Aquatic,deep water peak VO2 testing for individuals with spinal cord injury

Objective: To determine the reliability of peak VO₂ testing for individuals with spinal cord injury (SCI) in deep water and on land; and to examine the relationship between these two testing conditions.

Design: Reliability study.

Setting: Comprehensive rehabilitation center in Baltimore, MD, USA.

Participants: 17 participants (13 men, 4 women) with motor complete and incomplete SCI. Participants were randomized into either aquatic or arm cycle ergometer first measurements.

Intervention: Pilot study to assess peak VO₂.

Outcome measures: Peak VO₂ measured with metabolic cart in supported deep water with the addition of Aquatrainer® connection, and on land with arm cycle ergometer. Two trials were conducted for each condition with 48?h separating each test.

Results: Peak oxygen consumption reliability was statistically significant for both conditions, aquatic (r?=?0.93, P?<?0.001) and arm cycle ergometry (r?=?0.96, P?<?0.001). Additionally, aquatic and arm cycle peak VO₂ correlation existed (r?=?0.72, P?<?0.001). For these 17 participants, lower extremity motor score influenced supported, deep water peak VO₂, B?=?0.57, P?<?0.02, whereas age, sex, and weight did not impact deep water or ergometer values.

Conclusion: Determining peak VO₂ for individuals with SCI is highly reproducible for arm cycle ergometry and in deep water assessment. Additionally, aquatic, deep water peak VO₂ testing is valid when compared to arm cycle ergometry. Although the peak VO₂ relationship between deep water and arm cycle ergometry is high, variance in the two conditions does exist. Therefore, it is important to assess peak VO₂ via the same exercise modality utilized in the treatment intervention.     

Restoration of cough via spinal cord stimulation improves pulmonary function in tetraplegics

Background: Spinal cord injury (SCI) results in significant loss in pulmonary function secondary to respiratory muscle paralysis. Retention of secretions and atelectasis and, recurrent respiratory tract infections may also impact pulmonary function.

Objective: To determine whether usage of lower thoracic spinal cord stimulation (SCS) to restore cough may improve spontaneous pulmonary function in individuals with chronic SCI.

Design/Methods: 10 tetraplegics utilized SCS system on a regular daily basis. Spontaneous inspiratory capacity (IC), maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were measured at baseline prior to usage of the device and repeated every 4–5 weeks over a 20-week period. Maximum airway pressure generation (P) during SCS (40?V, 50?Hz, 0.2?ms) at total lung capacity (TLC) with subject maximal expiratory effort, at the same timepoints were determined, as well.

Results: Following daily use of SCS, mean IC improved from 1636?±?229 to 1932?±?239?ml (127?±?8% of baseline values) after 20 weeks (P?<?0.05). Mean MIP increased from 40?±?7, to 50?±?8?cmH₂O (127?±?6% of baseline values) after 20 weeks, respectively (P?<?0.05). MEP also improved from 27?±?3.7 to 33?±?5 (127?±?14% of baseline values) (NS). During SCS, P increased from baseline in all participants from mean 87?±?8?cmH₂O to 117?±?14 cmH₂O at weeks 20, during TLC with subject maximal expiratory effort, respectively (P?<?0.05). Each subject stated that they experienced much greater ease in raising secretions with use of SCS.

Conclusion: Our findings indicate that use of SCS not only improves expiratory muscle function to restore cough but also results in improvement inspiratory function, as well.     

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.     

Physiological and perceptual effects of precooling in wheelchair basketball athletes

Objective: To investigate the physiological and perceptual effects of three precooling strategies during pre-exercise rest in athletes with a spinal cord injury (SCI).

Design: Randomized, counterbalanced. Participants were precooled, then rested for 60 minutes (22.7?±?0.2°C, 64.2?±?2.6%RH).

Setting: National Wheelchair Basketball Training Centre, Australia.

Participants: Sixteen wheelchair basketball athletes with a SCI.

Interventions: Participants were precooled through; 1) 10 minutes of 15.8°C cold water immersion (CWI), 2) ingestion of 6.8?g/kg^?1 of slushie (S) from sports drink; 3) ingestion of 6.8?g/kg^?1 of slushie with application of iced towels to the legs, torso and back/arms (ST); or 4) ingestion of 6.8?g/kg^?1 of room temperature (22.3°C) sports drink (CON).

Outcome measures: Core temperature (T_gi), skin temperature (T_sk), heart rate (HR), and thermal and gastrointestinal comfort.

Results: Following CWI, a significant reduction in T_gi was observed compared to CON, with a greatest reduction of 1.58°C occurring 40 minutes post-cooling (95% CI [1.07, 2.10]). A significant reduction in T_gi following ST compared to CON was also observed at 20 minutes (0.56°C; [0.03, 1.09]) and 30 minutes (0.56°C; [0.04, 1.09]) post-cooling. Additionally, a significant interaction between impairment level and time was observed for T_gi and HR, demonstrating athletes with a higher level of impairment experienced a greater reduction in HR and significant decrease in rate of decline in T_gi, compared to lesser impaired athletes.

Conclusion: CWI and ST can effectively lower body temperature in athletes with a SCI, and may assist in tolerating warm conditions.     

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.     

Surgical management of patients following traumatic spinal cord injury: Identifying barriers to early surgery in a specialized spinal cord injury center

Context/Objective: Early surgery in individuals with traumatic spinal cord injury (T-SCI) can improve neurological recovery and reduce complications, costs and hospitalization. Patient-related and healthcare-related factors could influence surgical delay. This study aimed at determining factors contributing to surgical delay in individuals with T-SCI.

Design: Prospective cohort study.

Setting: Single Level I trauma center in Québec, Canada.

Participants: One hundred and forty-four patients who sustained a T-SCI.

Interventions: None.

Outcome measures: Socio-demographic and clinical administrative data were collected during the pre-operative period. The cohort was stratified in early surgery, or ES (<24 hours post-trauma) and late surgery, or LS (≥ 24 hours post-trauma) groups. A multivariate logistic regression analysis using patient- and healthcare-related factors was carried out to identify the main predictors of LS.

Results: 93 patients had ES (15.6?±?4.7 hours post-trauma), which is 31 hours earlier than the 51 patients in the LS group (46.9?±?30.9 hours; P??3). The transfer delay from trauma site to the SCI center was 8 hours shorter (5.0?±?3.0 hours vs 13.6?±?17.0; P??3) for the ES group, and the surgical plan was completed 17 hours faster (6.0?±?4.0 hours vs 23.3?±?23.6 hours; P??3) than for the LS group. The occurrence of LS was predicted by modifiable factors, such as the transfer delay to the SCI center, the delay before surgical plan completion, and the waiting time for the operating room.

Conclusions: A dedicated team for surgical treatment of individuals with T-SCI, involving direct transfer to the SCI center, faster surgery planning and access to the operating room in hospitals dealing with emergencies from all subspecialties could improve surgical delay and increase the rate of patients undergoing ES.     

LED session prior incremental step test enhance VO<Subscript>2max</Subscript> in running

This study aimed to investigate the effect of prior LED sessions on the responses of cardiorespiratory parameters during the running incremental step test. Twenty-six healthy, physically active, young men, aged between 20 and 30 years, took part in this study. Participants performed two incremental load tests after placebo (PLA) and light-emitting diode application (LED), and had their gas exchange, heart rate (HR), blood lactate, and rating of perceived exertion (RPE) monitored during all tests. The PLA and LED conditions were compared using the dependent Student t test with significance set at 5%. The T test showed higher maximum oxygen uptake (VO_2max) (PLA?=?47.2?±?5.7; LED?=?48.0?±?5.4 ml kg^?1 min^?1, trivial effect size), peak velocity (V_peak) (PLA?=?13.4?±?1.2; LED?=?13.6?±?1.2 km h^?1, trivial effect size), and lower maximum HR (PLA?=?195.3?±?3.4; LED?=?193.3?±?3.9 b min^?1, moderate effect size) for LED compared to PLA conditions. Furthermore, submaximal values of HR and RPE were lower, and submaximal VO₂ values were higher when LED sessions prior to the incremental step test were applied. A positive response of the previous LED application in the blood lactate disappearance was also demonstrated, especially 13 and 15 min after the test. It is concluded that LED sessions prior to exercise modify cardiorespiratory response by affecting running tolerance during the incremental step test, metabolite clearance, and RPE. Therefore, LED could be used as a prior exercise strategy to modulate oxidative response acutely in targeted muscle and enhance exercise tolerance.     

A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: A pilot study

Objective: To conduct a pilot study of an intervention to decrease fall incidence and concerns about falling among individuals living with Spinal Cord Injury who use manual wheelchairs full-time.

Design: Pre/post. After a baseline assessment, a structured intervention was implemented. The assessment protocol was repeated 12 weeks after the baseline assessment.

Setting: Research laboratory and community.

Participants: 18 individuals living with SCI who use a manual wheelchair full-time with an average age of 35.78?±?13.89 years, lived with SCI for 17.06?±?14.6 years; 61.1% were female.

Intervention: A 1:1, 45 minute, in-person intervention focused on factors associated with falls and concerns about falling: transfers skills and seated postural control.

Outcome measures: Participants reported fall incidence and completed the Spinal Cord Injury Fall Concerns Scale, Community Participation Indicators and the World Health Organization Quality of Life – short version (WHOQOL-BREF). Transfer quality was assessed with the Transfer Assessment Instrument (TAI) and seated postural control with the Function In Seating Test (FIST).

Results: Recruitment, assessment and delivery of the intervention were successfully completed. After exposure to the intervention, fall incidence significantly decreased, (P?=?0.047, d_{z ?}=?0.507) and FIST scores improved (P?=?0.035, d_z? =?0.54). Significant improvements were also found in the WHOQOL-BREF Physical (P?=?0.05, d_{z ?}=?1.566) and Psychological (P?=?0.040, d_{z ?}=?0.760) domains.

Conclusion: The feasibility of the structured intervention was established and the intervention has the potential to reduce fall incidence and improve quality of life among individuals living with SCI who use a wheelchair. Appropriately powered randomized controlled trials of the program are warranted.     

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.     

Higher dietary intake of vitamin D may influence total cholesterol and carbohydrate profile independent of body composition in men with Chronic Spinal Cord Injury

Study Design: A case-control design.

Objectives: To determine the effects of dietary vitamin D intake on insulin sensitivity (Si), glucose effectiveness (Sg), and lipid profile in individuals with spinal cord injury (SCI).

Methods: 20 male, paraplegic (T3-L1) with chronic (> one year) motor complete SCI (AIS A or B) were recruited. Three-day dietary records were analyzed for dietary vitamin D (calciferol), and participants were assigned to one of two groups, a high vitamin D intake group and a low vitamin D intake group based on the mid-point of vitamin D frequency distribution. Individuals in both groups were matched based on age, weight, time since injury and level of injury. Sg, Si and lipid profiles were measured of the two groups.

Results: The high vitamin D group had an average intake of 5.33?±?4.14 mcg compared to low vitamin D group, 0.74?±?0.24 mcg. None of the 20 participants met the recommended guidelines for daily vitamin D intake. The higher vitamin D group had a significantly lower (P?=?0.035) total cholesterol (148.00?±?14.12 mg/dl) than the lower vitamin D group (171.80?±?36.22 mg/dl). Vitamin D adjusted to total dietary intake was positively correlated to improvement in Si and Sg (P<0.05).

Conclusion: The findings suggest that persons with SCI consume much less than the recommended guidelines for daily vitamin D intake. However, a higher dietary intake of vitamin D may influence total cholesterol and carbohydrate profile as demonstrated by a significant decrease in total cholesterol and improvement in glucose homeostasis independent of body composition changes after SCI.     

Arm crank ergometry improves cardiovascular disease risk factors and community mobility independent of body composition in high motor complete spinal cord injury

Objective: Evaluate the effect of aerobic exercise using arm crank ergometry (ACE) in high motor complete (ISNCSCI A/B) spinal cord injury (SCI) as primarily related to cardiovascular disease (CVD) risk factors and functional mobility and secondarily to body composition and metabolic profiles.

Design: Longitudinal interventional study at an academic medical center.

Methods: Ten previously untrained participants (M8/F2, Age 36.7 y ± 10.1, BMI 24.5 ± 6.0) with high motor complete SCI (C7-T5) underwent ACE exercise training 30 minutes/day?×?3 days/week for 10 weeks at 70% VO_2Peak.

Outcome Measures: Primary outcome measures were pre- and post-intervention changes in markers of cardiovascular fitness (graded exercise testing (GXT): VO₂, VO_2Peak, respiratory quotient [RQ], GXT time, peak power, and energy expenditure [EE]) and community mobility (time to traverse a 100ft-5° ramp, and 12-minute WC propulsion test). Secondary outcome measures were changes in body composition and metabolic profiles (fasting and area under the curve for glucose and insulin, homeostasis model assessment [HOMA] for %β-cell activity [%β], %insulin sensitivity [%S], and insulin resistance [IR], and Matsuda Index [ISI_Matsuda]).

Results: Resting VO₂, relative VO_2Peak, absolute VO_2Peak, peak power, RQ, 12-minute WC propulsion, fasting insulin, fasting G:I ratio, HOMA-%S, and HOMA-IR all significantly improved following intervention (P < 0.05). There were no changes in body composition (P>0.05).

Conclusions: Ten weeks of ACE at 70% VO_2Peak in high motor complete SCI improves aerobic capacity, community mobility, and metabolic profiles independent of changes in body composition.     

Exercise testing protocol using a roller system for manual wheelchair users with spinal cord injury

Objective: Determine the validity and reliability of an exercise testing protocol to evaluate cardiorespiratory measures in manual wheelchair users (MWUs) with spinal cord injury (SCI) using a roller-based (RS) wheelchair system.

Design: Repeated measures within-subject design.

Setting: Community-based research laboratory.

Participants: Ten adults with SCI requiring the use of a manual wheelchair.

Interventions: Not applicable.

Outcome measures: Cardiorespiratory measures (peak oxygen consumption [VO₂peak], respiratory exchange ratio [RER], pulmonary ventilation [VE], energy expenditure [EE], heart rate [HR], accumulated kilocalories [AcKcal]) and perceived exertion (RPE) were measured during three separate maximal exercise tests using an arm crank ergometer (ACE) and an RS.

Results: At maximal exertion, there were no significant differences in variables between groups, with moderate-to-strong correlations (P?<?0.05, r?=?0.79–0.90) for VO₂, HR, RPE, AcKcal, and rate of EE between RS and ACE trials. Significant moderate-to-strong correlations existed between RS trials for VO₂, AcKcal, rate of EE, and peak power output (P?<?0.01, r?=?0.77–0.97).

Conclusions: VO_2peak was highly correlated between ACE and RS trials and between the two RS trials, indicating the RS protocol to be reliable and valid for MWUs with SCI. Differences in perceived exertion and efficiency at submaximal workloads and maximal pulmonary ventilation at peak workloads indicated potential advantages to using the RS.     

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.     

High‐Intensity Interval Training Improves Peak Oxygen Uptake and Muscular Exercise Capacity in Heart Transplant Recipients

Heart transplant (HTx) recipients usually have reduced exercise capacity with reported VO_2peak levels of 50–70% predicted value. Our hypothesis was that high‐intensity interval training (HIIT) is an applicable and safe form of exercise in HTx recipients and that it would markedly improve VO_2peak. Secondarily, we wanted to evaluate central and peripheral mechanisms behind a potential VO_2peak increase. Forty‐eight clinically stable HTx recipients >18 years old and 1–8 years after HTx underwent maximal exercise testing on a treadmill and were randomized to either exercise group (a 1‐year HIIT‐program) or control group (usual care). The mean ± SD age was 51 ± 16 years, 71% were male and time from HTx was 4.1 ± 2.2 years. The mean VO_2peak difference between groups at follow‐up was 3.6 [2.0, 5.2] mL/kg/min (p < 0.001). The exercise group had 89.0 ± 17.5% of predicted VO_2peak versus 82.5 ± 20.0 in the control group (p < 0.001). There were no changes in cardiac function measured by echocardiography. We have demonstrated that a long‐term, partly supervised and community‐based HIIT‐program is an applicable, effective and safe way to improve VO_2peak, muscular exercise capacity and general health in HTx recipients. The results indicate that HIIT should be more frequently used among stable HTx recipients in the future.     

Psychological defense mechanisms among individuals with SCI with adjustment disorder

Objectives: The used psychological defense styles among individuals with spinal cord injury (SCI) with adjustment disorders (AJD) have not yet been described. In the present investigation, the prevalence of AJD among people with SCI has been estimated and the pattern of used defense styles has been identified.

Design: Cross-sectional investigation.

Setting: A tertiary rehabilitation center in Iran.

Participants: Individuals referred to Brain and Spinal Cord Injury Research Center were invited to participate in a screening interview. AJD was diagnosed based on DSM-V criteria. Those with AJD diagnosis were scheduled for another interview to assess defense mechanisms.

Outcome measures: Demographic and injury-related variables were recorded. Defense mechanisms were assessed by the 40-item version of the Defense-Style Questionnaire (DSQ-40).

Results: Among 114 participants, 32 (28%) were diagnosed with AJD among whom 23 subjects attended the second interview. Mean age and time since injury were 29.57?±?9.29 years and 11.70?±?6.34 months, respectively. The majority of patients were using idealization defense mechanism (91.3%). In the second and third place, passive aggression (87.0%) and somatization (82.6%) defense mechanisms were observed, respectively. Neurotic style was dominantly used (11.52?±?2.26). Sex, marital status, educational level, cause of the injury and injury level were not related to defense style (P: 0.38, 0.69, 0.88, 0.73, and P: 0.32, respectively).

Conclusion: Prevalence of AJD is estimated to be 28% among individuals with SCI. The most prevalent defense style was neurotic and the dominant used defense mechanism was “idealization.” The role of demographic and injury-related variables in determining the used defense mechanisms was insignificant.     

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.     

Trans-sacral epiduroscopic laser decompression versus the microscopic open interlaminar approach for L5-S1 disc herniation

Context/Objective: Trans-sacral epiduroscopic laser decompression (SELD) is an alternative to microscopic open lumbar discectomy (OLD). SELD and OLD for L5-S1 lumbar disc herniation (LDH) have not been compared. We compared clinical results, including pain control, between SELD and OLD.

Design: Retrospective analysis.

Setting: Korean hospital.

Participants: Eighty patients treated with SELD (n?=?40) or microscopic OLD (n?=?40) for L5-S1 LDH.

Interventions: N/A.

Outcome Measures: Clinical data were compared over 6 months. Functional status was evaluated using Oswestry Disability Index (ODI, 0–100%) and time to return to work. Preoperative and postoperative pain was measured using a visual analog scale (VAS, 0–10). Radiological assessment was performed preoperatively and postoperatively.

Results: The ODI and VAS scores for leg and back pain significantly improved in both groups. At 6-months after the procedure, the average ODI decreased to 13.2?±?11.2 from 54.5?±?14.5 for SELD and 9.5?±?10.4 from 57.5?±?16.0 for OLD. The average leg VAS decreased to 1.9?±?1.2 from 6.0?±?1.4 for SELD and 2.3?±?1.3 from 6.7?±?1.6 for OLD. Back VAS reduced to 2.6?±?1.3 from 7.2?±?1.5 for OLD. Time to return to work was 1.1?±?1.1 weeks for SELD and 5.4?±?2.1 weeks for OLD. Clinical outcomes of SELD were non-inferior to those of OLD in terms of pain control.

Conclusion: A scar-free procedure and early return to normal life are advantages of SELD.     

“The ABCs of AD”: A prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals

Context/Objective: Despite the availability of consensus-based resources, first responders and emergency room (ER) health care professionals (HCPs) have limited knowledge regarding autonomic dysreflexia (AD) recognition and treatment. The purpose of this study was to assess the efficacy of “The ABCs of AD” educational seminar for improving HCPs’ short- and long-term knowledge of AD recognition, diagnosis, and management.

Design: Multi-center prospective pre, post, and follow-up questionnaire study.

Setting: Level I trauma centers with emergency departments in British Columbia, Manitoba, and Ontario.

Methods: ER professionals completed measures immediately before and after (n?=?108), as well as 3-months following (n?=?23), attendance at “The ABCs of AD” seminar.

Outcome Measures: AD knowledge test; seminar feedback.

Results: Following the seminar, participants had higher ratings of their AD knowledge and had significantly higher AD knowledge test scores (M?±?SD pre?=?11.85?±?3.88, M?±?SD post?=?18.95?±?2.39, out of 22; P?<?0.001, d?=?2.21). Most participants believed the seminar changed their AD knowledge, and rated the seminar information as having the potential to influence and change their practice. AD knowledge test scores significantly decreased between post-seminar and 3-month follow-up (M?±?SD 3mo?=?17.04?±?3.28; P?=?0.004, d?=?–0.70); however, 3-month scores remained significantly higher than baseline.

Conclusion: “The ABCs of AD” seminar improves HCPs’ perceived and actual AD knowledge in the short-term. To enhance knowledge retention in both the short- and long-term, the inclusion of additional active learning strategies and follow-up activities are recommended. The seminar is being translated into an online training module to enhance the dissemination of the AD clinical practice guidelines among first responders, ER staff, and SCI practitioners.     

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.