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Sparg T, Petersen L, Mayers P, Rogers C. South African adolescents' lived experiences of acquired hearing loss following multidrug-resistant tuberculosis treatment. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1336346. [PMID: 38469378 PMCID: PMC10925655 DOI: 10.3389/fresc.2024.1336346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/10/2024] [Indexed: 03/13/2024]
Abstract
Objective The impact of acquiring hearing loss might be exacerbated during adolescence, as this normal transition from childhood to adulthood is characterised by identity construction and social intensity. This study aimed to describe the lived experiences of South African adolescents with acquired hearing loss following aminoglycoside treatment for multidrug resistant tuberculosis. Design The study adopted a descriptive phenomenological design and in-depth, semi-structured interviews were conducted in English, isiZulu and Afrikaans. The data was managed and analysed according to a modified version of Hycner's framework. Study sample Six participants aged 16-24 years with bilateral, mild to profound hearing loss acquired from aminoglycoside treatment were recruited from two South African provinces. Results Three themes emerged which created a triple burden for participants. They endured socio-economic hardship encompassing limited economic and emotional support. Participants battled the consequences of life-threatening MDR-TB including illness, hospitalisation, stigma, and other challenges. Finally, participants were left with life-changing hearing loss. Conclusion The findings indicate the necessity of holistic management of adolescents with aminoglycoside-related acquired hearing loss and serves as motivation to improve ototoxic monitoring practices and patient uptake of monitoring services and calls for the cessation, or at least cautious use, of aminoglycosides.
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Affiliation(s)
- Tarryn Sparg
- Division of Communication Sciences and Disorders, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lucretia Petersen
- Division of Communication Sciences and Disorders, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Pat Mayers
- Division of Nursing and Midwifery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christine Rogers
- Division of Communication Sciences and Disorders, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Reeves B, Martin R. Exploring problems for school reintegration following spinal cord injury: Perspectives on the kindergarten through fifth-grade population. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:962682. [PMID: 36188981 PMCID: PMC9470753 DOI: 10.3389/fresc.2022.962682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/04/2022] [Indexed: 12/03/2022]
Abstract
When a child acquires a spinal cord injury or disorder (SCI/D), they are faced with sudden onset of changes. Engagement in education, play, and leisure is immediately impacted. Using survey methodology, return to school for children in kindergarten through fifth grade following SCI/D was examined. Families at a large spinal cord rehabilitation center for the pediatric population on the East Coast of the United States were surveyed via email about their child's return to school to understand support and barriers a child faces when returning to school following SCI/D. Survey findings indicated that children face barriers related to school access, transportation, and educational support upon return to school. The primary barrier identified was access to educational support. Using survey findings, an in-clinic outpatient return-to-school recommendation form was developed to bridge the gap between medical model therapists and school staff that is specific to each child's needs. The curriculum is being developed to support families and therapists in preparing a child to return to school following SCI/D and to educate families to advocate for their child in the school setting. Future recommendations include further research regarding the placement of children in the school environment following SCI/D.
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Affiliation(s)
- Brooke Reeves
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States
- Correspondence: Brooke Reeves
| | - Rebecca Martin
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Onal B, León MR, Augutis M, Mattacola E, Graham A, Hart K, Kelly E, Scheel-Sailer A, Taylor J. Health and LifeDomain ResearchPriorities in Children, Adolescents and Young Adults With Pediatric-Onset Spinal Cord Injury: A National Cross-Sectional Survey in England. Top Spinal Cord Inj Rehabil 2022; 28:91-110. [PMID: 35521061 PMCID: PMC9009198 DOI: 10.46292/sci21-00053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Although feedback from people with adult-onset spinal cord injury (SCI) has been considered in developing research programs, little is known about pediatric-onset SCI priorities. Objectives To describe the health and life (H&L) domain research priorities of youth with pediatric-onset SCI living in England. Methods Youth with pediatric-onset SCI (≥6 months) were recruited from five English rehabilitation centers and invited with their parents/caregivers to complete the age-appropriate surveys designed by the Pan-European Paediatric Spinal Cord Injury (PEPSCI) collaboration. Results A total of 73 surveys were received (32 from participants with SCI and 41 from their parents/caregivers), providing information on 47 individuals with SCI: 2- to 7-year-olds (29.8%), 8- to 12-year-olds (19.2%), 13- to 17-year-olds (17.0%), and 18 to 25-year-olds (34.0%). The top three research priorities reported by parents/caregivers of 2- to 12-year-old and 13- to 25-year-olds were pain (81%/89%), physical function (91%/83%) and health care access (78%/78%). Eighty-nine percent of 8- to 12-year-olds emphasized schooling, peer relationships, and general mood as their research priorities. The top three research priorities for Health or Life domains reported by 13- to 25-year-olds included spasms (95%), pain (91%), pressure injuries (91%), health care access (83%), physical function (78%), and daily personal needs (74%). Conclusion Although there should be an emphasis on addressing important life domain issues for 8- to 12-year-olds with SCI, adolescents and young adults mostly prioritized health domain research priorities in addition to health care access. This survey will aid health care and clinical research organizations to engage stakeholders to implement a comprehensive SCI research strategy in England for the pediatric population.
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Affiliation(s)
- Bashak Onal
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, Buckinghamshire, UK
,Stoke Mandeville Spinal Research, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
,Buckinghamshire Clinical Commissioning Group, Aylesbury, UK
| | - Marta Ríos León
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Emily Mattacola
- School of Psychology, University of Buckingham, Buckingham, UK
| | - Allison Graham
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, Buckinghamshire, UK
| | - Kirsten Hart
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, Buckinghamshire, UK
| | - Erin Kelly
- American Academy of Pediatrics, Itasca, Illinois, USA
| | | | | | - Julian Taylor
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, Buckinghamshire, UK
,Stoke Mandeville Spinal Research, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
,Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
,Harris Manchester College, University of Oxford, Oxford, UK
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Carney J, Fisher R, Augutis M, Charlifue S, Biering-Sørensen F, Höfers W, Hwang M, Wayne New P, Post M, Sadowsky C, Vogel L, Augustine L, Dent K, Mulcahey MJ. Development of the International Spinal Cord Injury/Dysfunction Education Basic Data Set. Spinal Cord Ser Cases 2019; 5:87. [PMID: 31700685 PMCID: PMC6821817 DOI: 10.1038/s41394-019-0229-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/02/2019] [Accepted: 08/11/2019] [Indexed: 11/08/2022] Open
Abstract
Study design Consensus among international experts. Objectives The objective of this project was to develop the International Spinal Cord Injury/Dysfunction (SCI/D) Education Basic Data Set. Setting International expert working group. Methods The published guidelines for developing the International SCI Basic Data Sets were used to develop the International SCI/D Education Basic Data Set. Existing measures and literature on education and disability were reviewed to develop a preliminary draft of the basic education data set through iterative modifications via biweekly conference calls and email communication. The draft was disseminated to the larger International Workgroup for Development of Pediatric SCI/D Basic Data Sets and then to the members of the International Spinal Cord Society (ISCoS), American Spinal Injury Association (ASIA), and relevant expert groups and interested individuals for comments. All feedback received was taken into consideration before the final data set was approved by ISCoS and ASIA. Results The finalized version of the International SCI/D Education Basic Data Set Version 1.0 contains 16 items divided into three domains: school setting/therapeutic services, school participation/academic success, and barriers/attitudes. Most of the variables have been adapted from established measures. This data set is intended for children and youth up to and including high school, but not for emerging adults in higher education or postsecondary vocational training or trade schools. Conclusion The International SCI/D Education Basic Data Set has been developed for collection of a minimal amount of highly relevant information on the education experience in children and youth with SCI/D. Further validation work is needed. Sponsorship This project was funded by the Rick Hansen Institute, Research Award #G2015-27 (Mulcahey, PI).
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Affiliation(s)
- Joan Carney
- Rehabilitation Department, Kennedy Krieger Rehabilitation Institute, Baltimore, MD USA
| | | | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | | | - Fin Biering-Sørensen
- Department of Spinal Cord Injuries, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wiebke Höfers
- Physiotherapy Department, Sunnaas Hospital, Bjørnemyr, Norway
| | - Miriam Hwang
- Research Department, Shriners Hospitals for Children, Chicago, IL USA
| | - Peter Wayne New
- Epworth-Monash Rehabilitation Unit, Department of Epidemilogy and Preventitive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Marcel Post
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Cristina Sadowsky
- Rehabilitation Department, Kennedy Krieger Rehabilitation Institute, Baltimore, MD USA
| | - Lawrence Vogel
- Research Department, Shriners Hospitals for Children, Chicago, IL USA
| | - Lilly Augustine
- School of Education and Psychology, Jönköping University, Jönköping, Sweden
| | - Kathryn Dent
- Department of Occupational Therapy, Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Jefferson (Philadelphia University+Thomas Jefferson University), Philadelphia, PA USA
| | - M. J. Mulcahey
- Department of Occupational Therapy, Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Jefferson (Philadelphia University+Thomas Jefferson University), Philadelphia, PA USA
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Haywood C, Pyatak E, Leland N, Henwood B, Lawlor MC. A Qualitative Study of Caregiving for Adolescents and Young Adults With Spinal Cord Injuries: Lessons From Lived Experiences. Top Spinal Cord Inj Rehabil 2019; 25:281-289. [PMID: 31844380 PMCID: PMC6907026 DOI: 10.1310/sci2504-281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To examine characteristics of caregiving from the perspectives of adolescents and young adults (AYAs) with spinal cord injuries (SCIs) and their informal caregivers to address outstanding gaps in knowledge relating to definitions of caregiving and its associated practices for this population. Methods: A multiphase qualitative design was applied, using phenomenological and narrative methods to capture data in participants' homes and communities. Participants were recruited from rehabilitation hospitals and community organizations throughout Los Angeles County, California. Inclusion criteria for AYAs included being 15-22 years old, having acquired an SCI within the previous 5 years, and using a wheelchair for mobility. The AYAs nominated persons they identified as primary caregivers to also participate. Data were collected through individual and group interviews as well as activity observations. Results: Data from the 17 participants (9 AYAs and 8 informal, primary caregivers) revealed ways in which the meaning of caregiving varied among dyads. Caregiving practices extended beyond physical assistance to include support for a range of day-to-day activities spanning from practical needs to facilitating developmental trajectories. Although AYAs expressed ideas about preferred caregiver characteristics, care partnerships appeared to be guided more by availability than preference. Conclusion: Phenomenological analysis revealed that the meaning of "caregiving" and its associated practices are highly individualized for AYAs with SCIs. Caregiving is rooted in personal needs related to effects of SCI and developmental goals. Everyday practices are shaped by individual relationships and the beliefs of AYAs and their caregivers. Addressing influences of caregiving on long-term health and function may require attention to developmental processes, caregiver "fit," and ways care is, or can be, distributed throughout broader networks according to personal needs and preferences.
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Affiliation(s)
- Carol Haywood
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth Pyatak
- University of Southern California, Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California
| | - Natalie Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin Henwood
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Mary C. Lawlor
- University of Southern California, Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California
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Lindwall JJ, Russell HF, Kelly EH, Klaas SJ, Mulcahey MJ, Betz RR, Vogel LC. Coping and participation in youth with spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 18:220-31. [PMID: 23459106 DOI: 10.1310/sci1803-220] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Coping and participation are important adjustment outcomes of youth with spinal cord injury (SCI). Research addressing how these outcomes are related is limited. OBJECTIVE This cross-sectional study examined relationships between coping and participation in youth with SCI. METHOD Youth ages 7 to 18 years were recruited from 3 hospitals specializing in rehabilitation of youth with SCI. The Kidcope assessed coping strategies, and the Children's Assessment of Participation and Enjoyment (CAPE) examined participation patterns. Point biserial and Pearson correlations assessed relationships among variables, and hierarchical multiple regression analyses examined whether coping significantly contributed to participation above and beyond significant demographic and injury-related factors. RESULTS The sample included 294 participants: 45% female, 65% Caucasian, 67% with paraplegia. Mean age was 13.71 years (SD = 3.46), and mean duration of injury was 5.39 years (SD = 4.49). Results indicated that higher levels of social support and lower levels of self-criticism predicted higher participation in informal activities, lower levels of social withdrawal predicted participation in informal activities with a greater diversity of individuals, lower levels of blaming others predicted higher enjoyment of informal activities, and higher levels of cognitive restructuring predicted participation in formal activities with a greater diversity of individuals and in settings further from home. CONCLUSION Results suggest higher levels of social support and cognitive restructuring and lower levels of self-criticism, social withdrawal, and blaming others predicted favorable participation outcomes. Interventions for youth with SCI that encourage higher levels of positive coping strategies and lower levels of negative and avoidant strategies may promote positive participation outcomes.
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Affiliation(s)
- Jennifer J Lindwall
- Department of Psychology, St. Jude Children's Research Hospital , Memphis, Tennessee
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Vogel LC, Betz RR, Mulcahey MJ. Spinal cord injuries in children and adolescents. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:131-48. [PMID: 23098710 DOI: 10.1016/b978-0-444-52137-8.00008-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This chapter provides an overview of spinal cord injuries (SCI) in children and adolescents, including epidemiology, medical and musculoskeletal complications, rehabilitation and psychosocial aspects. Males are more commonly affected than females during adolescence; however, as the age at injury decreases, the preponderance of males becomes less marked, and by 3 years of age the number of females with SCIs equals that of males. The neurologic level and degree of completeness varies with age; among children injured prior to 12 years of age approximately two-thirds are paraplegic and approximately two-thirds have complete lesions. Among adolescents, approximately 50% have paraplegia and 55% have complete lesions. Management of pediatric-onset SCI should be family centered and developmentally based, responsive to the dynamic changes that occur during growth and development. Distinctive anatomical and physiological features of children and adolescents, along with growth and development, are responsible for unique manifestations and complications of pediatric SCI. SCI without radiological abnormalities (SCIWORA), birth injuries, lap-belt injuries, upper cervical injuries, and the delayed onset of neurological deficits are relatively unique to pediatric SCI. Children who sustain their SCI before puberty experience a higher incidence of musculoskeletal complications, such as scoliosis and hip dislocation.
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Postinjury Depression Is a Serious Complication in Adolescents After Major Trauma: Injury Severity and Injury-Event Factors Predict Depression and Long-Term Quality of Life Deficits. ACTA ACUST UNITED AC 2011; 70:923-30. [DOI: 10.1097/ta.0b013e31820cf03e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baker I, de Paula A, Serratore L, Hanna M, Diviney K, Clark N, Bailey V. Towards Independence: The New South Wales (Australia) Experience of Transition to Adulthood of Young People With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2010. [DOI: 10.1310/sci1601-55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Augutis M, Levi R, Asplund K, Berg-Kelly K. Psychosocial aspects of traumatic spinal cord injury with onset during adolescence: a qualitative study. J Spinal Cord Med 2007; 30 Suppl 1:S55-64. [PMID: 17874688 PMCID: PMC2031979 DOI: 10.1080/10790268.2007.11753970] [Citation(s) in RCA: 20] [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: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Spinal cord injury (SCI) occurring during adolescence poses additional challenges because of the concurrent age-specific bio-psychosocial development. Full understanding of the psychosocial dimensions of rehabilitation requires exploration of the patient perspective. The objective of this study was to focus on psychosocial factors from the patient perspective in persons who had previously sustained a SCI during early and mid-adolescence (11-15 years of age). METHODS Twenty-four of the 28 persons who had sustained a SCI in Sweden from 1985 to 1996 participated in the study. Semistructured interviews were made an average of 10 years after injury. Narratives were analyzed qualitatively according to content analysis. RESULTS Parents and peers were found to have formed a crucial network. Parents frequently acted as advocates in interactions with health care providers, as supporters, and as containers of sorrow, frustration, and anger. Peers acted as promoters of activity and identity development. However, health care providers were perceived as not making sufficient use of this network. CONCLUSIONS Rehabilitation professionals might be encouraged to increase their knowledge of adolescence medicine to better meet the specific needs and demands of persons in this age group. It is further suggested that parents and peers be considered important partners in the joint rehabilitation effort.
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Affiliation(s)
- Marika Augutis
- Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Whalley Hammell K. Quality of life after spinal cord injury: a meta-synthesis of qualitative findings. Spinal Cord 2006; 45:124-39. [PMID: 17091119 DOI: 10.1038/sj.sc.3101992] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Meta-synthesis of qualitative research. OBJECTIVES To identify, compare and synthesize the factors found to contribute to, or detract from the experience of a life worth living following spinal cord injury (SCI). METHODS Published articles were identified from the Medline, CINAHL and Sociological Abstracts databases, a hand search through selected journals published since 1990, and from reference lists. These were assessed for their relevance to the focus of interest and appraised for rigour and quality. The key themes that emerged from the data were summarized, compared and synthesized. RESULTS The search located 64 papers and four books, of which seven papers met the review criteria for relevance and rigour, and in which 10 main concepts were identified: (1) body problems, (2) loss, (3) relationships, (4) responsibility for, and control of one's life, (5) occupation, and ability to contribute, (6) environmental context, (7) new values/perspective transformation, (8) good and bad days, (9) self-worth, (10) self-continuity. CONCLUSIONS This study demonstrates the utility of synthesizing qualitative research to provide a greater depth of insight into the factors that contribute to, and detract from, quality of life (QOL) after SCI. It also provides a more nuanced understanding of the experience of QOL following SCI than is achievable by quantitative methods. Future qualitative research is required to probe further the concepts and connections identified in this study, and to identify how rehabilitation services might best address these issues.
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Students with disabilities in post-secondary education: the perspectives of wheelchair users. Occup Ther Int 2006. [DOI: 10.1002/oti.91] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Potgieter CA, Khan G. Sexual Self-esteem and Body Image of South African Spinal Cord Injured Adolescents. SEXUALITY AND DISABILITY 2005. [DOI: 10.1007/s11195-004-2076-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- G Yavuzer
- Department of Physical Medicine and Rehabilitation, Ankara University Medical School, Ankara, Turkey.
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Bonaroti D, Akers JM, Smith BT, Mulcahey MJ, Betz RR. Comparison of functional electrical stimulation to long leg braces for upright mobility for children with complete thoracic level spinal injuries. Arch Phys Med Rehabil 1999; 80:1047-53. [PMID: 10489007 DOI: 10.1016/s0003-9993(99)90059-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To prospectively compare functional electrical stimulation (FES) to long leg braces (LLB) as a means of upright mobility for children with motor-complete thoracic level spinal cord injuries (SCIs). DESIGN Intrasubject group comparison of two interventions. SETTING Nonprofit pediatric orthopedic rehabilitation facility specializing in SCI. PATIENTS OR OTHER PARTICIPANTS Convenience sample of five children between 9 and 18 years old with motor-complete thoracic level SCI. The hip and knee extensors were excitable by electrical stimulation. INTERVENTIONS The FES system consisted of percutaneous intramuscular electrodes implanted to the hip and knee extensors and a push-button activated stimulator worn about the waist. Standing was accomplished by simultaneous stimulation of all implanted muscles. For foot and ankle stability, either ankle-foot orthoses (AFO) or supramalleolar orthoses were used. The LLB system consisted of a custom knee-ankle foot orthosis (KAFO) for four subjects and a custom reciprocating gait orthosis (RGO) for one subject who required bracing at the hip. For both interventions, either a front-wheeled walker or Lofstrand crutches were used as assistive devices. Each subject was trained in the use of both FES and LLB in seven standardized upright mobility activities: stand and reach, high transfer, toilet transfer, floor to stand, 6-meter walk, stair ascent, and stair descent. MAIN OUTCOME MEASURES For each mobility activity, five repeated measures of level of independence, using the 7-point Functional Independence Measure (FIM) scale, and time to completion were recorded for each intervention. Subjects were also asked which intervention they preferred. RESULTS For 94% of comparisons, subjects required equal (70%) or less (24%) assistance using FES as compared with LLB. Six of the seven mobility activities required less time to complete using FES, two activities at significant levels. The FES system was preferred in 62% of the cases, LLB were desired 27% of the time, and there was no preference in 11% of the cases. CONCLUSIONS The FES system generally provided equal or greater independence in seven mobility activities as compared with LLB, provided faster sit-to-stand times, and was preferred over LLB in a majority of cases. Follow-up evaluations of both modes of upright mobility are needed to compare long-term performance and satisfaction.
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Affiliation(s)
- D Bonaroti
- Research Department, Shriners Hospitals for Children, Philadelphia, PA 19140, USA
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Abstract
OBJECTIVE To determine the typical time elapsed between discharge from an inpatient spinal cord injury (SCI) rehabilitation program and the physical return to school, and to identify barriers faced by patients attempting to return to school. STUDY DESIGN A retrospective review of all patients ages 18 years or younger who sustained SCI between 1989 and 1995, with resultant paraplegia or tetraplegia, and who attended either primary or secondary school, completed their inpatient rehabilitation at our regional SCI center, and were using a wheelchair when discharged from the hospital. RESULTS Fifteen of 16 eligible patients agreed to participate. The median time for subjects with paraplegia to return to school after hospital discharge was 10 days; subjects with tetraplegia required a median of 62 days. Architectural and transportation barriers that patients encountered were identified. CONCLUSION Individuals with SCI return to school relatively soon after discharge from the hospital. Barriers do not prohibit a return to school, but they are problematic.
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Affiliation(s)
- P R Sandford
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Model Spinal Cord Injury Center at Froedtert Memorial Lutheran Hospital, Milwaukee 53226, USA
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Massagli TL, Dudgeon BJ, Ross BW. Educational performance and vocational participation after spinal cord injury in childhood. Arch Phys Med Rehabil 1996; 77:995-9. [PMID: 8857876 DOI: 10.1016/s0003-9993(96)90058-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine educational achievement and vocational success of children with SCI. DESIGN Surveys administered to students and teachers, and content analysis of school records. SETTING Regional pediatric rehabilitation program. PARTICIPANTS Participants were selected from 144 children with SCI treated from 1979 through 1992; 98 met inclusion criteria of onset of SCI before the age of 18 years, older than 3 years, residual paresis, and no cognitive impairment; 29% were lost to follow-up, and 53 of the 70 contacted were enrolled. MAIN OUTCOME MEASURES School completion rates, absenteeism, grades, ratings of participation; education and living situations after high school; history of paid employment. RESULTS The 53 responders were: 33 boys, 20 girls; 25 with paraplegia (47%), 28 with tetraplegia (53%); mean length of disability = 9.4 years; 12 primary students (23%), 19 secondary students (36%), and 22 postsecondary participants (41%). Students and teachers rated student participation and performance as average or above compared to peers; 84% of secondary students planned to attend college after graduation. Only 33% of high school students over age 15 had been employed. Ninety-one percent of postsecondary subjects had graduated from high school. Seven (32%) had graduated from college or a vocational program, 11 (50%) were enrolled in college full- or part-time, and 4 others (18%) were neither in school nor employed. Current employment rates were 71% of college graduates, 36% of those in college, and 0% of those who had never enrolled. Level of SCI was not related to employment. CONCLUSIONS Students with SCI demonstrate adequate participation and performance in educational settings, but may benefit from more vocational counseling and opportunities for paid employment.
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Affiliation(s)
- T L Massagli
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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Helgadóttir HL. Psychosocial issues following serious head injury: a case study of an adolescent girl. Rehabil Nurs 1996; 21:258-61. [PMID: 8868757 DOI: 10.1002/j.2048-7940.1996.tb00839.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article is a case study of an adolescent girl who sustained a serious head injury following an attack by strangers. The head injury caused an epidural hemorrhage that exerted pressure on her brain stem and resulted in spastic quadriplegia. In this case, the major issues in rehabilitation were the patient's ability to learn to communicate and normalize and gain control over various aspects of her life. Because of the lack of a specialized rehabilitation setting for children and adolescents, rehabilitation took place in an acute care setting, which makes this story unusual in many ways. Staff issues were significant because of the nurses' inexperience with rehabilitation issues and because of the setting. This article describes the primary nurse's experience with this patient over several months. During this phase of rehabilitation, psychosocial issues were a major concern. Fifteen months after rehabilitation began, the patient moved back home and returned to high school. She communicates by using a computer and by using her eyes, and she uses a wheelchair. Despite everything, she is determined to get better and to prepare herself for the future.
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Mulcahey MJ, Smith BT, Betz RR, Triolo RJ, Peckham PH. Functional neuromuscular stimulation: outcomes in young people with tetraplegia. THE JOURNAL OF THE AMERICAN PARAPLEGIA SOCIETY 1994; 17:20-35. [PMID: 8169602 DOI: 10.1080/01952307.1994.11735912] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Percutaneous intramuscular functional neuromuscular stimulation (FNS) systems were fitted to the forearms of five adolescents with tetraplegia in an effort to provide active grasp and release. Two assessments designed at Case Western Reserve University to evaluate functional outcomes of FNS in adults were employed. The common object test (COT) was used to assess hand function during five activities of daily living (ADLs): eating, drinking, writing, brushing teeth and applying toothpaste. A usage survey provided information on the frequency of FNS use in environments outside of the laboratory. In addition, interviews were employed using open-ended questions to gain a deeper understanding of the perceptions of FNS in the adolescents' own environments. Based on the COT results, each adolescent was able to perform ADLs with and without FNS. However, FNS allowed unilateral function so that the extremity without FNS was freed to assist in balance or participate in bilateral tasks. Also, FNS reduced the need for multiple devices, providing users with the potential to perform activities in a variety of environments without transporting adaptive equipment. Those who reported using FNS most often obtained hard-bound school books, held pens during classroom and homework assignments, engaged in leisure activities and performed hygiene tasks. FNS was also used as a means to communicate and socialize through hand gestures. Well-known factors that influence the independence of people with tetraplegia also appeared to affect FNS use.
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Affiliation(s)
- M J Mulcahey
- Shriners Hospitals for Crippled Children, Philadelphia, PA 19152
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