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Thermoregulation is impaired in individuals with a spinal cord lesion (SCI), affecting sweat capacity, heat loss, and core temperature. This can be particularly problematic for athletes with SCI who exercise in hot and humid conditions, like those during the Tokyo 2020 Paralympic Games. Heat acclimation can support optimal preparation for exercise in such challenging environments, but evidence is limited in endurance athletes with SCI. We evaluated whether seven consecutive days of exercise in the heat would result in heat acclimation. Five elite para-cycling athletes with SCI participated (two females, three males, median (Q1-Q3) 35 (31–51) years, four with paraplegia and one with tetraplegia). All tests and training sessions were performed in a heat chamber (30°C and 75% relative humidity). A time-to-exhaustion test was performed on day 1 (pretest) and day 7 (posttest). On days 2–6, athletes trained daily for one hour at 50–60% of individual peak power (PPeak). Comparing pretest and posttest, all athletes increased their body mass loss (p=0.04), sweat rate (p=0.04), and time to exhaustion (p=0.04). Effects varied between athletes for core temperature and heart rate. All athletes appeared to benefit from our heat acclimation protocol, helping to optimize their preparation for the Tokyo 2020 Paralympic Games. [ABSTRACT FROM AUTHOR]

This study addresses the need for highly sensitive tools to evaluate hand strength, particularly grasp and pinch strength, which are vital for diagnosing and rehabilitating conditions affecting hand function. Current devices like the Jamar dynamometer and Martin Vigorimeter, although reliable, fail to measure extremely low force or pressure values required for individuals with severe hand impairments. This research introduces a novel device, a modified Martin Vigorimeter, utilizing an ultra-soft latex chamber and differential pressure measurement to detect minute pressure changes, thus significantly enhancing sensitivity. The device offers a cost-effective solution, making advanced hand strength evaluation more accessible for clinical and research applications. Future research should validate its accuracy across diverse populations and settings, exploring its broader implications for hand rehabilitation and occupational health. [ABSTRACT FROM AUTHOR]

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

BACKGROUND To compare the pharmacological treatment of hypotension and orthostatic hypotension (OH) initiated based upon a blood pressure (BP) threshold, regardless of symptoms (TXT), to usual care pharmacological treatment of symptomatic hypotension (UC), during acute inpatient rehabilitation (AIR) following spinal cord injury (SCI). METHODS Block randomization, based on the neurological level of injury as: cervical lesions (C1–C8); high thoracic lesions (T1–T5), and low thoracic lesions (T6–T12), was used to determine responses to the primary question " was the therapy session affected by low BP or concern for low BP development? " Study participants and therapists were unaware of the group assignment. RESULTS A total of 66 participants enrolled; 25 (38%) in the TXT group, 29 (44%) in the UC group, and 12 (18%) withdrew. Responses to the primary question were recorded for 32 participants, 15 in the TXT, and 17 in the UC group. There was an average of 81 ± 51 therapy sessions/participant in the TXT and 60 ± 27 sessions/participant in the UC group. Of those therapy sessions, low BP or concerns for low BP affected an average of 9 ± 8 sessions/participant in the TXT group and 10 ± 12 sessions/participant in the UC group. Neither the total number of therapy sessions (P  = 0.16) nor group assignment (P  = 0.83) significantly predicted the number of sessions affected by low BP. CONCLUSIONS These data are not conclusive but indicate that the treatment of asymptomatic hypotension and OH does not increase time spent in therapy compared to UC treatment of symptomatic hypotension and OH in newly injured patients with SCI. CLINICAL TRIALS REGISTRATION #NCT02919917. [ABSTRACT FROM AUTHOR]

Nerve transfer after spinal cord injury has become increasingly popular. Accurate preoperative identification of lower motor neuron involvement in potential recipient nerves is critical. Electrodiagnostic testing has been shown to correlate with intraoperative findings; however, it is time-consuming, costly and may not be readily available. Stimulated manual muscle testing is an alternative diagnostic approach. It is inexpensive and easily done by the surgeon or therapist in the office; however, correlation with intraoperative stimulation has not been reported. A retrospective review was conducted for patients who underwent nerve transfer for tetraplegia with recorded preoperative stimulated manual muscle testing and intraoperative stimulation results. Nine patients including 37 nerve transfers were included. Of the 37 nerve transfers, 36 were accurately graded preoperatively by stimulated manual muscle testing. Stimulated manual muscle testing had a sensitivity of 89%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 97%. This study supports stimulated manual muscle testing for preoperative distinction between upper versus lower motor neuron injuries. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: Tetraplegia is a debilitating sequela of spinal cord injury (SCI). However, comprehensive approaches for determining the influence of various factors on activities of daily living (ADL) in patients with tetraplegia are limited. Therefore, this study aimed to determine the influence of physical factors on ADL in patients with tetraplegia after adjusting for demographic, SCI-related, and cognitive factors. Methods: This retrospective cross-sectional study enrolled 201 patients with tetraplegia who underwent inpatient rehabilitation at the National Rehabilitation Center in South Korea between 2019 and 2021. Patients' mean age was 50.5 years (standard deviation, 16.3), and 170 (84.6%) were men. The Korean Spinal Cord Independence Measure III (K-SCIM III) was used as the main outcome measure to assess patients' ADL ability. Hierarchical multiple regression modeling was conducted with K-SCIM as the dependent variable to examine the level of functioning and relative influencing factors. Results: Upper-extremity motor score (UEMS), upper-extremity spasticity and sitting balance scores were significant predictors of self-care; lower-extremity motor score (LEMS), musculoskeletal pain of shoulder, and sitting balance were significant predictors of respiratory and sphincter management; UEMS, LEMS, and sitting balance score were significant predictors of mobility; and UEMS, LEMS, musculoskeletal pain of shoulder, and sitting balance scores were significant predictors of the K-SCIM III total score after adjustment for demographic, SCI-related, and cognitive factors. Conclusions: Physical factors had the greatest impact on all subscores and the K-SCIM III total score. Upper- and lower-extremity muscle strength and sitting balance significantly affected functional ability across all subscores. [ABSTRACT FROM AUTHOR]

Abstract Background Tetraplegia is a debilitating sequela of spinal cord injury (SCI). However, comprehensive approaches for determining the influence of various factors on activities of daily living (ADL) in patients with tetraplegia are limited. Therefore, this study aimed to determine the influence of physical factors on ADL in patients with tetraplegia after adjusting for demographic, SCI-related, and cognitive factors. Methods This retrospective cross-sectional study enrolled 201 patients with tetraplegia who underwent inpatient rehabilitation at the National Rehabilitation Center in South Korea between 2019 and 2021. Patients’ mean age was 50.5 years (standard deviation, 16.3), and 170 (84.6%) were men. The Korean Spinal Cord Independence Measure III (K-SCIM III) was used as the main outcome measure to assess patients’ ADL ability. Hierarchical multiple regression modeling was conducted with K-SCIM as the dependent variable to examine the level of functioning and relative influencing factors. Results Upper-extremity motor score (UEMS), upper-extremity spasticity and sitting balance scores were significant predictors of self-care; lower-extremity motor score (LEMS), musculoskeletal pain of shoulder, and sitting balance were significant predictors of respiratory and sphincter management; UEMS, LEMS, and sitting balance score were significant predictors of mobility; and UEMS, LEMS, musculoskeletal pain of shoulder, and sitting balance scores were significant predictors of the K-SCIM III total score after adjustment for demographic, SCI-related, and cognitive factors. Conclusions Physical factors had the greatest impact on all subscores and the K-SCIM III total score. Upper- and lower-extremity muscle strength and sitting balance significantly affected functional ability across all subscores.

This Joel A. DeLisa Lecture on endovascular brain-computer interfaces was presented by Dr Thomas Oxley on February 23, 2023, at the Association of Academic Physiatrists Annual Scientific Meeting. The lecture described how brain-computer interfaces replace lost physiological function to enable direct communication between the brain and external digital devices, such as computers, smartphones, and robotic limbs. Specifically, the potential of a novel endovascular brain-computer interface technology was discussed. The brain-computer interface uses a stent-electrode array delivered via the jugular vein and is permanently implanted in a vein adjacent to the motor cortex. In a first-in-human clinical trial, participants with upper limb paralysiswho received the endovascular brain-computer interface could use the system independently and at home to operate laptop computers for various instrumental activities of daily living. A Food and Drug Administration-approved trial of the endovascular brain-computer interface in the United States is in progress. Future development of the system will provide recipients with continuous autonomy through digital access with minimal caregiver assistance. Physiatrists and occupational therapists will have a vital role in helping people with paralysis achieve the potential of implantable brain-computer interfaces. [ABSTRACT FROM AUTHOR]

Two medium-sized, 7-year-old dogs, with no previous history of pain, presented with acute neurologic symptoms consistent with intervertebral disk disease. Both cases had CT, where cervical pathology was identified. In one dog, the diagnosis was singular extensive cervical disk herniation with possible epidural hemorrhage and in the other, the diagnosis was multiple-site cervical disk herniation. The first dog, a Shar-Pei, underwent treatment with two standard adjacent ventral slots between the C4-C5 and C5-C6 intervertebral disk spaces and a fenestration between the C3 and C4 intervertebral disk spaces. The second case, a beagle, underwent a double adjacent standard ventral slot between the C5-C6 and C6-C7 intervertebral disk spaces. Both dogs recovered uneventfully after the surgery and showed no signs of recurrence during a 2-year follow-up period. This is the first detailed report of the use of a double adjacent ventral slot as a treatment for spinal decompression in medium-sized dogs with multiple-site spinal cord compression. [ABSTRACT FROM AUTHOR]

• This study investigated the cortical silent period (CSP) characteristics in stronger biceps (power = 3–5) and weaker triceps (power = 1–3) after SCI. • The CSP from the biceps had a longer duration, whereas it was delayed and shallow for the triceps in individuals with SCI. • The CSP characteristics were associated with upper arm functional ability supporting their relevance for motor recovery after SCI. Corticospinal inhibitory mechanisms are relevant to functional recovery but remain poorly understood after spinal cord injury (SCI). Post-injury characteristics of contralateral silent period (CSP), a measure of corticospinal inhibition evaluated using transcranial magnetic stimulation (TMS), is inconsistent in literature. We envisioned that investigating CSP across muscles with varying degrees of weakness may be a reasonable approach to resolve inconsistencies and elucidate the relevance of corticospinal inhibition for upper extremity function following SCI. We studied 27 adults with chronic C1-C8 SCI (age 48.8 ± 16.1 years, 3 females) and 16 able-bodied participants (age 33.2 ± 11.8 years, 9 females). CSP characteristics were assessed across biceps (muscle power = 3–5) and triceps (muscle power = 1–3) representing stronger and weaker muscles, respectively. We assessed functional abilities using the Capabilities of the Upper Extremity Test (CUE-T). Participants with chronic SCI had prolonged CSPs for biceps but delayed and diminished CSPs for triceps compared to able-bodied participants. Early-onset CSPs for biceps and longer, deeper CSPs for triceps correlated with better CUE-T scores. Corticospinal inhibition is pronounced for stronger biceps but diminished for weaker triceps muscle in SCI indicating innervation relative to the level of injury matters in the study of CSP. Nevertheless, corticospinal inhibition or CSP holds relevance for upper extremity function following SCI. [ABSTRACT FROM AUTHOR]

This qualitative study explored perceived barriers and facilitators to access and utilization of assistive technology (AT) among Veterans and civilians living with tetraplegia. We also explored differences in access to and utilization of AT between civilians and Veterans. Semi-structured focus groups were conducted with 32 adults (15 Veterans, 17 non-Veterans) living with tetraplegia between the ages of 18 and 65 and who were at least one-year post-injury. Focus groups were conducted at two rehabilitation sites: Craig Hospital and the Louis Stokes Cleveland VA Medical Center. Participants were asked to discuss what they perceive as (1) the facilitators and barriers of AT access and utilization, and (2) the value of AT use in everyday living. Data were analyzed using thematic analysis of verbatim transcripts. Facilitators of AT utilization and access included being connected to resources, trial-and-error, and knowledge gained from peers. Barriers to AT use included cost of devices, a general lack of awareness of resources, and requirements for eligibility; the latter two themes were endorsed solely by Veteran participants. Benefits of AT included increased independence, participation, productivity, quality of life, and safety. Findings highlight key facilitators of AT procurement and use, barriers that contribute to underutilization of AT, and important benefits experienced as a result of using AT that underscore the importance of AT for individuals with SCI. The need to maintain connections with rehabilitation resources (e.g., the Department of Vocational Rehabilitation, occupational and physical therapists, the VA, inpatient facilities) is vital to learning about and procuring AT. There is a need for a tailored approach to address AT underutilization in civilian and Veteran populations. Despite the barriers to AT use and the challenges associated with discovery of AT, utilization of AT may lead to increased independence, participation, productivity, quality of life, and safety. [ABSTRACT FROM AUTHOR]

• The median time until the first pneumonia event after spinal cord injury is 6 days. • Persons with traumatic AIS A, B, or C tetraplegia are at highest risk for pneumonia. • Elderly people are at increased risk for multiple pneumonia events. To describe the occurrence of pneumonia in individuals with acute spinal cord injury (SCI) and identify its key predictors. Multi-centric, longitudinal cohort study. 10 specialized SCI rehabilitation units in Europe and Australia. Eligible were 902 men and women with acute SCI, aged 18 years or older, with cervical or thoracic lesions and not dependent on 24-hour mechanical ventilation; 503 participated in the study (N=503). Not applicable. We assessed demographics and lesion related parameters at study entry, and any pneumonia events throughout inpatient rehabilitation. Respiratory function, decubitus, and urinary tract infections were assessed at 1, 3, and 6 months post injury as well as at discharge from inpatient rehabilitation. Time to event (pneumonia) analyses were done using the Kaplan-Meier method, and potential predictors for pneumonia were analyzed with multivariable survival models. Five hundred three patients with SCI were included, with 70 experiencing at least 1 pneumonia event. 11 participants experienced 2 or more events during inpatient rehabilitation. Most events occurred very early after injury, with a median of 6 days. Pneumonia risk was associated with tetraplegia (hazard ratio [HR]=1.78; 95% confidence interval [CI] 1.00-3.17) and traumatic etiology (HR=3.75; 95% CI 1.30-10.8) American Spinal Injury Impairment Scale (AIS) A (HR=5.30; 95% CI 2.28-12.31), B (HR=4.38; 95% CI 1.77-10.83), or C (HR=4.09; 95% CI 1.71-9.81) lesions. For every 10 cmH 2 O increase in inspiratory muscle strength, pneumonia risk was reduced by 13% (HR=0.87; 95% CI 0.78-0.97). Pneumonia is a major complication after SCI with the highest incidence very early after injury. Individuals with traumatic or AIS A, B, or C tetraplegia are at highest risk for pneumonia. [ABSTRACT FROM AUTHOR]

This article summarizes a study on heart rate variability (HRV) in newly injured traumatic cervical spinal cord injury (SCI) patients. The study found that the ratio of low to high frequency power was lower in patients with AIS grade B compared to AIS grade A patients, and this ratio was negatively correlated with the duration since injury. However, HRV did not vary with age or the level of cervical lesion. The findings provide insights into the factors that affect HRV in newly injured cervical SCI patients. The article does not disclose any conflicts of interest or external sources of support. [Extracted from the article]

ObjectiveSpinal cord injury (SCI) is a serious condition that can lead to partial or complete paraplegia or tetraplegia. Currently, there are few therapeutic options for these conditions, which are mainly directed toward the acute phase, such as surgical intervention and high-dose steroid administration. Mesenchymal stromal cells (MSC) have been shown to improve neurological function following spinal cord injury. The aim of the study was to evaluate the safety, feasibility, and potential efficacy of MSC transplantation in patients with cervical traumatic SCI.MethodsWe included seven subjects with chronic traumatic SCI (> 1 year) at the cervical level, classified as American Spinal Cord Injury Association impairment scale (AIS) grade A. Subjects received two doses of autologous bone marrow derived MSC, the first by direct injection into the lesion site after hemilaminectomy and the second three months later by intrathecal injection. Neurologic evaluation, spinal magnetic resonance imaging (MRI), urodynamics, and life quality questionnaires were assessed before and after treatment.ResultsCell transplantation was safe without severe or moderate adverse effects, and the procedures were well tolerated. Neurological evaluation revealed discrete improvements in sensitivity below the lesion level, following treatment. Five subjects showed some degree of bilateral sensory improvement for both superficial and deep mechanical stimuli compared to the pretreatment profile. No significant alterations in bladder function were observed during this study.ConclusionTransplantation of autologous MSC in patients with chronic cervical SCI is a safe and feasible procedure. Further studies are required to confirm the efficacy of this therapeutic approach.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT02574572, identifier NCT02574572.

Objective: To explore independence, usability, and self-reported quality of life (QOL) in eligible persons with spinal cord injury (SCI) who used a standing powered wheelchair over a 12-week period. Setting: VA SCI research facility. Participants: Four participants with chronic SCI who use a wheelchair as the primary means of mobility. Intervention: A standing power wheelchair was used three times a week (3.5 h/session) for 12 weeks in a supervised setting. Main Outcome Measures: safety, usability and feasibility, blood pressure in seated and standing positions, bowel, bladder, and pain item banks from the SCI-QOL Physical-Medical- Health domain, and overall user satisfaction with the device. Results: Participants consistently maintained normal blood pressure responses between seated and standing positions throughout the training sessions and learned to perform all the mobility tasks safely and independently. Participants reported improvements on the SCI-QOL and were generally satisfied with the upright standing power wheelchair. Conclusions: In this small case series of chronic, non-ambulatory individuals with SCI, the standing powered wheelchair was shown to be safe and efficacious. [ABSTRACT FROM AUTHOR]

Purpose : Trauma to the lower cervical spine is a serious lesion due to its neurological consequences which jeopardize the vital and functional prognosis. They constitute a public health problem due to their frequency and seriousness requiring rapid and adequate treatment. The aim of our study is to (1) describe the epidemiological, clinical, and radiological characteristics of lower cervical spine trauma patients; (2) support the therapeutic management of these patients and show our experience in surgery for lower cervical spine trauma; and (3) analyze the anatomical and functional results and discuss them with literature data. Methods: This is a retrospective descriptive study of 50 patients with lower cervical spine trauma treated surgically over a period of five years from January 1, 2016, to December 2020. Results: The average age of our patients was 34.5 years, with a sex ratio of 1.7. The etiologies are dominated by accidents on public roads (58%). They show neurological disorders such as spinal cord damage in 30% of cases and root damage in 20% of cases. The radiological assessment revealed eight tear drops, ten comminuted fractures, 12 severe sprains, 12 biarticular dislocations, six uniarticular dislocations, and two herniated discs. Treatment was surgical in all patients with an anterolateral approach and anterior arthrodesis. The evolution was favourable in 21 patients and stationary in 29 patients. Conclusion: Our study concluded that dislocations and fracture dislocations were the predominant type of injury in cases of AVP. Tetraplegia was mainly observed with uni- and biarticular dislocations. The variation in consolidation time was not correlated with trauma-to-surgery time. Better neurological recovery was observed with mild initial neurological damage than with initially severe damage. The appearance of an adjacent syndrome is less frequent with monosegmental arthrodesis than with multisegmental arthrodesis. Cage arthrodesis was an alternative to iliac harvesting with similar results. [ABSTRACT FROM AUTHOR]

Background: Sweat and thermal responses in individuals with spinal cord injury (SCI) are impaired depending on lesion characteristics. This is particularly problematic for athletes and may ultimately lead to reduced performance. This exploratory study investigated the feasibility of field-usable methods to objectively collect data relevant to sweat response in elite athletes with SCI. Differences in sweat response were also evaluated for different athlete characteristics. Methods: Measurements were performed during exercise and included core temperature (Tc), heart rate, urine specific gravity, fluid intake, sweat rate, and sweat electrolyte concentration. Differences for sex, lesion level (tetraplegia versus paraplegia), motor impairment (complete versus incomplete), and sport type (endurance versus team/skill) were evaluated. Results: Fifteen athletes (median (Q1–Q3) age, 30 (28–36) years; three females; 11 with complete lesions) were included. Endurance athletes were measured during indoor performance tests (n = 10), whereas team/skill athletes were measured during training sessions (n = 5). In the mixed exercise intensities, the average Tc was 37.7 (37.3–37.8) °C and the average heart rate was 126 (100–146) bpm. Dehydration, defined as a urine specific gravity > 1.020 ng/mL, was prevalent in six athletes before exercise and in five athletes after exercise. The sweat rate was lower in athletes with tetraplegia (p = 0.02) and in team/skill athletes (p = 0.008). Conclusions: Collecting sweat and thermal response data from athletes with SCI in the field is feasible. Given the suboptimal hydration status of many athletes, raising awareness of the importance of hydration seems valuable. [ABSTRACT FROM AUTHOR]