Asymptomatic median mononeuropathy among men with chronic paraplegia

Liang H-W, Wang Y-H, Pan S-L, Wang TG, Huang T-S. Asymptomatic median mononeuropathy among men with chronic paraplegia.

Objectives

To compare electrophysiologic abnormalities of the median nerve in asymptomatic paraplegic subjects and able-bodied controls and to examine the influence of personal factors on these parameters.

Design

Cross-sectional survey.

Setting

University hospital.

Participants

Forty-seven men with paraplegia and 36 able-bodied controls underwent nerve conduction studies on both upper limbs. All were free of hand numbness in the past month, diabetic mellitus, or neuromusculoskeletal injuries to the upper limbs.

Interventions

Not applicable.

Main Outcome Measure

Nerve conduction studies of the bilateral median and ulnar nerves.

Results

Although the 2 groups were of comparable age and had a similar body mass index (BMI), the subjects with paraplegia had a significantly higher proportion of asymptomatic median mononeuropathy than the controls (25.5% vs 5.6%, P=.02). The spinal cord injury (SCI) group had a prolonged median distal latency and a slowed digit-wrist sensory nerve conduction velocity. Multivariate general linear model analysis showed that prolonged motor and sensory latencies of the median nerve were associated with the SCI group and with greater BMI.

Conclusions

The asymptomatic subjects with paraplegia had a significantly higher frequency of median mononeuropathy than the able-bodied controls. There was also an association between BMI and distal latency of the median nerve.     

Posttraumatic Stress Disorder and Spinal Cord Injury

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.     

Association between mobility mode and C-reactive protein levels in men with chronic spinal cord injury

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.     

Predictors of Cardiopulmonary Hospitalization in Chronic Spinal Cord Injury

Waddimba AC, Jain NB, Stolzmann K, Gagnon DR, Burgess JF, Kazis LE, Garshick E. Predictors of cardiopulmonary hospitalization in chronic spinal cord injury.

Objective

To investigate longitudinal risk factors of hospitalization for circulatory and pulmonary diseases among veterans with chronic spinal cord injury (SCI). Circulatory and respiratory system illnesses are leading causes of death in patients with chronic SCI, yet risk factors for related hospitalizations have not been characterized.

Design

Prospective cohort study.

Setting

Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts.

Participants/Data Sources

Veterans (N=309) greater than or equal to 1 year post-SCI from the VA Boston Chronic SCI cohort who completed a health questionnaire and underwent spirometry at study entry. Baseline data were linked to 1996 through 2003 hospitalization records from the VA National Patient Care Database.

Interventions

Not applicable.

Main Outcome Measures

Cardiopulmonary hospital admissions, the predictors of which were assessed by multivariate Cox regression.

Results

Of 1478 admissions observed, 143 were a result of cardiopulmonary (77 circulatory and 66 respiratory) illnesses. Independent predictors were greater age (3% increase/y), hypertension, and the lowest body mass index quintile (<22.4kg/m²). A greater percentage-predicted forced expiratory volume in 1 second was associated with reduced risk. SCI level and completeness of injury were not statistically significant after adjusting for these risk factors.

Conclusions

Cardiopulmonary hospitalization risk in persons with chronic SCI is related to greater age and medical factors that, if recognized, may result in strategies for reducing future hospitalizations.     

Injurious falls among middle aged and older adults with multiple sclerosis

Peterson EW, Cho CC, von Koch L, Finlayson ML. Injurious falls among middle aged and older adults with multiple sclerosis.

Objective

To determine the prevalence of, and risk factors for, receiving medical attention for a recent injurious fall among middle-aged and older adults who have multiple sclerosis (MS).

Design

Survey.

Setting

United States.

Participants

Seven hundred people with MS, age 55 years or older and living in the United States, were randomly selected from the North American Research Committee on Multiple Sclerosis Registry and invited by mail to participate in the study. A total of 354 people, aged 55 to 94 years, completed the survey.

Interventions

Not applicable.

Main Outcome Measures

Participant's self-report regarding receipt of medical care for a fall-related injury (received care within the past 6mo, >6mo ago, or never).

Results

More than 50% of study participants reported injurious falls; 12%, in the 6 months before the interview. Proportional odds models were used to identify factors associated with increased odds of receiving medical attention for a fall-related injury within the past 6 months. Compared with study participants who reported receiving medical attention for a fall-related injury more than 6 months ago or never, participants who reported receiving medical attention for a fall-related injury within the past 6 months were more likely to report fear of falling (odds ratio [OR]=1.94; 95% confidence interval [CI], 1.27−2.96) and osteoporosis (OR=1.65; 95% CI, 1.03-2.62).

Conclusions

Injurious falls were commonly reported by survey participants. Findings suggest that management of fear of falling and osteoporosis are important components of comprehensive fall-injury prevention programs for people aging with MS.     

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.     

Analysis of muscle atrophy after hip fracture in the elderly

Ogawa H, Oshita H, Ishimaru D, Yamada K, Shimizu T, Koyama Y, Akaike A, Hori H. Analysis of muscle atrophy after hip fracture in the elderly.

Objectives

To examine the relationship between muscle atrophy, ambulatory ability, and fracture type, and to make a specific rehabilitation regimen for each fracture type.

Design

Observational study.

Setting

Public hospital.

Participants

Consecutive patients (N=53) with hip fracture (mean age, 83.6y) who underwent operative treatment.

Interventions

Not applicable.

Main Outcome Measures

The ambulatory ability score and the cross-sectional areas of lower-limb muscles as measured on computed tomography scans.

Results

Muscle atrophy was not related to fracture type. Although the mean ambulatory ability score decreased significantly from 4.5±0.3 points prior to injury to 3.0±0.6 points 1 month postadmission, the degree of muscle atrophy was not associated with the decrease in ambulatory ability.

Conclusions

It seems likely that other factors are more important than muscle atrophy and fracture type in determining recovery after surgical repair of a fracture and that there is no need for rehabilitation regimens based on fracture types.     

Gram-negative intravascular catheter-related bacteremia in patients with spinal cord injury

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.     

Longitudinal Changes in the Health-Related Quality of Life During the First Year After Traumatic Brain Injury

Lin M-R, Chiu W-T, Chen Y-J, Yu W-Y, Huang S-J, Tsai M-D. Longitudinal changes in the health-related quality of life during the first year after traumatic brain injury.

Objective

To track the health-related quality of life (HRQL) at discharge and at 6 and 12 months after a traumatic brain injury (TBI) and examine factors associated with changes in each HRQL domain.

Design

Longitudinal cohort study.

Setting

Using codes of the International Classification of Diseases, eligible participants who had a newly diagnosed TBI were identified from discharge records of 4 hospitals in northern Taiwan. Information on the HRQL and injury-related characteristics at the initial and 2 follow-up assessments was collected by extracting medical records and conducting telephone interviews.

Participants

Subjects (N=158) participated in the initial assessment, and 147 and 146, respectively, completed the follow-up assessments at 6 and 12 months after injury.

Interventions

Not applicable.

Main Outcome Measure

The brief version of the World Health Organization Quality of Life (WHOQOL-BREF) with 4 domains of physical capacity, psychologic well being, social relationships, and environment.

Results

Scores on all WHOQOL-BREF domains except social relationships greatly improved over the first 6 months and showed continued improvement at 12 months after injury. The domain scores of the WHOQOL-BREF at discharge were significantly associated with the preinjury HRQL level, marital status, alcohol consumption at the time of injury, Glasgow Outcome Scale (GOS) level, cognition, activities of daily living, social support, and depressive status. However, after adjusting for these baseline differences, only the GOS level and depressive status significantly influenced longitudinal changes in the psychologic and social domains over the 12-month period. Changes in the physical and environmental domains were not significantly associated with any characteristics of the study.

Conclusions

During the first year after a TBI, the magnitude of HRQL recovery differed across different HRQL domains. Many factors may have significant associations with the initial domain scores of HRQL after TBI; however, only a few factors can significantly influence longitudinal changes in the HRQL.     

Validity and Reliability of Assessment Tools for Measuring Unsupported Sitting in People With a Spinal Cord Injury

Boswell-Ruys CL, Sturnieks DL, Harvey LA, Sherrington C, Middleton JW, Lord SR. Validity and reliability of assessment tools for measuring unsupported sitting in people with a spinal cord injury.

Objectives

To develop simple tests to assess the abilities of people with spinal cord injury (SCI) to sit unsupported and to assess the construct validity and test-retest reliability of these tests.

Design

Cross-sectional comparisons, convenience sample.

Setting

Biomechanical laboratory.

Participants

People (N=30) with SCI between the C6 and the L2 level of 2 months to 37 years duration before assessment. The sample was stratified by impairment level (at T8) and time since injury (1y postinjury).

Interventions

Not applicable.

Main Outcome Measures

On 2 separate occasions, participants performed tests that measured the distance of upper-body sway and maximal torso leaning, errors made during a coordinated stability task, timed dressing/undressing of the upper body and alternating arm reaching, and percentage change in seated upper body/arm reaching.

Results

All tests showed good construct validity in that they distinguished between participants with higher (C6-T7) and lower (T8-L2) level impairments (P<.05) and between participants with acute (≤1y) and chronic (>1y) lesions (P<.05). The tests also showed good to excellent test-retest reliability (intraclass correlation coeffiecient_3,1 range, .51-.91).

Conclusions

These simple and quick-to-administer tests have both construct validity and test-retest reliability. They would be appropriate for research and clinical purposes to quantify the abilities of people with SCI to sit unsupported.     

Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury

Davies AL, Hayes KC, Dekaban GA. Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury.

Objective

To determine the serum cytokine profiles of patients with spinal cord injury (SCI) and varying clinical presentations relative to healthy, able-bodied, age-matched control subjects.

Design

Cross-sectional study.

Setting

Clinical research unit.

Participants

People with SCI (N=56) and different clinical presentations, and healthy, able-bodied, age-matched control subjects (N=35).

Interventions

Not applicable.

Main Outcome Measures

Serum levels of the proinflammatory cytokines interleukin (IL) 1β, IL-6, tumor necrosis factor alpha (TNF-α), the anti-inflammatory cytokines IL-4 and IL-10, the regulatory cytokine IL-2, the IL-1 receptor antagonist (IL-1RA), and autoantibodies against myelin-associated glycoprotein and GM₁ ganglioside (anti-GM₁) immunoglobulin (IgG and IgM), as determined by enzyme-linked immunosorbent assay. The relationship between elevated serum cytokine levels and clinical variables was also studied.

Results

SCI subjects exhibited serum concentrations of IL-6, TNF-α, IL-1RA, and anti-GM₁ (IgG) that were greater (P<.05) than control group values. Elevated cytokine concentrations were not associated with high white blood cell counts, level of injury, or American Spinal Injury Association classification; they were evident in SCI subjects who were asymptomatic for medical complications, but were further elevated in subjects with pain, urinary tract infection (UTI), and pressure ulcers.

Conclusions

Elevated levels of circulating proinflammatory cytokines and autoantibodies are present in the serum of SCI subjects without medical complications, and are further elevated in SCI subjects with neuropathic pain, UTI, or pressure ulcers, relative to healthy, able-bodied control subjects. These findings may be indicative of a protective autoimmunity, simply a consequence of occult or evident infection, or evidence of cytokine dysregulation that may contribute to an immune-mediated impairment of axonal conduction.     

Community Reintegration in Rehabilitated South Indian Persons With Spinal Cord Injury

Samuelkamaleshkumar S, Radhika S, Cherian B, Elango A, Winrose W, Suhany BT, Prakash MH. Community reintegration in rehabilitated South Indian persons with spinal cord injury.

Objectives

To explore community reintegration in rehabilitated South Indian persons with spinal cord injury (SCI) and to compare the level of community reintegration based on demographic variables.

Design

Survey.

Setting

Rehabilitation center of a tertiary care university teaching hospital.

Participants

Community-dwelling persons with SCI (N=104).

Interventions

Not applicable.

Main Outcome Measures

Craig Handicap Assessment and Reporting Technique (CHART).

Results

The mean scores for each CHART domain were physical independence 98±5, social Integration 96±11, cognitive independence 92±17, occupation 70±34, mobility 65±18, and economic self sufficiency 53±40. Demographic variables showed no statistically significant difference with any of the CHART domains except for age and mobility, level of education, and social integration.

Conclusions

Persons with SCI in rural South India who have completed comprehensive, mostly self-financed, rehabilitation with an emphasis on achieving functional ambulation, family support, and self-employment and who attend a regular annual follow-up show a high level of community reintegration in physical independence, social integration, and cognitive independence. CHART scores in the domains of occupation, mobility, and economic self-sufficiency showed lower levels of community reintegration.     

Longitudinal Changes in Physical Capacity Over 20 Years in Athletes With Spinal Cord Injury

Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.

Objective

To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI).

Design

Longitudinal study (20-y follow-up).

Setting

Laboratory setting.

Participants

Persons with SCI (N=7).

Interventions

Not applicable.

Main Outcome Measures

Maximum oxygen consumption V?o₂max) measured in 1986-1988 and in 2006.

Results

Subjects with SCI maintained stable V?o₂max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced V?o₂max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased V?o₂max by 43% and 45% after 20 years.

Conclusion

The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities.     

The effectiveness of progressively increasing stimulation frequency and intensity to maintain paralyzed muscle force during repetitive activation in persons with spinal cord injury

Chou L-W, Lee SC, Johnston TE, Binder-Macleod SA. The effectiveness of progressively increasing stimulation frequency and intensity to maintain paralyzed muscle force during repetitive activation in persons with spinal cord injury.

Objective

To compare the effectiveness of progressively increasing stimulation intensity, progressively increasing frequency, or progressively increasing both frequency and intensity on paralyzed quadriceps femoris muscle force maintenance during repetitive activation.

Design

Factorial design with different stimulation protocols as independent variables.

Setting

A muscle performance laboratory.

Participants

People (N=8) with spinal cord injury (SCI) (age, 14.63±1.77y).

Interventions

Not applicable.

Main Outcome Measure

Number of contractions when the peak force was 90% or more of a subject's maximal twitch force.

Results

The protocol involving progressively increasing stimulation intensity and then frequency generated more successful contractions (189.88±53.33) than progressively increasing the frequency followed by intensity (122.75±26.56 contractions). Regardless of the order, progressively increasing both intensity and frequency generated more successful contractions than progressively increasing intensity (97 contractions) or frequency (62 contractions) alone.

Conclusions

Our findings suggest that during repetitive electric activation, progressively increasing both stimulation frequency and intensity can produce more successful contractions than progressively increasing only frequency or intensity. These findings can help researchers and clinicians design more effective stimulation protocols for persons with SCI during functional electric stimulation applications.     

Menopause Characteristics and Subjective Symptoms in Women With and Without Spinal Cord Injury

Kalpakjian CZ, Quint EH, Bushnik T, Rodriguez GM, Terrill MS. Menopause characteristics and subjective symptoms in women with and without spinal cord injury.

Objective

To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI).

Design

Prospective cohort (4 data collection periods across 4 years).

Setting

Community.

Participants

Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed.

Interventions

None.

Main Outcome Measures

Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms).

Results

The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness.

Conclusions

Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition.     

The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility

Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.

Objective

To determine the measurement properties and diagnostic utility of the JFK Coma Recovery Scale-Revised (CRS-R).

Design

Analysis of interrater and test-retest reliability, internal consistency, concurrent validity, and diagnostic accuracy.

Setting

Acute inpatient brain injury rehabilitation hospital.

Participants

Convenience sample of 80 patients with severe acquired brain injury admitted to an inpatient Coma Intervention Program with a diagnosis of either vegetative state (VS) or minimally conscious state (MCS).

Interventions

Not applicable.

Main outcome measures

The CRS-R, the JFK Coma Recovery Scale (CRS), and the Disability Rating Scale (DRS).

Results

Interrater and test-retest reliability were high for CRS-R total scores. Subscale analysis showed moderate to high interrater and test-retest agreement although systematic differences in scoring were noted on the visual and oromotor/verbal subscales. CRS-R total scores correlated significantly with total scores on the CRS and DRS indicating acceptable concurrent validity. The CRS-R was able to distinguish 10 patients in an MCS who were otherwise misclassified as in a VS by the DRS.

Conclusions

The CRS-R can be administered reliably by trained examiners and repeated measurements yield stable estimates of patient status. CRS-R subscale scores demonstrated good agreement across raters and ratings but should be used cautiously because some scores were underrepresented in the current study. The CRS-R appears capable of differentiating patients in an MCS from those in a VS.     

Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands

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.     

Right Bundle Branch Block as a Screening Test for Pulmonary Embolism in Chronic Spinal Cord Injury

Frisbie JH, Sharma GVRK. Right bundle branch block as a screening test for pulmonary embolism in chronic spinal cord injury.

Objectives

To evaluate right bundle branch block (RBBB) on electrocardiograms (ECGs) as a screening tool for the diagnosis of pulmonary embolism (PE) in a chronic spinal cord injury (SCI) population and to determine the prevalence of PE.

Design

Retrospective analysis.

Setting

Boston Veterans Affairs Healthcare System.

Participants

Consecutive SCI participants (N=112) who were followed at this institution until death between 1999 and 2005 at an average age of 71 years, a duration of paralysis of 31 years, with a tetraplegic level in 62%, and no useful motor function in 84%.

Intervention

Not applicable.

Main Outcome Measures

PE, as a cause of RBBB, was diagnosed by autopsy, a source of thromboembolism, imaging, or other ECG signs of PE. Chronic obstructive lung disease was diagnosed by pulmonary function tests and myocardial infarction by ECG or echocardiogram.

Results

Twenty-nine participants (26%) had RBBB (6 with incomplete RBBB). Evidence that PE caused RBBB was found in 21 (72%), with 4 (3 massive) found by autopsy, 4 by the presence of an embolic source, 3 by imaging, 2 by the intermittent course of RBBB, 1 by abrupt onset of RBBB before death, and 7 by other ECG signs. RBBB represented chronic obstructive lung disease or myocardial infarction in the remaining 8. The onset of RBBB occurred either within months of SCI in 5 (1 before SCI) or years after SCI in 24 (6-50y, median 32y). RBBB was constant in 27 and intermittent in 2. The duration of RBBB ranged from 20 minutes to 31 years, median 4 years.

Conclusions

RBBB may be a useful initial screening test for PE complicating chronic SCI. PE, often recurrent and sometimes fatal, is prevalent in chronic SCI.