ORCID Profile
0000-0003-1024-3682
Current Organisation
University of Sydney
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Publisher: Springer Science and Business Media LLC
Date: 23-09-2012
DOI: 10.1038/NG.2417
Publisher: Oxford University Press (OUP)
Date: 30-09-2011
Publisher: Springer Science and Business Media LLC
Date: 03-2013
DOI: 10.1038/SC.2012.177
Abstract: To develop a web-based educational resource for health professionals responsible for the management of spinal cord injury (SCI). The resource:www.elearnSCI.org is comprised of seven learning modules, each sub ided into various submodules. Six of the seven modules address the educational needs of all disciplines involved in comprehensive SCI management. The seventh module addresses prevention of SCI. Each submodule includes an overview, activities, self-assessment questions and references. Three hundred and thirty-two experts from The International Spinal Cord Society (ISCoS) and various affiliated societies from 36 countries were involved in developing the resource through 28 subcommittees. The content of each submodule was reviewed and approved by the Education and Scientific Committees of ISCoS and finally by an Editorial Committee of 23 experts. The content of the learning modules is relevant to students and to new as well as experienced SCI healthcare professionals. The content is applicable globally, has received consumer input and is available at no cost. The material is presented on a website underpinned by a sophisticated content-management system, which allows easy maintenance and ready update of all the content. The resource conforms to key principles of e-learning, including appropriateness of curriculum, engagement of learners, innovative approaches, effective learning, ease of use, inclusion, assessment, coherence, consistency, transparency, cost effectiveness and feedback. www.elearnSCI.org provides a cost effective way of training healthcare professionals that goes beyond the textbook and traditional face-to-face teaching.
Publisher: BMJ
Date: 07-2015
Publisher: Springer Science and Business Media LLC
Date: 15-11-2019
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.PHYSIO.2017.08.003
Abstract: To quantify the relationship between the number of times articles are accessed on the Physiotherapy Evidence Database (PEDro) and the article characteristics. A secondary aim was to examine the relationship between accesses and the number of citations of articles. The study was conducted to derive prediction models for the number of accesses of articles indexed on PEDro from factors that may influence an article's accesses. All articles available on PEDro from August 2014 to January 2015 were included. We extracted variables relating to the algorithm used to present PEDro search results (research design, year of publication, PEDro score, source of systematic review (Cochrane or non-Cochrane)) plus language, subdiscipline of physiotherapy, and whether articles were promoted to PEDro users. Three predictive models were examined using multiple regression analysis. Citation and journal impact factor were downloaded. There were 29,313 articles indexed in this period. We identified seven factors that predicted the number of accesses. More accesses were noted for factors related to the algorithm used to present PEDro search results (synthesis research (i.e., guidelines and reviews), recent articles, Cochrane reviews, and higher PEDro score) plus publication in English and being promoted to PEDro users. The musculoskeletal, neurology, orthopaedics, sports, and paediatrics subdisciplines were associated with more accesses. We also found that there was no association between number of accesses and citations. The number of times an article is accessed on PEDro is partly predicted by how condensed and high quality the evidence it contains is.
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: 17-05-2021
Publisher: Springer Science and Business Media LLC
Date: 12-07-2016
DOI: 10.1038/SC.2016.108
Abstract: The objective of this study was to determine the reliability of measuring wound undermining in people with spinal cord injury (SCI). A psychometric study. The study was conducted at the Indian Spinal Injuries Centre, New Delhi, India. Thirty people with a complete or incomplete SCI and a pressure ulcer with wound undermining were recruited. Wound undermining was measured using the four cardinal points from a clock face (with 12 O'clock defined as towards the head). Inter-rater reliability was tested by comparing the wound undermining scores from two different assessors. Intra-rater reliability was tested by comparing the wound undermining scores from the same assessor on two different days. The intraclass correlation coefficients (95% confidence interval) for inter-rater and intra-rater reliability were 0.996 (0.992-0.999) and 0.998 (0.996-0.999), respectively. Repeat measurements by the same and different assessor were within 0.3 cm of each other, 80% and 83% of the time, respectively. Measurements of wound undermining have excellent reliability.
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: MDPI AG
Date: 21-12-2022
DOI: 10.3390/JCM12010068
Abstract: Adults with spinal cord injury (SCI) are reported to have heightened risk of cognitive impairment, notably mild cognitive impairment (MCI). Reports of increased risk of MCI are almost exclusively based on cross-sectional assessments of cognitive function using norm-referenced scores. Norm-referenced single-point assessments do not reflect cognitive decline at the in idual level but rather represent between group differences in cognitive function. The practice of relying solely on norm-referenced assessment to study MCI after SCI is therefore problematic as it lends to potential misclassification of MCI. Premorbid intelligence estimates permit comparison of people’s actual versus expected cognitive function and thereby can be used to validate the presence of genuine cognitive decline. These are not utilized in the assessment of MCI after SCI. This study simulated data for 500,000 adults with SCI to compare norm-referenced and premorbid-intelligence methods of screening for MCI to examine the potential extent of MCI misclassification after SCI resulting from the overreliance on norm-referenced methods and exclusion of premorbid intelligence methods. One in five to one in 13 simulated adults with SCI were potentially misclassified as having MCI showing that measures of premorbid cognitive function must be included in assessment of cognitive function after SCI.
Publisher: Cambridge University Press (CUP)
Date: 08-2011
Abstract: Several single nucleotide polymorphisms (SNPs) in candidate genes of DNA repair and hormone pathways have been reported to be associated with endometrial cancer risk. We sought to confirm these associations in two endometrial cancer case-control s le sets and used additional data from an existing genome-wide association study to prioritize an additional SNP for further study. Five SNPs from the CHEK2 , MGMT , SULT1E1 and SULT1A1 genes, genotyped in a total of 1597 cases and 1507 controls from two case-control studies, the Australian National Endometrial Cancer Study and the Polish Endometrial Cancer Study, were assessed for association with endometrial cancer risk using logistic regression analysis. Imputed data was drawn for CHEK2 rs8135424 for 666 cases from the Study of Epidemiology and Risk factors in Cancer Heredity study and 5190 controls from the Wellcome Trust Case Control Consortium. We observed no association between SNPs in the MGMT , SULT1E1 and SULT1A1 genes and endometrial cancer risk. The A allele of the rs8135424 CHEK2 SNP was associated with decreased risk of endometrial cancer (adjusted per-allele OR 0.83 95%CI 0.70-0.98 p = .03) however this finding was opposite to that previously published. Imputed data for CHEK2 rs8135424 supported the direction of effect reported in this study (OR 0.85 95% CI 0.65–1.10). Previously reported endometrial cancer risk associations with SNPs from in genes involved in estrogen metabolism and DNA repair were not replicated in our larger study population. This study highlights the need for replication of candidate gene SNP studies using large s le groups, to confirm risk associations and better prioritize downstream studies to assess the causal relationship between genetic variants and cancer risk. Our findings suggest that the CHEK2 SNP rs8135424 be prioritized for further study as a genetic factor associated with risk of endometrial cancer.
Publisher: MDPI AG
Date: 24-09-2020
Abstract: Persons experiencing disabilities often face difficulties to establish and maintain intimate partnerships and the decision whether to live alone or with others is often not their own to make. This study investigates whether in idual and country-level characteristics predict the partnership status and the living situation of persons with spinal cord injury (SCI) from 22 countries. We used data from 12,591 participants of the International SCI Community Survey (InSCI) and regressed partnership status and living situation on in idual (sociodemographic and injury characteristics) and country-level characteristics (Human Development Index, HDI) using multilevel models. Females, younger persons, those with lower income, without paid work, more severe injuries, and longer time since injury were more often single. Males, older persons, those with higher income, paid work, less severe injuries, and those from countries with higher HDI more often lived alone. This study provides initial evidence for the claim that the partnership status and the living situation of people with SCI are influenced by sociodemographic and socioeconomic factors and are not merely a matter of choice, in particular for those with severe injuries.
Publisher: Springer Science and Business Media LLC
Date: 07-03-2018
DOI: 10.1038/S41393-017-0033-3
Abstract: Narrative review. To find and discuss what has been published about the use of telehealth, on people with spinal cord injury (teleSCI). International. Cochrane Library, Ovid Medline, EMBASE and CINAHL, from 1996 till June 2017 have been searched. Searches in PsycINFO, from 1996 till September 2017, were included afterwards. Extracted data include studies in English language, containing information about spinal cord injury and disorders, and telehealth. Literature reviews, systematic reviews, and studies containing other types of neurological disorders, were excluded. Studies were grouped based on how and to whom telehealth was offered. Twenty nine studies were included in the review. They were categorized according to the way teleSCI was provided, and to what modality was used. Some studies utilized more than one modality. TeleSCI seems to be favorable concerning treatment and follow-up, as well as favorable socioeconomically and environmentally. The studies spanned across several aims and outcomes. There was also heterogeneity in number of participants, the differences in modalities, and in the level of evidence. Thus it was challenging to compare studies and make future recommendations. TeleSCI can be used for examination and guiding purposes. Further research is warranted to evaluate optimal utilization, methodology and efficacy. The first author has received funding from the Norwegian Extra Foundation.
Publisher: Springer Science and Business Media LLC
Date: 06-12-2017
DOI: 10.1038/SC.2016.162
Abstract: Within-participant randomised controlled trial. To determine whether strength training combined with usual care increases strength in partially paralysed muscles of people with recent spinal cord injury (SCI) more than usual care alone. SCI units in Australia and India. Thirty people with recent SCI undergoing inpatient rehabilitation participated in this 12-week trial. One of the following muscle groups was selected as the target muscle group for each participant: the elbow flexors, elbow extensors, knee flexors or knee extensors. The target muscle on one side of the body was randomly allocated to the experimental group and the same muscle on the other side of the body was allocated to the control group. Strength training was administered to the experimental muscle but not to the control muscle. Participants were assessed at baseline and 12 weeks later. The primary outcome was maximal isometric muscle strength, and the secondary outcomes were spasticity, fatigue and participants' perception of function and strength. There were no dropouts, and participants received 98% of the training sessions. The mean (95% confidence interval (CI)) between-group difference for isometric strength was 4.3 Nm (1.9-6.8) with a clinically meaningful treatment effect of 2.7 Nm. The mean (95% CI) between-group difference for spasticity was 0.03/5 points (-0.25 to 0.32). Strength training increases strength in partially paralysed muscles of people with recent SCI, although it is not clear whether the size of the treatment effect is clinically meaningful. Strength training has no deleterious effects on spasticity.
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: MDPI AG
Date: 05-06-2023
Abstract: (1) Background: Despite efforts to improve access to health services, between- and within-country access inequalities remain, especially for in iduals with complex disabling conditions like spinal cord injury (SCI). Persons with SCI require regular multidisciplinary follow-up care yet experience more access barriers than the general population. This study examines health system characteristics associated with access among persons with SCI across 22 countries. (2) Methods: Study data are from the International Spinal Cord Injury Survey with 12,588 participants with SCI across 22 countries. Cluster analysis was used to identify service access clusters based on reported access restrictions. The association between service access and health system characteristics (health workforce, infrastructure density, health expenditure) was determined by means of classification and regression trees. (3) Results: Unmet needs were reported by 17% of participants: lowest (10%) in Japan, Spain, and Switzerland (cluster 1) and highest (62%) in Morocco (cluster 8). The country of residence was the most important factor in facilitating access. Those reporting access restrictions were more likely to live in Morocco, to be in the lowest income decile, with multiple comorbidities (Secondary Conditions Scale (SCI-SCS) score 29) and low functioning status (Spinal Cord Independence Measure score 53). Those less likely to report access restriction tended to reside in all other countries except Brazil, China, Malaysia, Morocco, Poland, South Africa, and South Korea and have fewer comorbidities (SCI-SCS 23). (4) Conclusions: The country of residence was the most important factor in facilitating health service access. Following the country of residence, higher income and better health were the most important facilitators of service access. Health service availability and affordability were reported as the most frequent health access barriers.
Publisher: Springer Science and Business Media LLC
Date: 27-11-2012
DOI: 10.1038/SC.2012.141
Abstract: Retrospective analysis. To study the causes, consequences and outcomes of neglected traumatic spinal cord injuries (Neg-TSCIs) admitted at the center. Tertiary level spinal injury center, India. Information was collected from case sheets of 61 persons with Neg-TSCI for whom comprehensive management could not be initiated till at least 4 weeks after the injury and another 62 persons for whom treatment was initiated within 2 days of injury. The range of duration of neglect was 4-676 weeks. Rehabilitation had not been initiated in 93.4% of Neg-TSCI patients. There was a statistically significant poorer functional outcome in Neg-TSCI. Neg-TSCIs are injuries in which comprehensive management is not initiated in a timely fashion. Lack of/inadequate awareness was the most common specific cause. Neg-TSCIs add to the complexity of vertebral lesion management, physical and psychosocial rehabilitation. They have a much higher incidence of complications, which are more severe and difficult to manage. They require a longer hospitalization, add to the costs and adversely affect functional outcomes. The findings differ from that of the few studies done in developed countries in that premature discharge in first admission with inadequate or no rehabilitation was the major general cause of neglect rather than overlooked diagnosis and that there was generally an unsupervised period at home before admission to the definitive center. The study brings out the importance of avoiding any delays in starting comprehensive management after spinal injury and taking treatment in a definitive spinal injury center.
Publisher: Wiley
Date: 17-05-2016
Publisher: Informa UK Limited
Date: 19-09-2023
Publisher: MDPI AG
Date: 10-06-2022
DOI: 10.3390/JCM11123344
Abstract: The assessment of mild cognitive impairment (MCI) following spinal cord injury (SCI) is vital. However, there are no neurocognitive screens which have been developed specifically to meet the unique requirements for SCI, nor are there consistent MCI criteria applied to determine the rates of MCI. The aim of this study was to determine the suitability of a neurocognitive screen for assessing MCI in adults with SCI. A total of 127 participants were recruited. Socio-demographic and injury related variables were assessed. All participants completed the screen. Descriptive statistics are provided for total/domain screen scores and all items, and the screen’s ability to distinguish MCI was examined. Congeneric confirmatory factor analyses (CFA) were employed to investigate structural validity. The screen total score was sensitive to differences in neurocognitive capacity, as well as for time since the injury occurred (p 0.01). The MCI rate ranged between 17–36%. CFA revealed attention and visuoconstruction domains had an adequate model fit and executive function had poor fit, while CFA models for memory and language did not fit the data (did not converge), hence could not be determined. While the screen differentiated between those with MCI and those without, and MCI as a function of time since injury, limitations of its suitability for assessing MCI after SCI exist, demonstrating the need for a specialized neurocognitive screen for adults with SCI.
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: Springer Science and Business Media LLC
Date: 15-05-2012
DOI: 10.1038/SC.2012.45
Abstract: To identify the demographic profile of persons with traumatic spinal cord injury (TSCI) admitted at the center. Indian Spinal Injuries Centre. Retrospective analysis. Information was collected in 2010 from case sheets of 1138 persons with TSCI admitted from January 2002 to May 2010. A telephonic survey was conducted to get further insight into fall from height (FFH) or road traffic accident (RTA) as a mode of injury. The mean, median and mode for the age were 34.4, 32 and 30 years, respectively. Male:female ratio was 5.9:1 and 63.18% (n = 719) were married. RTA was the most common (45%) and FFH the second most common (39.63%) mode of injury. Overall, 66.67% suffered from paraplegia and 71.18% had complete injuries. As compared to other Indian published studies, our study had a much larger number of persons with TSCI and could be considered as the most representative amongst available literature for the Indian population. The study suggests that the demographics of spinal injury in India differs significantly from that in the developed countries since there was a lower mean age, much larger number of males, married in iduals, injuries due to two wheeler accidents/falls, paraplegics and complete injuries. In contrast to other published Indian pilot studies, RTA was the most common mode of injury. Our study brings out the need for a proper epidemiological study and for establishing services for pre-hospital and acute care.
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: Wiley
Date: 08-06-2023
DOI: 10.1111/PSYP.14356
Abstract: Pulse rate variability (PRV) is often used as an alternative to heart rate variability (HRV) to measure psychophysiological function. However, its validity to do so is unclear, especially in adults with spinal cord injury (SCI). This study compared PRV and HRV in adults with higher‐level SCI (SCI‐H, n = 23), lower‐level SCI (SCI‐L, n = 22), and able‐bodied participants (AB n = 44), in a seated position as a function of performance in a reactivity task (Oxford Sleep Resistance Test: OSLER). PRV and HRV was measured using reflective finger‐based photoplethysmography (PPG) and electrocardiography, respectively, at baseline, immediately post‐OSLER, and after five‐minute recovery. Agreement between PRV and HRV was determined by Bland–Altman analysis and differences between PRV and HRV over time by linear mixed effects model (LMM) analysis. Concurrent validity was assessed through correlation analyses between PRV and HRV. Additional correlation analyses were performed with psychosocial factors. Results indicated insufficient to moderate agreement between PRV and HRV. LMM analyses indicated no differences over time for standard deviation of normal‐to‐normal intervals and low‐frequency power but significant differences for root mean square of successive differences and high frequency power. Nevertheless, PRV and HRV were highly correlated (Median r = .878 (.675–.990)) during all assessment periods suggesting sufficient concurrent validity. Similar correlation patterns were also found for PRV and HRV with psychosocial outcomes. While differences existed, results suggest PRV derived from reflective finger‐based PPG is a valid proxy of HRV in tracking psychophysiological function in adults with SCI and could therefore be used as a more accessible monitoring tool.
Publisher: Springer Science and Business Media LLC
Date: 02-06-2009
DOI: 10.1038/SC.2009.54
Abstract: Prospective Pilot Study. To determine the safety and feasibility of autologous olfactory mucosal transplantation into the spinal cord in chronic spinal cord injured using the technique developed by Carlos Lima et al. Spinal Injury Center, New Delhi. Five chronic, motor complete, traumatic spinal cord injury (SCI) patients with neurological level C5-T12 underwent the procedure. Participants were assessed at baseline and at 6 monthly intervals. Safety and tolerability were evaluated through monitoring for any adverse events and tests including magnetic resonance imaging (MRI) evaluation. Efficacy assessment was done through neurological, functional and psychological evaluation, electrophysiological studies and urodynamics. Surgery was tolerated well by all American Spinal Injury Association (ASIA) Impairment Scale (AIS) A participants. The only AIS B participant lost sensory scores significantly after surgery but is gradually regaining it. MRI evaluation revealed a syrinx in one participant and increase in length of myelomalacia in four participants. There were no other adverse findings on MRI evaluation. There was no significant improvement in any of the neurological, electrophysiological or urodynamic efficacy variables. Statistically significant improvement was seen in functional scores as evaluated by Spinal Cord Independence Measure, Beck Depression Inventory scores and life impact scores on International Spinal Cord Injury Scale. The procedure is relatively safe and feasible in AIS A participants with thoracic level injuries at 18 month follow-up. No efficacy could be demonstrated which could be attributed to the procedure.
Publisher: MDPI AG
Date: 04-08-2022
DOI: 10.3390/JCM11154557
Abstract: Spinal cord injury (SCI) is a severe neurological injury that results in damage to multiple bodily systems. SCI rehabilitation requires a significant focus on improving adjustment to the injury. This paper presents a detailed description of the Spinal Cord Injury Adjustment Model (SCIAM), which clarifies how in iduals adjust to SCI and contends that adjustment to SCI is a multifactorial process involving non-linear dynamic adaptation over time. Evidence supporting SCIAM is also discussed. Mediation analyses were conducted to test the mediator dynamics proposed by the model. The analyses tested the relationship between two moderators (self-care and secondary health conditions), mediators (two self-efficacy items and appraisal of quality of life or QoL), and positive versus negative vitality/mental health as outcomes. Results showed that higher self-efficacy and perceived QoL was related to greater independence in self-care and reduced negative impacts of secondary health conditions. This study supported the mediation role of self-efficacy and other appraisals such as perceived QoL in enhancing self-care and buffering the negative impact of health challenges. In conclusion, it is important to employ a holistic model such as SCIAM to conceptualise and increase understanding of the process of adjustment following a severe neurological injury such as SCI.
Publisher: MDPI AG
Date: 25-06-2023
DOI: 10.3390/JCM12134258
Abstract: Background: Mild cognitive impairment (MCI) is a common secondary condition associated with spinal cord injury (SCI). Cognitive reserve (CR) is believed to protect against cognitive decline and can be assessed by premorbid intelligence (pmIQ). Despite the potential utility of pmIQ as a complementary metric in the evaluation of MCI in SCI, this approach has been infrequently employed. The purpose of this study was to examine the association between MCI and pmIQ in adults with SCI with the aim of exploring the potential value of pmIQ as a marker of CR in this population. Methods: Cognitive function was assessed on three occasions in adults with SCI over a 12-month period post-injury, and pmIQ was assessed once at baseline. Demographic and mental health measures were also collected, and logistic regression was conducted to determine the strength of association between pmIQ and MCI while adjusting for factors such as mental health and age. Results: The regression analysis revealed that at the time of admission to SCI rehabilitation, the MCI assessed by a valid neurocognitive screen was strongly associated with pmIQ. That is, if a person has MCI, there was 5.4 greater odds (p 0.01) that they will have poor pmIQ compared to a person without MCI after adjustment for age and mental health. Conclusions: The assessment of CR is an important area that should be considered to improve the process of diagnosing MCI in adults with an acute SCI and potentially facilitate earlier intervention to slow or prevent cognitive decline.
No related grants have been discovered for Mohit Arora.