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Cole S, Wang Z, Chen Z, Hua C, Chen Y, Evans D. Is Spending Nights Away From Home Associated With Participation and Life Satisfaction After Spinal Cord Injury? A Longitudinal Perspective. Top Spinal Cord Inj Rehabil 2023; 29:73-85. [PMID: 38076499 PMCID: PMC10704217 DOI: 10.46292/sci22-00020] [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] [Indexed: 12/18/2023]
Abstract
Background Community reintegration after SCI rehabilitation consists of readjustment not only to the home setting but also to the social and occupational spheres, which often require people to spend nights away from home. Because community reintegration contributes to life satisfaction after SCI, it is necessary to investigate how travel participation is related to occupational and social participation and life satisfaction. Additionally, better management of the long-term effects of SCI requires better understanding of the changes in participation and life satisfaction over time. Objectives To examine how participation and life satisfaction change over time following SCI, and to investigate whether spending nights away from home is associated with occupational and social participation and life satisfaction over time. Methods This is a longitudinal analysis of data extracted from the publicly available database of Spinal Cord Model Systems from 1996 to 2016. A generalized linear mixed model was developed to examine the changes of outcome variables over time while controlling demographic variables. Results Travel and social participation declined while life satisfaction increased as people lived longer with SCI, controlling for confounders. No significant change was identified in occupational participation. Spending nights away from home was significantly and positively associated with social and occupational participation and life satisfaction over time. Although travel participation of people with SCI declined over time, its association with social participation strengthened as the number of postinjury years increased. Conclusion Travel participation plays an important role in successful community reintegration. Rehabilitation services and travel services should provide training and resources on travel after SCI for improved participation and life satisfaction.
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Affiliation(s)
- Shu Cole
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana
| | - Zikun Wang
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana
| | - Zhongxue Chen
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana
| | - Chenggang Hua
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, The University of Alabama at Birmingham, Birmingham, Alabama
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Zeinaddini-Meymand A, Baigi V, Mousavi-Nasab MM, Shool S, Sadeghi-Naini M, Azadmanjir Z, Jazayeri SB, Berchi Kankam S, Dashtkoohi M, Shakeri A, Fakharian E, Kouchakinejad-Eramsadati L, Pirnejad H, Sadeghi-Bazargani H, Bagheri L, Pourandish Y, Amiri M, Pour-Rashidi A, Harrop J, Rahimi-Movaghar V. Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran. Global Spine J 2023:21925682231202425. [PMID: 37732722 DOI: 10.1177/21925682231202425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs). METHODS The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase. RESULTS In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1 hour and <8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%). CONCLUSION These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.
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Affiliation(s)
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sina Shool
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Department of Neurosurgery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Zahra Azadmanjir
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- International Neurosurgery Group (ING), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Dashtkoohi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Aidin Shakeri
- Department of Neurosurgery, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Homayoun Sadeghi-Bazargani
- Research Center for Evidence Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Laleh Bagheri
- Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Yasaman Pourandish
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Malihe Amiri
- Department of Neurosurgery, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - James Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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Tasiemski T, Kujawa J, Tederko P, Rubinelli S, Middleton JW, Craig A, Post MWM. Comparison of life satisfaction in persons with spinal cord injury living in 22 countries with different economic status. Arch Phys Med Rehabil 2021; 103:1285-1293. [PMID: 34922932 DOI: 10.1016/j.apmr.2021.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze and compare life satisfaction (LS) in persons with spinal cord injury (SCI) living in 22 countries participating in the International SCI (InSCI) community survey. The study tested the hypothesis that there are differences in LS across InSCI countries according to the countries' economic status specified as gross domestic product per capita purchased power parity (GDP-PPP). DESIGN Cross-sectional survey. SETTING Community setting (22 countries representing all 6 World Health Organization regions). PARTICIPANTS Persons (N=12,108) with traumatic or non-traumatic SCI aged at least 18 years, living in the community and able to respond to one of the available language versions of the questionnaire. INTERVENTIONS Not applicable. MAIN OUTCOMES Life satisfaction measured by 5 items selected from the World Health Organization Quality of Life Assessment-BREF (WHOQOL-5): satisfaction with overall quality of life, health, daily activities, relationships, and living conditions. LS index was calculated as the mean of these 5 items. RESULTS The highest level of LS was reported by persons with SCI living in USA, Malaysia, and Switzerland (mean range: 3.76-3.80), and the lowest by persons with SCI living in South Korea, Japan and Morocco (mean range: 2.81-3.16). There was a significant cubic association between LS index and GDP-PPP. Regression Trees analysis revealed the main variables differentiating LS index were GDP-PPP and monthly income, followed by time since injury and education. CONCLUSIONS Life satisfaction reported by persons with SCI related mainly to their country economic situation expressed by GDP-PPP and monthly income. The results of this study underscore the need for policy dialogues to avoid inequalities and improve the life experience in persons with SCI.
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Affiliation(s)
- Tomasz Tasiemski
- Department of Adapted Physical Activity, Faculty of Sport Sciences, Poznan University of Physical Education, Poland.
| | - Jolanta Kujawa
- Department of Medical Rehabilitation, Faculty of Health Sciences, Medical University of Lodz, Poland
| | - Piotr Tederko
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Poland
| | - Sara Rubinelli
- Department of Health Science and Medicine, University of Lucerne and Swiss Paraplegic Research
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, NSW Australia and Faculty of Medicine and Health, The University of Sydney, Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, NSW Australia and Faculty of Medicine and Health, The University of Sydney, Australia
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Struijk LNSA, Bentsen B, Gaihede M, Lontis R. Speaking Ability while Using an Inductive Tongue-Computer Interface for Individuals with Tetraplegia: Talking and Driving a Powered Wheelchair - a Case Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2483-2486. [PMID: 30440911 DOI: 10.1109/embc.2018.8512834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper assesses the ability of speaking while using an inductive tongue-computer interface. Lately, tongue- computer interfaces have been proposed for computer/robotic interfacing for individuals with tetraplegia. To be useful in home settings these interfaces should be aesthetic and interfere as little as possible with the limited preserved functionality of individuals with tetraplegia. As tongue interfaces from an aesthetical point of view are preferred to be entirely intra-oral it is relevant to address their effect on speech. Here we show that reading more than 566 words while using an inductive tongue-computer interface results in a maximum sensor activation time of less than 0.6 s, which means that false activations can be avoided by a sensor dwell time of 0.6 s. Furthermore, we show that it is possible to speak while controlling a powered wheelchair with the inductive tongue computer interface.
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DiMarco AF, Geertman RT, Tabbaa K, Polito RR, Kowalski KE. Economic Consequences of an Implanted Neuroprosthesis in Subjects with Spinal Cord Injury for Restoration of an Effective Cough. Top Spinal Cord Inj Rehabil 2018; 23:271-278. [PMID: 29339903 DOI: 10.1310/sci2303-271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To determine if an implanted neuroprosthesis for restoration of an effective cough is less costly than conventional methods of respiratory management. Methods: Nonrandomized clinical trial of participants (N = 14) with spinal cord injury (SCI) using the Cough Stimulator device in the inpatient hospital setting for Cough Stimulator implantation and outpatient hospital or residence for follow-up. A neuroprosthesis was implanted for restoration of an effective cough. The annual costs associated with respiratory management, without (pre implantation) and with (post implantation) the neuroprosthesis, were examined over a 4-year period. Results: The total cost related to implantation of the Cough Stimulator was $59,891, with no maintenance costs over subsequent years. The incidence of respiratory tract infections and the need for caregiver support fell significantly following implantation. The costs associated with respiratory tract infections fell significantly from a mean of $36,406 ± 11,855/year to $13,284 ± 7,035/year (p < .05) pre and post implantation, respectively. Costs fell further to $8,817 ± 5,990 and $4,467 ± 4,404 following the 2nd and 3rd years post implantation (p < .05), respectively. The costs associated with caregiver support fell significantly from $25,312 ± 8,019/year to $2,630 ± 2,233/year (p < .05) pre and post implantation, respectively, and remained low in subsequent years (p < .05). Other costs related to secretion management fell significantly and remained low in subsequent years (p < .05). Break-even analysis demonstrated that this point was reached in the first year. Conclusion: The results of this investigation demonstrate that implantation and use of the Cough Stimulator resulted in significant reductions in the overall costs of respiratory management in this patient population.
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Affiliation(s)
- Anthony F DiMarco
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University.,MetroHealth Research Institute, Case Western Reserve University
| | | | - Kutaiba Tabbaa
- Department of Anesthesiology, Case Western Reserve University
| | | | - Krzysztof E Kowalski
- Department of Medicine, Case Western Reserve University.,MetroHealth Research Institute, Case Western Reserve University.,Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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Characteristics of persons with spinal cord injury who drive in Malaysia and its barriers: a cross sectional study. Spinal Cord 2017; 56:341-346. [DOI: 10.1038/s41393-017-0034-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/12/2017] [Accepted: 10/26/2017] [Indexed: 11/09/2022]
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Palimaru A, Cunningham WE, Dillistone M, Vargas-Bustamante A, Liu H, Hays RD. A comparison of perceptions of quality of life among adults with spinal cord injury in the United States versus the United Kingdom. Qual Life Res 2017; 26:3143-3155. [PMID: 28712004 PMCID: PMC11108652 DOI: 10.1007/s11136-017-1646-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To identify which aspects of life are most important to adults with spinal cord injury (SCI) and compare perspectives in the United States and the United Kingdom. METHODS We conducted 20 in-depth interviews with adults with SCI (ten in the US and ten in the UK). Verbatim transcriptions were independently analyzed line-by-line by two coders using an inductive approach. Codes were grouped into themes about factors that constitute and affect quality of life (QOL). RESULTS Five overarching themes emerged: describing QOL in the context of SCI; functional adjustment; medical care; financial resources; and socio-political issues. Twenty subthemes emerged on factors that affect QOL. Participants in both samples identified medical care as a key influence on QOL. The US group talked about a predominantly negative influence (e.g., fragmented primary and specialist care, insurance constraints, bureaucracy), whereas UK interviewees mentioned a predominantly positive influence (e.g., universal provision, including free and continuous care, free wheelchairs and home care, and length of rehabilitation commensurate with level of injury). Functional adjustment, such as physical and mental adjustment post-discharge and aging with SCI, was another important contributor to QOL, and varied by country. Most US interviewees reported poor knowledge about self-care post-discharge and poor quality of home adaptations compared to the UK group. CONCLUSIONS For adults living with SCI, good QOL is essential for successful rehabilitation. Differences between interviewees from the two countries in perceived medical care and functional adjustment suggest that factors affecting QOL may relate to broader health system characteristics.
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Affiliation(s)
- Alina Palimaru
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. S., Los Angeles, CA, 90095, USA.
| | - William E Cunningham
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. S., Los Angeles, CA, 90095, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, UCLA, Geffen School of Medicine, Los Angeles, CA, 90095, USA
| | - Marcus Dillistone
- Royal Society of Medicine, 1 Wimpole Street, Marylebone, London, W1G 0AE, UK
| | - Arturo Vargas-Bustamante
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. S., Los Angeles, CA, 90095, USA
| | - Honghu Liu
- Division of Public Health & Community Dentistry, School of Dentistry, UCLA, Los Angeles, CA, 90095, USA
| | - Ron D Hays
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. S., Los Angeles, CA, 90095, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, UCLA, Geffen School of Medicine, Los Angeles, CA, 90095, USA
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Itzick M, Kagan M, Tal-Katz P. Perceived social support as a moderator between perceived discrimination and subjective well-being among people with physical disabilities in Israel. Disabil Rehabil 2017; 40:2208-2216. [PMID: 28549403 DOI: 10.1080/09638288.2017.1331380] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Perceived social support has gained importance as a significant preventive factor of depressive symptoms and as helpful for rebuilding feelings of self-worth and subjective well-being among people with physical disabilities. The current study examined whether perceived social support moderates the association between perceived discrimination and subjective well-being among people with physical disabilities in Israel. MATERIALS AND METHODS Data were collected by means of structured questionnaires among a convenience sample of 433 people with physical disabilities in Israel and hierarchical multiple regression was performed. RESULTS AND CONCLUSIONS The findings reveal that perceived social support has a moderating role in the association between perceived discrimination and subjective well-being among people with physical disabilities, such that those with low and moderate levels of perceived social support showed a negative association between perceived discrimination and subjective well-being, while those with high levels of perceived social support showed no association between perceived discrimination and subjective well-being. Findings are discussed in light of the social model of disability, and practical implications are suggested. Implications for Rehabilitation A negative association was found between perceived discrimination and subjective well-being among people with physical disabilities with low and moderate levels of perceived social support. Professionals working with people with physical disabilities must acknowledge the importance of social support for people with physical disabilities and for their families. Professionals working with people with physical disabilities should take a proactive approach to locating disabled people who do not receive or do not have adequate social support and offer them assistance. Professionals working with people with physical disabilities should engage in wide social activities aimed at providing resources and opportunities to service beneficiaries. Society bears the collective responsibility to act in order to reduce the social problem of discrimination against people with disabilities, as well as to raise public awareness of this issue.
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Affiliation(s)
- Michal Itzick
- a School of Social Work , Ariel University , Ariel , Israel
| | - Maya Kagan
- a School of Social Work , Ariel University , Ariel , Israel
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Andreasen Struijk LNS, Bentsen B, Gaihede M, Lontis ER. Error-Free Text Typing Performance of an Inductive Intra-Oral Tongue Computer Interface for Severely Disabled Individuals. IEEE Trans Neural Syst Rehabil Eng 2017; 25:2094-2104. [PMID: 28541213 DOI: 10.1109/tnsre.2017.2706524] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
For severely paralyzed individuals, alternative computer interfaces are becoming increasingly essential for everyday life as social and vocational activities are facilitated by information technology and as the environment becomes more automatic and remotely controllable. Tongue computer interfaces have proven to be desirable by the users partly due to their high degree of aesthetic acceptability, but so far the mature systems have shown a relatively low error-free text typing efficiency. This paper evaluated the intra-oral inductive tongue computer interface (ITCI) in its intended use: Error-free text typing in a generally available text editing system, Word. Individuals with tetraplegia and able bodied individuals used the ITCI for typing using a MATLAB interface and for Word typing for 4 to 5 experimental days, and the results showed an average error-free text typing rate in Word of 11.6 correct characters/min across all participants and of 15.5 correct characters/min for participants familiar with tongue piercings. Improvements in typing rates between the sessions suggest that typing ratescan be improved further through long-term use of the ITCI.
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Factors Which Facilitate or Impede Interpersonal Interactions and Relationships after Spinal Cord Injury: A Scoping Review with Suggestions for Rehabilitation. Rehabil Res Pract 2017; 2016:9373786. [PMID: 28127471 PMCID: PMC5227179 DOI: 10.1155/2016/9373786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/20/2016] [Accepted: 11/16/2016] [Indexed: 11/22/2022] Open
Abstract
Interpersonal interactions and relationships can influence an individual's perceptions of health and quality of life in the presence of disability. In the case of people with spinal cord injury (SCI), positive interpersonal interactions and relationships have been shown to contribute to resilience and adaptability. Understanding factors which facilitate or impede the development and maintenance of relationships after SCI may form the basis for proactive relationship support for people with SCI. To gain a broad insight into these factors, a scoping review was undertaken. Databases were searched for English language studies published between 2000 and 2015 that informed the review question. Sixty-two (62) studies were identified. Thematic analysis was conducted on data extracted from the studies and 51 factors which may facilitate relationships and 38 factors which may impede relationships after SCI were noted. The majority of factors could be categorized as environmental or personal according to the domains of the International Classification of Functioning, Disability, and Health (ICF). The facilitating factors included partner and social support, reciprocity in relationships, and presenting oneself positively. Impeding factors included physical environmental barriers, real and perceived social biases, and poor self-image. Factors identified may inform the provision of supportive, holistic rehabilitation for people with SCI.
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Tsai IH, Graves DE, Chan W, Darkoh C, Lee MS, Pompeii LA. Environmental barriers and social participation in individuals with spinal cord injury. Rehabil Psychol 2017; 62:36-44. [PMID: 28045281 DOI: 10.1037/rep0000117] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study aimed to examine the relationship between environmental barriers and social participation among individuals with spinal cord injury (SCI). METHOD Individuals admitted to regional centers of the Model Spinal Cord Injury System in the United States due to traumatic SCI were interviewed and included in the National Spinal Cord Injury Database. This cross-sectional study applied a secondary analysis with a mixed effect model on the data from 3,162 individuals who received interviews from 2000 through 2005. Five dimensions of environmental barriers were estimated using the short form of the Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF). Social participation was measured with the short form of the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) and their employment status. RESULTS Subscales of environmental barriers were negatively associated with the social participation measures. Each 1 point increase in CHIEF-SF total score (indicated greater environmental barriers) was associated with a 0.82 point reduction in CHART-SF total score (95% CI: -1.07, -0.57) (decreased social participation) and 4% reduction in the odds of being employed. Among the 5 CHIEF-SF dimensions, assistance barriers exhibited the strongest negative association with CHART-SF social participation score when compared to other dimensions, while work/school dimension demonstrated the weakest association with CHART-SF. CONCLUSIONS Environmental barriers are negatively associated with social participation in the SCI population. Working toward eliminating environmental barriers, especially assistance/service barriers, may help enhance social participation for people with SCI. (PsycINFO Database Record
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Affiliation(s)
- I-Hsuan Tsai
- School of Public Health, National Defense Medical Center
| | - Daniel E Graves
- Department of Neurological Surgery/Division of Physical Medicine & Rehabilitation, The University of Louisville
| | - Wenyaw Chan
- School of Public Health, The University of Texas Health Science Center at Houston
| | - Charles Darkoh
- School of Public Health, The University of Texas Health Science Center at Houston
| | | | - Lisa A Pompeii
- School of Public Health, The University of Texas Health Science Center at Houston
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N S Andreasen Struijk L, Lontis ER, Gaihede M, Caltenco HA, Lund ME, Schioeler H, Bentsen B. Development and functional demonstration of a wireless intraoral inductive tongue computer interface for severely disabled persons. Disabil Rehabil Assist Technol 2016; 12:631-640. [PMID: 27678024 DOI: 10.1080/17483107.2016.1217084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Individuals with tetraplegia depend on alternative interfaces in order to control computers and other electronic equipment. Current interfaces are often limited in the number of available control commands, and may compromise the social identity of an individual due to their undesirable appearance. The purpose of this study was to implement an alternative computer interface, which was fully embedded into the oral cavity and which provided multiple control commands. METHODS The development of a wireless, intraoral, inductive tongue computer was described. The interface encompassed a 10-key keypad area and a mouse pad area. This system was embedded wirelessly into the oral cavity of the user. The functionality of the system was demonstrated in two tetraplegic individuals and two able-bodied individuals Results: The system was invisible during use and allowed the user to type on a computer using either the keypad area or the mouse pad. The maximal typing rate was 1.8 s for repetitively typing a correct character with the keypad area and 1.4 s for repetitively typing a correct character with the mouse pad area. CONCLUSION The results suggest that this inductive tongue computer interface provides an esthetically acceptable and functionally efficient environmental control for a severely disabled user. Implications for Rehabilitation New Design, Implementation and detection methods for intra oral assistive devices. Demonstration of wireless, powering and encapsulation techniques suitable for intra oral embedment of assistive devices. Demonstration of the functionality of a rechargeable and fully embedded intra oral tongue controlled computer input device.
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Affiliation(s)
- Lotte N S Andreasen Struijk
- a Department of Health Science and Technology, Center for Sensory Motor Interaction , Aalborg University , Aalborg , Denmark
| | - Eugen R Lontis
- a Department of Health Science and Technology, Center for Sensory Motor Interaction , Aalborg University , Aalborg , Denmark
| | - Michael Gaihede
- b Department of Otolaryngology , Head and Neck Surgery, Aalborg University Hospital, Denmark and Department of Clinical Medicine, Aalborg University , Denmark
| | - Hector A Caltenco
- c Certec, Deptartment of Design Sciences , Lund University , Lund , Sweden
| | - Morten Enemark Lund
- a Department of Health Science and Technology, Center for Sensory Motor Interaction , Aalborg University , Aalborg , Denmark
| | - Henrik Schioeler
- d Department of Electronic Systems , Aalborg University , Aalborg , Denmark
| | - Bo Bentsen
- a Department of Health Science and Technology, Center for Sensory Motor Interaction , Aalborg University , Aalborg , Denmark
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Cotner BA, Njoh EN, Trainor JK, O'Connor DR, Barnett SD, Ottomanelli L. Facilitators and barriers to employment among veterans with spinal cord injury receiving 12 months of evidence-based supported employment services. Top Spinal Cord Inj Rehabil 2016; 21:20-30. [PMID: 25762857 DOI: 10.1310/sci2101-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Return to work is associated with positive rehabilitation outcomes for persons with spinal cord injury (SCI); however, more research is needed on vocational support for persons with disabilities seeking employment. OBJECTIVE The association between facilitators and barriers of employment and employment outcome was examined among Veterans with SCI who participated in an evidence-based supported employment (EBSE) program. METHODS Using a mixed-methods, nested case-control design, data on facilitators and barriers to employment were extracted from qualitative interviews and quantitative measures administered in person to 34 Veterans with SCI who completed 12 months of an EBSE program. Participants who did (case) and did not (control) obtain competitive employment were matched on time since SCI. Facilitators and barriers to employment were compared between the groups. RESULTS Self-report measures administered at baseline were examined; there were no statistically significant factors that predicted employment outcomes after 12 months of EBSE program participation. Qualitative interview data revealed program-specific facilitators and Veteran characteristics that were associated with employment outcomes. CONCLUSIONS Qualitative data illustrate how the integration of the vocational rehabilitation specialist on the medical team is helpful for addressing identified disability-specific barriers, including practical matters such as transportation and caregiving schedules, to facilitate employment outcomes.
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Affiliation(s)
- Bridget A Cotner
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida
| | - Eni N Njoh
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida
| | - John K Trainor
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida
| | - Danielle R O'Connor
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida
| | - Scott D Barnett
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida ; Institute for Credentialing Research, American Nurses Credentialing Center , Washington, DC
| | - Lisa Ottomanelli
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida ; Department of Rehabilitation and Mental Health Counseling, University of South Florida , Tampa, Florida
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Zhang JL, Chen J, Wu M, Wang C, Fan WX, Mu JS, Wang L, Ni CM. Several time indicators and Barthel index relationships at different spinal cord injury levels. Spinal Cord 2015; 53:679-81. [PMID: 25622731 DOI: 10.1038/sc.2014.206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/05/2014] [Accepted: 10/12/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES To compare different injury levels in spinal cord injury (SCI) patients with respect to operation intervention time (OIT), rehabilitation intervention time (RIT), average length of hospital stay (ALOS) and Barthel Index (BI) on admission and discharge. SETTING China. METHODS We retrospectively analyzed data from 95 SCI cases who received treatment in our rehabilitation center from 2010-2013. RESULTS SCI resulted from high falls (55.79%), traffic accidents (28.42%), diseases (8.42%) and low falls (7.37%). We found no correlations between OIT, RIT, ALOS and discharge BI for all spinal segments (P>0.05). The OIT of thoracic SCI and lumbar SCI correlated negatively with RIT (P<0.01). The OIT of lumbar SCI correlated negatively with ALOS (P<0.05). CONCLUSION BI had no correlation with OIT, RIT or ALOS for all spinal segments; the OIT of thoracic and lumbar SCI correlated negatively with RIT; and the OIT of lumbar SCI correlated negatively with ALOS.
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Affiliation(s)
- J L Zhang
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - J Chen
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - M Wu
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - C Wang
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - W X Fan
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - J S Mu
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - L Wang
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
| | - C M Ni
- The Department of Rehabilitation Medicine, Anhui Provincial Hospital affiliated Anhui Medical University, Hefei, China
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The association of assistive mobility devices and social participation in people with spinal cord injuries. Spinal Cord 2014; 52:209-15. [PMID: 24469145 DOI: 10.1038/sc.2013.178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 12/12/2013] [Accepted: 12/23/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We assumed that assistive technology in mobility devices (that is, wheelchairs with external power and driving modified vehicle (MV) with or without driving on wheelchair) may facilitate social participation for wheelchairs users who have spinal cord injuries (SCIs). This study examined the relationship between mobility devices and social participation in this population. METHODS We included 2986 individuals who had received initial rehabilitation at one of 18 regional centers of the Model Spinal Cord Injury System in the United States, had been interviewed between 2004 and 2010, and were wheelchair users (use a wheelchair > or = 40 h per week and cannot ambulate 150 feet at home). We performed secondary panel-data analysis using a mixed-effect model on data from 3498 follow-up interviews. Participation (measured by the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) and employment status) and the use of wheelchair and MV were recorded. RESULTS Among the participants, 33% drove an MV, and 44% used an external-powered wheelchair. The use of an MV was positively related to employment and CHART-SF score, regardless of driving directly or driving with a wheelchair. People who drove an MV were found to have approximately two more business associates to contact to once a month and ∼2 additional days out of home per week compared with those without an MV. No significant association was shown between the type of wheelchair used and participation. CONCLUSION The use of an MV was found to be positively associated with social participation in an SCI population.
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Litchke LG, Lloyd LK, Schmidt EA, Russian CJ, Reardon RF. Effects of concurrent respiratory resistance training on health-related quality of life in wheelchair rugby athletes: a pilot study. Top Spinal Cord Inj Rehabil 2013; 18:264-72. [PMID: 23459144 DOI: 10.1310/sci1803-264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the effects of 9 weeks of training with a concurrent flow resistance (CFR) device versus a concurrent pressure threshold resistance (CPTR) device on health-related quality of life (HRQoL) in wheelchair rugby (WR) athletes. METHOD Twenty-four male WR athletes (22 with tetraplegia, 1 with a spastic cerebral palsy, and 1 with congenital upper and lower limb deformities) were matched by lesion level, completeness of injury, and rugby classification prior to being randomly assigned to 1 of 3 groups: (1) CPTR (n=8), (2) CFR (n=8), or (3) controls (CON, n=8). Pre/post testing included assessment of HRQoL as measured by the Short-Form Health Survey Version 2.0 (SF-36v2). Manufacturer protocol guidelines for the CFR and CPTR groups were followed for breathing exercises. RESULTS Sixteen participants completed the study (CPTR=4, CFR=5, CON=7). The Mann-Whitney U rank order revealed significantly greater reductions in bodily pain (P = .038) and improvements in vitality (P = .028) for CFR versus CON. CONCLUSION Results from this study suggest that training with a CFR device improves some aspects of HRQoL (eg, vitality and bodily pain) in WR athletes. Further research with a larger sample size is needed to examine the impact of these devices on improving HRQoL for wheelchair athletes.
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Munce SEP, Perrier L, Tricco AC, Straus SE, Fehlings MG, Kastner M, Jang E, Webster F, Jaglal SB. Impact of quality improvement strategies on the quality of life and well-being of individuals with spinal cord injury: a systematic review protocol. Syst Rev 2013; 2:14. [PMID: 23432954 PMCID: PMC3599324 DOI: 10.1186/2046-4053-2-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/08/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND After a spinal cord injury, quality of life, as well as the determinants of quality of life, has been widely assessed. However, to date, there have been no systematic reviews on the impact of quality improvement strategies, including self-management strategies, on the quality of life and well-being of individuals with a spinal cord injury. The current protocol outlines a strategy for a systematic review that aims to identify, assess, and synthesize evidence on the impact of quality improvement strategies on the quality of life and physical and psychological well-being of individuals with spinal cord injury. METHODS/DESIGN All study designs, except qualitative studies will be included. Studies reporting on quality improvement including audit and feedback, case management, team changes, electronic patient registries, clinician education, clinical reminders, facilitated relay of clinical information to clinicians, patient education, (promotion of) self-management, patient reminder systems, and continuous quality improvement among individuals with spinal cord injury will be included. The primary outcome is quality of life. The secondary outcomes are physical and psychological well-being. Studies will be included regardless of publication status, year of dissemination, or language of dissemination. Potentially relevant articles not written in English will be translated. We will search Medline, CINAHL, EMBASE, and PsycINFO. The use of these databases will be supplemented by other data sources, including unpublished data. Two independent reviewers will conduct all levels of screening, data abstraction, and quality appraisal. Results will be grouped according to the target group of the varying quality improvement strategies (that is, health system, health-care professionals, or patients) and/or by any other noteworthy grouping variable, such as etiology of spinal cord condition or by sex. If deemed appropriate, a meta-analysis will be conducted. DISCUSSION This systematic review will identify those quality improvement strategies aimed at the health system, health-care professionals, and patients that impact the quality of life and well-being of individuals with spinal cord injury. Knowledge and application of such quality improvement strategies may reduce inappropriate health-care utilization costs, such as acute care inpatient readmission in the years post injury. Prospero registry number: CRD42012003058.
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Affiliation(s)
- Sarah EP Munce
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
| | - Laure Perrier
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Sharon E Straus
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Monika Kastner
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Eunice Jang
- Department of Applied Psychology & Human Development Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Fiona Webster
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND A tertiary spinal cord injury (SCI) center was established in the northern region of Hong Kong, China and a multidisciplinary SCI rehabilitation program was developed to reintegrate patients into the community. OBJECTIVE To investigate functional outcomes for Chinese people with SCI across a 1-year period. DESIGN Longitudinal prospective design. METHODS Thirty community-dwelling participants with traumatic SCI were recruited. Functional status was measured using functional independence measure (FIM) on admission, upon discharge, 1-month, 3-month, 6-month, and 1-year post-discharge. Information on use of assistive devices and life role were also obtained. RESULTS Twenty-three (76.67%) participants were men. Seventeen participants (10 with tetraplegia and 7 with paraplegia) were classified ASIA A, B, or C; 13 (7 with tetraplegia and 6 with paraplegia) were classified as ASIA D. Significant differences in FIM motor scores were only found between the tetraplegia group and three other diagnostic groups using Bonferroni post-hoc tests of repeated measure ANOVA (analysis of variance) (P < 0.05). Longitudinally, contrast tests of repeated measure ANOVA showed significant differences during the hospitalization period for all diagnostic groups. People in the ASIA D group showed significant functional improvement even after 1-year post-discharge (P < 0.05). At 1-year post-discharge, only two participants were engaged in either remunerative employment or academic pursuit. CONCLUSION Despite functional status improvement, few people with traumatic SCI were re-engaged in productive life role 1 year after discharge. Studies with longer follow-up would be beneficial.
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Affiliation(s)
- Sam Chi Chung Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | - Alice Po Shan Chan
- Occupational Therapy Department, Tai Po Hospital, Tai Po, NT, Hong Kong, China
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19
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Sale P, Mazzarella F, Pagliacci MC, Aito S, Agosti M, Franceschini M. Sport, free time and hobbies in people with spinal cord injury. Spinal Cord 2012; 50:452-6. [PMID: 22231542 DOI: 10.1038/sc.2011.161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
STUDY DESIGN Prospective, multicenter follow-up (F-U) observational study. OBJECTIVES To investigate the changes in participation and sports practice of people after spinal cord injury (SCI) and their impact on perceived quality of life (QoL). METHODS The questionnaire investigated the health status and management of clinical conditions and attendance of social integration, occupation, autonomy, car driving, sentimental relationships and perceived QoL in a SCI population 4 years after the first rehabilitation hospitalization. RESULTS Respondents were 403, 83.4% male; 39% was tetraplegic. At F-U, 42.1% worked and studied, 42.2% still held their jobs or studies, and 69% drove the car. In all, 77.2% had bowel continence and 40.4% urinary continence. The results showed that for the 68.2% of respondents, the attendance of friends, relatives and colleagues during their free time was the same or increased compared with the time before the injury, whereas 31.8% showed a decrease. The amount of time the 52.1% of respondents left home was the same or increased compared with before the trauma, whereas 50.6% of the respondents said that the time they were engaged in hobbies was either the same or increased. CONCLUSION SCI people who perceived their QoL as being higher, and whose attendance, autonomy and time was increased in respect to hobbies, were mainly men with an age range between 36 and 40 years, unmarried, paraplegic and with A-B Asia Score. Regarding the amount of time dedicated to practicing sports, the only difference was the most of that respondents, who indicated a decrease, were women.
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Affiliation(s)
- P Sale
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy.
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20
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Guilcher SJT, Craven BC, McColl MA, Lemieux-Charles L, Casciaro T, Jaglal SB. Application of the Andersen's health care utilization framework to secondary complications of spinal cord injury: a scoping review. Disabil Rehabil 2011; 34:531-41. [PMID: 22087755 DOI: 10.3109/09638288.2011.608150] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this scoping review was to identify research priority areas related to secondary complications and associated health care use for individuals with spinal cord injury (SCI). METHOD DATA SOURCES Peer-reviewed journals were identified using CINAHL, MEDLINE, PubMed, Embase, Social Sciences Abstracts, Social Works Abstract and PsycInfo search engines. Key references were hand searched. STUDY SELECTION A total of 289 abstracts were identified from the initial search strategy. We removed studies that did not measure health care and those that did not involve analytical investigation. DATA EXTRACTION The selected 31 studies were reviewed in detail using a coding template based on the domains and sub-components of the Andersen model (i.e. environmental, population characteristics, health behavior and outcome). RESULTS Most studies measured predisposing characteristics (e.g., age, gender) and need characteristics (e.g., level of injury). There was a notable absence of environmental characteristics (e.g., health system, neighborhood variables), enabling characteristics and health behaviors (beyond diet and nutrition). CONCLUSIONS We identified a gap in the SCI literature. Future research should focus on longitudinal study designs with more representation of non-traumatic spinal cord injury, as well as utilizing more advanced statistical analyses (i.e., multivariate level) to adjust for confounding variables.
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Affiliation(s)
- Sara J T Guilcher
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Vinjamuri R, Weber DJ, Mao ZH, Collinger JL, Degenhart AD, Kelly JW, Boninger ML, Tyler-Kabara EC, Wang W. Toward synergy-based brain-machine interfaces. ACTA ACUST UNITED AC 2011; 15:726-36. [PMID: 21708506 DOI: 10.1109/titb.2011.2160272] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper demonstrates a synergy-based brain-machine interface that uses low-dimensional command signals to control a high dimensional virtual hand. First, temporal postural synergies were extracted from the angular velocities of finger joints of five healthy subjects when they performed hand movements that were similar to activities of daily living. Two synergies inspired from the extracted synergies, namely, two-finger pinch and whole-hand grasp, were used in real-time brain control, where a virtual hand with 10 degrees of freedom was controlled to grasp or pinch virtual objects. These two synergies were controlled by electrocorticographic (ECoG) signals recorded from two electrodes of an electrode array that spanned motor and speech areas of an individual with intractable epilepsy, thus demonstrating closed loop control of a synergy-based brain-machine interface.
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Affiliation(s)
- Ramana Vinjamuri
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Norweg A, Jette AM, Houlihan B, Ni P, Boninger ML. Patterns, Predictors, and Associated Benefits of Driving a Modified Vehicle After Spinal Cord Injury: Findings From the National Spinal Cord Injury Model Systems. Arch Phys Med Rehabil 2011; 92:477-83. [DOI: 10.1016/j.apmr.2010.07.234] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 07/22/2010] [Accepted: 07/22/2010] [Indexed: 11/25/2022]
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Thietje R, Giese R, Pouw M, Kaphengst C, Hosman A, Kienast B, van de Meent H, Hirschfeld S. How does knowledge about spinal cord injury-related complications develop in subjects with spinal cord injury? A descriptive analysis in 214 patients. Spinal Cord 2010; 49:43-8. [PMID: 20820180 DOI: 10.1038/sc.2010.96] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Monocentric cohort study. OBJECTIVE To investigate the acquisition of knowledge about spinal cord injury (SCI)-related complications in SCI patients. SETTING Level 1 trauma center. METHODS All patients with a traumatic or non-traumatic SCI were included in the study. Data were collected at admission, post-admission at 1 and 3 months and post-discharge at 6, 18 and 30 months. The discharge of all patients was between 3 and 6 months post-admission. Knowledge about pressure ulcers and bladder management was tested using the 'Knowledge' score. This score has a minimum and maximum of 0 and 20 points. To detect differences across the multiple time intervals, the Friedman test was used. Differences in the number of patients with poor (0-8), average (9-12) and good knowledge (13-20) between the different age classifications (age at injury) were calculated using a χ (2)-test. RESULTS A total of 214 patients were included. At discharge subjects had increased their knowledge score to 11.2 compared with 5.4 on admission (P < 0.001). After 30 months, however, the mean score decreased to 10.8 points. At the time of discharge, the number of patients who achieved poor, average or good knowledge were 48 (22.4%), 65 (30.4%) and 101 (47.2%), respectively. Subjects of ∼50 years old and tetraplegics had better (P < 0.001) knowledge compared with subjects of ∼50 years old and paraplegics, respectively. CONCLUSION In this study, less than 50% of SCI patients had good knowledge about bladder management and pressure ulcers after being discharged.
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Affiliation(s)
- R Thietje
- BG Trauma Hospital Hamburg, Centre for Spinal Injuries, Hamburg, Germany.
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Abstract
La lesión medular es una entidad neurológica causante de importantes procesos de discapacidad. Su incidencia en el país puede estar cercana a los mayores estimativos mundiales debido a las condiciones actuales de violencia. El aumento de la expectativa de vida de esta población —gracias a los avances tecnológicos y científicos en prevención, atención y manejo de complicaciones— lleva a la necesidad de proveer servicios de rehabilitación integrales que trasciendan los aspectos funcionales y permitan la inclusión social. Para este propósito es necesario un abordaje integral de la situación, que en el ámbito de la evaluación debe incluir no sólo la estimación de la condición de salud, sino todo lo relacionado con el funcionamiento de las personas en su vida diaria. La clasificación internacional del funcionamiento, la discapacidad y la salud, brinda un marco conceptual para abordar la discapacidad y el funcionamiento humano relacionado con la salud desde un enfoque biopsicosocial que articula las dimensiones corporal, individual y social de las personas y su relación con los factores del ambiente. Este enfoque de abordaje, plasmado en el instrumento de evaluación denominado WHO-DAS II, se considera un referente importante para evaluar la discapacidad asociada a la lesión medular.
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Saadat S, Javadi M, Divshali BS, Tavakoli AH, Ghodsi SM, Montazeri A, Rahimi-Movaghar V. Health-related quality of life among individuals with long-standing spinal cord injury: a comparative study of veterans and non-veterans. BMC Public Health 2010; 10:6. [PMID: 20047697 PMCID: PMC2819993 DOI: 10.1186/1471-2458-10-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 01/05/2010] [Indexed: 12/03/2022] Open
Abstract
Background Spinal cord-injured (SCI) patients experience poor health-related quality of life (HRQOL) and they usually report lower HRQOL than the general population or population subgroups in Iran and elsewhere. The aim of this study was to compare HRQOL between veterans and non-veterans with SCI in Iran. Methods This was a cross-sectional study. HRQOL was measured using the 36-item Short Form Health Survey (SF-36). Thirty-nine male veterans and 63 non-veteran males with SCI were included in the study. Regression analyses were applied to determine the variables affecting physical and mental health-related quality of life among the patients. Results The male veterans had a lower HRQOL than the non-veterans with SCI. The differences were significant for all measures except for physical and social functioning. The greatest difference was observed for bodily pain (P = 0.001). The regression analysis results indicated that a longer time since injury was associated (P = 0.01) with better physical health-related quality of life (PCS), while being a veteran (P < 0.001) and having a spinal lesion in the cervical region (P = 0.001) were associated with poorer PCS. Older age (P < 0.001) and higher education (P = 0.01) were associated with better mental health-related quality of life (MCS), while being a veteran and having a spinal lesion in the cervical region (P = 0.02) were associated with poorer MCS. Conclusion The study findings showed that veterans with SCI experienced lower HRQOL than their non-veteran counterparts. A qualitative study is recommended to evaluate why HRQOL was lower in veterans than in non-veterans with SCI although veterans had higher incomes as a result of their pensions and increased access to equipment, and medications. To improve quality of life in both veterans and non-veterans with spinal cord injuries, policy changes or implementation of new interventions may be essential so that veterans could receive additional support (e.g. counseling, recreation therapy, vocational therapy, etc.) and non-veterans could meet their basic needs.
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Affiliation(s)
- Soheil Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Parameters for positive outcome of the in-hospital rehabilitation of spinal cord lesion patients: the Boberg Quality Score. Spinal Cord 2010; 48:537-41. [DOI: 10.1038/sc.2009.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Based on the Roy adaptation model, this cross-sectional study was conducted with 15 spinal cord injured individuals and their family members to examine the physical, emotional, functional, and social components of adaptation to spinal cord injury at 1 year (n=7 dyads) and 3 years (n=8 dyads) post-injury. Findings indicate that spinal cord injured individuals and their family members, regardless of time since the initial injury, have a moderate level of adaptation and adjustment to spinal cord injury. The data suggested that adaptation to spinal cord injury during the first 3 years can be enhanced by providing ongoing social and educational support for not only the injured individuals, but also their family members.
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Health system factors associated with rehospitalizations after traumatic spinal cord injury: a population-based study. Spinal Cord 2009; 47:604-9. [DOI: 10.1038/sc.2009.9] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE To review literature on return to work (RTW) and employment in persons with spinal cord injury (SCI), and present employment rates, factors influencing employment, and interventions aimed at helping people with SCI to obtain and sustain productive work. METHODS A systematic review for 2000 - 2006 was carried out in PubMed/Medline, AMED, (ISI) Web of Science, EMBASE, CINAHL, PsycInfo and Sociological abstracts database. The keywords 'spinal cord injuries', 'spinal cord disorder', 'spinal cord lesion' or 'spinal cord disease' were cross-indexed with 'employment', 'return to work', 'occupation' or 'vocational'. RESULTS Out of approximately 270 hits, 110 references were used, plus 13 more found elsewhere. Among individuals with SCI working at the time of injury 21 - 67% returned to work after injury. RTW was higher in persons injured at a younger age, had less severe injuries and higher functional independence. Employment rate improved with time after SCI. Persons with SCI employed ranged from 11.5% to 74%. Individuals who sustained SCI during childhood or adolescence had higher adult employment rates. Most common reported barriers to employment were problems with transportation, health and physical limitations, lack of work experience, education or training, physical or architectural barriers, discrimination by employers, and loss of benefits. Individuals with SCI discontinue working at younger age. CONCLUSIONS This review confirmed low employment rates after SCI. Future research should explore interventions aimed at helping people with SCI to obtain and sustain productive work.
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Affiliation(s)
- Ingeborg Beate Lidal
- Department of Research, Sunnaas Rehabilitation Hospital, 1450 Nesoddtangen, Norway.
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Carpenter C, Forwell SJ, Jongbloed LE, Backman CL. Community Participation After Spinal Cord Injury. Arch Phys Med Rehabil 2007; 88:427-33. [PMID: 17398242 DOI: 10.1016/j.apmr.2006.12.043] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe participation among a community-based sample of adults with spinal cord injury (SCI) and to explore the relationship between participation and life satisfaction. DESIGN Survey. SETTING Community. PARTICIPANTS A sample of 357 people (response rate, 44%) with SCI recruited through the British Columbia Paraplegic Association. The mean age +/- standard deviation was 46.0+/-14.7 years, mean time since SCI was 13.0+/-11.0 years, and 68% of the respondents were men. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Descriptive survey data on community participation specifically related to social involvement, physical activity and relationship with others, transportation, and community access. Life satisfaction and happiness assessed using the Satisfaction With Life Scale and Happiness Scale. RESULTS No limitations to participation were experienced by 18.5% of the respondents. Satisfaction with transportation was associated with owning one's own vehicle (P<.001). There was overall satisfaction with access to community buildings (mean score range, 6.9-8.5; where 10 is most satisfied). Being physically active was important to a majority and 75% were currently engaged in physical activity. Those living alone were less satisfied (mean, 7.3+/-2.7; where 10 is most satisfied) with the support they received than those living with others (8.5+/-1.7). Respondents were generally happy (5.0+/-1.4) and satisfied with life (18.6+/-7.6). CONCLUSIONS This study provides a rich description of the multifaceted nature of participation and its association with life satisfaction as identified by people with SCI living in the community.
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Affiliation(s)
- Christine Carpenter
- Department of Physiotherapy and Dietetics, Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
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Chan SC, Chan AP. User satisfaction, community participation and quality of life among Chinese wheelchair users with spinal cord injury: a preliminary study. Occup Ther Int 2007; 14:123-43. [PMID: 17624872 DOI: 10.1002/oti.228] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The purpose of the present study was to investigate the relationships between spinal cord injury (SCI), wheelchair users' satisfaction, perceptions of their community participation and quality of life (QoL).Thirty-one community wheelchair users with SCI were administered the Chinese version of the Quebec User Evaluation of Satisfaction with assistive Technology (C-QUEST), the abbreviated Hong Kong version of the World Health Organization Quality of Life Questionnaire (WHO QoL-BREF (HK)) and selected items of 'Participation Restrictions' and 'Environmental Factors' of the International Classification of Functioning Disability and Health (ICF). Only a weak correlation was found between the C-QUEST services sub-scores and one ICF environmental factor, that is, health-related professionals (Spearman's r = 0.453; p < 0.05). The C-QUEST device sub-scores were also weakly correlated with four domain scores of the WHO QoL-BREF (HK) (Spearman's r = 0.412-0.567; p < 0.05). Social relationship, participation in leisure and driving activities had a moderate association with scores of the WHO QoL-BREF (HK) (-0.405 > Spearman's r > -0.583; p < 0.05). It is concluded that community participation (e.g. use of transportation) and human environment (e.g. friends and peers) were more related to QoL, than to users' satisfaction with a wheelchair. Further research with a larger sample is recommended to examine the variables related to SCI and QoL.
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Affiliation(s)
- Sam C Chan
- Occupational Therapy Department, Tai Po Hospital, Hong Kong SAR, China.
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Pagliacci MC, Franceschini M, Di Clemente B, Agosti M, Spizzichino L. A multicentre follow-up of clinical aspects of traumatic spinal cord injury. Spinal Cord 2006; 45:404-10. [PMID: 17102809 DOI: 10.1038/sj.sc.3101991] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective, multicentred follow-up (FU) observational study. OBJECTIVES Prospectively evaluate survival, complications, re-admissions and maintenance of clinical outcome in people experiencing traumatic spinal cord injury (SCI). SETTING Seven spinal units and 17 rehabilitation centres participating in the previous GISEM (ie Italian Group for the Epidemiological Study of Spinal Cord Injuries) study. METHOD A total of 511 persons with SCI, discharged between 1997 and 1999 after their first hospitalisation, were enrolled. A standardised questionnaire was administered via telephone. RESULTS Of the 608 persons originally enrolled, 36 died between discharge and follow-up (mean 3.8+/-0.64 years). Of the remainder, 403 completed telephone interviews, 72 refused to participate and 97 could not be contacted. More than half of the patients interviewed (53.6%) experienced at least one SCI-related clinical problem in the 6 months preceding interview; the most frequent being urological complications (53.7%). At least one re-admission was recorded in 56.8% of patients between discharge and FU interview. Of the patients interviewed, 70.5% reported bowel autonomy and 86% bladder management autonomy. On multivariate analysis, lack of bowel/bladder autonomy was the most common variable with a strong predicting value for mortality, occurrence of complications and re-admissions. CONCLUSION Re-admission and major complications seem common after SCI and should be considered when planning facilities. Failure to obtain bowel/bladder autonomy upon discharge from rehabilitation proved to be the most common predictive factor of poor outcome during the period between discharge and FU interview.
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Affiliation(s)
- M C Pagliacci
- Spinal Cord Injury Unit, Silvestrini Hospital, Perugia, Italy
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Snoek GJ, IJzerman MJ, Post MW, Stiggelbout AM, Roach MJ, Zilvold G. Choice-Based Evaluation for the Improvement of Upper-Extremity Function Compared With Other Impairments in Tetraplegia. Arch Phys Med Rehabil 2005; 86:1623-30. [PMID: 16084817 DOI: 10.1016/j.apmr.2004.12.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 11/17/2004] [Accepted: 12/07/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess preference of reconstructive treatment of upper extremities in subjects with tetraplegia compared with preference of treatment of 3 other impairments and to determine the effect of subjects' characteristics on preference of upper-extremity reconstruction. DESIGN Survey. SETTING Two specialized spinal cord injury centers in the Netherlands. PARTICIPANTS A consecutive sample of 47 patients with tetraplegia in stable condition. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The quality weight of 5 tetraplegic health states determined with the time trade-off technique and expressed as a single value (the "utility") on a scale between 0 (worst possible situation) and 1 (best possible situation). RESULTS The response rate was 92%. The utility of tetraplegia +/- standard deviation was .57+/-.30. The utilities of tetraplegia without impairment in one of the following functions were .69+/-.33 for sexuality, .69+/-.33 for standing/walking, .63+/-.31 for bladder and bowel function, and .65+/-.32 for upper-extremity function. The differences between these utilities and the utility of tetraplegia were significant (P<.05). No significant differences were found between the utilities of the impairments. Improvement of a specific impairment contributed between 14% and 28% to the potential overall gain in the tetraplegic health state utility. CONCLUSIONS The combination of impairments determines the low utility of the tetraplegic health state. No priority for improvement of any of the investigated impairments was found. This emphasizes the need for the meticulous selection of patients for treatment of specific conditions. Further research should try to determine the crucial factors in the decision-making process of patients for specific interventions.
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Affiliation(s)
- Govert J Snoek
- Spinal Cord Injury Department, Roessingh Rehabilitation Centre, Enschede, the Netherlands; Research and Development Department, Roessingh Rehabilitation Centre, Enschede, the Netherlands
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Post MWM, Bloemen J, de Witte LP. Burden of support for partners of persons with spinal cord injuries. Spinal Cord 2005; 43:311-9. [PMID: 15685263 DOI: 10.1038/sj.sc.3101704] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVES (1) To describe the support given to persons with spinal cord injuries (SCI) by their partners, (2) to describe the perceived burden of support by partners and (3) to examine predictors of perceived burden of support. SETTING The Netherlands. METHODS All members of the Dutch patients organisation DON (N = 1004) and their caregivers, if applicable, were invited. Physical disability of the person with SCI was measured using the Barthel Index (BI). A number of secondary conditions, other practical problems and psychosocial problems were recorded. Partner support was described using a list of ADL-support, other practical support and emotional support. Burden of support was measured by a six-item measure (Cronbach's alpha 0.92), Nonparametric descriptive statistics and correlations were used. Linear regression was used to identify predictors of caregiver burden. RESULTS Responses were obtained from 461 persons with SCI. Of 265 couples, patient as well as partner data were available. Mean age of the partners was 49.4 years (SD 12.2) and 69.8% were women. Mean BI of the persons with SCI was 12.3 (SD 4.7) on a 0-20 scale and 60.4% were seriously disabled (BI < 15). Most partners provided various kinds of support. ADL-support and other practical support were given much more often by partners of persons with serious disability, but less difference was seen regarding emotional support. Professional (paid) support was obtained by 45.3% of all couples. Perceived burden of support was high in 24.8% of partners of persons with serious disabilities against 3.9% of partners of persons with minor disabilities. Significant predictors of caregiver burden were (in order of importance) the amount of ADL support given, psychological problems of the patient, partner age, partner gender, BI score and time after injury (total explained variance 47%). CONCLUSION A substantial proportion of partners of persons with SCI suffer from serious burden of support. Prevention of caregiver burnout should be part of the lifelong care for persons with SCI.
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Affiliation(s)
- M W M Post
- IRv, Institute for Rehabilitation Research, Hoensbroek, The Netherlands
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Abstract
In the United States alone, there are more than 200,000 individuals living with a chronic spinal cord injury (SCI). Healthcare for these individuals creates a significant economic burden for the country, not to mention the physiological, psychological, and social suffering these people endure everyday. Regaining partial function can lead to greater independence, thereby improving quality of life. To ascertain what functions are most important to the SCI population, in regard to enhancing quality of life, a novel survey was performed in which subjects were asked to rank seven functions in order of importance to their quality of life. The survey was distributed via email, postal mail, the internet, interview, and word of mouth to the SCI community at large. A total of 681 responses were completed. Regaining arm and hand function was most important to quadriplegics, while regaining sexual function was the highest priority for paraplegics. Improving bladder and bowel function was of shared importance to both injury groups. A longitudinal analysis revealed only slight differences between individuals injured <3 years compared to those injured >3 years. The majority of participants indicated that exercise was important to functional recovery, yet more than half either did not have access to exercise or did not have access to a trained therapist to oversee that exercise. In order to improve the relevance of research in this area, the concerns of the SCI population must be better known and taken into account. This approach is consistent with and emphasized by the new NIH roadmap to discovery.
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Affiliation(s)
- Kim D Anderson
- Reeve-Irvine Research Center, Department of Anatomy and Neurobiology, University of California at Irvine, Irvine, California 92697-4292, USA.
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Abstract
The years after SCI may be associated with acceleration of the aging process because of diminished physiologic reserves and increased demands on functioning body systems. Clinicians with expertise in the treatment and prevention of SCI-specific secondary complications need to collaborate with gerontologists and primary care specialists and need to invest in the training of future physicians to ensure a continuum of accessible, cost-effective, and high-quality care that meets the changing needs of the SCI population. Managed care payers often do not adequately cover long-term disability needs to prevent secondary SCI-specific complications. In this era of increasing accountability, evidence-based clinical practice guidelines are needed to document scientific evidence and professional consensus to effectively diagnose, treat, and manage clinical conditions; to reduce unnecessary testing and procedures; and to improve patient outcomes. Longitudinal research is needed to minimize cohort effects that contribute to misinterpretation of cross-sectional findings as representative of long-term changes in health and functioning. However, longitudinal studies confound chronologic age, time since injury, and environmental change. Thus, time-sequential research, which controls for such confounding effects, is essential, as is research on the effects of gender,culture, and ethnicity. If we consider how much progress has been made over the past 50 years with respect to SCI mortality related to infectious disease, we can expect to achieve even greater progress against the effects of aging in the next 50 years. Recent developments in molecular biology regarding growth and neuro-trophic factors are bringing us closer to the goal of repairing the damaged spinal cord. The challenge remains for rehabilitation professionals to provide the most comprehensive and holistic approach to long-term follow-up, with an emphasis on health promotion and disease prevention, to postpone functional decline and enhance QOL.
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Affiliation(s)
- Jaishree Capoor
- Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029, USA.
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Abstract
STUDY DESIGN An exploratory, qualitative methodology. OBJECTIVES To explore perceptions of quality of life (QOL) among community-dwelling people with high spinal cord injuries (SCI) and the factors they identified as contributing to, enabling or constraining the quality of their lives. SETTING Urban communities on Vancouver Island and in the lower mainland of British Columbia, Canada. METHODS Semi-structured interviews with both men (n=11) and women (n=4) with complete high SCI (C1-C4). Interpretive analysis was grounded in the themes that arose from the interview transcripts. RESULTS Time since injury ranged from 4 to 28 years. The mean current age was 35 years, with a range from 21 to 50 years of age. High SCI disrupted not just a body but an entire biography of plans, daily activities and valued occupations. Initially feeling helpless and useless, the participants were unanimously glad to be alive at the time of the study and several described perceptions of very high QOL. The themes which emerged from the data were over-lapping and inter-dependent and described a process of refocusing values and re-establishing a view of the self as able and valuable following injury. The three primary themes addressed issues of autonomy, the meaningful use of time, and relationships. CONCLUSIONS The study findings suggest that life with a high SCI can be rich and fulfilling if society is prepared to enable and support this; and that QOL outcomes might be maximized by adopting a biographical orientation to the rehabilitation process. SPONSORSHIP This research was funded by a University of British Columbia Graduate Fellowship, a studentship from the Rick Hansen Man in Motion Foundation and a doctoral fellowship from the Social Sciences and Humanities Research Council of Canada.
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Hammell KW. Exploring quality of life following high spinal cord injury: a review and critique. Spinal Cord 2004; 42:491-502. [PMID: 15263890 DOI: 10.1038/sj.sc.3101636] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Review. OBJECTIVES To explore the concept of quality of life (QOL), critique the practice and problems of assessing QOL following spinal cord injury (SCI) and to review the findings of studies into QOL for people with SCI both below and above the level of C4. METHODS Relevant articles were identified from the Medline and CINAHL databases for approximately the period 1990-2003, cross-indexing 'spinal cord injury' or 'quadriplegia/tetraplegia' with 'quality of life', 'life satisfaction', 'social adjustment' or 'psychological adaptation'. This search was augmented through papers identified in reference lists. Articles were excluded if they were designed solely to examine the impact of a specific intervention upon QOL; or if they examined satisfaction with various life domains without explicitly linking these to perceptions of QOL. Papers were also accessed that addressed the philosophical and epistemological issues involved in QOL conceptions and assessment. RESULTS Review of the literature highlights the philosophical and methodological difficulties associated with the quantitative measurement of a qualitative experience; and with the assessment of life domains chosen by researchers. Analysis of QOL research undertaken among people with all levels of SCI demonstrates that dissatisfaction with life following injury arises primarily from social disadvantage. However, little research has been conducted specifically to ascertain perceptions of QOL among people with high SCI. CONCLUSIONS Ensuring the relevance of future research into QOL following high SCI requires qualitative methodology and mixed methods. Further research is needed to determine how rehabilitation professionals can act on the findings of their QOL assessments and enhance the QOL experienced by people with spinal cord injury in the context of their environments. SPONSORSHIP The early phase of this study was supported by: University of British Columbia Graduate Fellowship; Rick Hansen Man in Motion Foundation (studentship); Social Sciences and Humanities Research Council of Canada: doctoral fellowship.
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