Telepsychology for Individuals With Spinal Cord Injury: Protocol for a Randomized Control Study of Video-Based Cognitive Behavioral Therapy.

Background: A substantial proportion of individuals with spinal cord injury (SCI) experience depression, which has been negatively associated with recovery and community participation after injury. Despite significant barriers to seeking and receiving in-person mental health care, little research has focused on the efficacy of telepsychology among individuals with SCI. Objectives: To describe the design and implementation of an ongoing single-center, randomized controlled, video-based cognitive behavioral therapy (CBT) intervention among individuals with SCI. Methods: Participants within 1 year of SCI will be randomized 1:1 to intervention or usual care in a 24-week study. Intervention participants will engage in 10 sessions of CBT over 12 weeks with a licensed clinical psychologist, using iPads via Apple FaceTime. Primary outcomes are depressive symptomatology, anxiety, and life satisfaction (as measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Satisfaction with Life Scale, respectively) measured at three time points (baseline, 12 weeks, and 24 weeks). These and other measures are also assessed during monthly telephone surveys conducted between primary timepoints. Results: Recruitment is ongoing. Forty-six participants have been enrolled thus far. Conclusion: Telepsychology is a convenient, flexible, and effective alternative to traditional in-person services. We anticipate that intervention participants will experience improvements in depressive and anxiety symptoms and will have greater life satisfaction. Telepsychology interventions among individuals with SCI are tasked to maintain participant privacy, provide assistive technology and/or engage caregivers to minimize mobility limitations, and manage risk remotely. Challenges encountered include recruitment during the COVID-19 pandemic. Early intervention on symptoms of psychological morbidity using telepsychology may facilitate greater adaptation following SCI.

Implantation of Sacral Nerve Stimulator Without Rhizotomy for Neurogenic Bladder in Patient With Spinal Cord Injury: 2-Dimensional Operative Video.

There are approximately 12 000 new individuals with spinal cord injury (SCI) each year, and close to 200 000 individuals live with a SCI-related disability in the United States. The majority of patients with SCI have bladder dysfunction as a result of their injury, with over 75% unable to void volitionally following their injury. In patients with traumatic SCI, intermittent catheterization is commonly recommended, but a lack of adherence to clean intermittent catheterization (CIC) has been observed, with up to 50% discontinuing CIC within 5 yr of injury. The Finetech Brindley Bladder System (FBBS) is an implantable sacral nerve stimulator for improving bladder function in patients with SCI, avoiding the need for CIC. The FDA-approved implantation (Humanitarian Device Exemption H980008) of the FBBS is combined with a posterior rhizotomy to reduce reflex contraction of the bladder, improving continence. However, the posterior rhizotomy is irreversible and has unwanted effects; therefore, the current FDA-approved implantation is being studied without rhizotomy as part of a clinical trial (Investigational Device Exemption G150201) (ClinicalTrials.gov Identifier: NCT02978638). In this video, we present a case of a 66-yr-old female who presented 40-yr status post-T12 SCI, resulting in complete paraplegia and neurogenic bladder not satisfactorily controlled with CIC. We demonstrate the operative steps to complete the implantation of the device without rhizotomy in the first patient enrolled as part of the clinical trial Electrical Stimulation for Continence After SCI (NCT02978638). Appropriate IRB and patient consent were obtained.