These findings confirm both a substantial population of men with SCI and with testosterone deficiency, and a significant association between testosterone level and severity of SCI. Measuring serum total testosterone levels should be included in standard screenings for patients with SCI, particularly those with motor complete injuries.

Online video is an accessible, effective, and well-accepted way to present ongoing SCI education and can reach a wider geographical audience than in-person presentations.

Background Pregnant women with congenital or acquired spinal cord injury face challenges due to compromised neurologic function and mobility, factors that may also affect fetal/infant health. Few studies have examined pregnancy course and longer‐term outcomes in this population. Objective To assess pregnancy outcomes among women with spinal cord injury, paralysis, or spina bifida using population‐based data. Design Retrospective cohort study. Setting Washington state linked birth‐hospital discharge records. Participants All women (N = 529) with spinal cord injury, paralysis, or spina bifida with singleton live birth deliveries 1987‐2012, and a comparison group of women without disabilities (N = 5282). Methods Diagnosis codes were screened to identify cases and a 10:1 random sample of comparison women. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated overall and separately for each condition using multivariable regression. Subsequent hospitalizations or death were identified via linkage to hospital discharge/death records for 2 years after delivery. Main Outcome Measurements Pregnancy course (weight gain, gestational diabetes, preeclampsia, infection, venous thromboembolism), delivery/labor characteristics, infant characteristics (birthweight/size, gestational age), and longer‐term outcomes (occurrence/reasons for maternal/infant rehospitalization, mortality). Results Women with these spinal conditions had increased adjusted risks of prenatal urinary tract infection/pyelonephritis (RR 26.43, 95% CI 13.97‐49.99), venous thromboembolism (RR 9.16, 95% CI 2.17‐38.60), preterm rupture of membranes (RR 2.15, 95% CI 1.18‐3.90), and cesarean delivery (RR 1.88, 95% CI 1.70‐2.09). They had longer hospitalizations and increased rehospitalization (RR 1.54, 95% CI 1.28‐1.87), including for postpartum depression (RR 8.15, 4.29‐15.48) or injury (RR 13.05, 95% CI 6.60‐25.81). Their infants were more often small for gestational age (RR 1.65, 95% CI 1.33‐2.06), but had no increased risk of rehospitalization or death. Conclusions We observed no increased long‐term morbidity among infants of women with these conditions. Possible increased maternal morbidities during the first postpartum years indicate areas for intervention. Level of Evidence III.

Study Objectives: Obstructive sleep apnea (OSA) predicts poor functional outcome after stroke and increases the risk for recurrent stroke. Less is known about continuous positive airway pressure (CPAP) treatment on stroke recovery. Methods: In a pilot randomized, double-blind, sham-controlled trial, adult stroke rehabilitation patients were assigned to auto-titrating or sham CPAP without diagnostic testing for OSA. Change in Functional Independence Measure (FIM), a measure of disability, was assessed between rehabilitation admission and discharge. Results: Over 18 months, 40 patients were enrolled and 10 withdrew from the study: 7 from active and 3 from sham CPAP (p > 0.10). For the remaining 30 patients, median duration of CPAP use was 14 days. Average CPAP use was 3.7 h/night, with at least 4 h nightly use among 15 patients. Adherence was not influenced by treatment assignment or stroke severity. In intention-to-treat analyses (n = 40), the median change in FIM favored active CPAP over sham but did not reach statistical significance (34 versus 26, p = 0.25), except for the cognitive component (6 versus 2.5, p = 0.04). The on-treatment analyses (n = 30) yielded similar results (total FIM: 32 versus 26, p = 0.11; cognitive FIM: 6 versus 2, p = 0.06). Conclusions: A sham-controlled CPAP trial among stroke rehabilitation patients was feasible in terms of recruitment, treatment without diagnostic testing and adequate blinding-though was limited by study retention and CPAP adherence. Despite these limitations, a trend towards a benefit of CPAP on recovery was evident. Tolerance and adherence must be improved before the full benefits of CPAP on recovery can be assessed in larger trials. I NTRO DUCTI O N Stroke is the leading cause of long-term disability in the UnitedStates, yet treatments that improve function after stroke are limited. Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for ischemic and hemorrhagic stroke, 1,2 with prevalence after stroke or transient ischemic attack estimated to be over 70%.3 Stroke patients with OSA compared to those without have worse functional outcome, longer hospitalization and rehabilitation stays, and higher mortality. [4][5][6][7][8][9] Despite the high risk of sleep apnea among patients with stroke and the implications for both stroke recovery and recurrent stroke, few stroke survivors undergo screening, testing, or treatment for OSA. 10 Barriers to evaluation and treatment involve OSA awareness among stroke survivors and clinical providers, access to in-laboratory polysomnography (PSG) testing, and the lack of consensus among stroke providers on the ideal timing for sleep testing.Treatment with continuous positive airway pressure (CPAP) among patients diagnosed with OSA is associated with improved functional and motor outcome after stroke, 11 but trials are limited by poor CPAP tolerance and adherence. 12,13 Compared to the general OSA population, patients with acute stroke are typically older with more functional disability and may have more diffic...

Study design: Retrospective chart review. Objective: To define the temporal course of weight gain in persons with new spinal cord injury (SCI), and to identify predictors of weight gain in this population. Setting: A United States Department of Veterans Affairs (VA) SCI Unit. Methods: A retrospective chart review in a VA SCI Unit was conducted. Participants (n = 85) included all persons with new SCI completing initial rehabilitation at the center between 1998 and 2006. Outcome measures were mean change in body mass index (BMI) between rehabilitation admission and final follow-up, time of greatest BMI change, and distribution of participants by BMI classification. These measures were also examined relative to SCI level, American Spinal Injury Association Impairment Scale (AIS) grade, primary mode of mobility, and age at rehabilitation admission. Results: Mean BMI increased by 2.3 kg/m 2 between rehabilitation admission (mean 45 days post-injury) and final follow-up (mean 5 years post-injury). The distribution of participants shifted from lower BMI classifications at rehabilitation admission to higher BMI classifications at final follow-up. For participants transitioning from normal to overweight or obese, the greatest increase occurred during the first year after acute rehabilitation. Neurological level, impairment category, primary mode of mobility, and age at rehabilitation admission did not significantly predict BMI change. BMI at rehabilitation admission correlated significantly with BMI at final follow-up (P < 0.0005). Conclusions: These findings confirm a significant increase in BMI after new SCI and suggest that persons with new SCI are at greatest weight gain risk during the first year following acute rehabilitation.