Assessing sexual functions of the adult with traumatic quadriplegia

The individual who sustains a spinal cord injury resulting in traumatic quadriplegia experiences a drastic alteration in his lifestyle from both physiological and psychological perspectives. The effects of spinal cord injury on a patient's sexuality will be explored according to Carrera's rule for optimum sexual functioning: all systems go, a positive self-image, and nurturing environment.     

Sexuality and sexual life in women with spinal cord injury: a controlled study.

OBJECTIVE: To describe sexual life in women with spinal cord injury. DESIGN: Controlled cross-sectional, questionnaire. PARTICIPANTS AND METHODS: Women, 18-65 years, treated at spinal cord centres in Sweden, Denmark, Norway, Finland and Iceland. 545 women (57%) completed the questionnaires. The age-matched control group consisted of 507 women. The 104-item Spinal Cord Injury Women Questionnaire, was designed to assess different dimensions of sexuality. RESULTS: 80% of the women with spinal cord injury had engaged in sex after the injury. Reasons for not wanting or not having the courage to be intimate and sexual were physical problems, low sexual desire, low self-esteem and feelings of being unattractive. The motivations of both the women with spinal cord injury and controls to engage in sexual activity were intimacy-based rather than primarily sexual. Being in the right mood both before and during sex to become receptive to sexual stimulation was important. CONCLUSION: For women who are able to overcome the physical restrictions and mental obstacles due to injury, it is possible to regain an active and positive sexual life together with a partner. Sexual information and counselling should be available both during initial rehabilitation and later when the women have returned to their homes.     

扩散张量成像在急性脊髓损伤中的研究进展

脊髓是中枢神经系统的重要组成部分,不同时期、不同程度的脊髓损伤造成的后果及预后也不同,急性脊髓损伤病情发展迅速且较为严重。常规磁共振成像(magnetic resonance imaging,MRI)上的信号变化对于临床评估具有一定的局限性,磁共振扩散加权成像(diffusion weighted imaging,DWI)和磁共振扩散张量成像(diffusion tensor imaging,DTI)通过测量水分子的扩散运动,从微观上反映脊髓的损伤情况,不仅能早期及时地判断出急性脊髓损伤,而且能定量分析白质纤维束损伤的严重程度,为临床对这类患者的干预提供一定的价值信息。本文简要介绍了磁共振扩散加权成像和磁共振扩散张量成像技术在急性脊髓损伤中的应用情况及研究进展。     

Physical therapists' knowledge of sexuality of adults with spinal cord injury.

Helping the adult with spinal cord injury to adjust to sexual limitations is an important and neglected part of his rehabilitation. Health professionals of all fields have been perceived to be deficient in their knowledge of the sexuality of the adult with spinal cord injury. A test with 40 statements reflecting myths, misconceptions, and truths about the effect of spinal cord injury on sexual function was administered to 30 physical therapists responsible for rehabilitating these adults. At least 28 of the 40 items were missed by 10 percent or more of the therapists. Experience and participation in educational programs appeared to contribute to the respondents' knowledge, as reflected by the test, but only experience was a statistically significant variable.     

Nutrition in acute spinal cord injury

Nutrition in acute spinal cord injury is complicated. Not every aspect of nutrition as it relates to the acutely injured spinal cord patient is known. The stress response to injury, fever, infection, sepsis, and surgery alter nutritional needs, as does the spinal cord injury itself. The sequelae of spinal cord injury, including denervation atrophy and paralysis, glucose intolerance, skin and wound breakdown, poikilothermy, anemia, respiratory paralysis, pneumonia, paralytic ileus, gastrointestinal ulcers and hemorrhage, neurogenic bowel and bladder, and depression, all affect the nutritional needs of the patient. Orthopedic appliances, pharmacologic agents, and other injuries can also alter nutritional requirements. Nutritional assessment in acute spinal cord injury is also complex. It should include medical and diet history, physical examination, intake and output measurements, prediction of energy expenditure and protein requirements, or--even better--measurements of energy expenditure with indirect methodology, using the metabolic cart or pulmonary artery catheter. Application of computerized tomography and radioisotope studies may prove valuable in the future. Finally, the direct relationship between nutrition and physiologic alterations of acute spinal cord injury necessitates that the critical care nurse incorporate nutrition-focused thinking into many aspects of the acute spinal cord--injured patient's care.     

Primary care after spinal cord injury. What every physician should know

Primary care physicians can help patients with spinal cord injury return to the community by accepting them into their practice. The transition from physiatrist to primary care physician after formal rehabilitation is a cooperative effort. Knowing how to treat the common skin, pulmonary, cardiovascular, autonomic, neuromotor, and musculoskeletal complications of spinal cord injury is essential. Just as important is the willingness to address problems of sexual dysfunction and psychosocial issues. If so prepared, primary care physicians can provide excellent care to patients with spinal cord injury and thereby assume an important role in the long-term rehabilitation of these patients.     

无骨折脱位型颈脊髓损伤程度的影响因素研究

目的探讨无骨折脱位型颈脊髓损伤程度的影响因素。方法回顾性分析44例无骨折脱位的颈脊髓损伤病例的MRI资料。从矢状位和轴位图像观察记录：脊髓损伤的长度，脊髓损伤处椎间盘突出最大径，椎间盘突出类型，脊髓损伤处椎管前后径、黄韧带厚度、椎体后缘骨赘有无和脊髓损伤节段，同时记录患者的年龄和性别。以脊髓损伤长度为应变量，以性别、年龄、椎间盘突出最大径、椎管前后径、椎间盘突出类型、黄韧带厚度、椎体后缘骨赘有无、脊髓损伤节段为自变量，进行多因素相关性分析。结果①44例中，脊髓损伤的长度为3～22mm，椎间盘突出的最大径为4～8mm，椎管前后径为4～9mm，黄韧带厚度为2—7mm，脊髓损伤平面位于C。～C，水平。②颈脊髓损伤的程度与颈椎间盘突出程度、颈椎管径前后径、颈椎黄韧带的厚度、颈脊髓损伤节段相关，差异有显著性意义（P〈0、01）。结论无骨折脱位的颈脊髓损伤的程度与颈椎间盘突出程度正相关，与颈椎管径前后径负相关，与颈椎黄韧带的厚度、颈脊髓损伤节段相关，与椎间盘突出的类型、椎体后缘有无骨赘、性别和年龄无关。     

Effective bowel management for patients after spinal cord injury

After loss of ability to ambulate, the loss of voluntary control of bowel function has been described as the second most distressing aspect of life following spinal cord injury (SCI) (Glickman and Kamm, 1996). It may be the most distressing for the newly injured person (Rogers, 1991). The significance of this loss and the importance of effective management are emphasised by DeLisa and Kirshblum (1997) who suggest that 'establishing an effective bowel programme is critical because incontinence may interfere with a patient's physical, psychological, social, recreational, and sexual function'.     

The order of reacquirement of activity of daily living functions in people with spinal cord injury during rehabilitation after initial medical treatment and its affecting factors.

The purpose of this study was to investigate the order of reacquisition of activity of daily living (ADL) functions during inpatient rehabilitation at our spinal cord injury unit following the individual's initial medical care and to investigate what initial medical and biological factors would affect the ADL functions which the individual with spinal cord injury could perform 14 weeks after the beginning of inpatient rehabilitation. Fifty-two patients with spinal cord injuries who were hospitalized in the rehabilitation unit after their initial medical care participated in this study. The participants' ADL abilities were measured using the Barthel Index every four weeks after hospitalization for a period of 26 weeks. The order of reacquisition of ADL functions included in the Barthel Index was analyzed. Multiple regression analysis was performed to analyze the initial medical and biological factors affecting ADL reacquisition 14 weeks after hospitalization. The order of reacquisition of the ADL functions was almost the same in each individual. The multiple regression equations of the Barthel Index score and number of ADL functions after 14 weeks were both significant and the explanatory variables in both equations included the patients' age, complications on the initial stage and traumatic brain injury as an associated injury with spinal cord injury. We concluded that the patient's score on the Barthel Index and what the patient could actually perform 14 weeks after hospitalization could be predicted from the patient's status at hospitalization in the rehabilitation unit. This predictable correlation can contribute to the rehabilitation management for spinal cord injuries.     

Cuidados enfermeros en el varón con lesión medular y disfunción sexual

The impact of spinal cord injury and its sequels requires important efforts of adaptation. In several studies, people with spinal cord injury claim to have covered most of their needs at physical, emotional and social level, but they are not yet fully satisfied with their sexual life. Sexual function is usually impaired in men with spinal cord injuries, and is sometimes related to problems of erection, ejaculation and/or orgasm. This issue is not a priority in the first phase, but it appears over the subsequent periods when patients often ask for a solution to this problem.A case-study is presented of a 25 year old male with chronic complete spinal cord injury (ASIA A), L4-L5 level, who reported sexual dysfunction and attended an annual review in the National Hospital for Paraplegics. After performing a nursing assessment using the functional health patterns of Gordon, the team proposed a nursing care plan according to the taxonomy of NANDA (North American Nursing Association), NOC (Nursing Outcome Classification) and NIC (Nursing Intervention Classification).Nurses are the healthcare professionals who have more direct and continuous contact with these patients. Specific programs need to be designed to provide them with the sexual education, which should contain adequate emotional and sexual information.We believe that an appropriate and systematic assessment of patient's sexuality, as well as the application of the (NANDA, NOC, NIC) nurse methodology, may be very helpful in improving the outcomes of these specific interventions.     

Neurogenic bladder,neurogenic bowel,and sexual dysfunction in people with spinal cord injury

The purpose of this article is to review the literature related to the effects of spinal cord injuries on genitourinary, gastrointestinal, and sexual function. These important areas of function are profoundly affected by spinal cord injuries, with the effects of injury being dependent on the specific level and degree of neurologic dysfunction. Our ability to manage neurogenic bladder dysfunctions and neurogenic bowel dysfunctions has improved over the past few years; however, in general the techniques used have not significantly changed. In contrast, a significant amount of new information has been made available regarding the effects of specific neurologic injuries on sexual response, particularly female sexual response. Moreover, techniques to remediate erectile dysfunction and infertility in the male have vastly improved the fertility potential of men with spinal cord injuries. Further research is warranted in all of these areas.     

脊髓损伤病人膀胱功能障碍的治疗与护理现状

脊髓损伤(SCI)后泌尿系统并发症是SCI病人感染死亡的危险因素。对SCI病人膀胱功能障碍的分类、治疗方法以及护理进展进行综述。     

Spinal cord injury: preventing secondary injury.

Spinal cord injury is devastating to the victim, as well as being costly in terms of medical expenses, lost wages, and lost independence. The initial damage to the spinal cord results from several mechanisms of injury--flexion, extension, compression, penetration, rotation, and the disease process. When the spinal cord is injured and there is necrosis of the nervous tissue, no regeneration of that tissue occurs. Unlike in the peripheral nervous system, where regeneration is possible, the spinal cord is part of the central nervous system, as is the brain. The spinal cord extends from the base of the skull to the L1 vertebrae: the cervical levels innervate the diaphragm and muscles of the arms; the thoracic levels innervate the muscles of the chest and abdomen; and the lumbar and sacral levels innervate the muscles of the legs. In addition, the sacral levels are responsible for bowel, bladder, and sexual function. The higher the level of injury, the more severe the loss of function because, not only is the level of injury affected, but also the levels below. Injury occurs by initial trauma to the surrounding ligaments, bones, and muscles, which then affect the spinal cord. There may be total loss of function with damage completely across the cord or partial loss of function with damage affecting only part of the cord. No current treatment can reverse this initial injury, which causes irreversible damage within minutes of injury. Secondary damage occurs as the injury spreads over several hours. Treatment can help prevent this secondary damage.     

Acute management of the patient with spinal cord injury

Spinal cord injuries are not as common as many other types of injuries. The victims are often young, the injury debilitating, and the effects devastating and incalculable. The acute management of patients with spinal cord injury can significantly affect the patient's eventual neurologic and functional outcome and ultimately their quality of life. Early interventions are aimed at reestablishing physiologic homeostasis, lessening the amount of secondary injury, and preserving neurologic function.     

Interdisciplinary management of hemicorporectomy after spinal cord injury.

Hemicorporectomy (HCP) is infrequently used, but its effects can devastate the patient's body image, autonomic function, and physical abilities even more than a spinal cord injury of comparable level. Interdisciplinary management is of the utmost importance. This report describes the 2 year course, including four separate rehabilitation admissions, of a patient who was initially paraplegic, and then underwent a HCP for complications secondary to a cauda equina ependymoma. The patient's expectations for functional independence were established by his successful initial spinal cord rehabilitation. The HCP was performed 6 months after initial discharge secondary to infected Harrington rods and rapid spread of the tumor. Extensive use of the interdisciplinary team approach allowed comprehensive analysis and treatment of the patient's comfort, mobility, skin tolerance, and upper extremity functional abilities. Four successive prostheses were developed and modified, until all concerns were successfully addressed. The patient ultimately became completely independent at the wheelchair level. The evaluations, treatment plan, and emphasis of each discipline, including physical therapy, occupational therapy, rehabilitation nursing, therapeutic recreation, social work, vocational rehabilitation, and physiatry are summarized. Differences between the patient's course and standard spinal cord rehabilitation are detailed.     

Wheelchair racing: an important modality in acute rehabilitation after paraplegia

Sports rehabilitation has been proven effective with patients having spinal cord injury. This case discusses a man with T12/LI paraplegia who had acute rehabilitation augmented by competitive long distance wheelchair racing. Stress testing was used to evaluate cardiorespiratory fitness and to develop parameters whereby maximally efficient training could occur. Wheelchair modifications for racing were necessary. Competitive wheelchair racing was found valuable for this patient's physical, emotional and social rehabilitation. Patient involvement in racing has continued since discharge and the Boston Marathon was completed by wheelchair less than 1 year after onset of spinal cord injury.     

Role stabilization in families after spinal cord injury

The purpose of this investigation was to determine how family roles changed after spinal cord injury of a child or spouse. Parental and spousal roles--including provider, child care and socialization, housekeeper, sexual, recreational, therapeutic, and kinship roles--were studied. Results indicated that, overall, families that experienced spinal cord injury did not significantly change in role functioning. In most instances, mothers, fathers, husbands, and wives continued to play roles that traditionally were a part of their family functioning. Spinal cord injury, however, was perceived by family members as a crisis event that lessened over time, but that for the majority of respondents continued indefinitely.     

Development of international standards to document sexual and reproductive functions after spinal cord injury: preliminary report

Clinicians need standard terminology to communicate effectively about remaining autonomic function in persons after spinal cord injury. This article illustrates the development of standard nomenclature that describes the impact of injury on sexual functioning. A standard anatomic diagnosis and a secondary means of describing the presence of male and female sexual dysfunction, genital arousal, and orgasmic function are discussed.     

Critical rehabilitation of the patient with spinal cord injury

Most healthcare practitioners have worked with patients with spinal cord injury at some point in their career, for some it is a specialty. The critical care area usually only has patient with spinal cord injury for a brief time before they are transferred. More recently, there are longer intensive care unit stays due to multiple trauma and lack of insurance. Nurses must be cognizant of indications, contraindications, and best practice interventions to contribute positively to patient's long-term outcomes. As part of the multispecialty team, nurses can be pivotal in preventing secondary complications, especially pressure ulcers. Rehabilitation team members can be consulted early to provide expertise in managing this complex diagnostic group.     

Humanistic aspects of sexuality as related to spinal cord injury

As spinal cord injury results in loss of motor, sensory and autonomic function, spinal cord-injured individuals sense a loss of their sexuality. Therefore, it is important that patients receive sexual counseling. With encouragement and education, they have the potential to learn new ways of achieving sexual gratification. Through the acquisition of knowledge about sexuality and adaptive techniques, nurses have the power to teach factual information and provide resources as necessary, resulting in healthful transition post-injury.