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Senthinathan A, Penner M, Tu K, Morris AM, Craven BC, Li Z, Guan J, Jaglal SB. Identifying Patterns of Primary Care Antibiotic Prescribing for a Spinal Cord Injury (SCI) Cohort Using an Electronic Medical Records (EMR) Database. Top Spinal Cord Inj Rehabil 2023; 29:153-164. [PMID: 38174137 PMCID: PMC10759849 DOI: 10.46292/sci23-00047s] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Individuals with a spinal cord injury (SCI) are considered higher users of antibiotics. However, to date there have been no detailed studies investigating outpatient antibiotic use in this population. Objectives (1) To describe primary care antibiotic prescribing patterns in adults with SCI rostered to a primary care physician (PCP), and (2) to identify patient or PCP factors associated with number of antibiotics prescribed and antibiotic prescription duration. Methods A retrospective cohort study using linked health administrative and electronic medical records (EMR) databases from January 1, 2013 to December 31, 2015 among 432 adults with SCI in Ontario, Canada. Negative binomial regression analyses were conducted to identify patient or physician factors associated with number of antibiotics prescribed and prescription duration. Results During the study period, 61.1% of the SCI cohort received an antibiotic prescription from their PCP. There were 59.8% of prescriptions for urinary tract infections (UTI) and 24.6% of prescriptions for fluoroquinolones. Regression analysis found catheter use was associated with increased number of antibiotics prescribed (relative risk [RR] = 3.1; 95% CI, 2.3-4.1; p < .001) and late career PCPs, compared to early-career PCPs, prescribed a significantly longer duration (RR = 1.8; 95% CI, 1.1-3.1; p = .02). Conclusion UTIs were the number one prescription indication, and fluoroquinolones were the most prescribed antibiotic. Catheter use was associated with number of antibiotics, and PCP's years of practice was associated with duration. The study provided important information about primary care antibiotic prescribing in the SCI population and found that not all individuals received frequent antibiotics prescriptions.
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Affiliation(s)
- Arrani Senthinathan
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Melanie Penner
- Bloorview Research Institute / Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Andrew M. Morris
- Antimicrobial Stewardship Program, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Infectious Diseases, Sinai Health, University Health Network, and University of Toronto, Toronto, ON, Canada
| | - B. Catharine Craven
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | | | | | - Susan B. Jaglal
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Rehabilitation Science Institute and Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Nizeyimana E, Joseph C, Phillips J. Quality of life after traumatic spinal cord injury in a developing context: the influence of contextual factors and injury characteristics. Disabil Rehabil 2022; 44:2020-2026. [DOI: 10.1080/09638288.2020.1827051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Eugene Nizeyimana
- Department of Physiotherapy, University of the Western Cape, Cape Town, South Africa
| | - Conran Joseph
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
| | - Joliana Phillips
- Department of Physiotherapy, University of the Western Cape, Cape Town, South Africa
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Zanca JM, Gilchrist C, Ortiz CE, Dyson-Hudson TA. Pilot clinical trial of a clinical meditation and imagery intervention for chronic pain after spinal cord injury. J Spinal Cord Med 2022; 45:339-353. [PMID: 34612802 PMCID: PMC9135436 DOI: 10.1080/10790268.2021.1970894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To assess the feasibility and potential benefits of clinical meditation and imagery (CMI) for people with chronic spinal cord injury (SCI) and chronic pain. DESIGN Pilot randomized, controlled trial. SETTING Outpatients with SCI in the United States. PARTICIPANTS 24 adults with chronic SCI (>1 year) and a >3 month history of pain rated ≥4/10 on average over the last week. INTERVENTIONS 4-week program of once-weekly 2-hour group classes, offered in-person and online. CMI group participants were taught mindfulness, mantra meditation, and guided imagery practices. Control group participants received education on topics related to health and function after SCI. OUTCOME MEASURES Pain interference (primary outcome), pain cognitions, pain intensity/unpleasantness, depressive symptomology, perceived stress. RESULTS Pain interference decreased to a greater extent in the control group at both Day 42 and Day 70, with a large effect size (d > 1.0). Several secondary outcome measures showed changes consistent with more favorable outcomes in the CMI group at both Day 42 and Day 70, with a large effect size d > 0.80, including worst pain intensity over the last week, depressive symptomology, belief in pain as a sign of harm and perceived control over pain. Perceived stress improved to a greater extent in the control group (d = 1.16 at Day 42, d = .20 at Day 70). CONCLUSION CMI is feasible and acceptable to implement with people with SCI and chronic pain. Further study is warranted to assess potential benefits for pain-related outcomes.
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Affiliation(s)
- Jeanne M. Zanca
- Center for Spinal Cord Injury Research, Kessler Foundation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Correspondence to: Jeanne M. Zanca, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ07052, USA.
| | - Christine Gilchrist
- Department of Integrative Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Caroline E. Ortiz
- Department of Integrative Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Trevor A. Dyson-Hudson
- Center for Spinal Cord Injury Research, Kessler Foundation, West Orange, New Jersey, USA
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Effects of Visual Stimulation with Bonsai Trees on Adult Male Patients with Spinal Cord Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091017. [PMID: 28872600 PMCID: PMC5615554 DOI: 10.3390/ijerph14091017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 02/08/2023]
Abstract
Nature therapy has been demonstrated to induce physiological relaxation. The psychophysiological effects of nature therapy (stimulation with bonsai trees) on adult male patients with spinal cord injury (SCI) were examined. Oxyhemoglobin concentration changes in the prefrontal cortex were measured using near-infrared spectroscopy, and heart rate variability was analyzed. Psychological responses were evaluated using the modified semantic differential method and Profile of Mood States (POMS) subscale scores. Visual stimulation of adult male patients with SCI elicited significantly decreased left prefrontal cortex activity, increased parasympathetic nervous activity, decreased sympathetic nervous activity, increased positive feelings, and resulted in lower negative POMS subscale scores. Nature therapy can lead to a state of physiological and psychological relaxation in patients with SCI.
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Dickson A, Allan D, O'carroll R. Biographical disruption and the experience of loss following a spinal cord injury: an interpretative phenomenological analysis. Psychol Health 2014; 23:407-25. [PMID: 25160576 DOI: 10.1080/14768320701219136] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Individual in-depth interviews with eight people who had experienced a total spinal cord injury were conducted, focussing on the experience of living with a spinal cord injury. The interviews were transcribed verbatim and were analysed for recurrent themes using Interpretative Phenomenological Analysis (IPA). Here we present three inter-related recurrent themes: 'Loss of control'; 'Loss of independence' and 'Loss of identity'. Participants reported an ongoing sense of loss, characterised largely by a diminishing sense of personal control. This loss of personal control manifested itself in incontinence, emotion and loss of movement. Helplessness and embarrassment were common responses. A loss of independence was associated with incontinence but also with a loss of spontaneity. A loss of identity ensued and participants reported feeling 'invisible'. The findings are discussed in relation to both extant spinal cord literature and chronic health literature. Recommendations for future research are suggested.
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Affiliation(s)
- Adele Dickson
- a Department of Psychology , University of Stirling , Stirling , FK9 4LA , UK
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Bombardier CH, Fann JR, Wilson CS, Heinemann AW, Richards JS, Warren AM, Brooks L, Warms CA, Temkin NR, Tate DG. A randomized controlled trial of venlafaxine XR for major depressive disorder after spinal cord injury: Methods and lessons learned. J Spinal Cord Med 2014; 37:247-63. [PMID: 24090228 PMCID: PMC4064574 DOI: 10.1179/2045772313y.0000000138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
CONTEXT/OBJECTIVE We describe the rationale, design, methods, and lessons learned conducting a treatment trial for major depressive disorder (MDD) or dysthymia in people with spinal cord injury (SCI). DESIGN A multi-site, double-blind, randomized (1:1) placebo controlled trial of venlafaxine XR for MDD or dysthymia. Subjects were block randomized and stratified by site, lifetime history of substance dependence, and prior history of MDD. SETTING Six SCI centers throughout the United States. PARTICIPANTS Across participating centers, 2536 subjects were screened and 133 were enrolled into the trial. Subjects were 18-64 years old and at least 1 month post-SCI. Interventions Twelve-week trial of venlafaxine XR versus placebo using a flexible titration schedule. OUTCOME MEASURES The primary outcome was improvement in depression severity at 12 weeks. The secondary outcome was improvement in pain. RESULTS This article includes study methods, modifications prompted by a formative review process, preliminary data on the study sample and lessons learned. We describe common methodological and operational challenges conducting multi-site trials and how we addressed them. Challenges included study organization and decision making, staff training, obtaining human subjects approval, standardization of measurement and treatment, data and safety monitoring, subject screening and recruitment, unblinding and continuity of care, database management, and data analysis. CONCLUSIONS The methodological and operational challenges we faced and the lessons we learned may provide useful information for researchers who aim to conduct clinical trials, especially in the area of medical treatment of depression in people with SCI.
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Affiliation(s)
- Charles H. Bombardier
- Department of Rehabilitation Medicine, Psychiatry and Behavioral Sciences and Epidemiology (Fann), University of Washington School of Medicine, Seattle, WA, USA
| | - Jesse R. Fann
- Department of Rehabilitation Medicine, Psychiatry and Behavioral Sciences and Epidemiology (Fann), University of Washington School of Medicine, Seattle, WA, USA
| | | | - Allen W. Heinemann
- Rehabilitation Institute of Chicago, Northwestern University, Chicago, IL, USA
| | - J. Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Larry Brooks
- Department of Rehabilitation Medicine, University of Miami, Miami, FL, USA
| | - Catherine A. Warms
- Department of Rehabilitation Medicine, Psychiatry and Behavioral Sciences and Epidemiology (Fann), University of Washington School of Medicine, Seattle, WA, USA
| | | | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Krause JS, Reed KS, McArdle JJ. Factor Structure and Predictive Validity of Somatic and Nonsomatic Symptoms From the Patient Health Questionnaire-9: A Longitudinal Study After Spinal Cord Injury. Arch Phys Med Rehabil 2010; 91:1218-24. [DOI: 10.1016/j.apmr.2010.04.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/07/2010] [Accepted: 04/17/2010] [Indexed: 11/25/2022]
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Chapin MH, Holbert D. Employment at Closure Is Associated With Enhanced Quality of Life and Subjective Well-Being for Persons With Spinal Cord Injuries. REHABILITATION COUNSELING BULLETIN 2010. [DOI: 10.1177/0034355210367685] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed whether persons with spinal cord injuries who had been successfully rehabilitated into employment following receipt of rehabilitation services had better quality of life and subjective well-being than the unsuccessfully rehabilitated who did not obtain employment following receipt of rehabilitation services. Persons who were successfully rehabilitated had a significantly higher overall quality of life and health and higher quality of life in their physical health, psychological health, social relationships, and environmental domains than the unsuccessfully rehabilitated. The successfully rehabilitated also had higher psychological, financial, and physical well-being than the unsuccessfully rehabilitated. Rehabilitation counselors can use quality of life and subjective well-being measures to provide more focused interventions during rehabilitation and as an outcome measure in addition to employment upon completion of rehabilitation services.
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Abstract
OBJECTIVE To develop and validate a latent model of health outcomes among persons with spinal cord injury. METHODS Survey data were collected at a large specialty hospital in the southeastern USA from 1,388 adult participants with traumatic spinal cord injury of at least 1 year's duration. Multiple indicators of health outcomes were used, including general health ratings, days adversely affected by poor health and poor mental health, treatments and hospitalizations, depressive symptoms, symptoms of illness or infection (eg, sweats, chills, fever), and multiple individual conditions (eg, pressure ulcers, subsequent injuries, fractures, contractures). RESULTS We performed exploratory factor analysis on half of the sample and confirmatory factor analysis on the other. A 6-factor solution was the best overall solution, because there was an excellent fit with the exploratory factor analysis (root mean square error of approximation = 0.042) and acceptable fit with the confirmatory factor analysis (root mean square error of approximation = 0.065). Four of the factors were types of secondary conditions, including symptoms of illness or infection, orthopedic conditions, pressure ulcers, and subsequent injuries. The 2 remaining factors reflected global health and treatment. Gender, race-ethnicity, age, injury severity, and years of education were all significantly related to at least 1 factor dimension, indicating variations in health outcomes related to these characteristics. CONCLUSION Identification of the 6 factors represents an improvement over the utilization of multiple individual indicators, because composite scores generated from multiple individual indicators provide more informative and stable outcome scores than utilization of single indicators.
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Affiliation(s)
- James S Krause
- College of Health Professions, Medical University of South Carolina, 77 President St, Suite 117, PO Box 250700, Charleston, SC 29425, USA.
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Lidal IB, Veenstra M, Hjeltnes N, Biering-Sørensen F. Health-related quality of life in persons with long-standing spinal cord injury. Spinal Cord 2008; 46:710-5. [DOI: 10.1038/sc.2008.17] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rajan S, McNeely MJ, Warms C, Goldstein B. Clinical assessment and management of obesity in individuals with spinal cord injury: a review. J Spinal Cord Med 2008; 31:361-72. [PMID: 18959353 PMCID: PMC2582426 DOI: 10.1080/10790268.2008.11760738] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Diagnosing and managing obesity in individuals with spinal cord injury (SCI) remain challenging. METHODS Literature on the epidemiology, impact, and management of obesity in individuals with SCI was reviewed. FINDINGS Although nearly 66% of individuals with SCI are either overweight or obese, little guidance is available to measure and monitor obesity in the clinical setting. The use of anthropometric indices and specific cut points available for able-bodied persons is limited by the body composition changes that follow SCI. Indices of upper body obesity warrant examination in SCI because they provide an index of central obesity, which is more closely linked to some obesity-related conditions than is overall obesity. Investigations into the sequelae of excess body fat and its distribution are also needed in SCI because past research in this area has been inconclusive. Although limited, evidence regarding obesity interventions in SCI may be promising. CONCLUSIONS The best anthropometric tool to define obesity in the clinical setting remains unknown. SCI-specific assessment tools and a better understanding of the sequelae of excess body weight will lead to better targeting of prevention and treatment efforts. More research is needed on the individual components of a weight management program unique to SCI. Until then, providers are urged to use a team approach and draw on existing resources and applicable research in able-bodied individuals to facilitate weight management in individuals with SCI.
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Affiliation(s)
- Suparna Rajan
- VA Puget Sound Health Care System, Seattle, Washington, USA.
| | | | | | - Barry Goldstein
- 1VA Puget Sound Health Care System, Seattle, Washington,2University of Washington, Seattle, Washington
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Dieruf K, Ewer L, Boninger D. The natural-fit handrim: factors related to improvement in symptoms and function in wheelchair users. J Spinal Cord Med 2008; 31:578-85. [PMID: 19086716 PMCID: PMC2607131 DOI: 10.1080/10790268.2008.11754605] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE People with spinal cord injury (SCI) may spend several decades using a wheelchair as their primary means of mobility. Secondary injury and a decline in independence over time are common with manual wheelchair users who, in turn, may require increased assistance as time passes. The Natural-Fit contoured handrim has been shown to improve symptoms and function in people with SCI who use manual wheelchairs and who have experienced upper extremity pain. The objective of this study was to determine the factors associated with improved symptoms and functions. PARTICIPANTS 87 people who purchased the ergonomic wheelchair handrims. Participants were predominately men, with a median age of 51 to 55 years, median level of injury T10 to T12, median time in a wheelchair of 15 years, and they had used the contoured rims for 1 to 2 years. METHODS This was a mail survey of 217 people who purchased the rims. The survey was mailed out from the manufacturer and was anonymously returned to the physical therapy department of a university. A $10 incentive was offered for returning the survey. RESULTS The majority of participants reported improvements in upper extremity symptoms, ease of wheelchair propulsion, and functional status. Longer use of the rims was associated with reported improvement in ease of wheelchair propulsion and reduction in pain in hands and wrists. CONCLUSION If a simple modification of the wheelchair can help bring about significant changes in the users' symptoms and function, this modification should be incorporated by people who use manual wheelchairs before decline in function begins. Proactive intervention may alleviate symptoms, help the person maintain maximal independence, and prolong the length of time the individual remains independent.
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Affiliation(s)
- Kathy Dieruf
- Department of Orthopedics, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Lynette Ewer
- 2University of New Mexico, Physical Therapy Program, Albuquerque, New Mexico
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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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DeSanto-Madeya S. The meaning of living with spinal cord injury 5 to 10 years after the injury. West J Nurs Res 2006; 28:265-89; discussion 290-3. [PMID: 16585805 DOI: 10.1177/0193945905283178] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A phenomenological study was conducted with 20 spinal cord injured persons and their family members to examine the meaning of living with spinal cord injury 5 to 10 years after the initial injury. Seven themes emerged from the data. The themes are looking for understanding to a life that is unknown, stumbling along an unlit path, viewing self through a stained glass window, challenging the bonds of love, being chained to the injury, moving forward in a new way of life, and reaching normalcy. The uncovered meanings enhance our understanding and appreciation that living with spinal cord injury is a continuous learning experience. The study findings may be useful in the development of self-care strategies and ongoing interventions that focus on maintaining physical and psychological health for both spinal cord injured persons and their family members throughout the course of living with the disability.
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Affiliation(s)
- Susan DeSanto-Madeya
- College of Nursing and Health Sciences, University of Massachusetts-Boston, MA 02125, USA.
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Affiliation(s)
- Marca L Sipski
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA
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Vall J, Braga VAB. Dor neuropática central após lesão medular traumática: capacidade funcional e aspectos sociais. ESCOLA ANNA NERY 2005. [DOI: 10.1590/s1414-81452005000300008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Estudo de caso comparativo com o objetivo de avaliar a capacidade funcional e os aspectos sociais de dois pacientes, ambos com lesão medular traumática, sem e com dor neuropática central associada, respectivamente. Para avaliar a capacidade funcional, foi utilizado como instrumento o Functional Independence Measure ou Escala de Independência Funcional. E para avaliar os aspectos sociais foi construído o ecomapa de cada paciente, preconizado pelo modelo Calgary de avaliação de famílias. Ambos foram aplicados no domicílio do paciente. Os resultados mostraram que o paciente com dor neuropática central secundária à lesão medular possui baixa capacidade funcional e precária rede social de apoio, quando comparado com o paciente com as mesmas condições, porém sem dor associada.
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