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Papers by Jonathan Strayer

American Journal of Physical Medicine & Rehabilitation, Mar 1, 1996

Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat... more Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat. Subarachnoid lidocaine has been used in selected patients with some success. Mexiletine, an analog of lidocaine that acts at Na+/K+ channels in the peripheral nerve, has been found effective in persons with diabetic dysesthetic neuropathy. The effect of mexiletine in the treatment of spinal cord dysesthetic pain was examined in this study. Fifteen patients were enrolled, and 11 patients completed the prospective, randomized, placebo-controlled, double-blind, crossover design trial. Inclusion/exclusion criteria were carefully defined. A 1-wk washout period was followed by a 4-wk drug trial of either mexiletine (450 mg/day) or placebo. This was repeated for the second medication in the second arm of the study. Patients were followed weekly with McGill and visual analog pain scales. Baseline, midpoint, and endpoint Barthel function scores were recorded. The Wilcoxon's signed-rank test and paired t test were used for statistical analysis. Results showed no significant effect of mexiletine on SCI dysesthetic pain scales or Barthel index. In conclusion, in this trial, mexiletine did not appear to decrease spinal cord injury-related dysesthetic pain.

Spinal Cord, 2006

Study design: Controlled, repeat-measures study. Objectives: To determine if functional electrica... more Study design: Controlled, repeat-measures study. Objectives: To determine if functional electrical stimulation (FES) can affect bone atrophy in early spinal cord injury (SCI), and the safety, tolerance and feasibility of this modality in bone loss remediation.

Spinal Cord, 2000

Study design: A prospective double blind cross over trial of intravenous 4-Aminopyridine (4-AP). ... more Study design: A prospective double blind cross over trial of intravenous 4-Aminopyridine (4-AP). Objective: To determine the ecacy of this drug in the treatment of spinal cord injured (SCI) patients for neurologic impairment, pain and spasticity. Setting: The post anesthesia care unit (PACU) of a tertiary care acute hospital. Methods: Twelve paraplegic patients were enrolled in a double blind cross over intravenous trial of 4-Aminopyridine (4-AP). Thirty milligrams of 4-AP or placebo were administered over a 2 h period. Patients were serially examined during and after the infusion clinically for pain, sensorimotor function, hypertonicity and motor control using electromyography (EMG). Samples of blood and cerebrospinal¯uid (CSF) were also analyzed at similar intervals. Results: Despite penetration of 4-AP into the CSF, no signi®cant dierences were noted in the clinical and EMG parameters at the times measured. Individual changes in sensory function were reported by some patients in both the placebo and 4-AP trials, however mean values were not robust. Frequently, patients complained of unpleasant symptoms during the 4-AP infusion. Conclusion: The intravenous route may not be the best way to administer this drug as no short term bene®ts were observed.

Archives of Physical Medicine and Rehabilitation, Jun 1, 2007

Objective: To determine the feasibility and impact of an outpatient, electric stimulation cycling... more Objective: To determine the feasibility and impact of an outpatient, electric stimulation cycling (ESC) protocol on a patient with incomplete spinal cord injury (SCI). Design: Pre-post case study. Setting: Outpatient rehabilitation hospital. Participant: A 24-year old man with an incomplete SCI occurring 25 months before study entry at the T12-L1 level. Intervention: A 2-phase, 10-week ESC intervention occurring 3 days a week. Phase 1 provided 30-minute ESC sessions at increasing resistance with electric stimulation applied to the quadriceps and hamstrings; phase 2 required cycling independently (ie, without stimulation) at maximal effort for increasing lengths of time. Main Outcome Measures: Gait velocity, stride length, and step length, all collected during a 10-meter walking test, and the Walking Index of Spinal Cord InjuryϪII (WISCI-II). Results: During phase 1, the patient quickly increased workload, session duration, and distance; during phase 2, duration that the subject was able to cycle without stimulation increased markedly. After the entire intervention, the subject exhibited diminished edema, new ability to voluntarily step, new ability to voluntarily dorsiflex the ankle and voluntarily flex the toe, and new ability to perform valued activities, such as transfers. He also exhibited increased mean gait velocity (.33m/s), left (.11m) and right (.07m) stride length, left (.06m) and right (.05m) step length, and a 10-point WISCI-II increase. The subject was also able to discontinue use of several medications after intervention. Conclusions: SCI patients' endurance and gait deficits can possibly be effectively addressed on an outpatient basis and with minimal assistance by using this regimen.

Archives of Physical Medicine and Rehabilitation, Jun 1, 1997

Spinal Cord, 2011

Setting: Retrospective analysis and retrospective follow-up. Introduction: Spinal cord injury (SC... more Setting: Retrospective analysis and retrospective follow-up. Introduction: Spinal cord injury (SCI) patients have today a nearly normal lifespan. Avoidance of medical complications is key to this end. The aim of the study was to analyse health in individuals surviving 25 years or more after traumatic SCI in Stockholm and Florence, and compare medical complications. Methods: Data from the databases of the Spinal Unit of Florence and from the Spinalis, Stockholm were analysed. Patients included were C2-L 2, American Spinal Cord Association (ASIA) Impairment Scale (AIS) A-C, and X25 years post traumatic SCI. Patients underwent a thorough neurological and general examination, and were interviewed about medical events during those years. Analysed data include: gender, age at injury, current age, neurological level, AIS, cause of injury, presence of neuropathic pain (NP), and spasticity and medical complications. Results: A total of 66 Italian patients and 74 Swedish patients were included. The only statistical difference between the groups was cause of injury due to falls was higher in the Florence group (Po0.01). Male/female ratio was 4:1. Traffic accidents were the most common cause of injury. In all, 60% were paraplegics. Pressure ulcers (PU) occurred in nearly 60% and 32% experienced NP. Respiratory complications (RC) occurred in 25% among tetraplegics. Neurological deterioration occurred in 14%. Conclusion: PU, bony fractures, spasticity and NP are important problems after SCI. RC are of clinical importance in the tetraplegics. Complications occur during all periods after injury. Many patients are otherwise healthy 25 years or more after SCI.

The Journal of Spinal Cord Medicine, 2011

American Journal of Physical Medicine & Rehabilitation, 1997

American Journal of Physical Medicine & Rehabilitation, 1996

Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat... more Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat. Subarachnoid lidocaine has been used in selected patients with some success. Mexiletine, an analog of lidocaine that acts at Na+/K+ channels in the peripheral nerve, has been found effective in persons with diabetic dysesthetic neuropathy. The effect of mexiletine in the treatment of spinal cord dysesthetic pain was examined in this study. Fifteen patients were enrolled, and 11 patients completed the prospective, randomized, placebo-controlled, double-blind, crossover design trial. Inclusion/exclusion criteria were carefully defined. A 1-wk washout period was followed by a 4-wk drug trial of either mexiletine (450 mg/day) or placebo. This was repeated for the second medication in the second arm of the study. Patients were followed weekly with McGill and visual analog pain scales. Baseline, midpoint, and endpoint Barthel function scores were recorded. The Wilcoxon's signed-rank test and paired t test were used for statistical analysis. Results showed no significant effect of mexiletine on SCI dysesthetic pain scales or Barthel index. In conclusion, in this trial, mexiletine did not appear to decrease spinal cord injury-related dysesthetic pain.

Archives of Physical Medicine and Rehabilitation, 1997

American Journal of Physical Medicine & Rehabilitation, 1995

Physical Medicine & Rehabilitation Secrets, 2008

Physical Medicine & Rehabilitation Secrets, 2008

Objective: To determine the feasibility and impact of an outpatient, electric stimulation cycling... more Objective: To determine the feasibility and impact of an outpatient, electric stimulation cycling (ESC) protocol on a patient with incomplete spinal cord injury (SCI). Design: Pre-post case study. Setting: Outpatient rehabilitation hospital. Participant: A 24-year old man with an incomplete SCI occurring 25 months before study entry at the T12-L1 level. Intervention: A 2-phase, 10-week ESC intervention occurring 3 days a week. Phase 1 provided 30-minute ESC sessions at increasing resistance with electric stimulation applied to the quadriceps and hamstrings; phase 2 required cycling independently (ie, without stimulation) at maximal effort for increasing lengths of time. Main Outcome Measures: Gait velocity, stride length, and step length, all collected during a 10-meter walking test, and the Walking Index of Spinal Cord InjuryϪII (WISCI-II). Results: During phase 1, the patient quickly increased workload, session duration, and distance; during phase 2, duration that the subject was able to cycle without stimulation increased markedly. After the entire intervention, the subject exhibited diminished edema, new ability to voluntarily step, new ability to voluntarily dorsiflex the ankle and voluntarily flex the toe, and new ability to perform valued activities, such as transfers. He also exhibited increased mean gait velocity (.33m/s), left (.11m) and right (.07m) stride length, left (.06m) and right (.05m) step length, and a 10-point WISCI-II increase. The subject was also able to discontinue use of several medications after intervention. Conclusions: SCI patients' endurance and gait deficits can possibly be effectively addressed on an outpatient basis and with minimal assistance by using this regimen.

The Journal of Spinal Cord Medicine, 2011

Little is known about those veterans with spinal cord injuries and disorders (SCI/D) who smoke ci... more Little is known about those veterans with spinal cord injuries and disorders (SCI/D) who smoke cigarettes. This study identified the factors associated with smoking in this population, motivations for smoking, and the readiness for smoking cessation. Current practices for the delivery of evidence-based tobacco cessation were also examined. Design: Methods included surveys of veterans with SCI/D, medical record reviews of current smokers, and telephone interviews with SCI/D providers. Setting: Six Veterans Health Administration facilities with SCI centers and one SCI clinic. Participants: Survey data were analyzed for 1210 veterans, 256 medical records were reviewed, and 15 providers served as key informants. Interventions: Observational study. Outcome measures: Veterans self-reported smoking status, quit attempts, methods and care received, motivation for smoking, and health care conditions. Medical record review and informant interviews examined the tobacco cessation care provided. Results: Whereas 22% of the respondents were current smokers; 51% were past smokers. Current smokers more often reported respiratory illnesses and/or symptoms, alcohol use, pain, and depression than past or never smokers, and approximately half made quit attempts in the past year. Smokers received referral to counseling (57%) and/or prescription for medication/nicotine replacement (23%). Key informants identified difficulty of providing follow-up and patients' unwillingness to consider quitting as barriers. Conclusion: Veterans with SCI/D who smoke also had other health problems. Providers offer counseling and medication, but often have difficulty following patients to arrange/provide support. Identifying other support methods such as telehealth, considering the use of combination cessation therapies, and addressing other health concerns (e.g. depression) may affect tobacco cessation in this population.

American Journal of Physical Medicine & Rehabilitation, Mar 1, 1996

Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat... more Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat. Subarachnoid lidocaine has been used in selected patients with some success. Mexiletine, an analog of lidocaine that acts at Na+/K+ channels in the peripheral nerve, has been found effective in persons with diabetic dysesthetic neuropathy. The effect of mexiletine in the treatment of spinal cord dysesthetic pain was examined in this study. Fifteen patients were enrolled, and 11 patients completed the prospective, randomized, placebo-controlled, double-blind, crossover design trial. Inclusion/exclusion criteria were carefully defined. A 1-wk washout period was followed by a 4-wk drug trial of either mexiletine (450 mg/day) or placebo. This was repeated for the second medication in the second arm of the study. Patients were followed weekly with McGill and visual analog pain scales. Baseline, midpoint, and endpoint Barthel function scores were recorded. The Wilcoxon's signed-rank test and paired t test were used for statistical analysis. Results showed no significant effect of mexiletine on SCI dysesthetic pain scales or Barthel index. In conclusion, in this trial, mexiletine did not appear to decrease spinal cord injury-related dysesthetic pain.

Spinal Cord, 2006

Study design: Controlled, repeat-measures study. Objectives: To determine if functional electrica... more Study design: Controlled, repeat-measures study. Objectives: To determine if functional electrical stimulation (FES) can affect bone atrophy in early spinal cord injury (SCI), and the safety, tolerance and feasibility of this modality in bone loss remediation.

Spinal Cord, 2000

Study design: A prospective double blind cross over trial of intravenous 4-Aminopyridine (4-AP). ... more Study design: A prospective double blind cross over trial of intravenous 4-Aminopyridine (4-AP). Objective: To determine the ecacy of this drug in the treatment of spinal cord injured (SCI) patients for neurologic impairment, pain and spasticity. Setting: The post anesthesia care unit (PACU) of a tertiary care acute hospital. Methods: Twelve paraplegic patients were enrolled in a double blind cross over intravenous trial of 4-Aminopyridine (4-AP). Thirty milligrams of 4-AP or placebo were administered over a 2 h period. Patients were serially examined during and after the infusion clinically for pain, sensorimotor function, hypertonicity and motor control using electromyography (EMG). Samples of blood and cerebrospinal¯uid (CSF) were also analyzed at similar intervals. Results: Despite penetration of 4-AP into the CSF, no signi®cant dierences were noted in the clinical and EMG parameters at the times measured. Individual changes in sensory function were reported by some patients in both the placebo and 4-AP trials, however mean values were not robust. Frequently, patients complained of unpleasant symptoms during the 4-AP infusion. Conclusion: The intravenous route may not be the best way to administer this drug as no short term bene®ts were observed.

Archives of Physical Medicine and Rehabilitation, Jun 1, 2007

Objective: To determine the feasibility and impact of an outpatient, electric stimulation cycling... more Objective: To determine the feasibility and impact of an outpatient, electric stimulation cycling (ESC) protocol on a patient with incomplete spinal cord injury (SCI). Design: Pre-post case study. Setting: Outpatient rehabilitation hospital. Participant: A 24-year old man with an incomplete SCI occurring 25 months before study entry at the T12-L1 level. Intervention: A 2-phase, 10-week ESC intervention occurring 3 days a week. Phase 1 provided 30-minute ESC sessions at increasing resistance with electric stimulation applied to the quadriceps and hamstrings; phase 2 required cycling independently (ie, without stimulation) at maximal effort for increasing lengths of time. Main Outcome Measures: Gait velocity, stride length, and step length, all collected during a 10-meter walking test, and the Walking Index of Spinal Cord InjuryϪII (WISCI-II). Results: During phase 1, the patient quickly increased workload, session duration, and distance; during phase 2, duration that the subject was able to cycle without stimulation increased markedly. After the entire intervention, the subject exhibited diminished edema, new ability to voluntarily step, new ability to voluntarily dorsiflex the ankle and voluntarily flex the toe, and new ability to perform valued activities, such as transfers. He also exhibited increased mean gait velocity (.33m/s), left (.11m) and right (.07m) stride length, left (.06m) and right (.05m) step length, and a 10-point WISCI-II increase. The subject was also able to discontinue use of several medications after intervention. Conclusions: SCI patients' endurance and gait deficits can possibly be effectively addressed on an outpatient basis and with minimal assistance by using this regimen.

Archives of Physical Medicine and Rehabilitation, Jun 1, 1997

Spinal Cord, 2011

Setting: Retrospective analysis and retrospective follow-up. Introduction: Spinal cord injury (SC... more Setting: Retrospective analysis and retrospective follow-up. Introduction: Spinal cord injury (SCI) patients have today a nearly normal lifespan. Avoidance of medical complications is key to this end. The aim of the study was to analyse health in individuals surviving 25 years or more after traumatic SCI in Stockholm and Florence, and compare medical complications. Methods: Data from the databases of the Spinal Unit of Florence and from the Spinalis, Stockholm were analysed. Patients included were C2-L 2, American Spinal Cord Association (ASIA) Impairment Scale (AIS) A-C, and X25 years post traumatic SCI. Patients underwent a thorough neurological and general examination, and were interviewed about medical events during those years. Analysed data include: gender, age at injury, current age, neurological level, AIS, cause of injury, presence of neuropathic pain (NP), and spasticity and medical complications. Results: A total of 66 Italian patients and 74 Swedish patients were included. The only statistical difference between the groups was cause of injury due to falls was higher in the Florence group (Po0.01). Male/female ratio was 4:1. Traffic accidents were the most common cause of injury. In all, 60% were paraplegics. Pressure ulcers (PU) occurred in nearly 60% and 32% experienced NP. Respiratory complications (RC) occurred in 25% among tetraplegics. Neurological deterioration occurred in 14%. Conclusion: PU, bony fractures, spasticity and NP are important problems after SCI. RC are of clinical importance in the tetraplegics. Complications occur during all periods after injury. Many patients are otherwise healthy 25 years or more after SCI.

The Journal of Spinal Cord Medicine, 2011

American Journal of Physical Medicine & Rehabilitation, 1997

American Journal of Physical Medicine & Rehabilitation, 1996

Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat... more Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat. Subarachnoid lidocaine has been used in selected patients with some success. Mexiletine, an analog of lidocaine that acts at Na+/K+ channels in the peripheral nerve, has been found effective in persons with diabetic dysesthetic neuropathy. The effect of mexiletine in the treatment of spinal cord dysesthetic pain was examined in this study. Fifteen patients were enrolled, and 11 patients completed the prospective, randomized, placebo-controlled, double-blind, crossover design trial. Inclusion/exclusion criteria were carefully defined. A 1-wk washout period was followed by a 4-wk drug trial of either mexiletine (450 mg/day) or placebo. This was repeated for the second medication in the second arm of the study. Patients were followed weekly with McGill and visual analog pain scales. Baseline, midpoint, and endpoint Barthel function scores were recorded. The Wilcoxon's signed-rank test and paired t test were used for statistical analysis. Results showed no significant effect of mexiletine on SCI dysesthetic pain scales or Barthel index. In conclusion, in this trial, mexiletine did not appear to decrease spinal cord injury-related dysesthetic pain.

Archives of Physical Medicine and Rehabilitation, 1997

American Journal of Physical Medicine & Rehabilitation, 1995

Physical Medicine & Rehabilitation Secrets, 2008

Physical Medicine & Rehabilitation Secrets, 2008

Objective: To determine the feasibility and impact of an outpatient, electric stimulation cycling... more Objective: To determine the feasibility and impact of an outpatient, electric stimulation cycling (ESC) protocol on a patient with incomplete spinal cord injury (SCI). Design: Pre-post case study. Setting: Outpatient rehabilitation hospital. Participant: A 24-year old man with an incomplete SCI occurring 25 months before study entry at the T12-L1 level. Intervention: A 2-phase, 10-week ESC intervention occurring 3 days a week. Phase 1 provided 30-minute ESC sessions at increasing resistance with electric stimulation applied to the quadriceps and hamstrings; phase 2 required cycling independently (ie, without stimulation) at maximal effort for increasing lengths of time. Main Outcome Measures: Gait velocity, stride length, and step length, all collected during a 10-meter walking test, and the Walking Index of Spinal Cord InjuryϪII (WISCI-II). Results: During phase 1, the patient quickly increased workload, session duration, and distance; during phase 2, duration that the subject was able to cycle without stimulation increased markedly. After the entire intervention, the subject exhibited diminished edema, new ability to voluntarily step, new ability to voluntarily dorsiflex the ankle and voluntarily flex the toe, and new ability to perform valued activities, such as transfers. He also exhibited increased mean gait velocity (.33m/s), left (.11m) and right (.07m) stride length, left (.06m) and right (.05m) step length, and a 10-point WISCI-II increase. The subject was also able to discontinue use of several medications after intervention. Conclusions: SCI patients' endurance and gait deficits can possibly be effectively addressed on an outpatient basis and with minimal assistance by using this regimen.

The Journal of Spinal Cord Medicine, 2011

Little is known about those veterans with spinal cord injuries and disorders (SCI/D) who smoke ci... more Little is known about those veterans with spinal cord injuries and disorders (SCI/D) who smoke cigarettes. This study identified the factors associated with smoking in this population, motivations for smoking, and the readiness for smoking cessation. Current practices for the delivery of evidence-based tobacco cessation were also examined. Design: Methods included surveys of veterans with SCI/D, medical record reviews of current smokers, and telephone interviews with SCI/D providers. Setting: Six Veterans Health Administration facilities with SCI centers and one SCI clinic. Participants: Survey data were analyzed for 1210 veterans, 256 medical records were reviewed, and 15 providers served as key informants. Interventions: Observational study. Outcome measures: Veterans self-reported smoking status, quit attempts, methods and care received, motivation for smoking, and health care conditions. Medical record review and informant interviews examined the tobacco cessation care provided. Results: Whereas 22% of the respondents were current smokers; 51% were past smokers. Current smokers more often reported respiratory illnesses and/or symptoms, alcohol use, pain, and depression than past or never smokers, and approximately half made quit attempts in the past year. Smokers received referral to counseling (57%) and/or prescription for medication/nicotine replacement (23%). Key informants identified difficulty of providing follow-up and patients' unwillingness to consider quitting as barriers. Conclusion: Veterans with SCI/D who smoke also had other health problems. Providers offer counseling and medication, but often have difficulty following patients to arrange/provide support. Identifying other support methods such as telehealth, considering the use of combination cessation therapies, and addressing other health concerns (e.g. depression) may affect tobacco cessation in this population.