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To determine the long-term mortality rate and the types of morbidity among all people with spinal cord injuries (SCI) that occurred during the 1948 Israel War of Independence.
Chart review and telephone interviews for collecting demographic data, injury characteristics, marital status, physical activities, employment, morbidity and mortality.
Twent...
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To derive Australian normative scores for the Functional Assessment of Cancer Therapy-General Population (FACT-GP) and to confirm its factor structure.
Quality of life (QoL) data (as measured by the FACT-GP) were collected within the Queensland Cancer Risk Study (QCRS) in 2004. The QCRS explored cancer screening and cancer risk behaviours among 941...
Citations
... A spinal cord injury (SCI) results in permanent neurological deficits and premature ageing, contributing to accelerated morbidity and mortality throughout the lifespan (1)(2)(3) . After an SCI, a decrease in body weight (BW) is commonly ascribed to substantial depletion of body protein with a subsequent increase in fat mass. ...
... Energy intake ¼ Energy expenditure AE changes in body stores (1) Energy intake ¼ Energy expenditure (2) The determination of energy expenditure, and thereby energy requirements, is based on doubly labelled water (24,25) , the reference standard method that is limited by cost, technical experience and equipment and generalisability of findings to special populations, such as those with SCI. Surrogate energy metabolism and dietary assessment tools, such as indirect calorimetry (26) , dietary food records (21,27) and prediction equations (21,28,29) , have been widely used to estimate energy needs and intake in persons with and without SCI. ...
In chronic spinal cord injury (SCI), individuals experience dietary inadequacies complicated by an understudied research area. Our objectives were to assess (1) the agreement between methods of estimating energy requirement (EER) and estimated energy intake (EEI) and (2) whether dietary protein intake met SCI-specific protein guidelines. Persons with chronic SCI (n=43) completed 3-day food records to assess EEI and dietary protein intake. EER was determined with the Long and Institute of Medicine (IOM) methods and the SCI-specific Farkas method. Protein requirements were calculated as 0.8-1.0 g/kg of body weight (BW)/day. Reporting accuracy and bias were calculated and correlated to body composition. Compared to IOM and Long methods (P<0.05), the SCI-specific method did not overestimate the EEI (P=0.200). Reporting accuracy and bias were best for SCI-specific (98.9%, -1.12%) compared to Long (94.8%, -5.24%) and IOM (64.1%, -35.4%) methods. BW (r=-0.403), body mass index (r=-0.323), and total fat mass (r =-0.346) correlated with the IOM reporting bias (all, P<0.05). BW correlated with the SCI-specific and Long reporting bias (r=-0.313, P=0.041). Seven (16%) participants met BW-specific protein guidelines. The regression of protein intake on BW demonstrated no association between the variables (β=0.067, P=0.730). In contrast, for every 1 kg increase in BW, the delta between total and required protein intake decreased by 0.833 g (P=0.0001). The SCI-specific method for EER had the best agreement with the EEI. Protein intake decreased with increasing BW, contrary to protein requirements for chronic SCI.
... Loss of volitional control of micturition, consistent with an upper motor neuron-type injury, is accompanied by detrusor overactivity and detrusor-sphincter dyssynergia, where simultaneous detrusor and urinary sphincter contractions lead to high bladder pressure and insufficient emptying 4 . Major urological concerns contributing to increased morbidity and mortality include incontinence, repeated lower urinary tract (LUT) infections that can result in sepsis, chronic vesicoureteral reflux, and hydronephrosis with progression to renal insufficiency 5,6 . Furthermore, SCI above the sixth thoracic vertebra (T6) impairs cardiovascular reflexes, leading to autonomic dysreflexia (sudden elevation of blood pressure greater than 20 mmHg above one's usual baseline 7 ) that limits bladder storage 8 . ...
Profound dysfunctional reorganization of spinal networks and extensive loss of functional continuity after spinal cord injury (SCI) has not precluded individuals from achieving coordinated voluntary activity and gaining multi-systemic autonomic control. Bladder function is enhanced by approaches, such as spinal cord epidural stimulation (scES) that modulates and strengthens spared circuitry, even in cases of clinically complete SCI. It is unknown whether scES parameters specifically configured for modulating the activity of the lower urinary tract (LUT) could improve both bladder storage and emptying. Functional bladder mapping studies, conducted during filling cystometry, identified specific scES parameters that improved bladder compliance, while maintaining stable blood pressure, and enabled the initiation of voiding in seven individuals with motor complete SCI. Using high-resolution magnetic resonance imaging and finite element modeling, specific neuroanatomical structures responsible for modulating bladder function were identified and plotted as heat maps. Data from this pilot clinical trial indicate that scES neuromodulation that targets bladder compliance reduces incidences of urinary incontinence and provides a means for mitigating autonomic dysreflexia associated with bladder distention. The ability to initiate voiding with targeted scES is a key step towards regaining volitional control of LUT function, advancing the application and adaptability of scES for autonomic function.
... A spinal cord injury (SCI) results from trauma to or disease of the spinal cord, often causing permanent neurological deficits and accelerated morbidity and mortality throughout the lifespan. (1,2) Depending upon level and completeness of injury, SCI is associated with a range of comorbidities that can limit functional independence, mobility, and nutrient utilization. These comorbidities include, motor paralysis, sensory loss, neurogenic restrictive and obstructive pulmonary disease, neurogenic bradycardia, neurogenic hypotension, sympathetic dysfunction, neurogenic adaptive myocardial atrophy, coronary artery disease, anabolic deficiency, spasticity, sarcopenia, heterotopic ossification, osteoporosis, upper extremity overuse, neurogenic obesity, cardiometabolic syndrome (CMS; including, dyslipidemia, hypertension, and type 2 diabetes mellitus), pressure injuries, sexual dysfunction, and neurogenic bowel and neurogenic bladder. ...
Many persons with spinal cord injury (SCI) have one or more preventable chronic diseases related to excessive caloric intake, and poor eating patterns. Appropriate nutrient consumption relative to need becomes a concern despite authoritative dietary recommendations from around the world. These recommendations were developed for the nondisabled population and do not account for the injury-induced changes in body composition, hypometabolic rate, hormonal dysregulation, and nutrition status after SCI. Because evidence-based dietary reference intake values for SCI do not exist, ensuring appropriate consumption of macronutrient and micronutrients for their energy requirements becomes a challenge. In this compressive review, we briefly evaluate aspects of energy balance and appetite control relative to SCI. We report on the evidence regarding energy expenditure, nutrient intake, and their relationship after SCI. We compare this data to several established nutritional guidelines from American Heart Association, Australian Dietary Guidelines, Dietary Guidelines for Americans, Institute of Medicine Dietary Reference Intake, Public Health England Guidelines Government Dietary Recommendations, World Health Organization Healthy Diet, and the Paralyzed Veterans of America (PVA) Clinical Practice Guidelines. We also provide practical assessment and nutritional recommendations to facilitate a healthy dietary pattern after SCI. Because of a lack of strong SCI research, there are currently limited dietary recommendations outside of the PVA guidelines that capture the unique nutrient needs after SCI. Future multicenter clinical trials are needed to develop comprehensive, evidence-based dietary reference values specific for persons with SCI across the care continuum that rely on accurate, individual assessment of energy need.
... Functional impairments of the lower urinary tract (LUT) is an area of highest priority, as it has a dramatic negative impact on overall health and quality of life (Anderson, 2004;Ditunno et al., 2008;Piatt et al., 2016). Major urological concerns contributing to increased morbidity and mortality include repeated LUT infections that can lead to sepsis, chronic vesicoureteral reflux and hydronephrosis with progression to renal failure as a result of high-intravesical pressures, and inter-related cardiovascular complications such as autonomic dysreflexia (Van Kerrebroeck et al., 1993;Zeilig et al., 2000;Hagen et al., 2011) that limits bladder storage . Standard management of LUT dysfunction post-SCI includes a combination of pharmacological approaches to reduce bladder over-activity and pressure and catheter-based management to empty the bladder. ...
Spinal cord injury (SCI) results in profound neurologic impairment with widespread deficits in sensorimotor and autonomic systems. Voluntary and autonomic control of bladder function is disrupted resulting in possible detrusor overactivity, low compliance, and uncoordinated bladder and external urethral sphincter contractions impairing storage and/or voiding. Conservative treatments managing neurogenic bladder post-injury, such as oral pharmacotherapy and catheterization, are important components of urological surveillance and clinical care. However, as urinary complications continue to impact long-term morbidity in this population, additional therapeutic and rehabilitative approaches are needed that aim to improve function by targeting the recovery of underlying impairments. Several human and animal studies, including our previously published reports, have documented gains in bladder function due to activity-based recovery strategies, such as locomotor training. Furthermore, epidural stimulation of the spinal cord (scES) combined with intense activity-based recovery training has been shown to produce volitional lower extremity movement, standing, as well as improve the regulation of cardiovascular function. In our center, several participants anecdotally reported improvements in bladder function as a result of training with epidural stimulation configured for motor systems. Thus, in this study, the effects of activity-based recovery training in combination with scES were tested on bladder function, resulting in improvements in overall bladder storage parameters relative to a control cohort (no intervention). However, elevated blood pressure elicited during bladder distention, characteristic of autonomic dysreflexia, was not attenuated with training. We then examined, in a separate, large cross-sectional cohort, the interaction between detrusor pressure and blood pressure at maximum capacity, and found that the functional relationship between urinary bladder distention and blood pressure regulation is disrupted. Regardless of one’s bladder emptying method (indwelling suprapubic catheter vs. intermittent catheterization), autonomic instability can play a critical role in the ability to improve bladder storage, with SCI enhancing the vesico-vascular reflex. These results support the role of intersystem stimulation, integrating scES for both bladder and cardiovascular function to further improve bladder storage.
... In Denmark, urinary system complications, ischemic heart disease and respiratory complications were the most common causes of death among 169 SCI patients followed up for 25 years after the injury (20). Amongst Israeli SCI veterans who survived at least 10 years postinjury, genito-urinary complications and cardiovascular events were the most common causes of death (21). In this study, the most common complications were spasm, depression (BDI ≥10) and neuropathic pain. ...
Background:
The goal of this study was to determine hazard rate of death rate and the causes of death in Iranian patients with Traumatic spinal cord injury (TSCI).
Methods:
Overall, 1024 patients with chronic traumatic spinal cord injury referred to Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran from Jan 2013-2017 were enrolled. Epidemiological and neurological data, along with secondary complications were recorded for all participants. In the case of death, the cause, and the date of death were recorded. The Kaplan-Meier method was used for survival analysis. A log-rank test was carried out to compare survival due to different risk factors. Risk factors and relative risk estimates associated with death were assessed by means of a Cox regression model.
Results:
Nineteen percent were lost to follow up. During the follow-up period, 22 out of 830 remaining cases (2.6%) died. Deaths were only observed in patients with cervical injuries (59% in C1-C4 level and 41% in C5-C7 level). Kaplan-Meier Log-rank test showed that probability of survival was significantly less in females, complete injury cases, patients with cervical spine injury, depression, and ADR (Autonomic dysreflexia). Controlling for age, sex and education level, Cox regression model showed that hazard rate of death was significantly affected by the categorical variables such as level of injury (HR=0.2, 95% CI=0.12-0.39), severe ADR.
Conclusion:
Probability of survival is lower in female individuals, cases with complete injuries, patients with cervical spine injury, individuals with depression (BDI>10), and clients who experience ADR.
... Other complications associated with spinal cord injury morbidity include urinary tract infections, pressure sores, and other complications affecting the genitourinary, cardiovascular, metabolic, musculoskeletal, and gastrointestinal systems [5]. Although advancements in available treatment options have reduced the frequency of such complications, many of these can be rectified by daily exercise and improvement of quality of life [6]. ...
... Currently, Israel does not have a national SCI registry and no reliable data regarding SCI rehabilitation are available. Several papers have been published sporadically regarding epidemiology and survival following SCI in Israel [6][7][8][9][10]. The Israel National Trauma Registry contains data pertaining to persons with traumatic spine injuries. ...
... A fi sioterapia tem importante papel na assistência aguda do paciente lesado medular visando facilitar uma transição rápida e efi ciente para o processo de reabilitação. Isso pode incluir a prevenção de deformidades, maximização da função muscular e respiratória e aquisição de postura em pé [31]. Quando os pacientes se recuperam dos problemas agudos, são feitos planos de reabilitação baseados no prognóstico de futuras habilidades funcionais. ...
O objetivo deste estudo é analisar o uso do suporte de peso corporal (SPC) para o condicionamento físico e a reabilitação do lesado medular. O levantamento foi realizado através da seleção e listagem de estudos relacionados ao tema em língua portuguesa, inglesa e espanhola a partir do ano de 1990. Pôde ser constatado que existem alguns consensos sobre a utilização do SPC na reabilitação e prática de atividade física adaptada para indivíduos com lesão medular. Com esse sistema o tratamento é facilitado pela suspensão de uma parte do peso do paciente, pela ativação do gerador de padrão central (GPC) e pelo auxílio do terapeuta. Além disso, ocorre um menor gasto energético por parte do paciente e também não existem riscos de quedas. A utilização do SPC pode trazer benefícios motores como a reeducação da marcha e melhora da estabilização do tronco. Como uma forma de atividade física, promove alterações fisiológicas benéficas ao paciente, principalmente no sistema cardiovascular. Assim, pode auxiliar na diminuição da incidência das doenças secundárias à lesão medular.Palavras-chave: suporte de peso corporal, atividade física e reabilitação.
... More than one third of all included studies were from the United States (n = 28) [18, ; roughly 13% of studies were conducted in Canada (n = 10) [17,[63][64][65][66][67][68][69][70][71] , 5% in Israel (n = 4) [72][73][74][75] , 5% in Australia (n = 4) [9,[76][77][78] [7, . The study duration ranged from less than one year to more than 50 years, and included data beginning in 1935 until 2009. ...
... table). For those studies that reported the mean age, the mean age ranged between 23 and 62 [74,106] and between 48 [75] and 62 [48] among studies with adult TSCI and NTSCI populations. Among pediatric populations, the mean age was 11.8 for a TSCI-only population (among one year survivors-only) [83] , and 5 years in an NTSCI population [86] . ...
... Among those studies that investigated the causes of death, the reported leading causes of death were diverse (n = 22) [9, 10, 19, 37, 40, 42, 51, 65, 74, 78, 84, 86-90, 92, 94, 97, 106-109] . The most commonly reported leading cause of death was pneumonia (n = 5) [19,51,78,94,109] , followed by heart disease (n = 3) [10,74,84] . Only one study reported the crude number of deaths for causes of mortality by gender, and found that the leading cause of death among males was heart disease, compared to an Includes only those studies that reported risk of mortality by SCI-specific characteristics. ...
Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. This review evaluates the current evidence among people with SCIs worldwide in relation to the WHO region and country income level; demographic and lesion characteristics; and in comparison with the general population.
A systematic review of relevant databases for original studies. Pooled estimates were derived using random effects meta-analysis, restricted to traumatic SCI.
Seventy-four studies were included. In-hospital mortality varied, with pooled estimates of 24.1% (95% confidence interval (CI) 14.1-38.0), 7.6% (95% CI 6.3-9.0), 7.0% (95% CI 1.5-27.4), and 2.1% (95% CI 0.9-5.0) in the WHO regions of Africa, the Americas, Europe and Western Pacific. The combined estimate for low- and middle-income countries was nearly three times higher than for high-income countries. Pooled estimates of first-year survival were 86.5% (95% CI 75.3-93.1), 95.6% (95% CI 81.0-99.1), and 94.0% (95% CI 93.3-94.6) in the Americas, Europe and Western Pacific. Pooled estimates of standardized mortality ratios in tetraplegics were 2.53 (2.00-3.21) and 2.07 (1.47-2.92) in paraplegics.
This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. Improved standardization and quality of reporting is needed to improve inferences regarding the extent to which mortality outcomes following an SCI are related to healthcare systems, services and policies. © 2015 S. Karger AG, Basel.
... Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in subjects with chronic spinal cord injury (SCI). 1,2 This population usually exhibits a greater atherosclerotic burden than able-bodied persons (ABPs) 3 because of a higher prevalence of cardiovascular risk factors and physical inactivity, resulting in increased body weight, low high-density lipoprotein cholesterol (HDL), and hyperglycaemia. 4 Subjects with SCI typically experience body composition changes with rapid loss of muscle mass, thinning of bone tissue and fat accumulation especially in the sub-lesional area, which significantly affect functional capacity, quality of life and the risk for developing comorbidities. ...
Context:
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in subjects with long-term spinal cord injury (SCI). More specific recommendations for CVD prevention in this population are needed.
Methods:
One hundred thirty male subjects (47 subjects with SCI and 83 able-bodied persons (ABPs), mean age 43.89 ± 1.9 and 45.44 ± 12.2 years; P = 0.48) underwent transthoracic echocardiography (TTE). The effects of age, weight, mean arterial pressure (MAP) and level of physical training on cardiac adaptations were evaluated through multiple regression analysis.
Results:
In subjects with SCI, TTE revealed increased wall thickness (P < 0.05), lower E wave, E/A ratio and early diastolic myocardial relaxation velocity on Tissue Doppler Imaging (TDI) (P < 0.05) and higher systolic myocardial contraction velocity on TDI (0.10 ± 0.02 vs. 0.09 ± 0.02 m/seconds, P = 0.002) and peak systolic pressure to end-systolic volume ratio (3.62 ± 1.39 vs. 2.82 ± 0.90, P < 0.001) compared with ABPs. Aortic diameters were larger in subjects with SCI than ABPs. Differences remained statistically significant even after adjustment for age, weight, MAP, and level of physical training. Weight and age were found to be independent variables that substantially affected left ventricular structure and function in subjects with SCI.
Conclusions:
Subjects with post-traumatic chronic SCI and no overt cardiovascular risk factors, exhibit initial left ventricular remodeling (as assessed by TTE) compared with ABPs. Lifestyle modifications, including regular physical exercise and weight control, should be implemented in all subjects with SCI, even at a very early stage, in order to reduce cardiovascular risk and prevent the development of CVD.
