Active Lifestyle Is Associated With Reduced Dyspnea and Greater Life Satisfaction in Spinal Cord Injury.

OBJECTIVE: To assess the relations between measures of activity with dyspnea and satisfaction with life in chronic spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: Five SCI centers. PARTICIPANTS: Between July 2012 and March 2015, subjects (N=347) with traumatic SCI ≥1 year after injury who used a manual wheelchair or walked with or without an assistive device reported hours spent away from home or yard on the previous 3 days, sports participation, and planned exercise. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Satisfaction with Life Scale (SWLS) and dyspnea. Dyspnea was defined as shortness of breath when hurrying on the level or going up a slight hill, going slower than people the same age on the level because of breathlessness, or stopping for breath when going at your own pace, or after about 100yd (or after a few minutes) on the level. RESULTS: Dyspnea prevalence was 30%. Adjusting for asthma or chronic obstructive pulmonary disease, mobility mode, race, and season, there was a significant linear trend between greater SWLS scores and quartiles of time spent away from the home or yard (P=.0002). SWLS score was greater if participating in organized sports (P=.01), although was not significantly greater with planned exercise (P=.093). Planned exercise was associated with a reduced odds ratio (OR) of dyspnea (.57; 95% confidence interval [CI], .34-.95; P=.032), but organized sports was not (P=.265). Dyspnea was not significantly increased in persons who spent the fewest hours outside their home or yard (≤7h) compared with people who spent the most hours outside their home or yard (>23h) (OR=1.69; 95% CI, 0.83-3.44; P=.145). CONCLUSIONS: In SCI, a planned exercise program is associated with less dyspnea. An active lifestyle characterized by greater time spent away from home or yard and sports participation is associated with greater SWLS scores.

A novel classification system for traumatic central cord syndrome: the central cord injury scale (CCIS).

STUDY DESIGN: Retrospective study of 37 patients with traumatic central cord syndrome. OBJECTIVE: The purpose of this study is to review a series of patients with central cord syndrome and to introduce a classification system that is predictive of functional outcome. SUMMARY OF BACKGROUND DATA: Central cord syndrome is the most common incomplete spinal cord injury, yet a predictive classification system does not exist. METHODS: Thirty-seven patients with traumatic central cord syndrome had 1-year results of the motor portion of the Functional Independence Measurement (FIM) Score. Ten factors were analyzed for their predictive effect on the 1-year Motor FIM Score. RESULTS: There were 8 women and 29 men with a mean age of 55.1 years. The mean injury motor FIM was 21.9 and mean 1-year Motor FIM: 70.2 (P < 0.001). The following had a predictive effect on 1-year Motor FIM: Injury ASIA Motor Score (P < 0.013) and magnetic resonance imaging evidence of abnormal signal intensity (P < 0.007). Points were assigned to these factors, and patients were categorized as Central Cord Injury Scale (CCIS) 1, 2, or 3. CCIS 1: n = 6, mean 1-year Motor FIM = 40.8; CCIS 2: n = 19 and FIM = 72.4; and CCIS 3: n = 12 and FIM = 81.5. Each classification had an increasing percentage of patients who could walk without ever using a wheelchair and had independence in bladder and bowel function. CONCLUSION: The CCIS is predictive of a patient's functional outcome at 1 year and has the potential to help patients and physicians establish realistic expectations for functional recovery based on ASIA Motor Score and magnetic resonance imaging findings.

New benzylureas as a novel series of potent, nonpeptidic vasopressin V2 receptor agonists.

Vasopressin (AVP) is a hormone that stimulates an increase in water permeability through activation of V2 receptors in the kidney. The analogue of AVP, desmopressin, has proven an effective drug for diseases where a reduction of urine output is desired. However, its peptidic nature limits its bioavailability. We report herein the discovery of potent, nonpeptidic, benzylurea derived agonists of the vasopressin V2 receptor. We describe substitutions on the benzyl group to give improvements in potency and subsequent modifications to the urea end group to provide improvements in solubility and increased oral efficacy in a rat model of diuresis. The lead compound 20e (VA106483) is reported for the first time and has been selected for clinical development.

Pilot evaluation of functional questionnaire for predicting ability of patients with tetraplegia to self-catheterize after continent diversion.

BACKGROUND/OBJECTIVES: Creation of a continent catheterizable stoma has dramatically improved the ability of the patient with spinal cord injury to perform clean intermittent catheterization (CIC). However, not all patients are good candidates for this procedure. To aid in patient evaluation, we propose the use of a functional questionnaire to predict a candidate's ability to negotiate a continent catheterizable stoma. METHODS: A published functional questionnaire was adapted to assess the self-perceived ability to perform upper extremity tasks similar to those involved in the manipulation of catheter. Tetraplegic patients who had undergone creation of a content catheterizable stoma were given the questionnaire and asked to describe demographics, method of catheterization, motivational factors, and satisfaction with the procedure. RESULTS: Subjects varied in age (23-36 years) and level of impairment (C4-C6). Functional scores correlated with level of injury. Of the 4 women and 1 man who responded, only 2 were able to self-catheterize before diversion. Their catheterization times decreased significantly after creation of a continent stoma. Two patients unable to perform CIC preoperatively were able to perform CIC postoperatively. The patient with the lowest score was unable to perform CIC preoperatively or postoperatively. All were satisfied with outcome after diversion. CONCLUSIONS: In our small cohort, a low functional score was associated with inability to perform CIC after continent diversion. Administration of this questionnaire to a larger spinal cord injury population should aid in selecting appropriate candidates for the creation of a continent catheterizable stoma.

Traumatic tetraplegia: noninvasive respiratory management in the acute setting.

A 15-yr-old patient with high-level spinal cord injury developed ventilatory failure 24 hr after hospital admission and required continuous ventilatory support. Although he lost all ventilator-free breathing tolerance, he was managed by receiving noninvasive intermittent positive-pressure ventilation rather than intermittent positive-pressure ventilation via an endotracheal intubation. Cooperative, uncomplicated, acutely injured patients with spinal cord injury who develop ventilatory failure are candidates to use noninvasive intermittent positive-pressure ventilation to avoid intubation.