Objective: To evaluate the association between cardiovascular disease (CVD) and spinal cord injury (SCI) in a large representative sample.Methods: Data were compiled from more than 60,000 individuals from the 2010 cycle of the cross-sectional Canadian Community Health Survey (CCHS). Multivariable logistic regression analysis was conducted to examine this relationship, adjusting for confounders and using probability weighting to account for the CCHS sampling method.Results: After adjusting for age and sex, SCI was associated with a significant increased odds of heart disease (adjusted odds ratio [OR] 5 2.72, 95% confidence interval [CI] 1.94-3.82) and stroke (adjusted OR 5 3.72, 95% CI 2.22-6.23).Conclusions: These remarkably heightened odds highlight the exigent need for targeted interventions and prevention strategies addressing modifiable risk factors for CVD in individuals with SCI. Over the last decade, there have been marked changes in the trends of morbidity and mortality among individuals with spinal cord injury (SCI). With advances in acute care and in the management of septicemia, renal failure, and pneumonia, cardiovascular complications are now a leading cause of death in those with SCI. 1 Moreover, several risk factors for cardiovascular disease (CVD) are amplified in individuals with SCI compared with able-bodied individuals, including physical inactivity, dyslipidemia, blood pressure irregularities, chronic inflammation, and abnormal glycemic control. 2-22While most of the literature with respect to CVD and SCI has shown a higher prevalence of risk factors for CVD, 2-22 relatively few studies have examined the prevalence of CVD itself and corresponding risk estimates. [23][24][25][26] None of these studies has provided direct comparisons of risk estimates for multiple CVD outcomes in the SCI population compared to a non-SCI population, with appropriate adjustment for confounding, in a large representative sample.It thus remains unknown whether there is excess risk of both heart disease and stroke (after adjustment for potential confounders) in individuals with SCI. The current study addresses this knowledge gap by utilizing the national Canadian Community Health Survey (CCHS), which is comprised of comprehensive, up-to-date, cross-sectional data. Our aim was to estimate the prevalence of heart disease and stroke outcomes in the SCI population, to compare their risk with a non-SCI population, and to investigate this relationship after controlling for confounders.

Study Design: Secure, web-based survey. Objectives: Obtain information from the spinal cord injured (SCI) population regarding sexual dysfunctions, with the aim of developing new basic science and clinical research and eventual therapies targeting these issues. Setting: Worldwide web. Methods: Individuals 18 years or older living with SCI. Participants obtained a pass-code to enter a secure website and answered survey questions. A total of 286 subjects completed the survey. Results: The majority of participants stated that their SCI altered their sexual sense of self and that improving their sexual function would improve their quality of life (QoL). The primary reason for pursuing sexual activity was for intimacy need, not fertility. Bladder and bowel concerns during sexual activity were not strong enough to deter the majority of the population from engaging in sexual activity. However, in the subset of individuals concerned about bladder and/or bowel incontinence during sexual activity, this was a highly significant issue. In addition, the occurrence of autonomic dysreflexia (AD) during typical bladder or bowel care was a significant variable predicting the occurrence and distress of AD during sexual activity. Conclusion: Sexual function and its resultant impact on QoL is a major issue to an overwhelming majority of people living with SCI. This certainly constitutes the need for expanding research in multiple aspects to develop future therapeutic interventions for sexual health and SCI.

No abstract

BackgroundExoskeleton technology has potential benefits for wheelchair users’ health and mobility. However, there are practical barriers to their everyday use as a mobility device. To further understand potential exoskeleton use, and facilitate the development of new technologies, a study was undertaken to explore perspectives of wheelchair users and healthcare professionals on reasons for use of exoskeleton technology, and the importance of a variety of device characteristics.MethodsAn online survey with quantitative and qualitative components was conducted with wheelchair users and healthcare professionals working directly with individuals with mobility impairments. Respondents rated whether they would use or recommend an exoskeleton for four potential reasons. Seventeen design features were rated and compared in terms of their importance. An exploratory factor analysis was conducted to categorize the 17 design features into meaningful groupings. Content analysis was used to identify themes for the open ended questions regarding reasons for use of an exoskeleton.Results481 survey responses were analyzed, 354 from wheelchair users and 127 from healthcare professionals. The most highly rated reason for potential use or recommendation of an exoskeleton was health benefits. Of the design features, 4 had a median rating of very important: minimization of falls risk, comfort, putting on/taking off the device, and purchase cost. Factor analysis identified two main categories of design features: Functional Activities and Technology Characteristics. Qualitative findings indicated that health and physical benefits, use for activity and access reasons, and psychosocial benefits were important considerations in whether to use or recommend an exoskeleton.ConclusionsThis study emphasizes the importance of developing future exoskeletons that are comfortable, affordable, minimize fall risk, and enable functional activities. Findings from this study can be utilized to inform the priorities for future development of this technology.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-169) contains supplementary material, which is available to authorized users.

Study design: Secure, web-based survey. Objectives: Elicit specific information about sexual function from men with spinal cord injuries (SCI). Setting: World-wide web. Methods: Individuals 18 years or older living with SCI obtained a pass-code to enter a secure website and then answered survey questions. Results: The presence of genital sensation was positively correlated with the ability to feel a build up of sexual tension in the body during sexual stimulation and in the feeling that mental arousal translates to the genitals as physical sensation. There was an inverse relationship between developing new areas of arousal above the level of lesion and not having sensation or movement below the lesion. A positive relationship existed between the occurrence of spasticity during sexual activity and erectile ability. Roughly 60% of the subjects had tried some type of erection enhancing method. Only 48% had successfully achieved ejaculation postinjury and the most commonly used methods were hand stimulation, sexual intercourse, and vibrostimulation. The most commonly cited reasons for trying to ejaculate were for pleasure and for sexual intimacy. Less than half reported having experienced orgasm postinjury and this was influenced by the length of time postinjury and sacral sparing. Conclusion: SCI not only impairs male erectile function and ejaculatory ability, but also alters sexual arousal in a manner suggestive of neuroplasticity. More research needs to be pursued in a manner encompassing all aspects of sexual function.

The low-frequency asynchronous switch design (LF-ASD) was introduced as a direct brain-computer interface (BCI) technology for asynchronous control applications. The LF-ASD operates as an asynchronous brain switch (ABS) which is activated only when a user intends control and maintains an inactive state output when the user is not meaning to control the device (i.e., they may be idle, thinking about a problem, or performing some other action). Results from LF-ASD evaluations have shown promise, although the reported error rates are too high for most practical applications. This paper presents the evaluation of four new LF-ASD designs with data collected from individuals with high-level spinal cord injuries and able-bodied subjects. These new designs incorporated electroencephalographic energy normalization and feature space dimensionality reduction. The error characteristics of the new ABS designs were significantly better than the LF-ASD design with true positive rate increases of approximately 33% for false positive rates in the range of 1%-2%. The results demonstrate that the dimensionality of the LF-ASD feature space can be reduced without performance degradation. The results also confirm previous findings that spinal cord-injured subjects can operate ABS designs to the same ability as able-bodied subjects.

Objective: The objective of this study was to evaluate the association between spinal cord injury (SCI) and type 2 diabetes in a large representative sample and to determine whether an association exists irrespective of known risk factors for type 2 diabetes.Methods: Data were obtained on 60,678 respondents to the Statistics Canada 2010 Cycle of the cross-sectional Canadian Community Health Survey. Multivariable logistic regression, incorporating adjustment for confounders and probability weights to account for the Canadian Community Health Survey sampling method, was conducted to quantify this association.Results: After adjustment for both sex and age, SCI was associated with a significant increased odds of type 2 diabetes (adjusted odds ratio 5 1.66, 95% confidence interval 1.16-2.36). These heightened odds persisted after additional adjustment for smoking status, hypertension status, body mass index, daily physical activity, alcohol intake, and daily consumption of fruits and vegetables (fully adjusted odds ratio 5 2.45, 95% confidence interval 1.34-4.47). Conclusions:There is a strong association between SCI and type 2 diabetes, which is not ex- Over the last decade, researchers have noted important changes in the trends of morbidity and mortality among individuals with spinal cord injury (SCI). With advances in acute care and in the management of septicemia, renal failure, and pneumonia, chronic conditions are becoming a focus. The etiology of these comorbidities may extend beyond physical disability and may be compounded by additional autonomic and metabolic changes that occur as a result of the loss of descending control.

Study design: Secure, web-based survey. Objectives: Elicit specific information about sexual function from women with spinal cord injuries (SCI). Setting: World-wide web. Methods: Individuals 18 years or older living with SCI obtained a pass code to enter a secure website and then answered survey questions. Results: Bladder and/or bowel incontinence during sexual activity and/or sexual intercourse were significant concerns and prevented some women from seeking sexual activity. Autonomic dysreflexia (AD) during sexual activity was interpreted negatively by many and was found to interfere with sexual activity. Most subjects reported difficulty becoming psychologically aroused as well as physically aroused, which were both correlated with feeling that their SCI had altered their sexual sense of self. An inverse relationship existed between developing new areas of arousal above the level of lesion and not having sensation or movement below the lesion. The most commonly reported sexual stimulation leading to the best arousal involved stimulation of the head/neck and torso areas. The majority of subjects reported having experienced intercourse postinjury. Most participants reported difficulty with positioning during foreplay and intercourse, vaginal lubrication, and spasticity during intercourse. Almost half reported experiencing orgasm postinjury and this was positively associated with the presence of genital sensation. Conclusion: SCI significantly impairs psychological and physical aspects of female sexual arousal. In addition, bladder and bowel incontinence as well as AD negatively impact sexual activity and intercourse.