Sexual adjustment among upper class Nigerian male paraplegics and tetraplegics

A study was conducted to investigate the relationship between sexuality and various areas of adjustment to disability among 39 male upper class Nigerian paraplegics and tetraplegics. The results showed that the younger the subjects were, the better were the chances for sexual adjustment; there was close correlation between good sexual adjustment and the ability to use aids to daily living, mobility, ability to perform role activities, high morale, relative independence and general satisfaction about life. The subjects exhibited interest in sexual activities in a positive way contrary to popular opinion. It has been proposed that sex counselling should be a standard component of the rehabilitation effort for paraplegics and tetraplegics.

Psychiatric disorders in patients with spinal cord injuries

Although previous studies have reported that all patients with spinal cord injuries experience depression, they have not distinguished between despondency and depressive disorder. Of 30 patients with spinal cord lesions and depressive disorders diagnosed using the Schedule for Affective Disorders and Schizophrenia and the Research Diagnostic Criteria (RDC). 15 patients had RDC diagnoses before or after their injury. A depressive disorder developed in nine after injury. Eight depressive disorders developed within a month of the injury. Postinjury depressive disorders were more common in patients with complete spinal cord lesions but were divided equally between paraplegics and quadriplegics. Only one patient received antidepressants. The remainder recovered without treatment other than the rehabilitation program. The accident causing the injury seemed related to a psychiatric disorder before injury in six patients (four alcoholics and two hypomanics) and to drinking before the accident in 15 patients.

Depression in spinal cord injured patients

Many regard depression as an inevitable psychological sequela of spinal cord injury. This assumption, if inaccurate, may confound the rehabilitation process. We evaluated 22 patients with recent spinal cord injuries (less than 6 months), using a standardised interview and diagnostic process. Five patients (22 per cent) had diagnosable depressions after their injury. This is higher than the incidence of depression in the general population, but less than anticipated.

Non-traumatic acquired tetraplegia: case report

A patient who gradually developed tetraplegia caused by an intra-medullary tumour is described. Over a period of 13 years the patient and her family coped very well with the handicap. After neurosurgical intervention no neurological recovery was achieved, but her head movements were restored. This made mobility with an electrical chin-steered wheelchair possible. Some of the difference between an acute and a gradually acquired tetraplegia are discussed.

Electronic assistive devices: their impact on the quality of life of high level quadriplegic persons

The impact of electronic assistive devices (ie, the environmental control system or ECS) on the day-to-day living of high-level quadriplegics (C3-C5) was studied. Twenty male quadriplegic persons (7 ECS users and 13 nonusers) were interviewed using the following material: Activity Pattern Indicators (APIs), Bell Adjustment Inventory, Locus of Control, Multiple Affect Adjective Checklist and McClelland's adaptation of the Thematic Apperception Test. It was found that ECS impact was most clearly demonstrated in the API results. The ECS users made greater use of a variety of adaptive devices to function relatively more independently and with minimal assistance. The users participated in more activities and spent considerably more time educating themselves than the nonusers, who more frequently participated in quiet activities and spent more time in passive recreational activities in residence. Since the ECS and other adaptive devices have a positive impact on the lives of users, patients should be exposed to them as early as possible in their rehabilitation programs to promote their acceptance. Additionally, home planning and equipment ordering should be done conjointly before discharge so that patients and their families do not become acclimated to a less safe and less efficient way of functioning. An assessment protocol consisting of both intrapsychic and behavioral measures (similar to the one presented in this article) is recommended as a comprehensive and systematic way of evaluating both the short- and long-term effects of using assistive devices.

Relationship between cognitive activity and adjustment in four spinal-cord-injured individuals: a longitudinal investigation

Although most of the stress one faces in life occurs in anticipation of a stressful period, very little research has been done on what anticipatory cognitive activities are related to subsequent adjustment. The present study investigated the relationship between measures of anticipatory cognitive activity and subsequent adjustment in four spinal-cord-injured individuals. Measures of anticipatory cognitive activity, which were assessed before subjects left the rehabilitation center, were related to measures of adjustment, which were assessed when subjects returned to the rehabilitation center for a medical checkup anywhere from 7 to 13 1/2 weeks following discharge. Seven-month follow-ups were conducted with two of the subjects. Although the small sample size precluded any statistical analysis of the data, the rank orderings of subjects across the variables of interest revealed a number of interesting trends. The most striking trend was that the best adjusted subject predominantly employed rationalization and denial in anticipating going home. A theory to explain why these strategies may be effective for spinal-cord-injured individuals is proposed. Other trends revealed that individuals who avoid catastrophizing and worrying about what their life will be like, who think more about the various goals they may have once they leave the rehabilitation center, and who employ internal forms of mental rehearsal in anticipating going home tend to be better adjusted. Although any conclusions that can be drawn from this study are only suggestive, given the small sample size, the fruitfulness of conducting this type of research is demonstrated.

General principles of management of the paraplegic

The management of patients with traumatic paraplegia and tetraplegia has improved markedly in recent years. Survival now approaches the normal life expectancy, due to modern intensive care and understanding of potential complications of the spinal paralysis. Rehabilitation techniques lead to excellent physical and psychological adjustment, and community-based follow up with cooperation from the specialized spinal units has ensured continued good care after discharge.

Oral telescoping orthosis: an aid to functional rehabilitation of quadriplegic patients

The possibility of periodontal disease, chipping of various teeth, or extrusion from use of a mouthstick is minimized with a mouthpiece that covers the complete dentition. Even the simplest of these devices permits increased function for the quadriplegic patient. A case is reported of a young man for whom the oral telescoping orthosis was fitted with a mouthpiece that covered the complete dentition. Damage to the hard or soft tissue structures has not been apparent in eight years of use. Furthermore, the functional capability of the patient has been enhanced. The oral telescoping orthosis is recommended for motivated quadriplegic patients who retain sufficient control of the head and oral and pharyngeal muscles.

Increasing sensory and motor stimulation for the patient with quadriplegia

The common perception about the individual with quadriplegia (having a lesion at C5 and above) as a fragile, immobile, and medically unstable individual is in direct conflict with the concept of successful rehabilitation. Long hospitalizations, constant medical attention, and profound physical dependence often work against the efforts of those providing rehabilitation to ease the patient's transition back to as normal a life style as possible. This paper describes a successfully executed sensory and motor stimulation program, designed to meet the needs of the sensory-deprived individual with quadriplegia and to deemphasize the perception of both physical and psychological fragility.

A portable electronic 'calling device' as an aid to 'weaning' ventilator-dependent tetraplegic patients from intermittent positive pressure ventilation

An electronic calling device has been developed. It is easily portable and can be operated by the severely paralysed tetraplegic patient in order to attract attention. The patient can operate the sensor either during artificial ventilation or when breathing spontaneously via the tracheostomy tube at a stage prior to the insertion of a speaking tube.

Conceptual style and life satisfaction following spinal cord injury

The major purpose of this study was to explore the relationship between conceptual style and life satisfaction following a physical loss. It was predicted that conceptual abstractness is positively associated with life satisfaction. Fifty-four men between the ages of 18 and 41 who were paraplegic or quadriplegic, because of a spinal cord injury that occurred at least 18 months prior to the interview, were asked to complete questionnaires designed to measure their conceptual styles and their satisfaction with various aspects of their lives. The data suggest that: the respondents were generally satisfied with life; dissatisfaction was frequently greatest in family and other intimate relationships; and physical trauma may trigger changes in conceptual style in the direction of greater complexity and abstractness. The predicted positive association between conceptual abstractness and life satisfaction was supported in several instances by the data.

Psychosocial factors associated with pressure sores

To determine if psychosocial factors, not purely mechanical aspects, play an important part in the incidence of pressure sores, 141 subjects were tested on 3 psychosocial measures. Results indicate that differences exist among groups in pressure sore history and psychosocial measures. Contrary to the expectations of a mechanical skin problem model, quadriplegics as a group (rather than paraplegics) had a history of fewer pressure sores. Two variables, the subject's responsibility in skin care (RESPON) and his satisfaction with the activiities of life (SATIS), were significantly associated with the incidence of decubitus ulcers. The combination of RESPON, SATIS, and the total positive score from the Tennessee Self-Concept Scale in multiple linear regression accounted for (1) 26% of the pressure sore history in the total sample, (2) 40% in the paraplegic group, (3) 69% in the paraplegic with help group, and (4) 41% in the paraplegic without help group. The histories in the quadriplegic groups and subgroups did not show reliable associations with the 3 variables. SATIS contributed most in accounting for the incidence of pressure sores. The level of injury and these psychosocial factors are thus related to the incidence of pressure sores.

Psychological management of acute paraplegia in adolescence

Important management principles regarding emotional needs of the teenager with acute paraplegia during early hospitalization are discussed. One illustrative case is presented. Mourning reaction of the patient and family to this severe loss of bodily function is reviewed. Reaction of medical caretakers to this catastrophe is also discussed. It is emphasized that these concepts be applied by pediatricians in managing adolescent paraplegics.

A follow-up study of paraplegics and tetraplegics discharged from hospital

A study was conducted to investigate to what extent 76 paraplegics and tetraplegics were able to cope with their environment after discharge from hospital. The results showed that automobile accidents were responsible for most cases of paraplegia and tetraplegia; most patients died within one year of discharge from hospital; there was a significant differential in the survival rate between the upper and lower class patients in favour of the former; the younger the patient the longer was his chances of survival; the higher the lesion the greater were the chances of wife desertion among subjects and the lesser was the chance of survival; and finally none of the subjects except one was employed after discharge from hospital.