Journal of neurotrauma
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Journal of neurotrauma · May 2024
Neuromodulation through spinal cord stimulation restores ability to voluntarily cycle after motor complete paraplegia.
Abstract Epidural spinal cord stimulation (eSCS) of the lower thoracic spinal cord has been shown to partially restore volitional movement in patients with complete chronic spinal cord injury (cSCI). Combining eSCS with intensive locomotor training improves motor function, including standing and stepping, but many patients with cSCI suffer from long-standing muscle atrophy and loss of bone mineral density, which may prohibit safe implementation. Safe, accessible, and effective avenues for pairing neuromodulation with activity-based therapy remain unexplored. ⋯ Further, motor-assist cycling was well-tolerated without any adverse events. Cycling has the potential to be a safe research assessment and physical therapy modality for cSCI patients utilizing eSCS who have a high risk of injury with weight bearing exercise. The cycling modality in this study was demonstrated to be a straightforward assessment of motor function and safe for all participants regardless of age or time since initial injury.
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Journal of neurotrauma · May 2024
Wallerian degeneration assessed by multimodal MRI of cervical spinal cord is associated with neurological impairment after spinal cord injury.
While Wallerian degeneration (WD) is a crucial pathological process induced with spinal cord injury (SCI), its underlying mechanisms is still understudied. In this study, we aim to assess structural alterations and clinical significance of WD in the cervical cord following SCI using multi-modal magnetic resonance imaging (MRI), which combines T2*-weighted imaging and diffusion tensor imaging (DTI). T2*-weighted images allow segmentation of anatomical structures and the detection of WD on macrostructural level. ⋯ Smaller total and dorsal tissue bridges were related to greater mean CSA and lower fractional anisotropy values in WD (p < 0.05), respectively. Moreover, SCI participants with significantly larger CSAs and significantly lower microstructural integrity had worse sensory outcomes (p < 0.05). This comprehensive evaluation of WD can help us better understand the mechanisms of WD, monitor progression, and assess the effectiveness of therapeutic interventions after SCI.
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Journal of neurotrauma · May 2024
The Positive Correlation between Motor Function and Neuropathic Pain-like behaviors after Spinal Cord Injury: A Longitudinal Study of Mice.
Abstract With the recovery of motor function, some spinal cord injury (SCI) patients still suffer from severe pain-like behaviors symptoms. Whether motor function correlates with neuropathic pain-like behaviors remain unclear. In this study, a longitudinal cohort study of mice with moderate thoracic 10 contusion was performed to explore the characteristics of neuropathic pain-like behaviors and its correlation with motor function in different sexes. ⋯ Importantly, motor function recovery was positively associated with the outcomes of neuropathic pain-like behaviors after SCI, which was more obvious in female mice. Our data not only revealed the characteristics of neuropathic pain-like behaviors but also clarified the correlations between motor function recovery and neuropathic pain-like behaviors after SCI. These findings may provide new opinions and suggestions for promoting the clinical diagnosis and treatment of neuropathic pain-like behaviors after SCI.
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Journal of neurotrauma · May 2024
Machine learning web application for predicting functional outcomes in patients with traumatic spinal cord injury following inpatient rehabilitation.
Accurately predicting functional outcomes in patients with spinal cord injury (SCI) helps clinicians set realistic functional recovery goals and improve the home environment after discharge. The present study aimed to develop and validate machine learning (ML) models to predict functional outcomes in patients with SCI and deploy the models within a web application. The study included data from the Japan Association of Rehabilitation Database from January 1, 1991, to December 31, 2015. ⋯ The final models were deployed in a web application to provide functional predictions. The application can be found at http://3.138.174.54:8501. In conclusion, our prediction models developed using ML successfully predicted functional outcomes in patients with SCI and were deployed in an open-access web application.
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Journal of neurotrauma · May 2024
Epidemiology of Gunshot-related Spinal Injuries and Related Risk Factors for In-hospital Mortality in the United States from 2015-2019: An NTDB Analysis.
Firearm injuries in the U. S. pose a significant public health burden, but data on gunshot wounds (GSWs) specifically involving the spine are scarce. We examined epidemiological trends in GSWs to the spine and associated spinal cord injury (SCI) and mortality rates. ⋯ In-hospital mortality was high in patients with spinal GSWs (8.1%), and mortality was significantly higher with cervical involvement (18.1%), cervical SCI (30.7%), or thoracic incomplete SCI (13.6%) on univariate analysis. On multi-variate analysis of age (excluding patients <16 years of age), sex, Injury Severity Score (ISS), complete SCI, and spinal area of involvement, only greater patient age (age 40-65 years: adjusted odds ratio [aOR] 1.52, 95% confidence interval [CI] 1.09-2.11, p = 0.014; age >65 years: aOR 3.90, 95% CI 2.10-7.27, p < 0.001) and higher ISS (ISS 9-15: aOR 6.65, 95% CI 2.38-18.54, p < 0.001; ISS 16-24: aOR 18.13, 95% CI 6.65-49.44, p < 0.001; ISS >24: aOR 68.44, 95% CI 25.39-184.46, p < 0.001) were independently associated with in-hospital mortality risk after spinal GSW. These results demonstrate that spinal GSW is not uncommon and that older patients with more severe systemic injuries have higher in-hospital mortality risk.