Physical Capacity and Complications During and After Inpatient Rehabilitation for Spinal Cord Injury

A spinal cord injury (SCI) is an interruption of the neural pathways in the spinal canal and is characterized by muscle weakness, loss of sensation and autonomic dysfunction below the level of the lesion. The extent of these neurological deficits is determined by both the level and completeness of the lesion. A complete lesion results in loss of motor function and sensation in the lowest sacral segment whereas, following an incomplete lesion function in this segment is maintained.1 The SCI can either have a traumatic or a non-traumatic cause. In traumatic cases, injury is typically the result of a traffic or sporting accident, but an increasing number of injuries result from a low impact fall, for example, in those with osteoporosis.2,3 A non-traumatic SCI may be caused by metastasis, infection and spinal haemorrhage or infarction.3,4 An estimated 183 new traumatic SCI occur in The Netherlands per year, of whom 154 survive hospitalization, which corresponds to an incidence of over 10 per 1,000,000 per year.2 The incidence of non-traumatic SCI is easily underestimated because many are not registered as SCI, but this incidence largely exceeds the incidence of traumatic injuries.2,4‑6 As compared to the able-bodied population, the life expectancy of those with SCI is reduced. For example, a 20-year-old man with a traumatic paraplegia has an estimated life expectancy of 46 years, whereas an able-bodied man the same age, will have another 58 years to live.3,7 However, because the treatment of complications has improved over the past decades, the life expectancy following SCI has increased.2 Although the life expectancy may have improved, many patients report a low level of functioning and well-being.8‑10 Functioning following SCI may be threatened because most patients have complications, have a low physical capacity, and depend on others for daily activities.6,9,11,12 Therefore, it is important to investigate opportunities to optimize functioning following SCI

Functional independence and health-related functional status following spinal cord injury: A prospective study of the association with physical capacity

Objective: To determine changes in functional independence following spinal cord injury and to evaluate the association between functional independence and physical capacity. Design: Multi-centre prospective cohort study. Subjects: Patients with spinal cord injury admitted for initial rehabilitation. Methods: The motor Functional Independence Measure (FIMmotor) was determined at the start of rehabilitation (n=176), 3 months later (n=124), at discharge (n=160) and one year after discharge from inpatient rehabilitation (n=133). One year after discharge, physical and social dimensions of health-related functional status (Sickness Impact Profile 68; SIP68) were determined. On each occasion, physical capacity was established by measuring arm muscle strength, peak power output and peak oxygen uptake. Results: Multi-level random coefficient analyses revealed that FIMmotor improved during inpatient rehabilitation, but stabilized thereafter. Changes in FIMmotor were associated with peak power output. Multiple regression models showed that FIMmotor and peak power output at discharge were associated with FIMmotor one year after discharge (R2=0.85), and that peak power output at discharge was associated with the social dimension of the SIP68 (R2=0.18) one year after discharge. Conclusion: Functional independence improves during inpatient rehabilitation, and functional independence is positively associated with peak power output

Detection of alpha-toxin and other virulence factors in biofilms of staphylococcus aureus on polystyrene and a human epidermalmodel

Background & Aim: The ability of Staphylococcus aureus to successfully colonize (a)biotic surfaces may be explained by biofilm formation and the actions of virulence factors. The aim of the present study was to establish the presence of 52 proteins, including virulence factors such as alpha-toxin, during biofilm formation of five different (methicillin resistant) S. aureus strains on Leiden human epidermal models (LEMs) and polystyrene surfaces (PS) using a competitive Luminex-based assay. Results: All five S. aureus strains formed biofilms on PS, whereas only three out of five strains formed biofilms on LEMs. Out of the 52 tested proteins, six functionally diverse proteins (ClfB, glucosaminidase, IsdA, IsaA, SACOL0688 and nuclease) were detected in biofilms of all strains on both PS and LEMs. At the same time, four toxins (alpha-toxin, gamma-hemolysin B and leukocidins D and E), two immune modulators (formyl peptide receptor-like inhibitory protein and Staphylococcal superantigen-like protein 1), and two other proteins (lipase and LytM) were detectable in biofilms by all five S. aureus strains on LEMs, but not on PS. In contrast, fibronectinbinding protein B (FnbpB) was detectable in biofilms by all S. aureus biofilms on PS, but not on LEMs. These data were largely confirmed by the results from proteomic and transcriptomic analyses and in case of alpha-toxin additionally by GFP-reporter technology. Conclusion: Functionally diverse virulence factors of (methicillin-resistant) S. aureus are present during biofilm formation on LEMs and PS. These results could aid in identifying novel targets for future treatment strategies against biofilm-associated infections

Physical fitness in people with a spinal cord injury: the association with complications and duration of rehabilitation.

Objective: To assess the association between physical fitness and its recovery over time on the one hand, and complications and duration of phases of rehabilitation on the other. Design and setting: Prospective cohort study at eight rehabilitation centres. Subjects: People with a spinal cord injury were assessed four times: at the start of active rehabilitation (n = 110), three months later (n = 92), at discharge (n = 137) and a year after discharge from inpatient rehabilitation (n = 91). Main measures: Physical fitness was defined as aerobic capacity, determined at each occasion by the peak oxygen uptake (peak V

Investigation of bias due to loss of participants in a Dutch multicentre prospective spinal cord injury cohort study

Objective: To determine bias due to loss of participants (attrition bias) in a prospective cohort study. Design: A multi-centre prospective cohort study. Subjects: A total of 225 individuals with a spinal cord injury from 8 Dutch rehabilitation centres. Methods: Participants were considered non-participants when no information was collected at the measurement one year after discharge from inpatient rehabilitation. Using bivariate tests participants and non-participants were compared regarding personal, lesion, function and functional characteristics determined at the beginning of inpatient rehabilitation and at discharge. A logistic regression was performed to determine which characteristics predict participation at one year after discharge. Results: Of the participants at the start of the study, 31% (n=69) did not perform the tests one year after discharge from inpatient rehabilitation. Variables associated with study participation one year after discharge were: higher level of education, higher well-being score at the start of rehabilitation, and a shorter length of stay in hospital and rehabilitation centre at discharge of inpatient rehabilitation. Conclusion: Selective attrition in the longitudinal study might have led to an over-estimation of some of the results of the measurement one year after discharge from inpatient rehabilitation. © 2009 The Authors. Journal Compilation © 2009 Foundation of Rehabilitation Information

Predicting Respiratory Infection One Year After Inpatient Rehabilitation with Pulmonary Function Measured at Discharge in Persons with Spinal Cord Injury

Objective: To determine whether pulmonary function at discharge from inpatient rehabilitation can predict respiratory infection in spinal cord injury in the first year after discharge, and to determine which pulmonary function parameter predicts best. Design: Multicentre prospective cohort study. Subjects: A total of 140 persons with spinal cord injury. Methods: Pulmonary function was tested at discharge from inpatient rehabilitation. Pulmonary function parameters (expressed in absolute and percentage predicted values) were: forced vital capacity, forced expiratory volume in 1 sec, and peak expiratory flow. Respiratory infection was determined one year after discharge by a physician. Differences between the respiratory infection and non-respiratory infection groups were tested; and receiver operating characteristic curves were used to determine how accurately pulmonary function parameters could predict respiratory infection. Results: Of the 140 participants, 14 (10%) experienced respiratory infection in the first year after discharge. All pulmonary function parameters were significantly lower in persons who experienced respiratory infection than in those who did not. All pulmonary function parameters were almost equally accurate in predicting respiratory infection; only percentage predicted forced vital capacity was less accurate. Conclusion: Pulmonary function at discharge from inpatient rehabilitation can be used as a predictor of respiratory infection in the first year after discharge in spinal cord injury. No single pulmonary function parameter was a clearly superior predictor of respiratory infection. © 2009 The Authors