ORCID Profile
0000-0002-2777-8619
Current Organisation
University of Sydney
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Rehabilitation Engineering | Biomedical Engineering | Clinical Engineering | Care For Disabled | Pattern Recognition
Injury control | Industrial instrumentation | Medical instrumentation |
Publisher: Springer Science and Business Media LLC
Date: 27-06-2010
DOI: 10.1007/S11136-010-9685-6
Abstract: To evaluate the reliability, validity, sensitivity to change, and clinical usefulness of the Sydney Psychosocial Reintegration Scale (SPRS) and Community Integration Measure (CIM) for people with spinal cord injury (SCI). A s le of 58 people with recent traumatic SCI was followed up at 12 months post-discharge from inpatient rehabilitation. The SPRS, CIM, Craig Handicap Assessment and Reporting Technique (CHART) and SF-6D Health Utility Scale (SF-6D) were administered. The SPRS and CIM were internally consistent (α = .80 and .78, respectively). The SPRS showed greatest sensitivity to change as measured by percentage of participants meeting minimum difference in score change over time (21%). CIM and CHART had comparable sensitivity to change (14% minimum difference). SPRS correlated significantly with CHART (r = .72, P < .001), unlike CIM. Neither SPRS nor CIM discriminated between high and low impairment, unlike CHART. Correlations with CHART and SF-6D domains supported convergent and ergent validity of the SPRS domains. Research should continue to develop conceptually and psychometrically valid instruments to capture the multidimensionality of community integration. The SPRS and CIM show potential to extend measurement of community reintegration following SCI.
Publisher: Springer Science and Business Media LLC
Date: 09-09-2008
DOI: 10.1038/SC.2008.115
Abstract: A systematic review of the literature concerning the nature of the psychological morbidity in people with spinal cord injury (SCI). SCI is believed to place the in idual at a high risk of psychological morbidity. The objective of this paper was to examine systematically the prevalence of negative psychological states in people with SCI, as well as to explore mediating and contextual factors. Search engines such as Medline and PsycInfo were systematically searched using specific key words, such as SCI, depression, anxiety and so on. Only studies that fulfilled certain criteria such as the use of valid measures in assessing psychological morbidity were used in the review process. The systematic review revealed that clarification is still needed concerning the psychological consequences of people with SCI. However, findings suggest that approximately 30% of people with SCI are at risk of having a depressive disorder although in rehabilitation, and approximately 27% are at risk of having raised depressive symptoms when living in the community. The review also established that people with SCI have higher comparative risks of anxiety disorder, elevated levels of anxiety, feelings of helplessness and poor quality of life (QOL). People with SCI have an increased risk of suffering debilitating levels of psychological morbidity. Future research needs to clarify the extent and nature of psychological morbidity following SCI by conducting prospective and comprehensive research in large heterogeneous s les of people with SCI during the rehabilitation phase and following reintegration into the community.
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.INJURY.2011.12.010
Abstract: Patients who have sustained a traumatic spinal cord injury require appropriate management in the immediate post-injury period for both survival and to reduce the chances of costly and disabling permanent neurological deficits. Emerging time-critical neuroprotective therapies require the prompt recognition and transfer of patients to a specialised centre for early intervention. The Ambulance Research Institute, with the New South Wales State Spinal Cord Injury Service retrospectively linked prehospital data to spinal cord injury unit (SCIU) outcome data for all 324 patients transported by ambulance and subsequently admitted to a SCIU with a persisting traumatic spinal cord injury (SCI) between January 2004 and June 2008, with the aim of identifying factors that impact on the provision of timely and appropriate care. Paramedics appropriately managed 88% of SCI patients. Only 4.9% of patients had initial vital signs potentially indicative of neurological injury. The median time to a SCIU was 12h, with 60% of patients undergoing multiple transfers. The odds of reaching a SCIU in over 24h were 1.71 times greater for patients injured in a major city (95% CI 1.00-2.90) in comparison to other areas of NSW. More SCI patients with multiple trauma experienced delays in reaching a SCIU (59%), compared to patients with isolated SCI (40% p=0.039). Patients initially transported to a designated major trauma centre were more likely to be delayed in reaching a SCIU, regardless of whether their injury was an isolated SCI or associated with multiple trauma, compared with other patients. Patients who took greater than 24h to reach a SCIU were 2.5 times more likely to develop a secondary complication (95% CI 1.51-4.17, p=0.0004). Patients who sustained their SCI as a result of a low fall were older and less likely to have their SCI identified and treated early, with less than half of this group reaching a SCIU within 24h compared with other SCI patients (OR 0.42, 95% CI 0.19-0.93, p=0.004). Early recognition, appropriate prehospital management, triage, timely and appropriate interfacility transfers of all SCI patients are critical for access to specialised care and reducing preventable complications. Elderly fallers present particular challenges to early identification.
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.JPSYCHORES.2012.07.005
Abstract: Fatigue is a common symptom in people with neurological injury such as spinal cord injury (SCI), though its nature and occurrence in people with SCI are not well understood. The objective of this research was to investigate fatigue and its relationship to factors such as mood states and self efficacy in adult people with SCI compared to able-bodied controls. Participants included 41 adults with SCI living in the community and 41 able-bodied controls matched for age and sex ratios and education. All participants first completed a comprehensive psychological assessment and were then asked to take part in a 2-3 hour session composed of a regimen of cognitive tasks that required constant concentration and attention. Participants were assessed after completing this task. The SCI group was found to have significantly elevated levels of fatigue, as well as elevated depressive mood, anxiety and poor self-efficacy. The SCI group was also found to suffer excessive levels of tiredness as a consequence of the 2-3 hour task. Factors such as depressive mood and poor self-efficacy were shown to increase the risk of excessive tiredness. People with a neurological injury such as SCI have a high risk of having fatigue and are susceptible to experiencing excessive tiredness when performing extended tasks, and the presence of elevated depressive mood or poor expectations towards self management will increase this susceptibility. Implications for managing fatigue and improving social access in SCI populations are discussed.
Publisher: Springer Science and Business Media LLC
Date: 15-06-2022
DOI: 10.1038/S41393-022-00817-7
Abstract: Cross-sectional survey. To identify common problems across key domains of functioning, health and wellbeing, as well as evaluate self-reported quality of life (QoL) by people with SCI, examining differences by age, gender, injury characteristics and level of mobility. Data from four state-wide SCI clinical services, one government insurance agency and three not-for-profit consumer organisations. Participants were 18 years or over with SCI and at least 12 months post-injury, recruited between Mar’18 and Jan’19. The Aus-InSCI questionnaire comprised 193 questions, including socio-demographics, SCI characteristics, body functions and structures, activities and participation, environmental and personal factors, and appraisal of health and well-being. General linear model was used to examine differences in functioning and QoL. Participants (mean age 57 years, range 19–94 years) with tetraplegia and/or complete injuries had more health problems, activity articipation problems and environmental barriers. However, self-rated overall QoL did not differ for injury level or completeness. Participants with more recent injuries exhibited lower independence levels, more mental health problems and poorer satisfaction with self and their living conditions. Major activity articipation problems related to intimate relationships and accessing public transportation. Less than half of the working age population were engaged in paid work. The top two environmental barriers frequently related to accessing public places or homes and unfavourable climatic conditions. This large, comprehensive community survey draws a detailed picture of the lived experience of people with SCI in Australia, identifying priority needs, gaps in services and barriers to achieving a full and satisfying life.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2006
Abstract: To determine whether Methenamine Hippurate (MH) or cranberry tablets prevent urinary tract infections (UTI) in people with neuropathic bladder following spinal cord injury (SCI). Double-blind factorial-design randomized controlled trial (RCT) with 2 year recruitment period from November 2000 and 6 month follow-up. In total, 543 eligible predominantly community dwelling patients were invited to participate in the study, of whom 305 (56%) agreed. Eligible participants were people with SCI with neurogenic bladder and stable bladder management. All regimens were indistinguishable in appearance and taste. The dose of MH used was 1 g twice-daily. The dose of cranberry used was 800 mg twice-daily. The main outcome measure was the time to occurrence of a symptomatic UTI. Multivariate analysis revealed that patients randomized to MH did not have a significantly longer UTI-free period compared to placebo (HR 0.96, 95% CI: 0.68-1.35, P=0.75). Patients randomized to cranberry likewise did not have significantly longer UTI-free period compared to placebo (HR 0.93, 95% CI: 0.67-1.31, P=0.70). There is no benefit in the prevention of UTI from the addition of MH or cranberry tablets to the usual regimen of patients with neuropathic bladder following SCI.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2012
DOI: 10.1038/SC.2012.55
Abstract: Cohort of incident cases from 1955 to 2006. To analyse acute and long-term mortality, estimate life expectancy and identify survival patterns of in iduals experiencing traumatic spinal cord injury (SCI). Specialised SCI unit in Australia. Data for patients with traumatic SCI admitted to a spinal unit in Sydney, Australia between January 1955 and June 2006 were collated and deaths confirmed. Cumulative survival probability was estimated using life-table techniques and mortality rates were calculated from the number of deaths and aggregate years of exposure. Standardised mortality ratios (SMRs) were estimated from the ratio of observed to expected number of deaths. Life expectancy was then estimated using adjusted attained age-specific mortality rates. From 2014 persons, 88 persons with tetraplegia (8.2%) and 38 persons with paraplegia (4.1%) died within 12 months of injury, most often with complete C1-4 tetraplegia. Among first-year survivors, overall 40-year survival rates were 47 and 62% for persons with tetraplegia and paraplegia, respectively. The most significant increases in mortality were seen in those with tetraplegia and American Spinal Injury Association Impairment Scale (AIS) grades A-C lesions, with SMRs between 5.4 and 9.0 for people <50 years, reducing with advancing attained age. Estimated life expectancies from 25 to 65 years ranged between 69-64%, 74-65%, 88-91% and 97-96% for C1-4 AIS A-C, C5-8 A-C, T1-S5 A-C and all AIS D lesions, respectively. Survival related strongly to extent of neurological impairment. Future research should focus on identifying contextual factors, personal or environmental, that may contribute to the reduced life expectancy after SCI.
Publisher: Springer Science and Business Media LLC
Date: 12-01-2010
DOI: 10.1038/SC.2009.191
Abstract: A randomized controlled trial. To determine the effectiveness of electrical stimulation (ES)-evoked muscle contractions superimposed on progressive resistance training (PRT) for increasing voluntary strength in the quadriceps muscles of people with spinal cord injuries (SCI). Sydney, Australia. A total of 20 people with established SCI and neurologically induced weakness of the quadriceps muscles participated in the trial. Participants were randomized between experimental and control groups. Volunteers in the experimental group received ES superimposed on PRT to the quadriceps muscles of one leg thrice weekly for 8 weeks. Participants in the control group received no intervention. Assessments occurred at the beginning and at the end of the 8-week period. The four primary outcomes were voluntary strength (Nm) and endurance (fatigue ratio) as well as the performance and satisfaction items of the Canadian Occupational Performance Measure (COPM points). The between-group mean differences (95% confidence interval (CI)) for voluntary strength and endurance were 14 Nm (1-27 P=0.034) and 0.1 (-0.1 to 0.3 P=0.221), respectively. The between-group median differences (95% CI) for the performance and satisfaction items of the COPM were 1.7 points (-0.2 to 3.2 P=0.103) and 1.4 points (-0.1 to 4.6 P=0.058), respectively. ES superimposed on PRT improves voluntary strength, although there is uncertainty about whether the size of the treatment effect is clinically important. The relative effectiveness of ES and PRT is yet to be determined.
Publisher: Elsevier BV
Date: 07-2009
Publisher: IEEE
Date: 08-2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2013
Publisher: Springer Science and Business Media LLC
Date: 24-07-2007
Abstract: Review. This review article investigated the objective evidence of benefits derived from functional electrical stimulation (FES)-assisted gait for people with spinal cord injury (SCI). Both FES and gait have been proposed to promote not only augmented health and fitness, but specific ambulatory outcomes for in iduals with neurological disabilities. However, due to small s le sizes and the lack of functionality of the intervention, it has not been widely used in clinical practice. This review assessed whether there is sufficient evidence to encourage a more widespread deployment of FES gait within the rehabilitation community. Hand searches and online data collection were performed in Medline and Science Direct. Specific search terms used included SCI aralysis araplegia and tetraplegia with electrical stimulation/FES, gait and walking. The searches generated 532 papers. Of these papers, 496 were excluded and 36 papers were included in the review. Many reported benefits were not carefully investigated, and small s le sizes or different methodologies resulted in insufficient evidence to draw definitive conclusions. FES gait can enhance gait, muscle strength and cardiorespiratory fitness for people with SCI. However, these benefits are dependent on the nature of the injury and further research is required to generalize these results to the widespread population of SCI in iduals. Proof of the functionality and further evidence of the benefits of FES gait will assist in FES gait gaining clinical acceptance.
Publisher: American Psychological Association (APA)
Date: 11-2003
Publisher: Springer Science and Business Media LLC
Date: 23-06-2015
DOI: 10.1038/SC.2015.86
Abstract: Literature review/semi-structured interviews. To develop a spinal cord injury (SCI) research strategy for Australia and New Zealand. Australia. The National Trauma Research Institute Forum approach of structured evidence review and stakeholder consultation was employed. This involved gathering from published literature and stakeholder consultation the information necessary to properly consider the challenge, and synthesising this into a briefing document. A research strategy 'roadmap' was developed to define the major steps and key planning questions to consider next, evidence from published SCI research strategy initiatives was synthesised with information from four one-on-one semi-structured interviews with key SCI research stakeholders to create a research strategy framework, articulating six key themes and associated activities for consideration. These resources, combined with a review of SCI prioritisation literature, were used to generate a list of draft principles for discussion in a structured stakeholder dialogue meeting. The research strategy roadmap and framework informed discussion at a structured stakeholder dialogue meeting of 23 participants representing key SCI research constituencies, results of which are published in a companion paper. These resources could also be of value in other research strategy or planning exercises. This project was funded by the Victorian Transport Accident Commission and the Australian and New Zealand Spinal Cord Injury Network.
Publisher: American Spinal Injury Association
Date: 07-2014
DOI: 10.1310/SCI2003-225
Publisher: Springer Science and Business Media LLC
Date: 14-07-2010
DOI: 10.1038/SC.2009.88
Abstract: Randomized, assessor-blinded trial. To evaluate the effectiveness of a 6-week task-specific training programme on the abilities of people with chronic spinal cord injuries to sit unsupported. NSW, Australia. Thirty adults with spinal cord injuries of at least 1-year duration were recruited. Participants in the training group (n=15) performed up to 1 h of task-specific training three times a week for 6 weeks. Participants in the control group (n=15) did not receive any training or additional therapy. Primary outcome measures were the Canadian Occupational Performance Measure (COPM), and tests of Upper Body Sway, Maximal Balance Range and donning and doffing a T-shirt (the T-shirt test). The between-group mean difference (95% confidence interval) for the maximal balance range was 64 mm (95% confidence interval 20 to 108 mm P=0.006). There were no significant between-group mean differences for the COPM and the Upper Body Sway and T-shirt tests. This trial shows initial support for intensive task-specific training for improving the abilities of people with chronic spinal cord injuries to sit unsupported, although the real-world implications of the observed treatment effects are yet to be determined.
Publisher: Springer Science and Business Media LLC
Date: 23-06-2015
DOI: 10.1038/SC.2015.87
Abstract: Focus Group. To develop a unified, regional spinal cord injury (SCI) research strategy for Australia and New Zealand. Australia. 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. This first step in a regional SCI research strategy has articulated objectives for further development by the wider SCI research community. The initiative has also reinforced the importance of coordinated, collective action in optimising outcomes following SCI.
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/00207450701242826
Abstract: This study investigated brain wave activity associated with spinal cord injury (SCI). Electroencephalograms (EEG) were compared between 10 in iduals with SCI and 10 age and sex matched able-bodied controls using a 64-channel EEG montage. SCI participants had chronic (>12 months) paraplegic clinically complete injuries. The 64 channels of EEG data were spread diffusely over the cortex and were compared for delta (2-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz) wave components of the EEG frequency spectra. No significant magnitude or directional changes were found in the delta (2-4 Hz) or theta (4-8 Hz) wave frequency bands between these two groups. However, significant and consistent decreased alpha wave (8-13 Hz) and increased beta wave activity (13-30 Hz) were found in the SCI participants across the cortex compared to the able-bodied control group. These findings suggest that the SCI group have increased neural processing compared to the able-bodied in iduals, which may be related to ongoing reorganization of brain structures following SCI.
Publisher: Springer Science and Business Media LLC
Date: 23-06-2015
DOI: 10.1038/SC.2015.85
Abstract: This is a rapid evidence review. The objective of this study was to gain an overview of the volume, nature and findings of studies regarding priorities for spinal cord injury (SCI) research. A worldwide literature search was conducted. Six medical literature databases and Google Scholar were searched for reviews in which the primary aim was to identify SCI research priorities. Two systematic reviews were identified-one of quantitative and one of qualitative studies. The quality of the reviews was variable. Collectively, the reviews identified 31 primary studies 24 quantitative studies totalling 5262 participants and 7 qualitative studies totalling 120 participants. Despite the difference in research paradigms, there was convergence in review findings in the areas of body impairments and relationships. The vast majority of literature within the reviews focused on the SCI patient perspective. The reviews inform specific research topics and highlight other important research considerations, most notably those pertaining to SCI patients' perspectives on quality of life, which may be of use in determining meaningful research outcome measures. The views of other SCI research stakeholders such as researchers, clinicians, policymakers, funders and carers would help shape a bigger picture of SCI research priorities, ultimately optimising research outputs and translation into clinical practice and health policy change. Review findings informed subsequent activities in developing a regional SCI research strategy, as described in two companion papers. This project was funded by the Victorian Transport Accident Commission and the Australian and New Zealand SCI Network.
Publisher: Informa UK Limited
Date: 30-09-2022
DOI: 10.1080/09638288.2021.1979665
Abstract: This study sought to (i) investigate the proportion of Thai in iduals with spinal cord injury (Thai-SCI) who met SCI-specific physical activity (PA) guidelines, (ii) describe PA and health-related quality of life (HRQOL) of Thai-SCI across different sociodemographic strata, and, (iii) measure the variance in HRQOL associated with the intensity and volume of leisure-time physical activities (LTPA). Two surveys, measuring PA and HRQOL, were used in this study. Descriptive analysis, parametric and non-parametric tests for comparing two or more groups were used to analyse the data. The relationship between PA levels and HRQOL scores was investigated using Spearman's correlation coefficients. All statistical significance level in this study were set to alpha < 0.05. From the 200 participants, 14.5% met aerobic, 20.5% met strength training and 13.5% met both aerobic and strength training SCI-specific PA guidelines. Sedentary Thai-SCI accounted for 49% of the study s le. Thai-SCI spent 132.0 ± 254.3 (mean ± SD) minutes per week on moderate-to-heavy intensity LTPA. Average Physical and Mental Component Summary (PCS and MCS scores) of Thai-SCI were 42.3 ± 7.6 and 49.3 ± 8.4 (mean ± SD), respectively. Increases in average LTPA of moderate-to-heavy intensities were weakly correlated with increases in PCS scores and its sub-domains ( The average time spent on moderate-to-heavy intensity ADLs and LTPA were below SCI-specific PA guidelines and the WHO global recommendations for PA. The proportion of Thai-SCI who were sedentary was high, suggesting immediate action and implementation of strategies to promote PA for Thai-SCI.IMPLICATIONS FOR REHABILITATIONThe proportion of Thai people with spinal cord injury with a sedentary lifestyle was high.Healthcare providers in Thailand must engage to a greater degree in health-related physical activity promotion to effectively deliver physical activity and exercise knowledge to their clients with spinal cord injury.Likely, structured programs of physical activity and exercise deployed by healthcare professionals with the appropriate knowledge and skills might reverse the current trend to sedentary lifestyle in this population.Interventions to improve participation in physical activity and health-related quality of life should be tailored to the in idual needs of Thai in iduals with a spinal cord injury and might be better delivered seperately.
Publisher: Medical Journals Sweden AB
Date: 2013
Abstract: It was hypothesized that, for people with severe traumatic injuries, no association between long term health status and receiving financial compensation would be detected. Two prospective cohort studies. A group of people with severe traumatic brain injury (n = 132) and a group of people with traumatic spinal cord injury (n = 58). Health status and functioning were measured at baseline and at 5 years follow-up for both injury groups. Results per group were compared between those who received compensation and those who were non-compensable. In the brain injury cohort those receiving financial compensation showed a significantly worse Disability Rating Scale score after 5 years compared to the non-receiving group (p = 0.01). Financial compensation was a modest predictor for being disabled (scores ≥ 4) after 5 years (Exp (B) = 2.47, 95% confidence interval 1.03 to 5.93). In the spinal cord injury cohort those receiving financial compensation scored significantly lower with the Short-Form 36 General Health Survey/Physical Component Summarise scores after 5 years than those who did not (p = 0.04). Again, receiving financial compensation had a modest predictive value for the Short-Form 36/Physical Component Summarise scores after 5 years (B = -4.72, SE = 2.16, 95% confidence interval -9.05 to -0.38). Financial compensation may have a small negative association with recovery, even for people with severe traumatic injury.
Publisher: Medical Journals Sweden AB
Date: 2012
Abstract: To evaluate the reliability and validity of WHODAS II within the spinal cord injury population. Sixty-three people with traumatic spinal cord injury. The World Health Organization Disability Assessment Scale II (WHODAS II), Craig Handicap Assessment and Reporting Technique, and Medical Outcomes Study 36-item Short-Form Health Survey (MOS SF-36) were administered at 2 years post discharge from rehabilitation. Distribution, reliability, discriminant validity, and convergent/ ergent validity were evaluated using classical tests. Rasch analyses were applied to assess dimensionality, item spread, and person/item reliability. Cronbach's alpha coefficients ranged from 0.61 (getting around) to 0.97 (participation). Ceiling effects were present in 4 out of 6 domains. WHODAS II discriminated between levels of impairment and work force status on 'self-care', 'getting around', 'life activities', and total score. Correlations with MOS SF-36 supported convergent/ ergent validity. Five items didn't fit the Rasch model. The item erson map reveald a shortage of items able to differentiate the more able person. WHODAS II demonstrated good person and item separation and reliability. This study provides preliminary support for reliability and validity of WHODAS II in a spinal cord injured population. Limitations were noted for dimensionality and item person distribution. Findings need to be confirmed in larger s les.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2000
Abstract: Four in iduals with a spinal cord injury underwent 16 weeks of isometric electrical stimulation training to both legs for 60 min, five times per week during the first 5 months after injury, while two SCI in iduals remained untrained. A baseline biopsy s le of the vastus lateralis muscle was obtained within 1 month of injury, and another biopsy s le was taken after a further 16 weeks. The untrained, paralyzed skeletal muscle displayed a reduction in (1) type I fibers (from 50% to 9%), (2) myosin heavy chain (MHC) I (from 27% to 6%), and (3) fiber cross-sectional area of type I, type IIA and type IIX fibers (-62%, -68%, and -55%, respectively) when compared to the baseline s le of muscle taken within 1 month of injury. In contrast, the trained group showed smaller alterations in type I fibers (from 49% to 40%) and MHC I composition (from 39% to 25%), while fiber cross-sectional area was similar to baseline levels for type I, type IIA and type IIX fibers (-3%, -8%, and -4%, respectively). In conclusion, electrical stimulation training can largely prevent the adverse effects of a spinal cord injury upon paralyzed human skeletal muscle if applied soon after the injury.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2005
Abstract: Review. To review published articles on the assessment, diagnosis and treatment of pain following spinal cord injury (SCI) and to synthesise evidence from these materials to formulate and propose a systematic approach to management. Relevant articles regarding the treatment of pain were identified from electronic databases using the search terms (('spinal cord injury' or 'spinal cord injuries') and 'pain') and both ('treatment') and ('randomised controlled trials'). Relevant articles were also identified through citations in indexed journal publications and book chapters on this topic. Review of the literature indicates that there are a large variety of treatments used in the management of pain following SCI with a small number supported by strong evidence for effectiveness. A treatment algorithm is proposed based on identification of underlying pain contributors and application of appropriate treatment. Although there are relatively few studies clearly indicating efficacy in this population, an algorithm for the management of pain following SCI might assist to maximise our effectiveness in the treatment of this condition. It is recognised that choice of treatment is also determined by factors such as medication availability, cost and side effects as well as the preferences and characteristics of the person being treated. Nevertheless, an algorithm is proposed as a way to synthesise our current level of knowledge, identify gaps for further study and aid in the management of this difficult problem.
Publisher: IEEE
Date: 08-2011
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.JPAIN.2013.03.002
Abstract: Chronic pain, chronic fatigue, and depressive mood are prevalent conditions in people with spinal cord injury (SCI). The objective of this research was to investigate the relationship between these conditions in adults with SCI. Multivariate analysis of variance, contingency analyses, and hierarchical regression were used to determine the nature of the relationship, as well as the contribution to this relationship of self-efficacy, a potential mediator variable. Seventy participants with SCI living in the community completed an assessment regimen of demographic and psychometric measures, including validated measures of pain, fatigue, depressive mood, and self-efficacy. Results indicated that participants with high levels of chronic pain had clinically elevated depressive mood, confusion, fatigue, anxiety and anger, low vigor, and poor self-efficacy. Participants with high chronic pain had 8 times the odds of having depressive mood and 9 times the odds of having chronic fatigue. Regression analyses revealed that chronic pain contributed significantly to elevated depressive mood and that self-efficacy mediated (cushioned) the impact of chronic pain on mood. Furthermore, both chronic pain and depressive mood were shown to contribute independently to chronic fatigue. Implications of these results for managing chronic pain in adults with SCI are discussed. The relationship between pain, negative mood, fatigue, and self-efficacy in adults with SCI was explored. Results support a model that proposes that chronic pain lowers mood, which is mediated (lessened) by self-efficacy, whereas pain and mood independently increase chronic fatigue. Results provide direction for treating chronic pain in SCI.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.APMR.2015.02.027
Abstract: To conduct a prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury (SCI), determine psychotropic medication usage, and establish predictors of psychological disorders after transition to the community. Longitudinal design with multiple measures. Assessment occurred in SCI units and the community. Adults with SCI (N=88) admitted over a period of 32 months into 3 SCI units. Participants completed inpatient rehabilitation for an acute SCI. Longitudinal assessment occurred up to 6 months postdischarge. Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI. The Mini International Neuropsychiatric Interview, a structured diagnostic psychiatric interview, was conducted to determine the presence of psychological disorders. Medical measures included severity of secondary conditions or complications. Psychological measures included measures of anxiety and depressive mood, resilience, pain catastrophization, self-efficacy, and cognitive capacity. Rates of psychological disorders of 17% to 25% were substantially higher than rates found in the Australian community. The occurrence of psychological disorder comorbidities was also very high. Anxiety was significantly elevated in those with a psychological disorder. Psychotropic medications were prescribed to more than 36% of the s le, with most being antidepressants. Factors predictive of psychological disorders included years of education, premorbid psychiatric sychological treatment, cognitive impairment, secondary complications, resilience, and anxiety. SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge. Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community. Additional resources should be invested in improving the mental health of adults with SCI.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Springer Science and Business Media LLC
Date: 02-2004
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.APMR.2008.04.011
Abstract: To develop and implement a service model for people with spinal cord injury (SCI) living in rural regions. Service development, pilot evaluation study. Regional and remote areas of the state of New South Wales, Australia. Persons with SCI, caregivers, and health professionals. Phase 1 included initial needs analysis, followed by education and resource development tailored to needs of rural health professionals, caregivers, and persons with SCI. Phase 2 included coordination, professional support, and network development by part-time rural key worker and metropolitan-based project officer, documenting health- and service-related issues. Self-perception of confidence as a result of education as well as reported issues, adverse health events, and barriers to service provision. Clinician confidence in managing people with SCI improved after education. Various health-related, environmental, and psychosocial issues were reported. Limited availability of resources and health infrastructure, particularly in more isolated or smaller towns, challenged service provision. Rural key workers played a central role in supporting local clinicians and service providers, improving communication and service coordination between rural health professionals and metropolitan SCI services. Education and support for rural workforce that may be limited in numbers and capacity, and a model facilitating communication and coordination between services, are essential for improving health outcomes of rural people with SCI.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2000
DOI: 10.1109/86.867870
Abstract: Paralyzed muscle fatigue is the eventual depression of force due to either prolonged or repetitive electrical stimulation of motor units. The robustness and safety of future functional electrical stimulation (FES) systems will rely on their ability to detect the onset of muscle fatigue. The relative degree of muscle activation can be estimated by monitoring the M-wave. The aim of this study was to test a proposed method of quantitative fatigue assessment that detects muscle force output and its corresponding M-wave measured concurrently. The detection of force and M-wave concurrently allows any reduction in muscle force output to be attributed to either changes in the fatigue state of the stimulated muscle or changes in the degree of stimulus activation of that muscle. The fatigue assessment scheme can thereby accommodate the corresponding changes in muscle force caused by an alteration in the stimulation intensity during fatigue. The Extensor Digitorum Communis (EDC), Extensor Pollicis Longus (EPL), and Flexor Pollicis Longus (FPL) muscles of two C5/C6 tetraplegic men were studied. Stimulation recruitment tests over the pulsewidth range from 0 to 200 micros, were performed at intervals during 20 min of maximal stimulation (200 micro/s). Muscle force correlated to the M-wave parameter, second phase area, with mean correlation coefficients of greater than 0.82, when the muscle was in either a nonfatigued or fatiguing state. After the initial force, likely to be primarily due to the fast glycolytic (FG) motor units, had declined the M-wave demonstrated only minor changes throughout the fatigue of muscle force during 20 min of constant maximal stimulation. The second phase area and root-mean-square (rms) of the M-wave [see Fig. 2(a) reflected muscle activation during modulated stimulation and also remained relatively constant during the fatigue-related force decline when the muscle was stimulated at a constant intensity. This detection of M-wave parameters satisfies the defined requirement for a myoelectric parameter that indicates electrical activation, but is relatively invariant to muscular fatigue. Index Terms-Electrical stimulation, electromyography (EMG), functional electrical stimulation (FES), muscle fatigue, spinal cord injury, tetraplegia.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2007
Abstract: Brain wave activity in people with paraplegia, with and without neuropathic pain, was compared to brain wave activity in matched able-bodied controls. To investigate whether spinal cord injury with neuropathic pain is associated with a slowing of brain wave activity. Australia. Electroencephalographic (EEG) data were collected in the eyes open (EO) and eyes closed (EC) states from 16 participants with paraplegia (eight with neuropathic pain and eight without pain) and matched able-bodied controls. Common EEG artefacts were removed using independent component analysis (ICA). Peak frequency in the theta-alpha band and EEG power in the delta, theta, alpha and beta frequency bands were compared between groups. The results show significant slowing of the EEG in people with neuropathic pain, consistent with the presence of thalamocortical dysrhythmia (TCD). Furthermore, people with neuropathic spinal cord injury (SCI) pain had significantly reduced EEG spectral reactivity in response to increased or decreased sensory input flowing into the thalamocortical network, as modulated by the eyes open and eyes closed states. The results provide further evidence for alterations in brain electric activity that may underlie the development of neuropathic pain following SCI.
Publisher: MDPI AG
Date: 27-09-2018
Abstract: This study aimed to describe the epidemiological characteristics, the occupational context, and the cost of hospitalised work-related traumatic spinal injuries, across New South Wales, Australia. A record-linkage study of hospitalised cases of work-related spinal injury (ICD10-AM code U73.0 or workers compensation) was conducted. Study period 2013–2016. Eight hundred and twenty-four in iduals sustained work-related spinal injuries 86.2% of whom were males and had a mean age of 46.6 years. Falls led to 50% of the injuries predominantly falls from building/structures, ladders or between levels. Falls occurred predominantly in the construction industry (78%). Transport crashes caused 31% of injuries and 24% in heavy vehicles. Half of all the transport injuries occurred ‘off road’. The external cause was coded as ‘non-specific work activity’ in 44.5% of cases missing in 11.5%. Acute care bed days numbered at 13,302 total cost $19,500,000. High numbers of work-related spinal injuries occurred in the construction industry particularly falling from a height. Off-road transport-related injuries were significant and likely unaddressed by ‘on-road’ prevention policies. Medical record documentation was insufficient in injury mechanism and context specificity. Workers in the construction industry or those using vehicles off-road were at high risk of spinal injury, suggesting inefficient systems approaches or ineffective prevention policies. Reducing the use of non-specific external cause codes in patients’ medical records would improve the measurement of policy effectiveness.
Publisher: Informa UK Limited
Date: 20-04-2022
DOI: 10.1080/09638288.2021.1913246
Abstract: This research sought to translate and culturally adapt the content of the original Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) into the Thai language and to assess its inter- and intra-rater reliability. This study was ided into two parts (i) translation and cross-cultural adaptation, using a six-step guideline-based translation-validation process and (ii) reliability assessment of the translated survey tool using intraclass correlation coefficients (ICCs), Bland-Altman plots and one-way ANOVA analyses. The Thai-PARA-SCI was successfully developed. The results revealed an excellent inter-rater reliability (ICC = 0.99, 95% CI range from 0.959-0.999) and the Bland-Altman plots showed little difference in times spent engaged physical activity. Intra-rater reliability results were affected inadvertently by testing across an unusual period, demonstrating poor to moderate scores (ICC ranged from 0.05-0.69, 95% CI ranged from -0.067-0.830) with the Bland-Altman plots showing very different ranges of time spent on physical activity. This study achieved its aims of culturally and systematically translating the English PARA-SCI interview script into the Thai version with excellent scores for inter-rater reliability and was proven to be understandable by prospective users (Thai-PT) and participants (Thai-SCI).Implications for RehabilitationA robust cross-cultural translation and adaptation of the Physical Activity Recall Assessment for people with Spinal Cord Injury (PARA-SCI) into the Thai context has been undertaken, providing an effective exemplar for converting patient reported health outcome measures between languages of different root origins.When using the PARA-SCI as a pre- and post-intervention outcomes survey, clinicians should ensure that the timing of interview administration does not coincide with any unintended alterations in work-life balance, to ensure that the data are representative of the habitual physical activity levels performed by participants in their daily lives.Due to the possibility that physical activity levels could vary day-by-day or week-to-week, using the same day measurement findings may be a more reliable way to deploy the PARA-SCI than repeated assessments week(s) apart.
Publisher: Journal of Rehabilitation Research & Development
Date: 2009
Publisher: Springer Science and Business Media LLC
Date: 13-10-2015
DOI: 10.1038/SC.2015.174
Abstract: Group cohort design. To determine the influence of spinal cord injury (SCI) and neurological level on heart rate variability (HRV) and associations with fatigue. SCI rehabilitation outpatient and community settings in New South Wales, Australia. Participants included 45 adults with SCI living in the community and 44 able-bodied controls. Socio-demographic, neurological injury, psychological, HRV and eye blink variables were assessed. Multivariate analysis of variance and post hoc protected t-tests were used to determine differences in HRV and fatigue as a function of the neurological level. Pearson's correlation analysis was used to determine the relationships between these factors. Participants with SCI had significantly reduced sympathetic activity. Those with tetraplegia had lowered sympathetic activity compared with those with paraplegia and able-bodied controls. Neither were differences in parasympathetic activity found between groups nor were there any significant differences found for the time domain or non-linear domains. Higher levels of fatigue were found in the SCI s le, and participants with tetraplegia had higher fatigue levels compared with those with paraplegia. Fatigued participants were more likely to have altered autonomic function-that is, reduced sympathetic activity. Higher levels of neurological impairment in people with SCI are more likely to result in disordered cardiovascular control involving reduced sympathetic activity, whereas elevated fatigue was found to be associated with increased sympathetic dysfunction. Findings highlight the need to address risks associated with this dysfunction, such as improved HRV and fatigue screening for people with SCI and improved education on cardiovascular risk factors.
Publisher: Wiley
Date: 02-06-2015
DOI: 10.1111/BJHP.12143
Abstract: Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, and mental health. The main objective of this research was to establish inpatient factors that contribute to social participation following discharge into the community. Prospective longitudinal design with measures taken three times, soon after admission to rehabilitation (N = 88), at discharge from the inpatient phase (N = 81) and 6 months following discharge (N = 71). Participants included adults with SCI admitted into three SCI units over a 33-month period. Assessment included demographic, injury, and psychosocial health measures. Adjustment was defined by the extent of social re-integration or participation post-discharge after 6 months in the community. Social participation was measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6 months post-discharge. Six months after discharge, around 55% of the s le had difficulties with social participation. The odds against being employed for an adult with poor social participation was found to be 8.4 to 1. Factors that predicted social participation included a younger age, having less severe secondary medical complications like bladder and bowel dysfunction, having a higher cognitive capacity, perceiving one has control (self-efficacy) over one's life and environment, and having greater perceived social support. These results provide direction for enhancing existing psychosocial health strategies within SCI rehabilitation, affording an opportunity for every person who sustains a permanent SCI to have optimal capacity for social participation. Statement of contribution What is already known on this subject? Spinal cord injury (SCI) is associated with significant challenges to wellbeing, including a high risk of secondary chronic illnesses, risk of co-morbid mental health problems, financial insecurity and social isolation. Research has shown poor social participation can lead to problems in re-integration into society following discharge from inpatient rehabilitation. Research to date has examined various factors related to poor social participation, but the majority of this research has been survey based with convenience s les. What does this study add? This study adds results of prospective longitudinal research on adjustment following SCI, where adjustment was defined by the rate of social participation when living in the community. About one-third of SCI participants were found to have very poor social participation, and only one-third had found some form of employment 6 months after discharge. Multiple factors were found to predict and contribute to poor social participation, including older age when injured, more severe medical complications, cognitive deficits, poor perceptions of control or self-efficacy, and poor social support.
Publisher: Elsevier BV
Date: 06-2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2009
DOI: 10.1016/J.PAIN.2008.10.007
Abstract: The most obvious impairments associated with spinal cord injury (SCI) are loss of sensation and motor control. However, many subjects with SCI also develop persistent neuropathic pain below the injury which is often severe, debilitating and refractory to treatment. The underlying mechanisms of persistent neuropathic SCI pain remain poorly understood. Reports in utees describing phantom limb pain demonstrate a positive correlation between pain intensity and the amount of primary somatosensory cortex (S1) reorganization. Of note, this S1 reorganization has also been shown to reverse with pain reduction. It is unknown whether a similar association between S1 reorganization and pain intensity exists in subjects with SCI. The aim of this investigation was to determine whether the degree of S1 reorganization following SCI correlated with on-going neuropathic pain intensity. In 20 complete SCI subjects (10 with neuropathic pain, 10 without neuropathic pain) and 21 control subjects without SCI, the somatosensory cortex was mapped using functional magnetic resonance imaging during light brushing of the right little finger, thumb and lip. S1 reorganization was demonstrated in SCI subjects with the little finger activation point moving medially towards the S1 region that would normally innervate the legs. The amount of S1 reorganization in subjects with SCI significantly correlated with on-going pain intensity levels. This study provides evidence of a link between the degree of cortical reorganization and the intensity of persistent neuropathic pain following SCI. Strategies aimed at reversing somatosensory cortical reorganization may have therapeutic potential in central neuropathic pain.
Publisher: Medical Journals Sweden AB
Date: 2015
Abstract: To describe a novel early vocational rehabilitation programme (In-Voc) for inpatients with spinal cord injury and to report early vocational outcomes. Observational longitudinal cohort study. One hundred adults with spinal cord injury admitted to spinal units in Sydney, Australia within a 24-month period. In-Voc was offered to all inpatients within the first 6 months of acquired spinal cord injury and was provided by trained vocational consultants. Baseline demographics, opinions about work readiness, details of the vocational services provided and preliminary employment outcomes were documented. The In-Voc programme was relatively short in duration (median 11 weeks, range 3-39 weeks) with a median total of 9.1 h (range 1-75.2 h) of service delivered per participant. At case closure (median 3 weeks post-discharge), 29/84 (34.5%) of participants were in paid employment (7% full-time, 8% part-time, 7% on sick leave, and 12% working with hours unknown), 36% were unemployed (6% seeking work, 16% not seeking work, 14% job seeking status unknown), 13% were students or in-training, and 17% were in vocational rehabilitation. Our research suggests that implementing an early vocational rehabilitation programme with in iduals in the hospital setting is feasible and has good potential for enhancing post-injury labour-force participation.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.JPAIN.2022.04.001
Abstract: Developing a greater understanding of the social and environmental factors that are related to differential outcomes for in iduals who experience persistent pain and disability is important for achieving health equity. In this study, we aimed to develop insights into the role of the social determinants of health (SDH) in care experiences and health status for socio-economically disadvantaged adults who experience persistent low back pain or persistent pain following spinal cord injury. Our objectives were to investigate 1) relationships between the SDH and health outcomes, 2) care experiences, and 3) perceived barriers and facilitators to optimal pain care. We conducted a mixed-methods convergent parallel study involving an online survey and semistructured interviews. We analyzed the data from each method separately and integrated the findings. One hundred sixty-four adults completed the survey and 17 adults completed the semistructured interviews. We found large or moderate-sized correlations between greater selfreported social isolation and poorer health outcomes. Experiencing a higher number of adverse SDH was moderately correlated with lower quality of life and was significantly correlated with all other outcomes. We generated 5 themes from the qualitative analysis: active strategies are important for well-being low agency facilitators of optimal care barriers to optimal care and health inequities, and derived meta-inferences that highlight the complex inter-relationships between the SDH and health outcomes in this cohort. The findings of our study can importantly inform endeavors to improve equity of pain care for adults with low back pain or spinal cord injury and persistent pain. PERSPECTIVE: This study illustrates the complex interplay between adverse social determinants of health and poorer health status for adults with persistent pain and provides evidence to support the important role of social isolation. Developing an understanding of the life-contexts of those seeking care is a vital step towards addressing health inequities.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-07-2008
DOI: 10.1016/J.PAIN.2007.08.032
Abstract: Spinal cord injury (SCI) results in deafferentation and the onset of neuropathic pain in a substantial proportion of people. Based on evidence suggesting motor cortex activation results in attenuation of neuropathic pain, we sought to determine whether neuropathic SCI pain could be modified by imagined movements of the foot. Fifteen subjects with a complete thoracic SCI (7 with below-level neuropathic pain and 8 without pain) were instructed in the use of movement imagery. Movement imagery was practiced three times daily for 7days. On the eighth day, subjects performed the movement imagery in the laboratory and recorded pain ratings during the period of imagined movement. Six out of 7 subjects with neuropathic pain reported an increase in pain during imagined movements from 2.9+/-0.7 during baseline to 5.0+/-1.0 during movement imagery (p<0.01). In SCI subjects without neuropathic pain, movement imagery evoked an increase in non-painful sensation intensity from a baseline of 1.9+/-0.7 to 4.8+/-1.3 during the movement imagery (p<0.01). Two subjects without a history of pain or non-painful phantom sensations had onset of dysesthesia while performing imagined movements. This study reports exacerbation of pain in response to imagined movements and it contrasts with reports of pain reduction in people with peripheral neuropathic pain. The potential mechanisms underlying this sensory enhancement with movement imagery are discussed.
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.APMR.2007.09.001
Abstract: To study the interaction between quality of life in people with spinal cord injury (SCI) and expectations of daily living (self-efficacy) and pain. Cross-sectional study with multiple independent measures. Home survey. Included 106 persons with SCI of 12 months or more in duration who were living in the community and had enrolled from past admission lists in a rehabilitation unit. Participants received no treatments as part of the study but were asked to complete 2 questionnaires by postal survey in their postrehabilitation stage. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Moorong Self-Efficacy Scale. Persons with SCI were found to have lowered quality of life (QOL) compared with the Australian general population. Low self-efficacy and pain intensity were found to reduce QOL across all SF-36 domains even further. Factors such as completeness of lesion, sex, age at time of injury, and time since injury were not associated with reduced QOL. Tetraplegia was associated with lower QOL in physical functioning and greater limitation due to bodily pain. A combination of low self-efficacy and pain intensity was associated with an increased reduction in QOL compared with reductions seen for these factors by themselves. Rehabilitation strategies may need to concentrate on improving QOL by targeting factors like low self-efficacy.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Springer Science and Business Media LLC
Date: 06-12-2005
Abstract: Repeated-measures design. To assess the validity and responsiveness of five additional mobility and locomotor (5-AML) items when used in conjunction with the Functional Independence Measure (FIM) for assessing the mobility and locomotor function of in iduals with spinal cord injury (SCI). Specialised acute spinal and rehabilitation units in Sydney, Australia. A previously published scale comprising five key mobility and locomotor skills was further refined. The five items included a bed mobility and vertical (floor-to-chair) transfer item and three wheelchair propulsion items (pushing 200 m over flat ground, pushing up a r and negotiating a kerb). A total of 43 eligible patients with SCI (ASIA A-C impairment) admitted consecutively to two acute SCI units in Sydney between 1999 and 2002 were recruited, with four being lost to follow-up. Locomotor and mobility outcomes were measured at regular intervals for up to 6 months with the FIM and the 5-AML. Construct validity of the 5-AML was assessed by testing ability of items to discriminate between different impairment groups (tetraplegia and paraplegia). Item responsiveness was assessed by analysing ability to detect changes in mobility and locomotor function over time. Factor analysis techniques were used to test the hypothesis that the 5-AML, when used in conjunction with the FIM, provides a more sensitive measure of mobility and locomotor function than the FIM alone. The 5-AML items were shown to be valid and responsive, measuring aspects of 'real world' mobility and locomotor function not reflected by the FIM. The bed mobility item was highly responsive to change over time for the tetraplegic group, but quickly reached a ceiling in the paraplegic group. The vertical (floor-to-chair) transfer item showed greater responsiveness over time and less ceiling effect for the paraplegic group than any of the FIM locomotor or mobility items. The three wheelchair propulsion items better discriminated between people with tetraplegia and paraplegia, and were more sensitive to changes in locomotor ability over the 6-month period than FIM locomotor items. Results of a preliminary factor analysis indicated that the 5-AML items measure different aspects of mobility and locomotor function than the FIM. The 5-AML items, when used in conjunction with the FIM, provides better delineation of function between people with tetraplegia and paraplegia and provides a more responsive measure of change in function over time than the FIM alone.
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.APMR.2009.02.016
Abstract: To develop simple tests to assess the abilities of people with spinal cord injury (SCI) to sit unsupported and to assess the construct validity and test-retest reliability of these tests. Cross-sectional comparisons, convenience s le. Biomechanical laboratory. People (N=30) with SCI between the C6 and the L2 level of 2 months to 37 years duration before assessment. The s le was stratified by impairment level (at T8) and time since injury (1 y postinjury). Not applicable. On 2 separate occasions, participants performed tests that measured the distance of upper-body sway and maximal torso leaning, errors made during a coordinated stability task, timed dressing/undressing of the upper body and alternating arm reaching, and percentage change in seated upper body/arm reaching. All tests showed good construct validity in that they distinguished between participants with higher (C6-T7) and lower (T8-L2) level impairments (P<.05) and between participants with acute ( 1 y) lesions (P<.05). The tests also showed good to excellent test-retest reliability (intraclass correlation coeffiecient(3,1) range, .51-.91). These simple and quick-to-administer tests have both construct validity and test-retest reliability. They would be appropriate for research and clinical purposes to quantify the abilities of people with SCI to sit unsupported.
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.APMR.2005.11.011
Abstract: To report the development and validation of a new hand-held muscle strength-testing device that is integrated with orientation sensors and designed to test the strength of major muscle groups at a given limb or joint position. Design description and validation study. University-based human movement facility. Twenty-eight able-bodied, healthy subjects. Not applicable. A device was developed based on a hand-held force dynamometer with integrated orientation sensors. The validity and reliability (interrater, intertrial) of 5 maximum isometric contractions of hip flexion, knee extension, and ankle plantarflexion and dorsiflexion were assessed. The results were compared with those from an isokinetic dynamometer (KinCom). The new manual muscle tester was highly reliable and valid in estimating muscle strength of the lower limbs. The coefficient of variation between trials of all movements was low, with a mean less than 10% (range, 3.7%-8.9%). The only significant difference in muscle strength between the new device and the isokinetic dynamometer was found for hip flexion. The new hand-held muscle strength tester appears to be a reliable and valid clinical assessment tool that can be used to objectively assess muscle strength at particular limb positions and/or joint angles. This feature appears to represent a technical advance in portable muscle strength devices, providing comparable information to those obtained by isokinetic dynamometers at a fraction of the cost and size. However, the device needs to be validated in clinical populations, such as patients with spinal cord injury and stroke, in order to demonstrate its general clinical utility.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.INJURY.2014.12.032
Abstract: Spinal cord injuries occur worldwide often being life-threatening with devastating long term impacts on functioning, independence, health, and quality of life. Systematic review of the literature to determine the efficacy of cervical spinal immobilisation (vs no immobilisation) in patients with suspected cervical spinal cord injury (CSCI) and to provide recommendations for prehospital spinal immobilisation. Searches were conducted of the Cochrane library, CINAHL, EMBASE, Pubmed, Scopus, Web of science, Google scholar, and OvidSP (MEDLINE, PsycINFO, and DARE) databases. Studies were included if they were relevant to the research question, published in English, based in the prehospital setting, and included adult patients with traumatic injury. The search identified 1471 citations, of which eight observational studies of variable quality were included. Four studies were retrospective cohorts, three were case series and one a case report. Cervical collar application was reported in penetrating trauma to be associated with unadjusted increased risk of mortality in two studies [(OR, 8.82 95% CI, 1.09-194 p=0.038) & (OR, 2.06 95% CI, 1.35-3.13)], concealment of neck injuries in one study and increased scene time in another study. While, in blunt trauma, one study indicated that immobilisation might be associated with worsened neurological outcome (OR, 2.03 95% CI, 1.03-3.99 p=0.04, unadjusted). We did not attempt to combine study results due to significant heterogeneity of study design and outcome measures. There is a lack of high-level evidence on the effect of prehospital cervical spine immobilisation on patient outcomes. There is a clear need for large prospective studies to determine the clinical benefit of prehospital spinal immobilisation as well as to identify the subgroup of patients most likely to benefit.
Publisher: Springer Science and Business Media LLC
Date: 17-05-2021
Publisher: Springer Science and Business Media LLC
Date: 24-09-2022
DOI: 10.1038/S41393-022-00850-6
Abstract: Cross-sectional survey. To describe design and methods of Australian arm of International Spinal Cord Injury (Aus-InSCI) community survey, reporting on participation rates, potential non-response bias and cohort characteristics. Survey of community-dwelling people with SCI at least 12 months post-injury, recruited between March 2018 and January 2019, from state-wide SCI services, a government insurance agency and not-for-profit consumer organisations across four Australian states. The Aus-InSCI survey combined data for people with SCI from nine custodians, using secure data-linkage processes, to create a population-based, anonymised dataset. The Aus-InSCI questionnaire comprised 193 questions. Eligibility, response status and participation rates were calculated. Descriptive statistics depict participant characteristics. Logistic regression models were developed for probability of participation, and inverse probability weights generated to assess potential non-response bias. 1579 adults with SCI were recruited, a cooperation rate of 29.4%. Participants were predominantly male (73%), with 50% married. Mean age was 57 years (range 19–94) and average time post-injury 17 years (range 1–73). Paraplegia (61%) and incomplete lesions (68%) were most common. Males were more likely than females to have traumatic injuries ( p 0.0001) and complete lesions ( p = 0.0002), and younger age-groups were more likely to have traumatic injuries and tetraplegia ( p 0.0001). Potential non-response bias evaluated using selected outcomes was found to be negligible in the Aus-InSCI cohort. The Aus-InSCI survey made efforts to maximise coverage, avoid recruitment bias and address non-response bias. The distributed, linked and coded (re-identifiable at each custodian level) ‘virtual quasi-registry’ data model supports systematic cross-sectional and longitudinal research.
Publisher: Elsevier BV
Date: 12-1999
DOI: 10.1016/S0003-9993(99)90330-1
Abstract: To investigate the effect of medially linking knee-ankle-foot orthoses (KAFOs) on postural stability and sway during (1) quiet standing and (2) functional activities for persons with spinal cord injury (SCI). A randomized, mixed design, with the factors being activity (quiet standing and two function-mimicking tasks), SCI (present or not), and type of orthosis used in SCI group (linked or unlinked KAFO). Nine men with T5 to T12 paraplegia, 8 of whom had complete lesions and 1 with some sacral sparing (American Spinal Injury Association grade B) without proprioception, matched to 9 able-bodied men. Mean litude of sway and sway path in anteroposterior and mediolateral directions, derived from center of pressure measurements on a force platform. All men with SCI were able to stand unsupported and perform function-mimicking activities in medially linked KAFOs however, when wearing unlinked KAFOs only 5 could maintain balance during quiet stance and 3 could maintain balance during activity. Significant differences were found between linked and unlinked KAFOs side-to-side mean litude of sway was less and sway path was greater for SCI subjects when they wore the linked KAFOs. Medial linkage of bilateral KAFOs provides an effective strategy to improve stability and increase postural control for persons with SCI, facilitating performance of functional activities during standing without upper limb support.
Publisher: Informa UK Limited
Date: 2011
DOI: 10.3109/09638288.2010.524276
Abstract: This article seeks to outline the design and implementation of cognitive behavioural pain management programmes (PMPs) for people with spinal cord injury (SCI), illustrated by the experiences in a recently evaluated programme (SpinalADAPT). It is hoped that this will provide an easily accessible account of the relevant design and implementation issues for those who seek to deliver such programmes to persons with a SCI. A collaborative team of pain and SCI professionals developed a modified version of a standard cognitive behavioural pain management programme (ADAPT) based upon experiences of those with SCI who had previously attempted ADAPT. A number of structural and content elements of the programme were identified that required modification in order to accommodate the particular needs of those with SCI. The modified programme was subsequently successfully delivered by a combination of SCI and pain health professionals. Three groups of in iduals completed the SpinalADAPT, and an evaluation of outcomes compared to standard care are reported elsewhere (Nicholson Perry et al., Clin J Pain 2010 :206-216). It appears feasible to appropriately modify standard PMPs for participants with SCI, and that such programmes may offer benefits in terms of improved quality of life. Further revision and evaluation of such programmes is required.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2000
DOI: 10.1109/86.867885
Abstract: Grasp and release has been provided to both upper extremities of subjects with tetraplegia using percutaneous and fully implanted stimulation. This is to determine quantitatively the performance of these subjects in three bimanual tests using two handed stimulation. Their performance here is compared with two separate cases: the same tests using single handed stimulation assisted by a nonstimulated hand and using two unstimulated hands. It was found that bilateral stimulation significantly improved the efficacy of performing the bimanual tests assessed over that using unilateral stimulation assisted by the nonstimulated hand (in two of three tests) or no stimulation three of three tests). These results show quantitative evidence of the benefits of providing bilateral stimulation for the completion of bimanual tasks for persons with tetraplegia who are appropriate candidates for stimulated grasp. These benefits were observed especially in cases where the ability of the subject in completing the task using unilateral stimulation was not strong.
Publisher: Springer Science and Business Media LLC
Date: 05-02-2022
DOI: 10.1038/S41393-021-00744-Z
Abstract: Clinical practice guidelines. The objective was to update the 2016 version of the Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI). The guidelines are relevant for inpatient, outpatient and community SCI rehabilitation settings in Canada. The guidelines were updated in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations. The working group identified and reviewed 46 additional relevant articles published since the last version of the guidelines. The panel agreed on 3 new screening and diagnosis recommendations and 8 new treatment recommendations. Two key changes to these treatment recommendations included the introduction of general treatment principles and a new treatment recommendation classification system. No new recommendations to model of care were made. The CanPainSCI recommendations for the management of neuropathic pain after SCI should be used to inform practice.
Publisher: American Psychological Association (APA)
Date: 08-2011
DOI: 10.1037/A0024524
Abstract: This exploratory study examined the extent to which postinjury employment was predictable when patients were followed up 2 years' postdischarge from a specialist Spinal Cord Injury (SCI) Unit. Seventy-two in iduals with SCI for whom there were discharge Functional Independence Measure (FIM) scores, 60 complete sets of data were available for Discriminant Function Analysis. Using a combination of variables assessed prior to or shortly after discharge from rehabilitation, complemented by psychosocial variables assessed at the time of follow-up, moderate classification accuracy was achieved with respect to employment status at the 2-year follow-up period (72%), with the set of predictor variables being more accurate at predicting those subsequently in paid employment (83%) than those not (67%). The main implication of the study results is that nontraditional variables (i.e., variables other than injury and demographic variables), including, particularly, contextual environmental variables such as community integration, access to transport, and social support, are worthy of further research, especially because many of these are amenable to rehabilitation program interventions, and thus may facilitate the attainment of enhanced rates of postdischarge employment among those living with SCI.
Publisher: Medical Journals Sweden AB
Date: 2009
Abstract: To identify the extent to which early participation and environmental variables, when assessed at discharge from hospital, add to injury and demographic variables in the prediction of employment following traumatic spinal cord injury. Prospective study in which participants were assessed on a range of injury, demographic, participation and environmental measures at discharge from inpatient rehabilitation and then followed up 12 months later to assess their employment status. A cohort of 72 eligible patients discharged from hospitals' rehabilitation units. Using injury, demographic and contextual variables as predictors, 94% of not employed and 65% of employed cases (87% overall) could be correctly classified. The contextual variables made a significant contribution to improving predictive power, beyond that achieved by use of the more restricted set of injury and demographic variables. Three variables made significant, independent contributions at the third and final step of a sequential logistic regression: Functional Independence Measure score at discharge, high-skill pre-injury occupation, and perceived community integration (CIM score, at discharge). To assist in raising employment achievements post-injury, attention should be given during rehabilitation to factors beyond the traditional patient injury and demographic variables, as well as considering community integration support services when developing vocational rehabilitation service plans.
Publisher: Elsevier BV
Date: 05-2005
DOI: 10.1016/J.JBIOMECH.2004.05.026
Abstract: The purpose of this study was to verify the performance of recently developed body-worn sensor packs against 3D motion analysis of trunk and lower-limb movements. Five sensor packs, each consisting of rate gyroscope and two 2-D accelerometers controlled by a microprocessor were attached to the trunk, thighs, and shanks of an able bodied subject. A 6-camera motion analysis system (MAS) recorded multiple trials of sit-to-stand movements and normal walking. Time domain signals from each sensor pack were significantly correlated (r = 0.90-0.99 < 0.05) with a root mean square errors of less than 5 degrees when compared against the same limb angle measurements calculated by the MAS. These data demonstrate that these external sensor packs are accurate devices for measuring trunk and lower-limb sagittal plane orientation in real-time.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.NEUROIMAGE.2010.06.051
Abstract: Spinal cord injury (SCI) can be accompanied by chronic pain, the mechanisms for which are poorly understood. Here we report that magnetic resonance spectroscopy measurements from the brain, collected at 3T, and processed using wavelet-based feature extraction and classification algorithms, can identify biochemical changes that distinguish control subjects from subjects with SCI as well as sub iding the SCI group into those with and without chronic pain. The results from control subjects (n=10) were compared to those with SCI (n=10). The SCI cohort was made up of subjects with chronic neuropathic pain (n=5) and those without chronic pain (n=5). The wavelet-based decomposition of frequency domain MRS signals employs statistical significance testing to identify features best suited to discriminate different classes. Moreover, the features benefit from careful attention to the post-processing of the spectroscopy data prior to the comparison of the three cohorts. The spectroscopy data, from the thalamus, best distinguished control subjects without SCI from those with SCI with a sensitivity and specificity of 0.9 (Percentage of Correct Classification). The spectroscopy data obtained from the prefrontal cortex and anterior cingulate cortex both distinguished between SCI subjects with chronic neuropathic pain and those without pain with a sensitivity and specificity of 1.0. In this study, where two underlying mechanisms co-exist (i.e. SCI and pain), the thalamic changes appear to be linked more strongly to SCI, while the anterior cingulate cortex and prefrontal cortex changes appear to be specifically linked to the presence of pain.
Publisher: Wiley
Date: 05-2009
DOI: 10.1016/J.EJPAIN.2008.06.003
Abstract: Although psychological aspects of SCI-related pain have been investigated in those with chronic pain, little data is available regarding these factors in those early in the course of the injury. Using a s le admitted for SCI rehabilitation, this paper describes the relationships between usual pain intensity, mood, disability and both pain and SCI-related psychological factors. The s le were largely similar to other s les of in iduals with SCI-related chronic pain in terms of mood, but were noted to be less catastrophic in their thinking about pain than a comparative pain clinic s le. They also reported SCI self-efficacy and acceptance scores consistent with other SCI s les. Compared with other SCI populations there were mixed findings in relation to physical disability. Consistent with previous findings in chronic pain SCI s les, usual pain intensity was found to have a strong relationship with symptoms of anxiety and depression, and pain-related life interference. SCI acceptance was significantly negatively associated with depression scores, pain catastrophizing was significantly positively associated with both anxiety and depression scores, and SCI self-efficacy was significantly negatively associated with both anxiety and depression scores. SCI self-efficacy was also significantly positively associated with physical function scores. These findings suggest that pain-related psychological factors may have importance even early in the clinical course following SCI, but that it is important, however, to consider more general SCI-related psychological factors alongside them. In addition, these findings suggest the possibility that early interventions based upon the cognitive behavioural treatment of pain may be integrated into SCI rehabilitation programmes.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Springer Science and Business Media LLC
Date: 02-03-2023
DOI: 10.1007/S11136-023-03376-3
Abstract: To determine the relationships between impact of secondary health conditions (SHCs), treatment of SHCs, and life satisfaction (LS) following spinal cord injury (SCI) across 21 countries. Hypotheses were as follows: (1) Persons with SCI and fewer SHCs report higher LS and (2) Persons who receive treatment for SHCs report higher LS than those who do not receive treatment. Cross-sectional survey, including 10,499 persons with traumatic or non-traumatic SCI aged 18 years or older and living in the community. To assess SHCs, 14 items adapted from the SCI-Secondary Conditions Scale were used (range 1–5). SHCs index was calculated as the mean of all 14 items. LS was assessed using a selection of 5 items from the World Health Organization Quality of Life Assessment. LS index was calculated as the mean of these 5 items. South Korea, Germany, and Poland exhibited the highest (2.40–2.93) and Brazil, China, and Thailand the lowest (1.79–1.90) impact of SHCs. Indexes for LS and SHCs were inversely correlated (– 0.418 p 0.001). Mixed Model Analysis showed that the fixed effect (key predictors of the study) of SHCs index ( p 0.001) and the positive interaction between SHCs index and treatment ( p = 0.002) were significant determinants of LS. Persons with SCI across the world are more likely to perceive better LS if they experience fewer SHCs and receive treatment for SHCs, in comparison to those who do not. Prevention and treatment of SHCs following SCI should be a high priority in order to improve the lived experience and enhance LS.
Publisher: American Spinal Injury Association
Date: 07-2008
DOI: 10.1310/SCI1401-61
Publisher: JMIR Publications Inc.
Date: 03-06-2020
Abstract: europathic pain is a debilitating secondary condition for many in iduals with spinal cord injury. Spinal cord injury neuropathic pain often is poorly responsive to existing pharmacological and nonpharmacological treatments. A growing body of evidence supports the potential for brain-computer interface systems to reduce spinal cord injury neuropathic pain via electroencephalographic neurofeedback. However, further studies are needed to provide more definitive evidence regarding the effectiveness of this intervention. he primary objective of this study is to evaluate the effectiveness of a multiday course of a brain-computer interface neuromodulative intervention in a gaming environment to provide pain relief for in iduals with neuropathic pain following spinal cord injury. e have developed a novel brain-computer interface-based neuromodulative intervention for spinal cord injury neuropathic pain. Our brain-computer interface neuromodulative treatment includes an interactive gaming interface, and a neuromodulation protocol targeted to suppress theta (4-8 Hz) and high beta (20-30 Hz) frequency powers, and enhance alpha (9-12 Hz) power. We will use a single-case experimental design with multiple baselines to examine the effectiveness of our self-developed brain-computer interface neuromodulative intervention for the treatment of spinal cord injury neuropathic pain. We will recruit 3 participants with spinal cord injury neuropathic pain. Each participant will be randomly allocated to a different baseline phase (ie, 7, 10, or 14 days), which will then be followed by 20 sessions of a 30-minute brain-computer interface neuromodulative intervention over a 4-week period. The visual analog scale assessing average pain intensity will serve as the primary outcome measure. We will also assess pain interference as a secondary outcome domain. Generalization measures will assess quality of life, sleep quality, and anxiety and depressive symptoms, as well as resting-state electroencephalography and thalamic γ-aminobutyric acid concentration. his study was approved by the Human Research Committees of the University of New South Wales in July 2019 and the University of Technology Sydney in January 2020. We plan to begin the trial in October 2020 and expect to publish the results by the end of 2021. his clinical trial using single-case experimental design methodology has been designed to evaluate the effectiveness of a novel brain-computer interface neuromodulative treatment for people with neuropathic pain after spinal cord injury. Single-case experimental designs are considered a viable alternative approach to randomized clinical trials to identify evidence-based practices in the field of technology-based health interventions when recruitment of large s les is not feasible. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000556943 bit.ly/2RY1jRx RR1-10.2196/20979
Publisher: Informa UK Limited
Date: 19-09-2023
Publisher: Springer Science and Business Media LLC
Date: 09-03-2004
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1016/J.GAITPOST.2005.12.017
Abstract: We report on three different methods of gait event detection (toe-off and heel strike) using miniature linear accelerometers and angular velocity transducers in comparison to using standard pressure-sensitive foot switches. Detection was performed with normal and spinal-cord injured subjects. The detection of end contact (EC), normally toe-off, and initial contact (IC) normally, heel strike was based on either foot linear accelerations or foot sagittal angular velocity or shank sagittal angular velocity. The results showed that all three methods were as accurate as foot switches in estimating times of IC and EC for normal gait patterns. In spinal-cord injured subjects, shank angular velocity was significantly less accurate (p<0.02). We conclude that detection based on foot linear accelerations or foot angular velocity can correctly identify the timing of IC and EC events in both normal and spinal-cord injured subjects.
Publisher: Elsevier BV
Date: 06-1999
DOI: 10.1016/S0268-0033(98)00079-5
Abstract: To evaluate the accuracy in determining centre of pressure when using a force platform for stabilometry research. Technical report. Previous studies have determined the accuracy of locating the centre of pressure by applying force through a single point. In human stabilometry research however, force is distributed across two feet and the centre of pressure located between the feet. Forces were applied to a Kistler force platform using a force applied through a single point as well as when force was distributed between two metal blocks. Errors in calculating centre of pressure were substantially larger when force was applied through a single point than when the force was distributed between two blocks. Evaluating centre of pressure accuracy by applying force through a single point overestimates the errors inherent in human stabilometry research. Evaluating changes in the centre of pressure of human subjects standing on a force platform is a common tool for evaluating control mechanisms of balance. Accurate information regarding the centre of pressure is essential for the validity of this research.
Publisher: Springer Science and Business Media LLC
Date: 11-03-2014
DOI: 10.1038/SC.2014.25
Abstract: Cross-section design. The development of reliable screen technology for predicting those at risk of depression in the long-term remains a challenge. The objective of this research was to determine factors that classify correctly adults with spinal cord injury (SCI) with depressed mood and to develop a diagnostic algorithm that could be applied for prediction of depressed mood in the long-term. SCI rehabilitation unit, rehabilitation outpatient clinic and Australian community. Participants included 107 adults with SCI. The assessment regimen included demographic and injury variables, negative mood states, pain intensity, health-related quality of life and self-efficacy. Participants were ided into those with 'normal' mood versus those with elevated depressed mood. Discriminant function analysis (DFA) was then used to isolate factors that in combination, best classify the presence or absence of depressed mood. At the time of assessment, 24 participants (22.4%) had elevated depressed mood. DFA identified six factors that discriminated between those with depressed mood (P<0.01) and those with normal mood, explaining 61% of the variance. Factors consisted of pain intensity, mental health, emotional and social functioning, self-efficacy and fatigue. DFA correctly classified 91.7% (n=22 of 24) of those with depressed mood and 95.2% (n=79 of 83) of those without. Demographic, injury and physical health function variables were not found to discriminate depressed mood. Clinical implications of applying a diagnostic algorithm for detecting depression in adults with SCI are discussed. Prospective research is needed to test the predictive efficacy of the algorithm.
Publisher: JMIR Publications Inc.
Date: 29-09-2020
DOI: 10.2196/20979
Abstract: Neuropathic pain is a debilitating secondary condition for many in iduals with spinal cord injury. Spinal cord injury neuropathic pain often is poorly responsive to existing pharmacological and nonpharmacological treatments. A growing body of evidence supports the potential for brain-computer interface systems to reduce spinal cord injury neuropathic pain via electroencephalographic neurofeedback. However, further studies are needed to provide more definitive evidence regarding the effectiveness of this intervention. The primary objective of this study is to evaluate the effectiveness of a multiday course of a brain-computer interface neuromodulative intervention in a gaming environment to provide pain relief for in iduals with neuropathic pain following spinal cord injury. We have developed a novel brain-computer interface-based neuromodulative intervention for spinal cord injury neuropathic pain. Our brain-computer interface neuromodulative treatment includes an interactive gaming interface, and a neuromodulation protocol targeted to suppress theta (4-8 Hz) and high beta (20-30 Hz) frequency powers, and enhance alpha (9-12 Hz) power. We will use a single-case experimental design with multiple baselines to examine the effectiveness of our self-developed brain-computer interface neuromodulative intervention for the treatment of spinal cord injury neuropathic pain. We will recruit 3 participants with spinal cord injury neuropathic pain. Each participant will be randomly allocated to a different baseline phase (ie, 7, 10, or 14 days), which will then be followed by 20 sessions of a 30-minute brain-computer interface neuromodulative intervention over a 4-week period. The visual analog scale assessing average pain intensity will serve as the primary outcome measure. We will also assess pain interference as a secondary outcome domain. Generalization measures will assess quality of life, sleep quality, and anxiety and depressive symptoms, as well as resting-state electroencephalography and thalamic γ-aminobutyric acid concentration. This study was approved by the Human Research Committees of the University of New South Wales in July 2019 and the University of Technology Sydney in January 2020. We plan to begin the trial in October 2020 and expect to publish the results by the end of 2021. This clinical trial using single-case experimental design methodology has been designed to evaluate the effectiveness of a novel brain-computer interface neuromodulative treatment for people with neuropathic pain after spinal cord injury. Single-case experimental designs are considered a viable alternative approach to randomized clinical trials to identify evidence-based practices in the field of technology-based health interventions when recruitment of large s les is not feasible. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000556943 bit.ly/2RY1jRx PRR1-10.2196/20979
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.APMR.2011.09.008
Abstract: To study the impact of fatigue on health-related quality of life (HR-QOL) associated with spinal cord injury (SCI). Matched group design with several independent measures. University-based laboratory. Persons with SCI (n=41) and an average 16.5 years duration of community living with SCI and a group of able-bodied controls (n=41) with similar sex ratio, age, and level of education. Participants with SCI were enrolled through rehabilitation unit contacts and through advertising in newsletters. Not applicable. The main independent measures reported in this article include the Iowa Fatigue Scale and the Medical Outcomes Study 36-Item Short-Form Health Survey. As expected, persons with SCI were found to have significantly lower HR-QOL. Fatigue was found to be more prevalent in the SCI group, and was associated with lower HR-QOL in both groups. Factorial analysis of variance indicated significant interactions in which persons with SCI with low fatigue levels had similar HR-QOL to the able-bodied controls regardless of their fatigue level, while persons with SCI with elevated fatigue had significantly reduced HR-QOL. Factors such as age, education, completeness and level of lesion, and community integration were not associated with increased fatigue levels. However, a shorter time since injury was found to be significantly associated with higher levels of fatigue. The Iowa Fatigue Scale data suggest over 50% of the SCI group had elevated fatigue, which was associated with significantly reduced HR-QOL. Research is needed that identifies factors that raise vulnerability to fatigue, and strategies designed to address the negative impacts of fatigue need to be evaluated.
Publisher: Springer Science and Business Media LLC
Date: 22-08-2022
DOI: 10.1038/S41393-022-00845-3
Abstract: Cross-sectional population-based survey for the Australian cohort of the International Spinal Cord Injury (InSCI) Community Survey. To differentiate subgroups of people with spinal cord injury (SCI) who self-report good and poor overall quality of life (QoL) using domains of the International Classification of Functioning (ICF), and to evaluate how these factors contribute to QoL when considered together, while controlling confounders. Australian survey data from four state-wide SCI services, one government insurance agency, and three not-for-profit consumer organisations. Explanatory factors for QoL were compared between participants reporting poor vs. good QoL. Path models estimated total, direct and mediated contributions from each explanatory factor to QoL ratings after accounting for confounders. Most participants (62%) reported good or very good QoL, 12% reported poor or very poor QoL. When explanatory factors were considered together, the strongest total effects on QoL involved social integration (+0.36 SDs), subjective social position (+0.29), secondary health condition burden (−0.28), activity articipation problem burden (−0.26), day-to-day assistance (−0.26), mental health (+0.18), pain (−0.16), self-efficacy (+0.15), vitality (+0.14) and environmental barriers (−0.11). Effects of social integration, mental health, vitality, self-efficacy, pain and activity articipation problems were partly or wholly direct. Opportunities to improve QoL in people with SCI exist at every level of the health system. Virtually all aspects of the ICF framework make a substantive difference to QoL outcomes. Social and psychological factors and ability to complete desired activities have key direct effects and influence effects of secondary health condition burden and environmental barriers.
Publisher: Elsevier BV
Date: 08-1996
DOI: 10.1016/S0003-9993(96)90264-6
Abstract: Spasticity and pain are common disabling sequelae following spinal cord injury (SCI) and are often difficult to manage. The two problems are also not infrequently related. A variety of pharmacological and other approaches have been described for management of these problems in SCI. This case study reports a 32-year-old woman with an established incomplete C5 tetraplegia (anterior cord syndrome) who developed severe, intractable anal spasm following a hemorrhoidectomy, which persisted despite very good healing. This prevented evacuation of her bowels and resulted in severe rectal pain and episodes of autonomic dysreflexia. Attempts to modify the rate and mode of delivery of intrathecal baclofen through an existing programmable infusion pump failed to reduce anal sphincter spasm or improve symptoms. A right-sided pudendal block with lignocaine provided some relief. Clonidine was added to baclofen in the pump reservoir and both drugs were administered intrathecally in combination. This resulted in an immediate improvement in anal sphincter spasm and pain relief, allowing rapid reestablishment of her normal bowel pattern without need for any supplemental analgesia. It appears that intrathecal clonidine may have an important role in the treatment of spasticity, either as a single or an adjuvant agent, when intrathecal baclofen alone is ineffective or there is increasing tolerance to baclofen. Intrathecal clonidine may also prove useful in the management of intractable neuropathic pain.
Publisher: Springer Science and Business Media LLC
Date: 03-09-2013
DOI: 10.1038/SC.2013.95
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.APMR.2014.03.017
Abstract: To examine relations between psychological distress, health-related quality of life (HR-QOL), and burden among caregivers of people with traumatic spinal cord injury (SCI) over time, and to determine whether the data are more consistent with a wear and tear or adaptation trajectory. Prospective longitudinal cohort study with measurements at 4 time points (6wk prior to discharge from subacute inpatient rehabilitation and 6wk, 1y, and 2y postdischarge to community). Rehabilitation units. Participants (N=44 spouses, parents, others) nominated as a primary caregiver by the person with SCI. Not applicable. General Health Questionnaire-28 (GHQ-28), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index (CSI) assessed the extent of psychological distress, HR-QOL, and burden, respectively, among caregivers. Functional status and community participation/care needs of the persons with SCI were assessed by the FIM and Craig Handicap Assessment and Reporting Technique, respectively. Multilevel piecewise models showed that psychological distress (GHQ-28 score) decreased significantly after discharge (slope estimate =-.03, P<.008). At the predischarge time point, the caregivers' mental component summary score on the SF-36 was significantly lower than Australian national norms. The scores improved from predischarge to 6 weeks postdischarge (slope estimate =.39, P<.001), but they did not change significantly across the following 2 time points (slope estimate =.02, P=.250). At all 3 postdischarge time points, the mental component summary scores were not significantly different to national norms. In contrast, the physical component summary score of the SF-36 did not significantly change across the predischarge and 6-week postdischarge time points (slope estimate =-.14, P=.121) and the 3 postdischarge time points (slope estimate <.01, P=.947). Scores at all 4 time points were not significantly different to the national norms. Caregiver burden showed no significant change over the study period (predischarge to 6wk postdischarge slope estimate =.02, P=.426 3 postdischarge time point slope estimates <-.01, P=.334). Reflecting this, 42% of caregivers met CSI caseness criterion at the first time point, and 46% met the criterion at the fourth (2y) time point. Higher burden was significantly correlated with increased hours of care being provided by the caregiver and lower FIM scores and lower community participation (for the person with SCI) at each time point. Psychological distress correlated with caregiver burden at 6 weeks and 1 year postdischarge but not at 2 years postdischarge. The trajectory of scores for psychological distress and HR-QOL was consistent with caregiver adaptation to the challenge of providing support to a person with SCI in the early postdischarge period. Caregiver burden did not display similar reductions but did not worsen over the study period.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2015
DOI: 10.1038/SC.2015.32
Abstract: This is a longitudinal design study. The objective of this study was to determine factors that predict resilience in people with spinal cord injury (SCI) at discharge from inpatient rehabilitation and after reintegration into the community 6 months post discharge. This study was conducted in SCI rehabilitation units and the community in New South Wales, Australia. Participants included 88 adults with SCI admitted over almost 3 years into three SCI Units in Sydney. Standardized self-report and clinician-based measures were used. Longitudinal assessment occurred up to 6 months post discharge. Sociodemographic, injury and psychological variables were assessed at admission, before discharge and 6 months post discharge. Standard multiple regression was used to determine factors that predict resilience at discharge from hospital and 6 months post discharge. Almost 70% of the participants were classified as resilient at discharge and 66% after 6 months of living in the community. Multiple factors significantly predicted resilience at discharge and 6 months post discharge, including self-efficacy, low levels of negative mood and lower functional independence, whereas social support and low severity of secondary conditions trended to significance. Demographic and injury variables did not contribute significantly. Self-efficacy and low levels of negative mood states strongly contribute to resilience. The determination of these predictors will assist in improving rehabilitation programs to strengthen the resilience of people with SCI. However, given that 40-44% of the variance in resilience was explained by the group of factors entered, future longitudinal research is needed to determine not only whether resilience correlates but also whether these associations change over time.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 06-2000
DOI: 10.1109/86.847827
Abstract: Electrical stimulation has been applied to the paralyzed muscles of both hands of two persons with tetraplegia using percutaneous and implantable electrodes. Two separate methods of user control were being investigated. The first monitored the myoelectric signals from the user's own sternocleidomastoid muscles and the second monitored wrist joint angle. These signals were used as commands to modify the stimulated grasps. The hands were instrumented to detect the degree of hand closure and grip force and the users matched these to specific target parameters using the controller during tracking tasks. Performance in these tracking tasks was measured quantitatively. Wrist control was found to be less sensitive to the direction of hand opening/closing required than the myoelectric control. The user's performance with the myoelectric control demonstrated sensitivity to the target size and the speed of hand movement in response to the command control. The wrist controller required less training than the myoelectric controller for users to become proficient in its use. Based on these results, the wrist controller and the myoelectric controller both provide successful control of bilateral hand grasp and release. Of the two controllers, the wrist controller is likely to provide the greater ease of use, although it is only available to the population of users with active wrist extension.
Start Date: 02-2006
End Date: 12-2010
Amount: $245,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 2004
End Date: 12-2005
Amount: $276,317.00
Funder: Australian Research Council
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