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BACKGROUND: We report the changes in the health condition after using a service dog of a person with a complete C5 spinal cord injury (SCI). CASE: A 48-year-old married man began using a service dog after suffering a complete C5 SCI. We conducted a semi-structured interview based on the International Classification of Functioning, Disability, and Health (ICF) rehabilitation sets to describe the change in the participant's experience after using a service dog. The interview was converted into written form, and information regarding the changes in the participant's health condition was extracted. These data were categorized by similarity and then classified by the ICF conceptual framework. DISCUSSION: The participant experienced multiple changes in his health condition after using a service dog. These included the following factors from the ICF - "Body Function" category: "increased vitality and motivation," "emergence of self-affirmation," and "physical improvement." Health changes form the "Activities and Participation" category included: "emergence of new roles," "increased resilience," "expansion of moving area," "acquisition of activities incorporated with a service dog assist," "emergence of autonomous health management," "expansion of relation with other people," and "expansion of social activity." The participant experienced "reduction of psychological barriers," categorized under "Personal Factor," and "expansion of support environment," categorized under "Environmental Factor."
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Objective To study the effect of high-flow nasal cannula oxygen therapy (HFNC) in reduction in re-intubation rate, length of ICU stay and improvement of respiratory function in patients with high cervical spinal cord injury.Methods Single center retrospective study was carried out in our intensive care unit from September 2016 to March 2018. Post-operative patients ready for planned extubation with high cervical spinal cord injury were included. The length of ICU stay, re-intubation rate in case of respiratory failure, respiratory rate, pulse rate, MAP, SaO2, PaO2/FiO2, and PaCO2 of patients at 6, 24 and 72 h after extubation were compared between the HFNC and conventional oxygen therapy (COT) groups. Results During the study period, 38 patients were enrolled in the study. Of them, 16 patients were assigned in the HFNC group and 22patients in the COT group. Re-intubation rate was significantly different between the two groups (18.8％ vs 27.3％, P<0.05), but the length of ICU stay had no significant difference [(15.5±3.4) days vs (16.6±5.2) days]. The respiratory rate, pulse rate, SaO2 and PaO2/FiO2 at 6 h after extubation in the HFNC group were improved markedly than those in the COT group (P<0.05); and the PaCO2 and PaO2/FiO2 at 24 and 72 h after extubation in the HFNC group had much more improvement than those in the COT group (P<0.05). Conclusions Among individuals with post-operative high cervical spinal cord injury, high-flow oxygen therapy could reduce re-intubation rate, and PaCO2 level, and improve the respiratory function, but cannot reduce the length of ICU stay. High-flow oxygen therapy may offer advantages for patients with high cervical spinal cord injury.
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INTRODUCTION: Case reports, case series and case control studies have looked at the use of phrenic nerve stimulators in the setting of high spinal cord injuries and central hypoventilation syndromes dating back to the 1980s. We evaluated the evidence related to this topic by performing a systematic review of the published literature. METHODS: Search terms "phrenic nerve stimulation," "phrenic nerve and spinal cord injury," and "phrenic nerve and central hypoventilation" were entered into standard search engines in a systematic fashion. Articles were reviewed by two study authors and graded independently for class of evidence according to published guidelines. The published evidence was reviewed, and the overall body of evidence was evaluated using the grading of recommendations, assesment, development and evaluations (GRADE) criteria Balshem et al. (J Clin Epidemiol 64:401-406, 2011). RESULTS: Our initial search yielded 420 articles. There were no class I, II, or III studies. There were 18 relevant class IV articles. There were no discrepancies among article ratings (i.e., kappa = 1). A meta-analysis could not be performed due to the low quality of the available evidence. The overall quality of the body of evidence was evaluated using GRADE criteria and fell within the "very poor" category. CONCLUSION: The quality of the published literature for phrenic nerve stimulation is poor. Our review of the literature suggests that phrenic nerve stimulation is a safe and effective option for decreasing ventilator dependence in high spinal cord injuries and central hypoventilation; however, we are left with critical questions that provide crucial directions for future studies.
