The Sexual Health Clinician is a health care specialist who is able to assess the sexual potential of physically disabled persons and assist them in the development of acceptable alternatives in sexual practices. This specialty role was first developed at the Spinal Cord Injury Unit, Shaughnessy Hospital in Vancouver, B.C., Canada, to answer a need of spinal cord injured patients, their partners and family. The opportunity to join the Service arose in May, 1981 following one year as the Senior Occupational Therapist on the Spinal Cord Injury Unit. This paper, which describes the experience of an occupational therapist as a member of the Sexual Health Service, is presented in five brief parts: 1. a background history; 2. a description of the sexual problems of the spinal cord injured and the goals of rehabilitation in this area; 3. the role of the Sexual Health Clinician; 4. the strengths and limitations of Occupational Therapy in this new role; 5. a brief discussion of the the need for a sex-related role and curriculum for students of Occupational Therapy.
We reviewed 225 cases of amyoplasia, and the association of amyoplasia with gastroschisis and with monozygotic twinning was confirmed. In addition, an apparently increased association of bowel atresia and defects in the muscular layer of the trunk wall with amyoplasia was observed. The association of amyoplasia, monozygotic twinning, and these trunk wall defects strongly suggests that the pathogenesis of amyoplasia is linked to some type of vascular compromise.
An astrocytoma of the cervical spinal cord was diagnosed in a 3-year-old Siberian Husky. The dog had an 8-week history of progressive neurologic deficits that finally resulted in nonambulatory tetraparesis. Neurologic examination, CSF analysis, myelography, exploratory laminectomy and histopathologic examination were performed. Intramedullary spinal cord tumors such as astrocytomas are rare, and this case illustrates the manner in which spinal cord tumors may be confused with other nervous system diseases, both from a clinical and clinicopathologic standpoint.
Nine patients with serious cervical spine injuries that occurred while they were playing rugby were seen in a British Columbia acute spinal cord injury unit during the period 1975-82. All the injuries had occurred during the "scrum" or the "tackle". Two of the patients were rendered permanently quadriplegic, and one patient died. There is a need for a central registry that would record all cervical spine injuries in rugby players as well as for changes in the rules of the game.
Clinical and histological study of 8 cases of Vilyui encephalomyelitis (VEM), characterized by chronic and acute course has shown that all the features of local non-purulent encephalomyelitis with marked dystrophic and atrophic changes of neural tissue were characteristic of VEM. Immunomorphological reaction that manifested as perivascular and membrane lymphoplasmacytic infiltrations was observed in patients with a more acute VEM course or with exacerbation of chronic VEM. Hydrocephalus is considered as a serious aggravating factor that favours atrophic nervous changes during protracted and chronic VEM course.
Spinal cord concussion is a transient disturbance of spinal cord function, with or without vertebral damage and no demonstrable pathologic changes, that results from a rapid change in velocity following trauma, and resolves within 48 hours. In a retrospective review of patients with spinal injury referred to a tertiary care center, spinal cord concussion was observed in 3.7% of patients. Thirteen cases are presented. A variety of clinical presentations may occur, all of which can be explained on the basis of the magnitude or direction of acceleration of the spinal cord. The cervical cord is most commonly affected, but concussion can occur at any level of the spinal cord. Spinal cord concussion is often associated with pre-existing vertebral abnormalities that result in narrowing of the spinal canal or areas of hypermobility.
An epidemiologic survey of central nervous system (CNS) neoplasms in Central Finland revealed a total of 367 neoplasms, 298 of which were diagnosed during 1975-82, the remaining being diagnosed earlier. Histological verification was available in 83% of intracranial and 90% of intraspinal neoplasms. 14% of the intracranial neoplasms diagnosed during 1975-82 were found incidentally at autopsy. Metastases corresponded to 18% of all CNS neoplasms. Age- and sex-adjusted annual incidence rates for primary and metastatic intracranial neoplasms were 12.3 and 3.4/100,000, and for intraspinal neoplasms 1.3 and 0.7/100,000, respectively. The total incidence of all CNS neoplasms was 17.7/100,000/year. Of the different types of intracranial neoplasms, meningiomas were more frequent among women than among men with a ratio of 8:1; metastases were more common among men with a ratio of 2.5:1. For primary intracranial neoplasms, point prevalences (January 1, 1983) were 65.9/100,000 and intraspinal neoplasms 9.1/100,000. The corresponding period prevalences for 1982 were 73.7 and 9.5/100,000.
All cases of motor neuron disease (MND), encompassing amyotrophic lateral sclerosis (ALS), progressive bulbar paralysis (PBP) and progressive spinal muscular atrophy (PSMA), in northern Sweden, diagnosed between 1969-1980 have been analysed. 128 cases were found, corresponding to an average annual incidence rate of 1.67 per 100,000. The prevalence on December 31, 1980 was 4.8 per 100,000. Age-specific incidence rates were higher in the high age groups with a maximum at 60-64 years for males, at 70-74 years for females and at 65-69 years for the sexes combined. The median age at onset was 61 years. Clustering was not found in mining districts and overrepresentation of miners and stone treaters was not observed. Minor differences in incidence rates, as measured by the standardized morbidity ratio, SMR, were found between the inland, coastal and mountain areas. The median survival time after onset of disease was 32 months for ALS, 30 months for PBP and 70 months for PSMA. The combined survival rate for all MND cases was 28% after 5 years and 15% after 10 years. The male to female ratio was 1.1:1, and 4.7% were familial cases.