The Mount Sinai Spinal Cord Injury Model System of the Department of Rehabilitation Medicine provides a regional multidisciplinary system of care that includes a number of innovative clinical programs for people with spinal cord injury (SCI) in the New York City metropolitan area. The system contributes longitudinal data about persons with SCI to the SCI National Database. The National Database includes more than 30,000 individuals. Persons with acute injury who are enrolled in a Model System can remain in the database and contribute to our knowledge of SCI throughout their lifetime. Investigators perform approximately 300 follow-up interviews per year at Mount Sinai.

The objectives of the Mount Sinai Spinal Cord Injury Model System focus on improving the quality of life of persons with SCI through:

• State-of-the-science clinical care
• Innovative research
• Multi-platform extensive dissemination of research results and other information on SCI to consumers and professionals

The comprehensive clinical program consists of

• NYC Emergency Medical Services, ensuring the early and safe extrication of individuals with SCI from the injury site, pre-hospital care, and rapid transport to a trauma center
• Emergency department and acute medical/surgical care units within the Mount Sinai Health System, including the Mount Sinai Morningside Trauma Center
• Comprehensive CARF-accredited SCI acute inpatient and outpatient rehabilitation services taking place within a 25-bed SCI inpatient rehabilitation unit (serving 60 patients with traumatic SCI each year) and a large outpatient area. Core rehabilitation services include physical therapy, occupational therapy, speech-language pathology, social work, peer mentoring, outreach coordination, rehabilitation psychology, therapeutic recreation, and vocational rehabilitation.

The research program of the Mount Sinai Spinal Cord Injury Model System aims to improve the quality of life for SCI survivors by developing effective treatments of post-SCI secondary conditions.

Current projects include:

• A local randomized clinical trial that will evaluate the Safety, feasibility, and efficacy of transcutaneous spinal cord stimulation on stabilizing blood pressure for acute inpatients with spinal cord injury
•  
• Participation in three collaborative module research projects with other model systems. Currently, these include:
  • Feasibility, Reliability, and Long-term Prognostic Capability of the International Standards to Document Autonomic Function after Spinal Cord Injury (ISAFSCI) during acute inpatient rehabilitation – Mount Sinai Lead Module 
    •  
    • Accelerating Racial and Ethnic Equity in SCI Rehabilitation Outcomes Module
    • The Status of Oral Health in People with Spinal Cord Injury in the United States Module

Dissemination activities include a monthly e-newsletter, The Spinal Connection; accessible web-based information; journal publications; presentations at international, national, regional, and local meetings; and involvement of consumers through a Community Advisory Committee.

Thomas Bryce, MD is the principal investigator of this project.

The Feasibility, Reliability, and Long-term Prognostic Capability of the International Standards to Document Autonomic Function after Spinal Cord Injury (ISAFSCI) during acute inpatient rehabilitation – Mount Sinai Lead Module is part of the Mount Sinai Spinal Cord Injury Model System. Participants in this research study can participate in this specific module if they qualify for the MAIN STUDY.

For the estimated millions of people living with SCI globally, impaired Autonomic Nervous System (ANS) regulation can lead to cardiovascular dysfunction, adverse changes in bowel and bladder control, abnormal sweating and temperature regulation, disrupted immune function, and cardiometabolic syndromes. Many people with SCI prioritize restoration of ANS function above regaining the ability to walk; as such, focus has increased substantially regarding the secondary consequences of ANS dysfunction in the SCI community. This study aims to use the recently developed and revised International Standards to document Autonomic Function following SCI (ISAFSCI), to improve the clinical monitoring of ANS disorders in newly injured patients with SCI across several health care facilities. The primary objective of this study is to determine the feasibility of collecting ISAFSCI information in conjunction with administration of the International Standards for the Neurological Classification of SCI (ISNCSCI) to inform widespread integration of the ISAFSCI into clinical practice for monitoring the ANS functions during acute inpatient rehabilitation (AIR) following SCI. Eligible participants will include newly injured patients admitted to the AIR units of participating SCIMS centers who meet the SCIMS eligibility criteria and are admitted during the 42-month recruitment period. Objectively and accurately assessing the degree of ANS dysfunction following SCI and tracking changes over time and in response to therapeutic intervention will ultimately lead to improved clinical care, health, and well-being.

For more information please contact: Christine Hyun at ChristineS.Hyun@mountsinai.org / or Jorge Chavez at Jorge.Chavez2@mountsinai.org.

Jill M Wecht, EdD is the principal investigator of this model system project.

Pain is one of the most common problems after spinal cord injury. Approximately 90% of persons with spinal cord injury report pain 6 months after their injury, while approximately 80% report pain at 1, 3, 5, 10, 20, and 25 years after injury. Research suggests that pain remains a significant problem for persons with spinal cord injury throughout their lifetimes. Also, people with spinal cord injury consider adequate pain management one of their highest unmet needs.

For these reasons it is important to understand how various types of pain occur and change over time. It is also important to understand different levels of severity of pain and how pain may interfere with life activities. Understanding pain after spinal cord injury may provide clinicians with better diagnostic tools and potential target for treatment. Having a better understanding of pain could help guide clinical decisions and inform newly injured patients on what to expect in the long-term with regard to their pain.

As pain affects most people after spinal cord injury, in a significant way, a greater understanding of this secondary consequence of spinal cord injury, through research, is clearly needed to advance preventative and treatment strategies. There is sufficient scientific evidence to support the need for an Exploration and Discovery project regarding the development of specific pain types over the course of the first year after SCI.

The objectives of this multi-site collaborative project include:

• To present a comprehensive description of the commonness of pain sub-types and pain treatments used by persons with spinal cord injury in the US over the first year post injury
• To describe how the start of pain, interference with daily activities, and intensity of pain vary over the first year in newly injured persons with spinal cord injury
• To identify neurosensory characteristics and psychosocial factors that will help clinicians predict the later development of persistent pain after spinal cord injury
• To explore the relationship between pain, life satisfaction, resilience and other psychosocial factors and track how they may predict pain over time.

The expected outputs of this study have a strong likelihood of advancing the science related to pain assessment and treatment after spinal cord injury. The outputs could provide clinicians with potential new approaches to treatment and ultimately the ability to improve the quality of life of those with spinal cord injury.

Thomas Bryce, MD is the principal investigator of this project. Visit our Investigators Page for training information.

The purpose of this research study is to test the safety of a new investigational noninvasive spinal cord stimulation device called ExaStim and to see if it will help improve movement and sensation in the upper body, arms, and hands of individuals with spinal cord injury.

If you choose to participate, you will be asked to:

• Attend all scheduled visits (a total of 28 visits, lasting approximately 13 weeks), including a screening visit to ensure you meet all of the criteria for the study, 24 visits where you will receive the study treatment or a sham treatment, 2 visits to check on your hand functions in the middle and end of the treatment, and a follow-up visit 4 weeks after the last treatment visit to check on your well-being
• Answer any questions truthfully, including questions about your medications and medical history
• Be willing and able to follow the study directions and procedures
• Tell the study staff about any problems or side effects
• Ask questions as you think of them
• Tell the investigator or study staff if you change your mind about staying in the study
• Receive study compensation

Chung-Ying Tsai, PhD is the principal investigator of this project.