Showing papers in "Spinal Cord in 1994"
TL;DR: The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury (ISBWC) as mentioned in this paper is a standard for the classification of spinal cord injury. But it is not a classification of neurological disorders.
Abstract: The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury
1,709 citations
TL;DR: The first 500 patients to have sacral anterior root stimulators implanted for bladder control are described and of 479 survivors, 424 were using their stimulators when last followed up between 3 months and 16.1 years after implantation.
Abstract: The first 500 patients to have sacral anterior root stimulators implanted for bladder control are described. Of 479 survivors, 424 were using their stimulators when last followed up between 3 months and 16.1 years (mean 4 years) after implantation.
316 citations
278 citations
TL;DR: The results suggest that preventative and management steps are required to ensure continued independence and quality of life in this group over time, and that limitations in upper limb function may be seen in this population at relatively young ages.
Abstract: Research has shown that wheelchair use in long term paraplegia is associated with upper limb pain and degeneration that interferes with the independent performance of activities of daily living. This paper proposes a model to explain the development of upper limb problems in persons with long term paraplegia, and one that will guide in the prevention and management of this type of long term complication.
263 citations
TL;DR: The data suggest that TES may have a significant clinical value in the treatment of spinal metastasis, and it was proved that T ES on one vertebra has little effect on spinal cord circulation.
Abstract: We have developed a new surgical technique, 'total en bloc spondylectomy' (TES), to treat a solitary metastasis in the thoracic or lumbar vertebra. This operation is designed as a local cure for the metastatic site and involves the radical resection of the affected vertebra with a wide margin. The spondylectomy consists of two steps: en bloc laminectomy with posterior spinal instruments for stabilisation (first step) and en bloc corporectomy and replacement using a vertebral prosthesis (second step). TES makes it possible to remove the affected vertebra extracompartmentally with its tumour barrier and accomplishes circumferential decompression of the spinal cord. Before clinical practice, we constructed experimental models using cats to examine spinal cord blood flow (SCBF) after ligation of the nerve roots and circumspinal decompression. The changes of SCBF were negligible, so it was proved that TES on one vertebra has little effect on spinal cord circulation. This method was used in 24 patients. Fourteen of the 18 patients with neurological deficits improved remarkably, and the 23 evaluable cases experienced pain relief. Impending paralysis was prevented in all six patients by this surgical intervention. There has been no recurrence of the local tumour after surgery. After a median follow up period of 14.1 months, 12 patients have survived. These data suggest that TES may have a significant clinical value in the treatment of spinal metastasis.
174 citations
TL;DR: The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury is a guide to the classification of spinal cord injuries and injuries to the nervous system.
Abstract: The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury
172 citations
TL;DR: Most SCI men with ejaculatory dysfunction should be considered candidates for PVS, and an adequate peak-to-peak amplitude is essential to exceed an 'ejaculatory threshold' in the majority ofSCI men.
Abstract: A total of 66 men with a spinal cord injury (SCI) and ejaculatory dysfunction were included in two different but comparable study populations I (n = 25) and II (n = 41). The level of lesion ranged from C2 to L1 (44 complete). Penile vibratory stimulation (PVS) to induce ejaculation was performed with two different types of vibrators in population I and considerably different ejaculation rates (antegrade+retrograde) occurred depending on the vibrator used. Our experience suggested discrepancies between the manufacturers' specifications and the actual vibrator outputs concerning frequencies and peak-to-peak amplitudes. Retrospectively performed determinations revealed that the manufacturers' specifications regarding the frequencies were accurate whereas the peak-to-peak amplitudes were inaccurate. With a frequency of 100 Hz and determined peak-to-peak amplitudes of 1 mm and 2.5 mm, ejaculation rates of 32% and 96%, respectively, were obtained in population I. This indicates that an adequate peak-to-peak amplitude is essential to exceed an 'ejaculatory threshold' in the majority of SCI men. Furthermore, an ejaculation rate of 83% obtained in a subsequent prospective study of 41 SCI men (population II) verified that a frequency of 100 Hz and a peak-to-peak amplitude of 2.5 mm seems to approach the ideal vibrator output. The ejaculation responses obtained by JS (first author) were reproduced when the PVS was performed by the patient or his partner, indicating that the vibrator output is more important than PVS experience. No major adverse reactions due to autonomic dysreflexia were observed. The lowest level of SCI where antegrade or retrograde ejaculation occurred was T9 and L1, respectively. No absolute predictors for ejaculatory success or failure in relation to patient age, years since lesion, completeness of SCI, urinary bladder management method, hip flexion and bulbocavernous reflexes were observed. Therefore, most SCI men with ejaculatory dysfunction should be considered candidates for PVS.
171 citations
TL;DR: Examination of the SCI scores suggest that psychological morbidity was confined to a group of approximately 30% of persons, whilst the remaining persons were not severely anxious or depressed, and traditional stage models of adjustment to SCI which suggest that the passage of time is associated with better adjustment were not supported.
Abstract: This study is a 1 year extension of a controlled 1 year follow up study of spinal cord injured persons The study assessed the extent of spinal cord injury (SCI) persons' depression and anxiety in comparison to an able bodied control group matched for age, sex, education and as far as possible, occupation Psychological adjustment to SCI was assessed in terms of scores on the Trait Anxiety Inventory and the Beck Depression Inventory Results obtained at the 2 year follow up were not significantly changed from those obtained over the first year There was no significant improvement in anxiety and depression scores in the SCI group 2 years post injury Examination of the SCI scores suggest that psychological morbidity was confined to a group of approximately 30% of persons, whilst the remaining persons were not severely anxious or depressed Traditional stage models of adjustment to SCI which suggest that the passage of time is associated with better adjustment were not supported by the present data
134 citations
TL;DR: The effects of walking with and without parallel bars, providing 40% body weight support (BWS) and increasing speed on the gait pattern of spastic paretic subjects during treadmill locomotion were investigated and changes in electromyographic and sagittal angular displacement profiles favoured a more normal swing phase of the more involved limb.
Abstract: The effects of walking with and without parallel bars, providing 40% body weight support (BWS) and increasing speed on the gait pattern of spastic paretic subjects during treadmill locomotion were investigated. In asymmetrically involved subjects, walking without parallel bars led to a more symmetrical gait pattern with decreased compensation of the less involved side. This was accompanied by changes in electromyographic (EMG) and sagittal angular displacement profiles which favoured a more normal swing phase of the more involved limb. When symmetrically involved subjects walked without parallel bars, increases in EMG activity, with prolonged activation during the stance phase were noted, especially in the distal muscles. Providing 40% BWS facilitated gait when walking without parallel bars especially in the asymmetrically or severely involved subjects who showed marked difficulty at 0% BWS. Forty percent BWS led to a decrease in clonus associated with walking without parallel bars. Higher treadmill speeds increased clonus in some subjects while in others it only caused a small increase in EMG amplitude. Implications for gait training are discussed.
127 citations
TL;DR: The variables studied were age at injury, social status, the cause of the accident, spinal level of injury and physical complications, and subjective quality of life (QOL) which showed four patterns during the 5 year period.
Abstract: In order to meet a long expressed need for a longitudinal study on personal adjustment to traumatic spinal cord injury, 17 consecutively treated persons with complete traumatic spinal cord injury were interviewed 0.5-5 years after the injury on six occasions, with a total of 102 interviews. The variables studied were age at injury, social status, the cause of the accident, spinal level of injury and physical complications. The subjective quality of life (QOL) was reported on a 0-10 scale at all interviews and showed four patterns during the 5 year period. Five subjects reported that they were coping very well, with an almost unchanged QOL after the injury. Six reported good coping after an initially low QOL in the first years. Two subjects reported an unstable QOL, and four persons reported a continually low QOL without improvement. Variables related to unsatisfactory coping were severe pain, age above 35 years at the time of trauma, and being blameless for the accident.
124 citations
TL;DR: No significant analgesic effects of valproate could be demonstrated although serum concentration and dose reached a high level, and it is recommended that further studies be performed.
Abstract: Chronic central pain is a frequent complication after spinal cord injury. Anticonvulsant drugs, among them valproate, have been recommended for treatment. In this paper we conducted a double-blind, cross-over study comparing valproate and placebo for severe chronic central pain. During the study, serum concentration of valproate, pain and side effects were registered and the dose was adjusted according to these. No significant analgesic effects of valproate could be demonstrated although serum concentration and dose reached a high level. Few studies of pain following spinal cord injury exist and we recommend that further studies be performed.
TL;DR: It was concluded that the method used in this study provides a quantitative and objective estimation of physical strain and may therefore be a useful tool to identify task difficulty during rehabilitation and to evaluate the results of task and physical training on the physical strain during ADL.
Abstract: To describe physical strain during activities of daily living (ADL), 44 men with spinal cord injuries (C4-L5) performed a set of standardised tasks The physical strain was defined as the highest heart rate response expressed as a percentage of the individual heart rate reserve (%HRR) The physical strain averaged over the subjects who performed all tasks (n = 24) was (mean +/- SD): 202 +/- 72 %HRR (washing hands), 204 +/- 73 %HRR (passing a side-hung door), 288 +/- 108 %HRR (transfer to a toilet), 312 +/- 131 %HRR (ascending an 8 cm curb) 339 +/- 120 %HRR (transfer to a shower seat), 351 +/- 105 %HRR (transfer to bed), 364 +/- 133 %HRR (preparing lunch), 371 +/- 120 %HRR (washing up), 387 +/- 149 %HRR (ascending a ramp), 398 +/- 156 %HRR (transfer to a shower wheelchair), 414 +/- 121 %HRR (changing sheets), and 459 +/- 104 %HRR (entering a car) Physical strain could be notably high, but large variations among subjects were present During all tasks, subjects with tetraplegia had significantly higher levels of strain than subjects with low (T6-L5) lesions Physical strain was inversely related to parameters of physical capacity: isometric strength (r: -034 to -072), sprint power (r: -034 to -069), peak oxygen uptake (r: -041 to -081) and maximal power output (r: -052 to -082) Parameters of physical capacity were better predictors of physical strain than was the lesion level, and explained 37-71% of the variance in strain during ADL It was also concluded that the method used in this study provides a quantitative and objective estimation of physical strain and may therefore be a useful tool to identify task difficulty during rehabilitation and to evaluate the results of task and physical training on the physical strain during ADL
TL;DR: Sixty men with spinal cord injury who had developed pressure ulcers in the past but whose skin was intact when they joined the study were followed for 2 years, or until a pressure ulcer developed as discussed by the authors.
Abstract: Sixty men with spinal cord injury who had developed pressure ulcers in the past but whose skin was intact when they joined the study were followed for 2 years, or until a pressure ulcer developed Forty of the men were contacted every 4-6 weeks to answer questions about their skin care practices and to provide a 24 hour urine sample The others were only contacted at the beginning and the end of the study to answer a questionnaire and to provide a urine sample Changes in skin collagen metabolism were monitored by measuring urinary excretion of a metabolite, glucosyl-galactosyl hydroxylysine (glu-gal Hyl), corrected for creatinine excretion Sustained increases in levels of glu-gal Hyl excretion were detected at least 2 months and as much as 5 months in advance of overt clinical signs of ulcer development Increased excretion of glu-gal Hyl was significantly associated (p < 005) with the development of a pressure ulcer An increase in the urinary excretion of glu-gal Hyl is an indication of increased degradation of skin collagen Body mass index (weight/height2) of 33% of subjects with pressure ulcers, and 12% of those without, was at least one standard deviation below the mean of all subjects Thirty-six percent of those who smoked developed ulcers, while only 26% of the nonsmokers did(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Investigation of spinal cord injury among residents of Utah found an annual incidence rate of 4.3 per 100,000, with the highest rates occurring among males 15-24 years of age, and the accuracy and completeness of reporting in this surveillance system were examined.
Abstract: From 1989 through 1991, we conducted surveillance of spinal cord injury (SCI) among residents of Utah. We found an annual incidence rate of 4.3 per 100,000, with the highest rates occurring among males 15-24 years of age. Motor vehicles were the leading cause of injury, followed by falls, and sports and recreation. We also examined the accuracy and completeness of reporting in this surveillance system. We found the predictive value positive of SCI diagnoses reported in hospital discharge data to be only 61%. When we considered only patients who received acute hospital care in-state, we found that the sensitivity of hospital discharge data 89%. These findings indicate serious problems in the reporting of spinal cord injury diagnoses in hospital discharge data and the need to verify case reports based on these data. There is also a need to study this problem in other jurisdictions to determine if overreporting is widespread.
TL;DR: It is demonstrated that the venous vascular properties in the legs of individuals with paraplegia have changed, i.e. a decrease in venous distensibility and capacity and an increase in venus flow resistance.
Abstract: The purpose of this study was to examine the properties of the venous vascular system in the lower extremities of individuals with long-standing paraplegia (PP). The venous volume variations (VVV), the venous capacity (VC), the venous emptying rate (VER) and the venous flow resistance (VFR) were measured in the left calf of 14 male PP and 12 male able-bodied subjects (ABS) by means of strain-gauge occlusion plethysmography. VVV and VC were significantly lower in PP compared to ABS, -45% and -50% respectively. Both groups showed a similar resting venous pressure in the calf (PP = 24.4 mmHg; ABS = 19.6 mmHg). VER was significantly lower (-60%) and hence VFR was significantly higher (+75%) in PP compared to ABS. This study demonstrates that the venous vascular properties in the legs of individuals with paraplegia have changed, i.e. a decrease in venous distensibility and capacity and an increase in venous flow resistance. This is most probably the result of vascular adaptations to inactivity and muscle atrophy rather than the effect of a non-working leg-muscle pump and sympathetic denervation.
TL;DR: Emotional support was found to be positively related to the outcomes of life satisfaction, adjustment to disability and the absence of depressive symptomatology, which sends a clear message to rehabilitation and community service providers to be watchful of survivors with limited social support, concerns about their health and an apparent lack of financial resources.
Abstract: It has always been understood that those who deal effectively with a disability call upon special resources that members of the able bodied population are not required to develop. However, the nature and relationship of these resources to aging outcomes is as yet only superficially understood. The present study provides further information and clarification about the resources needed for aging with a spinal cord injury. The sample consists of 70 individuals who have had a spinal cord injury for at least 15 years, and who are currently over the age of 45, and are therefore either anticipating or experiencing aging. Data from the sample were examined to produce a model of resources empirically associated with positive outcomes in aging. Emotional support was found to be positively related to the outcomes of life satisfaction, adjustment to disability and the absence of depressive symptomatology. Further, health concerns, financial security and instrumental support were also related to specific outcomes. These findings send a clear message to rehabilitation and community service providers to be watchful of survivors with limited social support, concerns about their health and an apparent lack of financial resources. The findings underline the need for better access to health services, and improved knowledge and attitudes of community health care providers working with older disabled individuals.
TL;DR: To survey the situation of traumatic spinal cord injuries (SCI) in Japan, the SCI Prevention Committee of the Japanese Medical Society of Paraplegia sent out by mail study charts in the form of questionnaires to institutions nationwide, using the statistical method of the nationwide epidemiological survey described by Hashimoto et al.
Abstract: To survey the situation of traumatic spinal cord injuries (SCI) in Japan, the SCI Prevention Committee of the Japanese Medical Society of Paraplegia sent out by mail study charts in the form of questionnaires to institutions nationwide. Using the statistical method of the nationwide epidemiological survey described by Hashimoto et al,1 the annual estimated incidence was obtained from the number of patients registered, and from the questionnaire reply rate at each prefecture. The number of registered patients in 1990 was 3465 and the mean reply rate was 56.6%. There were 2665 registered patients with a neurological deficit (Frankel A-D) and the annual SCI incidence was 39.4 per million. The male:female ratio was 4.3:1 and the ratio of cervical cord injures to those caudal to the cervical cord was 2.9:1. The mean age at the time of injury was 48.5 years. The cause most frequently seen was traffic accidents, the second most frequent being falls from a height. Besides those two, sports injuries and falls on level ground were the third most frequent causes of SCI in the young generation and in elderly people respectively.
TL;DR: The recent sociopolitical changes and especially the general escalation of violence in the country is reflected in the observed changes in the epidemiology of spinal cord injuries, particularly gunshot wounds, in South African plegic patients.
Abstract: The records of all patients (492 males and 124 females) admitted into a spinal rehabilitation programme over a period of 6 years were reviewed. Most of the patients were in the age group 20-29 years and trauma accounted for 89% of all spinal cord lesions. Gunshot injuries were the commonest (36%), followed by injuries related to motor vehicle accidents (MVA) (25%), stab wounds (20%) and falls from heights (2.4%). Aetiological patterns changed over the 6 year period covered: gunshot injuries increased markedly and stab wounds decreased in number. The records of a medico-legal laboratory in the same geographic region revealed the same trend. Neurological recovery rates were better in patients with stab wounds and nontraumatic lesions than in those with MVA-related injuries and gunshot wounds. When compared to similar studies from other countries, our results show a disproportionately high incidence of violent injuries, particularly gunshot wounds, in South African plegic patients. We concluded that the recent sociopolitical changes and especially the general escalation of violence in the country, is reflected in the observed changes in the epidemiology of spinal cord injuries.
TL;DR: The effectiveness of a combined physiotherapy/cycling programme in the rehabilitation of people with spinal injuries is demonstrated, as has been done at the Sir George Bedbrook Spinal Unit.
Abstract: Twelve patients were involved in a 3 month stimulation induced cycling programme at the Royal Perth Rehabilitation Hospital. A number of the patients were less than 1 year post injury, all except one had an incomplete injury, and most were receiving physiotherapy. All patients who completed the programme increased their time of cycling and, in all but one case, the exercise load, indicative of a local training effect. Significant improvements were found in voluntary isometric strength, stimulated isometric strength and stimulated isometric endurance of the quadriceps, muscle grading of the quadriceps and biceps femoris and the cross-sectional areas of the quadriceps and total thigh muscle. No change was found in voluntary isokinetic strength of the quadriceps. All patients with incomplete injuries reported improvements in the activities of daily living (ADL) after the programme. Bone mineral density (BMD) was examined in two patients, one less than 1 year post injury, and one greater than 4 years post injury. The programme of cycling did not restore BMD in the latter patient. However, while the former patient still displayed a reduced BMD after the programme, it is unknown whether this loss of bone was retarded. This needs further investigation. This study demonstrates the effectiveness of a combined physiotherapy/cycling programme in the rehabilitation of people with spinal injuries. To be successful this type of programme has to be incorporated into the rehabilitation process, as has been done at the Sir George Bedbrook Spinal Unit.
TL;DR: The regular and frequent follow up of the patient on a yearly or alternate year basis to monitor the patient with spinal injury for this complication, as well as other complications, is the best way to ensure that post traumatic syringomyelia is diagnosed and managed early in order to avoid further disability.
Abstract: The need for increased awareness and a high index of suspicion for post traumatic syringomyelia is emphasised. Early clinical diagnosis confirmed by MRI and early treatment can avert or minimise the potentially devastating effects of post traumatic syringomyelia. The regular and frequent follow up of the patient on a yearly or alternate year basis to monitor the patient with spinal injury for this complication, as well as other complications, is the best way to ensure that post traumatic syringomyelia is diagnosed and managed early in order to avoid further disability.
TL;DR: In order to restore bladder function after spinal cord injury, a controllable new reflex pathway has been established in rats that involves a somatic reflex arc with an artificially modified efferent branch which passes the somatic motor impulses to the bladder.
Abstract: In order to restore bladder function after spinal cord injury, a controllable new reflex pathway has been established in rats. It involves a somatic reflex arc with an artificially modified efferent branch which passes the somatic motor impulses to the bladder. This is achieved by intradural microanastomosis of the left L4 ventral root to L6 ventral root, while leaving the L4 dorsal root intact as a starter of micturition. The 'skin-CNS-bladder' reflex pathway is designed to initiate voiding by scratching the skin. After axonal regeneration, 15 of the 24 rats with the new pathway underwent electrophysiological study. Single stimuli (0.3-3 mA, 0.02-0.2 ms duration) to the left L4 nerve resulted in evoked potentials (0.5-1 mV) recorded from the left L6 nerve distal to the anastomosis. The bladder detrusor contraction was very quickly initiated by trains of the stimuli and bladder pressures increased rapidly to levels similar to controls. Neural tracing study with horseradish peroxidase (HRP) on six rats with the pathway demonstrated that the somatic motor axons regenerated successfully into the pelvic nerve, and the bladder was reinnervated by the L4 somatic motor neurons. The bladder contraction can also be initiated by electrostimulation of left sciatic nerve as well as scratching the L4 related skin. A new concept may be derived from the skin-CNS-bladder reflex pathway: the impulses delivered from the efferent neurons of a somatic reflex arc can be transferred to initiate responses of an autonomic effector.
TL;DR: Four patients developed infarction of the lumbar cord as a result of induced hypotension and all patients showed a lesion in the territory of the artery of Adamkiewicz.
Abstract: Four patients developed infarction of the lumbar cord as a result of induced hypotension. All patients showed a lesion in the territory of the artery of Adamkiewicz. The pathophysiology of the blood supply of the spinal cord is discussed, and in particular the anatomy of the artery of Adamkiewicz. The reason why this artery is so vulnerable to hypotension is discussed.
TL;DR: Under boosted conditions the rise in T was eliminated while NE levels were significantly elevated above unboosted levels, which may suggest an inhibitory role for CA on T production or release under conditions of extreme stress.
Abstract: Episodes of short high intensity exercise are associated with an increase in circulating total testosterone (T) in men. Mechanisms may include hemoconcentration, decreased metabolic clearance and/or increased synthesis. Beta-blockade abolishes the T response suggesting a direct beta-adrenergic effect on the testes. Some spinal cord injured (SCI) athletes deliberately induce autonomic dysreflexia (boosting) to enhance performance. Associated with this practice are elevated catecholamine (CA) levels and exaggerated responses to serum catecholamine levels. Since basal T levels are reported to be normal in the SCI male, the T response to acute high intensity exercise might be expected to be exaggerated by boosting and associated elevated CA levels. The acute exercise T response has not been examined in SCI men to date. To determine whether the increased CA values associated with boosting enhanced the exercise-induced T elevation we measured circulating levels of T, cortisol (C), norepinephrine (NE) and epinephrine (E) before and after maximal exertion and a simulated 7.5 km race with and without boosting in eight elite quadriplegic athletes. Maximal incremental exercise and a simulated 7.5 km race resulted in a rise in T similar to able bodied men under normal exercise conditions. Under boosted conditions the rise in T was eliminated while NE levels were significantly elevated above unboosted levels. The data may suggest an inhibitory role for CA on T production or release under conditions of extreme stress. Other possible mechanisms include C induced suppression, impaired gonadotropin stimulation of the Leydig cell and CA mediated alterations in gonadal blood supply.
TL;DR: Use of a LoFric catheter for intermittent catheterisation was associated with significantly lesser degree of urethral inflammatory response when compared to the use of a PVC catheter, and minor degrees of inflammation need to be quantitatively determined while assessing two different catheters for intermittentCatheterisation.
Abstract: Local reactions of the urethral wall are known to occur by repeated introduction of a catheter in the urethra. Urethritis was found in 2-19% of patients practising intermittent catheterisation. Although the use of catheters of smaller size and the liberal use of lubricants may prevent urethral irritation and trauma, it was postulated that hydrophilic catheters (LoFric, Astra Tech Ltd, Stroud, England) induce significantly less trauma than PVC catheters because of the binding of the water molecules to the catheter surface which consists of polyvinylpyrrolidone and sodium chloride. Although urethritis and urethral stricture may represent one end of the spectrum of repeated urethral trauma, minor degrees of inflammation need to be quantitatively determined while assessing two different catheters for intermittent catheterisation. The degree of urethral inflammation in patients practising intermittent catheterisation was studied by urethral cytology and staining the smear by Papanicolaou's method. The number of neutrophil polymorphs and epithelial cells in three random high power fields in the urethral smear was counted and the percentage ratio of polymorphs to epithelial cells was calculated. Group 1 comprised 14 patients practising intermittent catheterisation with a PVC catheter and group 2 comprised 17 patients performing intermittent catheterisation with a LoFric catheter. There was no significant difference between the two groups as regards the age, diagnosis, size of the catheter used for intermittent catheterisation and the number of times that they performed catheterisation during a 24 hour period. Urethral cytology revealed a percentage (mean ratio) ratio of polymorphs to epithelial cells of 66 in group 1 and 0.04 in group 2. (< 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Occupations prior to the spinal cord injury were wide ranging throughout all employment categories, with the engineering and science category being most prevalent, and those in employment post injury showed a move towards the administration, clerical and finance categories.
Abstract: This study has attempted to ascertain the employment status of a group of 114 expatients with a traumatic spinal cord injury (SCI) The group was 1-7 years post injury Out of the 114 subjects, 31% were in paid employment and 21% were either in full time education or training There were 23% unemployed and seeking work and 25% unemployed and not seeking work Occupations prior to the spinal cord injury were wide ranging throughout all employment categories, with the engineering and science category being most prevalent Those in employment post injury showed a move towards the administration, clerical and finance categories, with science and engineering also providing some jobs
TL;DR: From the partner's perspective, feelings of emotional closeness, mutual concerns and willingness to engage in a variety of sexual activities seem to be more important for sexual fulfilment than the physiological aspects of sexuality.
Abstract: In addition to the physical disability, a spinal cord injury affects self esteem and partner relationships. This study addressed partner experiences in relation to sexual interest, behaviour and satisfaction. A measure of satisfaction within relationships was also included. Forty-nine partners of SCI persons completed a comprehensive survey including an 80 item questionnaire and a VAS quality-of-life measure. Partner ages ranged from 18 to 79 years (median 34 years). Thirty-nine partners were women and 10 partners were men. Significance testing of relationships included bivariate, partial and multiple correlation procedures. Sixty-one per cent of the partners appreciated the quality of their sexual relationship and most partners (84%) considered their relationship overall to be satisfying. Half of the couples engaged in sex, with or without intercourse, once a week or more. Fifty-five per cent of the partners reported being content with the frequency of their sexual interaction while one third would have wished more frequent activity. Almost half of the partners (45%) considered their current sex life to be as good as or even better than their previous sex life. High general satisfaction with life, a varied repertoire of rewarding sexual expressions, including intercourse and concern about the able bodied partner's sexual pleasure were positive predictors of an active and fulfilling sexual relationship. From the partner's perspective, feelings of emotional closeness, mutual concerns and willingness to engage in a variety of sexual activities seem to be more important for sexual fulfilment than the physiological aspects of sexuality.
TL;DR: Age seems to be a more important factor for sexual adjustment after a spinal cord injury, rather than whether the relationship is established before or after injury.
Abstract: This study compared the emotional and sexual aspects of relationships before and after spinal cord injury, from the partner's point of view. In addition, the personality characteristics of the partners were investigated. Twenty-six relationships were established before the injury and 23 after. The couples in preinjury relationships had been married or cohabiting for 3.5-51 years (median 24 years), while postinjury relationships ranged from 1 to 8 years (median 2 years). There were substantial differences in age between preinjury and postinjury partners, 21-79 years (median 51 years) and 18-45 years (median 28 years), respectively. Data collection included an 80-item questionnaire, designed to determine different aspects of sexuality, a visual analogue scale Quality of Life (VAS QL) measure and an established inventory of personality characteristics, the Karolinska Scales of Personality (KSP). Eighty-eight per cent of the partners in preinjury and 86% in postinjury relationships considered their overall relationship to be satisfactory. Concerning the sexual aspects of the relationships, several differences were revealed, all favouring postinjury relationships. Some of these held true even when age was treated as a significant factor and statistically controlled. Although the frequency of sexual activity and the variety of sexual expressions used were lower in the preinjury relationships, and perceived deterioration of sex life due to the injury was higher among preinjury partners, there was no significant difference between the two groups in satisfaction with current sex life. Thus, age seems to be a more important factor for sexual adjustment after a spinal cord injury, rather than whether the relationship is established before or after injury. The partners' personality characteristics differed only slightly from those of a sex and age matched reference group and not at all between partners in pre- and postinjury relationships.
TL;DR: This study confirms the safety and efficacy of self-administered intracavernous PGE-1 for neuropathic impotence, however, because of a significant rate of voluntary cessation, patients should be counseled regarding the full range of therapeutic alternatives to intraca Vernous therapy.
Abstract: The administration and suitability of intracavernous PGE-1 in men with neuropathic erectile dysfunction is reported herein. Twenty-seven men with neuropathic erectile dysfunction (SCI, 14; multiple sclerosis, 7; discogenic disease, 6) were evaluated and treated with intracavernous PGE-1. An average of 3.2 office sessions were required to learn adequate self-injection technique and determine optimal dosage requirements. Initial dosage for SCI men was 2.5 μg and increased in 2.5 μg increments to a mean maintenance dose of 6.2 μg. Quarterly monitoring up to 28 months demonstrated satisfactory erectile rigidity and duration of erection in all patients electing to pursue home administration of PGE-1. During this interval, over 40% of patients dropped out of the treatment program. No priapism or changes in serum chemistries, CBC, or platelets were observed during this period. Corporal fibrosis although not palpable, was detected subclinically by penile ultrasound in two men. This study confirms the safety and efficacy of self-administered intracavernous PGE-1 for neuropathic impotence. However, because of a significant rate of voluntary cessation, patients should be counseled regarding the full range of therapeutic alternatives to intracavernous therapy.
TL;DR: The group of men with spinal cord injuries had the lowest scores for the availability of social integration, indicating that the social isolation which has previously been identified amongst people with head injuries may not be attributable solely to brain damage.
Abstract: Studies have indicated that loss of social contact remains the primary complaint of people with head injuries many years after discharge. In an attempt to disentangle specific and nonspecific effects of head injury a study was undertaken to compare a group of 15 men with severe closed head injuries and their wives, with a group of 15 men with complete, traumatic spinal cord injuries and their partners (n = 60). Time since discharge extended from 4 months to several years. This paper focuses primarily upon the results and implication of the responses from the group of men with spinal cord injuries and their partners. The Interview Schedule for Social Interaction was correlated with the Leeds Scale for the Self Assessment of Anxiety and Depression. All groups reported low availability and adequacy of social integration and exhibited high levels of depression. The group of men with spinal cord injuries had the lowest scores for the availability of social integration, indicating that the social isolation which has previously been identified amongst people with head injuries may not be attributable solely to brain damage.
TL;DR: A programme is needed in Romania to prevent the accidents that cause spinal injuries and to improve clinical management, to aid the prevention of accidents and to train staff and relatives in the care of those with spinal cord injuries.
Abstract: Retrospective and prospective epidemiological studies in Bucharest indicated a high rate of spinal injuries (about 28.5 per million population per year) in Romania. Most patients were poor, male, manual workers. Half of them were aged less than 40. Falls, particularly from horse-drawn carts, and road traffic accidents were the most frequent causes of injury. In summer, diving accidents were a common cause of spinal injuries. Sixty per cent of the patients had cervical injuries. Pressure sores became less frequent as staff and relatives were trained to turn and position patients. Because gastroduodenal bleeding and deep vein thrombosis were rare, the systematic use of drugs to prevent these conditions was deemed to be unnecessary, given the financial constraints. A shortage of beds and facilities made it difficult to manage associated injuries in a neurosurgical clinic in Bucharest or to admit all patients for rehabilitation. Thirty-nine per cent of all patients admitted with spinal injuries had spinal surgery (61% of those with neurological impairment). Bone grafting was the most common procedure for cervical injuries; surgical stabilisation was not commonly performed due to the shortage of plates and screws. The mortality rate in the early days post injury decreased from 22% (1985-1991) to 10.1% (1992) as medical management improved and the relatives helped with care in the acute phase. A programme is needed in Romania to prevent the accidents that cause spinal injuries and to improve clinical management. As a result of this study, three films were made to aid the prevention of accidents and to train staff and relatives in the care of those with spinal cord injuries.