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.     

Treatment of erectile dysfunction secondary to spinal cord injury: Sexual and psychosocial impact on couples.

17 males with spinal cord injury (SCI) and their partners, screened for suitability for pharmacological intervention for erectile dysfunction, were assessed pre- and postintervention on measures of marital, social, personality, and sexual functioning. Intervention did not affect general measures of life satisfaction or personality functioning. A positive impact on a general measure of marital satisfaction and on several measures of sexual functioning was noted, generally more so for SCI males than their partners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the PHQ-9 screen for depression across time since injury among persons with spinal cord injury.

Objective: The overlap of somatic-depressive symptoms and physical sequelae of spinal cord injury (SCI) has raised concerns regarding the validity of depression screens used within the SCI population. The Patient Health Questionnaire-9 (PHQ-9) measure parallels Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) criteria of major depression. The authors investigated PHQ-9 factor structure among persons with SCI at various times postinjury. Design: Data from 2,570 participants at 1 year (N = 682), 5 years (N = 517), 15 years (N = 653), and 25 years (N = 718) postinjury were used. Emergent factors were correlated with satisfaction with life. Results: A 2-factor solution emerged for all groups, with 3 affective referenced items (feeling depressed/hopeless, feeling bad about self/failure, and suicidal ideation) and 3 somatic referenced items (sleep disturbance, low energy/fatigue, and appetite disturbance) loading consistently on Affective and Somatic factors, respectively, at all time points. Factor scores negatively correlated with satisfaction with life. Conclusions: Dual factor structure of the PHQ-9 is present at various times postinjury in the SCI population. It remains unclear whether somatic item endorsement reflects depressive symptomatology per se; however, endorsement is still associated with satisfaction with life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of marital life in Korean spinal cord injured patients

The purposes of this study were to assess the quality of marital life and to investigate the most serious problem in the marital relationships of Korean spinal cord injured patients. 30 spinal cord injured (SCI) couples (SCI husbands and their non-disabled wives) who were married prior to injury and 30 able-bodied (AB) couples participated in a questionnaire study. The quality of marital life was measured with three parameters: marital stability, marital adjustment, and marital satisfaction. The results were as follows: (1) The marriage of chronic SCI couples was not noticeably unstable when compared with that of AB couples; (2) There was no significant difference in dyadic adjustment and marital satisfaction between SCI couples and AB couples; (3) There was no significant difference in marital stability, marital adjustment, and marital satisfaction between SCI husbands and their wives; (4) SCI couples had more cohesive marital relationships and SCI husbands expressed less affection to their wives than AB husbands and (5) Sex was the most serious problem in marriages of SCI couples. In conclusion: (1) the quality of marital life in chronic SCI couples is not highly different from that of AB couples; (2) There is no significant difference in the quality of marital life between chronic SCI husbands and their non-disabled wives; and (3) It is considered necessary that rehabilitation program for SCI patients should include information on the altered physiology of sexual function of SCI patients and subsequent mutual adaptation to changed sexual function.     

Urachal remnants

OBJECTIVE: Three a priori hypotheses were tested: (1) There are significant differences in sociosexual behaviors of women with physical disabilities compared with women without disabilities; (2) the sexual functioning of women with disabilities is significantly related to age at onset of disability; (3) psychological factors explain more of the variance in the sexual functioning of women with physical disabilities than do disability, social and environmental factors. DESIGN: Case-comparison study using written survey. SETTING: General community. PARTICIPANTS: The questionnaire was mailed to 1,150 women with physical disabilities who were recruited as volunteers or through independent living centers. Each woman gave a second copy of the questionnaire to an able-bodied female friend, which comprised the comparison group. The response rate was 45%, with 475 cases and 425 comparisons eligible to participate. The most common disability type was spinal cord injury (24%), followed by polio (18%), muscular dystrophy (11%), cerebral palsy (11%), multiple sclerosis (10%), joint disorders (7%), and skeletal abnormalities (5%). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sexual-functioning, consisting of four factors: (1) sexual desire, (2) sexual activity, (3) sexual response, (4) sexual satisfaction. RESULTS: Highly significant differences were found in level of sexual activity (p = .000001), response (p = .000009), and satisfaction (p=.000001) between women with and without disabilities. No significant differences were found between groups on sexual desire. Severity of disability was not significantly related to level of sexual activity. CONCLUSIONS: Psychological and social factors exert a strong impact on the sexual functioning of women with physical disabilities. Further investigations is needed of the effect of social environment on development of self-esteem and sexual self-image, and how these influences affect levels of sexual functioning in women with physical disabilities.     

Stress appraisal in women with spinal cord injury: Supplementary findings through mixed methods.

A study was conducted to examine how women with spinal cord injury (SCI) perceive the stressors they encounter, and how cognitive appraisal is associated with coping and life satisfaction. Fifty women with SCI were interviewed regarding their experience with stress and coping. The interviews were then coded using a framework based on stress and coping theory (transactional model). The systematic application of quantitative methods to the coded interview data allowed for statistical analyses, which demonstrated that the context in which the women spoke about their experiences with various stressors was associated with coping strategies, time since injury, and life satisfaction. Although stress and coping are commonly seen as interacting constructs that influence quality of life outcomes, current findings suggest that appraisal of stressors in the context of loss (more common among women more recently injured) may have a direct impact on life satisfaction apart from any coping strategies put into effect. Interventions designed to facilitate coping with loss and enhance problem-solving skills, along with education about available resources, may foster a sense of empowerment after SCI and ultimately change how stressors are perceived and managed in order to dampen their negative impact on life satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neural activity affects distribution of glutamate receptors during neuromuscular junction formation in Drosophila embryos

The prevalence of diseases associated with obesity, such as cardiovascular disease and diabetes mellitus, is higher in the spinal cord injury (SCI) population. Specifically, the mortality rate for cardiovascular disease is 228% higher in the SCI population. In addition, 100% of SCI individuals have osteoporosis in the paralysed extremities. These diseases are related to physical activity level, the level of the spinal cord lesion, and time post injury. Physically active SCI men and women have above-average fat mass (16 to 24% and 24 to 32%, respectively, compared with 15% for able-bodied men and 23% for able-bodied women), while sedentary SCI individuals have 'at-risk' levels of body fat (above 25% and 32%, respectively). The proportions and densities of the 3 main constituents comprising the fat-free body (mineral, protein and water) are altered following SCI. Bone mineral content decreases by 25 to 50%, and the magnitude of reduction is dependent on the level, completeness and duration of SCI. Because of denervation resulting in skeletal muscle atrophy, total body protein reduces by 30%, and total body water relative to bodyweight decreases by 15% following SCI. Indirect methods based on 2-component body composition models assume constant proportions and densities of mineral, protein, and water in the fat-free body. As a result, prediction equations based on 2-component models yield invalid estimates of fat and fat-free mass in the SCI population. Therefore, future research needs to directly quantify the proportions and densities of the constituents of the fat-free body in the SCI population relative to age, sex, physical activity level, level of the spinal cord lesion and time post injury, and to develop equations based on multicomponent body composition models.     

Sexuality after spinal cord injury: A conceptual model based on women's narratives.

Objective: To investigate how women experience and conceptualize their sexuality after traumatic spinal cord injury (SCI). Research Method: Semistructured interviews and member checks with 24 women with SCI (ages 18-67) were conducted and content analyzed. Results: A conceptual model of sexual domains is proposed. Proposed domains are self- versus other focus, genital versus whole-body focus, physical versus holistic intimacy, sexuality as bodily versus mental phenomenon, exuberance versus negativity, and past versus present focus. Domains are defined and illustrated with narrative excerpts. They are conceptualized as fluid and nonexclusive. Conclusion: Endorsement of domains can change through ongoing adjustment to injury and life events. Clinical implications and suggestions for future research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Preferred methods and messengers for delivering physical activity information to people with spinal cord injury: A focus group study.

Objective: To explore the perceptions of people with spinal cord injury (SCI) regarding preferred messengers and methods for obtaining physical activity (PA) information. Design: Using a phenomenological approach and interviewing techniques, five focus groups discussed PA information delivery methods and messengers. Participants: Sixteen community-dwelling adults with SCI (62.5% tetraplegia, 37.5% paraplegia; at least one-year postinjury) whose PA levels ranged from sedentary to regularly active. Results: Content analyses revealed that the preferred media for obtaining PA information were passive sources (e.g., Internet, DVDs, newsletters). The preferred messengers were peers and health service providers. There were diverse perspectives about the value and types of PA messages to share with people in the acute, rehabilitation, and postdischarge stages. Conclusions: The methods and messengers identified in this study illustrate the need for interdisciplinary engagement among various program and health care providers to work together to effectively deliver PA information to all individuals with SCI. People will be receptive to different messages, from different channels, at different times. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Attribution of responsibility for onset of spinal cord injury and psychosocial outcomes in the first year post-injury.

Attribution questionnaires were administered to spinal cord injury patients during rehabilitation and at 1-yr (postinjury) follow-up in a prospective study of the relationship between attributions and psychosocial outcomes. Ss were also asked to complete life and family satisfaction scales prior to discharge and at 1-yr follow-up. A staff member reviewed chart data and rated the patient as an innocent victim or risk denier. Sample sizes for analysis varied (because of dropouts and missing data) from 80 to 104 primarily male patients. Results show that self-attribution of responsibility was associated with lower life satisfaction during rehabilitation, but this difference dissipated by 1-yr postinjury. Self-attribution of responsibility was not predictive of patient assessed family adjustment. It is concluded that staff assessment of patient responsibility for onset of injury is not predictive of outcomes even when congruence/incongruence between patient and staff attributions is examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Radiofrequency catheter ablation therapy in elderly patients with supraventricular tachycardia

In the present study, long-term and short-term rat preparations were used to develop a model for investigating external anal sphincter (EAS) reflexes in intact and spinal cord-injured (SCI) rats. In this model, EAS distension with an external probe elicits reflex contractions of the EAS in intact, unanesthetized animals. At 2 h after spinal cord transection, none of the lesioned animals displayed EAS EMG activity. In fact, once distended, the EAS was incapable of maintaining closure of the anal orifice. Over a period of 4 days, spinalized animals developed a hyperreflexia of the EAS response. By 48 h, the rectified, integrated EAS EMG was significantly elevated in comparison with nonlesioned controls (EAS hyperreflexia). In addition, the duration of the EAS EMG bursts in response to sphincter distension had significantly increased. At 6 weeks after injury, the EAS was significantly hyperreflexic as measured by EMG burst duration and burst area. As with intact animals, posttransection EAS reflexes were highly anesthesia sensitive. These studies indicate that (1) brief distension of the anal orifice is sufficient to evoke a physiologically relevant reflexive activation of the EAS in the rat, (2) the 2- to 24-h postinjury areflexia observed in these experiments may be a suitable model for the study of spinal shock, and (3) the observed EAS hyperreflexia after chronic SCI may represent the permanent effects of removing descending inhibitory circuits and segmental plasticity, making this reflex an appropriate measure of defecatory dysfunction after spinal cord injury.     

Pre- and Postinjury Substance Misuse Among Veterans With Spinal Cord Injury.

Objective: To identify rates of substance misuse with onset before and after spinal cord injury (SCI) and to investigate whether patients with a history of substance misuse are more likely to report being intoxicated at the time of injury. Participants: One hundred twenty-four veterans with traumatic SCIs. Measures: Alcohol and nonalcohol psychoactive substance use disorder (PSUD) sections of the Structured Clinical Interview for DSM-III-R. Results: Forty (32%) had a lifetime PSUD. Of those, 55% recalled the onset of their PSUD occurring preinjury, 27.5% recalled the onset occurring postinjury, and 17.5% could not recall their age at onset. Compared with participants who reported postinjury onset of PSUD, those with reported preinjury onset were more likely to report intoxication at time of injury. No significant relation was found between intoxication at injury and presence of a lifetime PSUD. Conclusion: Intoxication at injury does not necessarily substantiate the existence of an underlying substance misuse problem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thyroid carcinoma in intrathoracic goiter

While research on spinal cord injury (SCI) is abundant, few studies focus on women. This population-based study investigates differences in the prevalence of secondary conditions between 128 women and 522 men. Case managers retrospectively interviewed 650 persons regarding medical and psychological conditions secondary to SCI, as well as other life issues. Overall, males and females show more similarities than differences in the ways in which they manage life with SCI. Differences were found, though, regarding etiology of initial injury, insurance coverage, caregiver use, transportation use, medication use, and in other medical and behavioral areas. Females are significantly involved in more automobile crashes than males, while males are involved in more galls than females. Females are more reliant on Medicaid, while males report more Medicare and Worker's Compensation coverage. Females are more likely to have a paid attendant as a caregiver while males are more likely to have their spouse or parents assist. Males report more independence in their use of transportation than females. Males and females also report significant differences in the use of medication. Females are more likely to use medication any time it is a treatment option. Males are more active, use tobacco more and have more arm fractures postinjury than females.     

Social Support and Adjustment After Spinal Cord Injury: Influence of Past Peer-Mentoring Experiences and Current Live-In Partner.

Objective: To compare the impact of 2 types of social support, past peer-mentoring experience (PME) and current live-in partner (LIP), on adjustment after spinal cord injury (SCI). Participants: Sixty-two individuals with SCI (mean age=42 years: 11.7 years since injury). Design: Cross-sectional survey. PME (yes vs. no) and LIP (yes vs. no) were nearly equally balanced, affording 2X2 factorial analyses. Outcome Measures: Craig Handicap Assessment and Reporting Technique, Brief Symptom Inventory, and Satisfaction With Life Scale. Results: PME, which typically concluded over 10 years ago, was associated with higher occupational activity and life satisfaction, whereas having an LIP was associated with greater mobility and economic self-sufficiency. Conclusion: PME positively complements more traditionally studied sources of social support, which is encouraging for the use of PME as a clinical intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alterations in temporal/spatial distribution of GFAP- and vimentin-positive astrocytes after spinal cord contusion with the New York University spinal cord injury device

Astrocytes become reactive as a result of various types of lesions and upregulate 2 intermediate filaments, glial fibrillary acidic protein (GFAP), and the developmentally regulated protein vimentin. Young female Sprague-Dawley rats were subjected to a spinal cord contusion at segment T10 using the New York University injury device. Animals were killed at 1, 2, 7, 14, and 30 days postinjury. Horizontal spinal cord sections spanning segments T7-T13 were assessed with antibodies to both intermediate filament proteins. The number of gray matter GFAP-positive astrocytes increased by 2 days postinjury, with segments adjacent (proximal) to the injury site showing greater responses than areas several segments away (distal). By 30 days following injury, astroglial cell numbers returned to normal levels. Vimentin-positive astrocytes also showed a graded proximal/distal response by 2 days following injury. Proximal regions remained significantly higher at 30 days following injury than control animals. Rostral/caudal changes were also evident, with regions caudal to the injury showing significantly higher numbers of vimentin positive astrocytes than those rostral, indicating that gray matter areas caudal to spinal cord injury may undergo more stress following spinal cord injury.     

Long-term outcomes and life satisfaction of adults who had pediatric spinal cord injuries

OBJECTIVE: To determine long-term outcomes and life satisfaction of adults who sustained pediatric spinal cord injury (SCI). DESIGN: Structured interview of adults who were 25 years or older who had pediatric SCI. SETTING: Community. PARTICIPANTS: A convenience sample of 46 patients from a total of 81 patients who received care in an SCI program: 1 refused participation, 4 died, and 30 were lost to follow-up. MAIN OUTCOME MEASURES: A structured questionnaire including physical, psychosocial, and medical information. The Craig Handicap Assessment and Reporting Technique and two measures of life satisfaction were also administered. RESULTS: Participants were 25 to 34 years old, mean 27 years. Thirty-two had tetraplegia and 14 had paraplegia. Thirty-one were men. Mean years of education was 14. Fifty-four percent were employed, 48% lived independently, and 15% were married. Life satisfaction was associated with education, income, satisfaction with employment, and social/recreation opportunities, and was inversely associated with some medical complications. Life satisfaction was not significantly associated with level of injury, age at injury, or duration of injury. CONCLUSIONS: Individuals who had pediatric SCI, much like adult-onset SCI, have the greatest opportunity for a satisfying adult life if rehabilitation emphasizes psychosocial factors such as education, employment, and long-term health management.