Testosterone and long pulse width stimulation (TLPS) for denervated muscles after spinal cord injury: a study protocol of randomised clinical trial.

INTRODUCTION: Long pulse width stimulation (LPWS; 120-150 ms) has the potential to stimulate denervated muscles and to restore muscle size in denervated people with spinal cord injury (SCI). We will determine if testosterone treatment (TT)+LPWS would increase skeletal muscle size, leg lean mass and improve overall metabolic health in persons with SCI with denervation. We hypothesise that the 1-year TT+LPWS will upregulate protein synthesis pathways, downregulate protein degradation pathways and increase overall mitochondrial health. METHODS AND ANALYSIS: Twenty-four male participants (aged 18-70 years with chronic SCI) with denervation of both knee extensor muscles and tolerance to the LPWS paradigm will be randomised into either TT+neuromuscular electrical stimulation via telehealth or TT+LPWS. The training sessions will be twice weekly for 1 year. Measurements will be conducted 1 week prior training (baseline; week 0), 6 months following training (postintervention 1) and 1 week after the end of 1 year of training (postintervention 2). Measurements will include body composition assessment using anthropometry, dual X-ray absorptiometry and MRI to measure size of different muscle groups. Metabolic profile will include measuring of basal metabolic rate, followed by blood drawn to measure fasting biomarkers similar to hemoglobin A1c, lipid panels, C reactive protein, interleukin-6 and free fatty acids and then intravenous glucose tolerance test to test for insulin sensitivity and glucose effectiveness. Finally, muscle biopsy will be captured to measure protein expression and intracellular signalling; and mitochondrial electron transport chain function. The participants will fill out 3 days dietary record to monitor their energy intake on a weekly basis. ETHICS AND DISSEMINATION: The study was approved by Institutional Review Board of the McGuire Research Institute (ID # 02189). Dissemination plans will include the Veteran Health Administration and its practitioners, the national SCI/D services office, the general healthcare community and the veteran population, as well as the entire SCI community via submitting quarterly letters or peer-review articles. TRIAL REGISTRATION NUMBER: NCT03345576.

The Implications of Power Mobility on Body Weight in a Veteran Population.

BACKGROUND: The prevalence of obesity is increasing in the United States. A common concern among health care providers is that prescribing a power mobility device (PMD) may decrease physical activity and lead to obesity and increasing morbidity. This study analyzes the effect of PMD prescriptions over a 2-year period on body mass index (BMI) and body weight in a population of veterans both as a whole and in BMI/age subgroups. METHODS: Prosthetics department medical records of veterans who received PMDs for the first time between January 1, 2011 and June 30, 2012 were reviewed. Of 399 records reviewed, 185 veterans met criteria for data analysis. The primary outcome measure was the change in BMI and body weight from time 1 (date of PMD prescription) to time 2 (2 years later). RESULTS: There was a significant decrease in BMI and weight in the first 2 years after receiving a PMD prescription. However, age moderated the relationship between BMI and time. CONCLUSIONS: PMD use does not seem to be associated with significant weight change. Further studies using control groups and assessing comorbidities are needed.

Training response to high-intensity interval training in a 42-year-old man with chronic spinal cord injury.

OBJECTIVE: To review the outcome of 12 weeks of periodized, high-intensity interval training (HIT) in a man with chronic traumatic spinal cord injury (SCI). METHODS: A 42-year-old man (180 cm tall, 68.4 kg and 32.0% Fat) with a C8/T1 motor complete SCI took part in 12 weeks of 3 days per week arm crank ergometry (ACE) interval training. Training consisted of a combination of HIT that included three times 5  min at ∼70% Peak Power (WPeak) and 5  min recovery (HIT5); four times 2.5  min at ∼85% WPeak and 5  min recovery (HIT2.5); ten times 1  min at ∼110% WPeak and 2  min recovery (HIT1). Heart rate (HR) zones were set as <75% HRPeak (Z1), 75-89% (Z2), and 90+% (Z3) and used to monitor overall training efficacy. RESULTS: Thirty-six sessions that included 8 HIT5, 10 HIT2.5, and 5 HIT1 sessions were completed. WPeak and VO2 Peak improved about 45% and 52%, respectively, by week 6, without further improvement at week 12, HR TRIMP scores and power in training sessions trended upward over the 12-week program. CONCLUSIONS: Twelve weeks of HIT resulted in a large increase in peak aerobic power, as well as submaximal endurance performance in our participant. The early plateau in maximal testing supports the use of submaximal training assessment important in the long-term training monitoring for SCI.

Prevention of recurrent autonomic dysreflexia: a survey of current practice.

OBJECTIVE: There is a dearth of literature on the treatment of chronic recurrent autonomic dysreflexia (AD), a well-known complication of spinal cord injury that can have life-threatening implications. This study sought to identify clinical practices regarding the treatment of AD, both acute and recurrent, in patients with spinal cord injury (SCI). METHODS: Online survey regarding AD management in SCI composed of 11 questions designed to obtain information on respondent characteristics, AD treatment options, and causes of AD. SETTING: Veterans Administration health care system. PARTICIPANTS: Veterans Health Administration National SCI Staff Physicians were sent an electronic email to participate in the anonymous web-based survey. INTERVENTION: None applicable. RESULTS: The response rate was 52%. The most commonly prescribed medications for minor and severe acute manifestations of AD were nitrates. For recurrent AD, clonidine was the most commonly prescribed medication. INTERPRETATION: Anti-hypertensive medications continue to be the mainstay in the management of both acute and chronic recurrent AD. Current literature is lacking in prospective randomized controlled trials investigating the relative efficacy of AD interventions. Evidence-based practice guidelines are necessary to improve clinical care.

Roux-en-Y gastric bypass for intractable biliary reflux in an individual with incomplete tetraplegia.

CONTEXT: Gastroesophageal reflux disease (GERD) is a common complication in the spinal cord injury (SCI) population. Surgical treatment of GERD has a unique risk/benefit profile in this population. FINDINGS: This 68-year-old male with chronic incomplete tetraplegia, dyslipidemia, and well-controlled diabetes mellitus underwent Roux-en-Y gastric bypass surgery (RYGBP) for intractable biliary reflux. Postoperatively, the patient had resolution of his symptoms but he also presented with significant weight loss and dumping syndrome. While he did have improvement in his dyslipidemia there was no change in his functional status. CONCLUSIONS: RYGBP is an option for refractory GERD treatment in the SCI population but preoperative risk assessment and close monitoring postoperatively is essential.

Survival of patients with spinal cord injury after cardiac arrest in Department of Veterans Affairs hospital: Pilot study.

Survivability characteristics after cardiopulmonary resuscitation in the population with spinal cord injury (SCI) are unclear but may be useful for advanced care planning discussions with patients. Retrospective evaluation from records of all SCI patients over 10 yr at a Department of Veterans Affairs medical center who experienced in-hospital cardiac arrest was performed. Demographic data and other common measurements were recorded. Thirty-six male subjects were identified, and only two patients survived to discharge (5.5% survival rate), both of whom were admitted for nonacute issues and were asymptomatic shortly before the cardiac arrest. The mean age at the time of cardiopulmonary arrest was 62.4 yr, with a mean time from cardiac arrest to death of 3.02 d. No significant demographic parameters were identified. Overall, SCI likely portends worse outcome for acutely ill patients in the situation of a cardiac arrest. Conclusions are limited by sample size.