The magnitude and correlates of alcohol and drug use before traumatic brain injury

OBJECTIVE: To describe preinjury alcohol and drug use and opportunities for secondary prevention among persons with recent traumatic brain injury (TBI). DESIGN: Survey. SETTING: Acute inpatient rehabilitation program. PARTICIPANTS: A total of 142 (91%) of 156 consecutive admissions who met inclusion criteria and were screened. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Alcohol and drug use questionnaires, alcohol problem questions, toxicology results, readiness to change, and treatment preference questions. RESULTS: Subjects were on average 37 years old, 80% were men, and 80% were white. Fifty-nine percent of the sample was considered "at-risk" drinkers and, as a group, subjects reported a high degree of preinjury alcohol-related problems. Thirty-four percent reported recent illicit drug use, and 42 (37%) of 114 cases with toxicology results were positive for illicit drugs. Motivation to change alcohol use correlated positively with greater self-reported alcohol consumption and problem severity. Most at-risk drinkers wanted to change on their own, whereas a minority were interested in treatment or Alcoholics Anonymous. CONCLUSION: Both alcohol abuse and drug use are common before TBI. Inpatient brain injury rehabilitation represents an important opportunity to identify and intervene in substance abuse problems.     

Satisfaction with sexual life among persons with traumatic spinal cord injury and meningomyelocele

PURPOSE: To study satisfaction with sexual life and self-assessed sufficiency of sexual counselling in persons with traumatic spinal cord injury (SCI) and meningomyelocele (MMC). METHOD: A postal questionnaire on aspects of health and functioning was answered by 190 persons with traumatic SCI who had been treated in the Spinal Injuries Unit in Sahlgrenska University Hospital, G?teborg, Sweden and 41 persons with MMC who were admitted to the Young Adult Teams in G?teborg, Bor?s and Sk?vde, Sweden. RESULTS: On a numerical scale from 0 (dissatisfied) to 10 (satisfied) the median of satisfaction with sexual life was 3 for the men and 4 for the women among the persons with traumatic SCI. In the MMC group the median of satisfaction with sexual life was 5 for the men and 8 for the women. Sexual dissatisfaction increased with increasing age in both groups. Inconvenience caused by urinary and faecal incontinence, as well as neuropathic pain increased sexual dissatisfaction in the men with traumatic SCI. A total of 69% of the men with traumatic SCI and 56-59% of the participants in other subgroups reported that the sexual counselling they had received was sufficient. CONCLUSIONS: The results corroborate findings from earlier studies that satisfaction with sexual life is rather low among persons with SCI. Especially ageing men with traumatic SCI who have sustained injury at an older age are a challenge for rehabilitation. The high satisfaction with sexual life in the women in comparison with the men with MMC is a finding not reported earlier. Our results suggest that adequate treatment of incontinence and pain might improve even sexual satisfaction. Sexual counselling should be given to all individuals with SCI and to their partners. Sexual counselling for young adults with MMC is an important part of the rehabilitation process.     

Changes in sexual activity following substance dependence treatment

Individuals who abuse alcohol and other drugs are at increased risk for HIV/AIDS, although time of greatest risk is unclear. Although many studies have documented decreased sexual risk behaviours following substance abuse treatment, some evidence indicates that sexual risk behaviours may actually increase with sobriety. In this study, individuals involved in a substance abuse treatment programme were asked about their sexual activity for the month prior to treatment and 6 months after treatment. Results showed higher levels of sexual activity, including risky sexual activity, 6 months after discharge from treatment. This increase was found for individuals regardless of whether they were abstaining from substance use at follow-up, with highest levels of sexual activity and risky sexual activity reported by those still consuming alcohol or other drugs. These findings support the need for inclusion of HIV/AIDS prevention and educational programmes during substance abuse treatment.     

Assault and substance abuse characterize burn injuries in homeless patients.

The homeless are at an increased risk for traumatic injury, but little is known about the injury etiology and outcome of homeless persons who sustain burn injuries. In this study, we analyze patient and injury characteristics of homeless persons admitted to a regional burn center. This is a retrospective cohort study of patients admitted to our burn center between 1994 and 2005. A total of 3700 adult patients were admitted during the study period and, of these, 72 (1.9%) were homeless. The cohort of homeless patients was compared with domiciled adult patients admitted during the same time period, analyzing baseline patient and injury characteristics and injury outcomes. Overall, homeless patients had more extensive burn injuries than domiciled patients (17.8% vs 11.2%TBSA, P < .001) and overall longer lengths of hospital stay (22 vs 12 days, P < .001). The homeless population also had significantly higher rates of alcohol (80.6% vs 12.8%, P < .001) and drug abuse (59.4% vs 12.8%, P < .001), history of mental illness (45.2% vs 11.0%, P < .001), and injury by assault (13.9% vs 2.0%, P < .001). Homeless patients tended to have more severe injuries; higher rates of substance abuse and mental illness; increased incidence of assault by burning; and longer lengths of hospital stay. Hospitalization of a homeless patient following injury may provide a unique opportunity to address co-occurring substance abuse and mental illness and approach injury prevention to improve patients' outcomes and reduce injury recidivism.     

Psychologic adjustment to spinal cord injury during first postdischarge year

A considerable body of clinical literature discusses patient adjustment to spinal cord injury (SCI) but there are few empirical data, particularly about postrehabilitation hospital adjustment. The present study targets changes in psychologic adjustment after initial rehabilitation hospitalization. Thirty-six persons with SCI completed a questionnaire designed to study such adjustment at 3 weeks, 3 months, and 1 year postdischarge. Twenty-nine able-bodied controls completed the same questionnaire at similar time intervals. Outcome measures used were the Beck Depression Inventory, the Wiggins Hostility Scale, and the Handicap Problems Inventory. Moderately increased depression and hostility in the SCI group compared to the able-bodied were found immediately postdischarge, but these differences were gone within a year. On a specific measure of adjustment to disability, the SCI group showed significantly increasing comfort with disability status over the same period. While there are reports of psychologic adjustment difficulties for persons with SCI postdischarge, the severity of these difficulties may have been overestimated and our findings suggest that problems appearing immediately after discharge appear to resolve rapidly.     

Use of psychoactive substances in persons with spinal cord injury: A literature review

ObjectiveTo undertake a critical review of literature on use of legal and illegal psychoactive substances (PAS) in persons with spinal cord injury (SCI) before and after trauma.Material and methodsHundred and five articles published between 1980 and 2014 on alcohol and drug use in persons with SCI before and after trauma were retrieved from the PubMed and PsycInfo search engines.ResultsBefore injury, 25% to 96% of people with SCI reported using alcohol, while 32% to 35% had used illegal drugs. At the time of injury, 31% to 50% of individuals with SCI were intoxicated with alcohol, 16% to 33% with drugs and 26% with a combination of drugs and alcohol. Among those reporting PAS use before injury, up to 50% stated that they had reduced their use during active rehabilitation, during which time only 6% consumed psychoactive substances for the first time. A variety of risk factors are associated with consumption subsequent to spinal cord injury: personality alteration (impulsiveness, aggressiveness), posttraumatic depression, poor coping skills, lack of social support and pain. PAS use can affect the process of rehabilitation, diminish the effectiveness of medication and result in various medical complications.Discussion/conclusionsFew studies have explored the use of alcohol, drugs and psychoactive medications before SCI and during active rehabilitation. To our knowledge, no study has analyzed the evolution of PAS use after hospital discharge, even though return home is associated with new stressors that may trigger risky behaviors. It should be a priority, as early as possible during rehabilitation, to detect persons at risk of developing PAS abuse.     

Satisfaction with sexual life among persons with traumatic spinal cord injury and meningomyelocele

Purpose. To study satisfaction with sexual life and self-assessed sufficiency of sexual counselling in persons with traumatic spinal cord injury (SCI) and meningomyelocele (MMC).

Method. A postal questionnaire on aspects of health and functioning was answered by 190 persons with traumatic SCI who had been treated in the Spinal Injuries Unit in Sahlgrenska University Hospital, Göteborg, Sweden and 41 persons with MMC who were admitted to the Young Adult Teams in Göteborg, Borås and Skövde, Sweden.

Results. On a numerical scale from 0 (dissatisfied) to 10 (satisfied) the median of satisfaction with sexual life was 3 for the men and 4 for the women among the persons with traumatic SCI. In the MMC group the median of satisfaction with sexual life was 5 for the men and 8 for the women. Sexual dissatisfaction increased with increasing age in both groups. Inconvenience caused by urinary and faecal incontinence, as well as neuropathic pain increased sexual dissatisfaction in the men with traumatic SCI. A total of 69% of the men with traumatic SCI and 56 – 59% of the participants in other subgroups reported that the sexual counselling they had received was sufficient.

Conclusions. The results corroborate findings from earlier studies that satisfaction with sexual life is rather low among persons with SCI. Especially ageing men with traumatic SCI who have sustained injury at an older age are a challenge for rehabilitation. The high satisfaction with sexual life in the women in comparison with the men with MMC is a finding not reported earlier. Our results suggest that adequate treatment of incontinence and pain might improve even sexual satisfaction. Sexual counselling should be given to all individuals with SCI and to their partners. Sexual counselling for young adults with MMC is an important part of the rehabilitation process.     

The relation of shoulder pain and range-of-motion problems to functional limitations, disability, and perceived health of men with spinal cord injury: a multifaceted longitudinal study

OBJECTIVES: To determine if shoulder pain and range-of-motion (ROM) problems can be predicted by demographic, injury-related, body weight, and radiographic data over 3 years and to determine the relationships among these shoulder problems and functional limitations, disability, and perceived health. DESIGN: A longitudinal, 2-panel study in which data were collected at 2 points in time, 3 years apart. SETTING: The community. PARTICIPANTS: Eighty-nine adult men with traumatic spinal cord injury (SCI) in the Houston-Galveston, TX, area. MAIN OUTCOME MEASURES: The acromioclavicular (AC) and the glenohumeral (GH) joints were x-rayed on plain film in standard anteroposterior position. Functional limitations were determined with the FIM instrument; disability was measured with the Craig Handicap Assessment and Reporting Technique (CHART). RESULTS: Thirty percent had shoulder pain and 22% had shoulder ROM problems. Men with shoulder pain had lived longer with SCI, were more likely to report shoulder ROM problems, had lower CHART mobility scores, and were more likely to rate their health as fair than those without shoulder pain. Shoulder ROM problems were more common among men who were older, had AC joint narrowing, had lower FIM scores, and reported poorer health. CONCLUSION: Shoulder pain and ROM problems were relatively prevalent. Demographic, injury-related, and radiographic variables were identified that were predictive of these problems over a period of at least 3 years. The shoulder problems were related to functional limitations, disability, and perceived health.     

外伤性脊髓损伤患者提高ADL能力所需住院康复治疗的时间

目的:探讨外伤性脊髓损伤(SCI)患者获取提高ADL能力较为合理的住院康复治疗时间。方法:观察28例外伤性SCI患者的康复过程,在康复治疗开始前及治疗后1、2、3、6和9个月时分别作出ADL评估,比较ADL得分情况及不同时间ADL能力提高的程度。结果:28例患者在经过3个月的住院康复治疗后,26例ADL评分获得显著提高,其中21例ADL能力获得提升,在随后6个月的治疗中,26例患者与治疗3个月时比较ADL评分无明显增高,ADL能力也未进一步提升。结论:外伤性SCI患者提高ADL能力合理的住院康复治疗时间应为3个月。     

Cognitive deficits in spinal cord injury: epidemiology and outcome.

Cognitive deficits are common among patients with acute spinal cord injury (SCI), but reported prevalence figures vary because of different methods of study. Factors associated with cognitive deficits in patients with SCI include age, educational background, history of learning disability, chronic alcohol and substance abuse, and concomitant or recurrent traumatic brain injury. Psychologic testing of patients with and without cognitive deficits indicates that impaired psychosocial adjustment and adaptation are more frequent in SCI patients who have evidence of cognitive deficits. Various associations have been found between neuropsychologic test performance and major depression. Cognitive functioning and premorbid educational level appear to be associated with medical stability, the patient's ability to assimilate the necessary skills for survival and adaptation after SCI, and readmission patterns after discharge for initial inpatient rehabilitation.     

A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: implications for treatment matching

OBJECTIVE: To describe empirically valid and clinically meaningful types of alcohol use among persons with recent traumatic brain or spinal cord injury. DESIGN: Cross-sectional cohort survey. SETTING: Acute inpatient rehabilitation program in a level I trauma center. PARTICIPANTS: A total of 218 (87%) of 250 consecutive initial admissions who met inclusion criteria and completed interviews. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Alcohol and drug use questionnaires, alcohol problem questions, admission toxicology results, readiness to change, and treatment preference questions. RESULTS: Participants were on average 37 years old, 84% were men, and 82% were white. Four types were identified by using k-means cluster analysis based on preinjury alcohol consumption, alcohol problems, and alcohol dependence. Cluster groups differed on extrinsic variables such as drug use, readiness to change, and interest in treatment or in attending Alcoholics Anonymous. The 4 types corresponded to those with a history of (1) alcohol abuse; (2) alcohol dependence; (3) alcohol dependence in remission, partial remission, or relapsed; and (4) normal or nondrinkers. CONCLUSION: More effective care may be possible if clinicians match common patient types to specific interventions such as education, motivational interventions, formal substance abuse treatment, and relapse prevention.     

Spinal cord injury and concomitant traumatic brain injury. Results of a longitudinal investigation

One-hundred fifty persons with traumatic onset spinal cord injury (SCI) were administered a comprehensive neuropsychologic test battery an average of 7 weeks after SCI, and 67 were retested using the same battery an average of 38 weeks after initial testing. It was hypothesized that if traumatic brain injury were a significant sequela of SCI, retesting would reveal evidence of cognitive recovery over time and would further enable a clearer separation of preinjury cognitive capacity from the effects of injury. Significant improvement in test performance occurred across time to the degree and in a pattern similar to that noted in persons who have sustained mild to moderate traumatic brain injury. Hypothesized relationships between level and extent of SCI, etiology of injury and presence/absence of loss of consciousness and neuropsychologic test scores were not observed. Implications for the rehabilitation process are discussed.     

Perceived information needs of community-dwelling persons with chronic spinal cord injury: Findings of a survey and impact of race

Objective. To examine the perceived information needs of community-dwelling individuals with chronic spinal cord injury (SCI) and to determine factors that influence these needs.

Design and participants. Cross-sectional survey mailed to 620 persons with chronic SCI who completed acute inpatient rehabilitation.

Results. Of 103 (17%) returned surveys, 82 contained complete information and were useable for this study. Individuals with chronic SCI (M time since injury = 7 ± 6 years) endorsed a multitude of information needs across a broad range of domains. Participant endorsements were most commonly observed in the areas of aging (73%), research (72%), financial aid (66%), and education (63%). Independent variables expected to influence information needs, including Internet use, whether the rehabilitation specialist also served as the primary care physician, and time since injury, showed no significant effect. Race/ethnicity was found to predict perceived information needs, with nonwhite participants endorsing a significantly greater degree of needs than white participants in 11 of 23 (48%) domains.

Conclusions. Perceived information needs of community-dwelling persons with SCI are not fully met years after discharge from acute inpatient rehabilitation, which may have implications with respect to psychological adjustment. Race/ethnicity appears to exert a significant influence on the endorsement of perceived information needs, but this finding must be investigated further considering other possible mediating/moderating variables. Results must be considered in light of the relatively low response rate of eligible participants.     

Chronic spinal cord injury pain: pharmacological and non-pharmacological treatments and treatment effectiveness

Purpose.?To describe pharmacological and non-pharmacological pain treatments used for chronic spinal cord injury pain (CSCIP) and current treatment effectiveness in a large Dutch population with a spinal cord injury (SCI).

Method.?Postal survey among 575 persons with SCI. The main outcome measures were the pain intensity score of the Chronic Pain Grade questionnaire, past and current pain treatments, and perceived effectiveness of current pain treatments.

Results.?Response rate was 49% (279 persons) and 215 respondents (77.1%) had CSCIP. Most respondents with CSCIP (62.8%) reported more than one pain type, of which neuropathic pain was most frequently reported (69.3%). Of this group with CSCIP, 63.8% was currently involved in some kind of treatment, but nevertheless high levels of pain (mean 52.8 on a 0–100 scale) were reported. Massage (therapy)/relaxation (training), anticonvulsants, and non-steroidal anti-inflammatory drugs (NSAIDs) were the most often used treatments. The current treatments that were most often perceived as effective were acupuncture/magnetising, cannabis/alcohol, physiotherapy and exercise, and massage (therapy)/relaxation (training). TENS/ultrasound and antidepressants were least often perceived as effective.

Conclusions.?Many SCI pain treatments have been tried. Acupuncture/magnetising, cannabis/alcohol, and physiotherapy and exercise were considered most effective. Further research is needed to establish effective SCI pain treatments.     

Perceived information needs of community-dwelling persons with chronic spinal cord injury: findings of a survey and impact of race

Objective. To examine the perceived information needs of community-dwelling individuals with chronic spinal cord injury (SCI) and to determine factors that influence these needs.

Design and participants. Cross-sectional survey mailed to 620 persons with chronic SCI who completed acute inpatient rehabilitation.

Results. Of 103 (17%) returned surveys, 82 contained complete information and were useable for this study. Individuals with chronic SCI (M time since injury = 7 ± 6 years) endorsed a multitude of information needs across a broad range of domains. Participant endorsements were most commonly observed in the areas of aging (73%), research (72%), financial aid (66%), and education (63%). Independent variables expected to influence information needs, including Internet use, whether the rehabilitation specialist also served as the primary care physician, and time since injury, showed no significant effect. Race/ethnicity was found to predict perceived information needs, with nonwhite participants endorsing a significantly greater degree of needs than white participants in 11 of 23 (48%) domains.

Conclusions. Perceived information needs of community-dwelling persons with SCI are not fully met years after discharge from acute inpatient rehabilitation, which may have implications with respect to psychological adjustment. Race/ethnicity appears to exert a significant influence on the endorsement of perceived information needs, but this finding must be investigated further considering other possible mediating/moderating variables. Results must be considered in light of the relatively low response rate of eligible participants.