Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montage.

Background: There is growing interest in use of transcutaneous spinal stimulation (TSS) for people with neurologic conditions both to augment volitional control (by facilitating motoneuron excitability), and to decrease spasticity (by activating inhibitory networks). Various electrode montages are used during TSS, with little understanding of how electrode position influences spinal circuit activation. We sought to identify the thoracolumbar electrode montage associated with the most robust activation of spinal circuits by comparing posterior root-muscle reflexes (PRM reflexes) elicited by 6 montages.

Reconceptualizing Disorders of the Self as Disorders of Relationship.

Objective: To validate a universal neuropsychological model that suggests that disorders of the self are best conceptualized as disintegrated neuropsychological processes (i.e., sensations, mental experiences) that lack a sense of relationship to the unified experience/sense of self.

Driving after Concussion: Symptom Clusters and Neurocognition Uniquely Relate to Post-Concussion Driving Performance.

Purpose: To identify clinical concussion assessment outcomes that uniquely capture simulated driving performance among acutely concussed individuals, relative to controls.

Methods: Cross-sectional design. Twenty-eight college students within 72-hours of concussion and 46 non-concussed controls participated in the study.

Factors Influencing Speech-Language Pathology Referral and Utilization in Mild Traumatic Brain Injury: An Exploratory Analysis.

Purpose: Speech-language pathologists provide important services to people recovering from mild traumatic brain injury (mTBI), also called concussion, although they may be underutilized in outpatient care. Because health care providers face challenges in selecting assessments to efficiently describe patient needs, the purpose of this study was to describe factors related to patients receiving speech-language pathology services after mTBI, as well as how assessments predict amount of services received.

Method: In this retrospective chart review study, demographic factors, injury characteristics, and assessment scores were extracted from medical records of patients aged 14-65 years receiving services for recent (within 6 months) mTBI at an outpatient specialty clinic.

Thriving Through Adaptation: Adaptive Sports after Spinal Cord Injury.

This article focuses on identifying how health care providers can support a person with spinal cord injury to pursue and maintain involvement in adaptive sports. Benefits and barriers of sport participation, equipment considerations, and recommendations on how to determine sport appropriateness for a person with spinal cord injury will be provided. The authors emphasize through appropriate medical management and consideration of level of disability, functional performance, psychological readiness, and individual preference, a health care provider can play a valuable role in connecting individuals with spinal cord injury to adaptive sports and recreation.

Engaging wheelchair and scooter users in the co-design of an mHealth application for fall prevention and management: thematic analysis of focus group research.

This study aimed to explore the potential of a mobile health (mHealth) application (app) to support the delivery of a fall prevention and management program, Individualized Reduction of FaLLs (iROLL), for people with spinal cord injury (SCI) and multiple sclerosis (MS) who use wheelchairs and scooters (WC/S) full-time by seeking end-users' input into the functioning and ongoing design of the iROLL-O + mobile app. Two focus group discussions included nine adults with SCI or MS who used a WC/S for at least 75% of mobility, who experienced at least one fall in the past three years and have internet and access to an internet-capable device. One group had prior iROLL experience ( = 4); while the other had none ( = 5).

Randomized Trial to Evaluate Effects of Peer- and Clinician-Led Interventions for Caregivers of Individuals With Acquired Brain Injury.

Objective: To evaluate the effectiveness of 2 interventions for caregivers of patients with acquired brain injury (ABI) transitioning home after inpatient rehabilitation, to prepare them for the role of caregiving and reduce stress and depression.

Design: Controlled trial with participants randomly assigned to (1) usual care (UC), (2) clinician-delivered Problem-Solving Training (PST), or (3) peer-led Building Better Caregivers (BBC) training; both experimental interventions initiated during the inpatient rehabilitation stay, delivered virtually, of similar intensity (six 60-minute sessions), and focused on managing stress and building skills related to caregiving.

Setting: Nonprofit rehabilitation hospital specializing in care of persons with acquired brain and spinal cord injuries.

INTIMASY-TBI Guideline: Optimization of INTIMAcy, SexualitY, and Relationships Among Adults With Traumatic Brain Injury.

Introduction: Traumatic brain injury (TBI) can negatively impact intimacy, relationships, and sexual functioning through changes in physical, endocrine, cognitive, behavioral, and emotional function. Without intervention, diminished intimacy and/or sexual functioning in individuals with TBI may persist. Although most health care professionals agree that sexuality and intimacy in relationships are significant concerns and should be addressed in rehabilitation, these concerns are not typically discussed during rehabilitation and discharge planning for people with TBI.

mHealth learning strategies to support behaviour change in individuals using wheelchairs and/or scooters: a systematic review.

Purpose: The purpose of this systematic review of the literature is to build understanding of the key elements and recommendations for the design of mHealth technology for individuals using wheelchairs and/or scooters and identify key features associated with the use of mHealth to support healthy behaviour changes for this population.

Materials And Methods: Eight major electronic databases were systematically searched to identify mobile health (mHealth) interventions, which targeted adult WC/S users. Independent reviewers used Endnote and Covidence to manage articles meeting review criteria and to exclude duplicates.

Intrathecal Digoxin Administration During Spinal Anesthesia: A Case Report Outlining Recovery and Rehabilitation.

This case report highlights the rehabilitation outcomes of a 24-year-old female who received inadvertent intrathecal digoxin during a routine cesarean section, leading to encephalomeningitis, vestibulocochlear neuritis, and incomplete paraplegia. Despite initial neurological deficits, the patient demonstrated significant improvement in both cognition and functional mobility during a one-month inpatient rehabilitation program, ultimately achieving ambulation with assistive devices. This case underscores the potential for rehabilitation of neurological sequela following accidental intrathecal digoxin administration.

Optimizing Transcutaneous Spinal Stimulation: Excitability of Evoked Spinal Reflexes is Dependent on Electrode Montage.

Background: There is growing interest in use of transcutaneous spinal stimulation (TSS) for people with neurologic conditions both to augment volitional control (by facilitating motoneuron excitability), and to decrease spasticity (by activating inhibitory networks). Various electrode montages are used during TSS, with little understanding of how electrode position influences spinal circuit activation. We sought to identify the thoracolumbar electrode montage associated with the most robust activation of spinal circuits by comparing posterior root-muscle reflexes (PRM reflexes) elicited by 6 montages.

Reliability of the International Spinal Cord Injury Physical Therapy-Occupational Therapy Basic Data Set.

In interventional clinical trials for persons with spinal cord injury (SCI), the influence of experimental biological, pharmacological, or device-related interventions must be differentiated from that of physical and occupational therapy interventions, as rehabilitation influences motor-related outcomes. The International Spinal Cord Injury (ISCI) Physical TherapyOccupational Therapy Basic Data Set (PT-OT BDS) was developed with the intent to track the content and time of rehabilitation interventions that are delivered concurrently with experimental interventions. We assessed the reliability of the PT-OT BDS based on agreement between users.

Non-invasive Transcutaneous Spinal Cord Stimulation Programming Recommendations for the Treatment of Upper Extremity Impairment in Tetraplegia.

Objectives: This study analyzes the stimulation parameters implemented during two successful trials that used non-invasive transcutaneous spinal cord stimulation (tSCS) to effectively improve upper extremity function after chronic spinal cord injury (SCI). It proposes a framework to guide stimulation programming decisions for the successful translation of these techniques into the clinic.

Materials And Methods: Programming data from 60 participants who completed the Up-LIFT trial and from 17 participants who subsequently completed the LIFT Home trial were analyzed.

Association of patient photographs and reduced retract-and-reorder events.

Background: Wrong-patient order entry (WPOE) is a potentially dangerous medical error. It remains unknown if patient photographs reduce WPOE in the pediatric inpatient population.

Materials And Methods: Order sessions from a single pediatric hospital system were examined for retract-and-reorder (RAR) events, a surrogate WPOE measure.

Validation of scores from a telephone administered multiple sclerosis walking scale-12 in persons with multiple sclerosis.

Background: The Multiple Sclerosis Walking Scale-12 (MSWS-12) has typically been delivered through paper-and-pencil or computer-based administration.

Purpose: This study examined the validity of inferences from scores derived via a telephone administration of the MSWS-12 applied as part of screening of participants with walking dysfunction into a clinical trial of exercise training in MS.

Method: The MSWS-12 was administered on two occasions separated by approximately 2 weeks through the telephone and then in-person (i.

The Use of Long-Arm Serial Casting to Manage Multiple Sclerosis Spasticity: A Case Report.

Spasticity is common among individuals with multiple sclerosis (MS) and can have negative implications. Casting is a treatment intervention that is used to manage spasticity. The use of casting has been studied in individuals with brain injury and stroke, but no publications were found for its use in persons with MS.

Poverty and Disability: A State-Level Geospatial Analysis.

Individuals with disabilities are a growing yet understudied population. Nurses are in a prime position to address social determinants of health (SDOH), which is defined as the conditions in which people work, live, and learn that affect health. SDOH are largely responsible for the health inequities seen among individuals with disabilities.

Non-invasive spinal cord electrical stimulation for arm and hand function in chronic tetraplegia: a safety and efficacy trial.

Cervical spinal cord injury (SCI) leads to permanent impairment of arm and hand functions. Here we conducted a prospective, single-arm, multicenter, open-label, non-significant risk trial that evaluated the safety and efficacy of ARC Therapy to improve arm and hand functions in people with chronic SCI. ARC Therapy involves the delivery of externally applied electrical stimulation over the cervical spinal cord during structured rehabilitation.

Optimizing assessment of low frequency H-reflex depression in persons with spinal cord injury.

Considering the growing interest in clinical applications of neuromodulation, assessing effects of various modulatory approaches is increasingly important. Monosynaptic spinal reflexes undergo depression following repeated activation, offering a means to quantify neuromodulatory influences. Following spinal cord injury (SCI), changes in reflex modulation are associated with spasticity and impaired motor control.

Educational training and nursing professional self-perception in Mongolia: A prospective observational pre-post design study.

Aims: To determine whether professional self-perception of nurses in Mongolia improves following an educational intervention and to identify differences in scores among participant subgroups.

Design: A prospective observational pre-post design.

Methods: Using a convenience sample of 67 nurses in Mongolia in 2019, the Nursing Professional Values Scale-3 instrument was used pre- and post-intervention.

Recognition, Description, and Variability of Spasticity in Individuals With Multiple Sclerosis and Potential Barriers to Clinician-Patient Dialogue: Results From SEEN-MSS, a Large-Scale, Self-Reported Survey.

Background: The experience with spasticity varies among individuals with multiple sclerosis and spasticity (MSS), as they may not recognize it as spasticity or have the language to describe their symptoms. This can lead to potential delays in diagnosis and treatment.

Methods: Symptoms and Emotions Exploration Needed in Multiple Sclerosis Spasticity was an online survey completed by 1177 individuals with MSS in 2021.

Brief High-Velocity Motor Skill Training Increases Step Frequency and Improves Length/Frequency Coordination in Slow Walkers With Chronic Motor-Incomplete Spinal Cord Injury.

Objective: To quantify spatiotemporal coordination during overground walking among persons with motor-incomplete spinal cord injury (PwMISCI) by calculating the step length (SL)/step frequency (SF) ratio (ie, the Walk Ratio [WR]) and to examine the effects of motor skill training (MST) on the relationship between changes in these parameters and walking speed (WS).

Design: Between-day exploratory analysis.

Setting: Research laboratory in a rehabilitation hospital PARTICIPANTS: PwMISCI (N=26).