Association of musculoskeletal pain,fear-avoidance factors,and quality of life in active manual wheelchair users with SCI: A pilot study

Objective: Limited evidence examines the association of psychological factors, such as fear of movement and pain catastrophizing, with musculoskeletal pain patterns in active manual wheelchair users with spinal cord injury (SCI). This study investigated the relationship among musculoskeletal pain, fear avoidance factors, quality of life (QoL), activity and duration of injury in individuals with SCI.

Design: Cross-sectional correlational.

Setting: Community setting.

Participants: Twenty-six individuals with SCI (age?=?42?±?14 years, duration manual wheelchair use?=?17?±?13 years, work/school/volunteer hours/week?=?31?±?14; recreation/sports hours/week 10?±?12).

Outcome Measures: Demographics and self-report measures including the Musculoskeletal Pain Survey (MPS), Wheelchair Users Shoulder Pain Index (WUSPI), Tampa Scale of Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS), Fear of Pain (FPQ), Subjective Quality of Life Questionnaire (SQoL), and the Social Interaction Inventory (SII). Spearman’s rho (ρ) assessed correlation among measures.

Results: Strong association existed between age and duration of injury (ρ?=?0.66, P?<?0.001). SQoL offered a strong, direct correlation with age (ρ?=?0.63, P?=?0.01), duration of injury (ρ?=?0.70, P?=?0.001), and strong, inverse relationship with MPStotal (ρ?=??0.66, P?=?0.003) and MPS shoulder subscore (ρ?=??0.64, P?=?0.004). WUSPI demonstrated strong, inverse association with self-reported work hours (ρ?=??0.52, P?=?0.02) and a strong, direct relationship to PCS (ρ?=?0.79, P?=?<0001). PCS demonstrated a strong, inverse relationship to work/school/volunteer hours (ρ?=?0.71, P?<?0.001) and strong association to TSK-11_total (ρ?=?0.61, P?=?0.001). A moderate, inverse relationship was identified for recreational/sports hours and FPQ (ρ?=?0.48, P?=?0.03).

Conclusion: This cyclical relationship of musculoskeletal pain, reduced activity, and maladaptive psychological factors allude to interdependence of factors, supporting the multidisciplinary approach to care.     

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

Objective: To investigate potential linkages between pressure injury (PrI) recurrence following spinal cord injury (SCI) and muscle-based and circulatory biomarkers, specifically fatty metabolites and inflammatory cytokines.

Design: Observational study.

Setting: Tertiary Care Center.

Participants: 30 individuals with complete or incomplete SCI. Study participants either had never developed a PrI (Group I) or had a history of recurrent PrI (Group II).

Interventions: Not applicable.

Outcome Measures: Gluteal muscle histology, immunohistochemistry, muscle-based and circulatory fatty metabolites and inflammatory cytokines.

Results: Gluteal intramuscular adipose tissue (IMAT) was greater than 15% in most Group II (83%) individuals. Muscle tissue histology confirmed intramuscular structural differences. Fatty acid binding protein 4 (FABP4) and fatty acid binding protein 3 (FABP3) were reliably detected in muscle and blood and significantly correlated with IMAT (P?<?0.001). FABP4 was significantly higher in Group II muscle and blood (P?<?0.05). FABP3 was significantly higher in Group I muscle (P?<?0.05). Circulatory FABP3 levels were lower for Group I. Inflammatory biomarkers were more reliably detected in blood. Colony-Stimulating Factor-1 was slightly higher in Group II muscle. Circulatory interleukin-13 was significantly higher (P?<?0.01) in Group I. Vascular endothelial growth factor (VEGF-A) was significantly increased (P?<?0.05) in Group I muscle and blood.

Conclusion: Identifying individuals with SCI at highest risk for recurrent PrI may impact patient management. IMAT content evaluation illustrates that muscle quality is a key biomarker. Low circulatory inflammatory biomarker expression potentially limits clinical significance for between group differences. Circulatory levels of FABP4 hold great potential as a recurrent PrI risk biomarker.     

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.     

Evaluation of bone mineral loss in patients with chronic traumatic spinal cord injury in Iran

Abstract

Objectives

We described the associations between demographic and injury-related factors on bone mineral density (BMD) of the spine and the hip among adult patients with chronic spinal cord injury (SCI).

Design

BMD in spinal and femoral bone sites were assessed. Multivariate analysis was performed to evaluate the relationship between anthropometric and injury-related factors with BMD. Serum level and amount of dietary intake of calcium, phosphor, and 25-hydroxy vitamin D were measured.

Setting

A referral tertiary rehabilitation center in Iran.

Participants

Patients with SCI who had no previous history of endocrine disorders and were not on specific medications entered the investigation. Those with non-traumatic SCI, pregnant, or with substance dependency were excluded as well.

Interventions

No interventions were applied.

Main study outcome measures

Dual X-ray absorptiometry was performed to estimate BMD. Body mass index was positively associated with higher femoral (P < 0.01, r = 0.56) and hip (P < 0.0001, r = 0.82) BMD only in female participants. The high prevalence of vitamin D deficiency (60%) was noticeable.

Results

Older male patients revealed lower BMD only in spinal vertebrae (P < 0.02, r = ?0.21). A significant higher BMD loss in lumbar vertebras in male patients with complete spinal cord lesion (P < 0.009) was detected. Spinal reduction of BMD was more severe when the level of injury was above T6 (P < 0.02).

Conclusion

Along with the clarification of age, gender, post injury duration, and the other factors' effect on the BMD in the SCI patients, here we have also shown the noticeable prevalence of the 25-hydoxy vitamin D deficiency in these patients which needs attention.     

Longitudinal changes in body composition and metabolic profile between exercise clinical trials in men with chronic spinal cord injury

Study design: Longitudinal design.

Objectives: The study was undertaken to determine the effects of cessation of exercise interventions on body composition and metabolic profiles in men with chronic SCI.

Settings: Clinical trials within a Medical Center.

Methods: Eleven men with motor complete SCI were followed on average over a period of 2.5 years. Six men were involved in two different exercise interventions (functional electrical stimulation cycling versus arm cycling ergometer), 5 days/week for 16 weeks (exercise group), and five men served as a control (control group). Anthropometrics and dual energy X-ray absorptiometry (DXA) were captured to measure changes in lean mass (LM), fat mass (FM), percentage FM before, immediately after exercise, and after a period of 2.5 years. Basal metabolic rate (BMR) and lipid panel were also measured.

Results: Thigh circumference increased by 8.5% following exercise (P?=?0.042) and remained 6.4% greater than baseline measurements (P?=?0.012). Leg LM increased by 9% following the exercise intervention (P?=?0.03) and decreased by 16% in the follow-up visit (P?=?0.02). Percentage trunk and total body FM increased by 4.5% (P?=?0.008) and 3.5% (P?=?0.019) in the follow-up visit, respectively, and whole body LM increased by 8.4% and decreased back by 5.4% following a 2.5 year-period. BMR significantly decreased by 15.5% following the exercise (P?=?0.029) interventions.

Conclusion: Exercise training is accompanied with positive changes in body composition as well as compensatory decrease in BMR, that regressed back following 2.5 years of exercise cessation. Participation in an exercise trial is unlikely to confound the measurements of a follow-up trial.     

Auricular acupuncture for spinal cord injury related neuropathic pain: a pilot controlled clinical trial

Objective: To obtain preliminary data on the effects of an auricular acupuncture protocol, Battlefield Acupuncture (BFA), on self-reported pain intensity in persons with chronic Spinal Cord Injury (SCI) and neuropathic pain.

Design: Pilot randomized delayed entry single center crossover clinical trial at an outpatient rehabilitation and integrative medicine hospital center.

Methods: Chronic (> one year post injury) ASIA impairment scale A through D individuals with SCI with injury level from C3 through T12 and below level neuropathic pain with at least five on the Numeric Rating Scale (NRS) were recruited. Twenty-four subjects were randomized to either an eight-week once weekly ten-needle BFA protocol (n?=?13) or to a waiting list followed by the BFA protocol (n?=?11).

Outcome measures: The primary outcome measure was change in the pain severity NRS. Secondary outcome was the Global Impression of Change.

Results: Demographically there were no significant differences between groups. Mean pain scores at baseline were higher in acupuncture than control subjects (7.75?±?1.54 vs. 6.25?±?1.04, P?=?0.027). Although both groups reported significant reduction in pain during the trial period, the BFA group reported more pain reduction than the delayed entry group (average change in NRS at eight weeks –2.92?±?2.11 vs. ?1.13?±?2.14, P?=?0.065). There was a significant difference in groups when a group-by-time interaction in a mixed-effect repeated measures model (P?=?0.014).

Conclusion: This pilot study has provided proof of concept that BFA has clinically meaningful effect on the modulation of SCI neuropathic pain.     

Omega-3 fatty acids enhance tumor necrosis factor-alpha levels in heart transplant recipients.

BACKGROUND: Proinflammatory cytokines may contribute to clinical complications in heart transplant (HTx) recipients. Previous studies have shown immunomodulating effects of omega-3 fatty acids, but the results are somewhat conflicting. In this study, we examined plasma levels of tumor necrosis factor alpha (TNF-alpha), interleukin (IL) 10, and their relations to antioxidant vitamins in 45 HTx recipients before and after treatment with omega-3 fatty acids or placebo. METHODS: The patients were long-time survivors of heart transplantation, randomized in a double-blind fashion to receive omega-3 fatty acids (3.4 g/day) or placebo for 1 year. Plasma levels of cytokines were measured by enzyme immunoassays and vitamin A, vitamin E, and beta-carotene by high-performance liquid chromatography. RESULTS: In the omega-3, but not in the placebo group, there was a rise in the proinflammatory cytokine TNF-alpha (P<0.05), a decrease in the anti-inflammatory cytokine IL-10 (P=0.07), and a rise in TNF/IL-10 ratio (P<0.05) after 12 months, suggesting a proinflammatory net effect. In the omega-3 group, the increase in TNF-alpha was associated with an increase in eicosapentaenoic acid in plasma (r=0.58, P<0.02). During omega-3 fatty-acid treatment, but not during placebo, there was a decrease in vitamin E (P<0.05) and beta-carotene (P<0.05) levels, and the decrease in vitamin E was inversely correlated with the increase in TNF-alpha (r= -0.56, P<0.01). The rise in TNF-alpha levels during omega-3 fatty acids treatment was most pronounced in those patients with transplant coronary artery disease (P<0.04). CONCLUSION: Our data suggest that omega-3 fatty acids in HTx recipients may change the balance between proinflammatory and anti-inflammatory cytokines in an inflammatory direction, possibly related to prooxidative effects of these fatty acids.     

Prediction of thigh skeletal muscle mass using dual energy x-ray absorptiometry compared to magnetic resonance imaging after spinal cord injury

Objectives: A rapid decline in lean mass (LM), fat-free mass (FFM) and increased intramuscular fat (IMF) predispose persons with spinal cord injury (SCI) to chronic medical conditions including dyslipidemia, insulin resistance, type 2 diabetes mellitus and cardiovascular disease. (1) To determine the relationship between dual energy x ray absorptiometry (DXA) and gold standard magnetic resonance imaging (MRI) LM values; (2) to develop predictive equations based on this relationship for assessing thigh LM in persons with chronic SCI.

Study Design: Cross-sectional predicational design.

Settings: Clinical research medical center.

Participants: Thirty-two men with chronic (>1 y post-injury) motor complete SCI.

Methods: Participants completed total body DXA scans to determine thigh LM and were compared to measurements acquired from trans-axial MRI.

Outcome measures: MRI was used to measure whole muscle mass (MM_MRI-WM), absolute muscle mass (MM_MRI-ABS) after excluding IMF, and knee extensor muscle mass (MM_MRI-KE). DXA was used to measure thigh LM (LM_DXA) and (FFM_DXA). To predict MM_MRI-KE, LM_DXA was multiplied by 0.52 and yielded LM_DXA-KE.

Results: LM_DXA predicted MM_MRI-WM [r²_?=?0.90, standard error of the estimate (SEE)?=?0.23?kg, P?<?0.0001] and MM_MRI-ABS (r²?=?0.82, SEE?=?0.28?kg, P?<?0.0001). LM_DXA-KE predicted MM_MRI-KE (r²?=?0.78, SEE?=?0.16?kg, P?<?0.0001).

Conclusion: DXA measurements revealed an acceptable agreement with the gold standard MRI and may be a viable alternative for assessing thigh skeletal muscle mass after SCI.     

The analysis of serum lipid levels in patients with spinal cord injury

Study design: Retrospective study.

Objectives: The purposes of this investigation were to evaluate the serum lipid profile among a broad sample of patients with spinal cord injury (SCI), examining the impact of disease duration, lesion level, lesion grade and functional activity level on serum lipid levels of patients with SCI.

Setting: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey.

Methods: Serum lipid profiles of 269 participants with SCI were analyzed and correlated to disease duration, lesion level, lesion grade and ambulation status.

Results: Total cholesterol (TC) was higher than normal in 21.2%, low density lipoprotein cholesterol in 24.4%, and triglycerides levels in 31% of the patients. The high density lipoprotein cholesterol (HDL-c) level was found to be lower than 40?mg/dl in 79.5% of the patients, TC/HDL-c ratio was 4.5 and above in 65.7% of the patients in our study. TC/HDL-c ratio was significantly higher in patients with SCI with a disease duration of 0–12 months than the group with a longer disease duration (P?=?0.009). TC/HDL-c ratio was significantly higher in patients who could not be community ambulated than the patients who were community ambulated (P?=?0.005). HDL-c levels in patients with motor complete SCI were significantly lower than patients with motor incomplete SCI (P?=?0.028).

Conclusion: Dyslipidemia is observed in a large number of patients with SCI. The risk of dyslipidemia was seen to have increased in motor complete SCI patients, in patients who can not be community ambulated and whose disease duration is between 0 to 12 months.     

Short-term effects of respiratory muscle training combined with the abdominal drawing-in maneuver on the decreased pulmonary function of individuals with chronic spinal cord injury: A pilot randomized controlled trial

Objective: To investigate the effects of respiratory muscle training (RMT) combined with the abdominal drawing-in maneuver (ADIM) on the pulmonary function in patients with chronic spinal cord injury (SCI).

Methods: Thirty-seven subjects with SCI (level of injury: C4–T6, time since injury: 4–5 years) were randomly allocated to three groups; the integrated training group (ITG), the RMT group (RMTG), and the control group (CG). The ITG performed RMT using an incentive respiratory spirometer (IRS) and the ADIM using a stabilizer. The RMTG received only RMT using an IRS. Subjects in the CG received alternative and routine physical therapy or usual care. The interventions were conducted over an eight-week period. Pulmonary function was evaluated using spirometry to measure the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁).

Results: The differences between the pre- and post-test values for FVC (0.47?±?0.05 versus 0.15?±?0.06 versus –0.03?±?0.01) and FEV₁ (0.74?±?0.07 versus 0.27?±?0.17 versus 0.02?±?0.67)were significant among the groups. Post-test, in the ITG, the FVC and FEV₁ values showed significant differences from those in the RMTG and CG (F?=?11.48 and 11.49, P?=?0.002 and 0.001). Furthermore, following the 8­week intervention, the change ratio values of the FVC and FEV₁ of the ITG were increased further by an average of 9.75% and 7.91%, respectively, compared with those of the RMTG.

Conclusion: These findings suggest positive evidence that RMT with additional ADIM training can improve pulmonary function in SCI pulmonary rehabilitation.     

Utilization and access to healthcare services among community-dwelling people living with spinal cord injury

Objective: Describe the utilization, accessibility, and satisfaction of primary and preventative health-care services of community-dwelling individuals with spinal cord injury (SCI).

Design: Cross sectional, in-person or telephonic survey, utilizing a convenience sample.

Setting: Community.

Participants: Individuals with SCI greater than 12-months post injury.

Interventions: N/A.

Outcome measures: Demographic, injury related, and 34-item questionnaire of healthcare utilization, accessibility, and satisfaction with services.

Results: The final sample consisted of 142 participants (50 female, 92 male). Ninety-nine percent of respondents had a healthcare visit in the past 12-months with primary care physicians (79%), with SCI physiatrists (77%) and urologists (50%) being the most utilized. 43% of the sample reported an ER visit within the past 12-months, with 21% reporting multiple visits. People who visited the ER had completed significantly less secondary education (P?=?0.0386) and had a lower estimate of socioeconomic status (P?=?0.017). The majority of individuals (66%) were satisfied with their primary care physician and 100% were satisfied with their SCI physiatrist. Individuals who did not visit an SCI physiatrist were significantly more likely to live in a rural area (P?=?0.0075), not have private insurance (P?=?0.0001), and experience a greater decrease in income post injury (P?=?0.010).

Conclusion: The delivery of care for people with SCI with low socioeconomic status may be remodeled to include patient-centered medical homes where care is directed by an SCI physiatrist. Further increased telehealth efforts would allow for SCI physiatrists to monitor health conditions remotely and focus on preventative treatment.     

Regional estimates of cortical thickness in brain areas involved in control of surgically restored limb movement in patients with tetraplegia

Context/Objective: Spinal cord injury (SCI) causes atrophy of brain regions linked to motor function. We aimed to estimate cortical thickness in brain regions that control surgically restored limb movement in individuals with tetraplegia.

Design: Cross-sectional study.

Setting: Sahlgrenska University hospital, Gothenburg, Sweden.

Participants: Six individuals with tetraplegia who had undergone surgical restoration of grip function by surgical transfer of one elbow ?exor (brachioradialis), to the paralyzed thumb ?exor (?exor pollicis longus). All subjects were males, with a SCI at the C6 or C7 level, and a mean age of 40 years (range?=?31–48). The average number of years elapsed since the SCI was 13 (range?=?6–26).

Outcome measures: We used structural magnetic resonance imaging (MRI) to estimate the thickness of selected motor cortices and compared these measurements to those of six matched control subjects. The pinch grip control area was defined in a previous functional MRI study.

Results: Compared to controls, the cortical thickness in the functionally defined pinch grip control area was not significantly reduced (P?=?0.591), and thickness showed a non-significant but positive correlation with years since surgery in the individuals with tetraplegia. In contrast, the anatomically defined primary motor cortex as a whole exhibited substantial atrophy (P?=?0.013), with a weak negative correlation with years since surgery.

Conclusion: Individuals with tetraplegia do not seem to have reduced cortical thickness in brain regions involved in control of surgically restored limb movement. However, the studied sample is very small and further studies with larger samples are required to establish these findings.     

Five-Year Longitudinal Bone Evaluations In Individuals With Chronic Complete Spinal Cord Injury

Background/Objectives:Knowledge of spinal cord injury (SCI) bone changes has been derived primarilythrough cross-sectional studies, many of which are controvertible. Longitudinal studies are sparse, and longtermlongitudinal chronic studies are unavailable. The objective of this study was to provide a clearerperception of chronic longitudinal bone variations in people with complete SCI.

Methods:Bone status of 31 individuals with chronic, complete SCI was assessed twice using dual-energy xrayabsorptiometry at an average interval of 5.06 ± 0.9 years. Because the sample of women was small (4),the primary analyses of change and comparisons of those with paraplegia vs tetraplegia were confined to themale participants.

Results: Spine Z-scores showed a significant increase (P < 0.0001 ). The average Z-scores, initial and followup,were within the normal range. Hip Z-scores also showed a significant increase (P < 0.0001 ), and hipbone mineral density (BMD) increased in 48% of the participants. Knee BMD and lower extremity total bonemineral showed significant decreases (P < 0.003 and P < 0.02, respectively), but increases were seen in 33% and 26% at the respective sites. Individuals with tetraplegia had significantly lower values across all regions(P < 0.0001 ), and changes were significantly different compared with paraplegia (P < 0.0001 ). Bone valuesand changes in men vs women, despite the small sample of women, showed highly significant differences(P < 0.003?0.002).

Conclusion:Chronic effects of complete SCI do not exclusively result in continued loss of BMD or a staticstate of lowered BMD; gain in BMD may occur. The nature and magnitude of the effects of complete SCI on BMD vary by site, with sex and level of injury, which has implications for treatment and its assessment.     

Secondary conditions in a community sample of people with spinal cord damage

Objective: To compare secondary conditions in people with traumatic spinal cord injury (SCI) and non-traumatic spinal cord dysfunction (SCDys).

Design: Survey; completed August 2012 – June 2013.

Setting: Community, Australia.

Participants: Adults with spinal cord damage from any cause.

Interventions: Nil.

Outcome Measures: Demographic and clinical variables and the SCI-Secondary Conditions Scale (SCI-SCS).

Results: Survey completed by 150 people: 112 (74.7%) with traumatic SCI and 38 (25.3%) with non-traumatic SCDys a median of 10 years post onset. No significant difference (t?=?–0.6, P?=?0.6) in the total SCI-SCS score between those with SCI (mean 13.7) and SCDys (mean 14.4). Except for bladder problems (SCDys mean?=?1.5, SD?=?1.1; SCI mean?=?1.0, SD=1.1; t?=?–2.6, P?=?0.01) there were no significant differences between the aetiology groups regarding the conditions comprising the SCI-SCS (all other P values >0.1). The most common significant or chronic problems from the SCI-SCS were: sexual problems 41%; chronic pain 24%; bladder dysfunction 17%; spasms 17%; joint and muscle pain 15%; bowel dysfunction 14%; circulation problems 14%; contractures 9%; urinary tract infections 9%; pressure ulcer 7% and postural hypotension 5%. A linear regression analysis found that tetraplegia and higher disability were the only variables that significantly influenced (R²?=?0.13; P?=?0.005) the total SCI-SCS score and that sex, age, years post injury and etiology of spinal cord damage had no influence.

Conclusions: Secondary conditions following spinal cord damage do not appear to be influenced by etiology. Prevention and management of secondary conditions following need to consider people with non-traumatic SCDys as well as those with traumatic SCI.     

Sex dimorphism in the distribution of adipose tissue and its influence on proinflammatory adipokines and cardiometabolic profiles in motor complete spinal cord injury

Objective: We aimed to examine the influence of sex on the distribution of adipose tissue, as well as proinflammatory adipokine and cardiometabolic profiles, in chronic motor complete spinal cord injury (SCI).

Design: Cross-sectional and correlational study.

Setting: Academic rehabilitation hospital.

Participants: Forty-seven individuals with chronic motor complete SCI classified according to sex (males: age 44.0?±?10.9 y, body mass index (BMI) 27.2?±?5.8, level of injury (LOI) C4 - L1; females: 42.0?±?13.5 y, BMI 27.8?±?6.6, LOI C4 - T11).

Intervention: Not applicable.

Outcome Measures: Visceral (VAT), subcutaneous (SAT), and total trunk (TTAT) adipose tissue volumes were assessed utilizing magnetic resonance imaging and a VAT:SAT ratio was calculated. Proinflammatory adipokines (tumor neurosis factor-α, interleukin-6, plasminogen activator inhibitor-1, thrombin-activatable fibrinolysis inhibitor, and high sensitivity c-reactive protein) and cardiovascular, carbohydrate, and lipid profiles were evaluated according to standard techniques.

Results: VAT and VAT:SAT ratio were significantly greater in male participates with SCI (P?≤?0.002), while SAT volume was significantly greater in female participants with SCI (P?=?0.001). No difference was noted in TTAT between groups (P?=?0.341). Male participants with SCI demonstrated lower high-density lipoprotein-cholesterol (HDLC) profiles and an elevated total cholesterol to HDLC ratio (P?≤?0.003) compared with females. No other significant differences were found between groups concerning cardiometabolic profiles or proinflammatory adipokines; however, males exhibited poorer profiles overall. Proinflammatory adipokines significantly correlated with adipose tissue depots by sex (P?<?0.05).

Conclusion: The results show that sex influences the distribution of adipose tissue, and may influence proinflammatory and cardiometabolic profiles following SCI. The findings of this study highlight the need for further research with dietary modification and exercise to decrease health risks.     

Effect of acute intermittent hypoxia on motor function in individuals with chronic spinal cord injury following ibuprofen pretreatment: A pilot study

Introduction: Acute intermittent hypoxia (AIH) enhances lower extremity motor function in humans with chronic incomplete spinal cord injury (SCI). AIH-induced spinal plasticity is inhibited by systemic inflammation in animal models. Since SCI is frequently associated with systemic inflammation in humans, we tested the hypothesis that pretreatment with the anti-inflammatory agent ibuprofen enhances the effects of AIH.

Methods: A randomized, double-blinded, placebo-controlled crossover design was used. Nine adults (mean age 51.1?±?13.1 years) with chronic motor-incomplete SCI (7.7?±?6.3 years post-injury) received a single dose of ibuprofen (800?mg) or placebo, 90 minutes prior to AIH. For AIH, 9% O₂ for 90 seconds was interspersed with 21% O₂ for 60 seconds. Maximal voluntary ankle plantar flexion isometric torque was assessed prior to, and at 0, 30, and 60 minutes post-AIH. Surface electromyography (EMG) of plantar flexor muscles was also recorded.

Results: Torque increased significantly after AIH at 30 (P?=?0.007; by ～20%) and 60 (P?2?=?0.17, P?2?=?0.17, P?Conclusions: AIH systematically increased lower extremity torque in individuals with chronic incomplete SCI, but there was no significant effect of ibuprofen pretreatment. Our study re-confirms the ability of AIH to enhance leg strength in persons with chronic incomplete SCI.     

What determines low satisfaction with life in individuals with spinal cord injury?

Objective: To examine variables associated with satisfaction with life (SWL) in individuals with a spinal cord injury (SCI).

Design: Cross-sectional, national survey to assess SWL, demographic and injury characteristics, health care utilization, chronic conditions (obesity, diabetes, heart problems, lung problems, hypertension, high cholesterol), symptoms (poor sleep, pain, depression), social support, grief/loss, and independence.

Setting/Participants: Community-dwelling Veterans with SCI.

Outcome Measures/Analyses: Bivariate analyses were conducted to assess differences in demographics, injury characteristics, chronic conditions, symptoms, social support, grief/loss, and independence in individuals who reported low SWL (≤20) vs. average/high SWL (21-35). Multivariate logistic regression assessed factors independently associated with low SWL.

Results: 896 Veterans with SCI (62%) responded. Average age was 62 years, the majority were male (94%), Caucasian (77%), and had paraplegia (61%). Odds of low SWL were 2.4 times greater for individuals experiencing pain (OR?=?2.43, CI95: 1.47-4.02, P?=?0.0005). Odds of low SWL were increased for individuals reporting greater grief/loss due to their SCI (OR?=?1.14, CI95: 1.10-1.18, P?<?0.0001). Lesser odds of low SWL were seen for individuals reporting greater emotional social support (OR?=?0.97, CI95: 0.96-0.99, P?<?0.0001) and independence (OR?=?0.94, CI95: 0.90-0.97, P?<?0.0001).

Conclusions: Pain and feelings of grief/loss due to injury were associated with low SWL. Self-perceived independence and good social support were associated with better SWL. Along with addressing pain and facilitating independence and social support, these findings suggest that interventions to improve SWL should focus on helping individuals deal with grief/loss due to injury.     

Complementary alternative medicine practices and beliefs in spinal cord injury and non-spinal cord injured individuals

Context/Objective: To compare the beliefs and practices of individuals with spinal cord injury (SCI), their friends and family members (F&F SCI), and healthcare professionals (HCP) regarding complementary alternative medicine (CAM).

Design: A questionnaire regarding CAM practices and beliefs was administered to participants on paper or online.

Setting: An academic rehabilitation hospital.

Participants: Ninety-six individuals voluntarily participated in the study. Participants included 28 patients with SCI, 36 F&F SCI, and 32 HCP.

Interventions: Not applicable

Outcome Measures: The questionnaire assessed participants’ prior or current use of 14 CAM modalities, their willingness to use CAM in the future or recommend its use, and their beliefs and opinions of CAM.

Results: Participants with SCI and their family and friends, were more likely than HCP to have used CAM (P?≤?0.01 and P?≤?0.03, respectively) and recommend its use (P?≤?0.04 and P?≤?0.03, respectively). All three groups showed statistical significance in their willingness to ever use certain CAM modalities (P?≤?0.03 for SCI, P?≤?0.04 for F&F SCI, and P?≤?0.02 for HCP). SCI, F&F SCI, and HCP groups had similar beliefs and opinions regarding CAM.

Conclusion: Patients with SCI as well as their friends and family, have significantly more experience with CAM and are more likely to recommend its use than HCP, suggesting that they are interested and find benefit in alternative healthcare. This warrants further investigation of the integration of CAM into general health practices for those with SCI.     

Interval training elicits higher enjoyment versus moderate exercise in persons with spinal cord injury

Background: High intensity interval training (HIIT) is a robust and time-efficient approach to improve multiple health indices including maximal oxygen uptake (VO₂max). Despite the intense nature of HIIT, data in untrained adults report greater enjoyment of HIIT versus continuous exercise (CEX). However, this has yet to be investigated in persons with spinal cord injury (SCI).

Objective: To examine differences in enjoyment in response to CEX and HIIT in persons with SCI.

Design: Repeated measures, within-subjects design.

Setting: University laboratory in San Diego, CA.

Participants: Nine habitually active men and women (age?=?33.3?±?10.5 years) with chronic SCI.

Intervention: Participants performed progressive arm ergometry to volitional exhaustion to determine VO₂peak. During subsequent sessions, they completed CEX, sprint interval training (SIT), or HIIT in randomized order.

Outcome Measures: Physical activity enjoyment (PACES), affect, rating of perceived exertion (RPE), VO₂, and blood lactate concentration (BLa) were measured.

Results: Despite a higher VO₂, RPE, and BLa consequent with HIIT and SIT (P?, PACES was significantly higher (P?=?0.03) in response to HIIT (107.4?±?13.4) and SIT (103.7?±?12.5) compared to CEX (81.6?±?25.4). Fifty-five percent of participants preferred HIIT and 45% preferred SIT, with none identifying CEX as their preferred exercise mode.

Conclusion: Compared to CEX, brief sessions of submaximal or supramaximal interval training elicit higher enjoyment despite higher metabolic strain. The long-term efficacy and feasibility of HIIT in this population should be explored considering that it is not viewed as more aversive than CEX.