Incidence, aetiology and injury characteristics of traumatic spinal cord injury in Stockholm, Sweden: a prospective, population-based update

OBJECTIVES: To update the incidence rate, aetiology and injury characteristics of acutely-injured adults with traumatic spinal cord injury in Stockholm, Sweden, using international standards of reporting. Study design: Prospective, (regional) populationbased observation. SUBJECTS: Forty-nine consecutively enrolled individuals. METHODS: A surveillance system of newly-injured adults with traumatic spinal cord injury was implemented for an 18-month period. The International Spinal Cord Injury Core Data Set was used to collect data on those who survived the first 7 days postinjury. RESULTS: After an 18-month period, 49 incident cases were registered, of whom 45 were included in this study. The crude incidence rate was 19.0 per million, consisting mainly of men (60%), and the mean age of the cohort was 55 years (median 58). Causes of injury were almost exclusively limited to falls and transport-related events, accounting for 58% and 40% of cases, respectively. The incidence has remained stable when compared with the previous study; however, significant differences exist for injury aetiology (p = 0.004) and impairment level (p = 0.01) in that more fall- and transport-related spinal cord injury occurred, and a larger proportion of persons was left with resultant tetraplegia, in the current study, compared with more sport-related injuries and those left with paraplegia in the previous study. CONCLUSION: The incidence rate appeared to remain stable in Stockholm, Sweden. However, significant changes in injury aetiology and impairment-level post injury were found, compared with the previous study. There remains a need for developing fall-related prevention strategies in rehabilitation settings as well as in population-based programmes

Assisted reproduction technology in men with ejaculatory dysfunction with special reference to spinal cord injury

Background: Men afflicted by spinal cord injury (SCI), myelomcningocele (MMC) and testicular cancer (TC) with retroperitoneal Iymph node dissection (RPLND) share the problem of infertility due mainly, but not exclusively, to neurologic impairment. This problem has historically been neglected, partly due to lack of effective treatment, partly due to lack of appreciation of the importance of sexual and procreational issues for rehabilitation outcomes and quality of life. With the recent significant development of assisted reproduction technology (ART), investigation of the effectiveness of such methods when applied to these patients is of highest relevance in a holistic rehabilitative context. Aims: To evaluate the effectiveness of ART in infertile men with SCI, with particular reference to intracytoplasmic sperm injection (ICSI), and to compare it with previously published results using simpler methods. To evaluate the use of in vitro fertilization (IVF) and ICSI in men with anejaculatory infertility after TC/RPLND. To investigate if spermatogenesis in men with MMC is sufficient for ART. To evaluate the anaesthesiological management of electroejaculation (EEJ) in patients at risk for autonomic dysreflexia (AD). Patients and methods: Twenty-five couples with a SCI man underwent 53 ovum retrievals and 47 embryo transfers. Additionally, four frozen embryo replacements were carried out. (Papers I and III) Ten couples with a TC/RPLND man, with long-standing infertility due to anejaculation or retrograde ejaculation underwent EEJ under general anaesthesia (GA). The anterograde fraction was prepared and used for IVF. Additionally, one frozen embryo replacement was carried out. (Paper II) In nine men with MMC, retrieval of sperm was attempted by unassisted ejaculation, penile vibratory stimulation (PVS), EEJ in GA and/or testicular biopsy. (Paper IV) Thirty anejaculatory SCI men and 15 men with anejaculation due to TC/RPLND underwent 87 EEJ procedures in GA with assisted mask ventilation in a day surgery setting. (Paper V) Results Sixteen clinical pregnancies were established in the couples with a SCI man, leading to 12 deliveries (10 singletons and 2 duplex). Ten of the pregnancies were established after conventional IVF and six after ICSI. Spermatozoa were recovered in nine of ten TC/RPLND men. Sperm quality was variable and conventional IVF was considered impossible in three cases. Altogether six IVF treatment cycles in six couples resulted in five pregnancies, of which four resulted in a delivery and one resulted in a spontaneous abortion. One additional pregnancy was achieved after transfer of cryopreserved embryos. The fenilization rate (FR) was 54% (33/61) and the cleavage rate was 97% (32/33). No complications relating to the procedure was encountered. Two MMC men were able to achieve unassisted ejaculation. PVS was unsuccessful in the remaining seven subjects. In five subjects, EEJ yielded enough sperrn to make ICSI possible. In one case, testicular biopsy revealed spermatogenesis. Thus, in six of nine MMC men, fatherhood seemed possible. All 87 EEJ procedures gave ejaculation of semeo. Six episodes of hypenension occurred, all in subjects with SCI and a lesion at T6 or rostral. These episodes were successfully treated with calcium blockers. No adverse events occurred in the SCI group. Conclusions: A cumulative delivery rate of about 50% can be expected with assisted ejaculation and IVF/ICSI in couples with a SCI man where home insemination has been unsuccessful. IVF/ICSI is the method of choice if home insemination fails, if EEJ in GA is required, if semen quality is poor, or if there are concurrent female infertility factors. A high cumulative delivery rate can also be expected from EEJ and IVF/ICSI in anejaculatory men after TC/RPLND. Since semen retrieval in most instances requires EEJ in GA, IVF/lCSI is the method of choice. A sizeable proportion of men with MMC seems to have enough sperm for ICSI. The risk of severe hypertension and other complications from EEJ of SCI men in GA with assisted mask ventilation in a day surgery setting seems small, provided anaesthesia is managed by experienced staff. Our conclusion is that the safety of this procedure justifies its application in infertility treatment

Views on everyday life among adults with spina bifida : An exploration through photovoice

The aim of this study was to actively integrate expertise of persons living with spina bifida, to explore conditions embedded in their everyday life. This was important because young adults with spina bifida risk not being able to fully participate in the community on equal terms and in accordance with their own preferences. Photovoice, a community-based participatory research approach, was utilized to engage participants through dialogue and photography. An exhibition was created to share results with community and stakeholders. An overarching theme that characterized the experiences of the group was, "an adaptation for us, but it works for no one". Findings are presented as: "Accessibility-a never-ending project," "Tensions of a normative view," and "Power to influence." Findings integrated everyday life metaphors photographically depicted by broken elevators, unsafe transportation, closed doors and not experiencing real opportunities of involvement. Tensions in everyday life experienced by persons living with spina bifida can inform conditions relevant and necessary to support community participation, particulary among persons living with disability

SELF-REPORTED HEALTH PROBLEMS AND PRIORITIZED GOALS IN COMMUNITY-DWELLING INDIVIDUALS WITH SPINAL CORD INJURY IN SWEDEN

Objective: To explore self-reported health problems and functional goals in community-dwelling individuals with spinal cord injury in Sweden. Design: Cross-sectional descriptive study that used a survey designed by an experienced peer mentor with spinal cord injury. Subjects: Community-dwelling individuals with spinal cord injury from Sweden. Methods: The survey was distributed online by the community peer-based organization RG Active Rehabilitation. Results: A total of 203 individuals (55% males, 90% acquired spinal cord injury) from all regions in Sweden completed the survey. Of these, 33% reported living with amp;gt; 2 unbearable physical or psychological problems. While some problems (e.g. problems related to bladder and balance) were consistently ranked to be common across all years since injury and type of spinal cord injury, distribution of some other unbearable problems (e.g. type of pain, excessive weight) varied between subgroups. Years since injury, level of acquired spinal cord injury and sex, but not age-group or type of spinal cord injury, explained some of the variation in the goals. Conclusion: The high proportion of reported "unbearable" problems point to the stronger need for systematic, comprehensive, life-long, multi-disciplinary follow-up for people with spinal cord injury. The high rate of goals related to improving strength and fitness across all participants independently of their characteristics highlight the important role of community organizations that offer such lifetime services

Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- and tetraplegia.

OBJECTIVE: The aims were to describe VO2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels. DESIGN: Cross sectional. SETTING: Rehabilitation facility and laboratory environment. SUBJECTS: Sixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8. INTERVENTIONS: VO2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry. MAIN OUTCOME MEASURES: VO2peak, Absolute and relative oxygen consumption, Borg RPE. RESULTS: Absolute VO2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61-72% HRpeak and RPE 10-13 for MCP vs. 71-79% HRpeak, RPE 13-14 for MCT. CONCLUSION: Using current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO2peak, HRpeak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.Energiomsättning hos ryggmärgsskadad

Active rehabilitation for persons with spinal cord injury in Botswana: Effects of a community peer-based programme

Divanoglou, A ORCiD: 0000-0001-7376-6793Study design:: Prospective cohort study with a repeated measures analysis. Objectives:: To measure the effects of the Active Rehabilitation (AR) training programme for community-dwelling individuals with spinal cord injury (SCI) in Botswana on physical independence, wheelchair mobility, self-efficacy, life satisfaction, level of physical activity and community participation. Setting:: The inaugural AR training programme in Botswana, a community peer-based programme for people with SCI. The 10-day residential programme in Botswana was led by an international team of peer mentors and health professionals. Methods:: Participants with SCI (on average 4 years after injury) completed a survey comprising a battery of standardised outcome measures at three timepoints: at the start, on completion and at 5 months after the programme (n = 14). Participants also completed a practical wheelchair skills test at start and completion of the programme (n = 17). Results:: Participants improved in the mobility subscale of the Spinal Cord Independence Measure Self Report on completion (p = 0.011, d = 0.85) and at 5-month follow-up (p = 0.005, d = 0.93) as compared to baseline. They also achieved moderate improvement in self-efficacy to manage their condition (physical function domain of Moorong Self-Efficacy Scale) and large improvements in wheelchair mobility as assessed through the Queensland Evaluation of Wheelchair Skills test and the Wheelchair Skills Test Questionnaire. All positive results were retained at 5-month follow-up. Conclusions:: Findings indicate that the peer-based programme AR can play an important role in promoting physical independence, wheelchair mobility and injury-management self-efficacy in community-dwelling individuals with SCI in Botswana. © 2019, International Spinal Cord Society

Evaluating the feasibility of ReWork-SCI : a person-centred intervention for return-to-work after spinal cord injury

Objectives To evaluate the feasibility of: (1) ReWork-SCI with regard to adherence and acceptability and (2) a study design for evaluating ReWork-SCI with regard to recruitment, retention and outcome measures. Design Pre-test and post-test, single group, feasibility study. Setting Spinal cord injury (SCI) unit at a regional rehabilitation centre in Sweden. Participants Two women and five men (n=7). Eligible criteria: (1) sustained traumatic or non-traumatic SCI; (2) completed the first acute care episode in a hospital; (3) between 18 to 65 years of age; (4) assessed by a physician as approachable for participation in the intervention; (5) history of permanent or temporary employment; (6) self-reported desire to return to work; and (7) ability to communicate in English or Swedish. Intervention ReWork-SCI is a person-centred intervention for return-to-work (RTW), developed and evaluated using the Medical Research Council's guidelines. ReWork-SCI follows a person-centred, structured and coordinated intervention process led by a coordinator within a SCI rehabilitation team. Outcome measures The feasibility of ReWork-SCI and a study design was evaluated using a set of outcome measurement tools, vocational data, logbooks and semi-structured interviews. Results All eligible participants accepted enrolment and follow-up. All participants had a plan for RTW after 3 months and four participants had initiated part-time work or work trial 6 months after commencement of intervention. Adherence and acceptability were overall good. Challenges of the intervention related to the person-centred follow-up, staff shortage and rootedness in the SCI team. Conclusions ReWork-SCI was feasible and can contribute to a systematic design of an individualised plan, facilitate decision-making and build trust in the RTW process after SCI. Core features of the intervention was the systematic structure, use of a person-centred approach and dialogue with the employer. For the effectiveness of ReWork-SCI, modifications and considerations of study design are needed

Pregnancy, delivery, and neonatal outcomes among women with spinal cord injury in Sweden 1997-2015 : A population-based cohort study

Introduction The aim of this study was to describe the rate of pregnancy in spinal cord injured women in Sweden as well as pregnancy, delivery, and neonatal outcomes. Material and Methods This study was based on data from the Swedish Medical Birth Register and the National Patient Register. The study population included women with spinal cord injury who gave birth in Sweden during the period 1997 to 2015. The general population was used as reference and included all non-spinal cord injured patients who gave birth during the same period of time. Results In the spinal cord injury group, 109 births were identified. Eighty-nine (82%) of them were among paraplegic women and 20 (18%) were among tetraplegic women. Women with spinal cord injury in our study population had urinary tract infections during pregnancy in five cases (5%) and anemia during pregnancy in nine cases (8%), compared with 0.2% and 4%, respectively, in the general population. Compared with the general population more deliveries were induced in the study population, 18 (17%) in the spinal cord injury group and 12% in the general population. Vaginal delivery was achieved in 52 (48%) of the births with 42 of them (39%) being non-instrumental and 10 (9%) being instrumental vaginal deliveries. Elective cesarean section rate was 34% (n = 37). Sixteen infants (15%) were born preterm (gestational week <37). We found an overall low rate of pregnancy and delivery complications. Conclusions Our results show predominantly favorable outcomes of pregnancy and delivery in women with spinal cord injury as well as their infants. These results are in concordance with previous research

Gait and dynamic balance in adults with spina bifida

BACKGROUND: Spina bifida (SB) is a complex congenital malformation, often causing impaired gait performance depending on the level and extent of malformation. Research regarding gait and balance performance in adults with SB, has not been sufficiently described yet. RESEARCH QUESTION: What are the characteristics of spatiotemporal gait parameters and balance performance in adults with SB? Further, do persons with muscle function (MF) level 3 differ regarding gait and balance performance from those with MF level 1-2? METHODS: Cross-sectional observational study at an outpatient clinic. 41 adults with SB (18-65 years), who walked regularly. Spatiotemporal parameters of gait was assessed with the APDM system and balance performance with the Mini Balance Evaluation Systems Test (Mini-BESTest). Muscle strength in the legs was assessed with 0-5 manual muscle test, and participants were classified according to level of MF into groups MF1, MF2, and MF3. Two-sided t-test was used for parametric independent variables, and Cohen's d was used for effect sizes. The Mann-Whitney U test was used for non-parametric independent data and effect size was calculated by the z value (r = z/√n). RESULTS: Mean gait speed was 0.96 (SD 0.20) m/s and mean stride length 1.08 m (SD 0.17), individuals with MF3 showed significantly slower gaitspeed and shorter stride length (p < 0.05). Lumbar rotation was 21° (SD 11), and thoracic lateral sway 15° (IQR 15) with significantley difference (p < 0.001 and p < 0.05) for individuals in MF3. Mini-BESTest showed a mean score of 11.3 (SD 6.9), and individuals with MF3 showed significantly lower scores (p ≤ 0.001). SIGNIFICANCE: Gait and balance performance was reduced compared to normative data in almost all parameters, especially in persons with less muscle function. Increased knowledge from advanced gait analysis may help healthcare professionals to design rehabilitation programmes, in order to achieve and maintain a sustainable gait and balance performance