The authors of the new article in Journal of Clinical Medicine are Peter H. Gorman, MD, of the University of Maryland School of Medicine, Gail F. Forrest, PhD, of Kessler Foundation’s Tim and Caroline Reynolds Center for Spinal Stimulation, Dr. William Scott, of VA Maryland Healthcare System, Pierre K. Asselin, MS, Stephen Kornfeld, MD, Eunkyoung Hong, PhD, and Ann M. Spungen, EdD, of the James J. Peters VA Medical Center.

Bowel dysfunction, a common experience after spinal cord injury, can lead to chronic constipation and incontinence, causing discomfort and frustration. In one survey, more than a third of men with spinal cord injury reported that bowel and bladder dysfunction had the most significant effect on their lives post-injury. Unfortunately, these issues are not easily managed.

Rehabilitation professionals have traditionally managed bowel dysfunction using approaches that target the gastrointestinal system or require manual intervention, but some newer research suggests that physical activity and upright posture may enhance bowel motility. However, few studies have explored the possibility that exoskeletal-assisted walking — in which a person with spinal cord injury wears a robotic suit, enabling them to stand and walk — may be an effective addition to existing intervention plans.

In this study, the research team investigated whether exoskeletal-assisted walking improved bowel function in people with chronic spinal cord injury. They performed a three-center, randomized, controlled, crossover clinical trial in which 50 participants completed 36 sessions of exoskeletal-assisted walking. The researchers evaluated bowel function as a secondary outcome in 49 participants. Bowel function was measured via a 10-question bowel function survey, the Bristol Stool Form Scale, and the Spinal Cord Injury Quality of Life Bowel Management Difficulties instrument.

Results showed that the exoskeletal-assisted walking program provided some improvement in bowel function when compared to a control group. “We saw a notable reduction in bowel evacuation time, with 24 percent of participants reporting an improved experience,” said Dr. Forrest, co-author and associate director of the Center for Mobility and Rehabilitation Engineering Research at Kessler Foundation. “We also noted that participants’ stools trended toward better consistency, supporting our hypothesis that this intervention may improve several measures of bowel function.”

“Our results support the idea that walking, and not just standing, may have a beneficial effect on bowel function,” said Dr. Gorman, co-author and chief of the Division of Rehabilitation Medicine at the University of Maryland Rehabilitation and Orthopaedic Institute. “Our goal is to improve the quality of life of those with chronic spinal cord injury, and these encouraging results will help inform future studies on the emerging field of mobility intervention.”

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The threat posed by the Noble False Widow spider has been debated among spider and healthcare specialists for many years. This new study, published in the international medical journal Clinical Toxicology, confirms that some bite victims experience symptoms very similar to the true black widow spiders and some severe cases require hospitalisation.

Originating from Madeira and the Canary Islands, the Noble False Widow spider Steatoda nobilis, now has the potential to become one of the world’s most invasive species of spider. It was first documented in Britain over 140 years ago, but in recent decades the species has suddenly increased in numbers, significantly expanding its range and density.

The reasons behind this sudden expansion are not clear. Scientists have ruled out climate change as the likely cause but have suggested that a new genetic mutation within the species may have made Noble False Widows more adaptable to new environments. In addition, the species has benefited from an ever-increasing globalised economy, hitchhiking in containers and crates throughout the globe. Human movement has largely contributed to spread this species throughout Europe, North Africa, West Asia and parts of North and South America.

In parts of Ireland and Britain, it has become one of the most common species of spiders found in and around urban habitats. With the increase in False Widow spiders around homes, bites are becoming more prevalent, and scientists are now beginning to realise the full medical importance of these spiders.

Envenomation symptoms can be both localised and systemic, ranging from mild to debilitating pain and mild to intense swelling. Some victims have experienced tremors, reduced or elevated blood pressure, nausea and impaired mobility. In rare instances, victims have developed minor wounds at the bite site or had to be treated for severe bacterial infections.

The research team at NUI Galway have established a DNA database to allow clinicians dealing with cases to confirm the species identity using genetic analysis. This is especially important when the spider has been squashed so an accurate identification of the spider can be made. The study also provides epidemiology of bites which reveals that almost all bites occurred in and around the home, and 88% of bites occurred when the victim was either asleep in bed or when the spider was trapped in clothing. The team are encouraging members of the public to email them at falsewidow@nuigalway.ie if they think they may have been bitten.

Dr Michel Dugon, Head of the Venom Systems Lab at NUI Galway and senior author of the study, said: “In addition to their medically significant venom, Noble False Widows are extremely adaptable and competitive in the wild. Two decades ago, this species was almost unknown in Ireland, the UK or in continental Europe. We still have much to learn about its genetics, origin, behaviour and development. One thing is certain though: this species is here to stay, and we must learn how to live with it.”

Dr John Dunbar, Postdoctoral Researcher at the Venom Systems Lab at NUI Galway and lead author of the study, said: “Speculations around the potential severity of the bites by the Noble False Widow have been debated for many years. We only compiled envenomation cases where we had a clear identification of the spider responsible for the bite. We had to rely on DNA extraction and genetic profiling to confirm some cases. We are encouraging people to capture a photograph of the spider immediately after being bitten. Our latest study confirms without a doubt that Noble False Widows can cause severe envenomations (the process by which venom is injected).

“This species is increasing its range and population density which will undoubtedly lead to an increase in bites (since submitting our study in March we have already received further confirmed bite cases). While most cases will have a mild outcome, we need to continue to closely monitor bites by the Noble False Widow to understand the potential range of symptoms and to treat severe cases when they occur.”

Aiste Vitkauskaite, MSc student in Toxicology at NUI Galway and joint lead in the study, said: “Approximately ten species of Irish spiders have fangs large enough to bite through human skin, yet over the past five years, we have never heard of anybody being bitten by any of the native species. Within the same period, we have recorded dozens of confirmed or probable False Widow bites. These spiders will become increasingly common and so will their bites.”

Professor Derek O’Keeffe, Professor of Medical Device Technology at NUI Galway and Consultant Physician, University Hospital Galway said: “This innovative research led by Dr Dugon and his team clearly demonstrates that Noble False Widow spider bites may result in significant patient morbidity that requires hospital care. This is important as previously we only had anecdotal evidence of its potential harms in victims and therefore this new evidence will allow the updating of clinical guidelines and protocols. These findings demonstrates the key importance of interdisciplinary collaboration between scientists and clinicians to improve patient care.”