OBJECTIVES:The aim of this study was to examine if early intradetrusor injections of onabotulinumtoxin A (BTX) permanently prevent the development of neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI). MATERIALS AND METHODS:Double-blinded randomised controlled trial. Patients with a sensorimotor complete subacute traumatic suprasacral SCI received intradetrusor injection of BTX or placebo at baseline (within 12 weeks after injury) and 3 months later. Urodynamic and clinical evaluation was performed at baseline, at 3 months, at 12 months and at long-term follow-up after >24 months. The primary endpoint was occurrence of NDO with contractions above 40 cmH2O. The secondary endpoints included comparisons of urodynamic parameters, as well as clean intermittent catheterisation (CIC) frequency, occurrence of urinary incontinence, and quality of life (QOL) evaluated by questionnaires. RESULTS:Nine patients were included, with four in the placebo group and five patients in the BTX group. Two patients in the placebo group but none in the BTX group developed NDO with contractions above 40  cmH2O. Regarding the secondary outcome variables, there were lower maximum detrusor pressure, less frequent CIC, less incontinence, and better QOL in the BTX group at >24 months follow up. Although there was a trend toward better outcome measures, none of the differences were statistically significant. No adverse events were related to BTX in either group. CONCLUSION:Intradetrusor injection of BTX in patients with SCI during the subacute phase seems to be safe and may be beneficial, but further studies are needed.

BACKGROUND & AIMS:Traumatic spinal cord injury (SCI) induces rapid and adverse changes in body composition, yet effective strategies to prevent excess fat accumulation are limited. This study aimed to evaluate the effect of an individualized dietitian-led nutrition intervention on change in fat mass and related markers of adiposity during the first year following SCI. METHODS:In this single-center, open-label randomized controlled trial, adults with subacute traumatic SCI were randomized to an individualized dietitian-led intervention or usual care. The primary outcome was change in total fat mass (FM) over one year, assessed by multifrequency bioimpedance analysis. Secondary outcomes included fat mass index (FMI), visceral adipose tissue (VAT), waist circumference, fat-free mass, fat-free mass index, body weight, body mass index (BMI) and biomarkers (fasting glucose, 2-h oral glucose tolerance test, HbA1c, LDL, HDL and triglycerides). Intention-to-treat analyses used mixed-effects models adjusted for age, sex, and neurological severity. RESULTS:Sixty-two participants were randomized (32 intervention, 30 control). Participants were predominantly male (76%) with a mean age of 48 (SD 17) years. At 1 year, the adjusted between-group difference in FM change was -1.5 kg (95% CI -4.8 to 1.9; p = 0.39). Significant between-group differences were observed for VAT (-0.5 L; 95% CI -1.0 to -0.1; p = 0.02) and waist circumference (-4.0 cm; 95% CI -7.0 to -1.0; p = 0.01), with borderline significance for FMI (-1.6 kg/m2; 95% CI -3.2 to 0.0; p = 0.05). No significant between-group differences were observed for body weight, BMI, fat-free mass, or biomarkers. Sensitivity and per-protocol analyses yielded consistent results. CONCLUSIONS:Although the intervention did not significantly affect the primary endpoint of total fat mass, between-group differences were observed for VAT and waist circumference. These findings suggest that structured, individualized dietetic care initiated during SCI rehabilitation and continued post-discharge may attenuate accumulation of abdominal adiposity. Longer-term follow-up is needed to determine whether early attenuation of abdominal adiposity translates into reduced cardiometabolic risk and improved functional outcomes. CLINICAL TRIAL IDENTIFIER:NCT04109586.

Cystometry is a urodynamic investigation used to examine the pressure-volume relationship during bladder filling. In clinical practice, cystometry is typically performed with water or air-filled catheters connected to an external transducer. These catheters, which are primarily suited for short-duration measurements, can compromise pressure transmission due to air bubbles, clogging, bending, and movements, and they are not sensitive enough to rapid pressure fluctuations. Moreover, ensuring proper leveling of the transducer is crucial for accurate measurement. To overcome these limitations, a MEMS pressure sensor prototype was previously developed. This study now evaluates the concurrent validity and reliability of this prototype against a conventional cystometry system during a series of clinical cases involving 33 patients undergoing routine cystometry. Excluding three sensors for which a correct placement during cystometry could not be verified, 83.3% of sensors produced useful data. Among these, 88% demonstrated a strong correlation with the reference system in the time-amplitude domain and 72% exhibited a high correlation in the time-frequency domain. Although these sensors were manually assembled and did not go through a standardized manufacturing process to enhance stability and detect potential failures, over 78.8% of the 33 sensors tested remained functional after the trial. Therefore, these results support the adoption of this technology in clinical practice, as it may improve diagnostic efficiency, reduce patient discomfort, and potentially be used for long-term and ambulatory urodynamics.

Intelligent wearable sensors, empowered by machine learning and innovative smart materials, enable rapid, accurate disease diagnosis, personalized therapy, and continuous health monitoring without disrupting daily life. This integration facilitates a shift from traditional, hospital-centered healthcare to a more decentralized, patient-centric model, where wearable sensors can collect real-time physiological data, provide deep analysis of these data streams, and generate actionable insights for point-of-care precise diagnostics and personalized therapy. Despite rapid advancements in smart materials, machine learning, and wearable sensing technologies, there is a lack of comprehensive reviews that systematically examine the intersection of these fields. This review addresses this gap, providing a critical analysis of wearable sensing technologies empowered by smart advanced materials and artificial Intelligence. The state-of-the-art smart materials-including self-healing, metamaterials, and responsive materials-that enhance sensor functionality are first examined. Advanced machine learning methodologies integrated into wearable devices are discussed, and their role in biomedical applications is highlighted. The combined impact of wearable sensors, empowered by smart materials and machine learning, and their applications in intelligent diagnostics and therapeutics are also examined. Finally, existing challenges, including technical and compliance issues, information security concerns, and regulatory considerations are addressed, and future directions for advancing intelligent healthcare are proposed.

A traumatic cervical spinal cord injury (cSCI) is a severe consequence of trauma to the cervical spine with high mortality and morbidity rates. Epidemiological studies of traumatic cSCIs are necessary for planning preventive measures and health care resource allocation. This is a retrospective database study of 387 consecutive patients with traumatic cSCI admitted to hospitals in Southeast Norway between 2015 and 2022. The estimated incidence of traumatic cSCI was 1.6 per 100,000 per year. The incidence rates adjusted for standard European and global populations were 1.7 and 1.1 per 100,000 per year, respectively. The median patient age was 64 years, 75% were males, 40% had severe comorbidities, 65% of injuries were caused by falls, 25% were ethanol influenced, 44% had multiple traumas, and 96% were admitted to the Neurotrauma Center (NTC). In patients with C0-C2 injury, an odontoid fracture with dislocation of the odontoid fragment was most frequent. The most frequent subaxial injuries were, according to the AO Spine subaxial cervical spine injury classification system, minor nonstructural injuries (type A0) and translational injuries (type C). Eleven percent of patients were diagnosed with cSCIs at C0-C2, and 89% of cSCIs were subaxial. According to the American Spinal Injury Association (ASIA) Impairment Scale (AIS), 17% of cSCIs were classified as A, 12% B, 24% C, and 47% D. Forty-three percent of patients were classified as central cord syndrome, which was significantly associated with subaxial injuries and preinjury degenerative cervical spinal stenosis. Compromised respiration due to the cSCI itself was diagnosed in 17% of patients and was predominant in patients with complete cSCIs (AIS A or B) and high cervical injuries. These data will be helpful in planning the capacity of NTCs in the future. Interventions to prevent falls in elderly individuals and to increase awareness of ethanol as a risk factor for severe cSCIs are needed.

BackgroundTraumatic cervical spinal cord injury (cSCI) is a serious condition that requires a multidisciplinary treatment approach involving care at a neurotrauma center (NTC) and specialized rehabilitation. Contemporary population-based studies of cSCI are important for ensuring the quality and planning of health care approaches for these patients.MethodsThis is a population-based cohort study of patients with traumatic cSCI who were admitted to the NTC in Southeast Norway between 2015 and 2022. The main outcome variables were length of stay (LOS), rate of surgical fixation/stabilization, rate of transfer to specialized rehabilitation, and 90-day mortality. Uni-and multivariate binary logistic regression analyses were used to investigate the effect of different covariates on LOS, transfer to specialized rehabilitation and 90-day mortality.ResultsThe median age of the 370 patients admitted to the NTC was 64 years, 75% were males, 40% had severe comorbidities, 45% had multiple injuries, and 67% underwent primary triage at a local hospital (LH). Surgical cervical stabilization/decompression was performed in 78% of the patients. The median LOS at the NTC was 9 days, and increasing LOS was significantly associated with young age, American Spinal Injury Association Impairment Scale (AIS) grade B, surgery and prolonged ventilatory support. Inpatient specialized rehabilitation was provided to 54% of patients. Receiving specialized rehabilitation was associated with younger age, preinjury independent living, more severe cSCI, no need for acute phase tracheostomy, and surgical stabilization/decompression. Only 6% of the octogenarians received specialized rehabilitation. The 90-day mortality rate was 13%, which was associated with older age, preinjury dependent living, more severe cSCI, upper cervical injuries, and days on ventilator and inversely correlated with LOS.ConclusionAdvanced age, especially among octogenarians, was significantly linked to a lack of specialized rehabilitation. Qualified physicians should assess all patients with cSCI for their need of rehabilitation and their potential to benefit from it. If the number of patients who are likely to respond to rehabilitation outnumbers the capacity of the rehabilitation center, we have two choices. Either guidelines for prioritization of patients for rehabilitation should be developed, or the capacity of the rehabilitation centers should be increased.

Pressure monitoring in various organs of the body is essential for appropriate diagnostic and therapeutic purposes. In almost all situations, monitoring is performed in a hospital setting. Technological advances not only promise to improve clinical pressure monitoring systems, but also engage toward the development of fully implantable systems in ambulatory patients. Such systems would not only provide longitudinal time monitoring to healthcare personnel, but also to the patient who could adjust their way-of-life in response to the measurements. In the past years, we have developed a new type of piezoresistive pressure sensor system. Different bench tests have demonstrated that it delivers precise and reliable pressure measurements in real-time. The potential of this system was confirmed by a continuous recording in a patient that lasted for almost a day. In the present study, we further characterized the functionality of this sensor system by conducting in vivo implantation experiments in nine female farm pigs. To get a step closer to a fully implantable system, we also adapted two different wireless communication solutions to the sensor system. The communication protocols are based on MICS (Medical Implant Communication System) and BLE (Bluetooth Low Energy) communication. As a proof-of-concept, implantation experiments in nine female pigs demonstrated the functionality of both systems, with a notable technical superiority of the BLE.

BackgroundThe recommended treatment for cervical spinal cord injury (cSCI) is surgical decompression and stabilization within 24 h after injury. The aims of the study were to estimate our institutional compliance with this recommendation and identify potential factors associated with surgical delay.MethodsPopulation-based retrospective database study of patients operated for cSCI in 2015–2022 within the South-East Norway Health Region (3.1 million inhabitants). Data extracted were demographics, injury description, management timeline, place of primary triage [local hospital (LH) or neurotrauma center (NTC)]. Main outcome variables were: (1) time from injury to surgery at NTC, (2) time from injury to admission NTC, and (3) time from admission NTC to surgery.ResultsWe found 243 cSCI patients having acute neck surgery. Their median age was 63 years (IQR 47–74 years), 77% were male, 48% were ≥65 years old. Primary triage at an LH occurred in 150/243 (62%). The median time from injury to acute surgery was 27.8 h (IQR 15.4–61.9 h), and 47% had surgery within 24 h. The median time from injury to NTC admission was 5.6 h (IQR 1.9–19.4 h), and 67% of the patients were admitted to the NTC within 12 h. Significant factors associated with increased time from injury to NTC admission were transfer via LH, severe preinjury comorbidities, less severe cSCI, time of injury other than night, absence of multiple injuries. The median time from NTC admission to surgery was 16.7 h (IQR 9.5–31.0 h), and 70% had surgery within 24 h. Significant factors associated with increased time from NTC admission to surgery were increasing age and non-translational injury morphology.ConclusionLess than half of the patients with cSCI were operated on within the recommended 24 h time frame after injury. To increase the fraction of early surgery, we suggest the following: (1) patients with clinical suspicion of cSCI should be transported directly to the NTC from the scene of the accident, (2) MRI should be performed only at the NTC, (3) at the NTC, surgery should commence on the same calendar day as arrival or as the first operation the following day.

Concussion is common and usually resolves without complications. However, persistent symptoms occur in 10-15 % of patients. These post-concussion symptoms are predominantly somatic, cognitive and emotional. The condition is most common in those with previous somatic and mental health issues. The causes underlying long-term post-concussion symptoms are unclear, but a biopsychosocial explanatory model is currently regarded as the most appropriate basis for diagnosis and treatment. This clinical review article is based on key literature and our own clinical experiences with patients who have these long-term post-concussion symptoms.

Background: In Western countries, the typical cervical spine fracture (CS-Fx) patient has historically been a young male injured in a road traffic accident. Recent reports and daily clinical practice clearly indicate a change in the typical patient from a young male to an elderly male or female with comorbidities. This study aimed to establish contemporary population-based epidemiological data of traumatic CS-Fx for use in health care planning and injury prevention. Methods: This is a population-based clinical observational cohort study from the southeastern region of Norway with 3.0 million inhabitants. We included all patients diagnosed with a CS-Fx between 2015 and –2019. Information regarding demographics, preinjury comorbidities, trauma mechanisms, injury description, treatment, and level of hospital admittance is presented. Results: We registered 2153 patients with CS-Fx during a 5-years period, with an incidence of CS-Fx of 14.9/100,000 person-years. The median patient age was 62 years, 68% were males, 37% had a preinjury severe systemic disease, 16% were under the influence of ethanol, 53% had multiple trauma, and 12% had concomitant cervical spinal cord injury (incomplete in 85% and complete in 15%). The most common trauma mechanisms were falls (57%), followed by bicycle injuries (12%) and 4-wheel motorized vehicle accidents (10%). The most common upper CS-Fx was C2 odontoid Fx, while the most common subaxial Fx was facet joint Fx involving cervical level C6/C7. Treatment was external immobilization with a stiff neck collar alone in 65%, open surgical fixation in 26% (giving a 3.7/100,000 person-years surgery rate), and no stabilization in 9%. The overall 90-day mortality was 153/2153 (7.1%). Conclusions: This study provides an overview of the extend of the issue and patient complexity necessary for planning the health care management and injury prevention of CS-Fx. We suggest intensified fall preventive measures in the elderly, better public awareness of the risks of excessive ethanol use, and better road safety for bicyclists.

BACKGROUND European and Norwegian consensus-based guidelines for the management of acute low back pain endorse red flag screening. Red flag symptomatology may ignore notification in the case history and clinical findings. CASE PRESENTATION An active man in his sixties presented with acute low back pain with radiation to the left thigh. A paramedic on home visits found no serious disease. Over a period of 4 hours, progressive loss of sensation and weakness in both legs developed. He arrived at the Emergency Department with paralysis, reduced sensation distal from the hips, absent reflexes, urinary retention and reduced sphincter tone. INR was 2.6. MR scan showed an intradural haematoma compressing Th9-L1, and dislocation of medulla and conus. This was followed by urgent Th10–12 laminectomy and evacuation of subdural haematoma, and thereafter rehabilitation. Three years later, he has sequelae for spinal cord injury at level Th12 with impaired mobility and function in the legs. INTERPRETATION This case highlights that patients with ongoing anticoagulation and acute back pain have increased risk of spinal haematoma requiring emergency treatment. Anticoagulation therapy should therefore be included in red flag screening of acute back pain.

This case highlights that patients with ongoing anticoagulation and acute back pain have increased risk of spinal haematoma requiring emergency treatment. Anticoagulation therapy should therefore be included in red flag screening of acute back pain.

I Norge utarbeides årlig flere tusen sakkyndige erklæringer rekvirert av forsikringsselskap, klientadvokater, rettsvesen og Nav. Vårt inntrykk er at kvaliteten varierer, og det er påfallende at det ikke eksisterer noe organisert kvalitetssikring av spesialisterklæringene. I 1998 opprettet Sosialog helsedepartementet Røsægutvalget, som i 2000 kom i sin innstilling med en rekke forslag for å styrke kvaliteten på sakkyndighet i forsikringssaker (1).

Study design Health-related quality of life (HRQOL) data from two parallel independent single-blinded controlled randomized studies of manual (Study 1) and robotic (Study 2) locomotor training were combined ( ClinicalTrials.gov #NCT00854555). Objective To assess effects of body-weight supported locomotor training (BWSLT) programs on HRQOL in persons with long-standing motor incomplete spinal cord injury and poor walking function. Settings Two inpatient rehabilitation facilities and one outpatient clinic in Norway. Methods Data were merged into intervention (locomotor training 60 days) or control group (“usual care”). Participants completed questionnaires before randomization and 2–4 weeks after the study period, including demographic characteristics, HRQOL (36-Item Short-Form Health Status Survey, SF-36), physical activity (The International Physical Activity Questionnaire Short Form, IPAQ-SF), exercise barrier self-efficacy (EBSE), and motivation for training (Behavioral Regulation in Exercise Questionnaire, BREQ). Physical outcomes i.e., Lower extremity motor score (LEMS) was assessed. The main outcome was change in HRQOL. Secondary outcomes included changes in IPAQ-SF, EBSE, BREQ, and physical outcomes. Results We recruited 37 of 60 predetermined participants. They were autonomously motivated with high baseline physical activity. BWSLT with manual or robot assistance did not improve HRQOL, though LEMS increased in the BWSLT group compared with control group. Conclusions The study was underpowered due to recruitment problems. The training programs seem to benefit LEMS, but not other physical outcomes, and had minimal effects on HRQOL, EBSE, and motivation. Autonomous motivation and high physical activity prior to the study possibly limited the attainable outcome benefits, in addition to limitations due to poor baseline physical function.

OBJECTIVETo assess the effects of robot-assisted locomotor training in patients with chronic incomplete spinal cord injury.DESIGNRandomized single-blind controlled clinical trial.SETTINGThe intervention site was an outpatient clinic, and pre- and post-evaluations were performed in a rehabilitation hospital.PATIENTSA total of 24 subjects with American Spinal Injury Association Impairment Scale grades C or D, >?2 years post-injury.INTERVENTIONSSubjects were randomized to 60 days of robot-assisted locomotor training, or to usual care.METHODSWalking function, lower extremity muscle strength and balance were assessed single-blinded pre- and post-intervention.RESULTSAfter a 9-year recruitment period, only 24 of the planned 30 subjects had been enrolled (mean time since injury 17 (standard deviation (SD) 20) years for all subjects). Walking function, lower extremity muscle strength and balance improved modestly in both groups, with no statistically significant group difference in walking function or muscle strength, whereas postural control declined significantly in the intervention group, compared with controls (p?=?0.03).CONCLUSIONLate-onset robot-assisted locomotor training did not re-establish independent walking function. A modest, but non-significant, effect was seen on muscle strength and balance. However, significant between-group differences were found only in postural control in the control group.