Fatigue in persons with subacute spinal cord injury who are dependent on a manual wheelchair.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To determine the prevalence and severity of fatigue in persons with subacute spinal cord injury (SCI), assess whether demographic and lesion characteristics are related to fatigue and determine the relationship with physical fitness and physical behavior. SETTING: Measurements were performed 2 months before discharge from inpatient rehabilitation. METHODS: Thirty-six persons with subacute SCI, dependent on a manual wheelchair, mean age 43±15 and 83% men, completed the Fatigue Severity Scale (FSS). FSS scores >4 indicated fatigue. We recorded age and lesion characteristics, measured body mass index, measured peak power output and peak oxygen uptake during a maximal handcycling test and determined physical behavior using an accelerometer-based activity monitor. T-tests were used to test for differences in fatigue between subgroups based on age and lesion characteristics, and regression analyses to assess the relationship with physical fitness and physical behavior. RESULTS: Mean FSS was 3.3±1.3. Fatigue, including severe fatigue, was prevalent in 31% (95% confidence interval: 16-46) of participants compared with 18% in the general population. Furthermore, mean fatigue was significantly higher in persons with incomplete compared with complete lesions (t=2.22, P=0.03). Mean scores between other subgroups did not differ significantly. Of the physical fitness and physical behavior measures, only peak oxygen uptake tended to be related to more fatigue (B=-1.47, P=0.05). CONCLUSION: Fatigue was prevalent and is of concern in persons with subacute SCI. Those with incomplete lesions seem to be at higher risk. Because fatigue is known to persist among persons with SCI, interventions to reduce fatigue seem necessary.

Long-term patient satisfaction after reconstructive upper extremity surgery to improve arm-hand function in tetraplegia.

STUDY DESIGN: There is a paucity of literature about satisfaction after reconstructive surgery to improve upper limb function in persons with tetraplegia. The present literature describes mainly functional outcomes. OBJECTIVES: To evaluate long-term satisfaction after reconstructive upper extremity surgery in persons with tetraplegia. SETTING: Two rehabilitation centers in the Netherlands. METHOD: A three-part questionnaire consisting questions regarding satisfaction, activities, occupation, changes in functional ability and willingness to undergo the surgeries again was used. Internal reliability of the questionnaire was verified by factor analysis and calculation of Cronbach's alpha. RESULTS: In total, 39 out of 55 persons (70.9%) participated in the study. The participants' responses to questions about satisfaction, activities and occupation were positive in 73.5, 67.6 and 35.0%, respectively. Nearly 81% improved their functional ability. Approximately 65% of the participants were willing to undergo elbow extension surgery again and 77.1% expressed their willingness to undergo hand/wrist surgery again. Significant positive correlation was found between willingness to have surgery again and improvement in activities and occupation: Spearman's correlation coefficients: activities-elbow extension 0.63 (P=0.003), activities-hand/wrist 0.57 (P<0.001), occupation-elbow extension 0.53 (P=0.025), occupation-hand/wrist 0.57 (P=0.001). Differences between the subgroups who would have surgery again and those who would refrain were also significant; one-way analysis of variance for activities (F=9.54, P<0.01) and for occupation (F=6.60, P<0.02). CONCLUSION: In the Netherlands, the majority of persons with tetraplegia who underwent reconstructive upper extremity surgery were satisfied with the results. This was related to improvement in activities and occupation.

Is manual wheelchair satisfaction related to active lifestyle and participation in people with a spinal cord injury?

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To describe the satisfaction of the manual wheelchair user with hand rim wheelchair-related aspects (for example, dimensions, weight and comfort) and wheelchair service-related aspects and to determine the relationship between wheelchair users' satisfaction, personal and lesion characteristics, and active lifestyle and participation in persons with a spinal cord injury (SCI). SETTING: Eight Dutch rehabilitation centers with a specialized SCI unit. METHODS: The Dutch version of the Quebec user evaluation of satisfaction with assistive technology (D-QUEST) was filled out by 109 participants 1 year after discharge from inpatient SCI rehabilitation. Relationships between the D-QUEST scores and personal and lesion characteristics, and active lifestyle and participation (physical activity scale for individuals with physical disabilities (PASIPD), Utrecht activity list (UAL), mobility range and social behavior subscales of the SIP68 (SIPSOC)) were determined. RESULTS: A high level of satisfaction was found with wheelchair-related aspects. The participants were less satisfied with the service-related aspects. Participants with an incomplete lesion were slightly more satisfied regarding both aspects than those with a complete lesion. A higher satisfaction regarding wheelchair dimensions and a higher overall satisfaction were related to a more active lifestyle. Persons who were more satisfied with the simplicity of use of the wheelchair had a better participation score. CONCLUSION: Dutch persons with SCI are in general quite satisfied with their hand rim wheelchair. Some aspects of the wheelchair (dimensions and simplicity of use) are important to optimize as these are related to an active lifestyle and participation.

Assessment of upper extremity muscle function in persons with tetraplegia.

The objective was to investigate the actual level of muscle function impairment in tetraplegic persons and, inextricably related to this, the possibilities to compensate function loss using new muscle coalitions. In this cross-sectional group study, 20 persons with a cervical spinal cord injury (SCI) at segmental levels C5C6 or C7C8 and 10 control persons participated. Activity from 21 upper extremity and trunk muscles was recorded during standardised gross upper extremity task performance. No substantial differences in main activation patterns were found between C7C8 and control subjects. In contrast, main activation patterns in C5C6 persons showed an absence of selectivity, which may be explained by the participants activating every controllable muscle in an attempt to perform maximally. In order to identify more intricate differences in muscle activation between control and C7C8 persons a fine motor function task may be necessary. Muscle activation patterns during arm task performance were stable in all three groups.