Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation

Objective: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. Design: Multicentre longitudinal study. Subjects: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. Methods: Assessments at the start of active rehabilitation (n = 212), 3 months later (n = 143), at discharge (n = 191) and 1 year after discharge (n = 143). Results: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: 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. Conclusion: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations. © 2007 Foundation of Rehabilitation Information

The Wheelchair Circuit: Construct Validity and Responsiveness of a Test to Assess Manual Wheelchair Mobility in Persons With Spinal Cord Injury

Kilkens OJ, Dallmeijer AJ, de Witte LP, van der Woude LH, Post MW. The Wheelchair Circuit: construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury. Arch Phys Med Rehabil 2004;85:424-31. Objective To assess the validity and responsiveness of the Wheelchair Circuit, a test to assess manual wheelchair mobility in persons with spinal cord injury (SCI). Design Longitudinal. Subjects performed the Wheelchair Circuit at the start (T1) and at the end (T3) of inpatient functional rehabilitation. Construct validity and responsiveness were assessed. Setting Eight rehabilitation centers in the Netherlands. Participants Seventy-four subjects with SCI admitted for inpatient rehabilitation. Interventions Not applicable. Main outcome measures The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. The construct validity of the Wheelchair Circuit was assessed by testing whether the test scores were significantly related to the subjects' functional status, physical capacity, lesion level, motor completeness of the lesion, and age. To prove the test's responsiveness, it was assessed whether the test scores had significantly improved between T1 and T3. Results For construct validity, 4 of the 5 hypotheses were confirmed. For test responsiveness, all 3 test scores had significantly improved during rehabilitation, and the standardized response mean values ranged from 0.6 to 0.9. Conclusions The Wheelchair Circuit is a valid and responsive instrument with which to measure manual wheelchair mobility in subjects with SCI. © 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Rapid and extensive arterial adaptations after spinal cord injury

Contains fulltext : 50350.pdf (publisher's version ) (Closed access)OBJECTIVE: To assess the time course of adaptations in leg vascular dimension and function within the first 6 weeks after a spinal cord injury (SCI). DESIGN: Longitudinal study design. SETTING: University medical center and rehabilitation clinic. PARTICIPANTS: Six men were studied serially at 1, 2, 3, 4, and 6 weeks after SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Diameter, blood flow, and shear rate levels of the common femoral artery (CFA), superficial femoral artery (SFA), brachial artery, and carotid artery were measured with echo Doppler ultrasound (diameter, blood flow, shear rate). Endothelial function in the SFA was measured with flow-mediated dilation (FMD). In addition, leg volume and blood pressure measurements were performed. RESULTS: Femoral artery diameter (CFA, 25%; SFA, 16%; P<.01) and leg volume (22%, P<.01) decreased simultaneously, and these reductions were largely accomplished within 3 weeks postinjury. Significant increases were observed for basal shear rate levels (64% increase at week 3; 117% increase at week 6; P<.01), absolute FMD responses (8% increase at week 3, 23% increase at week 6; P<.05) and relative FMD responses (26% increase at week 3, 44% increase at week 6; P<.001). CONCLUSIONS: Our findings show a rapid onset of adaptations in arterial dimension and function to extreme inactivity in humans. Vascular adaptations include extensive reductions in femoral diameter and leg volume, as well as increased basal shear rate levels and FMD responses, which all appear to be largely accomplished within 3 weeks after an SCI

Functional independence and health-related functional status following spinal cord injury: A prospective study of the association with physical capacity

Objective: To determine changes in functional independence following spinal cord injury and to evaluate the association between functional independence and physical capacity. Design: Multi-centre prospective cohort study. Subjects: Patients with spinal cord injury admitted for initial rehabilitation. Methods: The motor Functional Independence Measure (FIMmotor) was determined at the start of rehabilitation (n=176), 3 months later (n=124), at discharge (n=160) and one year after discharge from inpatient rehabilitation (n=133). One year after discharge, physical and social dimensions of health-related functional status (Sickness Impact Profile 68; SIP68) were determined. On each occasion, physical capacity was established by measuring arm muscle strength, peak power output and peak oxygen uptake. Results: Multi-level random coefficient analyses revealed that FIMmotor improved during inpatient rehabilitation, but stabilized thereafter. Changes in FIMmotor were associated with peak power output. Multiple regression models showed that FIMmotor and peak power output at discharge were associated with FIMmotor one year after discharge (R2=0.85), and that peak power output at discharge was associated with the social dimension of the SIP68 (R2=0.18) one year after discharge. Conclusion: Functional independence improves during inpatient rehabilitation, and functional independence is positively associated with peak power output

Effectiveness of a Self-Management Intervention to Promote an Active Lifestyle in Persons With Long-Term Spinal Cord Injury: The HABITS Randomized Clinical Trial

Background. Most people with long-term spinal cord injury (SCI) have a very inactive lifestyle. Higher activity levels have been associated with health benefits and enhanced quality of life. Consequently, encouraging an active lifestyle is important and behavioral interventions are needed to establish durable lifestyle changes. Objective. The Healthy Active Behavioral Intervention in SCI (HABITS) study was aimed to evaluate the effectiveness of a structured self-management intervention to promote an active lifestyle in inactive persons with long-term SCI. Methods. This assessor-blinded randomized controlled trial was conducted at 4 specialized SCI units in the Netherlands. Sixty-four individuals with long-term SCI (>10 years), wheelchair-user and physically inactive, were included. Participants were randomized to either a 16-week self-management intervention consisting of group meetings and individual counseling and a book, or to a control group that only received information about active lifestyle by one group meeting and a book. Measurements were performed at baseline, 16 weeks, and 42 weeks. Primary outcome measures were self-reported physical activity and minutes per day spent in wheelchair driving. Secondary outcomes included perceived behavioral control (exercise self-efficacy, proactive coping), stages of change concerning exercise, and attitude toward exercise. Results. Mixed models analyses adjusted for age, sex, level of SCI, time since injury, baseline body mass index, and location did not show significant differences between the intervention and control groups on the primary and secondary outcomes (P ≥.05). Conclusions. A structured 16-week self-management intervention was not effective to change behavior toward a more active lifestyle and to improve perceived behavioral control, stages of change, and attitude

Passive shoulder range of motion impairment in spinal cord injury during and one year after rehabilitation

Objective: To investigate the prevalence and course of passive shoulder range of motion in people with a spinal cord injury and the relationships between shoulder range of motion limitations and personal and lesion characteristics. Design: Multicentre longitudinal study. Subjects: A total of 199 subjects with spinal cord injury admitted to specialized rehabilitation centres. Methods: Assessments of shoulder range of motion at the start of active rehabilitation, 3 months later, at discharge and one year after discharge. Results: Up to 70% (95% confidence interval (CI): 57-81) of the subjects with tetraplegia and 29% (95% CI: 20-38) of those with paraplegia experienced a limited range of motion of the shoulder during, or in the first year after, inpatient rehabilitation. Shoulder flexion was affected most. Up to 26% (95% CI: 20-37) of subjects had a shoulder range of motion limitation on both sides. Increased age, tetraplegia, spasticity of elbow extensors and longer duration between injury and start of active rehabilitation increased the risk. Presence of shoulder pain is associated with limited shoulder range of motion. Conclusion: Limited shoulder range of motion is common following spinal cord injury. Tetraplegia, increased age, spasticity of elbow extensors, longer duration between injury and start of active rehabilitation and shoulder pain are associated with an increased risk for shoulder range of motion problems and require extra attention. © 2009 The Authors

The longitudinal relation between physical capacity and wheelchair skill performance during inpatient rehabilitation of people with spinal cord injury.

Objective: To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury (SCI) during rehabilitation. Design: Observational prospective cohort study. Measurements were taken 3 times during subjects' rehabilitation. Setting: Eight rehabilitation centers in the Netherlands. Participants: Ninety-seven subjects with SCI. Interventions: Not applicable. Main Outcome Measures: Parameters of physical capacity were upper-extremity muscle strength (manual muscle test [MMT] sum score), peak oxygen uptake, and peak power output (POpeak). The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. Results: POpeak was related to all 3 scores of the Wheelchair Circuit, and the MMT sum score was related to the ability score and the performance time score. The results indicate that (1) subjects with higher values of POpeak and/or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and (2) when a subject increased his/her POpeak and/or MMT sum score, this was associated with better wheelchair skill scores. Conclusions: There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI. To optimize wheelchair skill performance, attention should be directed toward manual wheelchair exercise training and strength training of the upper body. © 2005 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Duration and functional outcome of spinal cord injury rehabilitation in the Netherlands.

This study describes the length of stay (LOS) and functional outcome of spinal cord injury (SCI) in the Netherlands and its determinants. Data of 157 patients from eight rehabilitation centers were available. Mean age was 40.0 years and 76.4% were traumatic injuries, 39.8% had tetraplegia, and 69.9% had a motor complete SCI. Median LOS was 240 days (interquartile range 164-322). Median motor Functional Independence Measure (FIM) scores at discharge were 37.3 for persons with complete tetraplegia and 69.7 for persons with complete paraplegia. Level and completeness of injury, bed rest because of pressure sores, and LOS were predictors of motor FIM scores. Duration of SCI rehabilitation in the Netherlands is long compared with the literature. Functional outcome appears slightly better in persons with complete tetraplegia, but not in persons with complete paraplegia when compared with data from the United States. International studies are necessary to reveal strengths and weaknesses of SCI rehabilitation systems in different countries