Impact of neuropathic pain on participation: perspectives from the Canadian SCI community survey.

STUDY DESIGN: Secondary analysis of an observational cohort study. OBJECTIVES: To determine if the perceived overall limitation of neuropathic pain on activities (NP limitation) covaries in 26 specific life activities in people with SCI, taking into account the severity of injury. SETTING: Community-based in Canada. METHODS: Secondary analysis of a cohort (N = 1481) was performed using questionnaires to rate NP frequency and limitation on activities as well as participation in 26 life activities. Relative risks (RR) analyses using Poisson regression were used to examine the data. RESULTS: Most participants (N = 1158; 78%) reported living with NP (from once a year to every day). When NP limitation was described as "not at all" or "very little" (N = 394; 34%), there was no statistically significant RR (p > 0.0019), suggesting no additional risk of not participating "as much as wanted" in any of activities compared to participants with no NP. When NP limitation was described as "to some extent" (N = 411; 35%), a significantly higher risk was observed for 5 of the 26 activities (1.34 < RR < 1.62), and for 23 activities with a large range (1.24 < RR < 3.20) when NP limitation was rated as "to a great extent or more" (N = 353; 31%). CONCLUSION: The variation of RR observed across the 26 activities suggests that the NP limitation may not be general but rather related to specific activity characteristics, which should be taken into account when evaluating NP limitations with a specific focus on the life activities being affected.

French-Canadian translation and validation of four questionnaires assessing hearing impairment and handicap.

OBJECTIVE: Questionnaires evaluating hearing impairment are available in English but there is a need for French standardised questionnaires for researchers as well as for audiologists and other clinicians. The objective of this study is to describe the translation and validation of four questionnaires that assess different aspects of hearing impairment and handicap among elders with hearing loss, by comparing the main score and psychometric evaluation of original and French-Canadian (FC) versions of the World Health Organization Disability Assessment Scale II (WHO-DAS II), the Screening Test for Hearing Problems (STHP), the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA). DESIGN: Vallerand method: translation and back-translation by two translators, revision by a committee of experts and pre-tested with five bilingual older participants. STUDY SAMPLE: Participants (n = 29) were 65 years of age or older including 21 with hearing aids. RESULTS: The psychometric properties (internal consistency, temporal stability after four weeks) indicate good reliability for most of the translated questionnaires and their subscales, especially the WHO-DAS II. CONCLUSIONS: The translations in FC of two hearing loss and two hearing aid questionnaires were validated. It is recommended to pursue the demonstration for temporal stability for the STHP.

Impact of pressure ulcers on individuals living with a spinal cord injury.

OBJECTIVE: To describe the impact of pressure ulcers on the ability to participate in daily and community activities, health care utilization, and overall quality of life in individuals living with spinal cord injury (SCI). DESIGN: Cross-sectional study. SETTING: Nationwide survey. PARTICIPANTS: Participants (N=1137) with traumatic SCI who were >1 year postinjury and living in the community were recruited. Of these, 381 (33.5%, 95% confidence interval, 30.8%-36.3%) had a pressure ulcer over the last 12 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures developed for the Rick Hansen Spinal Cord Injury Registry Community Follow-up Survey Version 2.0. RESULTS: Of the 381 individuals with pressure ulcers, 65.3% reported that their pressure ulcer reduced their activity to some extent or more. Pressure ulcers reduced the ability of individuals with SCI to participate in 19 of 26 community and daily activities. Individuals with 1 or 2 pressure ulcers were more dissatisfied with their ability to participate in their main activity than those without pressure ulcers (P=.0077). Pressure ulcers were also associated with a significantly higher number of consultations with family doctors, nurses, occupational therapists, and wound care nurses/specialists (P<.05). CONCLUSIONS: Pressure ulcers have a significant impact on the daily life of individuals with SCI. Our findings highlight the importance of implementing pressure ulcer prevention and management programs for this high-risk population and require the attention of all SCI-related health care professionals.

A life course perspective to spinal cord injury and employment participation in Canada.

BACKGROUND: Few studies have examined life course differences in the employment of Canadians with spinal cord injury (SCI). OBJECTIVE: To compare employment participation of young/middle-aged and older adults with SCI and to examine the association between employment and demographic and health factors, SCI-related needs, and social role participation at the 2 life phases. METHODS: A sample of young/middle-aged (18-54 years; n = 959) and older adults (55-64 years; n = 364) with SCI was recruited as part of a larger Canadian community survey. Pre- and postinjury employment were compared. Demographic and health factors, number of unmet SCI needs, and social role participation were collected and compared by life phase and employment status. Two multivariable logistic regression models were conducted and compared for young/middle-aged and older adults. RESULTS: Close to one-third of participants with SCI were working post injury (32%), a decline from the 62% of respondents working prior to their injury. Participants were more likely to work in less physically demanding job sectors including business/administration or health/science/teaching. An examination of life phase differences showed that young/middle-aged adults were more likely to be employed post injury (36%) when compared to older respondents (12% employed) who were more likely to report being retired (43%). Multivariable analyses revealed that for young/middle-aged adults, being married, attaining a postsecondary education, and having fewer unmet SCI needs were related to employment. Among older adults, having a traumatic injury was related to involvement in paid work. For both young/middle-aged and older adults, participating in more social roles was related to working. CONCLUSION: A life course perspective is important to understanding similarities and differences between young/middle-aged and older adults with SCI in their employment participation. Tailored programs and policies should be designed to promote labor force involvement at different phases of the working life course.

Spinal cord injury community survey: a national, comprehensive study to portray the lives of canadians with spinal cord injury.

BACKGROUND: To better understand service-related needs and the current situation of persons with spinal cord injury (SCI) living in the community, a more comprehensive approach for studying their interrelationships (needs vs community living outcomes) is greatly needed. OBJECTIVE: To describe the development, design, and findings of a Canadian survey portraying the life situation of people with SCI. METHOD: The SCI Community Survey covers demographics, health, SCI-specific needs, community participation, employment, quality of life, health care utilization, and overall health rating. A total of 1,549 persons with SCI completed the survey (Web or phone) between May 2011 and August 2012. RESULTS: Some major expressed needs for services to support community living are met to a great extent for a substantial proportion of people with SCI. Complications remain highly prevalent for some health issues, including pain, sexual dysfunction, and musculoskeletal disorders. The extent of community participation based on values and preferences varies tremendously among daily activities and social roles. Some dimensions of quality of life are rated positively (eg, family life) while others are greatly disrupted (eg, sex life and physical health). Most of these findings vary significantly between people with traumatic and nontraumatic lesions. CONCLUSION: This survey is the first in Canada and among the first worldwide to draw a comprehensive picture of major aspects of the lives of people with SCI including service needs. The results will help to determine the links between various aspects of community living and guide service providers and policy makers in focusing on major issues to enhance quality of life after SCI.

Spinal Cord Injury Community Survey: Understanding the Needs of Canadians with SCI.

BACKGROUND: There is a lack of literature regarding service needs of people with SCI living in the community. Better assessment of expressed and met and unmet needs would help in the development of effective service delivery. OBJECTIVE: From a national SCI Community Survey in Canada, the aim was to identify the most critical service needs of people living in the community at least 1 year post discharge from rehabilitation and the support they received to meet their needs. METHOD: Data were collected mainly through a secure Web site and encompassed demographics, personal and household income, an SCI severity measure, and an SCI community needs measure containing information on 13 SCI-related needs. RESULTS: A total of 1,549 persons with SCI (traumatic lesion, n = 1,137; nontraumatic lesion, n = 412) across Canada completed the survey. Most critical needs for community integration were expressed by a substantial proportion of survey participants, but significantly more expressed and met needs were reported by persons with a traumatic than a nontraumatic lesion. Personal and environmental characteristics influenced the probability of expressing and meeting needs (eg, severity of injury and household income). Help and support to meet expressed needs were received from government agencies, community organizations, and friends or family. CONCLUSION: Better assessment of expressed and met or unmet needs for services remains a challenge but will serve as a tool to optimize service delivery in the community. Environmental barriers to services, particularly the process of getting needs met and associated costs, remain an issue that requires a reconsideration of some aspects of access to services.

Understanding Quality of Life in Adults with Spinal Cord Injury Via SCI-Related Needs and Secondary Complications.

BACKGROUND: Understanding the factors that can predict greater quality of life (QoL) is important for adults with spinal cord injury (SCI), given that they report lower levels of QoL than the general population. OBJECTIVES: To build a conceptual model linking SCI-related needs, secondary complications, and QoL in adults with SCI. Prior to testing the conceptual model, we aimed to develop and evaluate the factor structure for both SCI-related needs and secondary complications. METHODS: Individuals with a traumatic SCI (N = 1,137) responded to an online survey measuring 13 SCI-related needs, 13 secondary complications, and the Life Satisfaction Questionnaire to assess QoL. The SCI-related needs and secondary complications were conceptualized into factors, tested with a confirmatory factor analysis, and subsequently evaluated in a structural equation model to predict QoL. RESULTS: The confirmatory factor analysis supported a 2-factor model for SCI related needs, χ(2)(61, N = 1,137) = 250.40, P <.001, comparative fit index (CFI) = .93, root mean square error of approximation (RMSEA) = .05, standardized root mean square residual (SRMR) = .04, and for 11 of the 13 secondary complications, χ(2)(44, N = 1,137) = 305.67, P < .001, CFI = .91, RMSEA = .060, SRMR = .033. The final 2 secondary complications were kept as observed constructs. In the structural model, both vital and personal development unmet SCI-related needs (ß = -.22 and -.20, P < .05, respectively) and the neuro-physiological systems factor (ß = -.45, P < .05) were negatively related with QoL. CONCLUSIONS: Identifying unmet SCI-related needs of individuals with SCI and preventing or managing secondary complications are essential to their QoL.

An Exploratory Analysis of the Potential Association Between SCI Secondary Health Conditions and Daily Activities.

BACKGROUND: Secondary health conditions (SHCs) are common following traumatic spinal cord injury (tSCI) and are believed to influence a person's ability to participate in daily activities (DAs). This association should be understood so that health care providers may target interventions with clarity and purpose to manage SHCs and facilitate DAs to maximal effect. OBJECTIVE: To explore the association between SHCs and DAs expressed as the increased chance of not participating as much as wanted in a DA when an SHC is present. METHODS: Community-dwelling persons with tSCI (n = 1,137) responded to the SCI Community Survey. The occurrence and frequency of 21 SHCs were determined. The extent of participation in 26 DAs was measured. The relative risk (RR) of not participating as much as wanted in a DA when a SHC is present was calculated. RESULTS: When some SHC were present, the RR of not participating as much as wanted increased significantly (range, 15%-153%; P < .001). Certain SHCs (light-headedness/dizziness, fatigue, weight problems, constipation, shoulder problems) were associated with a greater chance of not participating in many DAs. No single SHC was associated with every DA and conversely not every DA was associated with an SHC. CONCLUSIONS: Maximizing participation in DAs requires minimizing SHCs in every instance. Understanding the association between SHCs and DAs may facilitate targeted care resulting in less severe SHCs, greater participation in DAs, and benefits to both the individual and society.

Health care utilization in persons with traumatic spinal cord injury: the importance of multimorbidity and the impact on patient outcomes.

BACKGROUND: Persons with spinal cord injury (SCI) living in the community have high health care utilization (HCU). To date, the interrelationships among multiple secondary health conditions (multimorbidity due to comorbidities and complications) that drive HCU and their impact on patient outcomes are unknown. OBJECTIVE: To determine the association among multimorbidity, HCU, health status, and quality of life. METHODS: Community-dwelling persons with traumatic SCI participated in an online/phone SCI Community Survey. Participants were grouped using the 7-item HCU questionnaire (group 1 did not receive needed care and/or rehospitalized; group 2 received needed care but rehospitalized; group 3 received needed care and not rehospitalized). Personal, injury, and environmental factors; multimorbidity (presence/absence of 30 comorbidities/ complications); health status (Short Form-12); and quality of life measures (Life Satisfaction-11 first question and single-item quality of life measure) were collected. Associations among these variables were assessed using multivariate analysis. RESULTS: The 1,137 survey participants were divided into 3 groups: group 1 (n = 292), group 2 (n = 194), and group 3 (n = 650). Group 1 had the greatest number of secondary health conditions (15.14 ± 3.86) followed by group 2 (13.60 ± 4.00) and group 3 (12.00 ± 4.16) (P < .05). Multimorbidity and HCU were significant risk factors for having a lower SF-12 Mental (P < .001) and Physical Component Score (P < .001). They in turn were associated with participants reporting a lower quality of life (P < .001, for both questions). CONCLUSIONS: Multimorbidity and HCU are interrelated and associated with lower health status, which in turn is associated with lower quality of life. Future work will include the development of a screening tool to identify persons with SCI at risk of inappropriate HCU (eg, rehospitalization, not able to access care), which should lead to better patient outcomes and cost savings.

Self-report of one-year fracture incidence and osteoporosis prevalence in a community cohort of canadians with spinal cord injury.

BACKGROUND: Sublesional declines in hip and knee region bone mass are a well-established consequence of motor complete spinal cord injury (SCI), placing individuals with SCI at risk for fragility fracture, hospitalization, and fracture-related morbidity and mortality. OBJECTIVES: To describe the 1-year incidence of fracture and osteoporosis prevalence in a community cohort of Canadians with chronic SCI. METHODS: As part of the SCI Community Survey, consenting adult participants with chronic SCI completed an online or telephone survey regarding their self-reported medical comorbidities, including fracture and osteoporosis, in the 12 months prior to survey conduct. Survey elements included sociodemographic and impairment descriptors and 4 identified risk factors for lower extremity fragility fracture: injury duration ≥ 10 years, motor complete and sensory complete (AIS A or A-B) paraplegia, and female gender. RESULTS: Consenting participants included 1,137 adults, 70.9% were male, mean (SD) age was 48.3 (13.3) years, and mean (SD) time post injury was 18.5 (13.1) years. Eighty-four participants (7.4%) reported a fracture in the previous 12 months and 244 (21.5%) reported having osteoporosis in the same time period, with corresponding treatment rates of 84.5% and 64.8%, respectively. The variables most strongly associated with fracture were osteoporosis (odds ratio [OR], 4.3; 95% CI, 2.72-6.89) and having a sensory-complete injury (OR, 2.2; 95% CI, 1.38-3.50) or a motor complete injury (OR, 1.7; 95% CI, 1.10-2.72). CONCLUSIONS: The discordance between fracture occurrence and treatment and the strength of the association between osteoporosis diagnosis and incident fractures necessitates improved bone health screening and treatment programs, particularly among persons with complete SCI.

Perspectives of wheelchair users with chronic spinal cord injury following a walking program using a wearable robotic exoskeleton.

PURPOSE: To examine the perspectives of wheelchair users with spinal cord injury (WUSCI) regarding their participation in a 16-week walking program using a wearable robotic exoskeleton (WRE); and explore concerns and expectations regarding potential use of this device and intervention in the context of a home or community-based adapted physical activity program. METHOD: Semi-structured interviews were conducted using a narrative research, 3 weeks post-intervention. Thematic analysis resulted in 6 themes and 21 subthemes. RESULTS: Seven men and 4 women aged between 32 and 72 years were interviewed; 8 of them had a complete SCI. After the walking program, WUSCI reported positive psychological aspects (having fun and motivation) and experiencing improvements in physical aspects (strength, endurance, balance and flexibility, blood circulation and intestinal transit). The structural aspects of the WRE device were acceptable in a lab with research personnel (appearance, size, weight, and comfort). Participants had concerns about safety on uneven surfaces, and possibility of falling. They expressed the desire to use the WRE for more life habits than just walking. CONCLUSION: This is the first study in which WUSCI report that the WRE should be implemented in initial rehabilitation. Lack of availability for community use after rehabilitation remains a concern.

Participation in a walking training program using a wearable robotic exoskeleton, 1-3 times weekly over several weeks, may be well tolerated and provide physical and psychological benefits for wheelchair users with spinal cord injuries.Using a robotic exoskeleton during initial rehabilitation may be well received and help with regaining strength, endurance, balance, and flexibility as well as promoting blood circulation and intestinal transit.The use of the wearable robotic exoskeleton always needs supervision of a clinician for walking and can't be used independently by wheelchair users; there is no possibility for hands free for household tasks (e.g., washing floors, accessing cupboards or reaching shelves, using stairs), and for recreation (e.g., exercising, taking walks, cultural activities, concerts).

Neuro Service Dogs Impacts on Community-Dwelling Persons with Mild to Moderate Dementia and Their Caregiver.

Since there were no research data on the use of neuro service dogs (NSD) in 2018, a comparative case study research design was done. The cases comprised of a caregiver with a person with mild to moderate dementia, and either an NSD (n=5), a companion dog (n=28), or no dog (n=23). Monitor activity and online questionnaires were administrated. Interesting qualitative data on the roles of a NSD, advantages and inconvenients were fully described and published. Quantitative data could not confirm that NSD is benefit-cost, neither that it increases quality of sleep or level of exercise, compared to companion dogs.

Roles and usages of neuro service dogs for caregivers living at home with persons with dementia: An exploratory comparative case study.

The goal of the present study was to examine how canine assistance may support family caregivers and persons with dementia and to document and compare two modalities of home care support. An exploratory comparative case study research design was conducted. Three cases correspond of dyads of a caregiver, a person with mild to moderate dementia, and either a neuro service dog (NSD), a companion dog or no dog. Hypotheses are formulated to capture differences between cases. Recruitment was done in a service dog organisation, through Canadian Alzheimer associations and in records of a hospital. Data were collected through 45-60 minutes telephone interviews that included completion of the Caregiver's Burden Scale and sociodemographic questions. We used an inductive approach with qualitative data. There were five caregivers (mean age 54.8 years) who had an NSD, 28 caregivers (63.6 years) who had a companion dog, and 23 caregivers (63.8 years) without dog. In the category of roles and usages of the dog, 'Socialisation' and 'Help with a sense of direction' were the most addressed roles for dyads with the NSD. For dyads with companion dog and without dog, 'Engagement-and-meaning of life' as well as 'Physical activity with the dog' were the most discussed roles. The 'Sleep or wake up' role was the least discussed role across three cases. In the other categories, they were seven advantages and 10 inconvenients that were mentioned for canine assistance. For home care support, the presence of NSD has more positive impacts on both the person with dementia and their caregiver compared to the presence of a companion dog; the presence of a NSD results in the person with dementia accessing more indoor and outdoor public sites than with a companion dog; and dyads with a dog are informally socially engaged more frequently than those with no dog.

Design of Instructional Videos for People with Autism Who Want to Learn About Grocery Store Work: A Community, Business, Educational and Health Partnership.

To facilitate the integration of people with autism into the food industry labour market, this cross sectoral project aimed to design, validate and test instructional videos to concretely demonstrate various tasks in the grocery store, and to probe interest and assess knowledge about these tasks. Results are the delivery of 21 instructional videos validated for individuals with autism and 21 for mentors in grocery.

Neonatal stress and attenuation of the hypercapnic ventilatory response in adult male rats: the role of carotid chemoreceptors and baroreceptors.

Neonatal maternal separation (NMS) is a form of stress that disrupts respiratory control development. Awake adult male rats previously subjected to NMS show a ventilatory response to hypercapnia (HCVR; Fi(CO(2)) = 0.05) 47% lower than controls; however, the underlying mechanisms are unknown. To address this issue, we first tested the hypothesis that carotid bodies contribute to NMS-related attenuation of the HCVR by using carotid sinus nerve section or Fi(O(2)) manipulation to maintain Pa(O(2)) constant (iso-oxic) during hypercapnic hyperpnea. We then determined whether NMS-related augmentation of baroreflex sensitivity contributes to the reduced HCVR in NMS rats. Nitroprusside and phenylephrine injections were used to manipulate arterial blood pressure in both groups of rats. Pups subjected to NMS were separated from their mother 3 h/day from postnatal days 3 to 12. Control rats were undisturbed. At adulthood, rats were anesthetized [urethane (1g/kg) + isoflurane (0.5%)], and diaphragmatic electromyogram (dEMG) was measured under baseline and hypercapnic conditions (Pa(CO(2)): 10 Torr above baseline). The relative minute activity response to hypercapnia of anesthetized NMS rats was 34% lower than controls. Maintaining Pa(O(2)) constant during hypercapnia reversed this phenotype; the HCVR of NMS rats was 45% greater than controls. Although the decrease in breathing frequency during baroreflex activation was greater in NMS rats, the change observed within the range of pressure change observed during hypercapnia was minimal. We conclude that NMS-related changes in carotid body sensitivity to chemical stimuli and/or its central integration is a key mechanism in the attenuation of HCVR by NMS.

Implementation Evaluation of an Online Peer-Mentor Training Program for Individuals With Spinal Cord Injury.

Background: Community-based spinal cord injury (SCI) associations play a critical role in successful community integration of individuals having experienced an SCI, with knowledge translation being increasingly important for the process. The implementation of a new online peer-mentor training program was perceived as being useful in improving and standardizing training practices for peer mentors across Canada. It was also seen as an opportunity to explore the context, process, and influence of a formal implementation process in SCI community-based associations that are corporate members of SCI Canada with a view to informing future implementation efforts. Objectives: The objectives of this study were to (a) explore the context in which the implementation process will be conducted, (b) identify barriers and facilitators that influence the implementation process, and (c) measure the influence of the implementation process on service delivery. Methods: A sequential cross-sectional design was used with SCI Canada provincial member associations. SCI Canada's purpose is to support collaboration among provincial corporate members. SCI Canada enlisted the participation of several employees from the provincial associations to assess the implementation context using the Evidence-Based Practice Attitude Scale and the Organizational Readiness to Change Assessment and to identify barriers to and facilitators of the implementation of an evidence-based practice through an open-ended questionnaire based on the Consolidated Framework for Implementation Research. A pre-post design was used to evaluate the influence of the implementation process on peer-mentors using the Determinants of Implementation Behavior Questionnaire. Results: Participants reported an overall positive attitude toward evidence-based practice and a positive perception of the organizational readiness to change. The relevance of the practice chosen was a facilitator because peer support is central to the mission of SCI Canada and this type of practice is in line with the organization' culture and values. Equally important, but as an obstacle, is the scarcity of existing resources within the association in general and specifically resources devoted to the implementation of the program. Finally, the implementation process seems to influence half of the implementation determinant types on potential peer mentors. Conclusion: Community-based organizations, such as the provincial association members of SCI Canada, show positive context for the implementation of evidence-based practices. However, successful implementation of online peer-mentor training will require specific consideration of financial and human resources.

Perceived influence of intrinsic/extrinsic factors on participation in life activities after spinal cord injury.

BACKGROUND: Various types of limitations on community participation are experienced by people with spinal cord injury (SCI). OBJECTIVES: To determine: 1) the perceived influence of six intrinsic/extrinsic factors (i.e. physical impairment, emotional condition, thinking skills, environment, lack of assistance, discrimination) on participation in 26 life activities, 2) if this influence varied based on extent of participation, and 3) if personal or environmental characteristics influenced perceptions. METHODS: Secondary analysis of a cohort (SCI Community Survey, n = 1508) using the SCI Person-Perceived Participation in Daily Activities Questionnaire. Frequency tables, Fisher's exact tests and correspondence analyses. RESULTS: Respectively, 79.6% and 38.5% of respondents perceived that their physical impairment and the natural and/or built environment were the main factors that limited participation across all activities. Considering participation between three groups (no participation; less than wanted; as much as wanted), significant differences (p < 0.001) of perceptions were observed in 65% of the combinations (26 activities x 6 factors). The hypothesis that respondents who did not participate would perceive the highest proportion of limitations was confirmed in 41% of the combinations. Perceived influence of the intrinsic/extrinsic factors on participation was not significantly influenced by other personal or environmental characteristics. CONCLUSION: A majority of people with SCI perceived that their participation is limited by one or more of intrinsic/extrinsic factors. Perceptions regarding which factors influence participation differ between activities and these perceptions appear related to the extent of participation suggesting that those who actively participate could be the most sensitive to limitations in certain activities.

Quality of Life and Health Utility Scores Among Canadians Living With Traumatic Spinal Cord Injury - A National Cross-Sectional Study.

STUDY DESIGN: National, multicenter, cross-sectional study. OBJECTIVE: The goal of this study was to provide overall quality of life (QOL) and health utility (HU) values for patients with traumatic spinal cord injury (SCI) stratified by injury level and neurological status. SUMMARY OF BACKGROUND DATA: Traumatic SCI is a leading cause of disability. Varying injury level and severity generate a spectrum of neurological dysfunction and reduction in long-term QOL. METHODS: The Canadian SCI Community Survey was sent to Canadians living in the community after SCI. The impact of demographics, complications, and SCI classification on QOL was assessed using Analysis of variance, multiple linear regressions and ordinal logistic regression analyses. RESULTS: There were 1109 respondents with traumatic SCI. american spinal injury association impairment scale (AIS) grade was reported to be cervical motor complete in 20%, cervical motor incomplete in 28%, thoracolumbar motor complete in 32%, thoracolumbar motor incomplete in 16%, and normal (any level) in 1%. Injury level or AIS grade had no impact on either HU or QOL. The physical component of health-related quality of life (HRQOL) was significantly affected by the neurological level, but not the social or mental components. With a mean health utility score of 0.64 ±â€Š0.12, SCI patients living in the community reported having HRQOL similar to patients after total knee arthroplasty or lumbar spinal stenosis decompression. CONCLUSION: QOL or HU measured by generic HRQOL outcome tools should not be used as outcomes to assess the effectiveness of interventions targeting neurological function in traumatic SCI. A disease-specific instrument that captures the nuances specific to spinal cord injury patients is required. LEVEL OF EVIDENCE: 1.

Development and cognitive testing of the Nottwil Environmental Factors Inventory in Canada, Switzerland and the USA.

OBJECTIVE: To develop and pre-test the Nottwil Environmental Factors Inventory (NEFI), a questionnaire assessing the perceived impact of environmental factors on specific areas of participation (productive life, social life, and community life) experienced by people with spinal cord injury. SUBJECTS/PATIENTS: Thirty-seven participants with spinal cord injury in Canada, Switzerland and the USA. METHODS: A first draft of the NEFI was developed based on a new theoretical model, the International Classification of Functioning, Disability and Health (ICF) Core Sets for spinal cord injury, and expert consultation. Three rounds of cognitive testing were conducted to examine participants' comprehension of the conceptual framework and items, to identify challenges in cross-cultural measurement, and iteratively to refine the questionnaire. RESULTS: Participants were able to differentiate well between environmental factors influencing productive life and those influencing social life or community life, but not between environmental factors influencing social life and community life. Items intended to capture avoidance of participation due to barriers or overcoming of obstacles were generally well understood. CONCLUSION: For people with spinal cord injury, the NEFI may help to identify limiting and helpful environmental factors, while considering avoiding and overcoming behaviours. Quantitative validation and exploration of the possible use of the NEFI in other diagnostic groups is recommended.

Neonatal stress and abnormal hypercapnic ventilatory response of adult male rats: the role of central chemodetection and pulmonary stretch receptors.

Neonatal maternal separation (NMS) is a form of stress that interferes with respiratory control development. At adulthood, the hypercapnic ventilatory response (HCVR) of male NMS rats is lower than controls both during wakefulness and anesthesia. To address the mechanisms underlying the respiratory phenotype of NMS rats, we first used phrenic nerve recording in anesthetised (urethane: 1.0 g/kg+isoflurane: 0.5%), vagotomised, and artificially ventilated (hyperoxic) animals, to test the hypothesis that the central chemodetection is altered by NMS. As no difference was observed between groups, we then tested the hypothesis that NMS affects respiratory modulation by pulmonary stretch receptors (PSRs). Experiments were performed on urethane/isoflurane anesthetised, spontaneously breathing rats (with vagi intact). The role of PSR and their implication was assessed during normo- and hypercapnia (+10 mm Hg above baseline) by the induction of a positive airway pressure (Paw). The slopes of the relationships between the ventilatory variables (frequency, amplitude, and minute activity) and the different levels of Paw in each group were compared between groups. During normocapnia, the decrease in breathing frequency induced by increasing Paw was greater in control than in NMS rats, thereby revealing that NMS reduces the Hering-Breuer reflex (HBR). During hypercapnia, however, the responses of control and NMS rats were similar indicating that the stimulation of chemoreceptors by CO(2) reduced the influence of stretch receptors on ventilation. These results indicate NMS does not affect central CO(2) chemosensitivity of this preparation but that differences in PSR function and/or signal integration contribute to the effects of NMS on respiratory regulation.