STUDY DESIGN:A multicenter retrospective study. OBJECTIVE:Several classifications of cervical spinal cord injury without fracture-dislocation (CSCIWOFD) have been reported during past decades, but no classification propose suggestions for surgical approach decision. In this study, we aimed to establish a new classification of CSCIWOFD based on imaging features of patients, and to determine the surgical outcomes of the different types of CSCIWOFD after different surgical approaches. SETTING:Affiliated hospital of University in Nanchang, the Second Hospital of Shanxi Medical University in Taiyuan, Guangdong Provincial People's Hospital in Guangdong and Renji Hospital in Shanghai, China. METHODS:The clinical data of patients with CSCIWOFD who received conservative or surgical treatment at participating centers between January 2018 and December 2022 were retrospectively reviewed. Patients were classified into four types based on preoperative cervical spine X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) characteristics. The reliability and reproducibility of the new classification was evaluated by six observers from different centers at an interval of 4 weeks. All patients were followed up at least 2 years, and the surgical outcomes of the different types were analyzed. RESULTS:A total of 300 patients with CSCIWOFD were included. Among these patients, 15 received conservative treatment, 169 underwent anterior cervical surgery, 105 underwent posterior cervical surgery, and 11 underwent posterior combined with anterior surgery. The mean Kappa value for inter-observer reproducibility was 0.811, and for intra-observer reliability was 0.893. For Type II patients, the improvement rate of ASIA grade in anterior surgery was significantly higher than that in posterior surgery (P = 0.009). However, for Type III patients, the improvement rate following posterior surgery was higher than that of those undergoing anterior surgery, though no statistically significant difference was observed. In Type IV patients, the combined anterior and posterior approach resulted in a higher improvement rate compared to either the anterior or posterior surgery alone (63.64% vs. 33.33% vs. 16.67%), but again, no statistically significant difference was found. CONCLUSIONS:For patients with CSCIWOFD, a novel classification was developed based on preoperative imaging features, which was proven to be reliable. Type I patients can be treated with conservative treatment or anterior surgery; patients with Type II CSCIWOFD have good neurological outcomes after anterior surgery. For Type III patients, the posterior approach may offer better outcomes, while for Type IV patients, the combined anterior and posterior approach may be more effective.
STUDY DESIGN:Scoping Review OBJECTIVES: Randomised controlled trials (RCTs) are considered the gold standard for evaluating the effectiveness of clinical interventions. In spinal cord injury (SCI) care, nurses deliver many interventions, yet the number, quality, and level of nurse involvement in RCTs remains unclear. Poorly designed RCTs can introduce bias, and limited nurse participation may restrict the development of evidence-based nursing practice. This review aimed to determine: 1. The number and topics of RCTs on nurse-related interventions for people with SCI; 2. The extent of nurse leadership and participation in these RCTs; 3. The methodological quality of the RCTs. SETTING:Australia METHODS: Three databases were searched over a 20-year period for RCTs involving people with SCI and interventions relevant to nursing practice. Two authors independently screened studies for inclusion. Extracted data included study location, sample size, intervention type, nurse involvement, and authorship by nurses. Methodological quality was assessed using the PEDro scale. The protocol was registered with Open Science Framework ( https://osf.io/k9xde ), and PRISMA-ScR guidelines informed reporting. RESULTS:Forty-six RCTs were included from 29,744 retrieved articles. Five main intervention categories were identified, with most studies focusing on bladder and wound management. Studies were primarily conducted in Europe, Asia, and North America. Sample sizes ranged from 9 to 489 participants, with a median (IQR) of 61 (37-91). Nurses were authors on 29 out of the 46 trials, and 26% were nurse led. PEDro scores ranged from 2 to 9, with a median (IQR) of 5 (5-6.8). CONCLUSIONS:Few RCTs have evaluated nursing interventions for people with SCI. Many studies showed susceptibility to selection bias. Greater nurse leadership and participation in high-quality RCTs are needed to strengthen evidence-based SCI nursing care.
STUDY DESIGN:Retrospective data analysis. OBJECTIVE:To investigate the changes in demographic and neurological characteristics in patients with acquired traumatic or non-traumatic spinal cord injury/disease (SCI/D) over a 25-year period and their implications for rehabilitation and bladder management. SETTING:Specialized tertiary German center for spinal cord injury. METHODS:We retrospectively evaluated the data of SCI/D patients admitted to initial rehabilitation between January 1995 and December 1999 (1st period, n = 461) and between January 2020 and December 2021 (2nd period, n = 441). RESULTS:In the period from January 2020 to December 2021, SCI/D patients were significantly older at the onset of paralysis and more often female, paralyzed due to a non-traumatic cause or incompletely paralyzed than 25 years ago. The proportion of young adult patients (16-45-year-olds) fell from 61.4 to 23.1%, while the proportion of the over 61-year-olds rose from 14.2 to 49.3%. The proportion of non-traumatic SCI/D rose from 20.8 to 53.1%. The duration of primary rehabilitation decreased significantly from 158 to 85 days. The proportion of SCI/D patients with intermittent catheterisation on discharge from primary rehabilitation decreased from 62.7 to 27.2%, while the proportion of patients with indwelling catheter at the time of discharge from primary rehabilitation increased from 10.8 to 52.4%. CONCLUSION:The proven demographic changes should lead to considerations about targeted objectives and quality criteria for initial rehabilitation after acquired SCI/D. Further research on this topic should include patient-reported outcome measures. Adequate bladder management of these often elderly patients with non-traumatic SCI/D remains a challenge.
STUDY DESIGN:Scoping review. OBJECTIVES:Spinal cord injury causes complex and severe changes in affected skin and underlying tissues, increasing the risk of pressure ulcer development and impeding wound healing. This scoping review provides an updated overview on skin and tissue changes after spinal cord injury. Given the complexity and inconsistent evidence of the topic, this review outlines current knowledge and highlights research gaps. METHODS:A comprehensive literature search was conducted in Medline, Embase, Cochrane Library, and SCOPUS databases. Studies written in English addressing skin and tissue changes after spinal cord injury were included, with no restrictions on study type or publication year. Two reviewers independently screened the studies, and eligible articles were organized into the following six subgroups: 1) histopathology, 2) ultrasonography, 3) biomechanical properties, 4) skin perfusion, 5) sebum- and sweat gland excretion, and 6) microbiota. RESULTS:Out of 5387 articles screened, twenty-three met the inclusion criteria. Findings revealed epidermal atrophy characterized by progressive thinning over time, while the dermal layer demonstrated fibrosis and reduced collagen synthesis. Results on skin thickness were inconsistent, though increased tissue stiffness was consistently reported. Skin perfusion was compromised, with diminished reactive hyperemia, impaired vascular autoregulation, and reduced spontaneous skin oxygenation. CONCLUSION:Skin and tissue affected by spinal cord injury exhibit compromised quality with characteristics of aged and injured skin. Consequently, the skin is less able to resist pressure, shear stress, and ischemia. The reviewed literature reveals substantial gaps in knowledge, underscoring the need for further research to improve clinical care and management.
INTRODUCTION:Vaginal lithiasis is exceptionally rare and may mimic vesical lithiasis on imaging, particularly in women with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (nLUTD). Delayed recognition may cause recurrent infection, obstructive uropathy and upper urinary tract deterioration. CASE PRESENTATION:A 38-year-old woman with a T6 ASIA Impairment Scale (AIS) grade A SCI and nLUTD after epidural abscess drainage presented with continuous urinary leakage, recurrent febrile urinary tract infections and progressive renal impairment. Urine culture grew Pseudomonas aeruginosa. Non-contrast-enhanced computed tomography showed a 10 × 5.7 cm midline pelvic calculus with bilateral grade II-III ureterohydronephrosis, initially read as a giant intravesical stone. Persistent incontinence was inconsistent with presumed detrusor-sphincter dyssynergia, prompting clinical reassessment. Cystoscopy revealed an empty bladder and a midline vesico-vaginal fistula; colposcopy confirmed a giant vaginal calculus occupying the vaginal vault. The calculus was removed transvaginally using Kielland obstetric forceps. Hydronephrosis resolved and renal function improved; fistula repair was deferred per patient preference. DISCUSSION:A focused review identified fewer than 20 reported cases of primary vaginal lithiasis, most associated with nLUTD, neurological impairment, anatomical abnormalities, urinary fistulas or chronic urinary stasis. This case emphasizes that imaging alone may mislocalize pelvic calculi. In SCI patients with nLUTD, clinical and pelvic examination are essential and may establish the diagnosis while assessing for fistula. After risk stratification, structured long-term surveillance of the upper urinary tract and awareness among spinal cord-injured individuals and physicians are crucial to prevent complications and recurrence.
STUDY DESIGN:Retrospective study. OBJECTIVES:To evaluate the safety of the Atalante exoskeleton in patients with tetraplegia and high paraplegia. SETTING:Three inpatient rehabilitation centers in France. METHODS:Data from thirty-three inpatients with tetraplegia (12 motor complete (American Spinal Injury Association Impairment Scale (AIS) grade A or B), 10 motor incomplete (AIS C or D)) and high paraplegia (at or above T4 level; 10 motor complete and 1 motor incomplete) and an average time since Spinal Cord Injury (SCI) of 2.6 years (19 individuals < 12 months after injury), who completed at least one session of training with the Atalante exoskeleton, were analyzed. The primary outcome was the safety assessment through reported device-related adverse effects (AE). Secondary outcomes included pain (Numeric Pain Rating Scale), spasticity (Ashworth scale), walking ability (WISCI-II), and exoskeleton session data. RESULTS:Participants underwent a median of 7.5 (IQR: 3-22.8) exoskeleton training sessions, with a median verticalization duration of 22.4 min (IQR: 18-26.9) and 583.0 steps (IQR: 347.0-854.0) performed. The estimated rate of AEs per session across all sessions was 0.63%, with a 95% confidence interval ranging from -0.56 to 1.81%. One minor AE occurred in one patient, involving hypotension, fatigue and dizziness, leading to session discontinuation. No therapy-related pain or fracture was reported. Regarding secondary outcomes, spasticity remained unchanged while positive changes were observed in WISCI-II scores in 11 patients with incomplete SCI. CONCLUSIONS:After individual benefit-risk assessment, the Atalante exoskeleton can be safely used in a clinical setting for high SCI patients. SPONSORSHIP:Wandercraft.
Introduction Subacute post-traumatic ascending myelopathy (SPAM) is defined as a neurological deterioration extending several levels above the initial spinal cord injury (SCI) within the first few weeks post-injury, without associated mechanical instability or syringomyelia. This report details three cases of SPAM to highlight this condition.Cases presentation We present three case reports who sustained SPAM over the last 7 years at the Hospital Universitari Vall d'Hebron in Barcelona (Spain). The first patient was a 41-year-old male with a traumatic C5 SCI (AIS A), diagnosed of SPAM 35 days post-injury with a C3 SCI (AIS A) and treated with descending taper of dexamethasone (Dx). The second patient was a 45-year-old female with a traumatic C7 SCI (AIS A), diagnosed of SPAM 39 days post-injury with a C4 SCI (AIS A) and treated with a 3-day methylprednisolone (MP) bolus. The third patient was a 40-year-old male with a traumatic T7 SCI (AIS B), diagnosed of SPAM 11 days post-injury with a T5 SCI (AIS A) and treated with a 7-day MP bolus. The third patient showed improvement in AIS classification. A literature review of identification and treatment of SPAM was conducted.Discussion SPAM is a severe and rare complication that should be considered within weeks following an acute traumatic SCI. There is no consensus in the literature regarding the treatment of corticosteroids related to SPAM. In the three cases presented, methylprednisolone was associated with better outcomes than dexamethasone; however, given the small sample size, this observation remains preliminary and hypothesis-generating.
INTRODUCTION:Heterotopic ossification (HO) is a frequent complication in persons with spinal cord injury (SCI). This condition leads to limitations in movement and to abnormal posture, which can impair sitting and bed positioning and may result in pressure ulcers. Surgery is considered when HO causes severe limitations due to joint obstruction caused by the ossification. However, the defect left after resection is often extensive and may create significant dead spaces that can lead to seroma or hematoma formation if not adequately filled, increasing the risk of infection and prolonged hospitalization, and extended antibiotic therapy. CASE PRESENTATION:We report five cases of large HO treated with resection followed by muscle flap reconstruction to eliminate all dead spaces. All patients were male, with a median age of 44 years old; 3 patients were paraplegic and 2 tetraplegics; 3 patients presented with AIS A and 2 with AIS B. All HOs were in the trochanteric region and involve the hip joint, with a mean defect size of 9,6 × 39,7 × 9,4 cm. After HO resection the defects were filled with a rectus femoris muscle flap. In two cases we observed a seroma that was drained, and the defect was filled with another muscle flap (vastus lateralis and semimembranosus). DISCUSSION:In all reported cases, following muscle flap positioning, no seromas or hematomas were observed. We believe that this reconstructive technique can be beneficial in such cases and may become part of our standard approach to HO resection.
STUDY DESIGN:Cross-sectional study. OBJECTIVE:To quantify the safety, usage pattern, and satisfaction of seven subjects with paraplegia after prolonged home use of a commercial powered overground exoskeleton. SETTING:Centro Protesi Inail, the prosthetic centre of the Italian workers' compensation authority. METHODS:The participants were recalled for a single-day assessment. Five domains were investigated: i. SAFETY:occurrences of adverse events. ii. Active use, usability, and satisfaction: Number of gait steps and stair steps with exoskeleton, System Usability Scale (SUS), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST). iii. Health status and independence: Short Form-36 (SF-36), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder Scale (GAD-7), VO2 consumption associated to a sub-maximal arm crank ergometer test, Modified Ashworth Scale (MAS), Jobe's test and Speed's test, Spinal Cord Injury Measure (SCIM). iv. Perceived benefits: Self-perceived pain severity (VAS scale), Self-perceived bowel and bladder management (5-Likert scale). v. Performance: 6 min Walking Test (6MWT), 10 Meters Walking Test (10MWT). RESULTS:Most recruited subjects were able to use the exoskeleton actively and safely throughout the observation period, experiencing an overall improvement across all domains of investigation. In one case, the ambulation time was lower due to the unavailability of the caregiver. CONCLUSIONS:Home supply of powered exoskeleton for ambulation could be part of a rehabilitation program to support individuals with paraplegia in their daily life. However, the presence of a qualified caregiver emerged as dominant factor for technology abandonment.
BACKGROUND:Cervical spinal cord infarction is a rare condition, accounting for approximately 1-2% of all ischaemic events of the central nervous system (1,2). Diagnosis is often challenging due to clinical overlap with inflammatory, autoimmune, or compressive myelopathies (3). Early recognition is crucial to initiate appropriate treatment and avoid unnecessary or potentially harmful therapies. CASE PRESENTATION:We report the case of a 65-year-old previously healthy man who developed acute cervical pain and paraesthesia in the hands while exposed to sunlight, followed within one hour by complete tetraplegia and respiratory failure, with preserved sensation. Brain imaging was unremarkable, while cervical MRI revealed a T2 hyperintensity from C2 to C4, predominantly involving the anterior and paramedian columns ("H-sign") (4,5), without critical canal stenosis but with minimal disc indentations at C4-C6. CSF analysis was normal. Spinal angiography and transoesophageal echocardiography excluded arteriovenous fistulae, dissections, or embolic sources. A mild hyperhomocysteinaemia (15 µmol/L) was found, with positive anti-recoverin antibodies; anti-AQP4 was negative. The patient received corticosteroids and intravenous immunoglobulins, later discontinued when an ischaemic aetiology was suspected. Antiplatelet and prophylactic anticoagulation therapy were continued. The clinical course was complicated by ventilator-associated pneumonia due to Klebsiella aerogenes, successfully treated with cefepime. Partial motor recovery in the hands and feet was observed from day five onwards. CONCLUSIONS:The clinical and radiological findings, combined with the negative work-up for inflammatory, embolic, or compressive causes, support a diagnosis of cryptogenic ischaemic cervical myelopathy, probably of acute ischaemic-venous origin favoured by minimal disc indentations. This case highlights the diagnostic complexity of acute non-traumatic myelopathies and the crucial role of early multidisciplinary evaluation to establish the aetiology and initiate timely functional rehabilitation (6-8).
INTRODUCTION:Spinal cord injury (SCI) is a complex condition that significantly impacts the patient'squality of life. The integration of Aerobic Training (AT) with Conventional Therapy (CT) during rehabilitation is often underestimated, despite its potential to prevent long-term complications. This study aims to evaluate the integration of AT into the CT program of a hospitalized patient with ASIA B tetraplegia. CASE PRESENTATION:A 25 year oldindividual with complete motor tetraplegia was admitted to the hospital in the sub-acute phase. AT sessionsintegrated with CT were performed twice daily, 5 days a week including three hydrokinesis and standing frame therapy sessions on weekends. AT was delivered using an upper limb cycle ergometer, consisting of 10 min of work at 20% of predicted heart rate (HR), 5 min of rest, and 5 min of work at 35% of predicted HR. The MRC scale, SCIM scaleand WHO-QOL questionnaire were administered before and after six days of combined CT and AT. Heart rate reserve (HRR), Respiratory rate (RR), rate of perceived exertion (RPE), blood pressure and SpO₂ were measured before and after each AT session. DISCUSSION:Despite the brief duration of the rehabilitation program, preliminary adaptations were observed in parameters such as RPE. These findings suggest that AT may play a valuable role in rehabilitation protocols for patients with SCI in the subacute phase. However, due to thesingle patient design and short duration of intervention (six-days), further research with larger sample sizes and longer follow-up is necessary to validate these results.
Study designQualitative, descriptive study of audio recorded, transcribed and analyzed data, based on individual semi-structured interviews using an interview guide.ObjectivesTo describe the subjective experience and quality of life (QoL) of individuals with spinal cord injury (SCI) and identify elements of importance in determining QoL.SettingSwedish outpatient clinic.MethodsIndividuals with SCI were recruited from a specialized SCI outpatient clinic, with eligibility limited to those who had attended at least one prior clinical follow-up. No interventions were applied. Data were collected through qualitative interviews, and the primary outcome measure was the identification of key themes influencing QoL following SCI, as perceived and reported by participants.ResultsThe interviews identified several key factors with perceived impact on the subjects' QoL including difficulties in managing everyday life, the desire to live an independent life, the significance of community and a sense of belonging, current life situation in relation to others and past experiences, and dealing with physical problems, and in particular pain, related to SCI.ConclusionParticipants highlighted independence, social connections, and managing SCI- related physical issues as crucial for their quality of life. They emphasized the community's role in helping individuals with SCI, live meaningful lives and pursue personal goals and aspirations.
STUDY DESIGN:Cross-sectional, psychometric study OBJECTIVE: The Sense of Well-being Inventory (SWBI), Brief Adaptation to Disability Scale-Revised (B-ADS-R) are two of the major assessment tools used for HR-QoL assessment. The study aimed to translate, culturally adapt, and validate the SWBI and the B-ADS-R in Italian. SETTING:Paraplegic Center of Ostia METHODS: The original scale was translated from English to Italian using international guidelines. The psychometric properties analyzed were: content and construct validity, Internal consistency, and stability. Construct validity was assessed measuring correlation between the assessment tools and Life Space Assessment (LSA), Caregiver Burden Scale (CBS), Manual Wheelchair Slalom Test (MWST), and Adaptation Manual Wheelchair Circuit (AMWC) scales. RESULTS:The SWBI and the B-ADS-R translated and culturally adapted in Italian were administered to 72 people with Spinal Cord Injury. Both assessment tools resulted in high values of Cronbach's alpha (ranging from 0.72 to 0.95) and intraclass correlation coefficient. With regards to the content validity analysis interests correlations have been found between the B-ADS-R and the physical well-being subscale of the SWBI. CONCLUSION:The assessment tools analyzed provide rehabilitation professionals, especially those involved in vocational rehabilitation, with assessment measures beyond employment outcomes to improve the definition of success in rehabilitation related HR-QoL. The SWBI and the B-ADS-R help to provide a more valid picture of the individual's level of life satisfaction or HR-QoL.
STUDY DESIGN:Prospective, randomized, open-label, multicenter, parallel group study. OBJECTIVES:Neurogenic bowel dysfunction (NBD) is a common complication in spinal cord injury (SCI) patients, severely affecting quality of life. While transanal irrigation (TAI) has shown superior efficacy over conservative treatments (CT), its early adoption during the first hospitalization post-injury remains unexplored. This study aimed to compare early TAI initiation versus CT in managing NBD in SCI patients. SETTING:This study involved four spinal units across Italy. METHODS:SCI patients were randomized to receive TAI or CT during a four-week hospital stay, followed by continued treatment at home for 6 months. Bowel function, constipation, and continence were assessed using the Wexner scales, while quality of life was measured using the EQ-5D-5L and Spinal Cord Independence Measure (SCIM) questionnaires. Stool transit time and patient independence were also monitored. RESULTS:Twenty-two patients were enrolled, with the TAI group showing significant improvements in constipation (Wexner score reduction from 13.43 ± 4.24 at baseline to 7.55 ± 2.38 and 8.80 ± 4.16 at 4 weeks and 6 months, p = 0.02) and a trend toward continence improvement. A significant increase in the total SCIM score was observed in the TAI group (p = 0.02), particularly in respiratory and sphincter management. Quality of life improved in both groups, with a notable enhancement in self-care activities for the TAI group (p = 0.006). CONCLUSIONS:These preliminary results suggest early TAI adoption improves bowel management, especially constipation, and enhances patient independence. Larger studies are needed to validate these findings and assess long-term benefits.
IntroductionThe reproducibility of a paired associative stimulation (high-PAS) protocol, shown to be beneficial for rehabilitation in incomplete spinal cord injury (SCI), was investigated in a different technical environment. Whereas previous studies relied on a specific technical setup for high-PAS, here the protocol was replicated using alternative devices. Differences in technical attributes could influence the replicability of specific output. As the necessary technology is available in many clinical and research settings, validating the protocol across device systems is important for broader implementation of high-PAS in SCI rehabilitation. In this case, a high-PAS protocol was administered over 6 consecutive weeks in a patient with severe chronic incomplete SCI.Case presentationA 32-year-old male with chronic C5 American Spinal Injury Association Impairment Scale C tetraplegia participated in this study. Three muscle-nerve pairs from both upper extremities each received 20-min high-PAS, administered 22 times over 6 weeks. The patient was assessed by an experienced physiotherapist before high-PAS, immediately after it, and 1 month after. The intervention improved muscle strength, hand function, and daily task performance in both upper extremities.DiscussionThis study sought to replicate high-PAS improvement of motor and functional scores in a patient with severe chronic incomplete SCI and demonstrated that the results can be successfully recapitulated by alternative devices. The improvement observed was consistent with previous studies and supports applicability in more versatile technical environments.
INTRODUCTION:Health care advancements lead to increased survival after severe cervical spinal cord injury (cSCI). Already in the acute phase, the severity of the injury with its magnitude of expected medical complications and the devastating functional prognosis, can confront the patient and its medical team with pressing medical-ethical dilemmas regarding the (dis)continuation of treatment and/or end-of-life decisions. CASE PRESENTATION:In this case series we discuss four patients with severe cSCI that were admitted to the Maastricht University Medical Center, the Netherlands, in 2024, and in whom questions regarding end-of-life decision arose within a couple of days. While the neurological presentations were very similar, the personal wishes, beliefs and psychosocial situations varied greatly. The process of shared decision making, with multiple meetings with the treatment team, the patients (when possible) and their significant others, lead to the formulation of personalized treatment plans regarding discontinuation of treatment and/or end-of-life decisions. DISCUSSION:This case series shows that end-of-life decisions in patients with cSCI are complex and multifactorial. A biopsychosocial approach is needed to tailor a personalized treatment plan that includes medical, prognostic, personal and external factors. An interdisciplinary team that actively involves the patient and its significant others, facilitates the process of shared decision making, which may also have a beneficial effect on the grieving process for the people left behind.
STUDY DESIGN:Retrospective cohort study. OBJECTIVES:The purpose of this study was to describe bladder management during acute hospitalization for people with SCI and its association with length of hospitalization. SETTING:Acute hospitals within a single academic health system in the United States of America. METHODS:Data were extracted from the electronic health record for admissions between September 1, 2021, and September 30, 2023. Bladder management for all admissions was classified as either indwelling urinary catheter (IUC), clean intermittent catheterization (CIC), IUC and CIC, or no catheter. The relationship between bladder management, injury type, and length of stay was examined using a mixed effects linear regression model. RESULTS:The final sample included 1169 unique patients and 1652 admissions. Half (49.7%) of admissions required no urinary catheter. The IUC-only group comprised 18.9% of admissions while CIC and the combined IUC and CIC groups comprised 15.7% of admissions. Most admissions (84.3%) included a single bladder management strategy. Up to 63.1% of the combined IUC and CIC group implemented a trial of CIC more than once during the admission. Both IUC and CIC management was associated with a significant increase in hospital stay of 10.7 days (95% CI [5.3, 16.1], P < 0.001) for those with a cervical injury. CONCLUSION:These results provide valuable information about existing care patterns that can guide future quality improvement initiatives to enhance bladder management early after SCI.
Study designProspective interventional sham-controlled pilot study.ObjectivesTo investigate the effect of motor-tract paired-associative stimulation consisting of high-intensity transcranial magnetic stimulation and high-frequency electric stimulation of peripheral nerves (high-PAS) on moderate-to-severe upper limb neuropathic pain in patients with incomplete spinal cord injury compared with sham treatment in the same patients.SettingBioMag Laboratory, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.MethodsHigh-PAS was applied for 4 weeks to 5 patients with incomplete, non-traumatic SCI and chronic neuropathic pain in upper limb(s). Median, ulnar, and radial nerves of the more painful hand were stimulated. The same patients also received sham stimulation for 4 weeks. Pain was measured with Verbal Rating Scale weekly and with Brief Pain Inventory before and after both stimulation periods and after follow-up of 8 weeks.ResultsClinically significant relief in pain was not achieved with high-PAS or sham treatment.ConclusionsIn this pilot study, clinically significant pain relief was not observed with high-PAS compared with sham treatment. Larger studies are needed to confirm these findings. Nevertheless, pain is not a contraindication for high-PAS in rehabilitation. The previously reported positive effect on milder neuropathic pain may be due to improved muscle activity, different pain types, or placebo effect. High-PAS targeting sensory tracts instead of motor tracts merits further investigation for pain treatment.Trial registrationclinicaltrials.gov, ID NCT05362422
