Search Results (31)

Background/Objectives: Spinal cord injuries (SCIs) are among the most debilitating conditions and are a leading cause of disability in young people. This study aimed to analyze the causes of SCIs, assess injury severity using the AIS scale, and evaluate complications during rehabilitation in a hospital setting. Methods: The study involved 176 individuals with SCI, including 142 with a traumatic SCI (TSCI) and 34 with a non-traumatic SCI (NTSCI), rehabilitated at various times post-injury. The data on injury causes, paresis type, complications, wheelchair use, gender, age, and treatment methods were collected. The injury severity was assessed using the AIS. Results: A significant gender difference was found between the TSCI and NTSCI groups (85.2% male vs. 61.8% male). TSCI individuals were also younger. The causes of TSCI were traffic accidents, falls from height, and diving, while the causes for NTSCI included spinal ischemia, tumors, degenerative disc disease, and inflammation. TSCI individuals had more AIS A lesions (52.8% vs. 26.5%) and more cervical injuries (53.5% vs. 14.7%), whereas NTSCI individuals had more AIS C lesions (38.2% vs. 18.3%) and thoracic damage (58.8% vs. 35.2%). TSCI patients were more often treated surgically (95.7% vs. 61.8%) and used wheelchairs (88% vs. 55.9%). No significant differences were found in terms of complications between the groups, though TSCI individuals underwent more chronic rehabilitation. Conclusions: Our research shows that there are significant differences between TSCI and NTSCI both in terms of the level of damage and the severity of damage to neural structures (AIS scales), and thus significant differences in the patients’ functioning in later life for both groups of individuals. Full article

Background/Objectives: Preliminary observations support the view that spinal cord epidural stimulation (scES) combined with trunk-specific training can improve trunk stability during functional activities in individuals with thoracic spinal cord injury (SCI). We studied the acute effects of trunk-specific stimulation on sitting postural control. Methods: Twenty-three individuals with severe cervical SCI were implanted with an epidural stimulator. Postural control was assessed before any activity-based training, without and with trunk-specific scES. In particular, participants performed sitting with upright posture, forward/back lean, and lateral lean activities while sitting on a standard therapy mat. Full-body kinematics and trunk electromyography (EMG) were acquired. Anterior-posterior and lateral trunk displacement along with trunk velocity in all four directions were obtained and used to classify postural control responses. Results: Compared to no stimulation, application of trunk-specific scES led to trunk anterior–posterior displacement increases during forward/back lean (2.79 ± 0.97 cm; p-value = 0.01), and trunk lateral displacement increases during lateral lean (2.19 ± 0.79 cm; p-value = 0.01). After digital filtering of stimulation artifacts, EMG root mean square amplitudes for bilateral external oblique, rectus abdominus, and erector spinae muscles were higher with stimulation for all activities (all p-values < 0.03). Conclusions: The results indicate improvements in trunk lean distances and muscle activation when leaning activities are performed with trunk-specific epidural stimulation. Full article

Background: Spinal cord injury (SCI) frequently leads to pain, leading to significant disability. Pain sensitization, a key feature of SCI, is commonly assessed via quantitative sensory testing like the Pressure Pain Threshold (PPT), though the factors influencing PPT changes remain unclear. This study hypothesizes that specific clinical and neurophysiological factors modulate PPT in SCI patients. The primary objective is to identify predictors of PPT in SCI patients. Methods: We conducted a cross-sectional analysis of neurophysiological, clinical, and demographic data from 102 SCI patients in an ongoing prospective cohort study called “Deficit of Inhibition as a Marker of Neuroplasticity” (DEFINE study). Multivariable regression analyses were used to evaluate demographic, clinical, and functional variables associated with PPT, the primary outcome measure. Results: The sample comprised 87.9% males with an average age of 41. Trauma was the leading cause of SCI (77.45%), predominantly affecting the cervical and thoracic levels. Pain was reported by 44% of participants, and the mean PPT was 8.3 kPa, measured bilaterally. Multivariate analysis of PPT in the left, right, and bilateral thenar regions revealed consistent trends. Significant negative associations were found between bilateral PPT and low beta EEG frequency in the central area (β = −14.94, p = 0.017), traumatic lesion etiology (β = −1.99, p = 0.038), and incomplete lesions by the American Spinal Injury Association classification (β = −1.68, p = 0.012). In contrast, positive associations were observed with age (β = 0.08, p < 0.001). Conclusions: Our findings show that increased beta oscillations and traumatic brain injury having a lower PPT indicate that factors associated with maladaptive plasticity are associated with decreased and likely less functional PPT. On the other hand, increased motor function may help to regulate PPT in a more functional status. Full article

(1) Background: Respiratory dysfunction is a debilitating consequence of cervical and thoracic spinal cord injury (SCI), resulting from the loss of cortico-spinal drive to respiratory motor networks. This impairment affects both central and peripheral nervous systems, disrupting motor control and muscle innervation, which is essential for effective breathing. These deficits significantly impact the health and quality of life of individuals with SCI. Noninvasive stimulation techniques targeting these networks have emerged as a promising strategy to restore respiratory function. This study systematically reviewed the evidence on noninvasive electrical stimulation modalities targeting respiratory motor networks, complemented by previously unpublished data from our research. (2) Methods: A systematic search of five databases (PubMed, Ovid, Embase, Science Direct, and Web of Science) identified studies published through 31 August 2024. A total of 19 studies involving 194 participants with SCI were included. Unpublished data from our research were also analyzed to provide supplementary insights. (3) Results: Among the stimulation modalities reviewed, spinal cord transcutaneous stimulation (scTS) emerged as a particularly promising therapeutic approach for respiratory rehabilitation in individuals with SCI. An exploratory clinical trial conducted by the authors confirmed the effectiveness of scTS in enhancing respiratory motor performance using a bipolar, 5 kHz-modulated, and 1 ms pulse width modality. However, the heterogeneity in SCI populations and stimulation protocols across studies underscores the need for further standardization and individualized optimization to enhance clinical outcomes. (4) Conclusions: Developing standardized and individualized neuromodulatory protocols, addressing both central and peripheral nervous system impairments, is critical to optimizing respiratory recovery and advancing clinical implementation. Full article

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

Objectives: Estimating the risk of diabetes mellitus (DM) is important for the proper management of patients with spinal cord injury (SCI). We investigated the short-term and long-term risks of DM among patients with SCI, according to the presence or severity of post-SCI disability and the level of injury. Methods: We conducted a retrospective cohort study using the Korean National Health Insurance Service (2010–2018) database. After matching by age and sex, 6129 SCI patients and 22,979 controls were included. The primary outcome was incident DM, and risk was evaluated for both the short term (within 1 year after SCI) and the long term (after 1 year of SCI diagnosis). Results: The risk of DM was higher among patients with cervical- and thoracic-level SCI accompanied by disability compared to the controls during follow-up (4.6 ± 2.6 years). The short-term risk of DM was higher among patients with SCI (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.91–3.27) than among the controls and it was even higher among patients with severe disability (OR 5.38, 95% CI 2.91–9.27). According to the level of injury, patients with cervical SCI had the highest short-term risk of DM (with disability, OR 4.93, 95% CI 3.07–7.63). There was no significant increase of DM risk in the long term, after 1 year of SCI diagnosis. Conclusions: Patients with SCI accompanied by severe disability and cervical-level injury had higher risks of pronounced DM in the short term. The findings of this study emphasize the need for active surveillance of DM among patients with high-level SCI and disability, especially in the short term, in addition to continuous monitoring and proper management of DM in the long term. Full article

Several technologies have been introduced into neurorehabilitation programs to enhance traditional treatment of individuals with Spinal Cord Injury (SCI). Their effectiveness has been widely investigated, but their adoption has not been properly quantified. The aim of this study is to assess the distribution of conventional (Treatment As Usual—TAU) and technology-aided (Treatment With Technologies—TWT) treatments conveniently grouped based on different therapeutic goals in a selected SCI unit. Data from 104 individuals collected in 29 months were collected in a custom database and categorized according to both the conventional American Impairment Scale classification and a newly developed Multifactor (MF) clustering approach that considers additional sources of information (the lesion level, the level of independence in the activities of daily living, and the hospitalization duration). Results indicated an average technology adoption of about 30%. Moreover, the MF clusters were less overlapped, and the differences in TWT adoption were more pronounced than in AIS-based clustering. MF clustering was capable of grouping individuals based both on neurological features and functional abilities. In particular, individuals with motor complete injuries were grouped together, whereas individuals with sensorimotor incomplete SCI were collected separately based on the lesion level. As regards TWT adoption, we found that in the case of motor complete SCI, TWT for muscle tone control and modulation was mainly selected (about 90% of TWT), while the other types of TWT were seldom adopted. Even for individuals with incomplete SCI, the most frequent rehabilitation goal was muscle tone modulation (about 75% of TWT), regardless of the AIS level, and technologies to improve walking ability (about 12% of TWT) and balance control (about 10% of TWT) were mainly used for individuals with thoracic or lumbar lesions. Analyzing TAU distribution, we found that the highest adoption of muscle tone modulation strategies was reported in the case of individuals with motor complete SCI (about 42% of TAU), that is, in cases when almost no gait training was pursued (about 1% of TAU). In the case of cervical motor incomplete SCI, compared to thoracic and lumbar incomplete SCI, there was a greater focus on muscle tone control and force recruitment in addition to walking training (38% and 14% of TAU, respectively) than on balance training. Overall, the MF clustering provided more insights than the traditional AIS-based classification, highlighting differences in TWT adoption. These findings suggest that a wider overview that considers both neurological and functional characteristics of individuals after SCI based on a multifactor analysis could enhance the personalization of neurorehabilitation strategies. Full article

(1) Background. High-level spinal cord injury (SCI) disrupts trunk control, leading to an impaired performance of upright postural tasks in sitting and standing. We previously showed that a novel robotic postural stand training with spinal cord epidural stimulation targeted at facilitating standing (Stand-scES) largely improved standing trunk control in individuals with high-level motor complete SCI. Here, we aimed at assessing the effects of robotic postural stand training with Stand-scES on sitting postural control in the same population. (2) Methods. Individuals with cervical (n = 5) or high-thoracic (n = 1) motor complete SCI underwent approximately 80 sessions (1 h/day; 5 days/week) of robotic postural stand training with Stand-scES, which was performed with free hands (i.e., without using handlebars) and included periods of standing with steady trunk control, self-initiated trunk and arm movements, and trunk perturbations. Sitting postural control was assessed on a standard therapy mat, with and without scES targeted at facilitating sitting (Sit-scES), before and after robotic postural stand training. Independent sit time and trunk center of mass (CM) displacement were assessed during a 5 min time window to evaluate steady sitting control. Self-initiated antero-posterior and medial-lateral trunk movements were also attempted from a sitting position, with the goal of covering the largest distance in the respective cardinal directions. Finally, the four Neuromuscular Recovery Scale items focused on sitting trunk control (Sit, Sit-up, Trunk extension in sitting, Reverse sit-up) were assessed. (3) Results. In summary, neither statistically significant differences nor large Effect Size were promoted by robotic postural stand training for the sitting outcomes considered for analysis. (4) Conclusions. The findings of the present study, together with previous observations, may suggest that robotic postural stand training with Stand-scES promoted trunk motor learning that was posture- and/or task-specific and, by itself, was not sufficient to significantly impact sitting postural control. Full article

Study Design: This is a retrospective case series study. Objective: The aim of this study was to investigate whether frailty contributes to functional recovery in individuals with spinal cord injury (SCI). Methods: A total of 121 patients with SCI (106 cervical SCI, 15 thoracic SCI) discharged from our center over the past three years were studied. Moreover, 11-factor modified frailty index (mFI) scores, the length of hospital stays, the rate of returning home, and improvement in Spinal Cord Independence Measure (SCIM) scores were assessed retrospectively. Results: The average age at the time of injury for all 121 cases was 59.6 years. Based on pre-injury assessments, 24 cases were categorized as the Frail group, and 97 cases were categorized as the Robust group. The Frail group had SCIM improvement rates of 16.7% and a home discharge rate of 45.8%. In contrast, the Robust group had SCIM improvement rates of 33.5% and a home discharge rate of 68.0%, with statistically significant differences between the two groups. A significant negative correlation was observed between mFI scores and SCIM improvement rates (R = −0.231, p = 0.014). Conclusions: This study suggests that individuals with pre-existing frailty before SCI experience poorer SCIM improvement rates and face challenges in returning home. Full article

Exercise increases the serum level of interleukin-6 (IL-6), which in turn stimulates the production of various inflammatory cytokine antagonists, such as interleukin-1 receptor antagonist (IL-1ra). Individuals with cervical spinal cord injury (CSCI) are at high risk of inflammatory conditions. This study compared the effects of wheelchair half marathon on the immune system of male athletes with CSCI and those with thoracic/lumber spinal cord injury (SCI). Neutrophil count, IL-1ra, IL-6, and various endocrine parameters were measured before, immediately and 1 h after the race in five CSCI and six SCI who completed the wheelchair marathon race. The percentage of neutrophils was significantly higher in CSCI immediately and 1 h after the race, compared with the baseline, and significantly higher in SCI at 1 h after the race. IL-6 was significantly higher immediately and 1 h after the race in SCI, whereas no such changes were noted in IL-6 in CSCI. IL-1ra was significantly higher at 1 h after the race in both SCI and CSCI. The race was associated with an increase in IL-1ra in both CSCI and SCI. These findings suggest wheelchair half marathon race increases IL-1ra even under stable IL-6 status in male CSCI individuals, and that such post-race increase in IL-1ra is probably mediated through circulatory neutrophils. Full article

(1) Background: Respiratory muscle weakness is common following cervical spinal cord injury (cSCI). Transcutaneous spinal cord stimulation (tSCS) promotes the motor recovery of the upper and lower limbs. tSCS improved breathing and coughing abilities in one subject with tetraplegia. Objective: We therefore hypothesized that tSCS applied at the cervical and thoracic levels could improve respiratory function in cSCI subjects; (2) Methods: This study was a randomized controlled trial. Eleven cSCI subjects received inspiratory muscle training (IMT) alone. Eleven cSCI subjects received tSCS combined with IMT (six of these subjects underwent IMT alone first and then they were given the opportunity to receive tSCS + IMT). The subjects evaluated their sensation of breathlessness/dyspnea and hypophonia compared to pre-SCI using a numerical rating scale. The thoracic muscle strength was assessed by maximum inspiratory (MIP), expiratory pressure (MEP), and spirometric measures. All assessments were conducted at baseline and after the last session. tSCS was applied at C3-4 and Th9-10 at a frequency of 30 Hz for 30 min on 5 consecutive days; (3) Results: Following tSCS + IMT, the subjects reported a significant improvement in breathlessness/dyspnea and hypophonia (p < 0.05). There was also a significant improvement in MIP, MEP, and forced vital capacity (p < 0.05). Following IMT alone, there were no significant changes in any measurement; (4) Conclusions: Current evidence supports the potential of tSCS as an adjunctive therapy to accelerate and enhance the rehabilitation process for respiratory impairments following SCI. However, further research is needed to validate these results and establish the long-term benefits of tSCS in this population. Full article

Excessive distraction in corrective spine surgery can lead to iatrogenic distraction spinal cord injury. Diagnosis of the location of the spinal cord injury helps in early removal of the injury source. The time-frequency components of the somatosensory evoked potential have been reported to provide information on the location of spinal cord injury, but most studies have focused on contusion injuries of the cervical spine. In this study, we established 19 rat models of distraction spinal cord injury at different levels and collected the somatosensory evoked potentials of the hindlimb and extracted their time-frequency components. Subsequently, we used k-medoid clustering and naive Bayes to classify spinal cord injury at the C5 and C6 level, as well as spinal cord injury at the cervical, thoracic, and lumbar spine, respectively. The results showed that there was a significant delay in the latency of the time-frequency components distributed between 15 and 30 ms and 50 and 150 Hz in all spinal cord injury groups. The overall classification accuracy was 88.28% and 84.87%. The results demonstrate that the k-medoid clustering and naive Bayes methods are capable of extracting the time-frequency component information depending on the spinal cord injury location and suggest that the somatosensory evoked potential has the potential to diagnose the location of a spinal cord injury. Full article

Spinal cord injury (SCI) results in severe cardiovascular dysfunction due to the disruption of supraspinal control. Autonomic dysreflexia (AD), an uncontrolled rise in blood pressure in response to peripheral stimuli including common bowel routine, digital anorectal stimulation (DARS), reduces the quality of life, and increases morbidity and mortality. Recently, spinal cord stimulation (SCS) has emerged as a potential intervention to mitigate unstable blood pressure following SCI. The objective of this case series was to test the real-time effect of epidural SCS (eSCS) at the lumbosacral spinal cord, the most common implant location, on mitigating AD in individuals with SCI. We recruited three individuals with cervical and upper thoracic motor-complete SCI who have an implanted epidural stimulator. We demonstrated that eSCS can reduce the elevation in blood pressure and prevent DARS-induced AD. The blood pressure variability analysis indicated that eSCS potentially reduced vascular sympathetic nervous system activity during DARS, compared to without eSCS. This case series provides evidence to support the use of eSCS to prevent AD episodes during routine bowel procedures, improving the quality of life for individuals with SCI and potentially reducing cardiovascular risks. Full article

Spinal cord segmentation is the process of identifying and delineating the boundaries of the spinal cord in medical images such as magnetic resonance imaging (MRI) or computed tomography (CT) scans. This process is important for many medical applications, including the diagnosis, treatment planning, and monitoring of spinal cord injuries and diseases. The segmentation process involves using image processing techniques to identify the spinal cord in the medical image and differentiate it from other structures, such as the vertebrae, cerebrospinal fluid, and tumors. There are several approaches to spinal cord segmentation, including manual segmentation by a trained expert, semi-automated segmentation using software tools that require some user input, and fully automated segmentation using deep learning algorithms. Researchers have proposed a wide range of system models for segmentation and tumor classification in spinal cord scans, but the majority of these models are designed for a specific segment of the spine. As a result, their performance is limited when applied to the entire lead, limiting their deployment scalability. This paper proposes a novel augmented model for spinal cord segmentation and tumor classification using deep nets to overcome this limitation. The model initially segments all five spinal cord regions and stores them as separate datasets. These datasets are manually tagged with cancer status and stage based on observations from multiple radiologist experts. Multiple Mask Regional Convolutional Neural Networks (MRCNNs) were trained on various datasets for region segmentation. The results of these segmentations were combined using a combination of VGGNet 19, YoLo V2, ResNet 101, and GoogLeNet models. These models were selected via performance validation on each segment. It was observed that VGGNet-19 was capable of classifying the thoracic and cervical regions, while YoLo V2 was able to efficiently classify the lumbar region, ResNet 101 exhibited better accuracy for sacral-region classification, and GoogLeNet was able to classify the coccygeal region with high performance accuracy. Due to use of specialized CNN models for different spinal cord segments, the proposed model was able to achieve a 14.5% better segmentation efficiency, 98.9% tumor classification accuracy, and a 15.6% higher speed performance when averaged over the entire dataset and compared with various state-of-the art models. This performance was observed to be better, due to which it can be used for various clinical deployments. Moreover, this performance was observed to be consistent across multiple tumor types and spinal cord regions, which makes the model highly scalable for a wide variety of spinal cord tumor classification scenarios. Full article

Currently, there is uncertainty about the predictive factors for metastatic epidural spinal cord compression (MESCC) and consecutive symptomatology in tumor patients. Prognostic algorithms for identifying patients at risk for paralysis are missing. The influence of the pathologic fracture on the patient’s symptoms is widely discussed in the literature and we hypothesize that pathologic fractures contribute to spinal cord compression and are therefore predictive of severe paralysis. We tested this hypothesis in 136 patients who underwent surgery for spinal metastases. The most common primary cancers were prostate (24.3%, n = 33), breast (11.0%, n = 15), lung (10.3%, n = 14), and cancer of unknown primary (10.3%, n = 14). MESCC primarily affected the thoracic (77.2%, n = 105), followed by the lumbar (13.2%, n = 18) and cervical (9.6%, n = 13) spine. Pathologic fractures occurred in 63.2% (n = 86) of patients, mainly in osteolytic metastases. On the American spinal injury association (ASIA) impairment scale (AIS), 63.2% (n = 86) of patients exhibited AIS grade D and 36.8% (n = 50) AIS grade C-A preoperatively. The presence of a pathologic fracture alone did not predict severe paralysis (AIS C-A, p = 0.583). However, the duration of sensorimotor impairments, patient age, spinal instability neoplastic score (SINS), and the epidural spinal cord compression (ESCC) grade together predicted severe paralysis (p = 0.006) as did the ESCC grade 3 alone (p = 0.028). This is in contrast to previous studies that stated no correlation between the degree of spinal cord compression and the severity of neurologic impairments. Furthermore, the high percentage of pathologic fractures found in this study is above previously reported incidences. The risk factors identified can help to predict the development of paralysis and assist in the improvement of follow-up algorithms and the timing of therapeutic interventions. Full article