A historical study of appendicular fractures in veterans with traumatic chronic spinal cord injury: 2002-2007.

OBJECTIVE: Describe the incidence and distribution of appendicular fractures in a cohort of veterans with spinal cord injury (SCI). DESIGN: Retrospective, observational study of fractures in veterans with a chronic traumatic SCI. SETTING: The Veterans Health Administration (VA) healthcare system. PARTICIPANTS: Veterans included in the VA Spinal Cord Dysfunction Registry from Fiscal Years (FY) FY2002-FY2007. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Description of fractures by site and number. Mortality at one year following incident fracture among men with single vs. multiple fractures. RESULTS: Male and female veterans sustained incident fractures with similar observed frequency (10.5% vs 11.5%). The majority of fractures occurred in the lower extremities for both men and women. In men, a complete extent of injury (compared to incomplete) was associated with 41% greater relative risk (RR) of incident fracture (RR 1.41, 95% confidence interval [1.17, 1.70]) among those with tetraplegia, but not paraplegia. Furthermore, many men (33.9%, n = 434) sustained multiple fractures over the course of the study. There were no differences in mortality between men who sustained a single fracture and those who had multiple fractures. CONCLUSIONS: The extent of injury may be an important predictor of fracture risk for male veterans with tetraplegia. Once a fracture occurs, male veterans with SCI appear to be at high risk for additional fractures.

Life satisfaction and life values in people with spinal cord injury living in three Asian countries: a multicultural study.

OBJECTIVE: To compare the differences in life satisfaction and life values among people with spinal cord injury (SCI) living in three economically similar Asian countries: India, Vietnam, and Sri Lanka. DESIGN: Cross-sectional and comparative investigation using the unified questionnaire. SETTING: Indian Spinal Injuries Centre in New Delhi (India), Spinal Cord Rehabilitation Department of the Bach Mai Hospital in Hanoi (Vietnam), and Foundation for the Rehabilitation of the Disabled in Colombo (Sri Lanka). PARTICIPANTS: Two hundred and thirty-seven people with SCI using a wheelchair; 79 from India, 92 from Vietnam, and 66 from Sri Lanka. OUTCOME MEASURES: Life Satisfaction Questionnaire, Chinese Value Survey. RESULTS: People with SCI in Vietnam had significantly higher general life satisfaction than participants in India and Sri Lanka. Significant differences were identified in several demographic and life situation variables among the three Asian countries. With regard to "Traditional", "Universal", and "Personal" life values significant differences among three participating countries were identified in all domains. No significant relationships were identified between life satisfaction and life values for people with SCI in India, Vietnam, or Sri Lanka. CONCLUSION: It could be presumed that particular demographic and life situation variables are more powerful factors of life satisfaction following SCI than the dominant culture of a country expressed by life values.

Spinal cord injury medicine. 1. Epidemiology and classification.

UNLABELLED: This self-directed learning module reviews the demographics of traumatic and nontraumatic spinal cord injuries (SCIs). It is part of the study guide on SCI medicine in the Self-Directed Physiatric Educational Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the changing demographics of traumatic SCI, the classification of SCI, the common causes of nontraumatic SCI, and the incidence and prevalence of myelomeningocele. OVERALL ARTICLE OBJECTIVE: To summarize the demographics and classification of traumatic and nontraumatic spinal cord injuries in adults and children.

Spinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury.

UNLABELLED: This self-directed learning module highlights the basic acute care management of traumatic and nontraumatic spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Acute traumatic SCI is optimally managed in a level 1 trauma center. Decompression of the neural elements, stabilization of the spine, and maintenance of tissue perfusion are fundamental to optimizing outcomes. SCI patients are at high risk of pressure ulcers, venous thromboembolism, stress ulceration, bowel impaction, dysphagia, and pulmonary complications. Physiatric interventions are needed to prevent these complications. Prognostication of neurologic outcome based on early examination is an important skill to aid in creating a rehabilitation plan and to test for efficacy of early interventions. Nontraumatic SCI is an increasing population in rehabilitation centers. Establishing a diagnosis and treatment plan is essential, in conjunction with prevention of complications and early physiatric intervention. OVERALL ARTICLE OBJECTIVES: (a) To describe the diagnostic evaluation of traumatic and nontraumatic spinal cord injuries and (b) to summarize the medical, surgical, and physiatric interventions during acute hospitalization for these injuries.

Spinal cord injury medicine. 3. Rehabilitation phase after acute spinal cord injury.

UNLABELLED: This self-directed learning module highlights the rehabilitation aspects of care for people with traumatic spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the formulation of a rehabilitation plan based on functional goals by level of injury. Such a plan includes mobility, activities of daily living, equipment needs, and adjustment issues after injury. The effect of a concomitant brain injury on rehabilitation is discussed. Medical complications seen in the rehabilitation stage such as autonomic dysreflexia, heterotopic ossification, neurogenic bowel, and orthostasis are addressed. Preparation for discharge is crucial to allow for a smooth transition to home. There have been advances in SCI rehabilitation research including in wheelchair technology, functional electric stimulation, and partial body weight-supported ambulation. OVERALL ARTICLE OBJECTIVE: To describe outcomes and issues that may arise during the rehabilitation phase after spinal cord injury.

Spinal cord injury medicine. 4. Community reintegration after spinal cord injury.

UNLABELLED: This self-directed learning module highlights community reintegration after spinal cord injury (SCI). It is part of the study guide on spinal cord injury medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on physical, social, psychologic, and environmental barriers that affect people with SCI and on how these issues affect relations with others. Recreational and exercise options are also discussed. OVERALL ARTICLE OBJECTIVE: To summarize the barriers and opportunities of community reintegration for people with spinal cord injury.

Spinal cord injury medicine. 5. Long-term medical issues and health maintenance.

UNLABELLED: This self-directed learning module highlights long-term care issues in patients with spinal cord injury (SCI). It is part of the study guide on SCI in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The most common secondary medical complications include pressure ulcers, pneumonia, and genitourinary issues. Health care maintenance is important to prevent medical complications, for general health as well as for issues specific to SCI. Women with SCI have gender-specific issues regarding amenorrhea, sexuality, fertility, and menopause. Options exist to assist disabled men with sexuality and fertility complications. Pain is a common complication after SCI. Many new areas of research in the field of SCI are discussed. OVERALL ARTICLE OBJECTIVE: To discuss long-term care issues in patients with spinal cord injury, including health maintenance, secondary conditions, women's health, sexual function, pain, and spinal cord regeneration and recovery.

Spinal cord injury medicine. 6. Economic and societal issues in spinal cord injury.

UNLABELLED: This self-directed learning module presents a variety of social and economic issues facing people with spinal cord injury (SCI). It is part of the study guide on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the economic consequences of SCI, ethical issues in SCI, and the legislative efforts that have improved access and quality of life for people with disabilities. Costs of SCI include direct health care expenditures and lost earnings as a result of unemployment after SCI. Lifelong costs can be anticipated with the development of a comprehensive life care plan. Barriers to vocational reintegration continue to limit full participation for most people with SCI. Ethical issues central to SCI are related to the principles of autonomy and justice. As cure research becomes clinically applicable, the SCI community must work together to develop appropriate procedures to respect moral decision-making by all parties. Key legislation in the past century has resulted in important advances in the rights of people with disabilities. OVERALL ARTICLE OBJECTIVES: (a) To review the economic consequences of spinal cord injury, including lifelong direct costs, life care planning, and factors affecting employment and (b) to identify current ethical issues facing the spinal cord injury community and review the advances made in the rights of people with disabilities in the United States through legislation.

Analysis of sEMG during voluntary movement--Part II: Voluntary response index sensitivity.

In this paper, a method for analyzing surface electromyographic (sEMG) data recorded from the lower-limb muscles of incomplete spinal-cord injured (iSCI) subjects is evaluated. sEMG was recorded bilaterally from quadriceps, adductor, hamstring, tibialis anterior, and triceps surae muscles during voluntary ankle dorsiflexion performed in the supine position as part of a comprehensive motor control assessment protocol. Analysis of the sEMG centered on two features, the magnitude of activation and the degree of similarity [similarity index (SI)] of the sEMG distribution to that of healthy subjects performing the same maneuver (n = 10). The analysis calculations resulted in response vectors (RV) that were compared to healthy-subject-derived prototype response vectors resulting in a voluntary response index (VRI). Incomplete SCI subjects (n = 9) were used to test the sensitivity of this analysis method. They were given supported-weight treadmill ambulation training, which is expected to improve or at least not cause a deterioration of voluntary motor control. The VRI provided evidence that the quantitative sEMG analysis method used was able to differentiate between healthy subjects and those with iSCI, characterize individual differences among iSCI subjects, and track motor control changes occurring over time.

Predicting consistency of pain over a 10-year period in persons with spinal cord injury.

This longitudinal study was designed to test the hypothesis that persons who consistently report pain at three (women) or four (men) measurement points across 10 years (1988 to 1998) are different both physically and psychologically from those who inconsistently or never report pain. Participants were 96 persons with spinal cord injury (SCI) living in the community who participated at every measurement point. Measures included consistency of reports of pain (i.e., reported having had problems with pain in the 12 months prior to all, some, or no measurement points); demographic and injury-related data; and measures of physical and psychological health, function, and social support. Of the 96 participants, approximately half of the men and three-fourths of the women consistently reported pain at each point. Phase 1 predictors of the consistency of pain reports for men were being less impaired, being more independent, experiencing more stress, and receiving less social support. Women consistently reporting pain had more stress at Phase 1 than women inconsistently reporting pain. Persons with SCI at risk for chronic pain should be identified and referred to a multidisciplinary pain management program.

Interface pressure characteristics of alternating air cell mattresses in persons with spinal cord injury.

OBJECTIVES: To examine interface pressure characteristics for two alternating air cell mattresses used for pressure ulcer prevention and treatment in a spinal cord injury population. DESIGN: Prospective evaluation of Dynamic Flotation System (DFS) mattress and the Pegasus Airwave Mattress. Subjects acted as their own controls. SETTING: Veterans Affairs Medical Center Spinal Cord Injury Unit. PARTICIPANTS: Convenience sample of 15 subjects with spinal cord injuries. INTERVENTIONS: Minimum, maximum, and average interface pressures, and interface pressure range were measured by use of a force-sensing array system. The sacrum was chosen as the area of interest. Recordings lasted 9.5-10 minutes. Analyses were performed on 19 subjects in the supine and 45-degree upright positions for both mattresses. RESULTS: Maximum and average interface pressures and interface pressure ranges were significantly higher, whereas minimum interface pressures were significantly lower on the Pegasus vs the DFS. For either mattress, the 45-degree position resulted in significantly greater interface pressures. There was no consistent correlation found between interface pressures and body mass index. CONCLUSIONS: Interface pressure characteristics of these two mattresses are very different, and neither mattress retains performance in the 45-degree position. Which interface pressure characteristic is most clinically relevant remains undetermined. Avoidance of the 45-degree sitting position is recommended.

Stroke during pregnancy.

Stroke during pregnancy poses a challenge to the rehabilitation team. A 10-year review of one hospital's records revealed five pregnancies complicated by stroke. The mean age was 29 years (range, 21 to 35 years). Cerebrovascular accidents associated with pregnancy may be due to many causes, with intracranial hemorrhage due to arteriovenous malformation or aneurysm, arterial occlusion due to thrombosis or embolus, venous thrombosis, and vasculitis representing the more common etiologies. Three of the strokes in this study were due to intracranial hemorrhage, and two were due to thrombosis secondary to CNS vasculitis. Two case studies and a review of the literature are presented. Stroke during pregnancy represents a high-risk obstetrical situation that may complicate the rehabilitation process.

Functional assessment in a community setting.

Functional assessment for persons with disabilities has been an important component of the traditional inpatient rehabilitation process. Recently there has been increasing interest in functional assessment for persons residing in the community as a means to understanding the role of rehabilitation in community integration and the effects of aging on persons with disabilities. The instruments used for in-hospital functional assessment (e.g., the Functional Independence Measure and the Barthel Index) measure aspects of disability, specifically basic self-care and mobility skills, and may not be adequate for community assessment. Most often the functional activities that are of interest for persons I iving in the community include instrumental activities of daily living such as housekeeping and shopping; components of handicap such as social integration, community mobility, and productive use of time; and community participation. Instruments used to measure components of handicap (i.e., the Craig Handicap Assessment and Reporting Technique) and community participation (i.e., the Self-Observation and Report Technique) may be more appropriate for the evaluation of functional status for persons living in the community.