Secondary Medical Complications Research Articles

Characteristics and outcomes of gunshot-acquired spinal cord injury in South Africa.

Spinal cord injuries (SCIs) caused by assault present a unique challenge facing the healthcare system, in that very little is known about how these injuries manifest compared with other causes of injury. Understanding the nuances of gunshot SCIs could contribute towards better care provision. To determine the characteristics of gunshot SCI and compare both injury characteristics and outcomes between gunshot SCI and all other traumatic causes taken together. The gunshot SCI sub-cohort was derived from a 1-year prospective, population-based study, including both tertiary-level hospitals providing SCI care in the Cape Metropolitan area of South Africa (SA). All consenting 145 survivors, after a window period of 7days, were included, and their demographic and injury characteristics were captured according to the International SCI Core Basic Data Set. Further, selected secondary medical complications (outcomes) were prospectively and routinely assessed throughout acute care. Both descriptive and inferential statistics were used to describe and compare characteristics and outcomes, respectively. Of the 145 survivors of traumatic SCIs, 45 (31%) injuries were caused by gunshots. The gunshot SCI group consisted mainly of males (n=43, 96%), and the average age of injury onset was 26 years. Most survivors of the gunshot SCI group were paraplegic (69%), had complete lesions (69%) and vertebral injuries (96%), and presented with significant associated injuries (84%). When comparing gunshot SCI with all other traumatic causes, significant differences were found in relation to demographic and injury characteristics and adverse outcomes, indicating that those survivors with gunshot SCI were typically younger males with complete paraplegia, had more frequent secondary medical complications, and a longer hospital stay. This study contributes to the knowledge base of survivors with gunshot SCIs in a region of SA. Efforts should be made to reduce the occurrence of all gunshot SCIs, since those injuries affect survivors negatively in terms of injury characteristics and adverse outcomes.

Chapter 37 - Neurologic complications of acute environmental injuries

Environmental injuries can result in serious neurologic morbidity. This chapter reviews neurologic complications of thermal burns, smoke inhalation, lightning strikes, electric injury, near drowning, decompression illness, as well as heat stroke and accidental hypothermia. Knowing the pathophysiology and clinical presentation of such injuries is essential to proper management of primary and secondary medical complications. This chapter highlights the most frequently encountered neurologic injuries secondary to common environmental hazards, divided into the topics: injuries related to fire, electricity, water, and the extremes of temperature.

Prevalence of secondary medical complications and risk factors for pressure ulcers after traumatic spinal cord injury during acute care in South Africa.

Prospective, population-based cohort study. To determine the prevalence of selected complications following traumatic spinal cord injury during acute care and to identify the risk factors for pressure ulcers. The only tertiary academic (Groote Schuur) hospital in the catchment region providing specialised acute care. A descriptive, observational study of an inception cohort. Secondary complications were predefined and consisted of pressure ulcers, pulmonary complications (pneumonia and atelectasis), urinary tract infections, autonomic dysreflexia, deep vein thrombosis, pulmonary embolism, postural hypotension, neuropathic pain and spasticity. Possible risk factors for pressure ulcers included variables concerning demographic and injury characteristics and complications. Both univariate and multivariate logistic regression analyses were used. Data of 141 patients (97%) were analysed. In total, 71 (50.3%) patients had one or more complication. The most common was pressure ulcers (n=42; 29.8%), followed by pulmonary complications (n=33; 23.4%) and urinary tract infections (n=24; 17%). Significant risk factors were gun-shot injury, motor completeness (American Spinal Injury Association Impairment Scale (AIS) A│B), vertebral injury, no spinal surgery, pulmonary complications, urinary tract infection and level of consciousness. In the final multivariate model that correctly predicted 81.6% of subjects, motor completeness and vertebral injury remained significant independent factors, whereas having a urinary tract infection was associated with an increased risk (odds ratio: 2.86), but not significant at the 5% level. Pressure ulcers and pulmonary complications were prevalent during specialised acute phase. The occurrence of pressure ulcers, despite protocols in place, is worrisome. To prevent pressure ulcers, special attention seems necessary for persons with motor complete lesions and those with vertebral injuries.

Spinal Cord Injury in the Child and Young Adult

Spinal Cord Injury in the Child and Young Adult is an engaging and comprehensive resource for health care professionals who work with the spinal-cord injury (SCI) population. The editors are clinician-scientists with expertise in paediatric SCI, and each chapter is written by one or more content experts (more than 60 in total). This volume makes a valuable contribution, as few books exist on the topic of paediatric SCI. Chapter 1.1 introduces Bridget, a 21-year-old woman who sustained a non-traumatic SCI at age 14. As Bridget and her parents describe their experiences of living with SCI, we see that each family member has had their own challenges, triumphs, and coping strategies. A clinician who has worked with Bridget also weighs in on Bridget's experience. This is a very effective way to begin the book: the family's story illustrates the complex nature of paediatric SCI, including the transition into adulthood. The book is divided into eight sections. Section 1 includes chapters on epidemiology (chapter 1.2), life-care planning (chapter 1.3), and assessment (chapter 1.4). Chapter 1.3 clearly outlines the components of a life-care plan to help clinicians identify the resources required over a lifetime with SCI. Chapter 1.4 addresses the challenge of assessing children under the age of 5 years and reviews appropriate measures for children with SCI, including some commonly administered by physical therapists. Section 2 covers the early management of paediatric SCI, including chapters on pathophysiology (chapter 2.1), acute care (chapter 2.2), and management of spine stability (chapter 2.3). This section stresses the importance of early mobilization to prevent muscle atrophy, contractures, and skin breakdown, and exemplifies the role of physical therapy during this early stage. Section 3 discusses three issues unique to paediatric SCI: non-traumatic SCI (chapter 3.1); management of high tetraplegia (chapter 3.2); and dual diagnosis of brain injury and SCI (chapter 3.3), including a discussion of the unique rehabilitation challenges. Section 4, the largest in the book, covers medical management of paediatric SCI. Chapters 4.1–4.7 provide current information on neurogenic bowel and bladder, spasticity, autonomic dysfunction, secondary medical complications, skin integrity, metabolic complications, and pain. Physical therapists will be particularly interested in Section 5, on neuromuscular management, which thoroughly discusses orthopaedic complications – such as hip instability and neuromuscular scoliosis – prevalent in children who sustained the SCI at an early age. Chapter 5.3 addresses upper-extremity function and various management options, such as surgery, serial casting, and functional electrical stimulation. Section 6 consists of two chapters on physical rehabilitation. Chapter 6.2 highlights the importance of mobility, defined here as “free movement in all settings” (p. 308), to a child's development of cognitive, social, and communication skills. As well as detailed tables outlining the strengths and limitations of different wheelchair designs, this chapter provides helpful examples of wheelchair prescription for two children with very different mobility needs. Section 7, on psychosocial issues, covers topics such as psychosocial adjustment at various stages of development, participation in recreational activities, employment, and access to public education. In addition, the long-term outcomes of paediatric SCI are reported through the results of a US-based longitudinal study. Section 8, which closes the volume, identifies current research priorities, including biological interventions, advances in imaging, and recovery-based rehabilitation. This last topic is especially relevant to physical therapists, as it addresses the ongoing paradigm shift from compensation to neuro-recovery in the context of locomotor training. Most chapters use short case examples to effectively reinforce chapter content. Some are more detailed than others – for example, the chapter on pain (chapter 4.7) uses the case example not only to illustrate how pain may manifest in a child with SCI but also to discuss a management plan. These more detailed case examples were more satisfying to read and demonstrate how information provided in the chapter can be applied to clinical practice. A small number of illustrations are used throughout the book; a section of colour figures at the end supplements content on axonal regeneration, imaging, and pressure injuries. Spinal Cord Injury in the Child and Young Adult is an excellent introduction to SCI, but discusses topics in sufficient depth that a clinician with expertise in SCI would also find it useful. The authors provide practical, evidence-based recommendations for assessment and treatment. I recommend this book for health care professionals who work with children with SCI and/or adults with paediatric-onset SCI; it will help physical therapists see the big picture of paediatric SCI care.

Impact of psychological characteristics in self-management in individuals with traumatic spinal cord injury.

Study design:Cross-sectional survey.Objective:To examine the association between psychological characteristics in self-management and probable depression status in individuals with a traumatic spinal cord injury (SCI).Setting:Community-dwelling individuals with traumatic SCI living across Canada.Methods:Individuals with SCI were recruited by email via the Rick Hansen Institute as well as an outpatient hospital spinal clinic. Data were collected by self-report using an online survey. Standardized questionnaires were embedded within a larger survey and included the Hospital Anxiety and Depression Scale (HADS), the short version of the Patient Activation Measure (PAM), the Moorong Self-Efficacy Scale (MSES) and the Pearlin-Schooler Mastery Scale (PMS).Results:Individuals with probable depression (n=25) had lower self-efficacy (67.9 vs 94.2, P<0.0001), mastery (18.9 vs 22.9, P<0.0001) and patient activation (60.4 vs 71.6, P<0.0001) as well as higher anxiety (9.0 vs 5.5, P<0.0001), compared with their non-depressed counterparts (n=75). A logistic regression determined that lower self-efficacy and mastery scores as well as less time since injury were associated with depression status (P=0.002; P=0.02 and P=0.02, respectively). Individuals with higher anxiety scores were almost 1.5 times more likely to be depressed, while older age was positively associated with depression status (P=0.016 and P=0.024, respectively).Conclusion:Interventions for depression in SCI, including a self-management program, should target factors such as self-efficacy and mastery, which could improve secondary medical complications and overall quality of life.

Adjustment following chronic spinal cord injury: Determining factors that contribute to social participation

Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, and mental health. The main objective of this research was to establish inpatient factors that contribute to social participation following discharge into the community. Prospective longitudinal design with measures taken three times, soon after admission to rehabilitation (N = 88), at discharge from the inpatient phase (N = 81) and 6 months following discharge (N = 71). Participants included adults with SCI admitted into three SCI units over a 33-month period. Assessment included demographic, injury, and psychosocial health measures. Adjustment was defined by the extent of social re-integration or participation post-discharge after 6 months in the community. Social participation was measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6 months post-discharge. Six months after discharge, around 55% of the sample had difficulties with social participation. The odds against being employed for an adult with poor social participation was found to be 8.4 to 1. Factors that predicted social participation included a younger age, having less severe secondary medical complications like bladder and bowel dysfunction, having a higher cognitive capacity, perceiving one has control (self-efficacy) over one's life and environment, and having greater perceived social support. These results provide direction for enhancing existing psychosocial health strategies within SCI rehabilitation, affording an opportunity for every person who sustains a permanent SCI to have optimal capacity for social participation. Statement of contribution What is already known on this subject? Spinal cord injury (SCI) is associated with significant challenges to wellbeing, including a high risk of secondary chronic illnesses, risk of co-morbid mental health problems, financial insecurity and social isolation. Research has shown poor social participation can lead to problems in re-integration into society following discharge from inpatient rehabilitation. Research to date has examined various factors related to poor social participation, but the majority of this research has been survey based with convenience samples. What does this study add? This study adds results of prospective longitudinal research on adjustment following SCI, where adjustment was defined by the rate of social participation when living in the community. About one-third of SCI participants were found to have very poor social participation, and only one-third had found some form of employment 6 months after discharge. Multiple factors were found to predict and contribute to poor social participation, including older age when injured, more severe medical complications, cognitive deficits, poor perceptions of control or self-efficacy, and poor social support.

Use of complementary and alternative medicine in persons with spinal cord injury in Switzerland: a survey study.

Questionnaire-based survey study. To evaluate the use of and the satisfaction with complementary and alternative medicine (CAM) techniques in patients with spinal cord injury (SCI). Rehabilitation Center, Switzerland. Between May and September 2014, all patients with chronic (>1 year) SCI attending the urologic outpatient clinic were asked to fill in a questionnaire regarding the use of CAM. Of the 103 participants (66 men and 37 women), 73.8% stated that they have used some form of CAM since SCI, with acupuncture and homeopathy being the two techniques that were used most frequently (31% each). The most common indications for CAM use were pain and urinary tract infections (UTIs). CAM was used supplementarily rather than exclusively. Overall satisfaction (85.1%) as well as satisfaction rates for the different indications (pain: 85%; UTI: 90.5%) and for the most frequently used forms of CAM (homeopathy: 90.6%; acupuncture: 78.1%) were high. According to our data, there is a demand for adjunctive CAM procedures for the treatment of medical complications by persons with SCI. CAM led to high satisfaction levels. On the basis of these results, future research should systematically evaluate the therapeutic potential of the most popular CAM techniques, for example, acupuncture and homeopathy, for the treatment of secondary medical complications of SCI.

Chronic complications of spinal cord injury.

Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients' functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary long-term complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI.

Mental Health and Risk of Secondary Medical Complications in Adults With Pediatric-Onset Spinal Cord Injury

To investigate mental health problems in adults with pediatric-onset spinal cord injury (SCI) and explore how these problems relate to the risk of negative outcomes over time. The study included 466 adults who sustained an SCI prior to age 19 years and had been injured for at least 1 year. Participants were interviewed on an approximately annual basis using a study-specific questionnaire and standardized measures of depression, anxiety, substance use, and community involvement. Generalized estimating equations were used to assess the risk of negative outcomes across time as a function of depression, anxiety, and substance misuse. Of the participants who reported on each domain of mental health, 26% reported misuse of alcohol or drugs (122/466), 21% reported problems with depression (78/360), and 29% reported problems with anxiety (49/168). Depression was associated with increased odds of pressure ulcers, urinary tract infections, hospitalizations, pain, and smoking and lower levels of economic independence and mobility. Anxiety was associated with increased odds of hospitalization, pain, and smoking. Substance misuse predicted an increased risk of pressure ulcers, pain, and smoking and decreased odds of occupational involvement. When examining the effect of mental health with time, results showed that depression accelerated the risk of urinary tract infections, respiratory complications, and hospitalizations and anxiety and depression accelerated risk for lower occupational independence. The added burden that mental health difficulties pose for medical and psychosocial outcomes highlight the importance of monitoring and treating mental health symptoms in pediatric-onset SCI.

Review: Clinical benefits of functional electrical stimulation cycling exercise for subjects with central neurological impairments

Functional electrical stimulation (FES) cycling ergometer has been utilized in recent decades for rehabilitation by sequentially stimulating the large leg-actuating muscles of paralyzed leg muscles to produce cyclical leg motion. A number of studies reported physiological adaptations after regular FES-cycling exercise (FESCE) training in subjects with spinal cord injury, stroke, cerebral palsy and other conditions. This article provides a comprehensive overview of general aspects of FES cycling systems and clinical applications of FESCE. The studies cited in this article provide supportive findings for the potential clinical efficacy of FESCE for reducing the risk of secondary medical complications in subjects with paralysis. The potential therapeutic benefits of FESCE include conditioning the cardiopulmonary, muscular, and skeletal systems, and improving other physiological and psychological performances. Our recent pilot study also indicated that the decrease of leg spasticity in subjects with cerebral palsy is one of the acute effects of FESCE. In conclusion, we recommend that FESCE is of benefit in a variety of aspects to improve the general condition and to prevent deterioration in subjects with central neurological impairments.

International Perspectives on Caregiving

Every year, millions of people around the world suffer spinal cord injuries, traumatic brain injuries, and strokes. Spinal cord injury (SCI) often strikes young and healthy individuals and is estimated to affect between 11.5 and 57.8 individuals per million around the world, causing death, paralysis, and serious secondary medical complications [1]. Costs associated with SCI have been estimated at over $1 m per patient, including those associated with home modifications, supplies, nursing, and home care [12]. Like SCI, traumatic brain injury (TBI) is a leading global cause of death and disability in the young, estimated to affect roughly 10 million people around the world each year [6,7]. The costs of TBI are many, including those related to direct hospitalization and rehabilitation, lost earnings, and reduced quality of life [5]. Strokes are the third most common cause of death in developed countries around the world; an estimated 15 million people suffer strokes each year, and roughly 5.5 million of these die [10]. The economic burden of strokes is great: the American Heart Association estimates that $73.7b will be spent on treatment of stroke victims in 2010 alone, and strokes are a major cause of long-term serious disability [2]. Overall, persons with debilitating conditions like TBI, SCI, and strokes often require the services of shortand long-term care [3,8,14]. In general, family members often take on the role of caregiving which requires significant amounts of time and dedication,

Neurosurgical strategies for Gilles de la Tourette's syndrome.

Tourette's syndrome (TS) is a neurological disorder characterized by motor and vocal tics that typically begin in childhood and often are accompanied by psychiatric comorbidities. Symptoms of TS may be socially disabling and cause secondary medical complications. Pharmacological therapies remain the mainstay of symptom management. For the subset of patients in whom TS symptoms are medically recalcitrant and do not dissipate by adulthood, neurosurgery may offer an alternative treatment strategy. Greater understanding of the neuroanatomic and pathophysiologic basis of TS has facilitated the development of surgical procedures that aim to ameliorate TS symptoms by lesions or deep brain stimulation of cerebral structures. Herein, the rationale for the surgical management of TS is discussed and neurosurgical experiences since the 1960s are reviewed. The necessity for neurosurgical strategies to be performed with appropriate ethical considerations is highlighted.

Orthostatic Hypotension for People with Spinal Cord Injuries

Abstract Orthostatic (postural) hypotension (OH) is a clinical feature commonly seen in spinal cord injury (SCI) subjects with cervical and high thoracic lesions. It usually gets worse during head-up tilt postural change and is relieved by lying flat. The mechanisms of regulating the arterial blood pressure (BP) are complex. Normally, BP is maintained through a rapid and effective reflex adjustment of the autonomic nervous system, and with slower humoral compensatory changes to counteract the gravitational forces on blood. The leg muscle pumping mechanism also helps to facilitate venous return and improves BP. Failure of these mechanisms may lead to OH and orthostatic intolerance symptoms. The occurrence of OH may limit active participation in intense physical rehabilitation programmes by people with SCI, and facilitate the deterioration effects of immobilization and development of undesirable secondary medical complications. Advances in understanding the pathophysiology of OH are crucial for success in combating OH. Treatment usually includes both non-pharmacological and pharmacological measures. This article provides a review of the mechanisms of normal regulation of arterial BP, the pathophysiology of OH in SCI, and the common clinical management of OH.

The attainment of life goals by adult survivors of childhood cancer

9536 Background: Adult survivors of childhood cancer are at risk for disease- and therapy-related morbidity, which can adversely affect marriage and employment status, ability to obtain health insurance and access to care. Our aim was to identify factors associated with survivors’ ability to achieve these goals. Methods: We surveyed 1,437 survivors of different types of childhood cancer who were &gt;18 years of age and &gt;10 years from diagnosis. We compared our cohort's data to normative data in the Medical Expenditure Panel Survey and the Current Population Surveys of the U.S. Census Bureau. Survivors were categorized into 3 groups (hematological malignancy, solid tumors, or central nervous system tumors) and whether they had received radiation therapy. Results: The majority of respondents (response rate 65%) were survivors of hematological malignancies (71%), white (91%), and working full-time (62%); (43%) were married. When compared to age- and gender-adjusted national averages, only survivors of hematological malignancy who received radiation therapy were significantly less likely to be married than the general population (44% vs. 52%). Full-time employment among survivors was lower than national norms, except for survivors of hematological malignancy who had not received radiation therapy. The prevalence of having any health insurance, especially public insurance, was higher in all diagnostic groups than in the general population. Difficulty obtaining care was reported by 11% of all survivors; 12% reported not receiving needed health care. Additionally, 26.9% reported having been denied insurance. Current unemployment and lack of insurance were significantly associated with difficulty in obtaining care (p=0.049 and p&lt;0.001, respectively). CNS tumor survivors reported greater difficulty in obtaining needed care (p=0.030). Current employment and solid tumor diagnosis were associated with lower rates of denial of insurance (p=0.018 and p=0.003, respectively). Conclusion: Subgroups of adult childhood cancer survivors are at risk of problems with attaining life goals, including access to care. This has serious implications given the known long-term secondary medical complications in this at- risk population. No significant financial relationships to disclose.

Spinal Cord Injury Medicine. 5. Long-Term Medical Issues and Health Maintenance

Chiodo AE, Scelza WM, Kirshblum SC, Wuermser LA, Ho CH, Priebe MM. Spinal cord injury medicine. 5. Long-term medical issues and health maintenance. This self-directed learning module highlights long-term care issues in patients with spinal cord injury (SCI). It is part of the study guide on SCI in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The most common secondary medical complications include pressure ulcers, pneumonia, and genitourinary issues. Health care maintenance is important to prevent medical complications, for general health as well as for issues specific to SCI. Women with SCI have gender-specific issues regarding amenorrhea, sexuality, fertility, and menopause. Options exist to assist disabled men with sexuality and fertility complications. Pain is a common complication after SCI. Many new areas of research in the field of SCI are discussed. Overall Article Objective To discuss long-term care issues in patients with spinal cord injury, including health maintenance, secondary conditions, women’s health, sexual function, pain, and spinal cord regeneration and recovery.

Traumatic Brain Injury Research Since the 1998 NIH Consensus Conference

In 1998, an NIH sponsored Consensus Conference on Traumatic Brain Injury (TBI) Rehabilitation identified 30 different areas of needed research. A comprehensive review of recently generated research knowledge in the field of TBI has shown that a large number of Class III and IV evidence studies have been published, but relatively few of the more scientifically rigorous Class I or II studies. A rapid growth of publications on TBI rehabilitation has generated new knowledge in the epidemiology of TBI, the management of TBI and its secondary medical complications, rehabilitation of cognitive impairment, impact of TBI on community integration and quality of life, incidence of psychiatric dysfunction, and how caregivers and family members are affected. However, there is need to replicate many of these studies using more scientifically rigorous methodologies, while other areas of important TBI research remain largely unexplored.

A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation

This is a longitudinal validation study that is Part II of a two-part series. Part I focuses on the methods used to construct the neurobehavioral measure derived from the Disorders of Consciousness Scale (DOCS) as well as the evidence of reliability and validity. Part II illustrates, through a series of selected case reports, the clinical use of repeated DOCS measures to enhance and complement medical rehabilitation management. The use of repeated DOCS measures in scientific investigations of mechanisms of injury is also described. Participants included patients at rehabilitation hospitals who were 18 years of age and older and unconscious after severe brain injury. Medical decision making regarding short-term effects of pharmacological intervention was augmented and improved through the examination of individual neurobehavioral recovery patterns. We identified medications to treat secondary medical complications and successfully determined effective dosage, presumably improving prognosis for recovery. We facilitated and enhanced development and refinement of individualized rehabilitation programs. Two investigations of treatment effectiveness during coma recovery and examination of the relationship between behavioral changes and neural adaptation are also described. By systematically tracking and mapping individual patterns of neurobehavioral recovery, we show that medical and rehabilitation management after coma can be enhanced. In addition, we also show that by examining the relationship between the DOCS neurobehavioral measure with mechanistic indicators of neurological recovery such as functional magnetic resonance imaging, scientific investigations of treatment and rehabilitation effectiveness can be enhanced.

Seven-Year Trends in Stroke Rehabilitation: Patient Characteristics, Medical Complications, and Functional Outcomes

Studies of stroke trends have focused primarily on incidence, mortality, and hospitalization rates. There has been little evaluation of changes over time in the common patient characteristics, medical comorbidities, and functional outcomes of patients. The present study evaluated changes during a 7-year period. We found that while demographic variables, stroke severity, and most stroke characteristics remained relatively stable, disability levels at admission and discharge decreased and frequencies of both medical tube usage and many secondary medical complications increased over time. These changes have important implications for the clinical management of stroke patients in rehabilitation and for the organization and financing of stroke rehabilitation programs.

Comparison Of Medical Complications Following Nontraumatic And Traumatic Spinal Cord Injury

Background: Nontraumatic spinal cord injury (NT/SCI) has been shown to represent a significant proportion of individuals admitted for SCI rehabilitation. Although medical complications of patients with traumatic SCI (T/SCI) have been well studied, there is a paucity of literature regarding those with nontraumatic SCI. Our objective was to compare the incidence of secondary SCI medical complications in patients with nontraumatic and traumatic SCI.Design: A 2-year prospective data comparison of 117 patients with SCI admitted to a regional SCI rehabilitation unit and tertiary university medical center was undertaken. NT/SCI was defined as spinal stenosis, tumorous compression, vascular ischemia, and infectious etiologies.Methods: Outcome measures included secondary SCI medical complications, injury characteristics, demographics, and rehabilitation outcomes. Statistical analyses were conducted between the 38 NT/SCI and 79 T/SCI who met admission criteria for acute inpatient rehabilitation.Results: Statistically significant differences (P<.05) between nontraumatic and traumatic SCI were noted for deep venous thrombosis (7.9% vs 22.8%), pressure ulcers (21.1% vs 41.8%), autonomic dysreflexia (0% vs 24.1%), pneumonia (2.6% vs 26.6%), orthostatic hypotension (5.3% vs 36.7%), spasticity (21.1% vs 44.3%), and wound infections (16% vs 3%). Similar incidences were found for depression (23.7% vs 26.6%), urinary tract infections (52.6% vs 67.1%), heterotopic ossification (2.6% vs 7.6%), pain at admission (55.3% vs 62.0%), and gastrointestinal bleed (2.6% vs 2.5%). In addition, significant differences were noted between NT/SCI and T/SCI for age (55 years vs 39 years), rehabilitation length of stay (26.4 days vs 43.0 days), and neurologically complete injury (5.3% vs 45.6%).Conclusion: This study indicates that patients with NT/SCI present with different incidences of secondary SCI medical complications when compared with individuals with T/SCI. These data, along with differences in demographics, clinical presentation, and rehabilitation outcomes, have important implications for the medical, rehabilitation management, and long-term outcome of individuals with NT/SCI.

Early Versus Late Onset of Spinal Cord Injury Among the Elderly

The objective of this study is to compare elderly individuals with late (≥60 years old) versus early (<60 years old) onset spinal cord injury (SCI) across quality of life (QOL) domains for which cross-sectional design was used. The outcome measures selected were secondary medical complications (e.g., pneumonia, autonomic dysreflexia, number of days hospitalized), Functional Independence Measure (FIM), Satisfaction With Life Scale (SWLS), and the Craig Handicap Assessment and Reporting Technique (CHART). Analyses between groups showed that individuals with SCI onset 60 years of age or older were significantly older, had a greater proportion of incomplete lesions, were more likely to have SCI resulting from medical complication, and were less likely to be working. After controlling for differences in demographic and lesion characteristics, the majority of QOL domains were similar between groups. However, overall self-reported handicap (CHART-total score) was significantly greater among elderly with late onset SCI, particularly in the areas of physical independence and social integration. Differences in QOL between elderly with late versus early onset SCI were most prominent in the area of physical independence and social integration. The importance of appropriate statistical control, theoretical implications, and future directions are discussed.