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Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury
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Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (5 December 2022) | Viewed by 80428

Special Issue Editors

Prof. Dr. David R. Gater

E-Mail Website
Guest Editor
Tenured Professor, Chair and Spinal Cord Injury Medicine Fellowship Director, Department of Physical Medicine & Rehabilitation, University of Miami School of Medicine, Miami, FL 33136, USA
Interests: exercise rehabilitation; spasticity; electrodiagnostic medicine; nutrition; spinal cord injury; neurophysiology
Dr. B. Jenny Kiratli

E-Mail Website
Co-Guest Editor
Director of Clinical Research, Spinal Cord Injury Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
Interests: spinal cord injury; bone and fracture risk; physical activity and wellness
Dr. Gary J. Farkas

E-Mail Website
Co-Guest Editor
Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
Interests: spinal cord injury; neurorehabilitation; clinical exercise physiology; rehabilitation; abdominal obesity; physical rehabilitation; energy expenditure; metabolism; basal metabolism

Special Issue Information

Dear Colleagues,

The spinal cord is the central nervous system’s conduit from the brain to the rest of the body and translates sensory and motor information to and from the brain as well as autonomic and peripheral nervous systems. Spinal cord injury (SCI) can have devastating effects on sensory and motor neurological function as well as autonomic processes on cardiovascular, pulmonary, gastrointestinal, genitourinary, musculoskeletal, hematological, endocrine, and integumentary systems, creating profound psychosocial and spiritual dilemmas. This Special Issue will address the pathophysiology and treatment of secondary conditions associated with SCI.

Prof. Dr. David R. Gater
Dr. B. Jenny Kiratli
Dr. Gary J. Farkas
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • spinal cord injury
  • pathophysiology
  • personalized treatment

Published Papers (16 papers)

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Research

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20 pages, 4380 KiB  
Article
Nontraumatic Spinal Cord Injury: Epidemiology, Etiology and Management
by Diana M. Molinares, David R. Gater, Scott Daniel and Nicole L. Pontee
J. Pers. Med. 2022, 12(11), 1872; https://doi.org/10.3390/jpm12111872 - 08 Nov 2022
Cited by 16 | Viewed by 4012
Abstract
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a [...] Read more.
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a traumatic spinal cord injury (SCI), supraspinal influences on the peripheral nervous system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, sympathetic blunting, and parasympathetic dominance, resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions, and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of the less reported nontraumatic SCI (NTSCI), its classification, its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue. Finally, management strategies for NTSCI will be provided. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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15 pages, 1252 KiB  
Article
Neurogenic Bowel and Management after Spinal Cord Injury: A Narrative Review
by Gianna M. Rodriguez and David R. Gater
J. Pers. Med. 2022, 12(7), 1141; https://doi.org/10.3390/jpm12071141 - 14 Jul 2022
Cited by 10 | Viewed by 6243
Abstract
People with spinal cord injury (SCI) suffer from the sequela of neurogenic bowel and its disabling complications primarily constipation, fecal incontinence, and gastrointestinal (GI) symptoms. Neurogenic bowel is a functional bowel disorder with a spectrum of defecatory disorders as well as colonic and [...] Read more.
People with spinal cord injury (SCI) suffer from the sequela of neurogenic bowel and its disabling complications primarily constipation, fecal incontinence, and gastrointestinal (GI) symptoms. Neurogenic bowel is a functional bowel disorder with a spectrum of defecatory disorders as well as colonic and gastrointestinal motility dysfunction. This manuscript will review the anatomy and physiology of gastrointestinal innervation, as well as the pathophysiology associated with SCI. It will provide essential information on the recent guidelines for neurogenic bowel assessment and medical management. This will allow medical providers to partner with their patients to develop an individualized bowel plan utilizing a combination of various pharmacological, mechanical and surgical interventions that prevent complications and ensure successful management and compliance. For people with SCI and neurogenic bowel dysfunction, the fundamental goal is to maintain health and well-being, promote a good quality of life and support active, fulfilled lives in their homes and communities. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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27 pages, 1888 KiB  
Article
Pressure Injuries and Management after Spinal Cord Injury
by Nicole M. Vecin and David R. Gater
J. Pers. Med. 2022, 12(7), 1130; https://doi.org/10.3390/jpm12071130 - 12 Jul 2022
Cited by 12 | Viewed by 12981
Abstract
Spinal cord injury (SCI) results in motor paralysis and sensory loss that places individuals at particularly high risk of pressure injuries. Multiple comorbidities associated with autonomic, cardiovascular, pulmonary, endocrine, gastrointestinal, genitourinary, neurological, and musculoskeletal dysfunction makes it even more likely that pressure injuries [...] Read more.
Spinal cord injury (SCI) results in motor paralysis and sensory loss that places individuals at particularly high risk of pressure injuries. Multiple comorbidities associated with autonomic, cardiovascular, pulmonary, endocrine, gastrointestinal, genitourinary, neurological, and musculoskeletal dysfunction makes it even more likely that pressure injuries will occur. This manuscript will review the structure and function of the integumentary system, and address the multidisciplinary approach required to prevent and manage pressure injuries in this vulnerable population. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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20 pages, 935 KiB  
Article
Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury
by James Guest, Nilanjana Datta, George Jimsheleishvili and David R. Gater, Jr.
J. Pers. Med. 2022, 12(7), 1126; https://doi.org/10.3390/jpm12071126 - 11 Jul 2022
Cited by 23 | Viewed by 5986
Abstract
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a [...] Read more.
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a spinal cord injury (SCI), supraspinal influences on the spinal segmental control system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, pain and dysesthesia, sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of traumatic SCI, current and emerging methods of classification, and its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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15 pages, 2787 KiB  
Article
Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review
by Austin M. Henke, Zackery J. Billington and David R. Gater, Jr.
J. Pers. Med. 2022, 12(7), 1110; https://doi.org/10.3390/jpm12071110 - 07 Jul 2022
Cited by 17 | Viewed by 5767
Abstract
The autonomic nervous system (ANS), composed of the sympathetic and parasympathetic nervous systems, acts to maintain homeostasis in the body through autonomic influences on the smooth muscle, cardiac muscles, blood vessels, glands and organs of the body. The parasympathetic nervous system interacts via [...] Read more.
The autonomic nervous system (ANS), composed of the sympathetic and parasympathetic nervous systems, acts to maintain homeostasis in the body through autonomic influences on the smooth muscle, cardiac muscles, blood vessels, glands and organs of the body. The parasympathetic nervous system interacts via the cranial and sacral segments of the central nervous system, and the sympathetic nervous system arises from the T1–L2 spinal cord segments. After a spinal cord injury (SCI), supraspinal influence on the ANS is disrupted, leading to sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. Further, afferent signals to the sympathetic cord elicit unabated reflex sympathetic outflow in response to noxious stimuli below the level of SCI. This article outlines the pathophysiology of SCI on the ANS, clinical ramifications of autonomic dysfunction, and the potential long-term sequelae of these influences following SCI. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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12 pages, 285 KiB  
Article
Pediatric Spina Bifida and Spinal Cord Injury
by Joslyn Gober, Sruthi P. Thomas and David R. Gater
J. Pers. Med. 2022, 12(6), 985; https://doi.org/10.3390/jpm12060985 - 17 Jun 2022
Cited by 9 | Viewed by 3804
Abstract
Pediatric spina bifida (SB) and spinal cord injury (SCI) are unfortunately common in our society, and their unique findings and comorbidities warrant special consideration. This manuscript will discuss the epidemiology, pathophysiology, prevention, and management strategies for children growing and developing with these unique [...] Read more.
Pediatric spina bifida (SB) and spinal cord injury (SCI) are unfortunately common in our society, and their unique findings and comorbidities warrant special consideration. This manuscript will discuss the epidemiology, pathophysiology, prevention, and management strategies for children growing and developing with these unique neuromuscular disorders. Growth and development of the maturing child places them at high risk of spinal cord tethering, syringomyelia, ascending paralysis, pressure injuries, and orthopedic abnormalities that must be addressed frequently and judiciously. Similarly, proper neurogenic bladder and neurogenic bowel management is essential not just for medical safety, but also for optimal psychosocial integration into the child’s expanding social circle. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
15 pages, 1014 KiB  
Article
Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury
by Nathalie Elisabeth Perez, Neha Pradyumna Godbole, Katherine Amin, Raveen Syan and David R. Gater, Jr.
J. Pers. Med. 2022, 12(6), 968; https://doi.org/10.3390/jpm12060968 - 14 Jun 2022
Cited by 11 | Viewed by 7718
Abstract
Urinary incontinence is common after spinal cord injury (SCI) due to loss of supraspinal coordination and unabated reflexes in both autonomic and somatic nervous systems; if unchecked, these disturbances can become life-threatening. This manuscript will review normal anatomy and physiology of the urinary [...] Read more.
Urinary incontinence is common after spinal cord injury (SCI) due to loss of supraspinal coordination and unabated reflexes in both autonomic and somatic nervous systems; if unchecked, these disturbances can become life-threatening. This manuscript will review normal anatomy and physiology of the urinary system and discuss pathophysiology secondary to SCI. This includes a discussion of autonomic dysreflexia, as well as its diagnosis and management. The kidneys and the ureters, representing the upper urinary tract system, can be at risk related to dyssynergy between the urethral sphincters and high pressures that lead to potential vesicoureteral reflux, urinary tract infections, and calculi associated with neurogenic lower urinary tract dysfunction (NLUTD). Recent guidelines for diagnosis, evaluation, treatment and follow up of the neurogenic bladder will be reviewed and options provided for risk stratification and management. Mechanical, pharmacological, neurolysis and surgical management will be discussed. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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12 pages, 1959 KiB  
Article
Spasticity Management after Spinal Cord Injury: The Here and Now
by Zackery J. Billington, Austin M. Henke and David R. Gater, Jr.
J. Pers. Med. 2022, 12(5), 808; https://doi.org/10.3390/jpm12050808 - 17 May 2022
Cited by 9 | Viewed by 4027
Abstract
Spasticity is a common comorbidity of spinal cord injury (SCI) that is characterized by velocity dependent tone and spasms manifested by uninhibited reflex activity of muscles below the level of injury. For some, spasticity can be beneficial and facilitate functional standing, transfers, and [...] Read more.
Spasticity is a common comorbidity of spinal cord injury (SCI) that is characterized by velocity dependent tone and spasms manifested by uninhibited reflex activity of muscles below the level of injury. For some, spasticity can be beneficial and facilitate functional standing, transfers, and some activities of daily living. For others, it may be problematic, painful, and interfere with mobility and function. This manuscript will address the anatomy and physiology of neuromuscular reflexes as well as the pathophysiology that occurs after SCI. Spasticity assessment will be discussed in terms of clinical history and findings on physical examinations, including responses to passive and active movement, deep tendon reflexes, and other long tract signs of upper motor neuron injury, as well as gait and function. Management strategies will be discussed including stretch, modalities, pharmacotherapy, neurolysis, and surgical options. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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Review

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23 pages, 915 KiB  
Review
The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury
by Beverley Catharine Craven, Christopher M. Cirnigliaro, Laura D. Carbone, Philemon Tsang and Leslie R. Morse
J. Pers. Med. 2023, 13(6), 966; https://doi.org/10.3390/jpm13060966 - 08 Jun 2023
Cited by 2 | Viewed by 2484
Abstract
Background: The prevention of lower extremity fractures and fracture-related morbidity and mortality is a critical component of health services for adults living with chronic spinal cord injury (SCI). Methods: Established best practices and guideline recommendations are articulated in recent international consensus documents from [...] Read more.
Background: The prevention of lower extremity fractures and fracture-related morbidity and mortality is a critical component of health services for adults living with chronic spinal cord injury (SCI). Methods: Established best practices and guideline recommendations are articulated in recent international consensus documents from the International Society of Clinical Densitometry, the Paralyzed Veterans of America Consortium for Spinal Cord Medicine and the Orthopedic Trauma Association. Results: This review is a synthesis of the aforementioned consensus documents, which highlight the pathophysiology of lower extremity bone mineral density (BMD) decline after acute SCI. The role and actions treating clinicians should take to screen, diagnose and initiate the appropriate treatment of established low bone mass/osteoporosis of the hip, distal femur or proximal tibia regions associated with moderate or high fracture risk or diagnose and manage a lower extremity fracture among adults with chronic SCI are articulated. Guidance regarding the prescription of dietary calcium, vitamin D supplements, rehabilitation interventions (passive standing, functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES)) to modify bone mass and/or anti-resorptive drug therapy (Alendronate, Denosumab, or Zoledronic Acid) is provided. In the event of lower extremity fracture, the need for timely orthopedic consultation for fracture diagnosis and interprofessional care following definitive fracture management to prevent health complications (venous thromboembolism, pressure injury, and autonomic dysreflexia) and rehabilitation interventions to return the individual to his/her pre-fracture functional abilities is emphasized. Conclusions: Interprofessional care teams should use recent consensus publications to drive sustained practice change to mitigate fracture incidence and fracture-related morbidity and mortality among adults with chronic SCI. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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11 pages, 1117 KiB  
Review
Respiratory Complications and Weaning Considerations for Patients with Spinal Cord Injuries: A Narrative Review
by Kristopher A. Hendershot and Kristine H. O’Phelan
J. Pers. Med. 2023, 13(1), 97; https://doi.org/10.3390/jpm13010097 - 31 Dec 2022
Cited by 3 | Viewed by 2964
Abstract
Respiratory complications following traumatic spinal cord injury are common and are associated with high morbidity and mortality. The inability to cough and clear secretions coupled with weakened respiratory and abdominal muscles commonly leads to respiratory failure, pulmonary edema, and pneumonia. Higher level and [...] Read more.
Respiratory complications following traumatic spinal cord injury are common and are associated with high morbidity and mortality. The inability to cough and clear secretions coupled with weakened respiratory and abdominal muscles commonly leads to respiratory failure, pulmonary edema, and pneumonia. Higher level and severity of the spinal cord injury, history of underlying lung pathology, history of smoking, and poor baseline health status are potential predictors for patients that will experience respiratory complications. For patients who may require prolonged intubation, early tracheostomy has been shown to lead to improved outcomes. Prediction models to aid clinicians with the decision and timing of tracheostomy have been shown to be successful but require larger validation studies in the future. Mechanical ventilation weaning strategies also require further investigation but should focus on a combination of optimizing ventilator setting, pulmonary toilet techniques, psychosocial well-being, and an aggressive bowel regimen. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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32 pages, 504 KiB  
Review
Nutrition Education to Reduce Metabolic Dysfunction for Spinal Cord Injury: A Module-Based Nutrition Education Guide for Healthcare Providers and Consumers
by Alicia Sneij, Gary J. Farkas, Marisa Renee Carino Mason and David R. Gater
J. Pers. Med. 2022, 12(12), 2029; https://doi.org/10.3390/jpm12122029 - 07 Dec 2022
Cited by 1 | Viewed by 3088
Abstract
Spinal cord injury (SCI) results in a high prevalence of neurogenic obesity and metabolic dysfunction. The increased risk for neurogenic obesity and metabolic dysfunction is mainly due to the loss of energy balance because of significantly reduced energy expenditure following SCI. Consequently, excessive [...] Read more.
Spinal cord injury (SCI) results in a high prevalence of neurogenic obesity and metabolic dysfunction. The increased risk for neurogenic obesity and metabolic dysfunction is mainly due to the loss of energy balance because of significantly reduced energy expenditure following SCI. Consequently, excessive energy intake (positive energy balance) leads to adipose tissue accumulation at a rapid rate, resulting in neurogenic obesity, systemic inflammation, and metabolic dysfunction. The purpose of this article is to review the existing literature on nutrition, dietary intake, and nutrition education in persons with SCI as it relates to metabolic dysfunction. The review will highlight the poor dietary intakes of persons with SCI according to authoritative guidelines and the need for nutrition education for health care professionals and consumers. Nutrition education topics are presented in a module-based format with supporting literature. The authors emphasize the role of a diet consisting of low-energy, nutrient-dense, anti-inflammatory foods consistent with the Dietary Guidelines for Americans’ MyPlate to effectively achieve energy balance and reduce the risk for neurogenic obesity and metabolic dysfunction in individuals with SCI. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
12 pages, 537 KiB  
Review
Sexuality, Intimacy, and Reproductive Health after Spinal Cord Injury
by John Zizzo, David R. Gater, Sigmund Hough and Emad Ibrahim
J. Pers. Med. 2022, 12(12), 1985; https://doi.org/10.3390/jpm12121985 - 01 Dec 2022
Cited by 1 | Viewed by 3079
Abstract
Spinal cord injury (SCI) is a life-altering event often accompanied by a host of anxiety-provoking questions and concerns in the minds of affected individuals. Questions regarding the ability to resume sexual activity, partner’s satisfaction as well as the ability to have biological children [...] Read more.
Spinal cord injury (SCI) is a life-altering event often accompanied by a host of anxiety-provoking questions and concerns in the minds of affected individuals. Questions regarding the ability to resume sexual activity, partner’s satisfaction as well as the ability to have biological children are just a few of the unknowns facing patients following the devastating reality that is SCI. As a result of advances in SCI research over the last few decades, providers now have the knowledge and tools to address many of these concerns in an evidence-based and patient-centered approach. SCI can impair multiple components involved in sexual function, including libido, achieving and maintaining an erection, ejaculation, and orgasm. Many safe and effective fertility treatments are available to couples affected by SCI. Finally, learning to redefine one’s self-image, reinforce confidence and self-esteem, and feel comfortable communicating are equally as important as understanding functionality in regaining quality of life after SCI. Thus, this review aims to highlight the current state of SCI research relating to sexual function, reproductive health, and the search for meaning. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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22 pages, 1214 KiB  
Review
Psychosocial Consequences of Spinal Cord Injury: A Narrative Review
by Maggi A. Budd, David R. Gater, Jr. and Isabella Channell
J. Pers. Med. 2022, 12(7), 1178; https://doi.org/10.3390/jpm12071178 - 20 Jul 2022
Cited by 24 | Viewed by 7465
Abstract
Consequences of a spinal cord injury (SCI) entail much more than damage to the spinal cord. The lives of people with SCI, along with those around them, experience profound long-lasting changes in nearly every life domain. SCI is a physical (biological) injury that [...] Read more.
Consequences of a spinal cord injury (SCI) entail much more than damage to the spinal cord. The lives of people with SCI, along with those around them, experience profound long-lasting changes in nearly every life domain. SCI is a physical (biological) injury that is inextricably combined with various psychological and social consequences. The objective of this review is to present psychosocial challenges following SCI through the biopsychosocial model, beginning with acknowledgement of the larger societal effects of ableism and stigma before addressing the many unique psychosocial aspects of living with SCI. Included in this review are qualitative studies and systematic reviews on current psychosocial outcomes and consequences. This paper attempts to structure this information by dividing it into the following sections: relationships and family; changes in finances and employment; issues related to the person’s living situation; community reintegration; factors associated with mood and coping (e.g., depression, anxiety, substance use, and PTSD); self-harm behaviors (ranging from nonadherence to suicide); effects of traumatic brain injury; considerations regarding sexual health; aging with SCI; and concludes with a brief discussion about post-traumatic growth. Cultivating an understanding of the unique and interrelated psychosocial consequences of people living with SCI may help mitigate the psychosocial aftermath and serve as a reminder to providers to maintain a person-centered approach to care. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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12 pages, 306 KiB  
Review
Concomitant Brain Injury and Spinal Cord Injury Management Strategies: A Narrative Review
by Adriana D. Valbuena Valecillos, David R. Gater, Jr. and Gemayaret Alvarez
J. Pers. Med. 2022, 12(7), 1108; https://doi.org/10.3390/jpm12071108 - 06 Jul 2022
Cited by 5 | Viewed by 2430
Abstract
Spinal cord injury (SCI) is a catastrophic event with multiple comorbidities including spastic paralysis, sensory loss, autonomic dysfunction with sympathetic blunting, neurogenic orthostatic hypotension, neurogenic restrictive and obstructive lung disease, neuropathic pain, spasticity, neurogenic bladder, neurogenic bowel, immobilization hypercalcemia, osteopenia/osteoporosis, neurogenic obesity, and [...] Read more.
Spinal cord injury (SCI) is a catastrophic event with multiple comorbidities including spastic paralysis, sensory loss, autonomic dysfunction with sympathetic blunting, neurogenic orthostatic hypotension, neurogenic restrictive and obstructive lung disease, neuropathic pain, spasticity, neurogenic bladder, neurogenic bowel, immobilization hypercalcemia, osteopenia/osteoporosis, neurogenic obesity, and metabolic dysfunction. Cervical and thoracic SCI is all too often accompanied by traumatic brain injury (TBI), which carries its own set of comorbidities including headaches, seizures, paroxysmal sympathetic hyperactivity, aphasia, dysphagia, cognitive dysfunction, memory loss, agitation/anxiety, spasticity, bladder and bowel incontinence, and heterotopic ossification. This manuscript will review the etiology and epidemiology of dual diagnoses, assessment of both entities, and discuss some of the most common comorbidities and management strategies to optimize functional recovery. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
32 pages, 2960 KiB  
Review
The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury
by Gary J. Farkas, Adam M. Burton, David W. McMillan, Alicia Sneij and David R. Gater, Jr.
J. Pers. Med. 2022, 12(7), 1088; https://doi.org/10.3390/jpm12071088 - 30 Jun 2022
Cited by 10 | Viewed by 3575
Abstract
Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as “silent killers”, cardiometabolic risk and [...] Read more.
Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as “silent killers”, cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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11 pages, 302 KiB  
Review
Male Sexual Dysfunction and Infertility in Spinal Cord Injury Patients: State-of-the-Art and Future Perspectives
by Francesco Di Bello, Massimiliano Creta, Luigi Napolitano, Gianluigi Califano, Francesco Passaro, Simone Morra, Angelo di Giovanni, Giovanni Maria Fusco, Luigi Cirillo, Marco Abate, Vincenzo Morgera, Gianluigi Cacace, Luigi De Luca, Gianluca Spena, Claudia Collà Ruvolo, Francesco Paolo Calace, Celeste Manfredi, Roberto La Rocca, Giuseppe Celentano, Carmine Turco, Marco Capece, Carlo D’Alterio, Alessandro Giordano, Ernesto di Mauro, Francesco Trama, Ugo Amicuzi, Davide Arcaniolo, Ferdinando Fusco and Nicola Longoadd Show full author list remove Hide full author list
J. Pers. Med. 2022, 12(6), 873; https://doi.org/10.3390/jpm12060873 - 26 May 2022
Cited by 13 | Viewed by 3120
Abstract
Spinal cord injury (SCI) is a relevant medical and social problem. According to the World Health Organization, the commonly estimated worldwide annual incidence of SCI is 40 to 80 cases per million population. After the SCI experience, most men present with sexual dysfunction [...] Read more.
Spinal cord injury (SCI) is a relevant medical and social problem. According to the World Health Organization, the commonly estimated worldwide annual incidence of SCI is 40 to 80 cases per million population. After the SCI experience, most men present with sexual dysfunction (erectile dysfunction (ED) and ejaculatory dysfunction), fertility problems (such as impaired spermatogenesis, abnormalities in sperm viability, motility, and morphology), and systemic disorders such as genitourinary infection and endocrine imbalances. The best options available for managing the ejaculatory disorders in patients suffering from SCI are penile vibratory stimulation (PVS) and electroejaculation (EEJ). Furthermore, the treatment of ED in SCI patients consists of medical therapies including phosphodiesterase 5 inhibitors (PDE5i), intracavernosal injections (ICI), vacuum erection devices (VEDs), and surgical as penile prosthesis (PP). This review provides a snapshot of the current evidence for the mechanisms of sexual dysfunction and infertility in SCI patients, discusses the best management strategies for these conditions, and offers our perspective on the direction of future research. Full article
(This article belongs to the Special Issue Pathophysiology and Treatment of Secondary Conditions after Spinal Cord Injury)
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