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Soegaard K, Sig JR, Nielsen C, Verhaeghe S, Beeckman D, Biering-Sørensen F, Sørensen JA. "I am just trying to live a life!" -a qualitative study of the lived experience of pressure ulcers in people with spinal cord injuries. J Tissue Viability 2024; 33:50-59. [PMID: 38044163 DOI: 10.1016/j.jtv.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/22/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pressure ulcers (PUs) are frequently reported in people with spinal cord injuries (SCI). Wound management in people with SCI involves relieving pressure on the affected area by means of immobilisation and bed rest. The healing time of a PU can vary, but often takes several months or even years, causing people to stay in bed for prolonged periods of time. OBJECTIVE This study aims to explore the perspectives and lived experiences of people with SCI who are affected by PUs. DESIGN and method: This study is a qualitative explorative study that employs individual semi-structured in-depth interviews to obtain the narratives of people with SCI and a pressure ulcer. We used a phenomenological-hermeneutic approach that was inspired by Ricoeur's theory of interpretation. The analysis was performed in three levels: Naïve reading, structural analysis and critical interpretation and discussion. PARTICIPANTS and setting: Ten people with SCI who were being treated in the Danish healthcare system for their PU participated in this study: six participants had experienced a complete traumatic SCI, three had an incomplete traumatic SCI, and one had a non-traumatic complete SCI. The study included nine men and one woman, aged 49-81 years (mean 64). Nine had a PU in the seating area, while one had the ulcer on the leg. RESULTS The analysis revealed three themes: 1. Struggling to balance prevention with an active, meaningful life, 2. Challenges and consequences of pressure relief protocols and bed rest, 3. Experiencing prolonged and incoherent treatment with varying levels of staff engagement and competencies. CONCLUSIONS People with SCI and a PU have difficulty balancing their active, redefined lives when subjected to a strict pressure relief protocol. The consequences of immobility caused by pressure relief include reduced social and community participation and decreased quality of life. PU treatment is experienced as incoherent and unnecessarily lengthy, leading to a deterioration in the wounds. Improving PU treatment for people with SCI is of utmost importance and has the potential to benefit not only the people with SCI but also the healthcare system and the economy.
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Affiliation(s)
- Knaerke Soegaard
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark.
| | | | - Charlotte Nielsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium; Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Fin Biering-Sørensen
- University of Copenhagen, Denmark; Department for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark
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Guízar-Sahagún G, Grijalva I, Franco-Bourland RE, Madrazo I. Aging with spinal cord injury: A narrative review of consequences and challenges. Ageing Res Rev 2023; 90:102020. [PMID: 37487887 DOI: 10.1016/j.arr.2023.102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
Given the increase in life expectancy, aging with a pre-existing spinal cord injury (SCI) is becoming more common. This condition is challenging as compromised health status and functional independence can worsen. We aimed to provide an updated overview of the consequences of aging with SCI, highlighting the main challenges facing this population in a narrative review of the current literature we retrieved from the PubMed database from 2000 to 2022 on any aspect related to aging in persons with SCI. Here we address adverse circumstances that increase disability and hinder an active lifestyle, such as progressive physical deterioration, secondary health conditions, limitations in personal activity, changes in family and social support structures, aging of caregivers, and depletion of economic resources. Favorable changes are also observed, including psychosocial adjustments that improve quality of life. Additionally, various interventions are discussed to promote well-being, health, and social participation. Due to the relevance of this issue, people with SCI and all those who take care of them must have up-to-date information to carry out the necessary measures to promote healthy aging in a more inclusive social environment.
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Affiliation(s)
- Gabriel Guízar-Sahagún
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico.
| | - Israel Grijalva
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
| | - Rebecca E Franco-Bourland
- Department of Biochemistry, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 289 Calzada México-Xochimilco, Mexico City, Mexico
| | - Ignacio Madrazo
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
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Bezuidenhout L, Rhoda A, Moulaee Conradsson D, Mothabeng J, Joseph C. The Role of Environmental Factors on Health Conditions, General Health and Quality of Life in Persons with Spinal Cord Injuries in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095709. [PMID: 37174227 PMCID: PMC10178437 DOI: 10.3390/ijerph20095709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The objective was to describe the individual items of the environmental factors and to investigate the relationship between the environmental factors to health conditions, general health and quality of life in people with SCI in South Africa. METHODS Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury (InSCI) Community Survey. Four major domains, environmental factors, health conditions, general health and quality of life of the survey questionnaire responses, were used for the analysis. Regression models were used to determine the association between the independent variable, which consisted of the specific environmental factors items, and the dependent variables comprising health conditions, general health and quality of life. RESULTS The commonly reported environmental barriers were public access, lack of short- and long-distance transport and finances. Environmental factors such as public access (p < 0.001), short- (p < 0.001) and long-distance transport (p = 0.001), and friends' (p = 0.003) and colleagues' (p < 0.001) attitudes and communication (p = 0.042) were significantly associated with the presence of secondary health conditions. Finances (p = 0.026), family attitudes (p = 0.037) and communication (p = 0.039) had a significant association with worsened mental health. Services (p = 0.022) and communication (p = 0.042) were also significantly associated with decreased general health. CONCLUSION The results provide insight into modifiable environmental factors policymakers need to consider or adapt to improve the lives of people with SCI in South Africa with respect to health (secondary health conditions), as well as general and mental health.
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Affiliation(s)
- Lucian Bezuidenhout
- Faculty of Community and Health Sciences, University of Western Cape, Cape Town 7701, South Africa
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Anthea Rhoda
- Faculty of Community and Health Sciences, University of Western Cape, Cape Town 7701, South Africa
| | - David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town 7602, South Africa
- Medical Unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Joyce Mothabeng
- Department of Physiotherapy, University of Pretoria, Pretoria 0028, South Africa
| | - Conran Joseph
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town 7602, South Africa
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Maher JL, Whitmarsh C, Smith P, Taylor H, Fard A, Bilzon J. Feasibility study of high-intensity interval training to reduce cardiometabolic disease risks in individuals with acute spinal cord injury. BMJ Open 2023; 13:e068507. [PMID: 36737096 PMCID: PMC9900054 DOI: 10.1136/bmjopen-2022-068507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Individuals ageing with spinal cord injury (SCI) experience an accelerated trajectory of diseases and disorders, such as cardiovascular disease and diabetes, that resemble those experienced with ageing alone. Currently, an evidence-based approach toward managing this problem does not exist and therefore the purpose of this study is to determine the feasibility of conducting a high-intensity exercise intervention in individuals with acute (<6 months postinjury) SCI to improve cardiometabolic health. METHODS AND ANALYSIS We will conduct a single-centre, two parallel-arm, randomised feasibility study of a high-intensity interval training (HIIT) intervention in individuals with acute SCI. We will enrol 40 individuals (20 intervention, 20 control) with acute SCI attending inpatient rehabilitation at Salisbury District Hospital. Participants will be randomly allocated to the intervention group (HIIT) or control group for 18 weeks. Both groups will participate in standard care throughout the duration of the study. The HIIT group only will also perform supervised HIIT exercise on an arm cycle ergometer three times per week. Over the course of the intervention, most participants will be discharged from the hospital, and at this time, an arm cycle ergometer will be installed in their home and the intervention will transition into outpatient care. We will assess cardiorespiratory fitness, glycaemic control, lipid profile and body habitus as well as qualitative assessments of acceptability at weeks 0, 9 and 18 with the primary outcome being the feasibility of a full Randomised Controlled Trial (RCT). ETHICS AND DISSEMINATION This study will inform a longer-term, definitive, multicentre RCT to establish the impact of this exercise intervention in maintaining the cardiometabolic health of patients during the acute phase following SCI. Results will be disseminated in different formats including peer-reviewed journal articles, conference presentations and internet media, to a wide audience including clinicians, researchers and individuals with SCI. TRIAL REGISTRATION NUMBER ISRCTN57514022.
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Affiliation(s)
| | - Catherine Whitmarsh
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Paula Smith
- Department of Psychology, University of Bath, Bath, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Aram Fard
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
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Bigford GE, Garshick E. Systemic inflammation after spinal cord injury: A review of biological evidence, related health risks, and potential therapies. Curr Opin Pharmacol 2022; 67:102303. [PMID: 36206621 PMCID: PMC9929918 DOI: 10.1016/j.coph.2022.102303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
Individuals with chronic traumatic spinal cord injury (SCI) develop progressive multi-system health problems that result in clinical illness and disability. Systemic inflammation is associated with many of the common medical complications and acquired diseases that accompany chronic SCI, suggesting that it contributes to a number of comorbid pathological conditions. However, many of the mechanisms that promote persistent systemic inflammation and its consequences remain ill-defined. This review describes the significant biological factors that contribute to systemic inflammation, major organ systems affected, health risks, and the potential treatment strategies. We aim to highlight the need for a better understanding of inflammatory processes, and to establish appropriate strategies to address inflammation in SCI.
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Affiliation(s)
- Gregory E Bigford
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Boehl G, Raguindin PF, Valido E, Bertolo A, Itodo OA, Minder B, Lampart P, Scheel-Sailer A, Leichtle A, Glisic M, Stoyanov J. Endocrinological and inflammatory markers in individuals with spinal cord injury: A systematic review and meta-analysis. Rev Endocr Metab Disord 2022; 23:1035-1050. [PMID: 35978214 PMCID: PMC9515048 DOI: 10.1007/s11154-022-09742-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 10/25/2022]
Abstract
Spinal cord injury (SCI) can lead to dramatic physiological changes which can be a factor in developing secondary health conditions and might be reflected in biomarker changes in this elevated risk group. We focused specifically on the endocrine and inflammation profile differences between SCI and able-bodied individuals (ABI). Our aim was to determine the differences in inflammatory markers and endocrine profiles between SCI and ABI. We systematically searched 4 electronic databases for relevant studies. Human observational (cross-sectional, cohort, case-control) studies that compared biomarkers of interest between SCI and ABI population were included. Weighted mean difference between SCI and ABI was calculated using random-effects models. Heterogeneity was computed using I2 statistic and chi-squared test. Study quality was evaluated through the Newcastle-Ottawa Scale. The search strategy yielded a total of 2,603 studies from which 256 articles were selected for full-text assessment. Sixty-two studies were included in the meta-analysis. SCI individuals had higher levels of pro-inflammatory C-reactive protein and IL-6 than ABI. Creatinine and 25-hydroxyvitamin D3 levels were lower in SCI than ABI. Total testosterone levels and IGF-1 were also found to be lower, while cortisol and leptin levels were higher in SCI when compared to ABI. Accordingly, meta-regression, subgroup analysis, and leave-one-out analysis were performed, however, they were only able to partially explain the high levels of heterogeneity. Individuals with SCI show higher levels of inflammatory markers and present significant endocrinological changes when compared to ABI. Moreover, higher incidence of obesity, diabetes, osteoporosis, and hypogonadism in SCI individuals, together with decreased creatinine levels reflect some of the readily measurable aspects of the phenotype changes in the SCI group. These findings need to be considered in anticipating medically related complications and personalizing SCI medical care.
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Affiliation(s)
| | - Peter Francis Raguindin
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Ezra Valido
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Alessandro Bertolo
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Orthopedic Surgery, University of Bern, Bern Inselspital, Bern, Switzerland
| | - Oche Adam Itodo
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Public Health & Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | | | | | - Alexander Leichtle
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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Baehr LA, Kaimal G, Hiremath SV, Trost Z, Finley M. Staying active after rehab: Physical activity perspectives with a spinal cord injury beyond functional gains. PLoS One 2022; 17:e0265807. [PMID: 35320294 PMCID: PMC8942209 DOI: 10.1371/journal.pone.0265807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/08/2022] [Indexed: 11/27/2022] Open
Abstract
Lifestyle physical activity following spinal cord injury (SCI) is critical for functional independence, mental wellness, and social participation, yet nearly 50% of individuals with SCI report no regular exercise. The objective of this study was to better understand factors leading to this participation gap by capturing the physical activity perspectives of individuals living with SCI. We completed small group interviews with nine individuals living with SCI across the United States. Iterative thematic analysis systematically revealed meaningful core concepts related to physical activity engagement with SCI. Emergent themes revealed challenges to lifestyle physical activity behavior including gaps in physical activity education, isolation during psychological adjustment, and knowledge limitations in community exercise settings. A secondary theme related to the COVID-19 pandemic emerged, highlighting additional environmental constraints affecting participation. Our findings suggest that most physical activity education is delivered during inpatient rehabilitation and is related to physical function. Lifetime physical activity strategies are achieved through self-education and peer networking. Personal motivators for physical activity include secondary condition prevention, while social and emotional barriers prevent regular adherence. These findings can inform the development and delivery of physical activity programs to maximize physical activity engagement in individuals living with chronic SCI.
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Affiliation(s)
- Laura A. Baehr
- Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, PA, United States of America
- * E-mail:
| | - Girija Kaimal
- Creative Arts Therapies Department, Drexel University, Philadelphia, PA, United States of America
| | - Shivayogi V. Hiremath
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States of America
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Margaret Finley
- Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, PA, United States of America
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Schleifer G, Solinsky R, Hamner JW, Picard G, Taylor A. Hybrid Functional Electrical Stimulation improves anaerobic threshold in first three years following spinal cord injury. J Neurotrauma 2022; 39:1050-1056. [PMID: 35232233 PMCID: PMC9347388 DOI: 10.1089/neu.2021.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of the present investigation was to assess the effects of whole-body exercise on anaerobic threshold in individuals with spinal cord injury (SCI). Maximal oxygen uptake (VO2max) and oxygen uptake at anaerobic threshold (AT) were measured before and after 6 months of hybrid functional electrical stimulation row training in 47 participants with SCI aged 19-63, neurological levels of injury C4-L1, American Spinal Injury Association Impairment Scale grades A-D, and time since injury at enrollment from 3 months to 40 years. Changes in VO2max differed with time since injury, with greater increases earlier post injury. The early chronic group (<3 years since injury; n=31) increased VO2max from 1.65 ± 0.54 L/min at baseline to 1.83 ± 0.66 L/min at 6 months (p<0.05), while the late chronic group (>3 years since injury; n=16) did not change (1.42 ± 0.44 at baseline to 1.47 ± 0.41 L/min at 6 months, p=0.36). Consistent with VO2max changes, AT increased in the early chronic group (1.03 ± 0.31 to 1.20 ± 0.40 L/min, p<0.05) and did not change in the late chronic group (0.99 ± 0.31 to 0.99 ± 0.26 L/min, p=0.92). Cumulative duration of exercise training was positively correlated to change in VO2max (r=0.475, p<0.05) but not to change in AT. Hybrid functional electrical stimulation row training is effective for increasing aerobic capacity and anaerobic threshold in individuals with spinal cord injury; however, these fitness benefits are only significant in individuals initiating the exercise intervention within three years of injury.
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Affiliation(s)
- Grant Schleifer
- Harvard Medical School, 1811, 107 Ave Louis Pasteur, Boston, Massachusetts, United States, 02115;
| | - Ryan Solinsky
- Spaulding Rehabilitation Hospital, Physical Medicine and Rehabilitation, Cambridge, United States;
| | - Jason W Hamner
- Spaulding Rehabilitation Hospital, Physical Medicine and Rehabilitation, Cambridge, Massachusetts, United States;
| | - Glen Picard
- Spaulding Rehabilitation Hospital, 24498, Cardiovascular Research Laboratory, Cambridge, Massachusetts, United States;
| | - Andrew Taylor
- Spaulding Rehabilitation Hospital, 24498, Physical Medicine and Rehabilitation , Cambridge, United States;
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A mixed-methods study exploring and comparing the experiences of people who sustained a spinal cord injury earlier versus later in life. Spinal Cord 2022; 60:706-711. [PMID: 35169302 DOI: 10.1038/s41393-022-00767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Mixed-methods. OBJECTIVES (1) To explore psychosocial and quality of life outcomes between those injured early versus later in life, and (2) to explore their post-injury experiences. SETTING GF Strong Rehabilitation Centre, Vancouver, Canada. METHODS For this community-based study, we recruited individuals with SCI (>55 years of age) who were either injured between the ages of 15-30 (n = 15) or after the age of 50 (n = 15). We collected quantitative data about participants' sociodemographics and participants completed standardised questionnaires assessing personal factors, environmental factors, life habits, and quality of life. An independent samples t test was performed for continuous variables and the Chi-square test was conducted for the categorical variables. Qualitative data were collected via semi-structured interviews. Thematic content analysis was performed on the interview transcripts. RESULTS We found no statistically significant differences between the two groups on any of the psychosocial outcomes. However, those injured later in life were significantly more likely to be female, have a higher income, and live in residential care. We identified three main qualitative themes that were consistent across the two groups: 'dealing with health and changes in occupation', 'enacting interdependence', and 'living in the community'. Some sub-themes varied between groups. CONCLUSIONS To facilitate better rehabilitation, clinicians need to be aware of disparities among people with SCI relating to age of injury. Across age cohorts, it is important to increase independence, provide greater support when entering or returning to the workforce, and reduce societal stigma.
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Aikat R, Singh V. Identification of Mood and Body Mass Index as Modifiable Factors for Health Improvement in Spinal Cord Injury. Arch Rehabil Res Clin Transl 2021; 4:100174. [PMID: 35282145 PMCID: PMC8904861 DOI: 10.1016/j.arrct.2021.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Higher body mass index (BMI) is associated with lower positive affect in individuals with spinal cord injury (SCI). Women with SCI are at higher risk of developing increased negative affect than men. Older individuals with SCI have a greater chance of developing higher BMI. Premorbid personality traits with respect to mood and BMI are essential to interpret the association of BMI and positive affect.
Objective Design Setting Participants Interventions Main Outcome Measures Results Conclusions
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Jakimovska VM, Biering-Sørensen F, Lidal IB, Kostovski E. Community dwelling life- and health issues among persons living with chronic spinal cord injury in North Macedonia. Spinal Cord 2021; 60:245-250. [PMID: 34408273 DOI: 10.1038/s41393-021-00688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES The purpose was to reveal late health consequences and life issues after a traumatic spinal cord injury (tSCI) in North Macedonia (NM). SETTING Community dwelling adults with tSCI in NM. METHODS Persons that sustained tSCI in 1999-2005 were selected, physical examined and a questionnaire was administered. Descriptive statistics were conducted. RESULTS From 203 eligible persons, 40 agreed to participate. Mean (range) age at time of injury was 36 (27-75) years and time since injury ranged 9-20 years. Around seventy percent reported current health problems, of which pain and spasm (>60%) were most prevalent, followed by urinary tract infections and pressure injuries. About 30% had never been to a medical specialist and ≈70% had only once been to physiotherapy after discharge from the primary inpatient period. Only one participant had a fully adjusted home for a person with a disability. Those with most severe tSCI (American Spinal Injury Association Impairment Scale (AIS) A, B, and C) seldom left their homes. About 50% were retired and/or unemployed, 50% were working. CONCLUSION This is the first study describing community-dwelling persons with a tSCI in NM. Our study revealed that persons with tSCI reported health issues mostly related to pain, spasms, urinary tract infections and pressure injuries. They lacked follow-ups, experienced physical barriers and poor inclusion in the society, and lacked financial support. Therefore, they were often socially isolated and fully dependent on their families. NM is in need of structured rehabilitation programs and better adaption for persons with reduced mobility.
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Affiliation(s)
| | - Fin Biering-Sørensen
- Department for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Emil Kostovski
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway. .,Manifestsenteret, Røyken, Norway.
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Bigford GE, Szeto A, Kimball J, Herderick EE, Mendez AJ, Nash MS. Cardiometabolic risks and atherosclerotic disease in ApoE knockout mice: Effect of spinal cord injury and Salsalate anti-inflammatory pharmacotherapy. PLoS One 2021; 16:e0246601. [PMID: 33626069 PMCID: PMC7904230 DOI: 10.1371/journal.pone.0246601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/21/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To test in mice with a double mutation of the ApoE gene (ApoE-/-) whether spinal cord injury (SCI) hastens the native trajectory of, and established component risks for, atherosclerotic disease (AD), and whether Salsalate anti-inflammatory pharmacotherapy attenuates the impact of SCI. METHODS ApoE-/- mice were anesthetized and underwent a T9 laminectomy. Exposed spinal cords were given a contusion injury (70 k-dynes). Sham animals underwent all surgical procedures, excluding injury. Injured animals were randomized to 2 groups: SCI or SCI+Salsalate [120 mg/Kg/day i.p.]. Mice were serially sacrificed at 20-, 24-, and 28-weeks post-SCI, and body mass was recorded. At sacrifice, heart and aorta were harvested intact, fixed in 10% buffered formalin, cleaned and cut longitudinally for en face preparation. The aortic tree was stained with oil-red-O (ORO). AD lesion histomorphometry was calculated from the proportional area of ORO. Plasma total cholesterol, triglycerides and proatherogenic inflammatory cytokines (PAIC's) were analyzed. RESULTS AD lesion in the aortic arch progressively increased in ApoE-/-, significant at 24- and 28-weeks. AD in SCI is significantly greater at 24- and 28-weeks compared to time-controlled ApoE-/-. Salsalate treatment attenuates the SCI-induced increase at these time points. Body mass in all SCI groups are significantly reduced compared to time-controlled ApoE-/-. Cholesterol and triglycerides are significantly higher with SCI by 24- and 28-weeks, compared to ApoE-/-, and Salsalate reduces the SCI-induced effect on cholesterol. PAIC's interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor α (TNFα), monocyte chemoattractant protein-1 (MCP-1), and chemokine (C-C motif) ligand 5 (CCL-5) are significantly greater with SCI compared to ApoE-/- at varying timepoints. Salsalate confers a marginal reducing effect on PAIC's by 28-weeks compared to SCI. Regression models determine that each PAIC is a significant and positive predictor of lesion. (p's <0.05). CONCLUSIONS SCI accelerates aortic AD and associated risk factors, and anti-inflammatory treatment may attenuate the impact of SCI on AD outcomes. PAIC's IL-1β, IL-6, TNFα, MCP-1, and CCL-5 may be effective predictors of AD.
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Affiliation(s)
- Gregory E. Bigford
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Angela Szeto
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - John Kimball
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | | | - Armando J. Mendez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Mark S. Nash
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Physical Therapy, University of Miami, Coral Gables, Florida, United States of America
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13
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Riedman E, Scott H, Clarke P, Meade M, Forchheimer M, Tate D. "Earth angels" and parking spots: qualitative perspectives on healthy aging with spinal cord injury. Disabil Rehabil 2020; 44:1399-1408. [PMID: 32924639 DOI: 10.1080/09638288.2020.1817987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE People aging with spinal cord injury (SCI) can experience the premature onset of comorbid conditions, as well as the development and progression of secondary health conditions. The aim of this study was to understand the subjective experiences of persons aging with SCI in relation to their surrounding social and physical environments, including the impact of barriers and facilitators.Material/Methods: Eleven individuals who had an SCI for more than ten years and were 45 years or older participated in a semi-structured phone interview about their experiences with healthy aging, social participation, social supports, and community barriers. RESULTS Four main themes emerged in the qualitative data that captured the subjective experience of aging with SCI. These were: (1) Maintaining Physical Independence; (2) Importance of Resources and Special Equipment; (3) Planning Ahead; and (4) Finding Ways to Adapt. CONCLUSIONS The findings from this study highlight the importance of looking beyond individual factors to consider the social and environmental factors that support continued independence and participation in society as people living with long term SCI experience their aging process. Qualitative research that delves further into the dynamics behind this process is needed to fully anticipate the needs of this growing population.IMPLICATIONS FOR REHABILITATIONPeople aging with spinal cord injury (SCI) who are engaged in their social and physical environments have become increasingly adaptive when faced with accelerating and secondary comorbidities.Programs and facilities should ensure universal access to prevention and self-management programs that target physical activity and health habits when considered in the context of a patient's socio-environmental constraints and resources.Clinical healthcare providers need to engage with their patients to develop an early intervention approach to preserve functional capacity while navigating potential future health problems.Clinicians should act as advocates for ongoing policy changes that help promote an environment more inclusive towards people aging with SCI.
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Affiliation(s)
- Elizabeth Riedman
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Haley Scott
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Philippa Clarke
- Institute of Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Michelle Meade
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Martin Forchheimer
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Denise Tate
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
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Abstract
Introduction: People aging with long-term physical disabilities (PAwLTPD), meaning individuals with onset of disability from birth through midlife, often require long-term support services (LTSS) to remain independence. The LTSS system is fragmented into aging and disability organizations with little communication between them. In addition, there are currently no evidence-based LTSS-type programs listed on the Administration for Community Living website that have been demonstrated to be effective for PAwLTPD. Because of these gaps, we have developed a community-based research network (CBRN), drawing on the practice-based research network model (PBRN), to bring together aging and disability organizations to address the lack of evidence-based programs for PAwLTPD. Materials and Methods: Community-based organizations serving PAwLTPD across the state of Missouri were recruited to join the CBRN. A formative process evaluation of the network was conducted after a year to evaluate the effectiveness of the network. Results: Nine community-based organizations across the state of Missouri joined the CBRN. CBRN members include three centers for independent living (CILs), three area agencies on aging (AAAs), one CIL/AAA hybrid, one non-CIL disability organization, and one non-AAA aging organization. To date, we have held seven meetings, provided educational opportunities for CBRN members, and launched an inaugural research study within the CBRN. Formative evaluation data indicate that CBRN members feel that participation in the CBRN is beneficial. Conclusion: The PBRN model appears to be a feasible framework for use with community-based organizations to facilitate communication between agencies and to support research aimed at addressing the needs of PAwLTPD.
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De Souza LH, Frank AO. Clinical features of electric powered indoor/outdoor wheelchair users with spinal cord injuries: A cross-sectional study. Assist Technol 2020; 32:117-124. [PMID: 30036176 DOI: 10.1080/10400435.2018.1503205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This article aims to describe the characteristics of those with a primary diagnosis of spinal cord injury (SCI) attending a specialist wheelchair service providing electric powered indoor/outdoor chairs (EPIOCs). This cross-sectional study, with retrospective review of electronic and case note records, explores the complexities of additional clinical features associated with SCI and disability influencing prescription. Data were extracted under three themes; demographics, diagnostic/clinical information and wheelchair factors. There were 57 participants (35 men, 22 women) (mean age 53.51 ± 11.93, range 29-79 years) comprising 20 with paraplegia, 34 with tetraplegia and 3 with undocumented level. Paraplegics were significantly older than tetraplegics (p < 0.05). Thirty users had a complete SCI (mean age 49.87 ± 12.27 years) and 27 had another SCI lesion (mean age 57.56 ± 10.32 years). Those with a complete SCI were significantly younger than the rest (p < 0.02). Only 10 (9 tetraplegic) had SCI as the sole diagnosis. Twenty (15 tetraplegic) had one additional clinical feature, 14 had 2-3 (6 tetraplegic) and 13 (4 tetraplegic) had 4 or more. Ten users required specialised seating, 22 needed tilt-in-space EPIOCs while six required complex controls. The range and complexity of wheelchair and seating needs benefitted from a holistic assessment and prescription by a specialist multidisciplinary team.
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Affiliation(s)
- Lorraine H De Souza
- Department of Clinical Sciences and Institute for the Environment, Health and Society, Brunel University London, Uxbridge, Middlesex, UK
| | - Andrew O Frank
- Department of Clinical Sciences and Institute for the Environment, Health and Society, Brunel University London, Uxbridge, Middlesex, UK.,Stanmore Specialist Wheelchair Service, Royal National Orthopaedic Hospital, Stanmore, UK
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16
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Baldan-Martin M, Martin-Rojas T, Corbacho-Alonso N, Lopez JA, Sastre-Oliva T, Gil-Dones F, Vazquez J, Arevalo JM, Mourino-Alvarez L, Barderas MG. Comprehensive Proteomic Profiling of Pressure Ulcers in Patients with Spinal Cord Injury Identifies a Specific Protein Pattern of Pathology. Adv Wound Care (New Rochelle) 2020; 9:277-294. [PMID: 32226651 PMCID: PMC7099418 DOI: 10.1089/wound.2019.0968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/10/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: Severe pressure ulcers (PUs) do not respond to conservative wound therapy and need surgical repair. To better understand the pathogenesis and to advance on new therapeutic options, we focused on the proteomic analysis of PU, which offers substantial opportunities to identify significant changes in protein abundance during the course of PU formation in an unbiased manner. Approach: To better define the protein pattern of this pathology, we performed a proteomic approach in which we compare severe PU tissue from spinal cord injury (SCI) patients with control tissue from the same patients. Results: We found 76 proteins with difference in abundance. Of these, 10 proteins were verified as proteins that define the pathology: antithrombin-III, alpha-1-antitrypsin, kininogen-1, alpha-2-macroglobulin, fibronectin, apolipoprotein A-I, collagen alpha-1 (XII) chain, haptoglobin, apolipoprotein B-100, and complement factor B. Innovation: This is the first study to analyze differential abundance protein of PU tissue from SCI patients using high-throughput protein identification and quantification by tandem mass tags followed by liquid chromatography tandem mass spectrometry. Conclusion: Differential abundance proteins are mainly involved in tissue regeneration. These proteins might be considered as future therapeutic options to enhance the physiological response and permit cellular repair of damaged tissue.
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Affiliation(s)
- Montserrat Baldan-Martin
- Department of Vascular Physiopathology, National Hospital for Paraplegics (HNP), SESCAM, Toledo, Spain
| | - Tatiana Martin-Rojas
- Department of Vascular Physiopathology, National Hospital for Paraplegics (HNP), SESCAM, Toledo, Spain
| | - Nerea Corbacho-Alonso
- Department of Vascular Physiopathology, National Hospital for Paraplegics (HNP), SESCAM, Toledo, Spain
| | - Juan Antonio Lopez
- Department of Plastic Surgery, National Hospital for Paraplegics (HNP), SESCAM, Toledo, Spain
| | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, National Hospital for Paraplegics (HNP), SESCAM, Toledo, Spain
| | - Felix Gil-Dones
- Department of Vascular Physiopathology, National Hospital for Paraplegics (HNP), SESCAM, Toledo, Spain
| | - Jesus Vazquez
- Department of Plastic Surgery, National Hospital for Paraplegics (HNP), SESCAM, Toledo, Spain
| | | | - Laura Mourino-Alvarez
- Department of Vascular Physiopathology, National Hospital for Paraplegics (HNP), SESCAM, Toledo, Spain
| | - Maria G. Barderas
- Department of Vascular Physiopathology, National Hospital for Paraplegics (HNP), SESCAM, Toledo, Spain
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17
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Zanini C, Brach M, Lustenberger N, Scheel-Sailer A, Koch HG, Stucki G, Rubinelli S. Engaging in the prevention of pressure injuries in spinal cord injury: A qualitative study of community-dwelling individuals' different styles of prevention in Switzerland. J Spinal Cord Med 2020; 43:247-256. [PMID: 30540555 PMCID: PMC7054934 DOI: 10.1080/10790268.2018.1543094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Context: Spinal cord injury (SCI) is a complex chronic condition with multiple self-management requirements and a high prevalence of complications. Pressure injuries (PIs) are among the most common ones and represent a frequent reason for re-hospitalization. This study aimed to identify styles of prevention that individuals with SCI adopt to deal with the risk of developing PIs.Design: Qualitative explorative interview study. Data was collected through semi-structured interviews, which were transcribed verbatim and analyzed following the principles of thematic analysis.Setting: Switzerland.Participants: The participants were a purposive sample of community-dwelling Swiss residents with SCI for at least five years.Interventions: Not applicable.Outcome measures: Not applicable.Results: Although all participants (N = 20) showed at least a basic knowledge of prevention of PIs by describing some preventive measures, they had different prevention styles characterized by different behavioral patterns (i.e. complying with all recommended measures, performing only a selection of them or delegating them to others) and different beliefs and attitudes towards prevention.Conclusion: By identifying the style of prevention of an individual, it is possible to develop tailored interventions that have an impact on the factors which seem to play a role in determining the adoption of preventive behaviors (i.e. perceived susceptibility to PIs, attitudes towards prevention, and self-efficacy). Such interventions would constitute a concrete effort to support individuals with SCI during their self-management. Besides alleviating a frequent and disabling medical complication and contributing to an enhanced quality of life, these interventions might also help decrease healthcare costs.
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Affiliation(s)
- Claudia Zanini
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Mirjam Brach
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | | | | | | | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
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18
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Kaka AS, Beekmann SE, Gravely A, Filice GA, Polgreen PM, Johnson JR. Diagnosis and Management of Osteomyelitis Associated With Stage 4 Pressure Ulcers: Report of a Query to the Emerging Infections Network of the Infectious Diseases Society of America. Open Forum Infect Dis 2019; 6:ofz406. [PMID: 31696138 DOI: 10.1093/ofid/ofz406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/10/2019] [Indexed: 01/13/2023] Open
Abstract
Background Few studies exist to guide the management of patients with stage 4 pressure ulcers with possible underlying osteomyelitis. We hypothesized that infectious disease (ID) physicians would vary widely in their approach to such patients. Methods The Emerging Infections Network distributed a 10-question electronic survey in 2018 to 1332 adult ID physicians in different practice settings to determine their approach to such patients. Results Of the 558 respondents (response rate: 42%), 17% had managed no such patient in the past year. Of the remaining 464 respondents, 60% usually felt confident in diagnosing osteomyelitis; the strongest clinical indicator of osteomyelitis reported was palpable or visible bone at the ulcer base. Approaches to diagnosing osteomyelitis in patients with visible and palpable bone varied: 41% of respondents would assume osteomyelitis, 27% would attempt pressure off-loading first, and 22% would perform diagnostic testing immediately. Preferred tests for osteomyelitis were bone biopsy (for culture and histopathology) and magnetic resonance imaging. Respondents differed widely on favored route(s) (intravenous, oral, or both) and duration of antimicrobial therapy but would treat longer in the absence, vs presence, of full surgical debridement (P < .001). Overall, 62% of respondents opined that osteomyelitis under stage 4 pressure ulcers is usually or almost always treated excessively, and most (59%) suggested multiple topics for future research. Conclusions Regarding osteomyelitis underlying stage 4 pressure ulcers, ID physicians reported widely divergent diagnostic and treatment approaches. Most of the reported practice is not supported by the available evidence, which is quite limited and of low quality.
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Affiliation(s)
- Anjum S Kaka
- Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,University of Minnesota, Minneapolis, USA
| | | | - Amy Gravely
- Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Gregory A Filice
- Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,University of Minnesota, Minneapolis, USA
| | | | - James R Johnson
- Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,University of Minnesota, Minneapolis, USA
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19
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Abstract
Spinal cord injury results in multiple secondary comorbidities, which vary based on injury severity and other characteristics. Persons with spinal cord injury are at lifelong risk for many complications, most of which are at least partially preventable with proper medical care. The Veterans Health Administration Spinal Cord Injury and Disorders (SCI&D) System of Care offers these evaluations to all persons in their registries. Annual evaluations are performed at any of the 24 SCI&D Veterans Administration Centers nationwide. This allows veterans to receive the care from an interdisciplinary team that specializes in the care of veterans with spinal cord injury.
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20
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Yamaki K, Wing C, Mitchell D, Owen R, Heller T. Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care. J Aging Health 2018; 31:97S-123S. [PMID: 30442043 DOI: 10.1177/0898264318808192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We evaluated the impact of Medicaid managed care (MMC) on health service use and state costs among adults with early-acquired physical disabilities. Method: Using claims data, we tracked utilization of the emergency department (ED), inpatient admissions, outpatient physician visits, and state expenditures on enrollees who transitioned to MMC (n = 881). The inverse propensity score weight and a difference-in-differences regression model were used to estimate the impact of MMC using their counterparts who remained in fee-for-service (n = 1,552) as the comparison group. Results: MMC reduced ED use by 3.2% points/month (p < .001). Relative to younger enrollees (age ⩽45 years), MMC reduced inpatient admissions of older enrollees (age ⩾46 years) by 3.3% points/month (p < .001), and state expenditures by US$839/month (p < .01). Discussion: MMC could reduce the hospital service use of and state spending on enrollees with early-acquired physical disabilities. This impact may vary depending on the enrollees' age.
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21
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Participation restriction and assistance needs in people with spinal cord injuries of more than 40 year duration. Spinal Cord Ser Cases 2018; 4:28. [PMID: 29619249 DOI: 10.1038/s41394-018-0056-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/10/2018] [Accepted: 02/11/2018] [Indexed: 11/08/2022] Open
Abstract
Study design Prospective observational. Objectives Examine changes in participation restriction and assistance needs in a sample of people with long-standing spinal cord injuries (SCIs). Setting Two British spinal centres. Methods The sample consisted of British ageing with SCI study participants who were seen at baseline (1990 or 1993) and in the final follow-up (2010). Outcome measures were the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) and interview questions about assistance needs. Results Eighty-five Ageing study participants took part in 2010; their mean age was 67.65 years and the mean time since injury was 46.26 years. The mean CHART-SF physical independence subscore decreased from 97.44 in 1990 to 91.26 in 2010, mobility from 95.58 to 82.10, occupation from 86.82 to 64.49 and social integration from 96.29 to 88.68 (all p < 0.05). Increasing assistance needs were reported by 10.1% of participants in 1990, by 36.6% in 2010 (p < 0.05) and by 62.4% over the entire 20-year study period. Persons requiring more assistance were older and injured longer, had a more severe SCI and lower self-reported quality of life and life satisfaction (p < 0.05). In the multivariate logistic regression, the strongest predictor of needing more assistance was injury severity (p < 0.05). Conclusions An increase in participation restriction and in assistance needs was reported over the 20 year follow-up in persons injured more than 40 years ago. SCI severity was the main risk factor for needing more assistance. Clinical awareness of how participation changes with age may help provide timely intervention and offset declines.
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22
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Katzelnick CG, Weir JP, Chiaravalloti ND, Wylie GR, Dyson-Hudson TA, Bauman WA, Wecht JM. Impact of Blood Pressure, Lesion Level, and Physical Activity on Aortic Augmentation Index in Persons with Spinal Cord Injury. J Neurotrauma 2017; 34:3407-3415. [DOI: 10.1089/neu.2017.5065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Caitlyn G. Katzelnick
- VA RR&D National Center for Medication Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, New York
- Department of Research, Kessler Foundation, West Orange, New Jersey
| | - Joseph P. Weir
- Department of Health, Sport, and Exercise Science, University of Kansas, Lawrence, Kansas
| | - Nancy D. Chiaravalloti
- Department of Research, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Glenn R. Wylie
- Department of Research, Kessler Foundation, West Orange, New Jersey
- The War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, New Jersey
| | - Trevor A. Dyson-Hudson
- Department of Research, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - William A. Bauman
- VA RR&D National Center for Medication Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, New York
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jill M. Wecht
- VA RR&D National Center for Medication Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, New York
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
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23
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Tedeschi S, Negosanti L, Sgarzani R, Trapani F, Pignanelli S, Battilana M, Capirossi R, Brillanti Ventura D, Giannella M, Bartoletti M, Tumietto F, Cristini F, Viale P. Superficial swab versus deep-tissue biopsy for the microbiological diagnosis of local infection in advanced-stage pressure ulcers of spinal-cord-injured patients: a prospective study. Clin Microbiol Infect 2017; 23:943-947. [DOI: 10.1016/j.cmi.2017.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/12/2017] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
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Dunn JA, Hay-Smith EJ, Keeling S, Sinnott KA. Decision-Making About Upper Limb Tendon Transfer Surgery by People With Tetraplegia for More Than 10 Years. Arch Phys Med Rehabil 2017; 97:S88-96. [PMID: 27233596 DOI: 10.1016/j.apmr.2015.09.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/18/2015] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To quantify time from spinal cord injury to upper limb reconstructive surgery for individuals with tetraplegia; to explore influences on decision-making about surgery for persons with long-standing (>10y) tetraplegia; and to determine the applicability of our previously developed conceptual framework that described the decision-making processes for people with tetraplegia of <5 years. DESIGN Quantitative-qualitative mixed-methods study. SETTING Community based in New Zealand. PARTICIPANTS People (N=9) living with tetraplegia for >10 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES An audit of time frames between injury, assessment, and surgery for people with tetraplegia was undertaken. Interviews of people with tetraplegia were analyzed using constructivist grounded theory. RESULTS Sixty-two percent of people with tetraplegia assessed for surgery had upper limb reconstructive surgery. Most were assessed within the first 3 years of spinal cord injury. Over half had surgery within 4 years after injury; however, 20% waited >10 years. Changes in prioritized activities, and the identification of tasks possible with surgery, were influential in the decision-making process. Participants were aware of surgery, but required a reoffer from health professionals before proceeding. The influence of peers was prominent in reinforcing the improvement in prioritized activities possible after surgery. CONCLUSIONS Findings confirmed that the previously developed conceptual framework for decision-making about upper limb reconstructive surgery was applicable for people with tetraplegia of >10 years. Similarities were seen in the influence of goals and priorities (although the nature of these might change) and information from peers (although this influence was greater for those injured longer). Repeat offers for surgery were required to allow for changes in circumstances over time.
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Affiliation(s)
- Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand; Burwood Spinal Unit, Burwood Hospital, Christchurch, New Zealand.
| | - E Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Sally Keeling
- Health Care of the Elderly, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - K Anne Sinnott
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand; Burwood Academy of Independent Living, Burwood Hospital, Christchurch, New Zealand
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25
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Jakimovska VM, Kostovski E, Biering-Sørensen F, Lidal IB. Psychological distress and user experiences with health care provision in persons living with spinal cord injury for more than 20 years. Spinal Cord 2017; 55:864-869. [DOI: 10.1038/sc.2017.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/20/2017] [Accepted: 02/23/2017] [Indexed: 11/09/2022]
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26
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Guihan M, Sohn MW, Bauman WA, Spungen AM, Powell-Cope GM, Thomason SS, Collins JF, Bates-Jensen BM. Difficulty in Identifying Factors Responsible for Pressure Ulcer Healing in Veterans With Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97:2085-2094.e1. [PMID: 27373743 DOI: 10.1016/j.apmr.2016.05.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/29/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify characteristics associated with pressure ulcer (PrU) healing for individuals with spinal cord injury (SCI). DESIGN Secondary analysis of a large clinical trial's data for healing PrUs in individuals with SCI; prospective Delphi process was conducted with SCI and/or PrU experts. SETTING Spinal cord injury centers. PARTICIPANTS There were 629 screening and 162 treatment participants (N=791); 185 SCI clinicians/national PrU/wound care experts participated in the Delphi process. INTERVENTIONS None. MAIN OUTCOME MEASURE PrU healing of 50% and 100% at weeks 4 and 12. RESULTS Poisson regression models using the top Delphi-recommended factors found that only ulcer stage consistently predicted 50% and 100% healing at weeks 4 and 12. Additionally, ischial/perineal location was associated with 33% higher likelihood of 50% healing at week 4. Patient noncompliance with treatment recommendations, the top-ranked Delphi factor, did not predict healing at week 4 or 12. Expanded models found that at week 4, baseline PrU size, PrU stage IV, PrU pain, and American Spinal Injury Association grade A significantly predicted 100% healing, while at week 12, only PrU stage (IV) significantly predicted 100% healing. Significant predictors of 50% healing at week 4 included baseline PrU size, stage, ischial/perianal location body mass index >30kg/m2, foul odor, and signs of infection. At week 12, PrU duration, paraplegia predicted 50% healing. SCI center identifiers consistently showed 2- to 5-fold variation in predicting 50% PrU healing at weeks 4 and 12. CONCLUSIONS Delphi panel-recommended factors (eg, patient compliance) did not predict PrU healing. Reducing center-level variability in wound healing by learning from best practices should be a health system goal. PrU healing in SCI is still poorly understood, and future studies should focus on as yet unidentified or underappreciated factors.
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Affiliation(s)
- Marylou Guihan
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr Veterans Administration Hospital, Hines, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Min-Woong Sohn
- Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA
| | - William A Bauman
- Veterans Administration Rehabilitation Research and Development National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Administration Medical Center, Bronx, NY; Department of Medicine and Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ann M Spungen
- Veterans Administration Rehabilitation Research and Development National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Administration Medical Center, Bronx, NY; Department of Medicine and Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gail M Powell-Cope
- Center of Innovation for Disability and Rehabilitation Research, Tampa, FL; School of Nursing, University of South Florida, Tampa, FL
| | - Susan S Thomason
- Center of Innovation for Disability and Rehabilitation Research, Tampa, FL
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Perry Point Veterans Administration Medical Center, Perry Point, MD
| | - Barbara M Bates-Jensen
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr Veterans Administration Hospital, Hines, IL; School of Nursing, University of California at Los Angeles, Los Angeles, CA; David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
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27
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Ronca E, Scheel-Sailer A, Koch HG, Metzger S, Gemperli A. Inpatient migration patterns in persons with spinal cord injury: A registry study with hospital discharge data. SSM Popul Health 2016; 2:259-268. [PMID: 29349146 PMCID: PMC5757847 DOI: 10.1016/j.ssmph.2016.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 11/29/2022] Open
Abstract
This study investigated and compared patient migration patterns of persons with spinal cord injury, the general population and persons with morbid obesity, rheumatic conditions and bowel disease, for secondary health conditions, across administrative boundaries in Switzerland. The effects of patient characteristics and health conditions on visiting hospitals outside the residential canton were examined using complete, nationwide, inpatient health records for the years 2010 and 2011. Patients with spinal cord injury were more likely to obtain treatment outside their residential canton as compared to all other conditions. Facilitators of patient migration in persons with spinal cord injury and the general hospital population were private or accidental health insurances covering costs. Barriers of patient migration in persons with spinal cord injury were old age, severe multimorbidity, financial coverage by basic health insurance, and minority language region. Persons with spinal cord injury were traveling most for inpatient hospital care. Complete or higher-level injuries were associated with more patient migration. Old age and insurance type were strong predictors for receiving local care. Large geographical variability in patient migration patterns was found.
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Affiliation(s)
- Elias Ronca
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | | | | | | | - Armin Gemperli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Tweedy SM, Beckman EM, Geraghty TJ, Theisen D, Perret C, Harvey LA, Vanlandewijck YC. Exercise and sports science Australia (ESSA) position statement on exercise and spinal cord injury. J Sci Med Sport 2016; 20:108-115. [PMID: 27185457 DOI: 10.1016/j.jsams.2016.02.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/14/2016] [Accepted: 02/05/2016] [Indexed: 12/17/2022]
Abstract
Traumatic spinal cord injury (SCI) may result in tetraplegia (motor and/or sensory nervous system impairment of the arms, trunk and legs) or paraplegia (motor and/or sensory impairment of the trunk and/or legs only). The adverse effects of SCI on health, fitness and functioning are frequently compounded by profoundly sedentary behaviour. People with paraplegia (PP) and tetraplegia (TP) have reduced exercise capacity due to paralysis/paresis and reduced exercising stroke volume. TP often further reduces exercise capacity due to lower maximum heart-rate and respiratory function. There is strong, consistent evidence that exercise can improve cardiorespiratory fitness and muscular strength in people with SCI. There is emerging evidence for a range of other exercise benefits, including reduced risk of cardio-metabolic disease, depression and shoulder pain, as well as improved respiratory function, quality-of-life and functional independence. Exercise recommendations for people with SCI are: ≥30min of moderate aerobic exercise on ≥5d/week or ≥20min of vigorous aerobic ≥3d/week; strength training on ≥2d/week, including scapula stabilisers and posterior shoulder girdle; and ≥2d/week flexibility training, including shoulder internal and external rotators. These recommendations may be aspirational for profoundly inactive clients and stratification into "beginning", "intermediate" and "advanced" will assist application of the recommendations in clinical practice. Flexibility exercise is recommended to preserve upper limb function but may not prevent contracture. For people with TP, Rating of Perceived Exertion may provide a more valid indication of exercise intensity than heart rate. The safety and effectiveness of exercise interventions can be enhanced by initial screening for autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, thermoregulatory dysfunction, pressure sores, spasticity and pain.
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Affiliation(s)
- Sean M Tweedy
- The University of Queensland, School of Human Movement and Nutrition Sciences, Australia.
| | - Emma M Beckman
- The University of Queensland, School of Human Movement and Nutrition Sciences, Australia
| | - Timothy J Geraghty
- Queensland Spinal Cord Injuries Service, Princess Alexandra Hospital, Metro South Health, Australia
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg
| | - Claudio Perret
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, Switzerland
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, Australia
| | - Yves C Vanlandewijck
- Katholieke Universiteit Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Belgium
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Marti A, Boes S, Lay V, Reuben Escorpizo PT, Trezzini B. The association between chronological age, age at injury and employment: Is there a mediating effect of secondary health conditions? Spinal Cord 2015; 54:239-44. [DOI: 10.1038/sc.2015.159] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/06/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
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Ellenbroek D, Kressler J, Cowan RE, Burns PA, Mendez AJ, Nash MS. Effects of prandial challenge on triglyceridemia, glycemia, and pro-inflammatory activity in persons with chronic paraplegia. J Spinal Cord Med 2015; 38:468-75. [PMID: 24617559 PMCID: PMC4612202 DOI: 10.1179/2045772314y.0000000199] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
CONTEXT/OBJECTIVE Exaggerated postprandial lipemia has been reported after spinal cord injury (SCI). We examined metabolite and accompanying pro-inflammatory biomarker responses to repeat feeding of typical high-fat meals in individuals with chronic paraplegia. DESIGN Descriptive trial. METHODS Metabolites (triglycerides, glucose, and insulin) and inflammatory biomarkers (interleukin-6 and high-sensitivity C-reactive protein (hsCRP)) were measured under fasting conditions in 11 recreationally active individuals with chronic (>1 year) paraplegia. Subjects received high-fat meals at time point 0 and again at minute 240. Antecubital venous blood was obtained at time points -30 (fasting), 0 (first meal), 30, 60, 90, 120, 240 (second meal), 360, and 480 minutes. Correlations were examined among the study variables. Exploratory subgroup analysis was performed for subjects with levels of postprandial glucose greater than >200 mg/dl. RESULTS Triglycerides showed a significant rise 4 hours after eating. Basal inflammatory markers were elevated, and did not undergo additional change during the testing. Additionally, subjects with excessive postprandial glucose responses showed higher hsCRP levels than those having typical glucose responses both for fasting (11.8 ± 6.5 vs. 2.9 ± 2.7 mg/l, P = 0.064) and postprandial (11.1 ± 4.9 vs. 3.7 ± 3.8 mg/l, P = 0.018) values. CONCLUSIONS Despite elevations in metabolic response markers, inflammatory markers did not change significantly after consumption of population-representative (i.e. hypercaloric) mixed-nutrient meals. Levels of fasting CRP in the high-risk range are consistent with other reports in persons with SCI and continue to pose concern for their cardiovascular disease risk. The possible association between postprandial metabolic responses and inflammatory states warrants further investigation to identify individual component risks for this secondary health hazard.
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Affiliation(s)
- Dennis Ellenbroek
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jochen Kressler
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA,Correspondence to: Jochen Kressler, The Miami Project to Cure Paralysis, University of Miami, 1095 NW 14th Ter, Miami, FL 33136, USA.
| | | | - Patricia A. Burns
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
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Requejo PS, Furumasu J, Mulroy SJ. Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users. TOPICS IN GERIATRIC REHABILITATION 2015; 31:26-41. [PMID: 26366040 PMCID: PMC4562294 DOI: 10.1097/tgr.0000000000000042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Elderly and aging manual wheelchair (MWC) users have increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. This review paper addresses important issues for preserving function and mobility for elderly and aging individuals who use a MWC by presenting the current available evidence and recommendations. These include recommendations for maximizing function, by decreasing pain, improving the ability to self-propel, and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area.
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Affiliation(s)
- Philip S. Requejo
- Physical Therapy Department, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
- Rehabilitation Engineering Program, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
| | - Jan Furumasu
- Physical Therapy Department, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
| | - Sara J. Mulroy
- Physical Therapy Department, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
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Goodman BL, Schindler A, Washington M, Bogie KM, Ho CH. Factors in rehospitalisation for severe pressure ulcer care in spinal cord injury/disorders. J Wound Care 2014; 23:165-6, 168, 170-2 passim. [PMID: 24762380 DOI: 10.12968/jowc.2014.23.4.165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Repeated hospital admissions (RHA) for ongoing pressure ulcer (PU) care remains a significant challenge in the clinical management of the spinal cord injury/disorders (SCI/D) population. The current study investigated the significance of risk factors for PU treatment and RHA. METHOD A retrospective chart review of veterans admitted to the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC) Spinal Cord Injury (SCI) unit for Category III or IV PUs was carried out. A random sample of 105 individuals with SCI/D, evaluated by the Wound Care Team (WCT) from 2006 to 2009 was assessed. Multiple PU development risk factors were extracted from the electronic health record system using standardised data collection forms and entered into the Spinal Cord Injury Pressure Ulcer Database (SCIPUD). Potential associations with RHA were analysed. RESULTS Twenty variables were initially identified as potentially related to PU development. Descriptive statistics and statistically significant associations between risk factors and RHA were determined. Demographic factors showed no significant association with RHA. Duration of injury, power wheelchair use and sub-optimally managed spasticity (SMS) were significantly associated with higher RHA. Sub-optimally managed neurogenic bowel (SMNB) at admission was significantly associated with reduced RHA. CONCLUSION Factors previously found to be predictive of initial PU development may not, in fact, be predictive of RHA. Some protective trends were observed, such as polypharmacy and marital status, but these did not reach statistical significance in this preliminary study of admission characteristics, warranting further research. DECLARATION OF INTEREST There were no external sources of funding for this study. The authors have no conflicts of interests to declare.
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Affiliation(s)
- B L Goodman
- MPH, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC), Cleveland, Ohio, US. Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, US
| | - A Schindler
- BA, The Ohio College of Podiatric Medicine, Cleveland, Ohio, US
| | - M Washington
- RN, MS, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC), Cleveland, Ohio, US
| | - K M Bogie
- PhD, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC), Cleveland, Ohio, US. Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio, US
| | - C H Ho
- MD, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC), Cleveland, Ohio, US. Division of Physical Medicine & Rehabilitation, University of Calgary, Calgary, Canada
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Middleton JW, Simpson GK, De Wolf A, Quirk R, Descallar J, Cameron ID. Psychological distress, quality of life, and burden in caregivers during community reintegration after spinal cord injury. Arch Phys Med Rehabil 2014; 95:1312-9. [PMID: 24709035 DOI: 10.1016/j.apmr.2014.03.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/16/2014] [Accepted: 03/20/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine relations between psychological distress, health-related quality of life (HR-QOL), and burden among caregivers of people with traumatic spinal cord injury (SCI) over time, and to determine whether the data are more consistent with a wear and tear or adaptation trajectory. DESIGN Prospective longitudinal cohort study with measurements at 4 time points (6wk prior to discharge from subacute inpatient rehabilitation and 6wk, 1y, and 2y postdischarge to community). SETTING Rehabilitation units. PARTICIPANTS Participants (N=44; spouses, parents, others) nominated as a primary caregiver by the person with SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES General Health Questionnaire-28 (GHQ-28), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index (CSI) assessed the extent of psychological distress, HR-QOL, and burden, respectively, among caregivers. Functional status and community participation/care needs of the persons with SCI were assessed by the FIM and Craig Handicap Assessment and Reporting Technique, respectively. RESULTS Multilevel piecewise models showed that psychological distress (GHQ-28 score) decreased significantly after discharge (slope estimate =-.03, P<.008). At the predischarge time point, the caregivers' mental component summary score on the SF-36 was significantly lower than Australian national norms. The scores improved from predischarge to 6 weeks postdischarge (slope estimate =.39, P<.001), but they did not change significantly across the following 2 time points (slope estimate =.02, P=.250). At all 3 postdischarge time points, the mental component summary scores were not significantly different to national norms. In contrast, the physical component summary score of the SF-36 did not significantly change across the predischarge and 6-week postdischarge time points (slope estimate =-.14, P=.121) and the 3 postdischarge time points (slope estimate <.01, P=.947). Scores at all 4 time points were not significantly different to the national norms. Caregiver burden showed no significant change over the study period (predischarge to 6wk postdischarge slope estimate =.02, P=.426; 3 postdischarge time point slope estimates <-.01, P=.334). Reflecting this, 42% of caregivers met CSI caseness criterion at the first time point, and 46% met the criterion at the fourth (2y) time point. Higher burden was significantly correlated with increased hours of care being provided by the caregiver and lower FIM scores and lower community participation (for the person with SCI) at each time point. Psychological distress correlated with caregiver burden at 6 weeks and 1 year postdischarge but not at 2 years postdischarge. CONCLUSIONS The trajectory of scores for psychological distress and HR-QOL was consistent with caregiver adaptation to the challenge of providing support to a person with SCI in the early postdischarge period. Caregiver burden did not display similar reductions but did not worsen over the study period.
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Affiliation(s)
- James W Middleton
- Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, Australia; State Spinal Cord Injury Service, New South Wales Agency for Clinical Innovation, Australia.
| | - Grahame K Simpson
- Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Annelies De Wolf
- Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, Australia; State Spinal Cord Injury Service, New South Wales Agency for Clinical Innovation, Australia
| | - Ruth Quirk
- Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Ian D Cameron
- Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, Australia
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Rodakowski J, Skidmore ER, Anderson SJ, Begley A, Jensen MP, Buhule OD, Boninger ML. Additive effect of age on disability for individuals with spinal cord injuries. Arch Phys Med Rehabil 2014; 95:1076-82. [PMID: 24530841 DOI: 10.1016/j.apmr.2014.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the additive effect of age on disability for adults with spinal cord injury (SCI). DESIGN Prospective cohort study. SETTING SCI Model Systems. PARTICIPANTS Individuals with SCI (median age at injury, 32 y; range, 6-88 y) with a discharge motor FIM score and at least 1 follow-up motor FIM score who also provided measures of other covariates (N=1660). Of the total sample, 79% were men, 72% were white, 16% had incomplete paraplegia, 33% had complete paraplegia, 30% had incomplete tetraplegia, and 21% had complete tetraplegia. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary study outcome was the motor subscale of the FIM. A mixed-models approach was used to examine the additive effect of age on disability for individuals with SCI. RESULTS When controlling for motor FIM at discharge from rehabilitation, level and severity of injury, age at injury, sex, race, and the age × time interaction were not significant (P=.07). Age at the time of SCI was significantly associated with motor FIM (F1,238=22.49, P<.001). Two sensitivity analyses found significant interactions for both age × time (P=.03, P=.02) and age × time-square (P=.01, P=.006) models. Trajectory of motor FIM scores is moderated slightly by age at the time of injury. The older participants were at the time of injury, the greater the curvature and the more rapid decline were found in later years. CONCLUSIONS These findings indicate that age moderately influences disability for some individuals with SCI: the older the age at the time of injury, the greater the influence age has on disability. The findings serve as an important empirical foundation for the evaluation and development of interventions designed to augment accelerated aging experienced by individuals with SCI.
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Affiliation(s)
- Juleen Rodakowski
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA.
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | | | - Amy Begley
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Olive D Buhule
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
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Dunn JA, Rothwell AG, Mohammed KD, Sinnott KA. The effects of aging on upper limb tendon transfers in patients with tetraplegia. J Hand Surg Am 2014; 39:317-23. [PMID: 24480690 DOI: 10.1016/j.jhsa.2013.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effects of aging on hand function among patients with tetraplegia who had forearm tendon transfer surgery between 1982 and 1990. METHODS The study used a longitudinal cohort design that compared hand function outcomes in 2012 with those obtained 11 years earlier. A digital analyzer was used to measure key pinch and grip strength, and results were compared with those obtained in 2001 to determine changes in strength over time. The study also evaluated changes in participant's employment status, wheelchair use, and subjective changes in function using the Lamb and Chan questionnaire. RESULTS Participants had a mean key pinch strength force between 11.5 N (tenodeses) and 32.9 N (active transfers) and grip strength forces between 23 N (tenodeses) and 59 N (active transfers). Since 2001, people with active transfers either maintained strength or experienced decreased strength of 5% to 14%. Thumb tenodesis power decreased 40% to 51%, whereas finger tenodeses power increased 32% to 70%. Three activities in the Lamb and Chan questionnaire were identified by the majority of participants as being worse or much worse over the past 11 years. These were performing a pressure relief and propelling a manual wheelchair on level ground and up a ramp. These findings correspond with the increased number of participants who used a power wheelchair in 2012 (64%) compared with 2001 (26%). Close to half of the participants (46%) were employed compared with the 90% in 2001. CONCLUSIONS Tendon transfers continued to provide pinch and grip function for individuals with tetraplegia for many years following spinal cord injury. The decrease in strength of those with active transfers over the 11-year period was within the reported aging loss for the normal population. The small number of participants with tenodesis, however, limited our ability to draw meaningful conclusions for this group. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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Affiliation(s)
- Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago; the Burwood Spinal Unit, Canterbury District Health Board; and the Burwood Academy of Independent Living (BAIL), Burwood Hospital, Christchurch, New Zealand.
| | - Alastair G Rothwell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago; the Burwood Spinal Unit, Canterbury District Health Board; and the Burwood Academy of Independent Living (BAIL), Burwood Hospital, Christchurch, New Zealand
| | - Khalid D Mohammed
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago; the Burwood Spinal Unit, Canterbury District Health Board; and the Burwood Academy of Independent Living (BAIL), Burwood Hospital, Christchurch, New Zealand
| | - K Anne Sinnott
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago; the Burwood Spinal Unit, Canterbury District Health Board; and the Burwood Academy of Independent Living (BAIL), Burwood Hospital, Christchurch, New Zealand
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Thomas CK, Grumbles RM. Age at spinal cord injury determines muscle strength. Front Integr Neurosci 2014; 8:2. [PMID: 24478643 PMCID: PMC3899581 DOI: 10.3389/fnint.2014.00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/06/2014] [Indexed: 11/30/2022] Open
Abstract
As individuals with spinal cord injury (SCI) age they report noticeable deficits in muscle strength, endurance and functional capacity when performing everyday tasks. These changes begin at ~45 years. Here we present a cross-sectional analysis of paralyzed thenar muscle and motor unit contractile properties in two datasets obtained from different subjects who sustained a cervical SCI at different ages (≤46 years) in relation to data from uninjured age-matched individuals. First, completely paralyzed thenar muscles were weaker when C6 SCI occurred at an older age. Muscles were also significantly weaker if the injury was closer to the thenar motor pools (C6 vs. C4). More muscles were strong (>50% uninjured) in those injured at a younger (≤25 years) vs. young age (>25 years), irrespective of SCI level. There was a reduction in motor unit numbers in all muscles tested. In each C6 SCI, only ~30 units survived vs. 144 units in uninjured subjects. Since intact axons only sprout 4-6 fold, the limits for muscle reinnervation have largely been met in these young individuals. Thus, any further reduction in motor unit numbers with time after these injuries will likely result in chronic denervation, and may explain the late-onset muscle weakness routinely described by people with SCI. In a second dataset, paralyzed thenar motor units were more fatigable than uninjured units. This gap widened with age and will reduce functional reserve. Force declines were not due to electromyographic decrements in either group so the site of failure was beyond excitation of the muscle membrane. Together, these results suggest that age at SCI is an important determinant of long-term muscle strength, and fatigability, both of which influence functional capacity.
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Affiliation(s)
- Christine K. Thomas
- The Miami Project to Cure Paralysis, University of Miami Miller School of MedicineMiami, FL, USA
- Department of Neurological Surgery, University of Miami Miller School of MedicineMiami, FL, USA
- Department of Physiology and Biophysics, University of Miami Miller School of MedicineMiami, FL, USA
| | - Robert M. Grumbles
- The Miami Project to Cure Paralysis, University of Miami Miller School of MedicineMiami, FL, USA
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Scheel-Sailer A, Wyss A, Boldt C, Post MW, Lay V. Prevalence, location, grade of pressure ulcers and association with specific patient characteristics in adult spinal cord injury patients during the hospital stay: a prospective cohort study. Spinal Cord 2013; 51:828-33. [PMID: 23999106 DOI: 10.1038/sc.2013.91] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 07/05/2013] [Accepted: 07/24/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This was a prospective cohort study. OBJECTIVES The objective was to describe the incidence, prevalence, characteristics of pressure ulcers (PUs) and the association with specific patient characteristics in a consecutive sample of in-patients with a spinal cord injury (SCI). SETTING An acute care and rehabilitation clinic specialized in SCIs in Switzerland. METHODS The presence and characteristics of PUs for all adult patients with a SCI admitted to the clinic from 1 September 2009 to 28 February 2010 were recorded on a daily basis during their complete hospitalization. Risk factors were analyzed in univariate and multivariate logistic regression models. RESULTS A total of 185 patients were included in the study and observed for the entirety of their hospitalization. The prevalence of at least one PU was 49.2% in all patients, compared with 25.4% in the group of patients admitted without PUs. The incidence was 2.2 per person and year. In 91 patients, a total of 219 PUs were observed. PUs were most frequently located on the foot (36.1%), and the coccyx/sacrum (15.1%). The risk for occurrence of a PU increased with age (odds ratio (OR)=1.04) and post SCI (OR=1.03). In the multivariate analyses, the risk for PUs was lower for patients with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) of C or D (ORC=0.25, ORD=0.28) compared with patients with an AIS of A. CONCLUSION Using a daily documentation system, PUs were detected as a frequent complication of SCIs. Completeness of injury, age and time since injury were significant risk factors for PUs. The foot was a region at high risk for PUs.
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Alterations in mouse hypothalamic adipokine gene expression and leptin signaling following chronic spinal cord injury and with advanced age. PLoS One 2012; 7:e41073. [PMID: 22815920 PMCID: PMC3397960 DOI: 10.1371/journal.pone.0041073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 06/18/2012] [Indexed: 01/19/2023] Open
Abstract
Chronic spinal cord injury (SCI) results in an accelerated trajectory of several cardiovascular disease (CVD) risk factors and related aging characteristics, however the molecular mechanisms that are activated have not been explored. Adipokines and leptin signaling are known to play a critical role in neuro-endocrine regulation of energy metabolism, and are now implicated in central inflammatory processes associated with CVD. Here, we examine hypothalamic adipokine gene expression and leptin signaling in response to chronic spinal cord injury and with advanced age. We demonstrate significant changes in fasting-induced adipose factor (FIAF), resistin (Rstn), long-form leptin receptor (LepRb) and suppressor of cytokine-3 (SOCS3) gene expression following chronic SCI and with advanced age. LepRb and Jak2/stat3 signaling is significantly decreased and the leptin signaling inhibitor SOCS3 is significantly elevated with chronic SCI and advanced age. In addition, we investigate endoplasmic reticulum (ER) stress and activation of the uncoupled protein response (UPR) as a biological hallmark of leptin resistance. We observe the activation of the ER stress/UPR proteins IRE1, PERK, and eIF2alpha, demonstrating leptin resistance in chronic SCI and with advanced age. These findings provide evidence for adipokine-mediated inflammatory responses and leptin resistance as contributing to neuro-endocrine dysfunction and CVD risk following SCI and with advanced age. Understanding the underlying mechanisms contributing to SCI and age related CVD may provide insight that will help direct specific therapeutic interventions.
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Sale P, Mazzarella F, Pagliacci MC, Agosti M, Felzani G, Franceschini M. Predictors of changes in sentimental and sexual life after traumatic spinal cord injury. Arch Phys Med Rehabil 2012; 93:1944-9. [PMID: 22465584 DOI: 10.1016/j.apmr.2012.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 03/01/2012] [Accepted: 03/21/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate changes and identify predictors in interpersonal functioning and sexual life after traumatic spinal cord injury (SCI). DESIGN Prospective, multicenter, follow-up observational study. SETTING Subjects at home, interviewed by phone during a 6-month period, 3.8 mean years after discharge from 24 centers participating in a previous epidemiologic prospective survey. PARTICIPANTS Subjects (N=403) with traumatic SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES DEPENDENT VARIABLES satisfaction with sentimental life and satisfaction with sexual life compared with before the injury. INDEPENDENT VARIABLES demographic (age, sex, marital status, vocational status), SCI related (severity, level, bowel/bladder continence), car-driving ability, perceived quality of life (QoL), and impact of sentimental life, social integration, and vocational status on QoL. RESULTS Satisfaction with sentimental life was reportedly increased or the same as before SCI in 69% of the sample, but satisfaction with sexual life in only 31%. Lesser satisfaction with sexual life was reported by men than women (P=.002) and by married people than singles (P<.001). Significant predictors of sentimental life were perceived QoL and preserved driving ability (R(2)=.195). Bladder continence was positively associated with a better satisfaction with sexual life (R(2)=.368). Bowel continence did not remain a significant predictor of satisfaction with sexual life in multivariate analysis. CONCLUSIONS The challenge of a comprehensive rehabilitation of SCI, addressing the recovery of well-being including a satisfying sentimental and sexual life, requires identifying new issues that should be considered in up-to-date rehabilitation programs. The results indicate associations between driving ability and a better satisfaction with sentimental life. Further investigations are needed to explore whether the relationship is causative.
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Affiliation(s)
- Patrizio Sale
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy.
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An evidence-based review on the influence of aging with a spinal cord injury on subjective quality of life. Spinal Cord 2012; 50:570-8. [PMID: 22450883 DOI: 10.1038/sc.2012.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To identify changes in subjective quality of life (QoL) as one ages with a spinal cord injury (SCI). SETTING Vancouver, Canada. METHODS Electronic databases were searched for studies reporting on age-related QoL changes over time. Data from relevant studies were transcribed into data extraction forms and analyzed by years post injury (YPI) and chronologic age. Each study was assigned a level of evidence based on a modified Sackett scale. RESULTS In all, 21 studies, each with a low level of evidence, were included for review. The results indicated that regardless of chronologic age, individuals with relatively new SCI have the potential to improve their QoL. Among individuals with advanced YPI, overall QoL is consistently reported as good or excellent over time, however, with variations in different QoL domains. CONCLUSION The QoL of individuals aging with a SCI has the potential to improve, and remain high and stable over time. As the identified studies provide low levels of evidence, more longitudinal research with greater methodological and measurement rigor is needed to corroborate the findings and conclusions of this review.
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Investigating Changes in Quality of Life and Function Along the Lifespan for People With Spinal Cord Injury. Arch Phys Med Rehabil 2012; 93:413-9. [DOI: 10.1016/j.apmr.2011.10.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/20/2011] [Accepted: 10/21/2011] [Indexed: 11/18/2022]
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Abstract
BACKGROUND Pressure ulcer development is a common, serious complication after spinal cord injury (SCI). Although many biophysical agents are available for treatment, few randomized controlled trials of their efficacy have been done. OBJECTIVE The study objective was to examine the efficacy of low-pressure pulsatile lavage treatment for stage III and IV pressure ulcers in people with SCI. DESIGN This study was a randomized controlled trial. Participants and assessors were unaware of intervention assignments. SETTING This study was conducted in an SCI tertiary care center inpatient unit. PARTICIPANTS Participants were 28 people with SCI and stage III and IV pelvic pressure ulcers; 14 participants each were randomly assigned to treatment and control (sham treatment) groups. INTERVENTION Daily low-pressure pulsatile lavage treatment with 1 L of normal saline at 11 psi of pressure was applied to the treatment group along with standard dressing changes. The control group received only sham treatment and standard dressing changes. MEASUREMENTS Linear and volume measurements of pressure ulcer dimensions were obtained weekly for 3 weeks. RESULTS Statistical analysis with the t test revealed no statistically significant difference in demographics between groups. Random-coefficient models for analysis of linear and volume measurements revealed improvements over time for both groups. Time trend analysis revealed greater measurement decreases for the treatment group. Differences in rates of change (with 95% confidence intervals) for treatment and control groups, respectively, were: depth, -0.24 (0.09 to -0.58) cm/wk; width, -0.16 (0.06 to -0.39) cm/wk; length, -0.47 (0.18 to -1.12) cm/wk; and volume, -0.33 (0.13 to -0.80) cm(3)/wk. LIMITATIONS Study limitations were small sample size and inclusion of only one site. Additionally, participants were not queried about their group assignments. CONCLUSIONS Pulsatile lavage enhanced stage III and IV pelvic pressure ulcer healing rates in people with SCI relative to standard pressure ulcer treatment alone.
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LaVela SL, Evans CT, Prohaska TR, Miskevics S, Ganesh SP, Weaver FM. Males Aging With a Spinal Cord Injury: Prevalence of Cardiovascular and Metabolic Conditions. Arch Phys Med Rehabil 2012; 93:90-5. [DOI: 10.1016/j.apmr.2011.07.201] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 10/14/2022]
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LaVela SL, Johnson BW, Miskevics S, Weaver FM. Impact of a multicomponent support services program on informal caregivers of adults aging with disabilities. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2012; 55:160-174. [PMID: 22324332 DOI: 10.1080/01634372.2011.642472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A multicomponent support services program was implemented for veterans aging with disabilities and their informal caregivers (n = 42 dyads). Caregiver outcomes (satisfaction, physical and mental health status, burden, and benefits) were evaluated before and after program use. Caregivers reported significant improvements in mental health post-program. Caregivers who provided care to individuals with impaired physical health experienced meaningful improvements in burden after the support services were rendered. Supporting caregiver health status through such programs is vital to preserve noninstitutional long-term care for persons aging with disabilities, particularly when care is provided over many years to an individual with physical impairments.
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Affiliation(s)
- Sherri L LaVela
- Center for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Illinois 60141, USA.
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Post MWM, Brinkhof MWG, von Elm E, Boldt C, Brach M, Fekete C, Eriks-Hoogland I, Curt A, Stucki G. Design of the Swiss Spinal Cord Injury Cohort Study. Am J Phys Med Rehabil 2011; 90:S5-16. [PMID: 21975676 DOI: 10.1097/phm.0b013e318230fd41] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The overall goal of the Swiss Spinal Cord Injury Cohort Study (SwiSCI) is to gain a better understanding of how to support functioning, health maintenance, and quality-of-life of persons with spinal cord injury (SCI) along the continuum of care, in the community, and along their life span. The purpose of this study was to present the SwiSCI study design. SwiSCI is composed of three complementary pathways and will include Swiss persons 16 yrs or older who have diagnoses of traumatic or nontraumatic SCI. Pathway 1 is a retrospective study of medical files of patients admitted to one of the collaborating SCI centers between 2005 and 2009. Pathway 2 is a nationwide survey of persons with chronic SCI. Pathway 3 is an inception cohort study including persons with newly acquired SCI. SwiSCI is conducted in collaboration with the Swiss Paraplegic Association and the major specialized rehabilitation centers in Switzerland. Measurement instruments that are to be used in Pathway 2 and 3 cover body structures and functions, activities, participation, life satisfaction, and personal and environmental factors. SwiSCI is a prospective cohort study that will contribute to a comprehensive understanding of the lived experience of persons with SCI.
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Developing epidemiologic studies of people's lived experience: the Swiss Spinal Cord Injury Cohort Study as a case in point. Am J Phys Med Rehabil 2011; 90:S1-4. [PMID: 21975672 DOI: 10.1097/phm.0b013e318230fe6a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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