Use of an arginine‐enriched oral nutrition supplement in the healing of pressure ulcers in patients with spinal cord injuries: An observational study

Aim: Pressure ulcers are a serious secondary consequence of spinal cord injuries. The objective of the present study was to determine whether an arginine‐containing nutritional supplement can reduce the healing time of pressure ulcers in people with spinal cord injuries compared with those not consuming the supplement until full wound healing. Methods: Thirty‐four spinal cord injured patients with a grade 2, 3 or 4 pressure ulcer were prescribed two 237 mL tetrapaks/day of a supplement containing additional protein, arginine, zinc and vitamin C. Pressure ulcer healing was assessed with the Pressure Ulcer Scale for Healing tool. Results: Twenty patients consumed the nutritional supplement until full pressure ulcer healing had occurred, while 14 patients ceased consuming the supplement before full healing occurred because of intolerance, compliance or taste issues. A 2.5‐fold greater rate of healing was observed in patients consuming the supplement until full healing compared with those who ceased taking the supplement (8.5 ± 1.1 weeks vs 20.9 ± 7.0 weeks respectively; P= 0.04). There were no significant differences in age, nutritional status, gender or reason for admission between groups. Comparison of healing rates in the group consuming the supplement to full wound healing against expected rates derived from the medical literature showed a significantly shorter time‐to‐healing (grade 3 pressure ulcer: 6.5 ± 0.8 weeks vs 18.2 weeks; grade 4: 11.4 ± 2.0 weeks vs 22.1 weeks; P < 0.001). Conclusion: The present small‐scale study demonstrated the potential for specialised wound healing nutritional supplements to shorten the time to pressure ulcer healing in spinal cord injured patients.     

Lifetime Active Care: A qualitative study of long‐term family carers of people with spinal cord injury in Australia

This study reports the findings of a qualitative, grounded theory study which explored the experiences of partners and other long‐term family carers living with and supporting loved ones with spinal cord injury. The study is exploratory in that little was previously known about the experience of long‐term care‐giving in this context in Australia. Most research in this area has focused on this experience during the first 5 years postinjury. This study focuses on the experiences of family carers beyond that 5‐year period. The study aimed to explore the experience of partners and other long‐term family carers of people with spinal cord injury, and illuminate their daily lives, interests, concerns and caring approaches in this context. Data collection included in‐depth interviews, a focus group and an on‐line, password‐protected research blog for participant narrative reflections. Findings revealed that the experience of long‐term caring is complex, all‐encompassing and lifelong. This experience is conceptualised here as lifetime active care which always involves what we describe as protective, negotiated, surreptitious and strategic caring. These dimensions of caring are interdependent and deeply embedded in the daily, active support provided by long‐term carers of people with spinal cord injury. We argue that carers in this context are involved in processes that have, in other contexts, been conceptualised as narrative reconstruction and also that the four dimensions of caring identified involve significant emotion work. The social processes of lifetime active care may shed light on the experiences of family carers in other long‐term care contexts.     

Shifting the balance: conceptualising empowerment in individuals with spinal cord injury

Empowerment is believed to be an essential element in self‐management of disease and the promotion of self‐efficacy, and can be defined as the ability of individuals to increase control over aspects of their lives. In contrast, powerlessness in individuals with chronic illness can occur when they perceive that they lack the capacity, authority or resources to affect an outcome. Individuals with spinal cord injuries (SCIs) are at risk for powerlessness and have the potential to become empowered, but these concepts have not been explored within their context. The purpose of this study was to explore how individuals with SCI enact the empowerment process using Lord's (1991) process of empowerment framework. This study used a secondary analysis of a data set obtained from a mixed methods study exploring access to health and social care for 23 persons with SCI in Saskatchewan, Canada. The primary study data were collected from September 2012 to January 2013. The secondary analysis of data utilised a deductive thematic analysis approach and findings were conceptualised and applied to a model that represents the shift in balance between powerlessness and empowerment in individuals with SCI.     

Social representations of the wheelchair for people with spinal cord injury

In seeking to understand the social representation of the use of the wheelchair through the analysis of interviews with ten people who have suffered spinal cord injury, the construction of five representations was elaborated. The phenomenon experienced regarding the wheelchair provided a route of meanings and symbologies: essential equipment, after the person perceive the inability to walk; a symbol of disability when the person experienced functional dependence; means of locomotion and transport after the rescue of their potential functional; becoming an integral part or all of their body and, finally, the concept of autonomy on four wheels by adjusting to their new ability to walk emerges. The wheelchair as an extension of the modified body for spinal cord injury, returns them the right of locomotion, presents them not only with autonomy for various acts of life, but also restores their dignity, so essential to human life.     

User satisfaction, community participation and quality of life among Chinese wheelchair users with spinal cord injury: a preliminary study

The purpose of the present study was to investigate the relationships between spinal cord injury (SCI), wheelchair users' satisfaction, perceptions of their community participation and quality of life (QoL).Thirty-one community wheelchair users with SCI were administered the Chinese version of the Quebec User Evaluation of Satisfaction with assistive Technology (C-QUEST), the abbreviated Hong Kong version of the World Health Organization Quality of Life Questionnaire (WHO QoL-BREF (HK)) and selected items of 'Participation Restrictions' and 'Environmental Factors' of the International Classification of Functioning Disability and Health (ICF). Only a weak correlation was found between the C-QUEST services sub-scores and one ICF environmental factor, that is, health-related professionals (Spearman's r = 0.453; p < 0.05). The C-QUEST device sub-scores were also weakly correlated with four domain scores of the WHO QoL-BREF (HK) (Spearman's r = 0.412-0.567; p < 0.05). Social relationship, participation in leisure and driving activities had a moderate association with scores of the WHO QoL-BREF (HK) (-0.405 > Spearman's r > -0.583; p < 0.05). It is concluded that community participation (e.g. use of transportation) and human environment (e.g. friends and peers) were more related to QoL, than to users' satisfaction with a wheelchair. Further research with a larger sample is recommended to examine the variables related to SCI and QoL.     

Barriers to colorectal cancer screening for people with spinal cord injuries and/or disorders: A qualitative study

BackgroundLimited research has shown people with spinal cord injuries and/or disorders (SCID) are less likely to be up to date with colorectal cancer (CRC) screening and therefore more likely to be diagnosed with advanced stage CRC compared to people without SCID.ObjectiveThe aims of this study were to assess knowledge about CRC, CRC screening, and self-reported barriers to CRC screening for people with SCID.MethodsInterviews with 30 individuals with SCID were conducted using a semi-structured interview guide, audio recorded, and transcribed. Coding was performed using a hybrid approach of inductive and deductive analysis. Thematic analysis was used to identify, review, and modify themes and sub-themes.ResultsThemes identified included barriers to CRC screening, such as socioeconomic, health system, transportation, psychological, and environmental or accessibility barriers. While most respondents were able to describe one CRC screening method (usually colonoscopy), knowledge of other screening modalities was limited. Low CRC literacy and misinformation about CRC screening appeared to increase respondent association between CRC screening and colonoscopy. While most respondents associated CRC screening with colonoscopy, almost half reported the colonoscopy preparation was the most substantial barrier to screening.ConclusionsIn addition to addressing identified barriers such as accessibility and transportation, communication, and prevention interventions should be specifically targeted to ensure all people with SCID are informed about appropriate and various modalities and the benefits of screening. Specific, evidence-based guidelines on the use of stool specimens first with follow up direct visualization, if needed, should be developed for this population.     

Exploring the factors that influence the goal setting process for occupational therapy intervention with an individual with spinal cord injury

This paper investigates the factors that influence the process that occurs between an individual with a spinal injury and his/her occupational therapist when setting goals for therapy intervention. A single case study design was adopted using a combination of in-depth semistructured interviews with a therapist and patient, and observation of occupational therapy treatment sessions. After analysis of the results, the following four categories emerged as influencing the goal setting process: the context for setting goals; the concept of independence; the features of goals; and the process dimensions of goal setting. The study highlights that the patient and therapist's respective views of independence, and their understanding of the features of goals may influence the success of the goal setting process. Further investigation into these areas is indicated.     

Evidence‐Informed Program Improvement: Using Principles of Effectiveness to Enhance the Quality and Impact of Family‐Based Prevention Programs

In recent years, federal, state, and local governments and other funding organizations have increased pressure for greater effectiveness and accountability of prevention programs, including those oriented toward families. This rising demand for program accountability has fueled a growing interest in evidence‐based programs. Drawing on what is known about evidence‐based prevention programs, we discuss some common principles of effective programs and present a process for how practitioners can use these principles to improve the quality and impact of existing family programs. We term this approach evidence‐informed program improvement.     

椎管储备间隙减少的过伸性颈髓损伤的颈前路治疗

目的 探讨椎管储备间隙减少的颈髓过伸性损伤的受伤特征和前路手术治疗效果.方法 回顾性分析大连医科大学附属二院骨外科于2004年3月～2009年3月收治的52例患者的临床资料,所有病例均经MRI提示为原有椎管储备间隙减少,其中所有病例均有颈间盘突出,27例患者存在椎管狭窄,根据对25例对于致压物主要在间盘水平的病例,将病变间隙突出间盘切除,自体髂骨植骨块植骨或带有自体骨颗粒的钛网或椎间融合器植骨融合钢板内固定术 对于27例存在明显椎管狭窄者,单纯间盘切除不能彻底减压,行椎体次全切除钛笼植骨融合钢板内固定术.术后对临床结果进行JOA评分 观察并记录患者的神经功能恢复、临床症状的改善及颈椎融合情况,比较手术前、术后随访时JOA评分,评价临床治疗效果.结果 49例患者获得随访,3例外地患者失访,时间6～24个月,平均随访时间是10个月.按JOA评分术前患者JOA评分为（8.55±1.52）分,半年随访时JOA评分为（12.87±1.68）分,采用配对t检验对术前、术后随访时JOA评分进行统计学分析,有显著性差异（P＜0.001,α=0.05）,其中将手术改善率为（56.37±5.58）%.术后随访平均5个月X线片示椎体间骨性融合.结论 对于椎管储备间隙减少基础上造成的颈椎过伸性损伤的患者,颈前路减压植骨加带锁钢板内固定手术是一种较好的选择.     

Clinical observations in vibratory stimulation of the penis of men with spinal cord injury

Less than 10% of men with complete spinal cord injury experience ejaculation in intercourse. Vibratory stimulation of the penis triggers a predictable series of body reactions in most men with lessions above the thoracic 11th spinal cord level. These reactions are very similar to the physical manifestations of the sexual response in men with intact nervous systems. Between half and three quarters of men with lesions above the thoracic 11th spinal cord level ejaculate. The spermatozoa count is within the normal range. but the percentage of motile spermatozoa is low. The reactions leading to ejaculation take between 30 sec and 3 min and are characterized by rhythmic abdominal and leg spasms, lowered, then elevated pulse rates, elevation of blood pressure, and after the culmination of these experiences, relaxation, tiredness, and a general feeling of well-being. Autonomic dysreflexia (elevation of the blood pressure and severe headache) was avoided with preventive medication. The observations suggest that interrelated ejaculatory centers may be located in the thoracic 11th-and-below areas of the spinal cord. The vibratory stimulation technique has positive implications for both the reproductive and sexual needs of men with spinal cord injury and their partners.The authors acknowledge the generous grant of the Mr. & Mrs. P. A. Woodward Foundation toward the Fertility Project at the G. F. Strong Rehabilitation Centre and the University Hospital, Shaughnessy Site.