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Study design: Prospective cohort study. Objectives: To evaluate the effects of wheelchair skills training (WSTR) for participants with spinal cord injury (SCI) during peer-led Active Rehabilitation Camps (ARC) in Poland. We hypothesized that participation in ARC will improve wheelchair skill performance and self-efficacy in individuals with SCI. We also aimed to determine demographic and injury-related factors associated with greater improvements in wheelchair skill performance and self-efficacy. Setting: Thirteen consecutive ARCs in Poland. Methods: Participants (n= 122) with traumatic or nontraumatic SCI older than 16 years were evaluated at the beginning (T1) and completion (T2) of ARC and at 3-month follow-up (T3) through the Queensland Evaluation of Wheelchair Skills (QEWS) and the Wheelchair Skills Test Questionnaire (WST-Q). Results: At T2, 43% of participants reached the threshold for substantial clinically meaningful change in QEWS, 73% in WST-Q capacity, and 67% in confidence, with approximately half of those reporting such gains at T3. At a group level, participants achieved small effect-size improvements (QEWS) at T2; large effects in wheelchair skills capacity at T2 and T3; large effects in wheelchair skill confidence at T2, and low effects at T3. Prior attendance to ARC was the only independent variable that explained 10% of variance in wheelchair capacity gains. Conclusions: Peer-led WSTR during ARCs is highly effective at improving wheelchair skills in individuals with SCI. These improvements are largely retained after three months. Persons with SCI should have a chance to participate in more than one camp to maintain and further improve their wheelchair skills.

Study design: Psychometric study. Objectives: To i) describe the translation process and ii) explore the data completeness, targeting, reliability and aspects of validity of the Swedish version of Moorong Self-Efficacy Scale (s-MSES). Settings: Community rehabilitation program. Methods: Ninety-two program participants and 42 peer mentors with spinal cord injury (SCI) in Active Rehabilitation training programs (enrolled in the International Project for the Evaluation of activE Rehabilitation (Inter-PEER)) were included. The s-MSES was completed online, once for program participants and twice for peer mentors. The translation process was based on guidelines and involved researchers, clinicians and consumers. Results: Minor linguistic adaptations were made. Ninety-one percent obtained a total score. As expected, peer mentors exhibited ceiling effects in all subscales. Cronbach´s alpha for the total scale was 0.92 (subscales 0.74–0.83). The intraclass correlation coefficient was excellent for the total and subscale scores (0.78–0.91). The s-MSES exhibited sensitivity to changes and there were no systematic changes between evaluation points. The s-MSES correlated significantly and positively with life satisfaction and resilience, and negatively with depression/anxiety. Conclusion: The s-MSES was translated through a rigorous, consumer-involved process ensuring accurate linguistic translation and cultural adaptation. Our results support the data completeness, targeting, reliability and aspects of validity of the s-MSES. The s-MSES can thus be considered suitable to assess self-efficacy in persons with SCI in community rehabilitation settings. The now available Swedish version of the MSES will facilitate national research, clinical evaluations and international comparisons. Sponsorship: Not applicable.

Study design: Qualitative study. Objectives: To explore how peer mentors with spinal cord injury (SCI) experience their role in Active Rehabilitation programs in Sweden. Setting: Community peer-based training programs in Sweden. Methods: Twenty active peer mentors were strategically selected and invited to participate. Nine individuals of diverse age, level of SCI and time since injury participated in semi-structured interviews via video link. Qualitative content analysis was used to analyze the data. Results: The theme: Being a vulnerable superhero—a balancing act with rewardswas based upon five categories: Being a suitable fit for a demanding culture, Offering a shortcut to coping with spinal cord injury life, Feeling rewarded by helping others, Building trust is reciprocal, and Constituting the norm in a temporary community. The peer mentors expressed vulnerability of sharing life experiences, being a role model and building relationships with mentees. The theme emerged from notions of high expectations and demands of the SCI peer mentor role. Being a peer mentor empowered, educated and inspired the peer mentors themselves. Conclusions: Peer mentors were continuously balancing between being open and vulnerable, and being strong and capable. Personality traits were reported as more important aspects of the role than physical skills. The individual mentor-mentee meetings and relationships were considered more important than the actual training sessions. Feeling part of a community and the norm through meeting others in a similar situation was perceived as a reward and motivation for participating as a peer mentor.

Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation in the intensive care unit. The incidence, patient characteristics, and outcomes have not been described in a regional Australian setting.

Study design: Systematic review with meta-analysis. Objectives: To explore temporal changes in incidence rates, demographic and injury characteristics of incident traumatic spinal cord injury (TSCI) in Nordic countries. Methods: Peer-reviewed publications and periodic reports about epidemiology of TSCI in the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) are identified, reviewed and included in the meta-analysis. Data are stratified into 20-year intervals to allow for chronological comparisons. Pooled estimates are derived using random effects meta-analysis. Results: Twenty-three data sources are included presenting a total of 5416 cases. The pooled incidence rate for 2001–2020 is 15.4 cases/million/year compared to 17.6 and 18.3 cases/million/year during the two previous 20-year intervals. The proportion of cases with TSCI in the 15–29 age-group decreases from 50% (1961–1980) to 20% (2001–2020), while it increases from 9% to 35% in 60+ age-group. Transportation-related injuries decrease from 44% (1961–1980) to 27% (2001–2020). Conversely, fall-related injuries increase from 32% (1961–1980) to 46% (2001–2020). The proportion of individuals with incomplete tetraplegia increases from 31% (1961–1980) to 43% (2001–2020), while complete paraplegia decreases from 25% to 16%. Conclusion: The characteristics of TSCI in the Nordic countries have changed drastically over the last six decades, in line with clinical experiences, and limited research evidence from other countries. These changes indicate the need for adapting research focus, prevention strategies, design and provision of care, rehabilitation and community services towards older individuals, fall-related injuries, and incomplete injuries in Nordic countries and other settings internationally where such changes occur.

Study design:: Prospective cohort study with a repeated measures analysis. Objectives:: To measure the effects of the Active Rehabilitation (AR) training programme for community-dwelling individuals with spinal cord injury (SCI) in Botswana on physical independence, wheelchair mobility, self-efficacy, life satisfaction, level of physical activity and community participation. Setting:: The inaugural AR training programme in Botswana, a community peer-based programme for people with SCI. The 10-day residential programme in Botswana was led by an international team of peer mentors and health professionals. Methods:: Participants with SCI (on average 4 years after injury) completed a survey comprising a battery of standardised outcome measures at three timepoints: at the start, on completion and at 5 months after the programme (n?=?14). Participants also completed a practical wheelchair skills test at start and completion of the programme (n?=?17). Results:: Participants improved in the mobility subscale of the Spinal Cord Independence Measure Self Report on completion (p?=?0.011, d?=?0.85) and at 5-month follow-up (p?=?0.005, d?=?0.93) as compared to baseline. They also achieved moderate improvement in self-efficacy to manage their condition (physical function domain of Moorong Self-Efficacy Scale) and large improvements in wheelchair mobility as assessed through the Queensland Evaluation of Wheelchair Skills test and the Wheelchair Skills Test Questionnaire. All positive results were retained at 5-month follow-up. Conclusions:: Findings indicate that the peer-based programme AR can play an important role in promoting physical independence, wheelchair mobility and injury-management self-efficacy in community-dwelling individuals with SCI in Botswana.

Introduction:Active Rehabilitation (AR) is a community peer-based approach that started in Sweden in 1976. As a key component of the approach, AR training camps provide intensive, goal-oriented, intentional, group-based, customised training and peer-support opportunities in a community environment for individuals with spinal cord injury.Study design:Prospective cross-sectional study.Objectives:To describe the profile of the organisations that use components of the AR approach, and to explore the characteristics and the international variations of the approach.Setting:Twenty-two organisations from 21 countries from Europe, Asia and Africa reported using components of the AR approach during the past 10 years.Methods:An electronic survey was developed and distributed through a personalised email. Sampling involved a prospective identification of organisations that met the inclusion criteria and snowball strategies.Results:While there were many collaborating links between the organisations, RG Active Rehabilitation from Sweden and Motivation Charitable Trust from the United Kingdom were identified as key supporting organisations. The 10 key elements of the AR approach were found to be used uniformly across the participating organisations. Small variations were associated with variations in country income and key supporting organisation.Conclusions:This is the first study to describe the key elements and international variations of the AR approach. This will provide the basis for further studies exploring the effectiveness of the approach, it will likely facilitate international collaboration on research and operational aspects and it could potentially support higher integration in the health-care system and long-term funding of these programmes.

Study design:Systematic review and meta-synthesis of qualitative findings.Objectives:To establish the perceived effectiveness and mechanisms of community peer-based programmes based on narratives of consumers with spinal cord injury (SCI).Methods:Scopus, Academic Search Complete, CINAHL, Health Source, Medline, PsycARTICLES, PsychINFO, SPORTSDiscus and ProQuest were searched for articles published in English between January 1990 and December 2015. Qualitative studies referring to community peer-based interventions were included if most cases had a SCI. The results section of included studies was extracted and entered in NVivo. Data were inductively coded and analysed according to the three phases of Thematic Synthesis.Results:The search yielded 1402 unique records, out of which 126 were scrutinised in full. Four studies were appraised based on eight criteria and were finally included in the analysis. Three analytical themes emerged: (1) a unique learning environment created by the right mixture of learning resources, learning processes and a can-do attitude; (2) peer mentors—a unique learning resource with high level of relatedness that eases and empowers participants; and (3) an intervention that responds to important unmet needs and unrealised potential.Conclusions:Community peer-based programmes for people with SCI provide individualised training in important life areas, using a variety of learning resources and a plethora of learning processes. The high level of perceived effectiveness suggests that this type of intervention is an important tool of health systems post discharge from initial rehabilitation. Community organisations should be supported with evaluating their programmes through quality research.

AbstractBackground:Little is known about the possible impact of the system of care on mortality during the first year after acute traumatic spinal cord injury (TSCI).Objective:To evaluate latemortality (ie, >7 days after trauma) during the first year after acute TSCI in 2 European Union (EU) regions, Thessaloniki in Greece and Stockholm in Sweden.Methods:This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS), which is a prospective, population-based study. Incidence cohorts of TSCI cases were identified and followed up in both study regions through STATSCIS. Data from Thessaloniki region were collected through physical examination, medical records review, and interviews with TSCI individuals and the medical teams. Data from Stockholm were retrieved mainly from the Nordic Spinal Cord Injury Registry, as well as from direct contact with all intensive care facilities of the region.Results:The annual case mortality rate after acute TSCI was nearly 20% in Thessaloniki and 0% in Stockholm. The mean time of survival after trauma for the 12 mortality cases of Thessaloniki was 47 days (median = 24, SD±67, range = 8–228). Factors associated with mortality were higher age and presence of comorbid spinal disorders but also the inefficient transfer logistics, initially missed spinal instability, and unsuccessfully treated complications.Conclusions:The annual case mortality rate in Thessaloniki was dramatically higher than in Stockholm. The different approaches to care, one systematic and the other not, is postulated to be an important factor leading to such major discrepancies between the outcomes of these 2 EU regions.

To investigate, by transcranial magnetic stimulation, the effects of valproate on silent period and corticomotor excitability. Methods: thirty patients with generalized epilepsy were studied at baseline, and re‐examined 4 (S1) and 25 (S2) weeks after the administration of valproate (mean dose: 1040 ± 284 mg). Transcranial magnetic stimulation was performed with a figure of eight coil (recording, first dorsal interosseous). Threshold was measured at 1% steps. Silent period was measured using a recently described protocol. Briefly, silent periods were elicited at 5% increments from 0 to 100% maximum stimulus intensity. At each stimulus intensity, 4 silent periods were obtained and the average value of silent period duration was used to construct a stimulus/response curve of stimulus intensity versus silent period. The resulting curves were then fitted to a Boltzman function and were statistically compared. The motor‐evoked potential recruitment curve was constructed under active conditions and analyzed in a similar way. Valproate increased threshold from 36.5 ± 5.99% at baseline to 41.02 ± 7.84% at S1 (p < 0.0001, paired t‐test). The maximum value of the silent period curve decreased from 257.5 ± 3.9 ms at baseline to 230.3 ± 3.9 ms at S1 (p < 0.0001, F‐test and AIC) while the other best‐fit values (V50, slope, threshold) were not significantly affected. Regarding the motor‐evoked potential recruitment curve, the maximum value decreased significantly post‐drug (from 0.449 ± 0.007 to 0.392 ± 0.009, p < 0.01, F‐test and AIC test), whereas the rest of the best‐fit values remained unaffected. In patients with idiopathic generalized epilepsy, valproate increases threshold and reduces the maximum values of the silent period curve and the motor‐evoked potential recruitment curve. These findings probably reflect valproate's effects on voltage‐dependent Na+channels, as well as an activation of GABAAreceptors.

We used Lamotrigine LTG (50-600mg /24h) in 12 patients, 58-to 95-years-old (A Group) and other antiepileptics in nine patients (B Group) with the diagnosis of probable Alzheimer's disease (AD) and seizures. We also administered LTG (50-700mg/24h) in 16 patients (C Group) and other antiepileptics in nine patients (D Group) with other neurological disorders with cognitive disorders and seizures. The results showed that in eight from 12 patients with AD, and in nine from 16 with other neurological disorders, seizures stopped after treatment with LTG—while in five from nine patients with AD and six from 18 with other neurological disorders, seizures stopped after treatment with other antiepileptic drugs. Side effects in 28 patients treated with LTG included only three mild rashes, while side effects in 18 patients treated with other antiepileptic drugs included—six patients with fatigue, two with rashes, one with dizziness, one with low platelets, one with sleepiness and one with loss of hair. Conclusively, this study shows that LTG is an effective and safe monotherapy in patients with cognitive disorders and AD.

Myasthenia gravis (MG) is a neuromuscular disorder in which antibodies are directed against the nicotinic acetylcholine receptor (AChR) at the neuromuscular junction. Some investigators describe the existence of oligoclonal IgG bands and anti-AChR antibodies in the cerebrospinal fluid (CSF) of MG patients while other refuse it. This study was performed in 15 patients with clinical and electrophysiological diagnosis of MG. Oligoclonal IgG bands (OCB) and antibodies to the AChR from human skeletal muscle were determined in the serum and the CSF of the above MG patients. The last one was done in order to investigate any possible central nervous system (CNS) involvement.It was found that all the MG patients who had a high titre of anti- AChR antibodies in the serum (mean titre 29.2±24.3 nM, range 1.8 to 62 nM) did not present OCB and anti-AChR antibodies in their CSF. On the same time, in a group of 10 patients with a definite multiple sclerosis it was found that eight of them presented OCB in their CSF while the results were negative in another group of 10 patients without evidence of CNS disease. The last two groups served as control groups.Our findings are in accordance with the concept that MG is a pure neuromuscular disorder.

A combination of anti‐epileptic drugs is used for the necessary control of seizures. This results in a modulation of the metabolism in the epileptic patient and a concentration of the drugs and their metabolites in serum and in the brain, the target organ. Carbamazepine‐10,11 epoxide (CBZE) is the main active metabolite of carbamazepine (CBZ). We have studied their interrelationship in concentrations in the plasma of 68 patients receiving CBZ, either as monotherapy or in combination with phenytoin (PHT) and phenobarbital (PB). The rate of CBZ metabolism was modulated in drug co‐administration, which, depending on the grade of the induction of cytochrome p‐450, decreases or increases the concentration of CBZE. A graph plotting the relationship between CBZ and CBZE concentrations in patients stabilized on a regime of CBZ alone is linear. The ratio of concentrations of CBZE/CBZ in serum is 0.12 when CBZ is administered as monotherapy, rising to 0.14 (CBZ + PB), 0.18 (CBZ + PHT) and 0.25 (CBZ + PHT + PB) when administered with the other drugs mentioned. From this it can be hypothesized that the additive of induction activities of PHT and PB operates on the mixed function oxidase system.