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Robey KL. Identity related to living situation in six individuals with congenital quadriplegia. Disabil Rehabil 2007; 30:107-13. [PMID: 17852238 DOI: 10.1080/09638280701214206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study was a preliminary examination of structural aspects of identity, particularly identity associated with living situation, in individuals who have quadriplegia due to cerebral palsy. METHOD A hierarchical classes algorithm (HICLAS) was used to construct idiographic 'identity structure' models for three individuals who are living in an inpatient hospital setting and for three individuals living in community-based group residences. RESULTS Indices derived from the models indicate that the identity 'myself as one who has a disability' was structurally superordinate (i.e., resided at a high hierarchical level) for all six participants, suggesting a high level of importance of this identity in participants' sense of self. The models also indicate that while identity associated with one's particular living situation was superordinate for persons living in the hospital, it was not for persons living in community residences. CONCLUSIONS While conclusions based on this small sample are necessarily limited, the data suggest that identity associated with living situation might differ in structural centrality, and presumably subjective importance, for persons living in inpatient versus community-based settings.
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Kemp BJ, Spungen AM, Adkins RH, Krause JS, Bauman WA. The relationships among serum lipid levels, adiposity, and depressive symptomatology in persons aging with spinal cord injury. J Spinal Cord Med 2007; 23:216-20. [PMID: 17536289 DOI: 10.1080/10790268.2000.11753528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) appears to occur prematurely in persons with spinal cord injury (SCI). Stress may play a significant role in the development of CVD. Depression is the most common form of stress complicating the care of persons with SCI. METHODS In 188 persons with SCI, 46% with tetraplegia and 54% with paraplegia, the relationship between depression and the serum lipid profile was studied. Depression was measured by the Older Adult Health and Mood Questionnaire (OAHMQ) for persons with disability. Total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol and triglycerides were measured; body mass index (BMI) was computed and percent body fat was determined by dual-energy x-ray absorptiometry (DXA). RESULTS Depression and level of SCI were found to have significant interactive effects on serum lipid levels. Serum total and LDL cholesterol, as well as triglycerides, were all higher among persons with paraplegia who were depressed compared to those who were not depressed. This was not found in persons with tetraplegia. Inverse relationships were evident between serum triglycerides and HDL cholesterol levels. Persons with paraplegia who were depressed had significantly more adiposity than those not depressed. BMI correlated directly with serum triglycerides and indirectly with serum HDL cholesterol. CONCLUSION Depression appears to be a strong determinant of adverse lipid profiles in patients with paraplegia. association between depression and adiposity in these patients compounds the risk for cardiovascular disease.
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Reeves RR, Douglas SP, Garner RT, Reynolds MD, Silvers A. The individual rights of the difficult patient. Hastings Cent Rep 2007; 37:13; discussion 13-5. [PMID: 17474340 DOI: 10.1353/hcr.2007.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abrantes-Pais FDN, Friedman JK, Lovallo WR, Ross ED. Psychological or physiological: Why are tetraplegic patients content? Neurology 2007; 69:261-7. [PMID: 17460156 DOI: 10.1212/01.wnl.0000262763.66023.be] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the effects of spinal cord injury (SCI) on perceived health-related quality of life (QOL). BACKGROUND SCI is physically disabling, socially handicapping, and romantically limiting. Nevertheless, little is known about post-SCI neurocognitive and psychosocial life. Better understanding of the cognitive and emotional worlds of SCI patients is essential to better address and meet their needs and expectations. METHODS Twenty subjects with high-cord (T6 and above) complete (American Spinal Injury Association [ASIA] A) SCI (High SCI) were compared with 10 subjects with low-cord (T7 and below) ASIA A SCI (Low SCI) and with 11 Able-Bodied control subjects. Satisfaction with Life and Short Form-36 instruments were used to assess physical and emotional aspects of QOL. Analyses of variance were used to assess potential differences across groups. RESULTS Overall, satisfaction with life was the same among the groups. Expectedly, High SCI and Low SCI subjects reported lower physical functioning than Able-Bodied subjects (p < 0.0001). But, oddly, there were no differences in perceived physical role, physical health, or social functioning. Furthermore, High SCI subjects reported better perceived mental health than Able-Bodied control subjects (p = 0.004) and a trend over Low SCI subjects (p = 0.06), better perceived emotional role in society (p = 0.02), and greater vitality (p = 0.01) than Low SCI subjects and Able-Bodied subjects. CONCLUSIONS Despite severe physical impairment and disability and frequent medical complications, subjects with complete spinal cord injury at high anatomic levels report better than average quality of life, being overall content. Reasons for these findings are unclear. Psychological adaptive reactions are likely, but the possible role of physiologic and neurocognitive changes needs further exploration.
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Dahlberg A, Alaranta HT, Kautiainen H, Kotila M. Sexual activity and satisfaction in men with traumatic spinal cord lesion. J Rehabil Med 2007; 39:152-5. [PMID: 17351698 DOI: 10.2340/16501977-0029] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To estimate sexual activity and sexual satisfaction in men with spinal cord lesion. DESIGN Cross-sectional study. SUBJECTS All adult citizens in Helsinki with traumatic spinal cord lesion were identified. The final study group comprised 92 male subjects, corresponding to a participation rate of 79%. METHODS A structured questionnaire was sent to all subjects and they were invited for a clinical visit. Clinical examination was based on the manual of the American Spinal Injury Association (ASIA). Examinations were performed on all subjects by the same experienced physician and physiotherapist. RESULTS In total, 86% of the subjects experienced sexual desire and 68% had been sexually active during the last 12 months. A total of 65% of subjects reported experiencing orgasm since the injury, but most subjects rated it as weaker than before the injury. There were no statistically significant differences between the ASIA Impairment Scale groups. Men with paraplegia reported a more satisfactory sex life (p = 0.05) than those with tetraplegia. CONCLUSION This study confirms the earlier findings that the ability to reach orgasm is deficient in men with spinal cord lesion. The completeness of the lesion had no effect. The more severe locomotory disability might adversely affect the sex life of persons with tetraplegia compared with those with paraplegia.
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Wagner JP, Curtin CM, Gater DR, Chung KC. Perceptions of people with tetraplegia regarding surgery to improve upper-extremity function. J Hand Surg Am 2007; 32:483-90. [PMID: 17398358 DOI: 10.1016/j.jhsa.2007.01.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 01/18/2007] [Accepted: 01/19/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE In the United States, more than 100,000 Americans live with the disability of tetraplegia. These individuals must struggle through long and complicated rehabilitations. Upper-extremity reconstructive surgery can improve use of the upper limb for appropriate candidates; however, a prior national study showed that these procedures rarely are performed. This cross-sectional survey identified the attitudes and beliefs of people with tetraplegia that may dissuade potential candidates from receiving these procedures. METHODS An oral survey was designed to determine priorities of reconstruction in individuals with tetraplegia. This survey was administered to 50 people with tetraplegia. RESULTS Among those surveyed, 13 (26%) had never heard of upper-extremity reconstructive surgery, but 22 (44%) were interested in upper-extremity reconstruction. People with tetraplegia who had a negative first impression of these procedures were far less likely to want reconstruction 0 (0%) vs. 11 (45%). Of patients who learned about these procedures from their physicians, 10 (67%) had a negative first impression after the physician consultation. CONCLUSIONS Although many people with tetraplegia understand the benefits of upper-extremity reconstruction, a large number of them are unaware of or have unfavorable attitudes toward these procedures. These negative attitudes may account for the marked underuse of upper-extremity reconstructive procedures in the United States.
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Gioia MC, Cerasa A, Di Lucente L, Brunelli S, Castellano V, Traballesi M. Psychological impact of sports activity in spinal cord injury patients. Scand J Med Sci Sports 2006; 16:412-6. [PMID: 17121643 DOI: 10.1111/j.1600-0838.2005.00518.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether sports activity is associated with better psychological profiles in patients with spinal cord injury (SCI) and to evaluate the effect of demographic factors on psychological benefits. METHODS The State-Trait Anxiety Inventory, Form X2 (STAI-X2), the Eysenck Personality Questionnaire for extraversion (EPQ-R (E)) and the questionnaire for depression (QD) were administered in a cross-sectional study of 137 males with spinal cord injury including 52 tetraplegics and 85 paraplegics. The subjects were divided into two groups according to sports activity participation (high frequency vs no sports participation). Moreover, multiple regression analysis was adopted to investigate the influence of demographic variables, such as age, educational level, occupational status and marital status, on psychological variables. RESULTS Analysis of variance revealed significant differences among the groups for anxiety (STAI-X2), extraversion (EPQ-R (E)) and depression (QD). In particular, SCI patients who did not practice sports showed higher anxiety and depression scores and lower extraversion scores than sports participants. In addition, with respect to the paraplegics, the tetraplegic group showed the lowest depression scores. Following multiple regression analysis, only the sports activity factor remained as an independent factor of anxiety scores. CONCLUSION These findings demonstrate that sports activity is associated with better psychological status in SCI patients, irrespective of tetraplegia and paraplegia, and that psychological benefits are not emphasized by demographic factors.
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Al Zidjaly N. Disability and anticipatory discourse: the interconnectedness of local and global aspects of talk. Commun Med 2006; 3:101-12. [PMID: 17129199 DOI: 10.1515/cam.2006.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this paper, I use nexus analysis framework to examine how one quadriplegic man from Oman, named Yahya, directs the course of his present (and his future) through anticipatory discourse. In particular, I analyze conversations between Yahya and me regarding his future as they relate to actions I undertake on his behalf to effect a social change: to secure Yahya, an unmarried man, a permit to hire his own resident nurse/assistant (permits for such hirings are reserved only for married couples in Oman). I demonstrate how Yahya influences me to follow his agenda through constructing a helpless identity in narrative discourse. Reciprocally, I suggest that through the actions Yahya's caregivers subsequently undertake, they succeed in giving him a sense of control over an important aspect of his life (being able to hire his own assistant), and I demonstrate how Yahya subsequently displays agentivity in his narratives. I thus illustrate the interconnectedness of Yahya's anticipatory discourse and his caregivers' (macro-level) actions that cause societal change, as well as the interconnectedness of these actions and the kinds of selves Yahya constructs through anticipatory discourse in private (micro-level) interactions.
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Wilhelm B, Jordan M, Birbaumer N. Communication in locked-in syndrome: effects of imagery on salivary pH. Neurology 2006; 67:534-5. [PMID: 16894126 DOI: 10.1212/01.wnl.0000228226.86382.5f] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Couts CA, Gleason OC. Self-mutilation of fingers after cervical spinal cord injury. PSYCHOSOMATICS 2006; 47:269-70. [PMID: 16684947 DOI: 10.1176/appi.psy.47.3.269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Lin MR, Hwang HF, Chung KP, Huang C, Chen CY. Rating scale, standard gamble, and time trade-off for people with traumatic spinal cord injuries. Phys Ther 2006; 86:337-44. [PMID: 16506870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE The rating scale (RS), standard gamble (SG), and time trade-off (TTO) for people with traumatic spinal cord injuries (SCIs) have not been reported. This study compared psychometric performances of these preference-based measures among people with SCIs in Taiwan. SUBJECTS AND METHODS In total, 187 subjects from a nationwide registry of people with traumatic SCIs were interviewed by telephone. Score distributions, interrater reliability, discriminant ability, and convergent validity for the RS, SG, and TTO were compared. RESULTS The mean (median) values of the RS, SG, and TTO were 0.67 (0.70), 0.64 (0.75), and 0.53 (0.50), respectively, and their corresponding intraclass correlation coefficients for intrarater and interrater test-retest reliability were .92 and .89, .78 and .73, and .91 and .78. Compared with the SG and TTO, the RS had fewer floor and ceiling values as well as percent changes, more missing observations, a larger effect size, and better discrimination ability. The results of Spearman correlation and factor analysis showed that the SG strongly converged with the TTO (r=.65, and in a single common factor), but they weakly converged with the RS (r=.33 with the SG and r=.27 with the TTO). In the linear regression models, the RS was significantly associated with neurological severity, employment, educational level, and self-care ability; the SG was associated with neurological severity and employment; and the TTO was associated only with neurological severity. DISCUSSION AND CONCLUSION The RS generally performed better than the SG and TTO among people with traumatic SCIs; however, the underlying construct measured by the RS differed considerably from those measured by the SG and TTO.
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Hinterberger T, Birbaumer N, Flor H. Assessment of cognitive function and communication ability in a completely locked-in patient. Neurology 2006; 64:1307-8. [PMID: 15824375 DOI: 10.1212/01.wnl.0000156910.32995.f4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mukai A, Costa JL. The Effect of Modafinil on Self-Esteem in Spinal Cord Injury Patients: A Report of 2 Cases and Review of the Literature. Arch Phys Med Rehabil 2005; 86:1887-9. [PMID: 16181960 DOI: 10.1016/j.apmr.2005.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Revised: 12/23/2004] [Accepted: 01/12/2005] [Indexed: 10/25/2022]
Abstract
We report on 2 cases of the effect of modafinil on the self-esteem of patients with spinal cord injury (SCI). The first patient was a 33-year-old man with history of polysubstance abuse and a C6 American Spinal Injury Association (ASIA) grade A injury, who presented for follow-up to the outpatient rehabilitation clinic for depression, decreased motivation, and lowered self-esteem. The patient had tried a selective serotonin reuptake inhibitor (SSRI) without success, and reported increasing social and legal stressors. Within 1 month of starting on modafinil, he reported increased self-esteem and motivation, as well as decreased self-consciousness. The second patient was a 36-year-old woman with history of depression and a T11 ASIA grade A injury. She tried various SSRIs for depression and adjustment issues before she was started on modafinil. She lost weight and became more assertive and less self-conscious within 1 month after starting on modafinil. These 2 cases suggest that modafinil should be studied as a therapeutic option for treating lowered self-esteem in patients with SCI.
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Lee Y, Mittelstaedt R. Impact of injury level and self-monitoring on free time boredom of people with spinal cord injury. Disabil Rehabil 2005; 26:1143-9. [PMID: 15371027 DOI: 10.1080/09638280410001724825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to determine whether or not level of injury and personality characteristics creates an interaction effect that impacts the free time boredom of individuals with spinal cord injury (SCI). METHOD Using a survey method, a packet containing a cover letter, a consent form, research questionnaires, and a self-addressed, stamped envelope was sent to 500 individuals with SCI who were randomly selected by computer at one of the rehabilitation centres in USA. The research questionnaires included the measures of self-monitoring (SM) and free time boredom (FTB) along with some demographic factors such as gender, ethnicity, age, injury level, and etc. RESULTS This study found that a significant interaction effect between injury level and SM on FTB. That is, low self-monitors with tetraplegia reported higher levels of boredom in free time than high self-monitors with paraplegia. CONCLUSION Not all individuals with similar injury levels rate FTB in a similar degree. Individuals' personality characteristics play an important role in experiencing FTB. In particular, the significant interaction effect indicates a potential risk factor for clients with tetraplegia who are low in SM which should be an important consideration in the lives of people with tetraplegia following rehabilitation.
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Abstract
No neuropsychologic studies have been reported that assess cognitive functioning in survivors of locked-in syndrome (LIS) due to purely pontine lesions and then document the process of recovery by serial testing over a lengthy period. A previously well man in his early thirties was admitted to the hospital with progressive stroke symptoms and signs. Investigations showed occlusion of the basilar artery and acute infarction of the pons, including basis and tegmentum. Despite thrombolysis, he had persisting clinical features of the LIS. He had minimal change during the first month but then slowly improved. Recovery continued gradually, and he was discharged home 7 months after stroke; at this time he was ambulating with a cane, was mildly dysarthric, was able to swallow foods of modified consistency, and was independent in all self-care activities. Neuropsychologic testing, done 6 months after stroke, showed noteable cognitive impairments. These included mild difficulties with attention and concentration, significant reduction in speed of processing, moderate impairment of perceptual organization skills, mild inefficiencies in new learning of verbal information, and a moderate reduction in executive skills. Pathologic laughing and crying were also noted. There was progressive improvement in most areas of physical and cognitive functioning until at least 2 years after stroke. Neuropsychologic testing in this patient suggests that the LIS may be associated with impairments of higher-level cognitive functioning.
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Nelson VS, Dixon PJ, Warschausky SA. Long-term outcome of children with high tetraplegia and ventilator dependence. J Spinal Cord Med 2005; 27 Suppl 1:S93-7. [PMID: 15503710 DOI: 10.1080/10790268.2004.11753509] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVES Since 1978, 350 children with ventilator dependence, including 49 with spinal cord injuries (SCIs), have been followed at the University of Michigan C.S. Mott Children's Hospital. Some data were kept on these children prospectively and included in various studies relating to their outcomes and quality of life. This study was designed to determine physical outcomes of children with SCI and long-term mechanical ventilation (LTMV) and to determine predictors of quality of life for children with SCI and LTMV. METHODS Prospective data collection and retrospective chart reviews were conducted for all 49 children with SCI and LTMV followed at the University of Michigan C.S. Mott Children's Hospital from 1978 to 2003. RESULTS Of the 49 children with SCI and LTMV, 25 are alive, 16 have died following initial hospital discharge, and 8 have been lost to follow-up. Age at injury was under 5 years for 15, 5 to 9 years for 12, 10 to 14 years for 9, and over 14 years for 13. Forty had high tetraplegia, 7 had low tetraplegia, and 2 had paraplegia. Forty-two had ASIA A injuries, and 7 had ASIA D. All were discharged to their own homes or foster care. CONCLUSION Our research studies of children with ventilator dependence with and without history of SCI have examined daily activities, perceptions of their quality of life, and their health and medical complications. This study compares individuals 16 years of age and older with matched control groups of those with tetraplegic SCI who do not use ventilators and those with other diagnoses who use home ventilation. Overall, these children have done remarkably well medically and psychologically.
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Laureys S, Pellas F, Van Eeckhout P, Ghorbel S, Schnakers C, Perrin F, Berré J, Faymonville ME, Pantke KH, Damas F, Lamy M, Moonen G, Goldman S. The locked-in syndrome : what is it like to be conscious but paralyzed and voiceless? PROGRESS IN BRAIN RESEARCH 2005; 150:495-511. [PMID: 16186044 DOI: 10.1016/s0079-6123(05)50034-7] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The locked-in syndrome (pseudocoma) describes patients who are awake and conscious but selectively deefferented, i.e., have no means of producing speech, limb or facial movements. Acute ventral pontine lesions are its most common cause. People with such brainstem lesions often remain comatose for some days or weeks, needing artificial respiration and then gradually wake up, but remaining paralyzed and voiceless, superficially resembling patients in a vegetative state or akinetic mutism. In acute locked-in syndrome (LIS), eye-coded communication and evaluation of cognitive and emotional functioning is very limited because vigilance is fluctuating and eye movements may be inconsistent, very small, and easily exhausted. It has been shown that more than half of the time it is the family and not the physician who first realized that the patient was aware. Distressingly, recent studies reported that the diagnosis of LIS on average takes over 2.5 months. In some cases it took 4-6 years before aware and sensitive patients, locked in an immobile body, were recognized as being conscious. Once a LIS patient becomes medically stable, and given appropriate medical care, life expectancy increases to several decades. Even if the chances of good motor recovery are very limited, existing eye-controlled, computer-based communication technology currently allow the patient to control his environment, use a word processor coupled to a speech synthesizer, and access the worldwide net. Healthy individuals and medical professionals sometimes assume that the quality of life of an LIS patient is so poor that it is not worth living. On the contrary, chronic LIS patients typically self-report meaningful quality of life and their demand for euthanasia is surprisingly infrequent. Biased clinicians might provide less aggressive medical treatment and influence the family in inappropriate ways. It is important to stress that only the medically stabilized, informed LIS patient is competent to consent to or refuse life-sustaining treatment. Patients suffering from LIS should not be denied the right to die - and to die with dignity - but also, and more importantly, they should not be denied the right to live - and to live with dignity and the best possible revalidation, and pain and symptom management. In our opinion, there is an urgent need for a renewed ethical and medicolegal framework for our care of locked-in patients.
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Moor M, Hungerbühler A. [Challenges on all fronts]. KRANKENPFLEGE. SOINS INFIRMIERS 2005; 98:12-4. [PMID: 16001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Kübler A, Neumann N. Brain-computer interfaces--the key for the conscious brain locked into a paralyzed body. PROGRESS IN BRAIN RESEARCH 2005; 150:513-25. [PMID: 16186045 DOI: 10.1016/s0079-6123(05)50035-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Brain-computer interfaces (BCIs) are systems that allow us to translate in real-time the electrical activity of the brain in commands to control devices. They do not rely on muscular activity and can therefore provide communication and control for those who are severely paralyzed (locked-in) due to injury or disease. It has been shown that locked-in patients are able to achieve EEG-controlled cursor or limb movement and patients have successfully communicated by means of a BCI. Current BCIs differ in how the neural activity of the brain is recorded, how subjects (humans and animals) are trained to produce a specific EEG response, how the signals are translated into device commands, and which application is provided to the user. The present review focuses on approaches to BCIs that process the EEG on-line and provide EEG feedback or feedback of results to the user. We regard online processing and feedback cornerstones for routine application of BCIs in the field. Because training patients in their home environment is effortful and personal and financial resources are limited, only few studies on BCI long-term use for communication with paralyzed patients are available. The need for multidisciplinary research, comprising computer science, engineering, neuroscience, and psychology is now being acknowledged by the BCI community. A standard BCI platform, referred to as BCI2000, has been developed, which allows us to better combine and compare the different BCI approaches of different laboratories. As BCI laboratories now also join to unify their expertise and collaborations are funded, we consider it realistic that within few years we will be able to offer a BCI, which will be easy to operate for patients and caregivers.
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Prabhaka MM, Thakker TH. A follow-up program in India for patients with spinal cord injury: paraplegia safari. J Spinal Cord Med 2004; 27:260-2. [PMID: 15478530 DOI: 10.1080/10790268.2004.11753758] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Once patients with spinal cord injury (SCI) were discharged from the hospital, it was very difficult for them to return for follow-up, particularly during the first year, due to problems regarding finances and social issues, as well as extreme physical barriers. Because of these barriers, a large number of patients were presenting for re-admission for reasons that might have been prevented if they had come for routine follow-up. Therefore, it was felt that an attempt to visit the patient's residence to conduct a follow-up would be of great help. OBJECTIVES To evaluate and improve the status of rehabilitation of community-dwelling SCI patients in their homes and attempt to decrease the rate of re-admissions. MATERIAL AND METHODS In this program, the home visit team consisted of an orthopedic surgeon, physiotherapist, occupational therapist, prosthetist and orthotist engineer, medical social worker, and a nurse. Rehabilitated discharged patients received needed medical treatment, orthotics, and vocational guidance at their residences. Patients who required re-admission were assisted back to the hospital. CONCLUSION The home visit program decreased the number of re-admissions by improving the status of rehabilitation, which raised the quality of care for patients with SCI.
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Abstract
--Ms. B's wish for withdrawal of treatment was refused. --The nurses' role and autonomy in the decision-making is unclear. --Historically, tensions have existed in the doctor-nurse relationship. --Interprofessional collaboration is encouraged in order to facilitate team working. --Evidence is lacking that this is working and suggests continuing problems. --Legal and ethical education needs emphasizing in order to ensure respect for patient autonomy.
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Hammell KW. Exploring quality of life following high spinal cord injury: a review and critique. Spinal Cord 2004; 42:491-502. [PMID: 15263890 DOI: 10.1038/sj.sc.3101636] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Review. OBJECTIVES To explore the concept of quality of life (QOL), critique the practice and problems of assessing QOL following spinal cord injury (SCI) and to review the findings of studies into QOL for people with SCI both below and above the level of C4. METHODS Relevant articles were identified from the Medline and CINAHL databases for approximately the period 1990-2003, cross-indexing 'spinal cord injury' or 'quadriplegia/tetraplegia' with 'quality of life', 'life satisfaction', 'social adjustment' or 'psychological adaptation'. This search was augmented through papers identified in reference lists. Articles were excluded if they were designed solely to examine the impact of a specific intervention upon QOL; or if they examined satisfaction with various life domains without explicitly linking these to perceptions of QOL. Papers were also accessed that addressed the philosophical and epistemological issues involved in QOL conceptions and assessment. RESULTS Review of the literature highlights the philosophical and methodological difficulties associated with the quantitative measurement of a qualitative experience; and with the assessment of life domains chosen by researchers. Analysis of QOL research undertaken among people with all levels of SCI demonstrates that dissatisfaction with life following injury arises primarily from social disadvantage. However, little research has been conducted specifically to ascertain perceptions of QOL among people with high SCI. CONCLUSIONS Ensuring the relevance of future research into QOL following high SCI requires qualitative methodology and mixed methods. Further research is needed to determine how rehabilitation professionals can act on the findings of their QOL assessments and enhance the QOL experienced by people with spinal cord injury in the context of their environments. SPONSORSHIP The early phase of this study was supported by: University of British Columbia Graduate Fellowship; Rick Hansen Man in Motion Foundation (studentship); Social Sciences and Humanities Research Council of Canada: doctoral fellowship.
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