Craig is a 93-bed, private, not-for-profit, free-standing long-term acute care and rehabilitation hospital that provides a comprehensive system of inpatient and outpatient medical care, rehabilitation, neurosurgical rehabilitative care, and long-term follow-up services. Half of Craig's patients come from outside of Colorado each year, and in the past four years Craig has treated patients from all 50 states and several foreign countries. At any given time, the staff at Craig treats approximately 55 inpatients with spinal cord injuries, 30 with traumatic brain injuries, and 50-60 outpatients. Craig provides housing for out-of-state families and outpatients, including the first 30 days free for families of new inpatients.Craig Hospital is designated by the National Institute on Disability Rehabilitation and Research (NIDRR) as a Model System Center for both spinal cord injury and traumatic brain injury. Craig is also the NIDRR National Statistical TBI database for the other 15 Model System Centers in the U.S..
Healthcare expenditures in the United States are among the highest in the world, and behavioral healthcare costs account for a substantial portion of overall healthcare expenses. Injuries to hospital staff contribute to the high costs associated with delivering behavioral healthcare. Interventions to decrease aggression leading to staff injuries are paramount, but there are limited data on the features of patient physical aggression resulting in these injuries. We reviewed 960 narrative reports of staff injuries caused by patient physical aggression across two pediatric healthcare systems from 2022–2024. We analyzed the putative antecedents to physical aggression, injured staff’s occupation (e.g., nurse), body part injured, and whether the injury was reportable to government agencies. Direct care staff (e.g., 1:1 staff) and nurses were at the greatest risk for injuries from patient physical aggression. Most injuries across both systems were non-reportable to government agencies. At least one putative antecedent was clear within most reports, with intrusive strategies (e.g., restraint, seclusion, and response blocking) and the presence of aversive stimuli (e.g., medical care and staff directions) being most common. Contextualizing patient physical aggression can elucidate features (e.g., putative antecedents) informing strategies to mitigate the recurrence of such behavior and, relatedly, avoid many staff injuries. These outcomes support one avenue for behavior analysts to help healthcare systems better equip staff with ways to manage their safety by better understanding patient behavior.
Individuals with spinal cord injury (SCI) face a disproportionate burden of obesity and cardiometabolic disease, however, evidence to guide pharmacologic treatment is minimal. Mainstay diet and exercise recommendations often yield modest, unsustainable results for those with SCI. In the general population, glucagon-like peptide-1 receptor agonists and dual agonists (GLP-1s) have emerged as potent therapies for obesity and related cardiometabolic disorders. Initially developed for type 2 diabetes mellitus, GLP-1s improve glycemic control, promote substantial weight loss, and reduce other cardiometabolic risk factors. Although robust data from the general population show weight-dependent and independent benefits, evidence specific to SCI is limited to case presentations. These reports suggest the potential for significant reductions in body fat and improvements in cardiometabolic risk. However, concerns remain regarding potential complications, including worsened gastrointestinal dysfunction, reduced muscle mass with a proclivity to develop pressure injuries, and further compromises in bone density. This special communication draws on evidence from the general population and limited SCI-specific evidence to examine the relevance of GLP-1s for individuals with SCI and provides commentary on key clinical considerations for navigating their use in this population.
The Crossroads in Spinal Cord Injury Treatment: Present and Future conference, held in Houston, Texas in January 2026, brought together a multidisciplinary group of clinicians, researchers, engineers, and individuals living with spinal cord injury (SCI) to examine future directions of SCI care and research. This narrative summarizes themes, emphasizing the need to align scientific innovation with implementation in clinical settings. The conference was structured around priorities from individuals with SCI, including upper limb function, bowel and bladder management, pain, independence, and psychosocial well-being. Across sessions, speakers highlighted gaps in translation into practice. Major topics included challenges in clinical trial design, advocacy efforts to address policy barriers and inequities, and emerging approaches in neuromodulation, surgical reconstruction, and rehabilitation technologies. Additional focus areas included under-researched domains such as neurogenic bowel and bladder, disparities in care for women, and the clinical impact of autonomic dysfunction. Psychosocial health, pain, mental health, and sexuality were emphasized as central to quality of life. Engineering discussions underscored interdisciplinary collaboration and user-centered design. Overall, the conference highlighted that the field of SCI is at a critical crossroads, where progress will depend on effective implementation, equitable access, and integration of lived experience into research and clinical care.
BackgroundAnxiety symptoms are common after traumatic brain injury (TBI), and its impact over time may be influenced by demographic and injury-related factors. Specifically, there is a need to characterize post-injury anxiety symptom trajectories after TBI in understudied racial/ethnic groups.ObjectiveTo examine demographic and injury-related predictors of anxiety trajectories over the first 10 years following TBI in an Asian American and Pacific Islander (AAPI) sample.MethodsParticipants were 272 individuals enrolled in the U.S. TBI Model System study. Participants self-identified as AAPI and completed the Generalized Anxiety Disorder-7 scale (GAD-7) at 1, 2, 5, and/or 10-year post-injury follow ups. Over the 10-year period, unconditional growth models assessed curvature of GAD-7 score trajectories, and hierarchical linear modeling (HLM) identified baseline predictors of those trajectories. Secondary HLMs assessed changes in anxiety trajectory slopes over time as a function of significant baseline predictors.ResultsClinically significant anxiety symptoms affected 10.9-13.4% of the participants across the four time points. Over 10 years, anxiety was characterized by a linear, flat/stable, low-level trajectory. A higher overall anxiety trajectory was predicted by lower educational attainment and pre-injury history (vs. no such history) of mental health treatment, with no significant interactions between these predictors over time.ConclusionsEducational background and pre-injury mental health history are risk factors in the development and maintenance of anxiety symptoms in AAPIs with TBI and should be considered in culturally responsive screening and intervention. The disaggregation of AAPI subgroups may be help reframe and target treatment efforts in this heterogeneous population.
Telehealth increases access to allied healthcare in rural areas. People with Parkinson's disease (PD) need improved access to health care, and from a patient-centered perspective, the coordination of their healthcare should be a priority. Four speech-language pathologists, two physical therapists, two pharmacists, and two study coordinators provided a coordinated allied healthcare intervention for people with PD in rural Wyoming and Nevada. Both the providers of the intervention, as well as the participants who received it, were interviewed about their experiences with the eight-week intervention and asked about aspects that were successful or unsuccessful. Through a naturalistic paradigm using a qualitative description design, we analyzed the opinions and experiences regarding delivering or receiving this eight-week intervention. We analyzed the interview transcripts searching for patterns and categories that emerged when participants described their experiences with either delivering or receiving this eight-week intervention. We analyzed the patient and provider data separately, identifying themes for both groups. We then conducted a qualitative comparison of the two sets of themes. Ultimately, this analysis resulted in four shared themes between the intervention participants and the intervention providers: Technology benefits: Convenience without losing connection; Technology challenges: Internet access and stability; Intervention benefits: Improved outcomes and increased PD knowledge; and Future considerations for the intervention: Asynchronous resources and internet/software enhancements. Despite some technology challenges, healthcare providers and participants found that coordinated telehealth is an effective and successful way to deliver speech-language therapy, physical therapy, and medication management to people with PD in rural locations.
