The Role of Upper Extremity Motor Function in the Choice of Bladder Management in Those Unable to Volitionally Void due to Neurologic Dysfunction.

It is estimated that 425,000 individuals with neurologic bladder dysfunction (spinal cordinjury, spina bifida and multiple sclerosis) are unable to volitionally void and must rely oncatheter drainage. Upper extremity (UE) motor function is one of the most important factors indetermining the type of bladder management chosen in individuals who cannot volitionally void. Novel bladder management solutions for those with impaired UE motor function and concurrent impairments involitional voiding continue to be an area of need. Those with poor UE motor function more often choose an indwelling catheter, whereas those with normal UE motor function more often choose clean intermittent catheterization.

The presence of Candida parapsilosis with intrathecal baclofen pump in a person with high cervical spinal cord injury; infection or colonization? A Case Report.

INTRODUCTION: Intrathecal baclofen (ITB) therapy is an effective method of treating spasticity in persons with spasticity due to spinal cord injury (SCI), but complications are not rare and can include spinal fluid leaks, infection, and catheter/pump malfunction. CASE PRESENTATION: This study presents information related to an adult male patient with traumatic SCI and a history of two prior ITB pump pocket infections that required removal due to pump infection. The patient then developed skin erosion over the third pump, and the fluid around the pump grew methicillin-sensitive Staphylococcus aureus, diphtheroids, and Candida parapsilosis. The patient was initially treated with antibiotics and anti-fungal medication without removal of the ITB pump. The ITB pump was eventually removed 27 months later, and the fourth pump was implanted 10 months later. DISCUSSION: ITB pumps can be an effective treatment modality for spasticity in people with SCI; however, complications, including infection, can occur and require pump removal. This case illustrates a case of possible Candida colonization of the ITB pump, which was eventually removed.

Risk Factors Associated With Suicidal Ideation in Individuals With Spinal Cord Injury.

Objective: To assess the frequency of suicidal ideation (SI) among individuals with chronic spinal cord injury (SCI) and to identify risk factors associated with SI. Design: Cross-sectional. Setting: Community setting. Participants: Two hundred and forty-six individuals with chronic SCI participating in the Spinal Cord Injury Model Systems at a Level 1 Trauma center. Interventions: Not applicable. Main Outcome Measure: SI, as assessed by question 9 of the Patient Health Questionnaire-9. Results: Twenty-seven (11.0%) participants endorsed SI; 6 (22.2%) of whom endorsed active SI with a plan of self-harm. Participants who endorsed SI had significantly higher depressive symptoms, lower resilience, and lower satisfaction with life (all Ps<.001). They also had lower perceived health (P<.001), Craig Handicap Assessment & Reporting Technique Short Form (CHART-SF) physical independence (P=.013), and Spinal Cord Injury - Functional Index with Assistive Technology domains of basic mobility (P=.003), self-care (P=.042), and fine motor skills (P=.035). However, participants who endorsed SI were not significantly different in re-hospitalization rates and in other domains of CHART-SF and SCI-AT. Logistic regression, with a forward selection procedure, was used to identify significant predictors of endorsing SI in the context of multiple associated variables. Depressive symptoms (odds ratio [OR]=1.18, P=.020), resilience (OR=0.85, P=.003), and physical independence (OR=0.98, P=.019) remained significant predictors of SI. Conclusion: Study findings suggest higher levels of SI among people with SCI, a substantial proportion of whom have active SI. Individuals with SCI who endorse SI have greater burden of poor physical and mental health, as well as poorer functional status and adaptation. Interventions targeting multiple dimensions of quality of life may help reduce risk of SI and suicide among individuals with SCI.

Telepsychology for Individuals With Spinal Cord Injury: Protocol for a Randomized Control Study of Video-Based Cognitive Behavioral Therapy.

Background: A substantial proportion of individuals with spinal cord injury (SCI) experience depression, which has been negatively associated with recovery and community participation after injury. Despite significant barriers to seeking and receiving in-person mental health care, little research has focused on the efficacy of telepsychology among individuals with SCI. Objectives: To describe the design and implementation of an ongoing single-center, randomized controlled, video-based cognitive behavioral therapy (CBT) intervention among individuals with SCI. Methods: Participants within 1 year of SCI will be randomized 1:1 to intervention or usual care in a 24-week study. Intervention participants will engage in 10 sessions of CBT over 12 weeks with a licensed clinical psychologist, using iPads via Apple FaceTime. Primary outcomes are depressive symptomatology, anxiety, and life satisfaction (as measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Satisfaction with Life Scale, respectively) measured at three time points (baseline, 12 weeks, and 24 weeks). These and other measures are also assessed during monthly telephone surveys conducted between primary timepoints. Results: Recruitment is ongoing. Forty-six participants have been enrolled thus far. Conclusion: Telepsychology is a convenient, flexible, and effective alternative to traditional in-person services. We anticipate that intervention participants will experience improvements in depressive and anxiety symptoms and will have greater life satisfaction. Telepsychology interventions among individuals with SCI are tasked to maintain participant privacy, provide assistive technology and/or engage caregivers to minimize mobility limitations, and manage risk remotely. Challenges encountered include recruitment during the COVID-19 pandemic. Early intervention on symptoms of psychological morbidity using telepsychology may facilitate greater adaptation following SCI.

Adoption of Single-Use Clean Intermittent Catheterization Policies Does Not Appear to Affect Genitourinary Outcomes in a Large Spinal Cord Injury Cohort.

PURPOSE: In April 2008, Medicare amended its policy for clean intermittent catheterization, increasing coverage from 4 reused catheters per month to up to 200 single-use catheters. The primary reason for the policy change was an assumed decrease in risk of urinary tract infection with single-use catheters. Given its economic/environmental impact (∼50-fold increase in cost and plastic waste) and a paucity of supporting evidence, we retrospectively evaluate the policy's effect in a prospective spinal cord injury registry. MATERIALS AND METHODS: We accessed data for the years 1995 to 2020 from the National Spinal Cord Injury Database focusing on 1-year follow-up in those unable to volitionally void after injury. We asked 2 questions: (1) Did hospitalizations for genitourinary reasons decrease after the clean intermittent catheterization policy change?; and (2) Did clean intermittent catheterization adoption and adherence increase after the clean intermittent catheterization policy change? RESULTS: During the study period, 2,657 of the 6,843 (38.8%) participants unable to volitionally void after spinal cord injury were hospitalized during their first follow-up year. Of the cohort performing clean intermittent catheterization, fewer individuals were hospitalized for genitourinary reasons prior to the clean intermittent catheterization policy change compared to after (10.6% vs 14.6%, P < .001), a finding that persisted on multivariate logistic regression (odds radio, 0.67, P < .001). In addition, the number of individuals performing clean intermittent catheterization at 1-year follow-up was less after the policy change compared to prior (57.0% vs 59.1%, P = .044). CONCLUSIONS: Our findings suggest the 2008 policy change shifting clean intermittent catheterization coverage from catheter reuse to single-use did not decrease hospitalizations for urinary tract infection or increase clean intermittent catheterization uptake in individuals with spinal cord injury.

SCiPad: evaluating telemedicine via iPad facetime for general spinal cord injury care.

STUDY DESIGN: Uncontrolled clinical pilot study. OBJECTIVES: To assess usage, perceived impact, and satisfaction with a telemedicine program among individuals with spinal cord injury (tele-SCI). SETTING: Community-based. METHODS: Participants (N = 83) were recruited from acute SCI inpatient rehabilitation and outpatient SCI care at a community hospital to participate in a 6-month tele-SCI intervention administered by SCI subspecialty board-certified physiatrists via iPad FaceTime. In addition to monthly follow up interview calls, psychosocial and Quality of Life (QoL) measures were collected at baseline and post-intervention. A program satisfaction survey was also collected post-intervention. RESULTS: Seventy-five percent of participants engaged in tele-SCI visits (Median [IQR]: 2.5 [2.0, 4.0]) for a total of 198 tele-SCI visits. Bladder and bowel concerns were the leading topics discussed during tele-SCI visits, followed by neurological, pain, and functional concerns. Tele-SCI users resided further away (Median miles [IQR] - 114[73-177] vs. 81[46-116], p = 0.023) and reported seeking more clinical advice (Median [IQR] - 1.5[0-4.0] vs. 0[0-1.0], p = 0.002) compared to non-tele-SCI users. All other clinical utilization, baseline characteristics, psychosocial measures, and QoL did not differ among those who used tele-SCI and those who did not. The satisfaction survey suggested satisfaction with the tele-SCI intervention (89%), study equipment (89%), staff responsiveness (100%), and improved motivation for self-monitoring of health (71%). CONCLUSION: Study findings suggest that tele-SCI is a feasible modality for providing general SCI care. Further research is required to examine longer-term efficacy of remotely-provided care among individuals living with SCI.

The Effect of Early Infection on the Rate of Volitional Voiding after Spinal Cord Injury: A Potential Modifiable Risk Factor for Bladder Outcomes.

PURPOSE: Recently, it has been observed that early infections after spinal cord injury (SCI) are associated with decreased long-term motor and sensory recovery. We investigate the effects of early infection after SCI on long-term bladder function. MATERIALS AND METHODS: We assessed data for the years 1995 to 2006 using the National Spinal Cord Injury Database. Postoperative wound infections and pneumonia were used to classify infections during the acute inpatient and rehabilitation periods. The effect of early infections on volitional voiding status at 1-year followup was assessed. Age, gender and neurological status at rehabilitation discharge (level of injury, American Spinal Injury Association Impairment Scale [AIS] and bilateral lower extremity motor scores) were included in multivariate logistic regression modeling to control for confounding. RESULTS: Of the 3,561 persons studied, 1,233 (34.6%) had an early infection. Those with an infection during early recovery were less likely to void than their noninfected counterparts if in the AIS A (0.3% vs 1.9%, p=0.010), AIS B (3.8% vs 10.5%, p=0.018) and AIS C (29.1% vs 37.3%, p=0.071) classification, while those with less complete injuries (AIS D) did not appear to be affected (62.6% vs 65.4%, p=0.456). Similar findings were found when stratifying by lower extremity motor scores and persisted on multivariate analysis, where early infection decreased the odds of volitional voiding at 1-year followup (OR=0.79, p=0.042). CONCLUSIONS: Infections during the early recovery period may modify volitional voiding at 1-year followup by 20% or more. Future investigations to confirm our findings and potentially evaluate mitigation strategies are warranted.

Nutrition counseling and monitoring via tele-nutrition for healthy diet for people with spinal cord injury: A case series analyses.

OBJECTIVE: To evaluate the effect of a tele-nutrition counseling program on diet quality, weight, waist circumference, and quality of life in people with spinal cord injury (SCI). DESIGN: Prospective observational study. PARTICIPANTS: Fifteen participants with SCI were enrolled from an acute inpatient rehabilitation unit and outpatient SCI clinic; ten participants completed the intervention. INTERVENTIONS: Six tele-nutrition counseling sessions over 3 months, utilizing videoconferencing and a photographic food diary. OUTCOME MEASURES: Weight, waist circumference, Life Satisfaction Index A (LSIA), Knowledge and Nutrition Evaluation with Supplement on Eating Behavior, and Program Satisfaction Survey (PSS). RESULTS: Ten participants completed both baseline and 3-month follow-up evaluations and were used in this analysis. There were no statistically significant changes from baseline to 3-month follow up in weight, waist circumference, Knowledge and Nutrition Evaluation, and LSIA (P > .48). Using the Supplement on Eating Behavior total score to measure overall changes in healthy food choices, 9 out of 10 participants rated their healthy food choices as improving (P = .008). A post-hoc exploratory itemized analysis on the Supplement on Eating Behavior revealed significant improvements from baseline to 3-month follow-up in participant's self-reported choice of balanced meals (P = .008), reading food labels (P = .031), logging meals (P = .007), and monitoring portions of eating favorite foods (P = .031). Participants endorsed a 97-100% satisfaction rating in relation to perceived health benefits, equipment, and program satisfaction. CONCLUSION: This study provides preliminary data suggesting that tele-nutrition is an efficacious intervention that may improve diet quality for individuals with SCI.

Do improvements in upper extremity motor function affect changes in bladder management after cervical spinal cord injury?

INTRODUCTION: One of the most important predictors of clean intermittent catheterization (CIC) adoption after spinal cord injury (SCI) is upper extremity (UE) motor function at discharge from rehabilitation. It is not clear however if post-discharge improvements in UE motor function affect future bladder management decisions. METHODS: We assessed persons with cervical SCI in the National Spinal Cord Injury Dataset for the years 2000-2016 who underwent motor examination at discharge from rehabilitation and again at 1-year follow-up. Individuals were stratified based on a previously described algorithm which categorizes the ability to independently perform CIC based upon UE motor scores. Improvements in the predicted ability to self-catheterize over the first year after rehabilitation discharge were evaluated in relation to bladder management. RESULTS: Despite 15% of our SCI cohort improving from "less than able to independently catheterize" to "able to independently catheterize", more patients in the overall cohort dropped out of CIC (175/643 = 27.2%) than adopted CIC (68/548 = 12.4%) (P < .001). We found that in those initially categorized as "less than able to independently catheterize" at the time of rehabilitation discharge, CIC adoption was not significantly different at 1-year follow-up whether or not there was motor improvement to "able to independently catheterize" (12.7% vs 9.2% respectively, P = 0.665). Between these two groups, CIC dropout was also equivalent (34.3% vs 30.0% respectively, P = 0.559). CONCLUSIONS: In the first year after rehabilitation, more overall SCI patients transition away from CIC than convert to CIC. Significant improvements in UE motor function during the first year after rehabilitation discharge do not appear to affect bladder management decisions.

Time Burden of Bladder Management in Individuals With Spinal Cord Injury.

BACKGROUND: While clean intermittent catheterization (CIC) is the gold standard for bladder management after spinal cord injury (SCI), many individuals with SCI, for reasons not fully understood, choose alternative bladder management. We hypothesized that CIC is associated with an increased time burden in individuals with SCI. OBJECTIVES: To investigate the time required to perform neurogenic bladder management in individuals with SCI. METHODS: An electronic nonvalidated questionnaire was designed to determine the self-reported time spent performing bladder management. It was sent to participants in the Neurogenic Bladder Research Group SCI Registry, a national quality of life study of individuals with SCI. RESULTS: Eighty-seven individuals responded to the survey. CIC was the most common bladder management (76%). Men and women performing independent CIC had similar average times with each catheterization episode (8.8 vs. 8.5 minutes, p = .864) as did women with a catheterizable stoma compared to women catheterizing per urethra (8.2 minutes, p = .913). Longer catheterization times were associated with cervical spine injury (mean 12.4 minutes per catheterization) and women requiring caregiver assistance (mean 20 minutes per catheterization). In addition, obese/overweight women had longer CIC times than normal weight women (14.5 minutes vs. 7 minutes; p = .036), while catheterization time was similar for all men regardless of body mass index. Individuals with indwelling catheters spent less than a third of the time on bladder management per day compared to those doing CIC (17 vs. 53 minutes per day, p < .001). CONCLUSION: Management of neurogenic bladder after SCI, especially in those performing CIC, is time consuming. This time burden may play a role in long-term bladder management decisions.

The Time Burden of Specialty Clinic Visits in Persons With Neurologic Disease: A Case for Universal Telemedicine Coverage.

Objective: Those with chronic neurologic disorders are often burdened not only by the condition itself but also an increased need for subspecialty medical care. This may require long distance travel, while even small distances can be a hardship secondary to impaired mobility and transportation. We sought to examine the burden of time associated with clinical visits for those with chronic neurologic disorders and their family/caregivers. These topics are discussed as an argument to support universal coverage for telemedicine in this population. Design: Cohort Study. Setting: Specialty clinic at community hospital. Participants: 208 unique patients with chronic neurologic disability at physical medicine and rehabilitation or neurourology clinic over a 3-month period. Main Outcome Measures: Patient survey on commute distance, time, difficulties, and need for caregiver assistance to attend visits. Results: Approximately 40% of patients were covered by Medicare. Many patients (42%) perceived it difficult to attend their clinic visit with transportation difficulties, commute time, and changes to their daily schedule being the most commonly cited reasons. Most patients (75%) lived within 25 miles of our clinics and experienced an average commute time of 79.4 min, though 10% required 3 h or more. Additional family/caregiver assistance was required for 76% of patients, which resulted in an inclusive average commute time of 138.2 min per patient. Conclusion: Chronically neurologically-disabled patients and their caregivers may be burdened by the commute to outpatient appointments. To minimize this burden, increased emphasis on telemedicine coverage for those with chronic neurologic disability should be considered by all payors.

Cognitive Profiles Among Individuals With Spinal Cord Injuries: Predictors and Relations With Psychological Well-being.

OBJECTIVES: To examine predictors of profiles of cognitive functioning among individuals receiving acute inpatient spinal cord injury (SCI) rehabilitation, as well as associations between their cognitive functioning and psychological well-being (life satisfaction and depression) 6 months after the baseline assessment. DESIGN: Prospective observational study design, with 2 assessments approximately 6 months apart. SETTING: A rehabilitation unit at a level 1 trauma hospital during acute SCI hospitalization and outpatient setting after discharge. PARTICIPANTS: Individuals (N=89) with SCI. INTERVENTION: None. MAIN OUTCOME MEASURES: Cognitive functioning (assessed by the Repeatable Battery for the Assessment of Neuropsychological Status), life satisfaction (measured by the Life Satisfaction Index A), and depressive symptoms (measured by the Patient Health Questionnaire-9). RESULTS: Latent profile analysis identified 3 classes of individuals with similar patterns of cognitive functioning: class1 (average levels of cognitive performance across all assessed domains; n=48), class 2 (average cognitive performance, except in recall and memory; n=23), and class 3 (low cognitive functioning across multiple domains of cognition; n=18). Fewer years of education, history of smoking, history of substance use other than alcohol, and greater postconcussion symptoms were associated with higher odds of classification in class 3 (P<.05). Six months post baseline, individuals in class 3 reported significantly lower levels of life satisfaction than individuals in class 1 (χ2(1)=5.86; P=.045) and marginally higher depressive symptoms than individuals in class 2 (χ2(1)=5.48; P=.057). CONCLUSIONS: The impact of impaired cognition during acute rehabilitation may persist after discharge and influence the psychological well-being of individuals with SCI. Identifying individuals with cognitive dysfunction and attending to modifiable risk factors and may help ameliorate maladjustment after SCI.

Provision of care through telemedicine during a natural disaster: a case study.

INTRODUCTION: As the frequency and intensity of natural disasters increases, disaster preparedness is necessary for individuals with disabilities, including those with spinal cord injury (SCI). However, despite vulnerability to poorer outcomes, disaster preparedness for individuals with SCI is inadequate. Telemedicine has been effectively used to mitigate the impact of natural disasters. In this case study, we describe the provision of clinical care, via telemedicine, to an individual with SCI who was affected by the California Valley Fire in 2015. CASE PRESENTATION: The individual described was an adult who sustained a SCI. Before discharge from acute inpatient rehabilitation, they enrolled in a research study, through which they received outpatient SCI-specific care via telemedicine (teleSCI). The participant attended several teleSCI visits prior to the start of the Valley Fire. In the midst and immediate aftermath of prolonged wildfire, and despite experiencing significant personal loss as a result of the fire, the participant continued to receive teleSCI services. TeleSCI was used to address emergent and extant medical concerns and to facilitate replacement of medical supplies and equipment destroyed by fire. DISCUSSION: TeleSCI was used to provide continuity of care and was responsive to the needs of an individual with SCI severely affected by wildfire. Emergency preparedness that meets the needs of persons with disabilities is critical during times of crisis. Telemedicine may be an effective tool that can be applied to meet the medical needs of individuals with SCI and to mitigate the impact of disasters.

Effective self-stretching of carpal ligament for the treatment of carpal tunnel syndrome: A double-blinded randomized controlled study.

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome worldwide. There are limited studies on the effectiveness of carpal ligament stretching on symptomatic and electrophysiologic outcomes. PURPOSE OF THE STUDY: The purpose of this study was to evaluate the effect of self-myofascial stretching of the carpal ligament on symptom outcomes and nerve conduction findings in persons with CTS. STUDY DESIGN: This is a prospective, double-blinded, randomized, placebo-controlled trial. METHODS: Eighty-three participants diagnosed with median mononeuropathy across the wrist by nerve conduction study were randomized 1:1 to sham treatment or self-carpal ligament stretching. Participants were instructed to perform the self-treatment four times a day for six weeks. Seventeen participants in the sham treatment group and 19 participants in the carpal ligament stretching group completed the study. Pre- and post-treatment outcome measures included subjective complaints, strength, nerve conduction findings, and functional scores. RESULTS: Groups were balanced on age, sex, hand dominance, symptom duration, length of treatment, presence of nocturnal symptoms, and compliance with treatment. Even though the ANOVA analyses were inconclusive about group differences, explorative post hoc analyses revealed significant improvements in numbness (P = .011, Cohen's d = .53), tingling (P = .007, Cohen's d = .60), pinch strength (P = .007, Cohen's d = -.58), and symptom severity scale (P = .007, Cohen's d = .69) for the treatment group only. CONCLUSIONS: The myofascial stretching of the carpal ligament showed statistically significant symptom improvement in persons with CTS. Larger comparative studies that include other modalities such as splinting should be performed to confirm the effectiveness of this treatment option.

Pharyngeal Dysphagia in Individuals With Cervical Spinal Cord Injury: A Prospective Observational Cohort Study.

Objectives: To identify and describe the types and time course of dysphagia following cervical spinal cord injury (SCI). Methods: This was a prospective cohort study conducted in an SCI inpatient rehabilitation unit. Seventy-six individuals with SCI were enrolled. Inclusion criteria were age 18 years or older, admitted into SCI inpatient rehabilitation unit, and medically stable for participation in bedside swallow evaluation (BSE) and videofluoroscopic swallow study (VFSS). All participants first underwent a BSE, of whom 33 completed a VFSS. A follow-up BSE was conducted on individuals who tested positive on the initial BSE and continued to show signs of dysphagia. Diagnosis and type of dysphagia as well risk factors were collected. Results: Twenty-three out of 76 individuals with cervical SCI were diagnosed with dysphagia using the BSE. All participants with positive BSE and VFSS had pharyngeal dysfunction. For participants with a positive initial BSE and persisting dysphagia (n = 14), a follow-up BSE demonstrated resolution within 34 days. Risk factors associated with dysphagia were older age, nasogastric tube, invasive mechanical ventilation, tracheostomy, and pneumonia. Posterior spinal surgery was associated with a decreased risk of dysphagia. Conclusion: Dysphagia was present in 30% of individuals based on the initial BSE. All individuals with dysphagia demonstrated pharyngeal phase dysfunction on the VFSS. No participants experiencing dysphagia were missed on the BSE as confirmed by VFSS. In the subset of individuals who received a follow-up BSE, the time course of resolution of dysphagia was at most 34 days from initial BSE.

Correlation between thyroid function, testosterone levels, and depressive symptoms in females with spinal cord injury.

Study Design: Prospective case series. Objective: Investigate the association of testosterone and thyroid-stimulating hormone (TSH) levels with depressive symptoms in women after spinal cord injury (SCI). Setting: Community SCI clinic. Methods: Twenty-seven participants were enrolled in this study. Total testosterone (Total T) and TSH levels as well as the Center for Epidemiological Studies Depression Scale (CES-D) survey and monthly sexual activity were obtained from only 20 participants. Pearson's correlations were used to assess the relationship between age, time from injury, Total T level, TSH level, and CES-D total score. Follow-up analyses investigating the role of monthly sexual activity was also explored. Results: Participants' average age and time from injury was 44.4 ± 12.7 years old and 11.7 ± 8.89 years, respectively. Low Total T was observed in four participants and one of those participant's presented with low TSH as well. Nine women were classified as "at risk for clinical depression" on the CES-D (total score >15). Pearson's correlations revealed a significant association between time from injury and TSH (r = .536, p = .015), as well as CES-D total score (r = -.547, p = .013). Total T was associated with CES-D total score (ρ = -.541, p = .02). Conclusions: This study provides preliminary results on abnormal hormone levels and depressive symptoms in women after SCI. Twenty percent of this sample presented with low Total T, which was associated with increased depressive symptoms after accounting for time from injury. Further research is needed to investigate the impact of SCI on hormone function and mental health in women post SCI. Sponsorship: Sally Rynne National Association of Women's Health Quality Award 2002.

Validation of Upper Extremity Motor Function as a Key Predictor of Bladder Management After Spinal Cord Injury.

OBJECTIVE: To validate if better upper extremity (UE) motor function predicts clean intermittent catheterization (CIC) adoption and adherence after spinal cord injury (SCI) using a validated instrument (as opposed to prior research using scales based on expert opinion). DESIGN: We examined data from the Neurogenic Bladder Research Group SCI registry, a multicenter, prospective, observational study assessing persons with neurogenic bladder following SCI. All participants who were unable to volitionally void and were >1 year post injury were included. Participants were dichotomized into those performing CIC vs those using other bladder management methods. In addition to demographic and clinical characteristics, UE motor function was examined using the SCI-Fine Motor Function Index using validated categorization levels: (1) no activities requiring hand function, (2) some activities involving gross hand movement, (3) some activities requiring dexterity or coordinated UE movement, or (4) most activities requiring dexterity and coordinated UE movement. Associations were examined using logistic regression. SETTING: Multicenter study. PARTICIPANTS: Registry participants unable to volitionally void after SCI (N=1236). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Upper extremity motor function association with CIC. RESULTS: A total of 1326 individuals met inclusion criteria (66% performing CIC, 60% male, and 82% white). On multivariate analysis, better UE motor function was associated with a statistically increased odds of performing CIC (odds ratio, 3.10 [Level 3] and odds ratio, 8.12 [Level 4] vs Levels 1 and 2 [P<.001]). CONCLUSION: In persons with SCI who are unable to volitionally void, UE motor function is highly associated with CIC. These results validate prior findings and continue to suggest that following SCI, the degree of preserved UE motor function is associated with CIC more than any other factor.

Do appreciable changes in the upper extremity motor capability to perform clean intermittent catheterization come about with time after traumatic spinal cord injury?

INTRODUCTION: Bladder dysfunction after spinal cord injury (SCI) often requires clean intermittent catheterization (CIC) or other management strategies. A common dilemma in those desiring to perform CIC independently but lacking the appropriate upper extremity (UE) motor function is the timing of reconstructive surgery. METHODS: We assessed the National Spinal Cord Injury Data Set for the years 2000-2016. Our cohort consisted of persons with cervical SCI, who underwent complete motor examination upon discharge from rehabilitation and at 1-year follow-up. Using a previously published algorithm, UE motor scores were transformed to predict a patient's ability to independently perform CIC. Improvements in the predicted ability to self-catheterize were evaluated. RESULTS: Of the 1428 individuals meeting the inclusion criteria, improvements in the predicted UE motor function necessary to independently self-catheterize were observed in 39%, 42%, and 38% of those deemed possibly able, only able with surgical assistance, or unable to self-catheterize at rehabilitation discharge, respectively. On multivariate analysis, only increasing Association Impairment Scale (AIS) classification and AIS classification improvement over the first year were associated with an increased odds of improving predicted CIC ability (odds ratio [OR] = 1.44 for AIS C and 1.97 for AIS D compared with AIS A, and OR = 1.90 for AIS classification improvement versus stable AIS classification, P < 0.05 for each). CONCLUSION: Improvements in UE motor function to independently perform CIC occur in approximately 40% of persons with cervical SCI in the first year after rehabilitation discharge. Those with incomplete injuries are more likely to improve. These findings should enhance patient bladder management counseling and guide surgeons in determining an appropriate timeline for offering reconstruction.