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Matsuda T, Muranaga S, Zeni JA, Yoshida Y. Simple Mobility Tests Predict Use of Assistive Devices in Older Adults. J Geriatr Phys Ther 2024:00139143-990000000-00050. [PMID: 38744441 DOI: 10.1519/jpt.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non-health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non-health care caregivers in making decisions to adopt an AD for patients, clients, and family members. PURPOSE/OBJECTIVES The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals. METHODS Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use. RESULTS 80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers (P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048). DISCUSSION Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD. CONCLUSIONS If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation.
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Affiliation(s)
- Toru Matsuda
- Rehabilitation Administration Department, Kameda Medical Center, Kamogawa, Japan
| | - Shingo Muranaga
- Rehabilitation Administration Department, Kameda Medical Center, Kamogawa, Japan
| | - Joseph A Zeni
- Department of Rehabilitation and Movement Science, Rutgers the State University of New Jersey, Newark, New Jersey
| | - Yuri Yoshida
- Division of Physical Therapy at the University of New Mexico, Albuquerque, New Mexico
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Abou L, Martinez-Navarro O, Kratz A. Satisfaction with social roles and activities across mobility status among persons with spinal cord injury. Spinal Cord 2024; 62:264-269. [PMID: 38519562 DOI: 10.1038/s41393-024-00984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To examine the differences in satisfaction with social roles and activities among ambulatory individuals, manual wheelchair users, and power wheelchair users with spinal cord injuries (SCIs). SETTING Community setting. METHODS Participants completed surveys of their demographics and clinical data as well as the Spinal Cord Injury - Quality of Life Satisfaction with Social Roles and Activities- Short Form. Participants' mobility status was categorized into (1) ambulatory individuals, (2) independent manual wheelchair users, and (3) power wheelchair/scooter users. One-way ANOVA and ANCOVA were used, respectively, to examine unadjusted and adjusted differences in satisfaction with social roles and activities across mobility status. Adjustment covariates included age, sex, time since SCI, and SCI injury level. RESULTS A total of 129 participants (mean age = 47.4 ± 13.6 years, 73% male) were included in the analyses. Unadjusted (F = 3.8, p = 0.03) and adjusted models (F = 3.4, p = 0.04) evidenced significant differences in satisfaction with social roles and activities according to mobility status. Pairwise Bonferroni Post-Hoc analysis indicated that manual wheelchair users were more satisfied with their social roles and activities when compared to ambulatory individuals (mean difference = 2.8, p < 0.05). CONCLUSIONS Due to the current challenges associated with walking recovery after SCIs, clinicians may want to discuss the use of wheelchairs with individuals with limited walking ability when the goal is to improve participation and quality of life. Emphasizing alternative means of mobility may enhance satisfaction with social roles and activities.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Oriol Martinez-Navarro
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Healthcare Research Group, IRB Lleida, Institute for Biomedical Research Dr. Pifarre Foundation, Lleida, Spain
| | - Anna Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Jeawon M, Hase B, Miller S, Eng JJ, Bundon A, Chaudhury H, Maffin J, Clarkson R, Wright J, Mortenson WB. Understanding the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate. Disabil Rehabil 2024; 46:546-555. [PMID: 36740758 DOI: 10.1080/09638288.2023.2171495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate and to explore and discuss potential supports, services, and programs that would best assist them in the community. MATERIAL AND METHODS In this qualitative descriptive study, interviews were the primary means of data collection. These were supplemented with descriptive standardized measures of function and life satisfaction. Qualitative data were analyzed thematically. RESULTS Twenty-four participants were interviewed, their average age was 55 years and 46% were female. We identified three themes: 'I really couldn't go there', described the physical and social barriers experienced by participants, 'It'd be really nice to let the public know there are people out there like me' expressed the desire for greater social understanding of incomplete spinal cord injury, and 'I just don't quit', displayed the perseverance that participants demonstrated following their injury. CONCLUSION Findings indicate service providers to improve the inclusion of ambulatory individuals with incomplete spinal cord injury in their programs. Suggestions include designing programs (community, healthcare, return to work, peer support), environments using the principles of universal design for people with incomplete spinal cord injury who ambulate, and increasing consideration of their perspectives.Implication for rehabilitation:People with incomplete spinal cord injury who can ambulate live with invisible impairments, which are often not acknowledged by family, friends, health professionals, and people with complete spinal cord injuryThey may feel excluded from activities (organized by spinal cord injury associations) that were originally designed for people with complete spinal cord injuryGreater awareness among health professionals, friends, family, and people with complete spinal cord injury of the needs of people with incomplete spinal cord injury who can ambulate is needed to increase their inclusion.
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Affiliation(s)
- Murveena Jeawon
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Bethany Hase
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Susanna Miller
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- GF Strong Rehabilitation Centre, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Andrea Bundon
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Jocelyn Maffin
- Spinal Cord Injury - British Columbia, Vancouver, Canada
| | - Ryan Clarkson
- Spinal Cord Injury - British Columbia, Vancouver, Canada
| | - Jenna Wright
- Spinal Cord Injury - British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
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DiPiro ND, Murday D, Krause JS. Differences in personal characteristics and health outcomes between ambulatory and non-ambulatory adults with traumatic spinal cord injury. J Spinal Cord Med 2023:1-9. [PMID: 37819626 DOI: 10.1080/10790268.2023.2234726] [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: 10/13/2023] Open
Abstract
OBJECTIVE To identify differences in personal characteristics, health outcomes, and hospital utilization as a function of ambulatory status among adults with chronic SCI. DESIGN Prospective cohort study linked to state administrative billing data. SETTING Population-based SCI Registry from the Southeastern United States. PARTICIPANTS 1,051 adults (>18 years old) with chronic (>1-year), traumatic SCI. OUTCOME MEASURES The self-report assessment (SRA) included demographic, injury and disability characteristics, health status, psychological and behavioral factors, and participation and quality of life (QOL) variables. We linked cases to administrative billing data to assess hospital utilization, including Emergency Department (ED) visits and inpatient (IP) admissions (through the ED and direct IP) in non-federal state hospitals within the year following the SRA. RESULTS There were 706 ambulatory and 345 non-ambulatory participants. We found significant differences across all sets of factors and significant differences in hospital utilization metrics. Ambulatory adults had fewer ED visits (36% vs 44%), IP admissions through the ED (11% vs 25%) and IP only admissions (9% vs 19%) and spent fewer days in the hospital for both admissions through the ED (0.9 vs 4.6 days) and IP only admissions (0.7 vs 3.1 days). They also reported having fewer past year ED visits (44% vs 62%) and IP admissions (34% vs 52%). CONCLUSIONS We identified differences in personal characteristics, ED visits and IP admissions between ambulatory and non-ambulatory adults with SCI, providing a better understanding of the characteristics of those with SCI. The findings suggest the need for separate analyses based on ambulatory status when assessing long-term health outcomes including hospital utilization.
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Affiliation(s)
- Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Murday
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
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Onate-Figuérez A, Avendaño-Coy J, Fernández-Canosa S, Soto-León V, López-Molina MI, Oliviero A. Factors Associated With Fatigue in People With Spinal Cord Injury: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023; 104:132-142. [PMID: 35964699 DOI: 10.1016/j.apmr.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the association between fatigue and clinical and demographic variables in people with spinal cord injury (SCI). DATA SOURCES Five databases (MEDLINE, Physiotherapy Evidence Database, Cochrane, Google Scholar, Cumulative Index to Nursing and Allied Health) were searched up to November 2021. STUDY SELECTION Observational studies that reported the association between fatigue and clinical and demographic variables in English or Spanish were eligible. Reviews, qualitative research studies, and nonoriginal articles were excluded. Twenty-three of the 782 identified studies met the inclusion criteria for the meta-analysis. DATA EXTRACTION Two researchers independently extracted the data. The strength of the association between each factor and fatigue was determined by the effect size. When the results of the effect size were expressed with different statistics, the correlation coefficient was the preferred estimation. The risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies and the Newcastle-Ottawa Scale. DATA SUMMARY A pooled analysis of the associations between fatigue and 17 factors was performed. A direct association was found between fatigue and 9 factors (sorted by effect size): anxiety (r=0.57; 95% CI, 0.29-0.75), stress (r=0.54; 95% confidence interval [CI], 0.26-0.74), depression (r=0.47; 95% CI, 0.44-0.50), pain (r=0.34; 95% CI, 0.16-0.50), analgesic medication (r=0.32; 95% CI, 0.28-0.36), assistive devices (r=0.23; 95% CI, 0.17-0.29), lesion level (r=0.15; 95% CI, 0.07-0.23), incomplete SCI (r=0.13; 95% CI, 0.05-0.22), and medication (r=0.12; 95% CI, 0.01-0.23). An inverse association was found with 3 factors (sorted by effect size): self-efficacy (r=-0.63; 95% CI, -0.81 to -0.35), participation (r=-0.32; 95% CI, -0.58 to -0.001), and physical activity (r=-0.17; 95% CI, -0.28 to -0.05). No association was found with age, sex, educational level, time since injury, and spasticity. CONCLUSIONS Several factors were associated with fatigue in people with SCI, with those related to mental health showing the strongest associations. These results should be interpreted with caution because of the high heterogeneity observed in some factors.
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Affiliation(s)
- Ana Onate-Figuérez
- FENNSI Group, National Hospital for Paraplegics, SESCAM, Spain; GIFTO Group, Faculty of Physiotherapy and Nursing, Universidad de Castilla La Mancha (UCLM), Toledo; National Hospital for Paraplegics, SESCAM, Toledo, Spain
| | - Juan Avendaño-Coy
- GIFTO Group, Faculty of Physiotherapy and Nursing, Universidad de Castilla La Mancha (UCLM), Toledo.
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Kroman MF, Jørgensen V, Groven KS. Making sense of invisible bodily changes and new ways of doing physical activity: experiences of individuals following traumatic incomplete spinal cord injury. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2112754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
| | | | - Karen Synne Groven
- Oslo Metropolitan University, Oslo, Norway
- VID Scientific University, Oslo, Norway
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Singh H, Cheung L, Chan K, Flett HM, Hitzig SL, Kaiser A, Musselman KE. Comparing the causes, circumstances and consequences of falls across mobility statuses among individuals with spinal cord injury: A secondary analysis. J Spinal Cord Med 2021; 44:S193-S202. [PMID: 34779733 PMCID: PMC8604457 DOI: 10.1080/10790268.2021.1956252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the occurrence of falls and fall-related injuries, and the circumstances of falls among individuals with spinal cord injury (SCI) who ambulate full-time, use a wheelchair full-time and ambulate part-time. DESIGN A secondary analysis. SETTING Community. PARTICIPANTS Adults with SCI. INTERVENTION None. OUTCOME MEASURES The occurrence and circumstances of falls and fall-related injuries were tracked over six-months using a survey. Participants were grouped by mobility and fall status. A chi-square test compared the occurrence of falls and fall-related injuries, and the time and location of falls, and a negative binomial regression was used to predict the likelihood of falls by mobility status. Kaplan-Meier analysis was used to determine differences in the time to first fall based on mobility status. Group characteristics and causes of falls were described. RESULTS Data from individuals who ambulated full-time (n = 30), used a wheelchair full-time (n = 27) and ambulated part-time (n = 8) were analyzed. Mobility status was a significant predictor of falls (P < 0.01); individuals who used a wheelchair full-time had a third of the likelihood of falling than those who ambulated full-time (P < 0.01). Type of fall-related injuries differed by mobility status. Those who ambulated full-time fell more in the daytime (P < 0.01). Individuals who ambulated full-time and part-time commonly fell while walking due to poor balance, and their legs giving out, respectively. Those who used a wheelchair full-time typically fell while transferring when rushed. CONCLUSION Mobility status influences the likelihood and circumstances of falls. Mobility status should be considered when planning fall prevention education/training for individuals with SCI.
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Affiliation(s)
- Hardeep Singh
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Bridgepoint Collaboratory for Research & Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Lovisa Cheung
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Katherine Chan
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
| | - Heather M. Flett
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anita Kaiser
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Canadian Spinal Research Organization, Toronto, Canada
| | - Kristin E. Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Kristin E. Musselman, SCI Mobility Lab, KITE, Toronto Rehab-University Health Network, 520 Sutherland Drive, TorontoM4G 3V9, Canada.
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Ramanujam A, Momeni K, Ravi M, Augustine J, Garbarini E, Barrance P, Spungen AM, Asselin P, Knezevic S, Forrest GF. Dynamic Margins of Stability During Robot-Assisted Walking in Able-Bodied Individuals: A Preliminary Study. Front Robot AI 2020; 7:574365. [PMID: 33501335 PMCID: PMC7805966 DOI: 10.3389/frobt.2020.574365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Gait analysis studies during robot-assisted walking have been predominantly focused on lower limb biomechanics. During robot-assisted walking, the users' interaction with the robot and their adaptations translate into altered gait mechanics. Hence, robust and objective metrics for quantifying walking performance during robot-assisted gait are especially relevant as it relates to dynamic stability. In this study, we assessed bi-planar dynamic stability margins for healthy adults during robot-assisted walking using EksoGT™, ReWalk™, and Indego® compared to independent overground walking at slow, self-selected, and fast speeds. Further, we examined the use of forearm crutches and its influence on dynamic gait stability margins. Methods: Kinematic data were collected at 60 Hz under several walking conditions with and without the robotic exoskeleton for six healthy controls. Outcome measures included (i) whole-body center of mass (CoM) and extrapolated CoM (XCoM), (ii) base of support (BoS), (iii) margin of stability (MoS) with respect to both feet and bilateral crutches. Results: Stability outcomes during exoskeleton-assisted walking at self-selected, comfortable walking speeds were significantly (p < 0.05) different compared to overground walking at self-selected speeds. Unlike overground walking, the control mechanisms for stability using these exoskeletons were not related to walking speed. MoSs were lower during the single support phase of gait, especially in the medial-lateral direction for all devices. MoSs relative to feet were significantly (p < 0.05) lower than those relative to crutches. The spatial location of crutches during exoskeleton-assisted walking pushed the whole-body CoM, during single support, beyond the lateral boundary of the lead foot, increasing the risk for falls if crutch slippage were to occur. Conclusion: Careful consideration of crutch placement is critical to ensuring that the margins of stability are always within the limits of the BoS to control stability and decrease fall risk.
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Affiliation(s)
- Arvind Ramanujam
- Kessler Foundation, West Orange, NJ, United States
- Koneksa Health, New York, NY, United States
| | - Kamyar Momeni
- Kessler Foundation, West Orange, NJ, United States
- Rutgers, New Jersey Medical School, Newark, NJ, United States
| | | | | | | | - Peter Barrance
- Kessler Foundation, West Orange, NJ, United States
- Rutgers, New Jersey Medical School, Newark, NJ, United States
| | - Ann M. Spungen
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - Pierre Asselin
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - Steven Knezevic
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - Gail F. Forrest
- Kessler Foundation, West Orange, NJ, United States
- Rutgers, New Jersey Medical School, Newark, NJ, United States
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Michaud F, Lugris U, Cuadrado J, Kecskemethy A, Ou Y. A Procedure to Define Customized Musculoskeletal Models for the Analysis of the Crutch-Orthosis-Assisted Gait of Spinal Cord Injured Subjects. J Biomech Eng 2020; 142:1086381. [PMID: 32840292 DOI: 10.1115/1.4048202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Indexed: 01/12/2023]
Abstract
Subjects suffering from spinal cord injury with lower extremity impairment generally use a wheelchair to move. However, some of them are capable of walking with the help of orthoses and crutches. Standing up and walking regularly have huge benefits for the general health state of these subjects, since it reduces the negative consequences of sedentarism. Therefore, achieving adherence to assisted gait is important, but there is a risk of abandoning due to several issues such as pain, fatigue, or very low speed, which can make the subject return to solely use the wheelchair. Musculoskeletal models can provide estimations of muscular forces and activations, which in turn enable to calculate magnitudes such as joint reactions, energetic cost, and bone stress and strain. These magnitudes can serve to evaluate the impact of assisted gait in the subject's health and to assess the likelihood of adherence. Moreover, they can be used as indicators to compare different assistive devices for a particular subject. As every spinal cord-injured (SCI) subject represents a different case, a procedure to define customized musculoskeletal models for the crutch-orthosis-assisted gait of SCI subjects is proposed in this paper. Issues such as selection of muscles and integration of models of trunk, upper and lower extremities, and assistive devices (crutches and orthoses) are addressed. An inverse-dynamics-based physiological static optimization method that takes into account muscle dynamics at low computational cost is applied to obtain estimates of muscle forces and joint reactions. The method is experimentally validated by electromyography in a case study.
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Affiliation(s)
- Florian Michaud
- Laboratory of Mechanical Engineering, University of La Coruña, Mendizabal s/n, Ferrol 15403, Spain
| | - Urbano Lugris
- Laboratory of Mechanical Engineering, University of La Coruña, Mendizabal s/n, Ferrol 15403, Spain
| | - Javier Cuadrado
- Laboratory of Mechanical Engineering, University of La Coruña, Mendizabal s/n, Ferrol 15403, Spain
| | - Andres Kecskemethy
- Department of Mechanical and Process Engineering, Institute of Mechanics and Robotics, University of Duisburg-Essen, Lotharstr. 1, Duisburg 47057, Germany
| | - Ye Ou
- Chair of Mechanics and Robotics, University of Duisburg-Essen, Lotharstr. 1, Duisburg 47057, Germany
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10
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Cao Y, DiPiro ND, Brotherton SS, Krause JS. Assistive devices and future fall-related injuries among ambulatory adults with spinal cord injury: a prospective cohort study. Spinal Cord 2020; 59:747-752. [PMID: 33130822 DOI: 10.1038/s41393-020-00572-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective cohort study with two times of measurement. OBJECTIVE To assess the relationship between use of assistive devices for walking (at baseline) and the number of annual fall-related injuries (at follow-up) among a cohort of ambulatory adults with spinal cord injury (SCI). SETTING Medical University in the Southeastern United States. METHODS There were 622 ambulatory adults who met the eligibility criteria, 317 of whom completed both baseline and follow-up assessments. The participants completed a mailed self-report assessment (SRA) that measured self-reported number of fall-related injuries in the previous year, and the use of orthopedic equipment (assistive devices) for walking, including cane(s), crutches, walker, and braces, was assessed at both baseline and follow-up. RESULTS The percentage of at least one self-reported fall-related injury decreased from 22% at baseline to 13% at the follow-up. Walker and cane use at baseline was significantly associated with fall-related injuries at follow-up. Participants using one walking device related to 194% greater number of fall injures, and using multiple device related to 730% greater number of fall injures than those who used no devices. We also found walker users were associated with 214% greater number of fall injures, while cane users were associated with 160% greater number of fall injures. CONCLUSIONS The probability of fall-related injury remained high among persons who are ambulatory after SCI. Health care professionals should be aware of the balance between the goal of ambulation and the potential increased risk of fall-related injuries associated with assistive device use.
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Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Sandra S Brotherton
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Singh H, Shibi Rosen A, Bostick G, Kaiser A, Musselman KE. Exploring the causes and impacts of falls among ambulators with spinal cord injury using photovoice: a mixed-methods study. BMJ Open 2020; 10:e039763. [PMID: 32868369 PMCID: PMC7462239 DOI: 10.1136/bmjopen-2020-039763] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This study explored: (1) fall circumstances experienced by ambulators with spinal cord injury (SCI) over a 6-month period, (2) the impacts of falls-related injuries and fall risk and (3) their preferences/recommendations for fall prevention. DESIGN A sequential explanatory mixed-methods design with two phases. SETTING A Canadian SCI rehabilitation hospital and community setting. PARTICIPANTS Thirty-three ambulators with SCI participated in phase 1 and eight participants that fell in phase 1 participated in phase 2. METHODS In phase 1, fall circumstances were tracked using a survey that was completed each time a participant fell during the 6-month tracking period. Phase 2 involved photovoice; participants took photographs of factors that influenced their fall risk and how their fall risk impacted their work/recreational activities. Participants discussed the photographs and topics related to fall prevention in an individual interview and a focus group. RESULTS Of the 33 participants, 21 fell in 6 months. Falls commonly occurred in the home while participants were changing positions or walking. Most falls occurred in the morning or afternoon. In phase 2, interviews and focus group discussion revealed three themes: (1) falls are caused by bodily impairments (eg, impaired reactive response during slips and trips and weakness and altered sensation in legs/feet), (2) impacts of fall-related injuries and fall risk (eg, psychosocial effects of fall-related injuries, limiting community participation due to the risk of falling and activity-dependent concern of falling) and (3) approaches to fall prevention (eg, fall prevention strategies used, components of fall prevention and utility of professional fall prevention strategies/interventions). CONCLUSIONS Fall prevention interventions/strategies should focus on minimising a person's fall risk within their home as most falls occurred in the home environment. Ambulators with SCI would benefit from education and awareness about common fall circumstances that they may encounter in their daily lives.
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Affiliation(s)
- Hardeep Singh
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Arielle Shibi Rosen
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Neuroscience Program (interdepartmental), Department of Biology, Physiology, and Psychology, McGill University, Montreal, Québec, Canada
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Anita Kaiser
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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12
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Donovan J, Snider B, Miller A, Kirshblum S. Walking after Spinal Cord Injury: Current Clinical Approaches and Future Directions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Lawrason SVC, Todd KR, Shaw RB, Martin Ginis KA. Physical activity among individuals with spinal cord injury who ambulate: a systematic scoping review. Spinal Cord 2020; 58:735-745. [DOI: 10.1038/s41393-020-0460-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/27/2022]
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14
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Behavioral Factors and Unintentional Injuries After Spinal Cord Injury. Arch Phys Med Rehabil 2020; 101:412-417. [DOI: 10.1016/j.apmr.2019.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/26/2019] [Accepted: 09/13/2019] [Indexed: 11/20/2022]
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15
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Rigot S, Worobey L, Boninger ML. Gait Training in Acute Spinal Cord Injury Rehabilitation-Utilization and Outcomes Among Nonambulatory Individuals: Findings From the SCIRehab Project. Arch Phys Med Rehabil 2018; 99:1591-1598. [PMID: 29510092 DOI: 10.1016/j.apmr.2018.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/05/2018] [Accepted: 01/28/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI). DESIGN Prospective observational study using the SCIRehab database. SETTING Six IPR facilities. PARTICIPANTS Patients with new SCI (N=1376) receiving initial rehabilitation. INTERVENTIONS Patients were divided into groups consisting of those who did and did not receive GT. Patients were further subdivided based on their primary mode of mobility as measured by the FIM. MAIN OUTCOME MEASURES Pain rating scales, Patient Health Questionnaire Mood Subscale, Satisfaction With Life Scale, and Craig Handicap Assessment and Reporting Technique (CHART). RESULTS Nearly 58% of all patients received GT, including 33.3% of patients who were primarily using a wheelchair 1 year after discharge from IPR. Those who used a wheelchair and received GT, received significantly less transfer and wheeled mobility training (P<.001). CHART physical independence (P=.002), mobility (P=.024), and occupation (P=.003) scores were significantly worse in patients who used a wheelchair at 1 year and received GT, compared with those who used a wheelchair and did not receive GT in IPR. Older age was also a significant predictor of worse participation as measured by the CHART. CONCLUSIONS A significant percentage of individuals who are not likely to become functional ambulators are spending portions of their IPR stays performing GT, which is associated with less time allotted for other functional interventions. GT in IPR was also associated with participation deficits at 1 year for those who used a wheelchair, implying the potential consequences of opportunity costs, pain, and psychological difficulties of receiving unsuccessful GT. Clinicians should consider these data when deciding to implement GT during initial IPR.
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Affiliation(s)
- Stephanie Rigot
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Lynn Worobey
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA.
| | - Michael L Boninger
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
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16
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The course of fatigue after acute spinal cord injury. Spinal Cord 2016; 55:94-97. [DOI: 10.1038/sc.2016.102] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/15/2016] [Accepted: 05/18/2016] [Indexed: 11/08/2022]
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17
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Louie DR, Eng JJ, Lam T. Gait speed using powered robotic exoskeletons after spinal cord injury: a systematic review and correlational study. J Neuroeng Rehabil 2015; 12:82. [PMID: 26463355 PMCID: PMC4604762 DOI: 10.1186/s12984-015-0074-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/04/2015] [Indexed: 12/16/2022] Open
Abstract
Powered robotic exoskeletons are an emerging technology of wearable orthoses that can be used as an assistive device to enable non-ambulatory individuals with spinal cord injury (SCI) to walk, or as a rehabilitation tool to improve walking ability in ambulatory individuals with SCI. No studies to date have systematically reviewed the literature on the efficacy of powered exoskeletons on restoring walking function. Our objective was to systematically review the literature to determine the gait speed attained by individuals with SCI when using a powered exoskeleton to walk, factors influencing this speed, and characteristics of studies involving a powered exoskeleton (e.g. inclusion criteria, screening, and training processes). A systematic search in computerized databases was conducted to identify articles that reported on walking outcomes when using a powered exoskeleton. Individual gait speed data from each study was extracted. Pearson correlations were performed between gait speed and 1) age, 2) years post-injury, 3) injury level, and 4) number of training sessions. Fifteen articles met inclusion criteria, 14 of which investigated the powered exoskeleton as an assistive device for non-ambulatory individuals and one which used it as a training intervention for ambulatory individuals with SCI. The mean gait speed attained by non-ambulatory participants (n = 84) while wearing a powered exoskeleton was 0.26 m/s, with the majority having a thoracic-level motor-complete injury. Twelve articles reported individual data for the non-ambulatory participants, from which a positive correlation was found between gait speed and 1) age (r = 0.27, 95 % CI 0.02-0.48, p = 0.03, 63 participants), 2) injury level (r = 0.27, 95 % CI 0.02-0.48, p = 0.03, 63 participants), and 3) training sessions (r = 0.41, 95 % CI 0.16-0.61, p = 0.002, 55 participants). In conclusion, powered exoskeletons can provide non-ambulatory individuals with thoracic-level motor-complete SCI the ability to walk at modest speeds. This speed is related to level of injury as well as training time.
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Affiliation(s)
- Dennis R Louie
- University of British Columbia, Vancouver, Canada. .,Rehabilitation Research Program, 4255 Laurel Street, Vancouver, BC, Canada, V5Z 2G9. .,Vancouver Coastal Health Research Institute, Vancouver, Canada.
| | - Janice J Eng
- University of British Columbia, Vancouver, Canada. .,Rehabilitation Research Program, 4255 Laurel Street, Vancouver, BC, Canada, V5Z 2G9. .,Vancouver Coastal Health Research Institute, Vancouver, Canada. .,International Collaboration on Repair Discoveries, 818 West 10th Avenue, Vancouver, BC, Canada, V5Z 1M9. .,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, Canada, V6T 1Z3.
| | - Tania Lam
- University of British Columbia, Vancouver, Canada. .,International Collaboration on Repair Discoveries, 818 West 10th Avenue, Vancouver, BC, Canada, V5Z 1M9.
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Smith EM, Imam B, Miller WC, Silverberg ND, Anton HA, Forwell SJ, Townson AF. The relationship between fatigue and participation in spinal cord injury. Spinal Cord 2015; 54:457-62. [DOI: 10.1038/sc.2015.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/15/2015] [Accepted: 07/29/2015] [Indexed: 11/09/2022]
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Saunders LL, Krause JS. Injuries and Falls in an Aging Cohort with Spinal Cord Injury: SCI Aging Study. Top Spinal Cord Inj Rehabil 2015; 21:201-7. [PMID: 26363586 DOI: 10.1310/sci2103-201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limited research suggests that additional "subsequent" injuries occur frequently among persons with an existing spinal cord injury (SCI), which may result in further significant complications and added disability. OBJECTIVE The purpose of this study was to (a) report the 12-month incidence of injuries by age in an aging SCI cohort, (b) report the 12-month incidence of falls, (c) assess the impact of injuries on participation by age, and (d) assess the relationship of age with injuries and falls while controlling for potential confounding factors. METHODS Participants (N = 759) responded to questions about injuries and falls resulting in injury in the past year. Demographic and SCI characteristics, binge drinking, and prescription medication use were measured. RESULTS A total of 19.2% reported 1 or more injuries in the past year, and 10.4% reported a fall resulting in an injury in the past year. Among those who sustained 1 or more injuries, 22.8% had at least 1 hospitalization for an injury within the past 12 months. Additionally, 47.6% were limited in their normal daily activities for a week or more due to injury. Prescription medication use was associated with injury in the past year and falls resulting in injury. Equal time between walking and wheelchair use as the primary mode of locomotion was also associated with falls in the past year. CONCLUSIONS Future research should investigate circumstances surrounding subsequent injuries to aid in prevention efforts. Additionally, information is needed on whether subsequent injuries further contribute to physical disability.
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Affiliation(s)
- Lee L Saunders
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
| | - James S Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
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Martin Ginis KA, Papathomas A, Perrier MJ, Smith B. Psychosocial factors associated with physical activity in ambulatory and manual wheelchair users with spinal cord injury: a mixed-methods study. Disabil Rehabil 2015; 39:187-192. [DOI: 10.3109/09638288.2015.1045991] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Anthony Papathomas
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | | | - Brett Smith
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
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Dipiro ND, Saunders LL, Brotherton S, Kraft S, Krause JS. Pain and fatigue as mediators of the relationship between mobility aid usage and depressive symptomatology in ambulatory individuals with SCI. Spinal Cord 2014; 52:316-21. [PMID: 24418957 DOI: 10.1038/sc.2013.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/28/2013] [Accepted: 11/05/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional cohort study. OBJECTIVES To investigate a mediational model where pain (intensity and interference) and fatigue mediate the relationship between the use of mobility aids and moderate-to-severe depressive symptomatology among ambulatory participants with spinal cord injury (SCI). SETTING A medical university in the southeastern United States. METHODS Ambulatory adults (N=652) with chronic SCI responded to a mail-in survey. The Patient Health Questionnaire-9 was used to assess moderate-to-severe depressive symptomatology. The Brief Pain Inventory was used to assess pain intensity and interference, and the Modified Fatigue Impact Scale-5-item version was used to assess fatigue. Participants self-reported use of mobility aids. RESULTS On examining mobility aids used for ambulation, 65% were found to have used at least one aid. Severe pain intensity was reported by 11%, and 14% reported severe pain interference. Disabling fatigue was reported by 10% of the participants. Twenty-one percent (n=138) reported moderate-to-severe levels of depressive symptoms. On examining the relationships between mobility aids and depressive symptomatology, using people as a mobility aid was associated with increased odds of depressive symptomatology (2.6) and always using a wheelchair was associated with lower odds (0.3). However, these relationships were no longer significant after controlling for the mediating variables pain intensity, pain interference and fatigue. CONCLUSIONS Pain and fatigue mediate the relationship between usage of certain mobility aids and depressive symptomatology. The use of people to assist in ambulation is associated with greater odds of moderate-to-severe depressive symptomatology, while always using a wheelchair is associated with lower odds.
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Affiliation(s)
- N D Dipiro
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - L L Saunders
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - S Brotherton
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - S Kraft
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - J S Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Saunders LL, Dipiro ND, Krause JS, Brotherton S, Kraft S. Risk of Fall-Related Injuries among Ambulatory Participants with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2013; 19:259-66. [PMID: 24244091 DOI: 10.1310/sci1904-259] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND With medical and rehabilitation advances, many people are able to regain or maintain ambulation after spinal cord injury (SCI). However, those who are ambulatory may be at increased risk for falls. OBJECTIVE To assess the relationships between walking devices and behaviors, including alcohol use, prescription medication use, and exercise, with falls among persons with SCI who are ambulatory. METHODS A total of 515 adults with chronic SCI who were able to ambulate provided self-report of their use of assistive devices for ambulation, prescription medication use, alcohol use, exercise, and falls resulting in injury (FRI). RESULTS At least 1 FRI was reported by 20.3% of participants in the past year. Ambulatory participants who reported using a wheelchair as their primary mode of mobility were less likely to have an FRI than those who reported walking more than using a wheelchair. Those with perceived poor balance were 2.41 times more likely to have an FRI than those without poor balance. Those who reported less exercise than other persons with a comparable SCI severity were 2.77 times more likely to have an FRI than those reporting the same or more amount of exercise. Pain medication misuse also was associated with higher odds of an FRI. CONCLUSIONS Health care providers should be aware of the risk for FRI among those who are ambulatory. They should assess and consider not only ambulatory ability, but also behaviors, including prescription medication use and exercise, when recommending ambulation techniques.
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Affiliation(s)
- Lee L Saunders
- College of Health Professions, Medical University of South Carolina , Charleston, South Carolina
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