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 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.