Vocational perspectives after spinal cord injury

Objective: To give insight into the vocational situation several years after a traumatic spinal cord injury (SCI) and describe the personal experiences and unmet needs; to give an overview of health and functional status per type of SCI and their relationship with employment status.Design: Descriptive analysis of data from a questionnaire.Setting: Dutch rehabilitation centre with special department for patients with spinal cord injuries.Subjects: Fifty-seven patients with a traumatic SCI, aged 18-60 years, admitted to the rehabilitation centre from 1990 to 1998.Main measures: Questionnaire with items related to vocational outcome, job experiences, health and functional status.Results: Of 49 patients who were working at the moment of SCI 60% currently had a paid job. Vocational outcome was related to a higher educational level. A significant relation between the SCI-specific health and functional status and employment was not found. The respondents who changed to a new employer needed more time to resume work, but seemed more satisfied with the job and lost fewer working hours than those who resumed work with the same employer. In spite of reasonable to good satisfaction with the current work situation, several negative experiences and unmet needs were reported.Conclusions: Despite a high participation in paid work following SCI, the effort of the disabled worker to have and keep a job should not be underestimated.</p

Long-term outcome of sports injuries:results after inpatient treatment

OBJECTIVE: To investigate whether sports injuries result in long-term disabilities and handicaps and to establish variables with a prognostic value for the occurrence of these long-term consequences. MATERIALS AND METHODS: All patients older than 17 years of age and admitted to the University Hospital Groningen because of a sports injury were entered in the study. By filling in a questionnaire 1-4 years after the injury an inventory was made of the long-term consequences. MAIN OUTCOME MEASURES: Absenteeism from work and sports, experienced disabilities or handicaps and the Sickness Impact Profile 68 (SIP68). RESULTS: Out of 306 patients 229 (75%) returned a completed questionnaire. Sixty-seven per cent of the working population had been unfit for work up to one year, whereas 4% still had not resumed work. Absenteeism from sports was also considerable; nearly half of the population did not participate in sports for more than a year. Furthermore, 32% of the patients still experienced disability or handicap following the injury. This finding is in agreement with the results of the SIP68 (odds ratio 6.8; confidence interval (95% CI): 3.51-13.08). Two prognostic variables could be distinguished: 'gender' and 'type of sport'. Long-term consequences occur more often in women (p < 0.03) and with playing outdoor soccer, horse riding or skiing (p < 0.01). CONCLUSIONS: Sports injuries can lead to long-term disabilities and handicaps. The variables 'gender' and 'type of sport' were of prognostic significance. Record 2 of 12 - SilverPlatter MEDLINE(R)

AMPUTATION AND REFLEX SYMPATHETIC DYSTROPHY

Reflex sympathetic dystrophy is a chronic pain syndrome characterized by chronic burning pain, restricted range of motion, oedema and vasolability. Patients are difficult to treat and the prognosis is very often poor. This report emphasizes that an amputation in case of a reflex sympathetic dystrophy is mostly due to a too late recognition of this syndrome. In the international literature little is written about an amputation as a therapy for reflex sympathetic dystrophy. It is only mentioned as a therapy in the end stages of this syndrome. Sometimes a rejected amputation, as in this case report, can have a relatively good result. An early recognition of this pain syndrome produces the best possible outcome

Shoulder fusion for paralyzed upper limb

Fusion of the shoulder joint after a brachial plexus injury is a well known procedure in cases of flail shoulder in combination with normal motor and sensory function in the hand. However, in combination with modern orthoses to stabilize the elbow, fusion of the shoulder in cases of a totally flaccid and afunctional arm might be more beneficial. In a retrospective study the impact of shoulder fusion on daily abilities in a population with a completely flaccid arm caused by a brachial plexus injury was investigated. Compared with a similar population, consisting of 16 patients with an afunctional unstable shoulder, all 12 patients who underwent shoulder fusion proved to perform at a higher functional level. Shoulder fusion in combination with an elbow stabilizing orthosis for a completely flaccid upper limb is a beneficial procedure that leads to less disability and results in a better quality of life