The term spinal cord injury (SCI) comprises a wide range of conditions. As described by the WHO report International Perspectives on Spinal Cord Injury (WHO 2013), SCI refers to damage to the spinal cord arising from trauma (such as a car crash), or from non-traumatic disease or degeneration (such as tuberculosis), and encompasses both a baby born with spina bifida and a construction worker who falls from scaffolding.
SCIs are associated with costly consequences, for both individuals and society, and there is a strong research focus on preventing injury and improving outcomes. One example is the annual scientific meeting of the International Spinal Cord Society (ISCoS). This year’s meeting included about 600 participants from 49 countries and covered an extensive scientific program. The ISCoS program has a strong consumer focus; it discusses consumer engagement in research, community integration, and self-efficacy among other things. It also highlights the high priority of bladder and bowel problems among people with SCI. This is also reflected in many of the newly published scientific papers within the field of SCI.
Lower urinary tract infections are the most common concern but prevalence of fecal incontinence and bowel dysfunction is also significant, making an effective bowel management program important for people with SCI. Conservative treatment strategies are often promoted, and for bladder management, intermittent catheterization is a central method of choice. Upper limb function seems to determine the level of adoption of the therapy.
In general terms, SCI epidemiology seems to have changed during the last decades. In the US, for example, the mean age at injury has increased from 29 years (1970s) to 42 years, and life expectancy has improved. Other countries also report good long-term survival and independent productive lives among people with SCI. The incidence of traumatic SCI is more common among men than women, and the most common causes are falls and road traffic accidents.
Summary of Publications
Bowel Dysfunction Related to Spina Bifida: Keep It Simple.
https://www.ncbi.nlm.nih.gov/pubmed/28991086
Author and Origin
Brochard C, Peyronnet B, Dariel A, Ménard H, Manunta A, Ropert A, Neunlist M, Bouguen G, Siproudhis L. France
Summary
A prospective study of 228 patients with spina bifida focusing on anorectal and urological problems.
Conclusions
Lower urinary tract infections were the most common concern. However, prevalence of fecal incontinence and bowel dysfunction was high and was associated with obesity, urologic disorders and stool consistency rather than neurologic features.
Comments
A prospective study of adults with spina bifida investigating associations of bowel dysfunction and risk factors. See more details in the publication highlight.
Outcome of Bowel Management Program in Patient with Spinal Cord Injury.
https://www.waset.org/abstracts/nursing-and-health-sciences/62806
Author and Origin
Chobchuen R, Srikhan A, Wattanapan P. Thailand
Summary
Descriptive study of the outcome of a bowel management program consisting of e.g. diet modification, abdominal massage and digital stimulation, for 16 patients with spinal cord injury at a rehabilitation ward.
Conclusions
Implementation of an effective bowel management program reduced the severity of neurogenic bowel dysfunction in patients with spinal cord injury.
Comments
Descriptive study of the importance of introducing a bowel management program to patients with spinal cord injury.
Predictors of long-term bladder management in spinal cord injury patients-Upper extremity function may matter most.
https://www.ncbi.nlm.nih.gov/pubmed/29044679
Author and Origin
Zlatev DV, Shem K, Elliott CS. US
Summary
Observational retrospective study of the US National Spinal Cord Injury (SCI) Database 2000-2013, studying the association of upper limb motor score with ability to perform intermittent catheterization.
Conclusions
Poor upper limb function is a strong predictor of a failure to adopt intermittent catheterization. Other predictors are increasing age and female gender.
Comments
Study concluding that upper limb function in people with spinal cord injury determines adoption of intermittent catheterization during rehabilitation and a 1-year follow-up.
The Dilemma With the Terminology and the Studies of Intermittent Catheterization: What Is the Best Course of Action?
https://doi.org/10.1007/s11884-017-0452-1
Author and Origin
Madersbacher H. Austria
Summary
Review of terminologies around methods of catheterization, catheter material/design, and catheterization technique.
Conclusions
Intermittent catheterization is identified as a suitable method for management of the neurogenic bladder. Inconsistent terminology seems to be behind the lack of supportive evidence for specific catheter materials and catheterization techniques.
Comments
Review summarizing the different terminologies used for describing intermittent catheters and catheterization techniques.
Long-term outcome of paediatric spinal cord injury.
http://journals.sagepub.com/doi/pdf/10.1177/1460408617706387
Author and Origin
Kulshrestha R., Kumar N., Roy Chowdhury J., Osman A., El Masri W. UK
Summary
A retrospective review of clinical records of 69 patients who suffered spinal cord injury before the age of 18. 12% had normal voiding and 11% had normal bowel function.
Conclusions
The majority of patients achieved long-term survival and led independent productive lives, mainly due to patient education and ongoing support.
Comments
A retrospective review of the long-term effect on life if spinal cord injury occurs before the age of 18.
Aging with Spinal Cord Injury: An Update.
https://doi.org/10.1016/j.pmr.2017.06.013
Author and Origin
Frontera JE, Mollett P. US
Summary
Review of aging with spinal cord injury.
Conclusions
Spinal cord injury epidemiology has changed during recent decades. For example, mean age at injury has increased from 29 years (1970s) to 42 years and life expectancy has improved.
Comments
Review summarizing new epidemiology for spinal cord injury in the US.
Incidence of traumatic spinal cord injury in Italy during 2013-2014: a population-based study.
https://www.ncbi.nlm.nih.gov/pubmed/28872148
Author and Origin
Ferro S, Cecconi L, Bonavita J, Pagliacci MC, Biggeri A, Franceschini M. Italy
Summary
Observational prospective study of 445 traumatic spinal cord injury cases in Italy.
Conclusions
The incidence of traumatic spinal cord injury was 14.7 cases/million/ year. Males were 4 times more likely to be injured and the mean age was 54 years. Most common causes are falls and road traffic accidents.
Comments
Study presenting national epidemiologic data of traumatic spinal cord injuries from Italy.
This blog post is an extract of the Science Alert from Nov 2017 (76040-USX-1711)
