Masculine role variables and outcomes among men with spinal cord injury

Purpose.?Few studies have considered the impact of masculine role variables on outcome and adjustment to SCI among men. The present study examined the relations among SCI, views of masculinity, psychological adjustment, and rehabilitation outcomes among men with SCI.

Method.?The sample included 20 men with SCI receiving inpatient rehabilitation, with a mean age of 45 years. Data included demographic variables as well as Conformity to Masculine Norms Inventory (CMNI), Gender Role Conflict Scale (GRCS), Functional Independence Measure (FIM), and Satisfaction with Life Scale ratings, and change in marital status.

Results.?The findings revealed that satisfaction with life was positively related to scores on the CMNI Violence scale, FIM change from admission to discharge was positively related to the CMNI Emotional Control scale and negatively related to the CMNI Dominance scale. Change in marital status was inversely related to the CMNI Emotional Control and Primacy of Work scales and the GRCS Restricted Emotionality and Power, Success, and Competition scales.

Conclusions.?The findings show that certain aspects of the traditional masculine role (i.e., ability to modulate strong emotions) may be adaptive in the rehabilitation process, whereas other aspects (i.e., a dominant interpersonal style) may present a barrier to effective rehabilitation.     

Forgiveness and health-related outcomes among people with spinal cord injury

Purpose.?As motor vehicle accidents and violence cause the majority of spinal cord injuries (SCI) sustained in the USA and people with SCI will likely struggle with emotional issues related to the offender, the purpose of this exploratory study was to examine potential salutary effects of forgiveness among people with SCI incurred traumatically. Specifically, we hypothesized that forgiveness would have positive associations with health-related outcomes.

Method.?A community-based sample of 140 adults (19–82 years of age) with SCI completed a self-report survey regarding dispositional forgiveness of self and others, health behavior, health status, and life satisfaction. Hierarchical multiple regression analyses were employed to examine the relationships in question.

Results.?After controlling for demographic variables, forgiveness of self was significantly associated with health behavior and life satisfaction (uniquely accounting for 7% and 13% of the variance, respectively) and forgiveness of others was significantly associated with health status (uniquely accounting for 9% of the variance).

Conclusion.?Results suggest that forgiveness may play a role in the health and life satisfaction of people with traumatic SCI, with the benefit depending on the type of forgiveness offered.     

Outcomes of nurse caring as perceived by individuals with spinal cord injury during rehabilitation.

A study was undertaken to describe the meaning, process, and consequences of nurse caring from the perspective of persons with spinal cord injuries (SCI) during rehabilitation. The constant comparative method, or grounded theory, was used in this prospective, exploratory project. In-depth tape-recorded interviews were conducted with 22 participants throughout their initial rehabilitation stay. A process of knowledge acquisition and decision making, facilitated by nurses and therapists in special caring relationships with the persons with SCI, resulted in outcomes of well-being, self-care, autonomy in decision making, independence, and hope, all of which contributed to the persons with SCI's reintegration of self before their discharge from inpatient rehabilitation.     

Earnings among people with spinal cord injury

Krause JS, Terza JV, Dismuke C. Earnings among people with spinal cord injury.

Objective

To identify differences in conditional and unconditional earnings among participants with spinal cord injury (SCI) attributable to biographic, injury, educational, and employment factors by using a 2-part model (employment, earnings).

Design

A secondary analysis of cross-sectional survey data.

Setting

A Midwestern university hospital and a private hospital in the Southeastern United States.

Participants

All participants (N=1296) were adults between the ages of 18 and 64 who had a traumatic SCI at least 1 year before study initiation.

Interventions

Not applicable.

Main Outcome Measures

Earnings were defined by earnings within the previous 12 months and were measured by a single categoric item. Conditional earnings reflect the earnings of employed participants, whereas unconditional earnings reflect all participants with $0 in earnings recorded for those unemployed.

Results

Sex and race were significantly related to conditional earnings, even after controlling for educational and vocational variables. Additionally, conditional earnings (employed participants only) were related to 16 or more years of education, number of years employed, the percentage of time after SCI spent employed, and working in either government or private industry (not self-employed or family business). There was a greater number of significant variables for unconditional earnings, largely reflective of the influence of the portion employed (those not working having $0 in earnings).

Conclusions

Efforts to improve employment outcomes should focus on facilitating return to work immediately after injury, returning to preinjury job, maintaining regular employment, and working for placement in government or private industry. Special efforts may be needed to promote vocational outcomes among women and nonwhites.     

Effect and process evaluation of implementing standardized tests to monitor patients in spinal cord injury rehabilitation

Purpose.?To evaluate the implementation of standardized physical and functional tests to monitor patients with a spinal cord injury (SCI) in eight rehabilitation centers and to analyze the enablers and the barriers of the implementation process.

Method.?The method involved prospective effect and process evaluation. Team members responded to mailed questionnaires at the start (n?=?115) and end (n?=?82) of the 1-year implementation period. Furthermore, a questionnaire was administered to managers (n?=?8), coordinators (n?=?8), and 32 persons with SCI in four centers. Outcome of the effect evaluation was the phase of implementation of standardized testing in each center. The process evaluation analyzed enablers and barriers of the implementation process.

Results.?After a year of implementation, half of the centers shifted to higher implementation phases. None of the centers was classified in the highest phase. Enablers were the positive attitude of the team members regarding standardized testing and an encouraging local coordinator. Most important barrier was lack of time to implement the standardized testing.

Conclusion.?There is a large support for implementing standardized tests to monitor patients with SCI. During the 1-year, a positive shift was visible in the extent of implementation. Successful implementation of patient monitoring requires substantial amounts of time and effort of the rehabilitation centers involved.     

Investigating employment following spinal cord injury: outcomes,methods, and population demographics

Purpose: The purpose of this review was to synthesize the literature about spinal cord injury and employment, focusing on sample demographics, indicators of employment outcome, and the methods used. The review included literature from the previous decade; 2006–2017.

Methods: A systematic quantitative literature review methodology was utilized, wherein papers’ characteristics were extracted and categorized in a database according to their topics, employment outcome indicators, populations, locations, and methods. Frequency tables were generated and cross-tabulated to yield conclusions about the outcomes of the studies and the methods and samples used to yield these outcomes.

Results: The review highlighted three key themes; the emergence of broader employment outcome measures that go beyond employment rate; a lack of consistency in the reporting of sample characteristics such as time since injury or ethnicity; and the relative lack of research focusing on people with newly acquired spinal cord injury.

Conclusions: The literature review identified a number of limitations in the existing research including the lack of standardized reporting of employment outcomes and a need for increased consistency in reporting sample characteristics. In addition, there are gaps in the research about people with newly acquired spinal cord injury, particularly regarding the timing of interventions.

• Implications for Rehabilitation

• Spinal cord injury has the potential to disrupt a person’s career across their lifespan.

• Employment rate is the gold standard for evaluating employment outcomes.

• Broader measures of employment, including job retention and hours worked, have potential in evaluating and improving the quality of employment outcomes for this population.

• Further research with people with newly acquired spinal cord injuries would better support the provision of vocational rehabilitation services earlier in a person’s rehabilitation, potentially preserving jobs.

     

综合康复治疗对脊髓损伤后肌痉挛的影响

目的 观察颈、胸段脊髓损伤后肌痉挛患者经过综合康复治疗后的疗效，以及患者病程对康复治疗效果的影响。方法 将30例颈、胸段脊髓损伤后肌痉挛患者根据其病程分为早期组和晚期组，并分别给予运动治疗、热疗及气压式四肢血液循环促进装置等综合康复治疗，治疗前、后进行MAS评定。结果 2组患者治疗前、后MAS评分差异有显著性意义，并且早期组疗效优于晚期组。结论 对于脊髓损伤后肌痉挛应尽早采取综合康复治疗。     

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.     

Long-term community reintegration: concepts,outcomes and dilemmas in the case of a military service member with a spinal cord injury

Abstract

Purpose: Despite growing knowledge about medical and functional recovery in clinical settings, the long-term issue of community reintegration with a spinal cord injury (SCI) in the military context remains virtually unexamined. Thus, the U.S. Department of Defense created the SCI Qualitative Research Program to advance knowledge about service members’ reintegration into civilian life. The purpose of this paper is to better characterize the long-term outcomes related to the community participation experienced and desired vis-à-vis a case study of a military veteran who suffered a service-related traumatic SCI. Methods: An in-depth anthropological interview was used with Jake, a 28-year old marine with a service-related C5/C6 SCI. Data were analyzed using content analysis. Findings: Three significant themes were identified: opportunities for better engaging socially meaningful others may not be adequately included in so-called “client-centered” interventions; how management of the social self in inter-personal interactions and public spaces is critical to gaining broader societal acceptance; and how meaningful age normative relationships and activities are essential to establish lasting inclusive social connections. Conclusions: Jake’s case challenges existing models of rehabilitation predominantly focused on physical capacity building. Study findings point to the need for rehabilitation to invest more resources in efforts to address the existential and social elements of long-term social reintegration.

• Implications for Rehabilitation

• Both the veteran with SCI and their meaningful support network face challenges socially reintegrating after injury and rehabilitation.

• Empowering clients to envision future possibilities in terms of family, intimate relationships, and meaningful work are important to successful long-term social reintegration.

• Addressing the existential desires and social capacities of the individual may be as important as addressing physical functioning skills after SCI.

     

电针结合耳针治疗急性脊髓损伤的临床研究

目的评估电针结合耳针治疗急性脊髓损伤的疗效和安全性。方法我院1999年1月～2004年5月期间急性脊髓损伤美国脊髓损伤学会（ASIA）损伤分级A级和B级患者56例，随机分为针灸治疗组和对照组。针灸治疗组采用双侧后溪和申脉点电针，与脊髓相关耳穴的耳针，同时配合康复治疗。对照组仅仅采用康复治疗。分别记录入院时、出院时及出院后1年ASIA损伤分级及ASIA神经（运动、感觉）功能状况评分、独立性功能评定（FIM）及不良反应。结果在神经（感觉和运动）功能和FIM评分方面针灸治疗组优于对照组（P〈0．05），无明显不良反应。结论早期采用电针结合耳针治疗急性脊髓损伤有较好的疗效和安全性。     

Utilisation of patient perspective to validate clinical measures of outcome following spinal cord injury

Purpose. The purpose of this article is to utilise the perspective of persons with a spinal cord injury (SCI), gained from focus groups, to validate recommended clinical measures of outcome.

Method. Clinical measures of outcome as recommended by Wood-Dauphinee and the SCI Consensus Group were categorised using the World Health Organisation's International Classification of Functioning, Disability and Health (ICF). These were then cross-referenced to the problems of functioning identified by patients in 10 focus groups held in New Zealand as part of the International ICF Core Set project. The focus groups were performed separately for people in the post-acute situation and in the chronic situation to address different experiences since SCI.

Results. In the post-acute group, the recommended measures of functioning, the Functional Independence Measure (FIM), Hospital Anxiety and Depression Scale and Visual Analogue Scale for pain correlated well against the focus groups identification of problems of functioning. In the chronic group, the short-form Craig Handicap Assessment and Reporting Technique (sf-CHART), the SF-12 and the Life Satisfaction Questionnaire (LSQ) largely captured the problems of functioning identified. There were some categories that were common to both patient groups and were not changed by time since SCI. In addition, there were some problems of functioning identified by the patient groups that were not covered by the suggested measures.

Conclusions. Utilisation of a battery of outcome measures based on a theoretical framework can quantify problems of functioning in the SCI population. Although the measures suggested by SCI Consensus Group largely capture the problems of functioning, other outcome measures have been shown to be more responsive to the changes in the SCI population and also incorporate more of the identified problems of functioning.     

脊髓损伤病人的康复护理

从心理护理、制定康复护理目标、饮食指导、体位护理、膀胱功能训练、并发症的预防和护理、肢体功能训练、康复教育等8个方面介绍了脊髓损伤病人的康复护理。     

脊髓损伤病人的康复护理

从心理护理、制定康复护理目标、饮食指导、体位护理、膀胱功能训练、并发症的预防和护理、肢体功能训练、康复教育等8个方面介绍了脊髓损伤病人的康复护理。     

Minimal trauma causing fractures in patients with spinal cord injury

The osteoporosis that accompanies spinal cord injury renders bones more susceptible to fracture following minor degrees of trauma. Diagnosis is often delayed due to a subtle presentation with non-specific signs. Three cases are reported that illustrate characteristic features of long-bone fractures in spinal cord injury.     

Fatigue,pain, and depression: an invisible triad among persons with spinal cord injury

Background: Individuals with spinal cord injury (SCI) face an increased chance of secondary health complications. Fatigue, pain, and depression are among the most common of these complications, and may contribute to further disability post-injury. Prior cross-sectional studies have documented that fatigue, pain, and depression are correlated in patients with SCI, however there is a limited understanding of their temporal relationships.

Objectives: To examine the temporal relationships between fatigue, pain, and depression in persons with SCI.

Methods: This study is a prospective cohort study. Participants with SCI were recruited upon admission to an inpatient rehabilitation unit. Fatigue (Fatigue Severity Scale), pain (Brief Pain Inventory), and depression (Centre for Epidemiological Studies–Depression scale) were assessed at three points: baseline (within one week of admission), at the time of discharge, and into the community at six months post-discharge. Structural Equation Modeling was performed to test the directional relationships over time.

Major findings: The association between fatigue, pain, and depression grew in magnitude over time in the SCI rehabilitation. Pain at baseline and depression at discharge best predicted fatigue at discharge. Pain at baseline also predicted depression at discharge, which had an indirect effect on fatigue. Fatigue at follow-up was poorly predicted by baseline and discharge variables.

Conclusion: The present longitudinal study suggests temporal relationships whereby pain is followed by later depression and fatigue. These findings will allow clinicians to more effectively monitor and treat common comorbidities during SCI rehabilitation.     

外伤致脊髓损伤患者的康复期护理

目的:探讨外伤后脊髓损伤患者康复期的护理要点。方法:通过康复治疗小组进行治疗及心理支持,对108例外伤后脊髓损伤康复期患者实施各种康复护理措施。对可能出现的各种并发症,护士及早的康复介入,循序渐进,进行防治。结果:经过康复护理的早期介入,提高了脊髓损伤患者的生活质量,调动了脊髓损伤患者的主动性,发挥其残存功能,帮助他们重归家庭和社会。结论:外伤后脊髓损伤患者的康复,要尽早开始,减少并发症,并依靠患者自身的努力,改善生活自理能力。     

脊髓损伤的康复与预后

本文重点介绍完全性和不完全性脊髓损伤（SCI）神经恢复及行走功能预后，同时阐述运动损伤平面与功能预后的关系及提高远期康复目标的新治疗方法。     

脊髓损伤痉挛评估量表的信度及各量表间的相关性分析

目的 探讨分析脊髓损伤痉挛状态评估工具(SCI-SET)量表、改良Penn痉挛频率(MPSFS)量表、脊髓痉挛性反应评估工具(SCATS)量表和目测类比法量表(VAS)评估脊髓损伤患者肌肉痉挛的信度及各量表间相关性。 方法 2位治疗师分别应用上述4个量表对35例脊髓损伤患者的痉挛情况进行评估。首先,第一位物理治疗师应用上述4个量表对患者的肌肉痉挛情况进行第1次评估,另一位物理治疗师在第一位物理治疗师评估结束约半个小时后对患者再进行1次评估。3d后,由第一位物理治疗师在相同时间段和环境下对所有患者进行第2次重复评估。计算各量表重复评估及不同测试者间评估的组内相关系数（ICC）及其相应的测量标准误（SEM）、最小可测得差异值（MDD95）,分析第一位治疗师首次评估结果各量表间的相关性。 结果 SCI-SET量表的重测信度和不同测试者间的信度均为优秀（ICC=0.969和0.989）;MPSFS量表的重测信度为优秀（ICC=0.940）,不同测试者间的信度为好（ICC=0.898）;SCATS量表的重测信度和不同测试者间的信度均为优秀（ICC=0.948和0.939）;VAS量表评估痉挛的重测信度和不同测试者间的信度均为优秀（ICC=0.962和0.974）。SCI-SET、MPSFS、SCATS以及VAS等脊髓损伤痉挛评估量表的相关性分析结果显示,各痉挛量表间均有显著相关性（P<0.05）,其中SCI-SET与其它量表间呈负相关,而其余各量表间均呈正相关。SCI-SET与MPSFS间（r=-0.421）、SCI-SET与SCATS间（r=-0.457）以及MPSFS与SCATS间（r=0.498）呈中等相关性,而其它量表两两之间相关性较高（r=0.548～0.938）,且差异均有统计学意义（P<0.05）。 结论 MPSFS、SCATS、VAS 和SCI-SET量表具有良好的重测信度和测试者间信度,适用于脊髓损伤后痉挛的评估。