The Contribution of Group Learning to the Rehabilitation of Spinal Cord Injured Adults

This study, which involved both quantitative and qualitative methods, investigated the contribution of group learning to the rehabilitation of spinal cord injured adults. The views of spinal cord injured persons, their families, and professional nurses involved in spinal cord injury rehabilitation were compared. A telephone questionnaire that measured attitudes toward group learning and gathered demographic data was administered to 60 adults with spinal cord injuries in northern Illinois. Data analysis indicated a range of positive attitudes for all subjects. Personal interviews then were conducted with 8 spinal cord injured persons, 6 family members, and 8 rehabilitation nurses to compare perceptions about the effects of group learning. All those interviewed stated that contact among spinal cord injured persons is an important factor in adjustment to the injury. Positive attitudes toward group learning were communicated by all three subject groups. Motivation, sharing of experiences, camaraderie with and support from peers, and knowledge that they were not alone were identified as advantages of group learning.     

Determinants of well-being in primary caregivers of spinal cord injured persons

A study of well-being in middle-aged and elderly spinal cord injured persons (Decker & Schulz, 1985) found that long-term coping was facilitated by the presence of a primary support person or caregiver. The purpose of this study was to identify the determinants of life satisfaction and depression in 67 primary caregivers of middle-aged and elderly spinal cord injured persons. The study revealed that the availability of social support and feelings of control over one's life were important determinants of caregivers' well-being. In addition, those caregivers spending more time each day assisting the disabled person and feeling burdened by these responsibilities experienced more depression and less life satisfaction. In working with spinal cord injured persons, rehabilitation nurses must consider the well-being of the spinal cord injured person/primary caregiver dyad as an important focus of nursing assessment and intervention.     

Projet REFESCAR : expériences éducatives dans le champ de l’escarre de la personne lésée médullaire en France

In order to establish guidelines for patient’s therapeutic education within the field of pressure ulcer in persons with spinal cord injury, a survey of self-management practices has been carried out in 2012. This work summarizes the results of educational experiences, which included eight physical medicine and rehabilitation teams specialized in spinal cord injured patients management.     

25 years Heidelberg Rehabilitation Center for Spinal Cord Injuries--retrospect and prospects]

In the framework of a commemorative gathering and scientific symposium in November 1991, an account was given of the 25 years of service of the Rehabilitation Centre for Spinal Cord Injured Persons of the Heidelberg Orthopaedic University Hospital Foundation. Tribute was at the same time paid to the lifework of Kurt Lindemann, former director of the Orthopaedical University Hospital and rector magnificus of the Heidelberg Ruperto Carola University, in memory of the 25th anniversary of his death in 1966. Encouraged by the father of SCI rehabilitation Sir Ludwig Guttmann, of Stoke Mandevillehospital, England, Kurt Lindemann had taken the initiative for establishing this centre and prepared its opening in 1966. Comprising a clinical department, the Ludwig Guttmann House, and a department for vocational-social rehabilitation, the Kurt Lindemann House, the centre has since enabled provision of all measures required for comprehensive rehabilitation of spinal cord injured women, men and children--starting at the day of injury till full resettlement of this population in family, occupation, and society. Erected a quarter century ago, the centre has in the last two years been brought up to date architecturally and structurally; further measures for implementing the most recent state of the art in rehabilitating spinal cord injured patients lie ahead.     

Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre.

OBJECTIVE: To determine the most important barriers to and facilitators of the level of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre. DESIGN: Qualitative study with both cross-sectional and retrospective questions. SUBJECTS: Thirty-two persons with a spinal cord injury. METHODS: Semi-structured interview with questions concerning the current situation (>9 months after discharge) and retrospective questions concerning the period shortly after discharge (=3 months). The interview consisted of 10 topic categories assumed to have an impact on the level of everyday physical activity and covering the main parts of the International Classification of Functioning, Disability and Health (ICF) model. RESULTS: In the current situation, the most important barriers were problems with accessibility of stores and buildings, physical health problems and mental health problems. Shortly after discharge, the most important barriers were emotional distress, problems with self-care, and mental health problems. The most frequently mentioned facilitators were preparation in the rehabilitation centre with respect to daily activities and social activities and stimulation to be physically active. CONCLUSION: Persons with a spinal cord injury experience important barriers to physical activity, particularly on the ICF component Body Functions and Structure.     

Self-concept among persons with long-term spinal cord injury

Seventy-one persons with spinal cord injury who had been injured at least four years before, completed the Tennessee Self-Concept Scale and a questionnaire examining demographic factors and activity levels. Compared to scale norms, respondents had significantly higher Personal Self, Moral-Ethical Self, and Social Self scores and significantly lower Physical Self scores. Perceived independence, provision of one's own transportation, assistance needed, and living arrangements were significantly related to self-concept. Findings were discussed in relationship to past and future research and practice in rehabilitation of individuals with spinal cord injury.     

脊髓损伤患者居家护理的干预及效果

目的探讨居家护理干预对脊髓损伤患者康复知识与技能的影响,以期改善脊髓损伤患者的生活质量。方法采用便利抽样法选择2010年4-10月广西桂林医学院附属医院辖区范围内、在本院康复科出院且便于随访的脊髓损伤患者38例,通过建立居家护理干预团队、及时对患者进行康复知识与技能的指导,对其实施居家护理干预;干预前后采用同一问卷测评患者康复知识及技能掌握情况、训练情况以及并发症发生情况。结果 36例患者通过居家护理干预,康复技能掌握情况及自我训练情况明显改善,并发症发生率明显减少(P0.01)。结论对脊髓损伤患者实施居家护理干预,能明显提高患者康复技能,促进其健康行为的养成,同时可降低并发症发生率。     

Rehabilitation from the Other Side: A Patient's Perspective

Many rehabilitation nurses deal regularly with spinal cord injured patients, but rarely are those patients themselves nurses. This article offers a frank and realistic view of the rehabilitation process from the perspective of its author, a nurse who sustained a spinal cord injury in December 1977.     

Medical complications of spinal cord injury

Recent medical advances have greatly improved the prognosis for people who sustain spinal cord injury (about 10 000 people initially survive spinal cord injury each year in the US). Physicians may become involved with the acute care of spinal cord injured persons or care for complications which develop later. Certain conditions such as heterotopic bone formation and autonomic dysreflexia are seen almost exclusively in this group of patients; other complications such as urinary tract and soft tissue infections occur quite often. Common medical complications of spinal cord injured persons are reviewed, as well as their diagnosis and treatment.     

NEUROPHYSIOLOGY OF SEXUAL RESPONSE IN SPINAL CORD INJURY*

This article describes commonalities and differences in the neurophysiology of sexual response in persons with spinal cord injuries and the non-cord injured. Recognition of individual differences and other implications for sex education and counseling with the spinal cord injured are presented.     

Depressed mood in spinal cord injured patients: staff perceptions and patient realities

This study examined the correspondence between staff ratings and patient ratings of depressed mood for 102 newly spinal cord injured persons admitted to two regional spinal cord injury rehabilitation centers. Patients rated their mood by using the Depression Adjective Check List (DACL). Treatment staff also rated each patient by completing the DACL as they thought the patient would have on the same day. Ratings were made every three weeks during a patient's stay. Results indicate that patients were generally similar to the general population in terms of self-rated depressed mood. Staff members typically overestimated levels of patients' depressed moods. Staff members' ratings did correlate significantly, although modestly, with patients' self-ratings (r = .34, p less than .001). However, staff's accuracy in estimating patient mood did not increase as a function of increased exposure to the patient or years of experience in rehabilitation.     

Malnutrition in spinal cord injury: more than nutritional deficiency

Denervation of the spinal cord below the level of injury leads to complications producing malnutrition. Nutritional status affects mortality and pathology of injured subjects and it has been reported that two thirds of individuals enrolled in rehabilitation units are malnourished. Therefore, the aim should be either to maintain an optimal nutritional status, or supplement these subjects in order to overcome deficiencies in nutrients or prevent obesity. This paper reviews methods of nutritional assessment and describes the physiopathological mechanisms of malnutrition based on the assumption that spinal cord injured subjects need to receive adequate nutrition to promote optimal recovery, placing nutrition as a first line treatment and not an afterthought in the rehabilitation of spinal cord injury.     

Solitary colonic ulcer in a spinal cord injured patient

Bleeding from the lower gastrointestinal tract is rarely reported in spinal cord injured patients. A case is reported of such bleeding in a quadriplegic man with a solitary colonic ulcer diagnosed by flexible sigmoidoscopy and biopsy. The diagnosis of solitary colonic ulcers is difficult to make in spinal cord injured persons because presenting features may be masked by the neurologic deficits caused by the injury or may be falsely attributed to problems associated with the injury or to iatrogenic trauma. Solitary colonic ulcer should be included in the differential diagnosis of gastrointestinal bleeding in persons with spinal cord injury. Flexible sigmoidoscopy or colonoscopy is recommended for visualization and biopsy of the bleeding lesion.     

Prediction of marital adjustment among spinal cord injured persons

Predictors of positive marital adjustment among spinal cord injured persons were examined. Twenty couples in which one spouse sustained a spinal cord injury were administered the Marital Activities Inventory (MAI), the Sexual Interaction Inventory (SII), the Areas of Change Questionnaire (A-C), and the Locke-Wallace Short Marital Adjustment Test (SMAT). Results were analyzed using stepwise multiple regression analyses for both husbands' and wives' SMAT scores. Results indicated that for both husbands and wives, the number of recreational and social activities engaged in with others was the strongest predictor of positive marital adjustment. Further, little relationship was found between sexual satisfaction and marital adjustment. The findings were discussed as they apply to rehabilitation nursing practice.     

‘Bringing them back on the right track’: Perceptions of medical staff on the rehabilitation of individuals with violently acquired spinal cord injuries

Purpose.?To explore the perceptions of medical staff on the rehabilitation of spinal cord injured individuals, who became disabled from street violence.

Method.?A total of 16 medical staff members from two rehabilitation hospitals were interviewed, using a semi-structured interview. The interview recorded demographic information about the staff and probed at differences in clinical goals and practices with violently and non-violently injured individuals with spinal cord injuries. In all, 34 interviews were conducted from staff. Responses were tabulated and interpreted using a grounded theory approach.

Results.?Staff set goals of ‘increasing independence’ that are informed by their professional backgrounds. The ‘differences’ in persons with violently acquired disabilities were noted, both in terms of needs, resources and attitudes. Depending on the professional and racial background of the staff, there was an indication of different degrees of tolerance toward patients' non-compliance with rehabilitation goals. Staff members are largely welcoming of the perceived impact of peer mentoring as it increases the cultural competence of the hospital in dealing with individuals who were violently disabled.

Conclusions.?Findings, although exploratory, emphasise the dynamics of perception development, through the tensions in the goal of independent functioning and perceived differences in persons who became disabled from street violence.     

Discharge disposition from model spinal cord injury care system rehabilitation programs.

OBJECTIVE: To identify and quantify factors associated with discharge to a nursing home for people with spinal cord injuries. DESIGN: Case control within a cohort of spinal cord injured persons. SETTING: Model spinal cord injury care systems throughout the United States. PATIENTS: A total 16,633 patients consecutively discharged alive between 1973 and 1996 who were admitted to the model system within 1 year of injury, who were both injured in and resided in the catchment area of the model system, and who were discharged to either a nursing home or a community residence. MAIN OUTCOME MEASURE: Discharge disposition. RESULTS: Overall, 4.3% of patients were discharged to a nursing home. Factors that were significantly associated (p < .0001) with place of discharge were age, race, employment status at injury, bladder management method at discharge, education level, marital status, Frankel grade, functional independence in performing activities of daily living, independent ambulation, geographic region, neurologic level of injury, ventilator dependency, and third-party sponsor of rehabilitation. A multivariate predictive model was developed from these factors and was both 78% sensitive and specific in identifying patients who were discharged to a nursing home. CONCLUSIONS: Knowing the probability of nursing home placement can assist in evaluating the success of a rehabilitation program by allowing adjustment for case-mix differences across facilities.     

Innovative approach in rehabilitation nursing: providing primary care to tertiary care patients

In 1998 health care legislation in Ontario changed and allowed Primary Health Care Nurse Practitioners the possibility to expand their practice. At a rehabilitation centre, where spinal cord injured patients would seek primary health care services, a new amalgamated role was implemented to meet those needs. This article will described the advanced practice role that was developed, define the scope of practice, and demonstrate an innovative approach to service delivery. The role serves as a concrete link between primary health care services and tertiary care patients needs.     

Differential diagnosis of acute spinal cord diseases

We discuss the most important differential diagnosis in acute non traumatic spinal cord lesions. To therapy these patients, a large diagnostic and therapeutic spectrum must be considered. Nontraumatic spinal cord lesions include inflammatoric, immunologic, toxic-metabolic and physical reasons, tumours, bleedings, myelomalazies, neurodegenerative myelopathies and spinal deformities. The aimes of rehabilitation of these patients are almost similar to patients with tramatic spinal cord injured.     

The meaning of living with spinal cord injury 5 to 10 years after the injury

A phenomenological study was conducted with 20 spinal cord injured persons and their family members to examine the meaning of living with spinal cord injury 5 to 10 years after the initial injury. Seven themes emerged from the data. The themes are looking for understanding to a life that is unknown, stumbling along an unlit path, viewing self through a stained glass window, challenging the bonds of love, being chained to the injury, moving forward in a new way of life, and reaching normalcy. The uncovered meanings enhance our understanding and appreciation that living with spinal cord injury is a continuous learning experience. The study findings may be useful in the development of self-care strategies and ongoing interventions that focus on maintaining physical and psychological health for both spinal cord injured persons and their family members throughout the course of living with the disability.     

'It was hard but you did it': the co-production of 'work' in a clinical setting among spinal cord injured adults and their physical therapists

Purpose. This paper focuses on what takes place during the rehabilitation of spinal cord injured (SCI) adults. It analyses the cardinal rehabilitation task of transforming the compromised, limited and injured corporeal style of newly injured adults (best described phenomenologically as an 'I cannot do' or ' I no longer can') into a new style of embodiment, one in which 'I am newly abled'. This transformation is not a passive, surrendering experience. Rather, as informants repeatedly noted, 'rehabilitation is hard work'. This paper examines that 'work'.

Method. This paper draws from observational and interview data collected over an 18-month period in a metropolitan rehabilitation centre in the Midwestern United States. It presents an exemplar case of a clinical setting, that between a physical therapist and her SCI client.

Results. The interactional and meaning-making nature of clinical encounters are explicated, revealing the collaborative and situational constitution of rehabilitation work.

Conclusions. Experience-near, phenomenologically informed, research is shown to be a valuable way of understanding rehabilitation practices and how they might affect inpatients and staff.