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.
This paper provides a brief overview of the epidemiological data regarding Canadians with physical disabilities, with a particular emphasis on health status. A literature review is then presented, focusing on activity levels and the physiological and health-related quality of life benefits of activity for people with four different physical disabilities (arthritis, fibromyalgia, spinal cord injury, and multiple sclerosis). The unique physical activity barriers faced by people with physical disabilities are discussed. The paper concludes with recommendations for the development of a physical activity guide for Canadians with physical disabilities.
To describe the physician utilization patterns (family physicians (FP), specialist and emergency department (ED) visits) of adults with traumatic spinal cord injury (SCI) 1 year after the initial injury.
A total of 559 individuals with a traumatic SCI were identified. Five administrative databases were linked to examine health-care utilization in acute care, inpatient rehabilitation, chronic care rehabilitation, outpatient physician visits and ED visits. Factors predicting frequent physician, specialist and ED use were identified.
The mean number of physician visits for traumatic SCI patients during the first year after their injury onset was 31.7 (median 26). FPs had the greatest number of visits (mean 11.6, median 7) followed by physiatrists (mean 6.1, median 2). Factors predicting 50 or more physician visits included age 70 or above (OR=3.6, 95% CI=2.0-6.5), direct discharge to chronic care (OR=3.6, 95% CI=1.0-13.1) and in-hospital complication (OR=2.34, 95% CI=1.3-4.3). Age 70 or less (OR=0.19, 95% CI=0.0-0.9) and direct discharge to chronic care were associated with 50 or more specialist visits. Only rurality predicted two or more visits to the ED.
Individuals with traumatic SCI show significant physician utilization, especially among their FPs and physiatrists. Although the factors predicting higher physician and specialist utilization may reflect individuals with the most severe impairment, comorbid conditions or lack of social support, the model for higher ED visits may point to limited accessibility to/availability of primary care services for SCI patients in rural regions.
Over the last 20 years the Respiratory Unit at Danderyd Hospital, Sweden has treated and rehabilitated more than 90 patients on domiciliary ventilation, the majority of whom require night-time ventilation. Sixteen patients (11 men and 5 women) with high spinal cord lesions have been treated. Of these 16 patients, 9 are using diaphragmatic pacing. Every patient has a customised tube. If the patient can use diaphragmatic pacing the tube, as a rule, is single fenestrated. In patients using the ventilator full time, the tube is made to fit snugly in the trachea. When such a tube fits 'as a bullet in its tube' there is no need for a cuff. The patient has adequate ventilation and the small leak around the tube also permits good speech function. Sometimes a PEEP-valve is used to get a better voice.