[PDF] [PDF] 10 Neuropathic pain in spinal cord injury - International Spinal Cord

[PDF] Lésions de la moelle épinière - World Health Organization

Les lésions de la moelle épinière, un défi pour les systèmes de santé et la kées de manière centralisée sous une forme anonyme suivi de la mise en œuvre des dispositions de la Traumatic spinal cord injuries (SCI): a study of 104 cases Earthquake in Haiti: PAHO/WHO situation report on health activities post 

[PDF] International Perspectives on Spinal Cord Injury

8 oct 2012 · They gave me a sport wheelchair and planned for me to be a national wheel- Spinal cord injury (SCI) is a medically complex and life-disrupting condition Revue d'Epidemiologie et de Sante Publique, 2001, PAHO Earthquake in Haiti : PAHO/WHO situation report on health activities post earthquake

[PDF] 10 Neuropathic pain in spinal cord injury - International Spinal Cord

14 sept 2016 · Individuals with spinal cord injury (SCI) often suffer from chronic pain About 50 develop The phosphorylated form of the high-molecular-weight neurofilament subunit NF-H (pNF-H) in Emerging SCI Statistics In Haiti: Challenges and Progress Santé et Services Sociaux (INESSS), Quebec, Canada

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l'Organisation mondiale de la Santé ou l'UNICEF, de préférence à d'autres de nature analogue Il y a trop peu de praticiens formés à la prévention des traumatismes juvéno-infantiles moins de 18 ans (OMS, Charge mondiale de morbidité: mise life in males with spinal cord injury in Saudi Arabia Province, Haiti

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santé et en services sociaux (INESSS) lors de sa réunion du 28 septembre 2012 Mise en page L'Institut assume l'entière responsabilité de la forme et du contenu définitifs canadienne SCIRE (Spinal Cord Injury Rehabilitation Evidence) et sa to one of Québec's two designated centers of expertise for victims of SCI

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U S Special Coordinator for Haiti Interview In early December, we partnered with the Ministère de la Santé Publique It's why I have said there will be no exit [from Haiti] for me until there is more Healing Hands Spinal Cord Injury (SCI)

[PDF] View PDF File - Haitian Mental Health Network

representatives included Ms Weslyne Nicolas, Former State Representative Marie recently published “La Santé Mentale en Haiti après le 12 Janvier with no previous experience in rehabilitation care, admitted SCI patients from St Boniface's Spinal Cord Injury Rehabilitation Program and Boston Community Medical

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Patients with spinal cord injury in Haiti previously had a poor prognosis This article features a case study showing how care was transformed after the earthquake in 2010 by providing simple bladder care B efore the earthquake in Haiti in January 2010 spinal cord injury (SCI) was a specialty that was poorly understood in the country

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10

Neuropathic pain in spinal cord injury

Associate Professor Nanna Finnerup1

1Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aaarhus, Denmark

Plenary 1: Guttmann Lecture: Neuropathic pain in spinal cord injury. Nanna Finnerup, Festsaal (Plenary),

September 14, 2016, 8:10 AM - 8:55 AM

Individuals with spinal cord injury (SCI) often suffer from chronic pain. About 50% develop chronic neuropathic pain due to the lesion of the somatosensory pathways in the spinal cord or nerve roots.

Neuropathic pain tends to persist despite treatments attempts and may have a major impact on the quality

of life. This talk will discuss the prevalence, impact, and classification of SCI neuropathic pain and how

subclassification of neuropathic pain based on different clinical phenotypes may offer an approach for a

mechanism-based classification. The talk will briefly touch upon recent advances in the understanding of

the underlying mechanisms and risk factors and discuss the evidence-based treatment for spinal cord injury

pain. 156
A randomized controlled trial of auto-titrating continuous positive airway pressure treatment for obstructive sleep apnoea after acute quadriplegia (COSAQ).

Dr David Berlowitz1,2

1Institute for Breathing and Sleep. Austin Health, Melbourne, Australia, 2The COSAQ collaborative, Melbourne, Australia

Topical Papers 1, Forum (Parallel 3), September 14, 2016, 9:00 AM - 10:30 AM

Quadriplegia is a severe, catastrophic injury that acutely causes obstructive sleep apnoea alongside lifelong

physical disability. Treatment with nasal continuous positive airway pressure (CPAP) is particularly challenging in this group. We hypothesised that 3 months of auto-titrating CPAP would improve

neuropsychological function, sleepiness, quality of life, anxiety and depression more than usual care in

acute quadriplegia.

Methods. 11 spinal cord injury centres across Australia, New Zealand, Canada and the UK screened 1628

people (July 2009-October 2015) who sustained a new, traumatic quadriplegia. 337 people met the inclusion criteria and underwent full, portable polysomnography. 265 had an apnoea hypopnoea index

greater than 10, were classified as ͞OSA positiǀe" and proceeded to a 3 night CPAP trial. 160 tolerated at

least 4 hours of CPAP during run-in and were randomized.

Results. 149 participants (134 men, age 46+34, 81+57 days post-injury) completed the trial. Linear modelling

revealed no differences in improvement in attention and information processing, as measured by the Paced

Auditory Serial Addition Task, on intention-to-treat (p=.59; mean difference 2.6, 95% CI, -6.9 to 12.1) or per

protocol for adherence (primary outcome) analyses. Intention-to-treat analyses revealed that CPAP significantly improved the secondary outcome of sleepiness (p=0.01, 1.17, 2.1 to 0.25). Discussion: CPAP significantly improved sleepiness after acute quadriplegia but did not improve neurocognition beyond that seen with post-injury, spontaneous recovery. Trial registration: Australian New Zealand Clinical Trial Registry ACTRN12605000799651 238
Early intensive hand rehabilitation is not more effective than usual care after SCI͗ ͞Hands On" - A Randomised Trial Professor Mary Galea1, Professor Lisa Harvey2, Professor Sarah Dunlop3, Professor Leonid Churilov4

1The University Of Melbourne, Parkville, Australia, 2The University of Sydney, Sydney, Australia, 3The University of

Western Australia, Perth, Australia, 4Florey Institutes of Neurosciences and Mental Health, Parkville, Australia

Topical Papers 1, Forum (Parallel 3), September 14, 2016, 9:00 AM - 10:30 AM

Introduction: Loss of hand function is more debilitating than any other consequence of spinal cord injury.

Intensive task-specific training with functional electrical stimulation (FES) has shown promising results but

has not been examined within a high quality clinical trial. Here we examined efficacy of an intensive hand-

training program in people with recently acquired tetraplegia.

Methods: Seventy people with recent tetraplegia (C2 to T1, AIS A-D) were recruited from 7 spinal units in

Australia and New Zealand. Participants were randomly assigned to a control (n=33) or experimental

intervention (n=37). Both received usual care and 15 minutes of one-to-one hand therapy three times per

week without FES. Experimental participants received intensive training for one hand involving training with

an instrumented exercise workstation in conjunction with FES for 1 hour/day, 5 days/week for 8 weeks. The

primary outcome was the modified ARAT (m-ARAT) score at 8 weeks.

Results: Sixty-six participants completed the 8-week assessment and were included in the primary analysis.

The mean (SD) m-ARAT score for experimental (n=35) and control participants (n=31) at 8 weeks was 36.5

(16.0) and 33.2 (17.5), respectively, with an adjusted mean between-group difference of 0.9 points (95% CI:

-4.1 to 5.9, p=0.721).

Conclusion: Intensive hand training with FES does not improve hand function more than usual care plus

one-to-one therapy in people with recently acquired tetraplegia. 42
FES activation by a sniff controller for effective synchronized cough in people with upper thoracic or cervical SCI

Professor Amiram Catz1,2, Dr. Lior Haviv3, Dr. Hagit Friedman4, Mr. Uri Bierman1, Dr. Itzhak Glass1, Dr. Anton

Plotkin3, BSc. Aharon Weissbrod3, Dr. Sagit Shushan3, Dr. Vadim Bluvshtein1,2, Dr. Elena Aidinoff1,2,

Professor Noam Sobel3

1Loewenstein Rehabilitation Hospital, Raanana, Israel, 2Tel-Aviv University, The Sackler faculty of Medicine, Tel-Aviv ,

Israel, 3Department of Neurobiology, Weizmann Institute of Science , Rehovot , Israel, 4Department of Nursing, Faculty of

Health Sciences and Social Welfare, University of Haifa , Haifa , Israel Topical Papers 1, Forum (Parallel 3), September 14, 2016, 9:00 AM - 10:30 AM

Introduction: Coughing may be impaired in individuals with upper thoracic or cervical spinal cord injury

(SCI). Those with paralyzed hands often depend on a caregiver for coughing. Coughing can be assisted, in

these persons, by functional electric stimulation (FES) applied to abdominal muscles, but the efficacy of FES

depends on temporal synchronization with their cough. To achieve effective cough timing for these

patients, we used a sniff controller to trigger FES. The present study sought to optimize the activation timing

of the sniff-controlled FES, and to test efficacy of the resulting coughing.

Methods: We used computerized analysis of the nasal airflow trace and endoscopic video films of the glottis

of 16 able-bodied subjects to optimize the triggering timing of the sniff controller. We tested the efficacy of

coughing induced without assistance, with manual assistance of a caregiver, with caregiver activated FES,

with button self-activated FES, and with sniff-controlled self-activated FES, by measuring peak expiratory

flow (PEF) in 14 patients (2 females, ages 21-57) with C6-T4 SCI (11 AIS grade A, 2 grade B, 1 grade C).

Results: The optimal time-point for FES triggering was found to be 50 milliseconds after vocal-cord closure.

PEF was 5.42±1.55 L/s without assistance. All assisted methods provided equally effective improvement,

increasing PEF on average by 25 ± 27% (F[4,52]=7.99, p=0.00004). There was no difference between methods of assistance (F[3,39]=0.41, p=0.75). Conclusions: Sniff-controlled FES improved cough, and was the only method among those tested that allowed efficient coughing, independent of caregiver, in persons with paralyzed hands. 260
Prevalence of antibiotic associated diarrhoea in spinal cord injuries centres: a multicentre study.

Dr Samford Wong1,2,3, Dr Pierra Santullo1, Mr. Naveen Kumar4, Mr Joy Chowdhury4, Dr Ineta Zobina5, Mr S

Kolli5, Dr Angel García-Forcada6, Dr Fatima Paz6, Dr Marta Recio6, Dr Carlotte Kiekens7, Dr Nathalie Draulans7,

Dr Jean O'Driscoll8, Dt Ali Jamous9, Mr Mofid Saif1

1National Spinal Injury Centre, Aylesbury, United Kingdom , 2School of Health Sciences, City University London, London,

United Kingdom, 3Institute of Liver and Digestive Health, University College London, London, United Kingdom, 4Midland

Centre for Spinal Injuries, The Robert Jones and Agnes Hunt Orthopaedic Hospital , Oswestry, United Kingdom, 5Welsh

Spinal Cord Injuries Rehabilitation Centre, Rookwood Hospital, Wales, United Kingdom, 6Hospital Nacional de

Parapléjicos, Toledo, Spain, 7University Hospitals Leuven, , Belgium, 8Department of Microbiology, Stoke Mandeville

Hospital, Aylesbury, United Kingdom, 9Royal Buckinghamshire Hospital, Aylesbury, United Kingdom Topical Papers 1, Forum (Parallel 3), September 14, 2016, 9:00 AM - 10:30 AM

Introduction: Little is known about the use of antibiotics and the extent of antibiotic associated diarrhoea

(AAD) in spinal cord injuries (SCI) patients. The study aim was to (1) record the use of antibiotics; (2)

establish the prevalence of AAD and; (3) assess if any seasonal variation on antibiotic use and incidence of

AAD.

Methods: A retrospective study was conducted in five European SCI centres during October 2014 to June

2015. We define AAD as 2 or more watery stools type 5, 6 or 7 (Bristol stool scale) over 24 hours.

Results: One-thousand-two-hundred-and-forty-four adults (median age: 53 years, 29.7% female) with SCI

(52.1% tetraplegia ; 41.9% complete SCI ) were included. Of 231 (18.6% ) patients on antibiotics, the top

three indications for antibiotics were urinary-tract infections, pressure ulcers / wound infection and

osteomyelitis. Thirty-two of 231 (13.8%) developed AAD.

No statistical difference was observed on number of antibiotics, severity of SCI, use of proton-pump-

inhibitor and H2-blocker and use of laxatives in both groups. AAD was more common in the summer season

when compared to spring, autumn and winter. (25%, 3.7%, 6.9%, 17.6%, p=0.04). AAD was associated with

older adults (p<0.01); tetraplegia (p<0.01); hypoalbuminaemia (p=0.02) and elevated body-mass-index (p=0.02). Urinary-tracy-infection was more common during autumn season. (p<0.01)

Conclusion: This multi-centre study found AAD is common in SCI patients and maybe a risk factor for poorer

outcome and increased hospital cost. Further study testing whether probiotic can reduce incidence of AAD

is warranted, especially during summer season. 282
Carbohydrate Signaling Pathways after Exercise in Persons with Chronic

Spinal Cord Injury

Dr Ashraf Gorgey1,2, Dr Zachary Graham3, Dr William Bauman3, Dr Christopher Cardozo3, Dr. David Gater4

1Hunter Holmes Mcguire Va Medical Center, Richmond, United States, 2Virginia Commonwealth University, Richmond,

USA, 3National Center for the Medical Consequences of Spinal Cord Injury; James J. Peters VA Medical Center, Bronx ,

USA, 4Department of Physical Medicine and Rehabilitation, Penn State Milton S., Hershey Medical Center, Hershey, USA

Topical Papers 1, Forum (Parallel 3), September 14, 2016, 9:00 AM - 10:30 AM

Introduction: The study determined the effects of two forms of exercise training on signaling pathways

(GLUT-4, AMPK and PGC-1) of the triceps and Vastus lateralis (VL) muscles in men with chronic motor- complete SCI.

Methods: Nine men with chronic motor-complete SCI participated in two exercise interventions [functional

electrical stimulation cycling (FES; n=4) and arm cycling ergometer (ACE; n=5)] 5 days/week for 16 weeks.

Whole body soft tissue composition was measured by dual energy x-ray absorptiometry. An intravenous

glucose tolerance test was performed in each participant after a 10-12 hour overnight fast to measure

glucose effectiveness and insulin sensitivity. Muscle biopsies of the right VL and triceps muscles were

collected one week prior to and post the exercise training intervention.

Results: Training interventions failed to result in significant changes in soft tissue body composition or

carbohydrate metabolism. GLUT-4 protein expression [increased by 381% in the VL (P =0.14) after FES

training and increased 61% in the triceps (P =0.08) after ACE training]. PGC-1ɲ protein edžpression increased

230% in the VL (P =0.068) after FES training and 379% in the triceps (P =0.14) after ACE training. AMPK

protein expression increased 347% (P =0.14) in the VL after FES training and 347% in the triceps after ACE

training (P =0.14).

Conclusion:

FES-LEC training resulted in similar protein expressions in the VL muscle compared to the triceps by

effectively influencing three distinct carbohydrate signaling pathways. The findings highlight that vital

signaling pathways for carbohydrate metabolism are still intact in the paralyzed muscles years after SCI.

191
The role of peer support in the rehabilitation process and beyond: a comparison of different approaches to peer support

Mrs Claire Guy1, Miss Lucy Robinson1

1NSIC, Stoke Mandeville Hospital, Aylesbury, United Kingdom

Workshop 1: The role of peer support in the rehabilitation process and beyond: a comparison of different

approaches to peer support. Lucy Robinson, Festsaal (Plenary), September 14, 2016, 9:00 AM - 10:30 AM

Following the very successful workshop in Maastricht 2014 with Manfred-Sauer-Foundation, Germany, Dwarslaesie Organisatie Nederland and Back Up, United Kingdom entitled Improving quality of life for

people with spinal cord injury and their families: a comparison of different approaches to peer mentoring.

The three organisations continued to stay in touch and met up at Manfred-Sauer-Foundation, Germany and

then a new mentoring programme has since been set up at Dwarslaesie Organisatie following Back Up's model of mentoring. This workshop will summarise and compare four peer support case studies from four international

organisations who provide peer support for people with spinal cord injury (SCI). Peer support is widely

recognised as an important part of rehabilitation for people with SCI. This session will compare the

different approaches to peer support and explore how collaboration can inspire improvements in service

delivery and outcomes for people with SCI.

Each of these four presentations (15 minutes each) will bear particular reference to how these organisations

provide peer support; how they tailor support to the needs of persons with SCI; finally, how these organisations evaluate the impact of these services provided. A 30 minute structured panel discussion will follow about the ideas presented and the power of collaboration following the last workshop in Maastricht 2014. The audience will be encouraged to ask questions and engage in the issues discussed. The ideas and discussions elicited during the workshop will inform and inspire the future projects and activities.

Format:

Presentation: Patient support at NSIC, Stoke Mandeville, UK.

Presenter: Lucy Robinson, NSIC

Presentation: Including high level injuries (C1-4) in Peer led activities

Presenter: Will Clark

Presentation: Information-management in the rehabilitation process of SCI Presentation: Peer mentor RCT and integration into SCI rehabilitation culture, Shepherd Center, USA

Presenter: Julie Gassaway, Shepherd Center, USA

Panel members: Jos Dekkers, Dwarslaesie Organisatie Nederland

Lucy Robinson, NSIC

Robert Wynn, Spinal Cord Injury Association of Australia 149

EMSCI network: update and future directions

Prof. Armin Curt1, Dr. Rüdiger Rupp2, Prof. John Steeves3, Dr. Giorgio Scivoletto4, Dr. Doris Maier5, Prof. Norbert

Weidner2

British Columbia and Vancouver , Vancouver, Canada, 4Fondazione Santa Lucia, Rome, Italy, 5Berufsgenossenschaftliche

Unfallklinik Murnau, Murnau, Germany

Workshop 2: EMSCI network: update and future directions. Armin Curt, Geheime Ratstube (Parallel 1),

September 14, 2016, 9:00 AM - 10:30 AM

The European Multicentre Study in Spinal Cord Injury (EMSCI.org) was founded in 2001 with the overall aim

of understanding recovery profiles in patients suffering from acute spinal cord injury. Improved

understanding of recovery profiles was made possible through prospective collection of neurological and

functional outcomes data over 1 year post-injury from over 3000 patients. This data has been highly

informative for the development of novel trial designs, evaluating new outcome measures (GRASSP, Spinal

Cord Ability Ruler) and protocol development in several clinical and interventional studies. The critical

discussion ahead of us needs to shift from outcome assessments to translation of interventions to augment

the natural recovery of function after spinal cord injury.

Learning objectives:

Invited EMSCI speakers will focus on:

ͻ insights in the deǀelopments of EMSCI tools ͻ discussion of noǀel research findings and noǀel clinical trials ͻ strategies to standardize rehabilitation interǀentions

The overall emphasis of the workshop is to 1) provide clinicians and researchers in SCI information about

recent perspectives of the EMSCI network and, 2) facilitate interactions with the EMSCI network to stimulate clinical and research interactions on a broader international level. 368
Preǀention Committee Workshop on ͞Work related spinal injuries͗ The

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