Medicine and Health Sciences Commons^™

Increasing Social Inclusion And Engagement Of Exercise For Individuals With Spinal Cord Injuries: A Universal Resource Development For Wellness Facilities, Alexa Hall

Entry-Level Occupational Therapy Doctorate - Doctoral Capstone Symposium

Individuals with spinal cord injuries (SCIs) are 1.5 times more likely to disengage in exercise one-year post-injury despite 80% of these individuals agreeing that exercise is critical to their overall health and quality of life (Baehr. Et al., 2022). A needs assessment was conducted on why the lack of engagement in exercise exists for individuals with SCIs within fitness facilities to identify barriers preventing participation. A quality improvement program called the Spinal Cord Injury Wellness Toolkit was created based off these findings and implemented at the MUSC Wellness Center. 14 individuals with SCIs participated at wellness center; REDCap surveys were …

Interventions To Optimize Spinal Cord Perfusion In Patients With Acute Traumatic Spinal Cord Injury: An Updated Systematic Review, Nathan Evaniew, Benjamin Davies, Farzin Farahbakhsh, Michael G. Fehlings, Mario Ganau, Daniel E. Graves, James D. Guest, Radha Korupolu, Allan R. Martin, Stephen L. Mckenna, Lindsay A. Tetreault, Aditya Vedantam, Erika D. Brodt, Andrea C. Skelly, Brian K. Kwon

Department of Rehabilitation Medicine Faculty Papers

STUDY DESIGN: Systematic review update.

OBJECTIVES: Interventions that aim to optimize spinal cord perfusion are thought to play an important role in minimizing secondary ischemic damage and improving outcomes in patients with acute traumatic spinal cord injuries (SCIs). However, exactly how to optimize spinal cord perfusion and enhance neurologic recovery remains controversial. We performed an update of a recent systematic review (Evaniew et al, J. Neurotrauma 2020) to evaluate the effects of Mean Arterial Pressure (MAP) support or Spinal Cord Perfusion Pressure (SCPP) support on neurological recovery and rates of adverse events among patients with acute traumatic SCI.

METHODS: We …

Timing Of Decompressive Surgery In Patients With Acute Spinal Cord Injury: Systematic Review Update, Michael Fehlings, Laureen Hachem, Lindsay Tetreault, Andrea Skelly, Joseph Dettori, Erika Brodt, Shay Stabler-Morris, Britt Redick, Nathan Evaniew, Allan Martin, Benjamin Davies, Farzin Farahbakhsh, James Guest, Daniel Graves, Radha Korupolu, Stephen Mckenna, Brian Kwon

Department of Rehabilitation Medicine Faculty Papers

STUDY DESIGN: Systematic review and meta-analysis.

OBJECTIVE: Surgical decompression is a cornerstone in the management of patients with traumatic spinal cord injury (SCI); however, the influence of the timing of surgery on neurological recovery after acute SCI remains controversial. This systematic review aims to summarize current evidence on the effectiveness, safety, and cost-effectiveness of early (≤24 hours) or late (>24 hours) surgery in patients with acute traumatic SCI for all levels of the spine. Furthermore, this systematic review aims to evaluate the evidence with respect to the impact of ultra-early surgery (earlier than 24 hours from injury) on these …

Therapeutic Strategies Targeting Respiratory Recovery After Spinal Cord Injury: From Preclinical Development To Clinical Translation, Pauline Michel-Flutot, Michael A. Lane, Angelo C. Lepore, Stéphane Vinit

Farber Institute for Neuroscience Faculty Papers

High spinal cord injuries (SCIs) lead to permanent functional deficits, including respiratory dysfunction. Patients living with such conditions often rely on ventilatory assistance to survive, and even those that can be weaned continue to suffer life-threatening impairments. There is currently no treatment for SCI that is capable of providing complete recovery of diaphragm activity and respiratory function. The diaphragm is the main inspiratory muscle, and its activity is controlled by phrenic motoneurons (phMNs) located in the cervical (C3–C5) spinal cord. Preserving and/or restoring phMN activity following a high SCI is essential for achieving voluntary control of breathing. In this review, …

Spatial Characteristics Of Reactive Stepping Among People Living With Chronic Incomplete Spinal Cord Injury, Matthew G Heffernan, Jae Woung Lee, Katherine Chan, Janelle Unger, Susan Marzolini, Timothy N Welsh, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Objective: Compare the spatial characteristics of reactive stepping between individuals with chronic motor incomplete spinal cord injuries (iSCI) and able-bodied (AB) individuals.

Design: Cross sectional.

Setting: Lyndhurst Centre.

Participants: Twelve individuals with iSCI (3 males, 53.6 ± 15.2 years old) and 11 age- and sex-matched AB individuals (3 males, 54.8 ± 14.0 years old).

Interventions: The Lean-and-Release test was used to elicit reactive stepping. A horizontal cable, attached at waist height, was released when 8-12% body weight was supported in a forward lean position. Participants underwent up to 10 Lean-and-Release trials in a session. Kinematic and …

An Integrative Review Of Clinical Outcome Assessments Used To Measure Carryover Effects Of Exoskeletons And Functional Electrical Stimulation In Spinal Cord Injury, Martha K. Childress, Olivia M. Biller, Nicole Gerhardt, Ms, Otr/L, Cbis, Namrata Grampurohit, Phd, Otr/L, Rachel Y. Kim, Otd, Otr/L, Mj Mulcahey, Phd, Otr/L

Department of Occupational Therapy Posters and Presentations

Introduction

• Functional electrical stimulation (FES) and exoskeletons are rehabilitation technologies that provide direct functional ability and potential carryover effects
• Carryover effects may be due to neuromuscular recovery, behavioral compensation, or a combination of both (Figure 1)
• Clinical outcome assessments (COAs) are used to measure recovery of function with and without the device on

Engaging Stakeholders As Advisors On The Design Of A Large-Scale Calibration Study Of The Spinal Cord Injury Movement Index (Sci-Mi) Item Pools, Olivia M. Biller, Otdc, Jason Biundo, Bs, Edward S.-L. Mitchell, Mba, Ernest Ofori, Mb Chb, Lmcc, Bonnie Richardson, Rachel Y. Kim, Otd, Otrl/L, Nicole Gerhardt, Ms, Otr/L, Cbis, M.J. Mulcahey, Phd, Otr/L, Fasia

Department of Occupational Therapy Posters and Presentations

Introduction

• People living with spinal cord injury (SCI) in North America are involved in the following as stake holders in research: identifying priorities for research; planning interventions; and implementing rehabilitation or peer-support interventions.
• The best practice is for partnerships to span the continuum of research.
• Project purpose: to collaborate with an advisory board of individuals living with SCI, to make recommendations for the methods of a large-scale calibration study of the Spinal Cord Injury Movement Index )SCI-MI).
• The SCI-MI is being developed as a SCI clinical trial outcome assessment to evaluate the construct of movement in the context of function …

Refinement & Preliminary Examination Of A Fidelity Assessment For The Spinal Cord Injury -- Movement Index (Sci-Mi), Nicole Gerhardt, Otd(C), Otr/L

Department of Occupational Therapy Posters and Presentations

Introduction: Assessment fidelity refers to the adherence to intended procedures and guidelines when administering an assessment (Mowbray et al., 2003; Walton et al., 2020). Clinical outcome assessments (COAs) play a crucial role in the assessment of treatment effects in clinical trials. However, there is a scarcity of fidelity assessments for COAs, which has the potential to impact the accurate evaluation of treatment effects (Richardson et al., 2016). The Spinal Cord Injury Movement Index (SCI-MI) is a performance-based COA being developed with the intent to be used in spinal cord injury (SCI) clinical trials. As the stakes in SCI clinical trials …

Predicting Duration Of Outpatient Physical Therapy Episodes For Individuals With Spinal Cord Injury Based On Locomotor Training Strategy, Mauricio Garnier-Villarreal, Daniel Pinto, Chaithanya K. Mummidisetty, Arun Jayaraman, Candy Tefertiller, Susan Charlifue, Heather B. Tayler, Shuo-Hsiu Chang, Nicholas Mccombs, Catherine L. Furbish, Edelle C. Field-Fote, Allen W. Heinemann

Physical Therapy Faculty Research and Publications

Objective

To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy.

Design

Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services.

Setting

Rehabilitation and community wellness facilities at 4 SCI Model Systems centers.

Participants

Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of …

Spinal Cord Injury-Movement Index (Sci-Mi) Fine Motor Item Pool: Development And Preliminary Validation, Rachel Y. Kim, Otd, Nicole Gerhardt, Ms, Otr/L, Mj Mulcahey, Phd, Otr/L, Fasia

Department of Occupational Therapy Posters and Presentations

Purpose: Describe the conceptual framework and preliminary results from pretesting for content validation of the Fine Motor Item Pool of the SCI-MI.

Coaching In Context: Implications For Practice & Parent Perspectives, Rachel Y. Kim, Otd, Otr/L, N. Gerhardt, Ms, Otr/L, Cbis, Bernadette Alpajora, Otd, Otr/L, Mj Mulcahey, Phd, Otr/L, Fasia, Clcp

Department of Occupational Therapy Posters and Presentations

Introduction

• Informal care partners experience high levels of guilt, stress, anxiety, depression, and overall decreased health and wellness1-3.
• There is a gap in accessibility of services for informal care partners of individuals with chronic conditions4.
• Care partners of individuals with chronic conditions need long-term support and skill-building for the health & well-being of their care recipient and themselves5.

Coaching in Context

• Coaching in Context (CinC) (Figure 1) is a client-driven approach that leverages client’s strengths and addresses challenges through problem-solving skills.
• Coaches connect with clients to build a trusting relationship. The coach uses skillful questioning to enable the client to …

Highlighting Gaps In Spinal Cord Injury Research In Activity-Based Interventions For The Upper Extremity: A Scoping Review., Namrata Grampurohit, Alison Bell, Susan Duff, M. J. Mulcahey, Christina Calhoun Thielen, Gary Kaplan, Ralph J. Marino

Department of Occupational Therapy Faculty Papers

BACKGROUND: Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited.

OBJECTIVE: To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI.

METHODS: The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTseeker with the criteria: non-invasive activity-based interventions delivered atleast three times/week for two weeks, upper extremity functional outcomes, 13 years or older, English language, and neurological disorders three months post onset/injury.

RESULTS: The …

Perspectives Of Individuals With Chronic Spinal Cord Injury Following Novel Balance Training Involving Functional Electrical Stimulation With Visual Feedback: A Qualitative Exploratory Study, David J Houston, Janelle Unger, Jae W Lee, Kei Masani, Kristin E Musselman

Physical Therapy Publications

BACKGROUND: Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during periods of walking or standing. We recently reported the findings of a novel intervention combining functional electrical stimulation with visual feedback balance training (FES + VFBT) on standing balance abilities among five individuals with motor iSCI. However, the previous publication did not report the perceived impact of the intervention on the participants' lives. In this report, the experiences of these five individuals with incomplete spinal cord injury (iSCI) who had recently completed the four-week balance training program are described.

METHODS: Five individuals with a motor …

The Effect Of Perturbation-Based Balance Training And Conventional Intensive Balance Training On Reactive Stepping Ability In Individuals With Incomplete Spinal Cord Injury Or Disease: A Randomized Clinical Trial, Janelle Unger, Katherine Chan, Jae W Lee, B Catharine Craven, Avril Mansfield, Mohammad Alavinia, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability.

Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D.

Design: Randomized clinical trial.

Setting: Tertiary SCI/D rehabilitation center.

Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study.

Methods: Participants were randomly allocated …

Ampakines Stimulate Phrenic Motor Output After Cervical Spinal Cord Injury, L. B. Wollman, Kristi A. Streeter, A. F. Fusco, E. J. Gonzalez-Rothi, M. S. Sandhu, J. J. Greer, D. D. Fuller

Physical Therapy Faculty Research and Publications

Activation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors increases phrenic motor output. Ampakines are a class of drugs that are positive allosteric modulators of AMPA receptors. We hypothesized that 1) ampakines can stimulate phrenic activity after incomplete cervical spinal cord injury (SCI), and 2) pairing ampakines with brief hypoxia could enable sustained facilitation of phrenic bursting. Phrenic activity was recorded ipsilateral (IL) and contralateral (CL) to C2 spinal cord hemisection (C2Hx) in anesthetized adult rats. Two weeks after C2Hx, ampakine CX717 (15 mg/kg, i.v.) increased IL (61 ± 46% baseline, BL) and CL burst amplitude (47 ± 26%BL) in 8 of 8 …

Dynamic Body-Weight Support To Boost Rehabilitation Outcomes In Patients With Non-Traumatic Spinal Cord Injury: An Observational Study, Justin P. Huber, Lumy Sawaki

Neurology Faculty Publications

BACKGROUND: Dynamic body-weight support (DBWS) may play an important role in rehabilitation outcomes, but the potential benefit among disease-specific populations is unclear. In this study, we hypothesize that overground therapy with DBWS during inpatient rehabilitation yields greater functional improvement than standard-of-care in adults with non-traumatic spinal cord injury (NT-SCI).

METHODS: This retrospective cohort study included individuals diagnosed with NT-SCI and undergoing inpatient rehabilitation. All participants were recruited at a freestanding inpatient rehabilitation hospital. Individuals who trained with DBWS for at least three sessions were allocated to the experimental group. Participants in the historical control group received standard-of-care (i.e., no DBWS). …

Bringing Function To Families: Ot’S Role In Parenting With Sci, Alexandra Economou, Ots, Molly Flannery, Ots, Nikki Tutelman, Ots, Courtney Wagner, Ots, Rebecca Sinko, Otd, Otr/L

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives:

• Describe participation challenges that impact the role of parenting for parents with SCI
• Identify evidence-based intervention areas within the scope of OT that facilitate participation in the role of parenting with SCI
• Discuss the unique need and application for OT services to support parents with SCI

PICO Question:

What are interventions within the scope of OT practice that increase participation in the role of parenting with spinal cord injury (SCI)?

Unmasking Severe Hypotension After Intermittent Catheter For Distended Bladder In A Patient With Cervical Spinal Cord Injury, Dennis Nguyen, Neal Ekpoudia, Ellsworth Remson, Farzin Farhandnejad, Se Won Lee

Physical Medicine & Rehabilitation

See additional files.

Ectopic Pregnancy In A Woman With T9 Ais A Paraplegia Secondary To High-Grade Spinal Cord Pilocytic Astrocytoma, Elisabeth K. Acker

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Ectopic pregnancy in a woman with T9 AIS A (motor complete, sensory complete) paraplegia secondary to a high-grade spinal cord pilocytic astrocytoma

Background

In the United States, 20,000 women of childbearing age have a spinal cord injury (SCI). While SCI induces transient amenorrhea immediately after injury, women generally have normal reproductive function after SCI, and their fertility is unimpaired. Medications that commonly manage complications of SCI should be avoided or discontinued during pregnancy. Complications inherent to SCI, including urologic issues, are often exacerbated during pregnancy.

Methods

This is a case report on a female Veteran who initially presented to the …

Functional Electrical Stimulation Plus Visual Feedback Balance Training For Standing Balance Performance Among Individuals With Incomplete Spinal Cord Injury: A Case Series, David J Houston, Jae W Lee, Janelle Unger, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during walking or standing. Our objective was to evaluate a therapeutic tool for standing balance that combined functional electrical stimulation, applied bilaterally to the plantarflexors and dorsiflexors, with visual feedback balance training (FES+VFBT). Five adults with iSCI completed 12 FES+VFBT sessions over 4 weeks. During the training sessions, participants completed each of the four balance exercises twice. Visual feedback of the center-of-pressure (COP) location was provided as participants completed the balance exercises and received FES to assist with performance of the exercises. A closed-loop FES system was …

Quantifying Balance Control After Spinal Cord Injury: Reliability And Validity Of The Mini-Bestest, Katherine Chan, Janelle Unger, Jae Woung Lee, Gillian Johnston, Marissa Constand, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Context/Objective: Incomplete spinal cord injury (iSCI) causes deficits in balance control. The Mini-Balance Evaluation Systems Test (mini-BESTest) is a comprehensive measure; however, further testing of its psychometric properties among the iSCI population is needed. We evaluated the mini-BESTest’s test-retest reliability, and concurrent and convergent validity among individuals living with iSCI for more than one year.

Design: Cross-sectional study.

Setting: Rehabilitation hospital.

Participants: Twenty-one individuals with chronic motor iSCI (14 females, mean age 56.8 ± 14.0 years).

Interventions: None.

Outcome Measures: Participants completed the mini-BESTest at two sessions spaced two weeks apart. At the second session, participants …

Assistive Technology Options For Individuals With Quadriplegia, Bri Brown Ots, Natalie Geisler Ots, Hannah Terranova Ots

School of Occupational Therapy Master's Capstone Projects (2016-2021)

This project was undertaken in collaboration with Sonia Nurkse, MOT, OTR/L and Bridget Tanner, MSOT, OTR/L, two occupational therapists working on the inpatient rehabilitation unit at MultiCare Good Samaritan Hospital in Puyallup, Washington. A systematic review of the literature was conducted to answer the question, “What are the most effective, up-to-date, and user-friendly assistive technology options to support individuals with quadriplegia in functional tasks?” Five databases were searched and through screening and careful review, 19 articles were selected for critical appraisal. Due to the wide variety of devices, some commercially available and other prototypes, we were unable to compare them …

Rapid And Robust Restoration Of Breathing Long After Spinal Cord Injury, Philippa M. Warren, Stephanie C. Steiger, Thomas E. Dick, Peter M. Macfarlane, Warren J. Alilain, Jerry Silver

Spinal Cord and Brain Injury Research Center Faculty Publications

There exists an abundance of barriers that hinder functional recovery following spinal cord injury, especially at chronic stages. Here, we examine the rescue of breathing up to 1.5 years following cervical hemisection in the rat. In spite of complete hemidiaphragm paralysis, a single injection of chondroitinase ABC in the phrenic motor pool restored robust and persistent diaphragm function while improving neuromuscular junction anatomy. This treatment strategy was more effective when applied chronically than when assessed acutely after injury. The addition of intermittent hypoxia conditioning further strengthened the ventilatory response. However, in a sub-population of animals, this combination treatment caused excess …

Cannabis Shenanigans: Advocating For The Restoration Of An Effective Treatment Of Pain Following Spinal Cord Injury., Daniel E. Graves, Phd

Department of Rehabilitation Medicine Faculty Papers

Cannabis is an effective treatment for pain following spinal cord injury that should be available to patients and researchers. The major argument against the rescheduling of cannabis is that the published research is not convincing. This argument is disingenuous at best, given that the evidence has been presented and rejected at many points during the political dialog. Moreover, the original decision to criminalize cannabis did not utilize scientific or medical data. There is tension between the needs of a society to protect the vulnerable by restricting the rights of others to live well and with less pain. It is clear …

Comparison Of Abdominal Compression Devices In Persons With Abdominal Paralysis Due To Spinal Cord Injury, Michaela De Groot, Jennifer Swartz, Jennifer Hastings

Physical Therapy Research Symposium

Comparison of abdominal compression devices in persons with abdominal paralysis due to spinal cord injury.

Michaela de Groot, MA, SPT; Jennifer Swartz, MA, SPT; Jennifer Hastings PT, PhD, NCS University of Puget Sound, Tacoma WA

Objective: In the United States the incidence of spinal cord injury (SCI) is approximately 17,000 new cases a year and there are estimated to be 282,000 persons living with SCI. Approximately 80% of those injured sustain neurologic lesions that impair the function of the abdominal musculature. In the non-disabled population it is well understood that the strength of the abdominal wall is key to prevention …

Targeting Mitoneet With Pioglitazone For Therapeutic Neuroprotection After Spinal Cord Injury, Alexander G. Rabchevsky, Samir P. Patel, Patrick G. Sullivan

Spinal Cord and Brain Injury Research Center Faculty Publications

No abstract provided.

Comparing Seated Pressures In Daily Wheelchair And Sports Equipment And Investigating The Skin Protective Effects Of Padded Shorts., Torey M. Anderson Ba, Spt, Kaitlynn L.C. Mckirgan Bs, Spt, Dr. Jennifer Hastings Pt, Phd, Ncs

Physical Therapy Research Symposium

Background:

Adaptive sports are promoted for individuals with spinal cord injury to increase overall health and prevent cardiovascular and metabolic diseases, but the potential risk of pressure ulcer development with adaptive equipment (AE) is a concern. Current research has found seated pressures in AE that exceed clinically accepted values but no studies have measured pressure with a padded short to assess for its potential pressure reducing effects.

Objective:

Our study sought to evaluate average and peak seating pressure in both static and dynamic sport-specific positions, with and without the presence of three types of over-the-counter padded bicycle shorts, …

Efficacy And Safety Of Methylprednisolone Sodium Succinate In Acute Spinal Cord Injury: A Systematic Review, Michael G. Fehlings, Jefferson R. Wilson, James S. Harrop, Brian Kwon, Lindsay A. Tetreault, Paul M. Arnold, Jeffrey M. Singh, Gregory W.J. Hawryluk, Joseph R. Dettori

Department of Neurosurgery Faculty Papers

Study Design: Systematic review and meta-analysis. Objective: The objective of this study was to conduct a systematic review to assess the comparative effectiveness and safety of high-dose methylprednisolone sodium succinate (MPSS) versus no pharmacological treatment in patients with traumatic spinal cord injury (SCI). Methods: A systematic search was performed in PubMed and the Cochrane Collaboration Library for literature published between January 1956 and June 17, 2015. Included studies were critically appraised, and Grades of Recommendation Assessment, Development and Evaluation methods were used to determine the overall quality of evidence for primary outcomes. Previous systematic reviews on this topic were collated …

A Clinical Practice Guideline For The Management Of Acute Spinal Cord Injury: Introduction, Rationale, And Scope, Michael G. Fehlings, Lindsay A. Tetreault, Jefferson R. Wilson, Brian K. Kwon, Anthony S. Burns, Allan R. Martin, Gregory Hawryluk, James S. Harrop

Department of Neurosurgery Faculty Papers

Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient’s physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of …

A Clinical Practice Guideline For The Management Of Patients With Acute Spinal Cord Injury: Recommendations On The Use Of Methylprednisolone Sodium Succinate, Michael G. Fehlings, Jefferson R. Wilson, Lindsay A. Tetreault, Bizhan Aarabi, Paul A. Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory W. Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark R. Kotter, Shekar N. Kurpad, Brian Kwon, Ralph J. Marino, Allan R. Martin, Eric M. Massicotte, Geno J. Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Andrea C. Skelly, Anoushka Singh, Eve Tsai, Alexander R. Vaccaro, Albert Yee, James S. Harrop

Department of Rehabilitation Medicine Faculty Papers

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: The main conclusions …