With advances in acute care for individuals with spinal cord injury (SCI), chronic conditions are becoming a central focus.1–3 More specifically, impairments in respiratory function are one of the leading causes of morbidity and mortality among individuals with SCI,4 and have significant economic burden. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which has a major impact on cough effectiveness and susceptibility to infection.5–7 Prior studies have typically focused on breathing mechanics and pneumonia in the acute stages of SCI, but there is a dearth of evidence regarding secondary chronic conditions, such as asthma and chronic obstructive pulmonary disease (COPD), among SCI populations. In the general population, risk factors for the development of asthma and COPD include genetic, sociodemographic, and environmental components.8,9 In addition, traffic pollution and occupational exposures, and indoor exposure to pollutants such as mold, increase susceptibility to both diseases. However, that SCI may be an independent risk factor for COPD and asthma (or vice versa) has not been previously examined. It thus remains unknown whether there is a higher prevalence of chronic respiratory diseases (after adjustment for potential confounders) in individuals with SCI. The current study addresses this knowledge gap by utilizing the national Canadian Community Health Survey, which comprises comprehensive, up-to-date, cross-sectional data. Our aim was to estimate the prevalence of chronic respiratory outcomes in the SCI population, to compare their odds with a non-SCI population, and to investigate this relationship after controlling for confounders., Peer-reviewed article, Published. Received September 18, 2014; Accepted December 09, 2014.
Over the last decade, there have been marked changes in the trends of morbidity and mortality among individuals with spinal cord injury (SCI). With advances in acute care and in the management of septicemia, renal failure, and pneumonia, cardiovascular complications are now a leading cause of death in those with SCI.1 Moreover, several risk factors for cardiovascular disease (CVD) are amplified in individuals with SCI compared with able-bodied individuals, including physical inactivity, dyslipidemia, blood pressure irregularities, chronic inflammation, and abnormal glycemic control.2–22. While most of the literature with respect to CVD and SCI has shown a higher prevalence of risk factors for CVD,2–22 relatively few studies have examined the prevalence of CVD itself and corresponding risk estimates.23–26 None of these studies has provided direct comparisons of risk estimates for multiple CVD outcomes in the SCI population compared to a non-SCI population, with appropriate adjustment for confounding, in a large representative sample. It thus remains unknown whether there is excess risk of both heart disease and stroke (after adjustment for potential confounders) in individuals with SCI. The current study addresses this knowledge gap by utilizing the national Canadian Community Health Survey (CCHS), which is comprised of comprehensive, up-to-date, cross-sectional data. Our aim was to estimate the prevalence of heart disease and stroke outcomes in the SCI population, to compare their risk with a non-SCI population, and to investigate this relationship after controlling for confounders., Peer-reviewed article, Published. Received December 02, 2012 ; Accepted April 22, 2013.
Background Previous evidence suggests the effects of task-specific therapy can be further enhanced when sensory stimulation is combined with motor practice. Sensory tongue stimulation is thought to facilitate activation of regions in the brain that are important for balance and gait. Improvements in balance and gait have significant implications for functional mobility for people with incomplete spinal cord injury (iSCI). The aim of this case study was to evaluate the feasibility of a lab- and home-based program combining sensory tongue stimulation with balance and gait training on functional outcomes in people with iSCI. Methods Two male participants (S1 and S2) with chronic motor iSCI completed 12 weeks of balance and gait training (3 lab and 2 home based sessions per week) combined with sensory tongue stimulation using the Portable Neuromodulation Stimulator (PoNS). Laboratory based training involved 20 minutes of standing balance with eyes closed and 30 minutes of body-weight support treadmill walking. Home based sessions consisted of balancing with eyes open and walking with parallel bars or a walker for up to 20 minutes each. Subjects continued daily at-home training for an additional 12 weeks as follow-up. Results Both subjects were able to complete a minimum of 83% of the training sessions. Standing balance with eyes closed increased from 0.2 to 4.0 minutes and 0.0 to 0.2 minutes for S1 and S2, respectively. Balance confidence also improved at follow-up after the home-based program. Over ground walking speed improved by 0.14 m/s for S1 and 0.07 m/s for S2, and skilled walking function improved by 60% and 21% for S1 and S2, respectively. Conclusions Sensory tongue stimulation combined with task-specific training may be a feasible method for improving balance and gait in people with iSCI. Our findings warrant further controlled studies to determine the added benefits of sensory tongue stimulation to rehabilitation training., Peer-reviewed article, Published. Received: 10 July 2013 ; Accepted: 2 June 2014 ; Published: 6 June 2014.
Study Design: Secure, web-based survey. Objectives: Obtain information from the spinal cord injured (SCI) population regarding sexual dysfunctions, with the aim of developing new basic science and clinical research and eventual therapies targeting these issues. Setting: Worldwide web. Methods: Individuals 18 years or older living with SCI. Participants obtained a pass-code to enter a secure website and answered survey questions. A total of 286 subjects completed the survey. Results: The majority of participants stated that their SCI altered their sexual sense of self and that improving their sexual function would improve their quality of life (QoL). The primary reason for pursuing sexual activity was for intimacy need, not fertility. Bladder and bowel concerns during sexual activity were not strong enough to deter the majority of the population from engaging in sexual activity. However, in the subset of individuals concerned about bladder and/or bowel incontinence during sexual activity, this was a highly significant issue. In addition, the occurrence of autonomic dysreflexia (AD) during typical bladder or bowel care was a significant variable predicting the occurrence and distress of AD during sexual activity. Conclusion: Sexual function and its resultant impact on QoL is a major issue to an overwhelming majority of people living with SCI. This certainly constitutes the need for expanding research in multiple aspects to develop future therapeutic interventions for sexual health and SCI., Peer-reviewed article, Published.
Study Design: Secure, web-based survey. Objectives: Elicit specific information about sexual function from men with spinal cord injuries (SCI). Setting: World-wide web. Methods: Individuals 18 years or older living with SCI obtained a pass-code to enter a secure website and then answered survey questions. Results: The presence of genital sensation was positively correlated with the ability to feel a build up of sexual tension in the body during sexual stimulation and in the feeling that mental arousal translates to the genitals as physical sensation. There was an inverse relationship between developing new areas of arousal above the level of lesion and not having sensation or movement below the lesion. A positive relationship existed between the occurrence of spasticity during sexual activity and erectile ability. Roughly 60% of the subjects had tried some type of erection enhancing method. Only 48% had successfully achieved ejaculation postinjury and the most commonly used methods were hand stimulation, sexual intercourse, and vibrostimulation. The most commonly cited reasons for trying to ejaculate were for pleasure and for sexual intimacy. Less than half reported having experienced orgasm postinjury and this was influenced by the length of time postinjury and sacral sparing. Conclusion: SCI not only impairs male erectile function and ejaculatory ability, but also alters sexual arousal in a manner suggestive of neuroplasticity. More research needs to be pursued in a manner encompassing all aspects of sexual function., Peer-reviewed article, Published.
Study Design: Observational cross-sectional study. Objectives: Body mass index (BMI), measured as a ratio of weight (Wt) to the square of height (Wt/Ht(2)), waist circumference (WC) and waist-to-height ratio (WHtR) are common surrogate measures of adiposity. It is not known whether alternate scaling powers for height might improve the relationships between these measures and indices of obesity or cardiovascular disease (CVD) risk in individuals with spinal cord injury (SCI). We aimed to estimate the values of 'x' that render Wt/Ht(x) and WC/Ht(x) maximally correlated with dual energy x-ray absorptiometry (DEXA) total and abdominal body fat and Framingham Cardiovascular Risk Scores. Setting: Canadian public research institution. Methods: We studied 27 subjects with traumatic SCI. Height, Wt and body fat measurements were determined from DEXA whole-body scans. WC measurements were also obtained, and individual Framingham Risk Scores were calculated. For values of 'x' ranging from 0.0 to 4.0, in increments of 0.1, correlations between Wt/Ht(x) and WC/Ht(x) with total and abdominal body fat (kg and percentages) and Framingham Risk Scores were computed. Results: We found that BMI was a poor predictor of CVD risk, regardless of the scaling factor. Moreover, BMI was strongly correlated with measures of obesity, and modification of the scaling factor from the standard (Wt/Ht(2)) is not recommended. WC was strongly correlated with both CVD risk and obesity, and standard measures (WC and WHtR) are of equal predictive power. Conclusion: On the basis of our findings from this sample, alterations in scaling powers may not be necessary in individuals with SCI; however, these findings should be validated in a larger cohort., Peer-reviewed article, Published. Received 25 February 2014; revised 1 May 2014; accepted 1 August 2014; published online 30 September 2014.
Objective: The objective of this study was to evaluate the association between spinal cord injury (SCI) and type 2 diabetes in a large representative sample and to determine whether an association exists irrespective of known risk factors for type 2 diabetes. Methods: Data were obtained on 60,678 respondents to the Statistics Canada 2010 Cycle of the cross-sectional Canadian Community Health Survey. Multivariable logistic regression, incorporating adjustment for confounders and probability weights to account for the Canadian Community Health Survey sampling method, was conducted to quantify this association. Results: After adjustment for both sex and age, SCI was associated with a significant increased odds of type 2 diabetes (adjusted odds ratio = 1.66, 95% confidence interval 1.16–2.36). These heightened odds persisted after additional adjustment for smoking status, hypertension status, body mass index, daily physical activity, alcohol intake, and daily consumption of fruits and vegetables (fully adjusted odds ratio = 2.45, 95% confidence interval 1.34–4.47). Conclusions: There is a strong association between SCI and type 2 diabetes, which is not explained by known risk factors for type 2 diabetes., Peer-reviewed article, Published. Received May 14, 2013 ; Accepted August 21, 2013.
Study Design: Secure, web-based survey. Objectives: Elicit specific information about sexual function from women with spinal cord injuries (SCI). Setting: World-wide web. Methods: Individuals 18 years or older living with SCI obtained a pass code to enter a secure website and then answered survey questions. Results: Bladder and/or bowel incontinence during sexual activity and/or sexual intercourse were significant concerns and prevented some women from seeking sexual activity. Autonomic dysreflexia (AD) during sexual activity was interpreted negatively by many and was found to interfere with sexual activity. Most subjects reported difficulty becoming psychologically aroused as well as physically aroused, which were both correlated with feeling that their SCI had altered their sexual sense of self. An inverse relationship existed between developing new areas of arousal above the level of lesion and not having sensation or movement below the lesion. The most commonly reported sexual stimulation leading to the best arousal involved stimulation of the head/neck and torso areas. The majority of subjects reported having experienced intercourse postinjury. Most participants reported difficulty with positioning during foreplay and intercourse, vaginal lubrication, and spasticity during intercourse. Almost half reported experiencing orgasm postinjury and this was positively associated with the presence of genital sensation. Conclusion: SCI significantly impairs psychological and physical aspects of female sexual arousal. In addition, bladder and bowel incontinence as well as AD negatively impact sexual activity and intercourse., Peer-reviewed article, Published.