Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury

Stenson KW, Deutsch A, Heinemann AW, Chen D. Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury.

Objective

To examine the effect of obesity on change in FIM self-care and mobility ratings and community discharge for patients with traumatic spinal cord injury (SCI).

Design

Retrospective cohort study analyzing National Model Systems SCI Database data.

Setting

Fourteen Model Systems SCI programs.

Participants

Patients (N=1524) with a new traumatic SCI discharged from Model Systems rehabilitation centers between October 2006 and October 2009.

Interventions

None.

Main Outcome Measures

Change in FIM self-care and mobility ratings, discharge destination. Separate analyses were conducted by neurologic category: paraplegia incomplete, paraplegia complete, tetraplegia incomplete, and tetraplegia complete.

Results

Of all patients with traumatic SCI, approximately 25% were obese at admission. Patients who were obese were more likely to be married and slightly older than nonobese patients. In patients with paraplegia incomplete, obese patients had lower FIM self-care (−1.9; 95% confidence interval [CI], −3.4 to −.4) and mobility score gains (−1.5; 95% CI, −2.9 to −.1) than normal-weight patients. For patients with paraplegia complete, obese patients had significantly lower self-care (−2.2; 95% CI, −3.5 to −.8) and mobility score gains (−2.7; 95% CI, −3.9 to −1.5). For patients with tetraplegia incomplete and tetraplegia complete, FIM self-care and mobility ratings for obese patients were not significantly different from ratings for normal-weight patients. Within each neurologic category, the percentage of patients discharged to the community was not significantly different for nonobese and obese patients.

Conclusions

Obesity appears to be a barrier to meeting self-care and mobility functional goals for patients with paraplegia in inpatient SCI rehabilitation.     

Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes

Macciocchi S, Seel RT, Warshowsky A, Thompson N, Barlow K. Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes.ObjectiveTo determine the impact of co-occurring traumatic brain injury (TBI) on functional motor outcome and cognition during acute spinal cord injury (SCI) rehabilitation.DesignProspective, longitudinal cohort.SettingSingle-center National Institute of Disability and Rehabilitation Research SCI Model System.ParticipantsPersons aged 16 to 59 years (N=189) admitted for acute SCI rehabilitation during the 18-month recruitment window who met inclusion criteria.InterventionsNot applicable.Main Outcome MeasuresFIM Motor Scale (Rasch transformed) and acute rehabilitation length of stay (LOS).ResultsIn the tetraplegia sample, co-occurring TBI was not related to FIM Motor Scale scores or acute rehabilitation LOS despite having negative impacts on memory and problem solving. Persons with paraplegia who sustained co-occurring severe TBI had lower admission and discharge FIM Motor Scale scores and longer acute rehabilitation LOS than did persons with paraplegia and either no TBI or mild TBI. Persons with paraplegia and severe TBI had lower functional comprehension, problem solving, and memory and impairments on tests of processing speed compared with persons with paraplegia and no TBI, mild TBI, and moderate TBI. Persons with paraplegia and co-occurring mild and moderate TBI had equivalent acute rehabilitation motor outcomes and cognitive functioning compared with persons with paraplegia and no TBI.ConclusionsThis study provides evidence that persons aged 16 to 59 years with paraplegia and co-occurring severe TBI had worse motor outcomes and longer acute rehabilitation LOS than did persons with paraplegia and no TBI. Impairments in processing speed, comprehension, memory, and problem solving may explain suboptimal motor skill acquisition. Research with larger samples is required to determine whether mild and moderate TBI impact acute rehabilitation motor outcomes and LOS.     

创伤性脊髓损伤的早期康复效果

目的：确定创伤性脊髓损伤（SCI）的自然病程和早期康复的效果。设计：回顾性,多中心研究。环境：16所Rosai医院,1所医学院。参加者：123例SCI病人,其中男104例,女19例,平均年龄：(48.8±17.7）岁。干预：将病人分成早期康复组和延迟康复组。利用国际SCI分类表对差别进行测量。测量：利用美国脊髓损伤协会（ASIA）的分类标准将运动功能的康复率（MRR）表示为（出院时的ASIA运动分数－入院时的ASIA运动分数）/（100－入院时的ASIA运动分数）。利用MRR分期确定6个亚组（早期或晚期四肢瘫,中央脊损伤,偏瘫）的FIM和ASIA…     

Early rehabilitation effect for traumatic spinal cord injury

OBJECTIVE: To determine the natural course of traumatic spinal cord injury (SCI) and the effect of early rehabilitation on it. DESIGN: A retrospective, multicenter study. SETTING: Sixteen Rosai hospitals and 1 medical school. PARTICIPANTS: One hundred twenty-three SCI patients (104 men, 19 women; mean age, 48.8 +/- 17.7yr) enrolled. INTERVENTIONS: Dividing the subjects into an early rehabilitation group and a delayed group; differences were ensured by international classification of SCI. MAIN OUTCOME MEASURES: Using the American Spinal Injury Association (ASIA) classifications, the motor recovery rate (MRR) was defined as (ASIA motor score at discharge - ASIA motor score at admission)/(100 - ASIA motor score at admission). The regression lines for FIM instrument score and ASIA motor score were determined for 6 subgroups (early or delayed tetraplegia, central cord injury, paraplegia) by the MRR staging. The regression lines for physical or cognitive FIM score and ASIA motor score were also determined for 6 subgroups. RESULTS: Three stages were obtained: acute stage: 2 weeks postinjury; recovery stage: 2 weeks to 6 months postinjury; and chronic stage: more than 6 months postinjury. Regression lines showed that rehabilitation improved physical functional independence for ASIA motor score, especially in the early rehabilitation subgroups. There was no correlation between cognitive FIM score and ASIA motor score in 6 subgroups. CONCLUSION: Early SCI rehabilitation contributes to good physical activities of daily living for motor function.     

Medical rehabilitation for patients recovering from traumatic injuries to the cervical spine with spinal cord damage

This article discusses the operating premises of the rehabilitation process for persons with traumatic injuries to the cervical spine. The various stages in the rehabilitation process are described, along with the difficulties encountered by the rehabilitation team in the course of treatment. The problems associated with the future development of medical rehabilitation for SCI patients are also discussed.     

Association of antidepressant medication therapy with inpatient rehabilitation outcomes for stroke, traumatic brain injury, or traumatic spinal cord injury

Weeks DL, Greer CL, Bray BS, Schwartz CR, White JR Jr. Association of antidepressant medication therapy with inpatient rehabilitation outcomes for stroke, traumatic brain injury, or traumatic spinal cord injury.

Objective

To study whether outcomes in patients who have undergone inpatient rehabilitation for stroke, traumatic brain injury (TBI), or traumatic spinal cord injury (TSCI) differ based on antidepressant medication (ADM) use.

Design

Retrospective cohort study of 867 electronic medical records of patients receiving inpatient rehabilitation for stroke, TBI, or TSCI. Four cohorts were formed within each rehabilitation condition: patients with no history of ADM use and no indication of history of depression; patients with no history of ADM use but with a secondary diagnostic code for a depressive illness; patients with a history of ADM use prior to and during inpatient rehabilitation; and patients who began ADM therapy in inpatient rehabilitation.

Setting

Freestanding inpatient rehabilitation facility (IRF).

Participants

Patients diagnosed with stroke (n=625), TBI (n=175), and TSCI (n=67).

Interventions

Not applicable.

Main Outcome Measures

FIM, rehabilitation length of stay (LOS), deviation between actual LOS and expected LOS, and functional gain per day.

Results

In each impairment condition, patients initiating ADM therapy in inpatient rehabilitation had longer LOS than patients in the same impairment condition on ADM at IRF admission, and had significantly longer LOS than patients with no history of ADM use and no diagnosis of depression (P<.05). LOS for patients initiating ADM therapy as inpatients even exceeded LOS for patients without ADM history, but who had a diagnosis for a depressive disorder. Deviation in LOS was significantly larger in the stroke and TBI groups initiating ADM in IRF than their counterparts with no history of ADM use, illustrating that the group initiating ADM therapy in rehabilitation significantly exceeded expected LOS. Increased LOS did not translate into functional gains, and in fact, functional gain per day was lower in the group initiating ADM therapy in IRF.

Conclusions

Explanations for unexpectedly long LOS in patients initiating ADM in inpatient rehabilitation focus on the potential for ADM to inhibit therapy-driven remodeling of the nervous system when initiated close in time to nervous system injury, or the possibility that untreated sequelae (eg, depressive symptoms or fatigue) were limiting progress in therapy, which triggered ADM treatment.     

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.     

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.     

Wheelchair back-support options: functional outcomes for persons with recent spinal cord injury

OBJECTIVE: To evaluate the functional outcomes for people with a recent spinal cord injury (SCI) when using 3 different back-support options. DESIGN: Repeated-measures within-subject comparison. SETTING: Rehabilitation center. PARTICIPANTS: Twenty-seven manual wheelchair users with recent SCI. INTERVENTIONS: Three types of wheelchair back supports--a standard sling upholstery, a Jay J2 back, and a Pindot PaxBac--were used by each participant to evaluate performance of 4 functional tasks. MAIN OUTCOME MEASURES: Functional tasks included timed forward wheeling, ramp ascent, distance for forward vertical reach, and 1-stroke push. Product satisfaction was also rated. RESULTS: For most participants, best performance for each task varied with back support used. Significant differences in functional performance were found for the reaching activity (P=.01), with greater reach when the J2 was used. Satisfaction ratings also differed significantly (P=.017), with participants indicating greater satisfaction with the J2. Participants' choice of back support varied and did not consistently correspond with best performance. CONCLUSIONS: Except for reaching, performance of functional activities did not differ depending on back support used. Objective evaluation of reaching ability may assist in product decision making. Inclusion of a consistent battery of functional tasks could provide a standardized reference point for clients' subjective evaluations.     

Work participation among persons with traumatic spinal cord injury and meningomyelocele1.

OBJECTIVE: To study injury-related and individual factors as predictors of work participation in persons with traumatic and congenital spinal cord injury. DESIGN: Cross-sectional questionnaire study. SUBJECTS: One hundred and eighty-two persons with traumatic spinal cord injury treated in the Spinal Injuries Unit in Sahlgrenska University Hospital, G?teborg, Sweden, and 48 persons with meningomyelocele admitted to the Young Adult Teams in G?teborg, Bor?s and Sk?vde, Sweden. METHODS: A structured questionnaire was sent by post. Main outcome variable was participation in work. Logistic regression modelling was used to study the associations between the potential predictors and work participation. RESULTS: Employment rates were 47% in the traumatic spinal cord injury group and 38% in the meningomyelocele group. The presence of other somatic or mental disorder, and neuropathic pain decreased work participation among the men with traumatic spinal cord injury. Among persons with meningomyelocele, better ambulatory status and higher educational level increased work participation. In all groups higher independence in daily activities increased the probability of work participation. According to multivariable modelling carried out for the men with traumatic spinal cord injury, age over 55 years and the presence of mental disorder decreased work participation. CONCLUSION: Our data show that work participation is affected by individual and injury-related factors. Of the latter, many can be affected by rehabilitation.     

Computer and internet use by persons after traumatic spinal cord injury

Goodman N, Jette AM, Houlihan B, Williams S. Computer and internet use by persons after traumatic spinal cord injury.

Objective

To determine whether computer and internet use by persons post spinal cord injury (SCI) is sufficiently prevalent and broad-based to consider using this technology as a long-term treatment modality for patients who have sustained SCI.

Design

A multicenter cohort study.

Setting

Twenty-six past and current U.S. regional Model Spinal Cord Injury Systems.

Participants

Patients with traumatic SCI (N=2926) with follow-up interviews between 2004 and 2006, conducted at 1 or 5 years postinjury.

Interventions

Not applicable.

Results

Results revealed that 69.2% of participants with SCI used a computer; 94.2% of computer users accessed the internet. Among computer users, 19.1% used assistive devices for computer access. Of the internet users, 68.6% went online 5 to 7 days a week. The most frequent use for internet was e-mail (90.5%) and shopping sites (65.8%), followed by health sites (61.1%). We found no statistically significant difference in computer use by sex or level of neurologic injury, and no difference in internet use by level of neurologic injury. Computer and internet access differed significantly by age, with use decreasing as age group increased. The highest computer and internet access rates were seen among participants injured before the age of 18. Computer and internet use varied by race: 76% of white compared with 46% of black subjects were computer users (P<.001), and 95.3% of white respondents who used computers used the internet, compared with 87.6% of black respondents (P<.001). Internet use increased with education level (P<.001): eighty-six percent of participants who did not graduate from high school or receive a degree used the internet, while over 97% of those with a college or associate's degree did.

Conclusions

While the internet holds considerable potential as a long-term treatment modality after SCI, limited access to the internet by those who are black, those injured after age 18, and those with less education does reduce its usefulness in the short term for these subgroups.     

Sex-related differences of rehabilitation outcomes of spinal cord lesion patients

OBJECTIVES: To evaluate sex-related differences of spinal cord lesion patients. PATIENTS: Two hundred and eighty-one patients were included with evaluation of: lesion to admission time, aetiology, lesion level, associated injury, medical complications and surgical intervention, length of stay, American Spinal Injury Association (ASIA) impairment and motor scores. MAIN OUTCOME MEASURES: ASIA impairment grade and ASIA motor scores; Barthel Index, Rivermead Mobility Index and Walking Index for Spinal Cord Injury. RESULTS: In the entire group female patients had a lower frequency of traumatic lesions, a lower frequency of complications at admission and a higher frequency of incomplete lesions (ASIA impairment C). In the matching cohorts comparison female patients showed the same neurological and functional recovery as male patients. CONCLUSION: Gender does not seems to influence spinal cord rehabilitation outcomes despite the fact that men and women showed significant epidemiological differences. Further studies are needed to evaluate some aspects such as long-term bladder management and complications.     

Health-related quality of life in persons with traumatic spinal cord lesion in Helsinki.

OBJECTIVE: To estimate the health-related quality of life (HRQoL) of persons with spinal cord lesion. DESIGN: The study design was cross-sectional. SUBJECTS: All adult citizens in Helsinki with traumatic spinal cord lesion were identified. The final study group comprised 117 subjects, corresponding to a participation rate of 77%. METHODS: HRQoL was assessed by a generic 15-dimensional self-administered instrument (15D). Clinical examination was based on the manual of the American Spinal Injury Association. Examinations were performed on all subjects by the same experienced physician and physiotherapist. RESULTS: The average 15D score of the study group was significantly lower (p<0.001) than that measured in the age-matched general population sample. Subjects with spinal cord lesion had significantly more problems due to the neurological lesion but also on the dimensions of sleeping, discomfort and symptoms and vitality. In regression analysis of the study group the only variable explaining HRQoL was the neurological level of the lesion. Spinal cord lesion caused more depression and distress in persons with motor incomplete lesion than those with motor complete lesion. CONCLUSION: Persons with spinal cord lesion had lower HRQoL than the population in general. The results indicate that spinal cord lesion may cause problems in the areas of sleeping, discomfort and symptoms or vitality, in particular. More attention should be paid to finding ways of improving the situation of persons with motor incomplete lesion, especially in terms of psychological function.     

A validity study of the WHOQOL-BREF assessment in persons with traumatic spinal cord injury

OBJECTIVE: To examine the distribution of the scores, internal consistency, structure, and discriminant validity of the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) assessment in persons with traumatic spinal cord injury (SCI). DESIGN: Validation study using multitrait analysis and known-groups methods. SETTING: Community and hospital. PARTICIPANTS: Persons with SCI (N=111) and non-SCI respondents (N=169). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The WHOQOL-BREF assessment. RESULTS: The frequency distribution of the 4 domains of the WHOQOL-BREF assessment was nearly symmetric and showed no floor or ceiling effects. All domains showed good internal consistency (Cronbach alpha range, .74-.78), with the exception of the social relationships domain (alpha=.54). The 4-domain structure of the WHOQOL-BREF assessment was confirmed using multitrait analysis. The discriminant validity of the WHOQOL-BREF assessment in persons with SCI was satisfactory. CONCLUSIONS: The WHOQOL-BREF assessment is suitable for measuring QOL as perceived by a person with SCI.     

Medical and rehabilitation issues in the care of children with spinal cord injury

Rehabilitation of the child with SCI involves setting and changing goals appropriate to the child's age, development, and family expectations. Unlike adults with SCI, who may be very close to expected levels of independence at discharge from inpatient rehabilitation, children often require years of outpatient therapy to achieve optimal outcomes. Children with SCI also are at risk for unique complications, which can alter their function. The rehabilitation community extends beyond the usual hospital based practice to include school and transitional services. The focus of rehabilitation changes across stages of development to initially enhance independence in mobility and self-care skills, and later to promote academic achievement, independent living, and employment.     

医疗体育运动疗法在脊髓损伤社区康复中的应用

近 10年来 ,我国的康复事业有了很大的发展 ,但是 ,由于受人们对康复的认识和经济条件的限制 ,康复医疗设施大都设立在一些大、中城市 ,加之我国幅员辽阔 ,有相当多的脊髓损伤患者没有得到应有的康复治疗。所以 ,在社区开展康复服务是我国康复工作的一项重要内容 ,它将会使有康复需求的患者就近、就地得到康复治疗。医疗体育运动康复治疗在脊髓损伤康复训练中是一种行之有效的治疗方法 ,早已在残疾人康复开展较好的国家和各级残疾人运动会上得到证实。医疗体育运动疗法是运用体育运动项目对残疾人进行康复训练的一种手段。医疗体育运动治疗…     

Game-based exercises for dynamic short-sitting balance rehabilitation of people with chronic spinal cord and traumatic brain injuries

BACKGROUND AND PURPOSE: Goal-oriented, task-specific training has been shown to improve function; however, it can be difficult to maintain patient interest. This report describes a rehabilitation protocol for the maintenance of balance in a short-sitting position following spinal cord and head injuries by use of a center-of-pressure-controlled video game-based tool. The scientific justification for the selected treatment is discussed. CASE DESCRIPTION: Three adults were treated: 1 young adult with spina bifida (T10 and L1-L2), 1 middle-aged adult with complete paraplegia (complete lesion at T11-L1), and 1 middle-aged adult with traumatic brain injury. All patients used wheelchairs full-time. OUTCOMES: The patients showed increased motivation to perform the game-based exercises and increased dynamic short-sitting balance. DISCUSSION: The patients exhibited increases in practice volume and attention span during training with the game-based tool. In addition, they demonstrated substantial improvements in dynamic balance control. These observations indicate that a video game-based exercise approach can have a substantial positive effect by improving dynamic short-sitting balance.     

康复护理对脊柱骨折伴脊髓损伤患者日常生活能力及住院时间的影响

目的 分析康复护理对脊柱骨折伴脊髓损伤患者日常生活能力及住院时间的影响.方法 将我院2018年1月至2019年12月收治的80例脊柱骨折伴脊髓损伤患者按照护理方案的不同分为对照组(n=40)与试验组(n=40).对照组给予常规护理干预,试验组在常规护理干预的基础上行康复护理.比较两组干预前、后的日常活动能力、运动功能改...