Segmental infralesional pathological spontaneous activity in subacute traumatic spinal cord injury.

INTRODUCTION/AIMS: There is a dearth of knowledge regarding the status of infralesional lower motor neurons (LMNs) in individuals with traumatic cervical spinal cord injury (SCI), yet there is a growing need to understand how the spinal lesion impacts LMNs caudal to the lesion epicenter, especially in the context of nerve transfer surgery to restore several key upper limb functions. Our objective was to determine the frequency of pathological spontaneous activity (PSA) at, and below, the level of spinal injury, to gain an understanding of LMN health below the spinal lesion. METHODS: Ninety-one limbs in 57 individuals (53 males, mean age = 44.4 ± 16.9 years, mean duration from injury = 3.4 ± 1.4 months, 32 with motor complete injuries), were analyzed. Analysis was stratified by injury level as (1) C4 and above, (2) C5, and (3) C6-7. Needle electromyography was performed on representative muscles innervated by the C5-6, C6-7, C7-8, and C8-T1 nerve roots. PSA was dichotomized as present or absent. Data were pooled for the most caudal infralesional segment (C8-T1). RESULTS: A high frequency of PSA was seen in all infralesional segments. The pooled frequency of PSA for all injury levels at C8-T1 was 68.7% of the limbs tested. There was also evidence of PSA at the rostral border of the neurological level of injury, with 58.3% of C5-6 muscles in those with C5-level injuries. DISCUSSION: These data support a high prevalence of infralesional LMN abnormalities following SCI, which has implications to nerve transfer candidacy, timing of the intervention, and donor nerve options.

Community acquired pressure injuries in a work-related spinal cord injury population: Problem characterization and assessment of a working solution.

BACKGROUND: To characterize the problem of community-acquired pressure injuries (CAPIs) in a work-related spinal cord injury (SCI) population in Canada and assess the benefits of a person-centered solution. Characterization of the problem and a solution, albeit in an insured Worker's Compensation Board of British Columbia (WorkSafeBC) cohort, may inform the supply of solutions in the larger SCI population with disparate access to healthcare. METHODS: For this observational study, data on 244 WorkSafeBC clients, who received an intervention featuring pressure injury (PI) assessment between 2011 and 2015, were used to characterize the problem. Data on observed injuries, risk, referrals, and outcomes were linked to healthcare service claims. Employing an activity-based costing methodology, total expenditures on attributed services were calculated for clients with 1 or more PIs. Intervention cost and benefits from the insurer's perspective are considered. RESULTS: 84 of 244 clients had 1 or more PIs at assessment, with attributed mean cost of $56,092 in 2015 Canadian dollars (CAD). Mean cost by PI severity range from $9580 to $238,736. At an intervention cost of $820,618, detection of less severe injuries provided an opportunity to prevent progression and achieve $3 million in cost avoidance. Follow-up data suggest reasonable returns. Reductions in the incidence, number, and risk of pressure injuries were also observed. CONCLUSIONS: The analysis establishes the cost of CAPIs in a Canadian-based work-related SCI population and suggests preventative and early intervention is not only feasible but also practical. Results are relevant to decisions regarding the use of proactive prevention-based treatment models as opposed to reactive, solutions in the larger SCI population.

Aerobic exercise during early rehabilitation for cervical spinal cord injury.

BACKGROUND AND PURPOSE: People with spinal cord injuries (SCIs), particularly those with injuries causing tetraplegia, are at risk for cardiovascular illnesses. There is a compelling need to address poor cardiovascular health as early as possible after cervical SCI. The purpose of this case report is to illustrate the process of aerobic exercise prescription during inpatient rehabilitation for cervical SCI. CASE DESCRIPTION: The patient was a 22-year-old man who had sustained a complete C5 SCI during a swimming accident 12 weeks before he participated in an aerobic exercise program. The program was developed to facilitate aerobic capacity while minimizing muscular fatigue. The patient attended 18 sessions over a 2-month period. OUTCOMES: The patient's exercise tolerance increased in terms of both exercise duration and exercise intensity. Measurements of cardiovascular health, taken before and after training, revealed substantial increases in peak oxygen uptake (20%) and orthostatic tolerance over the course of the program. DISCUSSION: The patient experienced typical complications associated with acute SCI (eg, orthostatic hypotension, urinary tract infections). He exhibited several signs of improved exercise tolerance and wheelchair mobility during the 2-month program, indicating potential cardiovascular and functional improvements from the exercise training.

Reliability and validity of the six-minute arm test for the evaluation of cardiovascular fitness in people with spinal cord injury.

OBJECTIVES: To design a submaximal arm ergometry test (six-minute arm test [6-MAT]), for persons with spinal cord injury (SCI) and to determine the test-retest reliability and concurrent validity of this test. DESIGN: Prospective, exploratory, methodologic study. To determine test-retest reliability, subjects completed the 6-MAT on 2 days, separated by 1 week. Validity was determined by comparing 6-MAT results with peak oxygen consumption (VO2peak). SETTING: Tertiary rehabilitation center. PARTICIPANTS: Thirty subjects with SCI (mean age, 36.3y; 83% male). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects were evaluated on the 6-MAT and a VO2peak test. RESULTS: All subjects were able to complete the 6-MAT. Test-retest reliability of steady-state oxygen consumption (VO2) and heart rate during the 6-MAT were excellent (intraclass correlation coefficient [ICC], .81; 95% confidence interval [CI], .58-.92; ICC=.90; 95% CI, .75-.96, respectively). The correlation between VO2peak and 6-MAT VO2 was excellent (r=.92) and the correlations between VO2peak and 6-MAT heart rate (r=.63) and VO2peak and 6-MAT power output (r=.73) were good. CONCLUSIONS: This study showed that the 6-MAT has acceptable values for test-retest reliability and validity. The 6-MAT should be further tested for responsiveness to enhance its use as a clinical tool.

Cardiovascular Health and Exercise Rehabilitation in Spinal Cord Injury.

There appears to be an increased prevalence and earlier onset of cardiovascular disease (CVD) in persons with SCI. Physical inactivity is thought to be a key factor in the increased risk for CVD. Physical inactivity is highly prevalent in persons with SCI and it appears that activities of daily living are not sufficient to maintain cardiovascular fitness and health. This systematic review examines the current literature regarding the risk for CVD and the effectiveness of varied exercise rehabilitation programs in attenuating the risk for CVD in SCI.