Changes in nutrient intake and inflammation following an anti-inflammatory diet in spinal cord injury

Objective: The objective of the current study was to describe the observed changes in nutrient intakes following a 3-month anti-inflammatory diet, and to explore potential relationships between the change in nutrients and the change in various inflammatory mediators.

Design: A secondary analysis of a prior randomized controlled clinical trial.

Setting: Individuals with SCI within the Niagara region.

Participants: Twenty individuals with various levels and severities of SCI.

Intervention: Three-month anti-inflammatory diet.

Outcome Measures: The change in nutrient intake and corresponding changes to various inflammatory mediators.

Results: The treatment group demonstrated a significant reduction in fat intake (P?=?0.02), a significant increase in protein intake (P?=?0.02), and no change in carbohydrates (P?=?0.23) or energy intake (P?=?0.10). The treatment group showed a significant increase in some nutrients with established anti-inflammatory properties including vitamins A, C, and E, and omega-3 fatty acids (P?<?0.01). Significant reductions in proinflammatory nutrients were observed including trans fatty acids (P?=?0.05), caffeine (P?<?0.01), and sodium (P?=?0.02). The treatment group also showed significant reductions in the proinflammatory mediators interferon-y (P?=?0.01), interleukin-1β (P?<?0.01), and interleukin-6 (P?<?0.05). Further, several proinflammatory mediators were negatively correlated with anti-inflammatory nutrients, including vitamin A, carotenoids, omega-3 fatty acids, and zinc.

Conclusion: This study provides evidence that dietary alterations are effective at reducing chronic inflammation in individuals with SCI and provides a preliminary assessment of the related nutrient changes.     

Does attendance in SCI education courses impact health outcomes in acute rehabilitation?

Objective: Though education about secondary complications following spinal cord injury (SCI) is a component of many rehabilitation programs, there is little research on their success in promoting healthier outcomes. This study examined 1) whether greater education course attendance was associated with improved health outcomes and quality of life and 2) whether completion of bladder management and skin care courses was associated with decreased incidence of urinary tract infections (UTIs) and pressure ulcers (PUs).

Design: Retrospective medical record review.

Setting and Participants: Patients (N?=?106) in a Veterans Administration (VA) SCI rehabilitation program who completed at least one education class from August 2008 to September 2012.

Methods and Outcome Measures: Records were reviewed to determine the number of education courses completed and patients’ responses to the Satisfaction with Life Survey (SWLS), the short form of the Craig Handicap and Assessment Reporting Technique (CHART-SF), and Short Form Health Survey (SF-8) at admission, discharge, and 90 days post-discharge. Records were reviewed to determine frequency of UTIs and PUs from admission to discharge and from discharge to 90-day follow-up.

Results: Regression analyses revealed no association between number of classes and self-reported health and quality of life. Skin care class attendance was associated with a decreased number of PUs. Greater overall attendance at education courses was unexpectedly associated with a higher number of UTIs from admission to discharge.

Conclusion: Results of the study are mixed. Multiple factors appear to impact the success of education interventions. Future research is needed to clarify the best approach.     

The combined effect of granulocyte-colony stimulating factor (G-CSF) treatment and exercise in rats with spinal cord injury

Objective: To identify that the combined G-CSF and treadmill exercise is more effective in functional recovery after spinal cord injury (SCI).

Design: Rats were divided into 4 groups: a SCI group treated with G-CSF (G-CSF group, n?=?6), a SCI group treated with treadmill exercise plus G-CSF (G-CSF/exercise group, n?=?6), a SCI group with treadmill exercise (exercise group, n?=?6), and a SCI group without treatments (control group, n?=?6). We performed laminectomy at the T8–10 spinal levels with compression injury of the spinal cord in all rats. G-CSF (20?μg/ml) was administered intraperitoneally for 5 consecutive days after SCI in G-CSF and G-CSF/exercise groups. From one week after surgery, animals in G-CSF/exercise and exercise groups received 30?min of exercise 5 days per week for 4 weeks. Functional recoveries were assessed using the Basso, Beattie, and Bresnahan (BBB) scale and the inclined plane test. Five weeks after SCI, hematoxylin and eosin staining for cavity size and immunohistochemistry for glial scar formation and neuro-regeneration factor expression were conducted.

Setting: Inha University School of medicine, Incheon, Korea

Results: Rats in G-CSF/exercise group showed the most effective functional recovery in the BBB scale and the inclined plane test, and spinal cord cavity size by injury were the smallest, and immunohistochemistry revealed expression of higher BDNF (brain-derived neurotrophic factor) and VEGF (vascular endothelial growth factor) and lower GFAP (glial fibrillary acidic protein) than others.

Conclusion: Combined treatment provided more effective neuroplasty and functional recovery than individual treatments.     

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.     

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

Abstract

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

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

Setting: Ninety-four acute care Veterans Affairs facilities.

Participants: Patients with SCI/D.

Outcomes: Incidence rate of HO-HCFA CDI.

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

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

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

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.     

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.     

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.     

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.     

Adherence to US Preventive Services Task Force recommendations for breast and cervical cancer screening for women who have a spinal cord injury

Context: Women with spinal cord injury (SCI) may face barriers that result in disparities in receipt of recommended mammography and Papanicolaou testing.

Setting: South Carolina.

Participants: South Carolina women with SCI were identified using International Classification of Diseases codes in 2000–2010 Medicaid and Medicare billing data.

Outcome measures: Receipt of mammography and Pap testing was determined using procedure billing codes. Partial proportional odds models were estimated to examine the association between SCI and adherence with screening recommendations from the United States Preventive Services Task Force. Each individual's screening experience was classified as full adherence, partial adherence, or no screening.

Results: The cohort for mammography consisted of 3,173 women with SCI and 6,433 comparison women without SCI. The cohort for Pap testing consisted 5,025 women with SCI and 9,538 comparison women. Women with SCI were less likely to have full adherence with mammography recommendations (aOR?=?0.69, 95% CI 0.64, 0.76) and Pap test recommendations (aOR?=?0.53, 95% CI 0.49, 0.57). They were more likely to have no mammography screening (aOR?=?1.44, 95% CI 1.33, 1.57) and no Pap testing (aOR?=?1.89, 95% CI 1.77, 2.03) than women without SCI.

Conclusion: Using longitudinal data with multiple outcome levels, women with SCI were less likely to be fully adherent with receipt of recommended breast and cervical cancer screenings and more likely to have no screenings during the eligible years when compared to women without SCI.     

Cross-validity of one maximum repetition predictive equation for men with spinal cord injury

Objectives: The study aimed to test the cross-validation of a specific one maximum repetition (1RM) predictive equation based on the 4- to 12-maximum repetition test (4-12RM) for men with spinal cord injury (SCI).

Study design: Cross-sectional study.

Setting: Rehabilitation Hospital Network.

Participants: Fifty-eight men aged 31.9 (20.0–38.0) years (median and quartile) with SCI were enrolled in the study.

Interventions: None.

Outcomes measures: Volunteers were tested in 1RM test or 4-12RM of the bench press exercise with 2–3 interval days in a random order. The intraclass correlation coefficient (ICC) with Bland Altman plot was used to compare a specific predictive equation (SPE) and six current predictive equations (CPE) based on the 4- to 12-maximum repetition with the 1RM test.

Results: The SPE showed the highest intraclass correlation coefficient (ICC?=?0.91; 95%CI 0.85–0.95), the smallest range of the interval around the differences (Δ?=?36.6) and the second lowest mean difference between 1RM test and 1RM predictive equation (?2.4?kg). The CPE3 presented the lowest mean difference (?1.6?kg). All intraclass correlations’ predictive equations were classified as excellent.

Conclusion: The SPE presented a suitable and satisfactory validity to assess men with SCI at the bench press exercise. Thus, the equation is an accurate method to predict 1RM in SCI.     

D-dimer monitoring combined with ultrasonography improves screening for asymptomatic venous thromboembolism in acute spinal cord injury

Objective: We compared screening methods for asymptomatic venous thromboembolism (VTE) in patients with acute spine and spinal cord injuries (SCI). Patients were screened by D-dimer monitoring alone (DS group) or by D-dimer monitoring combined with ultrasonography (DUS group).

Design: Prospective cohort study.

Setting: One department of a university hospital in Japan.

Participants: 114 patients treated for acute SCI between 2011 and 2017.

Interventions: N/A.

Outcome Measures: D-dimers were measured upon admission and 1, 3, 5, 7, and 14 days thereafter. DUS-group patients also underwent an ultrasound 7 days after admission. If ultrasonography indicated deep venous thrombosis (DVT), or if D-dimer levels increased to ≥?10?µg/mL, the patient was assessed for VTE, including DVT or pulmonary embolism (PE), by contrast venography. We analyzed the incidence of VTE detected in the DS and DUS groups.

Results: In the DS group, D-dimers were elevated (≥?10?µg/mL) in 15 of 70 patients (21.4%), and 9 of the 15 had asymptomatic VTE (12.9%, DVT 11.4%, PE 5.7%). In the DUS group, one patient developed VTE on day 4, and D-dimers were elevated in 13 of 43 patients (30.2%), ultrasonography indicated DVT in 12 patients (27.9%), and asymptomatic VTE was diagnosed in 12 patients (27.9%, DVT 27.9%, PE 4.7%). The DUS group had a higher incidence of DVT (P?=?0.002) and VTE (P?=?0.042) than the DS group.

Conclusions: Combined D-dimer and ultrasound screening in patients with acute SCI improved the detection of VTE, including PE, compared with D-dimer screening alone.     

高压氧对脊髓损伤肌张力控制的队列研究

目的:探讨高压氧(hyperbaric oxygenation,HBO)对脊髓损伤(spinal cord injury,SCI)肌张力增高患者的治疗效果。方法:选择2009年3月至2011年4月脊髓损伤肌张力增高患者80例作为研究对象,男49例,女31例;年龄17～60岁,平均(34.12±6.61)岁;病程14～30d,平均(20.16±5.08)d。按就诊顺序、是否愿意同时进行高压氧治疗分成治疗组和对照组。其中治疗组40例,在运动康复训练和巴氯芬药物治疗的基础上,加用HBO治疗。治疗压力为2ATA;治疗方案为:面罩吸氧20min,休息5min,反复3个循环为1次,每日1次,10d为1个疗程,共治疗6个疗程。对照组40例,只进行运动康复训练和巴氯芬药物治疗,疗程同治疗组。两组均按国际通用修订的Ashworth评分(modified ash worth scale,MAS)方法分别于治疗3个疗程和6个疗程时对肌张力进行评估。结果:治疗3个疗程时对肌张力的控制,治疗组有效5例,显效0例;对照组有效4例,显效0例。治疗6个疗程时对肌张力的控制,治疗组有效24例,显效5例;对照组有效14例,显效2例。3个疗程时,治疗组与对照组疗效差异无统计学意义(P=0.508);6个疗程时治疗组疗效优于对照组(P<0.05)。结论:HBO对脊髓损伤肌张力增高患者有治疗作用,可作为一种常规辅助治疗方法,在临床上值得推广应用,但需要足够的疗程。     

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.     

Pattern of startle reflex to somatosensory stimuli changes after spinal cord injury

Introduction: Spinal cord injury (SCI) may cause functional changes at various levels in central and peripheral nervous systems. One of these changes is increased excitability above the lesion such as enhanced auditory startle responses (ASR). Startle response may also be obtained after somatosensory stimulus (startle reflex to somatosensory stimuli, SSS). In this study, we investigated changes of both ASR and SSS in SCI.

Method: We examined ASR and SSS in 14 patients with SCI and 18 age-matched healthy volunteers. SSS responses were recorded from orbicularis oculi (O.oc), sternocleidomastoid (SCM) and biceps brachii (BB) muscles by electrical stimulation of median nerve at the wrist. ASR was evoked by binaural auditory stimuli and recorded from O.oc, masseter, SCM and BB muscles. Probability, latency, amplitude and duration of responses were compared between two groups for each muscle.

Results: Presence of response over O.oc after somatosensory stimuli was decreased in patients compared to controls (P?=?0.004). There were no differences in SSS responses of other muscles. ASR latency was shorter in masseter, SCM and BB in patients with SCI, but only BB had significantly reduced latency (P?=?0.033). The duration of O.oc response was longer and the amplitude of SCM was larger in patients with SCI (P?=?0.037 and P?=?0.015, respectively).

Conclusion: ASR is enhanced after SCI whereas SSS of eye muscles is hypoactive and pattern of SSS after median stimulation changes in SCI.     

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.     

Changes in alcohol use after the onset of spinal cord injury

Objective: Identify the prevalence of alcohol consumption and binge drinking at time of spinal cord injury (SCI) onset, compare these rates to data from the general population, and identify changes in alcohol use at an average of 17 months post-injury.

Design: Cross sectional, mailed self-report assessment.

Setting: A specialty hospital in the southeastern United States.

Participants: Five hundred sixty-six inpatients completed the baseline measure. After eliminating those under age 18, there were 524 participants at baseline. 410 were approached for follow-up, with 201 of those responding.

Interventions: N/A.

Outcome Measures: Self-reported assessments were completed during inpatient rehabilitation and at follow-up approximately 17 months later. The two primary outcomes were the number of days consuming 5 or more drinks (binge drinking) and the number of days consuming any alcoholic beverages within the 30 days prior to the assessment. Comparison data were taken from the Behavioral Risk Factor Surveillance System.

Results: At SCI onset, the prevalence of alcohol use, particularly binge drinking, was substantially higher than the general population (SCI?=?44.9%; general population?=?13%). Drinking rates decreased by 17 months post-injury.

Conclusion: Alcohol use and binge drinking are elevated over the general population at the time of injury. Drinking patterns reflect a decrease following injury but remain slightly elevated, signifying a need for interventions to minimize long-term health consequences.     

Comparison of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) for spasticity in spinal cord injury - A pilot randomized cross-over trial

Objective: Spasticity following spinal cord injury (SCI) can impair function and affect quality of life. This study compared the effects of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) on lower limb spasticity in patients with SCI.

Design: Double blind randomized crossover design.

Setting: Neuro-rehabilitation unit, Manipal University, India.

Participants: Ten participants (age: 39 ± 13.6 years, C1–T11, 1–26 months post SCI) with lower limb spasticity were enrolled in this study.

Interventions: Participants were administered electrical stimulation with TENS and FES (duration - 30 minutes) in a cross over manner separated by 24 hours.

Outcome Measures: Spasticity was measured using modified Ashworth scale (MAS) [for hip abductors, knee extensors and ankle plantar flexors] and spinal cord assessment tool for spastic reflexes (SCATS). Assessments were performed at baseline, immediately, 1 hour, 4 hours, and 24 hours post intervention.

Results: A between group analysis did not show statistically significant differences between FES and TENS (P > 0.05). In the within group analyses, TENS and FES significantly reduced spasticity up to 4 hours in hip adductors and knee extensors (P < 0.01). SCATS values showed significant reductions at 1 hour (P?=?0.01) following TENS and 4 hours following FES (P?=?0.01).

Conclusion: A single session of electrical stimulation with FES and TENS appears to have similar anti-spasticity effects that last for 4 hours. The findings of this preliminary study suggest that both TENS and FES have the potential to be used as therapeutic adjuncts to relieve spasticity in the clinic. In addition, FES may have better effects on patients presenting with spastic reflexes.