Sexual health of persons with spine injuries complicated by neurological disorders

Mimo że Światowa Organizacja Zdrowia uznaje zdrowie seksualne za istotny składnik dobrostanu człowieka, jakość życia seksualnego osób niepełnosprawnych wciąż jest pomijana w procesie rehabilitacji medycznej i psychospołecznej. Jedną z przyczyn tej sytuacji jest niedostateczna wiedza na temat wpływu niepełnosprawności fizycznej na jakość życia seksualnego pacjenta oraz mylne przekonanie o nieodwracalności negatywnych skutków. Celem pracy jest przedstawienie aktualnej wiedzy dotyczącej zdrowia seksualnego osób po urazie kręgosłupa powikłanym zaburzeniami neurologicznymi. W pracy skoncentrowano się na omówieniu wpływu urazu na zaburzenie reakcji seksualnych u kobiet i mężczyzn. Przedstawiono również wiedzę na temat aspektów płodności oraz prokreacji osób po urazie kręgosłupa powikłanym zaburzeniami neurologicznymi. Dokonany przegląd literatury może być pomocny w opracowaniu modelu rehabilitacji seksualnej tej grupy pacjentów.Despite of World Health Organization recognizes sexual health as an important component of human wellbeing, sexual life quality of physically disabled persons is still neglected in medical and psychosocial rehabilitation. One of causes of this situation is poor knowledge about consequences of a physical disability on sexual life and inadequate opinions that these negative consequences are irreversible. The purpose of this paper is to present the state of the art of sexual health concentrating on people with spinal injuries complicated by neurological deficite. The influence of an injury on sexual reaction in women and men were considered. Moreover, fertility aspects and specific problems with pregnancies and labors were discussed. The performed review may be helpful in elaboration of sexual rehabilitation of these patients

Relationship between secondary health conditions and life satisfaction in persons with spinal cord injury:study across twenty-one countries

Purpose: To determine the relationships between impact of secondary health conditions (SHCs), treatment of SHCs, and life satisfaction (LS) following spinal cord injury (SCI) across 21 countries. Hypotheses were as follows: (1) Persons with SCI and fewer SHCs report higher LS and (2) Persons who receive treatment for SHCs report higher LS than those who do not receive treatment.Methods: Cross-sectional survey, including 10,499 persons with traumatic or non-traumatic SCI aged 18 years or older and living in the community. To assess SHCs, 14 items adapted from the SCI-Secondary Conditions Scale were used (range 1–5). SHCs index was calculated as the mean of all 14 items. LS was assessed using a selection of 5 items from the World Health Organization Quality of Life Assessment. LS index was calculated as the mean of these 5 items. Results: South Korea, Germany, and Poland exhibited the highest (2.40–2.93) and Brazil, China, and Thailand the lowest (1.79–1.90) impact of SHCs. Indexes for LS and SHCs were inversely correlated (– 0.418; p &lt; 0.001). Mixed Model Analysis showed that the fixed effect (key predictors of the study) of SHCs index (p &lt; 0.001) and the positive interaction between SHCs index and treatment (p = 0.002) were significant determinants of LS.Conclusion: Persons with SCI across the world are more likely to perceive better LS if they experience fewer SHCs and receive treatment for SHCs, in comparison to those who do not. Prevention and treatment of SHCs following SCI should be a high priority in order to improve the lived experience and enhance LS.</p

Evidence-based position paper of the UEMS PR M on the role of Physical and Rehabilitation Medicine (PR M) physician in the management of children and adults with spinal dysraphism

Spinal dysraphism (SD) or spina bifida (SB) is a congenital deformity that results from embryonic neural tube closure failure during fetal development. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. This paper aims to evaluate the role of the physical and rehabilitation medicine (PR M) physician and PR M practice for children and adults with spinal dysraphism. A systematic literature review and a consensus procedure involved all European countries delegates represented in the UEMS PR M section through a Delphi process. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The professional role of the PRM physician requires specific expertise in the treatment of patients with SD to plan, lead and monitor the rehabilitation process in an interdisciplinary setting and to participate in the assessment of the needs of these patients in the transitional phase from childhood to adulthood, with particular attention to the activity limitation and participation restriction.Peer reviewe

Zmiany parametrów wentylacyjnych w trakcie pionizacji osób po urazie rdzenia kręgowego w odcinku szyjnym

Background: Cervical spinal cord injury (CSCI) is followed by mixed respiratory dysfunction.Purpose: Evaluation of the ventilatory parameters of CSCI patients in postures typical for positional training. Material: 51 CSCI patients in a mean age of 34.4 (SD=14.6) years; complete motor deficite (CMD) 66.6%; injury of C5 level or above – 68.6%. Control group(CG): 10 healthy volunteers. Method: Spirometry and flow-volume examination in recumbent (R), sitting (S) and vetrical 60o tilt (V) positions. Main results: Expiratory reserve volume (ERV) undergoes significant positional changes in CG (R: 1.34 L, H: 0.25 L, V: 0.79 L; p=0.02), but not in CSCI patients. Transition from R to S in CMD persons results in a significant decrease in vital capacity (VC) (from 2.45 to 1.75 L; p=0.0008); inspiratory capacity (IC) (from 2.48 to 1.41 L; p=0.0008); forced expiratory volume in 1 second (FEV1) (from 2.21 to 1.64 L; p=0.002); forced vital capacity (FVC) (from 2.55 to 1.78 L; p=0.0004). The FEV1/FVC rate does not depend on positional changes ranging from 89.7% to 93.9% of the reference values. Ventilatory parameters in the incomplete motor deficite (ICMD) group do not differ significantly between the examined body positions. Transition between R and S in the CMD group results in a significant decrease in the peak expiratory flow (PEF) (from 4.23 to 3.53 L/s) and the peak inspiratory flow (PIF) (from 3.89 to 3.43 L/s), while in ICMD the PEF increases from 4.01 to 4.39 L/s and the PIF increases from 3.66 to 4.18 L/s.Conclusions: Transition from R to S in CSCI patients results in increased restriction. CMD patients express a reduction of peak flows while in the ICMD peak flows increase after transition between R and S. Shifting from S to a 60o vertical tilt with standard trunk stabilization does not change significantly the ventilatory parameters in CSCI patients

Współczesne metody oceny układu wydalniczego u osób po urazie kręgosłupa powikłanym zaburzeniami neurologicznymi – diagnostyka dolnych dróg moczowych

Introduction: Spinal injury with neurological deficit usually results in a neurogenic bladder disorder. The problem may range from total lack of micturition during the spinal shock phase to various forms of detrusor-sphincter dyssynergia. Typical consequences include increased intra-vesical pressure, inability to effectively empty the bladder, increased risk of vesico-ureteral reflux, infection, bladder or kidney stones, neoplastic complications within the urinary tract and renal failure. Proper diagnostics of urinary tract function and morphology enables choosing adequate bladder emptying strategy, early diagnosis and effective treatment of urinary complications in patients after spinal injury with neurological deficit.Study purpose: Presentation of contemporary methods of functional, imaging and endoscopic diagnostic tests of the lower urinary tract in patients with spinal injury with neurological deficit. We discuss clinical value and accuracy of particular diagnostic methods in prevention and monitoring of the therapy of urinary complications.Study form: Literature review.Conclusions: Although urodynamic studies serve as the principal tool among the modern methods of the lower urinary tract function assessment, simple functional tests such as measurement of residual urine volume measurement or cystometrogram may be helpful in clinical practice, particularly during the early post-traumatic phase. Ultrasonographic examination is the first choice imaging study. Clinical validity of screening cystoscopy in spinal injury with neurological deficit patients remains doubtful, but this procedure is of unquestionable value in cases with haematuria

Wpływ urazu kręgosłupa powikłanego zaburzeniami neurologicznymi na funkcje seksualne – dysfunkcje seksualne u mężczyzn

Sexual impairment and decreased fertility constitute a part of a complex dysfunction typical for men with spinal injury with neurological consequences (SINC). Despite the progress in medical sciences and quality of care provided for disabled persons, the problem is often neglected by medical professionals and caregivers.Aim of the study: Presentation of patophysiological background and specificity of sexual dysfunction typical for men following SINC. Review of contemporary treatment modalities designed for erectile dysfunction and infertility in men after SINC.Method: Literature review, authors’ clinical experience.Results and conclusions: Specific neurological deficit with overlapping adaptation problems and depression account for erectile dysfunction in men after SINC. There is a wide range of efficient therapies addressed to patients suffering from erectile disturbances resulting from SINC. Selection of a proper therapy depends on location (level) of the lesion of a neural structure, type of deficit, functional status, presence of symptoms of autonomic dysreflexia, concomitant diseases and patient’s individual preferences. Patient’s awareness of the disability and positive attitude towards acceptance of alternative forms of sexual expressions are crucial for the therapeutic success. Ejaculation dysfunction and infertility are common among men after SINC. Application of contemporary methods of assisted reproduction may be efficient in about half of male population with SINC

Impact of spinal injury with neurological consequences on sexual function: Sexual dysfunctions in women

Patophysiological background of sexual dysfunctions in women after spine injury with neurological consequePatophysiological background of sexual dysfunctions in women after spine injury with neurological consequences (SINC) is a difficult object of scientific investigations and is not as accurately described as sexual impairment in men after SINC. In particular, systematic reports on pregnancy and its complications in women after SINC are lacking. Aim of the study: Presentation of backgrounds and specificity of sexual disorders, dysfunctions of partner relationships and contraception in women after SINC.Method: Literature review, authors’ clinical experience.Results and conclusions: Persons with sexual dysfunction following SINC should be subjected to psychological evaluation and specified sexual education. These specific interventions should be introduced at the appropriate time and take into account functional progress made during rehabilitation and the level of patients’ acceptance of disability. Partner’s involvement is crucial for effective psychotherapy of persons after SINC. A possibility to take the advantage of experience of other persons with a similar disorder is of particular value during the therapy. There is a positve correlation between the ability to experience sexual satisfaction and quality of social adaptation after SINC. The form, acceptance and efficiency of sexual education in persons after SINC are affected by cultural conditions.nces (SINC) is a difficult object of scientific investigations and is not as accurately described as sexual impairment in men after SINC. In particular, systematic reports on pregnancy and its complications in women after SINC are lacking. Aim of the study: Presentation of backgrounds and specificity of sexual disorders, dysfunctions of partner relationships and contraception in women after SINC.Method: Literature review, authors’ clinical experience.Results and conclusions: Persons with sexual dysfunction following SINC should be subjected to psychological evaluation and specified sexual education. These specific interventions should be introduced at the appropriate time and take into account functional progress made during rehabilitation and the level of patients’ acceptance of disability. Partner’s involvement is crucial for effective psychotherapy of persons after SINC. A possibility to take the advantage of experience of other persons with a similar disorder is of particular value during the therapy. There is a positve correlation between the ability to experience sexual satisfaction and quality of social adaptation after SINC. The form, acceptance and efficiency of sexual education in persons after SINC are affected by cultural conditions

Responding to the World Health Organization Gobal Disability Action Plan in Ukraine: Developing a National Disability, Health and Rehabilitation Plan

In order to support the development of a National Disability, Health and Rehabilitation Plan (NDHRP) for Ukraine, a technical consultation was carried out by a Rehabilitation Advisory Team (RAT) of the International Society of Physical and Rehabilitation Medicine (ISPRM) in 2015. The consultation was based on assessment of the situation of persons with disabilities and the rehabilitation system in Ukraine. Recommendations for activities and projects to improve rehabilitation services within the healthcare system were developed and proposed. In order to reach consensus on the recommendations, dialogues were held with different stakeholders, including the Ministry of Public Health. The recommendations included: coordination of disability and rehabilitation policies within the Ministry of Public Health and among other involved ministries; translation and adaptation of international definitions of functioning, disability, and assessment tools into Ukrainian; data collection on the epidemiology of disability and the need for rehabilitation; implementation of health-related rehabilitation services; and implementation of international definitions and curricula of rehabilitation professions. The mission was regarded as successful and one year later a few changes had been adopted by the Ukrainian government. Further action based on this research is necessary. It will be important to track the changes and evaluate the results after an appropriate period of time

Współczesne metody oceny układu wydalniczego u osób po urazie kręgosłupa powikłanym zaburzeniami neurologicznymi – diagnostyka górnych dróg moczowych

Introduction: Morbidity and mortality related to urinary tract diseases in patients after spinal injury with neurological disturbances (SIND) are modifiable if prompt and rational diagnostics and therapy are implemented in comprehensive care. SIND increases the risk of urinary tract damage resulting from neurogenic bladder dysfunction, sequels of patient’s immobilisation, nephrotoxic effect of pharmacotherapy, necessity of bladder catheterisation. Severe damage to the urinary system resulting from reflux, urolithiasis, hydronephrosis, recurrent pyelonephritis can occur both during the early and the late phase following SIND. The risk of urinary tract cancer is markedly increased in SIND patients. The natural history of urinary tract diseases in SIND patients might be changed. The course of the disease can be scant in symptoms and signs until late stages. Study design: Overview of scholarly literature.Aim of the study: Presentation and analysis of clinical usefulness of modern tests applied in diagnostics of the urinary tract function in SIND patients. We discussed appropriateness and clinical usefulness of imaging and functional procedures of the upper urinary tract evaluation with special emphasis on basic laboratory tests, modern methods of glomerular filtration rate (GFR) assessment in SIND patients, as well as on the traditional and modern imaging studies.Conclusions: Modern comprehensive care of a patient with SIND, both at the early and late stage following spinal injury, should comprise systematic monitoring of renal function. Efficacious diagnosis is based on meticulous clinical examination. Auxiliary tests are performed according to their availability and the anticipated clinical relevance. First line diagnostic tests should comprise non-invasive techniques. Systematic and credible GFR assessment is indicated in SIND patients. Tests of choice include: 51CrEDTA or 99mTcDTPA clearance, assessment of cystatin-C level, as well as routine imaging studies of the kidneys such as renal radioisotope scanning and ultrasound examination. Urography and computed tomography may serve as auxiliary imaging techniques