Comparison of coronary artery calcification scores and National Cholesterol Education program guidelines for coronary heart disease risk assessment and treatment paradigms in individuals with chronic traumatic spinal cord injury.

OBJECTIVE: To investigate the risk of coronary heart disease (CHD) in individuals with spinal cord injury (SCI) according to the National Cholesterol Educational Program (NCEP) guidelines and CT coronary artery calcium scores (CCS). RESEARCH: Cross-sectional study of consecutive sample of males with SCI presenting to a single site for CHD risk assessment. PARTICIPANTS/METHODS: Males age 45-70 with traumatic SCI (American Spinal Injury Association (ASIA) A, B, and C) injured for at least 10 years with no prior history of clinical CHD. Medical history, blood-pressure, and fasting lipid panel were used to calculate risk for CHD with the use of the Framingham risk score (FRS). Risk and treatment eligibility status was assessed based on NCEP/FRS recommendations and by presence and amount of CCS. Percent agreement (PA) and kappa were calculated between the two algorithms. Spearman correlations were calculated between CCS and FRS and individual risk factors. RESULTS: A total of 38 men were assessed; 18 (47.4%) had CCS > 0. The PA between NCEP/FRS assessment and CCS was 18% with a kappa of -0.03. 11 (28.9%) had CCS > 100 or >75th percentile for their age, sex, and race, which might qualify them for lipid-lowering treatment. Only 26 were placed into the same treatment category by NCEP/FRS and CCS, for a PA of 68% with a kappa of 0.35. In all, 20 (52.6%) were eligible for lipid-lowering treatment by either NCEP/FRS (n=9) or CCS (n = 11). Seven subjects were above the treatment threshold based on CCS, but not NCEP/FRS and five subjects were above the NCEP/FRS threshold, but not CCS. Just four subjects were eligible by both algorithms. CCS only correlated with FRS (r = 0.508, P = 0.001) and age (r = 0.679, P < 0.001).

Adherence with the National Cholesterol Education Program guidelines in men with chronic spinal cord injury.

OBJECTIVE: Describe the management of dyslipidemia and adherence to the National Cholesterol Educational Program (NCEP) guidelines in men with Spinal Cord Injury (SCI). RESEARCH: Cross-sectional study of a consecutive sample of men with SCI presenting to a single site for coronary heart disease (CHD) risk assessment. PARTICIPANTS/METHODS: Men age 45 to 70 with traumatic SCI (ASIA A, B, and C) at least 10 years prior to participation in the study with no prior history of clinical CHD. Medical history, blood-pressure, and fasting lipid panel were used to calculate risk for CHD using NCEP guidelines and the Framingham Risk Score (FRS). Adherence to treatment recommendations and adequacy of control were assessed based on the NCEP guidelines. RESULTS: 38 men were assessed; 15/38 (39.5%, 95% CI: 24.0-56.6%) had dyslipidemia, defined as an LDL-C above their LDL-C treatment threshold (n=6) or being on treatment for dyslipidemia (n=9, for a 60% treatment rate (9/15, 95% CI: 32.3-83.7%)). Of the 9 individuals on treatment, 6 (66.7%) met their treatment goals (for a 40% overall control rate (6/15, 95% CI: 16.3-67.7%)). Dyslipidemia was well controlled in low risk individuals, but control was less common in higher risk individuals. CONCLUSIONS: Dyslipidemia is common in men age 45-70 with chronic SCI and no evidence of clinical cardiovascular disease. Rates of treatment and control of dyslipidemia in this population are far from optimal, especially among the intermediate- and high-risk groups.

Intermittent catheterization with a hydrophilic-coated catheter delays urinary tract infections in acute spinal cord injury: a prospective, randomized, multicenter trial.

OBJECTIVE: To investigate whether intermittent catheterization (IC) with a hydrophilic-coated catheter delays the onset of the first symptomatic urinary tract infection (UTI) and reduces the number of symptomatic UTIs in patients with acute spinal cord injury (SCI) compared with IC with standard, uncoated catheters. DESIGN: A prospective, randomized, parallel-group trial. SETTING: Fifteen North American SCI centers. Participants were followed up while in the hospital or rehabilitation unit (institutional period) and up to 3 months after institutional discharge (community period). The maximal study period was 6 months. PARTICIPANTS: A total of 224 subjects with traumatic SCI of less than 3 months' duration who use IC. METHODS: The participants were randomized within 10 days of starting IC to either single-use hydrophilic-coated (SpeediCath) or polyvinyl chloride uncoated (Conveen) catheters. MAIN OUTCOME MEASUREMENTS: The time from the first catheterization to the first antibiotic-treated symptomatic UTI was measured as well as the total number of symptomatic UTIs during the study period. RESULTS: The time to the first antibiotic-treated symptomatic UTI was significantly delayed in the hydrophilic-coated catheter group compared with the uncoated catheter group. The delay corresponded to a 33% decrease in the daily risk of developing the first symptomatic UTI among participants who used the hydrophilic-coated catheter. In the institutional period, the incidence of antibiotic-treated symptomatic UTIs was reduced by 21% (P < .05) in the hydrophilic-coated catheter group. CONCLUSIONS: The use of a hydrophilic-coated catheter for IC is associated with a delay in the onset of the first antibiotic-treated symptomatic UTI and with a reduction in the incidence of symptomatic UTI in patients with acute SCI during the acute inpatient rehabilitation. Using a hydrophilic-coated catheter could minimize UTI-related complications, treatment costs, and rehabilitation delays in this group of patients, and reduce the emergence of antibiotic-resistant organisms.

_ 2009 review and revisions of the international standards for the neurological classification of spinal cord injury.

The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) were recently reviewed by the ASIA's Education and Standards Committees, in collaboration with the International Spinal Cord Society's Education Committee. Available educational materials for the ISNCSCI were also reviewed. The last citable reference for the ISNCSCI's methodology is the ISNCSCI Reference Manual, published in 2003 by ASIA. The Standards Committee recommended that the numerous items that were revised should be published and a precedent established for a routine published review of the ISNCSCI. The Standards Committee also noted that, although the 2008 reprint pocket booklet is current, the reference manual should be revised after proposals to modify/revise the ASIA Impairment Scale (AIS as modified from Frankel) are considered. In addition, the Standards Committee adopted a process for thorough and transparent review of requests to revise the ISNCSCI.

Cardiovascular health and fitness in persons with spinal cord injury.

There are many issues after spinal cord injury that have an impact on cardiovascular health and fitness. This article discusses many of the secondary conditions and changes that occur and how they are affected by maintenance of an active lifestyle. It also discusses many of the benefits and difficulties individuals face in maintaining a regular exercise program after spinal cord injury.

Preliminary reliability and validity of a Spinal Cord Injury Secondary Conditions Scale.

BACKGROUND/OBJECTIVE: Although the impact of secondary conditions after spinal cord injury (SCI) on health, well being, and financial burden have been studied, there are psychometrically sound scales of secondary conditions in the extant literature. The use of such scales allows for cross-sample comparison of secondary condition prevalence rates and associations with functional, medical, and psychosocial factors. Thus, the purpose of this study was to evaluate the preliminary reliability of a SCI secondary conditions scale. METHODS: The Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) is a 16-item scale based on the Seekins Secondary Conditions Scale. Sixty-five individuals with SCI completed written surveys at 5 time-points over 2 years. RESULTS: Internal consistency across each of the time-points exceeded 0.76; test-retest reliability ranged from 0.569 to 0.805. Convergent validity was assessed with 6 physical functioning items from the SF-12. Spearman (coefficients were all statistically significant and ranged from 0.317 (accomplished less because of health problems) to 0.644 (pain). The most prevalent secondary conditions were chronic pain, joint and muscle pain, and sexual dysfunction. CONCLUSIONS: Preliminary testing of the SCI-SCS suggests that it is a reliable and valid scale, and further development (ie, factor analysis, item revision) and examination of validity are recommended with larger and more diverse SCI samples.

Spinal cord injury medicine. 1. Epidemiology and classification.

UNLABELLED: This self-directed learning module reviews the demographics of traumatic and nontraumatic spinal cord injuries (SCIs). It is part of the study guide on SCI medicine in the Self-Directed Physiatric Educational Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the changing demographics of traumatic SCI, the classification of SCI, the common causes of nontraumatic SCI, and the incidence and prevalence of myelomeningocele. OVERALL ARTICLE OBJECTIVE: To summarize the demographics and classification of traumatic and nontraumatic spinal cord injuries in adults and children.

Spinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury.

UNLABELLED: This self-directed learning module highlights the basic acute care management of traumatic and nontraumatic spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Acute traumatic SCI is optimally managed in a level 1 trauma center. Decompression of the neural elements, stabilization of the spine, and maintenance of tissue perfusion are fundamental to optimizing outcomes. SCI patients are at high risk of pressure ulcers, venous thromboembolism, stress ulceration, bowel impaction, dysphagia, and pulmonary complications. Physiatric interventions are needed to prevent these complications. Prognostication of neurologic outcome based on early examination is an important skill to aid in creating a rehabilitation plan and to test for efficacy of early interventions. Nontraumatic SCI is an increasing population in rehabilitation centers. Establishing a diagnosis and treatment plan is essential, in conjunction with prevention of complications and early physiatric intervention. OVERALL ARTICLE OBJECTIVES: (a) To describe the diagnostic evaluation of traumatic and nontraumatic spinal cord injuries and (b) to summarize the medical, surgical, and physiatric interventions during acute hospitalization for these injuries.

Spinal cord injury medicine. 3. Rehabilitation phase after acute spinal cord injury.

UNLABELLED: This self-directed learning module highlights the rehabilitation aspects of care for people with traumatic spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the formulation of a rehabilitation plan based on functional goals by level of injury. Such a plan includes mobility, activities of daily living, equipment needs, and adjustment issues after injury. The effect of a concomitant brain injury on rehabilitation is discussed. Medical complications seen in the rehabilitation stage such as autonomic dysreflexia, heterotopic ossification, neurogenic bowel, and orthostasis are addressed. Preparation for discharge is crucial to allow for a smooth transition to home. There have been advances in SCI rehabilitation research including in wheelchair technology, functional electric stimulation, and partial body weight-supported ambulation. OVERALL ARTICLE OBJECTIVE: To describe outcomes and issues that may arise during the rehabilitation phase after spinal cord injury.

Spinal cord injury medicine. 4. Community reintegration after spinal cord injury.

UNLABELLED: This self-directed learning module highlights community reintegration after spinal cord injury (SCI). It is part of the study guide on spinal cord injury medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on physical, social, psychologic, and environmental barriers that affect people with SCI and on how these issues affect relations with others. Recreational and exercise options are also discussed. OVERALL ARTICLE OBJECTIVE: To summarize the barriers and opportunities of community reintegration for people with spinal cord injury.

Spinal cord injury medicine. 5. Long-term medical issues and health maintenance.

UNLABELLED: This self-directed learning module highlights long-term care issues in patients with spinal cord injury (SCI). It is part of the study guide on SCI in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The most common secondary medical complications include pressure ulcers, pneumonia, and genitourinary issues. Health care maintenance is important to prevent medical complications, for general health as well as for issues specific to SCI. Women with SCI have gender-specific issues regarding amenorrhea, sexuality, fertility, and menopause. Options exist to assist disabled men with sexuality and fertility complications. Pain is a common complication after SCI. Many new areas of research in the field of SCI are discussed. OVERALL ARTICLE OBJECTIVE: To discuss long-term care issues in patients with spinal cord injury, including health maintenance, secondary conditions, women's health, sexual function, pain, and spinal cord regeneration and recovery.

Spinal cord injury medicine. 6. Economic and societal issues in spinal cord injury.

UNLABELLED: This self-directed learning module presents a variety of social and economic issues facing people with spinal cord injury (SCI). It is part of the study guide on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the economic consequences of SCI, ethical issues in SCI, and the legislative efforts that have improved access and quality of life for people with disabilities. Costs of SCI include direct health care expenditures and lost earnings as a result of unemployment after SCI. Lifelong costs can be anticipated with the development of a comprehensive life care plan. Barriers to vocational reintegration continue to limit full participation for most people with SCI. Ethical issues central to SCI are related to the principles of autonomy and justice. As cure research becomes clinically applicable, the SCI community must work together to develop appropriate procedures to respect moral decision-making by all parties. Key legislation in the past century has resulted in important advances in the rights of people with disabilities. OVERALL ARTICLE OBJECTIVES: (a) To review the economic consequences of spinal cord injury, including lifelong direct costs, life care planning, and factors affecting employment and (b) to identify current ethical issues facing the spinal cord injury community and review the advances made in the rights of people with disabilities in the United States through legislation.

Perceived barriers to exercise in people with spinal cord injury.

OBJECTIVE: To identify barriers to physical fitness faced by individuals with spinal cord injury preventing them from participating in a physical fitness program. DESIGN: In this cross-sectional study, a survey of barriers to exercise was administered to 72 individuals with spinal cord injury. RESULTS: Although 73.6% of the participants expressed an interest in an exercise program, less than half (45.8%) were currently active in an exercise program. Less than half (47.2%) reported that their physician had recommended an exercise program for them. The most frequently cited concerns about barriers to exercise fell into three areas: (1) intrapersonal or intrinsic (e.g., lack of motivation, lack of energy, lack of interest), (2) resources (e.g., cost of an exercise program, not knowing where to exercise), and (3) structural or architectural (e.g., accessibility of facilities and knowledgeable instructors). More individuals with tetraplegia reported concerns over exercise being too difficult and that health concerns kept them from exercising. Greater number of concerns was significantly related to higher levels of perceived stress. CONCLUSIONS: People with spinal cord injury face multiple barriers to physical fitness in functional, psychological, and architectural domains. Identification of these barriers can facilitate the participation of individuals with spinal cord injury in an exercise program, improving long-term health and wellness.