Evidence-based recommendations for health professionals to improve care of people with spinal cord injury and cognitive impairment: An update to the psychosocial clinical practice guide

Dr. Michael Fehlings is joined by Dr. Mohit Arora to discuss his recent publication in Spinal Cord “Evidence-based recommendations for health professionals to improve care of people with spinal cord injury and cognitive impairment: An update to the psychosocial clinical practice guide”. This episode covers the factors contributing cognitive impairment after SCI, cognitive screening approaches, and future directions for the field. 

Learning goals:

• Cognitive impairment after spinal cord injury is common, frequently overlooked, can occur immediately after injury, and arises from multiple contributing factors. If not proactively addressed, it can significantly compromise rehabilitation and long-term outcomes.
• Routine, validated cognitive screening should occur early and continue across the lifespan, supported by tailored communication strategies and person-centred care.
• We now have clear, evidence- and consensus-informed recommendations, but meaningful impact depends on system level implementation, including workforce training and supportive clinical environments.

What questions will be raised in this webinar/podcast?

• Introductory remarks from Michael Fehlings
• Michael Fehlings will ask guest(s) to summarize key points from the manuscript
• Michael Fehlings will discuss points with guest(s)
• Michael Fehlings will ask guest(s) about anticipated future directions for this work as well as clinical impact

The opinions of our host and guests are their own; ISCoS does not endorse any individual viewpoints, given products or companies. 

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Contact us directly with any questions or comments at iscos@associationsltd.co.uk

Transcript

Host Welcome And Article Intro

SPEAKER_01 0:10

Hello, I'm Professor Michael Phalings from the University of Toronto, and I'm editor-in-chief of Spinal Cord, which is the signature journal of the International Spinal Cord Society or ISCOS, and welcome to our podcast for Spinal Cord, in which we highlight uh each month um editor's choice articles that our editorial board feels are of particularly uh noteworthy. Uh today I'm very pleased uh to be with um uh Dr. uh Mohit Aurora, who's a um a PhD and uh physiotherapist and a clinician scientist. Um is a deputy head and senior research fellow at the John Walsh Center for Rehabilitation Research at the University of Sydney. So, Mohit, uh welcome. Thank you for uh joining. And uh today we'll be talking about an article uh that uh Dr. Aurora first authored uh together with the uh

Study Origins And Why It Matters

SPEAKER_01 1:18

team at the University of uh Sydney. The article is entitled Evidence-based recommendations for health professionals to improve care of people with spinal cord injury and cognitive impairment, an update to the psychosocial care practice uh guide. And I think this is a very important article. Uh Mohit, can you perhaps just briefly summarize the uh you know the background to the article and the key points in this article?

SPEAKER_00 1:46

Uh yeah, thank you, Dr. Felings, uh, for that nice introduction and the invitation. And I would like to also like say thank you for the opportunity to chat with me today for this over recently published work. So, yes, it will be a pleasure to summarize the key points like for this article. I I will just like uh start by saying this work represents a collaborative effort between my team and 17 spinal cord injury clinician specialists across New South Wales in Australia, and is led by myself and Professor Ashley Craig. This work is important because I think people with spinal cord injury are 13 times more likely to develop cognitive problems than the general population and can comprise like and then and can compromise their rehabilitation outcomes. Yet rehabilitation like professionals lack that evidence-based guidance and how to effectively assess, communicate with, and care for these

Core Recommendations And Person-Centred Care

SPEAKER_00 2:49

patients. So, this particular article provides 20 comprehensive recommendations based on the current evidence and expert consensus that were developed through a multi-stage development process. Coming to the key findings, I will start by saying firstly, cognitive screening should happen immediately after spinal cord injury, regardless of how the injury occurred due to multiple possible contributors. Secondly, I will add to that saying healthcare providers need more training in identifying signs and symptoms of cognitive impairment, including specialized communication strategies like use of simple language, providing written reminders, and allowing extra processing time for people who are identified with cognitive impairment. And most importantly, these recommendations emphasize on person-centric care that recognize that each person, each patient is unique in their needs and challenges. The guide also addresses everything from recognizing that early warning sign like forgetfulness and difficulties following instructions to implementing a system-wide change in rehabilitation center. Thank you.

SPEAKER_01 4:12

Thank you for uh you know that excellent summary. And um I I also want to point out for the listeners on this uh podcast that the article itself is open access. There's um an excellent uh graphical abstract um associated with the article, which nicely summarizes you know the key points. So um perhaps we could just talk about one or two points that that are are arising from um uh uh the article.

Beyond TBI: Unpacking Cognitive Causes

SPEAKER_01 4:42

Of course, it's recognized that a certain proportion of individuals with a spinal cord injury will have a traumatic brain injury, and the incidence of mild traumatic brain injury is probably underestimated in the spinal cord injury population, but your article has pointed out that the uh underlying issues related to cognitive impairment go well beyond the potential coincidence of a traumatic brain injury. Can you kind of amplify some of the uh the key causes for a potential cognitive impairment in people with a spinal cord injury?

SPEAKER_00 5:16

Sure, sure. This was like one of the like um one of the I will say like this was one of the key points what we have also identified during the conduct of study. This doesn't come as a surprise, it kind of more validated over approach and assumption when we found from literature that 80% of the cognitive deficit in spinal cord injury patient cannot just be explained by traumatic uh brain injury alone, but also indicating that the problem is more complex and multifaceted than initially understood. So, in some of the work which we have been continuing from this project is more around understanding that theoretical model, which we have now developed, and the next uh phase of that project is just validating with the data what we have collected over the last seven years. And some of the contributors of that

Five-Factor Model Of Impairment

SPEAKER_00 6:12

causes of uh cognitive impairment includes, like, I will just like broadly classify them in like five categories. Firstly, I'll say like that injury to the nervous central nervous system that disrupted neural pathway between spinal cord and the brain. The second factor being personal factor, which influences the brain health and resilience, the third factor being environmental factors that influence uh brain structure and function over time, fourth one being the secondary health conditions, which has like uh which relates to more around systemic inflammation and uh impact that brain function in day-to-day life. And lastly, the fake fifth uh key factor being the polypharmacy, where side effects and drug-to-drug interactions can affect the cognitive capacity of a person with spinal cord injury.

SPEAKER_01 7:08

Yeah, thank you. I think it's uh clearly I think one of the the key points that your article has um has discussed is the importance to raise awareness of the coincidence of cognitive impairment with spinal cord injury and to improve uh uh the re the recognition.

Future Directions And Living Guide

SPEAKER_01 7:28

So what what um do you anticipate are the uh the key uh anticipated future directions uh for this work and and the potential clinical impact um you know of these evidence-based recommendations?

SPEAKER_00 7:46

Um I will say um uh to answer that question, uh first of all, um Dr. Felings, this is like an important question, and I think this is something we are very, very passionate about how we can make this particular research area like more recognizable. And to do that, like I think moving forward, we are very committed to maintaining this guide as a living document with our next updated updates. We are so we we are committed to maintaining this document as a living document with the next update planned in 2028 with a broader expansion within the global context. And when I say like living guide or living document, I'm particularly valuing that in this area where the evidence is rapidly evolving, and over the past decade, we have seen that there is a grown research activity in the field, including several important publications within the last three to five years. In addition, I will also like say one of the things which also validated over understanding that the multimodal, that theoretical model I've just like mentioned previously, is also that understanding the cause. And now we are in the process of using that data-driven approaches to validate that model, to understand what amount of each factor can contribute to the cognitive impairment. Because some of the literature which is already published in the area, they say like the treatment what they offer doesn't provide like a good uh like treatment effect, of course, because they are not targeting different models or different models into that equation. That's why they're not seeing a response from their treatment. The other important work, which is like kind of links to this uh particular guideline work, is what we are about to start is co-designing a next generation

Next-Gen Tools, AI And Real-World Assessment

SPEAKER_00 9:40

ecological valid assessment tool of cognitive function in people with spinal cord injury, with the goal that it will improve the identification, management, and rehabilitation of cognitive impairment in this population. And we were also thinking there is a strong potential where we can also include in this next generation model how we can integrate that AI-assisted analytics and virtual reality-based intervention in that ecologically sound model where people are not coming to a clinician in that environment where they're doing assessments rather than doing some day-to-day activities, and we are capturing that how the cognitive impairment is actually uh affecting them in that real-world scenario.

SPEAKER_01 10:26

Thank you. It's certainly um very important uh uh work. So um we've just been having a uh a discussion with Dr. Mohit Aurora from the John Walsh uh Center for Rehabilitation Research at the University of Sydney. However, Aurora has been uh summarizing the key points uh from an editor's choice article in spinal cord entitled Evidence-based recommendations for health professionals to improve the care of people with spinal cord injury and cognitive impairment, an update to the uh psychosocial care practice uh uh guide. And Dr. Aurora, thank you so much for uh joining us. We um uh you know look forward to future directions from this uh very important uh work, and uh I look forward to seeing further presentations from your uh group um

Closing Thanks And Takeaways

SPEAKER_01 11:20

at ISCOS and further uh contributions uh to uh uh spinal cord. And on that note, I will uh draw this uh podcast to a close. And again, thank you so much for um for joining me in today's discussion.

SPEAKER_00 11:37

Thank you. Thank you, Dr. Felings, for the opportunity again. Really appreciate it.