Energy expenditure in people with motor-complete paraplegia.

This corrects the article DOI: 10.1038/ajg.2017.27.

Energy expenditure in people with motor-complete paraplegia.

STUDY DESIGN: The present descriptive clinical and laboratory study is cross-sectional in design. OBJECTIVES: The primary aim is to describe and compare resting energy expenditure (REE) and energy expenditure (EE) during different standardized sedentary, non-exercise and exercise activities in people with motor-complete paraplegia (Th7 to Th12.). A secondary aim was to compare men and women. METHODS: Thirty-eight adults (10 women) with SCI, T7-T12 AIS A-B, were recruited. All the data were collected through indirect calorimetry. REE was measured in supine for 30 min after 8 h of overnight fasting. Activity energy expenditure (AEE) for activities was measured for seven minutes during sedentary, non-exercise physical activity (NEPA) and exercise activities. RESULTS: AEE increased four to eight times when engaging in NEPA compared to that in sedentary activities. Men had significantly higher resting oxygen uptake compared to women, 0.19 vs 0.15 l min-1 (P=0.005), REE per 24 h, 1286 vs 1030 kcal (P=0.003) and EE during weight-bearing activities. However, these became nonsignificant after adjustment for body weight and speed of movement, with a mean resting oxygen uptake of 2.47 ml O2 per kg min-1 for the whole group (women 2.43 and men 2.57 ml O2 kg-1 min-1, P=0.49). CONCLUSIONS: NEPA increases AEE up to eight times compared to sedentary activities. Gender differences in oxygen uptake during both rest and weight-bearing activities were diminished after adjustment for body weight. The mean resting oxygen uptake for the whole group was 2.47 ml O2 kg-1 min-1. These results highlight the importance, especially of NEPA, for increasing total daily EE in the target population.

Participation in activities and secondary health complications among persons aging with traumatic spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To describe participation in activities and explore the relationship with secondary complications among persons aging with a traumatic spinal cord injury (SCI). SETTING: A regional SCI outpatient center in Sweden. METHODS: Data were collected through a phone survey, which included 10 activities from the instrument PARTS/M-v3 (PARTicipation Survey/Mobility version-3) together with data from the participants' medical records. Cross-tabulation and χ2 were used for data analysis. RESULTS: In this study, 121 persons matched the inclusion criteria and the final study sample comprised 73 participants (60% response rate): 55 men and 18 women. Mean age was 63.7±9.4 years, and mean time since injury was 36.3±9.2 years. Regardless of duration of SCI, all 73 participated in dressing, bathing and leisure activities. Women reported better health than men. Particularly for those who lived 36-55 years after injury; increasing pain, fatigue, spasticity and decreased muscle strength were negatively affecting participation in activities, especially exercise and active recreation. Additionally, a need to save strength/energy was also a reason for not participating in the activities. Perceived future support and concerns in relation to personal assistance, assistive devices and rehabilitation was also reported. CONCLUSION: Increasing secondary health complications and a need to save strength/energy influenced participation in activities. Laws and/or governmental policies regarding personal assistance and assistive devices did not always support participation in activities. Interventions should aim to create a balance among activities in everyday life.

Concerns about falling in wheelchair users with spinal cord injury--validation of the Swedish version of the spinal cord injury falls concern scale.

OBJECTIVE: Translation of the Spinal Cord Injury Falls Concern Scale (SCI-FCS); validation and investigation of psychometric properties. DESIGN: Translation, adaptation and validation study. SUBJECTS/PATIENTS: Eighty-seven wheelchair users with chronic SCI attending follow-up at Rehab Station Stockholm/Spinalis, Sweden. METHODS: The SCI-FCS was translated to Swedish and culturally adapted according to guidelines. Construct validity was examined with the Mann-Whitney U-test, and psychometric properties with factor and Rasch analysis. RESULTS: Participants generally reported low levels of concerns about falling. Participants with higher SCI-FCS scores also reported fear of falling, had been injured for a shorter time, reported symptoms of depression, anxiety and fatigue, and were unable to get up from the ground independently. Falls with or without injury the previous year, age, level of injury, sex and sitting balance did not differentiate the level of SCI-FCS score. The median SCI-FCS score was 21 (range 16-64). Cronbachs alpha (0.95), factor and Rasch analysis showed similar results of the Swedish as of the original version. CONCLUSION: The Swedish SCI-FCS showed high internal consistency and similar measurement properties and structure as the original version. It showed discriminant ability for fear of falling, time since injury, symptoms of depression or anxiety, fatigue and ability to get up from the ground but not for age, gender or falls. Persons with shorter time since injury, psychological concerns, fatigue and decreased mobility were more concerned about falling. In a clinical setting, the SCI-FCS might help identifying issues to address to reduce the concerns about falling.

Incidence and aetiology of traumatic spinal cord injury in Cape Town, South Africa: a prospective, population-based study.

STUDY DESIGN: Prospective, regional population-based study. OBJECTIVES: To provide the incidence, aetiology and injury characteristics of traumatic spinal cord injury (TSCI) in the City of Cape Town, South Africa. SETTING: All government-funded hospitals within the City of Cape Town, South Africa. METHODS: All survivors of acute TSCI, given that they met the inclusion criteria, were prospectively included for a 1-year period. The International Spinal Cord injury Core Data Set was used and systematically completed by specialist doctors. Further, international standards for neurological classification were adhered to. RESULTS: In total, 147 cases of acute TSCI were identified and 145 were included in the study. The male to female ratio was 5.9:1 and the mean age was 33.5 years, ranging from 18 to 93. The crude incidence rate was 75.6 per million (95% CI: 64.3-88.8) with assault as the main cause of injury, accounting for 59.3% of the cases, followed by motor vehicle accidents (26.3%) and falls (11.7%). Most injuries occurred in the cervical spine (53.1%), and American Spinal Injury Association Impairment Scale A severity was most common (39.3%) in the cohort. CONCLUSION: The incidence rate of TSCI in a region of South Africa was high when compared to previously postulated figures for the country. There is a need for primary preventative strategies to target younger men that are exposed to violent activities. A national study is required to learn whether these findings are only locally applicable or generalisable.

Effects of an exercise programme on musculoskeletal and neuropathic pain after spinal cord injury--results from a seated double-poling ergometer study.

OBJECTIVES: To assess pain relieving effects of an intensive exercise programme on a seated double-poling ergometer in individuals with spinal cord injury (SCI). SETTING: Stockholm, Sweden. METHODS: A total of 13 wheelchair-dependent individuals with a thoracic or lumbar SCI were recruited to a 10-week training period (three times weekly) assessing the effects of regular training on upper-body strength, aerobic and mechanical power, and crossover effects on functional performance, as well as cardiovascular risk factors. Eight of the participants reported pain and were included in this exploratory pain protocol and assessed using the International SCI Basic Pain Data set, the Wheelchair Users' Shoulder Pain Index and International SCI Quality of Life Basic Data set. RESULTS: For those with neuropathic pain, median pain intensity ratings decreased from 5 on a 0-10 numerical rating scale at base-line to 3 at the end of study, and four of seven participants reported an improvement on the Patient Global Impression of Change scale. For those with musculoskeletal pain (n = 5), median pain intensity ratings improved from 4 at baseline to 0 at the end of study. All but one rated no musculoskeletal pain at all at the end of study and number of days with pain per week decreased from 5.5 to 0.7. None of the participants developed pain, because of overuse during the training period and few reported unwanted side effects. CONCLUSION: Considering its promising effects and safety, an intensive exercise programme can be tried for treating musculoskeletal pain and also neuropathic pain following SCI.

Glossopharyngeal pistoning for lung insufflation in patients with cervical spinal cord injury.

STUDY DESIGN: A prospective cohort study. OBJECTIVES: To evaluate whether patients with cervical spinal cord injury (CSCI) are able to learn the technique of glossopharyngeal pistoning (breathing) for lung insufflation (GI) and if learned, to evaluate the effects of GI on pulmonary function and chest expansion after 8 weeks. SETTING: Karolinska University Hospital, Stockholm, Sweden. METHODS: Twenty-five patients with CSCI (21 men, four women) with a mean age of 46 years (21-70), from the Stockholm area, were used in this study. The participants performed 10 cycles of GI four times a week, for 8 weeks. Pulmonary function tests made before and after the GI training included vital capacity (VC), expiratory reserve volume (ERV), functional residual capacity (FRC; measured with nitrogen washout), residual volume (RV) and total lung capacity (TLC). Chest expansion was measured before and after training. RESULTS: Five of the twenty-five participants had difficulty in performing GI and were excluded in further analysis. Performing a GI maneuvre increased participants' VC on average by 0.88+/-0.5 l. After 8 weeks of training, the participants had significantly increased their VC 0.23 l, (P<0.001), ERV 0.16 l, (P<0.01), FRC 0.86 l, (P<0.001), RV 0.70 l, (P<0.001) and TLC 0.93 l, (P<0.001). Chest expansion increased at the level of the xiphoid process by 1.2 cm (P<0.001) and at the level of the fourth costae by 0.7 cm (P<0.001). CONCLUSIONS: After using GI for a period of 8 weeks, the participants with CSCI who could perform GI were able to improve pulmonary function and chest expansion.