Resource Guide for Secondary Complications of Individuals Aging with a Spinal Cord Injury

Purpose: The purpose of this scholarly project was to develop an easy to use resource guide to aid occupational therapists in working with those aging with a spinal cord injury (SCI) that have endured a secondary complication and advocating to other healthcare professionals the usefulness of occupational therapy in treatment of these individuals. Method: An extensive literature review was conducted using Cinahl, OT Search, PubMed, PsycInfo, various medical journals, OT course textbooks, and documents obtained from the American Occupational Therapy Association (AOTA) website. Information was gathered about aging with SCI, common secondary complications in SCI, OT’s role in SCI, OT’s role in pressure ulcer care, OT’s role in bladder and bowel dysfunction, and OT treatment for cardiovascular complications. Results: The Model of Human Occupation assisted in creating An Occupational Therapist’s Guide: Aging with a Spinal Cord Injury: Secondary Complications. The role of the occupational therapist was incorporated along with the Model of Human Occupation’s core components of volition, habituation, performance capacity and lived body, environment, dimensions of doing, and lifespan perspective as well as important findings from the literature review. Conclusions: The document created includes a thorough review of the three most common secondary complications in individuals aging with a SCI. The document addresses occupational therapy’s role in all areas of occupation for individuals aging with a SCI that have endured a secondary complication for both the occupational therapist as well as the ability to advocate to other healthcare professionals about the profession

Self-management interventions to improve skin care for pressure ulcer prevention in people with spinal cord injuries: A systematic review protocol

Background: Pressure ulcers are a serious, common, lifelong, and costly secondary complication of spinal cord injury (SCI). Community-dwelling people with a SCI can prevent them with appropriate skin care (i.e. pressure relieving activities, skin checks). Adherence to skin care remains suboptimal however, and self-management interventions that focus on improving this have been designed. Little is known on their content, effectiveness, or theoretical basis. The aim of the proposed systematic review is to synthesize the literature on self-management interventions to improve skin care in people with a SCI. Specific objectives are to describe these interventions in relation to their content, effectiveness, theory base, and adherence to reporting guidelines for intervention description. Methods: The search strategy will combine an electronic search of nine bibliographic databases (MEDLINE, Embase, PsycInfo, CENTRAL, CINAHL, Rehabdata, CIRRIE, PEDro, ERIC) and two trial registers with a manual search of relevant reference lists. Predefined eligibility criteria will be applied in a two-phase selection process involving title and abstract screening, followed by full-text screening. A data extraction spreadsheet will be applied to included papers. Intervention content will be coded using two taxonomies (behaviour change taxonomy; PRISMS self-management support taxonomy). A validated tool (Theory Coding Scheme) and the Template for Intervention Description and Replication (TIDieR) will be used to examine theoretical basis and assess adherence to reporting guidelines for intervention description. A small number of heterogeneous studies are likely to be included in this review therefore a narrative synthesis is planned. Discussion: This systematic review will help identify the gaps and priorities to guide future research activities in this area. Systematic review registration: PROSPERO CRD4201603319

Molecular Control of the Migratory Phase During Cutaneous Wound Healing

Superficial cutaneous injuries occur on a huge scale across the globe; while most will resolve without intervention or any lasting damage, many will experience complications that arise through delayed healing or as a consequence of the skins protective barrier being breached. The migration of cutaneous cells across a wound site is a crucial factor in establishing permanent restoration of the skins integrity. This study provides insight into molecular events that facilitate the migratory ability of cutaneous cells during this phase of the healing process. Through subcellular analysis, molecular manipulation and various imaging techniques of in vivo and in vitro wound models, this project has discovered that the autophagy pathway is activated in response to injury and also that the resultant autophagosomes form in a polarised manner towards the trailing end of migrating keratinocytes. Results indicate that initiation of autophagy is responsive to Wnt5a signals secreted by several cell types within the wound site and these signals must pass through Frizzled 3 receptors and Rho-associated protein kinase to activate nucleation of phagophore membranes. This study also develops and tests the use of novel wound healing platforms in the form of ex vivo murine models and 3-dimensional full-thickness human skin equivalents to help assess the role of autophagy specifically in the context of wound healin

Nursing and Clinical Evaluation in Spinal Cord Injury

This chapter aims to describe and evaluate the assessment tools for evaluating nursing and clinical aspects for people with SCI through a systematic review of scientific literature. The systematic review was conducted in line with COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) on PubMed, Scopus, CINAHL, and Web of Science. After removing duplicates, 3333 papers were screened. Of these, 476 were included in this systematic review. Among these, 55 papers were considered for this chapter. Results show 40 assessment tools that evaluate nursing and clinical aspects in persons with SCI. Among the 40 tools included in this chapter, most scales evaluate fatigue, skin management, bowel dysfunction, and pain. The most common assessment tools are the Spinal Cord Injury Pressure Ulcers Scale (SCIPUS) which is a 15-item risk assessment scale created to specifically evaluate the risk of pressure ulcer development, the Neurogenic Bowel Dysfunction (NBD) score which is a symptom-based score that evaluates the severity of colorectal dysfunction clinically, and the Brief Pain Inventory (BPI), which measures both pain intensity and pain interference with different domains of the life

A influência da posição corporal na prevenção de úlceras de pressão no indíviduo sentado

As Úlceras de Pressão preocupam doentes, famílias e profissionais de saúde. O seu aparecimento acarreta consequências graves para a saúde e custos elevados, quer para o doente como para as instituições de saúde, tornando-se por essa razão, numa preocupação constante e que urge por uma solução. Para os doentes com lesão vertebro - medular, as úlceras de pressão constituem a principal consequência, sendo que 70% desenvolvem uma úlcera de pressão. Intervir sobre o principal agente causal – a pressão – tem sido o principal objectivo da prática clínica e da investigação, sendo o reposicionamento a principal estratégia de alívio da pressão e a posição de deitado alvo do maior número de estudos publicados. Recentemente, estudos na posição de sentado e estudos sobre outros factores que intervêm na viabilidade tecidular, como a temperatura cutânea e os mediadores inflamatórios, têm sido foco de atenção por parte dos investigadores. Os indivíduos saudáveis não desenvolvem úlceras de pressão pois alteram a sua posição corporal ao longo do tempo, o que alivia a pressão e evita a lesão dos tecidos. O conhecimento dos ajustes corporais efectuados pelo indivíduo saudável permitirá estabelecer a frequência de reposicionamento do doente sentado que evite o aparecimento de lesão tecidular e que integre o plano de cuidados a indivíduos com limitação de mobilidade e de sensibilidade. Foi realizado um estudo quase - experimental, com 31 indivíduos saudáveis, 20 do sexo feminino e 11 do sexo masculino. Durante 1 hora permaneceram sentados sobre um tapete com sensores de pressão, sendo avaliada simultaneamente a aceleração do tronco, a temperatura cutânea e o desconforto. Foram ainda efectuadas 2 avaliações da integridade cutânea (antes e após a pressão) e 2 colheitas de sangue para verificar a concentração da interleucina 6 (antes e após a pressão). Os participantes efectuaram, em média, um reposicionamento a cada 4,6 minutos, movendo-se preferencialmente em dois eixos: horizontal e vertical. Os resultados apontam para um aumento de temperatura médio de 3,5ºC. Verificámos ainda que os praticantes de actividade física moderada apresentam níveis mais baixos de interleucina – 6, o que parece indicar que a prática de actividade física possa contribuir para a resistência tecidular e, como tal, integrar o plano de cuidados a indivíduos com limitações de mobilidade e de sensibilidade. Estudos futuros que aprofundem alguns dos temas aqui estudados serão essenciais para a compreensão multifactorial do aparecimento das úlceras de pressão.Pressure ulcers concern patients, families and healthcare professionals. Their appearance brings serious consequences to health and expensive costs for the patient and healthcare facilities, becoming a problem that needs an urgent solution. In what concerns to patients with spinal cord injury pressure ulcers are considered to be the main consequence, given the fact that 70% develop a pressure ulcer. Intervening on the main causative agent - the pressure - has been the main goal of clinical practice and research, and repositioning the main strategy for relieving the pressure and lying down position the target of the largest number of published studies. Recently, studies in sitting posture and studies about other causes that intervene in the tissue viability, as the skin temperature and inflammatory mediators have been a special concern for the researchers. Healthy individuals do not develop pressure ulcers because they change their body position, for as long as the time goes by, what releases the pressure and avoids tissue injury. The knowledge of body adjustments performed by the healthy individual will allow that the frequency of the reposition of the sitting patient prevents the appearance of an injured tissue and that integrates the healthcare plan to individuals with limitation of mobility and sensitivity. It has been made an almost - experimental study, with 31 healthy individuals, 20 of them were female and 11 male. For an hour they remained sat over a mat with pressure sensors, as the acceleration of the trunk, the skin temperature and the discomfort were being evaluated simultaneously. Two evaluations of skin integrity were made before and after the pressure, and also two blood collections to verify the concentration of interleukin 6 (before and after the pressure). On average, the participants have made a repositioning every 4,6minutes, moving preferentially along two axes: horizontal and vertical. The results point out to an increase of 3.5 degrees average temperature. We can also verify that those who have some physical activity present lower levels of interleukin – 6, so it seems that physical activity may contribute to tissue resistance and, as such, should be part of the plan care to individuals with limited mobility and sensitivity. Future studies concerning some of these issues studied here are essential to understand the multifactorial occurrence of pressure ulcers