Peer mentorships and benefits for individuals with SCI
Lay summary by Jasleen Dhaliwal Edited by Crystal Han This is the lay summary on the original article by iCORDians Robert Shaw, Emily Giroux, Dr. Heather Gainforth, and Dr. Kathleen Martin Ginis. Read the original article here. Why is this Read More...
Lay summary by Jasleen Dhaliwal Edited by Crystal Han This is the lay summary on the original article by iCORDians Robert Shaw, Emily Giroux, Dr. Heather Gainforth, and Dr. Kathleen Martin Ginis. Read the original article here. Why is this study important? Individuals with SCI who are transitioning from a hospital setting to community living can face challenging circumstances, such as feeling overwhelmed and learning how to cope, all while dealing with physical impairment. The process as a whole can be overwhelming and complex. The implementation of peer mentorship can facilitate a smooth transition. Peer mentorship programs pair a mentor with a mentee based on their similarities and interests. Overall, the authors of this study believe that the process of peer mentorship can help individuals with SCI in overcoming and coping with certain challenges associated with SCI, such as reintegrating back into society. What is the purpose of the study? The purpose of this study was to understand how the relationship between a mentor and a mentee differ between telephone call and video conference interactions. The results of this study allowed the authors to deduce the optimal conditions to best form strong mentor and mentee relationships. How was the study conducted? Mentors and mentees either met with each other over video chat or had a telephone conversation. Individuals with SCI were the mentees, whereas others were mentors. Volunteer mentors were recruited from a non profit organization, SCI British Columbia (SCI BC). This organization provides peer mentoring services for individuals with SCI. What do these findings mean for people with SCI? There are two major findings of this paper: Removal of barriers for individuals with SCI: The relationships formed between mentors and mentees did not differ based on mode of contact. These findings mean that individuals with SCI are able to access the necessary help to overcome certain challenges in a remote setting. Moreover, a supportive mentor and mentee relationship can form even in situations where the two individuals are not able to see each other’s faces. In fact, it was found that the nature of the conversations and dynamic of the mentor mentee relationship did not differ by much between video chats and telephone calls. This finding removes the transportation and physical barrier that many individuals with SCI experience. This finding also removes technological barriers, given that individuals do not need access to a smartphone or laptop in order to video chat. Instead, it is sufficient to have access to a phone and the opportunity to form a meaningful and headful relationship is still available. Long lasting benefits for all: Overall, individuals with SCI have reported several long lasting benefits after participating in peer mentorship experiences, such as an increase in motivation and self efficacy. On the other hand, for mentees, this has translated to an improvement in health, self management, and a reduction in unplanned hospital visits. Essentially, the peer mentorship program positively impacts the well being of both the mentor and the mentee. Limitations of the study In this study, the mentor and mentee relationship was developed over telephone calls and video conferences. The setting of this study greatly reflects the restricted in-person contact due to the ongoing COVID-19 pandemic. As a result, this study is limited in demonstrating the mentor-mentee relationship in a virtual setting. Furthermore, the authors are unable to make a comparison between a virtual and in-person mentor-mentee relationship. However, other published articles do conclude that there is no difference in the mode of delivery and impact on the mentee. What does this mean for the SCI community? For the SCI community, this means impacted individuals can access peer mentorship programs over the telephone. Above all, those who do not have access to a computer or internet still have access to the same resources as those who do.
Residual pelvic floor muscle activation following SCI
Lay summary by Alison Babichuk Edited by Rona Herzog, Crystal Han This is a lay summary of the original article by ICORD researchers Dr. Tania Lam, Dr. Mark Carpenter, and their colleagues Alison Williams, Gevorg Eginyan, Emily Deegan, and Mason Read More...
Lay summary by Alison Babichuk Edited by Rona Herzog, Crystal Han This is a lay summary of the original article by ICORD researchers Dr. Tania Lam, Dr. Mark Carpenter, and their colleagues Alison Williams, Gevorg Eginyan, Emily Deegan, and Mason Chow. Read the original article here. Pelvic floor muscles are crucial for everyday living, as they are involved activities such as coughing, postural adjustments, and controlling our bladders. In those diagnosed with a motor-complete spinal cord injury (mcSCI), movement is thought to be lost below the level of the injury, which would impact the function of the pelvic floor muscles. However, previous studies in people with mcSCI have shown that they are able to voluntarily control abdominal and leg muscles to below their injury level to some extent, and stimulation of certain brain regions using a method called transcranial magnetic stimulation (TMS) can result in slight motor activity in the trunk and leg muscles. These previous findings indicate the presence of some motor function in the lower limb regions after an mcSCI. However, this study was the first to examine if people with mcSCI also have motor activity in their pelvic floor muscles. What was the purpose of the study? This study set out to determine if there was remaining innervation to the muscles in those with mcSCI. The researchers focused on investigating if the pelvic floor muscles were able to be activated on their own, in addition to being co-activated along with other muscles. Finally, researchers also investigated if pelvic floor muscles showed motor activity in response to TMS over certain brain regions of participants. How was the study done? Participants all had mSCI, and were between the ages of 19-60. To see if the participants could voluntarily activate their pelvic floor muscles, they performed various physical tasks which included: abdominal exercises, hip extensions, pelvic floor exercises- known as “Kegel Exercises” To see if the participants retained a neural connection from their brain to their pelvic floor, the researchers applied TMS over the brain and examined with special sensors if the pelvic floor responded to this type of stimulation What were the results? The researchers found that abdominal exercises, like sit-ups, elicited significant motor activity in the pelvic floor muscles of the participants. All participants were found to have decreased levels of pelvic floor muscle activation in comparison to control participants. All participants showed some degree of pelvic floor muscle activation in response to TMS. Why is this important? Pelvic floor muscles play a key role in bladder control, which is ie one reason why people with mcSCI with weakened pelvic floors often experience urinary dysfunctions. It is therefore important to investigate interventions for people with mcSCI which target the pelvic floor muscles. Researchers found that activation of pelvic floor muscles is possible following an mcSCI, but only through co-simultaneous activation of other muscles, namely in the trunk muscles. Researchers were also able to demonstrate there is some retention of the connections to the pelvic floor muscles from the brain in the participants, which was seen through the motor activation during TMS. These findings are important as they suggest people with mcSCI may retain some pelvic floor muscle function post injury. Future studies should continue to explore the extent to which people with mcSCI can activate their pelvic floors, and investigate if pelvic floor muscle training is a viable option to treat urinary dysfunction.
The effect of adverse events on patients during lumbar spine surgery
Lay Summary by Fatima Waqar Edited by Rona Herzog This is a summary of research conducted by ICORD PI Dr. John Street and his fellow colleagues. To access the full article click here. What are Perioperative Adverse Events? Why is Read More...
Lay Summary by Fatima Waqar Edited by Rona Herzog This is a summary of research conducted by ICORD PI Dr. John Street and his fellow colleagues. To access the full article click here. What are Perioperative Adverse Events? Why is it important to study their effect on long-term patient outcome? For the purposes of this study, adverse events (AEs) are defined as incidents that happen during a patients’ initial operation or throughout their hospital admission prior to their discharge. AEs are further categorized as minor and major depending on how much of a threat they may impose on an individual’s life or overall health. AEs have been associated with patient disappointment, as they have the potential to negatively impact an individual’s physical function. It is important to note that the financial burden of AEs after spinal surgery is well identified in research, but very little is still known about how these events affect the well-being and quality of life of patients. One factor that may impact the lack of significant research on AEs and patients’ quality of life is the generalizability of the findings. Because many studies have smaller and less diverse sample sizes, using a single approved definition of AE can make it easy for the researchers to generalize their findings to the greater community. What is the purpose of the study? The purpose of this study is to determine how AEs that occur during lumbar spine surgeries affect patients’ satisfaction and quality of life at three distinct time intervals after surgery. Researchers followed up with patients at 3, 12, and 24 months after their surgeries. How was this study conducted? Patients included in the study were individuals undergoing elective surgery for degenerative lumbar spine conditions (lumbar disc disease, degenerative spondylolisthesis, spinal stenosis, and isolated lumbar degenerative deformity). A total of 3556 adult patients (18 years and older) enrolled in the Canadian Spine Outcomes and Research Network (CSORN) were studied. AEs were defined using the Spinal Adverse Events Severity System (SAVES-V2). Researchers also used multiple surveys and scales to measure the patient’s well-being and quality of life over the 3, 12, 24 month intervals. Those measurements included the Oswestry Disability Index (ODI), 12-Item Short-Form Health Survey (SF-12) Physical (PCS) and Mental (MCS) Component Summary Scales, Visual Analog Scale (VAS) leg and back, EuroQol-5D (EQ5D), and satisfaction. What did the researchers discover? Findings from the study showed that 2789 (78.4%) patients experienced no AE 85 (2.4%) patients had at least 1 major AE 682 (19.2%) patients experienced minor AEs only Researchers also determined multiple factors influencing the potential for patients to develop a major AE, which include: increased age fusion surgery patient’s overall health, measured via ASA Score (>2) increased blood loss during surgery increased surgical time by 1-min intervals Important predictors found for minor AEs include: increased age lumbar degenerative deformity (age related wear and tear of the lower back or lumbar spine) fusion surgery increased surgical time What do these findings mean for individuals in the community? After lumbar surgery, a higher proportion of patients with major or minor AEs require care in an intensive care or a step-down unit, they also have longer hospital stays, and are less likely to be directly discharged to home as compared to those without an adverse event. At 12 and 24 month follow-up after surgery, non-satisfaction and negative effects on physical function and quality of life were the highest among patients with major AEs. What can be done to improve long term patient outcome? It will be important moving forward that patients undergoing surgery for degenerative lumbar spine conditions are informed that minor AEs are relatively common but are unlikely to affect quality of life, whereas major AEs are relatively rare but have the potential to reduce physical functioning if they occur. Surgeons are made aware of the impacts of AEs and they should work towards developing practices to minimize AEs in those patients requiring more complex procedures.
Physical activity, chronic pain, and subjective well-being among individuals with SCI
Lay Summary by Nicholas Jo Edited by Rona Herzog and Crystal Han This is a summary of research conducted by ICORD researchers Kendra Todd, Sarah Lawrason, Robert Shaw, Dr. Kathleen Martin Ginis, and their colleague Dr. Derrick Wirtz. Click here Read More...
Lay Summary by Nicholas Jo Edited by Rona Herzog and Crystal Han This is a summary of research conducted by ICORD researchers Kendra Todd, Sarah Lawrason, Robert Shaw, Dr. Kathleen Martin Ginis, and their colleague Dr. Derrick Wirtz. Click here to access the original article. 65% of patients with a spinal cord injury (SCI) endure some form of chronic pain (e.g neuropathic or muscle-related). Post-SCI pain can be debilitating to an individual’s overall well-being and daily function. This can have adverse impacts on their psychological health, which has the potential to lead to an increased risk of anxiety and depressive symptoms. This highlights the urgency to investigate methods that may reduce chronic SCI pain and improve an individual’s well-being, while understanding the relationship between these two factors. Purpose of the Study: This was a scoping review, which means the researchers extracted and compiled findings from other studies in order to answer their research question. The purpose of this scoping review was to investigate the impact of leisure time physical activity (LTPA) on chronic pain and subjective-wellbeing among individuals with SCI. How was this review conducted? An inclusion criterion was created to filter relevant studies in order to investigate the effects of LTPA on both chronic pain and subjective well-being among individuals with SCI. For clarity purposes, chronic pain was defined as any pain lasting longer than twelve weeks. Subjective well-being measures included positive/negative affect, life satisfaction, and satisfaction in different areas of life (i.e. social relationships, employment, etc.). Based on the inclusion criterion the scoping review analyzed 15 published articles. The articles chosen all included: experimental or quasi-experimental designs (designs where the researcher deliberately uses an intervention to see if it has an overall effect) participants 18 years or older, who had sustained a SCI for more than one year the effects of the LTPA intervention on both chronic pain and subjective well-being. Findings from the systematic review: The findings listed below are based on different research articles included in the systematic review. Researchers identified four key findings with regards to how individuals responded to a LTPA intervention: Increased pain, decreased subjective well-being: Following 8-weeks of yoga participation, individuals reported increased levels of general body pain, decreased mindfulness, and a greater negative affect. Increased pain, improved subjective well-being: Following a 6-week yoga program; average pain worsened, while overall anxiety-depression, self-compassion and mindfulness increased. Decreased pain, improved subjective well-being: This key finding was supported by 12 of 15 articles included in the scoping review. A variety of LTPA interventions led to decreased pain and improved subjective well-being (e.g., 9-month aerobic and resistance exercise training, wheelchair propulsion, tai chi). Unchanged levels of pain, improved subjective well-being: Following a 6-week home-based aerobic exercise program; no reported impact on shoulder or general body pain, improved self-efficacy and individual quality of life. Exercise Guidelines for individuals with SCI Two standardized exercise guidelines have been developed to improve overall health and fitness for individuals with SCI: To improve cardiorespiratory fitness and muscular strength, individuals should perform 90 minutes of moderate-high intensity aerobic activity twice a week, with strength training 2x a week consisting of 3 sets of 8-10 reps for each exercise in each major muscle group. To improve cardiometabolic health, individuals should perform 30 minutes of moderate-high intensity aerobic exercise 3x a week. Individuals with pain post-SCI often refrain from physical activity in fear of elevating their pain sensations, which is contrary to what most research suggests. LTPA serves as an effective pain management modality among individuals with SCI. LTPA was demonstrated to reduce both neuropathic and musculoskeletal pain, highlighting the potential for LTPA to be prescribed as a pain management technique. The findings from the scoping review provide a direction for future research to evaluate the effects of LTPA on chronic pain and subjective well-being and develop new interventions to maximize the benefits of LTPA for individuals with SCI. Limitations Although there is clear indication of an effect of LTPA on chronic pain and subjective well-being, limitations in the research do exist. LTPA protocols are markedly inconsistent (including intensity, duration, and frequency), which has the potential to influence pain and subjective well-being outcomes differently. Each study used in this review also had varying classification methods for measuring pain and subjective well-being among participants.
Intermittent catheterization in wheelchair athletes with SCI
Lay Summary by Alanna Shwed Edited by Rona Herzog, Tiffany Fong, and Alyssa Chong This is a summary of research conducted by ICORD researchers Matthias Walter, Ian Ruiz, Jordan Squair, ICORD PI Dr. Andrei Krassioukov, and their colleagues Luis Rios Read More...
Lay Summary by Alanna Shwed Edited by Rona Herzog, Tiffany Fong, and Alyssa Chong This is a summary of research conducted by ICORD researchers Matthias Walter, Ian Ruiz, Jordan Squair, ICORD PI Dr. Andrei Krassioukov, and their colleagues Luis Rios and Marcio Averbeck. Click here to access the original research paper. After suffering a spinal cord injury (SCI) many people are unable to control their lower urinary tract (LUT), so they are unable to urinate voluntarily and/or they urinate when they do not want to. A catheter is commonly used to help a person with a SCI empty their bladder. Catheters can either be left in place (i.e., indwelling) or be inserted and removed several times a day (i.e., intermittent catheterization). Catheters that are left in place can increase an individual’s risk of developing a urinary tract infection (UTI). Intermittent catheterization is considered the better option because this preserves LUT function and reduces the risk of complications. However, despite developments and improvements in catheters, UTIs and urethral injuries are still highly prevalent, impacting the wellbeing of people living with a SCI. What is the purpose of this research? Complications from intermittent catheterization can be detrimental to an individual’s health but they also bring another level of complication for athletes with a SCI. Although high levels of physical activity can lead to improved physical health, complications from intermittent catheterization can negatively impact sport performance. Therefore, this study aimed to identify how common complications associated with intermittent catheterization are among athletes with a SCI. How was this research conducted? A cross-sectional study (i.e., one-time analysis) was conducted with 130 competitive wheelchair athletes with SCI from the 2015 ParaPan American Games, the 2016 Summer Paralympics, the 2017 Prairie League Tournament, and the 2017 Invitational Wheelchair Rugby Tournament. A survey was given to participants asking questions about the severity of their SCI, their remaining autonomic function, the history of their catheterization techniques, and history of complications, inflammations, or infections that have resulted from intermittent catheterization. What did researchers find? Researchers found that 84 out of 109 athletes who used intermittent catheterization experienced at least one complication associated with intermittent catheterization since sustaining their SCI. Despite intermittent catheterization being the preferred method for bladder emptying among individuals with a SCI, there is still a high overall prevalence of complications. What do these findings mean for people and athletes with SCI? Individuals with SCI may need to rely on catheterization for decades to come. However, with each UTI that a person experiences, there is a risk for developing a worse condition that can have very serious implications on quality of life or even lead to death. These implications are important for athletes with a SCI, who have not always received as much attention in research as compared to the SCI community as a whole. Intermittent catheterization and the potential effects on LUT function in athletes with SCI can negatively impact their training, sport performance, and overall health and well-being. The findings from this study indicate that prevention strategies involving continued education through SCI dedicated platforms (e.g., SCI blogs) and organizations (e.g., SCI BC) are key to reducing complications associated with intermittent catheterization. Continued education should involve updating the SCI population on the latest advances in both catheterization types as well as catheterization techniques. Further, behaviour medication may be another target as previous evidence suggests increased rates of UTIs in individuals who are reusing their single-use catheters. Note: Presently Dr. Krassioukov and his team are conducting research on the reuse of catheters and the impact it may have on the health of individuals with SCI. If interested, please contact Rachel Lai, the research coordinator of this project, by email.
Infographic by Crystal Han, inspired by SCIRE community page. Edited by Rona Herzog If you are interested in learning more, take a look at SCIRE Community’s page on Osteoporosis after SCI. Osteoporosis commonly affects individuals with SCI, primarily occurring below Read More...
Infographic by Crystal Han, inspired by SCIRE community page. Edited by Rona Herzog If you are interested in learning more, take a look at SCIRE Community’s page on Osteoporosis after SCI. Osteoporosis commonly affects individuals with SCI, primarily occurring below the level of injury. This is termed sublesional (below the lesion) osteoporosis. As shown below, osteoblasts are cells that work to build bone, while osteoclasts are cells that break down bone. After SCI, osteoblasts are not able to build bone at the same rate as osteoclasts are breaking it down. High levels of bone breakdown, decreased bone mineral density (linked to strength of the bone) in the hip and/or knee area, and an increased likelihood of fracture can be associated with sublesional osteoporosis. Potential factors contributing to SCI and osteoporosis include: overall changes to the body after injury, e.g. changes to the immune, hormonal, circulatory and nervous systems decreased weight-bearing activities decreased muscle activity lifestyle changes after injury, e.g. amount of physical activity The infographic below examines bone formation, bone regulation and osteoporosis after SCI. <img decoding="async" data-attachment-id="46437" data-permalink="https://icord.org/2020/10/osteoporosis-after-spinal-cord-injury/osteoporosis-update/" data-orig-file="https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update.png" data-orig-size="1620,2160" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="Osteoporosis update" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-768x1024.png" class="alignnone size-large wp-image-46437" src="https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-768x1024.png" alt="" width="768" height="1024" srcset="https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-768x1024.png 768w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-225x300.png 225w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-1152x1536.png 1152w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-1536x2048.png 1536w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-150x200.png 150w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-200x266.png 200w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-1080x1440.png 1080w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update.png 1620w" sizes="(max-width: 768px) 100vw, 768px" />
Developing and testing an E-learning program to increase physical activity among people with SCI
Lay Summary by Matthew Ma Edited by Rona Herzog This is a summary of a research study by researchers at the University of Alabama. ICORD PI Dr. Kathleen Martin Ginis is a co-author. Click here to access the original paper. Read More...
Lay Summary by Matthew Ma Edited by Rona Herzog This is a summary of a research study by researchers at the University of Alabama. ICORD PI Dr. Kathleen Martin Ginis is a co-author. Click here to access the original paper. Despite reports showing that regular physical activity benefits both mental and physical health, most people with spinal cord injury (SCI) do not meet the recommended amount of physical activity (PA). A possible reason is that people with SCI face many barriers towards PA, such as a lack of transportation to and from exercise facilities, lack of motivation, and fear of injury. In the past, long term interventions employing social cognitive theory (SCT) have been successful in increasing leisure time physical activity (LTPA) for people with neurological disabilities. However, there is a need for short term programs that can be used in settings such as clinics and hospital waiting rooms. What was the purpose of this study? Previous research has suggested that using story-telling strategies to promote PA benefits may be especially effective. People with SCI tend to lean towards one of three different “narrative styles”, which refers to how they think physical activity impacts their lives: the “chaos narrative”, which views their SCI as preventing them from doing PA; the “restitution/cure narrative”, which seeks to restore their pre-SCI self through LTPA; the quest narrative, which views participating in LTPA as a means of enjoyment, socialization, and improving their health The purpose of the study was to develop and test a brief interactive e-learning program that shares PA information in a way that can be tailored towards an individual’s preferred narrative style. The title of the e-learning program is e-STORIES (Exercise Strategies Through Optimized Relevant Interactive E-learning Storytelling). How was this study conducted? The study was conducted in four phases: In the first phase, the researchers created a storyboard outlining the flow of the program. This included designing the slides and determining the flow of the program based on how a user (e.g. people with SCI) would respond to survey questions. The second phase consisted of a national web-survey that aimed to gather information that would help refine the e-learning program. The information from the surveys included people’s current level of PA and the narrative style they identified with. The third phase was a panel review of the e-learning program by four experts: an exercise physiologist, a rehabilitation scientist, an information specialist, and a clinician. Each expert gave a summary of their suggested revisions, which were taken into consideration when the program underwent subsequent revisions. In the final phase, the program was tested by twelve people with SCI. The program’s usability was based on four different criteria: effectiveness, efficiency, usefulness, and satisfaction. Face-to-face interviews were conducted to inform the latter two criteria. What are the findings of the usability study? From the usability testing data, the researchers found that there were a few minor issues with program operation, including technical issues relating to the user interface. Consequently, the participants had slightly more trouble with the slides than was expected. However, the participants were still able to complete the program in a timely manner, on average. The general sentiment from participants was that the program made them think about PA in a more positive way, which was associated with motivation for goal setting and setting aside time for physical exercise. Interestingly, the study found no significant differences in the participants’ initial attitudes towards PA between the three narrative styles. What do these findings mean for future e-learning program development, and the SCI community? This study involved creating an evaluating a brief e-learning program aimed at increasing physical exercise in people with SCI. had high perceived usability and great potential for improving self-efficacy and self-regulatory skills. Furthermore, the program can be implemented effectively and can be completed in a timely manner, both of which are important in clinical settings that are time-sensitive. Short duration programs such as the e-STORIES program are useful and could serve as alternatives to long term exercise programs/interventions, which can be costly and inflexible. Further research is needed to test the e-learning program’s feasibility in real-life settings, where more variables may be at play in determining the program’s practicality and effectiveness. Definitions of article-specific terms: Effectiveness vs. Efficiency Effectiveness: a measure of the program’s ease of use. This was calculated as the number of slides a user had problems with divided by the number of slides without any problems. The benchmark for acceptable effectiveness was set at 90%. Efficiency: the time required to complete the program. The benchmark of acceptable efficiency was set to 30 minutes. Self-efficacy: a personal judgment of how well one is able to perform a behaviour. Self-regulation: the ability to adjust one’s thoughts, emotions, and behaviours to meet goals or to fit a certain situation. Social Cognitive Theory: the psychological theory that people’s behaviours are influenced by their own experiences, the behaviours of others, and the environment. Storyboard: a sequence of graphical images used to visualize the flow of the e-learning program.
Individualized training for powered wheelchairs results in greater satisfaction with prior set goals
The purpose of this study was to determine whether a powered wheelchair user’s ‘goal satisfaction’ improved after five sessions of individualized wheelchair skills training. The researchers also wanted to determine whether or not these changes in satisfaction were maintained 3 months after the training ended. Continue reading →
Lay Summary by Eric Hui Edited by Ana-Maria Oproescu This is a summary of a research study conducted with ICORD researchers Dr. Bonita Sawatzky, Dr. William Miller, and colleagues. Click here to access the original paper. What was the purpose of this study? The purpose of this study was to determine whether a powered wheelchair user’s ‘goal satisfaction’ improved after five sessions of individualized wheelchair skills training. The researchers also wanted to determine whether or not these changes in satisfaction were maintained 3 months after the training ended. What is ‘goal satisfaction’, and why are improvements in goal satisfaction important? Participants rated their satisfaction with each of their goals regarding mobility-related powered wheelchair skills, and this measure was termed ‘goal satisfaction’. The researchers decided that measuring changes in satisfaction with goals set prior to the training program would be most representative of increased capability and confidence in performing activities of daily living. Changes in satisfaction with goals were most representative of improvements in using powered wheelchairs because the goals could correspond with specific mobility-related skills, or the integration of skills into everyday life. Therefore, improvements in goal satisfaction are important because they reflect improvements in using powered wheelchairs. How was this research conducted? 17 powered wheelchair users were randomly assigned to different training interventions, which consisted of five 30-minute individualized Wheelchair Skills Training Program sessions. To measure the effect of the training interventions on goal satisfaction, participants were asked to self-report their satisfaction with each of their goals prior to the training, immediately after training, and 3 months after training. What did the researchers find? On a scale from 0 to 10 (with higher numbers corresponding to greater participant goal satisfaction), the participant’s mean score was 4.7 prior to training. The participant’s mean score rose to 8.0 immediately after training, and 8.3 three months after training. The difference in the mean satisfaction scores obtained “before training” and “immediately after training” was found to be statistically significant, which means that the improvement in goal satisfaction was most likely due to the training program, not due to chance. However, the difference in the mean satisfaction scores obtained “immediately after training” and “three months after training” were found to be not statistically significant, indicating that the difference might have been due to chance. Overall, the training intervention significantly increased participant goal satisfaction scores, and the increase lasted for at least 3 months after the training ended. Why are these findings important? Improvements in goal satisfaction can reflect improvements in mobility-related skills (such as manoeuvring or backing up) and the integration of skills. Improvements in mobility-related skills and the integration of skills could lead to increased activity and participation resulting in a higher quality of everyday life. Since individualized training was found to improve goal satisfaction (and improve the use of powered wheelchairs), powered wheelchair users can now assess whether individualized training would be beneficial to them or not.
How different variables affect wheelchair tipping probability
The tipping or falling of wheelchairs can cause an individual to sustain serious injuries, such as traumatic brain injuries, concussions, and bone fractures. The probability of wheelchair tipping can be heightened or reduced by a variety of factors and it is important that we understand these factors in order to increase wheelchair stability. Continue reading →
Summary by Grace Hu Edited by Ana-Maria Oproescu This is a summary of a research study that was conducted by ICORD researchers Dr. Jaimie Borisoff, Dr. Carolyn Sparrey, and colleague Dr. Thomas. Click here to access the link to the original study. Why is it important to study wheelchair tip probability? The tipping or falling of wheelchairs can cause an individual to sustain serious injuries, such as traumatic brain injuries, concussions, and bone fractures. The probability of wheelchair tipping can be heightened or reduced by a variety of factors and it is important that we understand these factors in order to increase wheelchair stability. What was the purpose of the study? The purpose of the study was to determine how adjusting different user variables and conditions affects the tip probability of a manual wheelchair during movement (ie. the ‘dynamic tip probability‘). The researchers examined the effects of seat angles, wheelchair speed, user position, user mass, and bump heights. How was this study conducted? The stability of a moving wheelchair was initially tested by using simulations on MADYMO software. The researchers then validated the simulation results by placing test dummies in a wheelchair and rolling them down a slope towards a small block. Each time the wheelchair was rolled down, different variables were adjusted to test the likelihood of the wheelchair tipping. The seat angles were set to values 0-20° below the horizontal, the wheelchair speeds were set to 0-20 km/ hour, the masses of the test dummies varied between 50-115 kg, and the dummy positions varied from 0-10 cm from where the backrest meets the wheelchair. In addition, different bump heights were added along the wheelchair path, varying from 0-4 cm in height. Statistical analysis revealed the effects of these variables on wheelchair tip probability. Different types of tipping included: backward tip, forward tip, rolling over a bump, and stopping due to a bump. What are the effects of different variables on dynamic tip probability? Wheelchair Speed: Increasing speed → Increases probability of wheelchair tipping forwards and backwards Increases probability of wheelchair rolling over bumps instead of stopping due to them Bump Height: Increasing bump height above 1.5 cm → Increases tip probability Seat Angle: Increasing the angle below horizontal → Increases chance of wheelchair’s continued movement over bumps instead of stopping Decreases forward tipping Increases backwards tipping Backrest Angle: Reclining → Has the greatest effect in decreasing forwards tipping The researchers found that increasing the wheelchair speed increased the probability of the wheelchair tipping forwards and backwards, as well as rolling over bumps instead of stopping due to them. In general, the wheelchairs rolled over bumps less than 1.5 cm in height and the tipping probability increased with greater bump height. Lowering the seat to greater angles below the horizontal also increased the chance of the wheelchair continuing its movement over bumps instead of stopping. Lowering the seat height also decreased forwards tipping while increasing backwards tipping — but overall, reclining the backrest had the greatest effect in decreasing forwards tipping. What’s the significance of these findings? These results suggest that forward tipping, which is responsible for the greatest risk of injury, can be reduced by decreasing one’s wheelchair speed, decreasing the size of bumps, reclining the wheelchair backrest, and lowering the wheelchair seat height. However, these findings may not be applicable to all types of wheelchairs, so it is important to remember that adjustments of variables should be made according to each individual wheelchair.
Jessica Archibald I am in the first year of my PhD program in Experimental Medicine at the University of British Columbia (UBC). My supervisor, Dr. John Kramer, is a principal investigator with ICORD (International Collaboration On Repair Discoveries), a spinal Read More...
Jessica Archibald I am in the first year of my PhD program in Experimental Medicine at the University of British Columbia (UBC). My supervisor, Dr. John Kramer, is a principal investigator with ICORD (International Collaboration On Repair Discoveries), a spinal cord injury research centre of VCH Research Institute and UBC. <img loading="lazy" decoding="async" data-attachment-id="43152" data-permalink="https://icord.org/2019/03/the-neuroscience-of-pain/archibald-jessica_croppedheadshot/" data-orig-file="https://icord.org/wp-content/uploads/2019/03/Archibald-Jessica_croppedheadshot.jpg" data-orig-size="600,526" data-comments-opened="1" data-image-meta="{"aperture":"3.5","credit":"Martin Dee","camera":"NIKON D750","caption":"","created_timestamp":"1537532108","copyright":"martindeephotography.com","focal_length":"105","iso":"1000","shutter_speed":"0.004","title":"","orientation":"1"}" data-image-title="Archibald-Jessica_croppedheadshot" data-image-description=" headshot of Jessica Archibald " data-image-caption=" This is me! " data-large-file="https://icord.org/wp-content/uploads/2019/03/Archibald-Jessica_croppedheadshot.jpg" class="wp-image-43152 alignright" src="http://icord.org/wp-content/uploads/2019/03/Archibald-Jessica_croppedheadshot.jpg" alt="" width="210" height="184" srcset="https://icord.org/wp-content/uploads/2019/03/Archibald-Jessica_croppedheadshot.jpg 600w, https://icord.org/wp-content/uploads/2019/03/Archibald-Jessica_croppedheadshot-300x263.jpg 300w, https://icord.org/wp-content/uploads/2019/03/Archibald-Jessica_croppedheadshot-228x200.jpg 228w" sizes="(max-width: 210px) 100vw, 210px" />My research focuses on understanding how pain works. Pain is common in spinal cord injury patients, affecting about 70% of this population. In this special blog post, I will discuss my research plans and share what inspires me to change current pain management strategies. The search to conquer pain: a contribution to human health A ground-breaking discovery occurred in 1846, probably affecting every human being in the world: William T.G Morton used inhaled ether as a surgical anaesthetic. Pain during surgery was eliminated. Before this time, surgeons could offer little beyond opium and alcohol to help patients endure agonizing procedures. This remarkable milestone allowed many sub-disciplines of medicine to thrive. Today we are faced with a different challenge with regards to pain. Pain can persist after a surgery or trauma, can develop as a result of a medical condition, or can occur spontaneously, with no evident cause. As a spinal cord injury patient states: My injury is C5/C6 (vertebrae in vertebral column), but my true disability is my pain. -Kramer Lab research participant Today 1 in 5 people world-wide suffer from ongoing pain. The national cost of pain in the US is as high as $635 billion a year, which exceeds the yearly costs for cancer ($243 billion), heart disease ($309 billion) and diabetes ($188 billion). While most pain therapies available today may conceal the pain, they don’t address its cause. The lack of successful pain-relief strategies is further highlighted by the current opioid crisis. <img loading="lazy" decoding="async" data-attachment-id="43217" data-permalink="https://icord.org/2019/03/the-neuroscience-of-pain/painsympoms-3/" data-orig-file="https://icord.org/wp-content/uploads/2019/03/Painsympoms-2.png" data-orig-size="686,277" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="Painsympoms" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2019/03/Painsympoms-2.png" class="alignright wp-image-43217" src="http://icord.org/wp-content/uploads/2019/03/Painsympoms-2.png" alt="" width="320" height="129" srcset="https://icord.org/wp-content/uploads/2019/03/Painsympoms-2.png 686w, https://icord.org/wp-content/uploads/2019/03/Painsympoms-2-300x121.png 300w, https://icord.org/wp-content/uploads/2019/03/Painsympoms-2-266x107.png 266w" sizes="(max-width: 320px) 100vw, 320px" />According to international human rights law, countries must provide adequate treatments and pain management strategies as part of their core obligation under the right to health. One of the main obstacles in seeking to achieve this goal lies in our lack of knowledge regarding the mechanism underlying pain. This is where my research comes in! My main objectives are to: Determine physiological indicators of pain. Examine novel interventions for pain. This will impact diagnosis, evaluation of risk, and create an opportunity to examine analgesic efficacy at an individual level. Can we measure pain? <img loading="lazy" decoding="async" aria-describedby="caption-attachment-43162" data-attachment-id="43162" data-permalink="https://icord.org/2019/03/the-neuroscience-of-pain/acc/" data-orig-file="https://icord.org/wp-content/uploads/2019/03/ACC.png" data-orig-size="323,288" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="ACC" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2019/03/ACC.png" class="wp-image-43162" src="http://icord.org/wp-content/uploads/2019/03/ACC.png" alt="" width="270" height="241" srcset="https://icord.org/wp-content/uploads/2019/03/ACC.png 323w, https://icord.org/wp-content/uploads/2019/03/ACC-300x267.png 300w, https://icord.org/wp-content/uploads/2019/03/ACC-224x200.png 224w" sizes="(max-width: 270px) 100vw, 270px" /> Figure 1- The anterior cingulate cortex is an area known to be active during pain perception and pain modulation. There are currently no approved biomarkers for clinical pain trials by the US Food and Drug Administration or the European Medicine agency. The definition of pain includes two aspects: a sensory response (i.e., detection of stimulus) and an emotional response (i.e., subjective interpretation). The latter is what clinicians depend on when patients verbally report the severity of their pain (on a 0-10 numeric rating scale). This measure, although valuable (as it ultimately describes how one feels and functions) only examines one side of the phenomenon. The subjective rating of pain leads to great variability in reports and creates confusion on how to treat patients who complain frequently, and raises the question if some patients are being under-treated. Normally pain enhances survival; it’s a way of communicating to the brain that there is danger, thereby initiating excitatory signals in the brain. On the other hand, cognitive processes (our ability to exert control over pain) can appraise the actual situation (i.e., dangerous or not). As pain cannot always be avoided (e.g., medical procedures, child birth etc.) the nervous system can initiate inhibitory signals in the brain (the so-called descending pain control system). But what happens if the nervous system transitions into an ‘over-protective’ state? For neuroscientists, pain presents a difficult problem, as it is a physiological process (just like your heart-rate) but it is innately subjective —only you can feel your own pain. Neuro-imaging techniques have enabled us to examine the brain’s response to experimental pain. Results have provided unique insights into the complex relationship between pain perception and brain anatomy, connectivity and biochemistry. The question now becomes: Can we identify neurophysiological patterns (or markers) that occur in response to pain? The details<img loading="lazy" decoding="async" data-attachment-id="43206" data-permalink="https://icord.org/2019/03/the-neuroscience-of-pain/glutgaba-2/" data-orig-file="https://icord.org/wp-content/uploads/2019/03/GlutGaba-1.png" data-orig-size="686,277" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="Glut&#038;Gaba" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2019/03/GlutGaba-1.png" class="alignright wp-image-43206" src="http://icord.org/wp-content/uploads/2019/03/GlutGaba-1.png" alt="" width="320" height="129" srcset="https://icord.org/wp-content/uploads/2019/03/GlutGaba-1.png 686w, https://icord.org/wp-content/uploads/2019/03/GlutGaba-1-300x121.png 300w, https://icord.org/wp-content/uploads/2019/03/GlutGaba-1-266x107.png 266w" sizes="(max-width: 320px) 100vw, 320px" /> Through magnetic resonance spectroscopy (MRS), a non-invasive technique that allows neurochemical quantification in the brain, excitatory (i.e., glutamate) and inhibitory (i.e., γ-aminobutyric acid [GABA]) chemicals can be measured during pain perception and pain processing. The preliminary results from my research (objective 1) illustrate a significant association between an excitatory neurotransmitter (glutamate) and increases in pain in an individual, in a pain-processing brain area (anterior cingulate cortex). This association could mean chemical neurotransmitter concentrations could be used as indicators of perceived pain intensity. <img loading="lazy" decoding="async" aria-describedby="caption-attachment-43212" data-attachment-id="43212" data-permalink="https://icord.org/2019/03/the-neuroscience-of-pain/msc_ts-2/" data-orig-file="https://icord.org/wp-content/uploads/2019/03/MSc_TS-1.png" data-orig-size="831,392" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="MSc_TS" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2019/03/MSc_TS-1.png" class="wp-image-43212" src="http://icord.org/wp-content/uploads/2019/03/MSc_TS-1.png" alt="" width="700" height="330" srcset="https://icord.org/wp-content/uploads/2019/03/MSc_TS-1.png 831w, https://icord.org/wp-content/uploads/2019/03/MSc_TS-1-300x142.png 300w, https://icord.org/wp-content/uploads/2019/03/MSc_TS-1-768x362.png 768w, https://icord.org/wp-content/uploads/2019/03/MSc_TS-1-266x125.png 266w" sizes="(max-width: 700px) 100vw, 700px" /> Figure 2- Glutamate concentrations (millimolars) in the anterior cingulate cortex are associated with pain ratings (0-10 numeric rating scale). This relationship is seen throughout an in-scanner pain experiment, during the application of painful heat and minutes after. <img loading="lazy" decoding="async" data-attachment-id="43179" data-permalink="https://icord.org/2019/03/the-neuroscience-of-pain/jessica-laser/" data-orig-file="https://icord.org/wp-content/uploads/2019/03/Jessica-laser.jpg" data-orig-size="3361,3024" data-comments-opened="1" data-image-meta="{"aperture":"2.4","credit":"","camera":"iPhone XS","caption":"","created_timestamp":"1553786551","copyright":"","focal_length":"6","iso":"400","shutter_speed":"0.025","title":"","orientation":"1"}" data-image-title="Jessica-laser" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2019/03/Jessica-laser-1024x921.jpg" class="alignleft wp-image-43179" src="http://icord.org/wp-content/uploads/2019/03/Jessica-laser-1024x921.jpg" alt="" width="300" height="270" srcset="https://icord.org/wp-content/uploads/2019/03/Jessica-laser-1024x921.jpg 1024w, https://icord.org/wp-content/uploads/2019/03/Jessica-laser-300x270.jpg 300w, https://icord.org/wp-content/uploads/2019/03/Jessica-laser-768x691.jpg 768w, https://icord.org/wp-content/uploads/2019/03/Jessica-laser-222x200.jpg 222w" sizes="(max-width: 300px) 100vw, 300px" />My research aims to examine the brain’s response after and/or during different pain-management strategies (e.g., cognitive training, placebo-effect), via different analytic techniques (objective 2). Although neural activation induced by unpleasant stimulation might not be specific to pain (as it may occur during different types of sensory stimulation), it can still provide relevant information in a controlled setting. These techniques could be used to evaluate the pain relief efficacy of a particular therapy. In this way, my research has a dual purpose of further understanding the mechanism of pain modulation, as well as explaining why there is pain relief when we perform an intervention. Put simply, the brain’s responses help us see if and how a certain therapy is working. Consider the placebo response, in which patients in agonizing pain can report pain relief after taking what they believe to be a painkiller, when in reality they have consumed a sugar pill. We know the perception of pain is changing, but what happens neurophysiologically? <img loading="lazy" decoding="async" data-attachment-id="43208" data-permalink="https://icord.org/2019/03/the-neuroscience-of-pain/meditation-4/" data-orig-file="https://icord.org/wp-content/uploads/2019/03/Meditation-2.png" data-orig-size="686,277" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="Meditation" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2019/03/Meditation-2.png" class="alignright wp-image-43208" src="http://icord.org/wp-content/uploads/2019/03/Meditation-2.png" alt="" width="320" height="129" srcset="https://icord.org/wp-content/uploads/2019/03/Meditation-2.png 686w, https://icord.org/wp-content/uploads/2019/03/Meditation-2-300x121.png 300w, https://icord.org/wp-content/uploads/2019/03/Meditation-2-266x107.png 266w" sizes="(max-width: 320px) 100vw, 320px" />Let’s now take meditation, a non-pharmacological intervention, that might result in better pain management outcomes for some patients. Research has shown that different areas of the brain change when pain is modulated cognitively versus modulating the actual intensity of the stimulation. My plan is to thoroughly assess these approaches to determine their neurophysiological effect and analgesic efficacy at an individual level. This would be a step towards personalized medicine. The results of my study could lead to avoidance of over-prescription, reduction in health-care costs, and fulfillment of human rights goals. <img loading="lazy" decoding="async" aria-describedby="caption-attachment-43211" data-attachment-id="43211" data-permalink="https://icord.org/2019/03/the-neuroscience-of-pain/summaryimage_/" data-orig-file="https://icord.org/wp-content/uploads/2019/03/SummaryImage_.png" data-orig-size="1399,792" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="SummaryImage_" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2019/03/SummaryImage_-1024x580.png" class="wp-image-43211" src="http://icord.org/wp-content/uploads/2019/03/SummaryImage_.png" alt="" width="700" height="396" srcset="https://icord.org/wp-content/uploads/2019/03/SummaryImage_.png 1399w, https://icord.org/wp-content/uploads/2019/03/SummaryImage_-300x170.png 300w, https://icord.org/wp-content/uploads/2019/03/SummaryImage_-768x435.png 768w, https://icord.org/wp-content/uploads/2019/03/SummaryImage_-1024x580.png 1024w, https://icord.org/wp-content/uploads/2019/03/SummaryImage_-266x151.png 266w" sizes="(max-width: 700px) 100vw, 700px" /> Figure 3- Can we measure neurochemical changes after pain-relief interventions? The potential for drug-free analgesia is worth exploring. Pain can be debilitating, preventing people from doing regular activities, and the addiction/adverse effects of current first line of treatment medications don’t necessarily improve quality of life. I believe reducing painkiller misuse around the world requires unified efforts from researchers and health-care professionals to educate ourselves, to understand how pain works, and how we can manage it. Such discoveries will affect the millions of people affected by ongoing pain today, as well as their families and caregivers. I want to change the perception of pain— one individual at a time. When talking with pain patients, a common theme arises: after numerous treatments fail, they are often told “it’s all in your head.” The consequences of this suggestion can be devastating for patients. My goal is to be a part of this shift in paradigm: the brain is what may help patients conquer their pain. We are only beginning to understand the complexity of the brain, and how it can be retrained. I am taking this leap because of the benefits it will have to humankind. If we want to treat pain, we need to invest in the brain. How I plan to achieve my goals Globally, more woman are pursuing science in higher education, although the gender gap expands at the PhD level and peaks at a researcher level. This means that woman are less likely than men to be in senior positions and achieve tenure. The research group I work with is predominantly female, and I am appreciative of working in a stimulating and encouraging environment. However, globally, women only represent 28% of the world’s scientists employed in research and development (2014). Through scholarships, I will have the support and guidance to carry out my research, develop myself as a future leader, and continue the movement of empowering females around the world. My ideal mentor will be someone I can turn to for advice, information, and guidance, and who can help me further build my network. I hope to develop a relationship with a well-established professional, from whom I can learn ways to improve the dissemination of research findings, knowledge translation, and data visualization skills. I’m hoping a mentor can help me strategize and secure funding to continue my research and strengthen my leadership skills. In turn, as a potential protégé I commit to taking a proactive role in learning, and having the willingness to be directed and advised. I hope I can also provide my mentor with my own insights and offer her a fresh perspective.