Department of Veterans Affairs
	Rehabilitation Research and Development Service	Previous Reflections

Secondary complications and restoration of function in SCI

This issue of the Journal of Rehabilitation Research and Development (JRRD), a publication of Rehabilitation Research and Development, Department of Veterans Affairs (VA), is dedicated to spinal cord injury with special focus on secondary complications and restoration of function. With this issue, JRRD expands from 8 to 12 articles to provide wider coverage of high-quality rehabilitation research.

MANUSCRIPTS FEATURED IN VOLUME 41, ISSUE 1

Identical twins studied to determine impact of SCI on physical activity & lean muscle mass, pg 1
Investigators determined energy expenditure and fat-free mass, as well as the relationships between these parameters, in persons with spinal cord injury (SCI). Thirteen pairs of identical twins discordant for SCI were studied. Data indicated twins with SCI had lower energy expenditure than their able-bodied co-twins. Regardless of paralysis, direct relationships existed between energy expenditure and lean mass. In persons with SCI, lean mass is reduced, and this reduction is directly related to energy expenditure.

Wingate Anaerobic Testing indicator of upper-body strength in persons with tetraplegia, pg 9
This study examined a range of resistance loads during arm Wingate Anaerobic Testing (WAnT) in persons with different levels of cervical SCI. The WAnT is a commonly used test of muscle power, which requires pedaling or arm cranking at maximum speed against a constant resistance. Investigators determined the appropriate external load for arm WAnT is specific to the level of tetraplegia. This simple and quick test may provide useful assessment of upper-body power in persons with cervical level SCI.

Passive joint moments may lead to enhanced neuroprostheses for people with SCI, pg 15
Study quantified and compared lower-limb passive joint moments in able-bodied volunteers and volunteers with SCI. Passive joint moments help control movement. Measuring and modeling the changes in passive properties following SCI will faciliate the development of better lower-limb musculoskeletal models, which can be used to develop enhanced neuroprostheses that use functional electrical stimulation to restore standing and walking to individuals with paraplegia.

Variable-frequency-train stimulation not effective in reducing muscle fatigue after SCI, pg 33
Variable-frequency-train (VFT) stimulation has received considerable interest for countering fatigue that occurs in muscle of able-bodied individuals during functional electrical stimulation. There is also much interest in using electrical stimulation for the rehabilitation of individuals with SCI. Study investigated the effectiveness of VFT stimulation on reducing quadriceps muscle fatigue in persons with complete SCI. Data provided the first evidence that VFT stimulation may not be effective at reducing fatigue without prior conditioning with electrical stimulation. These results may lead to improving the clinical use of electrical stimulation.

Portable neuromuscular stimulator aids exercise and mobility for individuals with paraplegia, pg 41
Over the past 25 years, functional electrical stimulation has become a viable rehabilitative tool for the paraplegic population. The design and development of a portable, neuromuscular stimulator for use by individuals with paraplegia are discussed in this article. Potential uses of the neuromuscular stimulator include exercise, mobility, and preventive skin care. The stimulator successfully met the design criteria and also passed all relevant safety and reliability testing, making it suitable for home use.

Neostigmine and glycopyrrolate promote bowel movement, pg 53
This study assessed the effects of neostigmine alone or neostigmine combined with glycopyrrolate on pulmonary suppression in individuals with SCI. Data suggest that although neostigmine promoted bowel movement, it also caused bronchoconstriction, which may worsen a weak respiratory system. When neostigmine is combined with glycopyrrolate, bowel movement is facilitated while bronchoconstriction is prevented. For patients with SCI who require bowel evacuation assistance, neostigmine and glycopyrrolate should be administered in combination.

Bronchodilator responses to metaproterenol sulfate among subjects with spinal cord injury, pg 59
This study compared bronchodilator responsiveness to metaproterenol sulfate between individuals with chronic tetraplegia and low paraplegia. Among individuals with tetraplegia, respiratory problems are a significant cause for morbidity and mortality. The use of agents to promote bronchodilation, or opening of the airways, may help these individuals to clear mucous and reduce the incidence of pulmonary complications. Data from this study suggest that individuals with tetraplegia may benefit from chronic use of a beta-2 adrenergic agonist such as inhaled metaproterenol sulfate. Longer-term studies are warranted.

Rear-wheel position impact on seating ergonomics and mobility efficiency in wheelchair users, pg 65
Pilot study explores the relationship between seating and propulsion ergonomics. Individuals with paraplegia performed two different activities: propulsion on a treadmill and computer work. Mechanical efficiency, estimated perceived exertion and breathlessness, stroke angle and frequency, estimated seating, and propulsion comfort were collected and analyzed from the treadmill session. Pelvic position, as well as estimated comfort and activity performance, was measured and analyzed from the computer session. Rear wheel position had a significant effect on seat inclination, weight distribution, stroke angle, and push frequency.

Level of stress, social support, independence predict pain in persons with SCI, pg 75
This longitudinal study explores whether persons who consistently report pain across 10 years (1988–1998) are different from those who inconsistently or never report pain. Ninety-six persons with SCI were measured on consistency of pain, demographic and injury-related data, physical and psychological health, function, and social support. Approximately half of the men and three-fourths of the women consistently reported pain. If pain is routinely assessed and better interventions are found, individuals with SCI may experience decreased pain and improved quality of life.

Effects of spinal cord injury level on carotid and femoral arteries, pg 89
The effect of SCI level on the carotid (neck) and femoral (thigh) arteries is explored in this manuscript. From a lying position, volunteers with and without SCI were asked to slowly tilt their heads to a 45° angle to measure artery dilation and blood flow. Investigators found that carotid diastolic diameter and flow were not significantly different in persons with SCI, compared with able-bodied individuals, as previously reported. While lying down, carotid diameter and flow were significantly increased in the tetraplegia compared with the paraplegia group.

Neuromuscular stimulation may prove an effective treatment strategy for SCI bowel care, pg 95
Constipation adversely affects the quality of life after SCI and its treatment strains healthcare resources. Article describes the pathogenesis of constipation and its management. Data indicate that colonic motility may be especially depressed during sleep after SCI, and this may exacerbate a sluggish colon transit time. Measures that increase contraction of abdominal muscles may facilitate defecation, which was especially helpful in participants with higher cord injury who lacked abdominal muscle control. Although data need confirmation, results from this study could contribute to lowering the cost of SCI-related bowel care programs and increasing the quality of life in individuals with SCI.

Routine abdominal ultrasound in patients with chronic SCI unwarranted, pg 101
Guidelines for assessing and tracking healthcare issues unique to patients with SCI are discussed. Electronic records of 174 individuals with spinal cord injuries or disorders were reviewed. Data revealed a high incidence of abnormal findings in the liver and frequent abnormalities in the pancreas, spleen, gallbladder, and kidney. No specific interventions, such as liver biopsy, resulted from the detection of the abnormalities. Researchers advocate for evidence-based assessment and surveillance to ensure patients are not asked to undergo unnecessary tests.

JRRD is a peer-reviewed, scientifically indexed publication covering all rehabilitation research disciplines: neurology, orthopedics, engineering, audiology, ophthalmology, outcomes, prosthetics, geriatrics, psychiatrics, and social integration. First published in 1964 as the Bulletin of Prosthetics Research, JRRD celebrates 40 years of disseminating research to the rehabilitation community. JRRD accepts original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers who investigate disability rehabilitation.

All articles in this issue have the listed accessibility approvals and visually impaired help features.

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