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Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 November 2024) | Viewed by 24880

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Special Issue Editors

Dr. Jennifer L. Maher

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Guest Editor

Department for Health, University of Bath, Bath BA1, UK
Interests: spinal cord injury; exercise; metabolism

Dr. Gregory E. Bigford

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Guest Editor

The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
Interests: SCI; metabolism; exercise rehabilitation; neuromuscular pathology

Special Issue Information

Dear Colleagues,

The International Journal of Environmental Research and Public Health (IJERPH) is currently running a Special Issue, “Spinal Cord Injury Rehabilitation, Treatment, and Quality of Life”. Dr Jennifer Maher (Department for Health, University of Bath) and Dr Gregory Bigford (The Miami Project to Cure Paralysis, University of Miami) are serving as the guest editors. Based on your expertise and outstanding work in this field, we would like to invite you to submit a *review or original research article* related to the topic(s) of this special issue.

This Special Issue aims to publish a series of high-quality interdisciplinary research across the translational spectrum, that provide insight into effective rehabilitation strategies for individuals with spinal cord injury. The scope of research includes strategies to improve functional outcomes, secondary health complications and psychosocial health, where physiological, neuromuscular, and biomechanical mechanisms of these interventions are strongly encouraged. Additionally, we also invite applied reviews that provide clinical recommendations on best practices, or preclinical reviews on novel and emerging therapies that may inform future clinical research. If you are not sure whether a given topic/content fits with our plans for this issue, please do not hesitate to contact us.

Dr. Jennifer L. Maher
Dr. Gregory E. Bigford
Guest Editors

Manuscript Submission Information

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Keywords

rehabilitation medicine
cardiometabolic health
secondary health complications
neurophysiology

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Published Papers (9 papers)

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Research

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15 pages, 590 KiB

Open AccessArticle

Self-Reported Difficulty with and Assistance Needed by People with Spinal Cord Injury to Prepare Meals at Home

by Katherine Froehlich-Grobe

Int. J. Environ. Res. Public Health 2024, 21(11), 1463; https://doi.org/10.3390/ijerph21111463 - 1 Nov 2024

Cited by 1 | Viewed by 1235

Abstract

Individuals with spinal cord injury (SCI) experience an increased risk for obesity and cardiometabolic disease. Recommendations to prevent and treat obesity for those with SCI follow those of the US Department of Agriculture to adopt a healthy eating pattern that includes eating a variety of fruits, vegetables, grains, dairy, and protein, plus limiting added sugars, saturated fats, and sodium. Yet, people with SCI eat too many calories, fat, and carbohydrates and too few fruits, vegetables, and whole grains. The study is based on secondary analyses of SCI participants (n = 122) who enrolled in a weight loss study to determine how SCI may impact their ability to prepare food at home. We hypothesize those with higher-level spinal injuries (specifically, those with cervical versus those with thoracic or lumbar/sacral injuries) experience significantly greater difficulty and are more likely to rely on others’ assistance to perform meal preparation tasks. Physiologic (weight, BMI, blood pressure, hemoglobin A1c) and self-reported data (demographic plus responses to the Life Habits Short Survey and meal prep items) were collected at baseline and qualitative data were obtained from a subsample after the intervention during phone interviews. Participants’ average age was 50 ± 14.7 years old, they lived with SCI for an average of 13.0 ± 13.1 years, and their average BMI was 32.0 ± 6.5. Participants were predominantly white (76.1%) men (54.1%) who had some college education (76.3%), though only 28.8% worked. A substantial proportion of respondents (30% to 68%) reported difficulty across the 13 tasks related to purchasing and preparing meals, with a proxy reported as the most common assistance type used across all tasks (17% to 42%). Forty-nine percent reported difficulty preparing simple meals, with 29% reporting a proxy does the task. More than half reported difficulty using the oven and stove, though between 60% to 70% reported no difficulty using other kitchen appliances (e.g., coffee machine, food processor, can opener), the refrigerator, or microwave. There was a significant difference in kitchen function by injury level. Those living with cervical-level injuries had significantly greater limitations than those with thoracic-level injuries. Spouses, other family members, and caregivers were most likely to serve as proxies and these individuals exerted both positive and negative influences on respondents’ dietary intake, based on qualitative data obtained during interviews. The results suggest that many people living with SCI experience functional and environmental barriers that impact their ability to prepare food and use kitchen appliances. Future research should examine how SCI-related functional limitations, transportation access, accessibility of the kitchen, ability to use appliances, availability of financial resources, and assistance by others to prepare foods impact people’s ability to follow a healthy eating pattern. Full article

(This article belongs to the Special Issue Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life)

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14 pages, 1750 KiB

Open AccessArticle

Assessing Regional Weather’s Impact on Spinal Cord Injury Survivors, Caregivers, and General Public in Miami, Florida

by Danielle Hildegard Bass, Pardis Ghamasaee, Gregory E. Bigford, Mandeville Wakefield, Lunthita M. Duthely and Daniel Samano

Int. J. Environ. Res. Public Health 2024, 21(4), 382; https://doi.org/10.3390/ijerph21040382 - 22 Mar 2024

Viewed by 2133

Abstract

(1) Background: Climate change is increasing the already frequent diverse extreme weather events (EWE) across geographic locations, directly and indirectly impacting human health. However, current ongoing research fails to address the magnitude of these indirect impacts, including healthcare access. Vulnerable populations such as persons with spinal cord injury (pSCI) face added physiologic burden such as thermoregulation or mobility challenges like closure of public transportation. Our exploratory research assessed commute and transport to healthcare facilities as well as the knowledge, attitudes and behaviors (KAB) of pSCI regarding EWE and climate change when compared to pSCI caregivers (CG) and the general public (GP). (2) Methods: A KAB survey was employed to conduct a cross-sectional assessment of pSCI, CG, and GP in Miami from October through November 2019 using snowball sampling. Descriptive and logistic regression statistical analyses were used. (3) Results: Of 65 eligible survey respondents, 27 (41.5%) were pSCI, 11 (17%) CG, and 27 (41.5%) GP. Overall, pSCI reported EWE, particularly flooding and heavy rain, affecting their daily activities including healthcare appointments, more frequently than CG or GP. The overall models for logistic regression looking at commute to and attendance of healthcare appointments were statistically significant. pSCI self-report being less vulnerable than others, and a large proportion of each group was not fully convinced climate change is happening. (4) Conclusions: This study provided insight to the KAB of 3 population subgroups in Miami, Florida. pSCI are significantly more vulnerable to the effects of regional weather events yet exhibit disproportionate self-perception of their vulnerability. Continued and more comprehensive research is needed to characterize the barriers that vulnerable populations face during weather events. Full article

(This article belongs to the Special Issue Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life)

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13 pages, 1434 KiB

Open AccessArticle

Effect of Training for an Athletic Challenge on Illness Cognition in Individuals with Chronic Disability: A Prospective Cohort Study

by Joy M. DeShazo, Ingrid Kouwijzer, Sonja de Groot, Marcel W. M. Post, Linda J. M. Valent, Christel M. C. van Leeuwen, Huacong Wen, Rachel E. Cowan and on behalf of the HandbikeBattle Group

Int. J. Environ. Res. Public Health 2024, 21(1), 58; https://doi.org/10.3390/ijerph21010058 - 30 Dec 2023

Viewed by 2494

Abstract

Illness cognitions (IC) influence how a patient adapts to a chronic disease. The aim was (1) to determine if training for a handcycling mountain time trial (HandbikeBattle) improves IC and (2) to identify factors associated with IC change scores. Persons with a chronic disability (N = 220; including N = 151 with spinal cord disorder) trained 5 months and participated in the time trial. The IC Questionnaire measured helplessness, acceptance, perceived benefits and was assessed before training (T1), after training (T2), and four months after the event (T3). Age, sex, body mass index (BMI), time since injury (TSI), disability characteristics, self-efficacy, mental health (MH) and musculoskeletal pain were obtained at T1. Multilevel regression analyses showed that helplessness decreased (from 11.96 to 11.28, p < 0.01) and perceived benefits increased (from 16.91 to 17.58, p < 0.01) from T1 to T2. For helplessness this decrease persisted during follow-up (11.16 at T3). Changes in helplessness were associated with self-efficacy (p = 0.02), MH (p = 0.02) and lesion completeness (p = 0.02), and were independent of disability type (p = 0.66), lesion level (p = 0.30) and demographics such as sex (p = 0.29) and age (p = 0.67). Training with peers may improve helplessness and perceived benefits in individuals with a chronic disability. Especially individuals with MH problems might benefit from training for an athletic challenge with peers to improve illness cognitions, and ultimately, quality of life. Full article

(This article belongs to the Special Issue Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life)

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17 pages, 4108 KiB

Open AccessArticle

The Effect of Lower Limb Combined Neuromuscular Electrical Stimulation on Skeletal Muscle Signaling for Glucose Utilization, Myofiber Distribution, and Metabolic Function after Spinal Cord Injury

by Amal Alharbi, Jia Li, Erika Womack, Matthew Farrow and Ceren Yarar-Fisher

Int. J. Environ. Res. Public Health 2023, 20(20), 6958; https://doi.org/10.3390/ijerph20206958 - 21 Oct 2023

Cited by 4 | Viewed by 3687

Abstract

Maintaining healthy myofiber type and metabolic function early after spinal cord injury (SCI) may prevent chronic metabolic disorders. This study compares the effects of a 2–5 week combined (aerobic + resistance) neuromuscular electrical stimulation (Comb-NMES) regimen versus a sham control treatment on muscle protein signaling for glucose uptake, myofiber type distribution, and metabolic function. Twenty participants (31 ± 9 years of age) with an SCI (C4-L1, AIS level A–C) within 14 days of the SCI were randomly assigned to control (N = 8) or Comb-NMES (N = 12). Sessions were given three times per week. Fasting blood samples and vastus lateralis muscle biopsies were collected 24–48 h before or after the last session. Western blots were performed to quantify proteins, immunohistochemical analyses determined muscle myofiber distribution, and enzymatic assays were performed to measure serum glucose, insulin, and lipids. Our main findings include a decrease in fasting glucose (p < 0.05) and LDL-C (p < 0.05) levels, an upregulation of CamKII and Hexokinase (p < 0.05), and an increase in type I (+9%) and a decrease in type IIx (−36%) myofiber distribution in response to Comb-NMES. Our findings suggest that maintaining healthy myofiber type and metabolic function may be achieved via early utilization of Comb-NMES. Full article

(This article belongs to the Special Issue Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life)

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11 pages, 804 KiB

Open AccessArticle

The Effect of Mindset and Breathing Exercises on Physical and Mental Health in Persons with Spinal Cord Injury—A Pilot Feasibility Study

by Sonja de Groot, Frank W. L. Ettema, Christel M. C. van Leeuwen, Wendy J. Achterberg, Thomas W. J. Janssen and Sven P. Hoekstra

Int. J. Environ. Res. Public Health 2023, 20(18), 6784; https://doi.org/10.3390/ijerph20186784 - 20 Sep 2023

Cited by 1 | Viewed by 5285

Abstract

This study investigated the feasibility and efficacy of mindset and breathing exercises (Wim Hof Method (WHM)) on physical and mental health in persons with spinal cord injury (SCI). Ten individuals with SCI participated in this pilot study. These ten participants followed a 4-week WHM intervention, with one weekly group session in the rehabilitation center and daily practice at home using the WHM app. An in-person exit-interview was conducted post-intervention to collect qualitative information on participants’ experiences, regarding the feasibility and effects of the intervention. Furthermore, tests and questionnaires were administered pre- and post-intervention to assess physical and mental health outcomes. Adherence to the weekly in-person meetings was excellent and no adverse events occurred. Physical and mental health outcomes in this small sample size showed some pre–post differences. This pilot feasibility study provides preliminary evidence supporting the feasibility and efficacy of the WHM, including mindset and breathing exercises, on physical and mental health of people with SCI. These results warrant a randomized-controlled trial, including cold exposure, of this novel intervention in people with SCI. Full article

(This article belongs to the Special Issue Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life)

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14 pages, 3554 KiB

Open AccessArticle

Boldine Alters Serum Lipidomic Signatures after Acute Spinal Cord Transection in Male Mice

by Zachary A. Graham, Jacob A. Siedlik, Carlos A. Toro, Lauren Harlow and Christopher P. Cardozo

Int. J. Environ. Res. Public Health 2023, 20(16), 6591; https://doi.org/10.3390/ijerph20166591 - 17 Aug 2023

Cited by 4 | Viewed by 1703

Abstract

Traumatic spinal cord injury (SCI) results in wide-ranging cellular and systemic dysfunction in the acute and chronic time frames after the injury. Chronic SCI has well-described secondary medical consequences while acute SCI has unique metabolic challenges as a result of physical trauma, in-patient recovery and other post-operative outcomes. Here, we used high resolution mass spectrometry approaches to describe the circulating lipidomic and metabolomic signatures using blood serum from mice 7 d after a complete SCI. Additionally, we probed whether the aporphine alkaloid, boldine, was able to prevent SCI-induced changes observed using these ‘omics platforms’. We found that SCI resulted in large-scale changes to the circulating lipidome but minimal changes in the metabolome, with boldine able to reverse or attenuate SCI-induced changes in the abundance of 50 lipids. Multiomic integration using xMWAS demonstrated unique network structures and community memberships across the groups. Full article

(This article belongs to the Special Issue Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life)

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6 pages, 283 KiB

Open AccessCommunication

Including People with Spinal Cord Injury in Research as Participants, Partners, and Personnel

by Kim D. Anderson

Int. J. Environ. Res. Public Health 2023, 20(15), 6466; https://doi.org/10.3390/ijerph20156466 - 28 Jul 2023

Cited by 1 | Viewed by 1939

Abstract

Individuals with disabilities are significantly underrepresented in research and are often not included in discussions on diversity, equity, inclusion, and accessibility. The Advisory Committee to the National Institutes of Health Director Working Group on Diversity formed an ad hoc Subgroup on Individuals with Disabilities to develop recommendations on how to enhance the inclusion of people with disabilities in the scientific workforce as well as throughout the research ecosystem. The article summarizes those recommendations and how they came about, then contextualizes them for the spinal cord injury (SCI) research field. Other fields that do not typically include individuals with disabilities in research can learn from the strong history of including people with SCI as research participants. There has been a growing drive within our field to enhance the inclusion of people living with SCI as research partners, but how are we doing with promoting their inclusion in the scientific workforce? Full article

(This article belongs to the Special Issue Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life)

Review

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15 pages, 593 KiB

Open AccessReview

A Scoping Review of Acute Sedentary Behaviour Studies of People with Spinal Cord Injury

by Nathan T. Adams, Bobo Tong, Robert Buren, Matteo Ponzano, Jane Jun and Kathleen A. Martin Ginis

Int. J. Environ. Res. Public Health 2024, 21(10), 1380; https://doi.org/10.3390/ijerph21101380 - 18 Oct 2024

Cited by 1 | Viewed by 1469

Abstract

People with a spinal cord injury (SCI) report less physical activity than other populations and may engage in more sedentary behaviour (SB), especially sitting time. SB negatively impacts physiological and psychosocial outcomes in the general population, yet minimal research has explored the effects in people with SCI. The goal of this scoping review was to catalogue and describe the effects of acute SB among people with SCI. We searched four databases before February 2024 for studies in which people with any SCI sat, laid, or reclined for more than one hour in a day, and any physiological, psychological, or behavioural (i.e., SB time) outcome was measured. In total, 2021 abstracts were screened, and eight studies were included (n = 172 participants). The studies were characterized by varied definitions, manipulations, and measures of SB. Most measured outcomes were physiological (e.g., metabolic, blood pressure), followed by behavioural (e.g., SB time) and psychological (e.g., well-being, affect). When SB was interrupted, only postprandial glucose and affect improved. Based on two studies, participants engaged in 1.6 to 12.2 h of SB per day. Average uninterrupted wheelchair sitting bouts lasted 2.3 h. Based on the very limited body of research, it is impossible to draw any conclusions regarding the nature, extent, or impact of SB in people with SCI. There is much work to carry out to define SB, test its effects, and determine if and how people with SCI should reduce and interrupt SB. Full article

(This article belongs to the Special Issue Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life)

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Other

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22 pages, 809 KiB

Open AccessStudy Protocol

Therapeutic Lifestyle Intervention Targeting Enhanced Cardiometabolic Health and Function for Persons with Chronic Spinal Cord Injury in Caregiver/Care-Receiver Co-Treatment: A Study Protocol of a Multisite Randomized Controlled Trial

by Gregory E. Bigford, Luisa F. Betancourt, Susan Charlifue and Mark S. Nash

Int. J. Environ. Res. Public Health 2023, 20(19), 6819; https://doi.org/10.3390/ijerph20196819 - 25 Sep 2023

Cited by 2 | Viewed by 3195

Abstract

Background: Chronic spinal cord injury (SCI) significantly accelerates morbidity and mortality, partly due to the increased risk of cardiometabolic diseases (CMD), including neurogenic obesity, dyslipidemia, and impaired glucose metabolism. While exercise and dietary interventions have shown some transient benefits in reducing CMD risk, they often fail to improve clinically relevant disease markers and cardiovascular events. Moreover, SCI also places caregiving demands on their caregivers, who themselves experience health and functional decline. This underscores the need for more substantial interventions that incorporate appropriate physical activity, heart-healthy nutrition, and behavioral support tailored to the SCI population. Objectives: This randomized clinical trial (RCT) protocol will (1) assess the health and functional effects, user acceptance, and satisfaction of a 6-month comprehensive therapeutic lifestyle intervention (TLI) adapted from the National Diabetes Prevention Program (DPP) for individuals with chronic SCI and (2) examine the impact of a complementary caregiver program on the health and function of SCI caregivers and evaluate user acceptance and satisfaction. Caregivers (linked with their partners) will be randomized to ‘behavioral support’ or ‘control condition’. Methods: Dyadic couples comprise individuals with SCI (18–65 years, >1-year post-injury, ASIA Impairment Scale A-C, injury levels C5-L1) and non-disabled SCI caregivers (18–65 years). Both groups undergo lock-step circuit resistance training, a calorie-restricted Mediterranean-style diet, and 16 educational sessions focused on diet/exercise goals, self-monitoring, psychological and social challenges, cognitive behavioral therapy, and motivational interviewing. The outcome measures encompass the cardiometabolic risks, cardiorespiratory fitness, inflammatory stress, multidimensional function, pain, life quality, independence, self-efficacy, program acceptance, and life satisfaction for SCI participants. The caregiver outcomes include multidimensional function, pain, quality of life, independence, and perceived caregiver burden. Discussion/Conclusions: This study evaluates the effects and durability of a structured, multi-modal intervention on health and function. The results and intervention material will be disseminated to professionals and consumers for broader implementation. Trial Registration: ClinicalTrials.gov, ID: NCT02853149 Registered 2 August 2016. Full article

(This article belongs to the Special Issue Spinal Cord Injury Rehabilitation, Treatment, and Health Related Quality of Life)

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