Pregnancy, delivery, and neonatal outcomes among women with spinal cord injury in Sweden 1997-2015: A population-based cohort study.

INTRODUCTION: The aim of this study was to describe the rate of pregnancy in spinal cord injured women in Sweden as well as pregnancy, delivery, and neonatal outcomes. MATERIAL AND METHODS: This study was based on data from the Swedish Medical Birth Register and the National Patient Register. The study population included women with spinal cord injury who gave birth in Sweden during the period 1997 to 2015. The general population was used as reference and included all non-spinal cord injured patients who gave birth during the same period of time. RESULTS: In the spinal cord injury group, 109 births were identified. Eighty-nine (82%) of them were among paraplegic women and 20 (18%) were among tetraplegic women. Women with spinal cord injury in our study population had urinary tract infections during pregnancy in five cases (5%) and anemia during pregnancy in nine cases (8%), compared with 0.2% and 4%, respectively, in the general population. Compared with the general population more deliveries were induced in the study population, 18 (17%) in the spinal cord injury group and 12% in the general population. Vaginal delivery was achieved in 52 (48%) of the births with 42 of them (39%) being non-instrumental and 10 (9%) being instrumental vaginal deliveries. Elective cesarean section rate was 34% (n = 37). Sixteen infants (15%) were born preterm (gestational week <37). We found an overall low rate of pregnancy and delivery complications. CONCLUSIONS: Our results show predominantly favorable outcomes of pregnancy and delivery in women with spinal cord injury as well as their infants. These results are in concordance with previous research.

Adults with spina bifida: ambulatory performance and cognitive capacity in relation to muscle function.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: Describe and compare ambulatory performance and cognitive capacity in relation to muscle function in an adult cohort with spina bifida. Also, explore factors associated with ambulation in participants with muscle function level 3. SETTING: Specialist clinic for adults with spinal cord disorders in Stockholm, Sweden. METHODS: A total regional cohort of adults (n = 219) with spina bifida was invited, 196 (104 women, mean age 35 years, SD 13 years) participated. Mode of mobility, cognitive capacity and muscle function were investigated. For participants with muscle function level 3, factors associated with ambulation were investigated using multivariate logistic regression analysis. RESULTS: In all, 84 participants (42%) were community ambulators, 22 (12%) household ambulators and 90 (46%) wheelchair users. There was a linear association between the lower degree of muscle function and scoliosis (P < 0.001). Mode of mobility varied despite similar muscle prerequisites in participants with muscle function level 3 (n = 58). Factors associated with ambulation in participants with muscle function level 3 were the absence of scoliosis, lower BMI and higher cognitive capacity. CONCLUSIONS: Cognitive capacity and mode of mobility varied widely across the cohort. However, in participants with muscle function level 3, despite similar muscular prerequisites, a large variation in the mode of mobility was found, suggesting that other factors were involved. It is important to prevent scoliosis, support a healthy lifestyle, as well as offer cognitive screening and support to promote ambulatory function and optimise independence in the everyday lives of adults with spina bifida.

"Challenges and facilitators-navigating in the landscape of spinal cord injury neuropathic pain"-a qualitative study on the use of prescribed drugs.

STUDY DESIGN: A qualitative study with an emergent design using semi-structured interviews in focus groups. OBJECTIVES: To explore the expectations, experiences and desires among individuals who are prescribed drugs for spinal cord injury (SCI) neuropathic pain (NP). SETTING: SCI rehabilitation centre. METHODS: Eighteen informants with SCI and NP were enrolled. The informants originated from large and small cities in southern Sweden. Data were collected in focus groups consisting of 4-5 individuals in four separate sessions. An emergent design was employed using an interview guide containing open questions. The interviews were transcribed verbatim and data were analyzed according to qualitative content analysis. RESULTS: A model of three themes emerged: "Balancing between pain and side-effects" described the difficult choices the informants had to make between drugs and their unwanted side-effects and pain, "Desiring competence and structure in pain management" described the informants wishes regarding pain management and "From hope to personal solutions" described the process from hope of total pain relief from drugs to the development of personal strategies. CONCLUSIONS: There is a great need for improvement of SCI-related neuropathic pain management since recommended drugs are insufficiently effective and accompanied by severe side-effects that impact quality of life but also due to structural limitations and physicians' lack of competence in pain management.

Evaluation of a re-engineered device for penile vibratory stimulation in men with spinal cord injury.

STUDY DESIGN: Cohort study OBJECTIVES: The purpose of this study was to evaluate the performance of a re-engineered device (Ferticare 2.0), which is replacing the previous standard (Ferticare 1.0) for penile vibratory stimulation in men with spinal cord injury. Most men with spinal cord injury are anejaculatory, requiring medical assistance to obtain their semen. Penile vibratory stimulation is generally recognized as the standard of care for semen retrieval in these anejaculatory men. SETTING: Major Research University in Miami, Florida, USA. METHODS: The Ferticare 2.0 device was applied to 15 men with spinal cord injury in a three-step protocol simulating normal use. Step 1: one device (2.5 mm amplitude, 100 Hz) was applied to the glans penis for 2 min. Step 2: If no ejaculation occurred, the amplitude was increased to 4.0 mm (100 Hz) and the device similarly applied. Step 3: If no ejaculation occurred, two devices, each 2.5 mm and 100 Hz were applied to the dorsum and frenulum of the glans penis. Participants at risk for autonomic dysreflexia were pretreated with sublingual nifedipine (20 mg), 15 min prior to stimulation. Blood pressure and other symptoms of autonomic dysreflexia were monitored. Participants answered a questionnaire about their experience with the device. RESULTS: Thirteen of 15 participants ejaculated with the device. No adverse events occurred. All participants commented they would recommend the device to other men with spinal cord injury. CONCLUSIONS: A re-engineered device, the Ferticare 2.0, is safe and effective for inducing ejaculation in men with spinal cord injury.

Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury.

STUDY DESIGN: Descriptive. OBJECTIVE: The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP). SETTINGS: Rehabilitation facility in Sweden. METHODS: The participants were 26 (19 men, 7 women) with C5-C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7-T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses. RESULTS: The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40-80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP. CONCLUSION: This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.

Correction: Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury.

A correction to this paper has been published and can be accessed via a link at the top of the paper.

Predictors of falls in persons with spinal cord injury-a prospective study using the Downton fall risk index and a single question of previous falls.

STUDY DESIGN: Prediction study. OBJECTIVES: To investigate the prediction accuracy of the Downton fall risk index (DFRI) and a question of falls the previous year; further to examine the association between time to first fall and risk indicators for falls in wheelchair users and ambulatory persons with Spinal Cord Injury (SCI). SETTING: Two SCI centres in Norway and Sweden (Sunnaas Rehabilitation Hospital, Rehab Station Stockholm /Spinalis). METHODS: Two hundred and twenty-four persons with traumatic SCI, ≥1 year post-injury, ≥18 years participated. Prospective falls were reported by text messages every second week for one year. Sensitivity, specificity and time to first fall (Kaplan Meier) were investigated for DFRI and the question of falls in the previous year. DFRI ≥3 was defined as a high risk of falls. Cox survival analysis was used to calculate hazard ratios for functional independence, gait speed and fear of falling. RESULTS: The sensitivity was 36-57% for DFRI and 82-89% for the question of falls, while specificity was 74-83%, and 34-49%. For DFRI, time to first fall was shorter in the high-risk group, for both wheelchair users (p = 0.005) and ambulatory persons (p = 0.006). Falls previous year increased the hazard ratio of falls for wheelchair users (HR = 3.35, 95% CI = 1.86 to 6.02) but not for ambulatory persons. CONCLUSIONS: Falls in the previous year showed a better predictive accuracy than DFRI due to the low sensitivity of DFRI. As previous falls had low specificity, it still remains difficult to predict falls in those who have not fallen yet.

Active Rehabilitation for persons with spinal cord injury in Botswana - effects of a community peer-based programme.

STUDY DESIGN: Prospective cohort study with a repeated measures analysis. OBJECTIVES: To measure the effects of the Active Rehabilitation (AR) training programme for community-dwelling individuals with spinal cord injury (SCI) in Botswana on physical independence, wheelchair mobility, self-efficacy, life satisfaction, level of physical activity and community participation. SETTING: The inaugural AR training programme in Botswana, a community peer-based programme for people with SCI. The 10-day residential programme in Botswana was led by an international team of peer mentors and health professionals. METHODS: Participants with SCI (on average 4 years after injury) completed a survey comprising a battery of standardised outcome measures at three timepoints: at the start, on completion and at 5 months after the programme (n = 14). Participants also completed a practical wheelchair skills test at start and completion of the programme (n = 17). RESULTS: Participants improved in the mobility subscale of the Spinal Cord Independence Measure Self Report on completion (p = 0.011, d = 0.85) and at 5-month follow-up (p = 0.005, d = 0.93) as compared to baseline. They also achieved moderate improvement in self-efficacy to manage their condition (physical function domain of Moorong Self-Efficacy Scale) and large improvements in wheelchair mobility as assessed through the Queensland Evaluation of Wheelchair Skills test and the Wheelchair Skills Test Questionnaire. All positive results were retained at 5-month follow-up. CONCLUSIONS: Findings indicate that the peer-based programme AR can play an important role in promoting physical independence, wheelchair mobility and injury-management self-efficacy in community-dwelling individuals with SCI in Botswana.

Energy expenditure after spinal cord injury in people with motor-complete tetraplegia or motor-complete paraplegia.

STUDY DESIGN: Cross-sectional. OBJECTIVES: This study aimed to describe and compare VO2 and energy expenditure at rest (REE) and during standardized sedentary, non-exercise physical activity, and exercise activities, in people with motor-complete tetraplegia (C5-C8). Further, REE and energy expenditure (EE) for the different activities were compared to data from a reference group of people with motor-complete paraplegia (T7-T12). SETTING: Sweden. METHODS: The sample of people with motor-complete tetraplegia consisted of 26 adults (seven women) with SCI, C5-C8 AIS A-B. REE and EE for the different activities were measured with indirect calorimetry. The results were further compared to people with motor-complete paraplegia. RESULTS: Resting VO2 was 2.57 ml O2 kg-1 min-1, 2.54 for men and 2.60 for women. The VO2 or activity energy expenditure related to body weight increased three to four times during non-exercise physical activity compared to sedentary activities for the people with motor-complete tetraplegia, and up to six times during exercise activity. No significant differences were seen in resting or sedentary activity VO2 between the people with motor-complete tetraplegia and those with motor-complete paraplegia. Activities of daily life revealed no or small differences in VO2, except for setting a table, while the people with tetraplegia had ∼50% lower VO2 during exercise activities. CONCLUSIONS: Non-exercise physical activities of daily life may be significant for increasing total daily EE in people with motor-complete tetraplegia. This might act to motivate the individual, and might be clinically important when designing adapted lifestyle intervention programs for the target group.

Mapping Out One's Own Paths Toward Work: Focus on Experiences of Return to Work After Spinal Cord Injury.

Involving persons with spinal cord injury (SCI) as experts in their lives is important for research to design relevant health care interventions. The purpose of this study was to use photovoice methods to explore experiences of barriers and possibilities in return to work among working adults with SCI. The photovoice group consisted of six persons living with SCI that met weekly over 2 months to share and discuss photos related to return to work. Five themes were identified: (a) there is only one way, (b) welcome back-or not, (c) to be like anyone else-or to be perceived as someone else, (d) friction in the absence of clarity, and (e) finding integrated strategies for everyday life with work. Work was experienced as rewarding and viable, but due to lack of societal and workplace support, a need to map out one's own paths toward work was identified.

Factors Associated With Recurrent Falls in Individuals With Traumatic Spinal Cord Injury: A Multicenter Study.

OBJECTIVE: To identify factors associated with recurrent falls in individuals with traumatic spinal cord injury (SCI). DESIGN: Cross-sectional multicenter study. SETTING: Two specialized rehabilitation centers. PARTICIPANTS: Included: individuals with traumatic SCI ≥1 year postinjury who were aged ≥18 years. Excluded: individuals with motor complete injuries above C5 or below L5. The study sample comprised participants (N=224; 151 wheelchair users, 73 ambulatory; 77% men; mean age ± SD, 50±15y; median time since injury, 15y [range, 1-56y]) who were consecutively recruited at regular follow-up. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Primary outcome was factors associated with recurrent falls (defined as low frequent [0-2] or recurrent [>2]) the previous year. Independent variables were demographic data, wheelchair user or ambulatory, work, health-related quality of life, risk willingness, alcohol consumption, ability to get up from the ground, and exercise habits. RESULTS: Fifty percent reported recurrent falls. In the final multiple logistic regression model, ambulation (odds ratio [OR]=2.67; 95% confidence interval [CI], 1.33-5.37), ability to get up from the ground (OR=2.22; 95% CI, 1.21-4.10), and regular exercise (OR=1.86; 95% CI, 1.05-3.31) were associated with recurrent falls (P≤.05), and with increasing age the OR decreased (OR=.97; 95% CI, .95-.99). CONCLUSIONS: Individuals with SCI should be considered at risk of recurrent falls, and thereby at risk of fall-related injuries. Fall prevention programs should be focused on ambulatory, younger, and more active individuals who had the highest risks for recurrent falls.

Spontaneous spinal cord infarction: a systematic review.

Background and objectives: Spontaneous spinal cord infarction (SCInf) is a rare condition resulting in acute neurological impairment. Consensus on diagnostic criteria is lacking, which may present a challenge for the physician. This review aims to analyse the current literature on spontaneous SCInf, focusing on epidemiology, the diagnostic process, treatment strategies and neurological outcomes. Methods: The study was performed in accordance with a previously published protocol. PubMed, Web of Science and Embase were searched using the keywords 'spontaneous', 'spinal cord', 'infarction' and 'ischaemic'. The eligibility of studies was evaluated in two steps by multiple reviewers. Data from eligible studies were extracted and systematically analysed. Results: 440 patients from 33 studies were included in this systematic review. Analysis of vascular risk factors showed that hypertension was present in 40%, followed by smoking in 30%, dyslipidaemia in 29% and diabetes in 16%. The severity of symptoms at admission according to the American Spinal Injury Association (ASIA) Impairment Scale was score A 19%, score B14%, score C36% and score D32%. The mean follow-up period was 34.8 (±12.2) months. ASIA score at follow-up showed score A 11%, score B 3%, score C 16%, score D 67% and score E 2%. The overall mortality during the follow-up period was 5%. When used, MRI with diffusion-weighted imaging (DWI) supported the diagnosis in 81% of cases. At follow-up, 71% of the patients were able to walk with or without walking aids. Conclusion: The findings suggest a significant role for vascular risk factors in the pathophysiology of spontaneous SCInf. In the diagnostic workup, the use of DWI along with an MRI may help in confirming the diagnosis. The findings at follow-up suggest that neurological recovery is to be expected, with the majority of patients regaining ambulation. This systematic review highlights gaps in the literature and underscores the necessity for further research to establish diagnostic criteria and treatment guidelines.

Breastfeeding Following Spinal Cord Injury: Consumer Guide for Mothers.

The World Health Organization (WHO) recommends that infants be breastfed exclusively for the first 6 months of age. However, there are few resources available on the effects a spinal cord injury (SCI) can have for breastfeeding mothers. It is difficult to find information to address the unique challenges women with SCI experience when planning or trying to breastfeed. Our international team, including women with SCI, health care providers, and SCI researchers, aims to address the information gap through the creation of this consumer guide. The purpose of this consumer guide is to share the most common issues women with SCI experience during breastfeeding and provide information, practical suggestions, recommendations, and key resources in lay language. General information about breastfeeding is available on the internet, in books, or from friends and health care providers. We do not intend to repeat nor replace general breastfeeding information or medical advice. Breastfeeding for mothers with SCI is complex and requires a team of health care providers with complementary expertise. Such a team may include family physician, obstetrician, physiatrist, neurologist, occupational and physical therapist, lactation consultant, midwife, and psychologist. We hope this consumer guide can serve as a quick reference guide for mothers with SCI planning of trying to breastfeed. This guide will also be helpful to health care providers as an educational tool.

Motherhood after Spinal Cord Injury: Breastfeeding, Autonomic Dysreflexia, and Psychosocial Health: Clinical Practice Guidelines.

The World Health Organization (WHO) recommends that children be breastfed exclusively for the first 6 months of age. This recommendation may prove challenging for women with spinal cord injury (SCI) who face unique challenges and barriers to breastfeeding due to the impact of SCI on mobility and physiology. Tailored provision of care from health care professionals (HCPs) is important in helping women navigate these potential barriers. Yet, HCPs often lack the confidence and SCI-specific knowledge to meet the needs of mothers with SCI. An international panel of clinicians, researchers, consultants, and women with lived experience was formed to create an accessible resource that can address this gap. A comprehensive survey on breastfeeding complications, challenges, resources, and quality of life of mothers with SCI was conducted, along with an environmental scan to evaluate existing postpartum guidelines and assess their relevance and usability as recommendations for breastfeeding after SCI. Building on this work, this article provides evidence-based recommendations for HCPs, including but not limited to general practitioners, obstetricians, pediatricians, physiatrists, lactation consultants, nurses, midwives, occupational therapists, and physiotherapists who work with prospective and current mothers with SCI.

Long-term Outcomes After Periprocedural and Spontaneous Spinal Cord Infarctions: A Population-Based Cohort Study.

BACKGROUND AND OBJECTIVES: Spinal cord infarction (SCInf) is a rare condition where consensus regarding diagnostic criteria is lacking, and misdiagnosis or delayed diagnosis can be detrimental. The aim of this study was to describe baseline findings and predictors of long-term functional outcome in a population-based cohort of patients with SCInf. METHODS: All adult patients (aged 18 years or older) treated at the spinal cord injury unit of the study center, between 2006 and 2019, and discharged with a G95 diagnosis (other and unspecified disease of the spinal cord) were screened for inclusion. The diagnostic criteria proposed by Zalewski et al. were retrospectively applied to evaluate the certainty of the SCInf diagnosis. RESULTS: A total of 270 patients were screened and 57 were included in the study, of whom 30 had a spontaneous SCInf and 27 had a periprocedural SCInf. The median American Spinal Cord Injury Association Impairment Scale (AIS) on admission was C, which at a median follow-up of 2.1 years had improved to D (p = 0.002). Compared with periprocedural cases, those with spontaneous SCInf showed significantly better admission AIS (median AIS D vs B, p < 0.001), fewer multilevel SCInf (27% vs 59%, p = 0.029), shorter hospital stay (median 22 vs 44 days, p < 0.001), and better AIS (median AIS D vs C, p < 0.001) and ambulatory status on long-term follow-up (66% vs 1%, p < 0.001). Regression analyses revealed that spontaneous SCInfs (odds ratio [OR] 5.91 [1.92-18.1], p = 0.002) and more favorable admission AIS (OR 33.6 [7.72-146], p < 0.001) were significant predictors of more favorable AIS at follow-up, with admission AIS demonstrating independent predictive ability (OR 35.9 [8.05-160], p < 0.001). DISCUSSION: SCInf is a rare neurologic emergency lacking specific management guidelines. While the presumptive diagnosis is based on the typical presentation and clinical findings, T2-weighted and diffusion-weighted MRI were the most useful diagnostic tools in establishing a definitive diagnosis. Our data show that spontaneous SCInf mostly affected a single spinal cord segment, whereas periprocedural cases were more extensive, had poorer AIS on admission, poorer ambulatory function, and longer hospital stays. Regardless of the etiology, significant neurologic improvements were seen at long-term follow-up, highlighting the importance of active rehabilitation.

Gait and dynamic balance in adults with spina bifida.

BACKGROUND: Spina bifida (SB) is a complex congenital malformation, often causing impaired gait performance depending on the level and extent of malformation. Research regarding gait and balance performance in adults with SB, has not been sufficiently described yet. RESEARCH QUESTION: What are the characteristics of spatiotemporal gait parameters and balance performance in adults with SB? Further, do persons with muscle function (MF) level 3 differ regarding gait and balance performance from those with MF level 1-2? METHODS: Cross-sectional observational study at an outpatient clinic. 41 adults with SB (18-65 years), who walked regularly. Spatiotemporal parameters of gait was assessed with the APDM system and balance performance with the Mini Balance Evaluation Systems Test (Mini-BESTest). Muscle strength in the legs was assessed with 0-5 manual muscle test, and participants were classified according to level of MF into groups MF1, MF2, and MF3. Two-sided t-test was used for parametric independent variables, and Cohen's d was used for effect sizes. The Mann-Whitney U test was used for non-parametric independent data and effect size was calculated by the z value (r = z/√n). RESULTS: Mean gait speed was 0.96 (SD 0.20) m/s and mean stride length 1.08 m (SD 0.17), individuals with MF3 showed significantly slower gaitspeed and shorter stride length (p < 0.05). Lumbar rotation was 21° (SD 11), and thoracic lateral sway 15° (IQR 15) with significantley difference (p < 0.001 and p < 0.05) for individuals in MF3. Mini-BESTest showed a mean score of 11.3 (SD 6.9), and individuals with MF3 showed significantly lower scores (p ≤ 0.001). SIGNIFICANCE: Gait and balance performance was reduced compared to normative data in almost all parameters, especially in persons with less muscle function. Increased knowledge from advanced gait analysis may help healthcare professionals to design rehabilitation programmes, in order to achieve and maintain a sustainable gait and balance performance.

Prevalence of postpartum depression and anxiety among women with spinal cord injury.

Objective: To examine the prevalence of postpartum depression (PPD) and postpartum anxiety (PPA) in mothers with spinal cord injury (SCI).Design: Retrospective, cross-sectional study.Setting: Online multi-national study.Participants: We surveyed an international sample of 102 women who gave birth following cervical SCI (C1-C8, n = 30), upper thoracic SCI (T1-T6, n = 12) or lower level SCI (T7 & below, n = 60). Participants were primarily from Canada and Sweden, and mean age at childbirth was 30 ± 6 years.Outcome Measures: Subscales from the Pregnancy Risk Assessment Monitoring System (PRAMS) were used to measure PPD (PRAMS-3D) and PPA (PRAMS-2A).Results: PPD and PPA were most prevalent in women with cervical SCI, followed by upper thoracic SCI then lower SCI. Self-reported PPD was more prevalent than clinically diagnosed PPD in women with cervical SCI (P = 0.03) and upper thoracic SCI (P = 0.03). With cervical SCI, 75% of women diagnosed with MDD before pregnancy scored >9 on the PRAMS PPD subscale, indicating clinically relevant PPD. However, only 10% were diagnosed with PPD. Of women with lower SCI diagnosed with MDD before pregnancy, 25% had a clinically relevant score for self-reported PPD; 7% were diagnosed.Conclusions: This is currently the largest study examining PPD and PPA after SCI. Clinicians should be aware that mothers with SCI (particularly high-level SCI) may have increased risk of PPD and PPA. PPD is poorly understood in women with SCI and may even be underdiagnosed. SCI-related risk factors for PPD and PPA should be explored.

An open prospective study on the efficacy of Navina Smart, an electronic system for transanal irrigation, in neurogenic bowel dysfunction.

BACKGROUND: Transanal irrigation (TAI) has emerged as a key option when more conservative bowel management does not help spinal cord injured (SCI) individuals with neurogenic bowel dysfunction (NBD). AIM: To investigate the short-term efficacy and safety of an electronic TAI system (Navina Smart) in subjects with NBD. DESIGN: We present an open, prospective efficacy study on Navina Smart, in individuals with NBD secondary to SCI, studied at three months. POPULATION: Eighty-nine consecutive consenting established SCI individuals (61 male; mean age 48, range 18-77) naïve to TAI treatment were recruited from ten centres in seven countries. Subjects had confirmed NBD of at least moderate severity (NBD score ≥10). METHODS: Subjects were taught how to use the device at baseline assisted by the Navina Smart app, and treatment was tailored during phone calls until optimal TAI regime was achieved. The NBD score was measured at baseline and at three months follow up (mean 98 days). Safety analysis was performed on the complete population while per protocol (PP) analysis was performed on 52 subjects. RESULTS: PP analysis showed a significant decrease in mean NBD score (17.8 to 10, p<0.00001). In subjects with severe symptoms (defined as NBD score ≥14), mean NBD scores decreased (19.4 to 10.9, p<0.0001). The number of subjects with severe symptoms decreased from 41 (79%) subjects at baseline to 16 (31%) at three months follow-up. Device failure accounted for the commonest cause for loss of data. Side effects possibly related to the device developed in 11 subjects (12%). Discontinuation due to failure of therapy to relieve symptoms was reported by 5 subjects (6%). CONCLUSION: Navina Smart is effective for individuals with NBD, even those with severe symptoms; long-term data will follow. Whilst there were some device problems (addressed by the later stages of subject recruitment) the treatment was generally safe. CLINICAL TRIAL: (ClinicalTrials.gov number NCT02979808).

Neurogenic Bowel Management Using Transanal Irrigation by Persons with Spinal Cord Injury.

Neurogenic bowel has received surprisingly little attention. Among individuals with spinal cord injury, bowel function is considered a major physical and psychological problem that stems from the severe negative impact on social life and mobility. With transanal irrigation, individuals with neurogenic bowel have received an additional tool that may simplify life and improve independence. A recent survey showed that as many as 37% of the spinal cord injury patients interviewed had not heard about transanal irrigation. It should be a high priority at spinal cord injury centers to support patients with the right tools for proper bowel management and care.

Views on everyday life among adults with spina bifida: an exploration through photovoice.

The aim of this study was to actively integrate expertise of persons living with spina bifida, to explore conditions embedded in their everyday life. This was important because young adults with spina bifida risk not being able to fully participate in the community on equal terms and in accordance with their own preferences. Photovoice, a community-based participatory research approach, was utilized to engage participants through dialogue and photography. An exhibition was created to share results with community and stakeholders. An overarching theme that characterized the experiences of the group was, "an adaptation for us, but it works for no one". Findings are presented as: "Accessibility-a never-ending project," "Tensions of a normative view," and "Power to influence." Findings integrated everyday life metaphors photographically depicted by broken elevators, unsafe transportation, closed doors and not experiencing real opportunities of involvement. Tensions in everyday life experienced by persons living with spina bifida can inform conditions relevant and necessary to support community participation, particulary among persons living with disability.