disability among individuals with SCI in the domain of social integration (odds ratio = 4.80, 95% confidence interval (CI) = 1.44, 16.04), as well as higher depression (B = 3.24, 95% CI = 1.06, 5.41) and lower life satisfaction (B = ?4.54, 95% CI= ?8.79, ?0.28).

Conclusion

This pilot study indicates that SCI providers are susceptible to implicit racial bias and provides preliminary evidence that greater implicit racial bias of physicians is associated with poorer psychosocial health outcomes for individuals with SCI. It demonstrates the feasibility of studying implicit bias among SCI providers and provides guidance for future research on physician bias and patient outcomes.