Rehabilitation and Therapy Commons^™

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 …

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 G Fehlings, Laureen D Hachem, Lindsay A Tetreault, Andrea C Skelly, Joseph R Dettori, Erika D Brodt, Shay Stabler-Morris, Britt J Redick, Nathan Evaniew, Allan R Martin, Benjamin Davies, Farzin Farahbakhsh, James D Guest, Daniel Graves, Radha Korupolu, Stephen L Mckenna, Brian K Kwon

Faculty, Staff and Student Publications

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 …

A Clinical Practice Guideline For The Management Of Patients With Acute Spinal Cord Injury: Recommendations On Hemodynamic Management, Brian K Kwon, Lindsay A Tetreault, Allan R Martin, Paul M Arnold, Rex A W Marco, Virginia F J Newcombe, Carl M Zipser, Stephen L Mckenna, Radha Korupolu, Chris J Neal, Rajiv Saigal, Nina E Glass, Sam Douglas, Mario Ganau, Vafa Rahimi-Movaghar, James S Harrop, Bizhan Aarabi, Jefferson R Wilson, Nathan Evaniew, Andrea C Skelly, Michael G Fehlings

Faculty, Staff and Student Publications

STUDY DESIGN: Clinical practice guideline development following the GRADE process.

OBJECTIVES: Hemodynamic management is one of the only available treatment options that likely improves neurologic outcomes in patients with acute traumatic spinal cord injury (SCI). Augmenting mean arterial pressure (MAP) aims to improve blood perfusion and oxygen delivery to the injured spinal cord in order to minimize secondary ischemic damage to neural tissue. The objective of this guideline was to update the 2013 AANS/CNS recommendations on the hemodynamic management of patients with acute traumatic SCI, acknowledging that much has been published in this area since its publication. Specifically, we sought …

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 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

Faculty, Staff and Student Publications

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 …

The Impact Of Robotic-Assisted Ambulation On The Cardiopulmonary System: A Systematic Review, Alexandrea Steele, Zachary Johnson, Alanna O'Malley, Laurie Brogan, Nicole Evanosky

Student Research Poster Presentations 2024

No abstract provided.

The Impact Of Robotic-Assisted Ambulation On The Cardiopulmonary System: A Systematic Review, Alexandrea Steele

Student Research Poster Presentations 2024

No abstract provided.

Traumatic Heterotopic Ossification: Pathophysiological Mechanisms, Epidemiological Characteristics, And Risk Factors, Nicola Kate Foster

Theses

Traumatic heterotopic ossification (tHO) refers to the complication of pathological formation of ectopic bone in soft tissues, which follows tissue insult secondary to burn, neurological and orthopaedic injury [2]. Common to these diagnoses is the involvement of central and or peripheral nervous system trauma. Although known risk factors are associated with developing tHO, the underlying cellular and molecular mechanisms are not fully understood. Research to date, primarily in single injury cohorts, has provided minimal translatable results [2]. Thus, clinical guidelines for early screening and prophylactic drug therapy are lacking, and treatment options are limited. To move the body of knowledge …

Safety And Feasibility Of Paired Vagus Nerve Stimulation With Rehabilitation For Improving Upper Extremity Function In People With Cervical Spinal Cord Injury: Study Protocol For A Pilot Randomized Controlled Trial, Nuray Yozbatiran, Gerard E Francisco, Radha Korupolu

Faculty, Staff and Student Publications

Introduction: Pairing vagus nerve stimulation with traditional rehabilitation therapies results in improved motor recovery in people with stroke. However, this approach has not yet been studied in people with spinal cord injury (SCI). Motor recovery continues to be challenging after SCI, and there is a need for innovative research strategies to enhance motor recovery after SCI. Hence, this pilot randomized controlled trial aims to evaluate the safety, feasibility, and potential efficacy of pairing vagus nerve stimulation (VNS) with rehabilitation therapy to restore the motor function of the paretic upper limbs in people with cervical SCI.

Methods and analysis: In this …

Impact Of Routine Urine Cultures On Antibiotic Usage In Those Undergoing A Routine Annual Spinal Cord Injury Evaluation, Sarah May, Annette Walder, Casey Hines-Munson, Ivy Poon, S Ann Holmes, Charlesnika T Evans, Barbara W Trautner, Felicia Skelton

Faculty, Staff and Students Publications

OBJECTIVE: The Veterans Health Administration (VHA), the largest single provider of spinal cord injury and disorder (SCI/D) care in the United States, currently mandates that every patient receives a screening urine culture during the annual evaluation, a yearly comprehensive history and physical examination. This testing has shown in a small subset of patients to overidentify asymptomatic bacteriuria that is then inappropriately treated with antibiotics. The objective of the current analysis was to assess the association of the annual evaluation on urine testing and antibiotic treatment in a national sample of Veterans with SCI/D.

DESIGN/METHOD: A retrospective cohort study using national …

Psychosocial Impacts Of The Covid-19 Pandemic On Women With Spinal Cord Injury, Heather B Taylor, Rosemary B Hughes, Diana Gonzalez, Muna Bhattarai, Susan Robinson-Whelen

Faculty, Staff and Student Publications

This study represents the first known research addressing the impact of the COVID-19 pandemic on women with spinal cord injury (SCI) in the United States. Women in this population face unique barriers that put them at elevated risk for compromised quality of life, risk that was magnified by physical and social restrictions imposed during the pandemic. This qualitative study examined the perceptions of women with SCI and the effect of the pandemic on their lives. The predominantly White and relatively well-educated sample of 105 women with traumatic SCI was diverse in age, injury characteristics, and geographic representation. Recruited across the …

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 …

60 Year Old Male With Autonomic Dysreflexia In C7 Ais A Secondary To A Suprapubic Catheter Inflation In The Membranous Urethra, Brandon Kase, Md, Joshua Levin, Do, Kristin Gustafson, Do

Department of Rehabilitation Medicine Posters

Introduction: Autonomic dysreflexia is a potentially lifethreatening complication in patients with a spinal cord injury above the level of T6. A dangerous symptom is an increase in blood pressure induced by reflex sympathetic hyperactivity secondary to a noxious stimuli which can lead to cerebral hemorrhages, seizures, heart failure or pulmonary edema.¹ The most common causes of autonomic dysreflexia are noxious stimuli to the 1) bladder such as urinary tract infection, distension, or catheterization; 2) bowel, such as constipation or 3) skin such as wounds, or tight clothing. Though Foley catheters and intermittent catheterizations are well known causes of dysreflexia …

Steroid Treatment Causes Weakness In Spinal Dural Arteriovenous Fistula, Mina Na, Do, Brandon Kase, Md, Roger Liu, Do, Kristin Gustafson, Do

Department of Rehabilitation Medicine Posters

Introduction: Spinal dural arteriovenous fistula (SDAVF) is an abnormal connection between the arterial and venous system creating an increase in blood flow and pressure into the spinal veins¹ at an estimated frequency of 5-10 cases per million per year.² Activities that increase intrathoracic and venous pressure such as Valsalva, abdominal compression and steroids_² can lead to a venous infarction, subarachnoid hemorrhage, paraplegia or tetraplegia.³ SDAVF is difficult to diagnose as it presents similarly to other neurologic disorders, but if diagnosed early, deficits can be prevented and reversed with intervention.¹

Case Description: A 54-year-old male presented …

Interpersonal Violence Against Women With Spinal Cord Injury: Adding Insult To Injury, Susan Robinson-Whelen, Rosemary B Hughes, Kimberley Aguillard, Diana Gonzalez, Heather B Taylor

Faculty, Staff and Student Publications

BACKGROUND: Mounting empirical evidence suggests that, compared to women without disabilities, women with disabilities are more likely to experience interpersonal violence (IPV). However, there is extremely limited research attention on IPV against women with spinal cord injury (SCI), a particularly understudied and underserved population.

OBJECTIVES: To conduct the first known examination of lifetime IPV experience in women with SCI, to explore demographic and disability-related correlates of IPV, and to examine the health impacts of IPV.

METHODS: The sample included 175 women with traumatic SCI from across the United States who enrolled in a randomized controlled trial of an online psychological …

Experiences Of Individuals With Spinal Cord Injury And Return To Work: A Scoping Review, Soofia Naqvi

Occupational Therapy Doctorate Capstone Projects

Background: Participation in productive work after a traumatic spinal cord injury (SCI) can often be a challenging experience. This experience is unique to each individual and is often impacted by personal and environmental factors as well as government policies. Previous studies have aimed to identify the factors associated with promoting successful return to work after SCI, but often the perceptions of those who experience SCI are excluded from these studies. This study aims to gain insights regarding the experiences of persons with SCI and participation in productive employment. Purpose: To analyze existing literature about the perceptions of persons with (SCI) …

Prognosis Of Paraplegia After Receiving Transarterial Chemoembolization For Recurrent Hepatocellular Carcinoma: A Case Report, I-Wei Chen, Hsueh-Chou Lai, Chien-Lin Lin

Rehabilitation Practice and Science

Transarterial chemoembolization (TACE) is the standard treatment for patients with Barcelona clinic liver cancer staging system stage B hepatocellular carcinoma. However, various TACE complications have been reported, and spinal infarction is one of the rarest. To date, only six specific case reports written in English have been published. We report a rare case of TACE-related spinal cord infarction and compare this case with cases in other reports and literature reviews. The patient experienced a sudden onset of paraplegia, sensory impairment below the T8 dermatome and had difficultly voiding immediately after TACE. The T2WI and DWI found hyperintensity 3.5 hours after …

Effect Of Repetitive Transcranial Magnetic Stimulation On Gait Function And Strength Among Patients With Spinal Cord Injury: A Meta-Analysis, Yen-Ting Chen, Yu-Chi Su, Yu-Ching Lin

Rehabilitation Practice and Science

Purpose: This meta-anaylysis investigated the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the context of spinal cord injury (SCI). The study focused on assessing its impact on muscle strength and gait speed, measured through the lower extremities motor score of the American Spinal Injury Association (ASIA) and 10-Meter Walk Test scores(10MWT). Methods: The PubMed, Cochrane Library, and Embase databases were searched for articles published through Oct 2023. We enrolled only randomized controlled trials. The Cochrane Collaboration risk of bias tool was used for quality assessment. Outcomes were analyzed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). We …

Protective Effect Of Previous Spine Surgery In Traumatic Cervical Spinal Cord Injury: A Case Report, Jennifer Sloan, Ronald Taylor

Posters

No abstract provided.

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 …

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

Fighting For Recovery On Multiple Fronts: The Past, Present, And Future Of Clinical Trials For Spinal Cord Injury, Valerie A Dietz, Nolan Roberts, Katelyn Knox, Sherilynne Moore, Michael Pitonak, Chris Barr, Jesus Centeno, Scott Leininger, Kent C New, Peter Nowell, Matthew Rodreick, Cedric G Geoffroy, Argyrios Stampas, Jennifer N Dulin

Faculty, Staff and Student Publications

Through many decades of preclinical research, great progress has been achieved in understanding the complex nature of spinal cord injury (SCI). Preclinical research efforts have guided and shaped clinical trials, which are growing in number by the year. Currently, 1,149 clinical trials focused on improving outcomes after SCI are registered in the U.S. National Library of Medicine at ClinicalTrials.gov. We conducted a systematic analysis of these SCI clinical trials, using publicly accessible data downloaded from ClinicalTrials.gov. After extracting all available data for these trials, we categorized each trial according to the types of interventions being tested and the types of …

Upper Limb Capabilities, Self-Care And Fine Motor Activities With And Without Equipment In Persons With Cervical Spinal Cord Injury At Discharge From Rehabilitation And 1 Year Post-Injury, Ralph J. Marino, David Chen, Sara Mulroy, Edelle Field-Fote, Benjamin Leiby

Department of Rehabilitation Medicine Posters

Introduction: There is little information on the impact of assistive technology or devices (AT) on function. The purpose of this project was to explore the impact of AT on self-care (SC) and fine motor (FM) function in persons with cervical SCI, and to examine the functional capabilities of those who benefit from AT.

Methods: Persons with acute cervical SCI, all levels and AIS grades, with an upper extremity motor score (UEMS) > 0 were enrolled. At discharge from rehabilitation and 1 year post-injury we collected the Capabilities of Upper Extremity questionnaire (CUE-Q), and the combined SC and FM questions of the …

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 …

Reducing Caregiver Burden In Spinal Cord Injuries And Disorders (Sci/D), Heather Berto

Department of Occupational Therapy Entry-Level Capstone Projects

The following capstone project focused on the exploration of clinical and community-based resources that help reduce caregiver burden in the adult spinal cord injuries and disease (SCI/D) population. In order to best serve the chosen population, this capstone project aimed to help adults with SCI/D and their caregivers have access to resources that assist with handling adjustment, learning independent living skills, and navigating their relationship with one another, while ultimately taking into consideration their specific mental health needs.

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 …

Occupation And Time-Use: The Narratives Of One Individual With Tetraplegia, Amanda Balser

Occupational Therapy Doctorate Capstone Projects

Background: Successful health-management habits of individuals with tetraplegia have correlated with better quality of life and occupational engagement. Objectives: Little is known about the experience of time-use during these practices and the influence these routines have on participation in other meaningful occupations. This study aimed to explore the stories an individual with tetraplegia has about time-use in health management practices, influences on time-use, and feelings about quality of life and life satisfaction. Methodology: Narrative inquiry was used to explore the stories of time-use of one individual living with tetraplegia. Findings: Eleven interpretive stories were thematically represented illustrating the complexity of …

Factors Associated With Ventilator Weaning Success And Failure In People With Spinal Cord Injury In An Acute Inpatient Rehabilitation Setting: A Retrospective Study, Radha Korupolu, Hannah Uhlig-Reche, Emmanuel Chigozie Achilike, Colton Reeh, Claudia Pedroza, Argyrios Stampas

Faculty, Staff and Student Publications

OBJECTIVES: To evaluate baseline characteristics, describe pulmonary outcomes, and identify weaning predictors for people with acute traumatic spinal cord injury (SCI) who are dependent on mechanical ventilation at admission to acute inpatient rehabilitation (AIR).

METHODS: The retrospective study was conducted at an AIR facility in the United States. It included 91 adults with acute traumatic SCI from 2015 to 2019 who were dependent on mechanical ventilation.

RESULTS: People who successfully weaned (85%) had fewer days from time of SCI to AIR admission (22 vs. 30,

CONCLUSION: In this retrospective study, there was an increased risk of pneumonia in people with …

Emerging Evidence For Intrathecal Management Of Neuropathic Pain Following Spinal Cord Injury, Jay Karri, James Doan, Christian Vangeison, Marissa Catalanotto, Ameet S Nagpal, Sheng Li

Faculty, Staff and Student Publications

A high prevalence of patients with spinal cord injury (SCI) suffer from chronic neuropathic pain. Unfortunately, the precise pathophysiological mechanisms underlying this phenomenon have yet to be clearly elucidated and targeted treatments are largely lacking. As an unfortunate consequence, neuropathic pain in the population with SCI is refractory to standard of care treatments and represents a significant contributor to morbidity and suffering. In recent years, advances from SCI-specific animal studies and translational models have furthered our understanding of the neuronal excitability, glial dysregulation, and chronic inflammation processes that facilitate neuropathic pain. These developments have served advantageously to facilitate exploration into …