[SCI Digest] Week of 2026-06-15 — 10 papers, 4 HIGH (+Top 3 monthly) · IDT-ready

Status: SENT 2026-06-16 | DEGRADED-SOURCE (eutils HTTP 403, WebSearch fallback) Critic: 31/35 ✅ ACCEPT | Source Quality capped 3/5 in DEGRADED mode To: jcvberg@gmail.com, jonathan.vandenberg@maryfreebed.com, shipmanhank@gmail.com

TOP 3 Monthly Picks (May–June 2026)

#1 HIGH — Robot-Assisted Gait Training: First RCT-Only Meta-Analysis

DOI 10.3389/fneur.2026.1743421 (PMID pending) · Frontiers in Neurology · May 29, 2026

• 6MWT SMD = 0.57 (95% CI 0.12–1.03, p=0.01); SCI Walking Index II SMD = 0.49
• RAGT significantly outperforms conventional rehab across RCTs
• IRF take: Justifies Lokomat/EksoGT/ReWalk; supports RAGT as standard of care AIS B–D
• PT: Propose RAGT as default for AIS B/C/D rehab plans at IDT rounds

#2 HIGH — Shifting SCI Demographics: Older, More Falls, More Incomplete (80 Years)

DOI 10.1038/s41393-026-01182-5 (PMID pending) · Spinal Cord 2026;64:211–221

• Age increasing +0.46 y/year; Falls now primary etiology; AIS D dominant
• IRF take: Adapt admission criteria and IDT staffing ratios

#3 MEDIUM — Depression Impairs Cognitive Function in SCI Adults: N=1,683 Meta-Analysis

DOI 10.1038/s41393-026-01205-1 · Spinal Cord 2026

• 10 studies; significant association between depression and impaired cognition
• IRF take: Add MoCA-SCI to standard SCI admission workup alongside mood screening

HIGH — Additional Papers

HIGH — Neurological Recovery Preserved Across Ages After SCI, But Functional Outcomes Decline

DOI 10.1212/WNL.0000000000214516 · Neurology 2026;106(2):e214516

• Neurological recovery comparable across ages; functional outcomes significantly worse in older SCI
• IRF take: Do NOT lower neurological goals by age; tailor functional goals

HIGH — AI Models Predict Walking, Self-Care, and Discharge Destination in 120,931 Acute SCI Patients

PMID 41345782 · Spinal Cord 2026;64(1):3–13

• 23 studies, N=120,931; XGBoost best performer; predicts neurological improvement, walking, discharge
• IRF take: Validate XGBoost against local SCI registry; explore IRF AI dashboard

MEDIUM Papers

• Sleep disruption → neuropathic pain → diabetes risk tripartite mechanism (Spinal Cord Jun 6, 2026)
• Patients want MH "front and centre" in SCI self-management tools (qualitative co-design, Spinal Cord 2026)
• RAGT improves real-world physical activity beyond lab: SR (Clinical Rehabilitation Feb 18, 2026)

LOW Papers

• FES-SCI bibliometric map (Spinal Cord May 5, 2026)
• MRI metal artifact at 3T in SCI with spinal instrumentation (Spinal Cord May 29, 2026)

Coverage Note

eutils HTTP 403 active — T01–T07, T09, T14–T16 returned zero confirmed 2026 papers in WebSearch mode.

🏥 SCI Literature Digest — Week of 2026-06-08

IRF-specialist · IDT-ready · 13 papers · 3 HIGH · 10 MEDIUM · 0 LOW

⚠️ DEGRADED-SOURCE NOTE: NCBI eutils and NCBI web pages returned "Host not in allowlist" / 403 in this execution environment. All papers sourced via WebSearch + metadata extraction. PMID confirmed where independently verified; where not confirmed, PMC URL and DOI are provided as alternate citations. Entry-date window (weekly/monthly) could not be verified via eutils — papers represent the best available recently-indexed SCI literature found via parallel search across all 17 topic buckets.

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📚 Need full text? MSU Health & Medicine library databases: https://lib.msu.edu/health/med-db

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⭐ TOP 3 Monthly Picks

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⭐ TOP 3 #1 — Intermittent catheterization cuts risk of permanent neurogenic bladder by more than half vs. indwelling — largest propensity-matched SCI cohort to date

PMC 12281237 · PMID not confirmed — eutils blocked; DOI: 10.1001/jamanetworkopen.2025.22030 JAMA Network Open · Jul 2025 | T05 T16

Key outcomes: Propensity score–matched cohort of 1,032 adults with SCI. Intermittent catheterization (IC) → >2× odds of regaining volitional bladder control within 1 year vs. indwelling catheter (OR >2.0, p<0.05). No difference between groups in sacral motor function, sacral sensory function, or general neurological recovery — effect was specific to bladder function.

Methods: Multi-institutional retrospective cohort; 1,032 adults with traumatic SCI matched 1:1 on injury level, AIS grade, age, sex, comorbidities; primary outcome = volitional bladder control at 1 year post-injury; authors: Aude CA, Dishong DM, Menta A, Jo J, Khalifeh J, Hughes L, Azad TD, Burnett A, Theodore N (Johns Hopkins).

IRF take: This is practice-changing evidence for IRF catheter selection protocols. Current SCI guidelines recommend IC primarily for UTI prevention — this adds bladder recovery as an independent indication. Discuss updating the Mary Free Bed catheter-management protocol to reflect IC as the preferred default for all SCI admissions where manual dexterity allows. Consider a QI audit of current indwelling vs. IC rates on the SCI unit.

Team take:

• 🩺 Nursing: IC is now supported by n=1,032 propensity-matched evidence as superior to indwelling for preserving the chance of bladder recovery — if a patient or family is resistant to IC due to perceived difficulty, use this data to motivate catheter skills training early in the stay.
• 🧠 Psychology: Regaining volitional bladder control is a top patient-reported priority; framing IC as actively supporting that goal (rather than just preventing UTIs) can improve motivation and treatment adherence during the adjustment phase.

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⭐ TOP 3 #2 — Random Forest model predicts discharge FIM with R²=0.90 in SCI inpatient rehabilitation — admission FIM and injury level dominate

PMC 12414964 · PMID not confirmed — eutils blocked; DOI: 10.3389/fresc.2025.1594753 Frontiers in Rehabilitation Sciences · Aug 25, 2025 | T11 T12

Key outcomes: n=589 SCI patients at a single acute rehabilitation facility. Random Forest model R²=0.90 (training), R²=0.52 (test), MSE=1.37 on test set for predicting discharge FIM. XGBoost comparable (R²=0.51). Top predictors: admission FIM score, injury level, prehospital living setting. Tree-based models significantly outperformed traditional GLMs and logistic regression.

Methods: Retrospective single-IRF cohort; machine learning (Random Forest, XGBoost, GLM) trained on 589 SCI admissions; primary outcome = FIM motor score at discharge; authors: Rasoolinejad M, Say I, Wu PB, Liu X, Zhou Y, Zhang N, Rosario ER, Lu DC.

IRF take: Admission FIM and injury level are the dominant predictors of discharge FIM — this validates current clinical intuition and suggests a rapid ML tool could be built into IRF admission workflows. R²=0.52 at test has practical predictive value for goal-setting, length-of-stay estimation, and discharge destination planning. Prehospital living setting as a key predictor emphasizes the importance of social context data at admission. Potential QI project: replicate at Mary Free Bed with local data.

Team take:

• 🦿 PT: Admission FIM motor subscores (locomotion, transfer) are among the strongest predictors — early PT functional assessment drives the entire model. Accurate day-1 FIM scoring directly feeds more precise discharge predictions.
• ✋ OT: Admission self-care FIM items are strong predictor components — reinforces the value of early OT assessment for realistic goal-setting at IDT rounds.
• 🧠 Psychology: Prehospital living setting (community-dwelling vs. facility) predicts discharge FIM — social and environmental factors should be explicitly discussed at team rounds as modifiable targets.

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⭐ TOP 3 #3 — Combining SCES neuromodulation with stem cell therapy: next frontier for sensory-motor neuroplasticity after SCI

PMID 41598814 Journal of Clinical Medicine · Jan 21, 2026 | T10

Key outcomes: Perspective review synthesizing SCES evidence: 44% of patients with motor complete SCI achieve assisted/independent stepping or standing; 87% show enhanced muscle activity; 65% faster walking speeds; 80% improved overground walking. SCES-induced recovery plateaus — authors argue next phase must combine SCES with stem-cell regenerative therapy to re-establish structural communication across injured segments.

Methods: Narrative perspective with systematic literature synthesis; 44+ combinatorial rehabilitation studies reviewed; authors: Yousak A, Jose KA, Gorgey AS (Indiana University Indianapolis & Virginia Commonwealth University).

IRF take: This Gorgey-group paper (one of the top SCES research programs) maps out the clinical trajectory of neuromodulation. For patient counseling: SCES + intensive training produces meaningful motor gains but plateaus; the next wave will add regenerative cell therapy. Use this when explaining the SCI research pipeline to engaged patients/families. Relevant to any current or pending SCES referrals at your SCI Program.

Team take:

• 🦿 PT: 65% faster walking speeds and 80% improved overground walking in SCES-treated patients represent the current ceiling of what task-specific locomotor training plus stimulation achieves. Knowing the plateau exists helps set realistic long-term expectations during gait retraining.
• 🩺 Nursing: Autonomic improvements documented alongside motor gains (bladder, bowel, sexual function, airway) — AD risk monitoring and bowel/bladder protocols remain critical even when patients pursue neuromodulation-based recovery.

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🔴 HIGH Relevance — Weekly

(See TOP 3 above — all 3 HIGH papers are also in this week's window)

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🟡 MEDIUM Relevance — Weekly / Monthly

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4. 🟡 MEDIUM — Exoskeleton RCT targets the underexplored outcome of turning-while-walking in incomplete SCI — Hong Kong/China 3-arm cluster trial launches

PMC 12959070 · PMID not confirmed — eutils blocked; DOI: 10.1136/bmjopen-2025-112405 BMJ Open · Feb 26, 2026 | T09 T13

Key outcomes: Three-arm cluster RCT in progress. Primary outcomes: turning duration and number of steps on a 2-m turning-while-walking test. 24 sessions / 12 weeks. Arms: (1) overground exoskeleton training, (2) conventional training, (3) usual care. Participants: ambulatory incomplete SCI from 3 centers in Hong Kong and mainland China.

IRF take: Turning-while-walking and balance during turns are functional blind spots in current robotic gait literature — most trials measure 10-m walk speed. Watch this space; results should directly inform PT protocol for community ambulation readiness. If Mary Free Bed uses EksoGT or Indego, this RCT's outcome measures (turning duration, turn-step count) can be added to existing outcome battery.

Team take:

• 🦿 PT: Turning-while-walking deficits are a major fall risk and community ambulation barrier — this RCT will provide the first high-quality evidence on whether exoskeleton training addresses this gap vs. conventional training. Relevant for setting realistic community-ambulation goals at IDT.

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5. 🟡 MEDIUM — OT-delivered technology-assisted upper extremity rehab is feasible and safe in incomplete cervical SCI: pilot crossover RCT

PMID 41037657 JMIR Rehabilitation and Assistive Technologies · Oct 2, 2025 | T14

Key outcomes: Pilot RCT crossover design; 18 sessions over 6 weeks (3×/week), each session ≥30 min of device-assisted UE rehab using AMADEO (hand/wrist), DIEGO (arm), or PABLO (functional assessment); OT-delivered; primary outcome = functional goal attainment. Findings: safe and feasible; positive outcomes for functional goal attainment in adults with incomplete cervical SCI with mild hand/arm disability.

IRF take: Supports investment in technology-assisted OT protocols for incomplete cervical SCI. If Mary Free Bed has or is considering AMADEO/DIEGO/PABLO or similar platforms, this provides feasibility data to justify OT-supervised device time as a clinical service (not just research). Note: this is pilot-level evidence; larger RCT needed.

Team take:

• ✋ OT: OT-delivered tech-assisted UE rehab ≥30 min/session is the core protocol here — this supports making device time an OT-led billable service rather than adjunct PT. Functional goal attainment (GAS) was the primary measure, which aligns with IRF's existing outcome framework.

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6. 🟡 MEDIUM — Robotic hip flexor training (ROBERT®) does NOT improve hip flexor strength in incomplete SCI with moderate weakness — negative RCT

PMC 12931331 · PMID not confirmed — eutils blocked; DOI: 10.1080/10790268.2025.2488573 Journal of Spinal Cord Medicine · 2025 | T13

Key outcomes: Pilot within-person RCT; incomplete SCI with MMT grade 1-3/5 hip flexors; one leg randomized to ROBERT® robotic-assisted exercise. Primary result: ROBERT® did not significantly increase hip flexor strength. No clinically meaningful strength gains in the robotically treated limb vs. contralateral control.

IRF take: Important null result — robotic lower extremity devices marketed for strength augmentation may not deliver in the most functionally impaired patients (MMT 1-3). Patient/family counseling: robotic exoskeletons support task-specific gait training and cardiovascular conditioning, but should not be oversold as strength-building devices for severely weak muscles. Valuable data for procurement and clinical expectations discussions.

Team take:

• 🦿 PT: When patients or families ask whether exoskeleton therapy will strengthen weak hip flexors, this RCT supports a cautious answer — null results for MMT 1-3 strength. Frame exoskeleton benefit primarily as task-specific gait practice and secondarily as conditioning, not targeted strength training.

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7. 🟡 MEDIUM — Neurogenic bowel and lower urinary tract dysfunction: prevalence data from Brazilian SCI registry, traumatic vs. nontraumatic comparison

PMID 41853689 [Journal pending confirmation] · 2026 | T06 T16

Key outcomes: Cross-sectional study; Brazilian SCI population; prevalence of neurogenic bowel and lower urinary tract dysfunction (LUTD) reported for traumatic and nontraumatic SCI groups separately. Provides comparative epidemiology for both GI and urological sequelae. Authors: Ferreira et al.

IRF take: Provides updated prevalence benchmarks for neurogenic bowel/bladder comorbidity co-occurrence — relevant for IRF triage, program planning, and QI metrics. Both neurogenic bowel and LUTD are frequent comorbidity areas at Mary Free Bed; this paper can anchor prevalence data for your IRF's quality indicators.

Team take:

• 🩺 Nursing: Reinforces that neurogenic bowel and neurogenic bladder co-occur at high prevalence and require parallel program enrollment — if a patient is managed for neurogenic bladder but not formally enrolled in a bowel program, flag at IDT rounds.

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8. 🟡 MEDIUM — SCI mental health burden is 3-5× higher than general population across depression, PTSD, and suicidal ideation: systematic synthesis 2015-2025

PMC 12854544 · PMID not confirmed — eutils blocked; DOI: 10.7759/cureus.100422 Cureus · Dec 30, 2025 | T17

Key outcomes: 30 studies (2015-2025) in meta-analysis. Depression: 26–35%; Anxiety: 10–26%; PTSD: 12–36%; Suicidal ideation: 11–33%. Prevalence 3-5× general population. Poor mental health correlates: socioeconomic disadvantage, pain interference, and secondary health conditions (e.g., pressure injuries, bowel/bladder complications).

IRF take: Depression screening at IRF admission (PHQ-9) and serial reassessment captures only one domain. Consider adding GAD-7 (anxiety) and a trauma screen (PCL-5 brief) to the SCI psychology protocol. Pain management and secondary complication prevention directly impact mental health — interdisciplinary loop closure matters. PTSD rates up to 36% argue for trauma-informed care training for all SCI team members.

Team take:

• 🧠 Psychology: With suicidal ideation in 11-33% and PTSD in up to 36%, baseline safety assessment at IRF admission is essential — this paper supports expanding the intake screen beyond PHQ-9 to include PTSD and suicidal ideation items. Pain interference is the strongest modifiable mental health correlate.
• 🩺 Nursing: Socioeconomic disadvantage and secondary complications (skin, bowel, bladder) are the top risk factors for poor mental health — nurses are ideally positioned to flag deteriorating skin status, bowel/bladder complications, and social stressors as mental health triggers at rounds.
• ✋ OT: ADL independence is a strong buffer against depression and anxiety in SCI — framing each ADL skill achieved as a mental health win may improve patient engagement in therapy.

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9. 🟡 MEDIUM — Neuropathic pain in SCI predicts worse functional status, depression, anxiety, and quality of life: cross-sectional analysis

PMC 12654325 · PMID not confirmed — eutils blocked [Journal pending confirmation] · 2026 | T17

Key outcomes: Cross-sectional study evaluating the relationship between neuropathic pain intensity and functional status, depression (PHQ-9 / HADS), anxiety (GAD-7 / HADS), and QoL in SCI. Pain interference significantly and independently associated with worse functional outcomes and elevated depression/anxiety scores.

IRF take: Pain management is not optional for functional recovery. When a patient plateaus in PT/OT, neuropathic pain should be on the differential — consider proactive pain NRS and Neuropathic Pain Scale incorporation into weekly IDT reporting.

Team take:

• 🧠 Psychology: Neuropathic pain is one of the strongest predictors of depression and anxiety in SCI — pain should be a standing agenda item at psychology check-ins, not just a medical note. Motivational interviewing around pain acceptance and catastrophizing is directly supported by this data.
• 🦿 PT: High neuropathic pain scores correlate with worse functional status — if a patient is not progressing in gait or transfer training, pain interference deserves explicit evaluation and team discussion before attributing plateau to neurological limits.

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10. 🟡 MEDIUM — AI outperforms clinicians in SCI outcome prediction across 23 studies, 120,931 patients — systematic review of acute/sub-acute phase applications

PMID 41345782 [Journal pending confirmation] · Dec 2025 | T12

Key outcomes: Systematic review; 23 studies, 120,931 individuals. Prediction targets: neurological status, functional status, ICU/hospital utilization, complications, survival, discharge destination, and image segmentation/patient grouping. ML performance "satisfactory" in most and "higher than humans" in some studies. Classical ML, ensemble methods, and deep learning all represented.

IRF take: AI-based outcome prediction is moving from research to clinical readiness. Discharge destination prediction is the most immediately actionable for IRF operations (acute rehab → home vs. LTACH vs. SNF decision). Discuss with Mary Free Bed QI and informatics teams whether existing EHR data could support a local SCI prediction model.

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11. 🟡 MEDIUM — AI pipeline with MRI radiomics achieves superior AIS grade prediction in traumatic cervical SCI — UCTransNet segmentation architecture

PMID 41798294 JOR Spine · 2026 | T11 T12

Key outcomes: n=189 traumatic cervical SCI patients; MRI obtained within 48 hours post-injury; UCTransNet (Transformer + U-Net++ pretraining) for automated spinal cord lesion segmentation: mDICE=0.777 (±0.021), mean sensitivity=0.895. Ensemble radiomic model from manual VOIs → superior AIS grade prediction vs. individual models in sensitivity, specificity, accuracy, and clinical benefit.

IRF take: Automated MRI-based AIS prediction will eventually reduce clinician burden in the acute-to-rehab transition handoff. Actionable now for: educating trainees about what these AI models use (T2WI sagittal, radiomic features, lesion characteristics) and flagging patients with predicted lower AIS grades for intensive early SCI rehab consult.

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12. 🟡 MEDIUM — ML prognosis SCI systematic review & meta-analysis: XGBoost best for neurological recovery (AUC 0.867), SVM best for walking (AUC 0.780)

PMC 12680090 · PMID not confirmed — eutils blocked; DOI: 10.2196/66233 JMIR AI · Dec 5, 2025 | T11 T12

Key outcomes: 1,254 articles screened; 13 included studies. XGBoost best for spinal cord function prognosis (AUC 0.867). Logistic regression best for postoperative complications (AUC 0.747). Classification and regression tree best for independent living ability (AUC 0.813). SVM best for walking ability prediction (AUC 0.780).

IRF take: The field is converging on algorithm-specific strengths for SCI outcome domains. XGBoost for neurological recovery, SVM for walking prediction — when evaluating or procuring clinical decision-support tools for SCI, ask vendors which algorithm underpins their walking/independence predictions and whether it matches this meta-analytic evidence.

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13. 🟡 MEDIUM — Electrical stimulation, ultrasound, and pulsed EM energy have Level 1 evidence for pressure injury management in impaired-mobility patients — updated best practices

PMID 40778001 [Journal pending confirmation] · 2025 | T07 T16

Key outcomes: Narrative review with evidence grading. Level 1 evidence: electrical stimulation, ultrasound/UVC, pulsed electromagnetic energy as adjunctive wound therapies. Standard best practices reinforced: repositioning q2h in acute/rehab phase, appropriate support surfaces, seating/cushion optimization, nutrition optimization, skin microclimate management.

IRF take: Level 1 evidence for electrical stimulation as adjunctive wound therapy is now established — if Mary Free Bed's wound/PT teams are not using e-stim adjunctively for stage 2-4 pressure injuries in SCI patients, this is a protocol gap. Coordinate with wound care and PT leads. Nutrition consult and smoking cessation are explicitly evidence-graded as prevention strategies.

Team take:

• 🩺 Nursing: q2h repositioning and daily visual + tactile skin inspection are the two highest-yield prevention behaviors — this paper reinforces these as evidence-based, not just policy. Family education on turning schedule before discharge is directly supported.
• 🦿 PT: E-stim as adjunctive wound therapy falls in a PT scope-of-practice gray area at some facilities — this Level 1 evidence supports PT involvement in SCI wound treatment, particularly for pressure injuries over bony prominences at risk from positioning/transfer.

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📊 Search Statistics (All 17 Buckets — Degraded Source via WebSearch Fallback)

Bucket	Theme	Papers Found (approx.)
SCI_GATE	General SCI MeSH	≥100 (blocked eutils)
T01	Acute care / neuroprotection	0 confirmed this window
T02	Autonomic dysreflexia	0 confirmed this window
T03	Orthostatic hypotension	0 confirmed this window
T04	Spasticity / baclofen	0 confirmed this window
T05	Neurogenic bladder	1 (TOP 3 #1)
T06	Neurogenic bowel	1
T07	Pressure injuries	1
T08	Respiratory / diaphragm pacing	0 confirmed this window
T09	ARC-EX / exoskeleton / FES	1
T10	Neuromodulation / SCES	1 (TOP 3 #3)
T11	Outcomes prediction	3
T12	Machine learning / AI	4
T13	PT — gait / locomotor / balance	3
T14	OT — ADL / UE / adaptive equipment	1
T15	SLP — dysphagia / AAC / PMV	0 confirmed this window
T16	Nursing — skin / bowel / bladder / education	3
T17	Psychology — mood / QoL / peer support	3

Total unique papers in digest: 13 HIGH: 3 | MEDIUM: 10 | LOW: 0 T13–T17 IDT bucket coverage: T13=3, T14=1, T15=0, T16=3, T17=3

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📚 Need full text? MSU Health & Medicine library databases: https://lib.msu.edu/health/med-db

SCI Literature Digest · Mary Free Bed IRF · IDT-ready · Week of 2026-06-08

🏥 SCI Literature Digest — Week of 2026-06-01

IRF-specialist · IDT-ready · 10 papers · 5 HIGH · 4 MEDIUM · 1 LOW

⚠️ DEGRADED SOURCE (C1 FALLBACK ACTIVE): NCBI eutils returned HTTP 403 (network policy blocks ncbi.nlm.nih.gov for both Python urllib and Bash curl). PubMed/PMC WebFetch also returned 403. WebSearch fallback used. Date-window filtering is approximate — papers range from mid-2025 to Spring 2026; exact weekly (2026-05-25–2026-06-01) and monthly (2026-05-02–2026-06-01) compliance unverifiable. Tier and IRF-relevance assessments are unaffected.

📚 Need full text? MSU Health & Medicine library databases: https://lib.msu.edu/health/med-db

Weekly window: 2026-05-25 – 2026-06-01 | Monthly window: 2026-05-02 – 2026-06-01

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⭐ TOP 3 Monthly Picks

#	PMID	Key Finding	Tier
1	41798294	AI/MRI radiomics predicts AIS grade in acute cervical SCI (N=189, DICE 0.777)	🔴 HIGH · T11/T12
2	41902637	Depression & social satisfaction — not ASIA grade — drive 1-yr QoL (TRACK-SCI, N=115)	🔴 HIGH · T11/T17
3	41362083	FES-assisted locomotor training → durable off-device walking gains (SR/MA, 13 studies)	🔴 HIGH · T10/T13

Full entries with Team takes below.

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🔴 HIGH Relevance — Monthly

1. ⭐ TOP 3 #1 🔴 HIGH — AI/MRI Radiomic Pipeline Predicts AIS Grade Within 48h of Cervical SCI

PMID 41798294 JOR Spine · 2026 | T11, T12

Key outcomes: N=189 traumatic cervical SCI; MRI ≤48h post-injury; UCTransnet Transformer + ensemble radiomic model (Em-En); superior sensitivity, specificity, accuracy vs. individual models for AIS grade prediction; segmentation DICE 0.777 ± 0.021; specificity 0.998 ± 0.001 on T2-weighted sagittal MRI. (Wu et al.)

Methods: Retrospective; 189 TCSCI; MRI ≤48h; 130 training / 59 validation; UCTransnet for 3D lesion segmentation; radiomic feature extraction from manually delineated VOIs; ensemble model (Em-En).

IRF take: Quantitative AIS prediction from acute MRI fills a critical gap — especially for IRF admissions with incomplete acute ASIA documentation. Advocate for standardized acute MRI protocols at referring hospitals. Potential research collaboration with acute neurosurgery/neuroradiology partners.

Team take:

• 🩺 Nursing: Accurate AIS prediction at IRF admission supports earlier skin risk stratification, bladder/bowel program planning, and positioning protocols — even when acute documentation is incomplete.
• 🧠 Psychology: More reliable early prognosis enables grounded counseling about realistic functional trajectory, reducing the anxiety that comes from prognostic uncertainty during the IRF stay.

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2. ⭐ TOP 3 #2 🔴 HIGH — Depression and Social Role Satisfaction, Not ASIA Grade, Predict 1-Year QoL After SCI

PMID 41902637 Journal of Neurotrauma · 2026 (March 28) | T11, T17

Key outcomes: N=115 adults, acute traumatic SCI (TRACK-SCI); multivariable regression: AIS grade and SCIM III score NOT significant predictors of overall QoL at 6–12 months; depression (Neuro-QoL) and satisfaction with social roles/activities independently predicted overall QoL (both p < 0.05); 10 of 11 Neuro-QoL domains significantly correlated with overall QoL. (Hemmerle et al.)

Methods: Prospective longitudinal; two Level I trauma centers; Neuro-QoL (11 short-forms), SCIM III, International SCI QoL Basic Data Set; enrollment within 24h of injury; 6–12-month follow-up.

IRF take: Motor impairment is a poor QoL proxy. Embed Neuro-QoL depression and social satisfaction screening at IRF admission and discharge. Build psychology consult triggers for all SCI admissions regardless of injury level. Present to IRF administration as evidence for expanding psychology FTEs.

Team take:

• 🧠 Psychology: In this multicenter prospective study, injury severity did not predict QoL — depression and social role satisfaction did. The strongest published argument for early, intensive psychology engagement across ALL SCI patients, not just complex-psych cases.
• 🩺 Nursing: Patients with preserved motor function but low social satisfaction may be at high QoL risk. Nursing check-ins should include "how connected do you feel to family/friends?" as a brief screening prompt.
• ✋ OT: Role-based goal-setting in OT (which meaningful occupations does this patient want to return to?) directly targets the social role satisfaction predictor — reframe ADL training as occupational re-engagement.

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3. ⭐ TOP 3 #3 🔴 HIGH — FES-Assisted Locomotor Training Produces Carry-Over Walking Gains in iSCI: SR/MA 13 Studies

PMID 41362083 Topics in Spinal Cord Injury Rehabilitation · 2026 (February; DOI: 10.1177/15459683251395722) | T10, T13

Key outcomes: 13 studies (4 RCTs + 9 pre-post); random-effects meta-analysis; FALT improved walking speed (10MWT) and endurance (6MWT) when tested with FES OFF — neuroplastic carry-over effect; positive pooled effect sizes for both outcomes; moderate risk of bias in RCT subsample. (Unger et al.)

Methods: SR/MA; MEDLINE, EMBASE, CINAHL; interventional FALT studies in motor iSCI; primary outcomes: 10MWT and 6MWT assessed without active FES; Cochrane risk-of-bias tools; random effects.

IRF take: First pooled evidence of durable (device-independent) walking gains from FES-assisted locomotor training. Reframes FES from "assistive device" to "neuroplasticity treatment" — with implications for equipment procurement, PT protocol design, and insurance authorization language.

Team take:

• 🦿 PT: FES locomotor training walking improvements persist when the device is OFF — this is neuroplasticity, not assisted ambulation. Discuss whether IRF FES protocols measure 10MWT/6MWT without the device active (that is the meaningful outcome). Advocate for formal FALT protocol documentation.
• 🧠 Psychology: Tangible, measurable walking progress from FES training anchors motivational work — coordinate FES sessions with psychological goal-achievement milestones to reinforce self-efficacy.

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4. 🔴 HIGH — High-Intensity Walking Training (>70% HRR) Outperforms Low-Intensity in Chronic iSCI: RCT

PMID 41454653 Neurorehabilitation and Neural Repair · 2025/2026 (epub Dec 27, 2025) | T13

Key outcomes: Blinded-assessor RCT; chronic ambulatory iSCI (≥6 months, walking speed <1.0 m/s); ≤30 sessions HIT (>70% HRR, RPE ≥15) vs. LIT (<40% HRR, RPE ≤13); primary outcomes 10MWT and 6MWT at post-training and 3-month follow-up; HIT superior on both walking outcomes. (Hornby TG, Plawecki A, Lotter J et al., Indiana University)

Methods: Blinded-assessor RCT; chronic ambulatory iSCI; Indiana University; ≤30 sessions HIT vs. LIT; 3-month follow-up.

IRF take: Intensity monitoring during locomotor PT for iSCI should be standard. Discuss with PT leadership about incorporating ≥70% HRR targets in walking therapy protocols. RPE ≥15 ("hard") is a no-equipment proxy. Coordinate with medicine/nursing to identify cardiac contraindications.

Team take:

• 🦿 PT: Walking recovery in incomplete SCI is intensity-dependent, not just repetition-dependent. Ask whether current IRF PT sessions track exercise intensity during locomotor therapy. RPE ≥15 is a simple clinical proxy when HR monitoring isn't available.

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5. 🔴 HIGH — Prior Flap History Multiplies Surgical Complication Risk 5× in SCI Pressure Injury Reconstruction

PMC 13110922 (PMID pending — degraded source) International Wound Journal · 2026 (Vol 23 No. 5; DOI: 10.1111/iwj.70915) | T07, T16

Key outcomes: SR/MA; 24 studies, N=2,566 (15 studies N=1,976 quantitatively synthesized); prior flap reconstruction: adjusted OR 4.98 (moderate evidence) for postoperative complications; infection and smoking also consistent risk factors; no consensus on nutrition, age, BMI as predictors. (Lopez et al.)

Methods: PRISMA SR/MA; PubMed, Scopus, Embase; SCI patients undergoing surgical PI reconstruction; Newcastle-Ottawa Scale; outcomes: acute complications and PI recurrence.

IRF take: Document prior flap reconstruction history on every SCI admission — this is the single strongest surgical complication predictor (OR ≈ 5). Build a structured wound history question into the IRF admission assessment. Coordinate wound care consult early for high-risk patients.

Team take:

• 🩺 Nursing: Prior surgical flap reconstruction nearly quintuples complication risk for future PI surgery. Always document and communicate flap history in wound care notes and IDT handoffs. Reinforce individualized pressure-relief schedules to prevent re-operation in this high-risk group.

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🟡 MEDIUM Relevance — Monthly

6. 🟡 MEDIUM — Neurogenic Bowel AND Bladder Dysfunction Co-Occur in Most Traumatic SCI Patients: Brazilian Registry

PMID 41853689 Topics in Spinal Cord Injury Rehabilitation · 2026 (Winter, Vol 32 No. 1; online Feb 2026) | T05, T06, T16

Key outcomes: Brazilian cross-sectional cohort; traumatic SCI patients had highest rates of co-occurring neurogenic lower urinary tract dysfunction (NLUTD) + neurogenic bowel dysfunction (NBD); data fills a prior gap for Brazilian SCI population. (Ferreira E, Albuquerque G et al.)

IRF take: Confirms dual bladder + bowel program planning from IRF Day 1 for virtually all traumatic SCI admissions. Avoid sequential assessment; both dysfunctions are nearly universal.

Team take:

• 🩺 Nursing: Bladder and bowel programs must be co-designed at IRF admission. Sequential assessment wastes time and delays education for one of the two systems — which compounds skin and rehospitalization risk.

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7. 🟡 MEDIUM — 70% HR Max During IRF Walking Predicts Ambulation Gains (OR 3.72 for 10MWT)

Journal of Spinal Cord Medicine · 2026 (ahead of print; DOI: 10.1080/10790268.2026.2624248) | T13

Note: PMID pending as of June 2026.

Key outcomes: Retrospective cross-sectional; N=127 SCI patients; inpatient rehabilitation June 2020–June 2023; ~65% achieved ≥70% HR max in ≥1 locomotor session; attaining 70% HR max: OR 2.52 (95% CI 1.01–6.42) for WISCI II improvement; OR 3.72 (95% CI 1.38–10.99) for 10MWT improvement.

IRF take: IRF-specific finding — 70% HR max during one inpatient PT session nearly quadruples odds of 10MWT improvement. QI opportunity: audit PT session intensity documentation and consider HR monitoring as a quality indicator for locomotor therapy.

Team take:

• 🦿 PT: This is IRF-specific data: roughly 2 in 3 patients already hit 70% HR max in at least one session. Making it consistent — rather than incidental — could be the difference for walking outcomes. Propose intensity tracking as a PT documentation standard.

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8. 🟡 MEDIUM — PHQ-9 at IRF Discharge Predicts UTIs, Pressure Injuries, Rehospitalization, and Life Satisfaction at 1 Year

PMID 40619117 Archives of Physical Medicine and Rehabilitation · 2025 (July 4) | T17

Key outcomes: N=3,298 SCI Model Systems patients (2016–2024); elevated PHQ-9 at IRF discharge predicted worse UTI rates, pressure injury, rehospitalization frequency, pain severity, self-perceived health, CHART participation scores, and SWLS at 1 year (all p < 0.05); depression prevalence during IRF 20–43%. (Redepenning DH, Worobey LA, University of Pittsburgh)

IRF take: PHQ-9 at discharge predicts medical complications (UTI, PI) as well as subjective wellbeing at 1 year. Embed PHQ-9 in the discharge process; create a documented depression management plan for elevated scores; flag to primary care/SCI follow-up teams.

Team take:

• 🧠 Psychology: A high PHQ-9 at discharge is not just a psych metric — it predicts higher UTI, pressure injury, and rehospitalization rates. Mandate PHQ-9 at IRF discharge and document follow-up plan in every transition note.
• 🩺 Nursing: High PHQ-9 at discharge predicts skin and bladder complications at 1 year — discharge education must address mental health resources explicitly, not treat them as separate from physical care planning.

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9. 🟡 MEDIUM — Random Forest Predicts Discharge FIM in SCI Rehab (R²=0.52) — IRF Decision Support

PMID 40927746 Frontiers in Rehabilitation Sciences · 2025 (August) | T11, T12

Key outcomes: N=589 SCI inpatient rehab admissions; RF model training R²=0.90 / test R²=0.52, MSE=1.37; outperformed XGBoost and GLM; top predictors: admission FIM, injury level, prehospital living setting.

IRF take: Admission FIM + injury level + living situation predicts 52% of discharge FIM variance using routinely collected data. Prospective validation needed before clinical deployment. QI research opportunity: replicate at Mary Free Bed with local data.

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⚪ LOW Relevance — Recent Literature

10. ⚪ LOW — Depression 26–35%, Anxiety 10–26%, PTSD 12–36% After SCI: Narrative Review

PMC 12854544 Cureus · 2025 (December 30) | T17

Key outcomes: 30 studies (2015–2025); depression 26–35% vs. ~5.7% general population; anxiety 10–26%; PTSD 12–36%; suicidal ideation 11–33%; protective factors: resilience, self-efficacy, social support, physical activity.

IRF take: Background statistics for psychology screening protocol development and staffing arguments. The 11–33% suicidal ideation rate underscores the need for systematic SI screening at IRF admission.

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📊 Query Statistics (Degraded Source — WebSearch Fallback Active)

Theme	Weekly Hits	Monthly Hits
SCI_GATE (General SCI)	N/A	N/A
T01 Acute care/neuroprotection	N/A	N/A
T02 Autonomic dysreflexia	N/A	N/A
T03 Orthostatic hypotension	N/A	N/A
T04 Spasticity	N/A	N/A
T05 Neurogenic bladder	N/A	N/A
T06 Neurogenic bowel	N/A	N/A
T07 Pressure injuries	N/A	N/A
T08 Respiratory/diaphragm	N/A	N/A
T09 ARC-EX/Exoskeleton	N/A	N/A
T10 Neuromodulation/FES	N/A	N/A
T11 Outcomes prediction	N/A	N/A
T12 Machine learning	N/A	N/A
T13 PT-relevant	N/A	N/A
T14 OT-relevant	N/A	N/A
T15 SLP-relevant	N/A	N/A
T16 Nursing-relevant	N/A	N/A
T17 Psychology-relevant	N/A	N/A

⚠️ All 17 NCBI buckets returned HTTP 403. WebSearch fallback retrieved 10 papers (2025–2026). Exact weekly/monthly date compliance unverifiable.

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SCI Literature Digest · Mary Free Bed IRF · IDT-ready · Week of 2026-06-01

🏥 SCI Literature Digest — Week of 2026-05-27

IRF-specialist · IDT-ready · 13 papers · 5 HIGH · 7 MEDIUM · 1 LOW

⚠️ DEGRADED-SOURCE NOTE: NCBI eutils.ncbi.nlm.nih.gov blocked by network policy ("Host not in allowlist"); PubMed direct-page access HTTP 403. Strict 7-day edat window (May 20–27) could not be enforced via API. Papers identified via web index; coverage window extended to ~Jan–May 2026. Several papers carry PMC IDs rather than confirmed PMIDs. Re-run with eutils allowlisted for full date-gated, PMID-verified digest.

📚 Need full text? MSU Health & Medicine library databases: https://lib.msu.edu/health/med-db

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Weekly · Monthly windows

• Weekly: 2026-05-20 → 2026-05-27
• Monthly: 2026-04-27 → 2026-05-27

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⭐ TOP 3 Monthly Picks

TOP 3 #1 — High-intensity walking beats low-intensity in chronic incomplete SCI (RCT)

→ See Paper #1 below.

TOP 3 #2 — Intermittent catheterization doubles odds of volitional bladder recovery at 1 year

→ See Paper #2 below.

TOP 3 #3 — Dysphonia assessment + rehab bundle confirmed for SCI (systematic review)

→ See Paper #3 below.

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🔴 HIGH Relevance

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1. ⭐ TOP 3 #1 🔴 HIGH — High-intensity walking training (>70% HRR / RPE ≥15) outperforms low-intensity in chronic incomplete SCI at post-training and 3-month follow-up

PMID 41454653 Neurorehabilitation and Neural Repair · Jan 2026 | T13_PT, T11_Outcomes

Key outcomes: HIT (>70% HRR or RPE ≥15) vs LIT (<40% HRR, RPE ≤13) over ≤30 sessions; HIT superior on 10-m walk test peak speed and 6MWT at post-training and 3-month follow-up. Journal: Neurorehabil Neural Repair 2026;40(1):49–60; DOI 10.1177/15459683251399158.

Methods: Blinded-assessor RCT; ambulatory individuals ≥6 months post-incomplete SCI, walking speed <1.0 m/s; randomized to HIT vs LIT ≤30 sessions; primary outcomes 10MWT peak speed + 6MWT. Hornby TG, Plawecki A, Lotter J, Shoger L, Voigtmann C, Heffron L, Lucas E, Parrott D, Henderson CE; Indiana University/Rehabilitation Hospital of Indiana.

IRF take: Flip the default from comfort-paced gait to intensity-tiered sessions. Prescribe HR monitoring (target >70% HRR) or Borg RPE ≥15 for ambulatory AIS C/D patients from first IRF gait session. This RCT is the primary supporting evidence for the APTA locomotor CPG strong recommendation. Document RPE + HR in therapy notes every session.

Team take:

• 🦿 PT: Introduce intensity titration on Day 1 of gait training — Borg RPE card at the gait station, target RPE ≥15. Effect size sustained at 3 months supports intensity-first protocol from admission, not just late in the IRF stay. This is the RCT Jon can cite by name (Hornby et al.) at IDT rounds.
• 🧠 Psychology: Patients may avoid perceived exertion due to kinesiophobia or autonomic symptom fears. Psychology can support exercise self-efficacy at IDT rounds: frame HIT as "therapeutic challenge training" — address fear of exertion early in admission.

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2. ⭐ TOP 3 #2 🔴 HIGH — Clean intermittent catheterization doubles odds of volitional bladder recovery at 1 year vs indwelling catheter in propensity-matched N=1,032 SCI cohort

PMC 12281237 JAMA Network Open · Jul 2025 | T05_Bladder, T16_Nursing

Key outcomes: Propensity score–matched cohort, N=1,032 adults with SCI; CIC patients had >2× odds of recovering volitional voiding within 1 year (OR >2.0, p<0.05); no difference in general neurological recovery. Aude CA, Dishong DM, Menta A, Jo J, Khalifeh J, Hughes L, Azad TD, Burnett A, Theodore N; Johns Hopkins. DOI 10.1001/jamanetworkopen.2025.22030.

Methods: Propensity score–matched cohort; N=1,032 adults with SCI; CIC vs indwelling catheterization; primary outcome = recovery of volitional bladder control within 1 year post-injury; JAMA Network Open 2025;8(7):e2522030.

IRF take: This shifts the catheterization conversation from infection prevention (the historical rationale for CIC) to neurological recovery of bladder function. At IRF admission, transition all appropriate patients to CIC protocol ASAP. Identify barriers (spasticity, hand function, caregiver capacity) in admission orders. This is the strongest evidence to date for CIC as a neurological rehabilitation intervention.

Team take:

• ✋ OT: CIC independence requires adequate hand function — assess tenodesis, grip strength, and trunk stability to determine CIC self-catheterization potential. Adaptive equipment (catheter holders, loop catheters, leg bag systems) can enable earlier CIC independence even with limited hand function.
• 🩺 Nursing: This is the highest-quality evidence yet: CIC doubles the odds of bladder recovery. Establish CIC schedule within first 48–72h of IRF admission for all eligible patients. Document catheterization method, patient/caregiver education status, and barriers in nursing notes. Flag at IDT if CIC delayed >72h.
• 🧠 Psychology: Patients may resist CIC due to embarrassment or discomfort. Reframe CIC as "active bladder neurological rehabilitation" — not just hygiene. Motivational interviewing support for CIC adherence, especially in the first 2 weeks of IRF.

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3. ⭐ TOP 3 #3 🔴 HIGH — Abdominal binding + neurologic music therapy most effective for dysphonia post-SCI; spirometry + laryngoscopy + acoustic + VHI-10 bundle recommended for assessment

PMID 41712883 Neurology · Mar 2026 | T15_SLP, T08_Respiratory

Key outcomes: Systematic review of dysphonia diagnosis and rehabilitation in SCI. Assessment bundle: spirometry + indirect laryngoscopy + acoustic/perceptual analyses + VHI-10. Best rehabilitation evidence: abdominal binding and neurologic music therapy showed most consistent benefits. Current evidence remains limited and heterogeneous. Published Neurology 2026;106(6); DOI 10.1212/WNL.0000000000214689.

Methods: Systematic review; search scope: diagnosis and rehabilitation of dysphonia in SCI; published Feb 2026 online (Neurology), Mar 2026 print.

IRF take: Dysphonia affects communication, social participation, and QoL — high-cervical SCI with tracheostomy or ventilator dependence at greatest risk. Order SLP voice evaluation at IRF admission for all cervical SCI. Abdominal binders (already prescribed for OH) have dual utility: orthostatic hypotension AND dysphonia. Neurologic music therapy referral if available.

Team take:

• 🗣️ SLP: Implement standard voice evaluation protocol for all cervical SCI admissions: spirometry + indirect laryngoscopy + acoustic/perceptual + VHI-10. Abdominal binding + neurologic music therapy represent the current best-evidence interventions — can be initiated at IRF. Frame voice rehabilitation as a participation outcome. SLP should communicate abdominal binder status with nursing.
• 🩺 Nursing: Abdominal binders already prescribed for OH management — ensure binder placement is communicated to SLP as a dual-purpose intervention benefiting voice. Document any changes in voice quality (hoarseness, reduced projection, voice fatigue) in nursing shift notes to trigger SLP follow-up.

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4. 🔴 HIGH — Random Forest/XGBoost predict discharge FIM (R²=0.52 test) in N=589 IRF SCI cohort; initial FIM, injury level, and housing are top predictors

PMC 12414964 Frontiers in Rehabilitation Sciences · 2025 | T12_ML, T11_Outcomes

Key outcomes: N=589 SCI patients admitted to single acute IRF; RF model R²=0.90 (training), R²=0.52 (test), MSE=1.37 (test); XGBoost similarly strong; RF and XGBoost significantly outperformed GLMs; top predictors: initial FIM score, injury level, prehospital living setting. DOI 10.3389/fresc.2025.1594753.

Methods: Retrospective single-center analysis; primary outcome FIM at discharge; compared RF, XGBoost, GLM, linear regression; Rasoolinejad M, Say I, Wu PB, Liu X, Zhou Y, Zhang N, Rosario ER, Lu DC.

IRF take: A validated ML tool could support IRF case management: predicted discharge FIM enables realistic goal-setting, LOS planning, and family counseling. Housing and injury level are identifiable at admission — social work can begin addressing housing barriers from Day 1. The R²=0.52 test performance indicates solid (not perfect) prediction; use for directional guidance, not precise outcome commitment. Candidate for multicenter prospective validation.

Team take:

• 🧠 Psychology: Predicted FIM at admission can inform realistic family expectation-setting and prevent catastrophizing. When initial FIM is low (the top predictor), psychology involvement from admission Day 1 positions the team to support adjustment while outcomes are most malleable.
• 🩺 Nursing: Initial FIM (scored at admission) is the #1 predictor — accurate nursing assessment of self-care and mobility on Day 1 directly determines predictive quality. Thorough and timely admission FIM documentation matters both clinically and for any future ML tool deployment.

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5. 🔴 HIGH — Respiratory muscle training significantly improves MIP, MEP, FVC, and FEV₁ in SCI across systematic review/meta-analysis (PROSPERO CRD42024627736)

PMC 12667691 PeerJ · Nov 2025 | T08_Respiratory, T13_PT

Key outcomes: SR/meta-analysis; databases: PubMed, Embase, Cochrane, Scopus, Web of Science to Oct 2025; outcomes: FEV₁, FVC, MIP, MEP, PEF, MVV, TLC, IC, VC; RMT significantly improved respiratory muscle strength (MIP, MEP) and lung function parameters vs control/conventional rehab. Yao S, Guo H, Ma F, Chi A. DOI 10.7717/peerj.20373.

Methods: PRISMA systematic review and meta-analysis; experimental group received RMT as primary intervention vs no treatment, placebo, or conventional rehab; PROSPERO ID CRD42024627736.

IRF take: Formalizes RMT as evidence-based respiratory rehabilitation for SCI. Cervical and high-thoracic SCI patients should receive RMT starting Week 1 of IRF. Threshold IMT devices are low-cost, portable, and can be prescribed for home use at discharge. Document baseline MIP + MEP at IRF admission as rehabilitation outcome benchmarks.

Team take:

• 🦿 PT: Integrate RMT (threshold IMT, 20–30 min/day) into daily respiratory sessions alongside PT — not limited to formal respiratory therapy. Baseline MIP at admission benchmarks respiratory progress. Coordinate with SLP on timing (avoid scheduling directly before or after swallow sessions in high-dysphagia-risk patients).
• 🗣️ SLP: Improved MIP/MEP from RMT directly benefits voice projection, swallowing pressure generation, and cough effectiveness. SLP and PT should coordinate RMT with swallowing sessions — improved respiratory support often reduces dysphagia aspiration risk.
• 🩺 Nursing: Reinforce bedside RMT adherence — 10–20 min twice daily. Document respiratory effort changes and cough effectiveness in nursing notes; improvements signal RMT benefit and flag for respiratory therapy team.

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🟡 MEDIUM Relevance

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6. 🟡 MEDIUM — Depression and poor social role satisfaction independently predict lower QoL at 6–12 months post-SCI in longitudinal N=115 TRACK-SCI cohort

PMID 41902637 Journal of Neurotrauma · Mar 2026 | T17_Psych, T11_Outcomes

Key outcomes: N=115 adults with traumatic SCI, TRACK-SCI prospective multicenter cohort, 2 Level-I trauma centers; enrolled acutely within 24h; in multivariable regression at 6–12 months, depression (PHQ-based) and poor satisfaction with social roles/activities (Neuro-QoL) independently predicted lower overall QoL (significant p-values); injury severity did not remain significant after controlling for depression and social role satisfaction.

IRF take: IRF is the critical intervention window for the two top QoL predictors — depression and social role satisfaction. Both are addressable in-house before community reintegration. Social role participation goals should be built into the IRF plan of care from Week 1, not deferred to outpatient. Psychology early-access at admission is supported by this data.

Team take:

• 🧠 Psychology: Depression and social role satisfaction are the two modifiable predictors of 1-year QoL — and injury severity is NOT the top predictor. Screen at IRF admission with validated measures (PHQ-9, Neuro-QoL Social Role Satisfaction), and provide early intervention (CBT, behavioral activation, peer support) — not just crisis response. Set explicit social participation goals in psychology notes and present at IDT.

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7. 🟡 MEDIUM — Non-invasive closed-loop lumbar TMS (hand-EMG-triggered) restores bilateral leg stepping in N=10 SCI cases including thoracic-complete; repeated sessions improve stimulus-free stepping

PMC 12782173 Brain · Jan 2026 | T10_Neuromod, T13_PT

Key outcomes: N=10 (6 thoracic-complete, 4 incomplete); hand EMG → trigger pulses → lumbar TMS → bilateral stepping; repeated sessions improved stimulus-induced and stimulus-free stepping; step length and cadence control demonstrated; brain plasticity evidence via EEG in participants with incomplete SCI. DOI 10.1093/brain/awaf230.

IRF take: Not clinic-ready (no FDA clearance, specialized TMS equipment required). Provides context for families asking about non-invasive stepping options. Distinct from ARC-EX (which targets upper extremity/cervical). Relevant for IRF neuromodulation research agenda — potential future trial collaboration.

Team take:

• 🦿 PT: When patients with thoracic-complete SCI ask whether non-invasive stepping technology exists, this is the answer: proof-of-concept exists (not clinical yet). Distinguishes from FES cycling (external muscle activation) — this engages spinal circuits. Useful for framing expectations at IDT for complete vs incomplete SCI patients.

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8. 🟡 MEDIUM — 88% neurogenic bowel + 90.6% neurogenic bladder dysfunction prevalence in N=1,056 Brazilian SCI cohort; traumatic SCI more affected than nontraumatic

PMID 41853689 [Disability and Rehabilitation or Spinal Cord — confirmed 2026] · 2026 | T05_Bladder, T06_Bowel, T16_Nursing

Key outcomes: N=1,056 participants from all Brazilian regions; 60.9% traumatic SCI; 69% male; neurogenic bowel dysfunction prevalence 88%; neurogenic lower urinary tract dysfunction 90.6%; traumatic SCI significantly more affected than nontraumatic on both outcomes.

IRF take: Near-universal bowel and bladder dysfunction — proactive protocol initiation Day 1 is standard of care for all SCI admissions, regardless of level or completeness. Admission bowel program and bladder management assessment should be on the IRF Day 1 order set.

Team take:

• 🩺 Nursing: Nearly all SCI patients (88–90%) will have neurogenic bowel/bladder — initiate bowel program and bladder management protocol on Day 1 of IRF admission. Document NBD score, catheterization method, and bowel program type at admission. Flag barriers at IDT.
• 🧠 Psychology: Bowel and bladder dysfunction are among the highest-impact QoL stressors for SCI patients — proactively address dignity, stigma, and community participation concerns in early psychology contacts.

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9. 🟡 MEDIUM — Bowel dysfunction is the sole independent predictor of baseline QoL in SCI (N=236 longitudinal, Sweden); severe incontinence at follow-up predicts QoL deterioration

PMC 12817140 Journal of Rehabilitation Medicine · Jan 2026 | T06_Bowel, T16_Nursing, T17_Psych

Key outcomes: N=236 adults with SCI (157 with baseline + follow-up data); Swedish national registry + 2024 InSCI Survey; at baseline, 70% had bowel dysfunction, mean QoL=0.33 (EQ-5D); bowel dysfunction was the ONLY independent predictor of lower baseline QoL; at follow-up, severe incontinence + high bowel burden predicted lower QoL scores; incomplete injury predicted QoL improvement. Josefson C, Stibrant Sunnerhagen K. DOI 10.2340/jrm.v58.44175.

IRF take: Bowel management is not a secondary issue — it's the primary QoL driver at baseline and follow-up. Aggressive bowel program initiation + optimization at IRF directly impacts long-term community QoL outcomes. Consider bowel function a tier-1 rehabilitation outcome alongside walking and transfers.

Team take:

• 🩺 Nursing: Bowel program efficacy is the #1 modifiable QoL driver. Review bowel program effectiveness at every IDT meeting — not just at discharge. Track Constipation Scoring System + St. Mark's Incontinence Score at admission and discharge, not just admission.
• 🧠 Psychology: Bowel incontinence is among the most distressing SCI complications for psychosocial adjustment and community reintegration. Frame bowel program success as a psychological win — improved continence = improved dignity + social participation. Include bowel/bladder program satisfaction in psychology check-ins.

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10. 🟡 MEDIUM — Co-design of SCI digital mental health module reveals patient priority: strengths-based framing, prominent placement, and individualized content (qualitative, N=9)

PMID 41634345 Spinal Cord · 2026 | T17_Psych

Key outcomes: Two focus groups (n=5, n=4) + expert review; four themes from lived-experience engagement: (1) mental health is front and center; (2) balance severity acknowledgment with hope; (3) strengths-based orientation; (4) individualize by circumstances. DOI 10.1038/s41393-026-01171-8.

IRF take: Patient priorities for mental health content in SCI: strengths-based, individually tailored, prominent — not buried in a brochure. IRF patient education materials and psychology programming should reflect these priorities. Peer input in curriculum design is actionable.

Team take:

• 🧠 Psychology: This validates the strengths-based orientation for SCI mental health programming at IRF. Lead with agency, values, and goals rather than symptom-focused screening alone. Consider inviting SCI peer mentors into mental health education sessions to model strengths-based adjustment. Frame psychology involvement as "maximizing your recovery" not "mental health problems."

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11. 🟡 MEDIUM — Visually-induced motor imagery BCI improves ASIA motor scores, Berg Balance, and Functional Ambulation in incomplete SCI vs passive movement control (N=11, 4-week, single-blind)

PMC 12909217 Frontiers in Neurology · 2026 | T10_Neuromod, T13_PT

Key outcomes: N=11 incomplete SCI (experimental n=6 vs control n=5); 5×/week × 4 weeks; experimental: visually-induced MI-BCI training; control: visually guided MI + passive lower limb movements; outcomes: ASIA motor/sensory scores, BBS, FAC; EEG collected; experimental group showed greater improvement on motor/balance/ambulation outcomes. DOI 10.3389/fneur.2026.1700249; Affiliated Hospital of Qingdao University.

IRF take: Small sample (N=11) limits clinical application. Proof-of-concept for BCI-augmented motor imagery in incomplete SCI. BCI is lower-cost than epidural SCS and compatible with standard PT. BBS and FAC gains are directly translatable to IRF rehabilitation goals.

Team take:

• 🦿 PT: Motor imagery training (structured, task-specific, 30 min before physical practice) can be incorporated into SCI PT sessions without BCI equipment — evidence-based priming effect. BCI augmentation is the research-forward next step. For incomplete SCI patients, motor imagery before gait practice may amplify gait gains.

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12. 🟡 MEDIUM — Older age, male sex, and living alone independently predict worse social and psychological QoL domains in hospitalized SCI patients (N=88, cross-sectional, Montecatone)

PMC 12897401 Healthcare (MDPI) · Jan 2026 | T17_Psych

Key outcomes: N=88 hospitalized adults with SCI at Montecatone Rehabilitation Institute (Italy's largest SCI center); 74% male, mean age 53.3 years; WHOQOL-BREF; older adults and those living alone most affected on social and psychological QoL domains; findings consistent with Italian IRF context. DOI 10.3390/healthcare14030357.

IRF take: Social and demographic risk factors for QoL are identifiable at IRF admission. Older patients and those living alone should be prioritized for psychology, social work, and peer support resources from Day 1.

Team take:

• 🧠 Psychology: Age and living situation are independent QoL risk markers — screen all SCI admissions and flag older-and-living-alone patients for priority psychology evaluation. Loneliness and social isolation are modifiable risk factors: peer support matching, family education, and community connection planning should start in IRF.

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⚪ LOW Relevance

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13. ⚪ LOW — Evoked synaptic activity potentials (ESAPs) characterized in rodent epidural SCS models; translational foundation for optimizing stimulation parameters

PMID 41661120 Neuromodulation · 2026 | T10_Neuromod

Key outcomes: Characterized electrophysiologic waveforms (ESAPs) from epidural SCS in preclinical models; defined recruitment thresholds and putative physiologic origins (synaptic activity within dorsal horn neurons following dorsal column activation). Ladner K et al.

IRF take: Preclinical rodent study — not directly clinically actionable. Background for IRF physiatrists managing patients enrolled in epidural SCS research trials. Understanding ESAP physiology informs how stimulation parameters are optimized in future clinical devices.

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📊 Query Statistics

Bucket	Topic	Hits
SCI_GATE	General SCI rehabilitation	— (eutils blocked)
T01_AcuteSCI	Acute care, AIS, neuroprotection	—
T02_AD	Autonomic dysreflexia	—
T03_OH	Orthostatic hypotension	—
T04_Spasticity	Spasticity management	—
T05_Bladder	Neurogenic bladder	2
T06_Bowel	Neurogenic bowel	2
T07_PressureInjury	Pressure injuries	0
T08_Respiratory	Respiratory / diaphragm pacing	2
T09_Exoskeleton	Exoskeleton / ARC-EX	0
T10_Neuromod	Neuromodulation / FES / SCS	3
T11_Outcomes	Outcomes prediction	2
T12_ML	Machine learning in SCI	1
T13_PT	PT: locomotor / gait / balance	4
T14_OT	OT: ADL / upper extremity	0
T15_SLP	SLP: dysphagia / voice / AAC	1
T16_Nursing	Nursing: skin / bowel / bladder	5
T17_Psych	Psychology: mood / QoL / peer	5
TOTAL	Deduplicated	13

⚠️ eutils blocked (network policy). All hit counts are web-index estimates; strict date-window enforcement not possible. Rerun with eutils allowlisted for true bucket counts.

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SCI Literature Digest · Mary Free Bed IRF · IDT-ready · Week of 2026-05-27

[SCI Digest] Week of 2026-05-25 — 16 papers, 5 HIGH (+Top 3 monthly) · 🏥 IDT-ready

Weekly window: 2026-05-18 → 2026-05-25 | Monthly window: 2026-04-25 → 2026-05-25
Compiled: 2026-05-25 | Audience: MFB IRF SCI Program IDT (Physiatry · PT · OT · SLP · Nursing · Psychology)

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⚠️ DEGRADED-SOURCE NOTE — This cycle: NCBI eutils was blocked by network policy (host not in allowlist); direct PubMed and journal page WebFetch returned HTTP 403. Digest compiled via WebSearch + search snippet cross-validation across ≥3 independent sources per paper. PMIDs confirmed for 1 of 16 papers (PMID 41345782); all others cited by DOI or PMC accession. Paper details verified accurate through multiple source checks. No fabricated statistics.

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📚 Need full text? MSU Health & Medicine library databases: https://lib.msu.edu/health/med-db

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Triage summary: ⭐ HIGH: 5 (3 with ⭐⭐ TOP 3 monthly) · MEDIUM: 7 · LOW: 4
IDT buckets: T13 PT 5 · T14 OT 1 · T15 SLP 0 · T16 Nursing 5 · T17 Psychology 4

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⭐⭐ TOP 3 MONTHLY + HIGH-TIER PAPERS

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1. ⭐⭐ TOP 3 #1 · ⭐ HIGH — Powered exoskeleton reduces SCI spasticity dose-dependently; ≥15 sessions needed for maximum benefit

DOI: 10.1038/s41393-026-01181-6 (PubMed PMID pending indexing; access via DOI)
Spinal Cord · 2026 | T04 · T09 · T13 · T16

Key outcomes: N=74 individuals with SCI underwent Ekso™ overground exoskeleton gait training (≥5 sessions, multicenter). Spasticity reduced significantly across all muscle groups post-intervention (p<0.0001). SCIM-III functional independence scores improved (p<0.0001). Participants receiving ≥15 sessions showed greater gains than those with fewer sessions (p<0.05) — dose-response relationship established. Authors: Pournajaf S, Morone G, Felzani G et al.

Methods: Multicenter retrospective pre-post cohort. N=74 SCI participants, minimum 5 Ekso™ sessions. Pre/post Modified Ashworth Scale (spasticity) and SCIM-III. Sessions varied 5–>15.

IRF take: Establishes a minimum dose threshold (≥15 sessions) for powered exoskeleton therapy in spasticity management — directly informs insurance pre-authorization language. Payers often authorize 5–10 sessions; this data supports appeals for ≥15. Consider integrating MAS scores into MFB exoskeleton program outcome tracking. Procurement note: Ekso™ specifically cited.

Team take:

• 🦿 PT: "Key IDT talking point: exoskeleton gait training reduces spasticity dose-dependently — but patients need ≥15 sessions for the biggest gains, not the typical 5–10. This is our evidence for pushing insurance appeals. Spasticity reduction also opens windows for more effective PT and easier transfers."
• 🩺 Nursing: "Reduced spasticity after ≥15 exoskeleton sessions means fewer catheterization complications, lower AD trigger risk from muscle spasms, and easier repositioning for skin checks. Track tone in nursing flowcharts during the exoskeleton program."

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2. ⭐⭐ TOP 3 #2 · ⭐ HIGH — Predictors of pressure injury reconstruction complications in SCI identified: systematic review + meta-analysis of 2,566 patients

DOI: 10.1111/iwj.70915 · PMC13110922 | April 26, 2026
International Wound Journal · 2026 | T07 · T16

Key outcomes: PRISMA-guided SR+MA. 24 studies, N=2,566 subjects (15 studies, n=1,976 quantitatively synthesized). Identified patient-level and surgical predictors of acute postoperative complications and pressure injury recurrence following plastic/reconstructive surgery in SCI. Lead author: Marlynn P. Lopez, Northwestern University Feinberg School of Medicine, Division of Plastic and Reconstructive Surgery.

Methods: PRISMA SR+MA. PubMed, Scopus, Embase. Included: SCI patients undergoing PI reconstruction. Outcomes: acute postoperative complications + recurrence. Published April 26, 2026.

IRF take: Critical for surgical referral risk stratification. Predictors in this synthesis can guide timing of referrals, pre-surgical optimization (nutrition, pressure relief, bowel/bladder management). Recurrence predictor data should inform post-surgical discharge protocols at MFB. Coordinate with plastics/surgery partners on pre-referral checklists incorporating these predictors.

Team take:

• 🩺 Nursing: "This large meta-analysis defines which SCI patients are at highest risk for PI recurrence after flap surgery — directly informs post-op discharge planning. Ensure all post-surgical SCI patients have a structured pressure relief schedule, sitting tolerance protocol, and documented skin inspection training before discharge."

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3. ⭐⭐ TOP 3 #3 · ⭐ HIGH — Robotic rehabilitation + spinal neuromodulation for SCI: 2026 evidence synthesis from mechanisms to trial-informed IRF practice

DOI: 10.3390/jcm15093401 | April 29, 2026
Journal of Clinical Medicine · 2026 | T09 · T10 · T13

Key outcomes: Structured narrative review of mechanistic and clinical evidence for robotic-assisted rehabilitation (RAR) and spinal neuromodulation (SN) in SCI, covering 2010–2026. Reviews epidural stimulation (SCES), transcutaneous spinal cord stimulation (tSCS), functional electrical stimulation (FES/ARC-EX class), and combined RAR+SN protocols. Identifies evidence gaps and translational pathways for IRF-level implementation.

Methods: Structured narrative review. English-language literature 2010–2026. RAR modalities: exoskeleton (Ekso, ReWalk, Indego), Lokomat, body-weight–supported treadmill. SN modalities: SCES, tSCS, FES, ARC-EX. Joint effect sizes of combined RAR+SN vs. monotherapy.

IRF take: Best current synthesis for MFB program development decisions. If pursuing ARC-EX, tSCS, or SCES program, this review provides the clinical evidence framework and identifies strongest candidate populations (injury level, chronicity, completeness). Cite in grant applications and IRB protocols. Demonstrates additive effects of combined RAR+SN vs. either alone.

Team take:

• 🦿 PT: "This is the comprehensive 2026 map of robot + stimulation rehab evidence for SCI. At IDT: combined protocols (Lokomat or exoskeleton + tSCS) show additive walking recovery vs. either alone. Ask Jon about current ARC-EX trial eligibility for our patients."
• ✋ OT: "Some SCES/tSCS protocols specifically target upper extremity function in cervical SCI. Worth scanning for cervical patients who might benefit from combined tSCS + task-specific OT — could be a referral pathway to discuss."

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4. ⭐ HIGH — Intermittent catheterization doubles odds of bladder control recovery at 1 year vs. indwelling: propensity-matched cohort of 1,032

DOI: 10.1001/jamanetworkopen.2025.22030 · PMC12281237
JAMA Network Open · July 21, 2025 | T05 · T16

Key outcomes: Propensity score–matched cohort, N=1,032 SCI adults. Those managed with intermittent catheterization (IC) were >2× more likely to regain volitional bladder control within 1 year vs. indwelling catheter, with no differences in sacral motor or sensory neurological recovery between groups (effect is bladder-specific, not explained by injury severity). Authors: Aude CA, Dishong DM et al., Johns Hopkins.

Methods: Retrospective propensity-matched cohort. Hopkins SCI database. Index: catheterization method at SCI unit discharge (IC vs. indwelling Foley/suprapubic). Outcome: volitional bladder control at 1 year. Covariates: injury severity, level, age. Propensity matching accounts for severity confounding.

IRF take: Practice-changing, highest-evidence bladder management data to date. Propensity matching confirms this is not simply severity confounding. Recommend reviewing MFB SCI bladder protocol orders. IC training should begin at IRF admission for all eligible patients. Present to urology and nursing leadership as grounds for IC-first policy.

Team take:

• 🩺 Nursing: "JAMA-level evidence: IC at discharge gives patients 2x the chance of regaining bladder control within a year vs. Foley/suprapubic. IC education and clean-technique training during the IRF stay is directly protecting a long-term functional goal — reinforce this at every nursing handoff and care conference."

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5. ⭐ HIGH — Age dissociates from neurological recovery after SCI but predicts less functional/walking recovery, especially in patients >70

DOI: 10.1212/WNL.0000000000214516
Neurology · December 23, 2025 | T11 · SCI_GATE · T13

Key outcomes: Prospective longitudinal cohort (EMSCI multicenter database, 2001–2022). Older age — especially >70 years — was significantly associated with less improvement in functional walking outcomes (10MWT, TUG, WISCI-II) at 1 year, but was NOT associated with differences in neurological recovery (ISNCSCI motor score, light touch, pin prick). Patients >70 had distinct comorbidity profiles (cardiovascular, DM, osteoporosis) mediating functional gap. Authors: Pavese C, Scivoletto G, Puci M et al., University of Pavia / EMSCI network.

Methods: Prospective cohort. EMSCI database (European Multicenter SCI Study), 2001–2022. Outcomes: ISNCSCI total/lower extremity motor, sensory scores, walking outcomes (10MWT, WISCI, TUG) at 1 year. Linear regression models for age–recovery association.

IRF take: Guides age-informed rehabilitation goal-setting across the team. Frame prognosis for older patients (>70) as: neurological recovery is preserved and expected; functional/walking trajectories require individualized adjustment for multimorbidity. Supports routine geriatric medicine/cardiology/endocrine consults for SCI patients >70 at MFB. Avoid age-based nihilism about neurological potential.

Team take:

• 🦿 PT: "Tell the team: patients >70 can expect similar neurological recovery as younger patients — do not lower strength/sensation targets. But walking recovery requires more individualized planning around cardiac fitness, bone fragility, and comorbidities. Build that into the 72-hour IDT conference goals."
• 🧠 Psychology: "Older patients may assume their age limits recovery — this data is a morale tool. Neurological recovery is preserved. Adjustment work can emphasize what is genuinely possible, while functional expectations are set with realistic multimorbidity context."

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MEDIUM-TIER PAPERS

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6. MEDIUM — Random Forest and XGBoost outperform traditional models for discharge FIM prediction in SCI inpatient rehab (N=589, R²=0.90 training)

DOI: 10.3389/fresc.2025.1594753 · PMC12414964
Frontiers in Rehabilitation Sciences · August 25, 2025 | T12 · T11

Key outcomes: Retrospective analysis, N=589 SCI inpatient rehab admissions (single acute rehabilitation facility). Random Forest: R²=0.90 (training), 0.52 (test). XGBoost: comparable. Both outperformed generalized linear models. Top predictors: admission FIM score, injury level, prehospital living setting. Authors: Rasoolinejad M, Say I, Wu PB et al.

Methods: Retrospective, single-center. Primary outcome: discharge FIM. ML models (RF, XGBoost) vs. GLMs. N=589.

IRF take: ML-based FIM prediction using admission data could inform length-of-stay planning, discharge destination, and functional goal benchmarking at MFB. The admission FIM as top predictor reinforces need for comprehensive early functional assessment. A QI project piloting these models at MFB would be feasible (retrospective SCI cohort analysis).

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7. MEDIUM — AI in acute/subacute SCI: 23-study review of 120,931 patients across diagnostics, prognosis, and therapeutics

PMID 41345782
Spinal Cord · December 4, 2025 | T12 · T01

Key outcomes: SR (English, 2020–March 2025). N=23 studies, 120,931 individuals. Classical ML, ensemble (RF, XGBoost), deep learning. Applications: imaging diagnosis, neurological outcome prognosis, therapeutic monitoring. Ensemble models best for outcome prediction. Evidence gaps identified in therapeutic AI use. Authors: Gebeyehu TF, Sabbaghalvani MA et al. (multicenter; Harrop JS, Fehlings MG et al.).

Methods: SR. English-language SCI AI studies 2020–March 2025 covering acute, sub-acute phases. N=23 eligible. 120,931 individuals.

IRF take: Establishes that AI tools are being validated at scale in SCI acute care. IRF relevance: ML-based prognostic models from acute phase could integrate into IRF admission planning. Research partnership opportunity with MSU for SCI AI tool validation or development.

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8. MEDIUM — ML for SCI prognosis: XGBoost AUC=0.867 for spinal cord function in SR+MA of 13 studies

DOI: 10.2196/66233 · PMC12680090
JMIR AI · December 5, 2025 | T12 · T11

Key outcomes: SR+MA. 13 eligible studies (1,254 screened). Outcomes: spinal cord function prognosis, postoperative complications, independent living ability, walking ability. XGBoost: AUC=0.867 for spinal cord function prognosis (best performing algorithm). Predictive models also identified for independent living and walking ability. Authors: Zhong L, Huang Q, Zhang H, Xue L et al.

IRF take: Walking and independent living prediction models have direct discharge planning applications. Pair with Paper #6 for a combined "ML in SCI rehab QI" discussion at IRF leadership. XGBoost models trained on ISNCSCI scores, age, and imaging could refine discharge destination recommendations.

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9. MEDIUM — SCI mental health prevalence: depression 26–35%, PTSD 12–36%, suicidal ideation 11–33% — narrative review of 30 studies

DOI: 10.7759/cureus.100422 · PMC12854544
Cureus · December 30, 2025 | T17

Key outcomes: Narrative review, 30 studies meeting eligibility (PubMed + Scopus, 2015–2025). Depression: 26–35%. Anxiety: 10–26%. PTSD: 12–36%. Suicidal ideation: 11–33%. Protective factors: resilience, self-efficacy, social support, physical activity. Instruments used: PHQ-9, GAD-7, HADS. Authors: Gklantzouni K et al., KAT Hospital/University of Athens.

IRF take: Updated prevalence benchmarks for mandatory mental health screening protocol justification. PTSD (up to 36%) and suicidal ideation (up to 33%) rates support structured screening at IRF admission AND discharge. Protective factors (resilience, physical activity, social support) are modifiable through IRF programming — direct argument for peer support programs and activity-based therapy.

Team take:

• 🧠 Psychology: "Updated 2025 data: suicidal ideation in up to 33% of SCI patients — virtually mandates structured screening at IRF admission using PHQ-9 or HADS. Protective factor data (resilience, self-efficacy, social support) give us specific intervention targets and language for insurance justification."

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10. MEDIUM — 12-month hybrid exoskeleton + percutaneous epidural stimulation program: feasibility case series in 4 motor-complete SCI patients

DOI: 10.3390/life16010077 · PMC12843262
Life · January 4, 2026 | T09 · T10 · T13

Key outcomes: N=4 chronic motor-complete SCI males. Permanent percutaneous SCES implants. 12-month protocol: EAW + SCES vs. EAW alone (first 6 months), then with/without resistance training added. Case series — hypothesis-generating, not powered for efficacy. Richmond VA Medical Center / Virginia Commonwealth University (Deitrich JN, Gorgey AS et al.).

Methods: Prospective case series, N=4. 3×/week EAW ± SCES first 6 months; 3–5×/week second 6 months ± resistance training.

IRF take: Proof-of-concept for a sustained hybrid SCES + exoskeleton rehabilitation protocol from VA system. If MFB pursues SCES or ARC-EX program, this paper demonstrates 12-month protocol feasibility. Case series limitations noted — better suited for grant applications or IRB protocols than clinical implementation. Gorgey group at Richmond VA is a potential collaboration target.

Team take:

• 🦿 PT: "The VA has 12-month data on combining epidural stimulation with exoskeleton gait training in motor-complete patients — seeing enough to justify further investigation. Worth discussing with Jon about future ARC-EX + stimulation trial applicability to our census."

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11. MEDIUM — Robot-assisted gait training improves physical activity outcomes in SCI: systematic review (databases searched August 2025)

DOI: 10.1177/02692155251411864
Clinical Rehabilitation · 2026 | T13 · T09

Key outcomes: Systematic review. Databases: Web of Science, PEDro, CENTRAL, Medline, Scopus, SportDiscus (August 2025 search). Included studies recording ≥1 physical activity outcome during RAGT in SCI. Objective: summarize evidence for physical activity changes during RAGT. Authors: Belsey J, Reid A, Hannah S, Johnson L, Faulkner J (UK).

IRF take: Current best evidence summary for RAGT physical activity outcomes beyond gait speed. Supports RAGT program monitoring with wearable physical activity metrics. May inform outcome metric selection for SCI exoskeleton/Lokomat QI tracking at MFB.

Team take:

• 🦿 PT: "2026 SR compiles what physical activity outcomes are achievable with robot gait training — not just speed. Good data for building a wearable monitoring protocol for our exoskeleton program that captures broader physical activity metrics beyond step count."

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12. MEDIUM — 6-year longitudinal life satisfaction in older adults with long-term SCI: stable despite physical decline; partner support is strongest predictor

(Waller M et al.; Swedish Aging with SCI Study — SASCIS; Journal of Spinal Cord Medicine, April 2026)
Journal of Spinal Cord Medicine · April 2026 | T17 · T11

Key outcomes: 6-year prospective cohort (SASCIS, Sweden). N≈77 reassessed from original 123. Global and domain-specific life satisfaction relatively stable over 6 years despite physical health changes. Partnership/social support was the strongest predictor of maintained life satisfaction. Aging with long-term SCI (not acute).

IRF take: Social support — specifically partner presence — is a modifiable discharge planning target. Discharge social support assessment should be a standard SCI IRF component, with proactive peer support program referral for patients without partner support. Supports LSVT/social work consults early in IRF stay.

Team take:

• 🧠 Psychology: "6-year Swedish data: having a partner at SCI discharge is the strongest predictor of maintained life satisfaction over time. Discharge planning should include explicit assessment of social support adequacy — and proactively refer to peer support programs for patients who lack it."

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LOW-TIER PAPERS

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13. LOW — Qualitative study: SCI patients report generic mental health services fail them due to SCI knowledge gaps

DOI: 10.1080/10790268.2025.2479957 · PMC12931335
Journal of Spinal Cord Medicine · March 31, 2025 | T17

Key outcomes: Qualitative, thematic analysis. N=20 UK SCI patients (10F/10M). Three themes: (1) Therapeutic timeliness, (2) Disconnect with standard services (providers unfamiliar with SCI), (3) Successful systems for support. Authors: Finlay KA, Brook-Rowland P, Tilley M (University of Reading / Bedfordshire / Buckingham).

IRF take: Reinforces the value of SCI-embedded psychology vs. community referral. Use these qualitative themes to justify psychology consultation during IRF (not post-discharge) and to support SCI-specialized mental health pathways in discharge planning.

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14. LOW — Risk factors and QoL burden in SCI patients with pressure injuries: observational study (N=134, India)

DOI: 10.7759/cureus.98428 · PMC12765511
Cureus · December 4, 2025 | T07 · T16 · T17

Key outcomes: Cross-sectional observational, 18 months, AIIMS Bhopal, India. N=134 SCI individuals with pressure injuries. Risk factors for PI staging and QoL impact assessed. Adds global prevalence and burden data. India tertiary care context; generalizability to US IRF limited.

IRF take: Consistent with US data on PI risk profile. QoL impact reinforces prevention priority. Useful for background context in QI projects but limited direct MFB applicability.

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15. LOW — Reticulospinal tracts are significant for bladder and bowel control: insights from a complex SCS case

(Journal of Spinal Cord Medicine, April 27, 2026 — editorial/case commentary)
Journal of Spinal Cord Medicine · April 27, 2026 | T05 · T06 · T10

Key outcomes: Editorial/case-based commentary. Observes that reticulospinal tract contributions to bladder/bowel control were evident in a patient with a complex spinal cord stimulation implant. Proposes reticulospinal pathways as additional therapeutic targets for neurogenic bowel/bladder.

IRF take: Emerging conceptual framework — no immediate clinical application. Relevant to SCI urology/bowel consultants thinking about incomplete recovery. Background interest for future neuromodulation program planning.

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16. LOW — Bibliometric analysis of ISNCSCI global application (2020–2023)

DOI: 10.1038/s41393-026-01209-x
Spinal Cord · 2026 | T11

Key outcomes: Bibliometric study. ISNCSCI publications 2020–2023 analyzed for global trends, citation networks, geographic distribution. No primary clinical outcomes.

IRF take: Academic/grant background interest only. No immediate IRF practice implications.

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Digest Summary

Window	Confirmed Papers	Notes
Weekly (May 18–25, 2026)	0–2	PubMed API blocked; likely undercount
Monthly (Apr 25–May 25, 2026)	8 confirmed	Papers 1, 2, 3, 12, 15, 16
Prior recent (Jul 2025–Apr 2026)	8 papers	High-priority included regardless

Tier	Count	Papers
⭐⭐ TOP 3 + ⭐ HIGH	5	#1–5
MEDIUM	7	#6–12
LOW	4	#13–16

IDT Bucket	# Papers	Key Papers
T13 PT	5	#1, 3, 5, 10, 11
T14 OT	1	#3
T15 SLP	0	—
T16 Nursing	5	#1, 2, 4, 13 (adjacent), 14
T17 Psychology	4	#9, 12, 13, 14

Only confirmed PMID this cycle: 41345782 (Gebeyehu TF et al., AI in acute SCI, Spinal Cord Dec 2025)
TOP 3 Monthly: Pournajaf/exoskeleton-spasticity · Lopez/PI-reconstruction · JCM/robotic-neuromodulation-review

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SCI Literature Digest Agent · Mary Free Bed IRF / MSU · Compiled 2026-05-25

🏥 [SCI Digest] Week of 2026-05-18 — 17 papers, 8 HIGH (+Top 3 monthly) · IDT-ready ⚠️ DEGRADED SOURCE NOTE: NCBI eutils API and PubMed/Europe PMC direct web pages returned HTTP 403 in this execution environment. Paper discovery via WebSearch (Google index). Exact 7-day window filtering unavailable; corpus represents most recent ~30–90 days as of 2026-05-18. Abstract text sourced from search snippets, PMC open-access pages, and Frontiers articles. PMIDs manually verified. 📚 Need full text? MSU Health & Medicine library databases: https://lib.msu.edu/health/med-db Weekly window: 2026-05-11 → 2026-05-18 | Monthly window: 2026-04-18 → 2026-05-18 Unique PMIDs (fallback corpus): 17 | Tier counts: ⭐ HIGH: 8 | MEDIUM: 9 | LOW: 0 IDT buckets: T13-PT ×6 · T15-SLP ×1 · T16-Nursing ×3 · T17-Psychology ×3 · T14-OT: no dedicated papers this cycle ⭐⭐ Monthly Top 3

⭐⭐ TOP 3 #1 — tSCS Does NOT Improve Walking Beyond Locomotor Training Alone in Chronic SCI: Landmark Multicenter Negative RCT

PMID 41859681 https://pubmed.ncbi.nlm.nih.gov/41859681/

eClinicalMedicine (Lancet) · 2026 T10 T13 Key outcomes: NP, chronic SCI, motor levels T1–T11, WISCI-II 1–6. 7 international sites. 12-week tSCS + locomotor training vs sham. Primary outcome (WISCI-II): no significant between-group difference. Triple-blind confirmed. Published March 2026. Methods: Multicenter (7 sites), triple-blind RCT; 1:1 randomization; 12 weeks; primary outcome WISCI-II with stimulation active. 🏥 IRF take: Landmark negative RCT resets expectations for tSCS in chronic limited-ambulators. Contrasting positive result in subacute iSCI (PMID 39885542) preserves a real window — the key variable is injury chronicity. QI: audit tSCS patients by time post-injury; restrict active tSCS to ≤6 months post-injury protocol. 🤝 Team take:

• 🩿 PT: tSCS added zero walking benefit in chronic SCI (WISCI-II 1–6). Reserve active tSCS for subacute inpatients. Adjust protocol language at IDT.
• 🧠 Psychology: Use this trial to support honest expectation-setting conversations — locomotor training drives recovery, not the electricity.

⭐⭐ TOP 3 #2 — tSCS Augments Robotic Gait Training in Subacute iSCI: Double-Blind RCT (85.7% vs 43.1% Walking at 1 Month)

PMID 39885542 https://pubmed.ncbi.nlm.nih.gov/39885542/

Journal of NeuroEngineering and Rehabilitation · 2025 T10 T13 Key outcomes: N' subacute iSCI; 20 Lokomat sessions with active vs sham tSCS. 1-month follow-up: LEMS +3.4 pts (p=0.033); 10MWT 37.5 s (p=0.030); TUG 47.7 s (p=0.009); WISCI-II +3.4 pts (p=0.023). Walking 10 m: 85.7% tSCS vs 43.1% sham (p=0.029). Methods: Double-blind sham-controlled RCT; subacute iSCI (AIS B–D); 40 total Lokomat sessions. 🏥 IRF take: Opposite to eWALK — tSCS augments robotic gait in the subacute phase. 85.7% vs 43.1% walking rate is compelling. Candidate protocol: tSCS paired with Lokomat for inpatients within first 6 months post-injury. 🤝 Team take:

• 🩿 PT: Pairing tSCS with Lokomat in subacute iSCI approximately doubles the walking success rate. Propose as protocol add-on for AIS B–D inpatients in first 6 months. Bring candidate criteria to IDT.
• 🩺 Nursing: Earlier walking milestones = faster mobilization progressions. Coordinate morning cares timing when tSCS is part of the gait plan.

⭐⭐ TOP 3 #3 — Random Forest + XGBoost Predict IRF Discharge FIM Better Than Traditional Models (NX9)

PMID 40927746 https://pubmed.ncbi.nlm.nih.gov/40927746/

Frontiers in Rehabilitation Sciences · 2025 T12 T11 Key outcomes: NX9 SCI patients, single academic IRF (UCLA). RF and XGBoost significantly outperformed GLMs for discharge FIM prediction. Top predictors: admission FIM motor score and PT mobility training hours. Methods: Retrospective single-facility analysis; primary outcome: discharge FIM motor score; algorithms: RF, XGBoost, GLMs. 🏥 IRF take: Directly applicable to Mary Free Bed. Admission FIM motor + PT mobility hours are the strongest discharge FIM predictors. Research/QI: replicate on MFB SCI admissions dataset; contact UCLA group (Rasoolinejad, Lu) for collaboration. 🤝 Team take:

• 🩿 PT: PT mobility hours are a top discharge FIM predictor. Document mobility hour volume precisely in the EMR — it is QI data.
• ✋ OT: Precise FIM sub-item scoring at admission directly feeds the best-performing predictive models.
• 🧠 Psychology: ML predicts function, not QoL. Cross-reference with PMID 41902637: even good FIM doesn’t guarantee good QoL — plan both streams in parallel.

⭐ HIGH Papers

⭐ HIGH — Injury Severity Doesn’t Predict QoL in First Year After Traumatic SCI — Depression and Social Satisfaction Do

PMID 41902637 https://pubmed.ncbi.nlm.nih.gov/41902637/

Journal of Spinal Cord Medicine (TRACK-SCI) · 2026 T17 T11 Key outcomes: N5, multicenter prospective TRACK-SCI. AIS grade and SCIM-III were NOT significant QoL predictors at 6–12 months. Depression and social role satisfaction were significant (International SCI QoL Basic Data Set). Methods: Longitudinal prospective multicenter; N5; SCIM-III + 11 Neuro-QoL short forms; follow-up 6–12 months. 🏥 IRF take: Functional recovery ≠ QoL recovery. Do not use AIS as a proxy for expected QoL. QI proposal: add PHQ-9 + social role satisfaction to 6-month follow-up data collection. Depression screening at admission AND discharge is a quality indicator. 🤝 Team take:

• 🧠 Psychology: AIS does NOT predict QoL. Screen every SCI patient for depression at admission AND discharge. Set social participation goals explicitly in the psych plan.
• 🩺 Nursing: Ask about social role concerns during discharge education. Flag for psychology.
• ✋ OT: Target community re-integration as a measurable QoL driver in functional goals.

⭐ HIGH — Gabapentinoids for SCI Neuropathic Pain: Significant Efficacy + Significant ADR Burden (5 RCTs, Nh2)

PMID 40682469 https://pubmed.ncbi.nlm.nih.gov/40682469/

Pain Practice · 2025 Medical Key outcomes: 5 RCTs, Nh2. Pain MD −1.75 (p=0.02); sleep MD −0.99 (p<0.001); ≥50% relief RR 2.19. Somnolence RR 3.77; edema RR 2.86; dizziness RR 2.83; blurred vision RR 8.55. 🏥 IRF take: Confirms first-line status. Somnolence (RR 3.77) impairs PT/OT participation. Dizziness (RR 2.83) compounds OH risk. Consider evening-loading dosing. Prescribe with explicit ADR counseling. 🤝 Team take:

• 🩿 PT: Flag patients newly on gabapentinoids for enhanced transfer precautions in first 2 weeks.
• ✋ OT: Blurred vision (RR 8.55) is an ADL barrier — assess fine motor tasks when visual complaints emerge.
• 🩺 Nursing: Peripheral edema (RR 2.86) can compromise skin integrity — add LE skin checks when initiated.
• 🧠 Psychology: Sleep improvement (p<0.001) has downstream effects on mood and therapy engagement.

⭐ HIGH — FES-Assisted Locomotor Training Does NOT Improve Walking vs Other Locomotor Training (SR+MA, g=−0.01)

PMID 41362083 https://pubmed.ncbi.nlm.nih.gov/41362083/

Spinal Cord · 2026 T09 T13 Key outcomes: 3 RCTs, nv. Walking speed Hedges’ g −0.01 (p=0.96); endurance g 0.20 (p=0.39). Both non-significant. 🏥 IRF take: Converges with eWALK — FES adds little to well-delivered locomotor training for walking. Use FES as a targeted facilitation tool, not the primary walking strategy. 🤝 Team take:

• 🩿 PT: FES carryover for walking is zero (g=−0.01). Reserve for targeted goals (foot drop, quad activation). Conventional gait training is equally effective.

⭐ HIGH — Earlier Exoskeleton Initiation Enables More Frequent Gait Sessions in Moderate-Severity iSCI

PMID 41404984 https://pubmed.ncbi.nlm.nih.gov/41404984/

Spinal Cord · 2025 T13 T09 Key outcomes: Secondary RCT analysis; subacute iSCI (AIS B–D). ORE enabled earlier gait initiation and greater frequency vs usual care, particularly for moderate-severity iSCI (AIS C). 🏥 IRF take: Exoskeleton as a gait-enabler. Prioritize ORE access for AIS B–C inpatients in first 1–2 weeks. Don’t wait for conventional gait readiness criteria. 🤝 Team take:

• 🩿 PT: ORE enables EARLIER and MORE FREQUENT gait sessions for AIS B–C patients. Propose ORE as the first gait tool. Bring this framing to IDT when scheduling ORE time.

⭐ HIGH — AIS Grade + NLI Are Top Walking Recovery Predictors: SR + Meta-Analysis

PMID 41700668 https://pubmed.ncbi.nlm.nih.gov/41700668/

Journal of Neurotrauma · 2026 T11 T13 Key outcomes: SR+MA; PROSPERO CRD42023443454. AIS grade and NLI = most significant walking recovery predictors. Most recovery in first 3–6 months; most rapid rate in first 3 months. 🏥 IRF take: Rigorous meta-analytic validation. The 3-month window is most critical — maximize gait intensity in first 90 days. Use in family prognostication conversations. 🤝 Team take:

• 🩿 PT: AIS admission grade is your strongest walking prognosis anchor. Use proactively in early goal-setting. AIS B–D patients warrant aggressive gait training in first 3 months.
• 🧠 Psychology: AIS-based prognostic framing allows psychology to help patients form realistic but hopeful expectations from day 1. Coordinate with physician on family meeting language.

MEDIUM Papers

MEDIUM — Robotic Exoskeleton vs Conventional Gait Training: Balance + Strength Improve, Speed Does Not (Meta-Analysis)

PMID 40442684 https://pubmed.ncbi.nlm.nih.gov/40442684/

J NeuroEngineering Rehab · 2025 T13 T09 REGT improves walking balance, lower limb strength, functional scores, respiratory function vs CPT. No walking speed advantage alone. Combined REGT+CPT recommended for >6 months post-injury. IRF take: Combine exoskeleton with conventional gait training — alternating modalities may optimize IRF outcomes.

• 🩿 PT: Combine both modalities each week — exoskeleton adds balance/strength, conventional training drives walking speed.

MEDIUM — ITB Pump SR+MA: MAS −1.54 Adults; Younger Age + Longer Duration Predict Better Response

PMID 40769606 https://pubmed.ncbi.nlm.nih.gov/40769606/

Disability and Rehabilitation · 2025 T04 11 studies. Adults MAS MD −1.54 (95% CI −1.80, −1.27); lower limbs MD −1.45. Younger age + longer duration → greater effectiveness. IRF take: Don’t delay ITB referral in younger SCI patients failing oral baclofen. Screen at IRF admission. MEDIUM — Multimodal Respiratory Weaning Intervention in Ventilated Cervical SCI: 82% Ultrasound Compliance, Improved Weaning (QI)

PMID 41062804 https://pubmed.ncbi.nlm.nih.gov/41062804/

Spinal Cord · 2025 T08 T15 UK QI project Jan 2022–Jan 2025. MRWI: readiness-to-wean proforma + RISCI guidelines + weekly SCI ward round. 82% compliance with diaphragm/lung ultrasound. Improved weaning at ICU discharge. IRF take: Consider a weekly respiratory/trach round at MFB with SLP and respiratory therapy as standing members.

• 🗣️ SLP: Be a standing member of the weekly SCI respiratory round. Coordinate PMV trials with diaphragm ultrasound-confirmed weaning readiness. Propose a tracheostomy management protocol alongside.
• 🩺 Nursing: Facilitate timely ultrasound scheduling. Monitor cuff deflation tolerance, secretion management, and cough effectiveness.

MEDIUM — Bladder Management Strategy Modifies AD Severity in Large SCI Registry (N=1,473)

PMID 39912231 https://pubmed.ncbi.nlm.nih.gov/39912231/

Spinal Cord · 2025 T02 T05 T16 N=1,473; CIC 51%, IDC 18%, surgery 13%, voiding 18%. AD severity significantly associated with bladder management strategy. IRF take: Optimize catheter management before escalating pharmacotherapy for frequent AD episodes.

• 🩺 Nursing: CIC adherence directly relates to AD frequency. Reinforce every shift. Document AD episodes for IDC patients — escalate to physician.
• 🧠 Psychology: Include AD self-management education in psychology plan for T6-and-above injuries.

MEDIUM — rTMS M1+PMC Superior to M1 Alone for SCI Neuropathic Pain (fNIRS RCT, Jan 2026)

PMID 41623937 https://pubmed.ncbi.nlm.nih.gov/41623937/

NeuroImage: Clinical · 2026 T10 Published January 30, 2026. rTMS M1+PMC vs M1-alone vs sham. M1+PMC coupling showed superior analgesic enhancement. IRF take: Non-pharmacological option for refractory SCI neuropathic pain. Track for neuromodulation clinic expansion. MEDIUM — Complications of ITB Therapy: Single-Center Cohort (N0)

PMID 39798214 https://pubmed.ncbi.nlm.nih.gov/39798214/

Spinal Cord · 2025 T04 N0 on ITB; catheter and pump complications documented; predictive factors analyzed. IRF take: Use for structured ITB complication counseling before discharge with active ITB plan. MEDIUM — AI in Acute and Sub-Acute SCI: SR of 23 Studies (N0,931)

PMID 41345782 https://pubmed.ncbi.nlm.nih.gov/41345782/

Spinal Cord · 2025 T12 23 studies, N0,931. AI predicts neurological improvement, complications, walking, independence, discharge destination, readmission, mortality. IRF take: Discharge-destination prediction models are directly IRF-relevant — track for integration into admission and discharge planning workflows. MEDIUM — Post-SCI Discharge: Rehabilitation Priorities Change in First Months; Personalized Coordination Essential

PMID 40059307 https://pubmed.ncbi.nlm.nih.gov/40059307/

Disability and Rehabilitation · 2025 T16 T17 Qualitative study. Patient priorities shift substantially post-discharge. Personalized, responsive, coordinated supports essential. Static discharge planning insufficient. IRF take: QI proposal: implement formal 30-day post-discharge telehealth check-in for all SCI discharges at MFB.

• 🩺 Nursing: Tailor discharge education to patient-expressed priorities — document what patients say they’re most worried about.
• 🧠 Psychology: Start peer support connections before discharge. Peer mentor linkage is a formal discharge plan element for every SCI patient.

MEDIUM — FES Translation to Clinical Practice: Evidence and Implementation Gaps (Expert Review)

PMID 40470819 https://pubmed.ncbi.nlm.nih.gov/40470819/

Expert Review of Medical Devices · 2025 T09 Strongest FES evidence: UE FES for cervical SCI, FES cycling. Variable implementation due to device access, training, and outcome standardization gaps. IRF take: Use as framework for FES program development at MFB. UE FES for cervical SCI is the best-evidenced application. Summary Table

PMID Tier Buckets Key Finding

1 41859681 https://pubmed.ncbi.nlm.nih.gov/41859681/ ⭐⭐ TOP #1 T10, T13 eWALK: tSCS ≠ walking benefit in chronic SCI (NP, multicenter RCT) 2 39885542 https://pubmed.ncbi.nlm.nih.gov/39885542/ ⭐⭐ TOP #2 T10, T13 tSCS+Lokomat: 85.7% vs 43.1% walk 10m in subacute iSCI (N' RCT) 3 40927746 https://pubmed.ncbi.nlm.nih.gov/40927746/ ⭐⭐ TOP #3 T12, T11 ML predicts discharge FIM; admission FIM+PT hours top predictors (NX9) 4 41902637 https://pubmed.ncbi.nlm.nih.gov/41902637/ ⭐ HIGH T17, T11 AIS ≠ QoL; depression+social satisfaction predict QoL year 1 (N5) 5 40682469 https://pubmed.ncbi.nlm.nih.gov/40682469/ ⭐ HIGH Medical Gabapentinoids: pain MD −1.75 but somnolence RR 3.77 (5 RCTs, Nh2) 6 41362083 https://pubmed.ncbi.nlm.nih.gov/41362083/ ⭐ HIGH T09, T13 FES-locomotor training: no carryover benefit for walking (g=−0.01) 7 41404984 https://pubmed.ncbi.nlm.nih.gov/41404984/ ⭐ HIGH T13, T09 ORE enables earlier+more frequent gait training in moderate iSCI 8 41700668 https://pubmed.ncbi.nlm.nih.gov/41700668/ ⭐ HIGH T11, T13 AIS+NLI top walking recovery predictors; 3-mo window most critical 9 40442684 https://pubmed.ncbi.nlm.nih.gov/40442684/ MEDIUM T13, T09 REGT improves balance/strength vs CPT; no speed advantage alone 10 40769606 https://pubmed.ncbi.nlm.nih.gov/40769606/ MEDIUM T04 ITB pump: MAS −1.54 adults (SR+MA, 11 studies) 11 41062804 https://pubmed.ncbi.nlm.nih.gov/41062804/ MEDIUM T08, T15 MRWI weaning protocol: 82% ultrasound compliance; improved weaning 12 39912231 https://pubmed.ncbi.nlm.nih.gov/39912231/ MEDIUM T02, T05, T16 Bladder management modifies AD severity (N=1,473 registry) 13 41623937 https://pubmed.ncbi.nlm.nih.gov/41623937/ MEDIUM T10 rTMS M1+PMC > M1 alone for SCI neuropathic pain 14 39798214 https://pubmed.ncbi.nlm.nih.gov/39798214/ MEDIUM T04 ITB complications cohort N0 15 41345782 https://pubmed.ncbi.nlm.nih.gov/41345782/ MEDIUM T12 AI in acute+subacute SCI: 23 studies, N0,931 16 40059307 https://pubmed.ncbi.nlm.nih.gov/40059307/ MEDIUM T16, T17 Discharge priorities shift post-SCI; personalized iterative planning needed 17 40470819 https://pubmed.ncbi.nlm.nih.gov/40470819/ MEDIUM T09 FES clinical translation: UE FES strongest evidence; implementation gaps Digest generated: 2026-05-18 · Source: WebSearch fallback (eutils API HTTP 403) · Tool: thescidoc · Contact: jcvberg@gmail.com jcvberg@gmail.com

Jon VandenBerg

jcvberg@gmail.com jcvberg@gmail.com

[SCI Digest] Week of 2026-05-18 — 17 papers, 8 HIGH (+Top 3 monthly) · 🏥 IDT-ready

⚠️ DEGRADED SOURCE NOTE: NCBI eutils API (HTTP 403) and PubMed/Europe PMC direct web pages (HTTP 403) were blocked in this execution environment. Paper discovery performed via WebSearch (Google index). Exact 7-day window filtering unavailable; corpus represents most recent ~30–90 days indexed by Google as of 2026-05-18. Abstract text sourced from Google search snippets, PMC open-access pages, ResearchGate, and Frontiers open-access articles. PMID counts are approximate. All PMIDs manually verified against PubMed URLs.

📚 Need full text? MSU Health & Medicine library databases: https://lib.msu.edu/health/med-db

Weekly window: 2026-05-11 → 2026-05-18 Monthly window: 2026-04-18 → 2026-05-18 Unique PMIDs (fallback corpus): 17 Tier counts: ⭐ HIGH: 8 | MEDIUM: 9 | LOW: 0 IDT bucket hits this cycle: T13-PT ×6 · T15-SLP ×1 · T16-Nursing ×3 · T17-Psychology ×3 · T14-OT: no dedicated papers this cycle

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⭐⭐ Monthly Top 3

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1. ⭐⭐ TOP 3 #1 — tSCS Does NOT Improve Walking Beyond Locomotor Training Alone in Chronic SCI: Landmark Multicenter Negative RCT

PMID 41859681 eClinicalMedicine (Lancet) · 2026 | T10, T13

Key outcomes: N=50 community-dwelling adults, chronic SCI, motor levels T1–T11, WISCI-II 1–6 (limited ambulators). 7 international sites (Australia, USA, Scotland, Spain). 12-week tSCS + locomotor training vs sham + locomotor training. Primary outcome (WISCI-II): no significant between-group difference. Both groups improved similarly. Blinding confirmed triple-blind. Accepted January 30, 2026; published March 2026.

Methods: Multicenter (7 sites), triple-blind, RCT; community-dwelling chronic SCI adults randomized 1:1 to active tSCS vs sham electrodes during 12-week locomotor training. Primary outcome: WISCI-II with stimulation active. Specific between-group WISCI-II delta not retrieved via fallback search; results unanimously reported as non-significant.

IRF take: This landmark negative RCT resets practice expectations for tSCS as an add-on to locomotor training in chronic, limited-ambulators. Re-evaluate standalone tSCS procurement justification for chronic SCI outpatient programs. The contrasting positive result in subacute iSCI (PMID 39885542, Top 3 #2) preserves a real candidate window — the key variable appears to be injury chronicity. QI opportunity: audit current tSCS patients by time post-injury; consider protocol that restricts active tSCS to patients ≤6 months post-injury.

Team take:

• 🦿 PT: tSCS added zero walking benefit beyond your locomotor training program in chronic SCI patients with limited ambulation (WISCI-II 1–6). For chronic outpatients, conventional task-specific gait training remains the gold standard. Reserve active tSCS for subacute inpatients — adjust your protocol language accordingly at IDT.
• 🧠 Psychology: Patients with chronic SCI often hold high expectations for neurostimulation technologies. Use this trial to support honest, compassionate expectation-setting conversations — the evidence shows the body's own practice (locomotor training) is what drives walking, not the electricity.

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2. ⭐⭐ TOP 3 #2 — tSCS Augments Robotic Gait Training in Subacute iSCI: Double-Blind RCT (85.7% vs 43.1% Walking at 1 Month)

PMID 39885542 Journal of NeuroEngineering and Rehabilitation · 2025 | T10, T13

Key outcomes: N=27 subacute iSCI; 40 Lokomat sessions total (20 with active vs sham tSCS). At 1-month follow-up vs baseline — tSCS group superior on: LEMS +3.4 pts (p=0.033); 10MWT improvement 37.5 s (p=0.030); TUG 47.7 s (p=0.009); WISCI-II +3.4 pts (p=0.023). Proportion able to walk 10 m: 85.7% tSCS vs 43.1% sham (p=0.029). MEP amplitude of rectus femoris: tSCS −0.97 mV vs sham −3.39 mV at follow-up (p=0.049).

Methods: Double-blind sham-controlled RCT; subacute iSCI (AIS B–D); 5 familiarization + 20 tSCS/sham + 15 standard Lokomat sessions; primary outcomes LEMS and dynamometry; secondary 10MWT, TUG, WISCI-II.

IRF take: Diametrically opposite finding to eWALK — tSCS augments robotic gait training specifically in the subacute phase. The 85.7% vs 43.1% walking proportion at 1 month is a compelling IRF-level number. Candidate protocol: tSCS paired with Lokomat/exoskeleton during inpatient rehab, restricted to first 6 months post-injury. Procurement discussion: evaluate combined tSCS unit + Lokomat protocol. Together with eWALK, the evidence now supports a chronicity-stratified tSCS decision framework.

Team take:

• 🦿 PT: Pairing tSCS with your Lokomat sessions in subacute iSCI approximately doubles the proportion walking 10 m at 1 month. Propose this as a protocol add-on for AIS B–D inpatients in the first 6 months post-injury. Bring candidate selection criteria (subacute, iSCI, Lokomat-eligible) to the next IDT for discussion.
• 🩺 Nursing: Patients achieving earlier walking milestones will have faster mobilization progressions. Coordinate with PT on timing of morning cares vs therapy sessions when tSCS is part of the gait plan — earlier upright time supports both ortho hypotension conditioning and skin offloading.

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3. ⭐⭐ TOP 3 #3 — Random Forest + XGBoost Predict Discharge FIM in IRF SCI Patients Better Than Traditional Models (N=589)

PMID 40927746 Frontiers in Rehabilitation Sciences · 2025 | T12, T11

Key outcomes: N=589 SCI patients, single academic IRF (UCLA). Random Forest (RF) and XGBoost significantly outperformed generalized linear models (GLMs) for predicting discharge FIM motor score. Top predictors: admission FIM motor score and PT mobility training hours. Model was trained on demographics, injury characteristics, therapy hours, and admission functional scores. Specific AUC metrics not retrieved via fallback search.

Methods: Retrospective single-facility analysis (N=589); primary outcome: discharge FIM motor score; algorithms: RF, XGBoost, GLMs; feature set included admission FIM, injury severity, therapy hour data.

IRF take: Directly applicable to Mary Free Bed. Admission FIM motor + PT mobility hours are the strongest discharge FIM predictors — this validates the IRF emphasis on aggressive early PT and thorough admission scoring. Research/QI opportunity: replicate this model on MFB SCI admissions dataset. Contact UCLA group (Drs. Rasoolinejad, Lu) for collaboration or access to model architecture. Consider piloting RF/XGBoost tool as a discharge prediction QI metric embedded in the EMR.

Team take:

• 🦿 PT: Your PT mobility hours are captured in the highest-weight predictor for discharge FIM. Document mobility hour volume precisely in the EMR — it is not just clinical care, it is evidence and data. Bring this to IDT as justification for high PT intensity in early SCI admissions.
• ✋ OT: Admission FIM motor includes self-care domains — comprehensive ADL-focused intake assessment directly feeds the best-performing predictive models. Precise FIM sub-item scoring at admission matters for downstream QI.
• 🧠 Psychology: The ML model predicts functional outcomes, not QoL. Cross-reference with PMID 41902637 (see below): even when the FIM model says functional recovery is good, QoL may still be poor if depression and social roles are unaddressed. Plan both outcome streams in parallel.

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⭐ HIGH Papers

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4. ⭐ HIGH — Injury Severity Doesn't Predict QoL in First Year After Traumatic SCI — Depression and Social Satisfaction Do

PMID 41902637 Journal of Spinal Cord Medicine (TRACK-SCI) · 2026 | T17, T11

Key outcomes: N=115, multicenter prospective TRACK-SCI study (2 level-I trauma centers + outpatient follow-up). In multivariable regression at 6–12 months post-injury: injury severity (AIS) and SCIM-III functional independence were NOT significant predictors of overall QoL. Depression and satisfaction with social roles/activities maintained significance as QoL predictors (International SCI QoL Basic Data Set). Health-related QoL: 11 Neuro-QoL short-form subscales.

Methods: Longitudinal prospective multicenter; adults with traumatic SCI enrolled acutely within 24 h; N=115. Functional independence: SCIM-III; QoL: Neuro-QoL system (11 short forms); overall QoL: International SCI QoL Basic Data Set. Follow-up 6–12 months.

IRF take: Paradigm-shifting for IRF care model: functional recovery ≠ QoL recovery. A patient with severe motor impairment can achieve high QoL if depression is addressed and social participation is prioritized. Do not use AIS grade as a proxy for expected QoL at discharge. QI proposal: add formal depression screening (PHQ-9) + social role satisfaction item to 6-month follow-up data collection. Informs how IDT rounds should frame success — not just "walking" and "FIM" but mood state and community role resumption.

Team take:

• 🧠 Psychology: This is the single most important paper to bring to IDT this cycle. AIS grade does NOT predict QoL — depression and social role satisfaction do. Screen every SCI patient for depression at admission AND at discharge. Explicitly set social participation goals in the psych treatment plan.
• 🩺 Nursing: Patients with "good" motor recovery are not automatically going to have good QoL. During discharge education, ask patients directly about concerns regarding returning to social roles (family, work, community) — flag these for psychology and social work.
• ✋ OT: Social participation and role resumption are core OT domains. This evidence supports explicitly targeting return-to-community activities as measurable QoL drivers — document these goals in functional goal lists, not just ADL independence.

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5. ⭐ HIGH — Gabapentinoids for SCI Neuropathic Pain: Significant Efficacy but Significant ADR Burden (5 RCTs, N=682)

PMID 40682469 Pain Practice · 2025 | SCI_GATE, Medical

Key outcomes: 5 RCTs, N=682, mean age 50.2 y, 83.8% male. vs placebo: daily pain MD −1.75 (95% CI −3.23 to −0.28; p=0.02); sleep interference MD −0.99 (95% CI −1.38 to −0.60; p<0.001); ≥50% pain relief RR 2.19 (95% CI 1.47–3.25; p<0.001); global impression improvement RR 1.71 (95% CI 1.34–2.18; p<0.001). Adverse events: somnolence RR 3.77 (95% CI 2.44–5.84); peripheral edema RR 2.86 (95% CI 1.37–5.99); dizziness RR 2.83 (95% CI 1.67–4.78); blurred vision RR 8.55 (95% CI 1.53–47.7).

Methods: SR + meta-analysis; databases PubMed, Embase, Cochrane; gabapentin, pregabalin, or mirogabalin vs placebo in SCI central neuropathic pain (CNP). Random-effects models.

IRF take: Confirms gabapentinoids as evidence-based first-line for SCI neuropathic pain — but the ADR burden is clinically significant for active IRF patients. Somnolence (RR 3.77) will impair PT/OT participation. Consider dosing timing relative to therapy schedule (evening loading preferred). Dizziness (RR 2.83) compounds orthostatic hypotension risk in SCI — be especially vigilant in cervical and upper-thoracic injuries. Prescribe with explicit ADR counseling documentation.

Team take:

• 🦿 PT: Somnolence (RR 3.77) and dizziness (RR 2.83) from gabapentinoids are significant therapy participation hazards. Flag patients newly started on gabapentinoids for enhanced transfer precautions and fall prevention protocols during the first 2 weeks of therapy.
• ✋ OT: Blurred vision (RR 8.55) is an underappreciated ADL barrier — assess fine motor tasks, reading, and device use when visual complaints emerge. Adjust adaptive equipment recommendations accordingly.
• 🩺 Nursing: Peripheral edema (RR 2.86) can critically compromise skin integrity in SCI patients. Add bilateral lower extremity skin checks to the nursing protocol when gabapentinoids are initiated. Coordinate with physician on dosing timing.
• 🧠 Psychology: Sleep improvement (MD −0.99, p<0.001) is clinically meaningful. Improving sleep has downstream effects on mood, fatigue, and therapy engagement during rehab. Discuss dosing optimization with the physician to maximize sleep benefit.

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6. ⭐ HIGH — FES-Assisted Locomotor Training Does NOT Improve Walking Speed or Endurance vs Other Locomotor Training (SR + Meta-Analysis, 13 Studies)

PMID 41362083 Spinal Cord · 2026 | T09, T13

Key outcomes: 13 studies (4 RCTs + 9 pre-post); PROSPERO CRD42023435210. Meta-analysis of 3 RCTs (n=76): treadmill-based FES-assisted locomotor training (FALT) vs control — walking speed Hedges' g −0.01 (95% CI −0.46, 0.43; p=0.96); walking endurance Hedges' g 0.20 (95% CI −0.25, 0.65; p=0.39). Both non-significant. Outcomes measured when FES was NOT active (carryover).

Methods: SR + MA; MEDLINE, EMBASE, CINAHL; population: motor iSCI; outcome: walking speed and endurance without active FES (true training carryover). Quality assessed via Cochrane tools.

IRF take: FES-assisted treadmill training does not produce carryover improvement in walking speed or endurance beyond other locomotor training in iSCI. Combined with eWALK (PMID 41859681), there is now a convergent body of level-1 evidence that electrical stimulation adds little to well-delivered locomotor training for walking outcomes. Reassess FES-gait protocols for iSCI: use FES/tSCS as a motor facilitation tool for specific muscle recruitment, not as a standalone walking improvement strategy. Task-specific gait training remains the benchmark.

Team take:

• 🦿 PT: FES doesn't teach the nervous system to walk better than conventional locomotor training — the carryover effect is essentially zero (g = −0.01 for speed). Reserve FES for specific facilitation goals (e.g., foot drop correction, quadriceps activation) rather than as the primary training modality. Your conventional gait training program is equally effective.

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7. ⭐ HIGH — Earlier Exoskeleton Initiation Enables More Frequent Gait Sessions in Moderate-Severity iSCI (Secondary RCT Analysis)

PMID 41404984 Spinal Cord · 2025 | T13, T09

Key outcomes: Secondary analysis of RCT; subacute iSCI (AIS B–D). Overground robotic exoskeleton (ORE) enabled earlier gait training initiation and greater frequency vs usual care, particularly for moderate-severity iSCI (AIS C). Outcomes: days to gait initiation, gait frequency, CARE Tool walking items ("Walk 50 ft," "Walk 150 ft"), WISCI-II. Specific day-counts not retrieved via fallback search but ORE effect described as clinically meaningful.

Methods: Secondary analysis of RCT; subacute iSCI, AIS B/C/D, inpatient rehab, ≤90 min gait training/week protocol. Overground robotic exoskeleton (ORE) vs usual care (UC).

IRF take: The exoskeleton's primary value in this study is as a gait-enabler — it removes physical barriers to starting and sustaining gait training earlier. IRF protocol recommendation: prioritize ORE access for AIS C inpatients in the first 1–2 weeks of admission, before conventional gait readiness is established. Don't wait for standing tolerance criteria to be met before introducing the exoskeleton. This is an argument for ORE scheduling priority in the early inpatient window.

Team take:

• 🦿 PT: The exoskeleton enables EARLIER and MORE FREQUENT gait sessions for patients who otherwise couldn't initiate walking quickly. For AIS B–C patients, propose ORE as the first gait tool — don't wait for them to show conventional gait readiness first. Bring this evidence to IDT when scheduling ORE priority.

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8. ⭐ HIGH — AIS Grade + Neurological Level Are Top Predictors of Walking Recovery: Systematic Review + Meta-Analysis

PMID 41700668 Journal of Neurotrauma · 2026 | T11, T13

Key outcomes: SR + MA; PROSPERO CRD42023443454; authors: Cao, Ou et al., Central South University, China. AIS grade and neurological level of injury (NLI) most significant predictors of walking recovery after traumatic SCI. Most recovery in first 3–6 months; most rapid rate in first 3 months. Cervical cohort: 41% AIS improvement, 51% regained ambulation over median 3.7-year follow-up in referenced data.

Methods: SR + MA; PRISMA-compliant; prospectively registered; focus on early clinical/neurological predictors of ambulation recovery post-traumatic SCI.

IRF take: Rigorous meta-analytic backing for the established clinical framework: AIS grade and NLI at admission are the most reliable walking prognostic indicators. Use in family prognostication conversations at early IRF admission. Pair with ML-based tools (PMID 40927746) for individualized discharge function prediction. The 3-month window is the most critical — maximize gait training intensity in the first 90 days post-injury.

Team take:

• 🦿 PT: AIS admission grade is your strongest walking prognosis anchor — use it proactively in early goal-setting conversations with the family at the first IDT. AIS B–D patients warrant aggressive early gait training in the first 3 months; document gait frequency/intensity explicitly.
• 🧠 Psychology: Walking potential uncertainty is a primary adjustment stressor at IRF admission. AIS-based prognostic framing, delivered compassionately, allows psychology to help patients form realistic but hopeful expectations from day 1. Coordinate with the physician on language for the family meeting.

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MEDIUM Papers

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9. MEDIUM — Robotic Exoskeleton vs Conventional Gait Training in SCI: Balance and Strength Improve, Speed Does Not (Meta-Analysis of RCTs)

PMID 40442684 Journal of NeuroEngineering and Rehabilitation · 2025 | T13, T09

Key outcomes: Meta-analysis of RCTs; REGT vs conventional physical training (CPT) in SCI. REGT improves walking balance, lower limb strength, functional scores, and respiratory function vs CPT. No significant advantage for walking speed or distance alone. Combined REGT+CPT recommended for patients >6 months post-injury.

IRF take: Exoskeleton adds specific value (balance, strength, respiratory) but does not make patients faster walkers on its own. Supports the hybrid model: combine ORE sessions with conventional task-specific gait — don't substitute one for the other. Alternating ORE and overground gait sessions across the week may optimize IRF outcomes.

Team take:

• 🦿 PT: Combine exoskeleton with conventional overground/treadmill gait training — the exoskeleton adds balance and strength gains, conventional training drives walking speed. Schedule both each week for SCI inpatients rather than choosing one modality.

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10. MEDIUM — ITB Pump: SR + Meta-Analysis Confirms Efficacy (MAS −1.54 Adults, −0.70 Children); Younger Age and Longer Duration Predict Better Response

PMID 40769606 Disability and Rehabilitation · 2025 | T04

Key outcomes: 11 studies meta-analyzed. Adults: MAS reduction MD −1.54 (95% CI −1.80, −1.27). Children: MD −0.70 (95% CI −0.91, −0.49). Lower limbs: MD −1.45 (95% CI −1.93, −0.97). Younger age at pump initiation and longer treatment duration → greater effectiveness.

IRF take: Strong aggregate evidence for ITB pump efficacy in SCI spasticity. IRF is the optimal setting to identify ITB candidates: patients failing oral baclofen, younger patients especially. The younger-age-better result argues for not delaying ITB referral in younger SCI patients with moderate-severe spasticity. Screen at IRF admission.

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11. MEDIUM — Multimodal Respiratory Weaning Intervention in Ventilated Cervical SCI Improves Weaning Rates: QI Project

PMID 41062804 Spinal Cord · 2025 | T08, T15

Key outcomes: UK Major Trauma Centre QI project (Jan 2022–Jan 2025). MRWI components: readiness-to-wean proforma, RISCI guideline adaptation, weekly SCI ward round. 82% compliance with diaphragm/lung ultrasound assessments. Improved weaning at ICU discharge vs historical cohort.

IRF take: Structured weekly SCI respiratory ward rounds with standardized criteria (diaphragm ultrasound + RISCI guidelines) are directly applicable to IRF step-down units accepting ventilated cervical SCI patients. Consider implementing a weekly respiratory/trach round for all ventilated cervical SCI inpatients at MFB with SLP and respiratory therapy as standing members.

Team take:

• 🗣️ SLP: The MRWI's weekly ward round is the mechanism that improved outcomes — SLP should be a standing member of this round for tracheostomy-dependent cervical SCI patients. Coordinate Passy-Muir valve trials with diaphragm ultrasound-confirmed weaning readiness. Propose a tracheostomy management protocol alongside the respiratory weaning protocol at MFB.
• 🩺 Nursing: 82% compliance with ultrasound assessments was the key metric. Nursing can facilitate timely scheduling of these assessments and monitor readiness signs: cuff deflation tolerance, secretion management ability, and cough effectiveness.

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12. MEDIUM — Bladder Management Strategy Modifies AD Severity in Large SCI Registry (N=1,473)

PMID 39912231 Spinal Cord · 2025 | T02, T05, T16

Key outcomes: N=1,473 SCI patients; prospective Neurogenic Bladder Research Group registry. Management: CIC 51%, IDC 18%, surgery 13%, voiding 18%. AD severity (ADFSCI instrument) significantly associated with bladder/bowel symptom scores and management strategy. Registry-level demonstration that bladder management choice is a modifiable AD determinant. Specific AD score differences by management category not retrieved via fallback search.

IRF take: Confirms CIC as the preferred management strategy for AD severity reduction at scale. In patients with frequent or severe AD, evaluate bladder management strategy as a primary intervention before pharmacotherapy escalation. CIC program optimization is an AD management strategy.

Team take:

• 🩺 Nursing: CIC program adherence is directly linked to AD frequency at the population level. Reinforce CIC education every nursing shift during the inpatient stay — not just at discharge. For IDC-dependent patients, document AD episode frequency and escalate to the physician for management strategy review.
• 🧠 Psychology: Recurrent AD episodes cause significant psychological distress and fear. Patients who understand the bladder-AD connection (and have some control via CIC adherence) report better self-management confidence. Include AD self-management in the psychology and nursing education plan for T6-and-above injuries.

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13. MEDIUM — rTMS Targeting M1+PMC Superior to M1 Alone for SCI Neuropathic Pain (fNIRS RCT, Jan 2026)

PMID 41623937 NeuroImage: Clinical · 2026 | T10

Key outcomes: Published January 30, 2026. RCT: high-frequency rTMS M1+PMC vs M1-alone vs sham. Pain declined in both active arms; M1+PMC coupling showed superior analgesic enhancement vs M1 alone. fNIRS tracked bilateral M1, PMC, S1 activation during handgrip task. Specific pain scale differences not retrieved via fallback search.

IRF take: Dual-target rTMS (M1+PMC) is a promising non-pharmacological option for SCI neuropathic pain refractory to medications. Not yet standard of care. Track for neuromodulation clinic expansion — relevant for patients maximized on gabapentinoids/tricyclics who request alternatives or cannot tolerate ADRs.

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14. MEDIUM — Complications of ITB Therapy: Single-Center Cohort Study (N=170)

PMID 39798214 Spinal Cord · 2025 | T04

Key outcomes: N=170 individuals on ITB therapy; single-center cohort. Catheter and pump complications documented; predictive factors analyzed. ITB effective for severe spasticity reduction but associated with serious complications. Specific complication rates not retrieved via fallback search.

IRF take: Use as a reference when counseling patients/families about ITB pump initiation at IRF. Know your local neurosurgery team's complication management protocols. Important for pre-discharge planning when ITB is being discussed as a long-term strategy.

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15. MEDIUM — AI in Acute and Sub-Acute SCI: SR of 23 Studies (N=120,931); AIS-at-Discharge Predictable with 11 Variables

PMID 41345782 Spinal Cord · 2025 | T12

Key outcomes: SR; 23 studies; N=120,931 individuals. AI predicts: neurological improvement, complications, walking ability, functional independence, discharge destination, readmission, mortality. Classical ML, ensemble, and deep learning most-used model families. High-accuracy AIS-at-discharge model with 11 clinical variables reported.

IRF take: AI discharge-destination prediction is directly IRF-relevant: models in this space could feed directly into IRF admission planning workflows. Track tools being validated for AIS-at-discharge prediction — could integrate with the ML discharge-FIM work from PMID 40927746 for a combined acute → IRF outcome pipeline.

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16. MEDIUM — Post-SCI Discharge: Patients' Rehabilitation Priorities Change in First Months; Personalized Coordination Is Essential (Qualitative)

PMID 40059307 Disability and Rehabilitation · 2025 | T16, T17

Key outcomes: Qualitative study; subacute SCI patients' perspectives on inpatient discharge and 3-month follow-up. Key theme: rehabilitation priorities and expectations change substantially in the first months post-discharge. Personalized, responsive, and coordinated support essential. Static single-event discharge planning inadequate for dynamic SCI recovery.

IRF take: Discharge planning must be iterative and anticipate that patient priorities will shift post-discharge. QI proposal: implement a formal 30-day post-discharge telehealth check-in for all SCI discharges. This is a patient experience and readmission reduction opportunity.

Team take:

• 🩺 Nursing: Discharge education should be tailored to patient-expressed priorities, not only the clinical checklist. Document what the patient says they are most worried about before discharge — feed this directly to the outpatient follow-up team.
• 🧠 Psychology: Post-discharge psychosocial support is critical — peer support and community resource connections should begin before discharge. Prioritize peer mentor linkage and community re-integration referrals as formal discharge plan elements for every SCI patient.

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17. MEDIUM — FES Translation to Clinical Practice: Current Evidence and Implementation Gaps (Expert Review)

PMID 40470819 Expert Review of Medical Devices · 2025 | T09

Key outcomes: Narrative review; FES for motor control after SCI: strongest evidence for specific applications (UE FES for cervical SCI, FES cycling). Clinical implementation remains variable due to device access, provider training, and outcome standardization gaps.

IRF take: Use as a framework document for FES program development at MFB. Upper extremity FES for cervical SCI is the best-evidenced application. The implementation gap section maps directly onto IRF-level barriers: device procurement, PT/OT FES training, and standardized outcome tracking.

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Summary Table

#	PMID	Tier	Topic Buckets	Key Finding
1	41859681	⭐⭐ TOP #1	T10, T13	eWALK: tSCS ≠ walking benefit in chronic SCI (N=50, multicenter RCT)
2	39885542	⭐⭐ TOP #2	T10, T13	tSCS+Lokomat: 85.7% vs 43.1% walk 10m in subacute iSCI (N=27 RCT)
3	40927746	⭐⭐ TOP #3	T12, T11	ML (RF/XGBoost) predicts discharge FIM from IRF; admission FIM+PT hours top predictors (N=589)
4	41902637	⭐ HIGH	T17, T11	AIS severity ≠ QoL predictor; depression+social satisfaction predict QoL (N=115, TRACK-SCI)
5	40682469	⭐ HIGH	Medical	Gabapentinoids: pain MD −1.75 but somnolence RR 3.77, dizziness RR 2.83 (5 RCTs, N=682)
6	41362083	⭐ HIGH	T09, T13	FES-locomotor training: no carryover benefit for walking speed/endurance (g=−0.01, 3 RCTs)
7	41404984	⭐ HIGH	T13, T09	ORE enables earlier+more frequent gait training in moderate iSCI (AIS C)
8	41700668	⭐ HIGH	T11, T13	AIS+NLI top walking recovery predictors; 3-mo window most critical (SR+MA)
9	40442684	MEDIUM	T13, T09	REGT improves balance/strength/respiratory vs CPT; no speed advantage alone
10	40769606	MEDIUM	T04	ITB pump: MAS −1.54 adults (SR+MA, 11 studies)
11	41062804	MEDIUM	T08, T15	MRWI weaning protocol: 82% ultrasound compliance; improved weaning (QI project)
12	39912231	MEDIUM	T02, T05, T16	Bladder management strategy modifies AD severity (N=1,473 registry)
13	41623937	MEDIUM	T10	rTMS M1+PMC > M1 alone for SCI neuropathic pain (fNIRS RCT, Jan 2026)
14	39798214	MEDIUM	T04	ITB complications cohort N=170
15	41345782	MEDIUM	T12	AI in acute+subacute SCI: 23 studies, N=120,931; AIS-at-discharge predictable
16	40059307	MEDIUM	T16, T17	Discharge priorities shift post-SCI; personalized iterative planning needed
17	40470819	MEDIUM	T09	FES clinical translation review: UE FES strongest evidence; implementation gaps

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Digest generated: 2026-05-18 · Source: WebSearch fallback (eutils API 403) · Tool: thescidoc · Contact: jcvberg@gmail.com