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J Neurotrauma ; 35(9): 1091-1105, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29239268


Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and bowel dysfunction. In those with high-level lesions, bowel management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving bowel care is integral for enhancing quality of life (QoL). We aimed to describe the relationships between bowel care, AD, and QoL in individuals with SCI. We performed an online community survey of individuals with SCI. Those with injury at or above T7 were considered at risk for AD. Responses were received from 287 individuals with SCI (injury levels C1-sacral and average duration of injury 17.1 ± 12.9 [standard deviation] years). Survey completion rate was 73% (n = 210). Bowel management was a problem for 78%: it interfered with personal relationships (60%) and prevented staying (62%) and working (41%) away from home. The normal bowel care duration was >60 min in 24% and most used digital rectal stimulation (59%); 33% reported bowel incontinence at least monthly. Of those at risk for AD (n = 163), 74% had AD symptoms during bowel care; 32% described palpitations. AD interfered with activities of daily living in 51%. Longer durations of bowel care (p < 0.001) and more severe AD (p = 0.04) were associated with lower QoL. Bowel management is a key concern for individuals with SCI and is commonly associated with symptoms of AD. Further studies should explore ways to manage bowel dysfunction, increase self-efficacy, and ameliorate the impact of AD to improve QoL.

Disreflexia Autonômica/etiologia , Disreflexia Autonômica/psicologia , Intestino Neurogênico/etiologia , Intestino Neurogênico/psicologia , Traumatismos da Medula Espinal/complicações , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intestino Neurogênico/terapia , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
J Spinal Cord Med ; 32(1): 54-62, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19264050


BACKGROUND/OBJECTIVE: Autonomic dysreflexia (AD) is a potentially life-threatening complication of spinal cord injury (SCI) characterized by episodic paroxysmal hypertension and bradycardia in response to a noxious stimulus below the level of injury. Recognition of AD is crucial for individuals with SCI and their family members to facilitate timely and appropriate management. The objectives of this study were to (a) evaluate knowledge of AD among SCI consumers and their family members and (b) identify the preferred format and timing of education regarding AD recognition and management for these stakeholders. METHODS: Cross-sectional descriptive study on a cohort of community-dwelling individuals with chronic SCI (N = 100) and their family members (N = 16) by self-report mail survey. Frequency distributions were used to tabulate survey responses on AD knowledge level and to characterize learning preferences and 2 x 2 chi2 analyses were conducted to determine whether there were factors (ie, impairment) associated with AD knowledge (ie, how to treat AD). RESULTS: Individuals with SCI and their family members have gaps in their knowledge of AD. Traumatic SCI etiology (vs nontrauma) was associated with greater knowledge about treating AD. Although the SCI sample was a high-risk group, 41% had not heard of AD. More concerning was that 22% of individuals with SCI reported symptoms consistent with unrecognized AD. Respondents indicated that AD education would be best delivered during rehabilitation by a healthcare professional. CONCLUSIONS: Further work is needed to promote knowledge about recognizing and managing AD. This may help reduce risk of cardiac and cerebrovascular disease in the SCI population.

Disreflexia Autonômica/etiologia , Disreflexia Autonômica/psicologia , Saúde da Família , Conhecimentos, Atitudes e Prática em Saúde , Traumatismos da Medula Espinal/complicações , Adulto , Idoso , Pressão Sanguínea/fisiologia , Estudos Transversais , Escolaridade , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Características de Residência , Inquéritos e Questionários
Spinal Cord ; 47(9): 681-6, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19274058


OBJECTIVES: To describe the prevalence and knowledge of autonomic dysreflexia (AD) from patient and caregiver perspectives, and its relationship to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification, level of injury, severity of injury, injury etiology, gender and race. METHODS: Participants were between 1 and 21 years old. Demographic information was collected from the medical records, and patients and caregivers were interviewed with the following questions: (1) Does the patient experience AD? (2) Does the patient/caregiver know what AD is? (3) Can the patient/caregiver name three signs/symptoms of an AD episode? (4) Does the patient/caregiver know how to treat AD? RESULTS: Overall, 40% of patients and 44% of caregivers said that the patient was symptomatic for AD. AD was more common in those with traumatic etiologies, in patients with injuries at or above T6 and those with greater injury severity as measured by the AIS. For patients and caregivers, AD was less common in the youngest age group (0-5 years old). Patients with greater knowledge of AD were more likely to have traumatic etiologies, have T6 or higher injuries, be in the oldest age at injury group, be older at time of examination and have had a shorter duration of injury. CONCLUSIONS: AD seems to be more common in patients with traumatic injuries, older ages at injury, greater injury severity on the AIS and level of injury at or above T6.

Disreflexia Autonômica/psicologia , Disreflexia Autonômica/reabilitação , Cuidadores/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Disreflexia Autonômica/classificação , Disreflexia Autonômica/etiologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Registros Médicos/estatística & dados numéricos , Análise de Regressão , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/complicações , Adulto Jovem
J Neurotrauma ; 21(2): 195-204, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15000760


The purpose of this study was to define the relationships among clinical characteristics of chronic pain, injury characteristics, affective factors and autonomic dysreflexia (AD) in people with chronic cervical spinal cord injury (SCI). A survey containing questions concerning the presence of AD, demographic factors, clinical characteristics of pain and affective symptoms, was mailed to people with traumatic SCI and chronic pain included in the Miami Project to Cure Paralysis database. Of all subjects (n = 330) reporting chronic pain in a previous study, 181 had cervical injuries. Of this subset, 117 (64.6%) participated in the study. Thirty-five people (29.9%) reported AD in our study. Although intense pain has previously been reported to trigger AD, the average pain intensity was not predictive of AD. Pair-wise comparisons indicated that people reporting AD marked significantly more painful areas in the drawing and used more descriptive pain adjectives. Anxiety and sadness were significantly more frequent among people with AD. Furthermore, aggravation of pain due to muscle spasms, infections, full bladder, and constipation was significantly more common among people with AD. The logistic regression analysis indicated that a combination of having widespread pain, experiencing aggravation of pain due to infections, having a complete injury, and experiencing anxiety significantly predicted AD. Our results suggest that relationships between chronic pain and AD exist. Since multiple pain types are common after SCI and may be associated with AD, it is important to determine which pain types that may be particularly important for the condition of AD.

Disreflexia Autonômica/etiologia , Dor/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Ansiedade/complicações , Disreflexia Autonômica/psicologia , Vértebras Cervicais , Doença Crônica , Coleta de Dados , Depressão/complicações , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Dor/psicologia , Medição da Dor , Valor Preditivo dos Testes , Traumatismos da Medula Espinal/psicologia