Shoulder Muscular Demand During Lever-Activated Vs Pushrim Wheelchair Propulsion In Persons With Spinal Cord Injury

Background/Objective: The high demand on the upper limbs during manual wheelchair (WC) use contributes to a high prevalence of shoulder pathology in people with spinal cord injury (SCI). Leveractivated (LEVER) WCs have been presented as a less demanding alternative mode of manual WC propulsion. The objective of this study was to evaluate the shoulder muscle electromyographic activity and propulsion characteristics in manual WC users with SCI propelling a standard pushrim (ST) and LEVER WC design.

Methods: Twenty men with complete injuries (ASIA A or B) and tetraplegia (C6, n = 5; C7, n = 7) or paraplegia (n = 8) secondary to SCI propelled STand LEVER WCs at 3 propulsion conditions on a stationary ergometer: self-selected free, self-selected fast, and simulated graded resistance. Average velocity, cycle distance, and cadence; median and peak electromyographic intensity; and duration of electromyography of anterior deltoid, pectoralis major, supraspinatus, and infraspinatus muscles were compared between LEVER and ST WC propulsion .

Results: Sign ificant decreases in pectoralis major and supraspinatus activity were recorded during LEVER compared with ST WC propulsion. However, anterior deltoid and infraspinatus intensities tended to increase during LEVER WC propulsion. Participants with tetraplegia had similar or greater anterior deltoid, pectoralis major, and infraspinatus activity for both ST and LEVER WC propulsion compared with the men with paraplegia.

Conclusions: Use of the LEVER WC reduced and shifted the shoulder muscular demands in individuals with paraplegia and tetraplegia. Further studies are needed to determine the impact of LEVER WC propulsion on long-term shoulder function.     

Shoulder Muscular Demand During Lever-Activated Vs Pushrim Wheelchair Propulsion in Persons With Spinal Cord Injury

Background/Objective:     

Breast And Gynecologic Health-Screening Behaviors Among 191 Women With Spinal Cord Injuries

Abstract

Objective: The purpose of this study was to advance the understanding of preventive health behaviors of women with spinal cord injury (SCI) by comparing the frequency of preventive health behaviors (a) between women with SCI and women in the general population, and (b) among women with SCI as a function of race/ethnicity and socioeconomic status (SES).

Design: Telephone interviews.

Participants: 191 women with SCI who had been treated at 1 of 4 Model SCI Systems hospitals. The sample included 66 white women, 59 African American women, 22 American Indian women, and 44 Hispanic women.

Main Outcome Measure: The Behavioral Risk Factor Surveillance System.

Results: Study participants reported significant differences in their frequency of either mammograms or Pap smears when compared with the general population. However, no significant differences were found among study participants when rates were compared by race/ethnicity to the general population. Also, no differences were found among the women with SCI as a function of race/ethnicity or income level.

Conclusion: The results are encouraging, because no deficits in preventive health care were identified among women with SCI as a function of race/ethnicity or SES.     

Influenza Vaccination Among Veterans With Spinal Cord Injury: Part 1. A Survey Of Attitudes And Behavior

Abstract

Background/Objective: Persons with spinal cord injury and disorders (SCID) are at increased risk of developing influenza, pneumonia, and ensuing complications. Influenza vaccine has been shown to be effective, yet vaccination rates have been low in this population. To improve these rates, barriers and facilitators to receiving influenza vaccine in this population were identified.

Methods: A cross-sectional telephone survey was conducted with a convenience sample of patients at 1 3 Department of Veterans Affairs (VA) Spinal Cord Injury (SCI) Centers between September and November 2000. Survey questions assessed perceptions regarding the influenza vaccine.

Results: Participants interviewed (N = 377) had a mean age of 5 8.6 years and were predominantly male and white. Most had had received the influenza vaccine at some time in the past; however, 3 5% had not received it in the previous year. The most common reason reported for not being vaccinated was the belief that it was not important. Those who knew the best time to be vaccinated were more likely to have been vaccinated the previous year (OR = 3.57, 9 5%, Cl: 2.1 2-6.01 ). Other predictors of vaccination included being married, being aged 65 and older, and being aware that the vaccine was a good way to prevent some pulmonary problems that can result from influenza.

Conclusions: Barriers to vaccination include poor understanding of the seriousness of influenza and of the vulnerability of someone with SCID to respiratory complications. Availability of the influenza vaccine at VA facilities and knowledge of when to be vaccinated were facilitators. Providers should use every opportunity to vaccinate patients and provide education about the value of influenza vaccination and when to be vaccinated.     

Assessment Of Behavior In Animal Models Of Spinal Cord Injury

Abstract

Summary: There has been a significant increase in the amount of research directed at understanding pathologic and behavioral consequences of spinal cord injury (SCI), and attempts to promote recovery offunction. Several different approaches can be used to induce SCI; each has particular strengths and weaknesses. Ultimately, behavior is an extremely relevant outcome measure for determining the functional consequences of the initial injury, spontaneous recovery of function, and the efficacy of therapeutic interventions that are developed. Behavioral assessment can encompass a wide range of tests, and the appropriateness of each measure must be considered in determining the merit of each study. This review provides a brief overview and discussion of techniques used to induce SCI and assess behavior. The appropriate use and interpretation of these methods is critical for proper study design, interpretation of experimental results, and extrapolation to clinical relevance.     

Treatment Of Major Depression In Individuals With Spinal Cord Injury

Abstract

Objective: This study evaluated the effects of treating major depression in individuals with spinal cord injury (SCI), focusing on the degree of improvement and correlated changes that could be expected in 6 months of treatment.

Design: Apretreatment–posttreatment designwas used. Random assignment to a nontreatment group could not be implemented ethically. Therefore, this study compared participants who declined treatment to persons who accepted treatment over a 24–month period.

Setting and Participants: Participants were outpatients of a large urban rehabilitation center in southern California. Twenty–eight participants who accepted treatment were assigned to a treatment group; 15 individuals who declined treatment were assigned to a nontreatment group. The age of the participants ranged from 20 to 7 4 years. Varying Ieveis of SCI dysfunction were represented. lnterventio1,1s: A 6–month combination of psychotherapy and antidepressant medication.

Outcome Measures: Adepression inventory, a community activities checklist, and a life satisfaction scale.

Results: A significant (P < 0.001) 57% reduction in depressive symptoms occurred in the treatment group, whereas there was no significant change in the nontreatment group. At theend of 6 months, 30% of participantshad no depression, 42%had minor depression, and 297% still had major depression, butto a lesser degree.Community activities increased significantly over the treatment period, as did life satisfaction.

Conclusion: The results suggest that depression is treatable in this population, although 6 months may not be sufficient to reach maximum benefit in all cases. This study further identified obstacles that limited the ability to randomize participants into treatment arms and made it difficult to deliver services to all those in need. Complications related to SCI, such as difficulties in transportation, likely restriet the ability to implement needed services to many individuals with SCI.     

A View Of The Future Model Spinal Cord Injury System Through The Prism Of Past Achievements And Current Challenges

Abstract

Objective: To examine the contributions of the Model Spinal Cord Injury System (MSCIS) program to the evaluation and care of individuals with spinal cord injury (SCI) and to acknowledge today's challenges to chart the future course of the MSCIS.

Methods: Retrospective review of the literature and prospective development of consensus by task force members and consultants. Integration of recent reported findings from panel presentations and publications regarding the MSCIS 2000 through 2005.

Findings: Significant strides have been made toward the improvement of care for individuals with SCI , which can be attributed to the quality of clinical investigation and education. This has been achieved through the leadership of MSCIS directors in partnership with members from national and international voluntary organizations. These efforts include more than 2,000 peer-reviewed publications from the MSCIS, which have served as a basis for practice guidelines in the field . Although much has been accomplished with regard to reducing medical and behavioral complications, mortality, and length of stay in the hospital and increasing successful return to the community, more is needed.

Conclusion: The MSCIS has a unique opportunity to provide solutions because of its world-renowned database and center, outcome measures, and infrastructure for trials. To maximize this opportunity, the MSCIS must continue to address the appropriate investigational and service issues by defining the best approach to data collection, rigorous clinical studies, and behavioral strategies in the next decade.     

Predictors Of Pressure Ulcer Recurrence In Veterans With Spinal Cord Injury

Background/Objective: To predict recurrence of pressure ulcers (PrUs) in a high-risk populationofveterans with spinal cord injury (SCI).

Design:Cross-sectional observational design.

Participants: A convenience sample of 64 subjects from 6 Department of Veterans Affairs (VA) SCI Centers who had been admitted to the hospital for the treatment of stage III-IV pelvic PrUs and were healed at the time of discharge back to the community.

Main Outcome Measures:Primary outcome measures were pelvic PrU recurrence, defined as selfreported new skin breakdown (stage II or greater) in the pelvic area (not necessarily in the same location as previous ulcer) and time to recurrence.

Results:There were no differences between those with/without recurrences with regard to age, age at/level of injury, number of previous ulcers or surgery, rate of or time, to recurrence. Mean age was 56 years; most were white and men, lived at home, and had some college education. Mean time since SCI was 22 years; 28% had tetraplegia; mean number of prior pressure ulcers was 3; and almost one half had a previous ulcer in the same location. The strongest predictor of recurrence in a multivariate logistic regression was African American race (odds ratio = 9.3). Additional predictors included higher scores on the Charlson Co-Morbidity Index (indicating a higher burden of illness), the Salzburg PrU Risk Assessment Scales, and longer sitting time at discharge.

Conclusion:Identifying individuals at highest risk for recurrence and developing effective prevention programs are essential rehabilitation goals. We recommend that the unique findings of this exploratory study be considered preliminary until replication of these results is published.     

Load Redistribution in Variable Position Wheelchairs in People With Spinal Cord Injury

Abstract

Background/Objective: Tilt and recline variable position seating systems are most commonly used for pressure relief to decrease potential for skin breakdown. This study provides quantitative information on the magnitudes of loading on the seat and back during phases of tilt, recline, and standing. The objective of this study was to show that the amount of force reduction at the seat would differ across these 3 methods within their respective clinical ranges.

Participants: Six able-bodied (AB) subjects (2 men, 4 women) with a median age of 25 years, and 10 subjects (8 men, 2 women) with spinal cord injury (SCI) with a median age of 35.5 years.

Methods: Subjects sat on a power wheelchair with Tekscan pressure mats placed underneath a foam backrest and cushion. Data were collected at 5 positions for each method. Order of position and method tested were randomized. Linear regressions were used to calculate the relationships of normalized seat and backrest forces to seat and backrest angles for each chair configuration.

Results: Normalized seat loads had strong linear relationships with the angles of change in tilt, recline, and standing for both groups. Maximum decreases in seat load occurred at full standing and full recline in the SCI subjects and in full standing in the AB subjects. Loads linearly increased on the back during tilt and recline and linearly decreased during standing for both groups.

Conclusions: Standing and recline offered similar seat load reductions at their respective terminal positions. Standing also reduced loading on the backrest. Recognizing that each method had clinical benefits and drawbacks, the results of this study indicate that tilt, recline, and standing systems should be considered as a means of weight shifting for wheelchair users.     

The Importance Of Influenza Vaccinations In Persons With Spinal Cord Injury And Disease

Abstract

Background/Objective: Spinal cord injury (SCI) impairs cardiovascular autonomic responses to exercise and, depending on the Ievei of injury, may result in hypotension and pathologic fatigue with exertion. Other clinical populations with sympathetic regulatory dysfundion, but without skeletal muscle paralysis, exhibit similar signs and symptoms. Their ability to engage in physical adivity improves with elevation of blood pressure through pharmacologic treatment: Midodrine, an oral alpha-sympathomimetic agent, has been shown to be safe and efficacious for this purpose. Use of this medication in individuals with SCI merits investigation.

Methods: Double-blind, placebo-controlled, randomized, crossover, within-subjeds protocol. Four participants with chronic,motor-complete injuries from C6 to C8 underwent 4 peak exercise tests (PXT) using a wheelchair ergometer, following administration of midodrine, 5 mg, 10 mg, and placebo, in random order. Heart rate, blood pressure, oxygen consumption (V02) , and perceived exertion were measured.

Results: Treatment with midodrine, 10 mg, was associated with elevated systolic blood pressure during peak exercise in 3 participants. Two participants showed a concurrent decrease in perceived exertion and increase in V02 . No adverse effeds of midodrine were evident.

Condusion: Midodrine enhances exercise performance in some individuals with SCI, similar to other clinical populations with cardiovascular autonomic dysfundion.     

The Importance Of Nutrition In The Care Of Persons With Spinal Cord Injury

Abstract

Background/Objective: Vitamin B12 (or cobalamin) deficiency is well known in geriatric patients, but not in those with spinal cord injury (SCI) . This retrospective study describes vitamin B1 2 deficiency in SCI.

Methods: This study utilized a retrospective chart review of patients with SCI who had received serum vitamin B1 2 testing over the last 1 0 years.

Results: Probable vitamin B1 2 deficiency was noted in 1 6 patients with SCI. Twelve patients had subnormal serum vitamin B12 levels (< 220 pg/ml), whereas 4 patients had low-normal vitamin B12 levels (< 300 pg/ml) with neurologic and/or psychiatric symptoms that improved following vitamin B1 2 replacement. Classic findings of paresthesias and numbness often were not evident; such findings likely were masked by the pre-existing sensory impairment caused by SCI. Of the 1 6 SCI patients, 7 were ambulatory; 4 of the 7 presented with deterioration of gait. In addition, 3 of the 1 6 SCI patients presented with depression and fatigue, 2 had worsening pain , 2 had worsening upper limb weakness, and 2 had memory decline. Of the 1 2 patients with subnormal serum vitamin B12 levels, 6 were asymptomatic. Classic laboratory findings of low serum vitamin B1 2 , macrocytic red blood cell indices, and megaloblastic anemia were not always present. Anem ia was identified in 7 of the 1 6 patients and macrocytic red blood cells were found in 3 of the 1 6 patients. Only 1 of the 1 6 SCI patients had a clear pathophysiologic mechanism to explain the vitamin B12 deficiency (ie, partial gastrectomy); none of the patients were vegetarian. Twelve of the SCI patients appeared to experience clinical benefits from cyanocobalamin replacement (some patients experienced more than 1 benefit), including reversal of anemia (5 patients), improved gait (4 patients), improved mood (3 patients), improved memory (2 patients), reduced pain (2 patients) , strength gain (1 patient), and reduced numbness (1 patient).

Conclusion: It is recommended that physicians consider vitamin B1 2 deficiency in their patients with SCI , particularly in those with neurologic and/ or psychiatric symptoms. These symptoms often are reversible iftreatment is initiated early.     

Efficacy And Safety Of Oral Sildenafil In Men With Erectile Dysfunction And Spinal Cord Injury

Abstract

Objective: To assess the efficacy of sildenafil in men with spinal cord injury (SCI) and erectile dysfunction (ED).

Methods: Seventeen men with SCI were selected from February to September 1998 for sildenafil treatment of ED. The initial dose of 25-mg was increased by 25-mg increments as needed. Patients underwent baseline physical examination and answered questions from the abridged International Index of Erectile Function before and during therapy.

Results:Sixteen patients tolerated therapy; 1 developed hypotension and dis continued therapy. There was significant improvement in erectile function (P < .05) after 5.3 ± 2.2 months when compared with baseline or previous therapies (P < .05). Of the 17 patients,94% recommended sildenafil to others. Six of these16 patients were available for long-term follow-up. There was further significant improvement in quality of erection (P < .05), but no change in satisfaction.

Conclusion:Sildenafil is effective and well tolerated in men with SCI and ED.     

Worklife After Traumatic Spinal Cord Injury

Abstract

Objective: To develop predictive models to estimate worklife expectancy after spinal cord injury (SCI).

Design: Inception cohort study.

Setting: Model SCI Care Systems throughout the United States.

Participants: 20,143 persons enrolled in the National Spinal Cord Injury Statistical Centerdatabase since 1973.

Intervention: Not applicable.

Main Outcome Measure: Postinjury employment rates and worklife expectancy.

Results: Using logistic regression, we found a greater likelihood of being employed in any given year to be significantly associated with younger age, white race, higher education level, being married, having a nonviolent cause of injury, paraplegia, ASIA D injury, longer time postinjury, being employed at injury and during the previous postinjury year, higher general population employment rate, lower level of Social Security Disability Insurance benefits, and calendar years after the passage of the Americans with Disabilities Act.

Conclusions: The likelihood of postinjury employment varies substantially among persons with SCI. Given favorable patient characteristics, worklife should be considerably higher than previous estimates.     

Incidence,Etiology, and Risk Factors for Fever Following Acute Spinal Cord Injury

Abstract

Objective: To identify the incidence, etiology, and risk factors for fevers in individuals with traumatic spinal cord injury (SCI).

Design: A retrospective review of the medical records of consecutive adult traumatic SCI patients over a 2- year period was performed.

Setting: The study was performed at a tertiary care, Level I trauma center.

Participants: Consecutive adult traumatic SCI admissions to acute care (n = 48) and rehabilitation (n = 40) were included in the study.

Main Outcome Measures: Incidence, etiology, mean maximum temperature elevation, and duration of fevers (temperature >99.9 F) were measured.

Results: The incidence of fever was 60.4% and 50% (acute care and rehabilitation, respectively). Total number of fevers was 58 and 66, acute and rehabilitation, respectively. Respiratory and urinary tract were the most common identifiable fever etiologies. Unidentified fever etiologies were numerous in both the acute and rehabilitation groups, representing 66% and 56% of cases, respectively. Significant differences (P < 0.05) were found between identified vs unidentified fever etiology groups for mean maximal temperature (102.5°F vs 101.1°F on acute and 101.5°F vs 100.7°F on rehabilitation), duration of fever (10.3 days vs 2.2 on acute and 2.8 days vs 1.3 on rehabilitation), fevers above 101.4°F (75% vs 29% on acute and 40% vs 8% on rehabilitation), cause of injury (gunshot wound on acute care) and completeness of injury (American Spinal Injury Association classification A on rehabilitation).

Conclusions: This study suggests that fevers occur commonly in patients with SCI, with respiratory and genitourinary system etiologies most commonly identified. Unidentified etiologies were common and were associated with lower temperature elevation and shorter fever duration. Injury etiology and completeness of injury may comprise additional risk factors. These factors should be taken into account when initiating cost- efficient fever workup in individuals with SCI.     

Posture Influence on the Pendulum Test of Spasticity in Patients with Spinal Cord Injury

The study aims to investigate the influence of different postures on spasticity results by pendulum test in patients with spinal cord injury (SCI). The setting was at the University of Campinas (UNICAMP), Campinas, SP, Brazil. Five individuals with SCI and five individuals in the control group were included. All individuals went through the pendulum test in three different positions: supine, semi‐supine at an angle of 30°, and sitting up at an angle of 60°. An electrogoniometer was attached to the right leg for measurement of knee joint angles. All situations were performed five times. Blood pressure was monitored during tests. Relaxation index (RI), normalized relaxation index (RIn), test duration in seconds, initial flexion angle, and resting angle were analyzed at three different positions. Results were compared between different positions, and statistically no differences were found. In individuals with SCI, RI (1.83 ± 0.2), RIn (1.14 ± 0.13), and test duration values (13.95 ± 4.14), in sitting up position, were similar to the control group results. In sitting up position, patients showed spasticity reduction. However, the other two postures produce pain and increase blood pressure in patients with tetraplegia. Therefore, these postures should be avoided in patients with lesions above T6, due to possible autonomic dysreflexia symptoms.     

Incidence And Clinical Correlates Of Increased Serum Creatine Kinase Levels In Persons With Spinal Cord Injury

Abstract

Background: Elevated plasma levels of creatine kinase (CPK) are found in various neuromuscular conditions as a result of muscle damage and necrosis. Elevated CPK has also been described in elite wheelchair athletes and in able-bodied individuals after strenuous exercise.

Methods: The incidence of elevated CPK in individuals with spinal cord injury (SCI) has not been well established. We reviewed laboratory data from 581 individuals with chronic SCI.

Results: Most individuals with SCI (73.3%) had CPK values within 95% confidence intervals for able-bodied individuals. The highest levels were seen in African Americans (21% had CPK values > 95 confidence intervals for able-bodied individuals). Significant associations between CPK and the following independent variables were identified: impairment group, gender, duration of injury, body mass index, and ethnic group. Multiple regression analysis revealed significant correlations between CPK and oxygen consumption (beta .37, P < .01) in 32 individuals who performed the exercise test.

Conclusions: These findings are important for clinicians evaluating symptoms of fatigue and myopathy in individuals with SCI.     

脊髓损伤病人的运动功能评定

目的 脊髓损伤（ＳＣＩ）病人的分级多采用Ｆｒａｎｋｅｌ分级标准,我们根据２６０例ＳＣＩ病人的观察,认为对病人活动功能影响最大的最运动功能与排尿功能,且上肢与下肢评级标准不尽相同,从而对分级提出改进意见。方法 本组２６０例, 伤后观察时间达１以上者１５６例,占６０％。损伤部位：Ｃ３－４￣Ｔ１ ９０例,Ｔ ２￣１０ ３７例,Ｔ１１￣Ｌ１ １０５例,Ｌ２－３ ２８例。脊髓损伤类型：完全截瘫１６９例,不全     

Pushrim Kinetics During Advanced Wheelchair Skills in Manual Wheelchair Users With Spinal Cord Injury

Objective:

To assess the peak force during wheelchair propulsion of individuals with spinal cord injury propelling over obstacles from the Wheelchair Skills Test.

Participants/Methods:

Twenty-three individuals with spinal cord injury (SCI) who are full-time manual wheelchair users were included in this prospective study. A SmartWheel (Three Rivers Holdings, LLC) was used to analyze each push while subjects negotiated standardized obstacles used in the Wheelchair Skills Test, including tile, carpet, soft surface, 5° and 10° ramps, 2 cm, 5 cm, and 15 cm curbs.

Results:

When the peak forces of the advanced skills were compared to level 10 m tile/10 m carpet, there was a statistically significant increase in all peak forces (P value ranged from .0001 to .0268).

Discussion:

It is well documented that a large number of individuals with SCI develop upper limb pain. One of the recommendations to preserve the upper limb is to minimize force during repetitive tasks.

Conclusion:

Advanced wheelchair skills require an increase in force to accomplish. The increase in forces ranged from 18% to 130% over that required for level 10 m tile/10 m carpet.     

Factors Related to Obstacle Crossing in Independent Ambulatory Patients With Spinal Cord Injury

Abstract

Background/Objectives: To evaluate factors related to the ability of ambulatory patients with spinal cord injury (SCI) to walk over small obstacles.

Study Design: Cross-sectional study.

Methods: Thirty-four patients with SCI (ASIA impairment scale [AIS] D) who were able to walk independently at least 10 m with or without walking devices were recruited for the study. Participants were required to walk over small obstacles (1,4, and 8 cm in height or width; total of 6 conditions). A “fail” was recorded when either the lower limbs or the walking device contacted the obstacle. Multiple logistic regression models were applied to determine the effects of walking devices (presence or absence), SCI levels (tetraparesis or paraparesis), and SCI stages (acute or chronic) on the ability of obstacle crossing.

Results: Fifteen participants (44%) failed to adequately clear the foot or walking device over obstacles in at least one condition (range 1–3 conditions). After adjusting for covariates, the chance of failure on obstacle crossing was greatly increased with the use of walking devices (odds ratio = 8.50; 95% CI = 0.85?75.03)

Conclusions: Gait safety in independent ambulatory participants with SCI remains threatened. Participants who walked with walking devices encountered a greater chance of failing to walk over obstacles as a result of inefficiently moving the foot or walking device over small obstacles. Thus, instead of training in an empty/ quiet room, rehabilitation procedures should incorporate contextual conditions that patients encounter at home and in the community in order to minimize risk of injury and prepare patients to be more independent after discharge.     

Fibrinogen Metabolism in Patients With Spinal Cord Injury

Abstract

Background/Objective: Deep venous thrombosis and pulmonary thromboembolism are common within weeks of spinal cord injury (SCI) but clinically uncommon in the chronically paralyzed. Fibrinogen half-life (FHL) and fibrin uptake of the legs (FUT), as indicators of an active thrombotic process, have been used to test this clinical impression.

Methods: Data from the use of autologous preparations of radioiodinated fibrinogen to determine FHL and FUT in 17 men paralyzed at cervical (6), thoracic (10), and lumbar levels (1), at ASIA grades A (15) and C (2) in 1974 to 1976 were reviewed. Group A consisted of 12 subjects 29 ± 8 years of age and paralyzed 1week to 5 months (median, 1 month). Group B consisted of 5 subjects 46 ± 17 years of age and paralyzed 24 to 96 months (median, 36 months). Group B subjects were older and paralyzed longer than Group A. Group C consisted of 4 able-bodied control subjects enrolled at the same time for FHL studies, and these subjects were 34 to 38 years of age.

Results: FHL was 61 ± 14 hours for all SCI subjects and 95 ± 23 hours for Group C (P = 0.001). Group A FHL was 59 ± 16 hours, and FUT was positive in 8 of 12 subjects. Group B FHL was 66 ±7 hours, and FUT was positive in 3 of 4 subjects (1 FUT not done; P= 0.30 and 1.0, respectively).

Conclusions: Fibrinogen metabolism was abnormal in patients with acute SCI at high risk for pulmonary thromboembolism (PE) but continued to be abnormal beyond the high risk period for PE, possibly because of the greater age of the patients in the long-term paralysis group.