Self-care independence after spinal cord injury: patient and therapist expectations and real life performance

Does Improvement in American Spinal Injury Association Impairment Scale Grade Correlate With Functional Recovery in All Patients With a Traumatic Spinal Cord Injury?

OBJECTIVE

The aim of the study is to determine what improvement on the American Spinal Injury Impairment Scale correlates with functional status after a traumatic spinal cord injury.

DESIGN

We performed an observational cohort study, analyzing prospective data from 168 patients with traumatic spinal cord injury admitted to a single level 1 trauma center. A multivariable analysis was performed to assess the relationship between functional status (from the Spinal Cord Independence Measure) at 1-year follow-up and American Spinal Injury Impairment Scale grade (baseline and 1-yr follow-up), while taking into account covariables describing the sociodemographic status, trauma severity, and level of neurological injury.

RESULTS

Individuals improving to at least American Spinal Injury Impairment Scale grade D had significantly higher Spinal Cord Independence Measure score compared with those not reaching American Spinal Injury Impairment Scale D (89.3 ± 15.2 vs. 52.1 ± 20.4) and were more likely to reach functional independence (68.5% vs. 3.6%), regardless of the baseline American Spinal Injury Impairment Scale grade. Higher final Spinal Cord Independence Measure was more likely with an initial American Spinal Injury Impairment Scale grade D (β = 1.504; 95% confidence interval = 0.46-2.55), and a final American Spinal Injury Impairment Scale grade D (β = 3.716; 95% CI = 2.77-4.66) or E (β = 4.422; 95% CI = 2.91-5.93).

CONCLUSIONS

Our results suggest that reaching American Spinal Injury Impairment Scale grade D or better 1 yr after traumatic spinal cord injury is highly predictive of significant functional recovery, more so than the actual improvement in American Spinal Injury Impairment Scale grade from the injury to the 1-yr follow-up.

Examining the Occupational Therapy Definition of Self-Care: A Scoping Review

Self-care practices such as exercise and meditation are commonly identified as strategies to address stress and chronic disease. However, in occupational therapy, the term self-care has traditionally referred to basic activities of daily living (ADL), potentially limiting the profession's ability to promote wellness among clients. This scoping review aimed to clarify how the term self-care has been used in select occupational therapy literature. We found that of 1,254 included articles, 54.9% use the term self-care ambiguously and that authors primarily apply the term to basic ADL. This understanding contrasts with the evidence from the wellness literature and the concept's use by the general population and other health professions. Findings serve as a call to redefine the term self-care to articulate clearly the profession's value in promoting population health and well-being.

Effectiveness of occupational therapy in improving activities of daily living performance in complete cervical tetraplegic patients; A quasi experimental study

OBJECTIVE

To determine the effectiveness of Occupational therapy (OT) in improving activities of daily living performance in complete cervical tetraplegic patients.

METHODS

A quasi experimental study was conducted at Paraplegic Center Peshawar from May 2018 to March 2019. Seventy two spinal cord injury patients with complete cervical tetraplegia having age 18-60 years were included in the study using non probability convenience sampling technique. A trained Occupational therapist conducted two occupational therapy sessions per day, three times a week on alternative days for a period of six weeks. Self-care portion of Spinal cord injury independence measure (SCIM) was used to collect pre and post data. Data was analyzed using SPSS version 20.

RESULTS

Mean age of the participants was 30.21±13.52.Majority of the participants were (n= 61, 84.7%) male while remaining 11 (15.3%) participants were female. Pre self-care total score was 0.39±0.987 and post self-care total score was 7.17±5.536. There was significant differences (P value <0.05) between pre and post scores of feeding, upper & lower body bathing, upper & lower body dressing, grooming and total self-care scores.

CONCLUSION

Occupational therapy significantly improves activities of daily living performance in complete cervical tetraplegic spinal cord injury patients.

Self-rated health among persons with spinal cord injury: what is the role of physical ability?

OBJECTIVES

Self-rated health (SRH) is a powerful concept that has greatly advanced our understanding of health and health outcomes. The SRH measure has become increasingly common in health research. Yet, puzzles remain about what shapes SRH ratings. The absence of knowledge is particularly acute in the context of disability. The aim of this study was to examine the relationship between SRH and self-rated physical ability in a sample of individuals with spinal cord injury (SCI).

METHODS

Data from 140 eligible participants drawn from a study of life in the community after SCI were analyzed. The study, cross-sectional in design, was conducted in a large urban city in the mid-western United States. Basic statistics such as ANOVA and chi-square tests were performed as appropriate, and a multiple linear regression analysis modeled the relationship between SRH and physical ability adjusting for potential confounding variables.

RESULTS

Self-rated physical ability was significantly associated with SRH after controlling for relevant covariates (P < 0.001). An analysis of the interaction between physical ability and level of injury revealed that the relationship was significant for persons with paraplegia but not for persons with tetraplegia.

CONCLUSIONS

This study provides evidence that self-rated physical ability is an important factor associated with SRH for persons with SCI, but that the strength of the relationship depends on level of injury (paraplegia vs. tetraplegia). The challenge for future research is to replicate the study using a more comprehensive measure of physical ability and to ask how beliefs in one's ability to do those activities that are most meaningful and desired shape SRH. Only in this way will our understanding of the physical ability-SRH relationship be clarified.

Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

(1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale.

SETTING

Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden.

METHODS

Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale.

RESULTS

Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items.

CONCLUSION

The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.