Characteristics and outcomes of COVID-19-Positive Individuals Admitted for Inpatient Rehabilitation in Toronto, Canada.

OBJECTIVE: To describe the sociodemographic features, impairments, and functional changes of COVID-19-positive individuals who underwent inpatient rehabilitation at three rehabilitation hospitals in Toronto, Canada. DESIGN: Retrospective chart review of patients admitted to three COVID-19 rehabilitation units between 20 April 2020 and 3 June 2020. Sociodemographic factors, impairments, length of stay, and Functional Independence Measure data were reported. RESULTS: A total of 41 patients were included in this study, including 22 males and 19 females. The median age was 75 years. Thirty-six percent of patients were admitted to the intensive care unit during their acute stay. The most commonly affected body functions were: neuromusculoskeletal (73.2%); combined cardiovascular, haematological, immunological, and respiratory (65.9%); and mental functions (29.3%). Median total Functional Independence Measure score was 85 at admission and 108.5 at discharge. CONCLUSION: This study represents some of the first data on the characteristics and outcomes of COVID-19-positive individuals admitted to inpatient rehabilitation in Toronto, Canada early in the COVID-19 pandemic.

Diagnostic accuracy and feasibility of depression screening in spinal cord injury: A systematic review.

Context: Individuals with spinal cord injury or disease (SCI/D) are at increased risk of depression, which is associated with poor short- and long-term outcomes. Accurate diagnosis is complicated by overlapping symptoms of both conditions, and a lack of consensus-derived guidelines specifying an appropriate depression screening tool. Objective: To conduct a systematic review to: (1) identify the diagnostic accuracy of established depression screening tools compared to clinical assessment; and, (2) to summarize factors that influence feasibility of clinical implementation among adults with SCI/D. Methods: A systematic search using MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane databases using the terms spinal cord injury, depression or mood disorder, and screening or diagnosis identified 1254 initial results. Following duplicate screening, five articles assessing eight screening tools met the final inclusion and exclusion criteria. Measures of diagnostic accuracy and feasibility of implementation were extracted. The Quality Assessment Tool for Diagnostic Accuracy Studies 2 (QUADAS-2) was used to assess study quality. Results: The Patient Health Questionnaire-9 (PHQ-9) had the highest sensitivity (100%), and specificity (84%). The 2-item version, the PHQ-2, comprised the fewest questions, and six of the eight tools were available without cost. Utilizing the QUADAS-2 tool, risk of bias was rated as low or unclear risk for all studies; applicability of the results was rated as low concern. Conclusion: The PHQ-9 is an accurate and feasible tool for depression screening in the adult SCI/D population. Future studies should evaluate the implementation of screening tools and the impact of screening on access to mental health interventions.

Development of Emotional Well-Being indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project.

Context: Emotional Well-Being (EWB) post-spinal cord injury or disease (SCI/D) is a critical aspect of adjustment to disability. Advancing care and assuring equity in care delivery within this rehabilitation care domain is essential. Herein, we describe the selection of EWB structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods: A pan-Canadian Working Group completed the following tasks: (1) defined the EWB construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with EWB; and, (4) prepared a process map. Facilitated meetings allowed selection and review of feedback following rapid-cycle evaluations of proposed structure, process and outcome indicators. Results: The structure indicator is the proportion of staff with appropriate education and training in EWB and access to experts and resources. The process indicator is the proportion of SCI/D patients who were screened for depression and anxiety symptoms at rehabilitation admission and rehabilitation discharge. The intermediary outcome is the proportion of SCI/D patients at risk for depression or anxiety at rehabilitation discharge based on screening symptom scores. The final outcomes are: (a) proportion of individuals at risk for depression or anxiety based on screening symptom scores; and (b) proportion of individuals who received referral for EWB services or intervention. Conclusion: The proposed indicators have a low administrative burden and will ensure feasibility of screening for depression and anxiety at important transition points for individuals with SCI/D. We anticipate that the current structures have inadequate resources for at-risk individuals identified during the screening process.

Altered accuracy of saccadic eye movements in children with fetal alcohol spectrum disorder.

BACKGROUND: Prenatal exposure to alcohol is a major, preventable cause of neurobehavioral dysfunction in children worldwide. The measurement and quantification of saccadic eye movements is a powerful tool for assessing sensory, motor, and cognitive function. The quality of the motor process of an eye movement is known as saccade metrics. Saccade accuracy is 1 component of metrics, which to function optimally requires several cortical brain structures as well as an intact cerebellum and brain-stem. The cerebellum has frequently been reported to be damaged by prenatal alcohol exposure. This study, therefore, tested the hypothesis that children with fetal alcohol spectrum disorder (FASD) will exhibit deficits in the accuracy of saccades. METHODS: A group of children with FASD (n = 27) between the ages of 8 and 16 and typically developing control children (n = 27) matched for age and sex, completed 3 saccadic eye movement tasks of increasing difficulty. Eye movement performance during the tasks was captured using an infrared eye tracker. Saccade metrics (e.g., velocity, amplitude, accuracy) were quantified and compared between the 2 groups for the 3 different tasks. RESULTS: Children with FASD were more variable in saccade endpoint accuracy, which was reflected by statistically significant increases in the error of the initial saccade endpoint and the frequency of additional, corrective saccades required to achieve final fixation. This increased variability in accuracy was amplified when the cognitive demand of the tasks increased. Children with FASD also displayed a statistically significant increase in response inhibition errors. CONCLUSIONS: These data suggest that children with FASD may have deficits in eye movement control and sensory-motor integration including cerebellar circuits, thereby impairing saccade accuracy.