Implementation and clinical impact of an interdisciplinary tool to promote skin integrity after flap surgery in Veterans with spinal cord injury.

Context/objective: Pressure injury (PrI) recurrence is common among persons with spinal cord injury and disorders (SCI/D) who undergo reconstructive flap surgery for pelvic stage 4 PrI (S4PrI). This paper describes the development and implementation of the Minneapolis Spinal Cord Optimization, Rehabilitation and Empowerment (SCORE), a preoperative interdisciplinary tool for risk assessment and mitigation, and reports its effect on the one-year flap failure rate (significant breakdown).

Design: Retrospective review.

Design refinement and evaluation of a mobile manual standing wheelchair.

Purpose: There are no manually propelled wheelchairs on the market that are mobile in both seated and standing positions. In response to this product gap, our group formerly designed a mobile manual standing wheelchair (MMSW) and gathered stakeholder feedback. The purpose of this study was to refine the MMSW based on feedback, including weight and width reduction, and evaluate its performance.

Supine arm cycling during the post-flap recovery period for persons with spinal cord injuries: The multi-purpose arm cycle ergometer (M-PACE) safety and pilot testing.

Objective: To describe how using a supine arm cycle ergometer can safely reduce deconditioning experienced by patients with spinal cord injury or disorder (SCI/D) during their four to six weeks of complete bed rest after surgery to close a stage 4 pressure injury.

Design: This pilot project used a newly designed arm cycle ergometer (known as the M-PACE) that extends over the bed, allowing a patient to lie completely supine while exercising.

Setting: The M-PACE was designed and built at the Minneapolis Veterans Affairs Health Care System (MVAHCS) and pilot tested at the MVAHCS SCI/D Center.

User-centered design and development of a trunk control device for persons with spinal cord injury: A pilot study.

Context/objective: There are no wheelchair products designed to allow users to dynamically control trunk posture to both significantly improve functional reach and provide pressure relief during forward lean. This pilot study sought to (1) gather stakeholder desires regarding necessary features for a trunk control system and (2) subsequently develop and pilot test a first-generation trunk control prototype.

Design: Multi-staged mixed methods study design.

Visualization of user interactions with a pressure mapping mobile application for wheelchair users at risk for pressure injuries.

Pressure injuries for individuals with spinal cord injuries (SCI) are correlated with mortality and are a leading cause for rehospitalizations. The Assisted Weight Shift (AW-Shift©) is a mobile pressure mapping application designed to provide users with a live map view and reminders to perform weight shifts. Novel visualization techniques were used to understand daily distributions of user interaction wit h AW-Shift©.

A novel ergonomic wheelchair reduces bacterial hand contamination.

Objective: To determine whether bacterial contamination of rider's hands is less with a novel ergonomic wheelchair (EW) than a standard wheelchair (SW).

Experimental Design: After wheelchair hand rims were disinfected, volunteers wearing nitrile gloves propelled each wheelchair through a standardised "run" in hospital. Post-run cultures were obtained from riders' gloved hands.

Development of a comprehensive mobile assessment of pressure (CMAP) system for pressure injury prevention for veterans with spinal cord injury.

: This paper reports the iterative redesign, feasibility and usability of the Comprehensive Mobile Assessment of Pressure (CMAP) system's mobile app used by Veterans with SCI.: This three-year, multi-staged study used a mixed-methods approach.: Minneapolis VA Health Care System, Minneapolis, Minnesota.

Microclimate evaluation of strap-based wheelchair seating systems for persons with spinal cord injury: A pilot study.

Study Purpose: The purpose of this pilot study was to assess microclimate characteristics of two versions of a strap-based wheelchair seating system (perforated and solid straps) and to conduct preliminary microclimate comparisons of subjects' current wheelchair seating systems.

Materials And Methods: In this pilot study, the microclimate properties of two variations (solid and perforated) of a strap-based seating system were compared with two commonly used seating systems. Six subjects sat on three different seating systems each for 100-min test periods, while temperature and relative humidity were measured with a single sensor adjacent to the skin-seat interface.

A drive system to add standing mobility to a manual standing wheelchair.

Current manual standing wheelchairs are not mobile in the standing position. The addition of standing mobility may lead to improved health and function for the user and may increase utilization of standing wheelchairs. In this project, a chain drive system was fitted to a manual standing wheelchair, adding mobility in the standing position.

Pilot study of strap-based custom wheelchair seating system in persons with spinal cord injury.

Custom wheelchair seats can be used to help prevent pressure ulcers in individuals with spinal cord injury. In this study, a strap-based system was evaluated in three Veterans with spinal cord injury. Interface pressure distributions were measured after transfers, wheeling, and pressure relief maneuvers and after fittings by three different therapists.

Elastic head support for persons with amyotrophic lateral sclerosis.

This article describes an inexpensive elastic head support for persons with amyotrophic lateral sclerosis (ALS) and neck muscle weakness and also presents a case series to examine its effectiveness. The device offers support to the head while the user is seated, standing, and walking, providing support for persons in various stages of ALS. The head support system was tested in seven male patients with ALS.

Effect of exercise on disorders of carbohydrate and lipid metabolism in adults with traumatic spinal cord injury: systematic review of the evidence.

Background/objective: Carbohydrate and lipid metabolism disorders may affect adults with spinal cord injuries (SCIs) differently than able-bodied individuals because of reduced physical activity in the SCI population. The objective of this study was to conduct a systematic review to determine the effectiveness of exercise to improve carbohydrate and lipid metabolism disorders in adults with chronic SCI.

Methods: Studies were identified in MEDLINE (1996-2008), Cochrane Library, bibliographies of identified articles, and expert recommendations.

Carbohydrate and lipid disorders and relevant considerations in persons with spinal cord injury.

Objectives: To assess the prevalence of carbohydrate and lipid disorders in adults with chronic spinal cord injury and evaluate their risk contribution to cardiovascular diseases and the potential impact of exercise and pharmacologic and dietary therapies to alter these disorders and reduce cardiovascular disease risk.

Data Sources: MEDLINE (PubMed), Cochrane Database and Web sites of the American Spinal Injury Association, American Paraplegia Society, Paralyzed Veterans of America, Consortium of Spinal Cord Medicine, and WorldCat through August 2007.

Review Methods: English language observational studies addressing prevalence of carbohydrate and lipid disorders were included if they evaluated at least 100 adults with chronic spinal cord injury or a total of 100 subjects if using a control group.

Use of botulinum toxin type B for the treatment of detrusor hyperreflexia in a patient with multiple sclerosis: a case report.

We describe a patient with multiple sclerosis (MS) who had detrusor hyperreflexia that was not responsive to oral medications or clean intermittent catheterization. This patient was successfully treated with 2 separate injections of botulinum toxin type B into the bladder. The results of the treatment lasted 4 months and there were no side effects.

Autonomic dysreflexia in multiple sclerosis.

Background: Although autonomic dysreflexia (AD) is well documented in the spinal cord injury (SCI) population, its occurrence in persons with multiple sclerosis (MS) is not. A dense multiple sclerotic lesion in the spinal cord at or above the sixth thoracic level can cause interruption of descending inhibitory impulses and thus result in AD. A patient with MS presented to our facility with classic signs and symptoms of AD.