Active Lifestyle Is Associated With Reduced Dyspnea and Greater Life Satisfaction in Spinal Cord Injury.

OBJECTIVE: To assess the relations between measures of activity with dyspnea and satisfaction with life in chronic spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: Five SCI centers. PARTICIPANTS: Between July 2012 and March 2015, subjects (N=347) with traumatic SCI ≥1 year after injury who used a manual wheelchair or walked with or without an assistive device reported hours spent away from home or yard on the previous 3 days, sports participation, and planned exercise. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Satisfaction with Life Scale (SWLS) and dyspnea. Dyspnea was defined as shortness of breath when hurrying on the level or going up a slight hill, going slower than people the same age on the level because of breathlessness, or stopping for breath when going at your own pace, or after about 100yd (or after a few minutes) on the level. RESULTS: Dyspnea prevalence was 30%. Adjusting for asthma or chronic obstructive pulmonary disease, mobility mode, race, and season, there was a significant linear trend between greater SWLS scores and quartiles of time spent away from the home or yard (P=.0002). SWLS score was greater if participating in organized sports (P=.01), although was not significantly greater with planned exercise (P=.093). Planned exercise was associated with a reduced odds ratio (OR) of dyspnea (.57; 95% confidence interval [CI], .34-.95; P=.032), but organized sports was not (P=.265). Dyspnea was not significantly increased in persons who spent the fewest hours outside their home or yard (≤7h) compared with people who spent the most hours outside their home or yard (>23h) (OR=1.69; 95% CI, 0.83-3.44; P=.145). CONCLUSIONS: In SCI, a planned exercise program is associated with less dyspnea. An active lifestyle characterized by greater time spent away from home or yard and sports participation is associated with greater SWLS scores.

Impact of a wheelchair education protocol based on practice guidelines for preservation of upper-limb function: a randomized trial.

OBJECTIVES: To determine if strict use of the Paralyzed Veterans of America's Clinical Practice Guidelines for Preservation of Upper Limb Function affects wheelchair setup, selection, propulsion biomechanics, pain, satisfaction with life, and participation of individuals with new spinal cord injuries (SCIs). DESIGN: Single blinded, randomized controlled trial. SETTING: Model SCI systems rehabilitation facility and community. PARTICIPANTS: Volunteer sample of manual wheelchair users with new SCIs (N=37). INTERVENTION: The intervention group was strictly educated on the clinical practice guideline by a physical therapist and an occupational therapist in an inpatient rehabilitation facility. The standard of care group received standard therapy services. MAIN OUTCOME MEASURES: Comparison of wheelchair setup, selection, propulsion biomechanics, pain, and Satisfaction With Life Scale and Craig Handicap Assessment and Reporting Technique scores at the time of discharge from inpatient rehabilitation and at 6 months and 1 year postdischarge. RESULTS: Participants in the intervention group pushed on tile with significantly lower push frequency (P=.02) at the discharge visit. On the ramp, the intervention group used a significantly larger push length (P=.03) across all time points. No significant differences were found between groups related to wheelchair setup, selection, pain, satisfaction with life, and participation. CONCLUSIONS: The intervention group showed better skills on key wheelchair propulsion biomechanics variables related to upper-limb health. Use of a structured education program may be an effective method of educating new manual wheelchair users to prevent the development of upper-limb impairments in an inpatient setting. Additional follow-up testing is necessary to determine whether the differences seen in propulsion skills translate into decreased pain and improved quality of life in the long term.

Identification of distinct monocyte phenotypes and correlation with circulating cytokine profiles in acute response to spinal cord injury: a pilot study.

BACKGROUND: Macrophage infiltration to the injury site during the acute response to traumatic spinal cord injury (SCI) is not uniform. Macrophage phenotype has been characterized as either proinflammatory (M1) or anti-inflammatory (M2). Results of animal studies suggest that M1 or M2 dominance at the site of injury relates to spontaneous recovery after SCI. OBJECTIVE: To investigate whether the phenotype of circulating macrophage precursors-monocytes (MO) is altered in the acute phase of SCI and corresponds to circulating inflammatory cytokines. STUDY DESIGN: A prospective observational cohort study. SETTING: A single academic medical center in Pennsylvania. PATIENTS: A cohort of 27 subjects with complete or incomplete traumatic SCI enrolled within 7 days after SCI injury. METHODS: The MO phenotype was defined within the first week after SCI by using flow cytometry and was compared with that of historic uninjured controls. Concentrations of 25 cytokines and/or chemokines were assessed by using Luminex in serial blood samples up to 2 weeks after SCI. An analysis of variance was used to determine the correlations between the phenotypes and the cytokine profiles. RESULTS: Patient subsets were identified with either M1- or M2-dominant circulating MOs distinct from the uninjured controls. The M1 dominant was associated with higher circulating levels of proinflammatory mediators interleukin (IL)12p70 and interferon gamma-induced protein 10 kDa (IP-10/CXCL10), and lower levels of anti-inflammatory cytokines IL-10, IL-15, and IL-7, whereas the M2 dominant exhibited the opposite cytokine profiles with significantly higher IL-10 and IL-7. CONCLUSION: In the acute phase after SCI, at comparable injury severity, subgroups of patients exhibit distinct M1 or M2 MOs dominance and the phenotype is correlated with M1- or M2-specific cytokine and/or chemokine profiles. Although further studies are needed to determine how these observed phenotypic differences relate to functional recovery, our findings (1) provide the first evidence, to our knowledge, that indicates the possible individual differences in the immune responses to the comparable traumatic SCI, with potential implications for management of acute SCI and rehabilitation; and (2) may represent easily accessible biomarkers with prognostic utility.

Impact of the clinical practice guideline for preservation of upper limb function on transfer skills of persons with acute spinal cord injury.

OBJECTIVES: To describe the development of a strict education protocol to implement the clinical practice guideline "Preservation of Upper Limb Function Following Spinal Cord Injury" into a clinical setting, and evaluate the effect of the protocol on transfer quality. DESIGN: Randomized controlled trial. SETTING: Acute Model Spinal Cord Injury Systems rehabilitation facility and community. PARTICIPANTS: Volunteer sample of full-time wheelchair users (N=70) with new spinal cord injuries randomized (1:1) to an intervention and standard-of-care group. INTERVENTION: The intervention group was educated on transfer skills with a structured protocol implemented by a physical and occupational therapist who were extensively educated on the clinical practice guidelines and current transfer research. The standard-of-care group received standard therapy services. MAIN OUTCOME MEASURES: Comparison of transfer quality evaluated by the Transfer Assessment Instrument at 4 time points during first year after injury. RESULTS: No significant differences were found between study groups. Secondary analysis based on type of transfer performed found that participants in the intervention group who performed assisted sitting pivot transfers performed higher-quality transfers (mean ± SE: 9.43±.55) compared with the standard-of-care group (mean ± SE: 7.81±.46) (P=.026) at 1 year after discharge. Also, participants who performed a dependent transfer had a higher average score across all 4 time points (mean ± SE: 9.14±.34) compared with the standard-of-care group (mean ± SE: 8.09±.29) (P=.019). CONCLUSIONS: For participants who perform assisted or dependent transfers, use of an evidenced-based, structured education program during acute inpatient rehabilitation has the potential to significantly improve the quality of transfers. Further follow-up testing is necessary with a larger sample size to determine the long-term effects.