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Older Publications

Below is a list of some of our publications. Newer, more recently published research can be found on our Published Research page.

The relationship between the implementation and effectiveness of a nationwide physical activity telephone counseling service for adults with spinal cord injury.

Authors: Tomasone JR, Arbour-Nicitopoulos KP, Latimer-Cheung AE, Martin Ginis KA.
Published in: Disabil Rehabil. 2016 Dec 28:1-11. doi: 10.1080/09638288.2016.1261415. [Epub ahead of print]
About: This study identified intervention dose and content as key implementation variables for an leisure-time physical activity (LTPA) telephone counseling service for adults with SCI. Implications for Rehabilitation An evidence- and theory-based telephone counseling service can effectively sustain LTPA intentions and increase LTPA behavior among adults with SCI. The first two months of the service are a critical period for enhancing LTPA participation and for minimizing dropouts. The provision of both informational and behavioral strategies is important for increasing aerobic LTPA levels among adults with SCI.

Challenging cardiac function post-spinal cord injury with dobutamine

Authors: DeVeau KM, Martin EK, King NT, Shum-Siu A, Keller BB, West CR, Magnuson DS.
Published in: Auton Neurosci. 2016 Dec 23. pii: S1566-0702(16)30286-7. doi: 10.1016/j.autneu.2016.12.005. [Epub ahead of print]
About: There is general consensus that spinal cord injuries (SCI) above T6 result in altered sympathetic control of the heart, which negatively influences cardiac structure and function. To by-pass disrupted circuitry and investigate cardiac responses under enhanced sympathetic activity we utilized dobutamine (DOB) stress echocardiography. Animals were divided into a T2, 25g-cm contusive SCI (SCI) or an uninjured control (CON) group. Echocardiography was performed pre-SCI and at 1, 2 and 6 weeks post-SCI. Increasing doses of DOB (5, 10 & 20μg/min/kg) were infused intravenously pre-SCI and at 1 and 6weeks post-SCI. Parasternal-short axis images were used to compare group differences in systolic function and track changes in response to SCI and DOB over time. One week post-SCI, stroke volume (SV), end diastolic volume (EDV), cardiac output (CO) and ejection fraction (EF) were all reduced compared to CON and these deficits persisted to 6weeks. We also found an increase in collagen deposition at 6weeks post SCI. Pre-SCI, DOB elicited a decrease in EDV and increases in CO, EF and HR but not SV. At 6weeks following SCI, in addition to increases in CO, EF and HR, DOB also induced increases in SV. This is the first report, to our knowledge, of DOB responses in a contusive SCI model with persistent cardiac impairments. The return of CO to pre-SCI levels and the substantial increase in SV at low DOB dosages shows that impaired descending control of the heart is directly contributing to reduced resting SV after SCI.

Response to letter by Drs. Alexander and Courtois in J Neurotrauma October 31 2016

Authors: Davidson RA, Elliott SLKrassioukov AV.
Published in: J Neurotrauma. 2016 Dec 21. doi: 10.1089/neu.2016.4907. [Epub ahead of print]
About: My co-authors and I would like to respond to a letter by Drs. Alexander and Courtois recently published in the October 31, 2016 issue of J Neurotrauma commenting on our May 2016 review entitled: Cardiovascular Responses to Sexual Activity in Able-Bodied Individuals and Those Living with Spinal Cord Injury (Davidson R, Elliott S, Krassioukov A).

Intelligent power wheelchair use in long-term care: potential users’ experiences and perceptions

Authors: Rushton PW, Mortenson WB, Viswanathan P, Wang RH, Miller WC, Hurd Clarke L; CanWheel Research Team.
Published in: Disabil Rehabil Assist Technol. 2016 Dec 16:1-7. [Epub ahead of print]
About: Findings from this study confirm the need for and potential benefits of intelligent power wheelchair use in long-term care. Future studies will involve testing IPW improvements based on feedback and insights from this study. Implications for rehabilitation Intelligent power wheelchairs may enhance participation and improve safety and feelings of well-being for long-term care residents with cognitive impairments. Intelligent power wheelchairs could potentially have an equally positive impact on facility staff, other residents, and family and friends by decreasing workload and increasing safety.

Parallel Metabolomic Profiling of Cerebrospinal Fluid and Serum for Identifying Biomarkers of Injury Severity after Acute Human Spinal Cord Injury

Authors: Wu Y, Streijger F, Wang Y, Lin G, Christie S, Mac-Thiong JM, Parent S, Bailey CS, Paquette S, Boyd MC, Ailon T, Street J, Fisher CG, Dvorak MFKwon BK, Li L.
Published in: Sci Rep. 2016 Dec 14;6:38718. doi: 10.1038/srep38718.
About: Suffering an acute spinal cord injury (SCI) can result in catastrophic physical and emotional loss. Efforts to translate novel therapies in acute clinical trials are impeded by the SCI community’s singular dependence upon functional outcome measures. Therefore, a compelling rationale exists to establish neurochemical biomarkers for the objective classification of injury severity. In this study, CSF and serum samples were obtained at 3 time points (~24, 48, and 72 hours post-injury) from 30 acute SCI patients (10 AIS A, 12 AIS B, and 8 AIS C). A differential chemical isotope labeling liquid chromatography mass spectrometry (CIL LC-MS) with a universal metabolome standard (UMS) was applied to the metabolomic profiling of these samples. This method provided enhanced detection of the amine- and phenol-containing submetabolome. Metabolic pathway analysis revealed dysregulations in arginine-proline metabolism following SCI. Six CSF metabolites were identified as potential biomarkers of baseline injury severity, and good classification performance (AUC > 0.869) was achieved by using combinations of these metabolites in pair-wise comparisons of AIS A, B and C patients. Using the UMS strategy, the current data set can be expanded to a larger cohort for biomarker validation, as well as discovering biomarkers for predicting neurologic outcome.

The influence of race length on arterial compliance following an ultra-endurance marathon

Authors: Bonsignore A, Bredin SS, Wollmann H, Morrison B, Jeklin A, Buschmann L, Robertson J, Buckler EJ, McGuinty D, Rice MS, Warburton DE.
Published in: Eur J Sport Sci. 2016 Dec 7:1-6. [Epub ahead of print]
About: There is inconclusive evidence concerning the effects of routine participation in ultra-endurance events on cardiovascular disease (CVD) risk. Arterial compliance is a reliable, non-invasive, and effective tool for evaluating CVD risk. The purpose of this research was to examine if race length influences acute changes in arterial compliance following an ultra-marathon event. A total of 46 ultra-marathon runners were recruited including 21 participants (39.8 ± 8.3 years, 6 females) in the 80-km event and 25 participants (43.7 ± 9.8 years, 3 female) in the 195-km event. Arterial compliance was measured via radial applanation tonometry (CR-2000, HDI) for diastolic pulse contour analysis before and following the race. Significant between-group differences were found for changes in large arterial compliance with a decrease (increase in stiffness) following the 195-km event and an increase following the 80-kilometre event (p < .05). Longer race lengths are associated with greater reductions in large arterial compliance following recreational ultra-marathon running. Assessment of arterial compliance might be a useful prognostic tool to assess the long-term risk of CVD among ultra-marathon runners.

Neuroprotection and secondary damage following spinal cord injury: concepts and methods.

Authors: Hilton BJ, Moulson AJ, Tetzlaff W.
Published in: Neurosci Lett. 2016 Dec 6. pii: S0304-3940(16)30939-9. doi: 10.1016/j.neulet.2016.12.004. [Epub ahead of print]
About: There is inconclusive evidence concerning the effects of routine participation in ultra-endurance events on cardiovascular disease (CVD) risk. Arterial compliance is a reliable, non-invasive, and effective tool for evaluating CVD risk. The purpose of this research was to examine if race length influences acute changes in arterial compliance following an ultra-marathon event. A total of 46 ultra-marathon runners were recruited including 21 participants (39.8 ± 8.3 years, 6 females) in the 80-km event and 25 participants (43.7 ± 9.8 years, 3 female) in the 195-km event. Arterial compliance was measured via radial applanation tonometry (CR-2000, HDI) for diastolic pulse contour analysis before and following the race. Significant between-group differences were found for changes in large arterial compliance with a decrease (increase in stiffness) following the 195-km event and an increase following the 80-kilometre event (p < .05). Longer race lengths are associated with greater reductions in large arterial compliance following recreational ultra-marathon running. Assessment of arterial compliance might be a useful prognostic tool to assess the long-term risk of CVD among ultra-marathon runners.

An evaluation of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury: input from the international community

Authors: Round AM, Park SE, Walden K, Noonan VK, Townson AF, Krassioukov AV.
Published in: Spinal Cord. 2016 Nov 29. doi: 10.1038/sc.2016.152. [Epub ahead of print]
About: The objective of this study is to describe a series of workshops held at international meetings to inform the spinal cord injury (SCI) community about the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) and to obtain feedback on both the workshop and the ISAFSCI assessment.

Clinicians’ perspective of the current diagnostic criteria for myofascial pain syndrome

Authors: Grosman-Rimon L, Clarke H, Mills PB., Chan AK, Kumbhare D.
Published inJ Back Musculoskelet Rehabil. 2016 Nov 11. [Epub ahead of print]
About: Myofascial pain syndrome (MPS) is one of the most common chronic musculoskeletal pain disorders. However, MPS is often under-diagnosed. The purpose of this study was to characterize practicing clinicians’ perspectives of the current diagnostic criteria for MPS.

Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation

Authors: Zbogar D, Eng JJMiller WCKrassioukov AV, Verrier MC.
Published inJ Neuroeng Rehabil. 2016 Nov 15;13(1):99.
About: Little information exists on the content of inpatient rehabilitation stay when individuals with spinal cord injury (SCI) are not engaged in structured rehabilitation therapy sessions. Investigation of inpatient therapy content is incomplete without the context of activities outside of this time. We sought to quantify physical activity occurring outside of physical therapy (PT) and occupational therapy (OT) sessions during inpatient SCI rehabilitation and examine how this activity changes over time from admission to discharge.

Data logger technologies for manual wheelchairs: A scoping review

Authors: Routhier F, Lettre J, Miller WC, Borisoff JF, Keetch K, Mitchell IM, CanWheel Research Team.
Published inAssist Technol. 2016 Nov 15. [Epub ahead of print].
About: In recent years, studies have increasingly employed data logger technologies to record objective driving and physiological characteristics of manual wheelchair users. However, the technologies used offer significant differences in characteristics such as measured outcomes, ease of use and level of burden. In order to identify and describe the extent of published research activity that relies on data logger technologies for manual wheelchair users, we performed a scoping review of the scientific and grey literature. Five databases were searched: Medline, Compendex, CINAHL, EMBASE and Google Scholar. The 119 retained papers document a wide variety of logging devices and sensing technologies measuring a range of outcomes. The most commonly used technologies were accelerometers installed on the user (18.8%), odometers installed on the wheelchair (12.4%), accelerometers installed on the wheelchair (9.7%) and heart monitors (9.7%). Not surprisingly, the most reported outcomes were distance, mobility events, heart rate, speed/velocity, acceleration and driving time. With decreasing costs and technological improvements, data loggers are likely to have future widespread clinical (and even personal) use. Future research may be needed to assess the usefulness of different outcomes and to develop methods more appropriate to wheelchair users, in order to optimize the practicality of wheelchair data loggers.

Scoping review of mobility scooter-related research studies

AuthorsMortenson WB, Kim J.
Published in: J Rehabil Res Dev. 2016;53(5):531-540. doi: 10.1682/JRRD.2015.05.0084.
About: Mobility scooters are three- or four-wheeled power mobility devices regularly used by people who have difficulty ambulating. They also differ from power wheelchairs in terms of their driving controls, programmability, seating, and mounting method. Given their growing popularity and anecdotal concerns around their use, a scoping review was undertaken to identify empirical research about mobility scooters and to analyze their study design and purpose. Data sources included MedLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsychINFO. Thirty-two studies met the inclusion criteria. Most studies were descriptive in nature and reported information about scooter users’ demographics, scooter-related activities, and accidents. The most common study design was a pre- and postintervention followed by a cross-sectional survey and retrospective review. Despite the increasing use of mobility scooters, surprisingly little scooter-related research has been conducted. Given the nature of most of the research in this area, further empirical evidence is needed to develop a better understanding about the frequency and causes of scooter accidents and the efficacy of interventions to improve users’ skills, mobility, and safety.

Long-Term Plasticity in Reflex Excitability Induced by Five Weeks of Arm and Leg Cycling Training after Stroke

Authors: Klarner T, Barss TS, Sun Y, Kaupp C, Loadman PM, Zehr EP.
Published inBrain Sci. 2016 Nov 3;6(4). pii: E54.
About: Neural connections remain partially viable after stroke, and access to these residual connections provides a substrate for training-induced plasticity. The objective of this project was to test if reflex excitability could be modified with arm and leg (A &amp; L) cycling training. Nineteen individuals with chronic stroke (more than six months postlesion) performed 30 min of A &amp; L cycling training three times a week for five weeks. Changes in reflex excitability were inferred from modulation of cutaneous and stretch reflexes. A multiple baseline (three pretests) within-subject control design was used. Plasticity in reflex excitability was determined as an increase in the conditioning effect of arm cycling on soleus stretch reflex amplitude on the more affected side, by the index of modulation, and by the modulation ratio between sides for cutaneous reflexes. In general, A &amp; L cycling training induces plasticity and modifies reflex excitability after stroke.

Increased Central Arterial Stiffness after Spinal Cord Injury: Contributing Factors, Implications and Possible Interventions

Authors: Lee AH, Phillips AA, Krassioukov AV.
Published inJ Neurotrauma. 2016 Nov 8. [Epub ahead of print]
About: Individuals with spinal cord injury (SCI) experience life-threatening cardiovascular events and various autonomic consequences in addition to the well-appreciated motor and neurological impairments. As a result, cardiovascular disease is a major cause of death after SCI, corresponding to a 2-4 fold increased risk of cardiovascular events. A combination of neuroanatomical changes, unstable blood pressure, and rapid deconditioning as a result of decreased physical activity likely contributes to accelerated cardiovascular disease progression in after SCI. Aortic pulse wave velocity (aPWV) is considered the gold-standard technique for evaluating central arterial stiffness, which itself is a correlate for greater cardiovascular disease risk in healthy individuals and a plethora of clinical conditions. In this review we discuss central arterial stiffness after SCI, and demonstrate it is consistently elevated in this population 2-3 m/s, which corresponds to a 30-45% increased risk of cardiovascular mortality and an approximately 40 year acceleration of age-related cardiovascular decline. We also discuss the potential factors contributing to increased central arterial stiffness are reviewed in light of the available literature, including autonomic disruptions, blood pressure instability, metabolic changes and physical inactivity. Furthermore, measurement techniques, risk factors, cardiac dysfunction, and differences in arterial stiffness from able-bodied populations are discussed. Finally, potential therapeutic interventions for preventing or improving central arterial stiffening are also explored including dietary, physical activity and pharmacological strategies.

Autoregressive transitional ordinal model to test for treatment effect in neurological trials with complex endpoints

Authors: Tanadini LG, Steeves JD, Curt A, Hothorn T.
Published in: BMC Med Res Methodol. 2016 Nov 8;16(1):149.
About: A number of potential therapeutic approaches for neurological disorders have failed to provide convincing evidence of efficacy, prompting pharmaceutical and health companies to discontinue their involvement in drug development. Limitations in the statistical analysis of complex endpoints have very likely had a negative impact on the translational process.

Eye movement accuracy determines natural interception strategies

Authors: Fooken J, Yeo SH, Pai DK, Spering M.
Published inJ Vis. 2016 Nov 1;16(14):1. doi: 10.1167/16.14.1.
About: Eye movements aid visual perception and guide actions such as reaching or grasping. Most previous work on eye-hand coordination has focused on saccadic eye movements. Here we show that smooth pursuit eye movement accuracy strongly predicts both interception accuracy and the strategy used to intercept a moving object. We developed a naturalistic task in which participants (n = 42 varsity baseball players) intercepted a moving dot (a “2D fly ball”) with their index finger in a designated “hit zone.” Participants were instructed to track the ball with their eyes, but were only shown its initial launch (100-300 ms). Better smooth pursuit resulted in more accurate interceptions and determined the strategy used for interception, i.e., whether interception was early or late in the hit zone. Even though early and late interceptors showed equally accurate interceptions, they may have relied on distinct tactics: early interceptors used cognitive heuristics, whereas late interceptors’ performance was best predicted by pursuit accuracy. Late interception may be beneficial in real-world tasks as it provides more time for decision and adjustment. Supporting this view, baseball players who were more senior were more likely to be late interceptors. Our findings suggest that interception strategies are optimally adapted to the proficiency of the pursuit system.

Intraperitoneal injection of IDO-expressing dermal fibroblasts improves the allograft survival

Authors: Khosravi-Maharlooei M, Pakyari M, Jalili RB, Kilani RT, Ghahary A.
Published in: Clin Immunol. 2016 Oct 29;174:1-9. doi: 10.1016/j.clim.2016.10.012. [Epub ahead of print]
About: Indoleamine 2,3-dioxygenase (IDO) is an immunosuppressive enzyme with tolerogenic effects on different immune cells. Our group has previously shown that co-transplantation of IDO-expressing fibroblasts with donor tissues can delay immune rejection by inducing local immunosuppression. In this study, we have employed a systemic approach to improve allograft survival without using any immunosuppressive medication. To achieve this, 10 million lentiviral transduced IDO-expressing donor derived fibroblasts were injected into the peritoneal cavity of allograft recipients. We showed that IDO-fibroblast therapy increases the survival of both islets and skin allografts and decreases the infiltration of immune cells in subcutaneous transplanted skins. Indirect pathway of allo-reactive T cell activation was suppressed more than the direct pathway. Injected IDO-fibroblasts were found in peritoneal cavity and mesenteric lymph nodes of the recipient mice. In conclusion, IDO-expressing fibroblast therapy proved to be a novel approach in improving the allogeneic graft survival.

Targeted Messages Increase Dairy Consumption in Adults: a Randomized Controlled Trial

Authors: Jung ME, Latimer-Cheung AE, Bofurne JE, Martin Ginis KA.
Published inAnn Behav Med. 2016 Oct 28. [Epub ahead of print]
About: Dairy consumption amongst North Americans aged 30-50 has been declining. Targeted messages have been identified as a cost-efficient method through which to increase health-enhancing behavior, such as dairy intake. The aim of this study is to assess the utility of targeted, framed, efficacy-enhancing messages on calcium consumption from dairy in adults aged 30-50 in a randomized controlled trial.

Optimizing finite element predictions of local subchondral bone structural stiffness using neural network-derived density-modulus relationships for proximal tibial subchondral cortical and trabecular bone

Authors: Nazemi SM, Amini M, Kontulainen SA, Milner JS, Holdsworth DW, Masri BA, Wilson DR, Johnston JD.
Published inClin Biomech (Bristol, Avon). 2016 Oct 27;41:1-8. doi: 10.1016/j.clinbiomech.2016.10.012. [Epub ahead of print].
About: Quantitative computed tomography based subject-specific finite element modeling has potential to clarify the role of subchondral bone alterations in knee osteoarthritis initiation, progression, and pain. However, it is unclear what density-modulus equation(s) should be applied with subchondral cortical and subchondral trabecular bone when constructing finite element models of the tibia. Using a novel approach applying neural networks, optimization, and back-calculation against in situ experimental testing results, the objective of this study was to identify subchondral-specific equations that optimized finite element predictions of local structural stiffness at the proximal tibial subchondral surface.

Engineering personalized neural tissue using functionalized transcription factors

AuthorsWillerth SM.
Published in: Neural Regen Res. 2016 Oct;11(10):1570-1571.
About: Diseases and disorders of the central nervous system often require significant interventions to restore lost function due to their complexity. Cell therapy offers great promise for treating diseases and disorders of the central nervous system.

A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities

Authors: Martin Ginis KA, Ma JK, Latimer-Cheung AE, Rimmer JH.
Published inHealth Psychol Rev. 2016 Dec;10(4):478-494. Epub 2016 Jun 29.
About: Dozens of published papers cite factors related to leisure-time physical activity (LTPA) participation among people with physical disabilities. Unfortunately, there has been little effort to synthesise this literature in a manner that is accessible and useful to the sectors (e.g., health care, recreation) responsible for LTPA promotion in disability populations. In this systematic review, over 200 factors were extracted from 22 review articles addressing barriers and facilitators to LTPA in children and adults with physical disabilities. Factors were grouped according to common themes, classified into five levels of a social ecological model, and coded according to whether they could be affected by the health-care and/or recreation sectors. Findings are discussed with regard to key factors to target in LTPA-enhancing interventions, relevant theories and models in which to frame interventions, the levels at which the interventions can be implemented, and intervention priorities. The synthesis provides a blueprint and a catalyst for researchers and practitioners to shift focus from conducting studies that merely describe LTPA barriers and facilitators, to developing and delivering strategies to increase LTPA among persons with physical disabilities.

High- and low-intensity exercise do not improve cognitive function after stroke: A randomized controlled trial

Authors: Tang A, Eng JJ, Krassioukov AV, Tsang TS, Liu-Ambrose T.
Published inJ Rehabil Med. 2016 Nov 11;48(10):841-846. doi: 10.2340/16501977-2163.
About: The objective of this study is to determine the effects of high versus low-intensity exercise on cognitive function following stroke.

The Development of a Universally Accepted Sacral Fracture Classification: A Survey of AOSpine and AOTrauma Members

Authors: Schroeder GD, Kurd MF1, Kepler CK, Krieg JC, Wilson JR, Kleweno CP, Firoozabadi R, Bellabarba C, Kandizoria F, Schnake KJ, Rajesekaran S, Dvorak MF, Chapman JR, Vialle LR, Oner FC, Vaccaro AR.
Published in: Global Spine J. 2016 Nov;6(7):686-694. Epub 2016 Mar 17.
About: The objective of this study is to determine the global perspective on controversial aspects of sacral fracture classifications.

The prevalence and effect of problematic spasticity following traumatic spinal cord injury

Authors: Holtz KA, Lipson R, Noonan VK, Kwon BK, Mills PB.
Published in: Arch Phys Med Rehabil. 2016 Oct 22. pii: S0003-9993(16)31162-5. doi: 10.1016/j.apmr.2016.09.124. [Epub ahead of print]
About: The objective of this study is to evaluate the prevalence and impact of spasticity following traumatic spinal cord injury (SCI).

MR-compatibility of a high-resolution small animal PET insert operating inside a 7 T MRI

Authors: Thiessen JD, Shams E, Stortz G, Schellenberg G, Bishop D, Khan MS, Kozlowski P, Retière F, Sossi V, Thompson CJ, Goertzen AL.
Published in: Phys Med Biol. 2016 Nov 21;61(22):7934-7956. Epub 2016 Oct 25.
About: A full-ring PET insert consisting of 16 PET detector modules was designed and constructed to fit within the 114 mm diameter gradient bore of a Bruker 7 T MRI. The individual detector modules contain two silicon photomultiplier (SiPM) arrays, dual-layer offset LYSO crystal arrays, and high-definition multimedia interface (HDMI) cables for both signal and power transmission. Several different RF shielding configurations were assessed prior to construction of a fully assembled PET insert using a combination of carbon fibre and copper foil for RF shielding. MR-compatibility measurements included field mapping of the static magnetic field (B 0) and the time-varying excitation field (B 1) as well as acquisitions with multiple pulse sequences: spin echo (SE), rapid imaging with refocused echoes (RARE), fast low angle shot (FLASH) gradient echo, and echo planar imaging (EPI). B 0 field maps revealed a small degradation in the mean homogeneity (+0.1 ppm) when the PET insert was installed and operating. No significant change was observed in the B 1 field maps or the image homogeneity of various MR images, with a 9% decrease in the signal-to-noise ratio (SNR) observed only in EPI images acquired with the PET insert installed and operating. PET detector flood histograms, photopeak amplitudes, and energy resolutions were unchanged in individual PET detector modules when acquired during MRI operation. There was a small baseline shift on the PET detector signals due to the switching amplifiers used to power MRI gradient pulses. This baseline shift was observable when measured with an oscilloscope and varied as a function of the gradient duty cycle, but had no noticeable effect on the performance of the PET detector modules. Compact front-end electronics and effective RF shielding led to minimal cross-interference between the PET and MRI systems. Both PET detector and MRI performance was excellent, whether operating as a standalone system or a hybrid PET/MRI.

Comparison of specimen-specific vertebral body finite element models with experimental digital image correlation measurements

Authors: Gustafson HM, Cripton PA, Ferguson SJ, Helgason B.
Published inJ Mech Behav Biomed Mater. 2016 Oct 7;65:801-807. doi: 10.1016/j.jmbbm.2016.10.002. [Epub ahead of print]
About: The purpose of this study was to load cadaveric vertebral bodies (n=6) in compression and compare the response, measured with digital image correlation (DIC) on the cortex, with the predicted response from specimen-specific vertebral finite element (FE) models. Five modulus-density relationships were evaluated, and for the strongest modulus-density relationship, the correlation between the DIC and FE displacements had R^2 values from 0.75 to 0.93. The stiffnesses derived from the DIC measurements were strongly predicted by the FE stiffnesses (R^2=0.90). DIC provides full-field measurements of surface displacement, eliminating the influence of system compliance, for validation of specimen-specific models.

Older Adults’ Online Dating Profiles and Successful Aging

Authors: Wada M, Mortenson WB, Hurd Clarke L.
Published in: Can J Aging. 2016 Oct 24:1-12. [Epub ahead of print]
About: This study examined how relevant Rowe and Kahn’s three criteria of successful aging were to older adults’ self-portrayals in online dating profiles: low probability of disease and disability, high functioning, and active life engagement. In this cross-sectional study, 320 online dating profiles of older adults were randomly selected and coded based on the criteria. Logistic regression analyses determined whether age, gender, and race/ethnicity predicted self-presentation. Few profiles were indicative of successful aging due to the low prevalence of the first two criteria; the third criterion, however, was identified in many profiles. Native Americans were significantly less likely than other ethnic groups to highlight the first two criteria. Younger age predicted presenting the first criterion. Women’s presentation of the third criterion remained significantly high with age. The findings suggest that the criteria may be unimportant to older adults when seeking partners, or they may reflect the exclusivity of this construct.

Morphology based anisotropic finite element models of the proximal femur validated with experimental data

Authors: Enns-Bray WS, Ariza O, Gilchrist S, Widmer Soyka RP, Vogt PJ, Palsson H, Boyd SK, Guy P, Cripton PA, Ferguson SJ, Helgason B.
Published inMed Eng Phys. 2016 Nov;38(11):1339-1347. doi: 10.1016/j.medengphy.2016.08.010. Epub 2016 Sep 15.
About: Finite element analysis (FEA) of bones scanned with Quantitative Computed Tomography (QCT) can improve early detection of osteoporosis. The accuracy of these models partially depends on the assigned material properties, but anisotropy of the trabecular bone cannot be fully captured due to insufficient resolution of QCT. The inclusion of anisotropy measured from high resolution peripheral QCT (HR-pQCT) could potentially improve QCT-based FEA of the femur, although no improvements have yet been demonstrated in previous experimental studies. This study analyzed the effects of adding anisotropy to clinical resolution femur models by constructing six sets of FE models (two isotropic and four anisotropic) for each specimen from a set of sixteen femurs that were experimentally tested in sideways fall loading with a strain gauge on the superior femoral neck. Two different modulus-density relationships were tested, both with and without anisotropy derived from mean intercept length analysis of HR-pQCT scans. Comparing iso- and anisotropic models to the experimental data resulted in nearly identical correlation and highly similar linear regressions for both whole bone stiffness and strain gauge measurements. Anisotropic models contained consistently greater principal compressive strains, approximately 14% in magnitude, in certain internal elements located in the femoral neck, greater trochanter, and femoral head. In summary, anisotropy had minimal impact on macroscopic measurements, but did alter internal strain behavior. This suggests that organ level QCT-based FE models measuring femoral stiffness have little to gain from the addition of anisotropy, but studies considering failure of internal structures should consider including anisotropy to their models.

Aerobic exercise and vascular cognitive impairment: A randomized controlled trial

Authors: Liu-Ambrose T, Best JR, Davis JC, Eng JJ, Lee PE, Jacova C, Boyd LA, Brasher PM, Munkacsy M, Cheung W, Hsiung GR.
Published inNeurology. 2016 Oct 19. pii: 10.1212/WNL.0000000000003332. [Epub ahead of print]
About: The objective of this study is to assess the efficacy of a progressive aerobic exercise training program on cognitive and everyday function among adults with mild subcortical ischemic vascular cognitive impairment (SIVCI).

The technical quality of online leisure time physical activity resources for people with physical disabilities

Authors: Shaw RB, Mallory KD, Arkell J, Martin Ginis KA.
Published in: Disabil Health J. 2016 Sep 13. pii: S1936-6574(16)30129-7. doi: 10.1016/j.dhjo.2016.09.002. [Epub ahead of print]
About: The internet is an important information source for people with disabilities. Unfortunately, little is known about the quality of online leisure time physical activity resources provided for people with physical disabilities. The objective of this study is to assess the quality of leisure time physical activity resources available online for people with physical disabilities.

Neuromechanical interactions between the limbs during human locomotion: an evolutionary perspective with translation to rehabilitation

Authors: Zehr EP, Barss TS, Dragert K, Frigon A, Vasudevan EV, Haridas C, Hundza S, Kaupp C, Klarner T, Klimstra M, Komiyama T, Loadman PM, Mezzarane RA, Nakajima T, Pearcey GE, Sun Y.
Published in: Exp Brain Res. 2016 Nov;234(11):3059-3081. Epub 2016 Jul 15.
About: During bipedal locomotor activities, humans use elements of quadrupedal neuronal limb control. Evolutionary constraints can help inform the historical ancestry for preservation of these core control elements support transfer of the huge body of quadrupedal non-human animal literature to human rehabilitation. In particular, this has translational applications for neurological rehabilitation after neurotrauma where interlimb coordination is lost or compromised. The present state of the field supports including arm activity in addition to leg activity as a component of gait retraining after neurotrauma.

The relationship between lower limb proprioceptive sense and locomotor skill acquisition

Authors: Qaiser T, Chisholm AE, Lam T.
Published in: Exp Brain Res. 2016 Nov;234(11):3185-3192. Epub 2016 Jul 5.
About: Sensorimotor integration is essential for controlling movement and acquiring new motor tasks in humans. The aim of this project was to understand how lower limb proprioceptive sense contributes to the acquisition of a skilled walking task. We assessed lower limb joint position and movement detection sense in healthy human subjects using the Lokomat robotic exoskeleton. Subjects walked on a treadmill to practice a skilled motor task (200 trials) requiring them to match their foot height during the swing phase to the height of a virtual obstacle displayed on a monitor in front of them. Subjects were given visual feedback on their error relative to the obstacle height after it was crossed. Lower limb joint position sense was related to the final performance error, but not the learning rate of the skilled walking task. The findings from this study support the role of lower limb proprioceptive sense on locomotor skill performance in healthy adult subjects.

Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation

Authors: Zbogar D, Eng JJ, Miller WC, Krassioukov AV, Verrier MC.
Published inSpinal Cord. 2016 Oct 18. doi: 10.1038/sc.2016.129. [Epub ahead of print]
About: The objective of this study is to quantify the amount of upper- and lower-extremity movement repetitions (that is, voluntary movements as part of a functional task or specific motion) occurring during inpatient spinal cord injury (SCI), physical (PT) and occupational therapy (OT), and examine changes over the inpatient rehabilitation stay.

Emergency management of autonomic dysreflexia with neurologic complications

Authors: Squair JW, Phillips AA, Harmon M, Krassioukov AV.
Published inCMAJ. 2016 Oct 18;188(15):1100-1103. Epub 2016 May 24.

Listening to music during sprint interval exercise: The impact on exercise attitudes and intentions

Authors: Stork MJ, Martin Ginis KA.
Published inJ Sports Sci. 2016 Oct 15:1-7. [Epub ahead of print]
About: This study investigated the impact of listening to music during exercise on perceived enjoyment, attitudes and intentions towards sprint interval training (SIT). Twenty men (24.8 ± 4.5 years) and women (20.1 ± 2.6 years) unfamiliar with SIT exercise completed two acute sessions of SIT, one with and one without music. Perceived enjoyment, attitudes and intentions towards SIT were measured post-exercise for each condition. Attitudes and intentions to engage in SIT were also measured at baseline and follow-up. Post-exercise attitudes mediated the effects of enjoyment on intentions in the music condition (95% confidence interval [CI]: [0.01, 0.07], κ^2 = 0.36) and in the no music condition (95% CI: [0.01, 0.08], κ^2 = 0.37). Attitudes towards SIT were significantly more positive following the music than no music condition (P = 0.004), while intentions towards SIT were not (P = 0.29). Further, attitudes and intentions towards SIT did not change from baseline to follow-up (Ps > 0.05). These findings revealed that participants had relatively positive attitudes and intentions towards SIT, which did not become more negative despite experiencing intense SIT protocols. This study highlights the importance of acute affective responses to SIT exercise for influencing one’s attitudes and intentions towards participating in SIT exercise. Such factors could ultimately play a key role in determining whether an individual engages in SIT exercise in the long term.

Biomaterial Strategies for Delivering Stem Cells as a Treatment for Spinal Cord Injury

Authors: Agbay A, Edgar JM, Robinson M, Styan T, Wilson K, Schroll J, Ko J, Khadem Mohtaram N, Jun MB, Willerth SM.
Published in: Cells Tissues Organs. 2016;202(1-2):42-51. Epub 2016 Oct 5.
About: Ongoing clinical trials are evaluating the use of stem cells as a way to treat traumatic spinal cord injury (SCI). However, the inhibitory environment present in the injured spinal cord makes it challenging to achieve the survival of these cells along with desired differentiation into the appropriate phenotypes necessary to regain function. Transplanting stem cells along with an instructive biomaterial scaffold can increase cell survival and improve differentiation efficiency. This study reviews the literature discussing different types of instructive biomaterial scaffolds developed for transplanting stem cells into the injured spinal cord. We have chosen to focus specifically on biomaterial scaffolds that direct the differentiation of neural stem cells and pluripotent stem cells since they offer the most promise for producing the cell phenotypes that could restore function after SCI. In terms of biomaterial scaffolds, this article reviews the literature associated with using hydrogels made from natural biomaterials and electrospun scaffolds for differentiating stem cells into neural phenotypes. It then presents new data showing how these different types of scaffolds can be combined for neural tissue engineering applications and provides directions for future studies.

Sensorimotor integration of vision and proprioception for obstacle crossing in ambulatory individuals with spinal cord injury

Authors: Malik RN, Cote R, Lam T.
Published in: J Neurophysiol. 2016 Oct 12:jn.00169.2016. doi: 10.1152/jn.00169.2016. [Epub ahead of print]
About: Skilled walking, such as obstacle crossing, is an essential component of functional mobility. Sensorimotor integration of visual and proprioceptive inputs is important for successful obstacle crossing. The objective of this study was to understand how proprioceptive deficits affect obstacle-crossing strategies when controlling for variations in motor deficits in ambulatory individuals with spinal cord injury.

Visual Contrast Sensitivity in Early-Stage Parkinson’s Disease

Authors: Ming W, Palidis DJ, Spering M, McKeown MJ.
Published inInvest Ophthalmol Vis Sci. 2016 Oct 1;57(13):5696-5704. doi: 10.1167/iovs.16-20025.
About: Visual impairments are frequent in Parkinson’s disease (PD) and impact normal functioning in daily activities. Visual contrast sensitivity is a powerful nonmotor sign for discriminating PD patients from controls. However, it is usually assessed with static visual stimuli. Here we examined the interaction between perception and eye movements in static and dynamic contrast sensitivity tasks in a cohort of mildly impaired, early-stage PD patients.

Mechanisms of action of an implementation intervention in stroke rehabilitation: a qualitative interview study

Authors: Connell LA, McMahon NE, Tyson SF, Watkins CL, Eng JJ.
Published inBMC Health Serv Res. 2016 Sep 30;16(1):534.
About: Despite best evidence demonstrating the effectiveness of increased intensity of exercise after stroke, current levels of therapy continue to be below those required to optimise motor recovery. We developed and tested an implementation intervention that aims to increase arm exercise in stroke rehabilitation. The aim of this study was to illustrate the use of a behaviour change framework, the Behaviour Change Wheel, to identify the mechanisms of action that explain how the intervention produced change.

Normative data for the segmental acquisition of contact heat evoked potentials in cervical dermatomes

Authors: Jutzeler CR, Rosner J, Rinert J, Kramer JL, Curt A.
Published inSci Rep. 2016 Oct 6;6:34660. doi: 10.1038/srep34660.
About: Contact heat evoked potentials (CHEPs) represent a neurophysiological approach to assess conduction in the spinothalamic tract. The aim of this study was to establish normative values of CHEPs acquired from cervical dermatomes (C4, C6, C8) and examine the potential confounds of age, sex, and height. 101 (49 male) healthy subjects of three different age groups (18-40, 41-60, and 61-80 years) were recruited. Normal (NB, 35-52 °C) followed by increased (IB, 42-52 °C) baseline stimulation protocols were employed to record CHEPs. Multi-variate linear models were used to investigate the effect of age, sex, and height on the CHEPs parameters (i.e., N2 latency, N2P2 amplitude, rating of perceived intensity). Compared to NB, IB stimulation reduced latency jitter within subjects, yielding larger N2P2 amplitudes, and decreased inter-subject N2 latency variability. Age was associated with reduced N2P2 amplitude and prolonged N2 latency. After controlling for height, male subjects had significantly longer N2 latencies than females during IB stimulation. The study provides normative CHEPs data in a large cohort of healthy subjects from segmentally examined cervical dermatomes. Age and sex were identified as important factors contributing to N2 latency and N2P2 amplitude. The normative data will improve the diagnosis of spinal cord pathologies.

Can concussion constrain the Caped Crusader?

AuthorsZehr EP, Wright B.
Published inBr J Sports Med. 2016 Oct 4. pii: bjsports-2016-096792. doi: 10.1136/bjsports-2016-096792. [Epub ahead of print]

Telerehabilitation in Stroke Recovery: A Survey on Access and Willingness to Use Low-Cost Consumer Technologies

Authors: Edgar MC, Monsees S, Rhebergen J, Waring J, Van der Star T, Eng JJ, Sakakibara BM.
Published in: Telemed J E Health. 2016 Oct 5. [Epub ahead of print]
About: Early telerehabilitation trials with stroke survivors have shown promising results, but there remains a lack of knowledge of what areas of rehabilitation people with stroke are interested and willing to receive using technology. The purpose of this study was to describe the access to low-cost consumer technologies and willingness to use them to receive rehabilitation services among stroke survivors.

Cardiac Consequences of Autonomic Dysreflexia in Spinal Cord Injury

Authors: West CR, Squair JW, McCracken L, Currie KD, Somvanshi R, Yuen V, Phillips AA, Kumar U, McNeill JH, Krassioukov AV.
Published in: Hypertension. 2016 Nov;68(5):1281-1289. Epub 2016 Oct 3.
About: Autonomic dysreflexia (AD), which describes episodic hypertension, is highly prevalent in people with spinal cord injury (SCI). In non-SCI, primary hypertension depresses cardiac contractile reserve via β-adrenergic mechanisms. In this study, we investigated whether AD contributes to the impairment in cardiac contractile function that accompanies SCI. We induced SCI in rodents and stratified them into sham, SCI, or SCI plus repetitive induction of AD. At 6-week post-SCI, we assessed cardiac function using in vivo (speckle-tracking echocardiography), ex vivo (working heart), and molecular approaches (Western blot). We also provide unique translational insight by comparing the relationship between the number of daily AD events and cardiac function in 14 individuals with cervical SCI. We found SCI and SCI plus repetitive induction of AD exhibited a reduction in left ventricular dimensions at 6-week post-SCI versus preinjury (P<0.049). Compared with sham, SCI exhibited a reduction in peak radial strain along with a down and rightward shift in the Starling curve (P<0.037), both of which were further depressed in SCI plus repetitive induction of AD (P<0.042). In response to β-adrenergic stimulation, SCI plus repetitive induction of AD exhibited an attenuated increase in contractile indices (P<0.001), despite no differences in β-receptor expression within the left ventricle. Our clinical data confirm our experimental findings by demonstrating significant associations between the number of daily AD events and markers of systolic and diastolic function along with left ventricular mechanics. Here, we provide the first evidence from a translational perspective that AD exerts insidious effects on cardiac function in rodents and humans with SCI.

Development and user validation of driving tasks for a power wheelchair simulator

Authors: Archambault PS, Blackburn É, Reid D, Routhier F, Miller WC.
Published in: Disabil Rehabil. 2016 Sep 27:1-8. [Epub ahead of print]
About: Mobility is important for participation in daily activities and a power wheelchair (PW) can improve quality of life of individuals with mobility impairments. A virtual reality simulator may be helpful in complementing PW skills training, which is generally seen as insufficient by both clinicians and PW users. To this end, specific, ecologically valid activities, such as entering an elevator and navigating through a shopping mall crowd, have been added to the McGill wheelchair (miWe) simulator through a user-centred approach.

Differences in health, participation and life satisfaction outcomes in adults following paediatric- versus adult-sustained spinal cord injury.

Authors: Ma JK, Post MW, Gorter JW, Martin Ginis KA.
Published in: Spinal Cord. 2016 Sep 20. [Epub ahead of print]
About: The objective of this study was to compare differences in self-reported health status, participation and life satisfaction outcomes between adults with a spinal cord injury (SCI) sustained during paediatric (P) versus adulthood (A) years. Regardless of time since injury, people who sustained a paediatric SCI reported better health and greater participation than those injured in adulthood. Nevertheless, both groups scored well below able-bodied normative values for all measures. The results highlight the importance of a comprehensive life-course approach to SCI rehabilitation, irrespective of age at the time of injury.

With Great Power Comes Great Responsibility-A Personal Philosophy for Communicating Science in Society

AuthorsZehr EP.
Published ineNeuro. 2016 Sep 8;3(5). pii: ENEURO.0200-16.2016.
About: Many think that communicating science is a necessary and rewarding activity. Yet finding compelling, relevant, and timely points of linkage between challenging scientific concepts and the experiences and interests of the general public can be difficult. Since science continues to influence more and more aspects of daily life and knowledge, there is a parallel need for communication about science in our society. Here I discuss the “middle-ground hypothesis” using popular culture for science communication and applying the “FUNnel model,” where popular culture is used as a lead-in and wrap-up when discussing science. The scientific knowledge we find in our hands does not belong to us-we just had it first. We can honor that knowledge best by sharing it as widely as possible using the most creative means at our disposal.

Morphology based anisotropic finite element models of the proximal femur validated with experimental data

Authors: Enns-Bray WS, Ariza O, Gilchrist S, Widmer Soyka RP, Vogt PJ, Palsson H, Boyd SK, Guy P, Cripton PA, Ferguson SJ, Helgason B.
Published inMed Eng Phys. 2016 Sep 15. pii: S1350-4533(16)30187-4.
About: Finite element analysis (FEA) of bones scanned with Quantitative Computed Tomography (QCT) can improve early detection of osteoporosis. The accuracy of these models partially depends on the assigned material properties, but anisotropy of the trabecular bone cannot be fully captured due to insufficient resolution of QCT. The inclusion of anisotropy measured from high resolution peripheral QCT (HR-pQCT) could potentially improve QCT-based FEA of the femur, although no improvements have yet been demonstrated in previous experimental studies. This study analyzed the effects of adding anisotropy to clinical resolution femur models by constructing six sets of FE models (two isotropic and four anisotropic) for each specimen from a set of sixteen femurs that were experimentally tested in sideways fall loading with a strain gauge on the superior femoral neck. Two different modulus-density relationships were tested, both with and without anisotropy derived from mean intercept length analysis of HR-pQCT scans. Comparing iso- and anisotropic models to the experimental data resulted in nearly identical correlation and highly similar linear regressions for both whole bone stiffness and strain gauge measurements. Anisotropic models contained consistently greater principal compressive strains, approximately 14% in magnitude, in certain internal elements located in the femoral neck, greater trochanter, and femoral head. In summary, anisotropy had minimal impact on macroscopic measurements, but did alter internal strain behavior. This suggests that organ level QCT-based FE models measuring femoral stiffness have little to gain from the addition of anisotropy, but studies considering failure of internal structures should consider including anisotropy to their models.

Reliability and validity of daily physical activity measures during inpatient spinal cord injury rehabilitation

Authors: Zbogar D, Eng JJMiller WCKrassioukov AV, Verrier MC.
Published in: SAGE Open Med. 2016 Sep 1;4:2050312116666941.
About: The objective of this study is to assess the test-retest reliability and convergent validity of daily physical activity measures during inpatient spinal cord injury rehabilitation. The test-retest reliability and convergent validity of the instrumented measures suggest that wrist and hip accelerometers are appropriate tools for use in research studies of daily physical activity in the spinal cord injury rehabilitation setting but are too variable for individual use.

Predicting recruitment feasibility for acute spinal cord injury clinical trials in Canada using national registry data

Authors: Thibault-Halman G, Rivers CS, Bailey C, Tsai E, Drew B, Noonan V, Fehlings M, Dvorak MF, Kuerban D, Kwon BK, Christie S.
Published in: J Neurotrauma. 2016 Sep 14. [Epub ahead of print]
About: Traumatic spinal cord injury (tSCI) represents a significant burden of illness, but is relatively uncommon and heterogeneous, making it challenging to achieve sufficient subject enrollment in clinical trials of therapeutic interventions for acute SCI. The Rick Hansen Spinal Cord Injury Registry (RHSCIR) is a national SCI Registry that enters SCI patients from acute-care centers across Canada. To predict the feasibility of conducting clinical trials of acute SCI within Canada, we have applied the inclusion/exclusion criteria of six previously conducted SCI trials to the RHSCIR dataset and generated estimates of how many Canadian individuals would theoretically have been eligible for enrollment in these studies. Data for SCI cases were prospectively collected for RHSCIR at 18 acute and 13 rehabilitation sites across Canada. RHSCIR cases enrolled between 2009-2013 who met the following key criteria were included: non-penetrating traumatic SCI; received acute care at a RHSCIR site; age >18- <75 years, and had complete admission single neurological level of injury data. Inclusion and exclusion criteria for the Minocycline in Acute Spinal Cord injury (Minocycline), Riluzole, Surgical Timing in Acute Spinal Cord Injury Study (STASCIS), Cethrin, Nogo antibody study (NOGO) and Sygen studies were applied retrospectively to this dataset. The numbers of patients eligible for each clinical trial were determined. 2166 of the initial 2714 cases (79.8%) met the key criteria and were included in the dataset. Projected annual numbers of eligible patients for each trial was: Minocycline 117 cases; Riluzole 62 cases; STASCIS 109 cases; Cethrin 101 cases; NOGO 82 cases; and Sygen 70 cases. An additional 8.0% of the sample had a major head injury (GCS≤ 12) and would have been excluded from the trials. RHSCIR provides a comprehensive national dataset which may serve as a useful tool in the planning of multicentre clinical SCI trials.

Online training improves paramedics’ knowledge of autonomic dysreflexia management guidelines

Authors: Martin Ginis KA, Tomasone JR, Welsford M, Ethans K, Sinden AR, Longeway M, Krassioukov AV.
Published in: Spinal Cord. 2016 Sep 13. [Epub ahead of print]
About: The objective of this study was to test the effects of the ‘ABCs of AD’ educational module on immediate and longer-term changes in paramedics’ knowledge and beliefs about using the autonomic dysreflexia clinical practice guidelines (AD-CPGs). ‘ABCs of AD’ has immediate and sustained effects on paramedics’ knowledge of attitudes toward and perceived pressure from patients to use the AD-CPGs. Updates to paramedic patient care guidelines and standards are needed to increase paramedics’ perceived control and self-efficacy to implement the guidelines, and their intentions to use the AD-CPGs.

Neuropathic pain following traumatic spinal cord injury: Models, measurement, and mechanisms

Authors: Kramer JL, Minhas NK, Jutzeler CR, Erskine EL, Liu LJ, Ramer MS.
Published in: J Neurosci Res. 2016 Sep 12. [Epub ahead of print]
About: Neuropathic pain following spinal cord injury (SCI) is notoriously difficult to treat and is a high priority for many in the SCI population. Resolving this issue requires animal models fidelic to the clinical situation in terms of injury mechanism and pain phenotype. This Review discusses the means by which neuropathic pain has been induced and measured in experimental SCI and compares these with human outcomes, showing that there is a substantial disconnection between experimental investigations and clinical findings in a number of features. Clinical injury level is predominantly cervical, whereas injury in the laboratory is modeled mainly at the thoracic cord. Neuropathic pain is primarily spontaneous or tonic in people with SCI (with a relatively smaller incidence of allodynia), but measures of evoked responses (to thermal and mechanical stimuli) are almost exclusively used in animals. There is even the question of whether pain per se has been under investigation in most experimental SCI studies rather than simply enhanced reflex activity with no affective component. This Review also summarizes some of the problems related to clinical assessment of neuropathic pain and how advanced imaging techniques may circumvent a lack of patient/clinician objectivity and discusses possible etiologies of neuropathic pain following SCI based on evidence from both clinical studies and animal models, with examples of cellular and molecular changes drawn from the entire neuraxis from primary afferent terminals to cortical sensory and affective centers.

Identification of a Chrysanthemic Ester as an Apolipoprotein E Inducer in Astrocytes

Authors: Fan J, Zareyan S, Zhao W, Shimizu Y, Pfeifer TA, Tak JH, Isman MB, Van den Hoven B, Duggan ME, Wood MW, Wellington CL, Kulic I.
Published inPLoS One. 2016 Sep 6;11(9):e0162384
About: The apolipoprotein E (APOE) gene is the most highly associated susceptibility locus for late onset Alzheimer’s Disease (AD), and augmenting the beneficial physiological functions of apoE is a proposed therapeutic strategy. In a high throughput phenotypic screen for small molecules that enhance apoE secretion from human CCF-STTG1 astrocytoma cells, we show the chrysanthemic ester 82879 robustly increases expressed apoE up to 9.4-fold and secreted apoE up to 6-fold and is associated with increased total cholesterol in conditioned media. Compound 82879 is unique as structural analogues, including pyrethroid esters, show no effect on apoE expression or secretion. 82879 also stimulates liver x receptor (LXR) target genes including ATP binding cassette A1 (ABCA1), LXRα and inducible degrader of low density lipoprotein receptor (IDOL) at both mRNA and protein levels. In particular, the lipid transporter ABCA1 was increased by up to 10.6-fold upon 82879 treatment. The findings from CCF-STTG1 cells were confirmed in primary human astrocytes from three donors, where increased apoE and ABCA1 was observed along with elevated secretion of high-density lipoprotein (HDL)-like apoE particles. Nuclear receptor transactivation assays revealed modest direct LXR agonism by compound 82879, yet 10 μM of 82879 significantly upregulated apoE mRNA in mouse embryonic fibroblasts (MEFs) depleted of both LXRα and LXRβ, demonstrating that 82879 can also induce apoE expression independent of LXR transactivation. By contrast, deletion of LXRs in MEFs completely blocked mRNA changes in ABCA1 even at 10 μM of 82879, indicating the ability of 82879 to stimulate ABCA1 expression is entirely dependent on LXR transactivation. Taken together, compound 82879 is a novel chrysanthemic ester capable of modulating apoE secretion as well as apoE-associated lipid metabolic pathways in astrocytes, which is structurally and mechanistically distinct from known LXR agonists.

Impact of bladder, bowel and sexual dysfunction on health status of people with thoracolumbar spinal cord injuries living in the community

Authors: Park SE, Elliott S, Noonan VK, Thorogood NP, Fallah N, Aludino A, Dvorak MF.
Published in: J Spinal Cord Med. 2016 Aug 31:1-12.
About: The disruption of autonomic function following a spinal cord injury (SCI) is common and can negatively affect quality of life. The objective of this study was to describe the prevalence of bladder/bowel incontinence and sexual dysfunction in community-dwelling individuals with a thoracolumbar SCI and examine the impact on general physical and mental health status.

Characterising the severity of autonomic cardiovascular dysfunction after spinal cord injury using a novel 24 hour ambulatory blood pressure analysis software

Authors: Popok D, West CR, Hubli M, Currie KD, Krassioukov AV.
Published inJ Neurotrauma. 2016 Aug 29. [Epub ahead of print]
About: Cardiovascular disease is one of the leading causes of morbidity and mortality in the spinal cord injury (SCI) population. SCI may disrupt autonomic cardiovascular homeostasis, which can lead to persistent hypotension, irregular diurnal rhythmicity and the development of Autonomic Dysreflexia (AD). There is currently no software available to perform automated detection and evaluation of cardiovascular autonomic dysfunction(s) such as those listed above from 24hr ambulatory blood pressure monitoring (ABPM) recordings in the clinical setting. The objective of the following study is to compare the efficacy of a novel 24 hour ABPM Autonomic Dysfunction (AD) Detection Software against manual detection and to use the software to demonstrate the relationships between level of injury and the degree of autonomic cardiovascular impairment in a large cohort of individuals. A total of 46 individuals with cervical (group 1, n =37) and high-thoracic (group 2, n=9) SCI participated in the study. Outcome measures included the frequency and severity of AD, frequency of hypotensive events, and diurnal variations in blood pressure and heart rate. There was good agreement between the Software and manual detection of AD events (Bland-Altman limits of agreement =±1.458 events). Cervical SCI presented with more frequent (p=0.0043) and severe AD (p=0.0343) vs. high thoracic SCI. Cervical SCI exhibited higher systolic and diastolic blood pressure during the night and lower heart rate during the day compared to high thoracic SCI. In conclusion, our ABPM AD Detection Software was equally as effective in detecting the frequency and severity of AD and hypotensive events as manual detection, suggesting this software can be used in the clinical setting to expedite ABPM analyses.

Cross-education of strength and skill: an old idea with applications in the aging nervous system

Authors: Barss TS, Pearcey GE, Zehr EP.
Published in: Yale J Biol Med. 2016 Mar 24;89(1):81-6.
About: Edward Wheeler Scripture’s 1894 work out of the Yale Psychological Laboratory has been influential in identifying the nervous system’s contribution to the bilateral improvements that are seen with unilateral strength and skill training. Scripture coined the term “cross-education” to describe this improvement in the untrained contralateral limb. While physiological changes accompany aging that may negatively affect the performance of physical tasks, far too much credit has been given to the natural aging process rather than the effects of inactivity. Emerging evidence indicates strength or skill training interventions induce significant neuroplasticity in an aging population. The model of unilateral training provides a unique approach in which to elicit such plasticity. This brief review highlights the innate ability of the nervous system to adapt to unilateral strength and skill training interventions, regardless of age, and provides a novel perspective on the robust plastic ability of the aging nervous system.

Short-Term Plasticity in a Monosynaptic Reflex Pathway to Forearm Muscles after Continuous Robot-Assisted Passive Stepping

Authors: Nakajima T, Kamibayashi K, Kitamura T, Komiyama T, Zehr EP, Nakazawa K.
Published inFront Hum Neurosci. 2016 Jul 22;10:368.
About: Both active and passive rhythmic limb movements reduce the amplitude of spinal cord Hoffmann (H-) reflexes in muscles of moving and distant limbs. This could have clinical utility in remote modulation of the pathologically hyperactive reflexes found in spasticity after stroke or spinal cord injury. However, such clinical translation is currently hampered by a lack of critical information regarding the minimum or effective duration of passive movement needed for modulating spinal cord excitability. We therefore investigated the H-reflex modulation in the flexor carpi radialis (FCR) muscle during and after various durations (5, 10, 15, and 30 min) of passive stepping in 11 neurologically normal subjects. Passive stepping was performed by a robotic gait trainer system (Lokomat(®)) while a single pulse of electrical stimulation to the median nerve elicited H-reflexes in the FCR. The amplitude of the FCR H-reflex was significantly suppressed during passive stepping. Although 30 min of passive stepping was sufficient to elicit a persistent H-reflex suppression that lasted up to 15 min, 5 min of passive stepping was not. The duration of H-reflex suppression correlated with that of the stepping. These findings suggest that the accumulation of stepping-related afferent feedback from the leg plays a role in generating short-term interlimb plasticity in the circuitry of the FCR H-reflex.

Left Ventricular Mechanics in Untrained and Trained Males with Tetraplegia

Authors: Currie KD, West CR, Stöhr EJ, Krassioukov AV.
Published inJ Neurotrauma. 2016 Sep 14. [Epub ahead of print]
About:Reduced left ventricular (LV) function is common in tetraplegia, yet it is unknown whether intrinsic myocardial function is attenuated. This study examined the effect of SCI and exercise-training status on LV mechanics (intrinsic function) and LV systolic/diastolic function by comparing untrained (UT) and trained (TT) individuals with tetraplegia and able-bodied (AB) individuals. Individuals with tetraplegia had a traumatic, chronic, motor-complete cervical spinal cord injury. Nine UT males (40 ± 10 years), 8 TT males (30 ± 5 years), and nine AB males (37 ± 9 years) participated in the study. LV indices were assessed using two-dimensional transthoracic echocardiography, with speckle-tracking analysis for the determination of LV mechanics. For systolic function, stroke volumes were lower in both UT (59 ± 9 mL; p < 0.001) and TT (63 ± 9 mL; p < 0.001) relative to AB (82 ± 11 mL), whereas systolic mechanics were similar across groups. Diastolic function was only reduced in UT, including a lower ratio of early-to-late transmitral filling velocity (1.55 ± 0.28) relative to TT (2.07 ± 0.42; p < 0.05) and AB (2.44 ± 0.61; p < 0.01) and longer isovolumetric relaxation times in UT (101 ± 7 ms) relative to TT (88 ± 11 ms; p < 0.05) and AB (85 ± 6 ms; p < 0.01). Diastolic mechanics (apical circumferential strain rate) were significantly enhanced in TT (3.03 ± 0.83 s-1) compared to AB (1.85 ± 0.65 s-1; p < 0.05). There was a trend (p = 0.062) for a between-group difference in apical radial diastolic strain rate (UT: -2.51 ± 0.83 s-1; TT: -3.92 ± 1.96 s-1; AB: -1.84 ± 0.46 s-1). In tetraplegia, attenuated LV systolic function is not attributed to intrinsic dysfunction, whereas exercise-training status appears to improve both global LV diastolic function and LV mechanics.

Cardiovascular response during urodynamics in individuals with spinal cord injury

Authors: Liu N, Zhou MW, Biering-Sørensen F, Krassioukov AV.
Published inSpinal Cord. 2016 Aug 2. [Epub ahead of print]
About: The objective of this study is to establish the frequency and severity of autonomic dysreflexia (AD) during urodynamics among individuals with chronic spinal cord injury (SCI) and to investigate the possible effect of the number of years since SCI on the severity of AD. Individuals with cervical SCI, DSD, poor bladder compliance or >2 years after SCI were associated with a higher possibility of developing AD during urodynamics. Furthermore, AD was more severe in complete (AIS A) individuals and was exacerbated with time after injury.

In with the new and out with the old: enter multivariate wavelet decomposition, exit transfer function

Authors: Phillips AA, Hansen A, Krassioukov AV.
Published inAm J Physiol Heart Circ Physiol. 2016 Sep 1;311(3):H735-7.
About: The human brain makes up only 2% of body weight, although it consumes more than 20% of oxygen and glucose at rest, with almost all adenosine triphosphate within the brain being produced by oxidative metabolism of glucose. In addition to a great need for substrate provision and by-product clearance, the metabolic circumstances in the brain are compromised by a limited intracellular capacity for energy storage. These two characteristics, combined with the paramount importance of brain function compared with other end organs, necessitate precise regulation of cerebral blood flow (CBF). Regulation of CBF is achieved through several factors including metabolic, myogenic, and neurogenic control, as well as systemic blood flow. Specifically, the primary controllers of CBF are partial pressure of arterial CO2, cerebral metabolism, cardiac output, and the autonomic nervous system. The role of the autonomic nervous system has been particularly difficult to assess due to a number of factors stemming from the redundant mechanisms at play involving a combination of neurovascular coupling, arterial blood gases, and systemic blood flow.

High Thoracic Contusion Model for the Investigation of Cardiovascular Function after Spinal Cord Injury

Authors: Squair JW, West CR, Popok D, Assinck P, Liu J, Tetzlaff WKrassioukov AV.
Published inJ Neurotrauma. 2016 Aug 25. [Epub ahead of print]
About: Cardiovascular disease is the leading cause of death for individuals with spinal cord injury (SCI). Because of a lack of a standardized and accessible animal model for cardiovascular disease after SCI, few laboratories have conducted pre-clinical trials aimed at reinstating descending cardiovascular control. Here, we utilized common contusion methodology applied to the midline of the upper-thoracic cord of adult Wistar rats accompanied with telemetric blood pressure monitoring and FluoroGold retrograde neuronal tracing, as well as lesion site and lumbrosacral afferent immunohistochemistry. We demonstrate widespread cardiovascular (i.e., impaired resting hemodynamics, autonomic dysreflexia) and hindlimb dysfunction at 1 month post-injury. Further, we provide a description of the neuroanatomical changes that accompany cardiovascular abnormalities. Specifically, we describe 1) the injury site including white matter sparing as well as lesion volume, and their correlations to cardiovascular as well as motor outcomes; 2) the severity of injury-dependent changes in sympathoexcitatory medullary neuron spinal connectivity, as measured using FluoroGold tracing; and 3) the extent of aberrant afferent plasticity within the lumbosacral region of the spinal cord, which has been linked to the development of autonomic dysreflexia. We believe that this model, which utilizes equipment common to numerous SCI laboratories, can serve as a research standard for studies specifically aimed at investigating autonomic neuroprotective and regenerative strategies following SCI.

Neuromechanical interactions between the limbs during human locomotion: an evolutionary perspective with translation to rehabilitation

AuthorsZehr EP, Barss TS, Dragert K, Frigon A, Vasudevan EV, Haridas C, Hundza S, Kaupp C, Klarner T, Klimstra M, Komiyama T, Loadman PM, Mezzarane RA, Nakajima T, Pearcey GE, Sun Y.
Published inExp Brain Res. 2016 Jul 15. [Epub ahead of print]
About: During bipedal locomotor activities, humans use elements of quadrupedal neuronal limb control. Evolutionary constraints can help inform the historical ancestry for preservation of these core control elements support transfer of the huge body of quadrupedal non-human animal literature to human rehabilitation. In particular, this has translational applications for neurological rehabilitation after neurotrauma where interlimb coordination is lost or compromised. The present state of the field supports including arm activity in addition to leg activity as a component of gait retraining after neurotrauma.

Exploiting Interlimb Arm and Leg Connections for Walking Rehabilitation: A Training Intervention in Stroke

Authors: Klarner T, Barss TS, Sun Y, Kaupp C, Loadman PM, Zehr EP.
Published in: Neural Plast. 2016;2016:1517968.
About: Rhythmic arm and leg (A&L) movements share common elements of neural control. The extent to which A&L cycling training can lead to training adaptations which transfer to improved walking function remains untested. The purpose of this study was to test the efficacy of A&L cycling training as a modality to improve locomotor function after stroke. Nineteen chronic stroke (>six months) participants were recruited and performed 30 minutes of A&L cycling training three times a week for five weeks. Changes in walking function were assessed with (1) clinical tests; (2) strength during isometric contractions; and (3) treadmill walking performance and cutaneous reflex modulation. A multiple baseline (3 pretests) within-subject control design was used. Data show that A&L cycling training improved clinical walking status increased strength by ~25%, improved modulation of muscle activity by ~25%, increased range of motion by ~20%, decreased stride duration, increased frequency, and improved modulation of cutaneous reflexes during treadmill walking. On most variables, the majority of participants showed a significant improvement in walking ability. These results suggest that exploiting arm and leg connections with A&L cycling training, an accessible and cost-effective training modality, could be used to improve walking ability after stroke.

Attitude to health risk in the Canadian population: a cross-sectional survey

Authors: Bansback N, Harrison M, Sadatsafavi M, Stiggelbout A, Whitehurst DG.
Published in: CMAJ Open. 2016 Jun 3;4(2):E284-91.
About: Risk is a ubiquitous part of health care. Understanding how people respond to risks is important for predicting how populations make health decisions. Our objective was to seek preliminary descriptive insights into the attitude to health risk in the Canadian population and factors associated with heterogeneity in risk attitude. We used a large market-research panel to survey (in English and French) a representative sample of the Canadian general population that reflected the age, sex and geography of the population. The survey included the Health-Risk Attitude Scale, which predicts how a person resolves risky health decisions related to treatment, prevention of disease and health-related behaviour. In addition, we assessed participants’ numeracy and risk understanding, as well as income band and level of education. We summarized the responses, and we explored the independent associations between demographics, numeracy, risk understanding and risk attitude in multivariable models. We concluded that in general, Canadians were averse to health risks, but we found that a sizeable, identifiable group of risk takers exists. Heterogeneity in preferences for risk can explain variations in health care utilization in the context of patient-centred care. Understanding risk preference heterogeneity can help guide policy and assist in patient-physician decisions

The relationship between lower limb proprioceptive sense and locomotor skill acquisition

Authors: Qaiser T, Chisholm AE, Lam T.
Published in: Exp Brain Res. 2016 Jul 5.
About: Sensorimotor integration is essential for controlling movement and acquiring new motor tasks in humans. The aim of this project was to understand how lower limb proprioceptive sense contributes to the acquisition of a skilled walking task. We assessed lower limb joint position and movement detection sense in healthy human subjects using the Lokomat robotic exoskeleton. Subjects walked on a treadmill to practice a skilled motor task (200 trials) requiring them to match their foot height during the swing phase to the height of a virtual obstacle displayed on a monitor in front of them. Subjects were given visual feedback on their error relative to the obstacle height after it was crossed. Lower limb joint position sense was related to the final performance error, but not the learning rate of the skilled walking task. The findings from this study support the role of lower limb proprioceptive sense on locomotor skill performance in healthy adult subjects.

Wheeled-mobility correlates of life-space and social participation in adult manual wheelchair users aged 50 and older

Authors: Sakakibara BM, Routhier F, Miller WC.
Published in: Disabil Rehabil Assist Technol. 2016 Jul 4:1-7.
About: The purpose of this study is to characterize the life-space mobility and social participation of manual wheelchair users using objective measures of wheeled mobility. Individuals (n = 49) were included in this cross-sectional study if they were aged 50 or older, community-dwelling and used their wheelchair on a daily basis for the past 6 months. Life-space mobility and social participation were measured using the life-space assessment and late-life disability instrument. The wheeled mobility variables (distance travelled, occupancy time, number of bouts) were captured using a custom-built data logger. The authors conclude that occupancy time and distance travelled are statistically significant predictors of life-space mobility. Lower occupancy time may be an indicative of travel to more distant life-spaces, whereas the distance travelled is likely a better reflection of mobility within each life-space. Occupancy time and number of bouts are significant predictors of participation frequency. Implications for rehabilitation Component measures of wheelchair mobility, such as distance travelled, occupancy time and number of bouts, are important predictors of life-space mobility and social participation in adult manual wheelchair users. Lower occupancy time is an indication of travel to more distant life-spaces, whereas distance travelled is likely a better reflection of mobility within each life-space. That lower occupancy time and greater number of bouts are associated with more frequent participation raises accessibility and safety issues for manual wheelchair users.

Universal disease-specific outcome instruments for spine trauma: a global perspective on relevant parameters to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients.

Authors: Sadiqi S, Verlaan JJ, Mechteld Lehr A, Dvorak MF, Kandziora F, Rajasekaran S, Schnake KJ, Vaccaro AR, Oner FC.
Published in: Eur Spine J. 2016 Jul 2.
About: Besides a patient reported outcome measure, the AOSpine Knowledge Forum Trauma aims to develop a new concept of a surgeon reported outcome measure (SROM) for spine trauma patients. This study aims to identify parameters that spine surgeons consider relevant to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients. An international cross-sectional web-based survey was conducted among spine surgeons from the five AOSpine International world regions. They were asked to evaluate the relevance of a compilation of 16 clinical and radiological parameters for thoracic and lumbar spine trauma patients, both for the short term (3 months-2 years) and long term (≥2 years), on a five-point scale. The responses were analyzed using descriptive statistics, frequency analysis, and Kruskal-Wallis test. Including a large and representative sample of spine trauma experts, this study identified parameters to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients. The results form the basis for the development of a SROM for this specific patient population.

Does the method of botulinum neurotoxin injection for limb spasticity affect outcomes? A systematic review.

Authors: Chan AK, Finlayson H, Mills PB.
Published in: Clin Rehabil. 2016 Jul 1.
About: The objective of this study was to systematically review randomized controlled trials of botulinum neurotoxin for limb spasticity to determine whether different injection techniques affect spasticity outcomes. MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials electronic databases were searched for English language human randomized controlled trials from 1990 to 13 May 2016. Studies were assessed in duplicate for data extraction and risk of bias using the Physiotherapy Evidence Database scale and graded according to Sackett’s levels of evidence. Nine of 347 studies screened met selection criteria. Four categories of botulinum neurotoxin injection techniques were identified: (1) injection localization technique; (2) injection site selection; (3) injectate volume; (4) injection volume and site selection. There is level 1 evidence that: ultrasound, electromyography, and electrostimulation are superior to manual needle placement; endplate injections improve outcomes vs. multisite quadrant injections; motor point injections are equivalent to multisite injections; high volume injections are similar to low volume injections; and high volume injections distant from the endplate are more efficacious than low volumes closer to the endplate. The authors conclude that level 1 evidence exists for differences in treatment outcomes using specific botulinum neurotoxin injection techniques. Findings are based on single studies that require independent replication and further study.

Predicting peak oxygen uptake from submaximal exercise after spinal cord injury.

Authors: Totosy de Zepetnek JO, Au JS, Hol AT, Eng JJ, MacDonald MJ.
Published in: Appl Physiol Nutr Metab. 2016 Jul;41(7):775-81.
About: The purpose of this study was to determine the validity of the 6-min arm ergometry test (6MAT) in predicting peak oxygen consumption (V̇O2peak) in individuals with chronic spinal cord injury (SCI). Fifty-two individuals with chronic SCI (age, 38 ± 10 years; American Spinal Injury Association Impairment Scale (AIS), A-D; neurological level of injury (NLI), C1-L2; years post-injury (YPI), 13 ± 10 years) completed an incremental arm ergometry V̇O2peak test and a submaximal 6MAT. Oxygen consumption (V̇O2) data from both tests were used to create a predictive equation with regression analysis. Subsequently, a cross-validation group comprising an additional 10 individuals with SCI (age, 39 ± 13 years; AIS, A-D; NLI, C3-L3; YPI, 9 ± 9 years) were used to determine the predictive power of the equation. All participants were able to complete both the V̇O2peak and 6MAT assessments. Regression analysis yielded the following equation to predict V̇O2peak from end-stage 6MAT V̇O2: V̇O2peak (mL·kg(-1)·min(-1)) = 1.501(6MAT V̇O2) – 0.940. Correlation between measured and predicted V̇O2peak was excellent (r = 0.89). No significant difference was found between measured (17.41 ± 7.44 mL·kg(-1)·min(-1)) and predicted (17.42 ± 6.61 mL·kg(-1)·min(-1)) V̇O2peak (p = 0.97). When cross-validated with a sample of 10 individuals with SCI, correlation between measured and predicted V̇O2peak remained high (r = 0.89), with no differences between measured (18.81 ± 8.35 mL·kg(-1)·min(-1)) and predicted (18.73 ± 7.27 mL·kg(-1)·min(-1)) V̇O2peak (p = 0.75). Results suggest that 6MAT V̇O2 can be used to predict V̇O2peak among individuals with chronic SCI. The 6MAT should be used as a clinical tool for assessing aerobic capacity when peak exercise testing is not feasible.

Accelerating skin wound healing by M-CSF through generating SSEA-1 and -3 stem cells in the injured sites.

Authors: Li Y, Jalili RB, Ghahary A.
Published inSci Rep. 2016 Jul 1;6:28979.
About: Wound healing is a complicated process requiring the collaborative efforts of different cell lineages. Our recent studies have found that one subset of hematopoietic cells can be induced to dedifferentiate into multipotent stem cells by means of a proliferating fibroblast releasable factor, M-CSF. Understanding the importance of stem cells on skin wound healing, here we evaluate the biological significance of M-CSF on skin wound healing. In an in vivo mouse skin excisional wound model, we found that SSEA-positive stem cells were present in wounded but not normal skin. After isolating skin cells from either normal or wounded skin by collagenase digestion, and analyzing the SSEA-1 positive cells by flow cytometry, we found a significant increase in the number of SSEA-1 positive cells in wounded skin. Topical application of M-CSF in skin wounds accelerated healing remarkably, while application of M-CSF-neutralizing antibody slowed wound healing. Furthermore, injection of EGFP-labeled hematopoietic cell-derived stem cells generated from M-CSF treated splenocytes resulted in EGFP-labeled cells being enriched in the skin wound site and further differentiated into functional organ-specific cells. Together, these data demonstrated that M-CSF makes a significant contribution to the healing process by inducing hematopoietic cell dedifferentiation into stem cells.

The course of fatigue after acute spinal cord injury.

Authors: Anton HA, Miller WC, Townson AF, Imam B, Silverberg N, Forwell S.
Published inSpinal Cord. 2016 Jun 28.
About: The objective of this study was to determine the prevalence and course of fatigue following acute spinal cord injury (SCI) during rehabilitation and after discharge. Fifty-two patients with traumatic SCI were assessed after admission to rehabilitation and followed until 6-months post discharge into the community. Fatigue was measured using the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale for Spinal Cord Injury (MFIS-SCI) at admission, discharge and 6 months after discharge. The researchers concluded that fatigue is common in SCI patients admitted to rehabilitation. Fatigue remained stable during rehabilitation and after discharge into the community. Clinicians should consider early screening for fatigue and interventions to reduce the consequences of fatigue in people with SCI.

Cerebrospinal Fluid Biomarkers to Stratify Injury Severity and Predict Outcome in Human Traumatic Spinal Cord Injury.

Authors: Kwon BK, Streijger F, Fallah N, Noonan V, Belanger LM, Ritchie L, Paquette SJ, Ailon T, Boyd MC, Street J, Fisher CG, Dvorak MF.
Published in: J Neurotrauma. 2016 Jun 27.
About: Neurologic impairment after spinal cord injury (SCI) is currently measured and classified by functional examination. Biological markers that objectively classify injury severity and predict outcome would greatly facilitate efforts to evaluate acute SCI therapies. The purpose of this study was to determine how well inflammatory and structural proteins within the CSF of acute traumatic SCI patients predicted American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade conversion and motor score improvement over 6 months. Fifty acute SCI patients (29 AIS A, 9 AIS B, 12 AIS C; 32 cervical, 18 thoracic) were enrolled and CSF obtained through lumbar intrathecal catheters to analyze IL-6, IL-8, MCP-1, Tau, S100β, and GFAP at 24 hours post-injury. The levels of IL-6, tau, S100β, and GFAP were significantly different between patients with baseline AIS grades of A, B, or C. The levels of all proteins (IL-6, IL-8, MCP-1, tau, S100β, and GFAP) were significantly different between those who improved an AIS grade over 6 months and those who did not improve. Linear discrimant analysis modeling was 83% accurate in predicting AIS conversion. For AIS A patients, the concentrations of proteins such as IL-6 and S100β correlated with conversion to AIS B or C. Motor score improvement was also strongly correlated with the 24-hour post-injury CSF levels of all 6 biomarkers. The analysis of CSF can provide valuable biological information about injury severity and recovery potential after acute SCI. Such biological markers may be valuable tools for stratifying individuals in acute clinical trials where variability in spontaneous recovery requires large recruitment cohorts for sufficient power.

Keratinocyte-Releasable Factors Stimulate the Expression of Granulocyte Colony-Stimulating Factor in Human Dermal Fibroblasts

Authors: Carr MJ, Li Y, Rezakhanlou AM, Ghahary A.
Published in: J Cell Biochem. 2016 Jun 24.
About: Interaction between keratinocytes and fibroblasts plays a critical role in maintaining skin integrity under both normal and pathological conditions. We have previously demonstrated that keratinocyte-releasable factors influence the expression of key extracellular matrix components, such as collagen and matrix metalloproteinases in dermal fibroblasts. In this study, we utilized DNA microarray analysis to examine the effects of keratinocyte-releasable factors on the expression of several cytokines in human dermal fibroblasts. The results revealed significantly higher granulocyte colony-stimulating factor (G-CSF) expression in fibroblasts co-cultured with keratinocytes relative to mono-cultured cells, which was verified by RT-PCR and western blot. G-CSF is an important hematopoietic factor also thought to play a beneficial role in wound healing through stimulating keratinocyte proliferation. To partially characterize the keratinocyte-releasable factors responsible for stimulating G-CSF production, keratinocyte-conditioned medium (KCM) was subjected to thermal treatment and ammonium sulfate precipitation before treating fibroblasts. The results showed that keratinocyte-releasable G-CSF-stimulating factors remain stable at 56°C and upon 50% ammonium sulfate precipitation. Knowing that keratinocytes release IL-1, which stimulates G-CSF expression in various immune cells, several experiments were conducted to ask whether this might also be the case for fibroblasts. The results showed that the addition of recombinant IL-1 markedly increased G-CSF expression in fibroblasts; however, IL-1 receptor antagonist only partially abrogated KCM-stimulated G-CSF expression, indicating the role of additional keratinocyte-releasable factors. These findings underline the importance of cross-talk between keratinocytes and fibroblasts, suggesting that communication between these cells in vivo modulates the production of cytokines required for cutaneous wound healing and maintenance.

Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation

Authors: Connell LA, McMahon NE, Tyson SF, Watkins CL, Eng JJ.
Published inPhys Ther. 2016 Jun 23
About: Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganisation and maximise recovery after stroke. To address this evidence-practice gap we developed a knowledge translation intervention using the Behaviour Change Wheel. The intervention involves collaborative working with stroke therapy teams to change their practice, and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise. The purposes of this case series are: (1) to provide an illustrative example of how a research-informed process changed clinical practice and (2) to report on staff and patients’ perceptions of the utility of the developed intervention. A participatory action research approach was used in three stroke rehabilitation units in the United Kingdom. The intervention aimed to change four therapist level behaviours: (i) screening patients for suitability for supplementary self-directed arm exercise, (ii) provision of exercises, (iii) involving family/carers in assisting with exercises and (iv) monitoring and progressing exercises. Data on changes in practice were collected by therapy teams using a bespoke audit tool. Utility of the intervention was explored in qualitative interviews with patients and staff. Components of the intervention were successfully embedded in two of the three stroke units. At these sites almost all admitted patients were screened for suitability for supplementary self-directed exercise. 77%, 70% and 88% of suitable patients across the three sites were provided exercises. Involving family/carers, and monitoring and progressing exercises, were not performed consistently. This study is an example of how a rigorous research-informed knowledge translation process resulted in practice change. Further research is needed to demonstrate that these changes can translate into increased intensity of upper limb exercise and affect patient outcomes.

Inter-Rater Reliability of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury.

Authors: Davidson RA, Carlson M, Fallah N, Noonan VK, Elliott SL, Joseph J, Smith KM, Krassioukov AV.
Published in: J Neurotrauma. 2016 Jul 8
About: The autonomic nervous system can be profoundly affected after spinal cord injury (SCI). Despite its importance to quality of life, autonomic function is rarely systematically assessed in the clinical setting. The International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) is an assessment designed to determine which autonomic functions are intact, impaired, or lost after SCI. The psychometric properties of the ISAFSCI have not yet been reported. The objective of this study was to describe the inter-rater reliability of the ISAFSCI. Participants with chronic traumatic SCI (greater than 1 year) able to remain on the same medications for the study period and communicate clearly with the assessor were recruited for the study. A standard protocol minimized variation between the sites. During the first assessment, neurologic examination (ISNCSCI) was performed and ISAFSCI completed. After 10-14 days, the ISAFSCI was repeated. Inter-rater reliability was calculated using percentage agreement, kappa, and weighted kappa statistics. Participants (n = 48) had an average age of 45 ± 12 years. Forty-one (85.4%) were male, 38 (79.2%) had a SCI at or above the T6 level, 24 (50.0%) had a complete SCI. Inter-rater reliability within the general autonomic component was moderate with kappa values ranging 0.41-0.6 (p < 0.05). Within the Lower Urinary Tract, Bowel, and Sexual Function component, agreement was good-strong with weighted kappa values 0.62-0.88 (p < 0.05). Given the results, we conclude that the ISAFSCI can be considered to have at least moderate and up to strong inter-rater reliability, especially in the bladder, bowel, and sexual function component of the assessment.

Powered robotic exoskeletons in post-stroke rehabilitation of gait: a scoping review.

Authors: Louie DR, Eng JJ.
Published in: J Neuroeng Rehabil. 2016 Jun 8;13(1):53.
About: Powered robotic exoskeletons are a potential intervention for gait rehabilitation in stroke to enable repetitive walking practice to maximize neural recovery. As this is a relatively new technology for stroke, a scoping review can help guide current research and propose recommendations for advancing the research development. The aim of this scoping review was to map the current literature surrounding the use of robotic exoskeletons for gait rehabilitation in adults post-stroke. Five databases (Pubmed, OVID MEDLINE, CINAHL, Embase, Cochrane Central Register of Clinical Trials) were searched for articles from inception to October 2015. Reference lists of included articles were reviewed to identify additional studies. Articles were included if they utilized a robotic exoskeleton as a gait training intervention for adult stroke survivors and reported walking outcome measures. Of 441 records identified, 11 studies, all published within the last five years, involving 216 participants met the inclusion criteria. The study designs ranged from pre-post clinical studies (n = 7) to controlled trials (n = 4); five of the studies utilized a robotic exoskeleton device unilaterally, while six used a bilateral design. Participants ranged from sub-acute (<7 weeks) to chronic (>6 months) stroke. Training periods ranged from single-session to 8-week interventions. Main walking outcome measures were gait speed, Timed Up and Go, 6-min Walk Test, and the Functional Ambulation Category. Meaningful improvement with exoskeleton-based gait training was more apparent in sub-acute stroke compared to chronic stroke. Two of the four controlled trials showed no greater improvement in any walking outcomes compared to a control group in chronic stroke. In conclusion, clinical trials demonstrate that powered robotic exoskeletons can be used safely as a gait training intervention for stroke. Preliminary findings suggest that exoskeletal gait training is equivalent to traditional therapy for chronic stroke patients, while sub-acute patients may experience added benefit from exoskeletal gait training. Efforts should be invested in designing rigorous, appropriately powered controlled trials before powered exoskeletons can be translated into a clinical tool for gait rehabilitation post-stroke.

Polyvinyl alcohol-graft-polyethylene glycol hydrogels improve utility and biofunctionality of injectable collagen biomaterials..

Authors: Hartwell R, Chan B, Elliott K, Alnojeidi H, Ghahary A.
Published in: Biomed Mater. 2016 Jun 8;11(3):035013.
About: Collagen-based materials have become a staple in both research and the clinic. In wound care, collagen-based materials comprise a core gamut of biological dressings and therapeutic strategies. In research, collagen-based materials are employed in everything from 3D cultures to bioprinting. Soluble collagen is well characterized to undergo fibrillation at neutral pH and 37 °C. To remain stable, a neutralized collagen solution must be maintained at 4 °C. These physical characteristics of collagen impose limitations on its utility. In our previous work, we identified that the incorporation of a simple polyvinyl alcohol:borate hydrogel could improve the rate of collagen gel fibrillation. In this work we sought to further investigate the interactions of polyvinyl alcohol blend variants, as surfactant-like polymers, in comparison with known non-polymer surfactants. To conduct our investigations scaffold variants were created using increasing concentrations of polyvinyl alcohol, differing combinations of polymers, and non-polymer surfactants Tweens 20 and 80, and TritonX-100. Activation energy for collagen fibrillation was found to significantly decrease in the presence of polyvinyl alcohols (p  <  0.01) at and above 0.4%w/v concentration. Further, addition of polyvinyl alcohol-graft-polyethylene glycol had the greatest enhancement (2.02 fold) on the fibrillation kinetics (p  <  0.01), wetting properties and the stability of the collagen scaffolds post-freeze drying. Our results demonstrated that the addition of polyvinyl alcohol hydrogels to a collagen solution could stabilize collagen solution such that the solution could easily be lyophilized (at pH 7) and then reconstituted with water. Cells cultured in polyvinyl alcohol scaffolds also exhibited more organized F-actin, as well as a reduced abundance of pro-collagen and α-smooth actin. In conclusion, our results demonstrate for the first time that polyvinyl alcohol, preferably polyvinyl alcohol-graft-polyethylene glycol, directly affects the physical properties of collagen and the physiology of cells cultured within improving the utility of the combined material for both research and clinic needs.

An integrative review of standardized clinical evaluation tool utilization in anticholinergic drug trials for neurogenic lower urinary tract dysfunction.

Authors: Stothers L, Tsang B, Nigro M, Lazare D, Macnab A.
Published in: Spinal Cord. 2016 May 31.
About: The objective of this study was to review prospective and randomized trials studying anticholinergic therapy for neurogenic bladder in SCI to identify whether trials included standardized clinical evaluation tools and reporting measures now recognized to enhance clinical trial data. A systematic search via EMBASE, MEDLINE, CENTRAL, CINAHL (Cumulative Index to Nursing and Allied Health Literature), HTA (Health Technology Assessment), CMR (Comprehensive Microbial Resource), HAPI (Health and Psychosocial Instruments) and PsycINFO using the key term spinal cord injury crossed with oxybutynin, tolterodine, darifenacin, solifenacin, fesoterodine, trospium chloride, propiverine, propantheline and anticholinergic(s) for 1946-2015 inclusive. We then collated whether standardized clinical tools, measures and descriptors were used within each study identified: American Spine Injury Association (ASIA) impairment scale; symptom scores validated in SCI; technical methodology for urodynamics/video urodynamics; urinary diaries; and standardized urologic terminology. A total of 1225 entries with 610 unique articles were identified, 14 randomized and 16 prospective studies. In 6/30 the population comprised SCI patients with neurogenic bladder alone; the remainder included mixed neurogenic etiologies. Classification using the ASIA impairment scale was used in <10% of studies; none used symptom scores validated in SCI; <50% reported urodynamic test methodology fully, incorporated urinary diaries or used International Continence Society Standardization Subcommittee urinary tract terminology. Integrative review of trials from 1946 to 2015 identified infrequent use of standardized clinical evaluation tools and reporting measures. Data from future trials evaluating therapies for neurogenic bladder would likely be more applicable to specific SCI patients if current standardized classification and descriptors now available were used consistently: for example, the ASIA scale, symptom scores validated in SCI, standardized urodynamic methodology, urinary diaries and urinary tract terminology. Studies recruiting SCI patients exclusively would also provide additional benefit.Spinal Cord advance online publication, 31 May 2016; doi:10.1038/sc.2016.63.

Association Between Paraspinal Muscle Morphology, Clinical Symptoms and Functional Status in Patients With Degenerative Cervical Myelopathy.

Authors: Fortin M, Dobrescu O, Courtemanche M, Sparrey CJ, Santaguida C, Fehlings MG, Weber MH.
Published in: Spine (Phila Pa 1976). 2016 May 23.
About: The objective of this cross-sectional study was to assess fatty infiltration and asymmetry of the multifidus (MF), semispinalis cervicis (SCer), semispinalis capitis (SCap) and splenius capitis (SPL) muscles in patients with degenerative cervical myelopathy (DCM), and evaluate their correlations with clinical symptoms and functional scores. Cervical muscle alterations have been reported in patients with chronic neck pain, but the assessment of cervical muscle morphology has been overlooked in patients with DCM. Thirty-eight patients diagnosed with DCM and spinal cord compression at C4-C5 or C5-C6 (first level of compression) were included. Cervical muscle measurements of cross-sectional area (CSA) and ratio of functional CSA (fat free area, FCSA) to total CSA were obtained from T2-weighted axial images at the level above, same, and level below the most cranial level of spinal cord compression. Muscle fatty infiltration and asymmetry was assessed at every level and their associations with respect to clinical signs and symptoms and functional scores were investigated. There was a significant increase in fatty infiltration (decrease in FCSA/CSA ratio) of the MF (p = 0.001) and SPL (p < 0.001) muscles at the level below the spinal cord compression. A significant increase in MF CSA asymmetry was also observed at the level below the compression. Lower MF FCSA/CSA ratio was associated longer 30-meters walking test time. Lower SCer FCSA/CSA was associated with corticospinal distribution motor deficits and atrophy of the hands. Greater asymmetry in SCap CSA was associated with higher Neck Disability Index (NDI) scores while lower asymmetry in MF CSA was associated with a positive Hoffman sign and weakness. A significant increase in muscle fatty infiltration and CSA asymmetry at the level below the compression was observed in patients with DCM. Our results also suggest an association between cervical muscle morphology and DCM clinical symptoms and functional status.

Broadening the Conceptualization of ‘Participation’ of Persons with Physical Disabilities: A Configurative Review and Recommendations.

Authors: Martin Ginis KA, Evans MB, Mortenson WB, Noreau LM.
Published in: Arch Phys Med Rehabil. 2016 May 20.
About: Within the context of physical disability, participation has typically been conceptualized in terms of one’s performance of different roles and activities. This perspective, however, ignores the meanings and satisfactions that a person derives from participating. Without an accepted conceptualization of participation that accounts for people’s subjective perceptions and experiences, it is challenging for decision-makers and service-providers to design meaningful participation-enhancing services, programs, and policies. Accordingly, our objectives were to: (a) conduct a review of definitions and conceptualizations of participation that extend beyond performance and capture people’s subjective experiences of participating, and (b) identify key experiential aspects of participation that can be used as a basis for conceptualizing and operationalizing the concept more broadly. The project involved a systematic, configurative review of relevant literature. Ten relevant articles were identified. Information on characteristics associated with experiential aspects of participation was extracted and subjected to a thematic analysis. Six themes emerged: Autonomy, Belongingness, Challenge, Engagement, Mastery, and Meaning. Drawing on these findings, it is recommended that the individual’s subjective perceptions of autonomy, belongingness, challenge, engagement, mastery and meaning associated with participating be incorporated into conceptualizations and operationalizations of the participation construct. This recommendation provides a starting point for clinicians, researchers and policy makers to conceptualize and measure the participation concept more consistently and more broadly.

The influence of the modulus-density relationship and the material mapping method on the simulated mechanical response of the proximal femur in side-ways fall loading configuration.

Authors: Pakyari M, Farokhi A, Khosravi M, Kilani RT, Ghahary A, Brown E.
Published in: Wound Repair Regen. 2016 May 19.
About: Skin transplantation provides an excellent potential model to investigate the immunology of allograft rejection and tolerance induction. Despite the theoretical ease of performing skin transplantation, as well as the potential of directly observing the reaction to the transplanted tissue, the poor reliability of skin transplantation in the mouse has largely precluded the use of this model. Furthermore, there is controversy regarding the most appropriate skin graft donor site due to poor success of back skin transplantation, as compared to the thinner ear or tail skin. The current study demonstrates a reliable method to successfully perform skin grafts in a mouse model, as well as the clinical and histologic outcome of syngeneic grafts. A total of 287 grafts were performed (in 126 mice) utilizing donor skin from the ear, tail or back. No graft failure or postoperative mortality was observed. Comparison of the current technique with two previously established protocols of skin transplantation (5.0 absorbable Suture + tissue glue technique and no-suture technique) demonstrates the significant improvement in the engraftment success of the new technique. In summary, a new technique for murine skin grafting demonstrates improved reliability across donor site locations and strains, increasing the potential for investigating interventions to alter the rejection process.

The influence of the modulus-density relationship and the material mapping method on the simulated mechanical response of the proximal femur in side-ways fall loading configuration.

Authors: Helgason B, Gilchrist S, Ariza O, Vogt P, Enns-Bray W, Widmer RP, Fitze T, Pálsson H, Pauchard Y, Guy P, Ferguson SJ, Cripton PA.
Published in: Med Eng Phys. 2016 Jul;38(7):679-89.
About: Contributing to slow advance of finite element (FE) simulations for hip fracture risk prediction, into clinical practice, could be a lack of consensus in the biomechanics community on how to map properties to the models. Thus, the aim of the present study was first, to systematically quantify the influence of the modulus-density relationship (E-ρ) and the material mapping method (MMM) on the predicted mechanical response of the proximal femur in a side-ways fall (SWF) loading configuration and second, to perform a model-to-model comparison of the predicted mechanical response within the femoral neck for all the specimens tested in the present study, using three different modelling techniques that have yielded good validation outcome in terms of surface strain prediction and whole bone response according to the literature. We found the outcome to be highly dependent on both the E-ρ relationship and the MMM. In addition, we found that the three modelling techniques that have resulted in good validation outcome in the literature yielded different principal strain prediction both on the surface as well as internally in the femoral neck region of the specimens modelled in the present study. We conclude that there exists a need to carry out a more comprehensive validation study for the SWF loading mode to identify which combination of MMMs and E-ρ relationship leads to the best match for whole bone and local mechanical response. The MMMs tested in the present study have been made publicly available at https://simtk.org/home/mitk-gem.

Effect of a tailored assistive technology intervention on older adults and their family caregiver: a pragmatic study protocol

Authors: Demers L, Mortenson WB, Fuhrer MJ, Jutai JW, Plante M, Mah J, DeRuyter F.
Published in: BMC Geriatr. 2016 May 13;16:103.
About: Many older adults with mobility limitations use assistive technology to help them perform daily activities. However, little attention has been paid to the impact on their family caregivers. This neglect produces an incomplete portrayal of the outcomes of assistive technology provision. This paper describes the protocol for a study that examines the impact of a tailored assistive technology intervention that is inclusive of assistance users and their family caregivers. This research will use a combination of quantitative and qualitative methods. The quantitative portion will be an experimental, single-blinded study in which participants are randomly assigned to either an experimental assistive technology intervention or a standard care group. We will enroll 240 participants (120 dyads) into the study from three Canadian sites. Participants will include older adults (>55) and family caregivers who provide ≥4 h per week of assistance with daily activities and social participation. The primary outcome measure for the older adults will be the Functional Autonomy Measurement System, and the primary outcome measure for the caregivers will be the Caregiver Assistive Technology Outcomes Measure. Qualitative data will be collected through detailed records of the therapists’ interventions, as well as through interviews with dyads and therapists following the interventions. Data collection will occur at baseline (T0) with follow-ups at 6 weeks (T1), 22 weeks (T2), and 58 weeks (T3) after baseline evaluation. The findings from this study will help service providers and clinicians to move forward with assistive technology recommendations that are more attuned to the needs of both older adults with mobility limitations and their family caregivers. Additionally, the study’s findings will enhance our conceptual understanding of the spectrum of assistive technology outcomes and set the stage for econometric studies assessing cost-effectiveness.

Development of a Nano-fibrous Wound Dressing with an Anti-fibrogenic Properties In Vitro and In Vivo model

Authors: Wellington CL, Frikke-Schmidt R.
Published inCurr Opin Lipidol. 2016 Jun;27(3):225-32.
About: This article evaluates recent experimental and human evidence regarding the involvement of lipids, lipoproteins, and apolipoproteins in neurodegenerative diseases, and reviews the current literature of the effects of cholesterol-lowering treatment on cognition. Plasma levels of traditional lipids and lipoproteins are not consistently associated with risk of dementia even though low plasma levels of apolipoprotein E, through unknown mechanisms, robustly predict future dementia. Experimental evidence suggests neuroprotective roles of several brain and cerebrospinal fluid apolipoproteins. Whether plasma levels of apolipoprotein E, or any other apolipoprotein with possible central nervous system and/or blood-brain barrier functions (apolipoproteins J, A-I, A-II, A-IV, D, C-I, and C-III) may become accessible biomarker components that improve risk prediction for dementia together with genetic risk variants and cardiovascular risk factors remains to be determined. Apolipoproteins with well established functions in peripheral lipid metabolism may play important roles for brain vascular health and Alzheimer’s disease pathophysiology. Experimental work on lipids, lipoproteins, and apolipoproteins in the central nervous system together with robust prospective human studies will help to substantiate the drug target potential of these lipid components.

Development of a Nano-fibrous Wound Dressing with an Anti-fibrogenic Properties In Vitro and In Vivo model

Authors: Poormasjedi-Meibod MS, Pakyari M, Jackson JK, Salimi Elizei S, Ghahary A.
Published in: J Biomed Mater Res A. 2016 May 3.
About: Dermal fibrosis, characterized by excessive extracellular matrix (ECM), is a pathological condition with limited effective therapeutic modalities. Lack of an anti-scarring dressing further impedes the preventive measures for this condition. Here we developed a novel anti-scarring dressing and investigated its potential as a slow-releasing vehicle for kynureninc acid (KynA), an anti-fibrotic agent. KynA was incorporated into polymethyl methacrylate (PMMA) nanofibers, containing increasing concentration of polyethylene glycol (PEG). Fibre morphology, water absorption capacity, surface hydrophilicity, in vitro drug release profile and in vivo anti-fibrotic effects were investigated. Increasing concentrations of PEG (1-20%) significantly increased surface hydrophilicity, water absorption capacity and drug release. Based on the obtained release profiles, PMMA+10%PEG was the preferred formulation for sustained KynA release up to 120 hours. In vitro studies confirmed the preservation of KynA anti-fibrotic properties during electrospinning, indicated by fibroblasts proliferation suppression and ECM expression modulation. In vivo application of KynA-incorporated films significantly inhibited collagen (23.89±4.79 vs. 6.99±0.41, Col-I/β-actin mRNA expression, control vs. treated) and fibronectin expression (7.18±1.09 vs. 2.31±0.05, Fibronectin/β-actin mRNA expression, control vs. treated) and enhanced the production of an ECM degrading enzyme (2.03±0.88 vs. 11.88±1.16 MMP-1/β-actin mRNA expression, control vs. treated). The fabricated KynA-incorporated films can be exploited as anti-fibrotic wound dressings.

Functionalizing Ascl1 with Novel Intracellular Protein Delivery Technology for Promoting Neuronal Differentiation of Human Induced Pluripotent Stem Cells

Authors: Robinson M, Chapani P, Styan T, Vaidyanathan R, Willerth SM.
Published in: Stem Cell Rev. 2016 May 2.
About: Pluripotent stem cells can become any cell type found in the body. Accordingly, one of the major challenges when working with pluripotent stem cells is producing a highly homogenous population of differentiated cells, which can then be used for downstream applications such as cell therapies or drug screening. The transcription factor Ascl1 plays a key role in neural development and previous work has shown that Ascl1 overexpression using viral vectors can reprogram fibroblasts directly into neurons. Here we report on how a recombinant version of the Ascl1 protein functionalized with intracellular protein delivery technology (Ascl1-IPTD) can be used to rapidly differentiate human induced pluripotent stem cells (hiPSCs) into neurons. We first evaluated a range of Ascl1-IPTD concentrations to determine the most effective amount for generating neurons from hiPSCs cultured in serum free media. Next, we looked at the frequency of Ascl1-IPTD supplementation in the media on differentiation and found that one time supplementation is sufficient enough to trigger the neural differentiation process. Ascl1-IPTD was efficiently taken up by the hiPSCs and enabled rapid differentiation into TUJ1-positive and NeuN-positive populations with neuronal morphology after 8 days. After 12 days of culture, hiPSC-derived neurons produced by Ascl1-IPTD treatment exhibited greater neurite length and higher numbers of branch points compared to neurons derived using a standard neural progenitor differentiation protocol. This work validates Ascl1-IPTD as a powerful tool for engineering neural tissue from pluripotent stem cells.

Social Media Representation of Chronic Cerebrospinal Venous Insufficiency Intervention for Multiple Sclerosis..

Authors: Ghahari S, Forwell SJ.
Published in: Int J MS Care. 2016 Mar-Apr;18(2):49-57.
About: We conducted a rigorous review of videos related to multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI) treatment posted by people with MS on one social media website (YouTube) that describe symptoms before and after the surgical procedure, as well as videos presented by health-care professionals (HCPs). All relevant videos posted from December 2009 to July 2011 were downloaded, viewed, and systematically organized. Categorical data were classified, and dominant messages were gleaned. A total of 1789 videos were extracted. A total of 621 videos by people with MS and 238 by HCPs were included. Eighty-six percent of people with MS anecdotally reported experiencing some improvement in at least one symptom. The most common message was that “CCSVI is not a miracle but worth trying.” Most HCPs posting videos recommended the procedure but called for continued research. We conclude that social media are conveying an anecdotal favorable message about CCSVI treatment for MS. The relative absence of videos offering a negative or more balanced perspective is a concern. Social persuasion through these videos creates a strong positive impression of CCSVI treatment, but the videos do not acknowledge the lack of supporting scientific evidence and the possible role of the placebo effect. Given the strong influence of social media on health-care decision making, researchers and clinicians should actively use social media to reach out to people with MS and describe the state of the evidence for MS treatments, both positive and negative.

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine.

Authors: Street JT, Andrew Glennie R, Dea N, DiPaola C, Wang Z, Boyd M, Paquette SJ, Kwon BK, Dvorak MF, Fisher CG.
Published in: J Neurosurg Spine. 2016 Apr 22:1-7.
About: The objective of this study was to determine if there is a significant difference in surgical site infection (SSI) when comparing the Wiltse and midline approaches for posterior instrumented interbody fusions of the lumbar spine and, secondarily, to evaluate if the reoperation rates and specific causes for reoperation were similar for both approaches. A total of 358 patients who underwent 1- or 2-level posterior instrumented interbody fusions for degenerative lumbar spinal pathology through either a midline or Wiltse approach were prospectively followed between March 2005 and January 2011 at a single tertiary care facility. A retrospective analysis was performed primarily to evaluate the incidence of SSI and the incidence and causes for reoperation. Secondary outcome measures included intraoperative complications, blood loss, and length of stay. A matched analysis was performed using the Fisher’s exact test and a logistic regression model. The matched analysis controlled for age, sex, comorbidities, number of index levels addressed surgically, number of levels fused, and the use of bone grafting. All patients returned for follow-up at 1 year, and adverse events were followed for 2 years. The rate of SSI was greater in the midline group (8 of 103 patients; 7.8%) versus the Wiltse group (1 of 103 patients; 1.0%) (p = 0.018). Fewer additional surgical procedures were performed in the Wiltse group (p = 0.025; OR 0.47; 95% CI 0.23-0.95). Proximal adjacent segment failure requiring reoperation occurred more frequently in the midline group (15 of 103 patients; 14.6%) versus the Wiltse group (6 of 103 patients; 5.8%) (p = 0.048). Blood loss was significantly lower in the Wiltse group (436 ml) versus the midline group (703 ml); however, there was no significant difference between the 2 groups in intraoperative complications or length of stay. The patients who underwent the Wiltse approach had a decreased risk of wound breakdown and infection, less blood loss, and fewer reoperations than the midline patients. The risk of adjacent segment failure in short posterior constructs is lower with a Wiltse approach.

Health state descriptions, valuations and individuals’ capacity to walk: a comparative evaluation of preference-based instruments in the context of spinal cord injury.

Authors: Whitehurst DG, Mittmann N, Noonan VK, Dvorak MF, Bryan S.
Published in: Qual Life Res. 2016 Apr 20.
About: This study explores variation in health state descriptions and valuations derived from preference-based health-related quality of life instruments in the context of spinal cord injury (SCI). Individuals living with SCI were invited to complete a web-based, cross-sectional survey. The survey comprised questions regarding demographics, SCI classifications and characteristics, secondary health complications and conditions, quality of life and SCI-specific functioning in activities of daily living. Four preference-based health status classification systems were included; Assessment of Quality of Life 8-dimension questionnaire (AQoL-8D), EQ-5D-5L, Health Utilities Index (HUI) and SF-6D (derived from the SF-36v2). In addition to descriptive comparisons of index scores and item/dimension responses, analyses explored dimension-level correlation and absolute agreement (intraclass correlation coefficient (ICC)). Subgroup analyses examined the influence of individuals’ self-reported ability to walk. Of 609 invitations, 364 (60 %) individuals completed the survey. Across instruments, convergent validity was seen between pain and mental health dimensions, while sizeable variation pertaining to issues of mobility was observed. Mean index scores were 0.248 (HUI-3), 0.492 (EQ-5D-5L), 0.573 (AQoL-8D) and 0.605 (SF-6D). Agreement ranged from ‘slight’ (HUI-3 and SF-6D; ICC = 0.124) to ‘moderate’ (AQoL-8D and SF-6D; ICC = 0.634). Walking status had a markedly different impact on health state valuations across instruments. Variation in the way that individuals are able to describe their health state across instruments is not unique to SCI. Further research is necessary to understand the significant differences in index scores and, in particular, the implications of framing mobility-related questions in the context of respondents’ ability to walk.

Regionally distinct cutaneous afferent populations contribute to reflex modulation evoked by stimulation of the tibial nerve during walking.

Authors: Nakajima T, Suzuki S, Futatsubashi G, Ohtsuska H, Mezzarane RA, Barss TS, Klarner T, Zehr EP, Komiyama T.
Published in: J Neurophysiol. 2016 Apr 13:jn.01011.2015.
About: During walking, cutaneous reflexes in ankle flexor muscle (tibialis anterior: TA) evoked by tibial nerve (TIB) stimulation are predominantly facilitatory at early swing phase, but reverse to suppression at late swing phase. Although the TIB innervates a large portion of the skin of foot sole, the extent to which specific foot sole regions contribute to the reflex reversals during walking remains unclear. Therefore, we investigated regional cutaneous contributions from discrete portions of the foot sole on reflex reversal in TA following TIB stimulation during walking. Summation effects on reflex amplitudes when applying combined stimulation from foot sole regions with TIB were examined. Middle latency responses (MLRs: 70-120 ms) after TIB stimulation were strongly facilitated during the late stance to mid-swing phases and reversed to suppression just before heel strike. Both forefoot medial (f-M) and forefoot lateral (f-L) stimulation in foot sole induced facilitation during stance to swing transition phases, but heel (HL) stimulation evoked suppression during the late stance to the end of swing phases. At the stance to swing transition, a summation of MLR amplitude occurred only for combined f-M&TIB stimulation. However, the same was not true for the combined HL&TIB stimulation. At the swing to stance transition, there was a suppressive reflex summation only for HL&TIB stimulation. In contrast, this summation was not observed for the f-M&TIB stimulation. Our results suggest that reflex reversals evoked by TIB stimulation arise from distinct reflex pathways to TA produced by separate afferent populations innervating specific regions of the foot sole.

Differences in Left Ventricular Global Function and Mechanics in Paralympic Athletes with Cervical and Thoracic Spinal Cord Injuries.

Authors: Currie KD, West CR, Krassioukov AV.
Published in: Front Physiol. 2016 Mar 29;7:110.
About: Following a spinal cord injury, there are changes in resting stroke volume (SV) and its response to exercise. The purpose of the following study was to characterize resting left ventricular structure, function, and mechanics in Paralympic athletes with tetraplegia (TETRA) and paraplegia (PARA) in an attempt to understand whether the alterations in SV are attributable to inherent dysfunction in the left ventricle. This retrospective study compared Paralympic athletes with a traumatic, chronic (>1 year post-injury), motor-complete spinal cord injury (American Spinal Injury Association Impairment Scale A-B). Eight male TETRA wheelchair rugby players (34 ± 5 years, C5-C7) and eight male PARA alpine skiers (35 ± 5 years, T4-L3) were included in the study. Echocardiography was performed in the left lateral decubitus position and indices of left ventricular structure, global diastolic and systolic function, and mechanics were derived from the average across three cardiac cycles. Blood pressure was measured in the supine and seated positions. All results are presented as TETRA vs. PARA. There was no difference in left ventricular dimensions between TETRA and PARA. Additionally, indices of global diastolic function were similar between groups including isovolumetric relaxation time, early (E) and late (A) transmitral filling velocities and their ratio (E/A). While ejection fraction was similar between TETRA and PARA (59 ± 4 % vs. 61 ± 7 %, p = 0.394), there was evidence of reduced global systolic function in TETRA including lower SV (62 ± 9 ml vs. 71 ± 6 ml, p = 0.016) and cardiac output (3.5 ± 0.6 L/min vs. 5.0 ± 0.9 L/min, p = 0.002). Despite this observation, several indices of systolic and diastolic mechanics were maintained in TETRA but attenuted in PARA including circumferential strain at the level of the papillary muscle (-23 ± 4% vs. -15 ± 6%, p = 0.010) and apex (-36 ± 10% vs. -23 ± 5%, p = 0.010) and their corresponding diastolic strain rates (papillary: 1.90 ± 0.63 s(-1) vs. 1.20 ± 0.51 s(-1), p = 0.028; apex: 3.03 ± 0.71 s(-1) vs. 1.99 ± 0.69 s(-1), p = 0.009). All blood pressures were lower in TETRA. The absence of an association between reduced global systolic function and mechanical dysfunction in either TETRA or PARA suggests any reductions in SV are likely attributed to impaired loading rather than inherent left ventricular dysfunction.

Balance Confidence: A Predictor of Perceived Physical Function, Perceived Mobility, and Perceived Recovery 1 Year After Inpatient Stroke Rehabilitation.

Authors: Torkia C, Best KL, Miller WC, Eng JJ.
Published in: Arch Phys Med Rehabil. 2016 Apr 6.
About: The objective of this study was to estimate the effect of balance confidence measured at 1 month poststroke rehabilitation on perceived physical function, mobility, and stroke recovery 12 months later. Balance confidence at 1 month postdischarge from inpatient rehabilitation predicts perceived physical function (model 1), mobility (model 2), and recovery (model 3) 12 months later after adjusting for important covariates. The covariates included in model 1 were age, sex, basic mobility, and depression. The covariates selected for model 2 were age, sex, balance capacity, and anxiety, and the covariates in model 3 were age, sex, walking capacity, and social support. The amount of variance in perceived physical function, perceived mobility, and perceived recovery that balance confidence accounted for was 12%, 9%, and 10%, respectively. After discharge from inpatient rehabilitation poststroke, balance confidence predicts individuals’ perceived physical function, mobility, and recovery 12 months later. There is a need to address balance confidence at discharge from inpatient stroke rehabilitation.

Re-Establishment of Cortical Motor Output Maps and Spontaneous Functional Recovery via Spared Dorsolaterally Projecting Corticospinal Neurons after Dorsal Column Spinal Cord Injury in Adult Mice.

Authors: Hilton BJ, Anenberg E, Harrison TC, Boyd JD, Murphy TH, Tetzlaff W.
Published inJ Neurosci. 2016 Apr 6;36(14):4080-92.
About: Motor cortical plasticity contributes to spontaneous recovery after incomplete spinal cord injury (SCI), but the pathways underlying this remain poorly understood. We performed optogenetic mapping of motor cortex in channelrhodopsin-2 expressing mice to assess the capacity of the cortex to re-establish motor output longitudinally after a C3/C4 dorsal column SCI that bilaterally ablated the dorsal corticospinal tract (CST) containing ∼96% of corticospinal fibers but spared ∼3% of CST fibers that project via the dorsolateral funiculus. Optogenetic mapping revealed extensive early deficits, but eventual reestablishment of motor cortical output maps to the limbs at the same latency as preoperatively by 4 weeks after injury. Analysis of skilled locomotion on the horizontal ladder revealed early deficits followed by partial spontaneous recovery by 6 weeks after injury. To dissociate between the contributions of injured dorsal projecting versus spared dorsolateral projecting corticospinal neurons, we established a transient silencing approach to inactivate spared dorsolaterally projecting corticospinal neurons specifically by injecting adeno-associated virus (AAV)-expressing Cre-dependent DREADD (designer receptor exclusively activated by designer drug) receptor hM4Di in sensorimotor cortex and AAV-expressing Cre in C7/C8 dorsolateral funiculus. Transient silencing uninjured dorsolaterally projecting corticospinal neurons via activation of the inhibitory DREADD receptor hM4Di abrogated spontaneous recovery and resulted in a greater change in skilled locomotion than in control uninjured mice using the same silencing approach. These data demonstrate the pivotal role of a minor dorsolateral corticospinal pathway in mediating spontaneous recovery after SCI and support a focus on spared corticospinal neurons as a target for therapy.

Evidence for an Age-Dependent Decline in Axon Regeneration in the Adult Mammalian Central Nervous System.

Authors: Geoffroy CG, Hilton BJ, Tetzlaff W, Zheng B.
Published in: Cell Rep. 2016 Apr 12;15(2):238-46.
About: How aging impacts axon regeneration after CNS injury is not known. We assessed the impact of age on axon regeneration induced by Pten deletion in corticospinal and rubrospinal neurons, two neuronal populations with distinct innate regenerative abilities. As in young mice, Pten deletion in older mice remains effective in preventing axotomy-induced decline in neuron-intrinsic growth state, as assessed by mTOR activity, neuronal soma size, and axonal growth proximal to a spinal cord injury. However, axonal regeneration distal to injury is greatly diminished, accompanied by increased expression of astroglial and inflammatory markers at the injury site. Thus, the mammalian CNS undergoes an age-dependent decline in axon regeneration, as revealed when neuron-intrinsic growth state is elevated. These results have important implications for developing strategies to promote axonal repair after CNS injuries or diseases, which increasingly affect middle-aged to aging populations

Soleus Hoffmann reflex amplitudes are specifically modulated by cutaneous inputs from the arms and opposite leg during walking but not standing.

Authors: Suzuki S, Nakajima T, Futatsubashi G, Mezzarane RA, Ohtsuka H, Ohki Y, Zehr EP, Komiyama T..
Published in: Exp Brain Res. 2016 Mar 31.
About: Electrical stimulation of cutaneous nerves innervating heteronymous limbs (the arms or contralateral leg) modifies the excitability of soleus Hoffmann (H-) reflexes. The differences in the sensitivities of the H-reflex pathway to cutaneous afferents from different limbs and their modulation during the performance of motor tasks (i.e., standing and walking) are not fully understood. In the present study, we investigated changes in soleus H-reflex amplitudes induced by electrical stimulation of peripheral nerves. Selected targets for conditioning stimulation included the superficial peroneal nerve, which innervates the foot dorsum in the contralateral ankle (cSP), and the superficial radial nerve, which innervates the dorsum of the hand in the ipsilateral (iSR) or contralateral wrist (cSR). Stimulation and subsequent reflex assessment took place during the standing and early-stance phase of treadmill walking in ten healthy subjects. Cutaneous stimulation produced long-latency inhibition (conditioning-test interval of ~100 ms) of the H-reflex during the early-stance phase of walking, and the inhibition was stronger following cSP stimulation compared with iSR or cSR stimulation. In contrast, although similar conditioning stimulation significantly facilitated the H-reflex during standing, this effect remained constant irrespective of the different conditioning sites. These findings suggest that cutaneous inputs from the arms and contralateral leg had reversible effects on the H-reflex amplitudes, including inhibitions with different sensitivities during the early-stance phase of walking and facilitation during standing. Furthermore, the differential sensitivities of the H-reflex modulations were expressed only during walking when the locations of the afferent inputs were functionally relevant.

H-GRASP: the feasibility of an upper limb home exercise program monitored by phone for individuals post stroke.

Authors: Simpson LA, Eng JJ, Chan M.
Published in: Disabil Rehabil. 2016 Mar 26:1-9.
About: The purpose of this study was to investigate the feasibility of a phone-monitored home exercise program for the upper limb following stroke. A pre-post double baseline repeated measures design was used. Participants completed an 8-week home exercise program that included behavioural strategies to promote greater use of the affected upper limb. Participants were monitored weekly by therapists over the phone. The following feasibility outcomes were collected: Process (e.g. recruitment rate); Resources (e.g. exercise adherence rate); Management (e.g. therapist monitoring) and Scientific (e.g. safety, effect sizes). Clinical outcomes included: The Chedoke Arm and Hand Inventory, Motor Activity Log, grip strength and the Canadian Occupational Performance Measure. The authors conclude that community dwelling individuals with stroke may benefit from a phone-monitored upper limb home exercise program that includes behavioural strategies that promote transfer of exercise gains into daily upper limb use. Implications for Rehabilitation A repetitive, task-oriented home exercise program that utilizes telephone supervision may be an effective method for the treatment of the upper limb following stroke This program is best suited for individuals with mild to moderate level impairment and experience a sufficient level of challenge from the exercises An exercise program that includes behavioural strategies may promote transfer of exercise gains into greater use of the affected upper limb during daily activities.

The Economic Burden of Autonomic Dysreflexia during Hospitalization for Individuals with Spinal Cord Injury

Authors:  Squair JW, White BA, Bravo GI, Martin Ginis KA, Krassioukov AV.
Published in: J Neurotrauma. 2016 Mar 22.
About: We sought to determine the economic burden of autonomic dysreflexia (AD) from the perspective of the Canadian healthcare system in a case series of individuals with spinal cord injury (SCI) presenting to emergency care. In doing so, we sought to illustrate the potential return on investments in the translation of evidence-informed practices and developments in the prevention, diagnosis, and management of AD. Activity-based costing methodology was employed to estimate the direct healthcare or hospitalization costs of AD following presentation to the emergency department. Differences in trends were noted between patients who were promptly diagnosed, managed, and discharged, and patients whose experience followed a less direct or ideal path to discharge. We recorded 29 emergency room visits for conditions ultimately diagnosed as AD. Overall, median length of stay was 3 days (interquartile range [IQR] = 1.25-5.75), but extended up to 103 consecutive days. Cost analysis revealed median healthcare costs of $5029 (IQR = $2397-9522) for hospital admissions for AD, with the highest estimated hospital cost for a single admission > $190,000. Emergency room admissions resulting from AD can result in dramatic healthcare costs. Delayed diagnosis and inefficient management of AD may lead to further complications, adding to the strain on already limited healthcare resources. Prompt recognition of AD; broader translation of evidence-informed practices; and novel diagnosis, self-management, and/or therapeutic/pharmaceutical applications may prove to mitigate the burden of AD and improve patient well-being.

Reflections on Physical Activity and Health: What Should We Recommend?

Authors:  Warburton DE, Bredin SS.
Published in: Can J Cardiol. 2016 Apr;32(4):495-504. doi: 10.1016/j.cjca.2016.01.024.
About: The health benefits of regular physical activity are irrefutable; virtually everyone can benefit from being active. The evidence is overwhelming with risk reductions of at least 20%-30% for more than 25 chronic medical conditions and premature mortality. Even higher risk reductions (ie, ≥ 50%) are observed when objective measures of physical fitness are taken. International physical activity guidelines generally recommend 150 minutes per week of moderate- to vigorous-intensity physical activity. A critical review of the literature indicates that half of this volume of physical activity might lead to marked health benefits. There is compelling evidence to support health promotion strategies that emphasize that health benefits can be accrued at a lower volume and/or intensity of physical activity. Public health policies are needed that reduce the barriers to physical activity participation such that everyone can reap the benefits of physical activity. It is also important to highlight that sedentary time (particularly sitting time) carries independent health risks. The simple message of “move more and sit less” likely is more understandable by contemporary society and is formed on the basis of a strong body of evidence. For practitioners who work directly with clients, it is recommended that an individualized prescription (dosage) that takes into consideration the unique characteristics and needs of the client is provided. Physical activity or exercise promotion should not be done in isolation; it should be part of an integrated approach to enhance healthy lifestyle behaviours.

Neuregulin-1 controls an endogenous repair mechanism after spinal cord injury.

Authors:  Bartus K, Galino J, James ND, Hernandez-Miranda LR, Dawes JM, Fricker FR, Garratt AN, McMahon SB, Ramer MS, Birchmeier C, Bennett DL, Bradbury EJ.
Published inBrain. 2016 Mar 17. pii: aww039.
About: Following traumatic spinal cord injury, acute demyelination of spinal axons is followed by a period of spontaneous remyelination. However, this endogenous repair response is suboptimal and may account for the persistently compromised function of surviving axons. Spontaneous remyelination is largely mediated by Schwann cells, where demyelinated central axons, particularly in the dorsal columns, become associated with peripheral myelin. The molecular control, functional role and origin of these central remyelinating Schwann cells is currently unknown. The growth factor neuregulin-1 (Nrg1, encoded by NRG1) is a key signalling factor controlling myelination in the peripheral nervous system, via signalling through ErbB tyrosine kinase receptors. Here we examined whether Nrg1 is required for Schwann cell-mediated remyelination of central dorsal column axons and whether Nrg1 ablation influences the degree of spontaneous remyelination and functional recovery following spinal cord injury. In contused adult mice with conditional ablation of Nrg1, we found an absence of Schwann cells within the spinal cord and profound demyelination of dorsal column axons. There was no compensatory increase in oligodendrocyte remyelination. Removal of peripheral input to the spinal cord and proliferation studies demonstrated that the majority of remyelinating Schwann cells originated within the injured spinal cord. We also examined the role of specific Nrg1 isoforms, using mutant mice in which only the immunoglobulin-containing isoforms of Nrg1 (types I and II) were conditionally ablated, leaving the type III Nrg1 intact. We found that the immunoglobulin Nrg1 isoforms were dispensable for Schwann cell-mediated remyelination of central axons after spinal cord injury. When functional effects were examined, both global Nrg1 and immunoglobulin-specific Nrg1 mutants demonstrated reduced spontaneous locomotor recovery compared to injured controls, although global Nrg1 mutants were more impaired in tests requiring co-ordination, balance and proprioception. Furthermore, electrophysiological assessments revealed severely impaired axonal conduction in the dorsal columns of global Nrg1 mutants (where Schwann cell-mediated remyelination is prevented), but not immunoglobulin-specific mutants (where Schwann cell-mediated remyelination remains intact), providing robust evidence that the profound demyelinating phenotype observed in the dorsal columns of Nrg1 mutant mice is related to conduction failure. Our data provide novel mechanistic insight into endogenous regenerative processes after spinal cord injury, demonstrating that Nrg1 signalling regulates central axon remyelination and functional repair and drives the trans-differentiation of central precursor cells into peripheral nervous system-like Schwann cells that remyelinate spinal axons after injury. Manipulation of the Nrg1 system could therefore be exploited to enhance spontaneous repair after spinal cord injury and other central nervous system disorders with a demyelinating pathology.

Reduction in bladder-related autonomic dysreflexia following onabotulinumtoxinA treatment in spinal cord injury.

Authors:  Fougere RJ, Currie KD, Nigro M, Stothers L, Rapoport D, Krassioukov AV.
Published in: J Neurotrauma. 2016 Mar 16.
About: Bladder-related events, including neurogenic detrusor over activity, are the leading cause of autonomic dysreflexia in spinal cord injured individuals. Self-reported autonomic dysreflexia is reduced following OnabotulinumtoxinA treatment for neurogenic detrusor over activity; however none of these trials have assessed autonomic dysreflexia events using the clinical cut-off of an increase in systolic blood pressure ≥20 mmHg. This study used a prospective, open-labelled design from 2013 to 2014 to quantitatively assess the efficacy of one cycle 200 U intra-detrusor injected OnabotulinumtoxinA (20 sites) on reducing the severity and frequency of bladder-related autonomic dysreflexia events and improving quality of life. Twelve men and five women with chronic, traumatic spinal cord injuries at or above the sixth thoracic level, and concomitant autonomic dysreflexia and neurogenic detrusor over activity underwent blood pressure monitoring during urodynamics and over a 24-h period using ambulatory blood pressure monitoring pre and one month post treatment. Post-OnabotulinumtoxinA, autonomic dysreflexia severity was reduced during urodynamics (systolic blood pressure increase: 42±23 mmHg vs. 20±10 mmHg, p<0.001) and during bladder-related events across the 24-h period (systolic blood pressure increase: 49±2 mmHg vs. 26±22 mmHg, p=0.004). Frequency of 24-h bladder-related autonomic dysreflexia events was also decreased post-OnabotulinumtoxinA (4±2 events vs. 1±1 events, p<0.001). Autonomic dysreflexia and incontinence quality of life indices were also improved post-OnabotulinumtoxinA (p<0.05). Intra-detrusor injections of OnabotulinumtoxinA for the management of neurogenic detrusor overactivity in individuals with high level spinal cord injuries decreased the severity and frequency of bladder-related episodes of autonomic dysreflexia, and improved bladder function and quality of life.

Distinct roles for metalloproteinases during traumatic brain injury

Authors: Zhang S, Kojic L, Tsang M, Grewal P, Liu J, Namjoshi D, Wellington CL,Tetzlaff W, Cynader MS, Jia W.
Published in: Neurochem Int. 2016 Mar 3. pii: S0197-0186(16)30023-7.
About: Significant protease activations have been reported after traumatic brain injury (TBI). These proteases are responsible for cleavage of transmembrane proteins in neurons, glial, and endothelial cells and this results in the release of their extracellular domains (ectodomains). Two TBI models were employed in this study, representing both closed head injury (CHI) and open head injury (OHI). In situ zymography, immunohistochemistry, bright field and confocal microscopy, quantification of immunopositive cells and statistical analysis were applied. The researchers found, using in situ zymography, that gelatinase activity of matrix metalloproteinases (MMP)-2 and MMP-9 was upregulated in cortex of both injury models. Using immunohistochemistry for several MPPs (Matrix metalloproteinases) and ADAMs (disintegrin and metalloproteinases), including MMP-2, -9, ADAM-10, -17, distinct patterns of induction were observed in the two TBI models. In closed head injury, an early increase in protein expression of MMP-2, -9 and ADAM-17 was found as early as 10 min post injury in cortex and peaked at 1 h for all 4 proteases examined. In contrast, after OHI the maximal expression was observed locally neighboring the impact site, at a later time-point, as long as 24 h after the injury for MMP-2 and MMP-9. Confocal microscopy revealed colocalization of the 4 proteases with the neuronal marker NeuN in CHI, but only MMP2 colocalized with NeuN in OHI. The researchers conclude that The findings may lead to a trauma-induced therapeutic strategy triggered soon after a primary insult to improve survival and to reduce brain damage following TBI.

The dynamics of electric powered wheelchair sideways tips and falls: experimental and computational analysis of impact forces and injury.

Authors: Erickson B, Hosseini MA, Mudhar PS, Soleimani M, Aboonabi A, Arzanpour S, Sparrey CJ.
Published in: J Neuroeng Rehabil. 2016 Mar 2;13(1):20. doi: 10.1186/s12984-016-0128-7.
About: To reduce the occurrence of wheelchair falls and to develop effective protection systems, the researchers aimed to quantify sideways tip and fall dynamics of electric power wheelchairs (EPWs). They hypothesized that driving speed, curb height and angle of approach would affect impact forces and head injury risk for wheelchair riders. The researchers further expected that fall dynamics and head injury risk would be greater for unrestrained riders compared to restrained riders. WThe researchers concluded that sideways tips and forward falls from wheelchairs were most sensitive to curb height and approach angle but were not affected by driving speed. Sideways tips and falls resulted in impact forces that could result in concussions or traumatic brain injury and require injury prevention strategies. Seat belts eliminated the risk of falling from an upright chair and reduced head impact forces in sideways wheelchair tips in this study; however, their use must be considered within the ethical and legal definitions of restraints.

Morphological and postural sexual dimorphism of the lumbar spine facilitates greater lordosis in females

Authors: Bailey JF, Sparrey CJ, Been E, Kramer PA.
Published in: Anat. 2016 Feb 24. doi: 10.1111/joa.12451.
About: Previous work suggests females are evolutionarily adapted to have greater lumbar lordosis than males to aid in pregnancy load-bearing, but no consensus exists. To explore further sex-differences in the lumbar spine, and to understand contradictions in the literature, we conducted a cross-sectional retrospective study of sex-differences in lumbar spine morphology and sacral orientation. In addition, our sample includes data for separate standing and supine samples of males and females to examine potential sex-differences in postural loading on lumbosacral morphology. We measured sagittal lumbosacral morphology on 200 radiographs. Measurements include: lumbar angle (L1–S1), lumbar vertebral body and disc wedging angles, sacral slope and pelvic incidence. Lumbar angle, representative of lordotic curvature between L1 and S1, was 7.3° greater in females than males, when standing. There were no significant sex-differences in lumbar angle when supine. This difference in standing lumbar angle can be explained by greater lordotic wedging of the lumbar vertebrae (L1–L5) in females. Additionally, sacral slope was greater in females than males, when standing. There were no significant sex-differences in pelvic incidence. Our results support that females have greater lumbar lordosis than males when standing, but not when supine – suggesting a potentially greater range of motion in the female spine. Furthermore, sex-differences in the lumbar spine appear to be supported by postural differences in sacral-orientation and morphological differences in the vertebral body wedging. A better understanding of sex-differences in lumbosacral morphology may explain sex-differences in spinal conditions, as well as promote necessary sex-specific treatments.

The influence of a polymer damper on swing-through crutch gait biomechanics

Authors: MacGillivray MK, Moncha, RH, Sawatzky B.
Published in: Medical Engineering & Physics. 2016 March: 38(3):275-279.
About: Forearm crutch technology has evolved slowly compared to other assistive mobility devices, despite the highly repetitive nature of forearm crutch gait and the high incidence of overuse injuries. Using 13 able-bodied volunteers between the ages of 19 and 27, we compared the ground reaction forces of a novel crutch design featuring an elastomeric polymer situated below the handle to an identical design without a damper system and to a commercially available generic rigid forearm crutch model. There were no differences in peak vertical force or impulse between crutches. The crutch with the damper system demonstrated a significantly smaller peak braking force and impulse compared to the generic forearm crutch model. However, the crutch with the damper system demonstrated a significantly larger peak propulsive force and impulse compared to both crutch models. This finding indicates that a forearm crutch with a damper system may help to propel the crutch forward when walking on level surfaces, which could impact forward momentum.

Relationships between wheeling parameters and wheelchair skills in adults and children with SCI

AuthorsSawatzky B. Hers N, MacGillivray MK.
Published inSpinal Cord (2015) 53, 561–564;
About: The purpose of this study was to determine the relationships between the outcome using a special wheel to measure forces following the SmartWheel Clinical Protocol (SCP) and using  a standardized wheelchair skills test (WST)), among adults and children with spinal cord injury. Sixteen adults and eight children participated in this study. Multiple regression analyses were used to determine significant predictors smartwheel outcomes to the total WST score. Wheeling speed was a significant predictor of the WST score for all surfaces tested. Speed on a 5-deg sloped ramp had the strongest relationship with WST score. Therefore, when time is restricted, testing speed on a 5-deg ramp may be the most useful variable to evaluate. However, the authors do not believe that one single variable should ever replace a full assessment of skills.

Caregiving services in spinal cord injury: a systematic review of the literature

Authors: Smith EM, Boucher N, Miller WC.
Published in: Spinal Cord. 2016 Feb 23.
About: The purpose of the study was to summarize and characterize the literature pertaining to the nature of and factors associated with caregiving services provided to individuals with spinal cord injury (SCI) and identify areas for interventional research to address the needs of care recipients. The authors conclude that caregiving services in SCI are predominantly provided by informal caregivers who are female. Quality of care from informal caregivers matches or exceeds quality of formal care. Total hours of care are dependent on the injury level and severity and care needs of the individual. Caregiver training is an important theme and has positive preliminary results on the quality of care provided. Intervention-based research is limited; further research to increase independence in activities of daily living and instrumental activities of daily living would reduce the need for caregiving hours.

A comparison of flat and ramped, contoured cushions as adaptive seating interventions for children with neurological disorders.

Authors: McDonald R, Sawatzky B, Franck L.
Published in: Health Psychology and Behavioral Medicine,3(1), 69-81.
About: This study is a part of an ongoing effort to address the lack of rigorous, scientific evidence to inform the prescription of adaptive seating interventions for children with neurological disorders. The aim is to investigate one aspect of the seat – the cushion, at the same time as developing a battery of tests which are objective, easy to implement and reliable with which adaptive seating interventions can be measured. 35 school-aged children with neurological disorders were assessed to compare the use of a flat and a ramped, contoured cushion. The measures used were an accelerometer to measure stability, two actigraphs on the wrists to measure activity, a pressure mapping system to measure weight distribution, goniometry to measure posture and activities to measure function. The results generally support the use of ramped, contoured cushions over flat cushions. The accelerometer and pressure mapping system show particular promise in future research. The actigraphs were unreliable. The goniometry showed the most difference between cushions, although it was the least reliable to implement and the seated functional activities need further work. Accelerometry and pressure mapping showed particular promise in the area of adaptive seating, with further work required in other areas. In particular, it is recommended that future efforts pursue the use of more reliable electronic measurement.

Epidemiology of sport-related spinal cord injuries: A systematic review.

Authors: Chan CW, Eng JJ, Tator CH, Krassioukov A; Spinal Cord Injury Research Evidence Team.
Published in: J Spinal Cord Med. 2016 Feb 11.
About: Despite the recognition of sports as a significant contributor in the etiology of spinal cord injury (SCI), no studies have systematically explored the epidemiology of SCI caused by sports. This paper aims to give a systematic overview of the epidemiology of sport-related spinal cord injury around the world. A systematic review was conducted to identify published literature reporting the epidemiology of SCI caused by sports. This paper identifies countries and sports with higher rates of sport-related SCIs where implementation of prevention programs and reporting systems to track SCI epidemiology may be helpful, and highlights gaps in our current knowledge for further investigation. The comparison of SCI occurrence for each sport across countries, as well as examination of the specific characteristics of SCI incurred for individual sports will assist in directing efforts for prevention.

The Prevalence of Wheelchair and Scooter Use Among Community-Dwelling Canadians.

Authors: Smith EM, Giesbrecht EM, Mortenson WB, Miller WC.
Published in: Phys Ther. 2016 Feb 4.
About: Mobility impairments are the third leading cause of disability for community-dwelling Canadians. Wheelchairs and scooters (WCSs) help compensate for these challenges. There is limited data within the last decade estimating the prevalence of WCS use in Canada. The objective of this study was to estimate the prevalence of wheelchair and scooter use in Canada, and explore relevant demographic characteristics of wheelchair and scooter users using a secondary analysis of cross-sectional national survey. This analysis is the first in over 10 years to provide a prevalence estimate and description of WCS users in Canada. Since 2004, there has been an increase in the proportion of the population who use WCSs, likely related to an aging Canadian population. These new prevalence data have potential to inform policy, research, and clinical practice.

Systematic Review and Meta-Analysis of Peer-Led Self-Management Programs for Increasing Physical Activity.

Authors: Best KL, Miller WC, Eng JJ, Routhier F.
Published in: Int J Behav Med. 2016 Feb 4.
About: Approximately 85 % of Canadians are not physically active enough to achieve health benefits. Peer-led self-management programs are becoming an increasingly popular strategy for modifying health behaviors, including physical activity. The purpose of this study was to systematically review and meta-analyze the effect of peer-led self-management interventions on physical activity. PubMed, MEDLINE, PsycINFO, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews databases were systematically searched to identify all relevant randomized controlled trials that evaluated the effect of peer-led self-management on physical activity. The studies were described and effect size data were included in meta-analyses. Subgroup analyses were performed according to type of physical activity outcome (i.e., duration, frequency, other). Peer-led self-management programs appear to be effective at increasing weekly duration of physical activity in various populations, but the effect size is small. Training peers to encourage increased physical activity may provide an effective method for reaching various clinical and non-clinical populations. More research is needed using validated and consistent physical activity outcomes.

Transcutaneous Electrical Nerve Stimulation for Management of Limb Spasticity: A Systematic Review.

Authors: Mills PB, Dossa F.
Published inAm J Phys Med Rehabil. 2016 Jan 29.
About: The purpose of this systematic review was to summarize the effect of transcutaneous electrical nerve stimulation (TENS) for management of limb spasticity. Randomized controlled trials were searched using electronic databases through July 2015. Fourteen randomized controlled trials were included, involving 544 participants.Intervention protocols fit within three categories: 1) TENS vs. no TENS or placebo TENS (n = 7), 2) TENS vs. another TENS protocol or another intervention for spasticity management (n = 7), and 3) TENS as an adjunct to another intervention for spasticity management (n = 4). There was level 1 and 2 evidence for TENS improving spasticity-related outcome measures within the International Classification of Functioning, Disability, and Health domains of body structure and function (e.g., Modified Ashworth Scale) as well as activity (e.g., gait). Better responses in outcome measures in the International Classification of Functioning, Disability, and Health activity domain were seen when TENS was used in combination with active therapy (e.g., exercise and task-related training) vs. as a single therapeutic modality.

High-resolution myelin water imaging in post-mortem multiple sclerosis spinal cord: A case report.

Authors: Laule C, Yung A, Pavolva V, Bohnet B, Kozlowski P, Hashimoto SA, Yip S, Li DK, Moore GW.
Published inMult Scler. 2016 Jan 27.
About: Loss of myelin in the spinal cord in multiple sclerosis (MS) is likely an important, and early, contributor to atrophy and associated disability. In vivo measurement of myelin is possible using myelin water fraction (MWF) imaging, but MWF has never been assessed in MS along the entire length of the spinal cord in vivo or in post-mortem tissue. The objective of this study was to assess the feasibility of measuring the distribution of MWF along the entire length of the spinal cord in post-mortem MS tissue using high-field MRI. In this study, myelin water maps showed cord anatomy in superb detail, white matter demonstrating a higher MWF than the grey matter. Anatomical variation in myelin distribution along cervical, thoracic and lumbar regions was observed. Lesions demonstrated myelin loss. The authors conclude that post-mortem myelin water imaging of formalin-fixed MS spinal cord is feasible.

Development of an integrated staircase lift for home access.

Authors: Mattie JL, Borisoff JF, Leland D, Miller WC.
Published in: J Rehabil Assist Technol Eng. 2015 Dec;2.
About: Stairways into buildings present a significant environmental barrier for those with mobility impairments, including older adults. A number of home access solutions that allow users to safely enter and exit the home exist, however these all have some limitations. The purpose of this work was to develop a novel, inclusive home access solution that integrates a staircase and a lift into one device. The development of an integrated staircase lift followed a structured protocol with stakeholders providing feedback at various stages in the design process, consistent with rehabilitation engineering design methods. A novel home access device was developed. The integrated staircase-lift has the following features: inclusivity, by a universal design that provides an option for either use of stairs or a lift; constant availability, with a lift platform always ready for use on either level; and potential aesthetic advantages when integrating the device into an existing home. The potential also exists for emergency descent during a power outage, and self-powered versions. By engaging stakeholders in a user centred design process, insight on the limitations of existing home access solutions and specific feedback on our design guided development of a novel home access device.

Effects of Pain and Pain Management on Motor Recovery of Spinal Cord-Injured Patients: A Longitudinal Study.

Authors: Cragg JJ, Haefeli J, Jutzeler CR, Röhrich F, Weidner N, Saur M, Maier DD, Kalke YB, Schuld C, Curt A, Kramer JK.
Published in: Neurorehabil Neural Repair. 2016 Jan 7.
About: Approximately 60% of patients suffering from acute spinal cord injury (SCI) develop pain within days to weeks after injury, which ultimately persists into chronic stages. To date, the consequences of pain after SCI have been largely examined in terms of interfering with quality of life. The objective of this study was to examine the effects of pain and pain management on neurological recovery after SCI. While initial pain classification and intensity did not reveal an effect on motor recovery following acute SCI, anticonvulsants conferred a significant beneficial effect on motor outcomes. Early intervention with anticonvulsants may have effects beyond pain management and warrant further studies to evaluate the therapeutic effectiveness in human SCI.

No Place Like Home? Surveillance and What Home Means in Old Age.

Authors: Mortenson WB, Sixsmith A, Beringer R.
Published in: Can J Aging. 2016 Jan 8:1-12.
About: New surveillance technologies like those included in ambient assisted living – such as body-worn and passive environmental sensors, smart interfaces, and communications networks – are being developed to improve the security and safety of “at risk” older people, but ethical questions have been raised about the extent to which they compromise the rights and privacy of the people being monitored. The qualitative study we conducted was designed to help us understand the ways these novel surveillance technologies would influence individuals’ everyday experiences of home. Participants felt new forms of surveillance would influence their sense of security, autonomy, and self-confidence, and would alter perceptions of home. The findings emphasize the need to improve our understanding of how ambient assisted living will affect the lives of those being monitored.

Development and pilot testing of a kneeling ultralight wheelchair design.

Authors: Mattie JL, Leland D, Borisoff JF.
Published in: Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:5024-7
About: “Dynamic wheeled mobility” offers “on the fly” seating adjustments for wheelchair users such that various activities performed throughout the day can be matched by an appropriate seat position. While this has benefits for user participation and health, the added weight in existing dynamic wheelchairs may impact the user’s ability to transport the frame, e.g. into cars. Other dynamic features to enable more participation avenues are also desirable. This paper outlines the development of a “kneeling” ultralight wheelchair design that offers dynamic wheeled mobility functionality at a weight that is comparable to many existing ultralight wheelchairs. In addition, the wheelchair’s kneeling function allows a lowered seat position to facilitate low-to-the-ground tasks such as floor transfers and other activities where sustained low level reaching may be required (e.g. playing with children, changing a tire, etc.). This paper also describes the development and pilot testing of an end user evaluation protocol designed to validate the wheelchair’s functionality and performance. Successful realization and commercialization of the technology would offer a novel product choice for people with mobility disabilities, and that may support daily activities, health, improved quality of life, and greater participation in the community.

Autonomic cardiovascular control and sports classification in Paralympic athletes with spinal cord injury.

Authors: West CR, Krassioukov AV.
Published in: Disabil Rehabil. 2016 Jan 5:1-8.
About: The purpose of this study was to investigate the relationship between the classification systems used in wheelchair sports and cardiovascular function in Paralympic athletes with spinal cord injury (SCI). The authors provide definitive evidence that sports specific classification is not related to the degree of remaining autonomic cardiovascular control in Paralympic athletes with SCI. The authors suggest that testing for remaining autonomic function, which is closely related to the degree of cardiovascular control, should be incorporated into sporting classification. Implications for Rehabilitation Spinal cord injury is a debilitating condition that affects the function of almost every physiological system. It is becoming increasingly apparent that spinal cord injury induced changes in autonomic and cardiovascular function are important determinants of sports performance in athletes with spinal cord injury. This study shows that the current sports classification systems used in wheelchair rugby and basketball do not accurately reflect autonomic and cardiovascular function and thus are placing some athletes at a distinct disadvantage/advantage within their respective sport.

Respiratory Training Improves Blood Pressure Regulation in Individuals With Chronic Spinal Cord Injury.

Authors: Aslan SC, Randall DC, Krassioukov AV, Phillips A, Ovechkin AV.
Published in: Arch Phys Med Rehabil. 2015 Dec 21.
About: The authors’ purpose was to investigate the effects of respiratory motor training (RMT) on pulmonary function and orthostatic stress-mediated cardiovascular and autonomic responses in individuals with chronic spinal cord injury (SCI). They conducted a before-after intervention case=controlled clinical study. The authors conclude that respiratory training increases respiratory capacity and improves orthostatic stress-mediated respiratory, cardiovascular, and autonomic responses, suggesting that this intervention can be an efficacious therapy for managing OH after SCI.

Fundamental biomechanics of the spine-What we have learned in the past 25 years and future directions.

Authors: Oxland TR.
Published in: J Biomech. 2015 Nov 30. pii: S0021-9290(15)00583-7. doi:
About: Since the publication of the 2nd edition of White and Panjabi׳s textbook, Clinical Biomechanics of the Spine in 1990, there has been considerable research on the biomechanics of the spine. The focus of this manuscript will be to review what we have learned in regards to the fundamentals of spine biomechanics. Topics addressed include the whole spine, the functional spinal unit, and the individual components of the spine (e.g. vertebra, intervertebral disc, spinal ligaments). In these broad categories, our understanding in 1990 is reviewed and the important knowledge or understanding gained through the subsequent 25 years of research is highlighted. Areas where our knowledge is lacking helps to identify promising topics for future research. In this manuscript, as in the White and Panjabi textbook, the emphasis is on experimental research using human material, either in vivo or in vitro. The insights gained from mathematical models and animal experimentation are included where other data are not available. This review is intended to celebrate the substantial gains that have been made in the field over these past 25 years and also to identify future research directions.

The role of caster wheel diameter and weight distribution to reduce drag forces for manual wheelchairs

Authors: Zepede R, Chan F, Sawatzky B.
Published in: Journal of Rehabilitation Research and Development. Accepted Dec 2015.
About: This study proposes a way to reduce energy loses during manual wheelchair propulsion in the form of rolling resistance friction by increasing the size of the front caster wheels and adjusting the weight distribution. Drag tests were conducted using a treadmill and a force transducer. Three different sizes of caster diameter (4”, 5” and 6”) and six different mass distribution combinations (based on percentage of total weight on the caster wheels) were studied. A Two-way ANOVA test was performed to compare caster size and weight distribution’s contribution to drag force of an ultra-lightweight wheelchair. The 4”contributed significantly more drag but only when weight was 40% over the casters. Weight distribution contributed more to drag regardless of the casters used.

Cardiovascular responses to orthostasis and their association with falls in older adults

Authors: Shaw BH, Loughin TM, Robinovitch SN, Claydon VE.
Published in: BMC Geriatr. 2015 Dec 24;15(1):174.
About: Orthostatic hypotension (OH) refers to a marked decline in blood pressure when upright. OH has a high incidence and prevalence in older adults and represents a potential intrinsic risk factor for falls in these individuals. Previous studies have not included more recent definitions for blood pressure responses to orthostasis, including initial, delayed, and recovery blood pressure responses. Furthermore, there is little research examining the relationships between cerebrovascular functioning and falling risk. Therefore, the authors aimed to: (i) test the association between different blood pressure responses to orthostatic stress and retrospective falling history and; (ii) test the association between cerebrovascular responses to orthostatic stress and falling history. The authors conclude that older adults with a positive falling history have impaired orthostatic control of blood pressure and CBFV. With better identification and understanding of orthostatic blood pressure impairments earlier intervention and management can be implemented, potentially reducing the associated risk of morbidity and mortality. Future studies should utilize the updated OH definitions using beat-to-beat technology, rather than conventional methods that may offer less accurate detection.

Authors: Stuart CA, Richards D, Cripton PA.
Published in: Br J Sports Med. 2016 Jan;50(1):62-70.
About:  The Whistler Sliding Centre (WSC) in British Columbia, Canada, has played host to many events including the 2010 Winter Olympics. This study was performed to better understand sliding sport incident (crash, coming off sled, etc) and injury prevalence and provide novel insights into the effect of slider experience and track-specific influences on injury risk and severity. The authors concluded that by investigating the influence of start location, incident location and slider experience on incident and injury frequency and severity, a better understanding has been achieved of the inherent risks involved in sliding sports. Incident monitoring, with particular focus on track ejection, should be an emphasis of sliding tracks.

Mid-urethral slings on YouTube: quality information on the internet?

Authors: Larouche M, Geoffrion R, Lazare D, Clancy A, Lee T, Koenig NA, Cundiff GW, Stothers L.
Published in: Int Urogynecol J. 2015 Dec 9.
About: Scant literature exists about the quality of urogynecological content on social media. Our objective was to measure the accuracy and comprehensiveness of YouTube videos related to mid-urethral sling (MUS) procedures. YouTube was searched using the terms “mid-urethral sling,” “vaginal tape,” “TVT,” “TOT,” “TVT surgery,” and “TOT surgery.” Duplicates and videos with less than 1,000 views were excluded. We developed a standardized questionnaire for this project, assessing each video’s target audience, main purpose, relevance, informed consent elements, surgical steps, and bias. The primary outcome was the presence of all elements of informed consent. Inter-rater reliability (IRR) was calculated using the Fleiss’ kappa statistic. Descriptive statistics were also obtained. The authors conclude that patient information about MUS on YouTube is lacking and often biased. Physicians and students viewing YouTube videos for educational purposes should be cognizant of the variability in the surgical steps demonstrated.

Evaluation of educational content of YouTube videos relating to neurogenic bladder and intermittent catheterization

Authors: Ho M, Stothers L, Lazare D, Tsang B, Macnab A.
Published in: Can Urol Assoc J. 2015 Sep-Oct;9(9-10):320-54
About: Many patients conduct internet searches to manage their own health problems, to decide if they need professional help, and to corroborate information given in a clinical encounter. Good information can improve patients’ understanding of their condition and their self-efficacy. Patients with spinal cord injury (SCI) featuring neurogenic bladder (NB) require knowledge and skills related to their condition and need for intermittent catheterization (IC). Information quality was evaluated in videos accessed via YouTube relating to NB and IC using search terms “neurogenic bladder intermittent catheter” and “spinal cord injury intermittent catheter.” Video content was independently rated by 3 investigators using criteria based on European Urological Association (EAU) guidelines and established clinical practice. The authors conclude that some good-quality educational videos about NB and IC are available on YouTube, but most are poor. The videos deemed good quality were not prominently ranked by the YouTube search algorithm, consequently user access is less likely. Study limitations include the limit of 50 videos per category and the use of a de novo rating tool. Information quality in videos with healthcare narrators was not higher than in those featuring merchant narrators. Better material is required to improve patients’ understanding of their condition.

Rigid and remodelled: Cerebrovascular structure and function after experimental high-thoracic spinal cord transection

Authors: Phillips AA, Matin N, Frias B, Zheng MM, Jai M, West C, Dorrance AM, Laher I, Krassioukov AV.
Published in: J Physiol. 2015 Dec 4.
About: High-thoracic or cervical spinal cord injury (SCI) is associated with several critical clinical conditions related to impaired cerebrovascular health, including: 300–400% increased risk of stroke, cognitive decline and diminished cerebral blood flow regulation. The purpose of this study was to examine the influence of high-thoracic (T3 spinal segment) SCI on cerebrovascular structure and function, as well as molecular markers of profibrosis. Seven weeks after complete T3 spinal cord transection (T3-SCI, n = 15) or sham injury (Sham, n = 10), rats were sacrificed for either middle cerebral artery (MCA) structure and function assessments via ex vivo pressure myography, or immunohistochemical analyses. Myogenic tone was unchanged, but over a range of transmural pressures, inward remodelling occurred after T3-SCI with a 40% reduction in distensibility (both P < 0.05), and a 33% reduction in vasoconstrictive reactivity to 5-HT trending toward significance (P = 0.09). After T3-SCI, the MCA had more collagen I (42%), collagen III (24%), transforming growth factor β (47%) and angiotensin II receptor type 2 (132%), 27% less elastin as well as concurrent increased wall thickness and reduced lumen diameter (all P < 0.05). Sympathetic innervation (tyrosine hydroxylase-positive axon density) and endothelium-dependent dilatation (carbachol) of the MCA were not different between groups. This study demonstrates profibrosis and hypertrophic inward remodelling within the largest cerebral artery after high-thoracic SCI, leading to increased stiffness and possibly impaired reactivity. These deleterious adaptations would substantially undermine the capacity for regulation of cerebral blood flow and probably underlie several cerebrovascular clinical conditions in the SCI population.

Tamoxifen induces cellular stress in the nervous system by inhibiting cholesterol synthesis.

Authors: Denk F, Ramer LM, Erskine EL, Nassar MA, Bogdanov Y, Signore M, Wood JN, McMahon SB, Ramer MS.
Published in: Acta Neuropathol Commun. 2015 Nov 26;3(1):74.
About: Tamoxifen (TAM) is an important cancer therapeutic and an experimental tool for effecting genetic recombination using the inducible Cre-Lox technique. Despite its widespread use in the clinic and laboratory, we know little about its effects on the nervous system. This is of significant concern because TAM, via unknown mechanisms, induces cognitive impairment in humans. A hallmark of cellular stress is induction of Activating Transcription Factor 3 (Atf3), and so to determine whether TAM induces cellular stress in the adult nervous system, we generated a knock-in mouse in which Atf3 promoter activity drives transcription of TAM-dependent Cre recombinase (Cre-ERT2); when crossed with tdtomato reporter mice, Atf3 induction results in robust and permanent genetic labeling of cells in which it is up-regulated even transiently.

Translation and validation of the Farsi version of the Wheelchair Outcome Measure (WhOM-Farsi) in individuals with spinal cord injury.

Authors: Alimohammad S, Parvaneh S, Ghahari S, Saberi H, Yekaninejad MS, Miller WC.
Published in: Disabil Health J. 2015 Oct 8.
About: The Wheelchair Outcome Measure (WhOM) evaluates participation outcomes associated with wheelchair use. While English and French versions of this measure have shown appropriate psychometric properties, it is not clear whether this measure is valid and reliable when used in a culture significantly different from the western culture. This purpose of this study was to establish validity and reliability for the WhOM-Farsi. The results illustrated there is evidence to support the validity and reliability of the WhOM-Farsi scores.

The need for a social revolution in residential care.

Authors: Theurer K, Mortenson WB, Stone R, Suto M, Timonen V, Rozanova J.
Published in: J Aging Stud. 2015 Dec;35:201-10.
About: Loneliness and depression are serious mental health concerns across the spectrum of residential care, from nursing homes to assisted and retirement living. Psychosocial care provided to residents to address these concerns is typically based on a long-standing tradition of ‘light’ social events, such as games, trips, and social gatherings, planned and implemented by staff. Although these activities provide enjoyment for some, loneliness and depression persist and the lack of resident input perpetuates the stereotype of residents as passive recipients of care. Residents continue to report lack of meaning in their lives, limited opportunities for contribution and frustration with paternalistic communication with staff. Those living with dementia face additional discrimination resulting in a range of unmet needs including lack of autonomy and belonging-both of which are linked with interpersonal violence. Research suggests, however, that programs fostering engagement and peer support provide opportunities for residents to be socially productive and to develop a valued social identity. The purpose of this paper is to offer a re-conceptualization of current practices. We argue that residents represent a largely untapped resource in our attempts to advance the quality of psychosocial care. We propose overturning practices that focus on entertainment and distraction by introducing a new approach that centers on resident contributions and peer support. We offer a model-Resident Engagement and Peer Support (REAP)-for designing interventions that advance residents’ social identity, enhance reciprocal relationships and increase social productivity. This model has the potential to revolutionize current psychosocial practice by moving from resident care to resident engagement.

Towards the Development of a Universal Outcome Instrument for Spine Trauma – A Systematic Review and Content Comparison of Outcome Measures used in Spine Trauma Research Using the ICF as Reference.

Authors: CumhurOner F, Jacobs WC, Lehr AM, Sadiqi S, Post MW, Aarabi B, Chapman JR, Dvorak MF, Fehlings MG, Kandziora F, Rajasekaran S, Vaccaro AR.
Published in: Spine (Phila Pa 1976). 2015 Oct 17.
About: There is a real need for a disease specific outcome instrument to measure the effect size of various treatment options in a variety of traumatic spinal column injuries. A systematic literature search was conducted in several databases. From the included studies, outcome measures were extracted. The items and underlying concepts of the identified outcome measures were specified and linked to the ICF categories.Finally, as far as available in literature, the clinimetric properties of the obtained measures were analyzed.The current systematic literature review revealed great diversity in the use and content of outcome measures to evaluate the functioning and health of spine trauma patients, with 17 different outcome measures linked to 57 unique ICF categories. This study creates an evidence base for a consensus meeting during which a core set of ICF categories for outcome measurement in spine trauma will be decided.

Identification of a hematopoietic cell dedifferentiation-inducing factor.

Authors: Li Y, Adomat H, Guns ET, Hojabrpour P, Duronio V, Curran TA, Jalili RB, Jia W, Delwar Z, Zhang Y, Elizei SS, Ghahary A.
Published in: J Cell Physiol. 2015 Nov 3.
About: It has long been realized that hematopoietic cells may have the capacity to trans-differentiate into non-lymphohematopoietic cells under specific conditions. However, the mechanisms and the factors for hematopoietic cell trans-differentiation remain unknown. In an in vitro culture system, we found that using a conditioned medium from proliferating fibroblasts can induce a subset of hematopoietic cells to become adherent fibroblast-like cells (FLCs). FLCs are not fibroblasts nor other mesenchymal stromal cells, based on their expression of type-1 collagen and other stromal cell marker genes. Our data indicate that hematopoietic cells can be induced by M-CSF to dedifferentiate to multipotent stem cells. This study also provides a simple method to generate multipotent stem cells for clinical applications. This article is protected by copyright. All rights reserved.

Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-Analysis

Authors: Evaniew N, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF.
Published in: Journal of Neurotrauma. 2015 Dec 15.
About: Previous meta-analyses of methylprednisolone (MPS) for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in the quality of evidence used for pooled effect estimates, and new primary studies have been recently published. We aimed to determine whether MPS improves motor recovery and is associated with increased risks for adverse events. We searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently screened articles, extracted data, and evaluated risk of bias. We pooled outcomes from randomized, controlled trials (RCTs) and controlled observational studies separately and used the Grades of Recommendation, Assessment, Development, and Evaluation approach to evaluate confidence. Pooled evidence does not demonstrate a significant long-term benefit for MPS in patients with acute TSCIs and suggests it may be associated with increased gastrointestinal bleeding. These findings support current guidelines against routine use, but strong recommendations are not warranted because confidence in the effect estimates is limited.

A history of spine biomechanics : Focus on 20th century progress

AuthorsOxland TR.
Published in: Unfallchirurg. 2015 Dec.
About: The application of mechanical principles to problems of the spine dates to antiquity. Significant developments related to spinal anatomy and biomechanical behaviour made by Renaissance and post-Renaissance scholars through the end of the 19th century laid a strong foundation for the developments since that time. The objective of this article is to provide a historical overview of spine biomechanics with a focus on the developments in the 20th century. The topics of spine loading, spinal posture and stability, spinal kinematics, spinal injury, and surgical strategies were reviewed.

Rigid and remodelled: Cerebrovascular structure and function after experimental high-thoracic spinal cord transection.

Authors: Phillips AA, Matin N, Frias B, Zheng MM, Jai M, West C, Dorrance AM, Laher I, Krassioukov AV.
Published in: J Physiol. 2015 Dec 4.
About: After spinal cord injury, there is a 300-400% increased risk of stroke, and cognitive decline thought to be mediated by poor cerebral blood vessel health. Over the past two years, Drs Phillips and Krassioukov in collaboration with Dr. Dorrance and Ms. Matin from Michigan State University have been developing a model of cerebrovascular dysfunction after SCI in order to better understand why and how cerebrovascular diseases occurs. The results of this first study demonstrate the utility of this model, showing that after high-level spinal cord injury (complete transection at 3rd thoracic spinal segment), significant narrowing and thickening of cerebral arteries ensues, leading to stiffer, and less reactive arteries. Furthermore, this study provides some insight in how this occurring, by demonstrating intact sympathetic pathways of the arteries, but an increased signalling for deposition of stiff proteins.

Neurovascular coupling in humans: Physiology, methodological advances and clinical implications

Authors: Phillips AA, Chan FH, Zheng MM, Krassioukov AA, Ainslie PN.
Published in: Journal of Cerebral Blood Flow & Metabolism. 2015 Oct 23.
About: Dr. Aaron Phillips, Dr, Philip Ainslie, Dr. Andrei Krassioukov, Franco Chan, and Annie Zheng have announced in this publication their new automated software for evaluating brain blood flow regulation in the clinical setting. Neurovascular coupling is a critical function matching neuronal activation with blood flow delivery in order to provide substrates and remove biproduct. This software allows for automated extraction and calculation of neurovascular coupling in humans, which Dr. Phillips, Krassioukov and Ainslie have shown in impaired in those with SCI, and is related to cognitive decline. This software will help them understand and reduce vascular-cognitive decline after SCI. The fact that this paper was accepted to the premier journal in the field (Journal of Cerebral Blood Flow and Metabolism) attests to the importance and relevance of this work.

Meta-Analysis of Placebo Responses in Central Neuropathic Pain: Impact of Subject, Study, and Pain Characteristics.

Authors: Cragg JJ, Warner FM, Finnerup NB, Jensen MP, Mercier C, Richards JS, Wrigley P, Soler D, Kramer JL.
Published in: Pain. 2015 Nov 16.
About: The aim of the current investigation was to identify factors that contribute to variable placebo responses in clinical trials involving individuals with central neuropathic pain. We performed a systematic review and meta-analysis of placebo-controlled trials examining pharmacological and non-invasive brain stimulation interventions for central neuropathic pain. Study design, subject characteristics, and pain ratings for the placebo group were extracted from each trial. Pooling of results and identification of moderating factors were carried out using random effects meta-analysis and meta-regression techniques. A total of 39 published trials met the inclusion criteria (SCI, n=26; stroke, n=6; MS, n=7). No significant publication bias was detected. Overall, there was a significant effect for placebo to reduce central pain (-0.64, CI:-0.83 to -0.45). Smaller placebo responses were associated with crossover-design studies, longer pain duration, and greater between-subject baseline pain variability. There were no significant effects for neurological condition (stroke vs. MS vs. SCI) or the type of intervention (e.g., pharmacological vs. non-invasive brain stimulation). In a planned sub-analysis, the severity of damage in the spinal cord also had no significant effect on the placebo response. Further study is warranted to identify factors that may explain the impact of pain duration on the placebo response at the individual subject level.

Multiple measures of corticospinal excitability are associated with clinical features of multiple sclerosis.

Authors: Neva JL, Lakhani B, Brown KE, Wadden KP, Mang CS, Ledwell NH, Borich MR, Vavasour IM, Laule C, Traboulsee AL, MacKay AL, Boyd LA.
Published inBehav Brain Res. 2015 Oct 17;297:187-195.
About: In individuals with multiple sclerosis (MS), transcranial magnetic stimulation (TMS) may be employed to assess the integrity of corticospinal system and provides a potential surrogate biomarker of disability. The purpose of this study was to provide a comprehensive examination of the relationship between multiple measures corticospinal excitability and clinical disability in MS (expanded disability status scale (EDSS)). Bilateral corticospinal excitability was assessed using motor evoked potential (MEP) input-output (IO) curves, cortical silent period (CSP), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF) and transcallosal inhibition (TCI) in 26 individuals with MS and 11 healthy controls. Measures of corticospinal excitability were compared between individuals with MS and controls. We evaluated the relationship(s) between age and clinical demographics such as age at MS onset (AO), disease duration (DD) and clinical disability (EDSS) with measures of corticospinal excitability. Corticospinal excitability thresholds were higher, MEP latency and CSP onset delayed and MEP durations prolonged in individuals with MS compared to controls. Age, DD and EDSS correlated with corticospinal excitability thresholds. Also, TCI duration and the linear slope of the MEP amplitude IO curve correlated with EDSS. Hierarchical regression modeling demonstrated that combining multiple TMS-based measures of corticospinal excitability accounted for unique variance in clinical disability (EDSS) beyond that of clinical demographics (AO, DD). Our results indicate that multiple TMS-based measures of corticospinal and interhemispheric excitability provide insights into the potential neural mechanisms associated with clinical disability in MS. These findings may aid in the clinical evaluation, disease monitoring and prediction of disability in MS.

Economic evaluation comparing intra-operative cone beam CT based navigation and conventional fluoroscopy for the placement of spinal pedicle screws: a patient-level data cost-effectiveness analysis.

Authors: Dea N, Fisher CG, Batke J, Strelzow J, Mendelsohn D, Paquette SJ, Kwon BK, Boyd MD, Dvorak MF, Street JT.
Published in: Spine J. 2015 Oct 6.
About: Medical costs are exploding in a unsustainable way. Health economic theory requires that medical equipment costs be compared to expected benefits. To answer this question for computer assisted spinal surgery, we present an economic evaluation looking specifically at symptomatic misplaced screws leading to reoperation secondary to neurological deficits or biomechanical concerns. We conclude that computer-assisted spinal surgery has the potential to reduce reoperation rates and thus to have serious cost-effectiveness and policy implications. High acquisition and maintenance costs of this technology can be offset by equally high reoperation costs. Our cost-effectiveness analysis showed that for high-volume centers with a similar case complexity to the studied population, this technology is economically justified.

A Worldwide Analysis of the Reliability and Perceived Importance of an Injury to the Posterior Ligamentous Complex in AO Type A Fractures.

Authors: Schroeder GD, Kepler CK, Koerner JD, Oner FC, Fehlings MG, Aarabi B, Dvorak MF, Reinhold M, Kandziora F, Bellabarba C, Chapman JR, Vialle LR, Vaccaro AR.
Published in: Global Spine J. 2015 Oct;5(5):378-82.
About: Study Design: Survey of spine surgeons. Objective: To determine the reliability with which international spine surgeons identify a posterior ligamentous complex (PLC) injury in a patient with a compression-type vertebral body fracture (type A). Methods: A survey was sent to all AOSpine members from the six AO regions of the world. The survey consisted of 10 cases of type A fractures (2 subtype A1, 2 subtype A2, 3 subtype A3, and 3 subtype A4 fractures) with appropriate imaging (plain radiographs, computed tomography, and/or magnetic resonance imaging), and the respondent was asked to identify fractures with a PLC disruption, as well as to indicate if the integrity of the PLC would affect their treatment recommendation. Results: Five hundred twenty-nine spine surgeons from all six AO regions of the world completed the survey. The overall interobserver reliability in determining the integrity of the PLC was slight (kappa = 0.11). No substantial regional or experiential difference was identified in determining PLC integrity or its absence; however, a regional difference was identified (p < 0.001) in how PLC integrity influenced the treatment of type A fractures. Conclusion: The results of this survey indicate that there is only slight international reliability in determining the integrity of the PLC in type A fractures. Although the biomechanical importance of the PLC is not in doubt, the inability to reliably determine the integrity of the PLC may limit the utility of the M1 modifier in the AOSpine Thoracolumbar Spine Injury Classification System.

Exploratory validation of a multidimensional power wheelchair outcomes toolkit.

Authors: Ben Mortenson W, Demers L, Rushton PW, Auger C, Routhier F, Miller WC.
Published in: Arch Phys Med Rehabil. 2015 Sep 21. pii: S0003-9993(15)01164-8.
About: The objective of the researchers was to evaluate the relationship among the measures in a power wheelchair outcomes toolkit. The authors performed path analysis of cross-sectional data from self-report questionnaires and one objective measure. The study provides empirical support for the measures included as part of the power wheelchair outcomes toolkit. They appear to provide complementary information on a variety of constructs related to power wheelchair use.

Development and feasibility of an automated call monitoring intervention for older wheelchair users: the MOvIT project.

Authors: Auger C, Miller WC, Jutai JW, Tamblyn R.
Published in: BMC Health Serv Res. 2015 Sep 16;15(1):386. doi: 10.1186/s12913-015-1048-0.
About: Recent advances in wheeled mobility technology are multiplying opportunities for community integration and improved quality of life. The mobility needs of older wheelchair users are particularly complex due to a constellation of chronic conditions and comorbidities that may compromise optimal use of the device. The purpose of the Mobility Outcomes via Information Technologies (MOvIT) project is to examine the feasibility of automated calls for the systematic monitoring for adverse outcomes associated with wheelchair use. The authors concluded that automated calls tailored for individuals with mobility limitations and associated comorbidities are a promising approach to reach clients who need post-rehabilitation support.

The relationship between fatigue and participation in spinal cord injury.

Authors: Smith EM, Imam B, Miller WC, Silverberg ND, Anton HA, Forwell SJ, Townson AF.
Published in: Spinal Cord. 2015 Sep 15.
About: The authors’ objectives were to explore the association between fatigue and community participation frequency and provide an adjusted model of the relationship including important covariates. They conclude that fatigue has a statistically significant negative association with participation for individuals withspinal cord injury, when controlling for pain, depressive mood, comorbidities and level of injury. Multifaceted clinical interventions and research addressing fatigue, pain and depressive symptoms are warranted.Spinal Cord advance online publication, 15 September 2015; doi:10.1038/sc.2015.149.

Measuring participation for children and youth with power mobility needs: a systematic review of potential health measurement tools.

Authors: Field DA, Miller WC, Ryan SE, Jarus T, Abundo A.
Published in: Arch Phys Med Rehabil. 2015 Sep 10.
About: The authors’ objective was to identify and critically appraise potential participation measurement tools for children aged 18 months to 17 years with power mobility (PM) needs. They concluded that while potential tools emerged (Assessment of Preschool Children’s Participation, Preference for Activities of Children, Child and Adolescent Scale of Participation, Child Engagement in Daily Life, Canadian Occupational Performance Measure and Questionnaire of Young People’s Participation), none were judged best suited for use with children having PM needs. Further empirical studies with this population are needed before recommending use for PM applications.

Drug delivery, cell-based therapies, and tissue engineering approaches for spinal cord injury.

Authors: Kabu S, Gao Y, Kwon BK, Labhasetwar V.
Published in: J Control Release. 2015 Sep 4.
About: Spinal cord injury (SCI) results in devastating neurological and pathological consequences, causing major dysfunction to the motor, sensory, and autonomic systems. The primary traumatic injury to the spinal cord triggers a cascade of acute and chronic degenerative events, leading to further secondary injury. Many therapeutic strategies have been developed to potentially intervene in these progressive neurodegenerative events and minimize secondary damage to the spinal cord. Additionally, significant efforts have been directed toward regenerative therapies that may facilitate neuronal repair and establish connectivity across the injury site. Despite the promise that these approaches have shown in preclinical animal models of SCI, challenges with respect to successful clinical translation still remain. The factors that could have contributed to failure include important biologic and physiologic differences between the preclinical models and the human condition, study designs that do not mirror clinical reality, discrepancies in dosing and the timing of therapeutic interventions, and dose-limiting toxicity. With a better understanding of the pathobiology of events following acute SCI, developing integrated approaches aimed at preventing secondary damage and also facilitating neuroregenerative recovery is possible and hopefully will lead to effective treatments for this devastating injury. The focus of this review is to highlight the progress that has been made in drug therapies and delivery systems, and also cell-based and tissue engineering approaches for SCI.

Pilot study of a peer-led wheelchair training program to improve self-efficacy using a manual wheelchair: A randomized controlled trial.

Authors: Best KL, Miller WC, Huston G, Routhier F, Eng JJ.
Published in: Arch Phys Med Rehabil. 2015 Sep 3.
About: The authors’ objective was to evaluate the effect of a peer-led wheelchair training program on self-efficacy for manual wheelchair (MWC) use. Secondary outcomes were to explore influences of the intervention on MWC skills, life-space mobility and satisfaction with participation. They concluded that A peer-led MWC training program improves wheelchair use self-efficacy in adult MWC users, and had a positive influence on other wheelchair-related outcomes. WheelSee may offer a promising intervention strategy to accommodate the training needs of community-living manual wheelchair users.

Influence of Active Recovery on Cardiovascular Function During Ice Hockey.

Authors: Burr JF, Slysz JT, Boulter MS, Warburton DE.
Published in: Sports Med Open. 2015;1(1):27.
About: Ice hockey is a popular sport comprised of high-intensity repeated bouts of activity. Light activity, as opposed to passive rest, has been shown to improve power output in repeated sprinting and could potentially help to offset venous pooling, poor perfusion, and the risk of an ischemic event. The objective of our study was, thus, to examine the efficacy of low-intensity lower body activity following a simulated hockey shift for altering hemodynamic function. We conclude that standing and pacing between shifts offers a realistic in-game solution to help slow the precipitous drop in cardiac output (heart rate and stroke volume) that typically occurs with passive rest. Prolonging the duration of an elevated cardiac output further into recovery may be beneficial for promoting recovery of the working skeletal muscles and also avoiding venous pooling and reduced myocardial perfusion.

Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).

Authors: Walden K, Bélanger LM, Biering-Sørensen F, Burns SP, Echeverria E, Kirshblum S, Marino RJ, Noonan VK, Park SE, Reeves RK, Waring W, Dvorak MF.
Published inSpinal Cord. 2015 Sep 1.
About: The Rick Hansen Institute-ISNCSCI Algorithm (RHI-ISNCSCI Algorithm) was developed based on the 2011 version of the ISNCSCI and the 2013 version of the worksheet. International experts developed the design and logic with a focus on usability and features to standardize the correct classification of challenging cases. A five-phased process was used to develop and validate the algorithm. Discrepancies between the clinician-derived and algorithm-calculated results were reconciled.

Toward Developing a Specific Outcome Instrument for Spine Trauma: An Empirical Cross-sectional Multicenter ICF-Based Study by AOSpine Knowledge Forum Trauma

Authors: Oner FC, Sadiqi S, Lehr AM, Aarabi B, Dunn RN, Dvorak MF, Fehlings MG, Kandziora F, Post MW, Rajasekaran S, Vialle L, Vaccaro AR.
Published in: Spine (Phila Pa 1976). 2015 Sep 1;40(17):1371-9.
About: There is no disease or condition-specific outcome instrument available that is designed or validated for patients with spine trauma, contributing to the present lack of consensus and ongoing controversies in the optimal treatment and evaluation of many types of spine injuries. Therefore, AOSpine Knowledge Forum Trauma started a project to develop such an instrument using the International Classification of Functioning, Disability and Health (ICF) as its basis.

A walking disaster: a case of incomplete spinal cord injury with symptomatic orthostatic hypotension.

Authors: Currie KD, Krassioukov AV.
Published in: Clin Auton Res. 2015 Aug 12.
About: Eight months post-injury, an ambulatory 58-year-old male with an incomplete spinal cord injury experienced syncope and a 52-mmHg drop in his systolic blood pressure during a tilt-table assessment. This case study highlights the necessity to examine autonomic function in all cases of spinal cord injury, regardless of injury severity.

Active-Arm Passive-Leg Exercise Improves Cardiovascular Function in Spinal Cord Injury: A Case Report.

Authors: West CR, Currie KD, Gee C, Krassioukov AV, Borisoff J.
Published in: Am J Phys Med Rehabil. 2015 Aug 7.
About: In a 43-yr-old male subject with a chronic T3 AIS A spinal cord injury, the acute cardiorespiratory responses to active upper-extremity exercise alone and combined active-arm passive-leg exercise (AAPLE) were investigated, along with the cardiorespiratory, cardiac, vascular, and body composition responses to a 6-wk AAPLE interval training intervention. AAPLE elicited superior acute maximal cardiorespiratory responses compared with upper-extremity exercise alone. In response to a 6-wk interval training regimen, AAPLE caused a 25% increase in peak oxygen uptake, a 10% increase in resting stroke volume, and a 4-fold increase in brachial artery blood flow. Conversely, there were no changes in femoral arterial function, body composition, or bone mineral density in response to training. As a potential clinical intervention, AAPLE may be advantageous over other forms of currently available exercise, owing to the minimal setup time and cost involved and the nonreliance on specialized equipment that is required for other exercise modalities.

Spinal Cord Injury and Migraine Headache: A Population-Based Study

Authors: Warner FM, Cragg JJ, Weisskopf MG, Kramer JK.
Published in: PLoS One. 2015 Aug 26;10(8):e0135550
About: The purpose of this study was to examine the association between migraine headaches and spinal cord injuries (SCI) in a large Canadian cohort, and to determine the impact of migraine headaches on self-perceived health. Data from a sample of 61,047 participants were obtained from the cross-sectional Canadian Community Health Survey. The multivariable age- and sex-adjusted model revealed a strong association between SCI and migraine headache, with an adjusted odds ratio for migraine of 4.82 (95% CI [3.02, 7.67]) among those with SCI compared to those without SCI. Furthermore, individuals who experienced both SCI and migraine tended to report poorer perceived general health compared with the other groups (i.e., SCI and no migraine). In summary, we report a strong relationship between migraine headache and SCI after controlling for major confounding variables, and show that migraine headaches and SCI may compound self-perceptions of health when occurring together. To shed new light on this association and potential mechanisms, further studies are warranted.

Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial

Authors: Kirby RL, Miller WC, Routhier F, Demers L, Mihailidis A, Polgar JM, Rushton PW, Titus L, Smith C, McAllister M, Theriault C, Thompson K, Sawatzky B.
Published in: Arch Phys Med Rehabil. 2015 Jul 29
About: The purpose of this study is to test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a Control group that receives standard care. Our secondary objectives were to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use and participation. Powered wheelchair users who receive formal wheelchair skills training demonstrate modest transient post-training improvements in their WST-Q performance scores, they have substantial improvements on individualized goals and they are positive about training.

Training with robot-applied resistance in people with motor-incomplete spinal cord injury: Pilot study

Authors: Lam T, Pauhl K, Ferguson A, Malik RN; BKin, Krassioukov A, Eng JJ.
Published inJ Rehabil Res Dev. 2015;52
About: This study examined the effect of age on sub-maximal wheelchair propulsion efficiency and sprint power output (SPO) in inexperienced able-bodied males. Two age groups were used for this study: a younger adult group (N = 10; mean age 24.8 ± 3.0 years) and an older adult group (N = 8; mean age 70.9 ± 5.2 years). No one had prior manual wheelchair experience. The primary outcome measures were gross mechanical efficiency (GME), mechanical effectiveness (ME) during sub-maximal treadmill wheeling and SPO during a max sprint test. There were no significant differences in GME; however, there was a significant difference in ME [0.74 ± 0.12 and 0.62 ± 0.08 (p = 0.007)] and sprint test [SPO = 224.66 ± 79.25 and 125.98 ± 53.02 (W) (p = 0.008)], for younger and older adults, respectively. Healthy, active older individuals can have a physiological capacity similar to younger populations to wheel sub-maximally, but their ME and lower SPO reduce the ability to propel manual wheelchairs during maximal wheeling.

Age-related changes to wheelchair efficiency and sprint power output in novice able-bodied males.

Authors: Hers N, Sawatzky BJ, Sheel AW.
Published inErgonomics. 2015 Jul 28
About: This study examined the effect of age on sub-maximal wheelchair propulsion efficiency and sprint power output (SPO) in inexperienced able-bodied males. Two age groups were used for this study: a younger adult group (N = 10; mean age 24.8 ± 3.0 years) and an older adult group (N = 8; mean age 70.9 ± 5.2 years). No one had prior manual wheelchair experience. The primary outcome measures were gross mechanical efficiency (GME), mechanical effectiveness (ME) during sub-maximal treadmill wheeling and SPO during a max sprint test. There were no significant differences in GME; however, there was a significant difference in ME [0.74 ± 0.12 and 0.62 ± 0.08 (p = 0.007)] and sprint test [SPO = 224.66 ± 79.25 and 125.98 ± 53.02 (W) (p = 0.008)], for younger and older adults, respectively. Healthy, active older individuals can have a physiological capacity similar to younger populations to wheel sub-maximally, but their ME and lower SPO reduce the ability to propel manual wheelchairs during maximal wheeling.

Navigating uncharted territory: a qualitative study of the experience of transitioning to wheelchair use among older adults and their care providers

Authors: Giesbrecht EM, Miller WC, Woodgate RL.
Published in: BMC Geriatr. 2015 Jul 28
About: An increasing number of older adults are procuring a wheelchair for mobility; however, the corresponding impact on related injuries, caregiver burden, and participation restriction is concerning. To inform the development of a wheelchair training program, we pursued a clearer understanding of the experience transitioning to wheelchair use for older adult users and their care provider. Six focus groups were conducted with older experienced wheelchair users (n = 10) and care providers (n = 4). Transcripts were analyzed using a Conventional Content approach; a coding framework enabled inductive theming and summary of the data. Three themes emerged from the user group: On My Own reflected both limited training and the necessity of venturing out, More Than Meets the Eye addressing barriers to use, and Interdependence between wheelchair users and the ambulatory community. Care provider responses fell into two themes: the All Encompassing impact of assumed responsibilities and Even the Best Laid Plans, where unpredictable and inaccessible environments sabotaged participation. The transition from ambulatory to wheelchair mobility can feel like uncharted territory. Balanced support and appropriate mentorship are fundamentally important and real-world encounters optimize independence and proficiency with skills. The impact on care providers is extensive, highlighting the importance of skills training.

Systematic review of adjunct therapies to improve outcomes following botulinum toxin injection for treatment of limb spasticity

Authors: Mills PB, Finlayson H, Sudol M, O’Connor R.
Published in: Clin Rehabil. 2015 Jul 21
About: The purpose of this study is to determine the quality of evidence from randomized controlled trials on the efficacy of adjunct therapies following botulinum toxin injections for limb spasticity. Ten adjunct therapies were identified. Evidence suggests that adjunct use of electrical stimulation, modified constraint-induced movement therapy, physiotherapy (all Level 1), casting and dynamic splinting (both Level 2) result in improved Modified Ashworth Scale scores by at least 1 grade. There is Level 1 and 2 evidence that adjunct taping, segmental muscle vibration, cyclic functional electrical stimulation, and motorized arm ergometer may not improve outcomes compared with botulinum toxin injections alone. There is Level 1 evidence that casting is better than taping, taping is better than electrical stimulation and stretching, and extracorporeal shock wave therapy is better than electrical stimulation for outcomes including the Modified Ashworth Scale, range of motion and gait. All results are based on single studies. There is high level evidence to suggest that adjunct therapies may improve outcomes following botulinum toxin injection. No results have been confirmed by independent replication. All interventions would benefit from further study.

Prazosin: a potential new management tool for iatrogenic autonomic dysreflexia in individuals with spinal cord injury?

Authors: Zheng MM, Phillips AA, Elliott SL, Krassioukov AV.
Published in: Neural Regen Res. 2015 April.
About: Spinal cord injury (SCI) is a devastating condition that not only results in a loss of motor functions but also severe autonomic dysfunctions. Autonomic dysreflexia (AD) is a life threatening episode of transient hypertension that occurs up to 30x/day (11x/day on average) in those with cervical or high thoracic SCI. Currently, the most commonly used medication to mitigate the severity of AD episodes during PVS is nifedipine (Adalat), an immediate-release calcium channel blocker. However, individuals with SCI experience persistently low resting blood pressure (BP) as well as orthostatic hypotension. Nifedipine lowers BP by blocking both the renin-angiotension (RAS) pathway and the α-adrenergic receptors. Prazosin (Minipress), on the other hand, is a selective α-adrenergic blocker that preserves the vasoactive actions of the RAS pathways. We recently conducted a clinical trial to examine the efficacy of prazosin at reducing AD severity in SCI outpatients undergoing PVS who regularly experienced severe iatrogenically-induced episodes of AD.

The influence of spine surgeons’ experience on the classification and intraobserver reliability of the novel AOSpine Thoracolumbar Spine Injury Classification System – an international study

Authors: Sadiqi S, Oner FC, Dvorak MF, Aarabi B, Schroeder GD, Vaccaro AR.
Published in: Spine (Phila Pa 1976). 2015 Jul 10.
About: Wide variability has been demonstrated for intraobserver reliability of the AOSpine classification system. The spine surgeons’ level of experience may play a crucial role in the appropriate classification of thoracolumbar fractures, and the degree of reproducibility of the same observer on separate occasions. However, this has not been previously investigated. The purpose of this study was to investigate the influence of the spine surgeons’ level of experience on the intraobserver reliability of the novel AOSpine Thoracolumbar Spine Injury Classification system, and the appropriate classification according to this system. This international study demonstrated that the spine surgeons’ level of experience does not substantially influence the classification and intraobserver reliability of the recently described AOSpine Thoracolumbar Spine Injury Classification System.

Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury

Authors: Henry Ahn, Christopher S. Bailey, Carly S. Rivers, Vanessa K. Noonan, Eve C. Tsai, Daryl R. Fourney, Najmedden Attabib, Brian K. Kwon, Sean D. Christie, Michael G. Fehlings, Joel Finkelstein, R. John Hurlbert, Andrea Townson, Stefan Parent, Brian Drew, Jason Chen, Marcel F. Dvorak, Rick Hansen Spinal Cord Injury Registry Network
Published in: CMAJ. 6 July 2015.
About: This paper was authored by members of the national Rick Hansen SCI Registry (RHSCIR) team using data from the Registry. More people over the age of 70 are incurring spinal cord injuries given the changing population demographics. It is not clear if there are differences in management of these older patients. The authors found that older patients with traumatic spinal cord injuries are less likely to receive surgery compared with younger patients and they experience a significant lag between both injury and acute admission to a specialized centre, and between admission and surgery. Future work will look at differences in outcome and advise treatment guidelines.

Training with robot-applied resistance in people with motor-incomplete spinal cord injury: Pilot study

Authors: Lam T, Pauhl K, Ferguson A, Malik R, Krassioukov AV, Eng JJ.
Published in:  Journal of Rehabilitation Research Development, 52(1), 113-130, 2015
About: This article describes a pilot study in which Dr. Tania Lam and her colleagues tested the possibility of using the Lokomat (a robotic gait-training device) to apply resistance against leg movements during gait training for people with partial spinal cord injuries. Their results indicated that resistance training with the Lokomat is feasible. Their data also suggest that resistance training could lead to better improvements in the performance of skilled overground walking tasks (such as stepping over obstacles or walking up stairs) compared with standard Lokomat training (without resistance), and that these improvements were retained for 6 months.

Modifiable and non-modifiable factors associated with employment outcomes following spinal cord injury: A systematic review.

Authors: Trenaman L, Miller WC, Querée M, Escorpizo R; SCIRE Research Team.
Published in: J Spinal Cord Med. 2015 Jul;38(4):422-31.
About: Employment rates in individuals with spinal cord injury (SCI) are approximately 35%, which is considerably lower than that of the general population. In order to improve employment outcomes a clear understanding of what factors influence employment outcomes is needed. The purpose of this study was to systematically review factors that are consistently and independently associated with employment outcomes in individuals with SCI, and to understand the magnitude of their influence. A number of key modifiable factors have been identified and can inform interventions aimed at improving employment outcomes for individuals with SCI. The authors conclude that future research should focus on determining which factors have the greatest effect on employment outcomes, in addition to developing and evaluating interventions targeted at these factors.

Developing a spinal cord injury research strategy using a structured process of evidence review and stakeholder dialogue. Part III: outcomes.

Authors: Middleton JW, Piccenna L, Lindsay Gruen R, Williams S, Creasey G, Dunlop S, Brown D, Batchelor PE, Berlowitz DJ, Coates S, Dunn JA, Furness JB, Galea MP, Geraghty T, Kwon BK, Urquhart S, Yates D, Bragge P.
Published in: Spinal Cord, 2015 June 23.
About: A 1-day structured stakeholder dialogue was convened in 2013 in Melbourne, Australia, by the National Trauma Research Institute in collaboration with the SCI Network of Australia and New Zealand. Twenty-three experts participated, representing local and international research, clinical, consumer, advocacy, government policy and funding perspectives. Preparatory work synthesised evidence and articulated draft principles and options as a starting point for discussion. A regional SCI research strategy was proposed, whose objectives can be summarised under four themes. (1) Collaborative networks and strategic partnerships to increase efficiency, reduce duplication, build capacity and optimise research funding. (2) Research priority setting and coordination to manage competing studies. (3) Mechanisms for greater consumer engagement in research. (4) Resources and infrastructure to further develop SCI data registries, evaluate research translation and assess alignment of research strategy with stakeholder interests. These are consistent with contemporary international SCI research strategy development activities.

Quantification of Lower Extremity Kinesthesia Deficits Using a Robotic Exoskeleton in People With a Spinal Cord Injury.

Authors: Chisholm AE, Domingo A, Jeyasurya J, Lam T.
Published in: Neurorehabil Neural Repair. 2015 Jun 18.
About: Our ability to sense movement is essential for motor control; however, the impact of kinesthesia deficits on functional recovery is not well monitored in the spinal cord injury (SCI) population. One problem is the lack of accurate and reliable tools to measure kinesthesia.  The purpose of this study was to establish the validity and reliability of a quantitative robotic assessment tool to measure lower limb kinesthesia in people with SCI. Our findings demonstrated that lower limb kinesthesia deficits are common in the SCI population and highlighted the importance of valid and reliable tools to monitor sensory function. Future studies need to examine changes in sensory function in response to therapy.

Cerebral blood flow responses to autonomic dysreflexia in those with high level spinal cord injury.

Authors: Phillips AA, Ainslie P, Warburton DE, Krassioukov AV.
Published in: J Neurotrauma. 2015 Jun 15.
About: Stoke risk is 3-4 fold increased after suffering a spinal cord injury. A primary and obvious suspect implicated in this elevated risk, is the daily repetitive exposure to transient hypertension (autonomic dysreflexia). During a larger study, where we were measuring cerebral blood flow, we noted episodes of autonomic dysreflexia occurring. These episodes were small in amplitude and slowly developing. Cerebral blood flow was preserved at baseline levels and did not dangerously rise leading to increased risk of cerebrovascular rupture. We have yet to characterize how cerebral blood flow responds to larger and more rapid episodes of autonomic dysreflexia.

Methylprednisolone for the treatment of patients with acute spinal cord injuries: A propensity score-matched cohort study from a Canadian multicenter spinal cord injury registry.

Authors: Evaniew N, Noonan V, Fallah N, Kwon BK, Rivers CS, Ahn H, Bailey C, Christie S, Fourney DR, Hurlbert RJ, Linassi G, Fehlings M, Dvorak MF.
Published in: J Neurotrauma. 2015 Jun 12.
About: The national Rick Hansen SCI Registry (RHSCIR) team investigated the use of methylprednisolone (a corticosteroid) to treat individuals with acute traumatic SCI. In a matched case-control analysis using national RHSCIR data, no evidence was found that methylprednisolone improves neurologic outcome following traumatic spinal cord injury as found in the controversial and much criticized 1990 NASCIS-II trial. This supports the downgrade of methylprednisolone as a treatment recommendation to a treatment option, and the evidence that it may increase odds of complications.

Perspectives on strategies and challenges in the conversation about stem cells for spinal cord injury.

Authors: Jacob KJ, Kwon BK, Lo C, Snyder J, Illes J.
Published in: Spinal Cord. 2015 Jun 2.
About: The purpose of this study was to examine how trusted communication between individuals with spinal cord injury (ISCIs) and physicians who care for ISCIs is affected by the discussion of advances in stem cell research and interventions locally and abroad. Semi-structured interviews were conducted with ISCIs and physicians. The authors of this study conclude that (1) Epistemic transparency should be privileged over silence. (2) A new generation of innovations in research and clinical trial dissemination about stem cells for SCI is needed to remedy the perceived inadequacies of existing information content and accessibility.

The power of power wheelchairs: Mobility choices of community-dwelling, older adults.

Authors: Mortenson WB, Hammell KW, Luts A, Soles C, Miller WC.
Published in: Scand J Occup Ther. 2015 May 31:1-8.
About: Power wheelchairs are purported to have a positive effect on health, occupation, and quality of life. However, there is limited knowledge about what factors shape power wheelchair use decisions. A study was undertaken to understand the mobility choices of community-dwelling, power wheelchair users. A series of semi-structured qualitative interviews was conducted with 13 older adult power wheelchair users. Three main styles of power wheelchair use were identified: reluctant use, strategic use, and essential use, and each type is illustrated using an aggregate case study. These findings highlight the need to alter the power relationship that exists between prescribers and device users and to effect policy changes that enable people with physical impairments to make as wide a range of mobility choices as possible.

Boosting in Elite Athletes with Spinal Cord Injury: A Critical Review of Physiology and Testing Procedures.

Authors: Gee CM, West CR, Krassioukov AV.
Published in: Sports Med. 2015 May 26.
About: Many individuals with spinal cord injury (SCI) experience autonomic dysfunction, which can have major implications on heart rate and blood pressure responses to exercise, and consequently athletic performance. Athletic performance may be improved by the induction of autonomic dysreflexia (‘boosting’), a dangerous and sometimes life-threatening condition. Here, we review the autonomic response to exercise in individuals with SCI and the current testing methods for boosting, and examine the potential for autonomic testing to be used in the classification of SCI athletes. Given the difficulties associated with researching the effects of boosting, only three studies have compared the physiological performance of elite athletes in the boosted and unboosted state. These studies found athletes had an improved performance of ~7 to 10 % in the boosted state. Blood pressure, heart rate, oxygen consumption, and circulating catecholamines were also higher in the boosted state. Although 27.1 % of athletes believe that boosting was common in their sport, no athlete has ever tested positive for boosting at an event sanctioned by the International Paralympic Committee. Athletes with SCI competing in sports that have a high cardiovascular demand/aerobic component may experience the greatest benefit of boosting. Boosting improves athletic performance even at blood pressure levels well below the current threshold for disqualification set by the International Paralympic Committee, a level at which individuals with SCI are putting their health and lives at serious risk.

Contemporary cardiovascular concerns after Spinal Cord Injury: mechanisms, maladaptations & management.

Authors: Aaron Phillips and Andrei Krassioukov
Published in: Journal of Neurotrauma. 12 May 2015.
About: This comprehensive review describes in detail the diverse cardiovascular issues faced by those living with spinal cord injury; discusses interventions and clinical management options, as well highlights cutting-edge insight into the mechanisms and consequences of cerebrovascular and cardiovascular decline. Click here to read the paper.

The surgical algorithm for the AOSpine thoracolumbar spine injury classification system.

Authors: Vaccaro AR, Schroeder GD, Kepler CK, Cumhur Oner F, Vialle LR, Kandziora F, Koerner JD, Kurd MF, Reinhold M, Schnake KJ, Chapman J, Aarabi B, Fehlings MG, Dvorak MF.
Published in: Eur Spine J. 2015 May 8.
About: The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar spine injury classification system. A survey was sent to AOSpine members from the six AO regions of the world, and surgeons were asked if a patient should undergo an initial trial of conservative management or if surgical management was warranted. The survey consisted of controversial injury patterns. Using the results of the survey, a surgical algorithm was developed. The authors conclude that The current algorithm uses a meaningful injury classification and worldwide surgeon input to determine the initial treatment recommendation for thoracolumbar injuries. This allows for a globally accepted surgical algorithm for the treatment of thoracolumbar trauma.

Health, Personal, and Environmental Predictors of Wheelchair-Use Confidence in Adult Wheelchair Users.

Authors: Sakakibara BM, Miller WC, Eng JJ, Routhier F, Backman CL.
Published in: Phys Ther. 2015 May 7.
About: There are no predictive models of wheelchair-use confidence. Therefore, clinicians and researchers are limited in their ability to screen and identify wheelchair users who may be more prone to low wheelchair-use confidence and may benefit from clinical intervention. The purpose of this study was to identify health-related, personal, and environmental factors that predict perceived wheelchair-use confidence in community-dwelling adults who use manual wheelchairs. The authors conclude that older women who use wheelchairs and who require assistance with wheelchair use may have low wheelchair-use confidence. The same is true for individuals who have no formal wheelchair-use training, who are in need of a seating intervention, and who report few hours of daily wheelchair use. These wheelchair users may require clinical attention and benefit from intervention.

Schwann cells generated from neonatal skin-derived precursors or neonatal peripheral nerve improve functional recovery after acute transplantation into the partially injured cervical spinal cord of the rat.

Authors: Sparling JS, Bretzner F, Biernaskie J, Assinck P, Jiang Y, Arisato H, Plunet WT, Borisoff J, Liu J, Miller FD, Tetzlaff W.
Published inJournal of Neuroscience, 35(17), 6714-6730, April 29 2015.
About: The Tetzlaff Lab is studying the transplantation of a type of cell called Schwann cells as a potential treatment for spinal cord injury. Right now, a human trial in Miami is using Schwann cells that are obtained surgically from nerves in a person’s leg, but this can lead to complications. The Schwann cells the Tetzlaff lab are using are derived from progenitor cells in the skin. The lab recently published a paper in the prestigious Journal of Neuroscience that compares Schwann cells from nerves to Schwann cells from skin, with promising results. Dr. Tetzlaff has prepared an easy-to-understand summary of the paper, which you can read here.