Adjustment following spinal cord injury.

Investigated specific coping strategies associated with psychological adjustment following spinal cord injury with a battery of assessments administered to 57 patients (median age 26.5 yrs) participating in a spinal cord injury rehabilitation program. Ss were divided into 3 groups based on degree of psychological distress. High-distress Ss reported using more Wish-Fulfilling Fantasy, Emotional Expression, Self-Blame, and Threat Minimization Coping strategies relative to the low and moderate distress groups. The Self-Blame Coping strategy was significantly correlated with psychological distress over and above age, time since injury, or level of injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Employment outcomes following spinal cord injury

PURPOSE: We determined the clinical utility of proton MR spectroscopy in defining the extent of disability in benign versus secondary-progressive multiple sclerosis (MS). METHODS: Thirty patients with clinically definite MS, including 16 patients with benign MS and 14 with secondary-progressive MS, and a group of 13 healthy volunteers were studied with combined stimulated-echo acquisition mode proton MR spectroscopy and MR imaging (all patients received contrast material). RESULTS: Acute enhancing lesions of benign and secondary-progressive MS were characterized by a reduction in N-acetylaspartate (NAA)/choline and NAA/creatine and an increase in inositol compounds/creatine as compared with normal white matter. Such variations were also detected in chronic unenhancing lesions in patients with secondary-progressive MS, although they were not found in chronic unenhancing lesions in patients with benign MS. Chronic lesions of the two forms of the disease have significative differences in NAA and inositol signals. CONCLUSION: Proton MR spectroscopy is able to show metabolic changes occurring in the white matter of patients with MS. Such changes differ according to the phase (acute versus chronic) and the clinical form (benign versus secondary-progressive) of the disease.     

Social support and depression following spinal cord injury.

Examined the associations of different social relationships with depressive behavior among 182 adults with acquired spinal cord injuries. Trained interviewers administered a social provisions scale and an inventory to diagnose depression. A cross-sectional design was used to investigate possible differential effects across time since the onset of injury. Relationships that reassured the worth of the individual were predictive of lower depression scores. To a lesser extent, relationships providing a sense of social integration were associated with lower depression scores. (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)     

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)     

Alcohol abuse history and adjustment following spinal cord injury.

Objective: Examined the relation of alcohol abuse history to emotional adjustment and pressure sore occurrence during the 1st 3 years following Spinal Cord Injury (SCI). Study Design: Comparisons were made between varying levels of prior abuse and depression and disability acceptance. A model predicting pressure sore occurrence over 3 years was computed. Participants: One hundred seventy-five persons completed the self-report measures; 105 were available for pressure sore evaluations. Main Outcome Measures: The Inventory to Diagnose Depression, the Acceptance of Disability Scales, and pressure sore occurrence. Results: Alcohol abuse was not associated with depression or disability acceptance. Severe alcohol abuse history was associated with pressure sores over the 3 years. Conclusions: Persons with prior history of severe alcohol abuse may be at increased risk for pressure sore occurrence during the 1st years of SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of emotional distress following a spinal cord injury.

Evaluated a new instrument, the Medical-Based Emotional Distress Scale (MEDS). The MEDS assesses emotional reactions (dysphoria, irritability) in response to a severe physical illness or disability, excluding symptoms that could be the direct result of a physical condition or problem, and includes subscales measuring affective reactions, behavioral changes, and cognitive distortions. A sample of 81 adults with a spinal cord injury was evaluated with the MEDS as well as the SCL-90, Zung Self-Rating Depression Scale, Hopelessness Scale, and Rosenberg Self-Esteem Scale. The MEDS subscales displayed moderately high internal consistency. Positive evidence of validity was found for MEDS subscales in the assessment of emotional distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol use and activity patterns following spinal cord injury.

Studied the relationship between predisability alcohol use and activity patterns in 103 persons with recent onset spinal cord injury. Ss reported biographic information, alcohol use, and number of drinking problems during the 6 mo prior to injury, completed a disability acceptance scale, and reported activities during hospitalization. Ss who drank more before injury and who reported more family drinking problems also reported a greater number of drinking problems; in turn, persons with more drinking problems reported spending less time in quiet activities such as sleeping and resting during rehabilitation hospitalization, but spent more time in quiet recreation (e.g., watching TV, reading). Furthermore, persons who drank more reported spending less time in productive activities such as rehabilitation therapies. Findings highlight relationships that may affect rehabilitation outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quantitative assessment of respiratory function following contusion injury of the cervical spinal cord

A prerequisite for higher-level visual tasks such as object recognition is a segmentation of the image into distinct two-dimensional regions. While it has long been assumed that the human visual system jointly exploits region and boundary cues for image segmentation, we report the results of psychophysical experiments which suggest that the visual system relies on geometric properties of bounding contours such as closure and not on the texture of the two-dimensional regions they partition. These findings suggest that the visual system may code and links contours into coherent shapes before surface properties are conjoined.     

Sexual satisfaction in males following spinal cord injury as a function of locus of control.

Examined the variance in mens' sexual satisfaction following spinal cord injury as it relates to their beliefs in their ability to control the reinforcements received from sexual experience. It was hypothesized that greater degrees of internal locus of control (LOC) would be associated with greater sexual satisfaction, taking into account the relative value that sexual experience has for the individual and the degree of impairment of sexual function. Questionnaire data were gathered on 118 paraplegic and quadriplegic men (aged 21–69 yrs). A hierarchical multiple regression analysis demonstrated that greater internal sex-related LOC accounted for a significant proportion of the variance in sexual satisfaction. However, value of reinforcement did not have the predicted effect on the relationship between the variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Musculocutaneous nerve palsy following traumatic spinal cord injury

Whipple's disease is a multisystem bacterial disease usually characterized by malabsorption, diarrhea and polyarthritis. Ocular manifestations include uveitis, vitreitis, retinis, myositis, papilledema and optic atrophy. We report a case of a chronic bilateral vitreitis in a 63 year-old man who had been treated for a Whipple's disease with gastrointestinal involvement 30 years before. The jejunal biopsy was negative but the polymerase-chain-reaction (PCR) revealed the presence of Trophyrema Whippelii in the vitreous prelevement of both eye. This new, original strategy of PCR is specific and more sensitive than histological diagnosis.     

Vocational achievements following spinal cord injury in Australia

Twenty alkanediamines were designed according to structure-activity relationships drawn from previous parts of this series and synthesized. Their general structure is CH3-(CH2)n-CHNH2-(CH2)m-CHNH2-(CH2)n-CH3, (n = 2-10; m = 3-6). Twelve of them inhibited the aggregation of human blood platelets in concentrations between 3-10 micromol/L halfmaximally (Born test, inducer collagen). With increasing m a decreasing n is necessary to achieve the optimum activity. In the most active compounds (7b, 7e, 7p) it is found that m + n = 9. When the nitrogen functions are hydroxyalkylated secondary amines with similar antiplatelet effects are obtained. The conversion of the amino groups into syndronimines is accompanied by the loss of activity. The bisethoxycarbonylderivatives of 7f and 7m (8f, 8m) exhibited antithrombotic effects in rats after oral administration.     

Employment following spinal cord injury: A covariance structure analysis.

120 former patients of a rehabilitation center responded to a survey that tested 2 structural models of employment status following spinal cord injury. The direct effect model provided a very poor representation of the data. The model proposed in this study provided a better fit, but also fell short of the minimum acceptable goodness-of-fit standards. Educational attainment (EA), motivation to work (MTW), social support, and driving one's own car had significant direct paths to employment status. EA and lesion level were linked to MTW. Age at injury directly predicted EA. The hypothesized link between locus of control and MTW was rejected, and subsequent investigation raised questions about its direction of causality with other variables in the model. A revised model for future research was presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eradication of urinary tract infection following spinal cord injury

A prospective study to evaluate the microbiological efficacy of antimicrobial treatment for urinary tract infection (UTI) was performed in 64 catheter-free spinal cord injured (SCI) patients who were visited monthly by a public health nurse who collected urine for culture and urinalysis. Patients also mailed urine dip slides for weekly bacterial counts. UTI was defined as a culture yielding > or = 100,000 colonies/ml. Treatment was given to asymptomatic patients only if pyuria (> or = 10 urinary leukocytes/high powered microscopic field) was present. Initial treatment was for 7-14 days (group 1). When it became apparent during the study that eradication was difficult and relapse or reinfection frequently occurred within a short time after cessation of antibiotic, a second treatment course of > or = 28 days (group 2) was given. By the end of the study, in which all patients were followed for a minimum of 30 days post treatment, 39/42 (93%) cases in group 1 and 11/13 (85%) in group 2 who had initial eradication, had relapsed or become reinfected. The median number of days and standard error for group 1 to relapse or become reinfected was 16 +/- 2.5, and for group 2 it was 27 +/- 6. Development of drug resistance was documented when bacteria isolated prior to any treatment were compared with strains isolated after > or = 28 days of antibiotics. In this study, urine sterility was achieved in a minority of treated UTIs and was relatively short lived.(ABSTRACT TRUNCATED AT 250 WORDS)     

Factors affecting employment following spinal cord injury: A qualitative study.

Examined factors that differentiated persons with spinal cord injury (SCI) who returned to work from those who did not. Ss were 6 employed persons with SCI matched with 6 unemployed persons with SCI on the basis of education, race, age, gender, time since injury, and level of function. Semistructured interviews 1 to 2 hrs in length were completed and transcribed. The responses of the employed were compared with those of the unemployed using grounded theory. The theory is inductively derived from the qualitative data. Psychological and environmental factors were the most salient factors affecting employment in this matched sample. Key psychological factors associated with employment were optimism, self-esteem, achievement orientation, and role models. Key environmental factors were monetary incentives, disincentives, access, and accommodation. Conclusions: The development of increased optimism may promote employment for persons with SCI. Employment barriers and the perception of these barriers as insurmountable need to be decreased. Policies that promote return to work with former employers are likely to improve employment rates for persons with SCI A more intensive job exploration process using job shadowing of peers and positive peer models may also improve employment after SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spontaneous long-term remyelination after traumatic spinal cord injury in rats

The capability of the central nervous system to remyelinate axons after a lesion has been well documented, even though it had been described as an abortive and incomplete process. At present there are no long-term morphometric studies to assess the spinal cord (S.C.) remyelinative capability. With the purpose to understand this phenomenon better, the S.C. of seven lesionless rats and the S.C. of 21 rats subjected to a severe weight-drop contusion injury were evaluated at 1, 2, 4, 6, and 12 months after injury. The axonal diameter and the myelination index (MI = axolemmal perimeter divided by myelinated fiber perimeter) were registered in the outer rim of the cord at T9 SC level using a transmission electron microscope and a digitizing computer system. The average myelinated fiber loss was 95.1%. One month after the SC, 64% of the surviving fibers were demyelinated while 12 months later, only 30% of the fibers had no myelin sheath. The MI in the control group was 0.72 +/- 0.07 (X +/- S.D.). In the experimental groups, the greatest demyelination was observed two months after the lesion (MI = 0.90 +/- 0.03), while the greatest myelination was observed 12 months after the injury (MI = 0.83 +/- 0.02). There was a statistical difference (p < 0.02) in MI between 2 and 12 months which means that remyelination had taken place. Remyelination was mainly achieved because of Schwann cells. The proportion of small fibers (diameter = 0.5 micron or less) considered as axon collaterals, increased from 18.45% at 1 month to 27.66% a year after the contusion. Results suggest that remyelination is not an abortive phenomenon but in fact a slow process occurring parallel to other tissue plastic phenomena, such as the emission of axon collaterals.     

Axonal sprouting following incomplete spinal cord injury: an experimental model

Estrogen replacement therapy in postmenopausal women is associated with a decreased mortality and morbidity from stroke. The present study was undertaken to investigate the effects of estrogen on endothelial cell glucose transporter 1 (GLUT 1) and on the cell viability during focal ischemia in a rat model. Female rats were ovariectomized (OVX) and 2 weeks later 17beta-estradiol (E2) was injected subcutaneously at a dose of 100 microg/kg 2 h before unilateral middle cerebral artery (MCA) occlusion. Ischemic lesion size was quantified using 2,3,5-triphenyl tetrazolium chloride (TTC) staining and GLUT 1 protein was analyzed by Western blotting. E2 treatment decreased ischemic lesion size in slices taken at 9 and 11 mm posterior from the olfactory bulb by 46.3% and 44.1%, respectively (P < 0.05). GLUT 1 protein decreased in both OVX and E2 groups by 24.6% and 22.7% respectively (P < 0.05) compared with the non-lesioned side in the core ischemic region, including the basal ganglia. GLUT 1 protein was increased in the E2-treated group compared with the control group (23.3%, P < 0.05) in the penumbral ischemic region of the cortex. Primary rat brain capillary endothelial cell (BCEC) cultures were established as an in vitro model for ischemic effects on endothelial cells. Estrogen reduced BCEC loss by 35.9%, 28.4% and 23.5% (P < 0.05) when glucose in the culture medium was reduced to 50%, 20% and 10%, respectively; and by 28.4% and 18.4% (P < 0.05) following 1 or 4 h of anoxia, respectively. This study demonstrates that estrogen treatment increases GLUT 1 transporters and protects BCEC loss which may in turn reduce focal ischemic brain damage.     

Brief screening for psychological and substance abuse disorders in veterans with long-term spinal cord injury.

Objective: To determine rates of positive screens for psychological and substance use disorders in persons with long-term spinal cord injury (SCI). Study Design: A naturalistic cohort design wherein consecutive admissions during an 8-month period completed the screening battery. Setting: Veterans Affairs SCI Center. Participants: One hundred fifteen men, 2 women, mean age 57.4 years, injured an average of 20 years, readmitted for various reasons. Main Outcome Measures: The Alcohol Use Disorders Identification Test (AUDIT) and screening items for depression and anxiety disorders. Results: Rates of positive screens ranged from 6.2% for alcohol problems to over 40% for anxiety disorders. Positive screens for depression and anxiety correlated positively with the number of recent hospital admissions. Conclusions: Systematic brief screening for psychological and substance abuse disorders in this population revealed rates of positive screens at least equal to those in other medical patient populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)