Spinal cord injury and prescribed opioids for pain: a scoping review.

OBJECTIVE: Spinal cord injury (SCI) is a life-altering neurological condition affecting physical and psycho-social functioning and associated high rates of pain. Thus, individuals with SCI may be more likely to be exposed to prescription opioids. A scoping review was conducted to synthesize published research findings on post-acute SCI and prescription opioid use for pain, identify literature gaps, and propose recommendations for future research. METHODS: We searched 6 electronic bibliographic databases (PubMed [MEDLINE], Ovid [MEDLINE], EMBASE, Cochrane Library, CINAHL, PsychNET) for articles published from 2014 through 2021. Terms for "spinal cord injury" and "prescription opioid use" were used. Included articles were in English and peer reviewed. Data were extracted using an electronic database by 2 independent reviewers. Opioid use risk factors for chronic SCI were identified and a gap analysis was performed. RESULTS: Of the 16 articles included in the scoping review, a majority were conducted in the United States (n = 9). Most articles lacked information on income (87.5%), ethnicity (87.5%), and race (75%). Prescription opioid use ranged from 35% to 64% in articles reporting this information (n = 7 articles, n = 3675 participants). Identified risk factors for opioid use included middle age, lower income, osteoarthritis diagnosis, prior opioid use, and lower-level spinal injury. Limited reporting of diversity in study populations, absence of risk of polypharmacy, and limited high quality methodology were identified gaps. CONCLUSIONS: Future research should report data on prescription opioid use in SCI populations, with additional demographics such as race, ethnicity, and income, given their importance to risk outcomes.

Anxiety in Response to Sustaining Spinal Cord Injuries and Disorders: When Should Clinicians Be Concerned?

OBJECTIVE: To recommend a cut-off score for the brief 2-item Generalized Anxiety Disorder (GAD-2) measure for persons with spinal cord injuries/disorders (PwSCI/D) and to estimate anxiety occurrence within this population using the full 7-item Generalized Anxiety Disorder (GAD-7). DESIGN: Multicenter retrospective analyses. SETTING: One inpatient rehabilitation center and 2 community sites for PwSCI/D. PARTICIPANTS: PwSCI/D 18 years or older (N=909) were included for analysis using retrospectively collected GAD-2 and GAD-7 data. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Occurrence of anxiety symptoms were compared using cut-off scores of ≥8 and ≥10 on the GAD-7. A cut-off score recommendation for the GAD-2 was determined using ROC curve, and sensitivity and specificity analyses. RESULTS: Occurrence of anxiety symptoms was 21% using a GAD-7 cut-off of ≥8 and 15% using a cut-off of ≥10. Analyses indicated optimal sensitivity for a GAD-2 score of ≥2 when a GAD-7 cut-off of ≥8 was used. CONCLUSIONS: Anxiety occurrence is elevated among PwSCI/D compared with the general population. For PwSCI/D, it is recommended that a cut-off score of ≥2 is used for the GAD-2 to maximize sensitivity and that a threshold of ≥8 is used for the GAD-7 to ensure the maximum number of individuals presenting with symptoms of anxiety are recognized for diagnostic interview. Study limitations are discussed.

Acupuncture use for pain after traumatic brain injury: a NIDILRR Traumatic Brain Injury Model Systems cohort study.

BACKGROUND: Pain after traumatic brain injury (TBI) is common and can become chronic. Acupuncture is an increasingly popular non-pharmacologic option in the United States and is commonly used for pain. OBJECTIVE: We explored demographics, injury characteristics, and pain characteristics of individuals who reported using acupuncture for chronic pain after TBI. METHODS: We analyzed a subset of data collected as part of the Pain After Traumatic Brain Injury collaborative study and identified individuals reporting a history of acupuncture as part of management for chronic pain after TBI. We characterized and compared basic demographic data, pain treatment engagements, pain severity, pain interference, functional independence, and pain locations using descriptive and inferential statistics. RESULTS: Our sample included 1,064 individuals. Acupuncture use (n = 208) was lower proportionally among females, Blacks/African Americans, Asians, less educated, and nonmilitary service members. Insurance type varied between acupuncture and non-acupuncture users. Functional and pain outcomes were similar, but acupuncture users reported a higher number of pain sites. DISCUSSION: Acupuncture is one treatment utilized by individuals with TBI and chronic pain. Further investigation would be helpful to understand the barriers and facilitators of acupuncture use to inform clinical trials to examine the potential benefit of acupuncture on pain outcomes after TBI.

Long-Term Follow-Up of Patients With Ventilator-Dependent High Tetraplegia Managed With Diaphragmatic Pacing Systems.

OBJECTIVE: To explore participants' experiences after implantation of a diaphragmatic pacing system (DPS). DESIGN: Cross-sectional, observational study using self-report questionnaires. SETTING: Participants were recruited from 6 Spinal Cord Injury Model System centers across the United States (Craig Hospital, CO; Jefferson/Magee Rehabilitation Hospital, PA; Kessler Rehabilitation Center, NJ; University of Miami, FL; The Shirly Ryan Ability Lab, IL; Shepherd Center, GA). INTERVENTIONS: Not applicable. PARTICIPANTS: Men and women (N=28) with tetraplegia were enrolled in the study between November 2012 and January 2015. MAIN OUTCOME MEASURES: Participants completed self-report questionnaires focused on their DPS usage and mechanical ventilation, as well as their experiences and satisfaction with the DPS. RESULTS: DPS is a well-tolerated and highly successful device to help individuals living with spinal cord injury who are dependent on ventilators achieve negative pressure, ventilator-free breathing. A small percentage of participants reported complications, including broken pacing wires and surgery to replace or reposition wires. CONCLUSIONS: This study provides insight into the usage patterns of DPS and both the potential negative and positive effects that DPS can have on the life of the user. Knowledge gained from this study can provide a foundation for further discussion about the benefits and potential risks of using a DPS to inform an individual's decision to pursue a DPS implant.

Utilization of Complementary and Integrative Health Care by People With Spinal Cord Injury in the Spinal Cord Injury Model Systems: A Descriptive Study.

OBJECTIVE: To characterize the use of complementary and integrative health care (CIH) by people with spinal cord injury. DESIGN: Cross-sectional self-report study. SETTING: Participants were recruited from 5 Spinal Cord Injury Model Systems (SCIMS) centers across the United States. INTERVENTIONS: Not applicable. PARTICIPANTS: A total of 411 persons enrolled in the SCIMS completing their SCIMS follow-up interview between January 2017 and July 2019 (N = 411). MAIN OUTCOME MEASURES: Participants completed a survey developed for this study that included questions about types of CIH currently and previously used, reasons for current and previous use, reasons for discontinuing use of CIH, and reasons for never using CIH since injury. RESULTS: Of the 411 respondents, 80.3% were current or previous users of CIH; 19.7% had not used CIH since injury. The most commonly used current types of CIH were multivitamins (40.0%) and massage (32.6%), whereas the most common previously used type of CIH was acupuncture (33.9%). General health and wellness (61.4%) and pain (31.2%) were the most common reasons for using CIH. The primary reason for discontinuing CIH was that it was not helpful (42.1%). The primary reason for not using CIH since injury was not knowing what options are available (40.7%). CONCLUSIONS: These results point to the importance for rehabilitation clinicians to be aware that their patients may be using 1 or more CIH approaches. Providers should be open to starting a dialogue to ensure the health and safety of their patients because there is limited information on safety and efficacy of CIH approaches in this population. These results also set the stage for further analysis of this data set to increase our knowledge in this area.

Associations Between Insurance Provider and Assistive Technology Use for Computer and Electronic Devices 1 Year After Tetraplegia: Findings From the Spinal Cord Injury Model Systems National Database.

OBJECTIVE: To investigate the association between insurance provider and reported assistive technology (AT) use to access computers and electronic devices 1 year after sustaining tetraplegia. DESIGN: Multicenter cross-sectional study. SETTING: Participants enrolled in the Spinal Cord Injury Model Systems (SCIMS) National Database. INTERVENTIONS: Not applicable. PARTICIPANTS: Men and women with tetraplegia (N=498) enrolled in the SCIMS National Database were included in the analysis. MAIN OUTCOME MEASURES: The primary study outcome was the use of AT when operating a computer or other mobile electronic device. The primary predictor was the subject's principal health insurance provider, which was grouped into the 3 categories: government (Medicare, Medicaid, and other government), private (private insurance, private funds, and other), and workers' compensation. RESULTS: Overall, 34.7% of participants reported using AT to access computers and electronic devices. Results of logistic regression analysis revealed sex, injury level, injury completeness, self-perceived health status, and 12-month history of pressure ulcer were all significantly associated with AT use. After adjusting for these factors, participants with workers' compensation were more likely to report AT use than individuals with either government or private insurance. CONCLUSIONS: Despite significant technological advances, AT is not readily available to the people who might benefit most from its use. Findings from the present study are the first to shed light on AT funding sources and reveal that individuals with workers' compensation are more likely use AT than individuals with either government or private insurance. Additional work focused on AT use and functional outcomes is needed to assess the effect of barriers to use. Collectively, this work may inform insurers of the importance of having AT available for this unique population to potentially improve quality of life and participation.

Re-inventing yourself after spinal cord injury: a site-specific randomized clinical trial.

STUDY DESIGN: Parallel-arm randomized controlled trial comparing an interactive group format versus a no-intervention control. OBJECTIVE: To evaluate the efficacy of a replicable group treatment program for improving self-efficacy after spinal cord injury (SCI) in a single center cohort of adults. SETTING: Regional SCI center. METHODS: Participants included 81 individuals with SCI who were at least 4 weeks post-discharge from initial rehabilitation. Those randomized to treatment participated in six interactive learning sessions (2 hours each, one session per week) with structured and facilitated group interactions to improve self-efficacy. A wait-list control group was followed at matching time points for all outcome measures. The primary outcome measure was the Moorong Self-Efficacy Scale (MSES); secondary outcomes were the Generalized Self-Efficacy Scale (GSES); Diener Satisfaction with Life Scale (SWLS); Participation Assessment with Recombined Tools - Objective (PART-O); Patient Health Questionnaire - 9 (PHQ-9); and General Anxiety Disorder 7-item (GAD-7). RESULTS: Individuals in the Treatment group had greater increases in MSES scores from baseline to immediately post-intervention (6 weeks) than the Control group, but that difference did not remain significant after controlling for multiple comparisons. However, the improvement in the treatment group relative to the control group was not maintained through follow-up at 30 weeks. There was no evidence of an immediate or sustained treatment effect on any of the secondary outcomes. CONCLUSIONS: Self-efficacy improved for participants with SCI in the Treatment group, however, this improvement was not significant or maintained on follow-up.

Factors Associated With Regular Dental Care in People With Spinal Cord Injury: A Secondary Analysis of Data From the FRASCI Study.

Background: Oral health and regular dental care are critical to overall health. Research has found associations between oral health and infections, respiratory disease, and poor quality of life in the general population. While risks for all are increased in people with spinal cord injury (SCI), there is limited information on dental care after SCI. Objectives: The purpose of this analysis was to examine factors associated with regular dental care in people with SCI. Methods: We analyzed data from 348 individuals with traumatic and nontraumatic SCI who were enrolled in the Fracture Risk after SCI (FRASCI) study. The dataset included two variables on dental care, as well as demographics, injury-related characteristics, and secondary conditions. Bivariate relationships were determined using two-sided t tests and chi-square tests. Results: Over 60% of the sample received regular dental care twice per year, and 71% reported seeing a dentist within the past year. Those participants receiving regular dental care twice a year were more likely to be female, be working, have more than a high school diploma, have private insurance, and need a caregiver compared to those who do not receive regular dental care. In addition, these participants were more likely to have had pneumonia since their SCI and have had a urinary tract infection in the past year and since injury. Conclusion: More data on oral health are needed to make conclusions about the impact of oral health on secondary conditions and quality of life in people with SCI.

Residential Mobility and Reasons for Moving Among People Living With Spinal Cord Injury: Results of a Multisite Survey Study.

Background: Residential mobility after spinal cord injury (SCI) has not been extensively examined despite a growing interest in investigating the relationship between neighborhood exposures and community living outcomes. Objectives: This study explores residential mobility patterns, the annual move rate, and reasons for moving among a community-living sample of adults with SCI. Methods: A survey was conducted with 690 people at six SCI Model Systems centers in the United States between July 2017 and October 2020. The outcomes included move status in the past 12 months, move distance, and the primary reason for moving. A sample from the 2019 American Community Survey (ACS) 5-year pooled estimates was obtained for comparative analysis. Descriptive statistics were used to summarize the distributions of the outcomes and differences between the samples. Results: The annual move rate for adults with SCI was 16.4%, and most moves were within the same county (56.6%). Recent movers were more likely to be young adults, be newly injured, and have low socioeconomic status. Housing quality, accessibility, and family were more frequently reported motivations for moving compared to employment. Young adults more commonly moved for family and accessibility, whereas middle-aged adults more commonly moved for housing quality. No notable difference was observed in the annual move rate between the SCI and the general population samples. Conclusion: These findings suggest an age-related pattern of residential relocation after SCI, which may be indicative an extended search for optimal living conditions that meet the housing and accessibility needs of this population.

Exploring perspectives on assistive technology use: barriers, facilitators, and access.

PURPOSE: This qualitative study explored perceived barriers and facilitators to access and utilization of assistive technology (AT) among Veterans and civilians living with tetraplegia. We also explored differences in access to and utilization of AT between civilians and Veterans. MATERIALS AND METHODS: Semi-structured focus groups were conducted with 32 adults (15 Veterans, 17 non-Veterans) living with tetraplegia between the ages of 18 and 65 and who were at least one-year post-injury. Focus groups were conducted at two rehabilitation sites: Craig Hospital and the Louis Stokes Cleveland VA Medical Center. Participants were asked to discuss what they perceive as (1) the facilitators and barriers of AT access and utilization, and (2) the value of AT use in everyday living. Data were analyzed using thematic analysis of verbatim transcripts. RESULTS AND CONCLUSIONS: Facilitators of AT utilization and access included being connected to resources, trial-and-error, and knowledge gained from peers. Barriers to AT use included cost of devices, a general lack of awareness of resources, and requirements for eligibility; the latter two themes were endorsed solely by Veteran participants. Benefits of AT included increased independence, participation, productivity, quality of life, and safety. Findings highlight key facilitators of AT procurement and use, barriers that contribute to underutilization of AT, and important benefits experienced as a result of using AT that underscore the importance of AT for individuals with SCI.

The need to maintain connections with rehabilitation resources (e.g., the Department of Vocational Rehabilitation, occupational and physical therapists, the VA, inpatient facilities) is vital to learning about and procuring AT.There is a need for a tailored approach to address AT underutilization in civilian and Veteran populations.Despite the barriers to AT use and the challenges associated with discovery of AT, utilization of AT may lead to increased independence, participation, productivity, quality of life, and safety.

The pet project: A qualitative exploration into the experience of pet ownership following spinal cord injury.

STUDY DESIGN: Qualitative study OBJECTIVES: To explore the unique experience of facilitators, barriers, rewards, and challenges related to pet ownership after spinal cord injury (SCI). SETTING: Zoom for Healthcare videoconferencing platform hosted from an American neuro-rehabilitation hospital in Colorado. METHODS: Sixteen individuals with SCI participated in three semi-structured focus groups of 5-6 participants each. Resulting discussions were transcribed and coded using a hybrid approach to thematic analysis. RESULTS: Experiences of pet ownership were categorized by their representativeness of four key themes: facilitators (conditions that make obtaining or maintaining pets easier), barriers (conditions that were prohibitive or that prevented people from having pets), rewards (benefits of pet ownership), and challenges (difficulties associated with pet ownership). Participants cited equipment, tools, and services as the most common facilitator for owning pets after SCI, with environment being the most commonly cited barrier. Companionship, love, and comfort/security were most commonly cited as rewards, while mobility was cited as a primary challenge of pet ownership after SCI. Additionally, two unexpected response themes emerged. Positive outweighs negative included assertions that benefits of having pets were not overshadowed by drawbacks, and Wishlist included desires for training and access to tools to facilitate pet ownership. CONCLUSIONS: Pet ownership is largely unexplored in individuals with SCI. Participants in this study indicated that pet ownership provides many benefits, though it is not without its challenges. Participants also noted the desire for training and resources to make pet ownership more accessible. Further exploration into informing development of those tools is warranted.

Medical, dental, and optical care utilization among community-living people with spinal cord injury in the United States.

CONTEXT/OBJECTIVE: Information about patterns of healthcare utilization for people living with spinal cord injury (SCI) is currently limited, and this is needed to understand independent community living after SCI. This study investigates self-reported healthcare utilization among community-living people with SCI and assesses disparities across demographic, socioeconomic, and injury-related subgroups. DESIGN: Secondary analysis of cross-sectional survey data administered via telephone interview. SETTING: 6 SCI Model Systems centers in the United States (California, Colorado, New Jersey, New York, Ohio, and Pennsylvania). PARTICIPANTS: Adults with chronic, traumatic SCI who were community-living for at least one year after the completion of an inpatient rehabilitation program (N = 617). INTERVENTIONS: Not applicable. OUTCOME MEASURES: Utilization of a usual source of 4 types of health care in the past 12 months: primary, SCI, dental, and optical. RESULTS: 84% of participants reported utilizing primary care in the past year. More than half reported utilizing SCI (54%) and dental (57%) care, and 36% reported utilizing optical care. There were no significant differences across key subgroups in the utilization of primary care. Participants who had been injured for 5 years or less and participants with greater educational attainment were more likely to report utilizing SCI care. Participants with higher household income levels were more likely to report using dental care. Female participants and older age groups were more likely to report using optical care. CONCLUSION: Rates of healthcare utilization among people with SCI are below recommended rates and vary across demographic, socioeconomic, and injury-related subgroups. This information can inform future research to target barriers to using healthcare services among community-living people with SCI.

A Study Protocol for a Multisite Randomized Controlled Trial of an Intervention to Improve Outcomes After Spinal Cord Injury.

Background: The consequences of spinal cord injury (SCI) can place significant demands on an individual's coping mechanisms. Interventions to promote psychological adjustment and coping are often included in inpatient rehabilitation programs; however, following discharge, many individuals with SCI do not receive ongoing counseling or education about psychological adjustment to disability. Effective postacute treatment models are needed to help individuals with SCI build skills that help them adapt to the stresses associated with a chronic physical disability, alleviate the consequences of anxiety and depression, and enhance subjective well-being. Objectives: To describe the protocol for a randomized clinical trial (RCT) of a 6-week intervention designed to improve psychosocial outcomes after SCI. Methods: To test efficacy and replicability of the intervention, we designed a three-arm, multisite RCT with assessments conducted at six time points. Our primary hypothesis is that participants in the Group arm will report greater improvements in psychosocial outcomes than participants who complete the intervention individually via video (Individual arm) or those who do not receive the intervention (Control arm). We also hypothesize that participants in the Group arm will maintain greater improvements in psychosocial outcomes longer than those in the individual or control arms. Conclusion: Results of the RCT will be presented and published to professionals and consumers, and intervention training and materials will be made available upon request.

BART to HIVEd: adapting an HIV education prevention program.

One of the fastest growing segments of the population infected with HIV is the nation's youths. Thus, prevention in this high-risk population is vital. The authors detail the process of adapting an evidence-based HIV/AIDS educational program (HIVEd) to the unique needs of high-risk youths in adjudicated and detained facilities and alternative high schools. The HIVEd program derives from St. Lawrence's Becoming A Responsible Teen (BART) curriculum. This article describes the modification of BART into HIVEd, identifies the challenges encountered and lessons learned, and suggests future directions for HIVEd as a useful tool for prevention of HIV/AIDS and sexually transmitted infection in high-risk youths.

STATINS AND BONE HEALTH: A MINI REVIEW.

Statins are a widely prescribed class of medications that inhibit similar pathways as the anti-resorptive bisphosphonate drugs. Statins target the mevalonate pathway by blocking HMG-CoA reductase. Several recent meta-analyses concluded statins are osteoprotective in the general population. Here we present current literature exploring the mechanisms underlying the putative osteoprotective effects of statins. We also review recent clinical studies, ranging from observational cohort studies to randomized clinical trials, testing the effect of statins on bone health in various populations.

Las estatinas son un grupo de drogas prescriptas en forma habitual, con la capacidad de bloquear vías de señalizaciÓn similares a las inhibidas por los amino-bisfosfonatos. Las estatinas inhiben la vía del mevalonato, a través del bloqueo de diferentes enzimas. Varios metaanálisis recientes llevaron a la conclusión de que las estatinas tienen capacidad osteoprotectora en la población general. En esta revisión presentamos la literatura actual describiendo los mecanismos que subyacen en el potencial efecto osteoprotector de las estatinas, como así también estudios observacionales y clínicos aleatorizados sobre el efecto de estatinas en la salud ósea en diversas poblaciones.

Aging after spinal cord injury: A 30-year longitudinal study.

BACKGROUND/OBJECTIVE: This longitudinal study investigated changes in life satisfaction, general health, activities, and adjustment over 3 decades among individuals with spinal cord injury (SCI). PARTICIPANTS: The cohort of participants was identified from outpatient records of a large Midwestern United States university hospital. In 1973, 256 individuals completed an initial survey. There were 5 subsequent follow-up surveys, with the most recent being in 2002. Seventy-eight participants completed materials on all 6 occasions. METHODS: The Life Situation Questionnaire was used to identify changes over the 30-year period in 6 areas of life satisfaction, self-rated adjustment (current and predicted), employment status, activities, and medical treatments. ANALYSES: These analyses used data from 3 points in time, separated by approximately 15-year intervals. One-way analysis of variance with repeated measures was used to identify changes in outcomes between 1973, 1988, and 2002 for all continuous variables. RESULTS: We found a mixed pattern of changes over the 30 years, with increases noted during the first 15-year period in sitting tolerance, educational and employment outcomes, satisfaction with employment, and adjustment. Although these changes tended to remain stable during the last 15 years, subtle declines were suggested in some areas, with clear declines noted in terms of diminished sitting tolerance, an increase in the number of physician visits, and decreased satisfaction with social life and sex life. CONCLUSIONS: The results suggest that many positive changes occur within the first 2 decades after SCI, followed by a period of stability in some life areas, but decline with aging in some participation and health-related aspects of life.

Statins and bonehealth: a mini review / Estatinas y salud ósea: una minirevisión

Statins are a widely prescribed class of medications that inhibit similar pathways as the anti-resorptive bisphosphonate drugs. Statins target the mevalonate pathway by blocking HMG-CoA reductase. Several recent meta-analyses concluded statins are osteoprotective in the general population. Here we present current literature exploring the mechanisms underlying the putative osteoprotective effects of statins. We also review recent clinical studies, ranging from observational cohort studies to randomized clinical trials, testing the effect of statins on bone health in various populations. (AU)

Las estatinas son un grupo de drogas prescriptas en forma habitual, con la capacidad de bloquear vías de señalización similares a las inhibidas por los amino-bisfosfonatos. Las estatinas inhiben la vía del mevalonato, a través del bloqueo de diferentes enzimas. Varios metaanálisis recientes llevaron a la conclusión de que las estatinas tienen capacidad osteoprotectora en la población general. En esta revisión presentamos la literatura actual describiendo los mecanismos que subyacen en el potencial efecto osteoprotector de las estatinas, como así también estudios observacionales y clínicos aleatorizados sobre el efecto de estatinas en la salud ósea en diversas poblaciones. (AU)

Comparison of the Patient Health Questionnaire and the Older Adult Health and Mood Questionnaire for self-reported depressive symptoms after spinal cord injury.

OBJECTIVE: To directly compare estimates of potential depressive disorders and clinically significant depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) and Older Adult Health and Mood Questionnaire (OAHMQ) among participants with spinal cord injury (SCI). RESEARCH DESIGN: 727 participants from a hospital in the Southeastern United States were administered the PHQ-9 and OAHMQ during a follow-up survey. We compared the rates of depressive disorders using cutoff scores and diagnostic criteria for each instrument. No independent psychiatric diagnostic interviews were conducted. RESULTS: The PHQ-9 and OAHMQ were significantly correlated (r = .78), and both were correlated with satisfaction with life (r = -.48, -.54). Using recommended diagnostic scoring procedures, 10.7% of participants met the diagnostic criteria for major depressive disorder with the PHQ-9; 9.3% met the criteria for major depression based on PHQ-9 > or = 10; and 19.7% based on PHQ-9 > or = 15. Using the OAHMQ, 19.7% reported probable major depression and 44.5% clinically significant symptomatology. CONCLUSIONS: The measures were highly correlated overall. However, the estimated prevalence of depressive disorders varied substantially between the 2 instruments. These estimates were comparable to those previously reported for each instrument (i.e., higher rates with the OAHMQ). Therefore, differing estimates of depressive disorders reported in the literature using these instruments were largely attributable to the instruments themselves.

Effect of co-morbid traumatic brain injury on functional outcome of persons with spinal cord injuries.

OBJECTIVE: This study was undertaken to determine if persons who sustain a spinal cord injury (SCI) and co-morbid brain injury (dual diagnosis [DDS]) evidence smaller functional gains and experience significantly longer rehabilitation lengths of stay than persons with only an SCI. DESIGN: This retrospective comparison study was performed at a 100-bed rehabilitation hospital specializing in acute SCI and traumatic brain injury rehabilitation. Summary scale outcome data of persons who sustained an SCI were compared with outcome data of a group of persons with a DDS. Comparisons were established by matching groups principally on level of SCI and admission Motor FIM trade mark score and secondarily on education, sex, and age. Outcome measures included admission Motor and Cognitive FIM score, discharge Motor and Cognitive FIM score, Motor and Cognitive FIM change, length of stay, and rehabilitation charges. RESULTS: Persons with a DDS evidenced a significantly more impaired Cognitive FIM score at admission and discharge from rehabilitation. Persons with a DDS also achieved a significantly lower Motor FIM change than persons with SCI. There were no significant differences between DDS and SCI groups regarding Cognitive FIM change, length of stay, or rehabilitation charges. Injury severity as defined by the Glasgow Coma Scale or intracranial lesions did not predict response to treatment in the DDS group. CONCLUSION: Persons with a DDS achieved smaller functional gains during rehabilitation than peers with SCI. Brain injuries seem to limit functional gains, although the relationship between brain injury severity and functional change is not linear. Prospective studies are needed to identify factors limiting functional gains in rehabilitation and assist in developing specific treatment programs for persons with SCI and brain injury.