Traumatic brain and spinal cord injuries continue to pose serious challenges for physicians around the world. In North America, the annual number of serious head and spinal injuries has decreased over the last two decades, and of those patients who reach a hospital, the mortality and long-term morbidity have also declined. The two major reasons for this reduction in death and disability after craniospinal trauma in the United States and Canada appear to be (1) widespread implementation of prevention measures, safety legislation, and public education initiatives; and (2) further improvements in and wider availability of emergency medical systems and regional trauma centers. Improvements in neurocritical care and the implementation of evidence-based treatment guidelines for severe head injury victims may also, in part, be responsible for improved survival rates and reduced disability rates. Unfortunately, numerous clinical trials of putative neuroprotective agents conducted in North America and elsewhere during the 1990s have failed to demonstrate efficacy in head-injured patients. However, methylprednisolone does appear to confer some benefit to a select population of spinal cord injury patients. These advances in the areas of prevention, regional trauma systems, treatment guidelines, and neurocritical care that have influenced survival rates and recovery of function are discussed.
To describe physical capacity, autonomic function, and perceptions of exercise among adults with subacute spinal cord injury (SCI).
Two inpatient SCI rehabilitation programs in Canada.
Participants (N=41; mean age ± SD, 38.9 ± 13.7y) with tetraplegia (TP; n=19), high paraplegia (HP; n=8), or low paraplegia (LP; n=14) completing inpatient SCI rehabilitation (mean ± SD, 112.9 ± 52.5d postinjury).
Peak exercise capacity was determined by an arm ergometry test. As a measure of autonomic function, orthostatic tolerance was assessed by a passive sit-up test. Self-efficacy for exercise postdischarge was evaluated by a questionnaire.
There was a significant difference in peak oxygen consumption and heart rate between participants with TP (11.2 ± 3.4;mL·kg(-1)·min(-1) 113.9 ± 19.7 beats/min) and LP (17.1 ± 7.5 mL·kg(-1)·min(-1); 142.8 ± 22.7 beats/min). Peak power output was also significantly lower in the TP group (30.0 ± 6.9W) compared with the HP (55.5 ± 7.56W) and LP groups (62.5 ± 12.2W). Systolic blood pressure responses to the postural challenge varied significantly between groups (-3.0 ± 33.5 mmHg in TP, 17.8 ± 14.7 mmHg in HP, 21.6 ± 18.7 mmHg in LP). Orthostatic hypotension was most prevalent among participants with motor complete TP (73%). Results from the questionnaire revealed that although participants value exercise and see benefits to regular participation, they have low confidence in their abilities to perform the task of either aerobic or strengthening exercise.
Exercise is well tolerated in adults with subacute SCI. Exercise interventions at this stage should focus on improving task-specific self-efficacy, and attention should be made to blood pressure regulation, particularly in individuals with motor complete TP.
To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI).
General community, international.
Volunteers (N=352) with SCI for more than 20 years.
The need for more help with ADLs.
The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI.
People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time.
*Department of Neurosurgery, University of Virginia, Charlottesville †Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York ‡Department of Orthopaedic Surgery, Northwestern University, Chicago, IL §Department of Orthopaedic Surgery, University of Utah, Salt Lake City ¶Department of Neurosurgery, University of Kansas, Kansas City ?Department of Orthopaedic Surgery, Washington University, St Louis, MO **Department of Neurosurgery, Rush Medical Center, Chicago, IL ††Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA ‡‡Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, Ontario, Canada; and §§Department of Neurological Surgery, University of California, San Francisco.
Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S161-70
Post hoc analysis of prospectively collected data.
Development of methods to determine in vivo spinal cord dimensions and application to correlate preoperative alignment, myelopathy, and health-related quality-of-life scores in patients with cervical spondylotic myelopathy (CSM).
CSM is the leading cause of spinal cord dysfunction. The association between cervical alignment, sagittal balance, and myelopathy has not been well characterized.
This was a post hoc analysis of the prospective, multicenter AOSpine North America CSM study. Inclusion criteria for this study required preoperative cervical magnetic resonance imaging (MRI) and neutral sagittal cervical radiography. Techniques for MRI assessment of spinal cord dimensions were developed. Correlations between imaging and health-related quality-of-life scores were assessed.
Fifty-six patients met inclusion criteria (mean age = 55.4 yr). The modified Japanese Orthopedic Association (mJOA) scores correlated with C2-C7 sagittal vertical axis (SVA) (r = -0.282, P = 0.035). Spinal cord volume correlated with cord length (r = 0.472, P
The Canadian C-spine (cervical spine) Rule (CCR) and the National Emergency X-Radiography Utilization Low-Risk Criteria (NLC) are criteria designed to guide C-spine radiography in trauma patients. It is unclear how these 2 rules compare with young children.
This study retrospectively examined case-matched trauma patients 10 years or younger. Two cohorts were identified-cohort A where C-spine imaging was performed and cohort B where no imaging was conducted. The CCR and NLC criteria were then applied retrospectively to each cohort.
Cohort A contained 125 cases and cohort B with 250 cases. Seven patients (3%) had significant C-spine injuries. In cohort A, NLC criteria could be applied in 108 (86.4%) of 125 and CCR in 109 (87.2%) of 125. National Emergency X-Radiography Utilization Low-Risk Criteria suggested that 70 (58.3%) cases required C-spine imaging compared to 93 (76.2%) by CCR. National Emergency X-Radiography Utilization Low-Risk Criteria missed 3 C-spine injuries, and CCR missed one. In cohort B, NLC criteria could be applied in 132 (88%) of 150 and CCR in 131 (87.3%) of 150. The NLC criteria identified 8 cases and CCR identified 13 cases that would need C-spine radiographs. Fisher's 2-sided Exact test demonstrated that CCR and NLC predictions were significantly different (P = .002) in both cohorts. The sensitivity of CCR was 86% and specificity was 94%, and the NLC had a sensitivity of 43% and a specificity of 96%.
Although CCR and NLC criteria may reduce the need for C-spine imaging in children 10 years and younger; they are not sensitive or specific enough to be used as currently designed.
During World War II new programs for medical treatment and rehabilitation reduced mortality rates following spinal cord injury from over 80 percent in World War I to below 10 percent by 1946. In Canada a group of physicians, veterans, and civilians developed one of the first comprehensive sets of programs and services to permit the return of veterans with spinal cord injury to independent life in the community, beyond the confines of hospitals or paraplegic colonies. This article reviews the activities of Dr. E. Harry Botterell, Lieutenant John Counsell, and Dr. Al Jousse in the development of a Canadian approach that revolutionized the life experiences and life expectancy of individuals with spinal cord injury. It describes the development of their philosophy of rehabilitation as well as the programs and services they established at the No. 1 Canadian Neurological Hospital in England, and at Christie Street Military Hospital, Lyndhurst Lodge, and the Canadian Paraplegic Association in Canada.
(1) Describe the self-care, productivity and leisure problems identified by individuals with a spinal cord injury (SCI) during rehabilitation, (2) describe the perceived level of satisfaction and performance with self-care, productivity and leisure activities following an SCI, (3) quantify the relationship between the Canadian occupational performance measure (COPM), a client-centred, individualized measure of function, and the functional independence measure (FIM).
Tertiary rehabilitation centre, spinal cord injury unit, GF Strong Rehabilitation Centre, Vancouver, Canada.
Health records from 41 individuals with an SCI admitted between 2000 and 2002 were reviewed. Information was obtained from assessments performed on admission and discharge. Self-care, productivity and leisure problems identified by individuals with an SCI were described and their perceived level of performance and satisfaction was calculated. The relationship between the COPM and the FIM was measured by the Pearson product correlation.
Self-care goals were identified most frequently (79%) followed by productivity (12%) and leisure (9%) goals. The top three problems identified by individuals with an SCI were functional mobility (including transfers and wheelchair use), dressing and grooming. A fair relationship was found between the COPM and the FIM (r between 0.351 and 0.514, P
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