Spinal cord injury rehabilitation in Riyadh, Saudi Arabia: time to rehabilitation admission, length of stay and functional independence.

OBJECTIVES: (1) To describe functional status, length of stay (LOS) and time to rehabilitation admission trends. (2) To identify independent predictors of motor function following rehabilitation. STUDY DESIGN: Retrospective cohort study. SETTING: Spinal injury rehabilitation unit at King Fahad Medical City, Riyadh, Saudi Arabia. METHODS: From chart review of 312 traumatic and 106 nontraumatic adult patients with spinal cord injury (SCI) we extracted information on time from injury to rehabilitation admission, rehabilitation LOS, Functional Independence Measure (FIM) motor score (admission and discharge), American Spinal Injury Association Impairment Scale (AIS) grade and demographics. Hierarchical regression was employed to investigate variables associated with discharge FIM motor score for traumatic and nontraumatic SCI. RESULTS: Mean±s.d., median days from injury to rehabilitation admission were 377±855, 150 days for traumatic SCI and 288±403, 176 days for nontraumatic SCI. For individuals with traumatic SCI, after accounting for admission FIM motor score, tetraplegia and time from injury to rehabilitation admission had a significant but small negative association with discharge FIM motor score. For individuals with nontraumatic SCI, increasing age and higher AIS grade had a significant negative association with discharge FIM motor score. CONCLUSIONS: Shorter time from injury to rehabilitation admission may improve outcomes for those with traumatic SCI. As time spent in rehabilitation was shorter than in most other countries, a change in practice in this area may be warranted. Developing strategies to improve outcomes for older patients with nontraumatic SCI would also be beneficial.

Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation.

STUDY DESIGN: Longitudinal observational study. OBJECTIVE: To quantify the amount of upper- and lower-extremity movement repetitions (that is, voluntary movements as part of a functional task or specific motion) occurring during inpatient spinal cord injury (SCI), physical (PT) and occupational therapy (OT), and examine changes over the inpatient rehabilitation stay. SETTING: Two stand-alone inpatient SCI rehabilitation centers. METHODS: Participants: A total of 103 patients were recruited through consecutive admissions to SCI rehabilitation. INTERVENTIONS: Trained assistants observed therapy sessions and obtained clinical outcome measures in the second week following admission and in the second to last week before discharge. MAIN OUTCOME MEASURES: PT and OT time, upper- and lower-extremity repetitions and changes in these outcomes over the course of rehabilitation stay. RESULTS: We observed 561 PT and 347 OT sessions. Therapeutic time comprised two-thirds of total therapy time. Summed over PT and OT, the median upper-extremity repetitions in patients with paraplegia were 7 repetitions and in patients with tetraplegia, 42 repetitions. Lower-extremity repetitions and steps primarily occurred in ambulatory patients and amounted to 218 and 115, respectively (summed over PT and OT sessions at discharge). Wilcoxon-signed rank tests revealed that most repetition variables did not change significantly over the inpatient rehabilitation stay. In contrast, clinical outcomes for the arm and leg improved over this time period. CONCLUSIONS: Repetitions of upper- and lower-extremity movements are markedly low during PT and OT sessions. Despite improvements in clinical outcomes, there was no significant increase in movement repetitions over the course of inpatient rehabilitation stay.

The effects of functional electrical stimulation leg cycle ergometry training on arterial compliance in individuals with spinal cord injury.

STUDY DESIGN: A prospective intervention of functional electrical stimulation leg cycle ergometry (FES-LCE) of four women with spinal cord injury (SCI). OBJECTIVE: To evaluate the effect of FES-LCE training on arterial compliance in individuals with chronic SCI of traumatic origin. SETTING: Tertiary rehabilitation center in Canada. METHODS: Large and small artery compliance were measured at the radial artery before and after a 3-month training program using FES-LCE. RESULTS: There was no significant change in large artery compliance after FES-LCE (16.0+/-4.2 to 16.8+/-6.1 ml mm Hg(-1) x 10, P=NS). There was a marked (63%) increase in small artery compliance after the FES training program (4.2+/-1.8 to 6.9+/-3.2 ml mm Hg(-1) x 100, P<0.05). CONCLUSION: It appears that FES-LCE is effective in improving small artery compliance in females with SCI.