The relationship between the extent of reciprocity with social supporters and measures of depressive symptomatology, impairment, disability, and handicap in persons with spinal cord injury.

140 adults (aged 19–77 yrs) were randomly selected from a sampling frame of 661 persons with spinal cord injury. They completed a questionnaire assessing amount of social support, degree of reciprocity with supporters, and satisfaction with relationships with supporters; the Center for Epidemiologic Studies Depression Scale; a self-report version of the Functional Independence Measure; and the Craig Handicap Assessment and Reporting Technique. A physician assessed the degree of paralytic impairment by means of the ASIA Total Motor Index Score. Relationships in which the supporter gave more than the participant were associated with more satisfaction with the relationship and more social support. The number of reciprocal relationships was positively associated with more desirable outcomes in the handicap dimensions of mobility, occupation, social integration, and economic self-sufficiency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury.

Objective: To examine associations between pain severity, psychological distress, catastrophizing, and indices of functional disability in a sample of persons with spinal cord injury (SCI). Catastrophizing was examined as a potential mediator of associations between pain severity, psychological distress, and functional disability. Design and Participants: Questionnaires assessing pain severity, psychological distress, catastrophizing, pain interference, and community integration were completed by 237 persons with SCI. Results: Psychological distress and pain severity were associated significantly with greater functional disability. Moreover, the association between pain severity and functional disability was strongest among persons with high psychological distress. Catastrophizing appeared to mediate the associations between pain severity, psychological distress, and functional disability. Conclusions: Pain severity and psychological distress have the potential for both direct and interactive effects on functional disability, possibly through the mediating effects of catastrophizing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using exercise to enhance subjective well-being among people with spinal cord injury: The mediating influences of stress and pain.

Purpose: To assess exercise as a strategy for reducing pain and improving subjective well-being (SWB) among people with spinal cord injury (SCI). Design: Randomized controlled trial. Method and Participants: Thirty-four individuals with SCI. Exercisers performed aerobic and resistance training twice weekly, whereas wait-list controls maintained their usual level of activity. Results: Analyses of covariance indicated that after 3 months, exercisers reported less pain, depression, and stress, as well as greater perceived quality of life and better physical self-concept than controls (ps     

Depression and subjective well-being among 97 American Indians with spinal cord injury: A descriptive study.

ABSTRACT. Objective: To measure both clinical and nonclinical aspects of depression and subjective well-being (SWB) among a sample of American Indians with spinal cord injury (SCI) and to identify factors associated with depression and SWB. Study Design: Interviews were conducted by telephone with all participants except those who did not have telephones (who returned materials by mail). Setting: A large rehabilitation hospital in the western-Rocky Mountain region of the United States. Participants: Ninety-seven American Indians with SCI completed a health-related interview that included measures of depression and SWB. All participants were adults with traumatic SCI of at least 1 year in duration, most of whom lived on reservations. Main Outcome Measures: Measures of biographic and injury status, depression, SWB, activities, and health-related behaviors. Results: The American Indian sample reported elevated levels of depression and diminished SWB in 5 of 8 areas relative to previous studies on non-American Indians with SCI. Hierarchical multiple regression accounted for 59% of the variance in depression scores and between 10% and 52% of the variance in SWB scales… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of subjective well-being after spinal cord injury: an empirical analysis by gender and race/ethnicity

OBJECTIVE: The purpose of this study was twofold: (1) to identify the underlying dimensions of subjective well-being after spinal cord injury (SCI), and (2) to develop reliable scales based on measurement of these dimensions. DESIGN: A field study was conducted by surveying the subjective well-being of two large samples of participants with SCI. Principal axis factor analysis with varimax rotation was applied to participant responses to 50 subjective well-being items. SETTING: All participants were selected from the outpatient files of two midwestern rehabilitation hospitals and from a large southeastern rehabilitation hospital. PARTICIPANTS: There were a total of 1,032 participants, 435 from the Midwest and 597 from the Southeast. MAIN OUTCOME MEASURES: The Life Situation Questionnaire-revised version (LSQ-R) was used to measure subjective well-being. It included two prominent sections, one for life satisfaction (20 items) and the other for self-reported problems (30 items). RESULTS: Seven subjective well-being factor scales were identified across the full participant sample: Engagement, Negative Affect, Health Problems, Career Opportunities, Finances, Living Circumstances, and Interpersonal Relations. The average alpha coefficient was .86 for the factor scales. Separate analyses of the midwestern and southeastern samples suggested stability of the factor structure, although gender and race/ ethnicity were related to subtle differences in subjective well-being. CONCLUSIONS: The results suggest that rehabilitation professionals need to pay attention to multiple aspects of subjective well-being after SCI.     

Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors

The prevalence and correlates of pressure ulcers in terms of their number, severity, and anatomical location were studied in a community-based sample of 100 men and 40 women with spinal cord injury. Thirty-three percent (n = 46) presented with one or more ulcers of at least one stage I severity when visually examined. Twenty-one individuals had more than one ulcer, the maximum number of ulcers being seven. Of 87 ulcers for which severity ratings were available, 30 (34.5%) were stage I, 33 (37.9%) were stage II, and 24 (27.6%) were either stage III or IV. Individuals with an ulcer exhibited more paralysis and were more dependent on others in activities of daily living. A greater proportion of blacks had more severe ulcers (stages III and IV) than their white counterparts. Persons with more severe ulcers incurred their injury later in life, and had significantly lower mean scores on the Occupation and Mobility dimensions of the Craig Handicap Assessment and Reporting Technique. The findings suggest that factors governing initial development of a pressure ulcer differ in part from those responsible for an ulcer progressing in severity.     

Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury

In the treatment of diabetes, the importance of kinesitherapy increases steadily. In fact, a prospective study (1996) which was done on 897 Finnish middle-aged males over a period of 4 years, showed that the risk of diabetes can be reduced to 50% by moderate physical exercise of 40 minutes per week compared with less active persons of the same age. The amount of kinesitherapeutic measures depends on the physiological resilience of the diabetes patient and on the extent of existing diabetes-induced lesions. An endurance kinesitherapy activates the carbohydrate metabolism and affects the glucosensitive receptors situated in peripheral and central organs. A muscle activity of ten minutes can already multiply by fifteen the increase of glucose absorption from the blood. Another positive result by physical effort is to be seen in the preventine and therapeutic effect of an increased insuline action. The individually adapted kinesitherapeutic endurance stimulation should last from five to ten minutes each day and reach at least 50% of maximum capacity but not more than 70%. This maximum capacity can among other things be gauged from the heart rate as well as from the breathing rate.     

Vocational interests of middle-aged men with traumatic spinal cord injury.

Objectives: Describe vocational interests of middle-aged men with traumatic spinal cord injury (SCI). Participants: Seventy-nine Caucasian men with traumatic SCI (mean age?=?44 years; mean time since onset?=?20 years), 74% with quadriplegia. Measure: Strong Interest Inventory. Results: Replicated the unique pattern of interests found by D. E. Rohe and G. T. Athelstan (1982) among younger men with SCI. Compared with the normative sample, participants were more introverted, less academically oriented, and primarily interested in physically challenging and action-oriented occupations despite their functional limitations. Conclusions: Middle-aged men with traumatic SCI have the same unique vocational interest pattern as their younger peers. This pattern is not an artifact of age or time since onset and may partially explain low rates of employment after SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological well-being after spinal cord injury: Perception of loss and meaning making.

Objective: This study examined the influence of medical injury severity, perceived loss of physical functioning (conceptualized as physical resource loss), and global meaning making on psychological well-being among 79 veterans living with a spinal cord injury. Measures: Structured interviews were completed to assess perceived loss of physical abilities using the Conservation of Resources—Evaluation and SF-36 Health Survey, global meaning making (Purpose in Life scale), and psychological well-being (Sense of Well-Being Inventory). Medical injury severity was calculated from medical records. Results: Medical injury severity was not related to psychological well-being, whereas perceived loss of physical functioning was inversely associated. Global meaning making was significantly related to and accounted for a large portion of the variance in psychological well-being. Results suggest that global meaning making partially mediates perceived loss of physical resources and psychological well-being. Conclusion: The perceived loss of physical abilities and the generation of meaning and purpose in life are important variables that relate to positive adaptation following spinal cord injury. Treatment implications related to factors that increase quality of life following spinal cord injury are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Excitotoxic spinal cord injury: behavioral and morphological characteristics of a central pain model

The involvement of tyrosine protein phosphorylation in the regulation of endothelial cell (EC) contraction and barrier function is poorly understood. We have previously shown that myosin light chain (MLC) phosphorylation catalyzed by a novel 214 kDa EC myosin light chain kinase (MLCK) isoform is a key event in EC contraction and barrier dysfunction [Garcia et al. (1995): J Cell Physiol 163:510-522; Garcia et al. (1997): Am J Respir Cell Mol Biol 16:487-491]. In this study, we tested the hypothesis that tyrosine phosphatases participate in the regulation of EC contraction and barrier function via modulation of MLCK activity. The tyrosine phosphatase inhibitor, sodium orthovanadate (vanadate), significantly decreased electrical resistance across bovine EC monolayers and increased albumin permeability consistent with EC barrier impairment. Vanadate significantly increased EC MLC phosphorylation in a time-dependent manner (maximal increase observed at 10 min) and augmented both the MLC phosphorylation and permeability responses produced by thrombin, an agonist which rapidly increases tyrosine kinase activities. The vanadate-mediated increase in MLC phosphorylation was not associated with alterations in either phosphorylase A Ser/Thr phosphatase activities or in cytosolic [Ca2+] but was strongly associated with significant increases in EC MLCK phosphotyrosine content. These data suggest that tyrosine phosphatase activities may participate in EC contractile and barrier responses via the regulation of the tyrosine phosphorylation status of EC MLCK.     

Does pain interference mediate the relationship of independence in ambulation with depressive symptoms after spinal cord injury?

Purpose/Objective: To test a mediational model that hypothesizes pain interference mediates the relationship between ambulatory status and depressive symptoms among participants with traumatic spinal cord injury (SCI). Research Method/Design: Responses to the Brief Pain Index (pain interference) and the Older Adult Health and Mood Questionnaire (depressive symptoms) were obtained from 1,545 adults with SCI. Logistic regression was used to calculate the odds of clinically significant symptomatology and probable major depression as a function of independence in ambulation and to evaluate the extent to which pain interference mediated the relationship between ambulation and a depressive diagnosis. Results: Partially dependent ambulators reported significantly greater odds of clinically significant symptomatology (2.30) and probable major depression (2.00) compared with independent ambulators prior to evaluation of pain interference (comparisons of wheelchair users with independent ambulators were not significant). However, these relationships were no longer significant after controlling for pain interference. Conclusions/Implications: Pain interference appears to mediate the relationship between ambulatory status and depressive symptoms after SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and the well-being of persons with spinal cord injury living in the community.

100 men and 40 women (all aged 19–77 yrs) with spinal cord injury completed a social support questionnaire, the Center for Epidemiologic Studies Depression Scale, the Life Satisfaction Index Form A, and a single-item self-assessment of health status. A physician assessed the presence or absence of urinary tract infection from laboratory findings and determined the absence, presence, and severity of pressure ulcers from physical examination. Amount of social support was positively related to life satisfaction and physical well-being. Satisfaction with one's support network was associated negatively with depressive symptomatology and positively with life satisfaction. There were significant differences in the correlations between life satisfaction and total social support for men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subjective well-being after spinal cord injury: Relationship to gender, race–ethnicity, and chronologic age.

Compared subjective well-being (SWB) scores as a function of gender and race-ethnicity while controlling for differences in chronologic age among a sample of participants with traumatic spinal cord injury (SCI). A field study of 597 people, including an oversampling of women and racial-ethnic minorities, was conducted. Multivariate analysis of covariance was used to compare SWB outcomes as a function of gender and race-ethnicity. SWB was measured by 2 global indexes and 7 factor scales of the revised Life Situation Questionnaire. Minority participants reported lower SWB than Caucasians on the Global Satisfaction index and on the Career Opportunities, Finances, and Living Circumstances scales. Men had lower scores than women on the Interpersonal Relations scale. Age was only modestly associated with SWB. The results suggest that rehabilitation professionals need to pay attention to gender, race-ethnicity, and age differences in response to SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Central nervous pain in patients with spinal cord injury. Medical and surgical treatment

About 50% of patients with spinal cord injury suffer from persistent central neurogenic pain. The authors review the case of a patient with traumatic paraplegia who developed persistent central neurogenic pain. The pain was described as burning in the buttock area, icing in the rectum area and as lancinating pain to the lower extremities. The combination of amitryptilin and morphine had a slight, short-term effect, but the pain did not respond to treatment with simple analgetica, dextropropoxyphen or ketobemidone, neither administered alone nor in combination with tricyclic antidepressants, carbamazepine or baclophen. Transcutanous nerve stimulation and acupuncture had no effect. The patient was operated on by means of the computer-assisted dorsal root entry zone (DREZ)-microcoagulation technique 2.5 years after the trauma. This technique is described in brief. The prevalence and classification of neurogenic pain, and possible medical and surgical treatment, are also discussed.     

Collection of semen from men in acute phase of spinal cord injury

In chronic spinal cord injury, semen obtained by assisted ejaculation is usually abnormal. We have assessed electroejaculation early after injury in seven patients. There were no adverse effects. Initial samples contained few or no spermatozoa but as patients emerged from spinal shock, semen improved and five had specimens cryopreserved. Thereafter sperm motility and viability decreased towards the pattern of chronic spinal cord injury by day 16. Cryopreservation was not possible in one patient with many medical complications and another who started electroejaculation 15 days after injury. Semen storage within the first 2 weeks after spinal cord injury is recommended for future fertility treatment.     

Hearing impairment, disability and handicap in elderly people living in residential care and in the community

The TFI-musculofasciocutaneous flap has become a standard procedure in recent years. Donor-site problems of this method, especially the biomechanical changes of the hip, the proximal femur and the knee joint are evaluated, employing biomechanical techniques. Harvesting of a TFL-flap leads to functional loss of the M. tensor fasciae latae and the iliotibial tract and band. This might lead to a weakening of active and passive stabilising structures of the hip and the knee joint. Loss of the iliotibial tract causes a loss of the lateral tension-band of the proximal femur and leads to a significant increase of shear forces on the proximal femoral shaft. The functionally important structures of the iliotibial tract for knee biomechanics are not influenced by harvesting of the TFL flap. Loss of the M. tensor fasciae latae leads to a mild reduction of hip flexion and internal rotation. The indication for a TFL-flap should consider the patient's activity to prevent overload damage of the proximal femoral shaft. In childhood, harvesting of the TFL flap is likely to influence the growing axial skeleton due to the loss of the iliotibial tract.     

Mechanical and thermal allodynia in chronic central pain following spinal cord injury

The interstitial cells of Cajal (ICC) are found in a number of different locations in the gastrointestinal tract, where they form close associations with both muscle cells and nerve terminals. In this study we examined the embryological origin of ICC in the mouse intestine to determine whether they arise from the neural crest or from the intestinal wall. Segments of intestine were removed from embryonic mice either before or after the arrival of neural crest cells (the precursors of enteric neurons and glial cells) and transplanted under the renal capsule of host (adult) mice and allowed to develop for 18-41 days. In the mouse intestine, antibodies to c-kit protein selectively label ICC at a variety of locations, and antibodies to the NK1 receptor (the receptor for substance P) labels ICC at the level of the deep muscular plexus in the small intestine and a subpopulation of enteric neurons in the large intestine. The presence of neurons in the explants was examined using antisera to neuron-specific enolase, substance P, and calretinin. In segments of small and large intestine explanted after the arrival of neural crest cells, immunoreactive neurons and c-kit- and NK1-immunoreactive ICC were present with a distribution similar to that seen in control tissue at a similar developmental age. In segments of large intestine explanted before the arrival of neural crest cells, neurons were not present; however, c-kit-immunoreactive ICC were present in these aneuronal explants, indicating that ICC do not arise from the neural crest. The source of ICC in mammals is therefore likely to be the mesenchyme of the gut.     

Goal adjustment capacities, coping, and subjective well-being: The sample case of caregiving for a family member with mental illness.

This study examined the associations between goal adjustment capacities, coping, and indicators of subjective well-being in 2 waves of data from individuals who provide care for a family member with mental illness. We hypothesized that goal adjustment capacities would predict higher levels of subjective well-being by facilitating coping with caregiving stress. Results showed that goal disengagement was associated with effective care-specific coping (e.g., less self-blame and substance use). Goal reengagement was also associated with effective care-specific coping (e.g., positive reframing), but at the same time it predicted the use of less effective strategies (e.g., venting and self-distraction). Moreover, goal disengagement predicted lower levels of caregiver burden and depressive symptoms and buffered the longitudinal effect of caregiver burden on increases in depressive symptoms. Goal reengagement, by contrast, predicted higher levels of caregiver burden and purpose in life and buffered the cross-sectional association between caregiver burden and depressive symptoms. Finally, effective (and less useful) care-specific coping statistically explained the adaptive (and maladaptive) effects of goal adjustment capacities on participants' well-being. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The effectiveness of vibratory stimulation in anejaculatory men with spinal cord injury. Review article

Most spinal cord injury (SCI) men have fertility problems caused by anejaculation and a decreased fertility of the ejaculate. There are several methods to induce ejaculation, such as vibratory stimulation and transrectal electrostimulation. In order to investigate the current state of knowledge about the effectiveness of vibratory stimulation and to prepare a controlled clinical trial we reviewed the available literature. Ten articles met our inclusion criteria. Articles were found by various strategies, such as computer searches and screening of relevant journals. We used a structured approach to evaluate these articles. In total 428 patients had been treated with vibration. Sixty percent (257) of the patients responded to treatment, ie produced ejaculate. Because of methodological shortcomings in most studies it remains unclear whether there is a relationship between injury type, such as level and completeness of the injury, and the response rate. Semen analyses showed a large intersubject variation. From the data available, it could be concluded that the semen volume is usually normal, whereas sperm motility and morphology of spermatozoa were in most cases far from normal. Side effects of vibratory stimulation were reported in 6% of the patients. Semen could be used for various (assisted) reproductive technologies, eg artificial insemination, in vitro fertilisation and microinsemination. Therefore, it is very important to know which stimulation method is most effective in treating anejaculatory SCI men. This review of the literature shows that the effectiveness of vibratory stimulation remains unclear. New, well designed clinical trials as well as basic research activities might clarify the effectiveness of vibratory stimulation and transrectal electrostimulation.