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  • Evidence
    • Acute Evidence
      • Cardiovascular Complications during the Acute Phase of Spinal Cord Injury
        • Methods
        • Introduction
        • Anatomy of the Autonomic Nervous System
        • Effect of Disrupted Autonomic Control on the Cardiovascular System
        • Cardiovascular Complications during Acute SCI
          • Neurogenic Shock
          • Orthostatic Hypotension
          • Autonomic Dysreflexia
          • Bradycardia and Arrhythmias
        • Interventions for Cardiovascular Complications during Acute SCI
          • Interventions for Neurogenic Shock
            • Pharmacological Interventions for Neurogenic Shock
          • Interventions for Treatment of Orthostatic Hypotension
            • Non-pharmacological Interventions for Orthostatic Hypotension
            • Pharmacological Interventions for Orthostatic Hypotension
          • Interventions for Hemodynamic Management
          • Interventions for Bradycardia
            • Pharmacological Interventions for Bradycardia
            • Surgical Interventions for Bradycardia
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Neuroprotection during the Acute Phase of Spinal Cord Injury
        • Methods
        • Abbreviations
        • Introduction
          • Phases of Injury
          • Overview of Secondary Injuries
        • Pharmaceutical Agents for Neuroprotection during Acute SCI
          • Steroids
          • Naloxone
          • Tirilazad Mesylate
          • Nimodipine
          • Erythropoietin
          • GM-1 Ganglioside
          • Granulocyte-Colony Stimulating Factor
          • Thyrotropin-Releasing Hormone
          • Gacyclidine
        • Additional Phase I and Phase II Clinical Trials for Neuroprotective Pharmaceutical Agents during Acute SCI
        • Summary
        • References
      • Respiratory Management during the Acute Phase of Spinal Cord Injury
        • Methods
        • Introduction
          • Neuronal Control of Breathing
          • Measurements for Lung Volume and Lung Capacity
          • Pulmonary Complications during Acute SCI
        • Mechanical Ventilation
          • Intubation
          • Tracheostomy
          • Comparative or Combination Interventions
          • Timing of Mechanical Ventilation
          • Secretion Removal Techniques during Acute SCI
          • Ventilation Weaning, Extubation and Decannulation
        • Non-Pharmacological Interventions for Pulmonary Function Improvement during Acute SCI
          • Respiratory Muscle Training
          • Diaphragm Pacing
          • Intermittent Positive Pressure Breathing for Acute SCI patients
        • Pharmacological Interventions for Pulmonary Function Improvement during Acute SCI
        • Hospital Programs for Respiratory Management during Acute SCI
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Imaging of Spinal Cord Injuries
        • Methods
        • Introduction
        • Radiography and Computed Tomography (CT)
        • Magnetic Resonance Imaging (MRI)
          • Spinal Cord Injury Without Radiographic Abnormality
        • Diffusion Tensor Imaging (DTI)
        • Summary
        • References
        • Abbreviations
      • Surgical Interventions during the Acute Phase of Spinal Cord Injury
        • Introduction
        • Surgery for Traumatic SCI
          • Decompression Surgery
          • Effect of Timing on Decompression and/or Stabilization Surgery Post SCI
          • Surgery for Traumatic Central Cord Syndrome
          • Surgical Stabilization
          • Prognosis Following Surgery for SCI
          • Surgical Management versus Other Methods
          • Bone Marrow Transfer
        • Management of Spinal Cord Compression by Metastatic Lesions
          • Decompression or Stabilization
          • Surgery in Combination with Radiotherapy
        • Laminoplasty and Laminectomy
          • Laminectomy and Fusion
          • Laminoplasty
        • Surgery for Miscellaneous Myelopathies
          • Cervical Spondylosis
          • Degenerative Compressive Myelopathy
          • Spinal Stenosis
          • Syringomyelia and Tethered Spinal Cord
        • Summary
        • References
        • Abbreviations
    • Rehabilitation Evidence
      • Aging
        • Abbreviations
        • Introduction
        • Life Expectancy and Mortality
        • Physiological Aging
          • Cardiovascular and Endocrine Systems
          • Immune System
          • Musculoskeletal System
          • Respiratory System
          • Nervous System
          • Skin and Subcutaneous Tissues
          • Genitourinary and Gastrointestinal Systems
          • Secondary Complications of Multiple Systems
        • Functional Independence
        • Quality of Life and Community Reintegration
        • Summary
        • References
      • Autonomic Dysreflexia
        • Introduction
        • Pathophysiology of AD
          • How to Assess – Autonomic Assessment Form
        • Management
        • Prevention Strategies
          • Prevention of AD during Bladder Procedures
            • Botulinum Toxin
            • Intravesical Capsaicin
            • Anticholinergics
            • Sacral Denervation
            • Bladder and Urethral Sphincter Surgery
          • Prevention of AD during Anorectal Procedures
          • Prevention of AD during Pregnancy and Labour
          • Prevention of AD during General Surgery
          • Prevention of AD during FES Exercise
          • Prevention of AD with Stoma
          • Prevention of AD in Acute Care
        • Management of Acute AD Episodes
          • Non-Pharmacological Management of AD
          • Pharmacological Management of AD
            • Nifedipine (Adalat, Procardia)
            • Nitrates (Nitroglycerine, Depo-Nit, Nitrostat, Nitrol, Nitro-Bid)
            • Captopril
            • Terazosin
            • Prazosin (Minipress)
            • Phenoxybenzamine (Dibenzyline)
            • Prostaglandin E2
            • Sildenafil (Viagra)
            • Other Pharmacological Agents Tested for Management of AD
        • Other Autonomic Dysfunctions
          • Bradycardia
          • Thermodysregulation
            • Thermoregulation during Exercise
            • Sweating
        • Summary
        • References
        • Abbreviations
      • Bladder Management
        • Introduction
        • Types of Bladder Dysfunction in SCI
          • Detrusor Overactivity with DSD
          • Detrusor Underactivity
        • Therapeutic Interventions for Detrusor Overactivity with Detrusor External Sphincter Dyssynergia in Spinal Cord Injury
          • Enhancing Bladder Volumes Pharmacologically
            • Anticholinergic Therapy for SCI-Related Detrusor Overactivity
            • Toxin Therapy for SCI-Related Detrusor Overactivity
              • Botulinum Toxin
              • Capsaicin and Resiniferotoxin
              • Nociception/Orphanin Phenylalanine Glutamine
            • Intravesical Instillations for SCI-Related Detrusor Overactivity
            • Other Pharmaceutical Treatments for SCI-Related Detrusor Overactivity
          • Enhancing Bladder Volumes Non-Pharmacologically
            • Electrical Stimulation to Enhance Bladder Volumes
            • Surgical Augmentation of the Bladder to Enhance Volume
          • Enhancing Bladder Emptying Pharmacologically
            • Alpha-adrenergic Blockers for Bladder Emptying
            • Botulinum Toxin for Bladder Emptying
            • Other Pharmaceutical Treatments for Bladder Emptying
          • Enhancing Bladder Emptying Non-Pharmacologically
            • Comparing Methods of Conservative Bladder Emptying
            • Intermittent Catheterization
              • Specific Aspects of using Intermittent Catheterization
              • Comparison of Intermittent Catheterization Catheter Types
            • Triggering-Type or Expression Voiding Methods of Bladder Management
            • Indwelling Catheterization (Indwelling or Suprapubic)
            • Condom Catheterization
            • Continent Catheterizable Stoma and Incontinent Urinary Diversion
            • Electrical Stimulation for Bladder Emptying (and Enhancing Volumes)
            • Sphincterotomy, Artificial Sphincters, Stents and Related Approaches for Bladder Emptying
          • Other Miscellaneous Treatments
        • Detrusor Areflexia
        • Urinary Tract Infections
          • Defining Urinary Tract Infections
          • Detecting and Investigating UTIs
          • Non-Pharmacological Methods of Preventing UTIs
            • Intermittent Catheterization and Prevention of UTIs
            • Specially Covered Intermittent Catheters for Preventing UTI
            • Other Issues Associated with Bladder Management and UTI Prevention
          • Pharmacological and Other Biological Methods of UTI Prevention
            • Bacterial Interference for Prevention of UTIs
            • Antibiotic Prophylaxis of UTIs
            • Antiseptic and Related Approaches for Preventing UTIs
            • Alternative Approaches for UTI Prevention
          • Educational Interventions for Maintaining a Healthy Bladder and Preventing UTIs
          • Pharmacological Treatment of UTIs
        • Summary
        • References
      • Bone Health
        • Abbreviations
        • Introduction
        • Fracture Risk following SCI
        • Sublesional Osteoporosis (SLOP) Detection and Diagnosis
        • Bone Outcome Measures
          • Imaging Modalities
          • Biochemical Markers
          • Histomorphometry
        • Clinical Guide
        • Pharmacological Therapy: Bisphosphonates
          • Pharmacologic Therapy: Prevention of Bone Loss (within 12 Months of Injury)
          • Pharmacologic Therapy: Treatment (1 Year Post-Injury and Beyond)
        • Non-Pharmacologic Therapy: Rehabilitation Modalities
          • Non-Pharmacologic Therapy: Prevention (within 12 Months of Injury)
          • Non-Pharmacologic Therapy: Treatment (1 Year Post-Injury and Beyond)
            • Electrical Stimulation
            • Vibration
            • FES Cycle Ergometry
            • Standing
            • Physical Activity
        • Combination Interventions
        • Interventions with Bone Biomarker Outcomes
        • General Discussion
        • Summary
        • Key Points
        • References
      • Bowel Dysfunction and Management
        • Abbreviations
        • Introduction
        • Neurogenic Bowel Dysfunction and Management
          • General Bowel Management Systematic Review
        • Conservative Bowel Management
          • Multifaceted Programs
          • Dietary Fibre
          • Stimulation of Reflexes in the Gastrointestinal Tract
          • Manual Evacuation of Faeces
          • Abdominal Massage
          • Electrical and Magnetic Stimulation
          • Bowel Irrigation Techniques
          • Prokinetic Agents
          • Pharmacological Rectal Stimulants
        • Colostomy and Ileostomy
        • Assistive Devices
        • Summary
        • Key Points
        • References
      • Cardiovascular Health and Exercise
        • Introduction
        • The Risk for Cardiovascular Disease in Persons with SCI
          • Systematic Review
        • Exercise Rehabilitation and Cardiovascular Fitness
          • Treadmill Training
          • Upper Extremity Exercise
          • Functional Electrical Stimulation (FES)
          • Other Forms of Exercise Interventions
        • Glucose Homeostasis
        • Lipid Lipoprotein Profiles
        • References
        • Abbreviations
      • Economic Evaluation
        • Introduction
          • Economic Evaluations
          • Cost of Illness Studies
        • Methods
          • Economic Evaluation Studies
          • Cost of Illness Studies
        • Results
          • Economic Evaluation Studies
            • Intrathecal Baclofen vs. Several Conventional Treatment Options
            • Hydrophilic Gel Reservoir vs. Non-Coated Catheters for Intermittent Self-Catheterization
            • Transanal Irrigation vs. Conservative Bowel Management
            • Sacral Anterior Root Stimulation for Neurogenic Bladder
            • Duplex Ultrasound Surveillance vs. No Surveillance for Deep Venous Thrombosis
            • Oral vs. Non-Oral Erectile Dysfunction Treatments
            • Electrical Stimulation Therapy vs. Standard Wound Care
            • Telephone Support for Pressure Ulcer Management
            • Negative Pressure Wound Therapy for Pressure Injuries
            • Use of a Fibrin Sealant for Surgical Treatment of Pressure Injuries
            • Implanted Neuroprosthesis for Restoration of Effective Cough
            • Surgical Management in Older Individuals with SCI
            • Early Decompression for Individuals with Traumatic Cervical SCI
            • Supported Employment for US Veterans with SCI
          • Cost of Illness Studies
            • Australia
            • Belgium
            • Canada
            • Nigeria
            • Spain
            • United States
        • Discussion
        • Summary
        • References
        • Abbreviations
      • Epidemiology of Traumatic SCI
        • Abbreviations
        • Introduction
        • Systematic Review
        • Incidence and Prevalence of SCI by Continent and Country
          • Incidence of SCI
          • Prevalence of SCI
          • Summary – Incidence and Prevalence
        • Frequency of SCI by Cause
          • Motor Vehicle Crashes
          • Falls
          • Sports and Recreation
          • Violence
          • Self-Harm
          • Work-Related Incidents
          • Natural Disasters
          • Other Causes
          • Summary – Frequency of SCI by Cause
        • References
      • Heterotopic Ossification
        • Introduction
        • Pathophysiology of Heterotopic Ossification
        • Risk Factors and Clinical Presentation
        • Diagnosis
        • Treatment of Heterotopic Ossification
          • Non-Steroidal Anti-Inflammatory Drugs as Prophylaxis
          • Warfarin as Prophylaxis
          • Bisphosphonates
          • Pulse Low Intensity Electromagnetic Field Therapy
          • Radiation Therapy
          • Surgical Resection
        • Summary
        • References
        • Abbreviations
      • Housing and Attendant Care
        • Introduction
        • Housing
        • Attendant Care
          • Intervention Studies for Primary Care Attendant
          • Non-Intervention Attendant Care Studies
        • References
        • Abbreviations
      • Lower Limb
        • Introduction
        • Systematic Reviews
        • Sitting, Standing and Balance Training
          • Sitting Balance
          • Standing Balance
        • Enhancing Strength Following Locomotor Training in Incomplete SCI
        • Electrical Stimulation to Enhance Lower Limb Muscle Function
          • Neuromuscular Electrical Stimulation (NMES)
          • Functional Electrical Stimulation
        • Gait Retraining Strategies to Enhance Functional Ambulation
          • Overground Training for Gait Rehabilitation
          • Body-Weight Supported Treadmill Training (BWSTT)
            • BWSTT in Acute/Sub-Acute SCI
            • BWSTT in Chronic SCI
            • BWSTT Combined with Spinal Cord Stimulation
        • Orthoses/Braces
          • Ankle Foot Orthosis in SCI
          • Hip-Knee-Ankle-Foot Orthosis in SCI
          • Powered Gait Orthosis and Exoskeletons in SCI
        • Functional Electrical Stimulation (FES)
          • Functional Electrical Stimulation to Improve Locomotor Function
          • Functional Electrical Stimulation with Gait Training to Improve Locomotor Function
          • Bracing Combined with FES in SCI
          • Biofeedback for Gait Rehabilitation
          • Whole-Body Vibration and Lower Limb Motor Output
        • Combined Gait Training and Pharmacological Interventions
        • Emerging Experimental Approaches
          • Conditioning Reflex Protocols
          • Repetitive Transcranial Magnetic Stimulation
          • Cellular Transplantation Therapies to Augment Strength and Walking Function
          • Case Report: Nutrient Supplement to Augment Walking Distance
        • Gaps in SCI Research for Lower Limb
        • References
        • Abbreviations
      • Mental Health after a Spinal Cord Injury
        • Introduction
        • Depression
          • Prevalence of Depression Post-SCI
          • Interventions for Treatment of Depression following SCI
            • Combined Psychotherapy and Pharmacotherapy
        • Summary
        • Key Points
        • References
      • Nutrition Issues Following Spinal Cord Injury
        • Introduction
        • Energy Imbalance
        • Dysphagia
          • Diagnosis of Dysphagia
          • Risk Factors for Dysphagia
        • Nutrition-Related Complications
          • Altered Glucose and Lipid Metabolism
          • Neurogenic Bowel
          • Neurogenic Bladder
          • Pressure Ulcers
          • Osteoporosis
        • Nutritional Intervention Programs for Energy Imbalance and Wellness
          • Diet and Exercise
          • Diet and Inflammatory Mediators
          • Health Promotion and Education
        • Nutritional Interventions for Dyslipidemia and Cardiovascular Disease Risk
          • Nutrition Counseling
          • Omega-3 Fatty Acid Supplementation
        • Nutritional Interventions for Vitamin Deficiencies and Supplementation
          • Vitamin D
          • Vitamin B12
          • Creatine
        • Cardiovascular and Hormonal Responses to Food Ingestion
        • Effects of Nutrient Intake on Ambulation Performance
        • Post-Meal Resting Energy Expenditure
        • Cardiovascular, Endocrine and Renal Responses to Dietary Sodium Restriction in Persons with Paraplegia and Tetraplegia
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Orthostatic Hypotension
        • Introduction
        • Systematic Review
        • Pharmacological Management of OH in SCI
        • Non-pharmacological Management of OH in SCI
          • Fluid and Salt Intake for Management of OH in SCI
          • Blood Pooling Prevention in Management of OH in SCI
          • Whole-Body Vibration in Management of OH in SCI
          • Effect of FES on OH in SCI
          • Effect of Exercise on OH in SCI
          • Effect of Standing Training on OH in SCI
          • General Discussion
        • References
        • Abbreviations
      • Pain Management
        • Introduction
        • Incidence, Quality and Significance
          • Incidence of Pain Post SCI
          • Impact on Quality of Life
          • Severe Pain and SCI Location
          • Natural History of SCI Pain
        • Location and Quality of SCI Pain
        • Classification of SCI Pain
        • Musculoskeletal or Mechanical Pain
        • Central or Neurogenic Dysesthetic Pain
        • Borderzone or Segmental Pain
        • Psychological Factors
          • Catastrophizing and Pain Post SCI
        • Non-Pharmacological Management of Post-SCI Pain
          • Massage
          • Osteopathy
          • Acupuncture
          • Physical Activity for Post-SCI Pain
          • Behavioural Management of Pain Post SCI
            • Visual Illusion
            • Hypnotic Suggestions
            • Biofeedback
            • Cognitive Behavioural Therapy
            • Mindfulness
          • Transcranial Direct Stimulation Post SCI Pain
          • Transcranial Electrical Stimulation Post SCI Pain
          • Static Magnetic Field Therapy Post SCI Pain
          • Transcutaneous Electrical Nerve Stimulation Post SCI Pain
          • Transcranial Magnetic Stimulation
          • Neuromuscular Electrical Stimulation
          • Functional Electrical Stimulation
          • Breathing Controlled Electrical Stimulation
          • Diet
        • Pharmacological Management of Post-SCI Pain
          • Pharmacological Measures Overall
          • Anticonvulsants in SCI Pain
          • Tricyclic Antidepressants in Post-SCI pain
          • Anaesthetic Medications
          • Antispasticity Medications
          • Opioids for Post-SCI Pain
          • Cannabinoids in Post-SCI Pain
          • Clonidine for Post-SCI Pain
          • Topical Capsaicin
          • Lithium Carbonate
          • Transdermal Nitroglycerine
        • Surgical Interventions
          • Spinal Cord Stimulation
          • Dorsal Longitudinal T-Myelotomy for Pain Management Post-SCI
          • Dorsal Rhizotomy
          • Mesenchymal Stromal Cells
          • Sympathectomy
          • Lateral Spinothalamic Tractotomy
          • Spinal Cordotomy
        • Summary
        • References
        • Abbreviations
      • Physical Activity
        • Effects of Physical Activity
          • Effects on Muscle Morphology, Strength and Endurance
          • Physical Activity and Functional Improvement Including Activities of Daily Living
          • Physical Activity and Subjective Well-Being
          • Physical Activity and Secondary Conditions
            • Physical Activity and Cardiovascular Health
            • Physical Activity and Respiratory Complications
            • Physical Activity and Bone Health
            • Physical Activity and Pain
            • Physical Activity and Spasticity
            • Physical Activity and Periodic Leg Movements
        • Increasing Physical Activity Participation in SCI
          • Physical Activity Participation Levels in SCI
          • Barriers to Physical Activity Participation in the SCI Population
          • Effectiveness of Interventions to Increase Physical Activity Participation in SCI
        • Summary
        • Key Points
        • References
      • Primary Care
        • Abbreviations
        • Introduction
        • Access and Utilization Issues for Primary Care of Adults with SCI
        • Outreach Programs
        • Health Issues of Key Importance in Primary Care for SCI
        • General Discussion and Implications
        • Summary
        • Key Points
        • References
      • Rehabilitation Practices
        • Common Abbreviations Used In SCI Rehabilitation
        • What is SCI Rehabilitation
        • Description of SCI Rehabilitation Outcomes
          • Rehabilitation Length of Stay
          • Neurological and Functional Status
        • Factors for Optimal Outcomes
          • Effect of Intensity on Rehabilitation Outcomes
          • Effect of Age on Rehabilitation Outcomes
          • Differences in Traumatic vs Non-Traumatic SCI Rehabilitation Outcomes
          • Effect of Gender and Race on Rehabilitation Outcomes
        • Specialized vs General SCI Units (Acute Care)
        • Early vs Delayed Admission to Specialized SCI Units
        • Health Care After SCI Inpatient Rehabilitation
          • Outpatient and Follow-up Care
          • Rehospitalization and Healthcare Utilization after Initial Rehabilitation in SCI
        • Key Points
        • Summary
        • Appendix: Studies Describing Rehabilitation Outcomes
        • References
      • Respiratory Management
        • Chapter Summary
        • Introduction
        • Systematic Review
        • Pharmaceutical Interventions
          • Airway Hyperresponsiveness and Bronchodilators
          • Anabolic Steroids
          • Other Pharmaceuticals
        • Mechanical Ventilation
          • Mechanical Ventilation and Weaning Protocols
          • Intermittent Positive Pressure Breathing (IPPB)
        • Tracheostomy Placement and Decannulation
          • Other Surgery
        • Exercise Training of the Upper and Lower Limbs
        • Inspiratory Muscle Training
          • Intermittent Hypoxia
        • Assistive Devices and Other Treatments
          • Girdle/Abdominal Binder
          • Vibration
          • Immersion
        • Sleep Disordered Breathing in SCI
          • Prevalence and Risk Factors
        • Cough Assist and Secretion Removal
        • Electrical Stimulation
          • Phrenic Nerve and Diaphragmatic Stimulation
          • Abdominal Neuromuscular Electrical Stimulation
        • References
        • Abbreviations
      • Sexual and Reproductive Health
        • Introduction
        • Systematic Review
        • Sexual Health Assessment
        • Sexual Activity in Spinal Cord Injured Men and Women
          • Sexual Behaviour
          • Sexual Satisfaction
        • Sexual and Reproductive Health in Men with SCI
          • Male Erectile Response and Enhancement
            • Phosphodiesterase Type 5 Inhibitors (PDE5i) and Other Oral Agents
            • Intracavernosal Injections (ICI) utilizing Penile Medications
            • Topical Agents
            • Intraurethral Preparations
            • Mechanical Methods: Vacuum Devices and Penile Rings
            • Surgical Penile Implants
            • Intrathecal Baclofen Pump and Sacral Root Stimulation
            • Perineal Muscle Training
            • Summary: Treatment for ED
          • Sensation, Ejaculation and Orgasm in Men with Spinal Cord Injury
          • Male Fertility
            • Sperm Retrieval
            • Sperm Quality
            • Male Fertility and Resulting Pregnancy
        • Sexual and Reproductive Health in Women with SCI
          • Sexual Response in Women with SCI
          • Gynecological Health
          • Pregnancy and Labour
          • Menopause
          • Sexual and Reproductive Health Promotion Behaviour in Women with Spinal Cord Injury
            • Pregnancy, Labour and Autonomic Dysreflexia
        • Sexual Behaviour
          • Body Image and Acceptance
          • Sexual Satisfaction
        • Sexual Education and Counselling
          • Sexual Health Education for SCI Clinicians
          • Sexual Education and Counselling for SCI Patients
          • Clinical Focus – Multidisciplinary Approach to Sexual and Fertility Rehabilitation
        • Summary
      • Skin Integrity and Pressure Injuries
        • Introduction
          • Impact of Pressure Injuries
          • Incidence and Prevalence
          • Risk Factors
          • Assessment and Diagnosis
          • Staging
          • Prevention
          • Treatment
        • Prevention
          • Prevention Through Affecting Intrinsic Factors
            • Electrical Stimulation
            • Fat Grafting
          • Prevention Through Affecting Extrinsic Factors
            • Considerations
              • Differences In Interface Pressure Between SCI and Other Populations
                • SCI vs. Able-Bodied Participants
                • SCI vs. Elderly Participants
              • Effect of Specialized Seating Teams on Pressure Management and Prevention
            • Education and Prevention Programs
              • Using Telerehabilitation for Delivery of Prevention or Treatment Programs
            • Equipment and Products for Pressure Management and Prevention
          • Treatment
            • Electrical Stimulation
            • Laser Treatment
            • Ultrasound/Ultraviolet C
            • Non-Thermal Pulsed Electromagnetic Energy
            • Topical Negative Pressure
            • Normothermic Dressings
            • Alternative Pharmacological Treatments
              • Recombinant Human Erythropoietin
              • Sustained-Release Platelet-Rich Plasma Therapy in Grade IV Pressure Injuries
              • Anabolic Steroid Agents
            • Dressings
            • Non-Surgical Management and Debridement
            • Topical Oxygen
            • Surgical and Other Miscellaneous Topical and Physical Treatments
            • Alternative Organic or Herbal Treatments
              • Medihoney®
              • Cured Rot and Flat Sore Ointment
              • Powdered Arginine Supplement
            • Miscellaneous Physical Treatments
            • Factors Associated with Pressure Injury Treatment Success
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Spasticity
        • Introduction
          • Definition
          • Pathophysiology
          • Impact
          • Determining Impact of Treatment
          • Outcome Measurement and Spasticity
          • Overview of Treatments
        • Non-Pharmacological Interventions for Spasticity
          • Passive Movement or Stretching
          • Interventions Based on Active Movement (Including FES-assisted Movement)
          • Interventions Based on Direct Muscle Electrical Stimulation
          • Interventions Based on Various Forms of Afferent Stimulation
          • Repetitive Transcranial Magnetic Stimulation
          • Transcranial Theta-Burst Stimulation
        • Neuro-Surgical Interventions for Spasticity
          • Cell Therapy for Spasticity
        • Pharmacological Treatment for Spasticity
          • Oral Medications
          • Intrathecal Baclofen for Reducing Spasticity
          • Effect of Medications Other Than Baclofen on Spasticity after SCI
            • Tizanidine
            • Clonidine
            • Fampridine (4-Aminopyridine)
            • Gabapentin
            • Other Anti-Spasmodics
          • Cannabinoids for Reducing Spasticity after SCI
          • Focal Neurolysis for Spasticity Management
            • Botulinum Toxin
            • Phenol
        • Summary
        • Key Points
        • References
      • Syringomyelia
        • Introduction
          • Epidemiology
          • Pathophysiology
          • Clinical Presentation and Natural History
        • Diagnosis and Monitoring
          • Magnetic Resonance Imaging
          • Myelography Enhanced Computed Tomography
          • Virtual Endoscopy by Computer Tomography
          • Ultrasonography
          • Intraoperative Somatosensory Evoked Potentials
        • Management
          • Shunting
          • Untethering
          • Subarachnoid–Subarachnoid Bypass
          • Cordectomy
          • Neural Tissue Transplantation
          • Cellular Therapies
        • Summary
        • References
        • Abbreviations
      • Upper Limb
        • Introduction
        • Therapy Based Interventions
          • Exercise and Strengthening
          • Orthoses
          • Skills Training and Education
          • Motor Imagery
          • Action Observation
        • Technology Based Interventions
          • Virtual Reality
          • Robotics
          • Brain Computer Interfaces
          • EMG Biofeedback
          • Neuroprostheses
        • Sensorimotor Stimulation Interventions
          • Neuromuscular Electrical Stimulation
          • Transcutaneous Electrical Nerve Stimulation
          • Functional Electrical Stimulation
          • Muscle Vibration
        • Non-Invasive Brain Stimulation Interventions
          • Repetitive Transcranial Magnetic Stimulation
          • Transcranial Direct Current Stimulation
        • Pharmacological Interventions
          • Baclofen
        • Reconstructive Surgery and Tendon Transfers
          • Hand
            • Pinch
            • Pinch and Grasp (Key-Pinch and Hook Grip)
          • Elbow Extension
            • Posterior Deltoid to Triceps
            • Biceps to Triceps
          • Multiple Reconstructions
        • Nerve Transfers
          • Fundamental Principles
          • Advantages over Tendon Transfers
          • Potential Drawbacks of Nerve Transfers
          • Assessment and Surgical Timing
          • Nerve Transfer Evidence
        • Complementary and Alternative Medicine
          • Freehand System
          • NEC-FES System
          • NESS H200 (formerly HandMaster-NMS-1)
          • Rebersek and Vodovik (1973) Neuroprosthesis
          • Belgrade Grasping-Reaching System
          • Bionic Glove
          • ETHZ-ParaCare System
          • Stimulus Router System
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Venous Thromboembolism
        • Introduction
        • Incidence
        • Diagnosis
          • Deep Venous Thrombosis Diagnostic Modalities
            • Clinical Presentation
            • Venous Ultrasound
            • Venography
            • D-Dimer Assay
          • Pulmonary Embolism
            • Clinical Presentation
            • Ventilation/Perfusion Scanning
            • Pulmonary Angiography
            • Spiral Computed Tomography Scan
        • DVT Prophylaxis
          • Pharmacological Agents
            • Low-Dose Unfractionated Heparin
            • Low-Molecular-Weight Heparin versus Low-Dose Unfractionated Heparin as Prophylaxis
          • Mechanical Methods
            • Physical Methods for Prophylaxis
          • Combined Physical and Pharmacological Methods
        • Vena Cava Filtration
        • Prevalence and Timing of Onset
        • Combined Mechanical and Pharmacological Modalities
        • Modalities of Thromboprophylaxis
          • Mechanical Modalities
          • Pharmacological Modalities
        • Inferior Vena Cava Filtration
        • Treatment
        • Summary
        • Key Points
        • Abbreviations
      • Wheeled Mobility and Seating Equipment
        • Introduction
        • Manual Wheelchairs
          • Wheelchair Propulsion
            • Stroke Pattern in Wheelchair Propulsion
            • Kinetics and Kinematics of Wheelchair Propulsion on Level Surfaces
            • Kinetics and Kinematics of Wheelchair Propulsion on Non-Level Surfaces
          • Effect of Wheelchair Frame and/or Set-up on Propulsion
            • Axle Position of Wheelchair
            • Weight of Wheelchair
            • Wheelchair Frame and Vibration
            • Wheelchair Tire Pressure
            • Wheelchair Handrims
            • Pushrim-Activated Power-Assist Wheelchairs
          • Training
            • Wheelchair Propulsion Training
            • Physical Conditioning and Wheelchair Propulsion
          • Wheelchair Use
            • Wheelchair Usage
            • Falls, Accidents, Repair and Maintenance Issues with Adverse Effects Related to Wheelchair Use
            • Wheelchair Satisfaction
            • Wheelchair Skills
        • Power Wheelchairs
          • Characteristics of Power Wheelchair Use
          • Power Wheelchair Driving Controls
          • Power Positioning Device Use
        • Alternate Forms of Wheeled Mobility
          • Segway
        • Seating Equipment for Wheelchairs
          • Pressure Mapping used in SCI
          • Postural Implications of Wheelchairs
          • Impact of Equipment on Functional Tasks
          • Seated Surfaces
          • Custom Contoured Cushion
          • Changes in Pressure during Static Sitting versus Dynamic Movement While Sitting
        • Position Changes for Managing Sitting Pressure/Postural Issues, Fatigue and Discomfort
        • Wheelchair Provision
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Work and Employment
        • Introduction
        • Systematic Review and Meta-Analysis
        • Personal Factors Associated with Employment Post-SCI
        • Environmental Factors Associated with Employment Post-SCI
        • Interventions for Enhancing Employment Post-SCI
        • Abbreviations
        • References
      • SCIRE Systematic Review Process: Evidence
        • Article Assessment
          • Literature Search Strategy
          • Quality Assessment Tool and Data Extraction
        • Determining Levels of Evidence and Formulating Conclusions
        • Appendices
          • Appendix 1: Specific Search Terms
          • Appendix 2: The PEDro Scale
          • Appendix 3: AMSTAR tool (Shea et al., 2007)
      • Rehab: From Bedside To Community
        • Epidemiology
          • Traumatic SCI
          • Non-traumatic SCI
        • Recovery
          • Neuroplasticity
          • Measures of Recovery
  • Outcome Measures
    • Browse Alphabetically
    • Browse by Clinical Area
      • Assistive Technology
        • Assistive Technology Device Predisposition Assessment (ATD-PA)
        • International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI)
      • Community Reintegration
        • Assessment of Life Habits Scale (LIFE-H)
        • Community Integration Questionnaire (CIQ)
        • Craig Handicap Assessment & Reporting Technique (CHART)
        • Impact on Participation and Autonomy Questionnaire (IPAQ)
        • Physical Activity Recall Assessment for People with Spinal Cord injury (PARA-SCI)
        • Physical Activity Scale for Individuals with Physical Disabilities (PASIPD)
        • Reintegration to Normal Living (RNL) Index
        • Spinal Cord Injury Falls Concern Scale (SCI-FCS)
      • Lower Limb & Walking
        • 10 Meter Walking Test (10 MWT)
        • 6-Minute Walk Test (6MWT)
        • Berg Balance Scale (BBS)
        • Clinical Outcome Variables Scale (COVS)
        • Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI)
        • Timed Motor Test (TMT)
        • Timed Up and Go Test (TUG)
        • Walking Index for Spinal Cord Injury (WISCI) and WISCI II
      • Mental Health
        • Beck Depression Inventory (BDI)
        • Brief Symptom Inventory (BSI)
        • CAGE Questionnaire
        • Center for Epidemiological Studies Depression Scale (CES-D and CES-D-10)
        • Depression Anxiety Stress Scale-21 (DASS-21)
        • Fatigue Severity Scale (FSS)
        • Hospital Anxiety and Depression Scale (HADS)
        • Patient Health Questionnaire-9 (PHQ-9)
        • Scaled General Health Questionnaire-28 (GHQ-28)
        • Spinal Cord Lesion Coping Strategies Questionnaire (SCL CSQ)
        • Spinal Cord Lesion Emotional Wellbeing Questionnaire (SCL EWQ)
        • Symptom Checklist-90-Revised (SCL-90-R)
        • Zung Self-Rating Depression Scale (SDS / ZSDS)
      • Neurological Impairment and Autonomic Dysfunction
        • American Spinal Injury Association Impairment Scale (AIS): International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)
        • 5-item SCI Sacral Sparing Self-report Questionnaire
      • Other Affected Physiological Systems
        • Exercise Self-Efficacy Scale (ESES)
        • Moorong Self-Efficacy Scale (MSES)
        • Spinal Cord Ability Ruler (SCAR)
        • Spinal Cord Injury Secondary Conditions Scale (SCI-SCS)
        • Spinal Cord Lesion Coping Strategies Questionnaire (SCL CSQ)
        • Spinal Cord Lesion Emotional Wellbeing Questionnaire (SCL EWQ)
        • Wheelchair Users Shoulder Pain Index (WUSPI)
        • Wingate Anaerobic Testing (WAnT)
      • Pain
        • Brief Pain Inventory (BPI)
        • Classification System for Chronic Pain in SCI
        • Donovan SCI Pain Classification System
        • Multidimensional Pain Inventory (MPI) – SCI version
        • Multidimensional Pain Readiness to Change Questionnaire (MPRCQ2)
        • Quantitative Sensory Testing (QST)
        • Tunk’s Classification Scheme
        • Wheelchair Users Shoulder Pain Index (WUSPI)
      • Quality of Life and Health Status
        • Health Behaviour Questionnaire (HBQ)
        • Health Utilities Index-Mark III (HUI-Mark III)
        • Incontinence Quality of Life Questionnaire (I-QOL)
        • Life Satisfaction Questionnaire (LISAT-9, LISAT-11)
        • Needs Assessment Checklist (NAC)
        • Neurogenic Bowel Dysfunction Score (NBD)
        • Quality of Life Index (QLI) – SCI Version
        • Quality of Life Profile for Adults with Physical Disabilities (QOLP-PD)
        • Quality of Well Being (QWB) and Quality of Well Being– Self-Administered (QWB-SA)
        • Qualiveen
        • Satisfaction with Life Scale (SWLS, Deiner Scale)
        • Short Form 36 (SF-36)
        • Sickness Impact Profile 68 (SIP 68)
        • University of Washington Self-Efficacy Scale short-form (UW-SES-6)
        • Waist Circumference
        • World Health Organization Quality of Life- BREF (WHOQOL-BREF)
      • Self Care & Daily Living
        • Appraisals of DisAbility: Primary and Secondary Scale (ADAPSS)
        • Barthel Index (BI)
        • Canadian Occupational Performance Measure (COPM)
        • Craig Hospital Inventory of Environmental Factors (CHIEF)
        • Frenchay Activities Index (FAI)
        • Functional Independence Measure (FIM)
        • Functional Independence Measure Self-Report (FIM-SR)
        • Functional Standing Test (FST)
        • Lawton Instrumental Activities of Daily Living Scale (IADL)
        • Klein-Bell Activities of Daily Living Scale (K-B Scale)
        • Quadriplegia Index of Function (QIF)
        • Quadriplegia Index of Function Modified (QIF-Modified)
        • Quadriplegia Index of Function-Short Form (QIF-SF)
        • Rivermead Mobility Index (RMI)
        • Satisfaction with Life Scale (SWLS, Deiner Scale)
        • Self Care Assessment Tool (SCAT)
        • Self Reported Functional Measure (SRFM)
        • Sense of Well Being Inventory (SWBI)
        • Spinal Cord Independence Measure (SCIM)
        • Spinal Cord Injury Lifestyle Scale (SCILS)
        • Spinal Cord Injury – Person-Perceived Participation in Daily Activities Questionnaire (SCI-PDAQ)
        • Spinal Function Abilities Scale (S-FAS)
      • Sexuality and Reproduction
        • American Spinal Injury Association Impairment Scale (AIS): International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)
        • Emotional Quality of the Relationship Scale (EQR)
        • Female Sexual Function Index (FSFI)
        • Knowledge, Comfort, Approach and Attitude towards Sexuality Scale (KCAASS)
        • Sexual Attitude and Information Questionnaire (SAIQ)
        • Sexual Behaviour Scale (SBS)
        • Sexual Interest, Activity and Satisfaction (SIAS) / Sexual Activity and Satisfaction (SAS) Scales
        • Sexual Interest and Satisfaction Scale (SIS)
      • Skin Health
        • Braden Scale
        • Gosnell Measure
        • Skin Management Needs Assessment Checklist (SMNAC)
        • Spinal Cord Injury Pressure Ulcer Scale – Acute (SCIPUS-A)
        • Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) Measure
        • Stirling’s Pressure Ulcer Severity Scale
        • Waterlow Scale
      • Spasticity
        • Ashworth and Modified Ashworth Scale (MAS)
        • Pendulum Test (Wartenberg)
        • Penn Spasm Frequency Scale (PSFS)
        • Spinal Cord Assessment Tool for Spastic Reflexes (SCATS)
        • Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET)
      • Upper Limb
        • Box and Block Test (BBT)
        • Capabilities of Upper Extremity Instrument (CUE)
        • Functional Standing Test (FST)
        • Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP)
        • Grasp and Release Test (GRT)
        • Hand-Held Myometer
        • Jebsen Hand Function Test (JHFT)
        • Modified Functional Reach Test (mFRT)
        • Six-Minute Arm Test (6-MAT)
        • Sollerman Hand Function Test
        • Tetraplegia Hand Activity Questionnaire (THAQ)
        • Van Lieshout Test Short Version (VLT-SV)
      • Wheeled Mobility
        • 4 Functional Tests for Persons who Self-Propel a Manual Wheelchair (4FTPSMW)
        • Timed Motor Test (TMT)
        • Tool for assessing mobility in wheelchair-dependent paraplegics
        • Wheelchair Circuit (WC)
        • Wheelchair Outcome Measure (WhOM)
        • Wheelchair Skills Test (WST)
    • Toolkit
    • Implementation Guide
    • SCIRE Systematic Review Process: Outcome Measures
      • Assessing the Outcome Measures – Methods
      • Inclusion criteria for Outcome Measures included in SCIRE
      • Why Assess Measures Used with the SCI population?
      • Classifying the Measures
    • Glossary
    • Abbreviations
  • Clinical Resources
    • Information Sheets and Treatment Algorithms
    • COVID-19
    • Continuing Medical Education (CME) – Coming Soon!
    • Clinical Practice Guidelines – Coming Soon!
  • Media
    • Videos
    • Newsletters
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  • About
    • Foreword
    • Our Team
    • Contact us
    • SCIRE Community Website
  • Evidence
    • Acute Evidence
      • Cardiovascular Complications during the Acute Phase of Spinal Cord Injury
        • Methods
        • Introduction
        • Anatomy of the Autonomic Nervous System
        • Effect of Disrupted Autonomic Control on the Cardiovascular System
        • Cardiovascular Complications during Acute SCI
          • Neurogenic Shock
          • Orthostatic Hypotension
          • Autonomic Dysreflexia
          • Bradycardia and Arrhythmias
        • Interventions for Cardiovascular Complications during Acute SCI
          • Interventions for Neurogenic Shock
            • Pharmacological Interventions for Neurogenic Shock
          • Interventions for Treatment of Orthostatic Hypotension
            • Non-pharmacological Interventions for Orthostatic Hypotension
            • Pharmacological Interventions for Orthostatic Hypotension
          • Interventions for Hemodynamic Management
          • Interventions for Bradycardia
            • Pharmacological Interventions for Bradycardia
            • Surgical Interventions for Bradycardia
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Neuroprotection during the Acute Phase of Spinal Cord Injury
        • Methods
        • Abbreviations
        • Introduction
          • Phases of Injury
          • Overview of Secondary Injuries
        • Pharmaceutical Agents for Neuroprotection during Acute SCI
          • Steroids
          • Naloxone
          • Tirilazad Mesylate
          • Nimodipine
          • Erythropoietin
          • GM-1 Ganglioside
          • Granulocyte-Colony Stimulating Factor
          • Thyrotropin-Releasing Hormone
          • Gacyclidine
        • Additional Phase I and Phase II Clinical Trials for Neuroprotective Pharmaceutical Agents during Acute SCI
        • Summary
        • References
      • Respiratory Management during the Acute Phase of Spinal Cord Injury
        • Methods
        • Introduction
          • Neuronal Control of Breathing
          • Measurements for Lung Volume and Lung Capacity
          • Pulmonary Complications during Acute SCI
        • Mechanical Ventilation
          • Intubation
          • Tracheostomy
          • Comparative or Combination Interventions
          • Timing of Mechanical Ventilation
          • Secretion Removal Techniques during Acute SCI
          • Ventilation Weaning, Extubation and Decannulation
        • Non-Pharmacological Interventions for Pulmonary Function Improvement during Acute SCI
          • Respiratory Muscle Training
          • Diaphragm Pacing
          • Intermittent Positive Pressure Breathing for Acute SCI patients
        • Pharmacological Interventions for Pulmonary Function Improvement during Acute SCI
        • Hospital Programs for Respiratory Management during Acute SCI
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Imaging of Spinal Cord Injuries
        • Methods
        • Introduction
        • Radiography and Computed Tomography (CT)
        • Magnetic Resonance Imaging (MRI)
          • Spinal Cord Injury Without Radiographic Abnormality
        • Diffusion Tensor Imaging (DTI)
        • Summary
        • References
        • Abbreviations
      • Surgical Interventions during the Acute Phase of Spinal Cord Injury
        • Introduction
        • Surgery for Traumatic SCI
          • Decompression Surgery
          • Effect of Timing on Decompression and/or Stabilization Surgery Post SCI
          • Surgery for Traumatic Central Cord Syndrome
          • Surgical Stabilization
          • Prognosis Following Surgery for SCI
          • Surgical Management versus Other Methods
          • Bone Marrow Transfer
        • Management of Spinal Cord Compression by Metastatic Lesions
          • Decompression or Stabilization
          • Surgery in Combination with Radiotherapy
        • Laminoplasty and Laminectomy
          • Laminectomy and Fusion
          • Laminoplasty
        • Surgery for Miscellaneous Myelopathies
          • Cervical Spondylosis
          • Degenerative Compressive Myelopathy
          • Spinal Stenosis
          • Syringomyelia and Tethered Spinal Cord
        • Summary
        • References
        • Abbreviations
    • Rehabilitation Evidence
      • Aging
        • Abbreviations
        • Introduction
        • Life Expectancy and Mortality
        • Physiological Aging
          • Cardiovascular and Endocrine Systems
          • Immune System
          • Musculoskeletal System
          • Respiratory System
          • Nervous System
          • Skin and Subcutaneous Tissues
          • Genitourinary and Gastrointestinal Systems
          • Secondary Complications of Multiple Systems
        • Functional Independence
        • Quality of Life and Community Reintegration
        • Summary
        • References
      • Autonomic Dysreflexia
        • Introduction
        • Pathophysiology of AD
          • How to Assess – Autonomic Assessment Form
        • Management
        • Prevention Strategies
          • Prevention of AD during Bladder Procedures
            • Botulinum Toxin
            • Intravesical Capsaicin
            • Anticholinergics
            • Sacral Denervation
            • Bladder and Urethral Sphincter Surgery
          • Prevention of AD during Anorectal Procedures
          • Prevention of AD during Pregnancy and Labour
          • Prevention of AD during General Surgery
          • Prevention of AD during FES Exercise
          • Prevention of AD with Stoma
          • Prevention of AD in Acute Care
        • Management of Acute AD Episodes
          • Non-Pharmacological Management of AD
          • Pharmacological Management of AD
            • Nifedipine (Adalat, Procardia)
            • Nitrates (Nitroglycerine, Depo-Nit, Nitrostat, Nitrol, Nitro-Bid)
            • Captopril
            • Terazosin
            • Prazosin (Minipress)
            • Phenoxybenzamine (Dibenzyline)
            • Prostaglandin E2
            • Sildenafil (Viagra)
            • Other Pharmacological Agents Tested for Management of AD
        • Other Autonomic Dysfunctions
          • Bradycardia
          • Thermodysregulation
            • Thermoregulation during Exercise
            • Sweating
        • Summary
        • References
        • Abbreviations
      • Bladder Management
        • Introduction
        • Types of Bladder Dysfunction in SCI
          • Detrusor Overactivity with DSD
          • Detrusor Underactivity
        • Therapeutic Interventions for Detrusor Overactivity with Detrusor External Sphincter Dyssynergia in Spinal Cord Injury
          • Enhancing Bladder Volumes Pharmacologically
            • Anticholinergic Therapy for SCI-Related Detrusor Overactivity
            • Toxin Therapy for SCI-Related Detrusor Overactivity
              • Botulinum Toxin
              • Capsaicin and Resiniferotoxin
              • Nociception/Orphanin Phenylalanine Glutamine
            • Intravesical Instillations for SCI-Related Detrusor Overactivity
            • Other Pharmaceutical Treatments for SCI-Related Detrusor Overactivity
          • Enhancing Bladder Volumes Non-Pharmacologically
            • Electrical Stimulation to Enhance Bladder Volumes
            • Surgical Augmentation of the Bladder to Enhance Volume
          • Enhancing Bladder Emptying Pharmacologically
            • Alpha-adrenergic Blockers for Bladder Emptying
            • Botulinum Toxin for Bladder Emptying
            • Other Pharmaceutical Treatments for Bladder Emptying
          • Enhancing Bladder Emptying Non-Pharmacologically
            • Comparing Methods of Conservative Bladder Emptying
            • Intermittent Catheterization
              • Specific Aspects of using Intermittent Catheterization
              • Comparison of Intermittent Catheterization Catheter Types
            • Triggering-Type or Expression Voiding Methods of Bladder Management
            • Indwelling Catheterization (Indwelling or Suprapubic)
            • Condom Catheterization
            • Continent Catheterizable Stoma and Incontinent Urinary Diversion
            • Electrical Stimulation for Bladder Emptying (and Enhancing Volumes)
            • Sphincterotomy, Artificial Sphincters, Stents and Related Approaches for Bladder Emptying
          • Other Miscellaneous Treatments
        • Detrusor Areflexia
        • Urinary Tract Infections
          • Defining Urinary Tract Infections
          • Detecting and Investigating UTIs
          • Non-Pharmacological Methods of Preventing UTIs
            • Intermittent Catheterization and Prevention of UTIs
            • Specially Covered Intermittent Catheters for Preventing UTI
            • Other Issues Associated with Bladder Management and UTI Prevention
          • Pharmacological and Other Biological Methods of UTI Prevention
            • Bacterial Interference for Prevention of UTIs
            • Antibiotic Prophylaxis of UTIs
            • Antiseptic and Related Approaches for Preventing UTIs
            • Alternative Approaches for UTI Prevention
          • Educational Interventions for Maintaining a Healthy Bladder and Preventing UTIs
          • Pharmacological Treatment of UTIs
        • Summary
        • References
      • Bone Health
        • Abbreviations
        • Introduction
        • Fracture Risk following SCI
        • Sublesional Osteoporosis (SLOP) Detection and Diagnosis
        • Bone Outcome Measures
          • Imaging Modalities
          • Biochemical Markers
          • Histomorphometry
        • Clinical Guide
        • Pharmacological Therapy: Bisphosphonates
          • Pharmacologic Therapy: Prevention of Bone Loss (within 12 Months of Injury)
          • Pharmacologic Therapy: Treatment (1 Year Post-Injury and Beyond)
        • Non-Pharmacologic Therapy: Rehabilitation Modalities
          • Non-Pharmacologic Therapy: Prevention (within 12 Months of Injury)
          • Non-Pharmacologic Therapy: Treatment (1 Year Post-Injury and Beyond)
            • Electrical Stimulation
            • Vibration
            • FES Cycle Ergometry
            • Standing
            • Physical Activity
        • Combination Interventions
        • Interventions with Bone Biomarker Outcomes
        • General Discussion
        • Summary
        • Key Points
        • References
      • Bowel Dysfunction and Management
        • Abbreviations
        • Introduction
        • Neurogenic Bowel Dysfunction and Management
          • General Bowel Management Systematic Review
        • Conservative Bowel Management
          • Multifaceted Programs
          • Dietary Fibre
          • Stimulation of Reflexes in the Gastrointestinal Tract
          • Manual Evacuation of Faeces
          • Abdominal Massage
          • Electrical and Magnetic Stimulation
          • Bowel Irrigation Techniques
          • Prokinetic Agents
          • Pharmacological Rectal Stimulants
        • Colostomy and Ileostomy
        • Assistive Devices
        • Summary
        • Key Points
        • References
      • Cardiovascular Health and Exercise
        • Introduction
        • The Risk for Cardiovascular Disease in Persons with SCI
          • Systematic Review
        • Exercise Rehabilitation and Cardiovascular Fitness
          • Treadmill Training
          • Upper Extremity Exercise
          • Functional Electrical Stimulation (FES)
          • Other Forms of Exercise Interventions
        • Glucose Homeostasis
        • Lipid Lipoprotein Profiles
        • References
        • Abbreviations
      • Economic Evaluation
        • Introduction
          • Economic Evaluations
          • Cost of Illness Studies
        • Methods
          • Economic Evaluation Studies
          • Cost of Illness Studies
        • Results
          • Economic Evaluation Studies
            • Intrathecal Baclofen vs. Several Conventional Treatment Options
            • Hydrophilic Gel Reservoir vs. Non-Coated Catheters for Intermittent Self-Catheterization
            • Transanal Irrigation vs. Conservative Bowel Management
            • Sacral Anterior Root Stimulation for Neurogenic Bladder
            • Duplex Ultrasound Surveillance vs. No Surveillance for Deep Venous Thrombosis
            • Oral vs. Non-Oral Erectile Dysfunction Treatments
            • Electrical Stimulation Therapy vs. Standard Wound Care
            • Telephone Support for Pressure Ulcer Management
            • Negative Pressure Wound Therapy for Pressure Injuries
            • Use of a Fibrin Sealant for Surgical Treatment of Pressure Injuries
            • Implanted Neuroprosthesis for Restoration of Effective Cough
            • Surgical Management in Older Individuals with SCI
            • Early Decompression for Individuals with Traumatic Cervical SCI
            • Supported Employment for US Veterans with SCI
          • Cost of Illness Studies
            • Australia
            • Belgium
            • Canada
            • Nigeria
            • Spain
            • United States
        • Discussion
        • Summary
        • References
        • Abbreviations
      • Epidemiology of Traumatic SCI
        • Abbreviations
        • Introduction
        • Systematic Review
        • Incidence and Prevalence of SCI by Continent and Country
          • Incidence of SCI
          • Prevalence of SCI
          • Summary – Incidence and Prevalence
        • Frequency of SCI by Cause
          • Motor Vehicle Crashes
          • Falls
          • Sports and Recreation
          • Violence
          • Self-Harm
          • Work-Related Incidents
          • Natural Disasters
          • Other Causes
          • Summary – Frequency of SCI by Cause
        • References
      • Heterotopic Ossification
        • Introduction
        • Pathophysiology of Heterotopic Ossification
        • Risk Factors and Clinical Presentation
        • Diagnosis
        • Treatment of Heterotopic Ossification
          • Non-Steroidal Anti-Inflammatory Drugs as Prophylaxis
          • Warfarin as Prophylaxis
          • Bisphosphonates
          • Pulse Low Intensity Electromagnetic Field Therapy
          • Radiation Therapy
          • Surgical Resection
        • Summary
        • References
        • Abbreviations
      • Housing and Attendant Care
        • Introduction
        • Housing
        • Attendant Care
          • Intervention Studies for Primary Care Attendant
          • Non-Intervention Attendant Care Studies
        • References
        • Abbreviations
      • Lower Limb
        • Introduction
        • Systematic Reviews
        • Sitting, Standing and Balance Training
          • Sitting Balance
          • Standing Balance
        • Enhancing Strength Following Locomotor Training in Incomplete SCI
        • Electrical Stimulation to Enhance Lower Limb Muscle Function
          • Neuromuscular Electrical Stimulation (NMES)
          • Functional Electrical Stimulation
        • Gait Retraining Strategies to Enhance Functional Ambulation
          • Overground Training for Gait Rehabilitation
          • Body-Weight Supported Treadmill Training (BWSTT)
            • BWSTT in Acute/Sub-Acute SCI
            • BWSTT in Chronic SCI
            • BWSTT Combined with Spinal Cord Stimulation
        • Orthoses/Braces
          • Ankle Foot Orthosis in SCI
          • Hip-Knee-Ankle-Foot Orthosis in SCI
          • Powered Gait Orthosis and Exoskeletons in SCI
        • Functional Electrical Stimulation (FES)
          • Functional Electrical Stimulation to Improve Locomotor Function
          • Functional Electrical Stimulation with Gait Training to Improve Locomotor Function
          • Bracing Combined with FES in SCI
          • Biofeedback for Gait Rehabilitation
          • Whole-Body Vibration and Lower Limb Motor Output
        • Combined Gait Training and Pharmacological Interventions
        • Emerging Experimental Approaches
          • Conditioning Reflex Protocols
          • Repetitive Transcranial Magnetic Stimulation
          • Cellular Transplantation Therapies to Augment Strength and Walking Function
          • Case Report: Nutrient Supplement to Augment Walking Distance
        • Gaps in SCI Research for Lower Limb
        • References
        • Abbreviations
      • Mental Health after a Spinal Cord Injury
        • Introduction
        • Depression
          • Prevalence of Depression Post-SCI
          • Interventions for Treatment of Depression following SCI
            • Combined Psychotherapy and Pharmacotherapy
        • Summary
        • Key Points
        • References
      • Nutrition Issues Following Spinal Cord Injury
        • Introduction
        • Energy Imbalance
        • Dysphagia
          • Diagnosis of Dysphagia
          • Risk Factors for Dysphagia
        • Nutrition-Related Complications
          • Altered Glucose and Lipid Metabolism
          • Neurogenic Bowel
          • Neurogenic Bladder
          • Pressure Ulcers
          • Osteoporosis
        • Nutritional Intervention Programs for Energy Imbalance and Wellness
          • Diet and Exercise
          • Diet and Inflammatory Mediators
          • Health Promotion and Education
        • Nutritional Interventions for Dyslipidemia and Cardiovascular Disease Risk
          • Nutrition Counseling
          • Omega-3 Fatty Acid Supplementation
        • Nutritional Interventions for Vitamin Deficiencies and Supplementation
          • Vitamin D
          • Vitamin B12
          • Creatine
        • Cardiovascular and Hormonal Responses to Food Ingestion
        • Effects of Nutrient Intake on Ambulation Performance
        • Post-Meal Resting Energy Expenditure
        • Cardiovascular, Endocrine and Renal Responses to Dietary Sodium Restriction in Persons with Paraplegia and Tetraplegia
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Orthostatic Hypotension
        • Introduction
        • Systematic Review
        • Pharmacological Management of OH in SCI
        • Non-pharmacological Management of OH in SCI
          • Fluid and Salt Intake for Management of OH in SCI
          • Blood Pooling Prevention in Management of OH in SCI
          • Whole-Body Vibration in Management of OH in SCI
          • Effect of FES on OH in SCI
          • Effect of Exercise on OH in SCI
          • Effect of Standing Training on OH in SCI
          • General Discussion
        • References
        • Abbreviations
      • Pain Management
        • Introduction
        • Incidence, Quality and Significance
          • Incidence of Pain Post SCI
          • Impact on Quality of Life
          • Severe Pain and SCI Location
          • Natural History of SCI Pain
        • Location and Quality of SCI Pain
        • Classification of SCI Pain
        • Musculoskeletal or Mechanical Pain
        • Central or Neurogenic Dysesthetic Pain
        • Borderzone or Segmental Pain
        • Psychological Factors
          • Catastrophizing and Pain Post SCI
        • Non-Pharmacological Management of Post-SCI Pain
          • Massage
          • Osteopathy
          • Acupuncture
          • Physical Activity for Post-SCI Pain
          • Behavioural Management of Pain Post SCI
            • Visual Illusion
            • Hypnotic Suggestions
            • Biofeedback
            • Cognitive Behavioural Therapy
            • Mindfulness
          • Transcranial Direct Stimulation Post SCI Pain
          • Transcranial Electrical Stimulation Post SCI Pain
          • Static Magnetic Field Therapy Post SCI Pain
          • Transcutaneous Electrical Nerve Stimulation Post SCI Pain
          • Transcranial Magnetic Stimulation
          • Neuromuscular Electrical Stimulation
          • Functional Electrical Stimulation
          • Breathing Controlled Electrical Stimulation
          • Diet
        • Pharmacological Management of Post-SCI Pain
          • Pharmacological Measures Overall
          • Anticonvulsants in SCI Pain
          • Tricyclic Antidepressants in Post-SCI pain
          • Anaesthetic Medications
          • Antispasticity Medications
          • Opioids for Post-SCI Pain
          • Cannabinoids in Post-SCI Pain
          • Clonidine for Post-SCI Pain
          • Topical Capsaicin
          • Lithium Carbonate
          • Transdermal Nitroglycerine
        • Surgical Interventions
          • Spinal Cord Stimulation
          • Dorsal Longitudinal T-Myelotomy for Pain Management Post-SCI
          • Dorsal Rhizotomy
          • Mesenchymal Stromal Cells
          • Sympathectomy
          • Lateral Spinothalamic Tractotomy
          • Spinal Cordotomy
        • Summary
        • References
        • Abbreviations
      • Physical Activity
        • Effects of Physical Activity
          • Effects on Muscle Morphology, Strength and Endurance
          • Physical Activity and Functional Improvement Including Activities of Daily Living
          • Physical Activity and Subjective Well-Being
          • Physical Activity and Secondary Conditions
            • Physical Activity and Cardiovascular Health
            • Physical Activity and Respiratory Complications
            • Physical Activity and Bone Health
            • Physical Activity and Pain
            • Physical Activity and Spasticity
            • Physical Activity and Periodic Leg Movements
        • Increasing Physical Activity Participation in SCI
          • Physical Activity Participation Levels in SCI
          • Barriers to Physical Activity Participation in the SCI Population
          • Effectiveness of Interventions to Increase Physical Activity Participation in SCI
        • Summary
        • Key Points
        • References
      • Primary Care
        • Abbreviations
        • Introduction
        • Access and Utilization Issues for Primary Care of Adults with SCI
        • Outreach Programs
        • Health Issues of Key Importance in Primary Care for SCI
        • General Discussion and Implications
        • Summary
        • Key Points
        • References
      • Rehabilitation Practices
        • Common Abbreviations Used In SCI Rehabilitation
        • What is SCI Rehabilitation
        • Description of SCI Rehabilitation Outcomes
          • Rehabilitation Length of Stay
          • Neurological and Functional Status
        • Factors for Optimal Outcomes
          • Effect of Intensity on Rehabilitation Outcomes
          • Effect of Age on Rehabilitation Outcomes
          • Differences in Traumatic vs Non-Traumatic SCI Rehabilitation Outcomes
          • Effect of Gender and Race on Rehabilitation Outcomes
        • Specialized vs General SCI Units (Acute Care)
        • Early vs Delayed Admission to Specialized SCI Units
        • Health Care After SCI Inpatient Rehabilitation
          • Outpatient and Follow-up Care
          • Rehospitalization and Healthcare Utilization after Initial Rehabilitation in SCI
        • Key Points
        • Summary
        • Appendix: Studies Describing Rehabilitation Outcomes
        • References
      • Respiratory Management
        • Chapter Summary
        • Introduction
        • Systematic Review
        • Pharmaceutical Interventions
          • Airway Hyperresponsiveness and Bronchodilators
          • Anabolic Steroids
          • Other Pharmaceuticals
        • Mechanical Ventilation
          • Mechanical Ventilation and Weaning Protocols
          • Intermittent Positive Pressure Breathing (IPPB)
        • Tracheostomy Placement and Decannulation
          • Other Surgery
        • Exercise Training of the Upper and Lower Limbs
        • Inspiratory Muscle Training
          • Intermittent Hypoxia
        • Assistive Devices and Other Treatments
          • Girdle/Abdominal Binder
          • Vibration
          • Immersion
        • Sleep Disordered Breathing in SCI
          • Prevalence and Risk Factors
        • Cough Assist and Secretion Removal
        • Electrical Stimulation
          • Phrenic Nerve and Diaphragmatic Stimulation
          • Abdominal Neuromuscular Electrical Stimulation
        • References
        • Abbreviations
      • Sexual and Reproductive Health
        • Introduction
        • Systematic Review
        • Sexual Health Assessment
        • Sexual Activity in Spinal Cord Injured Men and Women
          • Sexual Behaviour
          • Sexual Satisfaction
        • Sexual and Reproductive Health in Men with SCI
          • Male Erectile Response and Enhancement
            • Phosphodiesterase Type 5 Inhibitors (PDE5i) and Other Oral Agents
            • Intracavernosal Injections (ICI) utilizing Penile Medications
            • Topical Agents
            • Intraurethral Preparations
            • Mechanical Methods: Vacuum Devices and Penile Rings
            • Surgical Penile Implants
            • Intrathecal Baclofen Pump and Sacral Root Stimulation
            • Perineal Muscle Training
            • Summary: Treatment for ED
          • Sensation, Ejaculation and Orgasm in Men with Spinal Cord Injury
          • Male Fertility
            • Sperm Retrieval
            • Sperm Quality
            • Male Fertility and Resulting Pregnancy
        • Sexual and Reproductive Health in Women with SCI
          • Sexual Response in Women with SCI
          • Gynecological Health
          • Pregnancy and Labour
          • Menopause
          • Sexual and Reproductive Health Promotion Behaviour in Women with Spinal Cord Injury
            • Pregnancy, Labour and Autonomic Dysreflexia
        • Sexual Behaviour
          • Body Image and Acceptance
          • Sexual Satisfaction
        • Sexual Education and Counselling
          • Sexual Health Education for SCI Clinicians
          • Sexual Education and Counselling for SCI Patients
          • Clinical Focus – Multidisciplinary Approach to Sexual and Fertility Rehabilitation
        • Summary
      • Skin Integrity and Pressure Injuries
        • Introduction
          • Impact of Pressure Injuries
          • Incidence and Prevalence
          • Risk Factors
          • Assessment and Diagnosis
          • Staging
          • Prevention
          • Treatment
        • Prevention
          • Prevention Through Affecting Intrinsic Factors
            • Electrical Stimulation
            • Fat Grafting
          • Prevention Through Affecting Extrinsic Factors
            • Considerations
              • Differences In Interface Pressure Between SCI and Other Populations
                • SCI vs. Able-Bodied Participants
                • SCI vs. Elderly Participants
              • Effect of Specialized Seating Teams on Pressure Management and Prevention
            • Education and Prevention Programs
              • Using Telerehabilitation for Delivery of Prevention or Treatment Programs
            • Equipment and Products for Pressure Management and Prevention
          • Treatment
            • Electrical Stimulation
            • Laser Treatment
            • Ultrasound/Ultraviolet C
            • Non-Thermal Pulsed Electromagnetic Energy
            • Topical Negative Pressure
            • Normothermic Dressings
            • Alternative Pharmacological Treatments
              • Recombinant Human Erythropoietin
              • Sustained-Release Platelet-Rich Plasma Therapy in Grade IV Pressure Injuries
              • Anabolic Steroid Agents
            • Dressings
            • Non-Surgical Management and Debridement
            • Topical Oxygen
            • Surgical and Other Miscellaneous Topical and Physical Treatments
            • Alternative Organic or Herbal Treatments
              • Medihoney®
              • Cured Rot and Flat Sore Ointment
              • Powdered Arginine Supplement
            • Miscellaneous Physical Treatments
            • Factors Associated with Pressure Injury Treatment Success
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Spasticity
        • Introduction
          • Definition
          • Pathophysiology
          • Impact
          • Determining Impact of Treatment
          • Outcome Measurement and Spasticity
          • Overview of Treatments
        • Non-Pharmacological Interventions for Spasticity
          • Passive Movement or Stretching
          • Interventions Based on Active Movement (Including FES-assisted Movement)
          • Interventions Based on Direct Muscle Electrical Stimulation
          • Interventions Based on Various Forms of Afferent Stimulation
          • Repetitive Transcranial Magnetic Stimulation
          • Transcranial Theta-Burst Stimulation
        • Neuro-Surgical Interventions for Spasticity
          • Cell Therapy for Spasticity
        • Pharmacological Treatment for Spasticity
          • Oral Medications
          • Intrathecal Baclofen for Reducing Spasticity
          • Effect of Medications Other Than Baclofen on Spasticity after SCI
            • Tizanidine
            • Clonidine
            • Fampridine (4-Aminopyridine)
            • Gabapentin
            • Other Anti-Spasmodics
          • Cannabinoids for Reducing Spasticity after SCI
          • Focal Neurolysis for Spasticity Management
            • Botulinum Toxin
            • Phenol
        • Summary
        • Key Points
        • References
      • Syringomyelia
        • Introduction
          • Epidemiology
          • Pathophysiology
          • Clinical Presentation and Natural History
        • Diagnosis and Monitoring
          • Magnetic Resonance Imaging
          • Myelography Enhanced Computed Tomography
          • Virtual Endoscopy by Computer Tomography
          • Ultrasonography
          • Intraoperative Somatosensory Evoked Potentials
        • Management
          • Shunting
          • Untethering
          • Subarachnoid–Subarachnoid Bypass
          • Cordectomy
          • Neural Tissue Transplantation
          • Cellular Therapies
        • Summary
        • References
        • Abbreviations
      • Upper Limb
        • Introduction
        • Therapy Based Interventions
          • Exercise and Strengthening
          • Orthoses
          • Skills Training and Education
          • Motor Imagery
          • Action Observation
        • Technology Based Interventions
          • Virtual Reality
          • Robotics
          • Brain Computer Interfaces
          • EMG Biofeedback
          • Neuroprostheses
        • Sensorimotor Stimulation Interventions
          • Neuromuscular Electrical Stimulation
          • Transcutaneous Electrical Nerve Stimulation
          • Functional Electrical Stimulation
          • Muscle Vibration
        • Non-Invasive Brain Stimulation Interventions
          • Repetitive Transcranial Magnetic Stimulation
          • Transcranial Direct Current Stimulation
        • Pharmacological Interventions
          • Baclofen
        • Reconstructive Surgery and Tendon Transfers
          • Hand
            • Pinch
            • Pinch and Grasp (Key-Pinch and Hook Grip)
          • Elbow Extension
            • Posterior Deltoid to Triceps
            • Biceps to Triceps
          • Multiple Reconstructions
        • Nerve Transfers
          • Fundamental Principles
          • Advantages over Tendon Transfers
          • Potential Drawbacks of Nerve Transfers
          • Assessment and Surgical Timing
          • Nerve Transfer Evidence
        • Complementary and Alternative Medicine
          • Freehand System
          • NEC-FES System
          • NESS H200 (formerly HandMaster-NMS-1)
          • Rebersek and Vodovik (1973) Neuroprosthesis
          • Belgrade Grasping-Reaching System
          • Bionic Glove
          • ETHZ-ParaCare System
          • Stimulus Router System
        • Summary
        • Key Points
        • References
        • Abbreviations
      • Venous Thromboembolism
        • Introduction
        • Incidence
        • Diagnosis
          • Deep Venous Thrombosis Diagnostic Modalities
            • Clinical Presentation
            • Venous Ultrasound
            • Venography
            • D-Dimer Assay
          • Pulmonary Embolism
            • Clinical Presentation
            • Ventilation/Perfusion Scanning
            • Pulmonary Angiography
            • Spiral Computed Tomography Scan
        • DVT Prophylaxis
          • Pharmacological Agents
            • Low-Dose Unfractionated Heparin
            • Low-Molecular-Weight Heparin versus Low-Dose Unfractionated Heparin as Prophylaxis
          • Mechanical Methods
            • Physical Methods for Prophylaxis
          • Combined Physical and Pharmacological Methods
        • Vena Cava Filtration
        • Prevalence and Timing of Onset
        • Combined Mechanical and Pharmacological Modalities
        • Modalities of Thromboprophylaxis
          • Mechanical Modalities
          • Pharmacological Modalities
        • Inferior Vena Cava Filtration
        • Treatment
        • Summary
        • Key Points
        • Abbreviations
      • Wheeled Mobility and Seating Equipment
        • Introduction
        • Manual Wheelchairs
          • Wheelchair Propulsion
            • Stroke Pattern in Wheelchair Propulsion
            • Kinetics and Kinematics of Wheelchair Propulsion on Level Surfaces
            • Kinetics and Kinematics of Wheelchair Propulsion on Non-Level Surfaces
          • Effect of Wheelchair Frame and/or Set-up on Propulsion
            • Axle Position of Wheelchair
            • Weight of Wheelchair
            • Wheelchair Frame and Vibration
            • Wheelchair Tire Pressure
            • Wheelchair Handrims
            • Pushrim-Activated Power-Assist Wheelchairs
          • Training
            • Wheelchair Propulsion Training
            • Physical Conditioning and Wheelchair Propulsion
          • Wheelchair Use
            • Wheelchair Usage
            • Falls, Accidents, Repair and Maintenance Issues with Adverse Effects Related to Wheelchair Use
            • Wheelchair Satisfaction
            • Wheelchair Skills
        • Power Wheelchairs
          • Characteristics of Power Wheelchair Use
          • Power Wheelchair Driving Controls
          • Power Positioning Device Use
        • Alternate Forms of Wheeled Mobility
          • Segway
        • Seating Equipment for Wheelchairs
          • Pressure Mapping used in SCI
          • Postural Implications of Wheelchairs
          • Impact of Equipment on Functional Tasks
          • Seated Surfaces
          • Custom Contoured Cushion
          • Changes in Pressure during Static Sitting versus Dynamic Movement While Sitting
        • Position Changes for Managing Sitting Pressure/Postural Issues, Fatigue and Discomfort
        • Wheelchair Provision