What about us? Children's experiences of living with a sibling with spinal cord injury

Lived experiences of caregivers and survivors of paediatric spinal cord injury: A scoping review of qualitative studies

CONTEXT

Paediatric Spinal Cord Injury (SCI) has an impact on a child's dynamic development, disrupting their participation in school, community, and social relationships while simultaneously causing repercussions on their caregiver's life. The rare nature of paediatric SCI calls for a detailed inspection of the literature from the perspective of children and their caregivers.

OBJECTIVE

This scoping review of qualitative research determines the extent of literature from perspective of caregivers and individuals with paediatric SCI.

METHODS

9351 full-text published articles were identified from CINAHL, Ovid, PubMed, and Scopus between 2001 and 2021. After duplicate deletion, 8354 articles were left, and 103 full-text articles were assessed for their eligibility. Finally, eight articles were assessed for their relevance. Key themes that emerged from the data were summarized, compared, and synthesized.

RESULTS

Six studies were from the perspectives of individuals with SCI and two from caregiver's perspective. Three major themes were identified from caregivers' opinion studies: "Obstacles to community participation"; "Unmet needs related to a child with SCI"; and "Radiating effect on caregivers' lives"; whereas five were obtained from individuals with paediatric SCI opinion studies: "Adjusting to life with SCI"; "Hardships & hardiness"; "Peers & family/emotional support"; "Perception of self & body-image post injury"; and "Transitioning into post-traumatic life".

CONCLUSION

There is a need for more specialized rehabilitation centers and an accessible environment in public spaces. Also, the review sheds some light on the discriminatory attitude of society as a whole, which can be improved by providing proper knowledge and awareness of SCI.

International spinal cord injury socio-demographic basic data set (version 1.0)

STUDY DESIGN

Consensus based on the literature.

OBJECTIVE

Create an International Spinal Cord Injury (SCI) Socio-Demographic Basic Data Set (Version 1.0).

SETTING

International.

METHODS

The development included an iterative process where the authors reviewed existing variables containing socio-demographic variables and created a first dataset draft, which was followed by several revisions through email communications. In addition, the work was conducted in parallel with a similar endeavour within the National Institute of Neurological Disorders and Stroke SCI Common Data Elements project in the United States. Subsequently, harmonization between the two projects was sought. Following this, a review process was initiated, including The International SCI Data Sets Committee, the American Spinal Injury Association (ASIA) Board, and the International Spinal Cord Society (ISCoS) Scientific and Executive Committees, and then by publishing on the respective websites for membership feedback. The draft was sent to about 40 national and international organizations and several interested individuals for feedback. All review comments were discussed in the working group and responded to before the final draft was developed, and finally approved by ASIA Board and the ISCoS Scientific and Executive committees.

RESULTS

The final International SCI Socio-Demographic Basic Data Set includes the following variables: Date of data collection, Marital status, Household member count, Years of formal education, and Primary occupation.

CONCLUSION

The International SCI Socio-Demographic Basic Data Set will facilitate uniform data collection and reporting of socio-demographic information at the time of injury as well as at post-injury follow-ups to facilitate the evaluation and comparisons across studies.

Rehabilitation models of care for children and youth living with traumatic brain and/or spinal cord injuries: A focus on family-centred care, psychosocial wellbeing, and transitions

To describe current rehabilitation models of care and programmes, in Australia and internationally, related to family-centred care, psychosocial support, and transitions used for children and youth who have sustained major traumatic brain and/or spinal cord injuries. Fourteen services were interviewed, including eight medical rehabilitation services, three community-based rehabilitation services, two insurance services, and one state-wide education service provider. Semi-structured interviews were transcribed and analysed using qualitative content analysis in NVivo. Compared to the number of services supporting children and youth with traumatic brain injury, a very limited number supported those with spinal cord injury. Although valued and often included in the model of care, family-centred care was rarely systematically evaluated by the services. Most services provided psychosocial and transition support to children and youth, and their families in the short-term post-injury, but not in the long-term. Several challenges also hindered the smooth delivery of these support services, including poor communication between service providers. These findings show that services aimed to provide the best possible care to these children and youth, and their families; guided by rehabilitation models of care. However, challenges persist with regards to delivering family-centred care, coordinating return to school, and providing long-term support for psychosocial problems and transition.

Development and Implementation of a Pediatric Trauma Survivors Network Program

: The Trauma Survivors Network (TSN) was developed as a program of the American Trauma Society (ATS) to support recovery for adult trauma patients. However, the children of adult trauma patients, families of pediatric trauma patients, and pediatric trauma patients previously had scarce resources. Our institution, in collaboration with the ATS, sought to expand the TSN to support pediatric trauma patients, caregivers, and family members. We aimed to determine whether the TSN could be transferred to the pediatric population. Focus groups identified psychosocial needs of younger survivors, children of adult survivors, and caregivers. A Pediatric TSN Coordinator was hired, Pediatric TSN Peer Visitors were recruited and trained, and Pediatric TSN Activity Hour was implemented for pediatric patients and families. Since implementation 1 year ago, 26 peer visitors have been trained and have conducted approximately 200 visitations. In total, 93 patients and family members have attended Pediatric TSN Activity Hour. TSN services can be adapted to address psychosocial needs of pediatric trauma survivors, families, and children of trauma survivors. When possible, sharing resources between an existing adult TSN program and a pediatric program is valuable to facilitate expansion. TSN complements and strengthens the care offered at our institution by providing patient-centered and family-centered care services for the entire family at various stages of development. The implementation of this program might be different at sites without an existing adult TSN with established resources and support. This article describes the development and implementation of the program; we did not assess outcomes.

It is a marathon rather than a sprint: an initial exploration of unmet needs and support preferences of caregivers of children with SCI

STUDY DESIGN

Focus group study.

OBJECTIVES

Explore unmet needs and support preferences of caregivers of youth with spinal cord injury (SCI).

SETTING

One pediatric specialty rehabilitation hospital system in the United States.

METHODS

Four focus groups were conducted with a convenience sample of 26 caregivers who were primarily mothers (96%) and married (65%), and had at least some college education (85%). Children living with SCI were on average 12.8 years old (SD = 3.3, 8-18). The average age of injury was 4.7 years (SD = 4.4, 0-16.2); mean injury duration was 8.2 years (SD = 3.9, 2-16); 77% had paraplegia; and 58% were male. Focus groups were digitally recorded, transcribed verbatim, and coded using thematic analysis and NVivo.

RESULTS

Qualitative data highlighted caregiver perspectives on unmet needs relating to two phases of care: acute and rehabilitation vs. current life with SCI, and two kinds of stressors: those associated with SCI and care vs. those related to other areas of the caregivers' lives, especially their families. Caregivers described stressful interactions with care systems and community services, articulated several concerns regarding well-being of family members, and noted that both they and their children with SCI experienced isolation. Caregivers articulated preferences for additional support from professionals and peers.

CONCLUSIONS

Data suggest the need for ongoing caregiver interventions and strengthened family-centered care systems, including professional assistance navigating health systems and peer support. Intervention development would benefit from further qualitative data collection with additional caregivers of youth with SCI, including multiple family members, and families from more diverse care settings.

Five fathers' experience of an adult son sustaining a cervical spinal cord injury: an interpretative phenomenological analysis

The paper presents an in-depth idiographic study exploring the experience of fathers who have an adult son with a cervical spinal cord injury (SCI). Five participants were recruited and individual semi-structured interviews were conducted. The interviews were transcribed verbatim and analyzed using interpretative phenomenological analysis. Two superordinate themes are presented highlighting. First, the ongoing negative impact of their sons' injury on the participants' role as fathers'. This comprises the negative impact on emotions with guilt common for failing in their perceived role as a father. The dissonance experienced between wanting to help encourage their sons' independence. Concern experienced due to their sons altered life trajectory and anxiety because they would not be alive to protect their son in the future. Second, how participants cope and adjust to their son's SCI are presented. Comprising of how positive thinking, such as focusing on their son surviving the trauma and the influence of seeing their son cope well affects how participants cope. Also, reflecting on how the injury has changed their life helps participants, to an extent, make sense of the trauma. The results are discussed in relation to the relevant extant literature to give a unique perspective about how SCI impacts their perceived role as fathers and the struggle to cope and adjust to the trauma. Future research investigating the impact of SCI on the family is warranted to better understand the wider implications.

Pediatric Spinal Cord Injury: Recognition of Injury and Initial Resuscitation, in Hospital Management, and Coordination of Care

Spinal cord injury is uncommon in the pediatric population with a lifelong impact for the patient and family. Knowledge of spine embryology, mechanisms of injury that lead to specific injuries, appropriate utilization of radiographic imaging based on suspected injury, prehospital and hospital management of various spinal cord injuries is essential for providers attending to traumatically injured patients. In addition to patients who present with soft tissue and bony injuries diagnosed with clinical examination and confirmed with computed tomography or magnetic resonance imaging, it is important to note that the pediatric population is at a higher risk for spinal cord injury without radiographic abnormality than the adult population. Patients who survive the acute phase of injury face long-term rehabilitation and have an increased risk of depression and mortality. Understanding the long-term sequelae of spinal cord injuries is also an essential management component of traumatically injured children. A program that provides long-term rehabilitation, psychosocial and spiritual support, and adaptive environmental supports gives patients and their families the best opportunity for long-term recovery. A review of the current literature on the diagnosis, management, and follow-up of pediatric spinal cord injury is presented.