Spinal Cord Injury Update
Winter 2008: Volume 17, Number 1
Literature Review
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Bowel
The pattern of colorectal dysfunction changes with time since spinal cord injury.
A total of 159 individuals with SCI belonging to the Danish Spinal Cord Injuries Association completed a questionnaire on colorectal function in 1996 and 2006. There were significant increases over the decade in the percentage of respondents reporting that colorectal dysfunction had some or a major impact on their quality of life (25% in 1996 to 38% in 2006); that they defecated less than every second day (11% to 19%); and that they spent more than 30 minutes at each defecation (16% to 25%). Digital anorectal stimulation or evacuation was performed at least once every week by 48% in 1996, increasing to 56% in 2006. Fecal incontinence was reported at least once a month by 22% in 1996, decreasing to 17% in 2006. While the frequency and severity of constipation-related symptoms increase with time since SCI, there is a decrease in the frequency of fecal incontinence.
Faaborg PM, Christensen P, Finnerup N, et al.
Spinal Cord. 2007 Sep 25; [Epub ahead of print]
Complications
Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation.
A total of 212 persons with a SCI admitted to specialized rehabilitation centres were assessed for medical complications at the start of active rehabilitation (n=212), 3 months later (n=143), at discharge (n=191) and 1 year after discharge (n=143). Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications.
Haisma JA, van der Woude LH, Stam HJ, et al.
J Rehabil Med. 2007 May;39(5):393-8.
Male fertility
Higher Sperm DNA Damage in Semen from Men with Spinal Cord Injuries Compared to Controls.
The sperm chromatin structure assay (SCSA) was used to investigate sperm DNA damage in the semen of men with SCI compared to control subjects. Men with SCI had significantly higher DNA Fragmentation Index (DFI). There was no significant difference in the DFI of samples obtained after prolonged (two to four weeks) anejaculation (no ejaculation) than samples obtained three days later. There was no significant difference in the DFI of semen samples that had been processed to remove dead sperm and leukocytes (white blood cells) than in unprocessed samples. DFI is higher in semen from men with SCI versus controls, and while the cause is unknown, it does not seem to be due to prolonged anejaculation or to the presence of dead sperm or leukocytes. The relevance of these findings to fertility outcomes with SCI male partners remains to be determined.
Brackett NL, Ibrahim E, Grotas JA, et al.
J Androl. 2007 Sep 5; [Epub ahead of print]
Pain
Pregabalin in patients with central neuropathic pain: A randomized, double-blind, placebo-controlled trial of a flexible-dose regimen.
This study evaluated the effects of pregabalin on pain relief, tolerability, health status, and quality of life in 40 patients with central neuropathic pain caused by brain or spinal cord injuries. At baseline and 4 weeks after the start of treatment, subjects were evaluated with standard measures of pain intensity, health status and quality of life. Subjects were randomly assigned to receive increasing doses of either pregabalin (150, 300, and 600mg/day) or matching placebo capsules. After four weeks, there were significant reductions in pain as well as improvements in health status in patients suffering from severe central neuropathic pain.
Vranken JH, Dijkgraaf MG, Kruis MR, et al.
Pain. 2007 Aug 17; [Epub ahead of print]
Acupuncture for chronic shoulder pain in persons with spinal cord injury: a small-scale clinical trial.
In this randomized, double-blind, placebo-controlled trial, 17 manual wheelchair users with SCI and chronic shoulder pain were randomly assigned to receive 10 treatments of either acupuncture or invasive sham acupuncture (light needling of nonacupuncture points). Changes in shoulder pain intensity were measured using the Wheelchair User’s Shoulder Pain Index. Shoulder pain decreased significantly over time in both the acupuncture and the sham acupuncture groups, with no significant difference between the 2 groups. There was, however, a medium effect associated with the acupuncture treatment, which suggests that it may be superior to sham acupuncture. A more definitive randomized controlled trial using a similar design should be done.
Dyson-Hudson TA, Kadar P, LaFountaine M, et al.
Arch Phys Med Rehabil. 2007 Oct;88(10):1276-83.
Psychosocial
Depression in adults who sustained spinal cord injuries as children or adolescents.
A telephone interview on depression was given to 232 adults (age 25 or older) who had sustained SCI as children (age 18 or younger). Twenty-seven percent reported depressive symptoms ranging from mild to severe; 7% reported having suicidal thoughts within the last 2 weeks; and 3% reported symptoms consistent with probable major depressive disorder. Depression was significantly associated with incomplete injury as well as with many participation outcomes, health-related quality of life, life satisfaction, and medical complications. Depression is a significant problem among adults with pediatric-onset SCI and is associated with poorer outcomes and lower quality of life. These findings should be addressed as clinicians prepare children and adolescents with SCI to transition to adulthood.
Anderson CJ, Vogel LC, Chlan KM, Betz RR, McDonald CM.
J Spinal Cord Med. 2007;30 Suppl 1:S76-82.
Cognitions, coping, and social environment predict adjustment to pain in spinal cord injury.
A total of 157 patients completed surveys assessing physical and psychological functioning, as well as psychosocial, demographic, and injury-related variables. Greater catastrophizing and pain-related beliefs (e.g., the belief that pain signals damage) were related with increased pain interference and poorer mental health, while coping styles (e.g., resting, asking for assistance) were related only with pain interference. Alternatively, greater perceived social support was related with better mental health. The findings are consistent with a biopsychosocial model of chronic pain, in which psychosocial variables such as coping, catastrophizing, pain-related beliefs, and social support are related to adjustment in persons with SCI and pain. These results have implications for interventions designed to treat pain interference in persons with SCI.
Raichle KA, Hanley M, Jensen MP, Cardenas DD.
J Pain. 2007 Sep;8(9):718-29. Epub 2007 Jul 5.
Resilient, undercontrolled, and overcontrolled personality prototypes among persons with spinal cord injury.
A sample of 199 persons with SCI were assessed on personality dimensions (using the NEO Five-Factor Inventory) at admission to an inpatient medical rehabilitation program. The patients fell into three personality groups or prototypes: resilient, undercontrolled, and overcontrolled. The largest group was the undercontrolled type. The resilient and undercontrolled types were better adjusted than the overcontrolled types, showing lower levels of depression at admission and higher acceptance of disability at discharge. Those who were classified as resilient at admission showed the most effective social problem-solving abilities at discharge, and the overcontrolled showed the least. The authors discuss implications of these results for assessment and interventions in rehabilitation settings.
Berry JW, Elliott TR, Rivera P.
J Pers Assess. 2007 Dec;89(3):292-302.
A longitudinal analysis of emotional impact, coping strategies and post-traumatic psychological growth following spinal cord injury: a 10-year review.
Eighty-seven people with traumatic SCI were assessed at 12 weeks post-injury and followed up 10 years later using measurements of depression, anxiety, coping, functional independence and social support. Rates of anxiety and depression had changed little over the 10-year period. Two-thirds of the sample showed no signs or symptoms of depression, and coping strategies remained relatively stable over time. Rates of post-traumatic psychological growth were associated with higher levels of psychological distress, suggesting that many people living with SCI manage the consequences of their disability without significant levels of psychopathology. However, the coping strategies they employ remain critical in accounting for this adjustment. The relationship between post-traumatic growth and psychological well-being was found to be complex, raising many questions for future research.
Pollard C, Kennedy P.
Br J Health Psychol. 2007 Sep;12(Pt 3):347-62.
Respiratory
Acute respiratory tract infection visits of veterans with spinal cord injuries and disorders: rates, trends, and risk factors.
In a Veterans Health Administration population of 18,693 veterans with spinal cord injury and dysfunction (SCI&D), investigators examined the rates of outpatient visits over 5 years (1998-2002) for acute respiratory tract infections (ARIs), including pneumonia and influenza (P&I), lower respiratory tract infections (LRIs), and upper respiratory tract infections (URIs). There were 11,113 ARI visits over the 5-year period, with a slightly decreasing trend for LRI visits over time but no significant change for other ARIs over time. There were 30 - 35 pneumonia visits and 21 - 30 acute bronchitis visits per 1,000 SCI&D veterans per year. Older veterans were more likely than younger to have P&I visits and less likely to have URI visits. Veterans with paraplegia had fewer P&I visits than those with tetraplegia. Identifying risk factors associated with ARI visits is an important first step to improve prevention and treatment of ARIs and to improve the health of veterans with SCI&Ds.
Smith BM, Evans CT, Kurichi JE, et al.
J Spinal Cord Med. 2007;30(4):355-61.
Survey of use of the insufflator-exsufflator in patients with spinal cord injury.
The insufflator-exsufflator is a device that pulls secretions out of the lungs by first inflating the lung, then reversing the flow with enough force to simulate cough. Although it has been shown to be effective in assisting cough in individuals with SCI, many institutions do not use it. A questionnaire with 4 categories of questions (knowledge of the device, type of facility, clinical practice with the device, and patient and provider satisfaction) was mailed to members of the American Paraplegia Society. Eighty-six questionnaires (16%) were returned. The device was being used in 49% of the institutions, most commonly with a tracheostomy. Use did not correlate with size or type of facility. Patient and provider satisfaction with the insufflator-exsufflator was high.
Schmitt JK, Stiens S, Trincher R, et al.
J Spinal Cord Med. 2007;30(2):127-30.
Exercise
The effects of upper body exercise on the physical capacity of people with a spinal cord injury: a systematic review.
In this systematic review of the medical literature, the authors identified 14 articles of acceptable quality for analysis. These showed that, following training, average increase in peak power output (PO(peak)) was 26.1% and oxygen uptake (VO(2peak)) was 17.6%. While overall quality of the studies was too low to draw definitive conclusions, results of the few studies with acceptable quality seem to support the view that upper body exercise may increase the physical capacity of people with SCI. The magnitude of improvement, however, varies considerably among studies.
Valent L, Dallmeijer A, Houdijk H, et al.
Clin Rehabil. 2007 Apr;21(4):315-30.
Other
Traumatic brain injury is under-diagnosed in patients with spinal cord injury.
This was a cross-sectional study using prospective neurological, neuropsychological and neuroradiological (magnetic resonance imaging) examinations and retrospective medical record review. Thirty-one traumatic SCI patients on their first post-acute rehabilitation clinic visit were assessed for mild traumatic brain injury (TBI) using American Congress of Rehabilitation Medicine diagnostic criteria. Twenty-three (74%) met the diagnostic criteria for TBI, which was classified as moderate or severe in 17 patients and mild in 6 patients. The results suggest a high frequency of TBI in patients with traumatic SCI and stress a special diagnostic issue to be considered in this patient group.
Tolonen A, Turkka J, Salonen O, et al.
J Rehabil Med. 2007 Oct;39(8):622-6.
The risk of bankruptcy before and after brain or spinal cord injury: a glimpse of the iceberg’s tip.
The incidence of bankruptcy before injury and five years after was tracked in 3,527 adults admitted to hospital with brain or spinal cord injury from 1991 to 2002. The incidence of bankruptcy 5 years postinjury was 3.5%. Bankruptcy was more frequent in patients with commercial medical insurance than those insured by Medicaid. Bankruptcy was not consistently related to injury severity; patients with critical injuries tended to have a lower incidence of bankruptcy than those with mild injuries. Bankruptcy incidence was higher in younger patients and those with positive toxicology or moderately elevated blood alcohol concentration. Compared with preinjury, there was a 33% increase in bankruptcy incidence postinjury. The relative increase was highest in Medicaid patients. Better rehabilitation, workforce reintegration, and disability programs might reduce bankruptcy postinjury.
Hollingworth W, Relyea-Chew A, Comstock BA, et al.
Med Care. 2007 Aug;45(8):702-11.
How to obtain the complete articles
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