RESUMO
INTRODUCTION: Locked-in syndrome (LIS) is characterized by tetraplegia, anarthria, paralysis of cranial nerves, and facial musculature, with the preservation of consciousness and cognitive abilities, as well as vertical eye movements and eyelid movements, hearing, and breathing. Three types of LIS are distinguished: classic, incomplete, and total. The aim of the present study was to describe the life history of a person with LIS, as well as the wife's experience and perspective of this life history. METHODS: A qualitative life history study was conducted with two participants: a 54-year-old man diagnosed with LIS and his 50-year-old wife. Data were collected through interviews and autobiographical documents submitted by the participants and analyzed following Braun and Clarke's method of inductive thematic analysis. RESULTS: Five main themes were identified: (1) how to understand and overcome the new situation; (2) the process of care and rehabilitation; (3) communication; (4) writing as a way of helping oneself and others; and (5) personal autonomy and social participation. CONCLUSION: The participants valued the support of their friends and family in the acceptance stage of the new situation, giving special importance to the communication skills and medical attention received after diagnosis.
Assuntos
Síndrome do Encarceramento , Pesquisa Qualitativa , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Encarceramento/fisiopatologia , Feminino , Comunicação , Cônjuges/psicologia , Autonomia Pessoal , Participação Social , Redação , Quadriplegia/psicologia , Quadriplegia/fisiopatologiaRESUMO
STUDY DESIGN: Non-randomized clinical trial. OBJECTIVES: Examine the feasibility, physical and psychosocial effects of a high intensity functional training (HIFT) exercise program for people with spinal cord injury (pSCI) and their care partners (CPs). SETTING: Community fitness center in a Medically Underserved Area (Fort Smith, USA.) METHODS: A single-group design with three assessment points (before the program, at midpoint (13 weeks), and post-program (25 weeks) was used to examine the effects of up to 49 HIFT sessions over 25-weeks. Sessions were 60 to 75 min in duration and adapted to the abilities of participants. Feasibility measures included recruitment, retention, attendance, safety and fidelity (exercise intensity rated via session-Rating of Perceived Exertion (RPE). Physical measures included cardiovascular endurance, anaerobic power, and muscular strength. Psychosocial measures included perceived social support for exercise, exercise self-efficacy and health-related quality of life. RESULTS: Fourteen pSCI (7 with paraplegia and 7 with tetraplegia, 2 females) and 6 CPs (4 females) were included (median age = 60) (IQR = 15.8). Recruitment rates were 40% for pSCI and 32% for CPs. On average, participants attended 73% (22%) of exercise sessions with a median session-RPE of 5 (IQR = 1). Retention rates were 83% and 67% for pSCI and CPs, respectively. For pSCI and their CPs, large effect sizes were observed for cardiovascular endurance, anaerobic power, muscular strength, and social support for exercise. CONCLUSIONS: For pSCI and their CPs, HIFT appears feasible and potentially leads to improvements in physical and psychosocial health for both groups.
Assuntos
Terapia por Exercício , Traumatismos da Medula Espinal , Humanos , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/psicologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Terapia por Exercício/métodos , Idoso , Cuidadores/psicologia , Estudos de Viabilidade , Qualidade de Vida , Paraplegia/reabilitação , Paraplegia/etiologia , Paraplegia/fisiopatologia , Paraplegia/psicologia , Quadriplegia/reabilitação , Quadriplegia/etiologia , Quadriplegia/psicologia , Quadriplegia/fisiopatologiaRESUMO
Traumatic spinal cord injury (tSCI) resulting in quadriplegia is a life-altering injury for patients and caregivers. We conducted a retrospective review of patients treated for tSCI and quadriplegia at a level 1 trauma center to assess quality of life (QOL), socioeconomic factors, and mortality. Patients and caregivers were surveyed. Of the 65 patients included, 33 contacts were made. Seventeen surveys were completed (12 caregivers and 5 patients). Six unreachable patients were confirmed alive via medical record. Mortality rate among these 39 accessible patients was 23% (n = 9). Medicaid and uninsured patients experienced longer hospital length of stay (P < .0001) and discharged to home or nursing facilities (P < .0001) more often than those with private insurance or Medicare. Patients reported overall "good" QOL (80%) while caregivers reported overall decreased QOL markers. Our results reflect the resilience among this patient population, but also highlight the impact of this life-altering injury on the caregiver.
Assuntos
Quadriplegia , Qualidade de Vida , Traumatismos da Medula Espinal , Humanos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Quadriplegia/etiologia , Quadriplegia/psicologia , Masculino , Estudos Retrospectivos , Feminino , Adulto , Pessoa de Meia-Idade , Sobrecarga do Cuidador/psicologia , Resiliência Psicológica , Cuidadores/psicologia , Estados Unidos , Idoso , Fatores Socioeconômicos , Tempo de Internação/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Traumatic spinal cord injury (TSCI) is a debilitating neurological condition with significant long-term consequences on the mental health and well-being of affected individuals. We aimed to investigate anxiety and depression in individuals with pediatric-onset TSCI. METHODS: PubMed, Scopus, and Web of Science databases were searched from inception to December 20th, 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and studies were included according to the eligibility criteria. RESULTS: A total of 1013 articles were screened, and 18 studies with 4234 individuals were included in the final review. Of these, 1613 individuals (38.1%) had paraplegia, whereas 1658 (39.2%) had tetraplegia. A total of 1831 participants (43.2%) had complete TSCI, whereas 1024 (24.2%) had incomplete TSCI. The most common etiology of TSCI with 1545 people (36.5%) was motor vehicle accidents. The youngest mean age at the time of injury was 5.92 ± 4.92 years, whereas the oldest was 14.6 ± 2.8 years. Patient Health Questionnaire-9 was the most common psychological assessment used in 9 studies (50.0%). Various risk factors, including pain in 4 studies (22.2%), reduced sleep quality, reduced functional independence, illicit drug use, incomplete injury, hospitalization, reduced quality of life, and duration of injury in 2 (11.1%) studies, each, were associated with elevated anxiety and depression. CONCLUSIONS: Different biopsychosocial risk factors contribute to elevated rates of anxiety and depression among individuals with pediatric-onset TSCI. Individuals at risk of developing anxiety and depression should be identified, and targeted support should be provided. Future large-scale studies with long-term follow-up are required to validate and extend these findings.
Assuntos
Ansiedade , Depressão , Traumatismos da Medula Espinal , Humanos , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/complicações , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Criança , Adolescente , Paraplegia/psicologia , Paraplegia/etiologia , Paraplegia/epidemiologia , Pré-Escolar , Quadriplegia/psicologia , Quadriplegia/etiologia , Idade de Início , Qualidade de Vida/psicologiaRESUMO
In patients with locked-in syndrome (LIS), it is not known exactly to what extent cognitive functions are preserved and it is not known exactly how much it has improved. We aimed to examine the clinical and cognitive features of LIS 1 year after stroke. One hundred patients with locked-in syndrome (LIS) were recruited between January 2008 and May 2019 among 8200 patients with ischemic stroke. Patients were classified into two groups as single pontine infarcts (n = 72), and pontine plus multiple ischemic lesions (PMIL) (n = 28). Since the patients had limited motor and verbal response, the cognitive status of the patients in the early and late stages was evaluated with the Short Neuropsychological Questionnaire for Disabled Patients (SNQDP) test. At the onset of stroke, orientation to time and place was normal in 43% of patients with a single infarct compared with 18% of those with PMIL (OR 3.48; 95% CI 1.10-10.18; P = 0.015). There was no sustained visual fixation or tracking in 53% of patients with a single pontine infarct and 82% of those with PMIL (OR 4.12; 95% CI 1.41-12.02; P = 0.005). After 1-year follow-up, there was significant difference between patients with a single infarct and those with PMIL regarding to perception and execution, especially complex command follow (P = 0.042), attention span and concentration (P = 0.30), intelligible verbalization (P = 0.022). There was relatively high incidence (24%) of patients with a "good outcome" (mRS = 3) in those with single infarct. Given as in our study that many patients can show significant improvement in LIS, we recommend aggressive supportive measures, intense physical, speech and cognitive therapy to facilitate interaction with others and the environment.
Assuntos
Cognição , Síndrome do Encarceramento/psicologia , Adulto , Idoso , Encéfalo/patologia , Feminino , Seguimentos , Humanos , AVC Isquêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Quadriplegia/psicologia , Fala , Adulto JovemRESUMO
OBJECTIVE: To evaluate changes in duration of physical activity (PA) and sedentary behavior (SB) from discharge to 1 year after inpatient rehabilitation in ambulatory people with spinal cord injury (SCI). DESIGN: Longitudinal cohort study with objective measurements of physical behavior at discharge and at 6 and 12 months post discharge. SETTING: Three rehabilitation centers and the participant's home environment. PARTICIPANTS: Participants (N=47) with ambulatory function were consecutively recruited from the self-management and self-efficacy in patients with SCI cohort (age 18 years or older, recent SCI, expected inpatient stay ≥4wk). Mean age was 54.5±12.9 years, all had incomplete lesions, 53% were men, 49% had tetraplegia, and 51% were community ambulators at discharge. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Duration (min) of PA (summed duration of walking, cycling, running, and wheeling) and SB (sitting/lying). RESULTS: Mean duration of PA increased by 21 min/d (95% confidence interval, 7-35) and SB decreased by 64 min/d (95% confidence interval, -94 to -35) from discharge to 6 months after inpatient rehabilitation. No changes were found in the second half-year. One year after discharge mean PA was 116±59 min/d and mean SB was 665±121 min/d. The increase in PA was the result of an almost doubling of time spent walking. Variability in physical behavior and its change was large. Older age and lower ambulation level were associated with lower PA, lower ambulation level with higher SB, and tetraplegia was associated with a reduced increase in PA. CONCLUSIONS: At group level, duration of PA and SB improved following inpatient rehabilitation in ambulatory people with SCI. However, there were large differences between individuals. Levels 1 year after discharge were still unfavorable, particularly regarding SB.
Assuntos
Exercício Físico/psicologia , Comportamento Sedentário , Traumatismos da Medula Espinal/psicologia , Fatores de Tempo , Caminhada/psicologia , Adulto , Assistência ao Convalescente/psicologia , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Quadriplegia/fisiopatologia , Quadriplegia/psicologia , Quadriplegia/reabilitação , Centros de Reabilitação , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitaçãoRESUMO
BACKGROUND AND OBJECTIVE: Clinical observations indicate that implicit procedural learning, a central component of physical and psychosocial rehabilitation, is impeded following spinal cord injury. In accordance, previous research has revealed a specific deficit in implicit sequence learning among individuals with paraplegia using a standard, manual version of the serial reaction time task. To extend these findings and shed light on the underlying sources of potential spinal cord injury-related deficits in sequence learning, we used an ocular activated serial reaction time task to compare sequence learning performance between individuals with tetraplegia and healthy controls. PARTICIPANTS AND MEASURES: Twelve participants with spinal cord injury in C5-T1 were compared to 12 matched control participants on measures derived from an ocular activated serial reaction time task. Depression and additional cognitive measures were assessed to explore the source and specificity of potential sequence learning deficits. RESULTS: Like controls, and in contrast with previous findings in paraplegia, the spinal cord injury group showed intact implicit sequence learning, evidenced by declining reaction times and improved anticipation over the first six blocks of the serial reaction time task, and an advantage for the initial learning sequence over a novel interference sequence. CONCLUSIONS: The ocular activated serial reaction time task elicited a performance pattern similar to standard motor versions, such that participants with tetraplegia demonstrated unimpaired sequence learning. This suggests that previously reported implicit sequence learning deficits in spinal cord injury directly involved motor functioning rather than cognitive aspects of the task, and that the ocular activated sequence learning task could be a valid alternative for assessing implicit sequence learning in populations that cannot perform spinal-cord dependent motor tasks. Implications for post-spinal cord injury rehabilitation and adjustment are discussed.
Assuntos
Quadriplegia/psicologia , Tempo de Reação/fisiologia , Aprendizagem Seriada/fisiologia , Traumatismos da Medula Espinal/complicações , Adulto , Estudos de Casos e Controles , Movimentos Oculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desempenho Psicomotor , Quadriplegia/etiologia , Quadriplegia/fisiopatologiaRESUMO
STUDY DESIGN: Observational study. OBJECTIVE: To describe (1) user satisfaction, (2) the Quality of Life (QoL) and (3) fear of falling in individuals with tetraplegia or paraplegia who used a mono-ski for sit-skiing. SETTING: Spinal units and Sport associations. METHODS: An observational study of people with spinal cord injury (SCI) who used a sit-ski. Participants were recruited in various SCI rehabilitation centers and sport associations. Participants completed three assessment tools: the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0); the World Health Organization Quality of Life (WHOQoL-BREF); the Spinal Cord Injury Fall Concern Scale (SCI-FCS). Results were evaluated with chi-squared test and Kolmogorov-Smirnov's test and the significance was set for p values < 0.05. RESULTS: Fifteen participants were included. Results showed positive and statistically significant values for all the items of the SCI-FCS related to fear of falling, and for most of the items of the WHOQoL-BREF related to QoL and the QUEST 2.0 related to satisfaction with the device. CONCLUSIONS: This study highlights that sit skiing is correlated with high levels of satisfaction with the mono-ski, increases in QoL, and low levels of fear of falling. In adding these findings to the existent literature, it can be stated with more certainty that sit-skiing is a sport that can be recommended in rehabilitation and sports therapy programs.
Assuntos
Medo/psicologia , Satisfação Pessoal , Qualidade de Vida/psicologia , Esqui/psicologia , Traumatismos da Medula Espinal/psicologia , Esportes para Pessoas com Deficiência/psicologia , Acidentes por Quedas/prevenção & controle , Adulto , Vértebras Cervicais/lesões , Medo/fisiologia , Feminino , Humanos , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Paraplegia/psicologia , Paraplegia/reabilitação , Quadriplegia/psicologia , Quadriplegia/reabilitação , Postura Sentada , Esqui/fisiologia , Traumatismos da Medula Espinal/reabilitação , Esportes para Pessoas com Deficiência/fisiologia , Vértebras Torácicas/lesões , Adulto JovemRESUMO
Context/Objective: Cognitive deficits can impact as many as 60% of individuals with spinal cord injury (SCI). In an effort to identify the nature of cognitive deficits in SCI, we examined neuropsychological test performance in individuals with SCI, age matched healthy controls and older healthy controls.Design: Participants completed a motor-free neuropsychological test battery assessing attention, working memory, information processing speed, new learning /memory and executive control.Setting: Outpatient rehabilitation research facility.Participants: Participants included 60 individuals with chronic spinal cord injury [SCI; 32 with paraplegia (T2-T12) and 28 with tetraplegia (C3-T1)], 30 age-matched healthy controls (AMHC; 30-40 years old) and 20 older healthy controls (OHC; 50-60 years old).Outcome Measures: Wechsler Intelligence Scale - 3rd edition (WAIS-III) Digit Span and Letter-Number Sequencing; Symbol Digit Modalities Test (SDMT) - oral version; California Verbal Learning Test-II; Paced Auditory Serial Addition Test (PASAT); Wechsler Abbreviated Scale of Intelligence (WASI); Delis-Kaplan Executive Function System; Verbal Fluency subtest.Results: Significant differences were noted between the SCI and AMHC groups on measures of information processing speed, new learning and memory, and verbal fluency. No significant differences were noted between the groups on tests of attention or working memory.Conclusion: The current study documented differences in specific realms of cognitive functioning between a chronic SCI sample and AMHC. Implications for cognitive rehabilitation and overall quality of life are discussed. Additional research is needed utilizing a more comprehensive battery of motor-free neuropsychological tests that avoid the confound of upper limb motor limitations on cognitive performance.
Assuntos
Transtornos Cognitivos , Testes Neuropsicológicos/estatística & dados numéricos , Paraplegia/psicologia , Quadriplegia/psicologia , Traumatismos da Medula Espinal/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Traumatismos da Medula Espinal/reabilitaçãoRESUMO
People with quadriplegia have a high risk for respiratory illness, social isolation and depression. Previous research has demonstrated that therapeutic singing interventions can not only improve breathing function and speech loudness, but also improve mood and social connectedness for people with quadriplegia. Face-to-face group attendance is difficult for this population due to difficulties with distance and travel. Online environments offer an accessible and cost-effective solution for people to connect with others without leaving their home. In a two-phase iterative design, we explored and tested different approaches for delivering online music therapy sessions with 12 patients from an inpatient spinal cord injury rehabilitation service. Six participants in Phase 1 trialled different virtual reality headsets and completed a short interview about their experience of the equipment and online singing trials. Outcomes from Phase 1 testing led to the development of a custom-built virtual reality application for online group music therapy sessions with low-latency audio. We tested the acceptability and feasibility of this platform in comparison to face-to-face and teleconference options for music therapy with six different patients. These participants completed three validated questionnaires: System Usability Scale, Quebec User Evaluation of Satisfaction with assistive Technology, and Psychosocial Impact of Assistive Devices Scale, and an interview about their experience. Questionnaire scores were good with mean ratings of 4.4 for Quebec User Evaluation of Satisfaction with assistive Technology, 53 for System Usability Scale and positive mean Psychosocial Impact of Assistive Devices Scale scores of 1.5 for competence, 2 for adaptability and 1.5 for self-esteem. Thematic analysis of post-session qualitative interviews revealed five themes: virtual reality was a positive experience, virtual reality was immersive and transportative, virtual reality reduced inhibitions about singing in front of others, virtual reality may reduce social cues, and the virtual reality equipment was comfortable, accessible and easy to use. Telehealth options, including a custom-designed virtual reality program, with low-latency audio are an acceptable and feasible mode of delivery for therapeutic singing interventions for people with spinal cord injury. Future non-inferiority research is needed to test online delivery modes for music therapy in comparison to face-to-face treatment.
Assuntos
Musicoterapia/métodos , Quadriplegia/psicologia , Quadriplegia/reabilitação , Qualidade de Vida/psicologia , Canto , Realidade Virtual , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Inquéritos e Questionários , Resultado do Tratamento , Qualidade da Voz , Treinamento da VozRESUMO
BACKGROUND: Spinal cord injury (SCI) is a high-cost disabling condition, which brings a huge number of changes in individual's life. The emphasis of rehabilitation has moved from medical administration to issues that affect quality of life and community integration. This systematic review was conducted to identify the factors associated with community reintegration of patients with spinal cord injury. . METHODS: Google Scholar, PEDro, Pakmedinet, AMED, BIOMED central, Cochrane Library, MEDLINE, PsychoINFO, PUBMED, ScienceDIRECT, Scirus and Wiley Online Library databses were searched by using key words 'Spinal cord injury' 'Paraplegia' or 'Spinal Cord Lesion' or Tetraplegia. They were cross-linked with 'Community reintegration', 'Community participation' and 'Community access'. The methodological quality of the studies included was analysed by using McMaster University Tool and Thomas Tool. The data extracted included sample size, intervention, duration, results, outcome measures, and follow-up period. RESULTS: A total of 11 relevant studies were located. The evidence extracted was classified into four groups; health-related barriers or facilitators, environment-related barriers or facilitators, psychological barriers and social barriers that are associated with community reintegration of such individuals. CONCLUSIONS: The review revealed that there were more barriers in the form of health-related issues, personal and environmental, psychological and social issues that hinder the community reintegration of individuals with spinal cord injury compared to facilitators. Most studies identified special challenges related to environment in the sense of accessibility of home and public buildings and transportation. Removing barriers related to health, environment, and psychological and social factors can enhance community reintegration of such patients.
Assuntos
Atividades Cotidianas , Integração Comunitária , Participação Social , Traumatismos da Medula Espinal/reabilitação , Acessibilidade Arquitetônica , Atitude , Participação da Comunidade , Status Econômico , Humanos , Limitação da Mobilidade , Paraplegia/fisiopatologia , Paraplegia/psicologia , Paraplegia/reabilitação , Política Pública , Quadriplegia/fisiopatologia , Quadriplegia/psicologia , Quadriplegia/reabilitação , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/psicologiaRESUMO
Patients with completely locked-in syndrome (CLIS) are incapable of any voluntary muscle movement and do not have any means of communication. Recently functional near infrared spectroscopy (fNIRS) based brain computer interface (BCI) has been successfully used to enable communication with these patients. The developed fNIRS-BCI system relies on the intactness of language comprehension in these patients in all dimensions of language. Interwoven language and motor cortex in brain, and lack of muscular activity in long run, can cause language attrition due to complete immobility in CLIS patients. In this study we have investigated effects of semantic content of sentences presented to a CLIS patient on the performance of the BCI system during a YES/NO paradigm. Comparison of communication success rate in BCI classification between different semantic categories indicate that semantic content of sentences presented to a CLIS patient can affect the BCI performance. Affected concepts are mostly associated with executive words. These findings can be beneficial towards development of more reliable communication device for patients in CLIS. In addition, these results may assist in elucidating the cognitive changes in completely paralyzed patients with the passage of time since the onset of total immovability.
Assuntos
Interfaces Cérebro-Computador , Encéfalo/fisiopatologia , Quadriplegia/fisiopatologia , Semântica , Cognição , Feminino , Humanos , Masculino , Quadriplegia/psicologiaAssuntos
Terapia por Estimulação Elétrica/psicologia , Eletrodos Implantados , Necessidades e Demandas de Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Quadriplegia/psicologia , Traumatismos da Medula Espinal/psicologia , Adolescente , Adulto , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Inquéritos e Questionários , Extremidade Superior/cirurgia , Adulto JovemRESUMO
RATIONALE: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. OBJECTIVE: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. METHODS AND MEASUREMENTS: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. MAIN RESULTS: 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully 'adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect -1.15, 95% CI -10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference -1.26, 95% CI -2.2 to -0.32; p=0.01). CONCLUSION: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. TRIAL REGISTRATION NUMBER: ACTRN12605000799651.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Quadriplegia/complicações , Síndromes da Apneia do Sono/terapia , Traumatismos da Medula Espinal/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quadriplegia/psicologia , Qualidade de Vida , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/etiologia , Traumatismos da Medula Espinal/psicologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Tendon transfer surgery can effectively improve hand function for patients with tetraplegia but remains poorly utilized. Little is known regarding how patients' rehabilitation experiences influence their perception of function, identity, and coping to shape their reconstructive context. METHODS: We performed a cross-sectional qualitative analysis of 19 participants with C4-C7 cervical spinal injuries: 9 patients had undergone reconstruction; 10 had not. Semistructured interviews were conducted using an interview guide focusing on rehabilitation experience, the relationship between function and identity, and how patient experience evolved. Interview transcripts were analyzed using grounded theory. RESULTS: The study sample was predominantly male (79%), white (89%), and American Spinal Injury Association grades A-D (grade A: 42%; grade B: 32%; grade C: 16%; grade D: 10%). Recognizing rehabilitation's necessity, functional gains, and constructive patient-therapist relationships promoted engagement in therapy. Poor insurance coverage and financial constraints decreased rehabilitation access. Function affected identity through the degree to which it tied participants to a "patient" role. Early in recovery, patients' function, roles, and attitudes were fluid but solidified over time; how satisfied patients were with these final positions influenced how they coped. CONCLUSION: The balance of patients' positive and negative coping has been found to influence patients' progression to surgery. This study describes how function and identity contribute to coping. Participants' function and identity evolved during a finite period we call "the golden year," before reaching a fixed point around which they built their lives. The norms patients establish during this time may affect receptiveness to surgery.
Assuntos
Quadriplegia/psicologia , Quadriplegia/cirurgia , Transferência Tendinosa , Adaptação Psicológica , Adolescente , Adulto , Idoso , Atitude Frente a Saúde , Estudos de Coortes , Estudos Transversais , Feminino , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Motivação , Estudos Retrospectivos , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Adulto JovemRESUMO
STUDY DESIGN: Mixed methods OBJECTIVES: Continuous positive airway pressure (CPAP) therapy is the recommended treatment for obstructive sleep apnoea (OSA). The aim of this study was to estimate CPAP adherence in people with tetraplegia and OSA, and to explore the barriers and facilitators to CPAP use. SETTING: Hospital outpatient department in Melbourne, Australia METHODS: People with chronic tetraplegia and OSA were commenced with auto-titrating CPAP and supported for 1 month. Semi-structured interviews were conducted with participants at one month and analysed thematically. CPAP usage was measured at 1, 6 and 12 months, with "adherent" defined as achieving more than 4 h average per night. RESULTS: Sixteen participants completed the study (80% male; mean age 56 (SD = 15)). Mean nightly CPAP use at one month was 3.1 h (SD = 2.5; 38% adherent), and at 6 months and 12 months were 2.6 h (SD = 2.8; 25% adherent) and 2.1 h (SD = 3.2; 25% adherent). The perceived benefit/burden balance strongly influenced ongoing use. Burden attributed to CPAP use was common, and included mask discomfort, and physical and emotional problems. Adherent participants were motivated by the immediate daytime benefits to mood, alertness and sleepiness. There was a tendency to not recognise symptoms of OSA until after they were treated. CONCLUSION: CPAP use is challenging for people with tetraplegia, who experience substantial burden from using the device. When tolerated, the proximate benefits are substantial. People with tetraplegia need more intensive support for longer to help them overcome the burdens of CPAP and benefit from the treatment.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Quadriplegia/complicações , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Assistência Ambulatorial , Doença Crônica , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Pressão Positiva Contínua nas Vias Aéreas/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Satisfação do Paciente , Quadriplegia/psicologia , Pesquisa Qualitativa , Apneia Obstrutiva do Sono/psicologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of this study was to explore the relationships between specific functional abilities assessed from the third version of the Spinal Cord Injury Measure and health-related quality of life after a traumatic spinal cord injury. DESIGN: A prospective cohort of 195 patients who had sustained a traumatic spinal cord injury from C1 to L1 and consecutively admitted to a single level 1 spinal cord injury-specialized trauma center between April 2010 and September 2016 was studied. Correlation coefficients were calculated between Spinal Cord Injury Measure scores and Short Form 36 version 2 summary scores (physical component score; mental component score). RESULTS: The total Spinal Cord Injury Measure score correlated moderately with the physical component score in the entire cohort, correlated strongly with physical component score in tetraplegics, did not correlate with physical component score in paraplegics, and did not correlate with mental component score. Mobility subgroup and individual items scores showed the strongest correlations with the physical component score in the entire cohort, followed by self-care and sphincter management. CONCLUSIONS: This work is significant being the first to determine which specific functional abilities are mostly related to health-related quality of life and highlights the differences between tetraplegic and paraplegic patients. Our findings could help clinicians to guide rehabilitation plan based on importance of specific functional abilities in relationship with the health-related quality of life.
Assuntos
Desempenho Físico Funcional , Qualidade de Vida , Traumatismos da Medula Espinal/psicologia , Adulto , Avaliação da Deficiência , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Paraplegia/psicologia , Estudos Prospectivos , Quadriplegia/psicologiaRESUMO
STUDY DESIGN: Cross-sectional phenomenological qualitative study. OBJECTIVES: To investigate women's experience of sexuality after spinal cord injury (SCI) with a focus on rehabilitation and manging practical impact. SETTING: Women with SCI living in the community in United Kingdom (UK). METHODS: Participants were recruited via three UK SCI centres, ensuring tetraplegia, paraplegia and cauda equina syndrome representation. Single semi-structured interviews exploring individual's experiences around sexuality following SCI were recorded and transcribed for thematic analysis. RESULTS: Twenty-seven women aged 21-72 years, sexually active since SCI were interviewed, each lasting 17-143 min (mean 55 min). Six key themes emerged: physical change, psychological impact, dependency, relationships and partners, post injury sexual life and sexuality rehabilitation. CONCLUSIONS: Sexuality remains an important, valued aspect of female identity following SCI; sexual activity continues and though altered remains enjoyable and rewarding. Sexuality rehabilitation should commence early, preparing women for altered sexual sensation, disclosure of altered sexual function to partners, and encouraging early self-exploration. Techniques optimising continence management in preparation for and during sex should be taught. Participants identified a need for women-only education and support groups, increased peer support, self-esteem, communication and social skills training and even fashion advice and pampering sessions during rehabilitation. Support and education for partners are needed. Staff require support to be knowledgeable and confident in addressing women's sexuality needs. Use of the Ex-PLISSIT model for psychosexual support could help staff to better meet these needs.
Assuntos
Comportamento Sexual/psicologia , Traumatismos da Medula Espinal/psicologia , Adulto , Idoso , Síndrome da Cauda Equina/etiologia , Síndrome da Cauda Equina/psicologia , Síndrome da Cauda Equina/reabilitação , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Paraplegia/etiologia , Paraplegia/psicologia , Paraplegia/reabilitação , Quadriplegia/etiologia , Quadriplegia/psicologia , Quadriplegia/reabilitação , Pesquisa Qualitativa , Parceiros Sexuais/psicologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Adulto JovemRESUMO
OBJECTIVE: To assess (1) if fitness and mobility are related to behavior and perception of physical barriers and (2) if behavior and physical barrier perception are related. DESIGN: Cross-sectional case series. SETTING: Academic Medical Laboratory. PARTICIPANTS: Manual wheelchair users (N=50) with chronic spinal cord injury (62% paraplegia). INTERVENTION: None. MAIN OUTCOME MEASURES: Participants completed the following assessments: (1) fitness: graded exercise test (aerobic) and Wingate (anaerobic); (2) mobility: 6-minute push test and 30-second sprint test; (3) physical barrier behavior: Encounters of Environmental Features in the Environmental Aspects of Mobility Questionnaire (EAMQ); (4) physical barrier perception: Craig Hospital Inventory of Environmental Factor (CHIEF) Environmental Barriers domain. RESULTS: Individuals with paraplegia had higher fitness, mobility, and environmental barrier encounter rates and lower avoidance per encounter rates vs tetraplegia (all P≤.05). For individuals with tetraplegia only, as mobility and fitness increased, frequencies of (1) encounters increased; (2) avoidances per encounter decreased, in multiple EAMQ domains (all P≤.05). Perception of barriers did not differ between lesion levels (P=.79). Mobility and fitness were not related to environmental barriers perception in both groups (all P>.17). CONCLUSIONS: Fitness and mobility are associated with barrier behaviors (ie, encounters and avoidances) among individuals with tetraplegia, but not paraplegia. Despite a greater barrier avoidance rate, persons with tetraplegia do not perceive more physical barriers than persons with paraplegia. Surprisingly, fitness and mobility were not related to perception of barriers in either group. More research is required on if barrier perception, behavior, or both influence participation, to enable rehabilitation programs to tailor interventions to enhance participation.