Recurrence of initial pressure ulcer in persons with spinal cord injuries

Whether treated with surgery or by conservative, nonsurgical measures, pressure ulcers recur in 5% to 91% of spinal cord injured (SCI) patients. Factors other than the surgical technique used or the standard conservative management provided may be responsible. A retrospective study of 176 SCI patients with a history of one or more pressure ulcers was conducted at the Department of Veterans Affairs Medical Center at Castle Point, N.Y. Approximately 35% of patients who received either surgical or nonsurgical treatment had a recurrence. Patients who smoked and patients with diabetes or cardiovascular disease had higher recurrence rates.     

Social support and the prediction of health complications among persons with spinal cord injuries.

Examined the relationship between interpersonal behavior and adjustment to spinal cord injury in 95 patients (aged 20–66 yrs) hospitalized at 3 facilities. In the 1st study, where predictor variables included social support, depression, and demographic factors, elements of social support were not significantly associated with reasons for hospitalizations. Older age, complete lesions, and paraplegia were significantly related to skin breakdown, cognitive problems, and less likelihood of routine checkups; tetraplegia was associated with checkups. The 2nd study reviewed the medical charts of 52 Ss from the 1st study and tallied the incidence of decubitus ulcers and urinary tract infections reported during the year. Discriminant function analysis found level of injury, lesion, age, depression, and elements of social support to be significantly predictive of health complications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vocational interests of persons with spinal cord injury.

Administered the Strong-Campbell Interest Inventory to 134 males (mean age 26.3 yrs) and 22 females (mean age 31.7 yrs) with spinal cord injury to assess Ss' vocational interests. Ss' scores were compared to the norms for men and women. Rank-order analysis indicated that males' responses showed them to be introverted and more interested in working with things than data or people. Although the smaller sample of females makes conclusions less certain, the females' responses were similar to the males'. Since the interests of these people were often incongruent with the physical limitations imposed by their disability, findings suggest that counselors must apply extra ingenuity to assist in identifying vocational alternatives. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marriage rates among persons with spinal cord injury.

Postinjury marriage rates of 6,853 persons enrolled in the National Spinal Cord Injury Statistical Center database between 1973 and 1992 were determined. Only 781 marriages occurred, whereas 1,884 marriages were expected based on 29,660 person-years of follow-up and overall annual marriage rates that were specific for age, gender, and previous marital status. Within the study population, characteristics associated with significantly elevated marriage rates included age between 30 and 44, college education, being divorced at injury, paraplegia, independence in ambulation and activities of daily living, and not being institutionalized. Standardized marriage rates were significantly below general U.S. population norms for all study population subgroups except those who were widowed and those who were at least 45 years of age at injury. Further research should focus on identifying reasons for the reduced marriage rate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latent variable structure of the Brief Symptom Inventory in a sample of persons with spinal cord injuries.

Investigated the presence of underlying factors which may be helpful in understanding Brief Symptom Inventory (BSI) item responses with 215 inpatientsresponse with spinal cord injuries. BSI scores were analyzed with principal components and maximum-likelihood factor estimation, and 6 factors were retained: anxiety, depression, mental blocks, interpersonal sensitivity, spinal cord injury, and hostile suspiciousness. Examination of factor content indicated their relevance to aspects of the rehabilitation process. Evidence for construct validity was examined by comparing the factor scores of persons who were rehospitalized versus persons who were not rehospitalized in the first year following initial rehabilitation. The rehospitalized group had higher BSI depression, mental blocks, and spinal cord injury factor scores prior to discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pregnancy in women with spinal cord injuries

Most women with spinal cord injuries (SCI) resume normal reproductive function, can have sexual relationships, and become pregnant. Pregnancy is not contraindicated in women with SCI, but pregnant women with acute or chronic SCI pose unique challenges for perinatal health care providers. The normal physiologic changes of pregnancy may predispose women with SCI to potentially life-threatening complications, including autonomic hyperreflexia, pyelonephritis, respiratory insufficiency, thrombophlebitis, and unattended delivery of the infant. This article reviews the effect of SCI on female reproduction, pregnancy, and labor, and summarizes the treatment of the pregnant woman with a spinal cord injury.     

Predicting life satisfaction among adults with spinal cord injuries.

Examined life satisfaction among 91 adults with spinal cord injury (SCI) through structured personal interviews that used the Center for Epidemiological Studies Depression Scale, Rosenberg's Self-Esteem Scale, the Life 3 Measure, and a number of items related to satisfaction with various life domains. Results suggest leisure satisfaction was the most significant predictor of life satisfaction, explaining 43% of the variance in the life satisfaction scores; an additional 16% of the variance was explained by self-esteem and health satisfaction. Findings highlight the role of leisure satisfaction in enhancing life satisfaction among individuals with SCI, given the high unemployment rate in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spine update. Urological management in patients with spinal cord injuries

In the past, urologic complications contributed greatly to spinal cord injury mortality. With improved evaluation and treatment, this is no longer the case. Treatment should be guided by urodynamic data gathered after the resolution of spinal shock symptoms. Goals of treatment are to facilitate voiding, reduce incontinence, and prevent renal damage. Indwelling catheters are almost never indicated for long-term treatment of the neurogenic bladder. Commonly used treatments include intermittent catheterization, condom catheter drainage with sphincter ablation, and pharmaceutical manipulation. Electrical stimulation of sacral nerve roots shows promise for future therapy.     

Substance abuse and medical complications following spinal cord injury.

Evaluated the relationship between substance use; depression and disability acceptance; and 2 preventable medical complications, pressure ulcers and urinary tract infections (UTIs), following spinal cord injury (SCI). 103 SCI patients (aged 16–63 yrs) undergoing inpatient rehabilitation, were recruited for interviews after 2-, 6-, and 18-mo of admission. 80 Ss completed all 3 evaluations, of which, 71 were followed up for 30 mo. Information was obtained on substance use, severity of drinking problems, depression intensity, and psychological aspects of post-injury adaptation. An increased risk of pressure ulcers 30 mo after injury, was associated with use of psychotropic medications, and abstinence from alcohol, with a history of drinking problems. UTIs were related to illicit substance use. Impairment characteristics were important predictors initially after injury, while abstinence with a history of drinking problems predicted ulcers later. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse and medical complications following spinal cord injury.

This study examined relationships between medical complications resulting in hospital stays and alcohol and illicit substance use in 71 persons with recent spinal cord injury (SCI). At 5 intervals after injury, medical records were reviewed for pressure ulcers and urinary tract infections (UTIs). Abstainers with histories of drinking problems before SCI were at greater risk for UTIs from 7 to 12 months after injury and for longer hospital stays. Former drinkers may not have implemented the self-care skills that were a focus during inpatient rehabilitation. Preinjury illicit substance abuse was related to an increased risk of pressure ulcers 30 months after SCL Clinical implications are clear: Psychologists should inquire about substance use patterns, monitor psychological well-being, and explore the ways in which self-care habits are related to substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postinjury employment outcomes among African-American and White persons with spinal cord injury.

Investigated the postinjury employment status of 1,042 Whites and 196 Blacks enrolled in the National Spinal Cord Injury Statistical Center database to determine whether factors that influence re-employment differ for the 2 racial groups. These factors included age, education, and marital status at time of injury; gender; neurologic level and extent of injury; and vocational rehabilitation client status. Age and education were found to predict employment status for both Whites and Blacks, with education being an especially strong predictor for Blacks. Gender had an impact on re-employment only for Blacks, while neurologic level of injury was predictive only for Whites. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immunogenicity of pneumococcal vaccine in persons with spinal cord injury

OBJECTIVE: To determine immunogenicity and optimum timing for administering the 23-valent pneumococcal vaccine after spinal cord injury (SCI). DESIGN: Double-blind, randomized, placebo control study. SETTING: SCI unit in a tertiary care medical center and community. PARTICIPANTS: Eighty-seven persons with recent SCI. INTERVENTION: Participants were randomized to receive either placebo or pneumococcal vaccine at 16 to 18 days versus 4 to 6 months postinjury. MAIN OUTCOME MEASURES: Antibody concentrations were measured prior to intervention and 1, 2, and 12 months afterward to evaluate the immune response to five serotypes of Streptococcus pneumoniae. Effects of demographic and injury-related variables on immune response were also evaluated. RESULTS: Timing of vaccination did not influence mean antibody concentrations for any serotype (p > .05). Ninety-five percent of vaccinated persons had twofold or greater increases in antibody concentration for at least one serotype when measured 1 month after vaccination versus 35% of placebo groups (p < .01). After 12 months, 93% of vaccinated persons in both groups maintained antibody concentrations twofold or greater than baseline values. CONCLUSIONS: Most participants developed an immune response to at least one serotype that was maintained for at least 12 months. Immune response varied according to serotype. Given the favorable immune response and no effect of timing, persons with SCI should receive pneumococcal vaccine during initial hospitalization.     

Operant conditioning of spinal stretch reflexes in patients with spinal cord injuries

Hyperactive spinal stretch reflexes (SSRs) often occur with spinal cord injuries (SCI). These altered SSRs may impair movement. Recent studies in monkeys and human subjects have indicated that the magnitude of SSRs can be modulated using operant conditioning. The purpose of this study was to determine whether hyperactive biceps brachii SSRs could be operantly conditioned downward. Seventeen chronic (> 1 year postlesion) spinal cord-injured patients participated. Subjects were trained to keep biceps background (prestretch) electromyographic (EMG) activity and elbow angle at predetermined levels prior to having the elbow rapidly extended by a torque motor to elicit the biceps SSR. All subjects participated in six baseline sessions over a 2-week period. Then, subjects were randomly assigned to either control or training groups for the next 24 sessions over an 8-week period. By the end of the study, training subjects had significantly reduced biceps SSRs (t test, P < 0.001), while control subjects SSRs were not significantly reduced (t test, P > 0.05). The reduced SSRs persisted for up to 4 months following cessation of training. The results of this study support the hypothesis that hyperactive SSRs can be operantly conditioned downward in SCI patients.     

Perceived risk for influenza in veterans with spinal cord injuries and disorders.

Objective: Guided by the extended parallel process model (EPPM), the objective was to assess control processes dominant in influenza behavior decisions. Design: Cross-sectional survey. Results: Response rate was 31% (n=968). Regarding influenza risk, 59% were in danger control. Those in fear control were more likely to report influenza infection (p=.000). In the nonvaccinated, those in fear control were more likely to indicate not knowing where to get the vaccine (p=.016) and that it was unavailable (p=.027), and those in danger control believed they did not need it (p=.023). Zero critical values were more likely to indicate that no health provider recommended the shot (p=.002). Conclusions: Most perceived efficacy to be stronger than threat related to influenza; according to the EPPM, they are aware of their risk but recognize their ability to avert it. For those in danger control, messages should focus on increasing perceptions of severity and susceptibility to positively affect behavior change. For those in fear control, messages should focus on efficacy only. With a critical value of zero, no threat is induced, and a high-threat/high-efficacy approach should be taken. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting compliance with annual follow-up evaluations in persons with spinal cord injury

In this study a representative sample of German acute care hospitals is used to describe the effects of dementia within acute care hospitals. Data from hospital patients above age 60 with the diagnosis dementia (ICD 290, 293, 294 and 310), collected over an observation period of 12 years, are compared with nondemented hospital patients at the same ages. The differences in the average length of stay between demented and nondemented patients are only relatively small in German acute care hospitals. The degree of multimorbidity is higher and hospital infections are more frequent for demented patients. The main differences occur with mortality: demented inpatients of both sexes experience a hospital mortality which is about twice as high as for nondemented patients at the same ages.     

Smoking behavior and readiness to change in male veterans with spinal cord injuries.

Objectives: Little is known about psychological factors associated with tobacco use in persons with spinal cord injuries and disorders (SCI&D). Method: Veterans with SCI&D who were current or past smokers were mailed survey questions about physical dependence on nicotine, motivation to smoke, readiness to quit, and use of tobacco cessation methods. Results: Of 684 respondents, 19% were current smokers. They were younger (Ms = 56.4 vs. 63.3 years; p     

Dynamic processes in health outcomes among caregivers of patients with spinal cord injuries.

The developmental trajectories of health outcomes in caregivers of patients with spinal cord injuries (SCIs) were studied as a function of caregiver and patient characteristics. Hierarchical linear modeling analysis examined (a) intraindividual developmental patterns of depressive behavior, anxiety, and physical symptoms over the 1st year of the caregiving career and (b) correlates of heterogeneity in the developmental patterns among 62 caregivers of persons with SCIs. Physical symptoms and anxiety were highly interdependent. Anxiety was a salient predictor of initial levels of and the rate of change in physical symptoms of caregivers. Physical symptoms and younger patient age were significantly predictive of initial levels of anxiety. Physical symptoms and positive affect predicted initial levels of depressive behavior among caregivers. Expressive support predicted the rate of change in anxiety and depressive behavior over time. These findings illustrate the value of studying caregiving as a developmental process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between pressure sores and psychosocial adjustment in persons with spinal cord injury.

Demonstrated a relationship between the occurrence of pressure sores during inpatient medical rehabilitation and scores on the Human Service Scale (HSS). 566 Ss with spinal cord injury who were 1–4 yrs postinjury participated. Results indicate that Ss who had developed pressure sores during inpatient rehabilitation scored lower on the HSS 1–4 yrs after discharge than did Ss who had not developed such sores. Possible explanations of this relationship are discussed with respect to activity repertoire, psychosocial adjustment, and compliance vs control. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)