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.     

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)     

Predicting life satisfaction among adolescents from immigrant families in Norway

OBJECTIVE: To find out the degree of life satisfaction among adolescents with immigrant background, and the factors that may predict the level of life satisfaction among them. METHOD: Five hundred and six adolescents (mean age = 15.34, SD = 1.67) with immigrant background from Vietnam, Pakistan, Chile and Turkey were recruited from five major Norwegian cities, and were asked to fill in a questionnaire with several measures, including demographic information, life satisfaction, acculturation strategies, ethnic identity and mastery. A control group involving 209 Norwegian youth were also included in the study. RESULTS: On the whole the adolescents with immigrant background were found to be fairly satisfied with their life (M = 3.55, SD = 0.81). Using Socio-Economic Status as covariance, adolescents with immigrant background did not differ from their Norwegian counterparts on life satisfaction level (F = 0.58, p > 0.05). Chileans were found to be the most satisfied group, and Vietnamese the least satisfied. The higher life satisfaction among Chileans compared with the other ethnic groups is viewed as a possible selection bias. While demographic factors accounted for just 4% of the explained variance, personal factors accounted for over 20% of the explained variance. Mastery (beta = 0.39) and ethnic identity (beta = 0.17) were the two most important predictors of life satisfaction. Living in an ethnically homogenous neighbourhood was also found to be related to life satisfaction. Perceived discrimination and integration as an acculturation strategy were not related to life satisfaction. CONCLUSION: The study concludes that helping adolescents with immigrant background to develop a good sense of mastery and a positive ethnic identity will go a long way to boost their life satisfaction.     

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)     

Prediction of life satisfaction after spinal cord injury: A four-year longitudinal approach.

Responses to a life situation questionnaire were obtained in 1985 and 1989 from 286 adults with spinal cord injury. Multidimensional personality questionnaires were obtained in 1989 only. Multiple regression was used to identify the optimal predictors of 1989 satisfaction from predictor variables taken in 1985 and 1989. Results suggest that the predictors accounted for a greater percentage of variation in General Satisfaction compared with Economic Satisfaction. As expected, concurrent prediction was superior to the 4-yr longitudinal prediction. Adjustment measures were better predictors of satisfaction than were demographic and injury-related predictors (e.g., age, injury severity). A different pattern of predictors was identified between the 2 satisfaction areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive psychological variables in the prediction of life satisfaction after spinal cord injury.

Objective: To examine relationships between select positive psychological variables and life satisfaction in persons with spinal cord injury during acute rehabilitation and 3 months after discharge. Design: Prospective observational design; correlational and regression analyses. Eighty-seven adults who were participating in in-patient, acute rehabilitation for spinal cord injury in two metropolitan hospitals completed the following measures: Benefit finding Scale, Hope Scale, Brief Symptom Inventory, COPE, Positive and Negative Affect Schedule, and Satisfaction with Life Scale. Results: Hypothesized relationships of hope and positive affect (facilitator variables) with greater life satisfaction during the initial acute rehabilitation period were supported. Facilitators, as measured at baseline, accounted for a significant amount of variance in life satisfaction above and beyond barrier variables (depression, negative affect, and avoidant coping) both during the acute rehabilitation phase (R2 change = .20, p R2 change = .09, p     

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.     

Substance use by persons with recent spinal cord injuries.

Obtained substance use histories from 103 persons (aged 16–63 yrs) with recent spinal cord injuries (SCIs). Lifetime exposure to and recent use of several substances with abuse potential were greater than for a like-age national sample. Intoxication at time of injury was reported by 39%. The rate of exposure to and recent use of substances with abuse potential was significantly greater for Ss who reported intoxication at injury. Intoxication at SCI onset is a marker of preinjury substance use. It is important to screen for substance abuse in persons who incur traumatic injury. Timely assessment of and intervention for substance abuse could help enhance psychosocial and vocational outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation between spirituality and quality of life among individuals with spinal cord injury.

Objective: To determine how spiritual-based coping relates to quality of life in individuals with spinal cord injury (SCI). Design, Setting, & Participants: A telephone interview of 75 participants, primarily Caucasian single men aged 19 to 71 (enrolled in the Northern New Jersey Spinal Cord Injury Model System). Measures: Ellison's Spiritual Well-Being Scale, Duke Health Profile, Craig Handicap Assessment and Reporting Technique, Diener's Satisfaction With Life Survey. Results: Virtually all participants (98.7%) reported using some form of spiritual-based coping. Quality of life was highest among participants who use existential spiritual as opposed to religious spiritual coping. In particular, existential spirituality shared 27% variance with overall perceived life quality. Conclusions: Spiritual-based coping might be encouraged as a possible strategy to improve life quality. Clinicians should be cognizant of ongoing spiritual practices among persons with SCI. (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.     

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)     

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)     

Tethered spinal cord syndrome in adults

Twenty-six of 27 patients in whom an ulnar shortening osteotomy had been performed to treat ulnar impaction following distal radius (20 patients) or forearm (6 patients) fractures were evaluated at an average follow-up of 21 months. All but 3 patients were satisfied with the end-result and according to a modified Gartland-Werley score there were 1 excellent, 10 good, 10 fair and 5 poor results. This is distinctly inferior to other reports of mainly non-traumatic indications. Degenerative changes at the distal radioulnar joint were associated with fair and poor results and careful radiological examination of this joint is mandatory before ulnar shortening is performed in posttraumatic ulnar impaction syndrome. Bony union of the osteotomy was achieved at 12 to 16 weeks postoperatively except for 2 cases and there was no difference between transverse (13 cases) and oblique osteotomies (13 cases). We therefore prefer the technically easier transverse osteotomy and recommend the use of 3.5 dynamic compression plates for stabilisation which resulted in a low complication rate in our series and enables early active wrist mobilisation.     

Work-family spillover and life satisfaction among professional psychologists.

How do the professional lives of psychologists influence their personal and family lives? Data from 485 psychologists who responded to a survey on professional and family life were analyzed to examine work-to-family spillover, life satisfaction, and family support. Respondents reported a significantly higher incidence of positive spillover, termed family enhancers, than negative spillover, termed family stressors. The low incidence of family stressors suggested that stresses associated with the professional work of psychology do not routinely spill over into professionals' family lives. Both positive and negative spillover, however, played significant roles in mediating the relationship between work and family domains. On the positive side, a sense of personal accomplishment at work was associated with increased family enhancers, which appeared to lead to greater family support and life satisfaction. On the negative side, emotional exhaustion at work was associated with more family stressors, which appeared to lead to less family support and life satisfaction. The implications of these findings for training and practice are discussed. (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