Gender differences in patient experience among persons with spinal cord injury: A comparison across 22 countries.

BACKGROUND: Due to the majority of males within the population of persons with spinal cord injuries (SCI), a male-oriented perception of persons with SCI might affect care provision in the way of prioritizing male needs. OBJECTIVE: The objective of this cross-sectional study is to describe the patient experience of persons with SCI by gender. METHODS: This study was based on the International Spinal Cord Injury Survey with 12,588 participants from 22 countries. An interval-based patient experience score was attained by partial credit model. Regression analysis was used in exploring the association between patient experience and gender. RESULTS: Participants reported very good and good patient experience. Respectful treatment was reported by 78 % of participants; clear explanations by 75 %; involvement in decision-making by 71 %; satisfaction with services by 62 %. The average patient experience score was equal among males and females (average: 64, range: 0-100), with the highest score in participants from the USA (78) and the lowest - in Morocco (44). Patient experience score was not associated with gender. Females had lower odds of reporting better decision-making involvement, yet higher odds of better satisfaction. Older participants, with higher household income and better self-rated health, had lower odds of being satisfied. CONCLUSION: The majority of persons with SCI rated their experience as good or very good. Females were more likely to report higher satisfaction with services and lower involvement in decision-making. For other patient experience categories and the overall patient experience score, no association with gender was found.

Duration of detrusor overactivity as an independent predictive factor of upper urinary tract deterioration in patients with traumatic spinal cord injury: results of a retrospective cohort study.

OBJECTIVE: To determine whether duration of detrusor overactivity (DO) during a cystometric study is an independent predictive factor of upper urinary tract deterioration (UUTD) in patients with traumatic spinal cord injury (TSCI). STUDY DESIGN: Retrospective cohort study. SETTING: A rehabilitation facility in Chiang Mai, Thailand. METHODS: Data were obtained from medical records of patients who underwent cystometric evaluation at 6-12 months after TSCI. The independent predictor of interest is the duration of DO, which was evaluated by the DO/cystometry ratio (DOratio). Other conventional urodynamic parameters (maximum detrusor pressure, cystometric capacity, bladder compliance, and detrusor-sphincter dyssynergia) and clinical parameters (age, sex, level and severity of injury, comorbidities, bladder emptying method, and history of urinary tract infection) were determined. The outcome was UUTD, which is indicated by chronic kidney disease (GFR < 60 ml/min/1.73 m2), hydronephrosis, and/or vesicoureteral reflux. Multivariable Cox regression analysis was used to determine the independent associations between DOratio and UUTD by adjusting with all other parameters. RESULTS: Medical records of 194 patients with TSCI were included in the study. During a combined total of 1260 follow-up years of those patients, 34 UUTD events were identified, indicating an incidence rate of 27.0 cases per 1000 person-years. After adjusting for all other parameters, a high DOratio (≥0.33) was significantly associated with UUTD (hazard ratio = 3.00 [95% CI: 1.12-7.99], p = 0.025). CONCLUSION: DOratio may be an independent cystometric predictor of UUTD in patients with TSCI. However, further prospective study is needed prior to applying DOratio as a predictor of UUTD in clinical settings. CLINICAL TRIAL REGISTRATION: There was no clinical trial registration since this study is not a clinical trial.

Increasing employment opportunity for persons with spinal cord injury by digital working: an exampling case series from Thailand.

INTRODUCTION: Due to activity limitations and physical environmental barriers, low remunerative employment is a challenging issue for people with spinal cord injury (SCI) and relevant rehabilitation personnel. Since work opportunities in digital fields have continued to emerge, this study aims to report and discuss the possibility of using digital working as a strategy for increasing remunerative employment in people with SCI. CASE PRESENTATION: We report live experiences of four people with SCI in Thailand who have digital works with different types of jobs (image segmentation and identification for artificial intelligence development, online merchant, online streamer, cryptocurrency investor), different required digital skills (basic or intermediate digital skills), different employment statuses (employee or owner), and different incomes (from 50 to 200 USD/month). We also discuss advantages and potential risks of digital working for people with SCI and propose a model for care providers to facilitate safe digital work as a means of increasing remunerative opportunities for people with SCI. CONCLUSION: There is increasing interest in becoming involved in various types of digital work among people with SCI. Digital working could overcome many of the physical barriers; however, it also potentially introduces some potential economic and health risks for people with SCI. To minimize those risks, healthcare providers of people with SCI should prepare to develop the appropriate knowledge and attitudes regarding digital working and to learn how to properly facilitate digital working to increase remunerative employment in people with SCI.

The association between health service systems and pressure injury problems of individuals with chronic spinal cord injury in Malaysia, Indonesia, and Thailand: a cross-sectional study.

OBJECTIVES: To determine whether a health service system is an independent influencing factor of having pressure injury (PI) problems in individuals with chronic spinal cord injury (SCI) living in three countries. DESIGN: A cross-sectional study. METHODS: Data from the International Spinal Cord Injury Community Survey (InSCI) were analyzed. The PI problems were assessed using the Spinal Cord Injury Secondary Condition Scales (dichotomized to "having problem" and "not having problem". Health service systems were categorized as an inpatient-oriented SCI specialized system and a primary care-oriented system. A directed acyclic graph was applied to create a multivariable logistic regression model to determine the independent influencing factors of PI problems. RESULTS: Of 790 included participants, 277 (35%) had PI problems. Being recruited from countries with inpatient-oriented SCI specialized systems (Model 1) and visiting rehabilitation medicine/SCI physicians at least once a year (Model 2) is an independent negative correlating factor of PI problems (odds ratio = 0.569 [95%CI: 0.374-0.866] and 0.591 [95%CI: 0.405-0.864], respectively). CONCLUSION: SCI-specialized health service systems might be a protective factor of PI problems in middle-income country contexts. This result suggests the importance of having SCI-specialized services in middle-income countries to reduce the prevalence of PI problems.

Do individuals from an SCI-specialized rehabilitation facility have fewer secondary health conditions than those from a non-SCI-specialized rehabilitation facility? Analysis of the InSCI database from a middle-income country.

OBJECTIVES: To determine whether attending an SCI-specialized rehabilitation facility (SSRF) is independently associated with having fewer secondary health conditions (SHCs) in middle-income country contexts. STUDY DESIGN: Cross-sectional observational study. SETTING: Four rehabilitation facilities in Thailand (one SSRF and three non-SSRF). METHODS: Data from a Thai arm of the International Spinal Cord Injury Community Survey (InSCI) were analyzed. SHCs occurring within the last three months were evaluated using the Spinal Cord Injury Secondary Condition Scale. A causal diagram was applied to create a multivariable regression model to determine the independent effect of attending in the SSRF on having SHC as a single condition and as a sum score. RESULTS: Three hundred and thirteen individuals with chronic SCI were included in this study. Two hundred and nineteen participants (70%) were recruited from the SSRF. Being recruited from the SSRF was an independent negative correlating factor of the SHC sum score with an unstandardized coefficient of -1.12 (95% CI: -2.00-0.24). Being recruited from the SSRF was also an independent negative correlating factor of having bladder dysfunction, sexual dysfunction, and pressure ulcer SHC with an odds ratio of 0.32 (95% CI: 0.16-0.59), 0.43 (95% CI: 0.22-0.84), and 0.46 (95% CI: 0.24-0.89), respectively. CONCLUSION: Attending an SSRF was significantly associated with having fewer SHCs, specifically, bladder dysfunctions, sexual dysfunctions, and pressure ulcers. These results suggest the importance of having SSRF in middle-income countries for delivering effective care to people with SCI and standardized education to health care providers.

Minimal clinically important difference (MCID) and minimal detectable change (MDC) of Spinal Cord Ability Ruler (SCAR).

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To find minimal clinically important difference (MCID) and minimal detectable change (MDC) of Spinal Cord Ability Ruler (SCAR) in Thai participants with spinal cord injury (SCI). SETTING: Rehabilitation ward at Maharaj Nakorn Chiang Mai Hospital. METHODS: Data of individuals with SCI who were not diagnosed with central cord syndrome and were admitted for the first time for rehabilitation were analyzed. Upper extremities motor score, self-care and mobility items of Spinal Cord Independence Measure version III were collected and used to calculate SCAR difference between data on date of admission and discharge. MCID and MDC were calculated by distribution-based method and categorized for each subgroup according to SCI characteristics. RESULTS: From data of 311 individuals, MCID of SCAR is approximately 4 for individual with tetraplegia AIS A, B, C; and individual with AIS D at any level, and 2 for individual with paraplegia AIS A, B, C. MDC of SCAR should be 1 for individual with tetraplegia AIS A, B, C; and individual with AIS D at any level and 0.5 for individual with paraplegia AIS A, B, C. CONCLUSION: This study provides MCID and MDC of SCAR in each subgroup. These values could be used as a benchmark for clinicians and researchers to determine whether participant has significant improvement or not after receiving an intervention.

Performance of the Dutch clinical prediction rule for the ambulation outcome after spinal cord injury in a middle-income country clinical setting: an external validation study in the Thai retrospective cohort.

OBJECTIVE: To perform external geographic and domain validation of the clinical prediction rule (CPR) of the ambulation outcome of patients with traumatic spinal cord injury (SCI) originally developed by van Middendorp, et al. (2011) in Thais with traumatic and non-traumatic SCI. STUDY DESIGN: Retrospective cohort study. SETTING: A tertiary rehabilitation facility in Chiang Mai, Thailand. METHODS: A validation data set, including predictive (age and four neurological variables) and outcome (ambulation status) parameters was retrospectively collected from medical records of patients with traumatic and non-traumatic SCI admitted between December 2007 and December 2019. The performance of the original model was evaluated in both discrimination and calibration aspects, using an area under the receiver-operating characteristic curve (auROC) and calibration curves, respectively. RESULTS: Three hundred and thirty-three patients with SCI were included in the validation set. The prevalence of ambulators was 59% (197 of 333 participants). An auROC of 0.93 (95% CI 0.90-0.96) indicated excellent discrimination whereas the calibration curve demonstrated underestimation, especially in patients with AIS grade D. Performance of the CPR was decreased but acceptable in patients with non-traumatic SCI. CONCLUSIONS: Our external validation study demonstrated excellent discrimination but slightly underestimated calibration of the CPR of ambulation outcome after SCI. Regardless of the geographic and etiologic background of the population, the Dutch CPR could be applied to predict the ambulation outcome in patients with SCI.

Intractable postural hypotension resulting from cervical pseudomeningocele after a posterior cervical spinal surgery: a case report.

INTRODUCTION: Postural hypotension (PH) is common in patients with spinal cord injury (SCI), especially those with tetraplegia. To effectively treat PH, identifying and eliminating treatable predisposing factors of PH are prerequisites before applying any interventions. CASE PRESENTATION: We report a patient with post-acute cervical SCI who suffered from intractable PH resulting from pseudomeningocele causing unfavorable rehabilitation outcomes. A previously healthy 34-year-old man with complete C6 SCI resulting from C6-C7 fracture dislocation developed PH in the first week of the rehabilitation program. No specific predisposing factors including anemia, hyponatremia, and dehydration were identified. Non-pharmacological interventions and pharmacological treatment were administered to the patient without satisfactory result, causing a delay in rehabilitation progression. In the fourth week of rehabilitation program, a mass at the surgical site was detected. A cervical MRI revealed a large fluid collection at the posterior aspect of cervical spines with a size of 7.9 × 6.8 × 5.0 cm. A diagnosis of pseudomeningocele was made and surgical site debridement with closing dura by grafting was immediately conducted. One day after surgery, PH disappeared, and the patient could progress in his rehabilitation program and achieve his short-term goal within three weeks. CONCLUSION: Pseudomeningocele could be one of the precipitating factors of PH in patients with tetraplegia. Healthcare providers should consider investigating pseudomeningocele in patients who have intractable and unexplainable PH.

COVID-19 vaccination status in people with spinal cord injury: Results from a cross-sectional study in Thailand.

OBJECTIVE: To assess COVID-19 vaccination status among individuals with spinal cord injury (SCI). DESIGN: A cross-sectional study. SETTING: Twelve hospitals from all regions of Thailand. PARTICIPANTS: One hundred and eighty people with SCI were randomly selected from the Thai SCI registry database. INTERVENTION: Not applicable. OUTCOME MEASURES: The primary outcome, which was the COVID-19 vaccination status, and the secondary outcomes, which were the number of vaccination doses, satisfaction and dissatisfaction aspects, and barriers to vaccination, were recorded using a specifically developed questionnaire over the telephone during February to March 2022. Data were analyzed using descriptive analyses, bivariate, and multivariable analyses. RESULTS: Of the 96 people with SCI who were able to respond, the prevalence of receiving at least one dose was 77% but the prevalence of receiving a booster dose was 20%. Being non-traumatic SCI correlated negatively with having received any vaccination doses when compared to traumatic SCI. Most of the participants were satisfied with the government provision of COVID-19 vaccines. The major barriers to vaccination were problems related to a negative attitude toward the vaccination, followed by transportation difficulties and wheelchair-inaccessible vaccination sites. CONCLUSIONS: Seventy-seven percent of people with SCI participating in this study received at least one dose of the COVID-19 vaccine, whereas only 20% of them received a booster dose of the COVID-19 vaccination. To increase the prevalence of vaccination, healthcare providers should deliver the fact regarding COVID-19 vaccination to reduce negative attitudes, as well as remove physical barriers to vaccination places for people with SCI.

Impacts of Bladder Managements and Urinary Complications on Quality of Life: Cross-sectional Perspectives of Persons With Spinal Cord Injury Living in Malaysia, Indonesia, and Thailand.

BACKGROUND: The impact of bladder care and urinary complications on quality of life in persons with spinal cord injury who have neurogenic lower urinary tract dysfunction has not been elucidated, especially in those living in low-resource countries. METHODS: This multinational cross-sectional survey was conducted in rehabilitation facilities in Malaysia, Indonesia, and Thailand. Community-dwelling adults with traumatic or nontraumatic spinal cord injury participating in the International Spinal Cord Injury Community Survey from 2017 to 2018 were enrolled. Data regarding bladder management/care, presence of bladder dysfunction, urinary tract infection, and quality of life score were extracted from the International Spinal Cord Injury Community Survey questionnaire. The impact of bladder care and urinary complications on quality of life was determined using univariable and multivariable regression analysis. RESULTS: Questionnaires from 770 adults were recruited for analysis. After adjusting for all demographic and spinal cord injury-related data, secondary conditions, as well as activity and participation factors, urinary tract infection was an independent negative predictive factor of quality of life score ( P = 0.007, unstandardized coefficients = -4.563, multivariable linear regression analysis, enter method). CONCLUSIONS: Among bladder care and urinary complication factors, urinary tract infection is the only factor negatively impacting quality of life. These results address the importance of proper bladder management and urinary tract infection prevention in persons with spinal cord injury to improve their quality of life.

Prevalence and influencing factors of spinal cord injury-related osteoporosis and fragility fractures in Thai people with chronic spinal cord injury: A cross-sectional, observational study.

Objective: To investigate the prevalence and influencing factors of spinal cord injury (SCI)-related osteoporosis and fragility fractures in Thai people with chronic spinal cord injury.Design: A cross-sectional, observational study.Setting: Outpatient clinic, Department of Rehabilitation Medicine, Maharaj Nakorn Chiang Mai Hospital.Participants: Thais with chronic spinal cord injury (SCI) (duration of injury at least one year).Intervention: Not applicable.Outcome measures: Dual-energy X-ray absorptiometry (DXA) was performed to measure bone mineral density (BMD) at the hip. Analyses were performed to identify risk factors for SCI-related osteoporosis or fragility fracture development. Thai FRAX® score was calculated with and without BMD and compared for each participant.Results: Among 64 Thais with chronic SCI, the prevalence of SCI-related osteoporosis was 43.8%. Female sex, non-ambulatory status, and at least 10 years duration of spinal cord injury increased the risk of having SCI-related osteoporosis. The prevalence of fragility fracture was 9.4%. Female sex, duration of SCI, and being diagnosed with SCI-related osteoporosis increased the risk of having a fragility fracture. Thai FRAX® score without BMD value underestimated the risk of prevalent fracture in 7.8% of participants.Conclusions: SCI-related osteoporosis and fragility fractures are common in Thais with chronic SCI. Our findings emphasize the importance of SCI-related osteoporosis and fragility fracture surveillance in people with chronic SCI regardless of their ethnicity. FRAX® without BMD calculations could underestimate the risk of fragility fracture in people with chronic SCI. Therefore, further studies are needed to develop an SCI-specific fracture-risk assessment tool using risk factors proposed in previous studies and in this study.

Level of injury is an independent determining factor of gut dysbiosis in people with chronic spinal cord injury: A cross-sectional study.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To investigate the correlations between gut microbiota and metabolic parameters in people with different levels of chronic spinal cord injury (SCI). SETTING: An SCI-specialized rehabilitation facility in a university hospital. METHODS: Forty-three participants with chronic SCI were recruited. Blood samples of each participant were collected for analysis of metabolic parameters. Feces were collected after the bowel opening method the patient routinely uses to evaluate fecal bacterial microbiota using quantitative RT-PCR. Body composition was examined using dual-energy x-ray absorptiometry (DEXA). Data were analyzed to evaluate the correlations between gut microbiota and other parameters. RESULTS: Of the 43 participants, 31 people (72.1%) were paraplegic and 12 people (27.9%) tetraplegic. Thirty-two people (74.4%) were diagnosed with obesity using the percentage of body fat (% body fat) criteria. The mean (SD) ratio of Firmicutes:Bacteroides (F/B), which represents the degree of gut dysbiosis, was 18.3 (2.45). Using stepwise multivariable linear regression analysis, both having tetraplegia and being diagnosed with obesity from % body fat evaluated by DEXA were independent positively-correlating factors of F/B (p < 0.001 and p = 0.001, respectively), indicating more severe gut dysbiosis in people with tetraplegia than paraplegia. CONCLUSION: In people with chronic SCI, having tetraplegia and being diagnosed with obesity from % body fat evaluated by DEXA are independent positive-correlating factors of gut dysbiosis. These results indicate a significant association between gut microbiota and the characteristics of SCI as well as metabolic parameters.

Correlations between percent body fat measured by dual-energy X-ray absorptiometry and anthropometric measurements in Thai persons with chronic traumatic spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To determine and compare the correlations of percent body fat (%BF) evaluated by dual-energy X-ray absorptiometry (DEXA) and anthropometric measurements including body mass index (BMI), skinfold thickness, waist circumference, hip circumference, and waist to hip ratio in Thai persons with chronic traumatic spinal cord injury (SCI). SETTING: An SCI-specialized rehabilitation facility in a university hospital. METHODS: Forty-six Thais with chronic traumatic SCI from a chronic SCI cohort of Maharaj Nakorn Chiang Mai Hospital were enrolled. Anthropometric measurements including weight, height, BMI, waist circumference, hip circumference, waist to hip ratio, and skinfold thickness of four sites (biceps, triceps, subscapular, and suprailiac) were measured. The estimated %BF was calculated using the Durnin-Womersley formula based on the sum of 4-site skinfold thickness. Data of %BF was evaluated by DEXA within 3 months before anthropometric measurements of each participant were obtained. The correlations between each anthropometric parameter and % BF from DEXA were determined by the Pearson correlation coefficient. RESULTS: The correlation of %BF between two methods, i.e., DEXA and estimation based on 4-site skinfold thickness, was strongly positive (r = 0.829; p < 0.001). The correlations between %BF from DEXA and hip circumference, BMI, and waist circumference were moderately positive (r = 0.697, 0.540, and 0.540, respectively; all p < 0.001). CONCLUSION: Better than the other anthropometric measurements, the estimation of %BF based on the 4-site skinfold using the Durnin-Womersley formula is a practical method for evaluating obesity in Thai people with chronic traumatic SCI.

Health care and rehabilitation services utilization, benefits and satisfaction: a community survey of individuals with spinal cord injury in Thailand.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: This study aimed to explore and report on health care and rehabilitation service utilization, rehabilitation service benefits, and levels of satisfaction of individuals with spinal cord injury (SCI) living in communities in Thailand. SETTING: Four rehabilitation facilities in Thailand, two university hospitals (Maharaj Nakorn Chiang Mai Hospital in Chiang Mai Province and Siriraj Hospital in Bangkok), one large provincial hospital (Ratchaburi Hospital in Ratchaburi Province), and one national rehabilitation institute (Sirindhorn National Medical Rehabilitation Institute in Nonthaburi Province). METHODS: This study was part of the International Spinal Cord Injury Community Survey (InSCI). Individuals with SCI completed a set of questionnaires, then data related to their health care and rehabilitation services were extracted and analyzed. RESULTS: Of the 320 participants, most were male (71%), and the majority were living with paraplegia (73%). In cases of mild illnesses where hospitalization was not required, 46% went to a nearby health service hospital. In cases of serious illnesses where hospitalization was required, 39% went to a higher-level hospital. The majority (80%) were satisfied with their experience with health care services. The three top preferred products and services in descending order were wheelchairs and cushions, increased disability pension, medication and medical equipment including bladder relaxants, urinary catheters and urine bags. CONCLUSIONS: Individuals with SCI living in communities in Thailand preferred treatment at a nearby district hospital for mild illnesses with one-third transferring to a higher-level hospital for serious illnesses. The majority were satisfied with the health care services and rehabilitation services.

The metabolic role of spermidine in obesity: Evidence from cells to community.

Spermidine is a natural polyamine existing in all living cells known to play an important role in cellular functions. Recently, several studies have reported the effect of alterations in the spermidine pool on metabolic pathways. It has been shown that activation of spermidine/spermine N-1-acetyl-transferase (SSAT), the rate-limiting enzyme in polyamine catabolism, improved glucose and lipid metabolism. In addition, spermidine supplementation has been shown to protect against diet-induced obesity in animal models. However, some clinical studies demonstrated that polyamine levels are increased in childhood obesity and metabolic syndrome patients with type 2 diabetes (T2DM), while polyamine-rich food is associated with a lower incidence of cardiovascular disease (CVD). Therefore, this review aims to summarize and discuss the evidence from in vitro, in vivo and clinical studies on the possible roles of spermidine on metabolic pathways under physiological and obese conditions. All consistent and inconsistent findings are discussed and further studies aiming to fill any gaps in the knowledge are proposed.

The Role of Acupuncture on the Gut-Brain-Microbiota Axis in Irritable Bowel Syndrome.

Irritable bowel syndrome (IBS) is a chronic dysfunction of the gastrointestinal tract, commonly characterized by abdominal pain or abdominal discomfort. These symptoms can substantially reduce the quality of life and work productivity of the patients. The exact pathogenesis of IBS remains unclear, as it has become apparent that multiple pathways are activated in the condition, including inflammation, immunology, neurology and psychology. Recent evidence has shown that symptoms in IBS are related to the dysfunction of the nervous system, particularly the viscerosomatic pathway, through immune-to-brain communication. The potential link between brain-gut relationships is gut microbiota. The management of IBS mostly focuses on symptomatically treating the patients. There are a wide range of standard treatments, including pharmacological to psychological interventions which are effective in some patients. Therefore, a combination of therapies including both standard and complimentary treatments, including Traditional Chinese Medicine (TCM) such as acupuncture, have been used in treating IBS patients. Several in vivo and clinical studies have demonstrated the efficacy of acupuncture in treating IBS. Increasing attention has been paid to research regarding the action mechanisms of acupuncture for IBS. This paper summarizes and discusses the possible mechanisms associated with acupuncture on the pathophysiology of IBS, including gastrointestinal (GI) motility, visceral hypersensitivity, the immune system, neurotransmitters, and the brain-gut axis. The results fromin vivo and clinical studies have been included. In addition, the effects of acupuncture on gut microbiota in IBS are included and any contradictory findings are deliberated.

Reliability of the international spinal cord injury urodynamic basic data set version 1.0.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To assess interrater and intrarater reliability of the International Spinal Cord Injury (SCI) Urodynamic Basic Data Set (UBS) version 1.0. SETTING: Urodynamic clinic at Maharaj Nakorn Chiang Mai Hospital. METHODS: Two raters independently analyzed urodynamic tracings from 50 patients and completed the UBS twice, each test 1 month apart. The interrater and intrarater reliability of this data set were analyzed using Kappa, Weighted Kappa, and the Intraclass correlation coefficient (ICC). RESULTS: Of the 50 patients, 72% were male. The mean (SD) age was 48.2 (16.6) years. The median time (IQR) since the injury was 27 months (0-101 months). The interrater reliability of the items of UBS were substantial to almost perfect (0.78-0.99). The intrarater reliability of the first rater was fair to almost perfect (0.37-1.00). The intrarater reliability of the second rater was moderate to almost perfect (0.51-1.00). Relatively low interrater and intrarater reliability were observed in bladder compliance and urethral function items. CONCLUSION: The first version of UBS has acceptable interrater and intrarater reliability on most items. Although bladder compliance and urethral function have problematic interrater and intrarater reliability, they have been adjusted in the second version. Due to its simplicity and reliability, UBS is clinically useful for urodynamic assessment in people with SCI.

Colonic obstruction in a tetraplegic patient: a common symptom from an uncommon cause.

INTRODUCTION: It is difficult to diagnose an acute abdomen condition in people with spinal cord injury due to abnormal sensation below the injured level and multiple co-morbidities. These issues can mislead the exact diagnosis and delay proper treatment. CASE PRESENTATION: A 57-year-old male with C4 AIS C tetraplegia developed nausea and vomiting, abdominal distension and feeding intolerance. Serum electrolytes indicated severe hyponatremia. A provisional diagnosis of pseudo-gut obstruction was made. After the failure of 48 h of conservative treatment with a nasogastric and rectal tube, abdominal CT was performed and revealed sigmoid volvulus. CONCLUSIONS: Due to the inconclusive clinical features and lack of subjective complaints, early use of CT scan or MRI is preferable in people with SCI who are suspected of an emergency intra-abdominal condition.

A Patient With Acute Cervical Cord Injury and COVID-19: A First Case Report.

During the pandemic of coronavirus disease 2019, it is possible for rehabilitation physicians and personnel to take care of patients with concurrent spinal cord injury and coronavirus disease 2019. Here, we describe a case of acute cervical spinal cord injury resulting in complete tetraplegia C5 American Spinal Injury Association Impairment Scale A with unrecognized, severe acute respiratory syndrome coronavirus 2 infection. This resulted in large-scale quarantines of related surgical and rehabilitation staff, and the unexpected death of the patient despite receiving the treatments according to the standard guideline. Rehabilitation personnel who take care of acute spinal cord injury patients with coronavirus disease 2019 should consider the effect of spinal cord injury on the course of coronavirus disease 2019, the effect of coronavirus disease 2019 and its treatments on the course of spinal cord injury, and risks of severe acute respiratory syndrome coronavirus 2 transmission between patients and rehabilitation staff, to continue providing safe and effective rehabilitation programs.