Spinal Cord Injury Professionals Research Articles

Tempering technology with care

We truly live in amazing times. Every year – seemingly every day – we witness new, exciting technological advances, many of which have tremendous usefulness for persons with spinal cord injury (SCI). Just think about it: innovations in telephone, Smartphone, and Bluetooth® technology facilitate communication. Improved wheelchair features and switches not only allow for better control, but offer a more cosmetic design. In rehabilitation centers across the world, a number of new robotic exoskeletons are being studied to allow people with SCI to regain upright posture and, potentially, community ambulation. Patients are being placed on robotic trainers for locomotion and brain–computer interface technology is opening new avenues of treatment. Implanted electrical stimulation devices offer a variety of applications in both the research realm and already approved clinical protocols. For example, there are devices that enhance upper or lower extremity movement and functional activity, improve bowel and bladder function, and regulate respiratory function. In addition, most clinicians are now documenting patient status and even writing prescriptions on their computers or tablets. Technology is a gift, one that all of us, especially our patients, are increasingly dependent upon. However, it is critical that as SCI professionals, we do not forget the importance of the human touch and interaction in patient care. We need to be aware that our reliance on technology does not replace the contact and communication that we have with the patient and family. Shorter stays for rehabilitation post injury are becoming the norm. Patients are going home earlier, despite the fact that they may not have yet mastered such essentials of daily living as their bowel program. While they may be able to access information on their Smartphone, no electronic device can effectively teach them or their families how to properly recognize and treat autonomic dysreflexia. And we are forever mindful that technology cannot hold hands with a patient or family members to help them through a difficult transition. Of course, we all love technology and admittedly can no longer live without it. But let us make sure that technology adds to the patient experience and does not detract from the human interaction that remains a critical aspect of our work as rehabilitation professionals.

2010: A Year of Transitions

This year marks the 33rd consecutive year that the Journal of Spinal Cord Medicine has served the SCI community. As it has many times in the past, the journal faces transitions that promise both challenge and opportunity. JSCM is now the official journal of the newly formed Academy of Spinal Cord Injury Professionals (ASCIP), which comprises 4 sections, each representing the former associations that served SCI physicians (APS), psychologists and social workers (AASCIPSW), nurses (AASCIN), and therapist (TLC). Announced by the Academy Governance Board in January, this official designation formalizes the input of the spectrum of SCI professionals to JSCM and strengthens the journal's position among publications in the field. With the help of the ASCIP Journal Task Force, the Editorial Board is expanding with new members who will seek optimal ways to serve the membership of ASCIP as well as the global community. Later this year, JSCM will incorporate the content of Topics in Spinal Cord Injury Rehabilitation, (TSCIR), a review journal published quarterly by Thomas Land Publishers for the past 16 years. Each issue of TSCIR has focused on the thorough coverage of a timely topic related to an aspect of spinal cord injury, an editorial plan that complements the research articles, meeting abstracts and clinical content of JSCM. The multidisciplinary approach of TSCIR, its long history of in-depth topic development and its relationships with experts in SCI will further enhance the reach and influence of the journal. Through more than 3 decades, dedicated volunteers and staff have nurtured the journal, numerous authors have submitted their work, and reviewers have donated their time and talent to ensure optimal standards of peer review. None of this would have been possible without the generous financial sponsorship of Paralyzed Veterans of America and in decades past, United Spinal Association. Now is an appropriate time to trace JSCM's history through the numerous transitions that have contributed to its status as an acknowledged resource for professionals involved in improving the lives of people with SCI, whether through scientific research or clinical care (1). I think you'll agree that in many ways, the growth of the field of SCI medicine and rehabilitation is reflected in this journal's journey. I encourage each of you to be a part of its future.

JSCM: This Journal's Journey

JSCM: This Journal's Journey

Best Clinical Practice in Sexuality and Reproductive Health: The New Clinical Practic Guideline

Disseminating the latest in research and care to the community of spinal cord injury professionals is the mission of The Journal of Spinal Cord Medicine. One of the ways the Journal fulfills this mission is by reprinting the Clinical Practice Guidelines published by Paralyzed Veterans of America (1–6). In this issue, we add to the series of practical guidelines that have addressed acute management and secondary complications such as respiratory failure, pressure ulcers, etc (7). “Sexuality and Reproductive Health in Adults With Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Providers” addresses this important aspect of personal fulfillment and relationships. It is the 11th in this series of guidelines developed by the Consortium of Spinal Cord Medicine, an interdisciplinary group with representation from spinal cord injury experts in medicine, nursing, therapy and psychology. This guideline addresses a wide range of topics related to sexuality; according to Lawrence C. Vogel, MD, the chairman of the Consortium's steering committee, “It includes recommendations that address physical, interpersonal, emotional, and medical concerns. The guideline addresses the importance of privacy and individuality as well as the practical needs of individuals with spinal cord injuries.” JSCM is pleased to support this major step toward best clinical practice in sexuality and reproductive health, an important component of life satisfaction. This guideline raises questions deserving of further investigation in the areas of sex education and therapy, gender issues, sexual response, sexual dysfunction, and the impact of sexual satisfaction on health. We look forward to manuscripts that further the scope of the guideline and improve quality of life for people with disabilities.

Pressure Ulcer Prevention and Management in Spinal Cord-Injured Adults

The authors assessed the educational needs of adults with spinal cord injury (SCI) in the prevention and early detection of pressure ulcers (PrUs). Specific recommendations are provided for the top needs identified, along with key issues to consider in implementing solutions. The authors used a needs assessment methodology using a purposeful, maximum variation sampling strategy that was based on age, injury level and completeness, time since injury, and PrU history to select cases that would identify the diverse influences on PrU education. The authors interviewed 16 adults with SCI concerning perception of PrU risk, education, environmental considerations, and access to care. Also interviewed were 8 SCI professionals, including a physician specializing in rehabilitation medicine, physical and occupational therapists, a nurse case manager, and a wound care nurse practitioner. The outcome of this research is the identification of educational needs for adults with SCI in PrU prevention and early detection. The needs identified are rank-ordered, and possible educational objectives are considered for each. Education needs identified include the following: *Awareness of lifelong risk for developing PrUs, including the ability to assess own risk factors and how risk changes over time. *Ability to take charge of own skin care regimen and to partner with health care providers. *Perform prevention strategies consistently that fit level of functioning and activity, and update practices as risk changes. *Ability to coordinate social supports. The need for effective education among adults with SCI in the prevention and early detection of PrUs is critical.

Tetraplegia Hand Activity Questionnaire (THAQ): the development, assessment of arm-hand function-related activities in tetraplegic patients with a spinal cord injury.

Development of Tetraplegia Hand Activity Questionnaire (THAQ). Patients and spinal cord injury (SCI) professionals from five rehabilitation centres in the Netherlands and Belgium. To construct a disease-specific questionnaire to evaluate interventions to the arm-hand of tetraplegics in terms of gained and lost activities relevant to the patient. All arm-hand function-related activities were inventoried by examining existing scales and interviewing spinal cord injury patients and professionals in the field. Subsequently, item reduction was achieved; first, in the technical construction by incorporating all activities in an item list, then reducing the list by selecting the items most likely to be sensitive to change after surgical or functional electro stimulation interventions on the arm-hand as judged by an expert panel, using a Delphi method. The arm-hand-related activity inventory comprised 652 activities. The technical construction of the items and the Delphi procedure resulted in a questionnaire with 153 items. The experts considered many of the 'new' activities more relevant for the evaluation of hand function interventions than those found in scales studied in the literature. This is reflected in a relatively large proportion of new activities (69%) for the item list of the THAQ, and even more in the domains work/admin/telecom (88%) and leisure (100%). The questionnaire constructed to assess hand function-related activities contains relevant activities to evaluate arm-hand function-related interventions for tetraplegic SCI patients.