Back injury prevention program on a spinal cord injury unit

A back injury prevention program was developed for the Spinal Cord Injury (SCI) nursing staff at the San Diego Veterans Affairs Medical Center (SDVAMC). This preventive program has the following components: 1. All nursing staff are sent to a one hour "back school" in order to learn and practice proper body mechanics. This program is held in the therapy clinic and conducted by a kinesiotherapist. In addition, each nurse must be certified in transfer techniques by our clinical nurse specialist, before performing transfers on patients. 2. All nursing staff participate in 5-10 minutes of stretching, warm-up exercises at the beginning of their shift. These exercises are helpful as injuries are less likely to occur when muscles have been warmed up prior to lifting and moving patients. 3. All nursing staff wear a lumbar sacral back support while on duty. This device will offer physical support to the lower back as well as provide a mental reminder to use proper body mechanics when transferring patients. This back injury prevention program has been in effect since the opening of the SCI unit in March 1989. The rate of low-back injuries on the SCI unit from October 1989 to September 1990 was compared to the rate of low-back injuries on the other hospital units. As a result of this program, there were only four low-back injuries with six lost work days on the SCI unit. This rate compares favorably with the incidence of low-back injuries in other patient care areas.     

应用作业疗法治疗脊髓损伤性截瘫

应用作业疗法对脊髓损伤性截瘫患者进行康复医疗20例,其病程3个月～2年。完全截瘫19例;不完全截瘫1例;颈髓损伤3例;胸髓损伤13例;腰髓损伤3例;马尾神经损伤1例。治疗结果:显效者11例(55％);有效者7例(35％);无效者2例(10％)。总有效率为90％。     

Implementation of standards of practice: a spinal cord injury program

Developing and implementing standards of spinal cord injury nursing practice is an essential component of a program for evaluating and ensuring quality patient care. A comprehensive program for monitoring SCI nursing care as developed at the James A. Haley Veterans Hospital is described. Over a 12-month period, nursing staff utilized standards of practice to assure attainment of expected patient outcomes and increased staff involvement in the SCI quality assurance program. Evaluation of the task force project provides implications for use in other nursing practice settings.     

Pediatric spinal cord injury

Although the incidence of spinal cord injury in childhood is lower than in adults, the impact is significant when the number of years with resulting severe limitations are considered. Prevention is the key to spinal cord management in all age groups, but takes on a stronger, more emphasized sense of urgency with children. If methods of prevention fail, successful early management of a child with spinal cord injury is the best hope for a future filled with accomplishments.     

Sex education and counseling program on a spinal cord injury service.

A sex education and counseling program was designed for spinal cord-injured patients and their partners, and alternative approaches are briefly reviewed. Also notable is the importance of inservice training for staff working with the cord-injured.     

Assessment of a holistic wellness program for persons with spinal cord injury

OBJECTIVE: To test the effectiveness of a holistic (comprehensive and integrated) wellness program for adults with spinal cord injury. DESIGN: A total of 43 adults with spinal cord injury were randomly assigned to intervention or control groups. The intervention group attended six half-day wellness workshops during 3 mos, covering physical activity, nutrition, lifestyle management, and prevention of secondary conditions. Outcome measures included several physical measures and standard psychosocial measures. Statistical analyses included paired t tests, used to determine within-group differences, and multiple regression conducted to assess between-group differences. RESULTS: When comparing within-group baseline and final results, the intervention group reported fewer and less severe secondary conditions by the end of the study. Similarly, significant improvements were found in health-related self-efficacy and health behaviors. No significant changes in physiologic variables were observed. Although no significant between-group differences were observed, regression analyses suggested participation in the wellness program may be associated with improved health behaviors. CONCLUSION: Within-group comparisons suggest improvements in several areas of the participants' overall health behaviors. These findings, although preliminary, emphasize the potential role of health behaviors in positively influencing long-term health outcomes and quality of life.     

持续性脊髓压迫对脊髓损伤程度的影响

目的 探讨脊髓损伤(SCI)后脊髓压迫时间对损伤程度的影响。方法 以大脑皮层诱发电位(CSEP)和不同压迫时间为参数,自行设计一种犬的运动—静止压迫型SCI模型,选择T13为损伤中心,压迫脊髓,当 CSEP波幅下降达基础值的 50%时,维持静止压迫。将28只犬随机分为A、B、C、D 4组,A、B、C组脊髓分别受压30 min、90 min和180 min,D组为对照组,观察各组动物的组织病理学、影像学和行为学变化。结果 损伤组脊髓组织学均有损害,MRI显示损害程度随脊髓受压时间的延长逐渐加重( P<0.01);至术后28 d,各损伤组动物后肢功能均有恢复,BBB分级评分法评估组间有显著性差异( P <0.05)。结论 SCI后持续性脊髓压迫能加重损伤程度,应尽早解除脊髓压迫。     

Locomotor training within an inpatient rehabilitation program after pediatric incomplete spinal cord injury

BACKGROUND AND PURPOSE: The outcomes of intense locomotor training after incomplete spinal cord injury (SCI) have been described in adults with acute and chronic injuries and with various levels of ambulatory function. This case report describes a comprehensive inpatient rehabilitation program with a locomotor training component in a child with a severe incomplete SCI. CASE DESCRIPTION: A 5-year-old girl injured at C4 participated in locomotor training for 5 months during inpatient rehabilitation. OUTCOMES: The patient's Functional Independence Measure for Children II (WeeFIM II) mobility score increased from 5/35 to 21/35. Her Walking Index for Spinal Cord Injury II (WISCI II) score improved from 0 to 12. The patient returned to walking in the community with assistive devices. DISCUSSION: It is feasible to include an intense locomotor training program in the clinical rehabilitation setting for a child with a severe SCI, and the outcomes were consistent with results in adults. Further investigation with experimental designs and more participants will determine the extent to which this intervention benefits the pediatric population with SCI.     

Burns after spinal cord injury

The problem of burns after spinal cord injury is described. Chart review was performed on thirty-five known cases. All burns occurred below the level of the lesion (p less than .001). Causes included bathing and showering, food and beverage, and therapeutic and environmental heating devices. We conclude that spinal cord injured patients should be educated about the risk of burn injury and the situations in which burns can occur.     

Rehabilitation in spinal cord injury

Caring for the new quadriplegic is an immense undertaking involving multiple health care professionals who must function as a team. The physician in charge must understand rehabilitation principles and be able to communicate with all members of the team caring for the patient. Rehabilitation principles, if considered early, can greatly decrease the length of stay of the patient and allow him to maximize his potential for recovery. A basic knowledge of physicial and occupational therapy in paraplegia and quadriplegia in the acute stage as well as functional expectations in the long term have been presented.     

脊髓损伤后疼痛

各种文献所报道的脊髓损伤 (ｓｐｉｎａｌｃｏｒｄｉｎｊｕｒｙ ,ＳＣＩ)后疼痛的发生率差异很大 ,有报道称发生率为5 %— 70 % [1] ,也有报道认为 ,ＳＣＩ后疼痛很常见 ,其发生率一般可达到 6 5 % ,其中大约有 1/ 3属于严重疼痛[2 ] 。ＳＣＩ后疼痛会对患者的康复治疗以及日常活动造成不良影响 ,使其生活质量降低[3、4 ] 。但目前对ＳＣＩ后疼痛仍然缺乏有效的治疗措施 ,因此 ,有必要进行深入的研究。1影响ＳＣＩ后疼痛的因素在可能影响ＳＣＩ后疼痛的各种因素中[5、6 ] ,对损伤性质 (完全性或不完全性 )、损伤平面、心理状况等因素的研究…     

Employment after spinal cord injury

A predictive model for employment after spinal cord injury was developed. The study population consisted of 154 spinal cord injured persons who were treated at our hospital between 1973 and 1979, and followed for seven years after injury. Demographic, social, and injury severity data were abstracted from each subject's hospital record. Motivation to work, employment history, and sources of postinjury financial support, were assessed by a vocational rehabilitation counselor. The study population was divided into four groups: persons continuously unemployed after injury, homemakers, students, and those employed at some time during the seven-year follow-up period. Stepwise discriminant analysis was used to develop a predictive model that ultimately included seven variables: gender, motivation to work, whether the patient's last job required ambulation, race, educational level, a functional ability score, and whether the patient had children. The model correctly classified 82% of those persons who were continuously unemployed, 100% of homemakers, 63% of students, and 72% of employed subjects. Overall, 79% of subjects were classified correctly. The most important classification errors were between the unemployed and employed groups. Seventeen percent of employed patients were incorrectly classified as unemployed, and 11% of unemployed patients were incorrectly classified as employed. Although there are other determinants of postinjury vocational status, individual potential can be assessed by means of a comparatively small set of predictor variables.     

Sexuality and spinal cord injury

In the United States, more than 250,000 people are living with spinal cord injury (SCI). SCI is most often the result of direct trauma to the spinal cord, but can also be associated with congenital or degenerative disease. These individuals experience physical and psychologic consequences that have a profound impact on their sexual health. Using a holistic, developmental, team approach to care, the nurse is well positioned to address the acute and long-term sexual rehabilitation needs of the SCI patient. By assisting SCI patients through the grieving process and promoting a positive, yet realistic, self-concept, nurses can mitigate potential problems in body image disturbances, decreased self-esteem, and gender-specific sexuality issues.     

Sexuality and spinal cord injury

Spinal cord injury may have a profound effect on the patient's sexuality. In order to maximize the patient's potential, concern and support from health care professionals is needed. This article reviews normal sexual function and changes occurring following spinal cord injury. The PLISSIT model is described and is used to describe nursing interventions designed to deal with the sexual concerns of spinal cord-injured patients.     

Neonatal spinal cord injury.

In this review of the prognosis of patients having neonatal spinal cord injury, findings in 3 patients and 11 case histories from the literature are evaluated as to obstetric complications, clinical and pathologic examinations, and follow-up data from 2 to 12 years, or until death of the child. Eight of the 14 patients died: 4 at less than 3 months of age, 3 between 3 months and 1 year of age, and 1 at 3 1/2 years of age. Six children survived for more than 2 years for follow-up examination. Survival is dependent on the level of the lesion, with cervical lesions being almost incompatible with life. The quality of survival for those with levels of C8-T1 and below depends on the child's multiple medical complications.     

Pain after spinal cord injury

Evaluation of pain in a person with SCI should commence with a determination of the neurologic level and the completeness of injury. The pain then can be localized to one of three regions: above level, at level, or below level. The regional pain then should be categorized either as nociceptive or neuropathic and, after this, subdivided into a specific subtype. An evidence based treatment plan can be devised depending on the specific subtype, which may include physical measures, pharmacologic treatments, behavioral interventions, surgery, or an eclectic combination program. The treatment plan usually can provide some relief for any of the subtypes, although complete relief often is not possible.