ABSTRACT
OBJECTIVES: Explore the perceptions and beliefs related to pressure ulcers (PU), their prevention and treatment strategies, in order to discuss potential learning objectives for PU-related therapeutic education in persons with spinal cord injury (SCI). DESIGN: Qualitative study, using grounded theory for the analysis of data collected via a questionnaire. SETTING: Nine SCI referral centers, inpatient care. PARTICIPANTS: 131 persons with SCI were included. 76% were male, and 65% presented with paraplegia. The median age was 48 years (33.5; 58) and median time since injury was 11 years (3; 24.5). 70% had experience with PU. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Data collection via an open-ended questionnaire on the representation of PU, its prevention and life experience of having a PU. RESULTS: Six categories were identified: (1) identifying what might become problematic, (2) daily preventive actions, (3) detecting the early signs, (4) managing the early signs, (5) need for care, (6) experience with PU and being bedridden. Pressure ulcers have dramatic consequences on psychosocial health. Prevention and treatment require self-management skills, such as self-risk assessment abilities, self-detection skills and problem-solving strategies, to optimise daily PU prevention in persons with SCI. CONCLUSION: PU prevention tackled by persons with SCI bears some specificities that the physician must take into account in the construction of a self-management program in this high-risk population.
Subject(s)
Pressure Ulcer/etiology , Spinal Cord Injuries/complications , Adult , Chi-Square Distribution , Cohort Studies , Female , Humans , Male , Middle Aged , Qualitative Research , Risk Factors , Surgical Flaps/blood supply , Surgical Flaps/surgery , Surveys and QuestionnairesSubject(s)
Brain Injuries, Traumatic/rehabilitation , Return to Work , Stroke Rehabilitation , Adolescent , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Social Adjustment , Workplace , Young AdultABSTRACT
OBJECTIVE: Our objective was to study the impact of pregnancy and delivery on vesicourethral disorders in patients with multiple sclerosis (MS). DESIGN AND SETTING: We performed a retrospective chart review of records of women diagnosed with MS who were referred to the clinic. PARTICIPANTS: A total of 102 women with MS (mean age of 44.7 +/- 11.4 years at the time of the study and mean age of 30.0 +/- 9.6 years at the onset of MS) participated in the study. The mean duration of disease was 15 +/- 10 years. The mean Expanded Disability Status Scale score was 5.4 +/- 1.8. MAIN OUTCOME MEASURES: For each patient, demographic data, disease characteristics, urological and obstetrical history and urodynamic data were collected. Urinary disorders were classified as irritative (urinary urgency and frequency) or as obstructive (hesitancy of micturition, reduced or interrupted urinary stream and sensation of incomplete bladder emptying). Urodynamic study consisted of cystometry with continuous recording of urethral sphincter electromyography in 77 (76%) cases. Intravesical and intraurethral pressures were recorded. Bladder dysfunctions were classified into neurogenic detrusor overactivity or detrusor underactivity. RESULTS: Pregnancies and deliveries did not influence symptoms. Moreover, the only statistical difference from a urodynamic point of view was a decrease in maximal urethral closure pressure. CONCLUSION: No interaction between pregnancy, delivery and urinary symptoms was found in this study. The effects of pregnancy and delivery seemed to be the same in women with MS and in healthy women, with a tendency towards a decrease in urethral pressure in women with MS.
Subject(s)
Gravidity , Multiple Sclerosis/complications , Parity , Pregnancy Complications , Urination Disorders/complications , Adult , Delivery, Obstetric/adverse effects , Electromyography/methods , Female , Humans , Middle Aged , Pregnancy , Retrospective Studies , UrodynamicsABSTRACT
Stiff-person syndrome was diagnosed in a patient with chronic low back pain. The diagnosis of this rare neurological condition rests mainly on the clinical findings of axial and proximal limb rigidity, increased lumbar lordosis often accompanied with pain, and normal neurological findings apart from brisk deep tendon reflexes. Electromyography of the lumbar paraspinal muscles shows motor unit firing at rest with normal appearance of the motor unit potentials. Titers of antibody to glutamic acid decarboxylase are elevated. Diazepam is the treatment of reference. Physical therapy can substantially improve quality of life.
