Nontraumatic spinal cord injury: incidence, epidemiology, and functional outcome.

OBJECTIVES: To identify and compare the incidence, demographics, neurologic presentation, and functional outcome of individuals with nontraumatic spinal cord injury (SCI) to individuals with traumatic SCI. DESIGN: A 5-year prospective study. SETTING: Level I trauma center of a Regional SCI Model System. PATIENTS: Two hundred twenty adult SCI admissions. MAIN OUTCOME MEASURES: Demographics, etiology, level and completeness of injury, Functional Independent Measure (FIM) scores. RESULTS: Of SCI admissions, 39% were nontraumatic in etiology (spinal stenosis, 54%; tumor, 26%). Compared to subjects with traumatic SCI, those individuals with nontraumatic SCI were significantly (p < .01) older and were more likely married, female, and retired. Injury characteristics revealed significantly more paraplegia and incomplete SCI within the nontraumatic SCI group (p < .01). Both nontraumatic and traumatic SCI individuals had significant FIM changes from rehabilitation admission to discharge (p < .01). Those with tetraplegia-incomplete nontraumatic SCI had significantly higher admission motor FIM scores and shorter rehabilitation length of stay than in the traumatic group (p < .05). Paraplegic-complete and paraplegic-incomplete nontraumatic SCI subjects had lower discharge motor FIM scores, FIM change, and FIM efficiency than those with traumatic SCI. Similar discharge-to-home rates were noted in both nontraumatic and traumatic SCI groups. CONCLUSIONS: These data suggest that individuals with nontraumatic SCI represent a significant proportion of SCI rehabilitation admissions and, although differing from those with traumatic SCI in demographic and injury patterns, can achieve similar functional outcomes.     

A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: implications for treatment matching

OBJECTIVE: To describe empirically valid and clinically meaningful types of alcohol use among persons with recent traumatic brain or spinal cord injury. DESIGN: Cross-sectional cohort survey. SETTING: Acute inpatient rehabilitation program in a level I trauma center. PARTICIPANTS: A total of 218 (87%) of 250 consecutive initial admissions who met inclusion criteria and completed interviews. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Alcohol and drug use questionnaires, alcohol problem questions, admission toxicology results, readiness to change, and treatment preference questions. RESULTS: Participants were on average 37 years old, 84% were men, and 82% were white. Four types were identified by using k-means cluster analysis based on preinjury alcohol consumption, alcohol problems, and alcohol dependence. Cluster groups differed on extrinsic variables such as drug use, readiness to change, and interest in treatment or in attending Alcoholics Anonymous. The 4 types corresponded to those with a history of (1) alcohol abuse; (2) alcohol dependence; (3) alcohol dependence in remission, partial remission, or relapsed; and (4) normal or nondrinkers. CONCLUSION: More effective care may be possible if clinicians match common patient types to specific interventions such as education, motivational interventions, formal substance abuse treatment, and relapse prevention.     

Neoplastic versus traumatic spinal cord injury: an outcome comparison after inpatient rehabilitation.

OBJECTIVE: To compare outcomes of patients with neoplastic spinal cord compression (SCC) to outcomes of patients with traumatic spinal cord injury (SCI) after inpatient rehabilitation. DESIGN: A comparison between patients with a diagnosis of neoplastic SCC admitted to an SCI rehabilitation unit and patients with a diagnosis of traumatic SCI admitted to the regional Model Spinal Cord Injury Centers over a 5-year period, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. SETTING: Tertiary university medical centers. PATIENTS: Twenty-nine patients with neoplastic SCC and 29 patients with SCI of traumatic etiology who met standard rehabilitation admission criteria. MAIN OUTCOME MEASURES: Acute and rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, and discharge rates to home. RESULTS: Patients with neoplastic SCC had a significantly (p < .01) shorter rehabilitation LOS than those with traumatic SCI (25.17 vs 57.46 days). No statistical significance was found in acute care LOS. Motor FIM scores on admission were higher in the neoplastic group, but discharge FIM scores and FIM change were significantly lower. Both groups had similar FIM efficiencies and community discharges. CONCLUSIONS: Patients with neoplastic SCC can achieve rates of functional gain comparable to those of their counterparts with traumatic SCI. While patients with traumatic SCI achieve greater functional improvement, patients with neoplastic SCC have a shorter rehabilitation LOS and can achieve comparable success with discharge to the community.     

Neoplastic vs. traumatic spinal cord injury: an inpatient rehabilitation comparison

OBJECTIVE: To compare demographics, injury characteristics, and functional outcomes of patients with neoplastic spinal cord compression with those with traumatic spinal cord injuries. DESIGN: A prospective 5-yr comparison was undertaken comparing 34 patients with neoplastic spinal cord compression with 159 patients with traumatic spinal cord injury. RESULTS: Patients with neoplastic spinal cord compression were significantly older, more often female, and unemployed than patients with traumatic spinal cord injury. Neoplastic spinal cord compression presented more often with paraplegia involving the thoracic spine, and injuries were more often incomplete compared with traumatic spinal cord injury. Patients with neoplastic spinal cord compression had a significantly shorter rehabilitation length of stay compared with those with traumatic spinal cord injury. The neoplastic group had significantly lower FIM change scores. Both groups had similar FIM efficiencies and discharge to home rates. CONCLUSIONS: Patients with neoplastic spinal cord compression have different demographic and injury characteristics but can achieve comparable rates of functional gains as their traumatic spinal cord injury counterparts. Although patients with traumatic injuries achieve greater functional improvement, patients with neoplasms have a shorter rehabilitation length of stay and comparable FIM efficiencies and home discharge rates.     

The magnitude and correlates of alcohol and drug use before traumatic brain injury

OBJECTIVE: To describe preinjury alcohol and drug use and opportunities for secondary prevention among persons with recent traumatic brain injury (TBI). DESIGN: Survey. SETTING: Acute inpatient rehabilitation program. PARTICIPANTS: A total of 142 (91%) of 156 consecutive admissions who met inclusion criteria and were screened. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Alcohol and drug use questionnaires, alcohol problem questions, toxicology results, readiness to change, and treatment preference questions. RESULTS: Subjects were on average 37 years old, 80% were men, and 80% were white. Fifty-nine percent of the sample was considered "at-risk" drinkers and, as a group, subjects reported a high degree of preinjury alcohol-related problems. Thirty-four percent reported recent illicit drug use, and 42 (37%) of 114 cases with toxicology results were positive for illicit drugs. Motivation to change alcohol use correlated positively with greater self-reported alcohol consumption and problem severity. Most at-risk drinkers wanted to change on their own, whereas a minority were interested in treatment or Alcoholics Anonymous. CONCLUSION: Both alcohol abuse and drug use are common before TBI. Inpatient brain injury rehabilitation represents an important opportunity to identify and intervene in substance abuse problems.     

Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation

Yokoyama O, Sakuma F, Itoh R, Sashika H. Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation.

Objective

To compare outcomes, complications, and therapy intensity of inpatient rehabilitation in patients with paraplegia caused by spinal cord injury associated with aortic aneurysm repair (SCI-AA) versus patients with traumatic spinal cord injury (SCI).

Design

Case-controlled study.

Setting

SCI unit in a rehabilitation center.

Participants

Seventeen patients with SCI-AA and 17 patients with traumatic SCI.

Intervention

Standard rehabilitation therapy for SCI.

Main Outcome Measures

Length of stay (LOS) in acute and rehabilitation hospitals; FIM instrument scores; FIM change; FIM efficiency; complications; therapy intensity; and ambulatory state and return to community at discharge.

Results

No significant differences were noted in acute and rehabilitation LOS and admission FIM scores. Discharge FIM scores, FIM change, and FIM efficiencies were significantly lower in the SCI-AA group, which had many complications related to AA and SCI. Intensity of rehabilitation sports therapy in the SCI-AA group was significantly lower than that of the traumatic SCI group, but total therapy intensity did not differ significantly. Both had similar rates of return to ambulatory state and discharge to the community.

Conclusions

SCI-AA patients had many complications that interfered with rehabilitation therapy, and could not achieve functional gains comparable to those with traumatic SCI. However, both groups achieved comparable success with return to ambulatory state and discharge to the community.     

Geriatric trauma in the State of Illinois: substance use and injury patterns.

As the elderly population increases and they lead more active and healthy lifestyles, their exposure to the threats of injury multiply. Undoubtedly, the geriatric population will comprise a growing percentage of trauma patients. The role of alcohol and drug use in geriatric trauma has not been clearly defined. The purpose of this study is to determine the incidence of alcohol and illicit drug use in association with mechanism of injury in all elderly trauma patients presenting to level I and II trauma centers in the State of Illinois over 3 years. A retrospective analysis was performed on 3 years of data (January 1, 1994 to December 31, 1996), provided by the Illinois Department of Public Health as the Illinois Trauma Registry, which describes consecutive trauma patients presenting to level I and II trauma facilities in the State of Illinois. During the study period, there were a total of 134,846 trauma patient entries. Of these 32,382 (24.0%) were for patients 65 years of age or older. In those patients 65 and older, 1699 (5.2%) were tested for the presence of alcohol and 845 (49.7%) tested positive. Of the elderly patients who tested positive for alcohol, 71.8% were considered intoxicated (BAC >80 mg/dL). Urine toxicology screens were performed on 1785 (5.5%) elderly trauma patients, and 208 (11.6%) were positive. Besides alcohol, benzodiazipines and opiates were the most frequently detected drugs. For elderly patients under the influence of alcohol falls (49.5%) and motor vehicle crashes (36.7%) were the most common mechanism of injury. For geriatric patients testing negative for alcohol, motor vehicle crashes were a much more common mechanism of injury than falls (65.0% v 25.1%). Falls were a much more common cause of injury in elderly patients using alcohol than in those not using alcohol. Alcohol and substance abuse are possibly significant factors in geriatric trauma. Although only 5% of elderly trauma patients were tested for alcohol, nearly half had alcohol present on presentation to a trauma center, and the majority of these patients were intoxicated. Prospective studies are needed to determine the true incidence of alcohol use/abuse in the geriatric trauma population and the need for routine alcohol screening of these patients. Detection of alcohol abuse in elderly trauma patients could help identify individuals in need of counseling and rehabilitative treatment. It may also reduce future injuries in these patients.     

The effect of cocaine and amphetamines on vital signs in trauma patients

The object of this study was to determine if the presence of sympathomimetics (cocaine, benzoylecgonine, or amphetamine), detected by routine urine toxicology screen, affect the initial presenting pulse, blood pressure, respiratory rate, or level of consciousness in trauma patients. A retrospective chart review was performed on 1,679 patients enrolled in an urban level 1 trauma registry between October 1987, and July 1992, for whom complete toxicology data were available. There were no clinically significant differences in the vital signs of patients with positive toxicology screens and those with negative screens. There was a statistically significant increase in prehospital respiratory rate among patients with benzoylecgonine or amphetamines on admission toxicology screens when potential confounding factors were controlled. However, these effects disappeared upon arrival at the hospital. The detection of sympathomimetics by toxicology screening had no effect on pulse and systolic blood pressure when age, sex, mechanism, type, and severity of injury, prehospital IV fluid volume, and alcohol intoxication were controlled.     

Rehabilitation outcomes after infection-related spinal cord disease: a retrospective analysis

OBJECTIVES: To compare injury characteristics, demographics, and functional outcomes of patients with infection-related spinal cord disease (IR-SCD) vs. those with traumatic spinal cord injury (SCI). DESIGN: A 10-yr retrospective review of 34 consecutive patients with IR-SCD admitted to an SCI rehabilitation unit at a Level 1 tertiary university medical center. Outcome measures included length of stay (LOS), FIM motor scores, and home discharge rates. RESULTS: The cause of IR-SCD was most often spinal epidural abscess secondary to Staphylococcus aureus (74%). Weakness (90%) and neck/back pain (84%) were the most frequent initial admitting symptoms. Identifiable risk factors included history of recent infection (42%), diabetes mellitus (32%), and intravenous drug abuse (26%). SCD-related complications most commonly included pain (81%), urinary tract infection (52%), and spasticity (45%). When compared with traumatic SCI (n = 560), patients with IR-SCD comprised significantly less of the SCI/D rehabilitation admissions (3% vs. 61%), were older (53 vs. 40 yrs), and more often female (35% vs. 16%). Injuries were more commonly located in the thoracic region (48% vs. 38%). Patients with IR-SCD more often had incomplete injuries (94% vs. 57%). Thirty-two percent of IR-SCD patients had improvements in AIS impairment scale classification. LOS was longer on acute care (25 vs. 16 days), but similar on rehabilitation (36 vs. 34 days), and with lower FIM motor changes (16.2 vs. 22.8) during rehabilitation. Patients with IR-SCD were less often discharged to home (56% vs. 75%). CONCLUSIONS: Patients with infection-related SCD comprise a significant subset of SCI/D rehabilitation admissions and have differing demographic and injury characteristics compared with traumatic SCI. Despite less-severe injury characteristics and similar rehabilitation LOS, they achieve lower functional improvements and are less often discharged home, underscoring the importance of patient/family education and discharge planning.     

Nontraumatic vs. traumatic spinal cord injury: a rehabilitation outcome comparison

OBJECTIVE: Nontraumatic spinal cord injury (SCI) represents a significant proportion of individuals admitted for SCI rehabilitation; however, there is limited literature regarding their outcomes. As our society continues to age and nontraumatic injuries present with greater frequency, further studies in this area will become increasingly relevant. The objective of this study was to compare outcomes of patients with nontraumatic SCI with those with traumatic SCI after inpatient rehabilitation. DESIGN: A longitudinal study with matched block design was used comparing 86 patients with nontraumatic SCI admitted to a SCI rehabilitation unit and 86 patients with traumatic SCI admitted to regional model SCI centers, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. Main outcome measures included acute and rehabilitation hospital length of stay, FIM scores, FIM change, FIM efficiency, rehabilitation charges, and discharge-to-home rates. RESULTS: Results indicate that when compared with traumatic SCI, patients with nontraumatic SCI had a significantly (P < 0.01) shorter rehabilitation length of stay (22.38 vs. 41.35 days) and lower discharge FIM scores (57.3 vs. 65.6), FIM change (18.6 vs. 31.0), and rehabilitation charges ($25,050 vs. $64,570). No statistical differences were found in acute care length of stay, admission FIM scores, FIM efficiency, and community discharge rates. CONCLUSIONS: The findings indicate that patients with nontraumatic SCI can achieve rates of functional gains and community discharge comparable with traumatic SCI. Whereas patients with traumatic SCI achieved greater overall functional improvement, patients with nontraumatic SCI had shorter rehabilitation length of stay and lower rehabilitation charges. These findings have important implications for the interdisciplinary rehabilitation process in the overall management and outcome of individuals with nontraumatic SCI.     

FIM量表在外伤性颅脑损伤患者康复疗效评价中的应用

目的 :运用功能独立性评价量表 (FIM )评价外伤性颅脑损伤 (TBI)患者的康复治疗疗效 ,比较闭合性颅脑损伤 (CBI)和开放性颅脑损伤 (OBI)患者的临床特点和康复治疗的效果。方法 :79例TBI患者中 ,5 7例为CBI、2 2例为OBI。运用FIM量表评价两组患者康复治疗前后的功能情况 ,统计患者的入院天数 ,计算FIM效率。结果 :CBI和OBI患者入院时的FIM总评分分别为 81.5 1和 73.0 9;出院时FIM总评分分别为 115 .0 4和 117.77,两组平均增加 4 1%和 5 3%。两组患者康复治疗前后FIM各项评分自身相比有非常显著差异 (P <0 .0 0 1) ,但两组之间相比无显著差异。两组患者的FIM效率分别为 1.99分 /天和 1.71分 /天。结论 :康复治疗可有效改善TBI(无论是CBI还是OBI)患者的功能情况。康复治疗应强调早期和综合性治疗     

Relationships among premorbid alcohol use, acute intoxication, and early functional status after traumatic brain injury

Vickery CD, Sherer M, Nick TG, Nakase-Richardson R, Corrigan JD, Hammond F, Macciocchi S, Ripley DL, Sander A. Relationships among premorbid alcohol use, acute intoxication, and early functional status after traumatic brain injury.

Objective

To investigate the relationships among intoxication at time of injury, preinjury history of problem drinking, and early functional status in patients with traumatic brain injury (TBI).

Design

Prospective cohort study.

Setting

Acute inpatient TBI rehabilitation.

Participants

Participants were 1748 persons with TBI.

Interventions

Not applicable.

Main Outcome Measures

Blood alcohol levels (BALs) were obtained at admission to the emergency department, and a history of problem drinking was obtained through interview. Study outcomes, Disability Rating Scale (DRS), and FIM instrument scores were gathered at admission to inpatient rehabilitation.

Results

Multivariate regression analysis revealed that BAL and a history of binge drinking were predictive of DRS, but not FIM, scores. A higher BAL was associated with poorer functional status on the DRS. Paradoxically, a history of binge drinking was associated with more intact functional status on the DRS.

Conclusions

The relationships among intoxication at time of injury, history of problem drinking, and early outcome after TBI were modest. Injury severity had a more significant association with TBI functional status.     

Clinical trial of acupuncture for patients with spinal cord injuries

OBJECTIVE: To examine whether electrical acupuncture therapy through adhesive surface electrodes and concomitant auricular acupuncture therapy could improve the neurologic or functional recovery in acute traumatic spinal cord injury patients. DESIGN: A total of 100 acute traumatic spinal cord injury patients with American Spinal Injury Association (ASIA) impairment grading of A and B were recruited into this study. They were randomly divided into the acupuncture and control groups. In the acupuncture group, electrical acupuncture therapy via the adhesive surface electrodes were applied to the bilateral Hou Hsi (SI3) and Shen Mo (B62) acupoints. In auricular acupuncture, four acupoints related to the spinal cord were selected for stimulation at the antihelix, helix, and lower portion of the ear-back areas. Acupuncture therapy was initiated early in the emergency room setting or soon after spinal surgical intervention. Rehabilitation therapy was also provided to the patients during acupuncture therapy. In the control group, only rehabilitation therapy was provided to the patients. Neurologic and functional scores were assessed during the time of admission, hospital discharge, and 1-yr postinjury follow-up. RESULTS: There were significant improvements in neurologic (sensory and motor), functional, and FIM scores in the acupuncture group compared with the initial admission period when assessed during the time of hospital discharge and the 1-yr postinjury follow-up. A greater percentage of patients in the acupuncture group recovered to a higher ASIA impairment grading. CONCLUSION: The use of concomitant auricular and electrical acupuncture therapies, when implemented early in acute spinal cord injury, can contribute to significant neurologic and functional recoveries.     

高压氧治疗及针对性护理在外伤性脊髓损伤中的应用效果

目的探讨高压氧(HBO)治疗及针对性护理在外伤性脊髓损伤中的应用效果。方法选取56例外伤性脊髓损伤患者作为研究对象,根据随机数字表法将其分为对照组和观察组,各28例。两组均采取高压氧治疗,对照组给予常规护理,观察组在对照组基础上给予针对性护理。比较两组的治疗效果。结果观察组的治疗总有效率显著高于对照组(P<0.05)。治疗及护理后,两组的感觉功能、运动功能、FIM评分均升高,且观察组高于对照组(P<0.05)。治疗及护理后,两组的躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐惧、偏执及精神病性评分均下降,且观察组低于对照组(P<0.05)。结论 HBO治疗及针对性护理能够有效促进外伤性脊髓损伤患者脊髓功能的恢复,提高患者生活功能独立性,并改善其心理状态,具有显著的临床应用价值。     

Relation of disability costs to function: spinal cord injury

OBJECTIVE: This study evaluated the validity of the Functional Independence Measure (FIM instrument) in predicting (1) the number of minutes of daily assistance provided, (2) the cost of durable goods currently used, and (3) the number of paid helper hours provided daily to persons with spinal cord injury living in the community. DESIGN: A cross-sectional study. SUBJECTS: One hundred nine persons with spinal cord injury who were a median 6 years postdischarge from initial medical rehabilitation. RESULTS: A significant inverse linear relationship was observed between FIM scores and the square root values of the three cost-related measures. The FIM-18 and the FIM motor scores were the best single predictors of the square root of minutes of assistance (paid and/or unpaid) per day, explaining 85% of variance. The FIM motor measure was the best single predictor of square root of cost of durable goods, explaining 29% of variance. The Self-Care, FIM motor, and FIM-18 scores equally predicted square root of hours of paid help per day, explaining 58% of variance. CONCLUSION: The findings indicate FIM-related scores predict the amount of assistance needed and certain costs for persons with spinal cord injury disability.     

Functional improvement after pediatric spinal cord injury

OBJECTIVE: To describe the functional gain (FGain) with pediatric spinal cord injury inpatient rehabilitation and to identify the relationship of various factors to FGain in pediatric spinal cord injury inpatient rehabilitation. DESIGN: Retrospective chart review of a series of 91 children with spinal cord injury admitted from 1993 to 1998 in a freestanding rehabilitation hospital. Admission and discharge functional status were assessed with the Pediatric Functional Independence Measure (WeeFIM) instrument for children 7 yr. The outcome measure is the FGain (difference between the discharge and admission functional status). RESULTS: Significant gains in functional status were observed in all patients. FGain was not significantly related to age, sex, length of inpatient rehabilitation, pathogenesis, or completeness or neurologic level of injury. However, there was a trend for higher FGain for patients with incomplete spinal cord injury and traumatic spinal cord injury. CONCLUSIONS: Functional improvement occurs with pediatric spinal cord injury inpatient rehabilitation. There is a trend for higher FGain in patients with less severe injury and traumatic injury. The lack of relationship between FGain and length of inpatient rehabilitation suggests that a variety of other factors influence the relationship between FGain and length of inpatient rehabilitation.     

Analysis of the Factors Influencing Functional Outcomes in Patients with Spinal Cord Injury

[Purpose] The extent of functional independence ultimately achieved by an individual patient will be influenced by a variety of medical and non-medical factors. [Subjects and Methods] this study included 419 patients with spinal cord lesions treated in the Clinic for Rehabilitation “Dr M. Zotovic”, Belgrade, Serbia, from January 2000 to December 2009. The patients were divided in two groups according to achievement of increase in Functional Independence Measure (FIM) score of more than 13 at discharge compared to admission. A variety of clinical variables were followed in both groups. [Results] one hundred twenty-one patients (28.9%) showed improvements in FIM score of ≤13, while 298 (71.1%) patients showed an increases in FIM score of >13 at discharge compared to admission. Better functional recovery was observed in patients with non-traumatic spinal cord lesions, lower neurological levels of the lesion (OR = 6.07), and in patients treated surgically, but the level of the spinal cord lesion was the most influential factor affecting outcome. [Conclusion] the patients with spinal cord lesions should not only be grouped by traumatic and non-traumatic lesions only, but also sub-categorized, according to the etiology, level of injury and treatment method.Key words: Spinal cord lesions, Rehabilitation, Functional outcomes     

Alcohol use by persons with recent spinal cord injury

Detailed drinking histories, prevalence of alcohol abuse, and consequences of alcohol use were studied in 103 persons with recent spinal cord injury. Ninety-five percent of the sample acknowledge prior alcohol use. The mean weekday quantity of alcohol consumed was 5.9 drinks (SD = 4.7), with a range of one to 24 drinks per drinking episode during the six months before disability onset. The median frequency of alcohol use was one to two times per week. The sample's mean Michigan Alcoholism Screening Test (MAST) score was 6.8 (SD = 8.0), above the usual cutoff of 5.0, which is interpreted as indicating problematic alcohol use. Forty-nine percent of the sample had scores equal to or exceeding this cutoff. These results suggest that a significant number of individuals with recent spinal cord injuries have heavy drinking histories and experience behavioral problems resulting from alcohol use. The MAST proved to be an efficient method of assessing alcohol-related problems among those with recent spinal cord injuries. Finally, treatment and hospital policy implications are discussed.