Search

Objective: To determine the positive predictive value (PPV) of a sepsis‐screening protocol in patients with cervical spinal cord injury (SCI). Design/Method: Retrospective review of all patients with cervical SCI who screened positive for two or more systemic inflammatory response syndrome (SIRS) criteria while hospitalized in acute care or inpatient rehabilitation units over a 3.5‐year period. Sepsis was defined by the occurrence of (1) any culture order followed by an intravenous (IV) antibiotic within 72 hours or (2) an IV antimicrobial followed by a culture order within 24 hours. Results: A total of 134 patients screened positive for two or more SIRS criteria. Of these, 36 patients (26.9%) were diagnosed with sepsis. Factors associated with a true‐positive SIRS screen on multivariable analysis included American Spinal Injury Association Impairment Scale (AIS) grade A‐C (vs. D; p <.001). The PPV of the screen was 38% in patients with AIS A‐C and 9% in patients with AIS D. Altered mental status (AMS) was strongly associated with a diagnosis of sepsis; 16 of 18 (88.9%) of those with AMS had sepsis (p <.001). Age, sex, and neurologic level of injury were not associated with true‐positive screening. For patients with new SCI, the first true‐positive screen occurred a median of 31 days post‐injury. The most common SIRS criteria combinations in patients with true‐positive screens were elevated heart rate and either abnormal white blood cell count (43% of true positives) or abnormal temperature (26% of true positives). Abnormally low body temperature (<36°C) contributed to false‐positive screening for 10 of 38 (26%) AIS D patients who screened positive. Conclusion: Sepsis screening using SIRS criteria in hospitalized patients with tetraplegia has a PPV of 26.9%; it is significantly higher in patients with AIS A‐C versus D injuries. AMS, when combined with a positive SIRS screening, is strongly associated with sepsis. [ABSTRACT FROM AUTHOR]

Introduction: People with cervical spinal cord injury (SCI) identify improving upper extremity (UE) function as a top priority. In addition to comprehensive rehabilitation, UE surgeries, including nerve and tendon transfers, enhance function. However, barriers exist to disseminating information about surgical options to enhance UE function. Objective: To assess the experiences and preferences of people with cervical SCI and their caregivers in accessing information about surgery to enhance UE function. Design: Prospective cohort study. Participants were followed up for 24 months and completed up to three interviews. Setting: Tertiary care at academic and affiliated Veterans Administration Health Care Centers. Participants: Adults with cervical SCI (n = 35) ages 18 to 80 years with mid‐cervical SCI American Spinal Injury Association Impairment Scale A, B, or C (at least 6 months post‐injury) and their caregivers (n = 23) were eligible to participate. Participants were enrolled in three groups: nerve transfer, tendon transfer, or no UE reconstructive surgery. Interventions: Not applicable. Main Outcome Measure: Semi‐structured interviews about surgical knowledge and experiences. Results: Data were analyzed and three themes were identified. First, providing information about UE surgical options early post‐injury was recommended. The acute or inpatient rehabilitation phases of recovery were the preferred times to receive surgical information. Second, challenges with information dissemination were identified. Participants learned about UE surgery through independent research, medical provider interactions, or peers. Third, peers were identified as valuable resources for SCI needs and surgical information. Conclusions: Following cervical SCI, information about UE reconstructive surgeries should be a standard component of education during rehabilitation. An increased understanding of the reconstructive options available to improve UE function is necessary to educate stakeholders. Future research is needed to support the development of strategies to effectively present surgical information to individuals with SCI and health care providers. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) triggers an "accelerated aging" process that may include development of hypogonadism, even among younger men with SCI; however, few studies have investigated the prevalence or etiology of hypogonadism in men with SCI. Young men with SCI also are at increased risk for developing metabolic dysfunction after injury, which may be exacerbated by concomitant testosterone (T) deficiency, thus identifying the prevalence and risk factors for T deficiency in men with SCI is important for their long-term health.Objective: To investigate the prevalence, risk factors, and etiology of T deficiency (hypogonadism) in otherwise-healthy men with chronic, motor complete SCI.Design: Secondary cross-sectional analysis.Setting: Rehabilitation research centers in Washington, DC, and Miami, Florida.Participants: Men (n = 58) aged 18-45 years with chronic (≥1 year), motor complete SCI without comorbidities or use of testosterone therapy.Methods: Plasma concentrations of hormones were measured with standardized assays. Body composition was assessed with dual-energy x-ray absorptiometry scan.Main Outcome Measurements: Serum total T and calculated free T.Results: T deficiency was more common in men after SCI than in a matched cohort of similarly-aged men without SCI (25%, SCI versus 6.7%, non-SCI, P < .001). The risk of hypogonadism appeared to be increased in men with more extensive injury and with higher percent body fat. The majority of men with SCI with low T had low serum LH levels, suggesting that central suppression of the hypothalamic-pituitary-gonadal axis may be the most common etiology of hypogonadism after SCI.Conclusions: Hypogonadism is more common in young men with SCI than in similarly aged men without SCI, suggesting that SCI should be identified as a risk factor for T deficiency and that routine screening for hypogonadism should be performed in the SCI population.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Background: Many individuals with a spinal cord injury (SCI) have lived several decades with their injury, leading to a need for a deeper understanding of factors associated with healthy aging in people with long-term SCI.Objectives: To (1) describe secondary health conditions, activity limitations, and life satisfaction in older adults with long-term SCI, and to (2) investigate how sociodemographics, injury characteristics, and secondary health conditions are associated with their activity limitations and life satisfaction.Design: Cross-sectional descriptive cohort study.Setting: Home and community settings.Participants: A total of 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.Methods: Baseline data as part of the Swedish Aging with Spinal Cord Injury Study. Associations between variables were investigated with multivariable linear regression analyses.Main Outcome Measurements: Bowel and bladder function, nociceptive and neuropathic pain, spasticity, the Spinal Cord Independence Measure, third version, and the Satisfaction With Life Scale.Results: Bowel-related and bladder-related problems were reported by 32% and 44%, respectively, 66% reported moderate or severe nociceptive and/or neuropathic pain, and 44% reported spasticity. Activity limitations were moderate (mean Spinal Cord Independence Measure, third version, total score 65.2, range 8-100) where injury characteristics and spasticity explained 68% of the variance. Higher level and more severe SCI (based on the American Spinal Injury Association Impairment Scale) exhibited the strongest association with more activity limitations. Life satisfaction was rated just above the midpoint between satisfied and dissatisfied with life (mean Satisfaction With Life Scale total score 20.7, range 6-34). Marital status, vocational situation, bladder function and injury characteristics explained 38% of the variance, where having a partner showed the strongest association with greater life satisfaction. Activity limitations and life satisfaction were not associated with gender, age and time since injury.Conclusion: Older adults with long-term SCI can maintain a relatively high level of physical independence and generally are satisfied with their lives, regardless of gender, age or time since injury. The associations demonstrate the importance of injury characteristics for the performance of daily activities and the social context for life satisfaction in older adults with long-term SCI.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Chronic pain in persons with spinal cord injury (SCI) can significantly impact quality of life, with prevalence ranging from 26% to 96%.[1] Treatment of chronic pain is notoriously challenging and unsatisfactory for providers and patients.[[1]] Patients with traumatic SCI and fusion can develop adjacent-level degeneration.[3] Facet-mediated pain can be treated with radiofrequency ablation (RFA) of the medial branch nerves that innervate the zygapophyseal joints.[4] We present a patient with a history of SCI status post cervical fusion with facet-mediated neck pain who underwent cervical RFA. [Extracted from the article]

Background: Respiratory complications are major causes of morbidity and mortality in persons with a spinal cord injury, partly because of respiratory muscle paralysis. Earlier investigation has demonstrated that functional magnetic stimulation (FMS) can be used as a noninvasive technology for activating expiratory muscles, thus producing useful expiratory functions (simulated cough) in subjects with spinal cord injury.Objective: To evaluate the effectiveness of FMS for conditioning inspiratory and expiratory muscles in persons with tetraplegia.Design: A prospective before and after trial.Setting: FMS Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.Participants: Six persons with tetraplegia.Method: Each subject participated in a 6-week FMS protocol for conditioning the inspiratory and expiratory muscles. A magnetic stimulator was used with the center of a magnetic coil placed at the C7-T1 and T9-T10 spinous processes, respectively. Pulmonary function tests were performed before, during, and after the protocol.Main Outcome Measurements: Respiratory variables included maximal inspiratory pressure (MIP), inspiratory reserve volume (IRV), peak inspiratory flow (PIF), maximal expiratory pressure (MEP), expiratory reserve volume (ERV), and peak expiratory flow (PEF).Results: After 6 weeks of conditioning, the main outcome measurements (mean ± standard error) were as follows: MIP, 89.6 ± 7.3 cm H2O; IRV, 1.90 ± 0.34 L; PIF, 302.4 ± 36.3 L/min; MEP, 67.4 ± 11.1 cm H2O; ERV, 0.40 ± 0.06 L; and PEF, 372.4 ± 31.9 L/min. These values corresponded to 117%, 107%, 136%, 109%, 130%, and 124% of pre-FMS conditioning values, respectively. Significant improvements were observed in MIP (P = .022), PIF (P = .0001), and PEF (P = .0006), respectively. When FMS was discontinued for 4 weeks, these values showed decreases from their values at the end of the conditioning protocol, which suggests that continual FMS may be necessary to maintain improved respiratory functions.Conclusion: FMS conditioning of the inspiratory and expiratory muscles improved voluntary inspiratory and expiratory functions. FMS may be a noninvasive technology for respiratory muscle training in persons with tetraplegia. [ABSTRACT FROM AUTHOR]

Objective: To assess the accuracy of bedside swallow evaluation (BSE) compared with videofluorosopic swallow study (VFSS) in diagnosing dysphagia in individuals with tetraplegia due to spinal cord injury (SCI). Design: A prospective diagnostic accuracy study according to STAndards for the Reporting of Diagnostic accuracy studies (STARD) criteria. Setting: A county hospital with acute inpatient SCI unit. Patients: Thirty-nine subjects with SCI and tetraplegia were enrolled. All of the subjects underwent BSE, and 26 subjects completed the VFSS. Methods: Individuals with SCI underwent a BSE followed by a VFSS within 72 hours of the BSE. The subjects were diagnosed as having dysphagia if they had positive findings in either BSE or VFSS. Main Outcome Measures: Sensitivity, specificity, and positive and negative predictive values were calculated by using VFSS as the criterion standard. Results: Fifteen subjects (38%) were diagnosed as having dysphagia based on the BSE results. Among the subjects who completed the VFSS, 11 were diagnosed with dysphagia (42%) and 4 were diagnosed with aspiration (10%). Of the 26 subjects who completed both BSE and VFSS, only 1 subject was diagnosed differently compared with BSE (3.8%). Different diet recommendations were made in 4 cases after VFSS versus BSE. Different liquid recommendations were made in 8 cases after VFSS versus BSE. Sensitivity of BSE was 100% (95% confidence interval [CI], 71.5%-100%), specificity was 93.3% (95% CI, 68.1%-99.8%). A positive predictive value of BSE was 91.7% (95% CI, 61.5%-100%), and the negative predictive value was 100% (95% CI, 76.8%-100%). Conclusions: Dysphagia is present in approximately 38% of individuals with acute tetraplegia. Because only one of the 21 subjects was diagnosed differently based on VFSS, we believe that BSE is an appropriate screening tool for dysphagia for individuals with cervical SCI. However, VFSS provided additional information on diet and liquid recommendations, so there appears to be an important clinical role for the VFSS. [Copyright &y& Elsevier]

Objectives: To determine the effects of the level of injury on visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and the VAT:SAT ratio in individuals with tetraplegia (T-spinal cord injury [SCI]) and paraplegia (P-SCI) and the relationships among central adiposity and glucose and lipid profile. Design: Cross-sectional and correlation. Settings: Clinical hospital and academic settings. Methods: Thirteen individuals with motor complete SCI were divided into T-SCI (n = 6, C5-C7, American Spinal Injury Association Impairment Scale [AIS] A and B) and P-SCI (n = 7, T4-T11, AIS A and B) groups. Both groups underwent overnight fasting to measure serum lipid profile, plasma glucose, and insulin responses to an oral glucose tolerance test, which was followed by magnetic resonance imaging to quantify VAT and SAT cross-sectional areas (CSA) and volume across multi-axial slices. Results: The CSA and volumes of VAT and SAT were not different between T-SCI and P-SCI. VAT CSA was related to the fasting glucose in both groups, with nonsignificant association with glucose area under the curve. The CSA and volume of SAT were strongly associated with lipid profile outcomes in the T-SCI (r = 0.86-0.99, P < .02) but not in the P-SCI. Conclusion: The preliminary work suggests that the level of injury does not appear to influence the distribution of VAT and SAT. VAT and SAT distribution could not explain the difference noted in glucose and insulin profiles between the T-SCI and P-SCI groups. Finally, SAT is a strong predictor of lipid profile in individuals with T-SCI. [ABSTRACT FROM AUTHOR]

Persons with tetraplegia resulting from a cervical spinal cord injury believe that increasing upper limb (UL) function will improve their quality of life. Various lines of evidence demonstrate that persons with incomplete tetraplegia have the potential for improvements in both neural plasticity and function of the arms and hands. Therefore treatment to improve UL function in persons with incomplete tetraplegia should focus on improving motor control, not just compensation for the paralysis and sensory loss that follows a spinal cord injury. This article highlights the principles that underlie the facilitation of neural plasticity and functional changes: intensity, repeated practice, attention, and somatosensory augmentation. Evidence is presented for the application of these principles through the use of activity‐based interventions in persons with tetraplegia and the hypothesis is proposed that the use of activity‐based interventions will lead to greater, more beneficial neural plasticity as well as gains in UL function, in persons with incomplete tetraplegia. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging showed acute bilateral anterior cerebral artery (ACA) infarction of medial frontal regions. The clinical findings of ACA infarctions are variable and depend on the area of ACA circulation that is affected. [Extracted from the article]

Limited biceps electromyography revealed sustained activity at rest and more so during attempts to extend the elbow, which suggests inappropriate biceps-triceps co-contraction. Conclusions This case emphasizes the importance of managing upper motor neuron syndrome signs by using a combination of chemodenervation and therapy techniques to facilitate delayed recovery of UL function in tetraplegia. Diagnostic musculocutaneous nerve block decreased biceps hypertonia and increased active elbow extension. [Extracted from the article]

It has been established that patients with spinal cord injury are at an increased risk for developing pancreatitis in the first few weeks after their injury. Although people with long-term spinal cord injury are at an increased risk for cholelithiasis, they do not appear to be at increased risk for acute pancreatitis relative to people without spinal cord injury. [Extracted from the article]