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Oral Presentations: Secondary Health Conditions I

Track 1
Thursday, September 3, 2020
11:00 AM - 12:30 PM
Auditorium - Track 1


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Dr Yoshi-ichiro Kamijo
Associated Professor
Wakayama Medical University

Sweating and cutaneous vasodilation responses above the lesion during passive heat stress in persons with thoracic spinal cord injuries.

11:00 AM - 11:15 AM


Background: Sweating and cutaneous vasodilaiton responses in humans increase with an increase in body core and skin surface temperatures; a ratio of contributions is 10 to 1, respectively, via an excitation of sympathetic nervous system. But, the responses are absent or blunted on the skin below the lesion in persons with a spinal cord injury. The thermoregulatory dsyfunctions may contribute to a decline in performance of a competition. In able-body (AB) marathon, the optimum ambient temperature (Topt) to exert a competitiveness would be around 10 ºC and a race time tends to be worth once the temperature was over Topt. In our analysis from the past 20 years of the Oita International Wheelchair Marathon, a completion rate was ~8% in marathon and half-marathon under median ambient temperature (Ta) 18ºC (13.3-26.3, min-max) and relative humidity 63% (28-96). The rate tended to decrease the more with the more decreased Ta over 20 ºC. Furthermore, the completion rate of marathon was the lower with the higher solar radiation. Thus, competitiveness in wheelchair athletes would be influenced from climate condition beyond developing wheelchair and Topt may not be the same as AB. Diminished thermoregulatory capacity in persons with a spinal cord injury relates their competitiveness and varies Topt. However, information for their thermoregulation is still necessary.
Objectives: Sweat rate (SR) and cutaneous vasodilation responses to a thermal stress are absent in persons with a cervical spinal cord injury (CSCI) and are not observed distal to the lesion in persons with lower spinal cord injuries. It remains unknown whether the thermoregulatory responses above the lesion in spinal cord injuries are similar to AB, and related to the time since the injury.
Methods: 7persons with a thoracic spinal cord injury (TSCI; Th4-10; time since injury 1-24 yrs) and 10 AB subjects participated in this protocol. While in the supine position, 33-˚C water was circulated through a water-perfused suit worn by each subject. After 30-min rest, 10 min of baseline data were obtained. Then, 36- and 50-˚C waters were perfused through the upper and lower parts of the suit, respectively, until esophageal temperature increased by 1˚C.
Results: The present heat stress increased cutaneous vasodilation and SR on the chest (C4; sensate skin for SCI) in both groups. However, the increase in these variables was suppressed in LSCI. Moreover, the magnitude of the increase in chest SR at the end of heating was positively related to the time since the injury in LSCI (r=0.98; P<0.0001).
Conclusion: Sweating and cutaneous vasodilation responses at 1-˚C increase in esophageal temperature above the lesion are suppressed in LSCI and sweating responses is possibly affected by time since the injury. The impaired thermoregulatory responses may be associated with the completion rate in a wheelchair marathon.


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Dr Shanu Srivastava
Senior Psychologist
Indian Spinal Injuries Center New Delhi

Life of Non-SCI female partner from a sexual and psychological perspective in the Indian context.

11:45 AM - 12:00 PM


Introduction- The devastating condition of spinal cord injury affects self - esteem of patients and their partners' relationship. The sexual expression of a male partner with SCI may be affected not only by their physical condition but also by the attitude of the society and of their partners towards the disability. In the Indian context, Non-SCI female partners suppress their desire for sexual intimacy with their SCI male partner leading to psychological distress. This study addressed non-SCI female partner experience with their SCI male partner concerning their sexual interest, behavior, suppression, and physical as well as psychological satisfaction of sexual desire.

Method- This qualitative study was conducted at the Indian Spinal Injuries Center, New Delhi, India. The sample size was 30 non-SCI females. Data has been collected through the structured interview method from 30 non-SCI females whose partners with SCI (parapalegic-60% and tetraplegic-40%) had an injury at least one-year-old were rehabilitated at ISIC. The data was analyzed using a form of constant comparison that includes coding data into themes and then into categories to derive conclusions.
Result- - There was a significant change in sexual desire of females, Sexual desire reduced or almost vanished, 60% sexual dissatisfaction, 90% suppression of desire and psychological distress in the behavior of females, partner of SCI male.
Only 2% of females wanted to seek physical satisfaction outside the marriage. Only 1% of females were aware that suppressing sexual desire and needs were leading to psychological distress and irritable mood. During rehabilitation of their spinal cord injured partners, most couples received sexual counseling but during sexual counseling, the focus was on SCI male patients and their rehabilitation. Sexual counseling during rehabilitation always addressed female partners to directly switch their role from passive to the active partner. Only 2% of females had sexual knowledge about the active and passive roles of females during sexual activities. Most of the females were strongly stuck with the thought that only a missionary position can provide them satisfaction.

Conclusion- Although females were a passive partner in sexual activity, 90% were sexually satisfied before the injury of their partner. After the spinal cord injury of the male partner, females became active partners during sexual activities. There was significant dissatisfaction in the change of role in their sexual activity as an active partner and their role as a caretaker of SCI husband assisting him in bowel and bladder management. They did not get any sexual pleasure while indulging in sexual activities and just to indulge maintain the confidence level of their SCI partner. Almost all the females deprived themselves of sexual activity and suppressed sexual desire somewhere in their minds. The suppression of sexual desire resulted in psychological distress and irritable nature. Females need to be educated that they can have a satisfying sexual relationship being an active partner.


Dr.Shanu Srivastava as Senior Psychologist at the Indian spinal injuries center New Delhi, India. Providing psychological support to SCI patients through positive interventions based on counseling and cognitive behavior therapy. Ms.Pragya Ghildial working at Indian Spinal Injuries center New Delhi, India as a Senior Yogatherapist She is teaching Yoga to SCI patients and provides sexual counseling to females SCI patients.
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Prof Jean-Jeaques Wyndaele
Full Time Professor , Retired
University Antwerp Belgium

Comparing different methods to evaluate lower urinary tract sensation after SCI

12:00 PM - 12:15 PM


To analyse and compare the clinical data of 3 different standardized tests to evaluate LUT afferent innervation after Spinal Cord Injury (SCI).
Retrospective study of medical records of individuals with SCI . Data on touch sensation in the different perineal dermatomes1, on sensation of bladder filling during urodynamic testing 2, and on electrical perception thresholds (EPT) in different areas of the LUT3, were extracted, analysed and compared.
Statistical analysis was done with SPSS26.
Records of 460 individuals were analysed: 317 males and 143 females, with a mean age of 45±17 years (Range: 11- 88 years). All tests were performed during a single session after a mean of 7±12years (Range: 3 weeks-62 years) after SC lesion.
The sensation in perineal dermatomes was performed and recorded in 276 patients, evaluation of sensation of bladder filling in 383 and EPT in 115. In 10 individuals the EPT was studied 2( n=9) and 3 (n=1) times.
Sensation in perineal dermatomes was present in 140 patients (51%) and sensation of bladder filling during urodynamics in 190 (50%). EPT were considered absent due to no sensation during a stimulation of 80mA in 31 patients (30%).EPT were normal in all recorded locations in 18 (17%) and were pathologically high (but measurable) in 9 (9%) patients. In 46 patients (44%), some areas showed a normal and others a pathological EPT, indicating that innervation can be affected differently between bladder, bladder neck and urethra in SCI.
In 6 patients with repeated EPT measurements, pattern remained the same, in 2 sensation improved, and in 2 less sensitivity was noticed suggesting neurological evolution.
When comparing the different evaluation techniques, a different outcome (absent/present) was found in ± 70% (Pearson <0.005). When comparing AIS complete and incomplete, touch sensation in the perineal dermatomes had the best correlation of absence in complete and presence in incomplete lesions (91% and 96%), sensation of bladder filling and EPT had a lower correlation (58% and 34%) and (39% and 87%) respectively, but all correlations were statistically significant. These data show that specific afferent innervation of the LUT can be much better preserved than expected from clinical neurological examination. It also shows that every test gives supplementary specific information.
There are easy and valid investigations of the afferent innervation of the LUT after SCI. Different tests give supplementary information on sensory pathways and the findings have clinical value. More afferent pathways seem to remain active than expected from clinical neurological examination.
1. Aito S and D’Andrea M. Clinical assessment in Spinal Cord Injury. In: ISCos textbook on comprehensive management of spinal cord injuries (Ed Chhabra HS), Wolters Kluwer , New Delhi 2015, chapter 5, pp68-99.
2. Wyndaele JJ, Kovindha A. Urodynamic testing after spinal cord injury. A practical guide. Springer 2017; chapter 3, pp 11-12.
3. Van Meel TD, Wyndaele JJ. Reproducibility of Electrical Sensory Testing in Lower Urinary Tract at Weekly Intervals in Healthy Volunteers and Women With Non-neurogenic Detrusor Overactivity. Urology. 2012 Mar;79(3):526-31.


Bachelor Medical Sciences, Doctor in Medical Sciences-Surgery and Obstetrics, Specialist in Urology, PhD in Biomedical Science, Specialist in Rehabilitation, Second PhD in Urology Higher Education. Till his retirement in 2014, he worked as Full time Ordinary Professor and Chairman of Urology at University Antwerp (UA) and Antwerp University Hospital (UZA). He was the chair of the Animal and Clinical Research Lab of the Urological Department UA and UZA. He promoted 16 PhD Thesis’s and these doctors are working in different continents around the world and several hold academic senior positions. He continues scientific work in the field of SCI, bladder pain and functional urology. He is Fellow of the International Spinal Cord Society. He is member of many major international scientific groups. He is the actual chair of ESSIC, the International organisation for study of bladder pain syndrome. He is a past president of International Spinal Cord Society and the previous editor in chief of Spinal Cord and Spinal Cord Series & Cases. He is author of 373 publications in peer reviewed international and national journals, 94 editorials, 33 chapters in books and editor of 4 books.. He has been awarded several national and international prices, and is Grand Officer in the Order of the Crown Belgium.
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Dr Inge Eriks-hoogland
Swiss Paraplegic Centre

Evidence based clinical practice guideline for follow-up care after spinal cord injury

12:15 PM - 12:30 PM


Prevalence of secondary health conditions (SHC) in persons with spinal cord injury (SCI) is high and life expectancy of persons with SCI is still lower compared to able-bodied persons. Although it is established that follow-up care programs across the life span prevent health problems, current follow-up care programs are mostly expert opinion based and vary widely regarding content, frequency and setting. In order to provide patients with SCI up-to-date and best possible medical and rehabilitative care, an evidence based clinical practice guideline for follow-up care is needed.

Establish an evidence based clinical practice guideline for follow-up care for persons with SCI.

The German speaking society of Paraplegia (DMGP) commissioned their members to establish a guideline conform the guidance for AWMF (Association of the Scientific Medical Societies in Germany).

According to the guidance of the AWMF, a systematic review was performed to:

1. search for existing guidelines and literature for follow-up care programs and a methodological appraisal. All guidelines were evaluated according to the DELBI (German Guideline rating system) and literature according to the Scottish Intercollegiate Guideline Network (SIGN).

2. define secondary health problems based on existing literature and expert opinion to be included in the guideline (prevalence, severity, modifiability )

3. define population and sub-populations, frequency and setting of follow-up care and suggested outcome measures based on current evidence (existing guidelines, publications, expert opinion)

After a structured consensus process with SCI specialists and country representatives of patient association, level of evidence and grading of recommendation were defined.

The systematic review found 62 guidelines, 48 Cochrane reviews (spinal Cord injury) and 2963 publications. After title and abstract screening, 79 publications were full text read by two independent reviewers. All guidelines and publications were checked for their suitability and, if included, rated/classified according to the AWMF guidance. None of the guidelines of papers described an evidence based comprehensive clinical practice guideline for follow-up care.

In order to define health problems to be included in the guideline a second review of existing guidelines, literature and other sources was performed, discussed and completed by eight medical SCI specialist. This resulted in following health themes for regular follow-up care: 1. Nervous system including spasticity, sleep and cognitive function, 2. Neuropathic Pain, 3. Cardiovascular system, 4. Respiratory System including Sleep associated breathing disorders, 5. Immune system, 6. Digestive tract including Bowel, 7. Endocrine System and nutrition, 8. Urogenital System including sexual function, 9. Pregnancy and birth, 10. Musculoskeletal System, 11. Skin, 12. Psychological and psychiatric problems, 13. Medication and Polypharmacy.

Based on a specific literature review complemented with expert opinion for those health themes, a clinical practice guideline for follow-up care across the lifespan including content (patient interview, clinical exam, extended diagnostics and preferred outcome measures) as well as frequency and setting of follow-up care was defined.

The German speaking Society of Paraplegia established according to the guidance of the AWMF, an evidence based follow-up program for persons with spinal cord injury including content, frequency and outcome measures.


MD, PhD, Senior Physician Outpatient clinic Swiss Paraplegic Centre.