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Nursing Bioscience for Complex Care

Li, C., Khoo, S., & Adnan, A. (2017). Effects of aquatic exercise on physical function and fitness among people with spinal cord injury: A systematic review. Medicine96(11), e6328. https://doi.org/10.1097/MD.0000000000006328

This study aims to review aquatic therapy which is a traditional therapy used for treatment in the case of spinal cord injury patients. The study explores the effects of aquatic exercise interventions on fitness and physical function in spinal cord injury patients. The authors conducted a systematic review and meta-analysis of the studies about aquatic therapy and their effects or outcomes on the patients. Out of 276 studies, only 8 met the inclusion criteria and they chose studies from highly reviewed journals like Nature, Science, Science Translational Medicine, and others. Only the articles who were in the English language were selected rest of the articles were excluded from the study. The selected studies conducted interviews, randomized control trials, and case studies. The randomized control trials enable – most statistically powerful study design, most reliable techniques and biases are minimized but there is a risk of ethical issues and selective population (Chan et al., 2017). The authors found that combined aquatic exercises and physiotherapy enabled the patient to be physically independent for a few physical functions like maximal voluntary muscle contraction and walking ability. Moreover, other outcomes were increased leg strength and balance and increased cardio-respiratory efficiency levels. The strength of this study is it considered the physical fitness and physical functions that were improved after aquatic therapy of the spinal cord injury patients. According to Egan & Fitzpatrick (2018), aquatic therapy has many advantages like reduced cardiovascular risks, enhanced cardio-respiratory functioning, decreased muscle fatigue, enhanced aerobic capacity, and many others. Due to these diverse positive outcomes, it is widely used in treatment. The limitation of this study is it used/selected only those studies that were published in the English language. This creates a bias that might have left some useful articles that might be in a different language. It is found that aquatic therapies need more time, more effort, more space, expensive and it also leads to loss of body heat (Neira et al., 2017). 

Ren, C., Qin, R., Wang, P., & Wang, P. (2020). Comparison of anterior and posterior approaches for the treatment of traumatic cervical dislocation combined with spinal cord injury: Minimum 10-year follow-up. Scientific Reports10(1), 1-8. https://doi.org/10.1038/s41598-020-67265-2

The article is about posterior and anterior approach surgery in spinal cord injury patients. The author conducted to study to compare the outcomes of the anterior and posterior approach for the surgeries. This article conducted a retrospective review study of the records of many patients. The patients were followed by 10 years after their anterior and posterior surgeries for their outcomes like operation times, hospital stays, successful surgeries, and others. There were 92 patients in the anterior approach surgery group and 67 in the posterior approach group. Both men and women were chosen for the study of different age groups. It was found that anterior approach surgery is better than the posterior one, this is so because of the following positive outcomes: the cervical curve is maintained in a healthy state to great extent, soft tissue is relaxed by prying and traction, and better in restoring cervical alignment. In the case of the posterior group, there were longer operation times, longer hospital stays, and more blood losses. The strengths of the article are it chose both males and females for the study and the participants gave asked to provide written consent. They were recorded for their outcomes for the next 10 years and they collected the data from 2008 to 2010. The patients are evaluated on their various criteria like pain, the successful satisfactory results of surgery, and many others. The limitations are – many patients needed both anterior and posterior surgeries after their spinal cord injuries. It is found that anterior and posterior surgeries can cause many complications like vertebral artery injuries, tracheal injury, esophageal injury, hypoglossal nerve injuries, and others (Braafhart et al., 2020). It is also found that traction during anterior surgery leads to some complications like it can severe pain, long-term side effects of infection, worsening of the symptoms, and others (Ahuja et al., 2017). Moreover, as it is a retrospective study so it is easy, inexpensive, checks for more than one risk factor but it is not good for rare diseases because some biases may arise. The other risks for surgery in spinal cord injury are stroke, heart attack, blood clots, infection, bleeding, reaction to drugs, or reaction to anesthesia (Neira et al., 2017).

Theriault, E. R., Huang, V., Whiteneck, G., Dijkers, M. P., & Harel, N. Y. (2018). Antispasmodic medications may be associated with reduced recovery during inpatient rehabilitation after traumatic spinal cord injury. The Journal of Spinal Cord Medicine41(1), 63-71. https://doi.org/10.1080/10790268.2016.1245010

This article studies and explores the use of antispasmodic medications in the treatment of spinal cord injury and their association with functional and neurological outcomes. For this study, the author conducted a retrospective analysis of 1,376 patients. The data was collected by in-person examinations by therapists and physicians, interviews, and downloading of the medical records. They collected the data from 2007 to 2009 and the patients were monitored for a few days that were under medication administration to study the medication outcomes. It was found that patients with antispasmodic medication were discharged at a faster rate from health care centers. The functional and neural activity was found to be increased and neural plasticity after stroke is reduced in medicated patients. The strength of this study was it also discussed the pain, sleep, and depression that can be caused by the use of antispasmodic medications. According to Holtz et al. (2018), the antispasmodic has a high level of activity with many functional and neurological outcomes therefore they are preferred by the physicians in spinal cord injury treatments. Moreover, such patients who are taking antispasmodic drugs are less likely to develop a response to strokes and these drugs also help in smooth muscle relaxation as well. The limitation in this study is the data was not considered to be clinically significant because the study did not reach a statistically significant level. According to Schug et al. (2017), it is found that the antispasmodic medications used in spinal cord injuries can cause many side effects like constipation, dry mouth, abdominal bloating, dry eyes, weakness, drowsiness, dizziness, and many others. These issues in spinal cord injury patients can negatively affect his/her health and progress rate. Although, as their activity is very fast, they start acting within an hour of their administration but still due to their side effects they are used wisely for the safety of the patients (Corvillo et al., 2019).

References for Spinal Cord Injury Treatments

Ahuja, C. S., Wilson, J. R., Nori, S., Kotter, M. R., Druschel, C., Curt, A., & Fehlings, M. G. (2017). Traumatic spinal cord injury. Nature reviews Disease primers3(1), 1-21. https://doi.org/10.1038/nrdp.2017.18

Braafhart, M., de Laat, H. E., Wagner, T., van de Burgt, E. W., Hummelink, S., & Ulrich, D. J. (2020). Surgical reconstruction of pressure ulcers in spinal cord injury individuals: A single-or two-stage approach?. Journal of Tissue Viability. https://doi.org/10.1016/j.jtv.2020.08.004

Chan, D. C., Tsou, H. H., Chang, C. B., Yang, R. S., Tsauo, J. Y., Chen, C. Y., & Hsiung, C. A. (2017). Integrated care for geriatric frailty and sarcopenia: A randomized control trial. Journal of Cachexia, Sarcopenia and Muscle8(1), 78-88. https://doi.org/10.1002/jcsm.12132 

Corvillo, I., Armijo, F., Álvarez-Badillo, A., Armijo, O., Varela, E., & Maraver, F. (2019). Efficacy of aquatic therapy for neck pain: a systematic review. International Journal of Biometeorology, 1-11. https://doi.org/10.1007/s00484-019-01738-6

Egan, P., & Fitzpatrick, N. (2018). Therapeutic exercises part 2: Hydrotherapy (aquatic therapy). Physical Rehabilitation for Veterinary Technicians and Nurses, 308. https://doi.org/10.1097/PHM.0000000000000512

Holtz, K. A., Szefer, E., Noonan, V. K., Kwon, B. K., & Mills, P. B. (2018). Treatment patterns of in-patient spasticity medication use after traumatic spinal cord injury: A prospective cohort study. Spinal Cord56(12), 1176-1183. https://doi.org/10.1038/s41393-018-0165-0

Neira, S. R., Marques, A. P., Pérez, I. P., Cervantes, R. F., & Costa, J. V. (2017). Effectiveness of aquatic therapy vs land-based therapy for balance and pain in women with fibromyalgia: A study protocol for a randomised controlled trial. BMC Musculoskeletal Disorders18(1), 22. https://doi.org/10.1186/s12891-016-1364-5

Schug, S. A., Parsons, B., Almas, M., & Whalen, E. (2017). Effect of concomitant pain medications on response to pregabalin in patients with postherpetic neuralgia or spinal cord injury-related neuropathic pain. Pain Physician20(1), E53-E63. http://dx.doi.org/10.4102/ajod.v7i0.450

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