- Email: [email protected]
Do spinal cord-injured individuals with stronger sense of coherence use different psychological defense styles?
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Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
ISPR8-1300
Prevention and treatment of osteoporosis after spinal cord injury: A systematic review M. Lauwers 1,∗ , M. De Jaeger 2 , N. Draulans 1 , F. Luyten 3 , K. Peers 1 , C. Kiekens 1 1 KU Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium 2 University Hospitals Brussels, Department of Neurosurgery, Brussels, Belgium 3 KU Leuven, Department of Rheumatology, Leuven, Belgium ∗ Corresponding author. E-mail address: [email protected] (M. Lauwers) Introduction/Background Spinal cord induced osteoporosis is a significant health condition associated with fragility fractures beneath the level of injury. In the scientific literature several treatment options have been proposed. The aim of this paper is to review the current literature about treatments’ efficacy for osteoporosis in spinal cord injury. Material and method A systematic literature search is conducted in four electronic databases: PubMed, Embase, The Cochrane Library and PEDro. All identified records are analysed by title, abstract and if relevant by full text to determine if they meet all inclusion criteria. Additionally, the included RCTs are judged to a quality control according to the Cochrane Handbook for Systematic Reviews of Interventions, Risk of Bias Assessment. Due to the heterogeneity of the included trials no meta-analysis is performed. Results Thirty-two randomized controlled trials are included. Bisphosphonate therapy, if applied correctly, is effective to optimize bone quality, in both the early and chronic phase of the disease, although the evidence is debatable. Moderate-quality evidence suggests that intravenous administration of zoledronic acid is potentially the best approach to tackle this condition. Rehabilitation techniques, although widely used, show no proven efficacy on this matter. In addition, numerous experimental therapies have been proposed, but require further research to prove their applicability. Conclusion This systematic review suggests that bisphosphonate administration could attenuate sublesional bone loss, while we did not find conclusive evidence about various rehabilitation techniques. Although this paper does not provide final evidence, it could be a useful tool for future research purposes. Keywords Spinal cord injuries; Osteoporosis; Therapy Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.551 ISPR8-2482
Hot water immersion elevates interleukin-6 in persons with cervical spinal cord injury
K. Kouda ∗ , Y.I. Kamijo , T. Kinoshita , M. Banno , T. Yoshikawa , Y. Umemoto , F. Tajima Wakayama Medical University, Rehabilitation Medicine, Wakayama, Japan ∗ Corresponding author. E-mail address: [email protected] (K. Kouda) Introduction/Background Core temperature elevations can impact positively on immunity, potentially due to increases of catecholamines acting on immune cells’ adrenergic receptors. The dysfunctional sympathetic nervous system in individuals with cervical spinal cord injury (CSCI) impairs adrenergic responses and may contribute to depressed immunity and the occurrence of low-grade systemic inflammation related disorders. However, some immune markers improve following exercise in CSCI, even
though the positive effects are often blunted. Non-exercise induced body temperature manipulations have yet to be investigated in CSCI. Material and method Seven male participants with a motor complete CSCI and 8 male able-bodied controls were immersed for 60 min in water set at a temperature 2 C above the individuals’ resting oesophageal temperature. Blood was collected before, during, and every hour up to 4 h after immersion and analyzed for interleukin-6 (IL-6). Results Hot water immersion increased IL-6 in both groups (P < 0.001). IL-6 plasma concentrations were higher in CSCI, but it was not significant. Possibly, the reduced active muscle mass in CSCI does not allow for sufficient core temperature elevations during exercise to increase these cytokines. Together with the lower catecholamine levels usually found in CSCI, this may explain the blunted exercise response on some aspects of immunity. This seems especially concerning as higher average levels of IL-6 support the indication of chronic low-grade systemic inflammation in CSCI. Conclusion This is the first study to show an acute cytokine response induced by hot water immersion in CSCI. Passive elevation of core temperature may help to improve the cytokine profile in CSCI. Keywords Cytokine; Cervical spinal cord injury; Hot water immersion Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.552 ISPR8-0012
Do spinal cord-injured individuals with stronger sense of coherence use different psychological defense styles? M. Yazdanshenas Ghazwin Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Universal Scientific Education and Research Network USERN, Tehran, Iran E-mail address: [email protected] Introduction/Background Although the importance of sense of coherence (SOC) and psychological defense mechanisms (PDMs) in the process of coping has been demonstrated, it has not yet been clarified whether individuals with stronger SOC use specific PDMs. Material and method Demographic and injury-related variables including injury level, time since injury, American Spinal Cord Association (ASIA) Scale and Spinal cord independence measure-III were collected among individuals with spinal cord injury (SCI). SOC was assessed by the Short-form Sense of Coherence Scale. PDMs were identified using 40-version of the Defense Style Questionnaire. Results Neurotic defense style was the most commonly used style especially. The overall most commonly used PDM was ‘rationalization’, which was used by 95%. Individuals with stronger SOC used more mature style (P = 0.001, r = 0.52), particularly ‘humor’ and ‘suppression’ mechanisms (Po0.0001 and 0.024, respectively). There was a negative correlation between stronger SOC and the use of immature defenses including passive aggression (P = 0.001, r = −0.51), acting out (P = 0.001, r = −0.48), isolation (P = 0.009, r = −0.50), autistic fantasy (P = 0.010, r = −0.30) and somatization (Po0.0001, r = −0.62). Married individuals had significantly stronger SOC (P = 0.01). Age, gender, age at the time of injury incidence, time since injury, ASIA score and cause of injury were not determinants of SOC. Conclusion In this study, PDMs, which are more probable to be used by individuals with stronger SOC, have been identified. Mature defenses including ‘humor’ and ‘suppression’ are used by stronger SOC more often, whereas immature mechanisms are less likely to be used.
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Disclosure of interest ing interest.
The author declares that he has no compet-
https://doi.org/10.1016/j.rehab.2018.05.553 ISPR8-1350
Usability of the participation and quality of life (PAR-QoL) outcomes tool-kit website for spinal cord injury M. Beaudoin 1,2,∗ , K.L. Best 1,2 , F. Routhier 1,2 , L. Atack 3 , S.L. Hitzig 4,5,6,7 , D. Kairy 8,9 1 Université Laval, Département de réadaptation, Québec, Canada 2 Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada 3 Centennial College, Applied Research and Innovation Centre, Toronto, Canada 4 Sunnybrook Health Sciences Centre, St. John’s Rehab Research Program, Toronto, Canada 5 University of Toronto, Rehabilitation Sciences Institute, Toronto, Canada 6 University Health Network, Neural Engineering & Therapeutics Team, Toronto Rehabilitation Institute, Toronto, Canada 7 University of Toronto, Department of Occupational Science and Occupational Therapy, Toronto, Canada 8 Université de Montréal, École de réadaptation, Montréal, Canada 9 Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, n/a, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (M. Beaudoin) Introduction/Background Spinal cord injury (SCI) is a lifechanging event as it incurs primary impairment (e.g., paralysis, bladder dysfunction), as well as secondary health conditions (e.g., spasticity, pressure sores), and impacts on life domains (e.g., housing, transportation). As a result, assessing quality of life (QoL) post-SCI is challenging since QoL can be impacted in various ways depending on specific (or a combination of) health conditions and life domains. To address these challenges, the Participation and Quality of Life (PAR-QoL) website, an online knowledge mobilization tool, was developed to aid clinicians and researchers in the selection of QoL outcome tools specific to SCI. The aim of this study was to evaluate the usability and use of the website. Material and method Using a technology acceptance framework, an online usability survey was developed and employed to gain information about how the website was used, perceived ease of use, and improvement recommendations. The actual use was assessed through a 26-item survey and through Google analytics. Recruitment targeted researchers and clinicians who worked with individuals with SCI. Survey and web data were analyzed using descriptive statistics. Results Forty-six individuals responded. More than 60% used the website to find tools for work. The website was perceived as easy to use by 80% of respondents. To improve the website, respondent suggested rearranging classification, developing a French version, and adding more up-to-date evidence. There were a total of 181.179 users who made 303.810 visits to the website between April 2012 and November 2017. Returning visitors comprised 13% of the total visits. Conclusion The PAR-QoL website was perceived to be an important and useful knowledge mobilization tool with QoL outcome tools for SCI that are easy to find. Usability may be improved through modification of navigation processes and improved organization of content, which may facilitate greater uptake. Keywords Quality of life; Outcome tool; Usability Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.554
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Breastfeeding and motherhood after spinal cord injury: Barriers and challenges A. Krassioukov 1,∗ , T. Holmgren 2 , A. Lee 3 , H. Shea 3 , L. Hamilton 4 , N. Sandholdt 5 , I. Hellsing 5 , S. Elliott 4 , H. Claes 6 1 ICORD, Medicine, Vancouver, Canada 2 Karolinska, Medicine, Stockholm, Sweden 3 ICORD/UBC, Medicine, Vancouver, Canada 4 ICORD/UBC, Psychiatry, Vancouver, Canada 5 Spinalis/Karolinska, Medicine, Stockholm, Sweden 6 Spinalis/Karolinska, Medicine, Stockholms, Sweden ∗ Corresponding author. E-mail address: [email protected] (A. Krassioukov) Introduction/Background Lactation dysfunction following spinal cord injury (SCI) has been noted in the literature. However, studies often group together all women of physical disability or do not account for level of injury. The extent of lactation dysfunction in this population and impact of SCI on breastfeeding ability and behaviour is not well understood. The goal of the present study was to identify major barriers to lactation and breastfeeding related to spinal cord injury, specifically with comparison between high and low-level injuries. Material and method Two on line questionnaires were developed and completed by women who attempted breastfeeding with SCI, primarily in Canada and Sweden. Results The first questionnaire was completed by 52 women with spinal cord injury, and 38 participants completed the second questionnaire. Of the 52 women, 28 had high-level spinal cord injury (at or above T6 level) and 24 had low-level injury (below T6). Of the 78% of women with high-level injury reported insufficient milk production or ejection. Only 35% of women with low-level injury reported the same. 39% of women with high-level spinal cord injury experienced autonomic dysreflexia. Exclusive breastfeeding duration was significantly shorter (P < 0.05) in the high-level injury group (3.3 months) compared to women with low-level injury (6.5 months). Conclusion Our result demonstrated that lactation and breastfeeding is disrupted in women with SCI, particularly with injury at or above T6 level which is associated with shorter breastfeeding duration. Autonomic Dysreflexia (AD) is a common breastfeeding complication that should be addressed in all-prospective mothers with high-level spinal cord injury. Our findings provide the impetus for further research into AD, therapies to improve lactation, breastfeeding aids and support required to navigate SCI-related breastfeeding difficulties. Given the immense health benefits of breastfeeding, it is imperative to provide health care professionals with evidence-based information regarding challenges for breastfeeding and lactation for mothers with SCI. Keywords Breastfeeding; Women’s health; Spinal cord injury Disclosure of interest This research was supported by grant from Craig Neilsen Foundation (PI Dr. Krassioukov). https://doi.org/10.1016/j.rehab.2018.05.555
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
ISPR8-1300
Prevention and treatment of osteoporosis after spinal cord injury: A systematic review M. Lauwers 1,∗ , M. De Jaeger 2 , N. Draulans 1 , F. Luyten 3 , K. Peers 1 , C. Kiekens 1 1 KU Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium 2 University Hospitals Brussels, Department of Neurosurgery, Brussels, Belgium 3 KU Leuven, Department of Rheumatology, Leuven, Belgium ∗ Corresponding author. E-mail address: [email protected] (M. Lauwers) Introduction/Background Spinal cord induced osteoporosis is a significant health condition associated with fragility fractures beneath the level of injury. In the scientific literature several treatment options have been proposed. The aim of this paper is to review the current literature about treatments’ efficacy for osteoporosis in spinal cord injury. Material and method A systematic literature search is conducted in four electronic databases: PubMed, Embase, The Cochrane Library and PEDro. All identified records are analysed by title, abstract and if relevant by full text to determine if they meet all inclusion criteria. Additionally, the included RCTs are judged to a quality control according to the Cochrane Handbook for Systematic Reviews of Interventions, Risk of Bias Assessment. Due to the heterogeneity of the included trials no meta-analysis is performed. Results Thirty-two randomized controlled trials are included. Bisphosphonate therapy, if applied correctly, is effective to optimize bone quality, in both the early and chronic phase of the disease, although the evidence is debatable. Moderate-quality evidence suggests that intravenous administration of zoledronic acid is potentially the best approach to tackle this condition. Rehabilitation techniques, although widely used, show no proven efficacy on this matter. In addition, numerous experimental therapies have been proposed, but require further research to prove their applicability. Conclusion This systematic review suggests that bisphosphonate administration could attenuate sublesional bone loss, while we did not find conclusive evidence about various rehabilitation techniques. Although this paper does not provide final evidence, it could be a useful tool for future research purposes. Keywords Spinal cord injuries; Osteoporosis; Therapy Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.551 ISPR8-2482
Hot water immersion elevates interleukin-6 in persons with cervical spinal cord injury
K. Kouda ∗ , Y.I. Kamijo , T. Kinoshita , M. Banno , T. Yoshikawa , Y. Umemoto , F. Tajima Wakayama Medical University, Rehabilitation Medicine, Wakayama, Japan ∗ Corresponding author. E-mail address: [email protected] (K. Kouda) Introduction/Background Core temperature elevations can impact positively on immunity, potentially due to increases of catecholamines acting on immune cells’ adrenergic receptors. The dysfunctional sympathetic nervous system in individuals with cervical spinal cord injury (CSCI) impairs adrenergic responses and may contribute to depressed immunity and the occurrence of low-grade systemic inflammation related disorders. However, some immune markers improve following exercise in CSCI, even
though the positive effects are often blunted. Non-exercise induced body temperature manipulations have yet to be investigated in CSCI. Material and method Seven male participants with a motor complete CSCI and 8 male able-bodied controls were immersed for 60 min in water set at a temperature 2 C above the individuals’ resting oesophageal temperature. Blood was collected before, during, and every hour up to 4 h after immersion and analyzed for interleukin-6 (IL-6). Results Hot water immersion increased IL-6 in both groups (P < 0.001). IL-6 plasma concentrations were higher in CSCI, but it was not significant. Possibly, the reduced active muscle mass in CSCI does not allow for sufficient core temperature elevations during exercise to increase these cytokines. Together with the lower catecholamine levels usually found in CSCI, this may explain the blunted exercise response on some aspects of immunity. This seems especially concerning as higher average levels of IL-6 support the indication of chronic low-grade systemic inflammation in CSCI. Conclusion This is the first study to show an acute cytokine response induced by hot water immersion in CSCI. Passive elevation of core temperature may help to improve the cytokine profile in CSCI. Keywords Cytokine; Cervical spinal cord injury; Hot water immersion Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.552 ISPR8-0012
Do spinal cord-injured individuals with stronger sense of coherence use different psychological defense styles? M. Yazdanshenas Ghazwin Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Universal Scientific Education and Research Network USERN, Tehran, Iran E-mail address: [email protected] Introduction/Background Although the importance of sense of coherence (SOC) and psychological defense mechanisms (PDMs) in the process of coping has been demonstrated, it has not yet been clarified whether individuals with stronger SOC use specific PDMs. Material and method Demographic and injury-related variables including injury level, time since injury, American Spinal Cord Association (ASIA) Scale and Spinal cord independence measure-III were collected among individuals with spinal cord injury (SCI). SOC was assessed by the Short-form Sense of Coherence Scale. PDMs were identified using 40-version of the Defense Style Questionnaire. Results Neurotic defense style was the most commonly used style especially. The overall most commonly used PDM was ‘rationalization’, which was used by 95%. Individuals with stronger SOC used more mature style (P = 0.001, r = 0.52), particularly ‘humor’ and ‘suppression’ mechanisms (Po0.0001 and 0.024, respectively). There was a negative correlation between stronger SOC and the use of immature defenses including passive aggression (P = 0.001, r = −0.51), acting out (P = 0.001, r = −0.48), isolation (P = 0.009, r = −0.50), autistic fantasy (P = 0.010, r = −0.30) and somatization (Po0.0001, r = −0.62). Married individuals had significantly stronger SOC (P = 0.01). Age, gender, age at the time of injury incidence, time since injury, ASIA score and cause of injury were not determinants of SOC. Conclusion In this study, PDMs, which are more probable to be used by individuals with stronger SOC, have been identified. Mature defenses including ‘humor’ and ‘suppression’ are used by stronger SOC more often, whereas immature mechanisms are less likely to be used.
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Disclosure of interest ing interest.
The author declares that he has no compet-
https://doi.org/10.1016/j.rehab.2018.05.553 ISPR8-1350
Usability of the participation and quality of life (PAR-QoL) outcomes tool-kit website for spinal cord injury M. Beaudoin 1,2,∗ , K.L. Best 1,2 , F. Routhier 1,2 , L. Atack 3 , S.L. Hitzig 4,5,6,7 , D. Kairy 8,9 1 Université Laval, Département de réadaptation, Québec, Canada 2 Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada 3 Centennial College, Applied Research and Innovation Centre, Toronto, Canada 4 Sunnybrook Health Sciences Centre, St. John’s Rehab Research Program, Toronto, Canada 5 University of Toronto, Rehabilitation Sciences Institute, Toronto, Canada 6 University Health Network, Neural Engineering & Therapeutics Team, Toronto Rehabilitation Institute, Toronto, Canada 7 University of Toronto, Department of Occupational Science and Occupational Therapy, Toronto, Canada 8 Université de Montréal, École de réadaptation, Montréal, Canada 9 Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, n/a, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (M. Beaudoin) Introduction/Background Spinal cord injury (SCI) is a lifechanging event as it incurs primary impairment (e.g., paralysis, bladder dysfunction), as well as secondary health conditions (e.g., spasticity, pressure sores), and impacts on life domains (e.g., housing, transportation). As a result, assessing quality of life (QoL) post-SCI is challenging since QoL can be impacted in various ways depending on specific (or a combination of) health conditions and life domains. To address these challenges, the Participation and Quality of Life (PAR-QoL) website, an online knowledge mobilization tool, was developed to aid clinicians and researchers in the selection of QoL outcome tools specific to SCI. The aim of this study was to evaluate the usability and use of the website. Material and method Using a technology acceptance framework, an online usability survey was developed and employed to gain information about how the website was used, perceived ease of use, and improvement recommendations. The actual use was assessed through a 26-item survey and through Google analytics. Recruitment targeted researchers and clinicians who worked with individuals with SCI. Survey and web data were analyzed using descriptive statistics. Results Forty-six individuals responded. More than 60% used the website to find tools for work. The website was perceived as easy to use by 80% of respondents. To improve the website, respondent suggested rearranging classification, developing a French version, and adding more up-to-date evidence. There were a total of 181.179 users who made 303.810 visits to the website between April 2012 and November 2017. Returning visitors comprised 13% of the total visits. Conclusion The PAR-QoL website was perceived to be an important and useful knowledge mobilization tool with QoL outcome tools for SCI that are easy to find. Usability may be improved through modification of navigation processes and improved organization of content, which may facilitate greater uptake. Keywords Quality of life; Outcome tool; Usability Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.554
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Breastfeeding and motherhood after spinal cord injury: Barriers and challenges A. Krassioukov 1,∗ , T. Holmgren 2 , A. Lee 3 , H. Shea 3 , L. Hamilton 4 , N. Sandholdt 5 , I. Hellsing 5 , S. Elliott 4 , H. Claes 6 1 ICORD, Medicine, Vancouver, Canada 2 Karolinska, Medicine, Stockholm, Sweden 3 ICORD/UBC, Medicine, Vancouver, Canada 4 ICORD/UBC, Psychiatry, Vancouver, Canada 5 Spinalis/Karolinska, Medicine, Stockholm, Sweden 6 Spinalis/Karolinska, Medicine, Stockholms, Sweden ∗ Corresponding author. E-mail address: [email protected] (A. Krassioukov) Introduction/Background Lactation dysfunction following spinal cord injury (SCI) has been noted in the literature. However, studies often group together all women of physical disability or do not account for level of injury. The extent of lactation dysfunction in this population and impact of SCI on breastfeeding ability and behaviour is not well understood. The goal of the present study was to identify major barriers to lactation and breastfeeding related to spinal cord injury, specifically with comparison between high and low-level injuries. Material and method Two on line questionnaires were developed and completed by women who attempted breastfeeding with SCI, primarily in Canada and Sweden. Results The first questionnaire was completed by 52 women with spinal cord injury, and 38 participants completed the second questionnaire. Of the 52 women, 28 had high-level spinal cord injury (at or above T6 level) and 24 had low-level injury (below T6). Of the 78% of women with high-level injury reported insufficient milk production or ejection. Only 35% of women with low-level injury reported the same. 39% of women with high-level spinal cord injury experienced autonomic dysreflexia. Exclusive breastfeeding duration was significantly shorter (P < 0.05) in the high-level injury group (3.3 months) compared to women with low-level injury (6.5 months). Conclusion Our result demonstrated that lactation and breastfeeding is disrupted in women with SCI, particularly with injury at or above T6 level which is associated with shorter breastfeeding duration. Autonomic Dysreflexia (AD) is a common breastfeeding complication that should be addressed in all-prospective mothers with high-level spinal cord injury. Our findings provide the impetus for further research into AD, therapies to improve lactation, breastfeeding aids and support required to navigate SCI-related breastfeeding difficulties. Given the immense health benefits of breastfeeding, it is imperative to provide health care professionals with evidence-based information regarding challenges for breastfeeding and lactation for mothers with SCI. Keywords Breastfeeding; Women’s health; Spinal cord injury Disclosure of interest This research was supported by grant from Craig Neilsen Foundation (PI Dr. Krassioukov). https://doi.org/10.1016/j.rehab.2018.05.555