The impact of early spasticity on the intensive functional rehabilitation phase and community reintegration following traumatic spinal cord injury

Context/Objectives: To determine the impact of spasticity presenting during the acute care hospitalization on the rehabilitation outcomes following a traumatic spinal cord injury (TSCI).

Design: Retrospective cohort study.

Setting: A single Level 1 trauma center specialized in SCI care.

Participants: 150 individuals sustaining an acute TSCI.

Interventions: Not applicable.

Outcome Measures: The total inpatient functional rehabilitation length of stay. The occurrence of medical complications and the discharge destination from the inpatient functional rehabilitation facility were also considered.

Results: 63.3% of the cohort presented signs and/or symptoms of spasticity during acute care. Individuals with early spasticity developed medical complications during acute care and during intensive functional rehabilitation in a higher proportion. They were also hospitalized significantly longer and were less likely to return home after rehabilitation than individuals without early spasticity. Early spasticity was an independent factor associated with increased total inpatient rehabilitation length of stay.

Conclusion: The development of signs and symptoms of spasticity during acute care following a TSCI may impede functional rehabilitation outcomes. In view of its association with the occurrence of early spasticity, higher vigilance towards the prevention of medical complications is recommended. Early assessment of spasticity during acute care is recommended following TSCI.     

Epidemiological features of traumatic spinal cord injury in Chongqing,China

Objective: To describe the epidemiological characteristics and trends of traumatic spinal cord injury in Chongqing, China.

Study design: Hospital-based retrospective research.

Setting: Xinqiao Hospital, Chongqing.

Methods: We reviewed medical records of 554 patients with traumatic spinal cord injury (TSCI) admitted to Xinqiao Hospital from 2009 to 2013. Variables included gender, age, marital status, etiology, occupation, time of injury, level of injury, and severity of injury, the length of hospital stay, and treatment.

Results: The mean age of patients with TSCI was 45.6 ± 13.8 years, and the male/female ratio was 4.33:1. 94.2% (522 patients) of all patients with TSCI were married. Falls, comprising low falls and high falls (10.8% and 50.9%, respectively), were the leading reason for a hospital visit. And the second reason was MVCs (21.8%). The most common injury site was the cervical spinal cord, accounting for nearly more than 54%. The length of hospital stay ranged between 1 and 219 days (mean: 28.3 days). The proportions of complete tetraplegia, incomplete tetraplegia, complete paraplegia and incomplete paraplegia were 17.1%, 37.8%, 22.2%, and 22.9%, respectively.

Conclusion: The result revealed that the proportion of males was higher, as well as falls and MVCs were the first two main reasons, with older mean age of patients with TSCI than other countries. The occupations with highest risk for TSCI were peasants and laborers. All of these results prompted that preventive methods should be based on the characteristics of different type of patients with TSCI.     

Traumatic vs non-traumatic spinal cord injury: A comparison of primary rehabilitation outcomes and complications during hospitalization

Objective: To compare outcome for patients with traumatic (TSCI) and non-traumatic spinal cord injuries (NTSCI) after primary rehabilitation regarding neurological improvement measured by the American Spinal Injury Association Impairment Scale (AIS), length of stay and complications.

Design: Retrospective comparative cohort study on patients with TSCI and NTSCI, hospitalized during a ten-year period at Haukeland University Hospital, Norway. Impairment, length of stay and complications during first in-patient rehabilitation period were analyzed. Uni- and multivariate analysis was performed.

Setting: Spinal Cord Rehabilitation Unit, Haukeland University Hospital, Norway

Participants: A total of 174 persons with a spinal cord injury (SCI) were included; 102 with TSCI and 72 with NTSCI.

Outcome measures: Neurological improvement measured by AIS from admission to discharge, number of weeks in the hospital, frequency and significance of complications were compared.

Results: Improvement in AIS after primary rehabilitation did not differ between TSCI and NTSCI. Length of stay was in average 3.4 weeks longer for TSCI. Urinary tract infections and pressure ulcers significantly influenced length of stay in both groups. Urinary tract infections were more frequent in TSCI (67%) vs NTSCI (42%). Pressure ulcers were more frequent among NTSCI (24%) vs TSCI (14%). Pneumonia and neuropathic pain did not depend on etiology and did not influence length of stay.

Conclusions: Patients with SCI have a rehabilitation potential regardless of etiology. Complications are frequent in both groups and often prolong hospitalization. Complication patterns differ in the two groups, and specific prevention and optimal treatment will shorten and optimize the length of primary rehabilitation.     

Aps Funded Research Projects

Abstract

Objectives: Determine the unique effects of age across a variety of outcome domains following spinal cord injury (SCI).

Design: Cross-sectional; 61 32 individuals with traumatic onset SCI in the National Spinal Cord Injury Statistical Center (NSCISC) database.

Outcome Measures: Functional Independence Measure (FIM) , Sat isfaction With Life Scale (SWLS) , the Craig Hand icap Assessment and Reporting Technique (CHART), and the Short Form-12 (SF-12).

Results: Older age was most consistently associated with decreased self-reported outcomes across most domains assessed. More specifically, a significant linear decline with age was found for functional independence (FIM) , overall life satisfaction (SWLS) , perceived physical health (SF-12 physical health), and overall handicap (CHART-total score), particularly in the areas of physical independence, mobility, occupational functioning, and social integration (CHART subscales). However, regression analyses, controlling for numerous demographic and medical characteristics, indicated that the amount of unique variance that could be specifically attributed to age was relatively small. Age was unrelated to self-reported mental health (S F-1 2 mental health subscale) and economic functioning (CHART -economic self-sufficiency subscale). Pain interference in day-to-day activities (ie, a single item from SF-12) significantly increased with age.

Spinal Cord Med. 2003;26:37-44     

Epidemiology of traumatic spinal cord injury in Tianjin,China: An 18-year retrospective study of 735 cases

Study Design: Hospital-based retrospective study

Objectives: To evaluate the pathogenetic features of traumatic spinal cord injury (TSCI) during 1999–2016 according to changed injury etiology with time, explore different characteristics of patients suffered a TSCI during 1999–2007 and 2008–2016 in Tianjin, China.

Setting: Tianjin Medical University General Hospital

Methods: In this study, the medical records of TSCI patients were obtained from Tianjin Medical University General Hospital (TMUGH) from 1st January 1999 to 31th December 2016. Variables were recorded, including age, gender occupation, etiology, the level of injury, America Spinal Injury Association (ASIA) impairment scale, the severity, concomitant injuries, death and its cause. To explore the differences in characteristics by etiology and by two periods, related statistical methods were used to calculate the correlation of some variables. Differences in etiology of TSCI during 1999–2016 were evaluated and differences in epidemiological characteristics were separately compared and analyzed between the 1999–2007 period and the 2008–2016 period.

Results: From 1999–2016, 831 TSCI cases were identified and 96 cases were excluded from analyses. The male-to-female ratio was 2.9:1 and the mean age was 49.7±15.2 years, which changed significantly between 1999–2007 (45.1±14.2) and 2008–2016 (51.6±15.2). Traffic accidents (45.8%) were the leading cause of TSCI during the 1999–2007 period, followed by low falls (30.7%). However, the opposite result was observed during the 2008–2016 period. Significant difference was observed compared with thoracic, lumbar and sacral levels, cervical level was the most commonly affected levels and the percentage decreased to a certain degree between 1999–2007 and 2008–2016 (from 84.4% to 68.9%). The proportions of ASIA grades A, B, C, and D were 20.5%, 10.3%, 23.3%, and 45.9%, respectively. The percentage of complete tetraplegia decreased from 22.9% in 1999–2007 to 13.2% in 2008–2016, and the percentage of incomplete paraplegia increased from 9.7% to 27.9%.

Conclusion: According to the changes in the epidemiological characteristics of TSCI, relevant health service, laws and regulations, preventative strategies should be readjusted to follow up the changing situation and epidemiological characteristics of TSCI.     

Statewide Investigation of Medically Attended Adverse Health Conditions of Persons With Spinal Cord Injury

Abstract

Background/Objective: To report over a 10-year period the statewide prevalence and incidence of medically attended adverse health conditions in people with new traumatic spinal cord injury (TSCI).

Design: Retrospective cohort study.

Methods: (a) Identified all new TSCI cases discharged alive from statewide acute care hospitals, 1996 to 2000, using ICD-9-CM methodology, (b) Followed cases from 1996 to 2005 to quantify medically attended health conditions documented during emergency department visits, acute care hospitalizations, and outpatient hospital visits, (c) Used the life table method to calculate the prevalence and incidence of health conditions, (d) Examined Cox proportional hazard ratio of mortality by gender controlling for age and TSCI severity.

Results: Nine hundred eighty-eight residents (257 women, 731 men) with TSCI were alive 90 days after discharge from acute care hospitalization from 1996 to 2000. Nine hundred twenty-three (251 female, 672 male) (93.4%) residents had an observed medically attended adverse health condition in the 10-year follow-up period. The most prevalent classes of diseases and disorders were (a) muscle and connective tissue, (b) renal and urinary, (c) digestive, (d) circulatory, (e) respiratory, (f) endocrine/nutritional/metabolic, and (g) infectious. Incidence of new injury was 29.0% for males and 26.9% for females. During the follow-up period, 49 women (19%) and 104 men (14%) died.

Conclusions: People with TSCI experience diverse adverse health conditions in the 10 years after initial injury. An interdisciplinary health care provider team approach to allocating resources and implementing countermeasures to prevent or limit occurrence of these conditions is vital to these patients’ continuum of care.

J Spinal Cord Med. June 2010; 33(3): 221–231     

Mortality and causes of death after traumatic spinal cord injury in Estonia

Abstract

Study design

Retrospective population-based study with mortality follow-up.

Objective

To study mortality, causes and risk factors for death in Estonian patients with traumatic spinal cord injury (TSCI).

Setting

All Estonian hospitals.

Methods

Medical records of patients with TSCI from all regional, central, general, and rehabilitation hospitals in Estonia from 1997 to 2007, were retrospectively reviewed. Mortality status was ascertained as of 31 December 2011. Causes of death were collected from the Estonian Causes of Death Registry. Standardized mortality ratios (SMRs) were calculated for the entire sample and for causes of death. A Cox proportional hazards modeling was used to identify the risk indicators for death.

Results

During the observation period (1997–2011) 162 patients of 595 died. Nearly half of the patients (n = 76) died during the first year after TSCI. The main causes of death were external causes (30%), cardiovascular disease (29%). and suicide (8%). The overall SMR was 2.81 (95% confidence interval 2.40–3.28) and SMR was higher for women than for men (3.80 vs. 2.70). Cause-specific SMRs were markedly elevated for sepsis and suicide. Mortality was significantly affected by the age at the time of injury, neurological level, and extent of the injury as well as the year of TSCI and complications.

Conclusion

Life expectancy is significantly decreased in patients with TSCI in Estonia compared with the general population. Deaths during the first year after the injury have an important impact on statistics. Treatment of cardiovascular diseases, infections, and prevention of suicide are useful for reducing mortality in patients with TSCI.     

Evaluating prehospital care of patients with potential traumatic spinal cord injury: scoping review

Purpose

To gain insight into current research regarding prehospital care (PHC) in patients with potential traumatic spinal cord injury (TSCI) and to disseminate the findings to the research community.

Methods

In March 2019, we performed a literature search of publications from January 1990 to March 2019 indexed in PubMed, gray literature including professional websites; and reference sections of selected articles for other relevant literature. This review was performed according to Arksey and O’Malley’s framework.

Results

There were 42 studies selected based on the inclusion criteria for review; 18 articles regarding immobilization; 12 articles regarding movement, positioning and transport; four for spinal clearance; three for airway protection; and two for the role of PHC providers. There were some articles that covered two topics: one article was regarding movement, positioning and transport and airway protection, and two were regarding spinal clearance and the role of PHC providers.

Conclusion

There was no uniform opinion about spinal immobilization of patients with suspected TSCI. The novel lateral trauma position and one of two High Arm IN Endangered Spine (HAINES) methods are preferred methods for unconscious patients. Controlled self-extrication for patients with stable hemodynamic status is recommended. Early and proper identifying of potential TSCI by PHC providers can significantly improve patients’ outcomes and can result in avoiding unwanted spinal immobilization. Future prospective studies with a large sample size in real-life settings are needed to provide clear and evidence-based data in PHC of patients with suspected TSCI.

     

Social Support and Coping Strategies in Patients with Traumatic Brachial Plexus Injury

Background

Emotional and social characteristics may influence rehabilitation and recovery after traumatic brachial plexus injury.

Purposes

We sought to investigate if traumatic brachial plexus injury patients have different levels of social support and employ distinct coping strategies from uninjured control subjects. In addition, we studied which coping strategies are more commonly used among traumatic brachial plexus injury patients.

Methods

Questionnaires for social support (Interpersonal Support Evaluation List and Social Support Questionnaire) and coping strategies (Brief-Coping Orientation to Problems Experienced) were administered to traumatic brachial plexus injury patients and an age- and sex-matched volunteer cohort (without brachial plexus injury).

Results

There were no differences in interpersonal support (mean [SD] = 26.0 [8.6], 26.5 [6.8]), number of persons available for emotional support, and satisfaction with support between traumatic brachial plexus injury patients (n = 36) and volunteers (n = 43). The following coping strategies were more common among traumatic brachial plexus injury patients: active coping, self-distraction, denial, behavioral disengagement, venting, planning, self-blame, and acceptance.

Conclusion

Patients with traumatic brachial plexus injury have similar levels of social support as healthy volunteers but are more likely to use an array of coping strategies. Surgeons and other clinicians should be aware of coping strategies favored by patients, particularly the potential for behaviors detrimental to recovery such as behavioral disengagement, self-blame, and denial. This work will inform future investigations into the influence of social support and coping strategies on clinical outcomes after traumatic brachial plexus injury.

     

The Effects Of Colostomy On The Quality Of Life In Patients With Spinal Cord Injury: A Retrospective Analysis

Abstract

Purpose: The purpose of this study was to evaluate the effects of colostomy on the quality of life (QOL) in patients with spinal cord injury (SCI) by designing a questionnaire that used self-reported data and correlating these data with the clinical information obtained from patients' medical records.

Materials and methods: A comprehensive QOL questionnaire was designed to specifically address the following 5 domains: physical health, psychosocial adjustment, body image, self-efficacy, and recreation/leisure. This questionnaire was completed during a telephone or an in-person interview. The subjective data derived from the questionnaire were correlated with objective medical information obtained from a review of medical records.

Results: The QOL improved significantly (t = 9.128, P < .0001) after colostomy. All 27 (100%) patients were “satisfied,” and 16 (59%) of them were “very satisfied” with colostomy. Nineteen (70%) patients would have preferred to have the colostomy done earlier, and only 3(11%) patients wished it reversed. Colostomy reduced the number of hospitalizations caused by chronic bowel dysfunction by 70.4%. After colostomy, the average amount of time spent on bowel care was reduced from 117.0 min/day to 12.8 min/day (t = 7.964, P < .0001). All patients stated that colostomy simplified bowel care routine and increased independence. Significant improvements were recorded in the areas of physical health, psychosocial adjustment, and self-efficacy. Stoma prolapse and wound dehiscence were the most common complications of stomal surgery. When compared with medical data, patients were able to reliably recall average time with bowel problems (r = .881, P < .0001) and stomal surgery complications (r = .810, P < .0001).

Conclusion: Colostomy is a safe and effective treatment for chronic bowel dysfunction in patients with spinal cord injury. It is well accepted by the patients and significantly improves QOL and bowel management procedures. Correlation analysis indicates that subjective patient-reported data are consistent with objective data obtained from the medical records.     

Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations of Saskatchewan: a prospective outcomes study

BackgroundPeople of Aboriginal (Indigenous) ancestry are more likely to experience traumatic spinal cord injury (TSCI) than other Canadians; however, outcome studies are limited. This study aims to compare Aboriginal and non-Aboriginal populations with acute TSCI with respect to preinjury baseline characteristics, injury severity, treatment, outcomes and length of stay.MethodsThis was a retrospective analysis of participants with a TSCI who were enrolled in the prospective Rick Hansen Spinal Cord Injury Registry (RHSCIR), Saskatoon site (Royal University Hospital), between Feb. 13, 2010, and Dec. 17, 2016. Demographic, injury and management data were assessed to identify any differences between the populations.ResultsOf the 159 patients admitted to Royal University Hospital with an acute TSCI during the study period, 62 provided consent and were included in the study. Of these, 21 self-identified as Aboriginal (33.9%) and 41 as non-Aboriginal (66.1%) on treatment intake forms. Compared with non-Aboriginal participants, Aboriginal participants were younger, had fewer medical comorbidities, had a similar severity of neurologic injury and had similar clinical outcomes. However, the time to discharge to the community was significantly longer for Aboriginal participants (median 104.0 v. 34.0 d, p = 0.016). Although 35% of non-Aboriginal participants were discharged home from the acute care site, no Aboriginal participants were transferred home directly.ConclusionThis study suggests a need for better allocation of resources for transition to the community for Aboriginal people with a TSCI in Saskatchewan. We plan to assess outcomes from TSCI for Aboriginal people across Canada.     

The Effects Of Sildenafil On The Cardiovascular Response In Men With Spinal Cord Injury At Or Above The Sixth Thoracic Level

Abstract

Background: Sildenafil is efficacious for erectile dysfunction in men with spinal cord injury (SCI), but can induce hypotension in neurologically intact people. Those with SCI at or above the sixth thoracic level (T6) often have pre-existing hypotension, yet the cardiovascular response to sildenafil has not been studied in this group.

Objective: To evaluate the effect of sildenafil on the cardiovascular response in men with complete SCI at or above T6.

Methods: This was a randomized, double-blind, placebo-controlled, cross-over study. Twenty-three SCI participants were each randomly given placebo; sildenafil, 50 mg; and sildenafil, 1 00 mg; separated by at least 1 week. The following were measured before administration, and hourly for 4 hours afterward: (a) blood pressure (BP) and heart rate (HR) , both supine and sitting; and (b) perceived dizziness on a visual analog scale upon sitting.

Results: Analysis was done using a 4-way repeated-measures analysis of variance. No significant changes occurred with placebo. Sildenafil caused the following changes. Systolic BP changed little in thoracic spinal cord-injured (TSCI) participants, but decreased significantly (P < 0.005) in cervical spinal cord-injured (CSCI) participants. Diastolic BP decreased in all participants (P < 0.005). HR increased in the TSCI participants for 1 hour (P < 0.05), but was not altered in the CSCI participants. Dizziness increased in the TSCI participants after administration of 100 mg (P < 0.05) and in the CSCI participants after administration of 50 mg (P < 0.05). There were no adverse events or outcomes.

Conclusion: Sildenafil induces significant hypotension in people with cervical-level injuries-more so than in thoracic-level injuries-and can cause dizziness in both populations. It should be prescribed with caution and informed consent from the patient.     

The comparison of recovery patterns between ischemic spinal cord injury and traumatic spinal cord injury from acute to chronic phase

Objective: To investigate the neurological and functional recovery patterns of ischemic spinal cord injury (ISCI) compared with traumatic spinal cord injury (TSCI) in the acute to chronic phase.Design: Retrospective cohort study.Settings: Department of Neurology, Neurosurgery, Rehabilitation Medicine at a tertiary hospital.Participants: Fifty-four patients with ISCI and 86 patients with TSCI.Interventions: Not applicable.Outcome measures: MRI findings, American Spinal Injury Association Impairment Scale (AIS), modified Rankin Scale (mRS), Korean Spinal Cord Independence Measure (KSCIM), ambulatory status, and bladder status were reviewed. The functional outcomes were measured at admission, discharge, and >6 months after discharge.Results: AIS classification did not significantly change after 6 months in both ISCI and TSCI groups. Between admission and discharge, the proportion of patients needing a wheelchair or assistive device to ambulate decreased more in the ISCI group compared with the TSCI group [odds ratio (OR) 0.40, P = 0.04]. In addition, the proportion of catheterized voiding in the ISCI group was significantly higher than in the TSCI group at all time points (OR 5.12, P < 0.001). Lastly, both groups showed that functional improvement was the greatest between admission and discharge. In addition, the proportion of catheterized voiding decreased (Diff = −0.12, P = 0.019) and mRS score decreased (Diff=−0.48, P < 0.001) significantly in the ISCI group at >6 months post discharge.Conclusion: The ISCI group showed better recovery of mobility during inpatient rehabilitation period and worse recovery of bladder function as demonstrated by higher number of patients requiring bladder catheterization at all time points when compared with the TSCI group.     

Epidemiology of Traumatic Spinal Cord Injury in the Netherlands: Emergency Medical Service,Hospital, and Functional Outcomes

Background:Evaluating treatment of traumatic spinal cord injuries (TSCIs) from the prehospital phase until postrehabilitation is crucial to improve outcomes of future TSCI patients.Objective:To describe the flow of patients with TSCI through the prehospital, hospital, and rehabilitation settings and to relate treatment outcomes to emergency medical services (EMS) transport locations and surgery timing.Method:Consecutive TSCI admissions to a level I trauma center (L1TC) in the Netherlands between 2015 and 2018 were retrospectively identified. Corresponding EMS, hospital, and rehabilitation records were assessed.Results:A total of 151 patients were included. Their median age was 58 (IQR 37–72) years, with the majority being male (68%) and suffering from cervical spine injuries (75%). In total, 66.2% of the patients with TSCI symptoms were transported directly to an L1TC, and 30.5% were secondarily transferred in from a lower level trauma center. Most injuries were due to falls (63.0%) and traffic accidents (31.1%), mainly bicycle-related. Most patients showed stable vital signs in the ambulance and the emergency department. After hospital discharge, 71 (47.0%) patients were admitted to a rehabilitation hospital, and 34 (22.5%) patients went home. The 30-day mortality rate was 13%. Patients receiving acute surgery (<12 hours) compared to subacute surgery (>12h, <2 weeks) showed no significance in functional independence scores after rehabilitation treatment.Conclusion:A surge in age and bicycle-injuries in TSCI patients was observed. A substantial number of patients with TSCI were undertriaged. Acute surgery (<12 hours) showed comparable outcomes results in subacute surgery (>12h, <2 weeks) patients.     

The influence of level of spinal cord injury on adipose tissue and its relationship to inflammatory adipokines and cardiometabolic profiles

Objective: Level of injury (LOI) and the role of adipose tissue and its proinflammatory adipokines in cardiometabolic dysfunction following spinal cord injury (SCI) remains poorly understood. We aim to examine the influence of LOI on adipose tissue and its relationship to proinflammatory adipokines and cardiometabolic profiles following SCI.

Design: Cross sectional and correlational study.

Setting: Clinical hospital and academic setting.

Participants: Forty-seven individuals with chronic motor complete SCI (age 43.8±11.5 y, BMI: 27.3±5.3) were classified as having tetraplegia (TSCI; n=12) or paraplegia (PSCI; n=35).

Intervention: Non applicable.

Outcome Measures: Visceral (VAT) and subcutaneous (SAT) adipose tissue volumes were measured using magnetic resonance imaging. Proinflammatory adipokines (tumor neurosis factor-α, interleukin-6 (IL-6), plasminogen activatable inhibitor-1, thrombin-activatable fibrinolysis inhibitor, and high-sensitivity c-reactive protein) and cardiovascular, carbohydrate, and lipid profiles were assessed according to standard techniques.

Results: VAT volume was greater in TSCI versus PSCI (p=0.042); however, after covarying for age this significance was lost (p>0.05). IL-6 was significantly elevated in TSCI (p<0.05), while other markers of inflammation generally were elevated, but did not reach statistical significance (p>0.05). Systolic blood pressure and total cholesterol were significantly lower in TSCI (p<0.05), while fasting glucose was significantly lower in PSCI (p<0.05). A number of proinflammatory adipokines and cardiometabolic markers significantly correlated with adipose tissue depots by LOI (p<0.05).

Conclusion: The results show that LOI does not influence the distribution of adipose tissue, but does influence proinflammatory adipokines and cardiometabolic profiles following SCI. Further research is needed to evaluate impact of lean body mass on these findings.     

Secondary conditions in a community sample of people with spinal cord damage

Objective: To compare secondary conditions in people with traumatic spinal cord injury (SCI) and non-traumatic spinal cord dysfunction (SCDys).

Design: Survey; completed August 2012 – June 2013.

Setting: Community, Australia.

Participants: Adults with spinal cord damage from any cause.

Interventions: Nil.

Outcome Measures: Demographic and clinical variables and the SCI-Secondary Conditions Scale (SCI-SCS).

Results: Survey completed by 150 people: 112 (74.7%) with traumatic SCI and 38 (25.3%) with non-traumatic SCDys a median of 10 years post onset. No significant difference (t?=?–0.6, P?=?0.6) in the total SCI-SCS score between those with SCI (mean 13.7) and SCDys (mean 14.4). Except for bladder problems (SCDys mean?=?1.5, SD?=?1.1; SCI mean?=?1.0, SD=1.1; t?=?–2.6, P?=?0.01) there were no significant differences between the aetiology groups regarding the conditions comprising the SCI-SCS (all other P values >0.1). The most common significant or chronic problems from the SCI-SCS were: sexual problems 41%; chronic pain 24%; bladder dysfunction 17%; spasms 17%; joint and muscle pain 15%; bowel dysfunction 14%; circulation problems 14%; contractures 9%; urinary tract infections 9%; pressure ulcer 7% and postural hypotension 5%. A linear regression analysis found that tetraplegia and higher disability were the only variables that significantly influenced (R²?=?0.13; P?=?0.005) the total SCI-SCS score and that sex, age, years post injury and etiology of spinal cord damage had no influence.

Conclusions: Secondary conditions following spinal cord damage do not appear to be influenced by etiology. Prevention and management of secondary conditions following need to consider people with non-traumatic SCDys as well as those with traumatic SCI.     

Comparison of Rehabilitation Outcomes in Violent Versus Non-violent Traumatic SCI

Abstract

This paper represents the results of a cohort study comparing functional outcomes of individuals with violent and non-violent traumatic spinal cord injury (SCI) following inpatient rehabilitation. Twenty-seven consecutive patients with a diagnosis of traumatic SCI of violent etiology (gunshot wound, stabbing or assault) and 27 patients with non-violent etiology (motor vehicle accident and falls) were matched for neurological level of injury and classification. Demographic comparison of violent versus non-violent groups revealed mean age 30 versus 39, gender 93 percent versus 78 percent male, race 89 percent versus 59 percent non-white, 74 percent versus 41 percent unmarried and 56 percent versus 22 percent unemployed, respectively. Violent and non-violent traumatic SCI groups had similar lengths of stay, admission and discharge functional independent measures (FIM), FIM improvement, payor sources, hospital charges and discharge to home rates. Despite the differences noted in the demographics of violent and non-violent traumatic SCI, these two matched groups achieved similar functional outcomes and discharge disposition following inpatient rehabilitation. (J Spinal Cord Med 1998;21:32-36)     

Poster Presentations

Objective: To evaluate age-related variation in mobility independence among community-living wheelchair users with spinal cord injury (SCI).

Design: Community Survey (2011–2013) as part of the Swiss Spinal Cord Injury Cohort Study.

Setting: Community.

Participants: Individuals aged 16 years or older with traumatic or non-traumatic SCI permanently residing in Switzerland and using a wheelchair for moving around moderate distances (10–100?m).

Interventions: Not applicable.

Outcome Measures: Mobility-related items of the Spinal Cord Independence Measure-Self Report were matched to the three principal domains “changing basic body position,” “transferring oneself” and “moving around.” Binary outcomes (“independence” vs. “no independence”) were created for every domain and analyzed using multivariable logistic regression (adjusted for sex, socioeconomic factors, SCI characteristics, and health conditions).

Results: Regression analyses (N?=?949; 27% women; median age 51, interquartile range 41–61) showed a decline in the odds of independence (odds ratio; 95% confidence interval) with increasing age for “changing basic body position” (age 16–30 (reference), 31–45 (0.99; 0.53–1.83), 46–60 (0.64; 0.33–1.21), 61–75 (0.45; 0.22–0.92), 76+ (0.18; 0.07–0.44); P?Conclusions: Mobility independence was negatively associated with age in wheelchair users with SCI. Future longitudinal analyses are required to gain further insights into the causal factors for the age-related decline.