Incontinence and gait disturbance after intraventricular extension of intracerebral hemorrhage.

OBJECTIVE: We tested the hypothesis that intraventricular hemorrhage (IVH) is associated with incontinence and gait disturbance among survivors of intracerebral hemorrhage (ICH) at 3-month follow-ups. METHODS: The Genetic and Environmental Risk Factors for Hemorrhagic Stroke study was used as the discovery set. The Ethnic/Racial Variations of Intracerebral Hemorrhage study served as a replication set. Both studies performed prospective hot-pursuit recruitment of ICH cases with 3-month follow-up. Multivariable logistic regression analyses were computed to identify risk factors for incontinence and gait dysmobility at 3 months after ICH. RESULTS: The study population consisted of 307 ICH cases in the discovery set and 1,374 cases in the replication set. In the discovery set, we found that increasing IVH volume was associated with incontinence (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.10-2.06) and dysmobility (OR 1.58; 95% CI 1.17-2.15) after controlling for ICH location, initial ICH volume, age, baseline modified Rankin Scale score, sex, and admission Glasgow Coma Scale score. In the replication set, increasing IVH volume was also associated with both incontinence (OR 1.42; 95% CI 1.27-1.60) and dysmobility (OR 1.40; 95% CI 1.24-1.57) after controlling for the same variables. CONCLUSION: ICH subjects with IVH extension are at an increased risk for developing incontinence and dysmobility after controlling for factors associated with severity and disability. This finding suggests a potential target to prevent or treat long-term disability after ICH with IVH.

Manual wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury.

OBJECTIVES: To determine wheelchair (WC) skills success rates for manual WC users with spinal cord injury (SCI), to determine subject characteristics associated with the lowest success rates of WC skills, and to characterize the relationship between WC skills and measures of community integration and quality of life (QOL). DESIGN: Cross-sectional multisite study. SETTING: Six Spinal Cord Injury Model Systems (SCIMS) centers. PARTICIPANTS: Individuals with SCI (N=214) who were at least 11 months postinjury, treated at an SCIMS center, and who used a manual WC as their primary means of mobility. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Wheelchair Skills Test (WST) and questionnaires of demographics and characteristics, QOL, and community participation. RESULTS: Of the 31 skills in the WST assessed, success rates ranged from 19.6% to 100%. Eight skills had success rates of ≤75%: folding/unfolding the WC (71.5%), ascending (19.6%) and descending (47.2%) a 15-cm curb, ascending (23.2%) and descending (26.5%) stairs, transferring from ground to WC (40.6%), turning 180° in wheelie position (55.2%), and holding a 30-second stationary wheelie (59.9%). Male sex, paraplegia, employed status, lower education, younger age at injury, and white race were among the participant characteristics bivariately associated with higher success rates of several WC skills. After controlling for covariates, higher success rates of several WC skills and a higher total WST score predicted better self-perceived health, higher life satisfaction, and more community participation. CONCLUSIONS: For people with SCI who use a manual WC as their primary means of mobility, their ability to perform manual WC skills is associated with higher community participation and life satisfaction. Factors contributing to low success rates need to be investigated, and interventions to improve these rates are needed.

Trait anxiety in pregnant women predicts offspring birth outcomes.

The goal of our study was to characterise the relationships between trait anxiety symptoms of women during their pregnancies and birth outcomes of their offspring using a longitudinal cohort from the Maternal Health Practices and Child Development Project. We used the State-Trait Personality Index anxiety measure that is based on Spielberger's State-Trait Anxiety Inventory to measure self-reported trait anxiety at two gestational assessments (fourth and seventh months, representing the first and second trimesters, respectively) and at a third assessment shortly after delivery (representing the third trimester). Demographic, social, psychological, substance use and medical factors were assessed prenatally, and outcomes of the 763 live, singleton births were determined at delivery. In regression models, trait anxiety at the second and third trimesters predicted lower birthweight and shorter birth length, controlling for confounders. Anxiety reported at the third trimester predicted shortened gestational age, controlling for confounders. At the first and second trimesters, the relationship of birthweight and birth length to maternal trait anxiety was only significant for severe anxiety. Women whose anxiety reached severe levels for at least two trimesters were significantly more likely to deliver offspring of lower birthweight and shorter birth length than those women who reported severe anxiety at none or only one of the trimesters. Additionally, offspring of women who experienced severe anxiety during all three trimesters had shorter mean gestational age than offspring of women who did not report severe anxiety at any trimester. Women who report chronic, severe trait anxiety are at the highest risk of having shorter gestations and delivering smaller babies.