Association between mobility mode and C-reactive protein levels in men with chronic spinal cord injury

Morse LR, Stolzmann K, Nguyen HP, Jain NB, Zayac C, Gagnon D, Tun CG, Garshick E. Association between mobility mode and C-reactive protein levels in men with chronic spinal cord injury.

Objective

To assess clinical determinants of systemic inflammation in persons with chronic spinal cord injury (SCI).

Design

Cross-sectional survey.

Setting

Veterans Affairs medical center.

Participants

As part of an epidemiologic study assessing SCI-related health conditions, 63 men with chronic SCI provided a blood sample and information regarding locomotive mode and personal habits.

Interventions

Not applicable.

Main Outcome Measure

Plasma high-sensitivity C-reactive protein (CRP).

Results

The mean ± standard deviation age was 56±14y, and participants were assessed 21±13y after injury. Adjusting for heart disease, hypertension, and body mass index (BMI), the mean CRP in 12 motorized wheelchair users (5.11mg/L) was not significantly greater than 23 participants who used a manual wheelchair (2.19mg/L) (P=.085) but was significantly greater than the 17 who walked with an assistive device (1.41mg/L) (P=.005) and the 12 who walked independently (1.63mg/L) (P=.027). CRP was significantly greater in participants with obesity but was not related to age, smoking, or SCI level and severity. CRP was elevated in participants reporting a urinary tract infection (UTI) or pressure ulcer within a year, but adjustment for this did not account for the elevated CRP in motorized wheelchair users.

Conclusions

These results suggest that CRP in chronic SCI is independently related to locomotive mode, BMI, and a history of pressure ulcers and UTI. It is suggested that future studies in SCI investigate whether modifying these factors influence systemic inflammation and cardiovascular health.     

Evaluation of an innovative methodology to recruit research participants with spinal cord injury through durable medical equipment suppliers

Krahn G, McCarthy M, Westwood D, Powers L. Evaluation of an innovative methodology to recruit research participants with spinal cord injury through durable medical equipment suppliers.

Objective

To evaluate the effectiveness, strengths, and limitations of an innovative research method to recruit persons with spinal cord injury (SCI).

Design

A pilot study for feasibility.

Setting

Community-based durable medical equipment suppliers (DMESs) in the states of Oregon, Washington, and New York.

Participants

Three DMESs participated and successfully distributed surveys to 591 customers with International Classification of Disease, 9th Revision, codes reflecting SCI. Of these, 316 people completed surveys, with 270 identifying SCI among their disabling conditions.

Interventions

Not applicable.

Main Outcome Measures

The effort required to solicit recruitment assistance from DMESs, survey response rate, verification of SCI by self-report, and comparability of sample demographics to those of other SCI research samples from both the United States and other countries.

Results

A moderate level of effort was required to solicit recruitment assistance from DMESs. The survey had a 53% response rate, and 85% of respondents verified that they had an SCI by self-report. Sample demographics were generally similar to those of comparable research samples but with more single and unemployed persons responding and with longer duration of SCI.

Conclusions

This method of recruitment has the potential to address limitations of other recruitment methods but presents its own challenges with implementation. Potential sampling bias is discussed.     

Personal Bankruptcy After Traumatic Brain or Spinal Cord Injury: The Role of Medical Debt

Relyea-Chew A, Hollingworth W, Chan L, Comstock BA, Overstreet KA, Jarvik JG. Personal bankruptcy after traumatic brain or spinal cord injury: the role of medical debt.

Objective

To estimate the prevalence of medical debt among traumatic brain injury (TBI) and spinal cord injury (SCI) patients who discharged their debts through bankruptcy.

Design

A cross-sectional comparison of bankruptcy filings of injured versus randomly selected bankruptcy petitioners.

Setting

Patients hospitalized with SCI or TBI (1996-2002) and personal bankruptcy petitioners (2001-2004) in western Washington State.

Participants

Subjects (N=186) who filed for bankruptcy, comprised of 93 patients with previous SCI or TBI and 93 randomly selected bankruptcy petitioners.

Interventions

Not applicable.

Main Outcome Measures

Medical and nonmedical debt, assets, income, expenses, and employment recorded in the bankruptcy petition.

Results

Five percent of randomly selected petitioners and 26% of petitioners with TBI or SCI had substantial medical debt (debt that accounted for more than 20% of all unsecured debts). SCI and TBI petitioners had fewer assets and were more likely to be receiving government income assistance at the time of bankruptcy than controls. SCI and TBI patients with a higher blood alcohol content at injury were more likely to have substantial medical debts (odds ratio=2.70; 95% confidence interval, 1.04-7.00).

Conclusions

Medical debt plays an important role in some bankruptcies after TBI or SCI. We discuss policy options for reducing financial distress after serious injury.     

The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury

van Londen A, Herwegh M, van der Zee CH, Daffertshofer A, Smit CA, Niezen A, Janssen TW. The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury.

Objective

To study effects of surface electric stimulation of the gluteal muscles on the interface pressure in seated persons with spinal cord injury (SCI).

Design

One session in which alternating and simultaneous surface electric stimulation protocols were applied in random order.

Setting

Research laboratory of a rehabilitation center.

Participants

Thirteen subjects with SCI.

Intervention

Surface electric stimulation of the gluteal muscles.

Main Outcome Measures

Interface pressure, maximum pressure, pressure spread, and pressure gradient for the stimulation measurement. Variables were compared using 2-tailed paired t tests.

Results

Alternating and simultaneous stimulation protocol caused a significant (P<.01) decrease in interface pressure (-17±12mmHg, -19±14mmHg) and pressure gradient (-12±11mmHg, -14±12mmHg) during stimulation periods compared with rest periods. There was no significant difference in effects between the 2 protocols.

Conclusions

Surface electric stimulation of the gluteal muscles in persons with SCI causes a decrease in interface pressure. This might restore blood flow in compressed tissue and help prevent pressure ulcers.     

Predictors of Cardiopulmonary Hospitalization in Chronic Spinal Cord Injury

Waddimba AC, Jain NB, Stolzmann K, Gagnon DR, Burgess JF, Kazis LE, Garshick E. Predictors of cardiopulmonary hospitalization in chronic spinal cord injury.

Objective

To investigate longitudinal risk factors of hospitalization for circulatory and pulmonary diseases among veterans with chronic spinal cord injury (SCI). Circulatory and respiratory system illnesses are leading causes of death in patients with chronic SCI, yet risk factors for related hospitalizations have not been characterized.

Design

Prospective cohort study.

Setting

Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts.

Participants/Data Sources

Veterans (N=309) greater than or equal to 1 year post-SCI from the VA Boston Chronic SCI cohort who completed a health questionnaire and underwent spirometry at study entry. Baseline data were linked to 1996 through 2003 hospitalization records from the VA National Patient Care Database.

Interventions

Not applicable.

Main Outcome Measures

Cardiopulmonary hospital admissions, the predictors of which were assessed by multivariate Cox regression.

Results

Of 1478 admissions observed, 143 were a result of cardiopulmonary (77 circulatory and 66 respiratory) illnesses. Independent predictors were greater age (3% increase/y), hypertension, and the lowest body mass index quintile (<22.4kg/m²). A greater percentage-predicted forced expiratory volume in 1 second was associated with reduced risk. SCI level and completeness of injury were not statistically significant after adjusting for these risk factors.

Conclusions

Cardiopulmonary hospitalization risk in persons with chronic SCI is related to greater age and medical factors that, if recognized, may result in strategies for reducing future hospitalizations.     

Minimizing pre- and post-defibrillation pauses increases the likelihood of return of spontaneous circulation (ROSC)

Background

The three-phase model of ventricular fibrillation (VF) arrest suggests a period of compressions to “prime” the heart prior to defibrillation attempts. In addition, post-shock compressions may increase the likelihood of return of spontaneous circulation (ROSC). The optimal intervals for shock delivery following cessation of compressions (pre-shock interval) and resumption of compressions following a shock (post-shock interval) remain unclear.

Objective

To define optimal pre- and post-defibrillation compression pauses for out-of-hospital cardiac arrest (OOHCA).

Methods

All patients suffering OOHCA from VF were identified over a 1-month period. Defibrillator data were abstracted and analyzed using the combination of ECG, impedance, and audio recording. Receiver-operator curve (ROC) analysis was used to define the optimal pre- and post-shock compression intervals. Multiple logistic regression analysis was used to quantify the relationship between these intervals and ROSC. Covariates included cumulative number of defibrillation attempts, intubation status, and administration of epinephrine in the immediate pre-shock compression cycle. Cluster adjustment was performed due to the possibility of multiple defibrillation attempts for each patient.

Results

A total of 36 patients with 96 defibrillation attempts were included. The ROC analysis identified an optimal pre-shock interval of <3 s and an optimal post-shock interval of <6 s. Increased likelihood of ROSC was observed with a pre-shock interval <3 s (adjusted OR 6.7, 95% CI 2.0-22.3, p = 0.002) and a post-shock interval of <6 s (adjusted OR 10.7, 95% CI 2.8-41.4, p = 0.001). Likelihood of ROSC was substantially increased with the optimization of both pre- and post-shock intervals (adjusted OR 13.1, 95% CI 3.4-49.9, p < 0.001).

Conclusions

Decreasing pre- and post-shock compression intervals increases the likelihood of ROSC in OOHCA from VF.     

Effect of Respiration on the Static Rear Stability of Wheelchairs

Kirby RL, Heimrath O, Stewart A, Smith C, MacLeod DA. Effect of respiration on the static rear stability of wheelchairs.

Objective

To test the hypothesis that the static rear stability of an occupied wheelchair is greater during full inspiration than expiration.

Design

Within-subject comparisons.

Setting

Rehabilitation center.

Participants

Able-bodied participants (N=10).

Intervention

None.

Main Outcome Measures

We measured the static rear stability (brakes unlocked) of an occupied wheelchair on a test platform according to International Organization for Standardization standards. We also used the Exhalation Threshold Test. The Exhalation Threshold Test was positive if, having been positioned at the maximum degree of platform tilt needed to maintain stability during full inspiration, the wheelchair tipped backward when the participant exhaled.

Results

The mean static rear stability values at full inspiration and expiration ± SD were 16.5°±2.3° and 16.1°±2.4°, with a mean difference of .46°±.24° (3%; P=.002). The Exhalation Threshold Test was positive in 19 (95%) of 20 trials.

Conclusions

Respiration has a slight but statistically significant effect on the rear stability of occupied wheelchairs, with greater stability at full inspiration. This has potential clinical implications for stability testing and the training of wheelchair skills, but further study is needed.     

Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence

Macciocchi S, Seel RT, Thompson N, Byams R, Bowman B. Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence.

Objectives

To examine prospectively the incidence and severity of co-occurring traumatic brain injury (TBI) in persons with traumatic spinal cord injury (SCI) and to describe a TBI assessment process for SCI rehabilitation professionals.

Design

A prospective, cohort design to collect and analyze clinical variables relevant for diagnosing co-occurring TBI.

Setting

An urban, single-center National Institute of Disability and Rehabilitation Research Model Spinal Cord Injury System in the Southeastern United States.

Participants

People (N=198) who met inclusion criteria and provided consent within an 18-month recruitment window.

Interventions

Not applicable.

Main Outcome Measure

FIM cognitive scale.

Results

Based on participants' presence and duration of posttraumatic amnesia, initial Glasgow Coma Scale total score, and presence of cerebral lesion documented by neuroimaging, 60% of our traumatic SCI sample also sustained a TBI (n=118). Most co-occurring TBIs were mild (34%). Co-occurring mild complicated (10%), moderate (6%), and severe TBI (10%) were less common but still occurred in a significant percentage (26%) of persons with traumatic SCI. Persons with traumatic SCI who were injured in motor vehicle collisions and falls were more likely to sustain a co-occurring TBI. Cervical level traumatic SCI was associated with greater rates of TBI but not more severe injuries. Tree analyses established a practical algorithm for classifying TBI severity associated with traumatic SCI. Analysis of variance established criterion validity for the algorithm's TBI severity classifications.

Conclusions

Findings from our prospective study provide strong support that TBI is a common co-occurring injury with traumatic SCI. Incomplete acute care medical record documentation of TBI in the traumatic SCI population remains a considerable issue, and there is a significant need to educate emergency department and acute care personnel on the TBI clinical data needs of acute rehabilitation providers. A systematic algorithm for reviewing acute care medical records can yield valid estimates of TBI severity in the traumatic SCI population.     

Longitudinal Changes in Physical Capacity Over 20 Years in Athletes With Spinal Cord Injury

Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.

Objective

To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI).

Design

Longitudinal study (20-y follow-up).

Setting

Laboratory setting.

Participants

Persons with SCI (N=7).

Interventions

Not applicable.

Main Outcome Measures

Maximum oxygen consumption V?o₂max) measured in 1986-1988 and in 2006.

Results

Subjects with SCI maintained stable V?o₂max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced V?o₂max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased V?o₂max by 43% and 45% after 20 years.

Conclusion

The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities.     

Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury

Davies AL, Hayes KC, Dekaban GA. Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury.

Objective

To determine the serum cytokine profiles of patients with spinal cord injury (SCI) and varying clinical presentations relative to healthy, able-bodied, age-matched control subjects.

Design

Cross-sectional study.

Setting

Clinical research unit.

Participants

People with SCI (N=56) and different clinical presentations, and healthy, able-bodied, age-matched control subjects (N=35).

Interventions

Not applicable.

Main Outcome Measures

Serum levels of the proinflammatory cytokines interleukin (IL) 1β, IL-6, tumor necrosis factor alpha (TNF-α), the anti-inflammatory cytokines IL-4 and IL-10, the regulatory cytokine IL-2, the IL-1 receptor antagonist (IL-1RA), and autoantibodies against myelin-associated glycoprotein and GM₁ ganglioside (anti-GM₁) immunoglobulin (IgG and IgM), as determined by enzyme-linked immunosorbent assay. The relationship between elevated serum cytokine levels and clinical variables was also studied.

Results

SCI subjects exhibited serum concentrations of IL-6, TNF-α, IL-1RA, and anti-GM₁ (IgG) that were greater (P<.05) than control group values. Elevated cytokine concentrations were not associated with high white blood cell counts, level of injury, or American Spinal Injury Association classification; they were evident in SCI subjects who were asymptomatic for medical complications, but were further elevated in subjects with pain, urinary tract infection (UTI), and pressure ulcers.

Conclusions

Elevated levels of circulating proinflammatory cytokines and autoantibodies are present in the serum of SCI subjects without medical complications, and are further elevated in SCI subjects with neuropathic pain, UTI, or pressure ulcers, relative to healthy, able-bodied control subjects. These findings may be indicative of a protective autoimmunity, simply a consequence of occult or evident infection, or evidence of cytokine dysregulation that may contribute to an immune-mediated impairment of axonal conduction.     

Effects of Multijoint Spastic Reflexes of the Legs During Assisted Bilateral Hip Oscillations in Human Spinal Cord Injury

Onushko T, Hyngstrom A, Schmit BD. Effects of multijoint spastic reflexes of the legs during assisted bilateral hip oscillations in human spinal cord injury.

Objective

To investigate the timing and magnitude of muscle activation during an active-assist bilateral hip motor task in human spinal cord injury (SCI).

Design

A single test session using a novel robotic system to alternately flex and extend the hips from 40° of hip flexion to 10° of hip extension at 1 of 3 frequencies (.25, .50, .75Hz). Subjects were asked either to actively assist the movements or to remain relaxed during the imposed oscillations.

Setting

All data were collected in a research laboratory.

Participants

Ten subjects with motor incomplete (American Spinal Injury Association grade C or D) SCI and 10 individuals without neurologic injury participated in this study.

Interventions

Not applicable.

Main Outcome Measures

Electromyograms and joint torques were recorded from the lower extremities of SCI subjects and compared with electromyograms and joint torque patterns recorded from 10 neurologically healthy individuals completing the same tasks.

Results

In trials involving active assistance of the imposed hip oscillations, SCI subjects produced muscle activation patterns that were phased differently from muscle activity of neurologically intact subjects. SCI subjects generated peak torque at the end ranges of movement (ie, 40° hip flexion, 10° extension), whereas control subjects generated the greatest torque midway through the movements. Moreover, the phasing of active-assist hip torque in SCI subjects was similar to the phasing of reflexive hip torques produced during the unassisted condition (ie, SCI subjects instructed to relax), while control subjects produced no reflexive torques during unassisted trials.

Conclusions

The differences in the timing of muscle activity during the active-assist task in controls and SCI subjects highlights problems in generating appropriately timed muscle activity during ongoing movements. The similarity in muscle activity patterns for the active-assist and unassisted trials in SCI subjects further suggests that reflex feedback from hip afferents contributes substantially to muscle activation during active-assist movements. These findings demonstrate the disruptions in reflex regulation of movement in people with incomplete SCI and suggest that spastic reflexes might disrupt motor control.     

Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions

Middleton JW, McCormick M, Engel S, Rutkowski SB, Cameron ID, Harradine P, Johnson JL, Andrews D. Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions.

Objective

To develop and implement a service model for people with spinal cord injury (SCI) living in rural regions.

Design

Service development, pilot evaluation study.

Setting

Regional and remote areas of the state of New South Wales, Australia.

Participants

Persons with SCI, caregivers, and health professionals.

Intervention

Phase 1 included initial needs analysis, followed by education and resource development tailored to needs of rural health professionals, caregivers, and persons with SCI. Phase 2 included coordination, professional support, and network development by part-time rural key worker and metropolitan-based project officer, documenting health- and service-related issues.

Main Outcome Measures

Self-perception of confidence as a result of education as well as reported issues, adverse health events, and barriers to service provision.

Results

Clinician confidence in managing people with SCI improved after education. Various health-related, environmental, and psychosocial issues were reported. Limited availability of resources and health infrastructure, particularly in more isolated or smaller towns, challenged service provision. Rural key workers played a central role in supporting local clinicians and service providers, improving communication and service coordination between rural health professionals and metropolitan SCI services.

Conclusion

Education and support for rural workforce that may be limited in numbers and capacity, and a model facilitating communication and coordination between services, are essential for improving health outcomes of rural people with SCI.     

Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome

Noonan VK, Kopec JA, Zhang H, Dvorak MF. Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome.

Objective

To determine the effect of associated spinal cord injury (SCI) conditions on the health status and quality of life (QOL) in people with traumatic central cord syndrome.

Design

Cross-sectional design.

Setting

Community-based.

Participants

Subjects (N=70) with traumatic central cord syndrome who were a minimum of 2 years postinjury.

Interventions

Not applicable.

Main Outcome Measures

Presence of associated SCI conditions (neuropathic pain, spasticity, bowel, bladder, and/or sexual dysfunction, decreased motor function); health status (36-Item Short-Form Health Survey [SF-36], symptom satisfaction); and QOL.

Results

The SF-36 physical component score (PCS) was lower in subjects who reported problems with bowel, bladder, and/or sexual function (−6.9; 95% confidence interval [CI], −11.6 to −2.2). The PCS was decreased in subjects with a lower motor score and this relationship was negatively affected by spasticity and being less educated. The SF-36 mental component score was negatively affected by neuropathic pain and a lower motor score. Neuropathic pain and a lower motor score were both associated with subjects being dissatisfied with their symptoms. Subjects who had a higher motor score were more likely to have a higher QOL (odds ratio, 1.7; 95% CI, 1.1 to 2.7).

Conclusions

The associated SCI conditions bowel, bladder, and/or sexual dysfunction, neuropathic pain, decreased motor function, and spasticity negatively affect the health status of persons with traumatic central cord syndrome. Diminished motor recovery was the only associated SCI condition to impact QOL. By developing a conceptual model and adjusting for confounders, an estimate for each associated SCI condition's effect on patient outcomes was obtained. Our results indicate the importance of treating or ameliorating associated SCI conditions in order to maximize physical and mental functioning.     

Smoking among veterans with multiple sclerosis: prevalence correlates, quit attempts, and unmet need for services

Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. Smoking among veterans with multiple sclerosis: prevalence, correlates, quit attempts, and unmet need for services.

Objective

To describe the prevalence and correlates of smoking as well as quit attempts and unmet need for smoking cessation services in a national sample of veterans with multiple sclerosis (MS).

Design

Cross-sectional cohort study linking computerized medical record information to mailed survey data from 1999.

Setting

Veterans Health Administration (VHA).

Participants

Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires, as well as a 20% random subsample (n=569) who completed a more extensive assessment of smoking.

Interventions

Not applicable.

Main Outcome Measures

Items assessing smoking, quit attempts, and unmet need for smoking services.

Results

Among all survey respondents with MS, 28.5% (95% confidence interval [CI], 26.9-30.2) endorsed current smoking. Of extended survey respondents, 54.5% (95% CI, 46.6-62.1) reported a quit attempt in the past year, and 59.0% (95% CI, 51.1-66.4) reported not getting needed services for smoking in the past year. In fully adjusted logistic regression, smoking was associated with younger age, lower levels of education, being unmarried, higher levels of physical pain, and poorer mental health. A quit attempt was associated with higher levels of education and greater pain intensity.

Conclusions

Smoking among veterans with MS is common, with rates similar to those for other veterans. There is substantial need for cessation services. Cessation interventions should address correlates of smoking including pain, poorer mental health, and social isolation.     

Menopause Characteristics and Subjective Symptoms in Women With and Without Spinal Cord Injury

Kalpakjian CZ, Quint EH, Bushnik T, Rodriguez GM, Terrill MS. Menopause characteristics and subjective symptoms in women with and without spinal cord injury.

Objective

To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI).

Design

Prospective cohort (4 data collection periods across 4 years).

Setting

Community.

Participants

Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed.

Interventions

None.

Main Outcome Measures

Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms).

Results

The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness.

Conclusions

Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition.     

Injurious falls among middle aged and older adults with multiple sclerosis

Peterson EW, Cho CC, von Koch L, Finlayson ML. Injurious falls among middle aged and older adults with multiple sclerosis.

Objective

To determine the prevalence of, and risk factors for, receiving medical attention for a recent injurious fall among middle-aged and older adults who have multiple sclerosis (MS).

Design

Survey.

Setting

United States.

Participants

Seven hundred people with MS, age 55 years or older and living in the United States, were randomly selected from the North American Research Committee on Multiple Sclerosis Registry and invited by mail to participate in the study. A total of 354 people, aged 55 to 94 years, completed the survey.

Interventions

Not applicable.

Main Outcome Measures

Participant's self-report regarding receipt of medical care for a fall-related injury (received care within the past 6mo, >6mo ago, or never).

Results

More than 50% of study participants reported injurious falls; 12%, in the 6 months before the interview. Proportional odds models were used to identify factors associated with increased odds of receiving medical attention for a fall-related injury within the past 6 months. Compared with study participants who reported receiving medical attention for a fall-related injury more than 6 months ago or never, participants who reported receiving medical attention for a fall-related injury within the past 6 months were more likely to report fear of falling (odds ratio [OR]=1.94; 95% confidence interval [CI], 1.27−2.96) and osteoporosis (OR=1.65; 95% CI, 1.03-2.62).

Conclusions

Injurious falls were commonly reported by survey participants. Findings suggest that management of fear of falling and osteoporosis are important components of comprehensive fall-injury prevention programs for people aging with MS.     

Cardiovascular and metabolic responses during functional electric stimulation cycling at different cadences

Fornusek C, Davis GM. Cardiovascular and metabolic responses during functional electric stimulation cycling at different cadences.

Objective

To determine the influence of pedaling cadence on cardiorespiratory responses and muscle oxygenation during functional electric stimulation (FES) leg cycling.

Design

Repeated measures.

Setting

Laboratory.

Participants

Nine subjects with T4 through T10 spinal cord injury (SCI) (American Spinal Injury Association grade A).

Interventions

FES cycling was performed at pedaling cadences of 15, 30, and 50 revolutions per minute (rpm).

Main Outcome Measures

At each cadence, heart rate, oxygen uptake, and cardiac output were recorded during 35 minutes of cycling. Near infrared spectroscopy was used to quantify quadriceps muscle oxygenation.

Results

All pedaling cadences induced similar elevations in cardiorespiratory metabolism, compared with resting values. Higher average power output was produced at 30rpm (8.2±0.7W, P<.05) and 50rpm (7.9±0.5W, P<.05) compared with 15rpm (6.3±0.6W). Gross mechanical efficiency was significantly higher (P<.05) at 30 and 50rpm than at 15rpm. Quadriceps muscle oxygenation did not differ with pedaling cadences.

Conclusions

Cardiorespiratory responses and muscle metabolism adjustments during FES leg cycling were independent of pedal cadence. FES cycling at a cadence of 50rpm may not confer any advantages over 30 or 15rpm for cardiovascular fitness promotion in persons with SCI.     

Validity and Reliability of Assessment Tools for Measuring Unsupported Sitting in People With a Spinal Cord Injury

Boswell-Ruys CL, Sturnieks DL, Harvey LA, Sherrington C, Middleton JW, Lord SR. Validity and reliability of assessment tools for measuring unsupported sitting in people with a spinal cord injury.

Objectives

To develop simple tests to assess the abilities of people with spinal cord injury (SCI) to sit unsupported and to assess the construct validity and test-retest reliability of these tests.

Design

Cross-sectional comparisons, convenience sample.

Setting

Biomechanical laboratory.

Participants

People (N=30) with SCI between the C6 and the L2 level of 2 months to 37 years duration before assessment. The sample was stratified by impairment level (at T8) and time since injury (1y postinjury).

Interventions

Not applicable.

Main Outcome Measures

On 2 separate occasions, participants performed tests that measured the distance of upper-body sway and maximal torso leaning, errors made during a coordinated stability task, timed dressing/undressing of the upper body and alternating arm reaching, and percentage change in seated upper body/arm reaching.

Results

All tests showed good construct validity in that they distinguished between participants with higher (C6-T7) and lower (T8-L2) level impairments (P<.05) and between participants with acute (≤1y) and chronic (>1y) lesions (P<.05). The tests also showed good to excellent test-retest reliability (intraclass correlation coeffiecient_3,1 range, .51-.91).

Conclusions

These simple and quick-to-administer tests have both construct validity and test-retest reliability. They would be appropriate for research and clinical purposes to quantify the abilities of people with SCI to sit unsupported.     

The effectiveness of progressively increasing stimulation frequency and intensity to maintain paralyzed muscle force during repetitive activation in persons with spinal cord injury

Chou L-W, Lee SC, Johnston TE, Binder-Macleod SA. The effectiveness of progressively increasing stimulation frequency and intensity to maintain paralyzed muscle force during repetitive activation in persons with spinal cord injury.

Objective

To compare the effectiveness of progressively increasing stimulation intensity, progressively increasing frequency, or progressively increasing both frequency and intensity on paralyzed quadriceps femoris muscle force maintenance during repetitive activation.

Design

Factorial design with different stimulation protocols as independent variables.

Setting

A muscle performance laboratory.

Participants

People (N=8) with spinal cord injury (SCI) (age, 14.63±1.77y).

Interventions

Not applicable.

Main Outcome Measure

Number of contractions when the peak force was 90% or more of a subject's maximal twitch force.

Results

The protocol involving progressively increasing stimulation intensity and then frequency generated more successful contractions (189.88±53.33) than progressively increasing the frequency followed by intensity (122.75±26.56 contractions). Regardless of the order, progressively increasing both intensity and frequency generated more successful contractions than progressively increasing intensity (97 contractions) or frequency (62 contractions) alone.

Conclusions

Our findings suggest that during repetitive electric activation, progressively increasing both stimulation frequency and intensity can produce more successful contractions than progressively increasing only frequency or intensity. These findings can help researchers and clinicians design more effective stimulation protocols for persons with SCI during functional electric stimulation applications.