Gregory Nemunaitis

A Descriptive Study on Vitamin D Levels in Individuals With Spinal Cord Injury in an Acute Inpatient Rehabilitation Setting

To determine the prevalence of inadequate or severely deficient levels of vitamin D in patients with spinal cord injury (SCI) admitted to an inpatient rehabilitation service and to describe any associations between patient demographics and injury characteristics and vitamin D levels.

Increases in wheelchair breakdowns, repairs, and adverse consequences for people with traumatic spinal cord injury.

Objective The aims of this study were to report the current incidence of wheelchair breakdowns, repairs, and consequences and to compare current data with historical data. Design A convenience sample survey of 723 participants with spinal cord injury who use a wheelchair for more than 40 hrs/wk treated at a Spinal Cord Injury Model Systems center was conducted. Results Significant increases were found in the number of participants reporting repairs (7.8%) and adverse consequences (23.5%) in a 6-mo period (2006–2011) compared with historical data (2004–2006) (P < 0.001). When examining current data, minorities experienced a greater frequency and higher number of reported consequences (P = 0.03). Power wheelchair users reported a higher number of repairs and consequences than did manual wheelchair users (P < 0.001). Wheelchairs equipped with seat functions were associated with a greater frequency of adverse consequences (P = 0.01). Repairs did not vary across funding source, but individuals with wheelchairs provided by Medicare and Medicaid reported a higher frequency of consequences than did the combined group of the Department of Vocational Rehabilitation, Worker’s Compensation, and the Veterans Administration (P = 0.034 and P = 0.013, respectively). Conclusions The incidence and consequences of repairs are increasing from what was already a very high statistic in this United States population. Further investigation into causality is required, and intervention is needed to reverse this potential trend.

Implanted Electrical Stimulation of the Trunk for Seated Postural Stability and Function After Cervical Spinal Cord Injury: A Single Case Study

OBJECTIVES To explore and quantify the physical and functional effects of stabilizing the torso with electrical stimulation of the paralyzed hip and trunk musculature after motor complete tetraplegia. DESIGN Single-subject case study with repeated measures and concurrent controls. SETTING Academic outpatient rehabilitation center. PARTICIPANTS Forty-four-year-old man with C4 American Spinal Injury Association grade A tetraplegia 20 years postspinal cord injury. INTERVENTION A surgically implanted multichannel pulse generator and intramuscular stimulating electrodes to activate lumbar erector spinae, quadratus lumborum, and gluteus maximus muscles bilaterally. MAIN OUTCOME MEASURES Outcomes assessed with and without stimulation included (1) spinal alignment and pelvic orientation, (2) pulmonary function and ventilatory volumes, (3) forward bimanual reaching distance, (4) seated stability and resistance to externally applied disturbances, (5) maximal force and speed of rowing-like movements, and the ability to (6) independently return to an erect seated position from full forward or lateral flexion and (7) roll in bed without assistance. RESULTS Stimulation improved spinal convexity and kyphosis by 26 degrees and 21 degrees , reduced posterior pelvic tilt by 11 degrees , increased forced expiratory volume and vital capacity by 10% and 22%, and improved forward reach by more than 7cm. Average resistance to sagittal disturbances increased by more than 40% (P<.002), and mean force exerted during underhanded pulling more than doubled (P=.014) with stimulation. Restoration of upright sitting in both sagittal and coronal planes and bed turning was made possible through appropriately timed activation of the hip and trunk muscles. CONCLUSIONS A neuroprosthesis for controlling the paralyzed torso can positively impact spinal alignment, seated posture, pulmonary function, trunk stability, and reach. Stimulation of hip and trunk muscles can improve performance of activities of daily living as well as enable independent wheelchair and bed mobility.

Current Research Outcomes From the Spinal Cord Injury Model Systems.

This article serves as an introduction to this issue of the Archives of Physical Medicine and Rehabilitation that is devoted to current research findings of the Spinal Cord Injury Model Systems (SCIMS) program. The SCIMS program began in 1970, with funding from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education, to demonstrate a comprehensive care system for spinal cord injury (SCI) and also to conduct research to improve the health and quality of life of persons with SCI. Over the last 20 years, similar collaborative efforts for the dissemination of SCIMS research outcomes have produced conference proceedings in 1990, a book in 1995, and dedicated journal issues in 1999 and 2004. The collection of 24 articles in this issue shows the depth and breadth of work being carried out by the SCIMS investigators, from descriptive epidemiology to a randomized controlled trial, from neurologic recovery to community reintegration, and from health services utilization to assistive technology for mobility. Herein, we provide a brief overview of the SCIMS program, highlight the research initiatives currently underway, and describe the important findings of the original research articles contained in this issue.

Emergency Evacuation Readiness of Full-Time Wheelchair Users With Spinal Cord Injury

OBJECTIVES To determine the percentage of full-time wheelchair users with spinal cord injuries who felt they could evacuate from various locations, and the percentage who have a plan for evacuation. Study results will help clinicians and emergency officials understand needs related to evacuation preparedness. DESIGN Convenience sample survey. SETTING Six Spinal Cord Injury Model System centers, part of the national database funded through the Department of Education, National Institute on Disability and Rehabilitation Research. PARTICIPANTS People (N=487) with spinal cord injuries who use a wheelchair more than 40 hours a week. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The percentage of wheelchair users who felt they would be able to safely evacuate, had a plan for safe evacuation, or reported a need for assistive technology and human assistance to evacuate from various locations in the event of an emergency. RESULTS The highest percentage of participants felt they would be able to safely evacuate and had a plan for work evacuation. The lowest percentage of participants reported they could evacuate from their city/town in the event of an emergency and had a plan to evacuate their city/town in the event of a natural disaster. A large difference exists between the percentage of participants who felt they could evacuate and those who have a plan for evacuation. CONCLUSIONS A large discrepancy exists between the perception that one can evacuate and actually having a plan. The perception that one can evacuate without a plan or the use of assistive technology is an area of concern that must be further addressed by educators. Education must emphasize the need to have a defined evacuation plan and effective utilization of assistive technology.

The misapplication of the term spinal cord injury without radiographic abnormality (SCIWORA) in adults.

BACKGROUND Spinal cord injury without radiographic abnormality (SCIWORA) is generally considered a disease of children; however, it is commonly used when referring to adults who have spinal cord injury without computed tomography evidence of trauma (SCIWOCTET). The purpose of this study was to describe characteristics of patients with both adult and pediatric cervical SCIWOCTET admitted to hospitals in our region. METHODS A retrospective review of all patients admitted to our two ACS-verified trauma centers with cervical spinal cord injury from January 2005 to December 2009 was performed. All patients with vertebral or ligamentous injury identified on computed tomographic (CT) scan of the cervical spine were excluded. Data gathered on the remaining patients included demographics, injury mechanism, Injury Severity Score, neurologic level and severity of spinal cord injury, magnetic resonance imaging results, and mortality rates. RESULTS During the 5-year period of this study, 11,644 adult patients and 3,458 pediatric trauma patients were admitted. Of these, 313 patients were thought to have cervical spinal cord injury based on International Classification of Diseases, Ninth Revision (ICD-9) codes, 279 (89.1%) were excluded due to injury noted on CT cervical spine, and 9 were excluded as they were found to not truly have cervical spinal cord injury after review of the medical record. The remaining 25 patients were identified as having cervical SCIWOCTET. Twenty-three patients (92%) were male. The patient ages ranged from 10 to 83 years with a median age of 56 years. The mean Injury Severity Score was 22.6. Sixty-eight percent had a mechanism of fall. Degenerative changes were found on the CT scan of the cervical spine in 96% of all patients and in all 24 adult patients. There was only one pediatric patient with SCIWORA, a 10-year-old boy who had a normal CT scan of the cervical spine but had a persistent neurologic deficit. CONCLUSION SCIWOCTET is mainly a disease of adults, and its subset SCIWORA, a disease of children, is much less common. Adults with this disease have CT scans showing canal stenosis and significant degenerative changes in the cervical spine; thus, it is not accurate to state that they have SCIWORA. The characteristics of this patient population are important as SCIWOCTET is the concern when clearing the cervical spines of trauma patients with a CT scan of the cervical spine negative for injury. LEVEL OF EVIDENCE Epidemiologic study, level III.

Cell Telephone Ownership and Social Integration in Persons With Spinal Cord Injury

OBJECTIVES To describe the prevalence and demographic characteristics associated with cell telephone ownership and to investigate whether cell telephone ownership has a positive relationship with social integration. DESIGN Cross-sectional. SETTING Spinal Cord Injury (SCI) Model Systems. PARTICIPANTS Participants (N=7696) with traumatic SCI who were entered into the National SCI Database and completed a follow-up interview from April 2004 through April 2009. INTERVENTIONS None. MAIN OUTCOME MEASURES Cell telephone ownership; Craig Handicap Assessment Reporting Technique Social Integration subscale. RESULTS A total of 73% of participants owned a cell telephone. Persons who were younger, employed, achieved education beyond grade school, and had computer and e-mail access were more likely to own cell telephones. Not owning a cell telephone decreased the likelihood of belonging to the high-social-integration group compared with the low-integration group (odds ratio, .509; 95% confidence interval, .396-.654). Persons with low or medium social integration scores were less likely to own a cell telephone than those who had high social integration scores. CONCLUSION In this study, most participants owned a cell telephone, although 27% did not compared with 13% nonowners in the general population. Owning a cell telephone increased the likelihood of being more socially integrated compared with non-cell telephone ownership.

Early Predictors of Functional Outcome After Trauma

Despite the availability of routinely collected trauma data, researchers who investigate rehabilitation outcomes, functional evaluation, and comparative effectiveness have not incorporated this potentially clinically meaningful information in their modeling as predictors or adjustors.

Preventive Health Care Among Community-Dwelling Persons with Spinal Cord Injury

To describe preventive health examinations/tests and behaviors of persons with traumatic spinal cord injury (SCI).

Pushrim kinetics during advanced wheelchair skills in manual wheelchair users with spinal cord injury

OBJECTIVE To assess the peak force during wheelchair propulsion of individuals with spinal cord injury propelling over obstacles from the Wheelchair Skills Test. PARTICIPANTS/METHODS Twenty-three individuals with spinal cord injury (SCI) who are full-time manual wheelchair users were included in this prospective study. A SmartWheel (Three Rivers Holdings, LLC) was used to analyze each push while subjects negotiated standardized obstacles used in the Wheelchair Skills Test, including tile, carpet, soft surface, 5° and 10° ramps, 2 cm, 5 cm, and 15 cm curbs. RESULTS When the peak forces of the advanced skills were compared to level 10 m tile/10 m carpet, there was a statistically significant increase in all peak forces (P value ranged from .0001 to .0268). DISCUSSION It is well documented that a large number of individuals with SCI develop upper limb pain. One of the recommendations to preserve the upper limb is to minimize force during repetitive tasks. CONCLUSION Advanced wheelchair skills require an increase in force to accomplish. The increase in forces ranged from 18% to 130% over that required for level 10 m tile/10 m carpet.