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1.
Macciocchi S Seel RT Thompson N Byams R Bowman B 《Archives of physical medicine and rehabilitation》2008,89(7):1350-1357
Macciocchi S, Seel RT, Thompson N, Byams R, Bowman B. Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence.
Objectives
To examine prospectively the incidence and severity of co-occurring traumatic brain injury (TBI) in persons with traumatic spinal cord injury (SCI) and to describe a TBI assessment process for SCI rehabilitation professionals.Design
A prospective, cohort design to collect and analyze clinical variables relevant for diagnosing co-occurring TBI.Setting
An urban, single-center National Institute of Disability and Rehabilitation Research Model Spinal Cord Injury System in the Southeastern United States.Participants
People (N=198) who met inclusion criteria and provided consent within an 18-month recruitment window.Interventions
Not applicable.Main Outcome Measure
FIM cognitive scale.Results
Based on participants' presence and duration of posttraumatic amnesia, initial Glasgow Coma Scale total score, and presence of cerebral lesion documented by neuroimaging, 60% of our traumatic SCI sample also sustained a TBI (n=118). Most co-occurring TBIs were mild (34%). Co-occurring mild complicated (10%), moderate (6%), and severe TBI (10%) were less common but still occurred in a significant percentage (26%) of persons with traumatic SCI. Persons with traumatic SCI who were injured in motor vehicle collisions and falls were more likely to sustain a co-occurring TBI. Cervical level traumatic SCI was associated with greater rates of TBI but not more severe injuries. Tree analyses established a practical algorithm for classifying TBI severity associated with traumatic SCI. Analysis of variance established criterion validity for the algorithm's TBI severity classifications.Conclusions
Findings from our prospective study provide strong support that TBI is a common co-occurring injury with traumatic SCI. Incomplete acute care medical record documentation of TBI in the traumatic SCI population remains a considerable issue, and there is a significant need to educate emergency department and acute care personnel on the TBI clinical data needs of acute rehabilitation providers. A systematic algorithm for reviewing acute care medical records can yield valid estimates of TBI severity in the traumatic SCI population. 相似文献2.
Annemarie Relyea-Chew William Hollingworth Leighton Chan Bryan A. Comstock Karen A. Overstreet Jeffrey G. Jarvik 《Archives of physical medicine and rehabilitation》2009,90(3):413-419
Relyea-Chew A, Hollingworth W, Chan L, Comstock BA, Overstreet KA, Jarvik JG. Personal bankruptcy after traumatic brain or spinal cord injury: the role of medical debt.
Objective
To estimate the prevalence of medical debt among traumatic brain injury (TBI) and spinal cord injury (SCI) patients who discharged their debts through bankruptcy.Design
A cross-sectional comparison of bankruptcy filings of injured versus randomly selected bankruptcy petitioners.Setting
Patients hospitalized with SCI or TBI (1996-2002) and personal bankruptcy petitioners (2001-2004) in western Washington State.Participants
Subjects (N=186) who filed for bankruptcy, comprised of 93 patients with previous SCI or TBI and 93 randomly selected bankruptcy petitioners.Interventions
Not applicable.Main Outcome Measures
Medical and nonmedical debt, assets, income, expenses, and employment recorded in the bankruptcy petition.Results
Five percent of randomly selected petitioners and 26% of petitioners with TBI or SCI had substantial medical debt (debt that accounted for more than 20% of all unsecured debts). SCI and TBI petitioners had fewer assets and were more likely to be receiving government income assistance at the time of bankruptcy than controls. SCI and TBI patients with a higher blood alcohol content at injury were more likely to have substantial medical debts (odds ratio=2.70; 95% confidence interval, 1.04-7.00).Conclusions
Medical debt plays an important role in some bankruptcies after TBI or SCI. We discuss policy options for reducing financial distress after serious injury. 相似文献3.
Yokoyama O Sakuma F Itoh R Sashika H 《Archives of physical medicine and rehabilitation》2006,87(9):1189-1194
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. 相似文献4.
Tanya Onushko Allison Hyngstrom Brian D. Schmit 《Archives of physical medicine and rehabilitation》2010,91(8):1225-1235
Onushko T, Hyngstrom A, Schmit BD. Effects of multijoint spastic reflexes of the legs during assisted bilateral hip oscillations in human spinal cord injury.
Objective
To investigate the timing and magnitude of muscle activation during an active-assist bilateral hip motor task in human spinal cord injury (SCI).Design
A single test session using a novel robotic system to alternately flex and extend the hips from 40° of hip flexion to 10° of hip extension at 1 of 3 frequencies (.25, .50, .75Hz). Subjects were asked either to actively assist the movements or to remain relaxed during the imposed oscillations.Setting
All data were collected in a research laboratory.Participants
Ten subjects with motor incomplete (American Spinal Injury Association grade C or D) SCI and 10 individuals without neurologic injury participated in this study.Interventions
Not applicable.Main Outcome Measures
Electromyograms and joint torques were recorded from the lower extremities of SCI subjects and compared with electromyograms and joint torque patterns recorded from 10 neurologically healthy individuals completing the same tasks.Results
In trials involving active assistance of the imposed hip oscillations, SCI subjects produced muscle activation patterns that were phased differently from muscle activity of neurologically intact subjects. SCI subjects generated peak torque at the end ranges of movement (ie, 40° hip flexion, 10° extension), whereas control subjects generated the greatest torque midway through the movements. Moreover, the phasing of active-assist hip torque in SCI subjects was similar to the phasing of reflexive hip torques produced during the unassisted condition (ie, SCI subjects instructed to relax), while control subjects produced no reflexive torques during unassisted trials.Conclusions
The differences in the timing of muscle activity during the active-assist task in controls and SCI subjects highlights problems in generating appropriately timed muscle activity during ongoing movements. The similarity in muscle activity patterns for the active-assist and unassisted trials in SCI subjects further suggests that reflex feedback from hip afferents contributes substantially to muscle activation during active-assist movements. These findings demonstrate the disruptions in reflex regulation of movement in people with incomplete SCI and suggest that spastic reflexes might disrupt motor control. 相似文献5.
van Londen A Herwegh M van der Zee CH Daffertshofer A Smit CA Niezen A Janssen TW 《Archives of physical medicine and rehabilitation》2008,89(9):1724-1732
van Londen A, Herwegh M, van der Zee CH, Daffertshofer A, Smit CA, Niezen A, Janssen TW. The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury.
Objective
To study effects of surface electric stimulation of the gluteal muscles on the interface pressure in seated persons with spinal cord injury (SCI).Design
One session in which alternating and simultaneous surface electric stimulation protocols were applied in random order.Setting
Research laboratory of a rehabilitation center.Participants
Thirteen subjects with SCI.Intervention
Surface electric stimulation of the gluteal muscles.Main Outcome Measures
Interface pressure, maximum pressure, pressure spread, and pressure gradient for the stimulation measurement. Variables were compared using 2-tailed paired t tests.Results
Alternating and simultaneous stimulation protocol caused a significant (P<.01) decrease in interface pressure (-17±12mmHg, -19±14mmHg) and pressure gradient (-12±11mmHg, -14±12mmHg) during stimulation periods compared with rest periods. There was no significant difference in effects between the 2 protocols.Conclusions
Surface electric stimulation of the gluteal muscles in persons with SCI causes a decrease in interface pressure. This might restore blood flow in compressed tissue and help prevent pressure ulcers. 相似文献6.
Logan WC Sloane R Lyles KW Goldstein B Hoenig HM 《Archives of physical medicine and rehabilitation》2008,89(2):237-243
Logan WC Jr, Sloane R, Lyles KW, Goldstein B, Hoenig HM. Incidence of fractures in a cohort of veterans with chronic multiple sclerosis or traumatic spinal cord injury.
Objective
To measure skeletal fractures in a cohort of veterans with spinal cord dysfunction (SCD) due to multiple sclerosis (MS) or trauma-related spinal cord injury (SCI).Design
Retrospective cohort analysis.Setting
Database search.Participants
Study subjects were a subset of the 1996 Veterans Health Administration (VHA) National Spinal Cord Dysfunction Registry, from which 8150 patients were identified with either MS (n=1789) or SCI (n=6361). Inpatient and outpatient encounters for nonaxial fractures, based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, were identified through VHA administrative databases between October 1996 and June 2005. VHA Beneficiary Identification Records Locator Subsystem death file identified time of death.Interventions
Not applicable.Main Outcome Measures
Data from the 1996 VHA National Spinal Cord Dysfunction Registry survey was used to determine duration of disease and motor impairment (4 categories of motor impairment based on self-report of the number of limbs involved and degree of motor loss). Proportional hazard modeling evaluated the time to first fracture and Poisson regression evaluated relative risk (RR) of fracture by cause of SCD and degree of motor impairment, adjusting for age, sex, race, and duration of SCD.Results
Subjects were, on average, 52.5 years of age, acquired their SCD 22 years prior, and 386 of 8150 were deceased. During the study period, 4021 fracture encounters were identified representing 1738 unique fractures for 1085 of 7832 subjects, for a mean per-person fracture rate of 3.1 per 100 patient-years at risk. The RR of fracture differed according to cause of SCD and motor impairment. Fracture risk was increased by more than 2-fold in those with some motor impairment (RR=2.33, P<.001), by more than 80% with moderate motor impairment (RR=1.87, P<.001), and almost 70% for those with severe motor impairment (RR=1.67, P<.001), compared with those with little motor impairment. Trauma-related SCI increased the RR of fracture 80% (RR=1.82, P<.001) compared with MS.Conclusions
Persons with SCD have high rates of skeletal fractures. The highest fracture rates occurred in those with some to moderate motor impairment. There were significant differences in risk of fracture according to causal disease, controlling for motor impairment and duration. There appear to be unique contributors to risk of fracture beyond simply disuse. 相似文献7.
Krahn G McCarthy M Westwood D Powers L 《Archives of physical medicine and rehabilitation》2008,89(7):1341-1349
Krahn G, McCarthy M, Westwood D, Powers L. Evaluation of an innovative methodology to recruit research participants with spinal cord injury through durable medical equipment suppliers.
Objective
To evaluate the effectiveness, strengths, and limitations of an innovative research method to recruit persons with spinal cord injury (SCI).Design
A pilot study for feasibility.Setting
Community-based durable medical equipment suppliers (DMESs) in the states of Oregon, Washington, and New York.Participants
Three DMESs participated and successfully distributed surveys to 591 customers with International Classification of Disease, 9th Revision, codes reflecting SCI. Of these, 316 people completed surveys, with 270 identifying SCI among their disabling conditions.Interventions
Not applicable.Main Outcome Measures
The effort required to solicit recruitment assistance from DMESs, survey response rate, verification of SCI by self-report, and comparability of sample demographics to those of other SCI research samples from both the United States and other countries.Results
A moderate level of effort was required to solicit recruitment assistance from DMESs. The survey had a 53% response rate, and 85% of respondents verified that they had an SCI by self-report. Sample demographics were generally similar to those of comparable research samples but with more single and unemployed persons responding and with longer duration of SCI.Conclusions
This method of recruitment has the potential to address limitations of other recruitment methods but presents its own challenges with implementation. Potential sampling bias is discussed. 相似文献8.
Sepideh Pooyania Karen Ethans Tony Szturm Alan Casey Daryl Perry 《Archives of physical medicine and rehabilitation》2010,91(5):703-707
Pooyania S, Ethans K, Szturm T, Casey A, Perry D. A randomized, double-blinded, crossover pilot study assessing the effect of nabilone on spasticity in persons with spinal cord injury.
Objectives
To determine whether nabilone, a synthetic cannabinoid, alleviates spasticity in people with spinal cord injury (SCI).Design
A double-blind, placebo-controlled crossover study.Setting
Outpatient rehabilitation clinics.Participants
We recruited volunteers (N=12) with SCI and spasticity. One subject, a paraplegic man, dropped out of the study because of an unrelated cause. Eleven subjects completed the study; all subjects were men with an average age of 42.36 years; 6 of them were persons with tetraplegia, and 5 were persons with paraplegia.Interventions
The subjects received either nabilone or placebo during the first 4-week period (0.5mg once a day with option to increase to 0.5mg twice a day), and then outcome measures were assessed. After a 2-week washout, subjects were crossed over to the opposite arm.Main Outcome Measures
The primary outcome was the Ashworth Scale for spasticity in the most involved muscle group, in either the upper or lower extremities, chosen by the subject and clinician. The secondary outcomes included the sum of the Ashworth Scale in 8 muscle groups of each side of the body measured by the clinician; Spasm Frequency Scale and visual analog scale, reported by the subject; Wartenberg Pendulum Test, in order to quantify severity of spasticity; and the Clinician's and Subject's Global Impression of Change.Results
One subject dropped out during the placebo arm because of an unrelated urinary stricture, and 11 subjects completed the study. There was a significant decrease on active treatment for the Ashworth in the most involved muscle (mean difference ± SD, .909±.85; P=.003), as well as the total Ashworth score (P=.001). There was no significant difference in other measures. Side effects were mild and tolerable.Conclusions
Nabilone may be beneficial to reduce spasticity in people with SCI. We recommend a larger trial with a more prolonged treatment period and an option to slowly increase the dosage further. 相似文献9.
Hussain R Cevallos ME Darouiche RO Trautner BW 《Archives of physical medicine and rehabilitation》2008,89(2):339-342
Hussain R, Cevallos ME, Darouiche RO, Trautner BW. Gram-negative intravascular catheter-related bacteremia in patients with spinal cord injury.
Objective
To determine whether the prevalence of gram-negative catheter-related bloodstream infection (CRBSI) is higher in patients with spinal cord injury (SCI) than in patients without SCI.Design
Retrospective chart review from August 1998 to August 2006.Setting
A Veterans Affairs medical center, which serves as a tertiary care medical center to over 500 veterans with SCI and is the primary source of health care for veterans in southeast Texas.Participants
All hospitalized patients who had an International Classification of Diseases, Ninth Revision, code for bacteremia associated with their hospital stay.Interventions
Not applicable.Main Outcome Measure
The proportion of CRBSI caused by gram-negative organisms in the SCI patients to the proportion of CRBSI caused by gram-negative organisms in the non-SCI patients.Results
Eight (42%) of 19 episodes of CRBSI in the SCI were caused by a gram-negative organism as compared with 4 (11%) of 36 infections in the non-SCI group (P<.01). Factors associated with having a gram-negative organism rather than a gram-positive organism as the causative agent of CRBSI were SCI, femoral catheter site, prolonged hospitalization, decubitus ulcer, and urinary catheter.Conclusions
In our medical center, patients with SCI who develop CRBSI are more likely to have an infection with a gram-negative organism than are patients without SCI. This knowledge may guide initial empirical therapy of suspected bloodstream infection. 相似文献10.
Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury.
Objective
To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in persons with spinal cord injury (SCI).Design
A 2-week methodologic study was conducted to assess the internal consistency, reliability, and construct validity of the FSS.Setting
A tertiary spinal cord rehabilitation facility.Participants
Forty-eight community-living subjects at least 1 year post-SCI with American Spinal Injury Association (ASIA) grade A or B SCI and no medical conditions causing fatigue. The sample was predominantly male (n=31 [65%]) with tetraplegia (n=26 [54%]) and ASIA grade A injuries (n=30 [63%]). The average duration since injury was 14.9 years.Interventions
Not applicable.Main Outcome Measures
The ASIA Impairment Scale, the FSS, a visual analog scale for fatigue (VAS-F), the vitality scale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Center for Epidemiologic Studies Depression Scale (CES-D).Results
Mean FSS score ± standard deviation at baseline was 4.4±1.4, with 54% (n=26) scoring greater than 4. The internal consistency of the FSS was excellent (Cronbach α=.89). Two-week test-retest reliability was adequate (intraclass correlation coefficient, .84; 95% confidence interval, .74-.90). The magnitude of the relationship was as hypothesized for the VAS-F (r=.67) and CES-D (r=.58) and lower than hypothesized for the vitality subscore (r=−.48) of the SF-36.Conclusions
The FSS has acceptable reliability with regard to internal consistency, test-retest reliability, and validity in persons with motor complete SCI. 相似文献11.
James S. Krause Lee L. Saunders PhD Susan Newman PhD 《Archives of physical medicine and rehabilitation》2010,91(8):1182-1187
Krause JS, Saunders LL, Newman S. Posttraumatic stress disorder and spinal cord injury.
Objectives
To identify the prevalence of posttraumatic stress disorder (PTSD) after spinal cord injury (SCI) in a sample averaging over 2 decades postinjury at assessment. Related objectives are to confirm the factor structure, compare subscales with those reported in a nonclinical sample, and identify the relationship of PTSD with depression.Design
Survey.Setting
A medical university in the Southeastern United States.Participants
Participants were initially identified through specialty hospitals in the Midwest and Southeastern United States. A cohort of adults (N=927) with traumatic SCI of at least 1 year duration at enrollment in 2002 to 2003 and a minimum of 7 years at the time of assessment completed the study materials.Interventions
Not applicable.Main Outcomes Measures
PTSD was measured by the Purdue Posttraumatic Stress Disorder Scale-Revised, and depression was measured by the Patient Health Questionnaire 9-item.Results
PTSD was reported by less than 10% of the participants. Item endorsement decreased as a function of years postinjury, primarily because of low rates of endorsement among those 21 or more years postinjury. Confirmatory factor analysis did not result in an acceptable fit for subscales, item sets, or factors previously reported in the literature. Participants scored higher than a nonclinical sample (reported in the literature) on the arousal and avoidance subscales but lower on the re-experiencing subscale. Item endorsements were lower for the first set of items that relate directly to the SCI itself, with the highest item endorsement for “have difficulty remembering important aspects of event.” PTSD rarely occurred in the absence of a depressive disorder.Conclusions
PTSD does not appear to be highly prevalent in long-term SCI survivors, and endorsement of items related to re-experiencing and even recalling the injury are rare. Because SCI often is accompanied by mild traumatic brain injury, difficulty recalling the event may have an organic rather than psychologic component. 相似文献12.
Brose SW Boninger ML Fullerton B McCann T Collinger JL Impink BG Dyson-Hudson TA 《Archives of physical medicine and rehabilitation》2008,89(11):2086-2093
Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, Dyson-Hudson TA. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury.
Objectives
To investigate the presence of ultrasound (US) abnormalities in manual wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight.Design
Case series.Setting
National Veterans' Wheelchair Games 2005 and 2006.Participants
Volunteer sample of manual wheelchair users with SCI participating in the National Veterans' Wheelchair Games.Interventions
Not applicable.Main Outcome Measures
Presence of relationships between US findings, PE findings, pain, and subject characteristics.Results
The USPRS correlated with age, duration of SCI, and weight (all P<.01), and showed a positive trend with the total Wheelchair User's Shoulder Pain Index (WUSPI) score (r=.258, P=.073). Several US findings related to presence of PE findings for specific structures. The PESS score correlated with the WUSPI (r=.679, P<.001) and duration of SCI (P<.05). The presence of untreated shoulder pain that curtailed activity was noted in 24.5% of subjects, and this was related to increased WUSPI scores (P=.002).Conclusions
PE and US abnormalities are common in manual wheelchair users with SCI. The USPRS and PESS demonstrated evidence for external validity and hold promise as research tools. Untreated shoulder pain is common in manual wheelchair users with SCI, and further investigation of this pain is indicated. 相似文献13.
14.
van Koppenhagen CF Post MW van der Woude LH de Witte LP van Asbeck FW de Groot S van den Heuvel W Lindeman E 《Archives of physical medicine and rehabilitation》2008,89(9):1733-1740
van Koppenhagen CF, Post MW, van der Woude LH, de Witte LP, van Asbeck FW, de Groot S, van den Heuvel W, Lindeman E. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in The Netherlands.
Objective
To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation.Design
A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured.Setting
Eight rehabilitation centers in The Netherlands.Participants
Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances.Interventions
Not applicable.Main Outcome Measure
The Life Satisfaction Questionnaire.Results
Mean satisfaction with life ± SD as a whole was 5.3±0 before SCI and 4.3±1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (β=.31, P<.05), pain (β=.19, P<.05), and secondary impairments (β=.22, P<.05).Conclusions
Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation. 相似文献15.
Nash MS Koppens D van Haaren M Sherman AL Lippiatt JP Lewis JE 《Archives of physical medicine and rehabilitation》2008,89(11):2080-2085
Nash MS, Koppens D, van Haaren M, Sherman AL, Lippiatt JP, Lewis JE. Power-assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury.
Objective
Test effects of pushrim-activated power-assisted wheelchairs (PAPAWs) on the energetics and perceptual responses to steady-state and intensity-graded wheelchair propulsion in persons with paraplegia and tetraplegia having chronic shoulder pain.Design
Test, retest with a control condition.Setting
Academic medical center.Participants
Subjects (N=18) aged 19 to 70 years with chronic, motor-complete paraplegia and tetraplegia having confirmed shoulder pain.Interventions
Study participants underwent testing on 4 randomized nonconsecutive days during either 6 minutes of steady-state or 12 minutes of intensity-graded wheelchair propulsion on stationary rollers. Participants used their own manual wheelchair and either their customary wheels or power-assist wheels attached with an axle bracket.Main Outcome Measures
Oxygen consumption (V?o2, L/min), distance (m), energy cost (L/m), and ratings of perceived exertion (RPE; Borg Categorical 6-20 Scale) were measured during propulsion.Results
Significant main effects of testing were observed for V?o2, heart rate, and RPE in both subject groups. Distances propelled were significantly increased in both groups across both tests and in each of their 2-minute exercise stages.Conclusions
Use of PAPAWs by persons with paraplegia and tetraplegia having shoulder pain significantly lowers energy cost responses and perceived exertion compared with manual wheelchair propulsion while significantly increasing the distanced propelled. 相似文献16.
Elovic EP Brashear A Kaelin D Liu J Millis SR Barron R Turkel C 《Archives of physical medicine and rehabilitation》2008,89(5):799-806
Elovic EP, Brashear A, Kaelin D, Liu J, Millis SR, Barron R, Turkel C. Repeated treatments with botulinum toxin type A produce sustained decreases in the limitations associated with focal upper-limb poststroke spasticity for caregivers and patients.
Objective
To assess the safety and evaluate the effects of repeated treatments with botulinum toxin type A (BTX-A) on functional disability, quality of life (QOL), and muscle tone of patients with upper-limb poststroke spasticity, as well as its effect on caregivers.Design
Multicenter, open-label, repeated-dose study.Setting
Thirty-five clinical sites in North America.Participants
Patients (N=279) with upper-limb poststroke spasticity at 6 months or more poststroke.Intervention
Up to 5 intramuscular injections of BTX-A (200-400U) divided among the wrist, finger, thumb, and elbow flexors, with at least 200U in the wrist and finger flexors. Retreatment was permitted at 12 weeks or more after the last treatment.Main Outcome Measures
Investigators rated disability using the Disability Assessment Scale and muscle tone using the Ashworth Scale. Each patient's health-related QOL was assessed by using the Stroke Adapted Sickness Impact Profile and the visual analog scale of the European Quality of Life−5 Dimensions questionnaires.Results
Patients treated with BTX-A reported improvements in muscle tone, disability, and ability to function that were statistically significant and clinically meaningful. Significant improvements were observed at week 30 and at subsequent time points in QOL in the overall group and the high-dose group.Conclusions
Up to 5 treatments with BTX-A every 12 weeks for up to 56 weeks in patients with poststroke spasticity was well tolerated and significantly improved muscle tone, lessened disability, and improved patients' QOL. Further research is required to examine the effectiveness of repeated injections of BTX-A in patients with poststroke spasticity. 相似文献17.
Liang H Mojtahedi MC Chen D Braunschweig CL 《Archives of physical medicine and rehabilitation》2008,89(1):36-41
Liang H, Mojtahedi MC, Chen D, Braunschweig CL. Elevated C-reactive protein associated with decreased high-density lipoprotein cholesterol in men with spinal cord injury.
Objectives
To determine if people with spinal cord injury (SCI) have elevated C-reactive protein (CRP), to examine the association of CRP with high-density lipoprotein cholesterol (HDL-C), and to assess the influence of completeness and level of injury on these parameters.Design
Cross-sectional.Setting
Urban university.Participants
Men with SCI (n=129) who were free of infection and/or recent anti-inflammatory medication use as well as their 1:1 age- and race-matched able-bodied counterparts from the 1999-2002 National Health and Nutrition Examination Surveys.Interventions
Not applicable.Main Outcome Measures
High CRP was defined as 3mg/L or higher and low HDL-C as less than 1.04mmol/L.Results
Men with SCI were more likely to have high CRP (odds ratio [OR]=2.29; 95% confidence interval [CI], 1.33-3.95) and low HDL-C (OR=1.81; 95% CI, 1.01-3.27). The OR for low HDL-C in SCI was no longer significant when high CRP was controlled. CRP was higher in complete versus incomplete injury (median, 3.7mg/L vs 1.2mg/L; P=.005), and this elevation was independent of age, smoking, physical activity, waist circumference, and weight. No conclusion can be made on the association of injury level and CRP because of a lack of power.Conclusions
The elevated CRP, possibly the major risk factor, together with decreased HDL-C may contribute to greater incidence for cardiovascular disease in the SCI population. 相似文献18.
Morse LR Stolzmann K Nguyen HP Jain NB Zayac C Gagnon DR Tun CG Garshick E 《Archives of physical medicine and rehabilitation》2008,89(4):726-731
Morse LR, Stolzmann K, Nguyen HP, Jain NB, Zayac C, Gagnon D, Tun CG, Garshick E. Association between mobility mode and C-reactive protein levels in men with chronic spinal cord injury.
Objective
To assess clinical determinants of systemic inflammation in persons with chronic spinal cord injury (SCI).Design
Cross-sectional survey.Setting
Veterans Affairs medical center.Participants
As part of an epidemiologic study assessing SCI-related health conditions, 63 men with chronic SCI provided a blood sample and information regarding locomotive mode and personal habits.Interventions
Not applicable.Main Outcome Measure
Plasma high-sensitivity C-reactive protein (CRP).Results
The mean ± standard deviation age was 56±14y, and participants were assessed 21±13y after injury. Adjusting for heart disease, hypertension, and body mass index (BMI), the mean CRP in 12 motorized wheelchair users (5.11mg/L) was not significantly greater than 23 participants who used a manual wheelchair (2.19mg/L) (P=.085) but was significantly greater than the 17 who walked with an assistive device (1.41mg/L) (P=.005) and the 12 who walked independently (1.63mg/L) (P=.027). CRP was significantly greater in participants with obesity but was not related to age, smoking, or SCI level and severity. CRP was elevated in participants reporting a urinary tract infection (UTI) or pressure ulcer within a year, but adjustment for this did not account for the elevated CRP in motorized wheelchair users.Conclusions
These results suggest that CRP in chronic SCI is independently related to locomotive mode, BMI, and a history of pressure ulcers and UTI. It is suggested that future studies in SCI investigate whether modifying these factors influence systemic inflammation and cardiovascular health. 相似文献19.
Aquilani R Boselli M Boschi F Viglio S Iadarola P Dossena M Pastoris O Verri M 《Archives of physical medicine and rehabilitation》2008,89(9):1642-1647
Aquilani R, Boselli M, Boschi F, Viglio S, Iadarola P, Dossena M, Pastoris O, Verri M. Branched-chain amino acids may improve recovery from a vegetative or minimally conscious state in patients with traumatic brain injury: a pilot study.
Objective
To investigate whether supplementation with branched-chain amino acids (BCAAs) may improve recovery of patients with a posttraumatic vegetative or minimally conscious state.Design
Patients were randomly assigned to 15 days of intravenous BCAA supplementation (n=22; 19.6g/d) or an isonitrogenous placebo (n=19).Setting
Tertiary care rehabilitation setting.Participants
Patients (N=41; 29 men, 12 women; mean age, 49.5±21y) with a posttraumatic vegetative or minimally conscious state, 47±24 days after the index traumatic event.Intervention
Supplementation with BCAAs.Main Outcome Measure
Disability Rating Scale (DRS) as log10DRS.Results
Fifteen days after admission to the rehabilitation department, the log10DRS score improved significantly only in patients who had received BCAAs (log10DRS score, 1.365±0.08 to 1.294±0.05; P<.001), while the log10DRS score in the placebo recipients remained virtually unchanged (log10DRS score, 1.373±0.03 to 1.37±0.03; P not significant). The difference in improvement of log10DRS score between the 2 groups was highly significant (P<.000). Moreover, 68.2% (n=15) of treated patients achieved a log10DRS point score of .477 or higher (3 as geometric mean) that allowed them to exit the vegetative or minimally conscious state.Conclusions
Supplemented BCAAs may improve the recovery from a vegetative or minimally conscious state in patients with posttraumatic vegetative or minimally conscious state. 相似文献20.
Middleton JW McCormick M Engel S Rutkowski SB Cameron ID Harradine P Johnson JL Andrews D 《Archives of physical medicine and rehabilitation》2008,89(10):1941-1947
Middleton JW, McCormick M, Engel S, Rutkowski SB, Cameron ID, Harradine P, Johnson JL, Andrews D. Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions.