A two parallel group exploratory single center feasibility randomised controlled trial. A nested qualitative study will explore the acceptability of the study processes and patient and physiotherapists experiences of the interventions. The aim of this trial is to test the feasibility of undertaking an RCT investigating the effectiveness of a mult- component structured physical rehabilitation intervention aimed at reducing physical disability in adults with mild stable DCM compared with clinical surveillance. The study will take place in the national neurosurgical centre in Dublin, Ireland. A two parallel group exploratory single center feasibility RCT with will recruit 24 people with mild stable DCM from the outpatient clinics of a tertiary neurosurgical referral service. A nested qualitative study will explore the acceptability of the study processes and patient and physiotherapist experiences of the interventions. The intervention will include education, a physical activity behavioural change intervention, cervical range of motion exercises, neck, upper limb and scapular strengthening exercises and task specific hand function training. The primary outcomes are the feasibility of recruitment, adherence, and retention. The secondary outcomes which will be completed at baseline and 12 weeks follow up are the DCM core outcome set and an NRS for neck and arm pain. Developing novel rehabilitation interventions for people with DCM is the sixth most important research priority in the field of DCM. The findings from this feasibility RCT will inform the feasibility and design of a future definitive RCT. Caroline Treanor is undertaking a professional doctorate for which she has received financial support from the Royal College of Surgeons in Ireland Strategic Academic Recruitment (StAR) programme.

A descriptive quantitative study. To determine how much and what type of exercises and training were provided as part of usual physiotherapy and occupational therapy to participants of the SCI-MT Trial (the Early and Intensive Motor Training for People with Spinal Cord Injuries Trial). This information is important because the SCI-MT Trial concluded that additional motor training is redundant if people with SCI receive equivalent usual care as what was provided to participants of the SCI-MT Trial. Fifteen spinal injury units across Europe and Australia. Data were collected on the time participants of both groups of the SCI-MT Trial (n = 220) attended physiotherapy and occupational therapy provided as part of usual care over the 10-week intervention period. The International Spinal Cord Injury Physical Therapy and Occupational Therapy Basic Data Set was used to capture time spent on activity and impairment directed categories of exercises and training. Participants attended a median (interquartile range) of 8.3 (6.2 to 11.4) hours of physiotherapy and occupational therapy per week. Approximately 70% of therapy time was spent actively exercising or training with a median of 3.8 h per week spent on activity-directedand 1.9 h per week spent on impairment-directedexercises and training. The results of this study detail the amount and type of physiotherapy and occupational therapy that needs to be provided as part of usual rehabilitation care to render additional motor training redundant.

Retrospective observational cohort study SETTING: Three hospitals in China. To elucidate the pathogenesis of pediatric acute hyperextension spinal cord injury (PAHSCI) through comprehensive analysis of acute-phase clinical outcomes and multimodal magnetic resonance imaging (MRI) characteristics. We retrospectively analyzed 49 persons with PAHSCI. Case data and MRI multimodal imaging such as MRI, magnetic resonance angiography (MRA), and diffusion tensor imaging (DTI) were collected. Pathogenesis was analyzed based on clinical outcomes, radiological characteristics, spinal anatomy, and biomechanics. The primary cause of PAHSCI was back-bending training (45/49). The American Spinal Injury Association (ASIA) impairment scale distribution at admission was grade A (n = 29), B (n = 13), C (n = 4), D (n = 3). Final follow-up revealed grade A (n = 29), B (n = 4), C (n = 1), D (n = 10), E (n = 5). The level of spinal cord injury in most cases (48/49) was located at the Th9-L1 level, and intramedullary edema was observed on MRI in 48 persons at admission. Intramedullary hemorrhage was observed in 27 cases, and sequential MRI showed progressively increasing intramedullary edema. In 22 cases, atrophy or even disappearance of the middle and lower thoracic spinal cord occurred 2-6 months after spinal cord injury. MRI of 19 cases showed same radiological changes at the conus-cauda equina junction, which manifested as an arcuate depression on the anterior side of the conus medullaris. Seventeen persons with MRA examination did not have vascular malformations, vascular embolisms, or arteriovenous fistulas. We believe that the possible pathogenesis of PAHSCI is: "axial traction (especially at conus) + transverse compression (especially at Th9-10)" of the spinal cord and the resulting microvascular damage ultimately resulting in spinal cord ischemia, edema, necrosis, and the formation of a vicious cycle, ultimately causing spinal cord atrophy.

Cross-sectional study OBJECTIVE: To evaluate alternative scoring approaches for the modified Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) using severity- and mortality-based weights, and to examine their associations with functioning and self-reported health in individuals with SCI. Community METHODS: We analyzed data from 10,347 participants in the International Spinal Cord Injury Survey (InSCI). Eight scoring approaches were constructed from 14 secondary health conditions and a depression item, varying by severity coding and by whether mortality weights were applied equally or condition-specifically. Associations with functioning (ICF-based composite score) and self-reported health were assessed using Pearson and Spearman correlations, with additional country-level analyses to explore variability. All scoring approaches were negatively correlated with both outcomes, indicating that higher secondary health condition burden was associated with worse functioning and poorer health. The score combining the modified SCI-SCS with condition-specific mortality weights showed the highest correlations, though differences from the unweighted score were small. Both scores demonstrated moderate associations with the outcomes. Country-level analyses revealed variability, partly related to sample size, but overall patterns were consistent. The modified SCI-SCS demonstrated moderate and robust associations with functioning and self-reported health, supporting its use as a pragmatic proxy of overall health status in individuals with SCI. Weighting by mortality risks yielded only marginal gains, suggesting that the unweighted score remains a suitable option for research and practice. These findings advance the use of self-reported measures to capture health burden in SCI and encourage further validation with independent outcomes and across diverse contexts.

Study designa cross-sectional study.ObjectiveTo determine the prevalence and associated factors of abnormal sensory nerve conduction study of sural nerve and to describe the characteristics of sural sensory neuropathy in patients with spinal cord injury (SCI).SettingElectrodiagnostic unit, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University.MethodsPatients with any level of SCI who had no evidence of lower motor neuron lesion at the sacral level who visited the outpatient department, inpatient department, and urodynamic clinic at Maharaj Nakorn Chiang Mai Hospital between October 2023 and November 2024 were recruited. Nerve conduction studies (NCS) were performed following the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Guideline. The primary assessment was sural sensory NCS then the prevalence of sural neuropathy was calculated. Demographic and medical parameters were collected and analyzed to demonstrate the associations with sural neuropathy.ResultsAmong 95 participants, 23 were diagnosed with sural neuropathy, indicating a prevalence of 0.24 (95%CI: 0.16–0.34). Sural neuropathies observed in all participants were categorized into a type without evidence of compressive neuropathy. The independent associated factors of sural neuropathy were female, time since SCI longer than 10 years, cervical SCI, and history of pressure injury at the ischium.ConclusionsIn people with SCI, the prevalence of sural neuropathy is 24%. Due to limitations in the study design and data collection for detecting neuropathy and risk factors, further longitudinal studies are needed to understand the neurophysiological deterioration following SCI and to confirm these findings.

Retrospective cohort study. To identify clinical and demographic factors associated with functional recovery and length of hospital stay in individuals with spinal cord injury undergoing inpatient rehabilitation. Physical Medicine and Rehabilitation Center at Ankara Bilkent City Hospital, Turkey. Medical records of patients with spinal cord injury admitted for inpatient rehabilitation between January 2020 and September 2023 were retrospectively reviewed. Demographic characteristics, injury-related variables, neurological level, ASIA classification, SCIM III scores, complications, assistive rehabilitation interventions, bladder management, and functional status were collected. Univariate analyses (Mann-Whitney U, Kruskal-Wallis, Chi-square) were performed, followed by multivariate regression to identify independent predictors of functional outcomes. A total of 342 patients were included (mean age 38.9 ± 16.2 years). The mean length of stay was 41.6 ± 20.3 days. Univariate analyses showed that age, time since injury, neurological level, multiple hospitalizations, SCIM III scores, complications, advanced rehabilitation technologies, and bladder catheterization were significantly associated with both functional status and hospitalization duration (p < 0.05). Multivariate regression demonstrated that age (β = -0.24, 95% CI: -0.35 to -0.13, p < 0.001), presence of complications (β = -0.31, 95% CI: -0.46 to -0.17, p < 0.001), and bladder catheterization (β = -0.19, 95% CI: -0.32 to -0.07, p = 0.004) were independent predictors of discharge SCIM III scores. Age, neurological integrity, complications, and bladder management are key determinants of functional outcomes in SCI rehabilitation, while these factors also influence length of stay. Early complication prevention, optimized bladder care, and tailored rehabilitation strategies may enhance recovery and shorten hospitalization. No commercial sponsorship was received for this study.

To evaluate the feasibility of the Collaborative Power Mobility Innovative Learning OpporTunity (CoPILOT) wheelchair training protocol and intervention among new powerchair users with spinal injuries, focusing on feasibility metrics and clinical outcomes. An evaluator-blind, parallel randomized controlled trial. Rehabilitation hospital/community setting in Vancouver, Canada. Participants were randomized to CoPILOT or control group (the Wheelchair Skills Program (WSP)). Trained occupational therapists conducted sessions. Data included demographics and feasibility metrics (process, resource, management, treatment safety), as well as primary (Power Mobility Indoor Driving Assessment-PIDA) and secondary outcomes: Wheelchair Skills Test Questionnaire for Powered Wheelchairs-WST-Q-P (capacity and performance subscales), the Wheeling While Talking-WheelTalk task, and the Wheelchair Use Confidence Scale for Powered Wheelchair Users-WheelCon-P (Mobility and Social sub scores). 10 participants (9 male), mean age (SD) was 56.9 years (17.40), and all had prior manual wheelchair use. Attendance (SD) averaged 7.75 sessions (3.49) for CoPILOT group and 8.8 (3.70) for the WSP group. Both groups had baseline and final PIDA scores above 90%. On the WST-Q-P capacity subscale, CoPILOT improved by 8.25% (SD = 19.75), whereas WSP improved by 10.8% (SD = 9.86); on the performance subscale, CoPILOT improved by 8.00% (SD = 19.88) compared to 19.8% (SD = 24.52) for WSP. WheelTalk times, rose by 36.16 s (SD = 45.71) in CoPILOT but declined by 33.46 s (SD = 36.58) in WSP. For WheelCon-P, Mobility sub score increased by 26.75 (SD = 15.33) in CoPILOT versus -18.2 (SD = 77.24) in WSP, and Social sub score changed by -5 (SD = 6.93) versus 4 (SD = 11.94), respectively. The retention rate was 90%, yet neither group achieved the ≥80% session-adherence goal. CoPILOT showed promise in improving wheelchair skills and safety for new powerchair users with spinal injuries. However, recruitment and adherence challenges indicate a need for improved engagement and delivery methods. Further robust RCTs could compare CoPILOT's effectiveness with standard care. ClinicalTrials.gov ID: NCT02320786.

A 10-year single-center retrospective chart review. To evaluate the differences between conservative and surgical treatment of long bone fractures in individuals with chronic SCI, focusing on wheelchair mobilization, overall hospital days, and complication rates. Spinal cord injury Department, BG Trauma Center Frankfurt am Main, Germany. The study, conducted between 2014 and 2023, compared conservative and surgical treatment for long bone fractures in individuals with chronic SCI using descriptive statistics. Fifty-eight fractures were included (31 surgical, 27 conservative). Baseline characteristics did not differ between groups (p > 0.05). Median time to first wheelchair mobilization was 14 days in both groups (median difference 0 days; 95% CI, -4 to 5; p = 0.38). LOS was comparable (median 45 vs. 46 days; difference -1 day; 95% CI, -7 to 6; p = 0.98). Complications occurred in 1 of 31 surgically treated cases (3.2%) versus 9 of 27 conservatively treated (33.3%), corresponding to a risk difference of -30.1% (95% CI, -48.3 to -11.9; p = 0.002). Non-surgical treatment had a higher complication rate than surgical treatment. Both approaches were equivalent in time to first wheelchair mobilization, and neither showed a significantly shorter hospital stay.

To assess the test-retest reliability of sympathetic skin response (SSR) using supraorbital nerve stimulation method in individuals with spinal cord injury (SCI). Psychometric property testing. A rehabilitation facility in Chiang Mai, Thailand. SSR was done on two executive days in individuals with SCI, stimulating at supraorbital nerve and recording at the palmar and plantar surface of both hands and feet. Results were reported as hand- and foot-SSR scores. Test-retest reliability was analyzed using intraclass correlation coefficients (ICC). Forty individuals with SCI were recruited. ICC of hand and foot SSR scores were 0.963 (95%CI: 0.888-0.967) and 0.833 (95%CI: 0.707-0.908), indicating excellent and good test-retest reliability, respectively. Subgroup analyses showed a problematic decrease in test-retest reliability to a moderate level of the foot SSR score in the elderly subgroup (age ≥ 60). SSR induced by the supraorbital nerve stimulation showed excellent test-retest reliability for hand SSR and good reliability for foot SSR in the overall SCI population. SSR, induced by supraorbital nerve stimulation method and reported by SSR score, should be a reliable tool for evaluating autonomic functions in individuals with SCI.

Retrospective cohort study OBJECTIVES: Ventrally located cervical spinal meningiomas present significant surgical challenges due to their proximity to the spinal cord and nerve roots. This study aimed to evaluate the surgical outcomes of these tumors resected via the posterior approach and to compare them with dorsolaterally located meningiomas. The single institution in Japan. A retrospective review was conducted on 39 patients who underwent posterior surgical resection of cervical spinal meningiomas between 2008 and 2023, with a minimum follow-up of one year. Patients were classified into ventral (n = 17) and dorsolateral (n = 22) groups based on tumor localization. Neurological function was assessed using the Japanese Orthopedic Association (JOA) score, and surgical outcomes were compared. The groups had no significant differences in operative time or blood loss. However, nerve root resection was significantly more frequent in the ventral group (41.2 vs. 9.1%, p = 0.02), and perioperative complications and intraoperative motor-evoked potential amplitude reduction (35.3 vs. 4.5%, p = 0.03) were more common (41.2 vs. 13.6%, p = 0.06). Although postoperative JOA scores were lower in the ventral group (14.6 ± 0.6 vs. 16.4 ± 0.3, p = 0.01), both groups showed significant postoperative improvement compared to preoperative scores (p < 0.01). Despite the higher risk of nerve root sacrifice and limited neurological recovery associated with the posterior approach, considering the functional improvements from baseline, it remains a viable surgical option for ventrally located cervical meningiomas. Further studies comparing different surgical approaches are needed to optimize treatment strategies.