Publication YearTitlePublication Reference typeAccession NoJournalPublication VolumePublication IssuePublication PagesPublication WebsiteAbstractStaff MembersPublication Author(s)Participating CentersPublished statusName
2018Investigating the efficacy of web-based transfer training on independent wheelchair transfers through randomized controlled trials.JournalArchives of Physical Medicine and Rehabilitation9919-16.e10PubMedObjectives: To determine the efficacy of a web-based transfer training module at improving transfer technique across 3 groups: web-based training, in-person training (current standard of practice), and a waitlist control group (WLCG); and secondarily, to determine subject factors that can be used to predict improvements in transfer ability after training. Design: Randomized controlled trials. Setting: Summer and winter sporting events for disabled veterans. Participants: A convenience sample (N=71) of manual and power wheelchair users who could transfer independently. Interventions: An individualized, in-person transfer training session or a web-based transfer training module. The WLCG received the web training at their follow-up visit. Main outcome measure: Transfer Assessment Instrument (TAI) part 1 score was used to assess transfers at baseline, skill acquisition immediately posttraining, and skill retention after a 1- to 2-day follow-up period. Results: The in-person and web-based training groups improved their median (interquartile range) TAI scores from 7.98 (7.18-8.46) to 9.13 (8.57-9.58; P<.01), and from 7.14 (6.15-7.86) to 9.23 (8.46-9.82; P<.01), respectively, compared with the WLCG that had a median score of 7.69 for both assessments (baseline, 6.15-8.46; follow-up control, 5.83-8.46). Participants retained improvements at follow-up (P>.05). A lower initial TAI score was found to be the only significant predictor of a larger percent change in TAI score after receiving training. Conclusions: Transfer training can improve technique with changes retained within a short follow-up window, even among experienced wheelchair users. Web-based transfer training demonstrated comparable improvements to in-person training. With almost half of the United States population consulting online resources before a health care professional, web-based training may be an effective method to increase knowledge translation. Worobey LA, Rigot S, Hogaboom NS, Venus C, Boninger MLUniversity of Pittsburgh Model Center on Spinal Cord InjuryYescheberle
2017Longitudinal prediction of quality-of-life scores and locomotion in individuals with traumatic spinal cord injury.JournalArchives of Physical Medicine and Rehabilitation98122385-2392ScienceDirectObjectives: To examine (1) differences in quality-of-life scores for groups based on transitions in locomotion status at 1, 5, and 10 years postdischarge in a sample of people with spinal cord injury (SCI); and (2) whether demographic factors and transitions in locomotion status can predict quality-of-life measures at these time points. Design: Retrospective case study of the National SCI Database. Setting: Model SCI Systems Centers. Participants: Individuals with SCI (N=10,190) from 21 SCI Model Systems Centers, identified through the National SCI Model Systems Centers database between the years 1985 and 2012. Subjects had FIM (locomotion mode) data at discharge and at least 1 of the following: 1, 5, or 10 years postdischarge. Interventions: Not applicable. Main Outcome Measures: FIM–locomotion mode; Severity of Depression Scale; Satisfaction With Life Scale; and Craig Handicap Assessment and Reporting Technique. Results: Participants who transitioned from ambulation to wheelchair use reported lower participation and life satisfaction, and higher depression levels (P<.05) than those who maintained their ambulatory status. Participants who transitioned from ambulation to wheelchair use reported higher depression levels (P<.05) and no difference for participation (P>.05) or life satisfaction (P>.05) compared with those who transitioned from wheelchair to ambulation. Demographic factors and locomotion transitions predicted quality-of-life scores at all time points (P<.05). Conclusions: The results of this study indicate that transitioning from ambulation to wheelchair use can negatively impact psychosocial health 10 years after SCI. Clinicians should be aware of this when deciding on ambulation training. Further work to characterize who may be at risk for these transitions is needed. Hiremath SV, Hogaboom NS, Roscher MR, Worobey LA, Oyster ML, Boninger MLUniversity of Pittsburgh Model Center on Spinal Cord InjuryYescheberle
2018Reliability and validity of the revised transfer assessment instrument.JournalTopics in Spinal Cord Injury Rehabilitation243217–226PubMedBackground: Proper transfer technique is associated with improved biomechanics and decreased pain and pathology. However, many users do not use proper technique, and appropriate assessment and training are needed to address these deficits. The transfer assessment instrument (TAI) 4.0 was designed to meet those needs and improve on past versions by removing the need for clinician training, shortening administration time, and simplifying question content.  Objectives: Evaluate the psychometric properties of the TAI 4.0.  Methods: A convenience sample of full-time wheelchair users was scored on multiple transfers by four raters to assess interrater, intrarater, and test-retest reliability and concurrent validity of the TAI 4.0. Each user also was scored using a visual analog scale (VAS).  Results: For 44 participants, the mean TAI 4.0 and VAS across all transfers were 7.58 ± 1.12 and 7.44 ± 1.78, respectively, and scores were significantly correlated (r = 0.52-0.7). VAS scores were more strongly influenced by the flight/landing and body setup phases of the transfer. There were no significant associations between TAI 4.0 score and demographics. Intraclass correlation coefficients (ICC) ranged from 0.80 to 0.85 for interrater reliability, 0.60 to 0.76 for intrarater reliability, and 0.55 to 0.76 for test-retest reliability. The minimum detectable change (MDC) for the total score ranged from 1.02 to 1.30.  Conclusion: The TAI 4.0 provides reliable and valid quantitative assessment of an individual's transfer without the need for comprehensive training, as is the case with the TAI 3.0. The tool can be completed in 3 minutes (average) in a clinical setting with only a ruler and goniometer. Worobey LA, Zigler CK, Huzinec R, Rigot SK, Sung JH, Rice LAUniversity of Pittsburgh Model Center on Spinal Cord InjuryYescheberle
2018Gait training in acute spinal cord injury rehabilitation - Utilization and outcomes among non-ambulatory individuals: Findings from the SCIRehab Project.JournalArchives of Physical Medicine and Rehabilitation998P1591-1598PubMedObjectives: To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI). Design: Prospective observational study using the SCIRehab database. Setting: Six IPR facilities. Participants: Patients with new SCI (N=1376) receiving initial rehabilitation. Interventions: Patients were divided into groups consisting of those who did and did not receive GT. Patients were further subdivided based on their primary mode of mobility as measured by the FIM. Main outcome measures: Pain rating scales, Patient Health Questionnaire Mood Subscale, Satisfaction With Life Scale, and Craig Handicap Assessment and Reporting Technique (CHART). Results: Nearly 58% of all patients received GT, including 33.3% of patients who were primarily using a wheelchair 1 year after discharge from IPR. Those who used a wheelchair and received GT, received significantly less transfer and wheeled mobility training (P<.001). CHART physical independence (P=.002), mobility (P=.024), and occupation (P=.003) scores were significantly worse in patients who used a wheelchair at 1 year and received GT, compared with those who used a wheelchair and did not receive GT in IPR. Older age was also a significant predictor of worse participation as measured by the CHART. Conclusions: A significant percentage of individuals who are not likely to become functional ambulators are spending portions of their IPR stays performing GT, which is associated with less time allotted for other functional interventions. GT in IPR was also associated with participation deficits at 1 year for those who used a wheelchair, implying the potential consequences of opportunity costs, pain, and psychological difficulties of receiving unsuccessful GT. Clinicians should consider these data when deciding to implement GT during initial IPR. Rigot S, Worobey L, Boninger MLUniversity of Pittsburgh Model Center on Spinal Cord InjuryYescheberle
2019A cross-sectional study to investigate the effects of perceived discrimination in the health care setting on pain and depressive symptoms in wheelchair users with spinal cord injury.JournalArchives of Physical Medicine and Rehabilitation100122233-2243ScienceDirectObjectives: In a sample of wheelchair users with spinal cord injury (SCI), the objectives were to investigate which participant characteristics are associated with greater perceived discrimination in the health care setting, and how such discrimination relates to health outcomes of pain and depressive symptoms. Design: Survey, cross-sectional. Setting: Spinal Cord Injury Model Systems (SCIMS) Center. Participants: Full-time wheelchair users with SCI from 9 SCIMS centers (N=410), with data collected between 2011 and 2016. Interventions: N/A. Main Outcomes: A 7-item questionnaire inquiring about perceived discrimination by hospital staff, self-reported pain severity over the past month using a 0-10 Numeric Rating Scale, and depressive symptoms using the 2-question Patient Health Questionnaire screener. Results: Participants who were black or from the lowest income group were more likely to report experiencing more discrimination than those who were white or from the highest income group, respectively (incidence rate ratio=2.2-2.6, P<.01). Those who reported more perceived discrimination had greater risk of severe pain compared to no pain (relative risk [RR]=1.11; 95% confidence interval [95% CI], 1.01-1.23; P<.05), mild depressive symptoms (RR=1.09; 95% CI, 1.02-1.17; P<.05), and severe depressive symptoms (RR=1.12; 95% CI, 1.04-1.21; P<.05) compared to no symptoms. Conclusions: Wheelchair users with SCI who were from more disadvantaged groups (black, lower income levels) reported experiencing more discrimination in their health care setting. Furthermore, those who reported more discrimination were more likely to report worse mental and physical health outcomes. Attempts to reduce discrimination in health care settings may lead to better outcomes for people with SCI. These observations were correlational and not causal; a prospective analysis is necessary to prove causation. Future investigations should further explore the effect of discrimination on the many facets of living with an SCI. Hogaboom N, Fyffe DC, Botticello AL, Worobey LA, Boninger MLNorthern New Jersey Spinal Cord Injury System, University of Pittsburgh Model Center on Spinal Cord InjuryYescheberle
2020Concurrent validity and reliability of the Transfer Assessment Instrument Questionnaire (TAI-Q) as a self-assessment measure.JournalArchives of Rehabilitation Research and Clinical Translation24ScienceDirectObjectives: To evaluate the psychometric properties of the Transfer Assessment Instrument Questionnaire (TAI-Q), a self-assessment measure to evaluate transfer quality compared with clinician-reported measures. Design: Participants self-assessed transfers from their wheelchair to a mat table using the TAI-Q. For session 1, participants self-assessed their transfer both before and after reviewing a video of themselves completing the transfer (session 1). Self-assessment was completed for another transfer after a 10-minute delay (session 2, intrarater reliability) and after a 1- to 2-day delay (session 3, test-retest reliability). Self-assessment was compared with a criterion standard of an experienced clinician scoring the same transfers with the Transfer Assessment Instrument (TAI) version 4.0 (concurrent validity). Setting: 2017 National Veterans Wheelchair Games. Participants: Convenience sample of full-time wheelchair users (N=44). Interventions: Not applicable. Main Outcome Measures: TAI-Q and TAI. Results: After video review of their transfer, acceptable levels of reliability were demonstrated for total TAI-Q score for intrarater (intraclass correlation [ICC], 0.627) and test-retest reliability (ICC, 0.705). Moderate to acceptable concurrent validity was demonstrated with the TAI (ICC, 0.554-0.740). Participants tended to underestimate the quality of their transfer (reported more deficient items) compared with the TAI. However, this deficit decreased and reliability improved from pre-video review to post-video review and from session 1 to session 2. The minimum detectable change indicated that a change of 1.63 to 2.21 in the TAI-Q total score is needed to detect a significant difference in transfer skills. Conclusions: When paired with video review, the TAI-Q demonstrates moderate to acceptable levels of reliability and validity for the total score. Self-assessment was completed quickly (<5min) and could help to potentially screen for deficiencies in transfer quality and opportunities for intervention. Lynn A. Worobey, PhD, DPT, ATP; Stephanie K. Rigot DPT; Michael L. Boninger MD; Randall Huzinec, PT; Jong H. Sung, PhD, ATC; Kaitlin DiGiovine; Laura A. Rice PhD, MPT, ATPUniversity of Pittsburgh Model Center on Spinal Cord InjuryYescheberle
2021Treatments that are perceived to be helpful for non-neuropathic pain after traumatic spinal cord injury: A multicenter cross-sectional survey.JournalSpinal CordEpubNatureStudy design: Cross-sectional survey. Objectives: The objective of the study was to identify the treatments that people with traumatic spinal cord injury (SCI) used for their non-neuropathic pains (nonNeuPs) and how they subjectively rated the helpfulness of those treatments. Setting: Six centers from the Spinal Cord Injury Model Systems. Methods: Three hundred ninety one individuals who were at least 1-year post-traumatic SCI were enrolled. A telephone survey was conducted for pharmacologic and non-pharmacologic treatments utilized in the last 12 months for each participant’s three worst pains and the perceived helpfulness of each treatment for each pain. Results: One hundred ninety (49%) participants reported at least one nonNeuP (Spinal Cord Injury Pain Instrument score < 2) in the previous 7 days. NSAIDs/aspirin, acetaminophen, opioids, and cannabinoids were the most commonly used and helpful pharmacologic treatments for overall nonNeuP locations (helpful in 77–89% of treated pains). Body position adjustment, passive exercise, massage, resistive exercise, and heat therapy were reported as the most commonly used non-pharmacological treatments for nonNeuPs. Heat therapy, aerobic exercise, massage, and body position adjustment were the most helpful non-pharmacological treatments for overall nonNeuP locations (helpful in 71–80% of treated pains). Perceived helpfulness of treatments varied by pain locations, which may be due to different mechanisms underlying pains in different locations. Conclusions: Results of the study may help guide clinicians in selecting pain-specific treatments for nonNeuPs. The self-reported helpfulness of heat therapy, exercise, and massage suggests a possible direction for clinical trials investigating these treatments of nonNeuP while limiting the side effects accompanying pharmacologic treatments. Chung-Ying Tsai, Thomas N. Bryce, Andrew D. Delgado, Sara Mulroy, Bria Maclntyre, Susan Charlifue & Elizabeth R. Felix Mount Sinai Hospital Spinal Cord Injury Model System, Southern California Spinal Cord Injury Model System, Rocky Mountain Regional SCI System, South Florida SCIMSYescheberle
2021Relationship of patient characteristics and inpatient rehabilitation services to 5-year outcomes following spinal cord injury: A follow up of the SCIRehab project.JournalThe Journal of Spinal Cord MedicineEpubTaylor & Francis OnlineObjective: To examine associations of patient characteristics and treatment quantity delivered during inpatient spinal cord injury (SCI) rehabilitation with outcomes at 5 years post-injury and compare them to the associations found at 1 year post-injury. Design: Observational study using Practice-Based Evidence research methodology in which clinicians documented treatment details. Regression modeling was used to predict outcomes. Setting: Five inpatient SCI rehabilitation centers in the US. Participants: Participants were 792 SCIRehab participants who were >12 years of age, gave informed consent, and completed both a 1-year and 5-year post-injury interview. Outcome Measures: Outcome data were derived from Spinal Cord Injury Model Systems (SCIMS) follow-up interviews at 5 years post-injury and, similar to the 1-year SCIMS outcomes, included measures of physical independence, societal participation, life satisfaction, and depressive symptoms, as well as place of residence, school/work attendance, rehospitalization, and presence of pressure ulcers. Results: Consistent with 1-year findings, patient characteristics continue to be strong predictors of outcomes 5-years post-injury, although several variables add to the prediction of some of the outcomes. More time in physical therapy and therapeutic recreation were positive predictors of 1-year outcomes, which held less true at 5 years. Greater time spent with psychology and social work/case management predicted greater depressive symptomatology 5-years post-injury. Greater clinician experience was a predictor at both 1- and 5 -years, although the related positive outcomes varied across years. Conclusion: Various outcomes 5-years post-injury were primarily explained by pre-and post-injury characteristics, with little additional variance offered by the quantity of treatment received during inpatient rehabilitation. Kimberley R. Monden, Julie Hidden, C.B. Eagye, Flora M. Hammond, Stephanie A. Kolakowsky-Hayner, and Gale G. WhiteneckRocky Mountain Regional SCI System, Southeastern Regional Spinal Cord Injury Model System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Mount Sinai Hospital Spinal Cord Injury Model SystemYescheberle
2020Effects of home exercises on shoulder pain and pathology in chronic spinal cord injury: A randomized controlled trial.JournalAmerican Journal of Physical Medicine & Rehabilitation996504-513https://pubmed.ncbi.nlm.nih.gov/31851011/Objective: The aims of this study were to replicate findings that a home exercise program intervention improved shoulder pain and function and to assess changes in supraspinatus tendon pathology associated with the home exercise program in persons with chronic spinal cord injury. Design: The study is a single-blind randomized controlled trial. Individuals with spinal cord injury of at least 1 yr and chronic shoulder pain of moderate or greater average intensity were enrolled. Participants were randomized to a 12-wk home exercise program consisting of strengthening and stretching exercises or to an education-only control group, with immediate postintervention and 4-wk postintervention (16 wks) follow-ups. The main outcome measures were self-report measures of shoulder pain and impairment, the Physical Examination of the Shoulder Scale, quantitative ultrasound metrics of the supraspinatus tendon, and the Ultrasound Shoulder Pathology Rating Scale. Results: Thirty-two participants were randomized to home exercise program or education-only control condition. The mean ± SD age was 44.8 ± 12.5; 81.3% were male; 65.6% had motor complete paraplegia. Using a per-protocol, within-group analysis method, significant differences were observed between baseline and postintervention for the home exercise program group for the least pain intensity (P = 0.02), number of days with shoulder pain (P = 0.042), Physical Examination of the Shoulder Scale scores (dominant side, P = 0.036; nondominant side, P = 0.008), the Disabilities of the Arm, Shoulder, and Hand (P = 0.028), and the Patient Global Impression of Change (P = 0.015). The education-only control condition group demonstrated significant changes in average unpleasantness of shoulder pain after the intervention period (P = 0.049). Comparisons in changes from baseline between groups showed that the home exercise program group had greater improvements in nondominant-side Physical Examination of the Shoulder Scale scores and global impression of change, whereas the education-only control condition group had greater improvements in depressive symptoms.For quantitative ultrasound measures, no significant changes were found with within-group analyses for the home exercise program group, although the education-only control condition group demonstrated a decrease in tendon width in the nondominant-side supraspinatus tendon (P = 0.036). Comparison of changes between groups suggests that the education-only control condition group had a greater increase in dominant shoulder supraspinatus tendon ultrasound contrast at the end of the study. Conclusions: Changes in several measures of shoulder pain and function occurred after the home exercise program intervention, although the magnitude of changes was only significantly greater than those of the education-only control condition group for two measures. Significant changes in supraspinatus pathology were not detected with quantitative ultrasound metrics. Diana D Cardenas, Elizabeth R Felix, Rachel Cowan, Melanie F Orell, Robert IrwinSouth Florida SCIMS, University of Alabama at Birmingham Spinal Cord Injury Model System Yescheberle
2019The burden of traumatic spinal cord injury in the United States: disability-adjusted life yearsJournalARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION10095-100Hall OT, McGrath RP, Peterson MD, Chadd EH, DeVivo MJ, Heinemann AW, Kalpakjian CZ, National Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2017Upper extremity motor training of a subject with initially motor complete chronic high tetraplegia using constraint-induced biofeedback therapyJournalSpinal Cord Series and Cases317093Womble B, Taub E, Hickson, B, Purvish J, Mark V, Yarar-Fisher C, Mclain AB, Uswatte GUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2018Racial differences in weight gain: a 5-year longitudinal study of persons with spinal cord injuryJournalARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION991957-1964Wen H, Chen Y, He Y, Bickel S, Robinson-Whelen S, Heinemann AWNational Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2017Maresin-1 promotes inflammatory resolution, neuroprotection and functional neurological recovery after spinal cord injuryJournalJournal of Neuroscience4811731-11743Quijorna, I., David, S., Sullivan, A., Kopp, M., Martinez-Muriana, A., Serhan, C., Brommer, B., Schwab, J., Lopez Vales, R.Ohio Regional SCI Model System (ORSCIMS)Yesdevopsadmin
2019Utility of Functional Metrics Assessed During Acute Care on Hospital Outcomes: A Systematic ReviewJournalAMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION11522-532So C, Lage DE, Slocum CS, Zafonte RD, Schneider JCNew England Spinal CenterYesdevopsadmin
2018Functional status predicts acute care readmission in the traumatic spinal cord injury populationJournalJOURNAL OF SPINAL CORD MEDICINEepubp1-20Huang D, Slocum C, Silver JK, Morgan JW, Goldstein R, Zafonte R, Schneider JC.New England Spinal CenterYesdevopsadmin
2018 Gait Training in Acute Spinal Cord Injury Rehabilitation-Utilization and Outcomes Among Nonambulatory Individuals: Findings From the SCIRehab ProjectJournalArchives of Physical Medicine and Rehabilitation991591-1598Rigot S, Worobey L, Boninger MLUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2017Determinants of axon growth, plasticity and regeneration in the context of spinal cord injuryJournalAmerican Journal of Pathology1, 53-62Filous, A., Schwab, J.Ohio Regional SCI Model System (ORSCIMS)Yesdevopsadmin
2019Patient Preferences for Order of the Sensory Portion of the ISNCSCI ExaminationJournalJournal of Spinal Cord Medicine19p1-16Kirshblum, S., Didesch, M., Botticello, A., Kong, B., Androwis, D., Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2017Relationship of American Spinal Injury Association Impairment Scale Grade to Post-injury Hospitalization and Costs in Thoracic Spinal Cord InjuryJournalNeurosurgeryEpubDukes, E.M., Kirshblum, S., Aimetti, A.A., Qin, S.S., Bornheimer, R.K., Oster, G.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2020The effect of zoledronic acid on attenuation of bone loss at the hip and knee following acute traumatic spinal cord injury: A randomized-controlled study.JournalSpinal Cord58921–929https://www.nature.com/articles/s41393-020-0431-9Study design: Randomized double blind, placebo-controlled trial. Objectives: To examine the effect of early intravenous zoledronic acid (ZA) on bone markers and areal bone mineral density (aBMD) in persons with acute ASIA Impairment Scale (AIS) A traumatic spinal cord injury (SCI). Setting: Two inpatient rehabilitation units. Methods: Thirteen men, 2 women, aged 19–65, C4-T10 AIS A SCI, received 5 mg intravenous ZA vs. placebo 12–21 days post injury. Markers of bone formation (procollagen N-1 terminal propeptide [P1NP]), bone resorption (serum C-telopeptide [CTX]), and aBMD by dual-energy X-ray absorptiometry (DXA) for hip (femur—proximal, intertrochanteric, neck), and knee (distal femur, proximal tibia) were obtained at baseline, 2 weeks post infusion (P1NP, CTX only), 4 and 12 months post injury. Results: P1NP remained unchanged, while CTX decreased in ZA but increased in controls at 2 weeks (mean difference = −97%, p < 0.01), 4 months (mean difference = −54%, p < 0.05), but not 12 months (mean difference = 3%, p = 0.23). Changes in aBMD at the hip favored ZA at 4 months (mean difference 10.3–14.1%, p < 0.01) and 12 months (mean difference 10.8–13.1%, p < 0.02). At 4 months, changes in aBMD favored ZA at the distal femur (mean difference 6.0%, 95% CI: 0.7–11.2, p < 0.03) but not proximal tibia (mean difference 8.3%, 95% CI: −6.9 to 23.6, p < 0.23). Both groups declined in aBMD at 12 months, with no between group differences. Conclusion: ZA administered ≤21 days of complete traumatic SCI maintains aBMD at the hip and distal femur at 4 months post injury. This effect is partially maintained at 12 months. Christina V. Oleson, Ralph J. Marino, Christopher S. Formal, Christopher M. Modlesky & Benjamin E. Leiby Regional SCI Center of the Delaware ValleyYescheberle
2020Reliability of S3 pressure sensation and voluntary hip adduction/toe flexion and agreement with deep anal pressure and voluntary anal contraction in classifying persons with traumatic spinal cord injury.JournalThe Journal of Spinal Cord Medicine435616-622https://pubmed.ncbi.nlm.nih.gov/31204908/Context/Objective: The sacral examination components of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), namely deep anal pressure (DAP) and voluntary anal sphincter contraction (VAC), are often difficult to perform. We evaluated whether pressure sensation at the S3 dermatome (S3P), and voluntary hip adductor or toe flexor contraction (VHTC) are tenable alternatives. Here we report test-retest reliability and agreement of these components at 1 month after spinal cord injury (SCI), and impact of disagreement on American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades.  Design: Longitudinal cohort. ISNCSCI examination, S3P and VHTC conducted at 1-month post-injury; retest of the sacral exam, S3P and VHTC within 3 days. Follow-up examinations performed at 3, 6, and 12 months.  Setting: Five Spinal Cord Injury Model System Centers.  Participants: Subjects with acute traumatic SCI, neurological levels T12 and above, AIS grades A-C.  Interventions: None.  Outcome Measures: ISNCSCI exam, AIS grades.  Results: Fifty-one subjects had 1-month data, and 39 had at least one follow-up examination. Test-retest reliability indicated perfect agreement (kappa = 1.0) for all data except S3P (kappa = 0.96). The agreement was almost perfect between S3P and DAP (kappa = 0.84) and between VHTC and VAC (kappa = 0.81). VHTC and VAC differed more often with neurologic levels below T10, possibly due to root escape in conus medullaris injuries.  Conclusion: S3P and VHTC show promise as alternatives to DAP and VAC for determining sacral sparing in persons with neurologic levels T10 and above. Reliability and agreement should be evaluated at earlier timepoints and in children with SCI. Ralph J Marino, Mary Schmidt-Read, Anna Chen, Steven C Kirshblum, Trevor A Dyson-Hudson, Edelle Field-Fote, Ross Zafonte Regional SCI Center of the Delaware Valley, Northern New Jersey Spinal Cord Injury System, Southeastern Regional Spinal Cord Injury Model System, Spaulding New England Regional Spinal Cord Injury CenterYescheberle
2020Can the electrically stimulated manual muscle test differentiate upper from lower motor neuron injury in persons with acute SCI?JournalNeurological Research1-6https://pubmed.ncbi.nlm.nih.gov/32972329/Objective: To determine if the motor response on the stimulated manual muscle test (SMMT) in muscles with a grade 0 motor score on the manual muscle test (MMT) can differentiate lower motor neuron (LMN) from upper motor neuron (UMN) injury based on the presence of spontaneous activity (SA) with needle EMG. Design: Prospective Study. Participants/methods: Twenty-one subjects with acute traumatic cervical SCI. Methods: An upper extremity International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) evaluation was completed on all subjects. A needle EMG and an electrically stimulated manual muscle test (SMMT) were completed on all key upper extremity muscles with a MMT motor score of zero. Results: The MMT, SMMT and Needle EMG were done on 77 muscles. The SMMT motor score was 0 on 10 muscles and >1 on 67 muscles. The needle EMG identified spontaneous activity (SA) in 55/77 muscles. Seventy percent (7/10) of the muscles with MMT and SMMT motor score of zero demonstrated SA on EMG. Seventy-two percent (48/67) of the muscles with MMT motor score = 0 and SMMT motor score ≥1 demonstrated SA on EMG. Conclusion: In our study, 70% of the muscles with a SMMT motor response of zero and 72% of the muscles with a SMMT motor response greater than or equal to one demonstrated SA on EMG. The use of the SMMT as a clinical measure to differentiate LMN from UMN integrity may be limited when applied. Ashley de Padua, Cassandra Renfro, Maria Grabnar, Kevin Kilgore, Anne Bryden, Mary Joan Roach, Greg NemunaitisUniversity of Alabama at Birmingham Spinal Cord Injury Model System , Northeast Ohio Regional Spinal Cord Injury SystemYescheberle
2020Modified PRISM and SCI-SET spasticity measures for persons with traumatic spinal Cord injury: Results of a Rasch analyses.JournalArchives of Physical Medicine and Rehabilitation10191570-1579https://pubmed.ncbi.nlm.nih.gov/32497601/Objective: To evaluate the psychometric properties of the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) and Patient-Reported Impact of Spasticity Measure (PRISM) using Rasch analysis to optimize their validity and efficiency. Design: Rasch analysis of the SCI-SET and PRISM represents a secondary analysis of data collected as part of a collaborative research project of the SCI Model Systems Centers. The overall survey was organized into 4 sections: (1) participant demographics and injury characteristics, (2) participant experiences of spasticity, (3) SCI-SET, and (4) PRISM. Participants were recruited from the community via multiple avenues. Data were collected and managed via an online survey tool using a secure web-based data management application. Setting: Participating Spinal Cord Injury Model Systems Centers. Participants: Most participants (N=1239) had lived with their injury for more than 2 years and used a wheelchair as their primary mode of mobility. The majority of the sample (58%) sustained cervical injuries. Interventions: None. Main outcome measures: SCI-SET and PRISM. Results: The SCI-SET demonstrated strong measurement properties with acceptably high reliability and point-measure correlations and no evidence of multidimensionality. However, respondents underused some rating scale categories. Analyses of the PRISM demonstrated 3 distinct subscales relating to the physical, psychological, and social influences of spasticity; respondents underused some rating scale categories. Combining underused rating scale categories for both spasticity instruments resulted in increased reliability and reduced respondent burden compared with the original versions. Both the Modified SCI-SET (person separation reliability=0.93) and Modified PRISM (person separation reliability=0.85, 0.89, 0.83 for physical, psychological, and social subscores, respectively) display strong measurement properties. Conclusions: Measurement properties of the SCI-SET and PRISM improved from use of Rasch model methods. The SCI-SET required minor revisions, whereas the PRISM required definition of subscores. Both modified spasticity measures demonstrated adequate psychometric properties, and correlations among the modified measures were high, providing evidence of convergent validity. We recommend use of the Modified SCI-SET and Modified PRISM measures in future studies. W Mark Sweatman, Allen W Heinemann, Catherine L Furbish, Edelle C Field-FoteSoutheastern Regional Spinal Cord Injury Model System, Midwest Regional Spinal Cord Injury Care SystemYescheberle
2020Type and frequency of wheelchair repairs and resulting adverse consequences among veteran wheelchair users.JournalDisability and Rehabilitation: Assistive Technology1-7https://pubmed.ncbi.nlm.nih.gov/32762567/Purpose: Investigate the type and frequency of wheelchair repairs and resulting adverse consequences in a Veteran population. Design: Convenience cross-sectional sample survey. Setting: Data were collected at the 2017 National Veterans Wheelchair Games. Participants: Veterans who use a wheelchair ≥ 40 h/wk (n = 60). Intervention: Not applicable. Main outcome measures: Repairs and associated adverse consequences, wheelchair age and usage, type of repairs completed, time elapsed between breakdowns and repairs, and who completed repairs. Results: 60 participants reported 124 repairs in the previous 6 months with 88.3% of participants requiring at least one repair. Consequences were reported by 43.5% of those experiencing repairs and were most commonly secondary to repairs in the electrical system, wheelchair frame, power/control system, and wheels and casters. Travelling greater distances during the week and on weekends was associated with increased rates of repairs (p = 0.01 and p = 0.02, respectively) and consequences (p = 0.03 and p = 0.03, respectively). Power wheelchairs were more likely to require repairs than manual wheelchairs (p = 0.007). The median time to repair was 7 [0.8,30] days. Vendors completed 82.1% of the repairs. Those experiencing longer repair times were more likely to experience adverse consequences (p < 0.001). Conclusion: A high number of repairs and resulting adverse consequences occur for wheelchair users, particularly power wheelchair users, in a sample of Veterans. Interventions to prevent breakdowns and to address repairs and adverse consequences in a time-efficient manner are needed. Implications for rehabilitation In a sample of Veterans, a high number of repairs and resulting adverse consequences occur for wheelchair users, particularly power wheelchair users. There is an important clinical opportunity to help wheelchair users avoid repairs in the first place and reduce adverse consequences after breakdowns occur by improving wheelchair quality, providing preventative chair maintenance, and repairing breakdowns in a timely and efficient manner. These interventions may prove impactful in reducing the adverse medical, functional, and social consequences of wheelchair breakdowns. Geoffrey V. Henderson, MD; Michael L. Boninger, MD; Brad E. Dicianno, MD; and Lynn A. Worobey, PhD, DPT, ATPUniversity of Pittsburgh Model Center on Spinal Cord InjuryYescheberle
2019Cognitive, emotional, and physical functioning as predictors of paid employment in people with stroke, traumatic brain injury, and spinal cord injury.JournalAmerican Journal of Occupational Therapy732https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436116/OBJECTIVE. Our objective was to examine demographic, cognitive, emotional, and physical factors that predict return to paid employment for people after neurological injury. METHOD. Four hundred eighty adults with stroke (n = 149), traumatic brain injury (n = 155), and spinal cord injury (n = 176) completed an occupational outcome questionnaire and physical, emotional, and cognitive assessments at three rehabilitation facilities. RESULTS. Odds of employment were predicted by being married or partnered, having more education, requiring fewer prompts for task sequencing, and having higher inhibitory control (but were not predicted by specific type of injury). Participants who returned to work within 3 mo were more likely to work with the same employer and to take a full-time position than those who returned later. CONCLUSION. Executive functioning, in particular sequencing and inhibitory control, strongly predicts employment and highlights the importance of cognitive strategy training during occupational therapy with people who have sustained neurological injuries. Alex W. K. Wong, Cynthia Chen, M. Carolyn Baum, Robert K. Heaton, Berrit Goodman, and Allen W. HeinemannMidwest Regional Spinal Cord Injury Care SystemYescheberle
2016The impact of a physical activity program in persons with SCI.JournalPhysical Medicine and Rehabilitation 9710E72-73https://www.archives-pmr.org/article/S0003-9993(16)30655-4/fulltext Research Objectives: To determine the effectiveness of a physical activity program on ASIA motor scores and HDL in persons with SCI. Design: Randomized clinical trial. Setting: Outpatient hospital setting. Participants: Inclusion criteria were ≥1 year post-injury, SCI diagnosis, and ages 18-80 years. Those with cognitive deficits preventing learning, medical problems posing health risks, or a primary disability other than SCI were excluded. Thirteen participants with complete paraplegia (TSI: 13.1±7.3 years), 9 participants with incomplete paraplegia (TSI: 8.2±9.6 years), 13 participants with complete tetraplegia (TSI: 20.7±14.5 years), and 7 participants with incomplete tetraplegia (TSI: 8.6±6.4 years) were completely randomized to either the physical activity program (n=21) or control group (n=21). Interventions: Participants attended 6 workshops that were 4 hours in duration over 3 months. Workshops educated participants on how to engage in different physical activity modes, achieve their goals, and overcome barriers related to their goals. Main Outcome Measure(s): ASIA motor scores and HDL were measured pre-post program. Results: Although no significant differences were found in participants with tetraplegia, those randomized to the physical activity program saw a 2.3 point increase on ASIA motor scores (p=0.03; CI: 1.2-5.0) in participants with incomplete paraplegia and 2.1 mg/dL increase in HDL (p=0.04; CI: 1.2-4.7) for participants with complete paraplegia, compared to the control group. Conclusions: The results of this investigation indicate participating in a physical activity program has the potential to improve ASIA motor scores in persons with incomplete paraplegia and HDL in persons with complete paraplegia compared to a no-program control. These results suggest a physical activity program may improve motor function and some cardiometabolic health markers in persons with SCI. A similar study design should be employed with a larger sample to further validate our results. Ryan McGrath, Denise Tate, Martin Forchheimer, Claire Kalpakjian, Mark PetersonYescheberle
2018Experience of robotic exoskeleton use at four Spinal Cord Injury Model Systems Centers.JournalJournal of Neurologic Physical Therapy424256-267https://pubmed.ncbi.nlm.nih.gov/30199518/Background and purpose: Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians' experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians' perceptions of exoskeleton benefits and risks and developments that would enhance utility. Methods: We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions. Results: Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used exoskeletons during inpatient rehabilitation. A typical episode of outpatient exoskeleton therapy comprises 20 to 30 sessions and at least 2 staff members are involved in each session. Treatment focuses on standing, stepping, and gait training; therapists measure progress with standardized assessments. Beyond improved gait, participants attributed physiological, psychological, and social benefits to exoskeleton use. Potential risks included falls, skin irritation, and disappointed expectations. Participants identified enhancements that would be of value including greater durability and adjustability, lighter weight, 1-hand controls, ability to navigate stairs and uneven surfaces, and ability to balance without upper extremity support. Discussion and conclusions: Each spinal cord injury model system center had shared and distinct practices in terms of how it integrates robotic exoskeletons into physical therapy services. There is currently little evidence to guide integration of exoskeletons into rehabilitation therapy services and a pressing need to generate evidence to guide practice and to inform patients' expectations as more devices enter the market.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A231). Allen W Heinemann, Arun Jayaraman, Chaithanya K Mummidisetty, Jamal Spraggins, Daniel Pinto, Susan Charlifue, Candy Tefertiller, Heather B Taylor, Shuo-Hsiu Chang, Argyrios Stampas, Catherine L Furbish, Edelle C Field-FoteMidwest Regional Spinal Cord Injury Care System, Rocky Mountain Regional SCI System, Texas Model Spinal Cord Injury System, Southeastern Regional Spinal Cord Injury Model SystemYescheberle
2018Serum albumin predicts long-term neurological outcomes after acute spinal cord injury.JournalNeurorehabilitation and Neural Repair3217-17https://pubmed.ncbi.nlm.nih.gov/29276840/Background: There is a need to identify reliable biomarkers of spinal cord injury recovery for clinical practice and clinical trials. Objective: Our objective was to correlate serum albumin levels with spinal cord injury neurological outcomes. Methods: We performed a secondary analysis of patients with traumatic spinal cord injury (n = 591) participating in the Sygen clinical trial. Serum albumin concentrations were obtained as part of routine blood chemistry analysis, at trial entry (24-72 hours), 1, 2, and 4 weeks after injury. The primary outcomes were "marked recovery" and lower extremity motor scores, derived from the International Standards for the Neurological Classification of Spinal Cord Injury. Data were analyzed with multivariable logistic and linear regression to adjust for potential confounders. Results: Serum albumin was significantly associated with spinal cord injury neurological outcomes. Higher serum albumin concentrations at 1, 2, and 4 weeks were associated with higher 52-week lower extremity motor score. Similarly, the odds of achieving "marked neurological recovery" was greater for individuals with higher serum albumin concentrations. The association between serum albumin concentrations and neurological outcomes was independent of initial injury severity, treatment with GM-1, and polytrauma. Conclusions: In spinal cord injury, serum albumin is an independent marker of long-term neurological outcomes. Serum albumin could serve as a feasible biomarker for prognosis at the time of injury and stratification in clinical trials. Bobo Tong, Catherine R Jutzeler, Jacquelyn J Cragg, Lukas Grassner, Jan M Schwab, Steve Casha, Fred Geisler, John L K KramerOhio Regional SCI Model System (ORSCIMS)Yescheberle
2020A comparison of diagnostic stability of the ASIA Impairment Scale versus Frankel Classification Systems for traumatic spinal cord injury.JournalArchives of Physical Medicine and RehabilitationEpubhttps://pubmed.ncbi.nlm.nih.gov/32531222/Objective: To determine if the "sacral sparing" definition for completeness of traumatic spinal cord injury (SCI) is a more stable definition than the previously used Frankel Classification. Design: Retrospective analysis of persons enrolled in the Spinal Cord Injury Model Systems (SCIMS) database from 2011-2018. Setting: SCIMS centers. Participants: Individuals (N=804) with traumatic SCI, age >16 years at time of injury, admission to rehabilitation within 30 days, ASIA Impairment Scale (AIS) grades A- D at admission, and complete neurological data at admission and 1-year. Intervention: None applicable. Main outcome measures: Frankel and AIS scores were computed for a cohort of 804 eligible cases. Stability was compared between the two classification systems by calculating the proportions of cases where regression (conversion to a more severe impairment level) was observed. Results: A larger proportion of persons classified with "incomplete" injuries (grades B-D) at admission using the Frankel system regressed to complete status at 1-year compared to the AIS criteria (9.4% vs 2.0%). Those with B grade injuries regressed to A more often using Frankel as compared to the AIS system (19.7% to 5.4%). A larger proportion of people diagnosed as Frankel C or D regressed to Frankel A, as compared to AIS C or D who regressed to AIS A (5.0% to 1.1%). Conclusion: Greater number of persons diagnosed with neurologically incomplete SCI regressed to complete status at 1-year when using the Frankel compared to the AIS classification which is based upon sacral sparing. This reinforces the finding that the "sacral sparing" definition is a more stable classification in traumatic SCI. Steven Kirshblum, Amanda Botticello, John Benedetto, Jayne Donovan, Ralph Marino, Shelly Hsieh, Nicole WagamanNorthern New Jersey Spinal Cord Injury SystemYescheberle
2019Assessing the ability of comorbidity indexes to capture comorbid disease in the inpatient rehabilitation spinal cord injury population.JournalArchives of Physical Medicine and RehabilitationEpubhttps://www.sciencedirect.com/science/article/abs/pii/S0003999320303075Objective: To examine whether commonly used comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, the Centers for Medicare and Medicaid Services [CMS] comorbidity tiers) capture comorbidities in the acute traumatic and nontraumatic SCI inpatient rehabilitation population. Design: Retrospective cross-sectional study. Participants: Data were obtained from the Uniform Data System for Medical Rehabilitation from October 1, 2015 to December 31, 2017 for adults with spinal cord injury (SCI) (Medicare-established Impairment Group Codes 04.110-04.230, 14.1, 14.3). This study included SCI discharges (N=66,235) from 833 inpatient rehabilitation facilities. Main Outcome Measures: International Classification of Diseases–10th Revision–Clinical Modifications (ICD-10-CM) codes were used to assess 3 comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, CMS comorbidity tiers). The comorbidity codes that occurred with >1% frequency were reported. The percentages of discharges for which no comorbidities were captured by each comorbidity index were calculated. Results: Of the total study population, 39,285 (59.3%) were men and 11,476 (17.3%) were tetraplegic. The mean number of comorbidities was 14.7. There were 13,939 distinct ICD-10-CM comorbidity codes. There were 237 comorbidities that occurred with >1% frequency. The Deyo-Charlson comorbidity index, Elixhauser comorbidity index, and the CMS tiers did not capture comorbidities of 58.4% (95% confidence interval, 58.08%-58.84%), 29.4% (29.07%-29.76%), and 66.1% (65.73%-66.46%) of the discharges in our study, respectively, and 28.8% (28.42%-29.11%) of the discharges did not have any comorbidities captured by any of the comorbidity indexes. Conclusion: Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the SCI rehabilitation population. This work suggests that alternative measures may be needed to capture the complexity of this population. Donna Huang, MD; Sameer Siddiqui MD; Chloe S.Slocum MD, MPH; Richard Goldstein, PhD; Ross D. Zafonte, DO; Jeffrey C. Schneider, MDSpaulding New England Regional Spinal Cord Injury CenterYescheberle
2020Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems.JournalJournal of NeuroEngineering and Rehabilitation174Epubhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954546/Background: We know little about the budget impact of integrating robotic exoskeleton over-ground training into therapy services for locomotor training. The purpose of this study was to estimate the budget impact of adding robotic exoskeleton over-ground training to existing locomotor training strategies in the rehabilitation of people with spinal cord injury. Methods: A Budget Impact Analysis (BIA) was conducted using data provided by four Spinal Cord Injury (SCI) Model Systems rehabilitation hospitals. Hospitals provided estimates of therapy utilization and costs about people with spinal cord injury who participated in locomotor training in the calendar year 2017. Interventions were standard of care walking training including body-weight supported treadmill training, overground training, stationary robotic systems (i.e., treadmill-based robotic gait orthoses), and overground robotic exoskeleton training. The main outcome measures included device costs, training costs for personnel to use the device, human capital costs of locomotor training, device demand, and the number of training sessions per person with SCI. Results: Robotic exoskeletons for over-ground training decreased hospital costs associated with delivering locomotor training in the base case analysis. This analysis assumed no difference in intervention effectiveness across locomotor training strategies. Providing robotic exoskeleton overground training for 10% of locomotor training sessions over the course of the year (range 226–397 sessions) results in decreased annual locomotor training costs (i.e., net savings) between $1114 to $4784 per annum. The base case shows small savings that are sensitive to parameters of the BIA model which were tested in one-way sensitivity analyses, scenarios analyses, and probability sensitivity analyses. The base case scenario was more sensitive to clinical utilization parameters (e.g., how often devices sit idle and the substitution of high cost training) than device-specific parameters (e.g., robotic exoskeleton device cost or device life). Probabilistic sensitivity analysis simultaneously considered human capital cost, device cost, and locomotor device substitution. With probabilistic sensitivity analysis, the introduction of a robotic exoskeleton only remained cost saving for one facility. Conclusions: Providing robotic exoskeleton for over-ground training was associated with lower costs for the locomotor training of people with SCI in the base case analyses. The analysis was sensitive to parameter assumptions. Daniel Pinto, Mauricio Garnier, Jason Barbas, Shuo-Hsiu Chang, Susan Charlifue, Edelle Field-Fote, Catherine Furbish, Candy Tefertiller, Chaithanya K. Mummidisetty, Heather Taylor, Arun Jayaraman, Allen W. HeinemannMidwest Regional Spinal Cord Injury Care System, Rocky Mountain Regional SCI System, Southeastern Regional Spinal Cord Injury Model System, Texas Model Spinal Cord Injury SystemYescheberle
2019The impact of body mass index on one-year mortality after spinal cord injuryThe Journal of Spinal Cord Medicine1-9https://www.ncbi.nlm.nih.gov/pubmed/31729925Objective: Evaluate the association between body mass index (BMI, kg/m2) and one-year mortality among people who survived the first 90 days after spinal cord injury (SCI).Design: Cohort study.Setting: Eighteen SCI Model Systems centers throughout the United States.Participants: 6640 participants (men, 79.6%; mean age, 42.8 ± 17.7y; Whites, 62.3%) who had an SCI between October 2006 and March 2017.Interventions: Not applicable.Outcome Measures: All-cause mortality and causes of death. Life table method was used to estimate mortality rates, while Cox proportional hazard model was conducted to assess the impact of BMI on mortality after adjusting for demographic and injury-related factors.Results: Based on BMI obtained during initial rehabilitation, participants were classified into underweight (4.2%), normal weight (41.2%), overweight (30.9%) and obese (23.8%) groups, and their corresponding one-year mortality rates were 2.6%, 1.8%, 3.1%, 3.5%, respectively (P = 0.002). After adjusting for potential confounding factors, people with obesity had a higher mortality risk than those with normal weight (hazard ratio, 1.51; 95% confidence interval, 1.00-2.28). The most frequent causes of death for people with obesity were infective and parasitic diseases and respiratory diseases, while respiratory diseases were the most frequent for people with other BMI statuses.Conclusion: People with obesity who incur an SCI need special attention to prevent early mortality. Future studies should explore factors that contribute to such a higher mortality after SCI, such as preexisting conditions and comorbidities. The effects of BMI on long-term mortality also deserve further investigation. Wen, H, DeVivo, MJ, Mehta, T, Baidwan, N, Chen, YNational SCI Statistical CenterYesmbelay
2019Racial and Ethnic Differences in Obesity in People with Spinal Cord Injury: The Effects of Disadvantaged NeighborhoodJournalArchives of Physical Medicine and Rehabilitation10091599-1606 OBJECTIVE: To examine the role of neighborhood in the relation between race and obesity in people with spinal cord injury (SCI). DESIGN: A cross-sectional analysis of survey data from National SCI Database linked with neighborhood data from American Community Survey by census tract. SETTING: A total of 17 SCI Model Systems centers. PARTICIPANTS: Individuals (N=3385; 2251 non-Hispanic whites, 760 non-Hispanic blacks, 374 Hispanics) who completed a follow-up assessment during 2006-2017 (mean duration of injury, 8.3±9.9y) and resided in 2934 census tracts. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Body mass index (BMI) (kg/m2). RESULTS: The overall prevalence of obesity was 52.9% (BMI≥25.0) and 23.3% (BMI≥30.0). Hispanics were 67.0% more likely to be obese (BMI≥30.0 kg/m2) relative to non-Hispanic whites (odds ratio, 1.67; 95% confidence interval, 1.27-2.18), after controlling for demographic and injury-related characteristics. Most of the non-Hispanic blacks (66.8%) were living in neighborhoods with high concentrated disadvantaged index (CDI), compared to 35.0% of Hispanics and 9.2% of non-Hispanic whites living in this similar neighborhood status (P<.0001). After accounting for CDI, the odds of being obese in Hispanics decreased (odds ratio, 1.51; 95% confidence interval, 1.15-1.99). Regardless of race and ethnicity, people with SCI from disadvantaged neighborhoods were 42.0%-70.0% more likely to be obese than those from minimal CDI neighborhoods. CONCLUSIONS: Neighborhood characteristics partially diminish racial differences in obesity. Weight management for the SCI population should target those who are Hispanic and living in the disadvantaged neighborhoods. Yuying Chen, Huacong Wen, Sejong Bae, Amanda Botticello, Allen Heinemann, Mike Boninger, Bethlyn Vergo HoulihanNational SCI Statistical Center, University of Alabama at Birmingham Spinal Cord Injury Model System , Northern New Jersey Spinal Cord Injury System, Midwest Regional Spinal Cord Injury Care System, University of Pittsburgh Model Center on Spinal Cord Injury, Spaulding New England Regional Spinal Cord Injury CenterYescheberle
2017Spinal cord injury-induced immunodeficiency is mediated by a sympathetic-neuroendocrine adrenal reflexNature Neuroscience20111549-1559https://www.ncbi.nlm.nih.gov/pubmed/28920935Acute spinal cord injury (SCI) causes systemic immunosuppression and life-threatening infections, thought to result from noradrenergic overactivation and excess glucocorticoid release via hypothalamus-pituitary-adrenal axis stimulation. Instead of consecutive hypothalamus-pituitary-adrenal axis activation, we report that acute SCI in mice induced suppression of serum norepinephrine and concomitant increase in cortisol, despite suppressed adrenocorticotropic hormone, indicating primary (adrenal) hypercortisolism. This neurogenic effect was more pronounced after high-thoracic level (Th1) SCI disconnecting adrenal gland innervation, compared with low-thoracic level (Th9) SCI. Prophylactic adrenalectomy completely prevented SCI-induced glucocorticoid excess and lymphocyte depletion but did not prevent pneumonia. When adrenalectomized mice were transplanted with denervated adrenal glands to restore physiologic glucocorticoid levels, the animals were completely protected from pneumonia. These findings identify a maladaptive sympathetic-neuroendocrine adrenal reflex mediating immunosuppression after SCI, implying that therapeutic normalization of the glucocorticoid and catecholamine imbalance in SCI patients could be a strategy to prevent detrimental infections. Prüss, H, Tedeschi, A, Thiriot, A, Lynch, L, Loughhead, SM, Stutte, S, Mazo, IB, Kopp, MA, Brommer, B, Blex, C, Geurtz, LC, Liebscher, T, Niedeggen, A, Dirnagl, U, Bradke, F, Volz, MS, DeVivo, MJ, Chen, Y, von Andrian, UH, Schwab, JMOhio Regional SCI Model System (ORSCIMS), University of Alabama at Birmingham Spinal Cord Injury Model System Yesmbelay
2018Impact of Admission Imaging Findings on Neurological Outcomes in Acute Cervical Traumatic Spinal Cord InjuryJournal of Neurotrauma35121398-1406https://www.ncbi.nlm.nih.gov/pubmed/29361876Variable and unpredictable spontaneous recovery can occur after acute cervical traumatic spinal cord injury (tSCI). Despite the critical clinical and interventional trial planning implications of this tSCI feature, baseline measures to predict neurologic recovery accurately are not well defined. In this study, we used data derived from 99 consecutive patients (78 male, 21 female) with acute cervical tSCIs to assess the sensitivity and specificity of various clinical and radiological factors in predicting recovery at one year after injury. Categorical magnetic resonance imaging parameters included maximum canal compromise (MCC), maximum spinal cord compression (MSCC), longitudinal length of intramedullary lesion (IML), Brain and Spinal Injury Center (BASIC) score, and a novel derived Combined Axial and Sagittal Score (CASS). Logistic regression analysis of the area under the receiver operating characteristic curve (AUC) was applied to assess the differential predictive value of individual imaging markers. Admission American Spinal Injury Association Impairment Scale (AIS) grade, presence of a spinal fracture, and central cord syndrome were predictive of AIS conversion at one year. Both BASIC and IML were stronger predictors of AIS conversion compared with MCC and MSCC (p = 0.0002 and p = 0.04). The BASIC score demonstrated the highest overall predictive value for AIS conversion at one year (AUC 0.94). We conclude that admission intrinsic cord signal findings are robust predictive surrogate markers of neurologic recovery after cervical tSCI. Direct comparison of imaging parameters in this cohort of patients indicates that the BASIC score is the single best acute predictor of the likelihood of AIS conversion. Farhadi, HF, Kukreja, S, Minnema, A, Vatti, L, Gopinath, M, Prevedello, L, Chen, C, Xiang, H, Schwab, JMOhio Regional SCI Model System (ORSCIMS)Yesmbelay
2018Sensitivity of the SCI-FI/AT in Individuals With Traumatic Spinal Cord InjuryArchives of Physical Medicine and Rehabilitation9991783-1788https://www.ncbi.nlm.nih.gov/pubmed/29608900To examine the ability of the Spinal Cord Injury-Functional Index/Assistive Technology (SCI-FI/AT) measure to detect change in persons with spinal cord injury (SCI). Keeney, T, Slavin, M, Kisala, P, Ni, P, Heinemann, AW, Charlifue, S, Fyffe, DC, Marino, RJ, Morse, LR, Worobey, LA, Tate, D, Rosenblum, D, Zafonte, R, Tulsky, D, Jette, AMSpaulding New England Regional Spinal Cord Injury Center, Midwest Regional Spinal Cord Injury Care System, Rocky Mountain Regional SCI System, Northern New Jersey Spinal Cord Injury System, Regional SCI Center of the Delaware Valley, University of Pittsburgh Model Center on Spinal Cord InjuryYesmbelay
2018A pilot test of the GoWoman weight management intervention for women with mobility impairments in the online virtual world of Second Life®Disability and Rehabilitation1-12https://www.ncbi.nlm.nih.gov/pubmed/29889580Pilot test GoWoman, a small-group weight management intervention for mobility impaired women that was a disability- and gender-responsive adaptation of the Diabetes Prevention Program delivered in the online virtual world of Second Life®. Objectives were to (1) examine pre-/post-intervention differences in weight, waist circumference, diet, physical activity, self-efficacy for diet and physical activity, nutrition knowledge and social support for weight management, (2) determine intervention feasibility (fidelity, attrition, engagement, acceptability). Nosek, MA, Robinson-Whelen, S, Ledoux, TA, Hughes, RB, O'Connor, DP, Lee, RE, Goe, R, Silveira, SL, Markley, R, Nosek, TM, GoWoman ConsortiumTexas Model Spinal Cord Injury SystemYesmbelay
2018Wheelchair Breakdowns Are Associated With Pain, Pressure Injuries, Rehospitalization, and Self-Perceived Health in Full-Time Wheelchair Users With Spinal Cord InjuryArchives of Physical Medicine and Rehabilitation99101949-1956https://www.ncbi.nlm.nih.gov/pubmed/29698640To evaluate the relation between wheelchair breakdowns, their immediate consequences, and secondary health complications after spinal cord injury. "Immediate consequences" occur when part of a wheelchair breaks and leaves an individual stranded or injured, or causes him or her to miss medical appointments, work, or school. Hogaboom, NS, Worobey, LA, Houlihan, BV, Heinemann, AW, Boninger, MLMidwest Regional Spinal Cord Injury Care System, University of Pittsburgh Model Center on Spinal Cord InjuryYesmbelay
2017Test accommodations for individuals with neurological conditions completing the NIH Toolbox-Cognition Battery: An evaluation of frequency and appropriatenessRehabilitation Psychology624455-463https://www.ncbi.nlm.nih.gov/pubmed/29265866First, to evaluate the frequency with which individuals with neurological conditions require test administration accommodations for the NIH Toolbox-Cognition Battery (NIHTB-CB). Second, to evaluate the appropriateness of accommodations provided by administrators, including adherence to NIHTB-CB Reasonable Accommodations Guidelines Magasi, S, Harniss, M, Tulsky, DS, Cohen, ML, Heaton, RK, Heinemann, AWMidwest Regional Spinal Cord Injury Care SystemYesmbelay
2017Motor-free composites from the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) for people with disabilitiesRehabilitation Psychology624464-473https://www.ncbi.nlm.nih.gov/pubmed/29265867The National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) includes a group of brief measures (i.e., 30 min) designed to assess language, processing speed, working memory, episodic memory, and executive functioning. These subtests can be combined to create composite scores that reflect fluid and crystallized cognition, as well as overall cognition. The battery is of limited utility with individuals who have impaired upper extremity motor functioning. This manuscript examines the accuracy of the Oral Symbol Digit Modalities Test as a substitute for the Pattern Comparison Processing Speed Test for computing motor-free composite scores. Research Method/Design: Individuals with spinal cord injury (SCI; n = 188), traumatic brain injury (TBI; n = 159), or stroke (n = 180) completed the NIHTB-CB. We used the Oral Symbol Digit Modalities Test to create a Motor-Free Pattern Comparison score; this was used to create revised, Motor-Free Composite scores for Fluid Cognition and Overall Cognition. Carlozzi, NE, Goodnight, S, Umlauf, A, Heaton, RK, Heinemann, AW, Schalet, BD, Gershon, RC, Tulsky, DSMidwest Regional Spinal Cord Injury Care SystemNombelay
2019Outcome heterogeneity and bias in acute experimental spinal cord injury: A meta-analysisJournalNeurology931e40-e51Objective To determine whether and to what degree bias and underestimated variability undermine the predictive value of preclinical research for clinical translation. Methods We investigated experimental spinal cord injury (SCI) studies for outcome heterogeneity and the impact of bias. Data from 549 preclinical SCI studies including 9,535 animals were analyzed with meta-regression to assess the effect of various study characteristics and the quality of neurologic recovery. Results Overall, the included interventions reported a neurobehavioral outcome improvement of 26.3% (95% confidence interval 24.3–28.4). Response to treatment was dependent on experimental modeling paradigms (neurobehavioral score, site of injury, and animal species). Applying multiple outcome measures was consistently associated with smaller effect sizes compared with studies applying only 1 outcome measure. More than half of the studies (51.2%) did not report blinded assessment, constituting a likely source of evaluation bias, with an overstated effect size of 7.2%. Assessment of publication bias, which extrapolates to identify likely missing data, suggested that between 2% and 41% of experiments remain unpublished. Inclusion of these theoretical missing studies suggested an overestimation of efficacy, reducing the effect sizes by between 0.9% and 14.3%. Conclusions We provide empirical evidence of prevalent bias in the design and reporting of experimental SCI studies, resulting in overestimation of the effectiveness. Bias compromises the internal validity and jeopardizes the successful translation of SCI therapies from the bench to bedside. Watzlawick, R, Antonic, A, Sena, ES, Kopp, MA, Rind, J, Dirnagl, U, Macleod, M, Howells, DW, Schwab, JMNortheast Ohio Regional Spinal Cord Injury SystemYescheberle
2019Associations between insurance provider and assistive technology use for computer and electronic devices one year after tetraplegia: Findings from the Spinal Cord Injury Model Systems National DatabaseJournalArchives of Physical Medicine and RehabilitationepubOBJECTIVE: To investigate the association between insurance provider and reported assistive technology (AT) use to access computers and electronic devices 1 year after sustaining tetraplegia. DESIGN: Multicenter cross-sectional study. SETTING: Participants enrolled in the Spinal Cord Injury Model Systems (SCIMS) National Database. INTERVENTIONS: Not applicable. PARTICIPANTS: Men and women with tetraplegia (N=498) enrolled in the SCIMS National Database were included in the analysis. MAIN OUTCOME MEASURES: The primary study outcome was the use of AT when operating a computer or other mobile electronic device. The primary predictor was the subject's principal health insurance provider, which was grouped into the 3 categories: government (Medicare, Medicaid, and other government), private (private insurance, private funds, and other), and workers' compensation. RESULTS: Overall, 34.7% of participants reported using AT to access computers and electronic devices. Results of logistic regression analysis revealed sex, injury level, injury completeness, self-perceived health status, and 12-month history of pressure ulcer were all significantly associated with AT use. After adjusting for these factors, participants with workers' compensation were more likely to report AT use than individuals with either government or private insurance. CONCLUSIONS: Despite significant technological advances, AT is not readily available to the people who might benefit most from its use. Findings from the present study are the first to shed light on AT funding sources and reveal that individuals with workers' compensation are more likely use AT than individuals with either government or private insurance. Additional work focused on AT use and functional outcomes is needed to assess the effect of barriers to use. Collectively, this work may inform insurers of the importance of having AT available for this unique population to potentially improve quality of life and participation. Monden, KR, Sevigny, M, Ketchum, JM, Charlifue, S, Severe, E, Tefertiller, C, Berliner, J, Coker, J, Morse, LR, Taylor, HB, Kolakowsky-Hayner, SARocky Mountain Regional SCI System, Texas Model Spinal Cord Injury System, Mount Sinai Hospital Spinal Cord Injury Model SystemYescheberle
2017Long-term functional outcome in patients with acquired infections after acute spinal cord injuryJournalNeurology889892-900https://www.ncbi.nlm.nih.gov/pubmed/28130472To investigate whether prevalent hospital-acquired pneumonia and wound infection affect the clinical long-term outcome after acute traumatic spinal cord injury (SCI). Kopp, MA, Watzlawick, R, Martus, P, Failli, V, Finkenstaedt, FW, Chen, Y, DeVivo, MJ, Dirnagl, U, Schwab, JMUniversity of Alabama at Birmingham Spinal Cord Injury Model System , National SCI Statistical CenterYesmbelay
2017Challenges to Translation and the Hippocratic Oath by Premature Termination of Spinal Cord Stem Cell–Based TrialsJournalJAMA Neurology746635-636https://www.ncbi.nlm.nih.gov/pubmed/28437542Curt, A, Levi, AD, Schwab, JMOhio Regional SCI Model System (ORSCIMS)Yesmbelay
2017Randomized Trial of a Peer-Led, Telephone-Based Empowerment Intervention for Persons With Chronic Spinal Cord Injury Improves Health Self-ManagementJournalArchives of Physical Medicine and Rehabilitation9861067-1076https://www.ncbi.nlm.nih.gov/pubmed/28284835To evaluate the impact of "My Care My Call" (MCMC), a peer-led, telephone-based health self-management intervention in adults with chronic spinal cord injury (SCI) Houlihan, BV, Brody, M, Everhart-Skeels, S, Pernigotti, D, Burnett, S, Zazula, J, Green, C, Hasiotis, S, Belliveau, T, Seetharama, S, Rosenblum, D, Jette, ASpaulding New England Regional Spinal Cord Injury CenterYesmbelay
2019The association between the etiology of a spinal cord injury and time to mortality in the United States: A 44-year investigationJournalJournal of Spinal Cord Medicine 424444-452Objective: To determine the association between spinal cord injury (SCI) etiology categories and mortality, and examine the association between etiology sub-categories and mortality. Design: Prospective cohort study. Setting: Model Systems and Shriners Hospital SCI units. Participants: Data were analyzed from 42,627 cases in the SCI Model System Collaborative Survival Study Database from 1973 to 2017. Those with SCI etiologies categorized as vehicular, violent, sports, falls, pedestrian, and medical were included. Interventions: Not applicable. Outcome Measure: Time to mortality after SCI. Results: Relative to the sports related etiology category, those with medical, pedestrian, violence, falls, and vehicular related SCIs had a 2.00 (95% confidence intervals (CIs): 1.79–2.24), 1.57 (CIs: 1.34–1.83), 1.54 (CIs: 1.41–1.68), 1.35 (CIs: 1.25–1.45), and 1.26 (CIs: 1.17–1.35) higher hazard for mortality, respectfully. Persons with SCIs from automobile crashes had a 1.38 (CIs: 1.23–1.56) higher hazard for mortality, whereas those with SCIs from motorcycle crashes had a 1.21 (CIs: 1.04–1.39) higher hazard for mortality, relative to other etiologies within the vehicular category. Those with SCIs from diving had a 1.37 (CIs: 1.18–1.59) higher hazard for mortality relative to other etiologies within the sports category. Conclusions: Injury etiology categories and certain sub-categories were associated with a higher risk for early mortality. Understanding how additional factors such as socioeconomic status, co-occurring injuries, medical co-morbidities, and environmental aspects interact with SCI etiologies may provide insights for how etiology of injury impacts survival. These findings may serve as a development for extending long-term life expectancy by informing SCI prevention programs and care post-injury. McGrath, Ryan, Hall, Orman, Peterson, Mark, DeVivo, Michael, Heinemann, Allen, Kalpakjian, Claire Midwest Regional Spinal Cord Injury Care System, National SCI Statistical CenterYescheberle
2018Effects of exercise training vs. a high-protein diet on paralytic and non-paralytic limb muscles in individuals with long-standing spinal cord injuryJournal of Applied Physiology12564-72Yarar-Fisher C, Polston KFL, Eraslan M, Kinikli GI, Henley KY, Bickel CS, Windham ST, McLain AB, Oster RA, Bamman MM University of Alabama at Birmingham Spinal Cord Injury Model System Yesmbelay
2018A high-protein diet or combination exercise training to improve metabolic health in individuals with long-standing spinal cord injuryPhysiological Reports61-13Li J, Polston KFL, Eraslan M, Bickel CS, Windham ST, McLain AB, Oster RA, Bamman MM, Yarar-Fisher C University of Alabama at Birmingham Spinal Cord Injury Model System Yesmbelay
2018Evaluation of a Ketogenic Diet for Improvement of Neurological Recovery in Individuals with Acute Spinal Cord Injury: A Pilot, Randomized Safety and Feasibility TrialSpinal Cord Cases and Series41-8Yarar-Fisher C, Kulkarni A, Li J, Farley P, Renfro C, Aslam H, Bosarge P, Wilson L, Barnes S University of Alabama at Birmingham Spinal Cord Injury Model System Yesmbelay
2018Differences in glucose metabolism among women with spinal cord injury may not be fully explained by variations in body compositionArchives of Physical Medicine and Rehabilitation1001061-1067Li J, Hunter GR, Chen Y, McLain AB, Smith DL, Yarar-Fisher C University of Alabama at Birmingham Spinal Cord Injury Model System Yesmbelay
2019Women’s health challenges after spinal cord injuries and disordersIn Kirshblum S, Lin V (Ed.), Spinal Cord Medicine3rd edition955-986McLain A, Sipski Alexander M University of Alabama at Birmingham Spinal Cord Injury Model System Yesmbelay
2019Effects of virtual walking on spinal cord injury-related neuropathic pain: A randomized, controlled trialRehabilitation Psychology64113-24Richardson EJ, McKinley EC, Rahman AKMF, Klebine P, Redden DT, Richards JSUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesmbelay
2019Surgical and Nonsurgical Treatment of Penetrating Spinal Cord Injury: Analysis of Long-term Neurological and Functional OutcomesTopics in Spinal Cord Injury Rehabilitation252186-193https://www.ncbi.nlm.nih.gov/pubmed/31068749Michael Liam Kelly, MD, Mary Joan Roach, PhD, Gregory Nemunaitis, MD, Yuying Chen, MD, PhDUniversity of Alabama at Birmingham Spinal Cord Injury Model System , Northeast Ohio Regional Spinal Cord Injury SystemYesmbelay
2015Development and psychometric characteristics of the SCI-QOL pressure ulcers scale and short formJournalJ71735383303-314http://www.maneyonline.com/doi/abs/10.1179/2045772315Y.0000000017Article describes the development and psychometric characteristics of the Spinal Cord Injury – Quality of Life (SCI-QOL) Pressure Ulcers scale, a self-reported measure of the impact of pressure ulcers on health-related quality of life in individuals with spinal cord injury (SCI). Grounded-theory based qualitative item development methods, large-scale item calibration testing, confirmatory factor analysis (CFA), and item response theory-based psychometric analysis were performed. A total of 189 adults with traumatic SCI who experienced a pressure ulcer within the past 7 days completed 30 items related to pressure ulcers. Testing was conducted at several rehabilitation centers across the United States, including 5 SCI Model System centers and one Veterans Affairs medical center. CFA confirmed a unidimensional pool of items. IRT analyses were conducted. A constrained Graded Response Model with a constant slope parameter was used to estimate item thresholds for the 12 retained items. The SCI-QOL Pressure Ulcers scale may be administered in its entirety or as a 7-item short form and both are available for both research and clinical practice. Kisala, Pamela A., Tulsky, David S., Choi, Seung W., Kirshblum, Steven C.University of Michigan SCI Model System, Midwest Regional Spinal Cord Injury Care System, Rocky Mountain Regional SCI System, Northern New Jersey Spinal Cord Injury SystemYesarajbhandari
2015Measuring anxiety after spinal cord injury: Development and psychometric characteristics of the SCI-QOL anxiety item bank and linkage with GAD-7JournalJ71736383315-325http://www.maneyonline.com/doi/abs/10.1179/2045772315Y.0000000029Article describes the development and psychometric characteristics of the Spinal Cord Injury – Quality of Life (SCI-QOL) Anxiety item bank. Grounded-theory based qualitative item development methods were used to develop a calibrated item bank and computer adaptive test (CAT) to assess anxiety symptoms in individuals with spinal cord injury (SCI). Analyses included confirmatory factor analysis, item response theory calibration, and evaluation of differential item functioning. Scores were transformed to the Patient Reported Outcomes Measurement Information System (PROMIS) metric and statistical linking techniques were used to develop a crosswalk with the Generalized Anxiety Disorder (GAD-7), a widely used anxiety measure. Thirty-eight items assessing anxiety, 17 of which were PROMIS items, were administered to 716 individuals with traumatic SCI recruited from 5 SCI Model Systems centers and one Veterans Affairs medical center. After 13 items (including 2 PROMIS items) were removed, factor analyses confirmed unidimensionality. Item response theory analyses were used to estimate slopes and thresholds for the final 25 items (15 from PROMIS). The observed Pearson correlation between the SCI-QOL Anxiety and GAD-7 scores was 0.67. The SCI-QOL Anxiety item bank demonstrates excellent psychometric properties and is available as a CAT or short form for research and clinical applications. Kisala, Pamela A., Tulsky, David S., Kalpakjian, Claire Z., Heinemann, Allen W., Carle, Adam, Choi, Seung W.University of Michigan SCI Model System, Midwest Regional Spinal Cord Injury Care SystemYesarajbhandari
2015Overview of the spinal cord injury -- quality of life (SCI-QOL) measurement systemJournalJ71732383257-269http://www.maneyonline.com/doi/abs/10.1179/2045772315Y.0000000023Article describes the background and development of the Spinal Cord Injury -- Quality of Life (SCI-QOL) measurement system, a spinal cord injury (SCI)-specific, patient-reported outcome measure of health-related quality of life (HRQOL) covering physical, emotional, and social domains of functioning. The SCI-QOL was developed using item response theory (IRT) and comprises 22 subdomains that include 19 IRT-calibrated item banks and 3 fixed-length scales measuring physical, emotional, and social aspects of HRQOL. Its design ensures that each item is relevant to individuals with SCI. Each item bank may be administered as a full bank, short form, or computer adaptive test, while scales may be administered in fixed-length format only. Tulsky, David S., Kisala, Pamela A., Victorson, David, Tate, Denise G., Heinemann, Allen W., Charlifue, Susan, Kirshblum, Steve C., Fyffe, Denise, Gershon, Richard, Spungen, Ann M., Bombardier, Charles H., Dyson-Hudson, Trevor A., Amtmann, Dagmar, Kalpakjian, Claire Z., Choi, Seung W., Jette, Alan M.University of Michigan SCI Model System, Rocky Mountain Regional SCI System, Mount Sinai Hospital Spinal Cord Injury Model System, Midwest Regional Spinal Cord Injury Care System, Northern New Jersey Spinal Cord Injury System, Spaulding New England Regional Spinal Cord Injury Center, Rocky Mountain Regional SCI SystemYesdevopsadmin
Family caregivers of individuals with spinal cord injury: Exploring the stresses and benefitsNodevopsadmin
2016Spinal cord injury -- function index/assistive technology short formsJournalJ73923Study evaluated the psychometric properties of the Spinal Cord Injury-Functional Index/Assistive Technology (SCI-FI/AT) short forms (SFs) in the domains of basic mobility, self-care, fine motor function, and ambulation based on internal consistency, with specific SFs for people with paraplegia and tetraplegia. The study also examined correlations between SFs and full item banks, and a 10-item computerized adaptive test (CAT) version; the magnitude of ceiling and floor effects; and measurement precision across a broad range of function in adults with spinal cord injury (SCI). Data obtained from 460 adults with traumatic SCI from 9 national SCI Model Systems programs stratified by level of injury (paraplegia/tetraplegia), completeness of injury, and time since SCI included: SCI-FI/AT full item bank, 10-item CAT, and SFs (with separate Self-Care and Fine Motor Function SFs for subjects with tetraplegia and paraplegia). Results show that the SCI-FI/AT SFs demonstrated very good internal consistency, group-level reliability, and excellent correlations between SFs and scores based on the CAT version and the total item bank. Ceiling and floor effects are acceptable (except for unacceptable ceiling effects for persons with paraplegia on the Self-Care and Fine Motor Function SFs). The test information functions are excellent across a broad range of functioning typical of people with paraplegia and tetraplegia. Clinicians and researchers should consider using the SCI-FI/AT SFs to assess functioning with the use of assistive technology when CAT applications are not availableUniversity of Michigan SCI Model System, Spaulding New England Regional Spinal Cord Injury Center, University of Pittsburgh Model Center on Spinal Cord Injury, Rocky Mountain Regional SCI System, Midwest Regional Spinal Cord Injury Care System, Northern New Jersey Spinal Cord Injury System, New England Spinal Center, Regional SCI Center of the Delaware Valley, Kentucky Regional Spinal Cord Injury Model SystemYesdevopsadmin
2014Suicide mortality after spinal cord injury in the United States: Injury cohorts analysisJournalJ68257952230-235Study compared 12-year suicide-specific mortalities of 3 different injury cohorts, identified the risk factors for suicide mortality after spinal cord injury (SCI), and investigated whether suicide mortality is higher among those with SCI than in the general population. Data on suicide deaths were obtained from 31,399 participants injured between January 1, 1973, and December 31, 1999 who received services at 28 United States hospitals designated as SCI Model Systems. Based on their year of injury, participants were divided into 3 cohorts: injured between 1973 and 1979, injured between 1980 and 1989, and injured between 1990 and 1999. Analysis revealed that the crude annual suicide mortality rate during the first 12 years after SCI was 91 per 100,000 person-years for 1973 to 1979 injury cohort, 69 per 100,000 person-years for 1980 to 1989 injury cohort, and 46 per 100,000 person-years for 1990 to 1999 injury cohort. Suicide mortality was associated with race, injury severity, and years since injury. The standardized mortality ratios for the 3 cohorts were 5.2, 3.7, and 3.0, respectively. Suicide mortality among those with SCI decreased over 3 injury cohorts, but it still remained 3 times higher than that of the general population.Southeastern Regional Spinal Cord Injury Model System, National SCI Statistical CenterYesdevopsadmin
2015Distinguishing grief from depression during acute recovery from spinal cord injuryJournalJ720659681419-1425Study investigated whether grief is a psychometrically sound construct that is distinct from depression in individuals who recently sustained a spinal cord injury (SCI). A total of 206 patients with SCI were recruited from inpatient rehabilitation units at 3 SCI Model System sites. Most patients were non-Hispanic whites (85 percent) and most patients had sustained a cervical SCI (64.4 percent). Various injury etiologies were represented, with the majority being accounted for by falls (31.5 percent) and vehicle-related accidents (33.5 percent). An adapted version of the 12-item structured clinical interview for Prolonged Grief Disorder was used to assess symptoms of grief, and the Patient Health Questionnaire-9 was used to measure depression. Demographic and injury-related data were also collected. A principal component analysis of the grief measure suggested a 2-component solution. The content of items loading on the separate components suggested 2 subscales: loss (6 items; Cronbach alpha = .810) and trauma (6 items; Cronbach alpha = .823). Follow-up principal component analyses including both grief and depression measures suggested clear differentiation of grief-related loss from depression. The prevalence of clinically significant levels of grief was low (6 percent), and levels of depression were consistent with previous findings related to inpatient rehabilitation (23.5 percent). The items used to assess grief symptoms in this study appear to capture a psychometrically reliable construct that is distinct from that of depression.University of Michigan SCI Model System, Northwest Regional Spinal Cord Injury System, Texas Model Spinal Cord Injury SystemYesdevopsadmin
2016Objective and self-reported physical activity measures and their association with depression and satisfaction with life in persons with spinal cord injuryJournalJ7470097101714-1720Study examined associations between objective and self-reported measures of physical activity (PA) and the relationships of these measures with depression and satisfaction with life (SWL) in people with spinal cord injury (SCI). Data were collected from 86 individuals with traumatic SCI who use a manual wheelchair. Objective measures of PA included average daily distance and speed of wheelchair propulsion (WCP) measured by an odometer attached to the participants’ wheelchairs. Self-report questionnaires included demographics, the 24-hour recall of transfers, Physical Activity Recall Assessment for People with SCI, the Patient Health Questionnaire-2 (PHQ-2) to document depressive symptoms, and the Satisfaction With Life Scale (SWLS). Analysis revealed that both objective measures of WCP, average daily distance and speed, were predicted by the combination of self-reported daily time away from home/yard and lower frequency of car transfers. Daily distance of WCP was negatively correlated with depression (PHQ-2). Time in leisure PA was the only significant predictor of SWLS scores. Short-term recall of hours away from home/yard not spent driving or riding in a vehicle is suggested as a self-report measure that is moderately related to overall WCP PA in this population. Results of this study suggest that depression is related to decreased PA and WCP activity, while SWL is related to leisure PA.Spaulding New England Regional Spinal Cord Injury Center, Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2016Clinical interpretation of the spinal cord injury functional index (SCI-FI)JournalJ73836395527-534Study evaluated the validity of the functional ability levels for the Spinal Cord Injury–Functional Index (SCI-FI). Data were collected from 855 individuals with traumatic spinal cord injury (SCI) enrolled in 6 rehabilitation centers participating in the National SCI Model Systems Network. Cluster analyses identified three distinct groups that represent low, mid-range, and high SCI-FI functional ability levels. Comparison of clusters on personal and other injury characteristics indicated some significant differences between groups. These results strongly support the use of SCI-FI functional ability levels to document the perceived functional abilities of people with SCI. The results of the cluster analysis suggest that the SCI-FI functional ability levels capture function by injury characteristics. Clinical implications regarding tracking functional activity trajectories during follow-up visits are discussed.University of Michigan SCI Model System, Rocky Mountain Regional SCI System, Mount Sinai Hospital Spinal Cord Injury Model System, Northern New Jersey Spinal Cord Injury System, Midwest Regional Spinal Cord Injury Care System, New England Spinal CenterYesdevopsadmin
2015Information/education page: Evaluating your pressure prevention plan: A problem-solving worksheet for people with spinal cord injury and their health care providersJournalJ7269696112089-2090Article provides a worksheet to help people with spinal cord injury identify challenges they face when trying to prevent pressure ulcers and work with their health care providers to address those challenges. Instructions and links to more information about preventing pressure ulcers are also included.Rocky Mountain Regional SCI System, Northern New Jersey Spinal Cord Injury System, Southeastern Regional Spinal Cord Injury Model System, National SCI Statistical CenterYesdevopsadmin
2016Risk and protective factors for cause-specific mortality after spinal cord injuryJournalJ7469597101669-1678Study investigated the association of multiple sets of risk and protective factors (biographic and injury, socioeconomic, health) with cause-specific mortality after spinal cord injury (SCI). Participants were 8,157 adults with traumatic SCI who were enrolled in a SCI Model Systems facility after 1973. All-cause mortality was determined using the Social Security Death Index. Causes of death were obtained from the National Death Index and classified as infective and parasitic diseases, neoplasms, respiratory system diseases, heart and blood vessel diseases, external causes, and other causes. Competing risk analysis, with time-dependent covariates, was performed with hazard ratios (HRs) for each cause of death. The HRs for injury severity indicators were highest for deaths due to respiratory system diseases (highest HR for injury level C1-4, 4.84) and infective and parasitic diseases (highest HR for American Spinal Injury Association Impairment Scale [AIS] grade A, 5.70). In contrast, injury level and AIS grade were relatively unrelated to death due to neoplasms and external causes. Of the socioeconomic indicators, education and income were significantly predictive of a number of causes of death. Pressure ulcers were the only 1 of 4 secondary health condition indicators consistently related to cause of death. Findings suggest that infective disease and respiratory causes of death are those that are most strongly tied with SCI severity, with respiratory causes most directly related to the neurologic level of injury and infective diseases most strongly related to the AIS grade.Southeastern Regional Spinal Cord Injury Model System, University of Alabama at Birmingham Spinal Cord Injury Model System , National SCI Statistical CenterYesdevopsadmin
2015Development and psychometric characteristics of the SCI-QOL bladder management difficulties and bowel management difficulties item banks and short forms and the SCI-QOL bladder complications scale.JournalJ71734Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)383288-302http://www.maneyonline.com/doi/abs/10.1179/2045772315Y.0000000030Article describes the development and psychometric characteristics of the Spinal Cord Injury – Quality of Life (SCI-QOL) Bowel Management Difficulties and Bladder Management Difficulties item banks, and a short scale to measure bladder complications. Using a mixed-methods design, a pool of items assessing bladder and bowel-related concerns were developed using interviews and focus groups with individuals with spinal cord injury (SCI) and SCI clinicians. Items were revised based on expert review and patient feedback and then field tested. Thirty-eight bladder items and 52 bowel items and other item pools related to physical-medical health were administered to 757 individuals with SCI. Analyses included confirmatory factor analysis (CFA), graded response IRT modeling and evaluation of differential item functioning (DIF). The final item banks demonstrated unidimensionality and acceptable fit to a graded response IRT model. The final calibrated Bladder Management Difficulties bank includes 15 items, and the final Bowel Management Difficulties item bank consists of 26 items. Additionally, 5 items related to urinary tract infections (UTI) did not fit with the larger Bladder Management Difficulties item bank but performed relatively well independently and were thus retained as a separate scale. Results indicate that the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks are psychometrically robust and are available as computer adaptive tests or short forms. The SCI-QOL Bladder Complications scale is a brief, fixed-length outcomes instrument for individuals with a UTI. University of Michigan SCI Model System, Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2015Measuring grief and loss after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL grief and loss item bank and short formJournalJ71739383347-355http://www.maneyonline.com/doi/abs/10.1179/2045772315Y.0000000015Article describes the development and psychometric properties of the Spinal Cord Injury – Quality of Life (SCI-QOL) Grief and Loss item bank and short form. A literature review guided framework development of grief/loss. New items were created from focus groups. Items were revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis, item response theory calibration, and evaluation of differential item functioning (DIF). A 20-item pool was tested at several rehabilitation centers across the United States, including 5 SCI Model System centers and one Veterans Affairs medical center. A total of 717 individuals with SCI answered the grief and loss questions. The final calibrated item bank resulted in 17 retained items. A unidimensional model was observed and measurement precision was good. Ten items were flagged for DIF; however, after examination of effect sizes found this to be negligible with little practical impact on score estimates. The SCI-QOL Grief and Loss item bank represents a psychometrically robust measurement tool. Short-form items are also suggested and computer adaptive tests are available. University of Michigan SCI Model System, Northwest Regional Spinal Cord Injury System, Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2014Additive effect of age on disability for individuals with spinal cord injuriesJournalJ690839561076-1082Study examined the additive effect of age on disability for adults with spinal cord injury (SCI). Data regarding demographics, injury and medical characteristics, independence in activities of daily living, and psychosocial well-being were collected from participants with SCI who were enrolled in the SCI Model Systems between 1988 and 2011. The primary study outcome was the motor subscale of the Functional Independence Measure (FIM). A mixed-models approach was used to examine the additive effect of age on disability, using data for 1,660 individuals with SCI (median age at injury, 32 years) with a discharge motor FIM score and at least 1 follow-up motor FIM score. When controlling for motor FIM at discharge from rehabilitation, level and severity of injury, age at injury, sex, race, and the age-by-time interaction were not significant. Age at the time of SCI was significantly associated with motor FIM. Two sensitivity analyses found significant interactions for both age-by-time and age-by-time-square models. Trajectory of motor FIM scores is moderated slightly by age at the time of injury. The older participants were at the time of injury, the greater the curvature and the more rapid decline were found in later years. These findings indicate that age moderately influences disability for some individuals with SCI: the older the age at the time of injury, the greater the influence age has on disability.Northwest Regional Spinal Cord Injury System, University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2016Harmonization of databases: A step for advancing the knowledge about spinal cord injuryJournalJ7471097101805-1818This article provides an overview of existing spinal cord injury (SCI) clinical research databases, including their purposes, characteristics, and accessibility to users; and presents a vision for future collaborations required for clinical research in SCI. This vision highlights the need for validated and relevant data for longitudinal clinical trials and observational and epidemiologic SCI-related studies. Three existing SCI clinical research databases/registries are reviewed and summarized with regard to current formats, collection methods, and uses, including major strengths and weaknesses. Two ongoing efforts to provide a uniform approach to data collection are also reviewed. The databases reviewed offer different approaches to capture important clinical information on SCI. They vary on size, purpose, data points, inclusion of standard outcomes, and technical requirements. Each presents with a set of limitations including lack of population data and lack of a common platform for data comparisons and exchanges. It is clear that numerous issues need to be considered when planning to establish common ways of collecting data through data sets or patient registries, ranging from a carefully crafted implementation plan to establishing a framework for dissemination of data and findings. For the present, taking advantage of the vast but different data already collected over many decades may require a variety of statistical skills and epidemiologic techniques. Ultimately, the ability to speak the same language with regard to variables and assessment tools will facilitate international collaborations and enhance comparability, data pooling, and the ability to generalize findings to a broader population.University of Michigan SCI Model System, Rocky Mountain Regional SCI SystemYesdevopsadmin
2017Representativeness of the spinal cord injury model systems national databaseJournalJ77664Study investigated whether the Spinal Cord Injury Model Systems National Database (SCIMS-NDB) patient sample is representative of all adults aged 18 years or older admitted to inpatient rehabilitation centers in the United States (US) for new onset traumatic spinal cord injury (TSCI). Demographic, functional status, and injury characteristics were compared between 5,969 SCIMS-NDB cases and 99,142 cases from the Uniform Data System for Medical Rehabilitation and eRehabData data sets (national sample) discharged from inpatient rehabilitation in 2000–2010. Analysis revealed negligible differences (10 percent) exist in mean age and preinjury occupational status; the SCIMS-NDB sample was younger and included a higher percentage of individuals who were employed (62.7 versus 41.7 percent) and fewer who were retired (10.2 versus 36.1 percent). Results indicate that adults in the SCIMS-NDB are largely representative of the population of adults receiving inpatient rehabilitation for new onset TSCI in the US. However, users of the SCIMS-NDB may need to adjust statistically for differences in age and preinjury occupational status to improve generalizability of findings.Rocky Mountain Regional SCI System, Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2015Development and psychometric characteristics of the SCI-QOL ability to participate and satisfaction with social roles and activities item banks and short formsJournalJ71744383397-408http://www.maneyonline.com/doi/abs/10.1179/2045772315Y.0000000028Article describes the development and psychometric properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks and short forms. Focus groups helped define the constructs; cognitive interviews helped revise items; and confirmatory factor analysis and item response theory methods helped calibrate item banks and evaluate differential item functioning related to demographic and injury characteristics. The calibration sample consisted of 641 individuals from 5 SCI Model System sites and one Veterans Administration medical center; a reliability sample consisted of 245 individuals residing in the community. A subset of 27 Ability to Participate and 35 Satisfaction items demonstrated good measurement properties and negligible differential item functioning related to demographic and injury characteristics. Ten item short forms correlate (>0.96) with the full banks. Variable-length computer adaptive tests (CATs) with a minimum of 4 items, variable-length CATs with a minimum of 8 items, fixed-length CATs of 10 items, and the 10-item short forms demonstrate construct coverage and measurement error that is comparable to the full item bank. The Ability to Participate and Satisfaction with Social Roles and Activities CATs and short forms demonstrate excellent psychometric properties and are suitable for clinical and research applications. The SCI-specific measures correlate strongly with the Patient Reported Outcomes Measurement Information System (PROMIS) and Quality of Life in Neurological Disorders (Neuro-QOL) versions. University of Michigan SCI Model System, Midwest Regional Spinal Cord Injury Care System, Rocky Mountain Regional SCI System, Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2015Measuring depression after spinal cord injury: Development and psychometric characteristics of the SCI-QOL depression item bank and linkage with PHQ-9JournalJ71738383335-346http://www.maneyonline.com/doi/abs/10.1179/2045772315Y.0000000020Article describes the development and psychometric properties of the Spinal Cord Injury – Quality of Life (SCI-QOL) Depression item bank, computer adaptive test (CAT), and short form to assess depressive symptoms experienced by individuals with spinal cord injury (SCI). Grounded-theory-based qualitative item development methods and large-scale field testing were used. Analyses included confirmatory factor analysis, item response theory (IRT) calibration, and evaluation of differential item functioning. Scores were transformed to the Patient Reported Outcomes Measurement Information System (PROMIS) metric and statistical linking techniques were used to develop a crosswalk to the Patient Health Questionnaire (PHQ)-9. The item pool was tested at several medical institutions across the United States, including 5 SCI Model System centers and one Veterans Affairs medical center. A sample of 716 individuals with traumatic SCI completed 35 items assessing depression, 18 of which were PROMIS items. After removing 7 non-PROMIS items, factor analyses confirmed a unidimensional pool of items. A graded response IRT model was used to estimate slopes and thresholds for the 28 retained items. The SCI-QOL Depression measure correlated with the PHQ-9. The SCI-QOL Depression item bank provides a reliable and sensitive measure of depressive symptoms with scores reported in terms of general population norms. A crosswalk to the PHQ-9 was created to facilitate comparisons between measures. The item bank may be administered as a CAT or as a short form and is suitable for research and clinical applications. University of Michigan SCI Model System, Northwest Regional Spinal Cord Injury System, Rocky Mountain Regional SCI System, Midwest Regional Spinal Cord Injury Care System, Northern New Jersey Spinal Cord Injury System, New England Spinal CenterYesdevopsadmin
2016Active lifestyle is associated with reduced dyspnea and greater life satisfaction in spinal cord injuryJournalJ73962Study assessed the relationship between measures of activity with dyspnea and satisfaction with life in chronic spinal cord injury (SCI). Between July 2012 and March 2015, 347subjects with traumatic SCI ≥1 year after injury who used a manual wheelchair or walked with or without an assistive device reported hours spent away from home or yard on the previous 3 days, sports participation, and planned exercise. Outcome measures were the Satisfaction with Life Scale (SWLS) and dyspnea. Dyspnea was defined as shortness of breath when hurrying on the level or going up a slight hill, going slower than people the same age on the level because of breathlessness, or stopping for breath when going at a self-selected pace, or after about 100 yards (or after a few minutes) on the level. Dyspnea prevalence was 30 percent. Adjusting for asthma or chronic obstructive pulmonary disease, mobility mode, race, and season, there was a significant linear trend between greater SWLS scores and quartiles of time spent away from the home or yard. SWLS score was greater if participating in organized sports, although was not significantly greater with planned exercise. Planned exercise was associated with a reduced odds ratio (OR) of dyspnea (.57), but organized sports was not. Dyspnea was not significantly increased in persons who spent the fewest hours outside their home or yard (≤7h) compared with people who spent the most hours outside their home or yard (>23h) (OR=1.69). In SCI, a planned exercise program is associated with less dyspnea. An active lifestyle characterized by greater time spent away from home or yard and sports participation is associated with greater SWLS scores.Spaulding New England Regional Spinal Cord Injury Center, Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2015Functional ability level development and validation: Providing clinical meaning for spinal cord injury functional index scoresJournalJ720699681448-1457Study developed and evaluated functional ability levels for the Spinal Cord Injury Functional Index (SCI-FI) using calibration and reliability samples. The SCI-FI measures activity limitations in 5 domains: basic mobility, ambulation, wheelchair mobility, self-care, and fine motor function. SCI-FI data were obtained from 1,124 adults with traumatic spinal cord injury (SCI) recruited from the SCI Model Systems programs (855 and 269 for calibration and reliability samples, respectively) and stratified by diagnosis, severity, and time since injury. Five functional ability levels were identified for all SCI-FI domains, except fine motor having 4 functional ability levels. Statistical test results indicated no significant differences in the distribution pattern between the 2 samples across functional ability levels for all domains except for ambulation. Known-group comparisons were able to distinguish the SCI population as expected. Basic mobility, self-care, and wheelchair mobility domains had a cluster of patients with paraplegia and incomplete lesions at higher functional ability levels and patients with tetraplegia and complete lesions at lower functional ability levels. For the ambulation domain, the distribution was skewed to the lower end, with a relatively small percentage of patients with incomplete lesions (paraplegia and tetraplegia) at higher functional ability levels. For the fine motor domain, the distribution was skewed to higher functional ability levels, with a high percentage of persons with paraplegia at the highest level (complete and incomplete lesions). Concurrent validity analyses revealed SCI-FI functional levels to be significantly positively correlated with both the self-reported functional measure and the observer-rated Functional Independence Measure.University of Michigan SCI Model System, Rocky Mountain Regional SCI System, Mount Sinai Hospital Spinal Cord Injury Model System, Midwest Regional Spinal Cord Injury Care System, Northern New Jersey Spinal Cord Injury System, New England Spinal CenterYesdevopsadmin
2016Reliability and validity of S3 pressure sensation as an alternative to deep anal pressure in neurologic classification of persons with spinal cord injuryJournalJ7469197101642-1646Study investigated whether pressure sensation at the S3 dermatome (a new test) could be used in place of deep anal pressure (DAP) to determine completeness of injury as part of the neurological classification of spinal cord injury (SCI). This prospective, multicenter observational study was conducted as a collaborative module among 5 SCI Model Systems centers. A total of 125 participants with acute traumatic SCI, neurologic levels T12 and above, were examined at 1 month (baseline), 3, 6, and 12 months postinjury. Pressure sensation over the ischial tuberosities (S3) was tested at each time point and was repeated within 3 days of the 1-month examination. Test-retest reliability and agreement (k), sensitivity, specificity, and positive and negative predictive values were calculated. Test-retest reliability of S3 pressure at 1 month was almost perfect (k=.98). Agreement of S3 pressure with DAP was substantial both at 1 month (k=.73) and for all time points combined (k=.76). The positive predictive value of S3 pressure for DAP was 89.3 percent at baseline and 90.3 percent for all time points. No pattern in outcomes was seen in those cases where S3 pressure and DAP differed at 1 month. Based on the findings, the authors recommend S3 pressure as an alternative test of sensory sacral sparing for supraconus SCI, at least in cases where DAP cannot be tested. Further research is needed to determine whether S3 pressure could replace DAP for classification of SCI.Spaulding New England Regional Spinal Cord Injury Center, Northern New Jersey Spinal Cord Injury System, Southeastern Regional Spinal Cord Injury Model System, Regional SCI Center of the Delaware Valley, Kentucky Regional Spinal Cord Injury Model SystemYesdevopsadmin
2015Current pregnancy among women with spinal cord injury: Findings from the US national spinal cord injury databaseJournalJ728525311821-826Study examined the prevalence of pregnancy and associations with sociodemographic and clinical factors among women with spinal cord injury (SCI) enrolled in the United States (US) National SCI Database (NSCID). The NSCID collects data from patients receiving services at SCI Model Systems centers at years 1 and 5 and then every 5 years post injury. The data include SCI clinical details, functional impairments, participation measures, depressive symptoms and life satisfaction. Women aged 18 to 49 years are asked about hospitalizations in the last year relating to pregnancy or its complications. The data for this study represent 1,907 women who completed 3,054 interviews. Generalized estimating equations were used to examine bivariable associations between pregnancy and clinical and psychosocial variables and to perform multivariable regressions predicting pregnancy. Results showed that 2 percent of the women reported pregnancy during the prior 12 months. This annual prevalence differed significantly by the years elapsed since injury; the highest rate occurred 15 years post injury (3.7 percent). Bivariable analyses found that younger age at injury was significantly associated with current pregnancy. Compared with nonpregnant women, those reporting current pregnancy were significantly more likely to be married or partnered, have sport-related SCI, have higher motor scores and have more positive psychosocial status scores. Multivariable analyses found significant associations between current pregnancy and age, marital status, motor score and mobility and occupation scale scores. Current pregnancy rates among reproductive-aged women with SCI are similar to rates of other US women with chronic mobility impairments.University of Alabama at Birmingham Spinal Cord Injury Model System , National SCI Statistical CenterYesdevopsadmin
2014Measurement properties of the spinal cord injury-functional index (SCI-FI) short formsJournalJ691469571289-1297Study developed and evaluated the psychometric properties of short forms for each of the Spinal Cord Injury-Functional Index (SCI-FI) item banks (basic mobility, self-care, fine motor, ambulation, and manual and power wheelchair mobility). Data were collected from 855 individuals with traumatic spinal cord injury (SCI) recruited from 6 national SCI Model Systems facilities. Measurement properties were assessed in terms of internal consistency; correlations between short forms banks, full-item bank forms, and a 10-item computer adaptive test version; magnitude of ceiling and floor effects; and test information functions. The SCI-FI short forms (with separate versions for individuals with paraplegia and tetraplegia) demonstrate very good internal consistency, group-level reliability, excellent correlations between short forms and scores based on the total item bank, and minimal ceiling and floor effects (except ceiling effects for people with paraplegia on self-care, fine motor, and power wheelchair ability and floor effects for people with tetraplegia on self-care, fine motor, and manual wheelchair ability). The test information functions are acceptable across the range of scores where most individuals in the sample performed. Clinicians and researchers should consider the SCI-FI short forms when computer adaptive testing is not feasible.University of Michigan SCI Model System, Rocky Mountain Regional SCI System, Mount Sinai Hospital Spinal Cord Injury Model System, Midwest Regional Spinal Cord Injury Care System, New England Spinal Center, Northern New Jersey Spinal Cord Injury System, University of Michigan SCI Model SystemYesdevopsadmin
2016To what extent do neighborhood differences mediate racial disparities in participation after spinal cord injury?JournalJ7470297101735-1744Study investigated the contribution of residential neighborhood characteristics to race disparities in participation among community-living adults with chronic spinal cord injury (SCI). Survey data from the SCI Model Systems (SCIMS) database were linked with residential characteristics derived from national survey and spatial data to assess the contribution of social, economic, and physical neighborhood characteristics to race disparities in community participation after SCI. The sample consisted of 6,892 SCIMS database participants in 5,441 Census tracts from 50 states and the District of Columbia. The Craig Handicap Assessment and Reporting Technique was used to measure participation across 4 domains: physical independence, mobility, occupation, and social integration. Results indicated that racial minority groups had lower odds of reporting full participation relative to Whites across all domains, suggesting that Blacks and Hispanics are at risk for poorer community reintegration after SCI. Neighborhood characteristics, notably differences in socioeconomic advantage, reduced race group differences in the odds of full occupational and social integration, suggesting that the race disparities in community reintegration after SCI are partially attributable to variation in the economic characteristics of the places where people live. Findings suggest that addressing disadvantage at the neighborhood level may modify gaps in community participation after medical rehabilitation and provide further support for the role of the environment in the experience of disability.University of Michigan SCI Model System, Northern New Jersey Spinal Cord Injury System, National SCI Statistical CenterYesdevopsadmin
2014Evaluating a spinal cord injury-specific model of depression and quality of lifeJournalJ68479953455-465Study investigated whether demographic, injury, health, and functional factors similarly have the same predictive association with both somatic and nonsomatic symptoms of depression, and whether somatic and nonsomatic symptoms of depression have the same association with quality of life (QOL). One-year follow-up assessment data from 4,976 participants with traumatic SCI enrolled in the Spinal Cord Injury Model Systems National Database, obtained between 2006 and 2011, were analyzed. Somatic and nonsomatic symptoms of depression were measured using the Patient Health Questionnaire-9 and QOL was evaluated by the Satisfaction With Life Scale. Structural equation modeling showed that the hypothesized model provided a good fit to the data, but modification of the model led to a significant improvement in model fit. The health-related factors including pain severity, pain interference, and health status were similarly associated with both somatic and nonsomatic symptoms of depression. QOL was negatively associated with nonsomatic symptoms of depression but was unrelated to somatic symptoms of depression. Findings suggest that differences exist in the association between demographic, health, function, participation, and somatic and nonsomatic symptoms of depression as well as on QOL. Assessment of depression after SCI should include a careful assessment of health concerns given the relation between health-related factors and both somatic and nonsomatic symptoms of depression. Treatments of depressive symptoms may be improved by targeting health concerns, such as pain, along with a specific focus on nonsomatic symptoms to improve the QOL.University of Michigan SCI Model System, Northwest Regional Spinal Cord Injury System, Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2016Patterns of sacral sparing components on neurologic recovery in newly injured persons with traumatic spinal cord injuryJournalJ7469297101647-1655Study assessed the patterns of sacral sparing and recovery in newly injured individuals with traumatic spinal cord injury (SCI) admitted to rehabilitation centers within 30 days after injury with follow-up at discharge, at 1 year, or both. The International Standards for Neurological Classification of Spinal Cord Injury examination results at admission and follow-up were obtained from 1,738 participants enrolled in the SCI Model Systems database January 2011 to February 2015. Results showed that conversion from an initial American Spinal Injury Association Impairment Scale (AIS) grade A to incomplete status was 20 percent at rehabilitation discharge and 27.8 percent at 1 year, and was greater in cervical and low paraplegia levels (T10 and below) than in high paraplegia level injuries (T1-9). Conversion from AIS B to motor incomplete was 33.9 percent at discharge and 53.6 percent at 1 year, and the initial sparing of all sacral sensory components was correlated with the greatest conversion to motor incomplete status at discharge and at 1 year. For patients with initial AIS C, the presence of voluntary anal contraction (VAC) in association with other sacral sparing was most frequently observed to improve to AIS D status at discharge. However, the presence of VAC alone as the initial sacral sparing component had the poorest prognosis for recovery to AIS D status. At follow-up, regaining sacral sparing components correlated with improvement in conversion for patients with initial AIS B and C. The components of initial and follow-up sacral sparing indicated differential patterns of neurologic outcome in patients with traumatic SCI. The more sacral components initially spared, the greater the potential for recovery; and the more sacral components gained, the greater the chance of motor recovery. Consideration of whether VAC should remain a diagnostic criterion sufficient for motor incomplete classification in the absence of other qualifying sublesional motor sparing is recommended.Rocky Mountain Regional SCI System, Northern New Jersey Spinal Cord Injury System, Regional SCI Center of the Delaware ValleyYesdevopsadmin
2015Common data elements for spinal cord injury clinical research: A national institute for neurological disorders and stroke projectJournalJ71499534265-277Article describes the development of a comprehensive set of common data elements (CDEs), data definitions, case report forms, and guidelines for use in spinal cord injury (SCI) clinical research. As part of the CDE project at the National Institute of Neurological Disorders and Stroke (NINDS), nine working groups composed of international experts reviewed existing CDEs and instruments, created new elements when needed, and provided recommendations for SCI clinical research. The project was carried out in collaboration with and cross-referenced to development of the International Spinal Cord Society (ISCoS) International SCI Data Sets. The recommendations were compiled, subjected to internal review, and posted online for external public comment. The final version was reviewed by all working groups and the NINDS CDE team before release. The NINDS SCI CDEs and supporting documents are publically available on the NINDS CDE website and the ISCoS website. The CDEs span the continuum of SCI care and the full range of domains of the International Classification of Functioning, Disability and Health. Widespread use of CDEs can facilitate SCI clinical research and trial design, data sharing, and retrospective analyses. Continued international collaboration will enable consistent data collection and reporting, and will help ensure that the data elements are updated, reviewed, and broadcast as additional evidence is obtained.Rocky Mountain Regional SCI System, National SCI Statistical CenterYesdevopsadmin
2014Longitudinal analysis of hospitalization after spinal cord injury: Variation based on race and ethnicityJournalJ7007295112158-2166Study examined the longitudinal effects of race/ethnicity on hospitalization among adults with spinal cord injury (SCI) in the 10-year period after initial injury. Data were extracted from the 2011 National SCI Model Systems database for 3,175 non-Hispanic White, 1,396 non-Hispanic African American, and 575 Hispanic adults with SCI who received rehabilitation at one of the SCI Model Systems centers. Hospitalization, including rate of hospitalization, number of hospitalizations, and number of days hospitalized during the previous 12 months was assessed at the first-, fifth-, and tenth-year follow-up interviews. Significant differences were found in rates of hospitalization at 1 and 5 years postinjury, with participants from Hispanic backgrounds reporting lower rates than either Whites or African Americans. At 10 years postinjury, no differences were noted in the rate of hospitalization between racial/ethnic groups; however, compared with Whites and Hispanics, African Americans with SCI had 13 and 16 more days of hospitalization, respectively. Compared with the first year postinjury, the rate of hospitalization declined over time among Whites, African Americans, and Hispanics; however, for African Americans, the number of days hospitalized increased by 12 days at 10 years versus 5 years postinjury. Racial/ethnic variation appears to exist in postinjury hospitalization for individuals with SCI. Potential explanations for these variations are discussed, and recommendations are made for potential changes to policy and clinical care.University of Michigan SCI Model System, Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2015Zolendronic acid administration failed to prevent bone loss at the knee in persons with acute spinal cord injury: An observational cohort studyJournalJ73510Journal of Bone and Mineral Metabolism334410-421Study investigated the efficacy of zoledronic acid to prevent sublesional bone mineral density (BMD) loss at 6 and 12 months after acute spinal cord injury (SCI). Thirteen subjects with acute motor-complete SCI were prospectively studied: 6 patients received zoledronic acid (5 mg) and 7 subjects did not receive the drug (controls). Zoledronic acid was administered intravenously within 16 weeks of acute injury. Areal BMD was performed by dual energy X-ray absorptiometry at baseline, 6, and 12 months after administration of drug. The treatment group demonstrated sparing of BMD at the total hip at month 6 and at month 12. In contrast to the findings at the hip, the treatment group had a greater loss of BMD compared to the control group at the distal femur and proximal tibia at month 6 and at month 12. A single dose of zoledronic acid administered soon after acute SCI reduced the percentage of BMD loss at the hip, but appeared to have no effect to prevent BMD loss at the knee, the site where fracture risk is greatest in people with SCI.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2016The association between metabolic syndrome and pressure ulcers among individuals living with spinal cord injuryJournalJ75187Spinal Cord (formerly Paraplegia)5411967-972Study examined the relationship between metabolic syndrome (MetS) and pressure ulcers (PrU), after controlling for demographic and injury characteristics, socioeconomic factors, health behaviors and fatigue among 350 participants with spinal cord injury (SCI). Blood tests and physical examination were performed. Waist circumference, high-density cholesterol, triglycerides, blood pressure and fasting glucose were used to diagnose MetS according to Criteria for Clinical Diagnosis of Metabolic Syndrome defined by the American Heart Association. All other variables were self-reported. Three-stage multivariate logistic regression models evaluated the effects of three sequential sets of predictors, including demographic/injury, socio-environmental/behavioral and health factors, basing the order of analysis on the Theoretical Risk and Prevention Model. The prevalence of PrU and MetS was 11.0 percent and 35.3 percent, respectively. Ethnicity, smoking, alcohol consumption and MetS were statistically associated with PrU in the full model. Participants who were non-Hispanic, smokers, and drank over 30 drinks per month had greater odds of having a PrU compared with those who were Hispanic, non-smokers, and non-drinkers, respectively. Participants who had MetS had higher odds of PrU than those without MetS, even after adjusting for multiple covariates.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2016Women's experiences of living with neurogenic bladder and bowel after spinal cord injury: Life controlled by bladder and bowelJournalJ73311Disability and Rehabilitation386573-581Study explored women’s experiences of living with spinal cord injury (SCI) and neurogenic bladder and bowel (NBB), a chronic condition hindering the functioning and quality of life of people with SCI. Secondary analysis of semi-structured interviews from a larger qualitative study of 50 women with SCI was conducted. Transcripts were coded for bowel and bladder content. Pile-sorting techniques were used to identify emergent themes related to NBB. Meta-themes were categorized under the International Classification of Functioning, Disability and Health. Bladder and bowel topics were spontaneously discussed by 46 of the 50 study participants, suggesting the importance of this issue for women with SCI. Six meta-themes were identified: life controlled by bladder and bowel, bladder and bowel accidents, women’s specific challenges, life course disruption, bladder and bowel medical management, and finding independence. The results describe concerns, strategies, and the detrimental impact of NBB in the lives of women with SCI. Findings may assist healthcare and rehabilitation professionals and policy makers to improve accessibility and quality of life for women with NBB.University of Michigan SCI Model SystemYesdevopsadmin
2015Transcranial direct current stimulation (tDCS) and the cardiovascular responses to acute pain in humansJournalJ73920Clinical Neurophysiology12651039-1046Study examined whether transcranial direct current stimulation (tDCS) reduces both acute pain perception and the resultant cardiovascular responses and if it impacts basal hemodynamics. Data were acquired on 15 healthy subjects at rest and in response to three cold pressor tests: 0, 7, and 14 degrees centigrade. Subsequently, single sessions of sham and active anodal tDCS (2.0 mA for 40 minutes) were delivered to the left primary motor cortex (M1). Perceived pain was reduced only after active tDCS with the 14 degrees centigrade cold pressor test. This was accompanied by tendency for lesser increases in heart rate and blood pressure. The effect size of tDCS on peak heart rate and blood pressure responses at 14 degrees centigrade was 0.47 and 0.54, respectively. On the other hand, baseline heart rate, blood pressure, leg blood flow, and leg vascular resistance were unaffected by tDCS. No other responses were affected. Results demonstrate that M1 anodal tDCS has no effect on basal hemodynamics or cardiovascular autonomic outflow and has only modest effects on the responses to acute pain in healthy humans. The findings suggest that application of tDCS shifts the pain perception threshold in healthy individuals but does not significantly modulate efferent cardiovascular control at rest or in response to pain. Only with the least painful stimulus, tDCS modestly reduced perceived pain and the peak cardiovascular and autonomic responses.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2016Self-report of behaviors to manage neurogenic bowel and bladder by individuals with chronic spinal cord injury: Frequency and associated outcomesJournalJ73986Topics in Spinal Cord Injury Rehabilitation22285-98Study identified behaviors associated with the management of neurogenic bowel and bladder among individuals with chronic spinal cord injury (SCI) and explored whether relationships exist between the performance of those behaviors and outcomes related to health and quality of life (QOL). A survey developed to collect self-report information about the performance of specific behaviors associated with the management of neurogenic bowel was administered to 246 individuals with chronic SCI living in the community as part of a larger ongoing study. Results suggest that the methods that those with SCI use to manage neurogenic bowel and bladder are multifaceted. Many methods are performed consistently, but significant variations exist for some and are often associated with neurological status, methods of evacuation, and QOL. In general, there was little relationship between patterns of responses and either demographic or injury-related characteristics. Many people with SCI of long duration are not sure where they learned some of the management activities that they or their personal care assistants conduct. It is prudent for clinicians working with these people to review their recommendations periodically to ensure that they are current and understood.University of Michigan SCI Model SystemYesdevopsadmin
2014Updates for the international standards for neurological classification of spinal cord injuryJournalJ69550Physical Medicine and Rehabilitation Clinics of North America253505-517http://www.pmr.theclinics.comArticle reviews revisions made to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), the most widely used classification in the field of spinal cord injury medicine. Since its first publication in 1982, multiple revisions refining the recommended examination, scaling, and classification have taken place to improve communication, consistency, and clarity. The article presents a brief historical perspective on the development and changes over the years leading to the current ISNCSCI, describing the most recent updates in 2011 and 2013, as well as issues facing the ISNCSCI for the future.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2016The international spinal cord injury pain extended data set (version 1.0)JournalJ75191Spinal Cord (formerly Paraplegia)54111036-1046Article describes the development of the International Spinal Cord Injury Pain Extended Data Set (ISCIPEDS) to guide the assessment and treatment of pain after spinal cord injury (SCI). Members of the interdisciplinary working group recommended four assessment domains for the ISCIPEDS: (1) pain symptoms, including variables related to pain type, temporal course, severity, unpleasantness, tolerability of pain and questionnaires assessing pain type and symptom severity; (2) sensory signs to detect and quantify sensory abnormalities commonly associated with neuropathic pain, including dynamic mechanical and thermal allodynia, and hyperalgesia; (3) treatments (ongoing and past 12 months); and (4) psychosocial factors and comorbid conditions. The ISCIPEDS was designed to be used together with the International SCI Pain Basic Data Set and provide a brief yet thorough assessment of domains related to chronic pain in individuals with SCI. The data set includes pain-relevant self-reported assessments, questionnaires and sensory examinations. The recommendations were based on: (1) their relevance to individuals with SCI and chronic pain, (2) the existence of published findings supporting the utility of the selected measures for use in individuals with SCI, and to the greatest extent possible (3) their availability in the public domain free of charge.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2016Ultrasonographic median nerve changes after repeated wheelchair transfers in persons with paraplegia: Relationship with subject characteristics and transfer skillsJournalJ74853PM & R84305-313Study evaluated the effects of repeated transfers on ultrasound markers for carpal tunnel syndrome (CTS) in people with spinal cord injuries and to relate changes to subject characteristics and transfer skills. Participants were 30 wheelchair users with nonprogressive paraplegia recruited via research registries and at the 2013 National Veterans Wheelchair Games and 2014 Paralyzed Veterans of America Buckeye Games. Participants were older than 18 years and could complete transfers independently within 30 seconds without use of their leg muscles. Demographic questionnaires and physical examinations for CTS were completed. Quantitative ultrasound techniques were used to measure changes in the median nerve after a repeated-transfers protocol. The Transfer Assessment Instrument (TAI) was completed to quantify transfer ability. Main outcome measurements included median nerve cross-sectional area at the level of the pisiform (PCSA) and swelling ratio (SR), transfer quality, and skills via the TAI. PCSA increased after repeated transfers. Participants who used safe hand positions had a lower baseline SR. Participants with a higher body weight had a lower baseline SR provided they performed higher quality transfers. Participants who scooted to the front of the seat prior to transferring and who weighed more exhibited greater increases in PCSA in response to transfers. An acute increase was observed in median nerve CSA at the pisiform after repeated wheelchair transfers. Changes were greater in persons with higher body weight and in persons who did not perform certain transfer skills correctly (according to the TAI). It is possible that these factors contribute to chronic injury and possibly CTS.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2017Telehealth monitor to measure physical activity and pressure relief maneuver performance in wheelchair usersJournalJ78068Assistive Technology294202-209Study demonstrated the feasibility of a device for monitoring pressure relief maneuvers and physical activity for wheelchair users. The device counts the number of wheel pushes based on wheelchair acceleration and measures pressure relief maneuvers using a seat sensor consisting of three force sensing resistors. To establish the feasibility of the seat sensor for the detection of pressure relief maneuvers, 10 wheelchair users and 10 non-disabled controls completed a series of wheelchair depression raises, forward trunk leans, and lateral trunk leans. The seat sensor was placed underneath the user’s seat cushion. To establish the feasibility of wheel push counting, 10 full-time wheelchair users navigated a flat 50-meter outdoor track and a 100-mer outdoor obstacle course during self-propulsion (e.g., wheel pushes) and during assisted-propulsion (e.g., no wheel pushes). Of the 240 pressure relief maneuvers performed, 225 were properly classified by the seat sensor (94 percent accuracy, 96 percent sensitivity, 80 percent specificity). Sensitivity was highest for depression raises (98 percent) and lowest for front lean maneuvers (80 percent). The wheelchair activity monitor measured 2,112 pushes during the self-propulsion trials compared to 2,162 pushes measured with the instrumented push-rim (97.7 percent). During assisted-propulsion trials, there were 477 incorrectly identified pushes (8.0 per trial). This study demonstrated the feasibility of monitoring pressure relief maneuvers and physical activity during self-propulsion and assisted-propulsion for wheelchair users using a simple technology.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2016Wheelchair use and lipophilic statin medications may influence bone loss in chronic spinal cord injury: Findings from the FRASCI-bone loss studyJournalJ75554Osteoporosis International27123503-3511Study assessed clinical and demographic characteristics associated with change in bone density over a mean of 21 months in 152 men and women with chronic spinal cord injury (SCI) who were enrolled in the Fracture Risk after SCI (FRASCI) study. The association between statin use and bone loss following paralysis was also examined. A mixed-model procedure with repeated measures was used to assess predictors of change in bone mineral density at the distal femur and proximal tibia. No association was found between bone loss and traditional osteoporosis risk factors, including age, gender, body composition, or vitamin D level or status (normal or deficient). In both crude and fully adjusted models, wheelchair users lost bone compared to walkers. Similarly, lipophilic statin users gained bone at the knee compared to non-users. Results suggest that both walking and statins may be effective osteogenic therapies to mitigate bone loss and prevent osteoporosis in people with chronic SCI. The findings also suggest that loss of mechanical loading and/or neuronal factors contribute to disuse osteoporosis more than traditional osteoporosis risk factors.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2016Trajectories of life satisfaction after spinal cord injuryJournalJ74699Archives of Physical Medicine and Rehabilitation97101706-1713, 1713.e1This study was conducted to describe individual-level temporal change in life satisfaction after spinal cord injury (SCI) using individual growth curve (IGC) analysis of prospectively collected data from the National Spinal Cord Injury Database (NSCID). IGC methodology allows researchers and clinicians to anticipate patient-specific trajectories through use of an automated interactive tool. Projected trajectories hold promise in facilitating planning for inpatient and outpatient services, which could enhance long-term outcomes. Participants were 4,846 individuals with traumatic SCI who received care from SCI Model Systems and contributed Rasch-transformed Satisfaction With Life Scale scores to the NSCID. Analysis revealed that individual-level trajectories reflecting life satisfaction vary extensively and are associated with demographic and injury-related characteristics. Demographic characteristics include race, sex, pre-employment and discharge marital status, and level of education; injury-related factors include days in rehabilitation, neurologic level, age at injury, and injury etiology. Results are displayed graphically by way of a computer-generated interactive tool and represent different trajectories of individual-level changes in life satisfaction.National SCI Statistical CenterYesdevopsadmin
2017SCI peer health coach influence on self-management with peers: A qualitative analysisJournalJ77491Spinal Cord (formerly Paraplegia)55111016-1022Study explored the roles fulfilled by peer health coaches (PHCs) with spinal cord injury (SCI) during a randomized controlled trial called My Care My Call, a novel telephone-based, peer-led self-management intervention for adults with chronic SCI. The intervention consisted of 8 weekly calls, 4 bi-weekly calls, and 2 monthly calls, for a total of 14 calls over the course of 6 months. Calls focused on self-management and unmet health-care needs; peers chose conversation topics and PHCs had the flexibility to use specific tools and strategies to facilitate and focus conversations. Directed content analysis was used to qualitatively examine information from 504 tele-coaching calls, conducted with 42 participants with SCI, by two trained SCI PHCs. PHCs documented how and when they used the communication tools (CTs) and information delivery strategies (IDSs) they developed for the intervention. Interaction data were coded and analyzed to determine PHC roles in relation to CT and IDS utilization and application. Results showed that PHCs performed three principal roles: role model, supporter, and advisor. Role model interactions included CTs and IDSs that allowed PHCs to share personal experiences of managing and living with an SCI, including sharing their opinions and advice when appropriate. As supporters, PHCs used CTs and IDSs to build credible relationships based on dependability and reassuring encouragement. PHCs fulfilled the unique role of advisor using CTs and IDSs to teach and strategize with peers about SCI self-management.New England Spinal CenterYesdevopsadmin
2016The influence of wheelchair propulsion hand pattern on upper extremity muscle power and stressJournalJ75718Journal of Biomechanics4991554-1561Study used musculoskeletal modeling and forward dynamics simulations to investigate the influence of the hand pattern used during manual wheelchair propulsion on specific measures of upper-extremity muscle demand. The hand pattern (i.e., full-cycle hand path) used during manual wheelchair propulsion is frequently classified as one of four distinct hand pattern types: arc, single loop, double loop, or semicircular. Current clinical guidelines recommend the use of the semicircular pattern, which is based on advantageous levels of broad biomechanical metrics implicitly related to the demand placed on the upper extremity (e.g., lower cadence). The simulation results suggest that the double loop and semicircular patterns produce the most favorable levels of overall muscle stress and total muscle power. The double loop pattern had the lowest full-cycle and recovery-phase upper-extremity demand but required high levels of muscle power during the relatively short contact phase. The semicircular pattern had the second-lowest full-cycle levels of overall muscle stress and total muscle power, and demand was more evenly distributed between the contact and recovery phases. These results suggest that in order to decrease upper-extremity demand, manual wheelchair users should consider using either the double loop or semicircular pattern when propelling their wheelchairs at a self-selected speed on level ground.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2015Traumatic spinal cord injury in the United States, 1993-2012JournalJ73935Journal of the American Medical Association (JAMA)313222236-2243Study assessed trends in national incidence, etiology, health care utilization, and in-hospital mortality in acute traumatic spinal cord injury (SCI) from 1993 to 2012. Data from the Nationwide Inpatient Sample databases for the years 1993 through 2012, including a total of 63,109 patients with acute traumatic SCI were analyzed. Results showed that, between 1993 and 2012, the incidence rate of acute traumatic SCI remained relatively stable but, reflecting an increasing population, the total number of cases increased. The largest increase in incidence was observed in older patients, largely associated with an increase in falls, and in-hospital mortality remained high, especially among elderly adults. There was substantial morbidity and mortality during acute inpatient hospital stays among patients with traumatic SCI. There were also increases in the proportion of cases undergoing procedures such as intervertebral disk excision and spinal canal decompression performed during inpatient acute SCI admissions.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2016Spinal cord injury-induced immune deficiency syndrome enhances infection susceptibility dependent on lesion levelJournalJ75744Brain: A Journal of Neurology1393692-707https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014125/Study investigated whether spinal cord injury-induced immune deficiency syndrome (SCI-IDS) may account for the enhanced infection susceptibility based on spinal cord injury (SCI) lesion level. Pneumonia is the leading cause of death after acute SCI and is associated with poor neurological outcome. Researchers applied a clinically relevant model of experimental induced pneumonia to investigate whether the systemic SCI-IDS is sufficient to cause pneumonia dependent on lesion level and investigated whether findings are mirrored in a large prospective cohort study after human SCI. In a mouse model of inducible pneumonia, high thoracic lesions that interrupt sympathetic innervation to major immune organs, but not low thoracic lesions, significantly increased bacterial load in lungs. The ability to clear the bacterial load from the lung remained preserved in sham animals. Propagated immune susceptibility depended on injury of central pre-ganglionic but not peripheral postganglionic sympathetic innervation to the spleen. Thoracic-level SCI was confirmed by multiple regression analysis as an independent increased risk factor of pneumonia in patients after motor complete SCI independently from mechanical ventilation and preserved sensory function. This study presents evidence that SCI directly causes increased risk for bacterial infection in mice as well as in human patients. Besides obvious motor and sensory paralysis, SCI also induces a functional SCI-IDS (immune paralysis), sufficient to propagate clinically relevant infection in an injury-level dependent manner.National SCI Statistical CenterYesdevopsadmin
2015What would brain-computer interface users want: Opinions and priorities of potential users with spinal cord injuryJournalJ70940Archives of Physical Medicine and Rehabilitation963, Supplement 1S38-S45Study surveyed people with spinal cord injury (SCI) to determine their priorities for brain-computer interface (BCI) applications and design features along with the time investment and risk acceptable to obtain a BCI. Forty people with SCI participated, including of 30 individuals identified from the SCI research registry who were surveyed by telephone and 10 participants from a BCI usage study who were surveyed in person before BCI use. Descriptive statistics of functional independence, living situations and support structures, ratings of importance of different task and design features, and acceptable levels of performance, risk, and time investment were calculated from the survey data. Participants were classified as having low function or high function based on their Functional Independence Measure motor scores. Results indicated that BCIs were of interest to 96 percent of the low-function group. Emergency communication was the top priority task. The most important design features were “functions the BCI provides” and “simplicity of BCI setup.” Desired performance was 90 percent accuracy, with standby mode errors no more than once every 4 hours and speeds of more than 20 letters per minute. Dry electrodes were preferred over gel or implanted electrodes. Median acceptable setup time was 10 to 20 minutes, satisfying 65 percent of participants. Creating BCI functions appropriate to the needs of those with SCI will be of ultimate importance for BCI acceptance with this population.University of Michigan SCI Model SystemYesdevopsadmin
2014The uniform data system for medical rehabilitation: Report of follow-up information on patients discharged from inpatient rehabilitation programs in 2000-2010JournalJ68159American Journal of Physical Medicine and Rehabilitation933231-244Study presents yearly aggregated summaries of rehabilitation outcomes at admission, discharge, and follow-up from a national sample of patients receiving inpatient medical rehabilitation for stroke, traumatic brain injury, lower-extremity fracture, lower-extremity joint replacement, traumatic spinal cord injury (SCI), or debility. Data were obtained from more than 300 inpatient rehabilitation facilities in the United States that contributed inpatient and follow-up data to the Uniform Data System for Medical Rehabilitation during the period January 2002 through December 2010. The final sample included 287,104 patients with follow-up information. Aggregate variables reported include demographic information, social situation, and functional status, assessed by Functional Independence Measure (FIM) instrument ratings at admission, discharge, and follow-up. Follow-up data were obtained 80 to180 days after discharge through telephone interviews by trained clinical staff. The median time to follow-up was 95 days. Overall, more than 90 percent of the patients within each impairment group were living in the community at follow-up. Follow-up FIM total ratings were stable to slightly increased over time. Change scores (discharge to follow-up) increased in all six groups. The mean FIM gains from discharge to follow-up, as a percentage of mean gains from admission to discharge, varied by impairment category: 46 percent for SCI to 71 percent for lower-extremity fracture. Locomotion yielded the lowest ratings at all three assessments within each of the six impairment groups. The follow-up data indicate that gains in mean functional independence scores from admission to discharge and from discharge to follow-up gradually increased from 2002 to 2010.Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2016Risk factors associated with neurogenic bowel complications and dysfunction in spinal cord injuryJournalJ74696Archives of Physical Medicine and Rehabilitation97101679-1686Study assessed the prevalence of bowel-related complications in people with spinal cord injury (SCI) and identified the factors associated with constipation and incontinence as well as overall bowel dysfunction. A total of 291 subjects who incurred traumatic SCI with resultant neurogenic bowel were evaluated. Constipation, bowel incontinence, and neurogenic bowel dysfunction questionnaire scores were all derived from the Bowel and Bladder Treatment Index. Data analyses included descriptive and bivariate statistics as well as logistic and linear regression modeling. Results showed that risk factors contributing to bowel incontinence included overall bowel dysfunction as measured by the neurogenic bowel dysfunction score, timing of bowel program, being married or having a significant other, urinary incontinence, constipation, and use of diuretics. Constipation was best predicted by age, race/ethnicity, using laxatives/oral medications, incomplete tetraplegia, frequency of bowel movements, abdominal pain, access to clinicians and caregivers, and history of bowel surgeries. Neurogenic bowel dysfunction scores were predicted by neurologic classification; use of laxatives, oral medications, or both; bowel incontinence; and frequency of fiber intake. These results suggest a number of factors that should be considered when treating neurogenic bowel complications and dysfunction in people with SCI.University of Michigan SCI Model SystemYesdevopsadmin
2015The effect of a liner on the dispersion of sacral interface pressures during spinal immobilizationJournalJ71268Assistive Technology27117-SepStudy assessed sacral interface pressure and sensing area in healthy volunteers on a spine board and the effects of a gel pressure dispersion liner. Sacral pressure ulcers are a significant problem following spinal cord injury and are felt to be in part due to the high interface pressures generated while strapped to the spine board. Thirty-seven volunteers were placed on a pressure-sensing mat between the subject and the spine board. Measurements were carried out with and without a gel liner. Pressures and sensing area were recorded every minute for 40 minutes. The highest pressure was generated at the sacral prominence of each subject. Mean interface pressures were higher on the spine board alone than with the gel liner. Overall, mean sensing area was lower on the spine board than with the gel liner. The results revealed that standard spinal immobilization caused high sacral interface pressures. The addition of a gel liner on the spine board decreased overall mean sacral pressures and increased mean sensing area.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2016Transfer technique is associated with shoulder pain and pathology in people with spinal cord injury: A cross-sectional investigationJournalJ74705Archives of Physical Medicine and Rehabilitation97101770-1776Study investigated how transfer technique and subject characteristics relate to ultrasound measures of shoulder soft tissue pathology and self-reported shoulder pain during transfers in a sample of 76 wheelchair users with spinal cord injury (SCI). Outcome measures included: transfer pain items from the Wheelchair User’s Shoulder Pain Index; transfer technique assessed using the Transfer Assessment Instrument (TAI); and shoulder pathology markers examined using the Ultrasound Shoulder Pathology Rating Scale (USPRS). Better transfer technique (higher TAI) correlated with less injury (lower USPRS) and less pain during transfers. Greater age was the strongest predictor of greater pathology. An interaction between technique and weight was found: participants with lower body weights showed a decrease in pathology markers with better transfer technique, while those with higher weight showed little change with technique. Participants with better transfer technique exhibited less shoulder pathology and reported less pain during transfers. The relationship between technique and pathology was strongest in lower-weight participants. While causation cannot be proven because of study design, it is possible that using a better transfer technique and optimizing body weight could reduce the incidence of shoulder pathology and pain.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2016Spinal cord injury model systems: Review of program and national database from 1970 to 2015JournalJ74709Archives of Physical Medicine and Rehabilitation97101797-1804Article provides a brief review of the Spinal Cord Injury Model Systems (SCIMS) program throughout its history, to facilitate a better understanding and interpretation of the data presented in SCIMS research publications, including the articles published in this special journal issue. The SCIMS centers have provided continuous, comprehensive multidisciplinary care for persons with spinal cord injury (SCI) in the United States since their inception in 1970. In addition, the research conducted and the analysis of data collected at these centers facilitate advances in the care and the overall quality of life for people with SCI. Over the past 45 years, the SCIMS program and National Spinal Cord Injury Database (NSCID) have undergone major revisions, which must be recognized in the planning, conduct, and interpretation of SCIMS research to prevent misinterpretation of findings.National SCI Statistical CenterYesdevopsadmin
2017Weight change after spinal cord injuryJournalJ78076Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)402130-137Study examined the patterns of weight change after spinal cord injury (SCI) and identified associated risk factors using data obtained from 16 SCI Model Systems (SCIMS). Participants were 1,094 individuals with an SCI who were entered into the SCIMS and had a 1-year follow-up between October 2006 and November 2012. The primary outcome measure was change in body mass index (BMI) during the first year of injury. Height and weight were assessed during inpatient rehabilitation and 1 year after injury. The results showed mean BMI decreased from 26.3 to 25.8 kilograms per meter squared (kg/m²) during the first year after SCI. Weight loss was mainly observed among 576 individuals classified as overweight or obese during rehabilitation with a BMI decrease of 1.4 kg/m², which varied significantly by sex, education, neurological level, and the presence of vertebral injury. Weight gain was noted among 518 individuals classified as underweight or normal weight during rehabilitation with a BMI increase of 0.5 kg/m², with the greatest increase among individuals of Hispanic origin (1.2 kg/m²), other marital status (1.2 kg/m²), age group 31 to 45 years (1.1 kg/m²), with less than high school education (1.1 kg/m²), without spinal surgery (0.9 kg/m²), and with motor functionally incomplete injury (0.8 kg/m²). These findings suggest that strategies for weight management should be addressed after a SCI to ameliorate the potential for unhealthy weight change, particularly among at-risk groups.National SCI Statistical CenterYesdevopsadmin
2015The severity of bowel dysfunction in patients with neurogenic bladderJournalJ75726The Journal of Urology19451336-1341Study examined the level of severity and impact on quality of life of bowel dysfunction in people with neurogenic bladder, identified patient variables that correlate with worse bowel symptoms, and investigated whether the severity of bowel dysfunction correlates with the severity of bladder dysfunction. Of the 175 patients evaluated, 60.6 percent had traumatic spinal cord injury (SCI) and 18.3 percent had multiple sclerosis (MS). Median Fecal Incontinence Severity Index (FISI) scores were 18.0 (moderate). The median neurogenic bowel dysfunction score was 11.0 (moderate). Those scores were worse in patients with SCI compared to those with other diseases, younger patients, and those in the SCI group with higher levels of injury. Based on the Bristol stool scale, 65 percent of patients had abnormal stool consistency, mostly constipation. None of the FISI, Bristol, or neurogenic bowel dysfunction scores correlated significantly with quality of life measures. However, bladder symptom scores on the Michigan Incontinence Symptom Index (M-ISI) and American Urological Association symptom index correlated with FISI severity, while the neurogenic bowel dysfunction score correlated with M-ISI. Patients with abnormal stool consistency on the Bristol scale reported more urgency and stress incontinence on M-ISI. The findings suggest that bowel dysfunction is common among patients with neurogenic bladder. Those with worse bladder symptoms also experience worse bowel dysfunction. Bladder symptoms of incontinence and lower urinary tract symptoms correlated directly with bowel symptom scores, signifying how important it is for a treating urologist to address bowel dysfunction along with urinary issues.University of Michigan SCI Model SystemYesdevopsadmin
2014Unmet expectations of adjustment and depressive symptoms among people with chronic traumatic spinal cord injuryJournalJ69609Rehabilitation Psychology593313-320Study examined the effects of unmet expectations of adjustment to chronic traumatic spinal cord injury (TSCI) on depressive symptoms. A total of 863 participants who survived at least 1 year postinjury were assessed at 2 time points separated by 10 years. Using a 10-point ladder (1 = worst and 10 = best adjustment), self-predicted future adjustment was measured at Time 1. At Time 2, current adjustment was reassessed using the same scale to evaluate differences between predicted and actual adjustment. Adjustment expectations were considered unmet when actual adjustment ratings at Time 2 were lower than predicted adjustment at Time 1. Depressive symptoms were measured using the Older Adult Health and Mood Questionnaire at both time points. The results indicated that more than half of the participants experienced unmet expectations of adjustment over a 10-year period, and having unmet expectations was positively associated with depressive symptoms.Yesdevopsadmin
2015Relationship between hand contact angle and shoulder loading during manual wheelchair propulsion by individuals with paraplegiaJournalJ72810Topics in Spinal Cord Injury Rehabilitation214313-324Study investigated the relationships of hand contact angle with propulsion characteristics, pushrim forces, and shoulder kinetics during wheelchair propulsion (WCP) in individuals with paraplegia from spinal cord injury (SCI). Biomechanical data were collected from 222 individuals with paraplegia during WCP on a stationary ergometer at a self-selected speed. Multivariate linear regression analysis examined the association between: (1) location of the hand on the pushrim at initial contact and hand release during the push phase of the WCP cycle and (2) propulsion characteristics, pushrim forces, and shoulder kinetics. Results indicated that increased push arc was associated with greater velocity and cycle distance and reduced cadence. Initial contact angle and hand release angles were equally associated with cycle distance and cadence, whereas a more anterior release angle was associated with greater velocity. When controlling for body weight, a more posterior initial contact angle was associated with greater posterior shoulder net joint force and greater flexor net joint moment, whereas a more anterior hand release angle was significantly associated with increased vertical and greater lateral pushrim forces; greater shoulder net joint forces in all 3 planes (posterior, superior, and medial); and greater external rotator and adductor net joint moments. It is recommended that participants reach back to initiate contact with the pushrim to maximize push arc but avoid a more anterior hand position at release, because this could increase shoulder load during the push phase of WCPSouthern California Spinal Cord Injury Model SystemYesdevopsadmin
2014The association of assistive mobility devices and social participation in people with spinal cord injuriesJournalJ68745Spinal Cord (formerly Paraplegia)523209-215Study examined the relationship between the type of mobility devices used and social participation in wheelchairs users who have spinal cord injuries (SCI). It was hypothesized that using wheelchairs with external power and driving a modified vehicle (MV), with or without driving in a wheelchair, facilitates social participation for wheelchairs users with SCI. Data were collected from 2,986 individuals who had undergone rehabilitation at one of the regional centers of the Model SCI System in the United States. Participants used a wheelchair 40 or more hours per week and could not ambulate at least 150 feet at home. A secondary data analysis was performed using a mixed-effect model on data from 3,498 follow-up interviews. Outcomes included participation as measured by the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) and employment status, and wheelchair and MV use. Among the participants, 33 percent drove an MV, and 44 percent used an external-powered wheelchair. The use of an MV was positively related to employment and CHART-SF score, regardless of driving directly or driving with a wheelchair. People who drove an MV were found to have approximately two more business associates to contact to once a month and approximately 2 additional days out of home per week compared with those without an MV. No significant association was shown between the type of wheelchair used and participation.Kentucky Regional Spinal Cord Injury Model SystemYesdevopsadmin
2016Transfer component skill deficit rates among veterans who use wheelchairsJournalJ73749Journal of Rehabilitation Research and Development (JRRD) (formerly the Bulletin of Prosthetics Research)532279-294Study determined the deficit rates for transfer component skills among veterans who use wheelchairs and explored the relationship between deficit rates and subject characteristics. Seventy-four men and 18 women performed up to four transfers independently from their wheelchair to a mat table while a therapist evaluated their transfer techniques using the Transfer Assessment Instrument. The highest deficit rates concerned the improper use of handgrips (63 percent). Other common problems included not setting the wheelchair up at the proper angle (50 percent) and not removing the armrest (58 percent). Veterans over 60 years old and veterans with moderate shoulder pain were more likely to set up their wheelchairs inappropriately than younger veterans and veterans with mild shoulder pain. Women were less likely to remove their armrests than men. Subjects with disabilities other than spinal cord injury were less inclined to set themselves up for a safe and easy transfer than the subjects with spinal cord injury. The results provide insight into the disparities present in transfer skills among veterans and will inform the development of future transfer training programs both within and outside of the Department of Veterans Affairs.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2016Simplified approach to diagnosing sleep-disordered breathing and nocturnal hypercapnia in individuals with spinal cord injuryJournalJ73372Archives of Physical Medicine and Rehabilitation973363-371Study evaluated a home-based strategy for diagnosing sleep-disordered breathing and nocturnal hypercapnia in individuals with spinal cord injury (SCI). A total of 81 adults with C1-T6 SCI underwent an unsupervised home sleep apnea test combined with transcutaneous partial pressure of carbon dioxide/oxygen saturation by pulse oximetry monitoring. The main outcomes were prevalence of sleep-disordered breathing and nocturnal hypercapnia. Clinical and physiological variables were examined to determine which, if any, correlate with the severity of sleep-disordered breathing. Obstructive sleep apnea (OSA) was found in 81.3 percent of individuals, central sleep apnea (CSA) was found in 23.8 percent, and nonspecific hypopnea events, where respiratory effort was too uncertain to classify, were present in 35 percent. Nonspecific hypopnea events correlated strongly with CSA but weakly with OSA, suggesting that conventional sleep apnea test scoring may underestimate central/neuromuscular hypopneas. Nocturnal hypercapnia was present in 28 percent and oxygen desaturation in 18.3 percent. Neck circumference was the primary predictor for OSA, whereas baclofen use and obstructive apnea/hypopnea index weakly predicted CSA. Awake transcutaneous partial pressure of carbon dioxide and CSA were only marginally associated with nocturnal hypercapnia. The results suggest that unsupervised home sleep apnea testing with transcutaneous capnography effectively identifies sleep-disordered breathing and nocturnal hypercapnia in individuals with SCI.University of Michigan SCI Model SystemYesdevopsadmin
2014Using rasch motor FIM individual growth curves to inform clinical decisions for persons with paraplegiaJournalJ69626Spinal Cord (formerly Paraplegia)529671-676Study examined individual-level temporal changes in functional status for participants with paraplegia in the National Spinal Cord Injury Database (NSCID), as measured by Rasch-transformed Functional Independence Measure (FIM) motor scores. Non-linear random effects modeling, that is, individual growth curve analysis of retrospective data obtained from the NSCID. The authors generated non-linear individual level trajectories of recovery for Rasch-transformed FIM motor scores that rise rapidly from inpatient rehabilitation admission to a plateau. The trajectories are based on relationships between growth parameters and patient and injury factors: race, gender, level of education at admission, age at injury, neurological level at discharge, American Spinal Injury Association Impairment Scale at discharge, days from injury to first system inpatient rehabilitation admission, rehabilitation length of stay, marital status and etiology. Based on the study results, an interactive tool was developed to represent individual-level longitudinal outcomes as trajectories based upon an individual’s given baseline characteristics, that is, information supplied by the covariates and provides a robust description of temporal change for those with paraplegia within the NSCID. This methodology allows researchers and clinicians to generate and better understand patient-specific trajectories through the use of an automated interactive tool where a nearly countless number of longitudinal paths of recovery can be explored. The projected trajectories holds promise in facilitating planning for inpatient and outpatient services, which could positively impact long term outcomes.National SCI Statistical CenterYesdevopsadmin
2015The intersection of disability and healthcare disparities: A conceptual frameworkJournalJ71216Disability and Rehabilitation377632-641Article describes the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality and evaluates those frameworks in the context of healthcare for individuals with disabilities. The specific models examined include: the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM) models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman’s utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, the authors propose the Model of Healthcare Disparities and Disability (MHDD), an integrated model of disability and healthcare disparities that more comprehensively explains the experience of healthcare disparities for individuals with disabilities. The MHDD provides a framework for conceptualizing how a mismatch between personal and environmental factors may result in reduced healthcare access and quality, which in turn may lead to reduced functioning, activity, and participation among individuals with impairments and chronic health conditions.University of Michigan SCI Model SystemYesdevopsadmin
2018Understanding and preventing loss to follow-up: Experiences from the spinal cord injury model systemsJournalJ78720Topics in Spinal Cord Injury Rehabilitation24297-109Study identified demographic and clinical factors associated with loss to follow-up (FU) at post-injury years 1 to 35 among 25,871 people with spinal cord injury (SCI) enrolled in the National Spinal Cord Injury Database. Loss to FU was defined as no research information obtained from participants who were eligible for the planned data collection. Generalized linear mixed models were used for analysis of factors at each post-injury year. The loss to FU rates were 23.1 and 32.9 percent for post-injury years 1 and 5, respectively, and remained higher than 40 percent between post-injury years 20 and 35. The FU rate varied by study sites and was improved in recent injury cohorts. People who were more seriously injured and those who attained higher levels of education were more likely to return for FU than their counterparts. People who were at risk of being marginalized in society (non-whites, those with less education, the unemployed, victims of violence, and those with no health insurance) had the highest odds of being lost to FU across all post-injury years. These findings can be used to identify individuals who are less likely to participate in follow-up, which may allow targeted attention to improve their response rate.National SCI Statistical CenterYesdevopsadmin
2017Rasch analysis of alcohol abuse and dependence diagnostic criteria in persons with spinal cord injuryJournalJ75846Spinal Cord (formerly Paraplegia)555497-501Study examined the dimensionality and other psychometric characteristics of the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria for alcohol use disorders (AUD) in individuals with spinal cord injury (SCI). The objective was to determine whether AUDs should be conceptualized categorically as abuse and dependence as in the DSM-IV or on a single continuum with mild-to-severe category ratings as in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5). Data from 379 individuals who sustained SCI either traumatically or non-traumatically after the age of 18 and were at least 1 year post injury. Rasch analyses used the alcohol abuse and dependence modules of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Non-patient Edition. Fifty-seven percent of the entire sample endorsed criteria for alcohol abuse, and 25 percent endorsed criteria for alcohol dependence. Fit values were generally acceptable except for one item, suggesting that the items fit the expectation of unidimensionality. Examination of the principal components analysis did not provide support for unidimensionality. The item-person map illustrates poor targeting of items. Alcohol abuse and dependence criterion appear to reflect a unidimensional construct, a finding that supports a single latent construct or factor consistent with the DSM-5 diagnostic model.University of Michigan SCI Model SystemYesdevopsadmin
2015Lifetime prevalence of chronic health conditions among persons with spinal cord injuryJournalJ71254Archives of Physical Medicine and Rehabilitation964673-679Study assessed lifetime prevalence of 7 chronic health conditions (CHCs) among 1,678 adults with chronic traumatic spinal cord injury (SCI) who were at least 1 year postinjury, and had residual neurologic effects impeding full recovery. CHCs were measured using questions from the Behavioral Risk Factor Surveillance System for diabetes (not including gestational), heart attack (also called a myocardial infarction), angina or coronary artery disease, stroke, hypertension (not including during pregnancy), high blood cholesterol, or cancer. Of the participants, 49.5 percent reported having at least 1 CHC, with 23.2 percent reporting 2 or more CHCs. The most frequently reported CHC was high cholesterol (29.3 percent), followed by hypertension (28.7 percent) and diabetes (11.8 percent). Although the prevalence of CHCs significantly increased with increasing age, only hypertension and cancer were significantly associated with years postinjury. Four CHCs (diabetes, coronary artery disease, hypertension, high cholesterol) were significantly related to mobility status as measured by injury level and ambulatory status. However, after controlling for age, years postinjury, sex, and race, mobility status became nonsignificant in relation to coronary artery disease, but it remained significantly associated with diabetes, hypertension, and high cholesterol. Clinicians should be aware of the risk of CHCs in people with SCI and should screen for these conditions and regular maintenance activities related to SCI.University of Michigan SCI Model SystemYesdevopsadmin
2015Modifications in wheelchair propulsion technique with speedJournalJ75720Frontiers in Bioengineering and Biotechnology3171https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620433/Study determined how individual manual wheelchair users with paraplegia modify propulsion mechanics to accommodate expected increases in reaction forces (RFs) generated at the pushrim with self-selected increases in wheelchair propulsion (WCP) speed. Repetitive loading of the upper-limb joints during manual WCP has been identified as a factor that contributes to shoulder pain, leading to loss of independence and decreased quality of life. Upper-extremity kinematics and pushrim RFs were measured for 40 experienced manual wheelchair users with paraplegia while propelling on a stationary ergometer at self-selected free and fast propulsion speeds. Upper-extremity kinematics and kinetics were compared within subject between propulsion speeds. Between group and within-subject differences were determined. Increased propulsion speed was accompanied by increases in RF magnitude and shoulder net joint moment (NJM) and decreases in pushrim contact duration. Within-subject comparison indicated that 27 percent of participants modified their WCP mechanics with increases in speed by regulating RF orientation relative to the upper extremity segments. The results of this study indicate that increases in RF magnitudes associated with increases in WCP speed do not necessarily translate into comparable increases in shoulder NJMs. Reorientation of the RF relative to the upper extremity segments can be used as an effective strategy for mitigating rotational demands (NJM) imposed on the shoulder at increased propulsion speeds. Identification of propulsion strategies that individuals can use to effectively accommodate for increases in RFs is an important step toward preserving musculoskeletal health of the shoulder and improving health-related quality of life.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2015Pain severity and mobility one year after spinal cord injury: A multicenter, cross-sectional studyJournalJ73918European Journal of Physical and Rehabilitation MedicineStudy examined the relationship between pain severity and mobility among patients who have sustained a traumatic spinal cord injury (SCI). A multi-center, cross-sectional study was performed to assess the impact of mobility on self-reported pain using information from 1,980 subjects who sustained a traumatic SCI and completed a year-one follow-up interview between October 2000 and December 2013. The data was obtained from the SCI National Database, compiled by the affiliated SCI Model Systems. Analyses included a multivariable linear regression of patients' self-reported pain scores, measured using the Brief Pain Inventory, on mobility, quantified using the Craig Handicap and Assessment Reporting Technique Short-Form CHART-SF mobility total score, and other clinically relevant covariates. After controlling for potential confounders, a significant quadratic relationship between mobility and patients' self-reported pain was observed. Furthermore, female gender, unemployed occupational status, paraplegia, and the presence of depressive symptoms were associated with significantly higher pain scores. Statistically significant quadratic associations between pain scores and age at injury, life satisfaction total score, and the CHART-SF occupational total subscale were also observed. The findings suggest that among patients with moderate-to-high levels of mobility, pain scores decrease with increasing mobility.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2015Measurement of bone: Diagnosis of SCI-induced osteoporosis and fracture risk predictionJournalJ72805Topics in Spinal Cord Injury Rehabilitation214267-274Article reviews the biological and structural changes that are known to occur in bone after spinal cord injury (SCI) in the context of promoting future research to prevent or reduce risk of fracture in this population. The authors also review the most commonly used methods for assessing bone after SCI and discuss the strengths, limitations, and clinical applications of each method. Although dual-energy x-ray absorptiometry assessments of bone mineral density may be used clinically to detect changes in bone after SCI, three-dimensional methods such as quantitative computed tomography analysis are recommended as a primary outcome measure for clinical trials.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2014Neuromodulation of evoked muscle potentials induced by epidural spinal-cord stimulation in paralyzed individualsJournalJ70829Journal of Neurophysiology11151088-1099http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949232/Study investigated the functional and topographic organization of compound evoked potentials induced by epidural stimulation. It was hypothesized that chronically implanted electrode arrays over the lumbosacral spinal cord can be used to assess functionally spinal circuitry linked to specific motor pools. Three individuals with complete motor paralysis of the lower limbs participated in the study. The evoked potentials to epidural spinal stimulation were investigated after surgery in a supine position and in one participant, during both supine and standing, with body weight load of 60 percent. Recruitment curves of evoked potentials in knee and ankle muscles were collected at three localized and two wide-field stimulation configurations. Epidural electrical stimulation of rostral and caudal areas of lumbar spinal cord resulted in a selective topographical recruitment of proximal and distal leg muscles, as revealed by both magnitude and thresholds of the evoked potentials. Epidural stimulation activated both afferent and efferent pathways. The components of neural pathways that can mediate motor-evoked potentials were highly dependent on the stimulation parameters and sensory conditions, suggesting a weight-bearing-induced reorganization of the spinal circuitries.Kentucky Regional Spinal Cord Injury Model SystemYesdevopsadmin
2018Racial differences in data quality and completeness: Spinal cord injury model systems' experiencesJournalJ78721Topics in Spinal Cord Injury Rehabilitation242110-120Study examined the role of race/ethnicity on data quality and response completeness among individuals enrolled in a longitudinal spinal cord injury (SCI) database. This study included 7,507 adults (5,483 non-Hispanic whites, 1,414 non-Hispanic blacks, and 610 Hispanics) from 19 SCI Model Systems centers, who returned for follow-up between 2001 and 2006. The missing data rate was calculated for each outcome variable at each post-injury year, stratified by race/ethnicity. Missing data were defined as any missing, unknown, or refusal response to interview items. The overall missing rate was 29.7, 9.5, 9.7, 10.7, 12.0, and 9.8 percent for the Craig Handicap Assessment and Reporting Technique-Short Form (CHART) economic self-sufficiency subscale, CAGE questionnaire, drug use, Diener’s Satisfaction with Life Scale, Patient Health Questionnaire, and pain severity, respectively. The missing rate for the CHART measure was significantly higher among non-Hispanic blacks and Hispanics than among non-Hispanic whites, after controlling for demographics, injury factors, mode of data collection, and study sites. The missing data in the other outcome measures examined were also significantly higher among non-Hispanic blacks than among non-Hispanic whites, but were not significantly different between Hispanics and non-Hispanic whites. The results highlight the importance of research methodology designed to improve non-response or response incompleteness, particularly in non-Hispanic blacks, as we move to reduce racial/ethnic disparities and strive to explain how and why disparities occur in the SCI population.National SCI Statistical CenterYesdevopsadmin
2016Meta-analysis of placebo responses in central neuropathic pain: Impact of subject, study, and pain characteristicsJournalJ75725Pain1573530-540Study identified factors that contribute to variable placebo responses in clinical trials involving individuals with central neuropathic pain. Defined as a reduction in pain in the placebo arm of a clinical trial, the “placebo response” includes the placebo effect (the true psychobiological effects causing a reduction in pain) in addition to other contributing factors, such as natural history, and patient biases. A systematic review and meta-analysis was performed of placebo-controlled trials examining pharmacological and noninvasive brain stimulation interventions for central neuropathic pain. Study design, subject characteristics, and pain ratings for the placebo group were extracted from each trial. Pooling of results and identification of moderating factors were carried out using random effects meta-analysis and meta-regression techniques. A total of 39 published trials met the inclusion criteria: 26 involving individuals with spinal cord injury (SCI), 6 with stroke, and 7 with multiple sclerosis (MS). No significant publication bias was detected. Overall, there was a significant effect for placebo to reduce central pain. Smaller placebo responses were associated with crossover-design studies, longer pain duration, and greater between-subject baseline pain variability. There were no significant effects for neurological condition (stroke, MS, or SCI) or the type of intervention (pharmacological versus noninvasive brain stimulation). In a planned subanalysis, the severity of damage in the spinal cord also had no significant effect on the placebo response. Further study is warranted to identify factors that may explain the impact of pain duration on the placebo response at the individual subject level.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2017Pain acceptance decouples the momentary associations between pain, pain interference, and physical activity in the daily lives of people with chronic pain and spinal cord injuryJournalJ75848Journal of Pain (Replaced the Society's Pain Forum)183319-331Study examined whether pain acceptance moderates the momentary associations of pain intensity with pain interference and physical activity in people with chronic pain and spinal cord injury (SCI). To examine pain acceptance in daily life, 7 days of ecological momentary assessments of pain intensity and pain interference (5 times per day) with continuous accelerometry (physical activity) were collected in 128 individuals with chronic pain and SCI. Multilevel modeling revealed that pain acceptance significantly moderated the momentary association between pain intensity and pain interference; those with higher pain acceptance experienced a blunted increase in interference when pain was high. Pain acceptance also moderated the association between pain intensity and physical activity; high pain acceptance was associated with an increase and low pain acceptance with a decrease in physical activity in the context of high pain. The activities engagement component of pain acceptance was a slightly more robust driver of these interaction effects; whereas activities engagement significantly moderated the association between momentary pain and pain interference as well as physical activity, pain willingness exerted a significant moderating effect on the momentary association between pain intensity and pain interference only. These findings suggest that both components contribute to the decoupling effects of pain acceptance. Task persistence did not show the same moderating effects, indicating that pain acceptance may be unique from other types of behavioral pain coping in its ability to decouple expected associations between pain intensity, pain interference, and physical activity.University of Michigan SCI Model SystemYesdevopsadmin
2016Long-lasting effect of transcranial direct current stimulation in the reversal of hyperalgesia and cytokine alterations induced by the neuropathic pain modelJournalJ73915Brain Stimulation92209-217Study investigated the effects of transcranial direct current stimulation (tDCS) on the nociceptive response and on interleukin-1 beta (IL-1β), interleukin-10 (IL-10), and tumor necrosis factor alpha (TNF-α) levels in central nervous system (CNS) structures of rats with neuropathic pain (NP). tDCS is a non-invasive method of cerebral stimulation and represents a promising resource for pain management. After induction of NP by chronic constriction injury (CCI) of the sciatic nerve, the rats received 20 minutes of bicephalic tDCS for 8 days. Hyperalgesia was assessed by the hot plate and von Frey tests and evaluated at baseline, 7 days, and 14 days after CCI surgery, and also immediately, 24 hours, and 7 days following tDCS treatment. The levels of IL-1β, IL-10 and TNF-α in the cortex, spinal cord, and brainstem were determined at 48 hours and 7 days post-tDCS. The CCI model provoked thermal and mechanical hyperalgesia until at least 30 days post-CCI; however, bicephalic tDCS relieved the nociceptive behavior for up to 7 days after treatment completion. The findings suggest that bicephalic tDCS is effective to promote antinociceptive behavior in neuropathic pain, which can be reflected by a spinal neuroimmunomodulation linked to pro- and anti-inflammatory cytokine levels observed in the long-term.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2015Neural markers of neuropathic pain associated with maladaptive plasticity in spinal cord injuryJournalJ73917Pain Practice154371-377This study aimed to identify the most effective neural markers of neuropathic pain following spinal cord injury (SCI). A systematic PubMed review was conducted, compiling studies that were published prior to April, 2014 that examined neural markers associated with neuropathic pain after SCI using electrophysiological and neuroimaging techniques. Six studies were identified: 4 using electroencephalogram (EEG), 1 using magnetic resonance imaging (MRI) and FDG-PET (positron emission tomography), and 1 using MR spectroscopy. The EEG recordings suggested a reduction in alpha EEG peak frequency activity in the frontal regions of SCI patients with neuropathic pain. The MRI scans showed volume loss, primarily in the gray matter of the left dorsolateral prefrontal cortex. Using FDG-PET, hypometabolism in the medial prefrontal cortex was observed in SCI patients with neuropathic pain compared with healthy subjects. In the MR spectroscopy findings, the presence of pain was associated with changes in the prefrontal cortex and anterior cingulate cortex. When analyzed together, the results of these studies seem to point out to a common marker of pain in SCI characterized by decreased cortical activity in frontal areas and possibly increased subcortical activity. These results may contribute to planning further mechanistic studies as to better understand the mechanisms by which neuropathic pain is modulated in patients with SCI as well as clinical studies investigating best responders of treatment.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2016Proposed pedestrian pathway roughness thresholds to ensure safety and comfort for wheelchair usersJournalJ78047Assistive Technology284209-215Study used previous research data to determine appropriate roughness thresholds to characterize whether pedestrian pathways poses a comfort or health risk to wheelchair users. A previously published study investigated the correlation between the pathway roughness index (PRI) and whole body vibration (WBV) exposure to wheelchair users. The results of the previous vibration study showed that some surfaces can cause discomfort and could cause health risks to wheelchair users. The purpose of the current study was to translate the previous research evidence on WBV exposure and PRI into a PRI threshold that could be used to determine whether a pathway is safe, moderately safe, or unsafe for wheelchair users. Results suggest a PRI threshold of ≤50 millimeters per meter (1.2 inches per foot) for a surface segment of 100 meters (328 feet) in length, and ≤100 millimeters per meter (1.2 inches per foot) for a surface segment of 3 meters (9.8 feet) in length would protect wheelchair users against discomfort and possible health risks due to vibration exposure. For surfaces of different lengths, a 3-meter (9.8 feet) and 100-meter (328 feet) moving window should be used.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2015Mental imagery-induced attention modulates pain perception and cortical excitabilityJournalJ739141615https://www.researchgate.net/publication/276859346_Mental_imagery-induced_attention_modulates_pain_perception_and_cortical_excitabilityStudy examined the effects of mental imagery-induced attention on pressure pain threshold and cortical plasticity using transcranial magnetic stimulation (TMS). Mental imagery is the process of envisioning specific physical or cognitive activities or perceptual experiences with the intention of altering the facilitation of neuronal networks. This blinded, randomized, and parallel-design trial comprised 30 healthy right-handed male subjects. Exploratory statistical analyses were performed using analysis of variance and t-tests for pain and TMS assessments. Pearson’s correlation was used to analyze the association between changes in pain threshold and cortical excitability. In the analysis of pain outcomes, there was no significant interaction effect on pain between group versus time. In an exploratory analysis, a significant effect of group was only observed for the targeted left hand. Although there was only a within-group effect of mental imagery on pain, further analyses showed a significant positive correlation of changes in pain threshold and cortical excitability (motor-evoked potentials via TMS). Results indicate that mental imagery has a minor effect on pain modulation in healthy subjects. Its effects appear to differ compared with chronic pain, leading to a small decrease in pain threshold. Assessments of cortical excitability confirmed that these effects are related to the modulation of pain-related cortical circuits. These exploratory findings suggest that neuronal plasticity is influenced by pain and that the mental imagery effects on pain depend on the state of central sensitization. Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2016Outcomes and lessons learned from a randomized controlled trial to reduce health care utilizations during the first year after spinal cord injury rehabilitation: Telephone counseling versus usual careJournalJ74708Archives of Physical Medicine and Rehabilitation97101793-1796Study evaluated the effectiveness of telephone counseling (TC) in reducing medical complications and health care utilization and improving psychosocial outcomes during the first year after spinal cord injury (SCI) rehabilitation. A total of 168 patients participated in a single-site, single-blind, randomized controlled trial comparing usual care plus TC with usual care (UC). The TC group received up to eleven 30- to 45-minute scheduled telephone calls to provide education, resources, and support. The UC group received indicated referrals and treatment. The primary outcome was a composite of self-reported health care utilization and medical complications. Secondary outcomes were depression severity, current health state, subjective health, and community participation. No significant differences were observed between TC and UC groups in the primary or secondary psychosocial outcomes. This study had a number of strengths, but included potential design weaknesses. Intervention studies would benefit from prescreening participants to identify those with treatable problems, those at high risk for poor outcomes, or those with intentions to change target behaviors. Interventions focused on treatment goals and designed to work in collaboration with the participant’s medical care system may lead to improved outcomes.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2017Longitudinal prediction of quality-of-life scores and locomotion in individuals with traumatic spinal cord injuryJournalJ77413Archives of Physical Medicine and Rehabilitation98122385-2392Study examined differences in quality-of-life (QOL) scores for locomotion groups at 1, 5, and 10 years postdischarge in people with spinal cord injury (SCI) and investigated whether demographic factors and transitions in locomotion status can predict QOL measures at these time points. Data were collected from 10,190 individuals with SCI from 21 SCI Model Systems Centers, identified through the National SCI Database between the years 1985 and 2012. Subjects were those who had Functional Independence Measure data for mode of locomotion at discharge and at least 1 of the following: 1, 5, or 10 years postdischarge. Based on locomotion change or no change, individuals were categorized at each follow-up time point into 1 of 4 groups: (1) ambulation to ambulation, (2) wheelchair to wheelchair, (3) wheelchair to ambulation or wheelchair to both, or (4) ambulation to wheelchair or ambulation to both. Participants who transitioned from ambulation to wheelchair use reported lower participation and life satisfaction, and higher depression levels than those who maintained their ambulatory status. Participants who transitioned from ambulation to wheelchair use reported higher depression levels and no difference for participation or life satisfaction compared with those who transitioned from wheelchair to ambulation. Demographic factors and locomotion transitions predicted QOL scores at all time points. Findings suggest that transitioning from ambulation to wheelchair use can negatively impact psychosocial health 10 years after SCI. Clinicians should be aware of this when deciding on ambulation training. Further work to characterize who may be at risk for these transitions is needed.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2015Muscle activation varies with contraction mode in human spinal cord injuryJournalJ76588Muscle and Nerve512235-245Study examined muscle activation during single and repeated isometric, concentric, and eccentric knee extensor (KE) maximal voluntary contractions (MVCs) to better understand volitional force generation after chronic incomplete spinal cord injury (SCI). Torque and electromyographic (EMG) activity were recorded during single and repeated isometric and dynamic KE MVCs in 11 subjects with SCI. Central activation ratios (CARs) were calculated for all contraction modes in subjects with SCI and 11 healthy controls. Results showed that subjects with SCI generated greater torque, EMG, and CARs during single eccentric versus isometric and concentric MVCs. This pattern of activation contrasts with the decreased eccentric activation demonstrated by healthy controls. Torque and EMG remained similar during repeated eccentric MVCs; however, both increased during repeated isometric and concentric MVCs. The findings from this study may aid development of novel rehabilitation interventions.Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2015Preinjury cigarette smoking among those with traumatic spinal cord injuryJournalJ72922Rehabilitation Psychology604322-327Study assessed the prevalence of cigarette smoking at the time of spinal cord injury (SCI) onset compared to that of the general population in the same geographic area, and identified demographic, injury, behavioral, and psychological characteristics associated with cigarette smoking. Self-report assessments were completed by 524 patients during inpatient rehabilitation for new SCI. The prevalence of smokers at the time of SCI onset was 37.9 percent, substantially higher than the rate for those in the general population from the same geographic region (22.8 percent). Those who were smokers at SCI onset, on average, were older, had less education, were more likely to have consumed alcohol in the month prior to SCI onset, and had higher personality scores indicative of Impulsive/Sensation Seeking and Neuroticism/Anxiety. This study indicates that the rate of cigarette smoking at the time of SCI onset is elevated over the general population and is related to behavioral and psychological factors that may be important to consider with smoking cessation interventions.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2016Medical management of neurogenic bladder with oral therapyJournalJ73564Translational Andrology and Neurology5151-62http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739981/Article reviews the most current literature on the medical management of the neurogenic bladder to treat detrusor overactivity, improve bladder compliance, and treat urinary incontinence. The use of antimuscarinics, alpha blockers, tricyclic antidepressants, desmopressin and mirabegron are discussed along with combination therapy to improve efficacy.University of Michigan SCI Model SystemYesdevopsadmin
2015Outcome measures for hand function naturally reveal three latent domains in older adults: Strength, coordinated upper extremity function, and sensorimotor processingJournalJ75719Frontiers in Aging Neuroscience7108https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456581/Study examined whether and how the associations among six hand-specific outcome measures reveal latent functional domains in elderly individuals. Sixty-six healthy older adult participants and 33 older adults diagnosed with osteoarthritis (OA) of the carpometacarpal (CMC) joint completed six functional assessments: hand strength (grip, key, and precision pinch), Box and Block, Nine Hole Pegboard, and Strength-Dexterity tests. The first three principal components suffice to explain 86 percent of variance among the six outcome measures in healthy older adults, and 84 percent of variance in older adults with CMC OA. The composition of these dominant associations revealed three distinct latent functional domains: strength, coordinated upper-extremity function, and sensorimotor processing. Furthermore, in participants with thumb CMC OA, a blurring of the associations between the latent functional domains of strength and coordinated upper-extremity function was found. This motivates future work to understand how the physiological effects of thumb CMC OA lead upper-extremity coordination to become strongly associated with strength, while dynamic sensorimotor ability remains an independent functional domain. Thus, when assessing the level of hand function in older adults, it is particularly important to acknowledge its multidimensional nature-and explicitly consider how each outcome measure maps to these three latent and fundamental domains of function. Moreover, this ability to distinguish among latent functional domains may facilitate the design of treatment modalities to target the rehabilitation of each of them.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2016Loneliness among people with spinal cord injury: Exploring the psychometric properties of the 3-item loneliness scaleJournalJ74701Archives of Physical Medicine and Rehabilitation97101728-1734Study examined the construct of loneliness and its correlates in people with spinal cord injury (SCI), assessed the reliability and validity of the 3-item Loneliness Scale, and evaluated the unique impact of loneliness on psychological health. Data were collected from 175 people with SCI who participated in Spinal Cord Injury Model Systems follow-up interviews and completed the 3-item Loneliness Scale at 1 study site between April 2014 and June 2015. Examination of individual items showed that approximately 40 percent of the sample reported that they felt they lacked companionship, felt left out, and felt isolated from others either some of the time or often. Mean scores in the sample were elevated compared with published data on middle-aged and older adults. Results provided evidence of internal consistency, comparable to that reported in the literature, and preliminary evidence of convergent and divergent validity. Loneliness was related to psychological health even after controlling for measures of demographics, disability, and social integration, suggesting that loneliness captures more than just social isolation or social integration in people with SCI. Findings indicate that loneliness, which may be more common among people with SCI, is related to poorer psychological health. Given the serious physical and psychological health consequences of loneliness documented in the general literature, it is imperative that the experience of loneliness among people with SCI be given serious and systematic attention in the literature as well as in clinical practice.University of Michigan SCI Model SystemYesdevopsadmin
2014Moving towards multiple site outcomes in spinal cord injury pain clinical trials: An issue of clustered observations in trial design and analysisJournalJ69172Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)373278-287Article demonstrates how to design and power calculation of a clinical trial of spinal cord injury (SCI) pain using multiple pain sites per individual. The authors also discuss the consequences of failing to adjust for this factor and provide intraclass correlation (ICC) estimates for common pain outcome measures that may be used to power future clinical trials in SCI pain. Using an existing dataset from a past SCI pain clinical trial, the ICC was calculated for common pain outcome measures to illustrate appropriate corrections for powering, analyzing, and interpreting results from multiple pain sites per individual. Not accounting for the ICC can lead to incorrect power estimates in the design of a trial, and an inflated Type I error rate with a higher likelihood of misinterpretation of outcomes. Powering for future SCI pain trials and statistical analysis of trial outcomes may be substantially compromised if methods do not account for the intra-individual associations between pain sites, ultimately affecting study interpretations and evidence-based practice. ICC estimates based on SCI pain data are presented for purposes of estimating power for future trials.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2014Predictors of subclinical atherosclerosis in women with spinal cord injuryJournalJ68671Topics in Spinal Cord Injury Rehabilitation20290-95Study determined which risk factors for cardiovascular disease (CVD) are associated with increased carotid intima-media thickness (CIMT), a common indicator of atherosclerosis, in women with spinal cord injury (SCI). One hundred twenty-two adult females with chronic SCI were evaluated. Participants were asymptomatic and without evidence of CVD. Measures collected for all participants were age, race, smoking status, level and completeness of injury, duration of injury, body mass index, serum lipids, fasting glucose, hemoglobin A1c, and ultrasonographic measurements of CIMT. After conducting univariate analyses, hierarchical multiple linear regression was conducted to predict CIMT from demographic and physiologic variables. Results indicated that several variables were significantly correlated with CIMT during univariate analyses, including glucose, hemoglobin A1c, age, and race/ethnicity; only age was significant in the hierarchical regression analysis.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2018Measuring pain phenomena after spinal cord injury: Development and psychometric properties of the SCI-QOL pain interference and pain behavior assessment toolsJournalJ78596Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)413267-280Article describes the development and psychometric evaluation of patient-reported outcome measures that assess pain interference and pain behavior after spinal cord injury (SCI). These measures include the Spinal Cord Injury - Quality of Life (SCI-QOL) Pain Interference item bank, SCI-QOL Pain Interference short form, and SCI-QOL Pain Behavior scale. These were adapted from the Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference and Pain Behavior item banks and optimized for individuals with SCI. Seven hundred fifty-seven individuals with traumatic SCI completed 58 items addressing various aspects of pain. Items were then separated by whether they assessed pain interference or pain behavior, and poorly functioning items were removed. Confirmatory factor analyses confirmed that each set of items was unidimensional, and item response theory analyses were used to estimate slopes and thresholds for the items. Ultimately, 7 items (4 from PROMIS) comprised the Pain Behavior scale and 25 items (18 from PROMIS) comprised the Pain Interference item bank. Ten of these 25 items were selected to form the Pain Interference short form. The SCI-QOL Pain Interference item bank and the SCI-QOL Pain Behavior scale demonstrated robust psychometric properties. The Pain Interference item bank is available as a computer adaptive test or short form for research and clinical applications, and scores are transformed to the PROMIS metric.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2014Novel multi-system functional gains via task specific training in spinal cord injured male ratsJournalJ70828Journal of Neurotrauma319819-833Study investigated whether a step training paradigm could improve outcome measures of locomotion, bladder function, and pain/allodynia, using a severe contusion model of spinal cord injury (SCI) in male rats. Animals were randomly divided into two equal groups: one group received quadrupedal step training 1 hour a day for 12 weeks, beginning 2 weeks post-SCI, and the second group served as non-trained controls. Step training post-SCI resulted in significant multi-system functional gains. Beneficial outcomes after 3 months of daily quadrupedal step training sessions with manual assistance included improved bladder function, reduced at-level allodynia, and improved limb kinematics, gait, and hindlimb flexor-extensor bursting patterns relative to non-trained controls. These novel findings, demonstrating improved non-locomotor in addition to locomotor functions, suggest that step training post-SCI could contribute to multiple quality-of-life gains.Kentucky Regional Spinal Cord Injury Model SystemYesdevopsadmin
2014Impact of a wheelchair education protocol based on practice guidelines for preservation of upper-limb function: A randomized trialJournalJ67772Archives of Physical Medicine and Rehabilitation95110-19, 19.e1-19.e11Study examined the effect of the Paralyzed Veterans of America’s Clinical Practice Guidelines for Preservation of Upper Limb Function on wheelchair setup, selection, propulsion biomechanics, pain, satisfaction with life, and participation in individuals with new spinal cord injuries (SCIs). A single-blind, randomized controlled trial was completed by 37 manual wheelchair users with new SCIs enrolled in Model SCI System rehabilitation facilities. The intervention group was strictly educated on the clinical practice guideline by a physical therapist and an occupational therapist in an inpatient rehabilitation facility. The standard of care group received standard therapy services. Analysis compared wheelchair setup, selection, propulsion biomechanics, pain, and Satisfaction With Life Scale and Craig Handicap Assessment and Reporting Technique scores between the two groups at the time of discharge from inpatient rehabilitation and at 6 months and 1 year postdischarge. Participants in the intervention group pushed on tile with significantly lower push frequency at the discharge visit. On the ramp, the intervention group used a significantly larger push length across all time points. No significant differences were found between groups related to wheelchair setup, selection, pain, satisfaction with life, and participation. The intervention group showed better skills on key wheelchair propulsion biomechanics variables related to upper-limb health. The results suggest that the use of a structured education program may be an effective method of educating new manual wheelchair users to prevent the development of upper-limb impairments in an inpatient setting.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2014Differences between manufacturers in reported power wheelchair repairs and adverse consequences among people with spinal cord injuryJournalJ68561Archives of Physical Medicine and Rehabilitation954597-603Study compared the frequency of power wheelchair (PWC) repairs and consequences experienced over a 6-month period by individuals with spinal cord injury (SCI) who use a PWC at least 40 hours per week. Data were collected from 945 participants who were treated at a SCI Model System center and used a PWC 40 or more hours each week. The number of required wheelchair repairs and resulting adverse consequences (i.e., being stranded, missing work or school, or missing a medical appointment) were analyzed. The wheelchairs were compared overall and based on manufacturer, seating functions, Healthcare Common Procedure Coding System group, and model, and over time. Results indicated that the rates of required repairs (47.6 to 63.3 percent) and consequences (26.7 to 40.7 percent) were high for all manufacturers. Differences between manufacturers were found among PWCs without seating functions and among group 2 wheelchairs. Across the 10 most prescribed wheelchairs in this study, 54.5 to 73.9 percent of users required 1 or more repairs over a 6-month period. Increases in the number of repairs were also found for several PWC manufacturers with time. Differences were found in participant age, working status, years since injury, and presence of seating functions between manufacturers. The differences found in the number of repairs reported by survey respondents based on PWC manufacturer and the increases in repairs over time require further evaluation.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2016Empowering adults with chronic spinal cord injury to prevent secondary conditionsJournalJ74697Archives of Physical Medicine and Rehabilitation97101687-1695, 1695.e1-1695.e5Study developed and assessed the feasibility of My Care My Call, an innovative peer-led, community-based telephone intervention for 7 individuals with chronic spinal cord injury (SCI) using peer health coaches. My Care My Call applies a health empowerment approach for goal-setting support, education, and referral to empower consumers in managing their preventive health needs. For feasibility testing, peer health coaches, trained in brief action planning, called participants 6 times over 3 weeks. Identified focus areas were acceptability, demand, implementation, and practicality. Participant outcome data were collected through brief after-call surveys and qualitative exit interviews. Through a custom website, peer health coaches documented call attempts, content, and feedback. Analysis applied the constant comparative method. My Care My Call was highly feasible in each focus area for participants. Concerning acceptability, participants were highly satisfied, rating peer health coaches as very good or excellent in 80 percent of calls; felt My Care My Call was appropriate; and would continue use. Regarding demand, participants completed 88 percent of scheduled calls, reported that My Care My Call fills a real need, and would recommend it. Considering implementation, peer health coaches made 119 percent of expected calls, with a larger focus on compiling individualized resources. For practicality, call duration averaged 29 minutes, with 1 hour of additional time for peer health coaches. Participant effects included feeling supported, greater confidence toward goals, and greater connection to resources. Subsequently, several process changes enhanced peer health coach training and support through role-plays, regular support calls, and streamlined My Care My Call support materials.New England Spinal CenterYesdevopsadmin
2015Hand shape representations in the human posterior parietal cortexJournalJ75721Journal of Neuroscience354615466-15476Humans shape their hands to grasp, manipulate objects, and to communicate. Nonhuman primate studies have shown that visual and motor properties for grasps can be derived from cells in the posterior parietal cortex (PPC). This study showed for the first time how single neurons in the PPC of humans are selective for particular imagined hand shapes independent of graspable objects. Findings indicate that motor imagery to shape the hand can be successfully decoded from the PPC by implementing a version of the Rock-Paper-Scissors game and its extension Rock-Paper-Scissors-Lizard-Spock. By simultaneous presentation of visual and auditory cues, researchers can discriminate motor imagery from visual information and show differences in auditory and visual information processing in the PPC. These results also demonstrate that neural signals from human PPC can be used to drive a dexterous cortical neuroprosthesis.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2016Influence of age alone, and age combined with pinprick, on recovery of walking function in motor complete, sensory incomplete spinal cord injuryJournalJ74690Archives of Physical Medicine and Rehabilitation97101628-1634Study investigated whether age, pinprick scores in the lower extremities, and neurologic severity of injury influence recovery of ambulation in people with motor complete, sensory incomplete spinal cord injury (SCI) 1 year after initial injury. This retrospective analysis examined 249 subjects with American Spinal Injury Association Impairment Scale (AIS) grade B from the SCI Model System database from 2006 to 2015. The baseline neurologic examination at rehabilitation admission (2 to 4 weeks postinjury) was used for comparison with 1-year outcome measures of locomotion. At 1 year postinjury, household ambulation was assessed by telephone interview and by direct interview, as part of the annual neurologic exam, and the change in ASIA score was examined. Results showed a statistically nonsignificant increase in likelihood of walking for those age Regional SCI Center of the Delaware ValleyYesdevopsadmin
2014Disparities in access to health care among adults with physical disabilities: Analysis of a representative national sample for a ten-year periodJournalJ70488Disability and Health JournalStudy examined the effect of physical disability on disparities in access to health care, identified factors associated with unmet health care needs, and analyzed trends in access to care among working-age adults with and without physical disabilities. The three measures of access to care investigated were medical needs, dental needs, and prescription medication needs. A logistic regression analysis was conducted of a nationally representative sample of 163,220 adults aged 25 to 64 years, with and without physical disabilities, using pooled data from the 2002-2011 Medical Expenditure Panel Survey. Results indicated that individuals with physical disabilities have 75, 57, and 85 percent higher odds of having unmet medical, dental, and prescription medication needs, respectively, than those without physical disabilities. Sociodemographic and health factors were related to unmet needs in all three measures of access to care. In particular, being female, living at or near the poverty level, and lacking health insurance increased the odds of unmet health care needs. Predicted probabilities of unmet health care needs from 2002 to 2011 showed persistent gaps between individuals with and without physical disabilities, with a growing gap in unmet dental care.University of Michigan SCI Model SystemYesdevopsadmin
2015Examining implicit bias of physicians who care for individuals with spinal cord injury: A pilot study and future directionsJournalJ70880Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)381102-110Study examined the implicit racial bias among physicians caring for individuals with spinal cord injury (SCI) and its association with functioning and wellbeing for individuals with SCI. Data were collected from 162 individuals with SCI and 14 of their SCI physicians from 4 national SCI Model Systems sites. SCI physicians completed online surveys measuring implicit racial (pro-white/anti-black) bias. Individuals with SCI completed questionnaires assessing mobility, physical independence, occupational functioning, social integration, self-reported health, depression, and life satisfaction. Multilevel regression analyses were used to examine the associations of physician bias and outcomes of individuals with SCI. Results showed that physicians had a mean bias score of 0.62, indicating a strong pro-white/anti-black bias. Greater physician bias was associated with disability among individuals with SCI in the domain of social integration, as well as higher depression and lower life satisfaction. This pilot study indicates that SCI providers are susceptible to implicit racial bias and provides preliminary evidence that greater implicit racial bias of physicians is associated with poorer psychosocial health outcomes for individuals with SCI. It demonstrates the feasibility of studying implicit bias among SCI providers and provides guidance for future research on physician bias and patient outcomesUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2016Immediate biomechanical implications of transfer component skills training on independent wheelchair transfersJournalJ74707Archives of Physical Medicine and Rehabilitation97101785-1792Study evaluated the immediate effects of transfer training based on the Transfer Assessment Instrument (TAI) on upper-limb biomechanics during transfers. The TAI consist of 2 parts. Part 1 of the TAI divides a transfer into 15 items, each representing a component transfer skill. Part 2 evaluates the consistency of component skills and global performance of a transfer. Only the part 1 summary score was used in this study to evaluate whether the individual used specific component transfer skills. Twenty-four full-time manual wheelchair users performed 5 transfers to a level height bench, while their natural transfer skills were scored using the TAI, and their biomechanical data were recorded. Participants with 2 or more component skill deficits were invited to return to receive personalized transfer training. TAI part 1 summary scores and biomechanical variables at the shoulder, elbow, and wrist joints were compared before and immediately after transfer training. Sixteen of the 24 manual wheelchair users met the criteria for training, and 11 manual wheelchair users came back for the revisit. Their TAI part 1 summary scores improved from 6.31 to 9.92. They had significantly smaller elbow range of motion, shoulder resultant moment, and rates of rise of elbow and wrist resultant forces on their trailing side during transfers after training. On the leading side, shoulder maximum internal rotation and elevation angles, and shoulder resultant moments and rates of rise of shoulder resultant force and moment decreased after training. The TAI-based training showed short-term beneficial biomechanical effects on wheelchair users’ upper limbs. If the skills are practiced longer-term, they may help protect the upper limbs from developing pain and injuries.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2016Development of the international spinal cord injury activities and participation basic data setJournalJ74603Spinal Cord (formerly Paraplegia)547530-534The objective of this study was to develop an International Spinal Cord Injury (SCI) Activities and Participation (A&P) Basic Data Set. A committee of experts was established to select and define A&P data elements to be included in this data set. A draft data set was developed and posted on the International Spinal Cord Society (ISCoS) and American Spinal Injury Association websites and was also disseminated among appropriate organizations for review. Suggested revisions were considered, and a final version of the A&P Data Set was completed. Consensus was reached to define A&P and to incorporate both performance and satisfaction ratings. Items that were considered core to each A&P domain were selected from two existing questionnaires. Four items measuring activities were selected from the Spinal Cord Independence Measure III to provide basic data on task execution in activities of daily living. Eight items were selected from the Craig Handicap Assessment and Reporting Technique to provide basic data on the frequency of participation. An additional rating of satisfaction on a three-point scale for each item completes the total of 24 A&P variables. Collection of the International SCI A&P Basic Data Set variables in all future research on SCI outcomes is advised to facilitate comparison of results across published studies from around the world. Additional standardized instruments to assess activities of daily living or participation can be administered, depending on the purpose of a particular study.University of Michigan SCI Model SystemYesdevopsadmin
2018Investigating the efficacy of web-based transfer training on independent wheelchair transfers through randomized controlled trialsJournalJ77730Archives of Physical Medicine and Rehabilitation9919-16, 16.e1-16.e10Study assessed the efficacy of a web-based transfer training module on the performance of independent wheelchair transfers immediately after training and after a 1- to 2-day delay and identified subject characteristics that predict improvements in transfer ability after training. Seventy-one manual and power wheelchair users who could transfer independently were randomized to 3 groups: web-based training, in-person training (current standard of practice), and a waitlist control group (WLCG). The WLCG received the web training at their follow-up visit. The Transfer Assessment Instrument (TAI) part 1 score was used to assess transfers at baseline, skill acquisition immediately after training, and skill retention after a 1- to 2-day follow-up period. Results showed the in-person and web-based training groups improved their median TAI scores from 7.98 to 9.13, and from 7.14 to 9.23, respectively, compared with the WLCG that had a median score of 7.69 for both assessments. Participants retained improvements at follow-up. A lower initial TAI score was found to be the only significant predictor of a larger percent change in TAI score after receiving training. The results indicate that transfer training can improve technique with changes retained within a short follow-up window, even among experienced wheelchair users. Web-based transfer training demonstrated comparable improvements to in-person training.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2017Effects of training intensity on locomotor performance in individuals with chronic spinal cord injury: A randomized crossover studyJournalJ77953Neurorehabilitation and Neural Repair3111-Oct944-954Study evaluated the effects of locomotor training (LT) intensity on walking outcomes in individuals with motor incomplete spinal cord injury (iSCI). Using randomized a crossover design, 15 ambulatory participants with iSCI for longer than 1 year duration performed either high- or low-intensity LT for up to 20 sessions over 4 to 6 weeks. Four weeks following completion, the training interventions were alternated. Targeted intensities focused on achieving specific ranges of heart rate (HR) or ratings of perceived exertion (RPE), with intensity manipulated by increasing speeds or applying loads. Significantly greater increases in peak treadmill speeds and secondary measures of metabolic function and overground speed were observed following high- versus low-intensity training, with no effects of intervention order. Moderate-to-high correlations were observed between differences in walking speed or distances and differences in HRs or RPEs during high- versus low-intensity training. This pilot study provides the first evidence that the intensity of stepping practice may be an important determinant of LT outcomes in individuals with iSCI. Whether such training is feasible in larger patient populations and contributes to improved locomotor outcomes deserves further consideration.Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2016Fall-induced spinal cord injury: External causes and implications for preventionJournalJ75230Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)39124-31Study determined the demographic and clinical profile of people who sustained spinal cord injury (SCI) as a result of accidental falls and documented the usual circumstances surrounding the fall-induced SCI. Participants were 6,408 individuals with traumatic SCI enrolled in 21 SCI Model Systems centers throughout the United States between 2005 and 2014. Twenty-nine percent of these patients (1,877) sustained injuries caused by falls. The external causes (mechanisms and circumstances) of injury were documented by the International Classification of Diseases, 10th revision, Clinical Modification. Results indicated that falls on the same level from slipping, tripping, and stumbling were the most common cause of fall-induced SCI (20 percent), followed by falls from building (16 percent), stairs and steps (16 percent), and ladder (9 percent). People who were 61 years of age and older had the highest frequency of falls on the same level, while those aged 16 to 45 years had a higher percentage of falls from buildings, usually work-related. The mechanisms of falls also varied by sex and race. Associated injury and vertebral injury occurred frequently among falls from buildings and ladders. High falls were more likely to be work-related and result in thoracic and complete injury, while low falls were more commonly associated with cervical and motor functionally incomplete injury. The findings of different mechanisms of falls by age, sex, race, and medical consequences provide an insight for future interventions aimed at high risk persons, activities, and environmental factors for preventing or reducing fall-induced SCI.National SCI Statistical CenterYesdevopsadmin
2017Inflammatory mediators associated with pressure ulcer development in individuals with pneumonia after traumatic spinal cord injury: A pilot studyJournalJ76872Archives of Physical Medicine and Rehabilitation9891792-1799Study identified the changes in the plasma and urine levels of inflammatory mediators after the diagnosis of pneumonia that are associated with the onset of a first pressure ulcer (PU). Eighty-six individuals with traumatic spinal cord injury (SCI) were included in the initial analyses. Fifteen of the 86 developed pneumonia and had inflammatory mediator data available. Of these 15, 7 developed PUs and 8 did not. Twenty-three inflammatory mediators in plasma and urine were assayed. The differences in concentrations of plasma and urine inflammatory mediators between the closest time point before and after the diagnosis of pneumonia were calculated. Initial chi-square analysis revealed a significant association between pneumonia and PUs. Individuals with SCI and diagnosed pneumonia had nearly double the risk for developing PUs compared with those with no pneumonia. In individuals with pneumonia, Mann- Whitney U exact tests suggested an association between the formation of a first PU and a slight increase in plasma concentrations of tumor necrosis factor-alpha (TNF-a), and a decrease in urine concentrations of TNF-a, granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin (IL)-15 after onset of pneumonia. These findings suggest that a relatively small increase in plasma TNF-a, and decreases in urine TNF-a, GM-CSF, and IL-15 from just before to just after the diagnosis of pneumonia could be markers for an increased risk of PUs in individuals with pneumonia after traumatic SCI.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2014Disability and the built environment: An investigation of community and neighborhood land uses and participation for physically impaired adultsJournalJ70836Annals of Epidemiology247545-550Study examined the relationship between community and neighborhood land uses and community participation among adults with acquired physical disability. Data were obtained from the national Spinal Cord Injury Model Systems (SCIMS) database for 508 community-living chronically disabled adults in New Jersey. The following four domains of participation were assessed for the SCIMS and were used for this study: (1) physical independence, (2) mobility, (3) occupation, and (4) social integration. Participants’ residential addresses were geocoded to link individual survey data with Geographic Information Systems data on land use and destinations. Multivariate logistic regression models tested the influence of residential density, land-use mix, destination counts, and open space on the four participation domains at two geographic scales: the neighborhood (half-mile buffer) and community (five-mile buffer). All analyses were adjusted for demographic- and impairment-related differences. Results indicated that living in communities with greater land-use mix and more destinations was associated with a decreased likelihood of reporting optimum social and physical activity. Conversely, living in neighborhoods with large portions of open space was positively associated with the likelihood of reporting full physical, occupational, and social participation. These findings suggest that the overall living conditions of the built environment may be relevant to social inclusion for people with physical disabilitiesNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2015Examining health-care utilization in the first year following spinal cord injuryJournalJ71277Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)386690-695Study identified factors associated with health-care utilization during the first year after inpatient rehabilitation (IR) in individuals with traumatic spinal cord injury (SCI). One hundred sixty-eight patients were followed over 1 year after discharge from an SCI Model System IR program. Telephone follow-up occurred at 3, 6, 9, and 12 months. Participants were grouped into four impairment levels: (1) C1–4 American Spinal Injury Association (ASIA) Impairment Scale (AIS) A–C, (2) C5–C8 AIS A–C, (3) paraplegia AIS A–C, and (4) all AIS D. Three domains of healthcare utilization were examined: hospital care, outpatient provider visits, and home services. Health-care utilization in the first year following IR was high with 45 percent of subjects reporting re-hospitalization. Twenty percent of patients were initially discharged to a skilled nursing facility (SNF), and an additional 10 percent required SNF care during this first year. Overall, those with C1–4 AIS A–C used the most services. Participants discharged home used less health care compared to those discharged elsewhere. SCI due to falls (versus vehicular crashes) was associated with fewer in-home service visits. Age, sex, race, and education were unrelated to higher use. Those with greater neurological impairment or not discharged home after IR had higher health-care utilization, while age was not associated with utilization. Targeted efforts to reduce genitourinary and respiratory complications may reduce the need for hospital care in the first year after IR.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2014Hybrid functional electrical stimulation exercise training alters the relationship between spinal cord injury level and aerobic capacityJournalJ70074Archives of Physical Medicine and Rehabilitation95112172-2179Study assessed aerobic capacity during hybrid functional electrical stimulation (FES) row training in 14 volunteers with complete spinal cord injury (SCI) and assessed the relationships among lesion level, aerobic capacity, and peak ventilation before and after 6 months of FES row training. Peak aerobic capacity and peak exercise ventilation was measured before and after 6 months of FES row training, which was preceded by a variable period of FES strength training. Results indicated that FES row training significantly increased peak aerobic capacity and peak minute ventilation. Prior to FES row training, there was a close relationship between level of SCI and peak aerobic capacity that was markedly reduced after FES row training. In contrast, the relation between level of injury and peak minute ventilation was comparable before and after FES row training. The findings suggest that increased aerobic capacity reflects more than increased ventilation; FES row training effectively circumvents the effect of SCI on peak aerobic capacity by engaging more muscle mass for training, independent of the level of injury.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2014Development and use of a knowledge translation tool: The rehabilitation measures databaseJournalJ67791Archives of Physical Medicine and Rehabilitation951197-202Article discusses the development, utilization, and sustainability of the Rehabilitation Measures Database (RMD), a free, web-based searchable database of standardized instruments that was designed to support knowledge translation. It helps clinicians select valid and sensitive instruments for screening patients, monitoring progress, and assessing rehabilitation outcomes. The RMD was developed using feedback from focus groups and beta-test participants. Since its launch in 2011, RMD use has grown to an average of 1,851 hits per day from 168 countries. As of September 2013, 202 instrument summaries are viewable in the RMD. Most summaries are linked to copies of the instrument or to purchase instructions. A challenge in updating and expanding the RMD is securing the resources to ensure its future. Collaborative relationships with professional associations and graduate programs in the health sciences are critical in sustaining this resource.Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2014International standards for neurological classification of spinal cord injury: Cases with classification challengesJournalJ68411Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)372120-127The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine the levels of injury and to classify the severity of a spinal cord injury (SCI). The International Standards Committee of the American Spinal Injury Association often receives questions regarding the classification. The committee felt that disseminating some of the challenging questions posed, as well as the responses, would be of benefit for professionals utilizing the ISNCSCI. In this article, case scenarios that were submitted to the committee are presented with the responses as well as the thought processes considered by the committee members. The importance of this documentation is to clarify some points as well as update the SCI community regarding possible revisions that will be needed in the future based upon some rules that require clarification. Note: This manuscript is published jointly by Topics in Spinal Cord Injury Rehabilitation and the Journal of Spinal Cord Medicine.University of Michigan SCI Model SystemYesdevopsadmin
2016Effects of locomotor exercise intensity on gait performance in individuals with incomplete spinal cord injuryJournalJ75002Physical Therapy96121919-1929Study evaluated the effects of short-term manipulations in locomotor intensity on gait performance in people with motor incomplete spinal cord injury (iSCI) and investigated potential detrimental effects of high-intensity locomotor training on walking performance. Nineteen individuals with chronic iSCI performed a graded-intensity locomotor exercise task with simultaneous collection of lower-extremity kinematic and electromyographic data. Measures of interest were compared across intensity levels of 33 percent, 67 percent, and 100 percent of peak gait speed. A subset of 9 individuals participated in 12 weeks of high-intensity locomotor training. Similar measurements were collected and compared between pre-training and post-training evaluations. The results indicate that short-term increases in intensity led to significant improvements in muscle activity, spatiotemporal metrics, and joint excursions, with selected improvements in measures of locomotor coordination. High-intensity locomotor training led to significant increases in peak gait speed (0.64–0.80 meters per second), and spatiotemporal and kinematic metrics indicate a trend for improved coordination. Findings suggest that high-intensity locomotor exercise and training does not degrade, but rather improves, locomotor function and quality in individuals with iSCI, which contrasts with traditional theories of motor dysfunction following neurologic injury.Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2014Factors that influence changes in wheelchair cushion performance over timeJournalJ69070Assistive Technology26261-68Study monitored wheelchair cushion performance over time in order to identify the most important factors that predict cushion degradation. Cushions were obtained from a convenience sample of adult wheelchair users seen by the seating clinic at a rehabilitation hospital. The wheelchair users and their cushions were evaluated multiple times. Information was collected from participants’ about their posture and activities, their cushions, and use of their cushions. Cushion performance was determined by measuring interface pressure using a buttock model. Data analysis proceeded in two steps. First, principal component analysis was run to reduce the number of variables. Second, multiple regression determined which variables influenced the interface pressure performance variables. Results indicated that user characteristics and the manner in which the cushion is used have a greater influence on cushion performance than the chronological age of the cushion. This information can be useful to clinicians who should query users about cushion use when investigating the need to replace a cushion. This information is applicable to policies that govern cushion replacement and indicted that wear on a cushion is not equivocal across users.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2015Increased lower limb spasticity but not strength or function following a single-dose serotonin reuptake inhibitor in chronic strokeJournalJ72876Archives of Physical Medicine and Rehabilitation96122112-2119Study investigated the effects of single doses of a selective serotonin reuptake inhibitor (SSRI) on lower-limb voluntary and reflex function in individuals with chronic stroke. Ten individuals with post-stroke hemiplegia for more than 1 year were assessed before and 5 hours after they were randomly assigned to receive a single 10-milligram dose of escitalopram (SSRI) or placebo. Primary assessments included maximal ankle and knee isometric strength, and velocity-dependent plantarflexor stretch reflexes under passive conditions, and separately during and after 3 superimposed maximal volitional drive to simulate conditions of increased serotonin release. Secondary measures included clinical measures of lower limb coordination and locomotion. The results indicated that SSRI administration significantly increased stretch reflex torques at higher stretch velocities, with reflexes at lower velocities enhanced by superimposed voluntary drive. No significant improvements were seen in strength or in clinical measures of lower-limb function after the single-dose SSRI administration. Further studies should evaluate whether repeated dosing of SSRIs, or as combined with specific interventions, is required to elicit significant benefit of these agents on post-stroke lower-limb functionMidwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2015Differential impact and use of a telehealth intervention by persons with MS or SCIJournalJ72679American Journal of Physical Medicine and Rehabilitation9411987-999Study compared outcomes and patterns of engaging with a telehealth intervention (CareCall) by adult wheelchair users with severe mobility limitations. A secondary analysis was conducted of data from a pilot randomized controlled trial with 106 participants with spinal cord injury (SCI) and 36 participants with multiple sclerosis (MS). General linear model results showed that an interaction between baseline depression score and study group significantly predicted reduced depression at 6 months for subjects with both diagnoses. For those with MS, CareCall increased participants’ physical independence. No statistically significant differences in skin integrity were found between study groups for subjects with either diagnosis. All participants were similarly satisfied with CareCall, although those with MS engaged in almost double the amount of calls per person than those with SCI. Those with SCI missed more calls and required more extensive support from a nurse than those with MS. This study showed that an interactive telephone intervention was effective in reducing depression in adult wheelchair users with either MS or SCI, and in increasing health care access and physical independence for those with a diagnosis of MS. Future research should aim to enhance the efficacy of such an intervention for participants with SCI.New England Spinal CenterYesdevopsadmin
2015Evidence-based strategies for preserving mobility for elderly and aging manual wheelchair usersJournalJ73511Topics in Geriatric Rehabilitation (TGR)31126-41http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562294/Article addresses important issues for preserving function and mobility for elderly and aging individuals who use a manual wheelchair by reviewing the current available evidence and presenting recommendations. Elderly and aging manual wheelchair users have increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. Recommendations include strategies for reducing the mechanical loads and muscular demands through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2016How many spinal cord injury patients can catheterize their own bladder? The epidemiology of upper extremity function as it affects bladder managementJournalJ74535Spinal Cord (formerly Paraplegia)544287-291Study examined the upper-extremity (UE) motor function in patient with spinal cord injury (SCI) to provide insight into why clean intermittent catheterization (CIC) 'dropout' occurs and determine a more appropriate target percentage for CIC in this patient population. Discharge data were extracted from the National Spinal Cord Injury Database (NSCID) for the years 2006 to 2012. Neurologic motor scores for C5 to C8 (involved in UE movement) were transformed into a binary variable consisting of the ability (strong) or the inability (weak) to achieve active motion against resistance. An algorithm based on expert opinion and published literature was generated to categorize a person’s ability to perform CIC by the UE function alone. Of the 4,481 patients evaluated, 77.3 percent were unable to volitionally void. Of this subset, 58.8 percent were categorized as able to catheterize, 12.9 percent as possibly able, 4.3 percent as only able with surgical assistance, and 23.3 percent as unable. Among patients discharged with an indwelling catheter, 33.4 percent had adequate UE function for CIC. Among patients performing CIC at discharge, 14.1 percent had inadequate UE function for self-catheterization. The findings suggest that CIC dropout may occur, in part, because of inadequate UE motor function. In a best-case scenario, approximately 76 percent of patients with SCI who cannot volitionally void could potentially perform CIC given appropriate assistance.National SCI Statistical CenterYesdevopsadmin
2016Development and feasibility of health mechanics: A self-management program for individuals with spinal cord injuryJournalJ73989Topics in Spinal Cord Injury Rehabilitation222121-134This pilot study examined the feasibility of administering an individual, in-person version of Health Mechanics, an innovative self-management program designed to teach individuals with spinal cord injury (SCI) to maintain physical health and prevent secondary conditions. After baseline assessments, 27 participants were randomized to either the experimental intervention or a usual care group. Thirteen of the 19 participants in the intervention group completed the program. Follow-up assessments were completed at 3 and 6 months after baseline. Results suggest that the Health Mechanics intervention delivered in an in-person format was perceived as useful and relevant in addressing a diverse range of health issues with participants with a wide range of personal and impairment characteristics. However, attrition rates and barriers to recruitment suggested limitations in the acceptability of the format for this population. Additional research is needed to identify the populations that would most benefit from the program and the most efficacious context for administration.University of Michigan SCI Model SystemYesdevopsadmin
2015Innovative technologies for rehabilitation and health promotion: What is the evidence?JournalJ75761Physical Therapy953294-298Article introduces a special series that captures the essential role that innovative new technologies can play in physical therapy and rehabilitation practices globally. The articles that follow showcase research and case reports include perspectives about the role of social media in health care and health promotion, mobile health technologies, virtual reality-based tools for rehabilitation, and human-movement data collection.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2015Driving evaluation methods for able-bodied persons and individuals with lower extremity disabilities: A review of assessment modalitiesJournalJ75727Clinics (Sao Paulo)709638-647https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557573/Study identified existing driving evaluation modalities for able-bodied and lower extremity-impaired subjects (spinal cord injury patients and amputees) and evaluated the potential relationships between driving performance and the motor component of driving. An extensive scoping review of the literature was conducted to identify driving assessment tools that are currently used for able-bodied individuals and for those with spinal cord injury or lower-extremity amputation. The literature search focused on the assessment of the motor component of driving. References were electronically obtained via Medline from the PubMed, Ovid, Web of Science and Google Scholar databases. The search identified nine studies that described motor performance evaluations as components of driving assessment protocols in the general population. Most of these studies discussed the performance of older drivers and described specific motor assessment tests. Eight studies related to driving assessment for people with SCI or lower-limb amputation were identified. Of those studies, three were specifically designed to assess SCI subjects, and two focused on amputees. Overall, there is no clear evidence-based research or recommendation regarding how to properly assess fitness to drive among people with lower-extremity impairment. Very few articles were found concerning lower-extremity disabilities, thus confirming the need for further studies that can provide evidence and guidance for such assessments in the future. Little is known about the motor component of driving and its association with the other driving domains, such as vision and cognition. The available research demonstrates the need for a more evidenced-based understanding of how to best evaluate people with lower-extremity impairmentUniversity of Michigan SCI Model SystemYesdevopsadmin
2016Factors influencing the use of intermittent bladder catheterization by individuals with spina bifida in Brazil and GermanyJournalJ75845Rehabilitation NursingStudy identified and analyzed the factors that influence the use of intermittent catheterization (IC) by individuals with spina bifida and neurogenic bladder in Brazil and Germany. Data were collected using printed (Brazil) and online (Germany) questionnaires, and analyzed using multivariate logistical regression and analysis of variance. The study included 100 Brazilian and 100 German patients, aged 0-55 years, with spina bifida who utilized IC. Results indicated that IC was used by 188 of the 200 patients. Three variables were important for predicting who did or did not use IC: no discontinuation of IC, absence of technical difficulty, and daily frequency of IC. The findings suggest that difficulties with IC use experienced by spina bifida patients and their family members that predicted full discontinuation tended to be personal variables, rather than demographic or medical characteristics.University of Michigan SCI Model SystemYesdevopsadmin
2015Improvements in long-term survival after spinal cord injury?JournalJ71250Archives of Physical Medicine and Rehabilitation964645-651Study investigated whether there have been improvements in long-term survival after spinal cord injury (SCI) in recent decades. Specifically, this study examined mortality in people with SCI since 1973, focusing on the most recent period 2005 to 2012, to determine whether long-term survival, survival relative to the general population, and life expectancy .has changed. Participants were 31,531 patients treated at National SCI Model Systems facilities who survived 2 years after injury, were older than 10 years, and who did not require ventilator support. These subjects contributed 484,979 person-years of data, with 8,536 deaths over the 39-year (1973 to 2012) study period. The data were analyzed using the logistic regression model, Poisson regression model with comparison to the general population, and the computation of standardized mortality ratios for various groups. The outcome variable was survival or mortality, and the explanatory variables were age, sex, level and grade of injury, and calendar year. After adjustment for age, sex, race, etiology of injury, time since injury, and level and grade of injury, mortality in persons with SCI was higher in the 2005 to 2012 period than in 1990 to 2004 or 1980 to 1989, the odds ratios for these 3 periods were .857, .826, and .802, respectively, as compared with the 1970 to 1979 reference period. There was no evidence of improvement. The authors conclude that long-term survival after SCI has not changed over the past 30 years.National SCI Statistical CenterYesdevopsadmin
2015Differences in the community built environment influence poor perceived health among persons with spinal cord injuryJournalJ72392Archives of Physical Medicine and Rehabilitation9691583-1590Study assessed the association between characteristics of the built environment and differences in perceived health among individuals with spinal cord injury (SCI). A secondary analysis was conducted of data collected from 503 people with chronic SCI enrolled in the Spinal Cord Injury Model Systems database. All cases were residents of New Jersey, completed an interview during the years 2000 through 2012, had a complete residential address, and were community living at the time of follow-up. Bivariate tests indicated that persons with SCI residing in communities with more (vs less) mixed land use and small (vs large) amounts of open space were more likely to report poor perceived health. No associations were found between perceived health and differences in the residential or destination density of the community. Adjusting for variation in demographic, impairment, quality of life, and community socioeconomic characteristics accounted for the gap in the odds of reporting poor health between persons living in areas with large versus small amounts of open space. However, even after accounting for individual background differences, persons living in communities characterized by more heterogeneous land use were twice as likely to report poor health compared with persons living in less mixed areas. The results suggest living in a community with more heterogeneous land use was not beneficial to the perceived health of persons with chronic SCI living in New Jersey.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2015Energy cost of lower body dressing, pop-over transfers, and manual wheelchair propulsion in people with paraplegia due to motor-complete spinal cord injuryJournalJ71588Topics in Spinal Cord Injury Rehabilitation212140-148Study determined the energy expenditure associated with several basic physical tasks among individuals with paraplegia due to motor-complete spinal cord injury (SCI). Sixteen adults with motor-complete SCI below T2 level and duration of paraplegia greater than 3 months were included. Oxygen consumption (Vo2), caloric expenditure, and heart rate were measured at rest and while participants performed lower-body dressing (LBD), pop-over transfers (POTs), and manual wheelchair propulsion (MWP) at a self-selected pace. These data were used to calculate energy expenditure in standard metabolic equivalents (METs). Results indicated that resting Vo2 for adults with motor-complete paraplegia is lower than standard resting Vo2 in able-bodied individuals. Progressively more energy is required to perform MWP, LBD, and POTs, respectively. Use of the standard METs formula may underestimate the level of intensity an individual with SCI uses to perform physical activities.Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2016Health care self-advocacy strategies for negotiating health care environments: Analysis of recommendations by satisfied consumers with SCI and SCI practitionersJournalJ73144Topics in Spinal Cord Injury Rehabilitation22113-26Study identified strategies for self-advocacy and navigating the health care system as perceived by individuals with spinal cord injury (SCI) who report high satisfaction with their primary care, compared to the perceptions of SCI practitioners. Data were obtained through interviews conducted with 7 satisfied consumers with SCI and 4 experienced SCI practitioners. Analysis of consumer interview transcripts revealed 3 primary domains, with associated subdomains, against which practitioner data were compared. Consumers were asked about their experiences and recommendations for navigating primary care visits and equipment needs and, based on this, to recommend what they considered the most important self-advocacy skills and navigation strategies overall. Consumers recommended the most effective self-advocacy skills for health care settings, which also tended to be endorsed by SCI rehabilitation practitioners.New England Spinal CenterYesdevopsadmin
2014Injury perceptions, hope for recovery, and psychological status after spinal cord injuryJournalJ68726Rehabilitation Psychology592171-175Study investigated the influence of injury perceptions and hope for recovery on life satisfaction, purpose in life, and depressive symptoms measured during inpatient rehabilitation after spinal cord injury (SCI). Participants were 208 adults hospitalized for SCI inpatient rehabilitation, each of whom completed a modified version of the Illness Perception Questionnaire and three psychological outcome measures: the Purpose in Life Scale, the Satisfaction with Life Scale, and the abbreviated version of the Patient Health Questionnaire. Principal components analysis indicated one SCI perceptions factor regarding severity, permanence, and cure control of SCI, and a second factor related to hope for recovery. Whereas hope for recovery was nearly universal, injury perceptions were more varied. Favorable injury perceptions of SCI were predictive of purpose in life, while hope for recovery was predictive of life satisfaction. The study results indicated that hope for recovery and favorable SCI perceptions were related to positive psychological outcomes during inpatient rehabilitation, although the strength of the relationship was limited.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2016Dr. Samuel Stover: Promoting health and participation through leadership in spinal cord injury medicineJournalJ70823PM & R510809-815Article reviews the achievements and contributions of Dr. Samuel Stover to spinal cord injury (SCI) research and clinical care. An early leader in the field of SCI care in the United States, Dr. Stover contributed to the recognition and growth of the field in numerous ways. He was one of the individuals who was instrumental in the establishment and growth of the Spinal Cord Injury Model Systems (SCIMS) of Care program in the United States. The program continues, to this day, to provide cutting-edge care for people with traumatic onset SCI and the infrastructure for applied SCI research. The SCIMS’s primary aim has always been to improve the health and quality of life of this population. Stover was a key player in the development of the National SCI Dataset, which has been the model for a number of similar clinical research databases for persons with other acute and chronic disabling conditions. He is responsible for the development of the American Spinal Injury Association Standards for Neurological Classification of SCI and chaired the first committee in 1980. Stover’s research reflected his keen awareness of the importance of lifetime follow-up care for persons with SCI and the need for prevention and optimal treatment of the high-risk secondary complications of these unique patients. He always recognized that these potential complications would seriously impede his patients’ full participation in society and impact their quality of life.National SCI Statistical CenterYesdevopsadmin
2014Factors associated with pressure ulcer risk in spinal cord injury rehabilitationJournalJ70003American Journal of Physical Medicine and Rehabilitation9311971-986Study identified patient and clinical factors associated with the development of a stage 2 or higher pressure ulcer (PU) during spinal cord injury (SCI) rehabilitation. The 159 study patients, including 60 with new spinal injuries and 90 with earlier spinal injuries had identical rates at which they acquired a new PU (stage ≥2) in rehabilitation: 13.1 percent of the new SCI patients and 13.2 percent of the earlier SCI patients. The patients who came to rehabilitation with a PU or myocutaneous flap exhibited a higher rate of developing yet another PU while in rehabilitation (30.2 percent) than those who came to rehabilitation without an existing PU or flap (6.9 percent). Logistic regression analysis identified two variables that best predicted a patient’s risk at admission for developing a PU during rehabilitation: (1) entering rehabilitation with a PU and (2) admission Functional Independence Measure transfers score of less than 3.5. Using these two variables, rehabilitation centers can develop patient PU risk assessments to alert clinicians for the need to enhance vigilance, skin monitoring, and early patient education.National Capitol Spinal Cord Injury Model SystemYesdevopsadmin
2015Cortical activation during visual illusory walking in persons with spinal cord injury: A pilot studyJournalJ71263Archives of Physical Medicine and Rehabilitation964750-753Study determined the location of cortical activation during a visual illusion walking paradigm, a recently proposed treatment for spinal cord injury (SCI)-related neuropathic pain, in people with SCI compared with able-bodied controls. Three people with paraplegia and 5 able-bodied participants were included in this study. The walking stimuli consisted of a video of an actor walking along a path. The control stimuli consisted of the same actor propelling a manual wheelchair along the same path for the same length of time. Prior to the presentation of the stimuli during scanning, participants were instructed to imagine that they themselves were performing the movements of the actor, but without actual movement of limbs. They were instructed to gaze at a fixation point during resting state scanning. Cortical activation as measured by the blood oxygenation level-dependent method of functional magnetic resonance imaging. During visually illusory walking there was significant activation in the somatosensory cortex among those with SCI. In contrast, able-bodied participants showed little to no significant activation in this area, but they showed activation in the frontal and premotor areas. Results suggest that treatment modalities for SCI-related neuropathic pain that are based on sensory input paradigms (e.g., virtual walking, visual illusory walking) may work by targeting the somatosensory cortex, an area that has been previously found to functionally reorganize after SCI.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2017Are intensive data collection methods in pain research feasible in those with physical disability? A study in persons with chronic pain and spinal cord injuryJournalJ75847Quality of Life Research263587-300Study examined the feasibility (study compliance, protocol acceptability, and reactivity) of intensive data collection methods in adults with chronic pain and spinal cord injury (SCI). A secondary analysis was conducted of data from a 7-day ecological momentary assessment and end-of-day diary study in a sample of 131 community dwelling adults with SCI. The results showed rates of missing data ranged from 18.4 to 22.8 percent across measures. Participant compliance was related to time of day/presence of audible prompts, mobility aid use, race, and baseline levels of pain and pain interference, with more missing data at wake and bedtimes/no prompts, and for those who used hand-held mobility devices, identified as black/African American, and/or reported higher baseline pain and pain interference. Participants rated the study methodology as generally highly acceptable and expressed willingness to participate in similar studies of much longer duration. There was no evidence of reactivity, defined as temporal shifts in pain or pain interference ratings. Overall, intensive pain data collection is feasible in subjects with SCI with no evidence that the methodology impacts pain intensity or pain interference ratingsUniversity of Michigan SCI Model SystemYesdevopsadmin
2015Bladder cancer mortality after spinal cord injury over 4 decadesJournalJ68428The Journal of Urology19361923-1928Study estimated bladder cancer mortality in people with spinal cord injury (SCI) compared to the general population. Data and statistics were obtained from the National SCI Statistical Center and the National Center for Health Statistics. The mortality experience of the 45,486 patients with traumatic SCI treated at a SCI Model System or Shriners Hospital was compared to the general population using a standardized mortality ratio. The standardized mortality ratio data were further stratified by age, gender, race, time since injury and injury severity. Analysis of 566,532 person-years of follow-up between 1960 and 2009 identified 10,575 deaths, and 99 were categorized as deaths from bladder cancer. The expected number of deaths from bladder cancer would have been 14.8 if patients with SCI had the same bladder cancer mortality as the general population. Thus, the standardized mortality ratio is 6.7. Increased mortality risk from bladder cancer was observed for various ages, races and genders, as well as for those injured for 10 or more years and with motor complete injuries. Bladder cancer mortality was not significantly increased for ventilator users, those with motor incomplete injuries or those injured less than 10 years. Individuals with SCI can potentially live healthier and longer by reducing the incidence and mortality of bladder cancer. Study findings highlight the need to identify at-risk groups and contributing factors for bladder cancer death, leading to the development of prevention, screening and management strategies.National SCI Statistical CenterYesdevopsadmin
2016Comorbid traumatic brain injury and spinal cord injury: Screening validity and effect on outcomesJournalJ74689Archives of Physical Medicine and Rehabilitation97101628-1634Study evaluated the diagnostic accuracy of a self-report measure of traumatic brain injury (TBI) in people with spinal cord injury (SCI), and assessed the potential effect of TBI on acute and postacute inpatient rehabilitation outcomes. Step 2 of the Traumatic Brain Injury-4 (TBI-4) interview was used to estimate the presence and severity of TBI in 105 participants admitted to 2 SCI Model Systems programs. The TBI-4 was developed to identify people with a lifetime history of TBI among veterans seeking mental health services; Step 2 was found to be the best indicator of “probable TBI.” The incidence of TBI as determined by the TBI-4 self-report was compared with diagnosis based on a systematic medical records review by physicians blinded to self-reported TBI. Estimated incidence of TBI was 33 percent by chart review and 60 percent based on Step 2 of the TBI-4. Ninety-one percent of those with TBI based on chart review sustained mild injuries. At the optimal cutoff of “possible TBI,” the TBI-4 had a sensitivity of 83 percent, a specificity of 51 percent, and a Youden Index of 0.3. Compared with those without TBI, those with chart review-determined TBI had nonsignificant trends toward a longer acute care length of stay and a higher functional status at rehabilitation discharge, but equivalent 1-year outcomes. Step 2 of theTBI-4 did not meet Youden’s criteria (≥0.8) for good diagnostic accuracy in the context of recent SCI. Comorbid TBIs were almost exclusively mild and not associated with poorer outcomes 1 year after SCI.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2014Depression, pain intensity, and interference in acute spinal cord injuryJournalJ67980Topics in Spinal Cord Injury Rehabilitation20132-39Study investigated the independent contributions of pain intensity and pain interference to depression in individuals undergoing acute inpatient rehabilitation for traumatic spinal cord injury (SCI). Participants completed a survey that included measures of depression, pain intensity, and pain interference (in the domains of general activity, mood, mobility, relations with others, sleep, and enjoyment of life). Demographic and injury characteristics and information about current use of antidepressants and pre-injury binge drinking also were collected. Hierarchical multiple regression was used to test depression models in 3 steps: (1) age, gender, days since injury, injury level, antidepressant use, and pre-injury binge drinking (controlling variables); (2) pain intensity; and (3) pain interference (each tested separately). With one exception, pain interference was the only statistically significant independent variable in each of the final models. Although pain intensity accounted for only 0.2 to 1.2 percent of the depression variance, pain interference accounted for 13 to 26 percent of the variance in depression. The findings suggest that pain intensity alone is insufficient for understanding the relationship of pain and depression in acute SCI. Instead, the ways in which pain interferes with daily life appear to have a much greater bearing on depression.University of Michigan SCI Model SystemYesdevopsadmin
2014Adiponectin is associated with bone strength and fracture history in paralyzed men with spinal cord injuryJournalJ73514Osteoporosis International25112599-2607Study investigated the relationship between circulating adiponectin levels and bone strength in 27 paralyzed men with spinal cord injury (SCI). Plasma adiponectin levels were quantified by ELISA assay. Axial stiffness and maximal load to fracture of the distal femur were quantified via finite element analysis using reconstructed three-dimensional models of volumetric computerized tomography scans. Information on the timing, location, and cause of previous fractures was also collected. Axial stiffness and maximal load were inversely associated with circulating adiponectin levels after adjusting for injury duration and lower extremity lean mass. In individuals with post-SCI osteoporotic fractures, distal femur stiffness and maximal load were lower, and adiponectin was higher than those with no fracture history. Results indicate that bone strength is inversely associated with circulating adiponectin levels. Based on these findings, strength estimates may improve fracture risk prediction and detection of response to osteogenic therapies following SCI. Furthermore, the findings suggest that circulating adiponectin may indeed be a feasible biomarker for bone health and osteoporotic fracture risk in paralyzed individuals with SCI.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2014Association of acute pancreatitis or high level of serum pancreatic enzymes in patients with acute spinal cord injury: A prospective studyJournalJ73924Spinal Cord (formerly Paraplegia)5211817-820Study investigated the association of acute pancreatitis in acute spinal cord injury (SCI). A prospective observational study was conducted with 78 patients with an acute SCI diagnosis confirmed by clinical examination and image analysis, with partial, complete deficit or without deficit according to the American Spinal Injury Association (ASIA) Classification. The association of acute pancreatitis in patients with SCI was 11.53 percent. The occurrence of pancreatitis or high levels of serum pancreatic enzymes in patients with ASIA A was 41.7 percent and only 4.17 percent in patients with ASIA E (no neurological deficit). In all, 55.2 percent of patients who presented pancreatitis or high levels of serum pancreatic enzymes had cervical level of SCI and 34.5 percent had thoracic level. Adynamic ileus was observed in 68.96 percent of this group. The authors concluded that, in acute SCI, the occurrence of acute pancreatitis or high serum levels of pancreatic enzymes are more frequent in patients with ASIA A Classification, cervical/thoracic level of spinal injury and adynamic ileus.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2015Changes in cigarette smoking after traumatic spinal cord injuryJournalJ72929Rehabilitation Psychology604379-382Study identified changes in the prevalence of cigarette smoking approximately 1 year after discharge from inpatient rehabilitation for spinal cord injury (SCI). Self-report assessments were completed by 129 participants with SCI during initial inpatient rehabilitation and at an average follow-up of 489 days after injury. Results indicated that the prevalence of cigarette smoking declined from 36.4 percent at the time of SCI onset to 18.8 percent, and was not significantly different from the general population at follow-up. The results indicate that cigarette smoking rates decrease significantly in the first 16 months after SCI onset. This presents a window of opportunity for rehabilitation psychologists to initiate smoking cessation to reduce smoking rates and improve the health of people with SCI.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2015Computer keyboarding biomechanics and acute changes in median nerve indicative of carpal tunnel syndromeJournalJ75724Clinical Biomechanics30546-550Study investigated whether continuous keyboarding can cause acute changes in the median nerve at the inlet of the carpal tunnel and whether these changes correlate with wrist biomechanics during keyboarding. Thirty-seven healthy individuals performed a 60-minute typing task. Ultrasound images were collected at baseline, after 30 and 60 minutes of typing, then after 30 minutes of rest. Kinematic data were collected during the typing task. Variables of interest were median nerve cross-sectional area, flattening ratio, and swelling ratio at the pisiform; subject characteristics (age, gender, body mass index, wrist circumference, typing speed); and wrist joint angles. Results showed increased cross-sectional area and swelling ratio after 30 and 60 minutes of typing, and then decreased to baseline after 30 minutes of rest. Peak ulnar deviation contributed to changes in cross-sectional area after 30 minutes of typing. The results from this study confirmed a typing task causes changes in the median nerve, and changes are influenced by level of ulnar deviation. Furthermore, changes in the median nerve are present until cessation of the activity. While it is unclear if these changes lead to long-term symptoms or nerve injury, their existence adds to the evidence of a possible link between carpal tunnel syndrome and keyboarding.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2015An investigation of bilateral symmetry during manual wheelchair propulsionJournalJ75723Frontiers in Bioengineering and Biotechnology386https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464056/Study evaluated bilateral symmetry during manual wheelchair propulsion in a large group of subjects across different propulsion conditions. Three-dimensional kinematics and handrim kinetics along with spatiotemporal variables were collected and processed from 80 subjects with paraplegia. Participants propelled their wheelchairs on a stationary ergometer during three different conditions: level propulsion at their self-selected speed (free), level propulsion at their fastest comfortable speed (fast), and propulsion on an 8-percent grade at their level, self-selected speed (graded). Data analysis indicated that all kinematic variables had significant side-to-side differences, primarily in the graded condition. Push angle was the only spatiotemporal variable with a significant side-to-side difference, and only during the graded condition. No kinetic variables had significant side-to-side differences. The magnitudes of the kinematic differences were low, with only one difference exceeding 5 degrees. With differences of such small magnitude, the bilateral symmetry assumption appears to be reasonable during manual wheelchair propulsion in subjects without significant upper-extremity pain or impairment. However, larger asymmetries may exist in individuals with secondary injuries and pain in their upper extremity and different etiologies of their neurological impairment.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2015Biological approaches to treating intervertebral disk degeneration: Devising stem cell therapiesJournalJ73916Cell Transplantation242197-2208Article describes biological therapies under preclinical or clinical development with an emphasis on stem cell-based multimodal approaches that target prevention and treatment of intervertebral disk (IVD) degeneration. IVD degeneration is a common, chronic, and complex degeneration process that frequently leads to back pain and disability, resulting in a major public health issue. Systematical review of the basic science and clinical literature was performed to summarize the current status of devising biological approaches to treating IVD degeneration. Since the exact mechanisms underlying IVD degeneration have not yet been fully elucidated and conservative managements appear to be mostly ineffective, current surgical treatment focuses on removal of the pathological disk tissues combined with spinal fusion. The treatment options, however, often produce insufficient efficacy and even serious complications. Therefore, there have been growing demands and endeavors for developing novel regenerative biology-guided strategies for repairing the IVD via delivery of exogenous growth factors, introduction of therapeutic genes, and transplantation of stem cells, or combinatorial therapies. Overall, the data suggest that when applied under a recovery neurobiology principle, multimodal regimens comprising ex vivo engineered stem cell-based disks hold a high potential promise for efficacious clinical translations.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2015Coming soon: Vertical robotic rehabJournalJ71147New Mobility2625929, 31-33http://www.newmobility.com/2015/04/robotic-rehab/Article reviews the improved features of three different types of lower body exoskeletons in use at various rehabilitation facilities across the United States and throughout Europe. The ReWalk has received Food and Drug Administration approval for sale to individuals. The Ekso and the Indego both plan on following soon. Exoskeletons can be used for gait training, mobility or exercise. Each manufacturer sees its product as a way for people to gain greater mobility and freedom.Rocky Mountain Regional SCI SystemYesdevopsadmin
2016Depression trajectories during the first year after spinal cord injuryJournalJ73152Archives of Physical Medicine and Rehabilitation972196-203Study determined the number and type of depression trajectories during the first year after spinal cord injury (SCI) and identified baseline predictors of these trajectories. Of 168 patients admitted to inpatient rehabilitation for acute SCI and enrolled in a randomized controlled trial telephone follow-up intervention, which showed no outcome differences, 141 patients were assessed on at least 2 of the 4 follow-up occasions (3, 6, 9, and 12 months after SCI). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Unconditional linear latent class growth analysis models of PHQ-9 total scores revealed an optimal 3-class solution that identified 3 depression trajectories: stable low depression (63.8 percent), mild to moderate depression (29.1 percent), and persistent moderate to severe depression (7.1 percent). Preinjury mental health history and baseline pain, quality of life, and grief predicted class membership. The modal response to SCI was stable low depression, whereas persistent moderate to severe depression primarily represented a continuation or relapse of preinjury depression.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2014Adiponectin is a candidate biomarker of lower extremity bone density in men with chronic spinal cord injuryJournalJ70834291251-259http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3979427Study determined the association among bone mineral density (BMD), walking status, and circulating adipokines (adiponectin and leptin) in men with chronic spinal cord injury (SCI). In the general population, greater body fat is associated with greater BMD and this is often attributed to mechanical loading of the skeleton by fat mass and modulation of bone turn over by adipokines. A total of 149 participants were studied; 54 subjects walked independently or with an assistive device and 95 subjects used a wheelchair. Although adipokine levels did not vary significantly based on walking status, there was a significant inverse relationship between adiponectin and BMD in wheelchair users independent of body composition. The study found no association between adiponectin and BMD in the walkers and no association between leptin and BMD in either group. These findings suggest that for people with chronic SCI, walking may mitigate the effect of adiponectin-mediated bone loss. For wheelchair users, adipose-derived adiponectin may contribute to SCI-induced osteoporosis because the osteoprotective benefits of obesity appear to require mechanical loading during ambulation. Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2016Association between time to rehabilitation and outcomes after spinal cord injuryJournalJ74688Archives of Physical Medicine and Rehabilitation97101620-1627Study examined the relationship between time to rehabilitation after spinal cord injury (SCI) and rehabilitation outcomes at discharge and 1-year postinjury. Participants were 3,937 patients who experienced traumatic SCI between 2000 and 2014, were 18 years or older, and were admitted to a Spinal Cord Injury Model Systems center within 24 hours of injury. Time to rehabilitation was measured as the number of days between the injury and admission to inpatient rehabilitation. Outcome measures included the Rasch-transformed Functional Independence Measure (FIM) motor score at discharge and 1-year postinjury, discharge to a private residence, and the Craig Handicap Assessment and Reporting Technique (CHART) Physical Independence and Mobility scores at 1-year postinjury. After accounting for health status, a 10-percent increase in time to rehabilitation was associated with a 1.50 lower FIM motor score at discharge and a 3.92 lower CHART Physical Independence score at 1-year postinjury. Compared to the mean FIM motor score (37.5) and mean CHART Physical Independence score (74.7), the above-mentioned values represent relative declines of 4.0 percent and 5.3 percent, respectively. There was no association between time to rehabilitation and discharge to a private residence, 1-year FIM motor score, or the CHART mobility score. Findings suggest that earlier rehabilitation after traumatic SCI may improve patients’ functional status at discharge.National SCI Statistical CenterYesdevopsadmin
2014Cardiometabolic changes and disparities among persons with spinal cord injury: A 17-year cohort studyJournalJ68672Topics in Spinal Cord Injury Rehabilitation20296-104Study identified the magnitude of changes in biomarkers of cardiometabolic syndrome and diabetes over time in people aging with spinal cord injury (SCI), and determined how these biomarkers relate to demographics of race/ethnicity and sex. This cohort study was a 17-year follow-up of 150 participants from a full cohort of 845 adults with traumatic SCI who participated in research in which physiologic and serologic data on cardiovascular disease had been prospectively collected (1993-1997). Average years to follow-up were 15.7. Assessments were age, race, level and completeness of injury, duration of injury, blood pressure, body mass index, waist circumference, serum lipids, fasting glucose, hemoglobin A1c, and medications used. Primary outcome was meeting at least 3 of the criteria for cardiometabolic syndrome. Results showed that the frequency of cardiometabolic syndrome increased significantly from 6.7 percent to 20.8 percent or 38.2 percent, depending on the 2 diagnostic definitions used in the follow-up. It was significantly higher in Hispanics and apparently higher in women. Diabetes increased significantly by a factor of 6.7. These findings suggest that clinical practice guidelines need to be customized for women and Hispanics with SCI.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2017Complications of spinal cord injury over the first year after discharge from inpatient rehabilitationJournalJ76873Archives of Physical Medicine and Rehabilitation9891800-1805Study determined the prevalence and cumulative incidence of secondary complications of spinal cord injury (SCI) in the first year after discharge from inpatient rehabilitation and evaluated potential associations between risk of complications and sociodemographic and injury-specific factors. Data were collected from 169 adults with SCI who participated in a randomized controlled trial comparing telephone follow-up (at 3, 6, 9, and 12 months) with usual care during the first year after discharge. During each phone interview, participants were asked whether they had developed any of a specified list of 10 SCI-related complications since they were last contacted by the research team. Participants experienced a mean of 4.7 complications over 12 months. The most frequently reported complications were urinary tract infection (UTI), autonomic dysreflexia (AD), and pressure ulcers, with cumulative incidences of 62, 43, and 41 percent, respectively. Bone and soft tissue injuries (cumulative incidence, 35 percent) and bowel problems, including impaction or severe constipation (cumulative incidence, 33 percent), were also common. Cumulative incidences of AD, decubitus ulcers, UTI, and problems with bladder were greater in participants with higher level and more complete injuries, and some recurrent complications were common. Age at injury and impairment level significantly affected rates of complications, and subjects developed an average of 2.33 distinct complications during the study period. Although these data offer some insight into who with SCI is at highest risk for first time and recurrent complications, further study is needed to refine this understanding and to develop effective educational and prevention strategies.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2014Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humansJournalJ70830Brain: A Journal of Neurology13751394-1409Article discusses results from an ongoing study of stand and step training in combination with epidural stimulation in individuals with chronic motor complete spinal cord injury (SCI). This study demonstrates the ability of four individuals with chronic complete motor paralysis to execute voluntary tasks with selectivity of appropriate motor pools in the presence of epidural stimulation. High fidelity sensorimotor translation of visual and auditory signals were processed to control the timing and amount of force generated during the movements. In three of the four subjects, voluntary movement with epidural stimulation soon after implantation, even in the two subjects who had complete loss of both motor and sensory functions. By neuromodulating the spinal circuitry at sub-threshold motor levels with epidural stimulation, completely paralyzed individuals can process conceptual, auditory, and visual input to regain specific voluntary control of paralyzed muscles. The authors contend that they have uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury. The findings suggest that neuromodulation of the sub-threshold motor state of excitability of the lumbosacral spinal networks was the key to recovery of intentional movement in four of four individuals diagnosed as having complete paralysis of the legs.Yesdevopsadmin
2017Benefits of an exercise wellness program after spinal cord injuryJournalJ78079Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)402154-158Study examined the initial benefits of a structured group exercise program on exercise frequency and intensity, perceived health, pain, mood, and television watching habits for people with spinal cord Injury (SCI). Eighty-nine people with SCI participated voluntarily in a no-cost, twice weekly physical therapy group exercise class over 3 months. Forty-five of those participants completed both pre- and post-participation interviews on exercise frequency and intensity, perceived health, pain, mood, sleep, and television watching habits. Results showed a significant improvement in days of strenuous and moderate exercise as well as health state. There was an average decrease in pain scores, depression scores, number of hours spent watching television, and days per week of mild exercise. Findings suggest that participation in structured, small-group exercise as a component of a wellness program after SCI shows promise for improving regular exercise participation and health state, but benefits may also occur across other areas of health and function including mood, pain, and hours spent watching television. Further follow-up is needed to determine whether improvements can be maintained after program completion and across all neurological levels.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2014Colostomy pros and consJournalJ68711New Mobility2524751-55Article discusses the benefits and limitations of colostomies. A colostomy involves surgically redirecting the colon (large intestine) to a stoma (surgically created hole) in the abdominal region to allow fecal matter to exit the body into a bag that the user wears for that purpose. The author explains how a colostomy works and people with spinal cord injuries share their personal experiences with colostomies.Rocky Mountain Regional SCI SystemYesdevopsadmin
2016Cross-sectional investigation of acute changes in ultrasonographic markers for biceps and supraspinatus tendon degeneration after repeated wheelchair transfers in people with spinal cord injuryJournalJ74939American Journal of Physical Medicine and Rehabilitation9511818-830Study investigated how wheelchair transfers influence acute changes in ultrasound markers for biceps and supraspinatus tendon degeneration and determined how such changes correlate with transfer technique and demographic characteristics. Sixty-two wheelchair users with spinal cord injury (39 with paraplegia and 23 with tetraplegia) underwent quantitative ultrasound examinations for markers of biceps and supraspinatus tendon degeneration (tendon width, echogenicity, variance, and contrast) before and after a stressful repeated-transfers protocol. The Transfer Assessment Instrument was completed for each participant to identify transfer skills. Linear regression tested whether demographics and transfer skills correlated with ultrasound measures. The results showed that biceps tendon width increased after repeated transfers. Participants with greater body weight experienced greater increases in biceps width after transfers. Skills evaluating body position relative to the target surface and safe and stable hand and arm positions affected changes in biceps and supraspinatus width and echogenicity. The findings indicated that changes in biceps and supraspinatus ultrasound measures were related to body weight and performance of specific transfer skills. Further testing is needed to confirm whether the clinical meaning of the observed relationships and whether using certain transfer skills and reducing body weight can attenuate the development of tendinopathy.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2017Association between presence of pneumonia and pressure ulcer formation following traumatic spinal cord injuryJournalJ77092Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)404415-422Study investigated the relationship between the presence of pneumonia and pressure ulcers in individuals with spinal cord injury (SCI) during acute care and rehabilitation hospitalizations. Data were obtained from the SCI Model Systems program for patients enrolled from 1993 to 2006. A cohort of 3,098 individuals hospitalized in acute care and 1,768 in inpatient rehabilitation facilities was included in the analysis. Frequencies of pressure ulcer formation and episodes of pneumonia were noted in both settings. Results showed the development of pressure ulcers was 20.3 percent during acute care and 21.1 percent during in inpatient rehabilitation. Multivariate logistic regression analyses revealed a significant association of pneumonia with occurrence of pressure ulcers, the American Spinal Injury Association Impairment Scale grades, and utilization of mechanical ventilation in both settings. The study found a higher presence of pressure ulcers in individuals with pneumonia, after adjusting for injury severity, age, sex, and utilization of mechanical ventilation. Impaired inflammatory response and decreased mobility in individuals with pneumonia may predispose these individuals to develop pressure ulcers. Surveillance and preventive measures for pressure ulcers should be rigorous in individuals with SCI and pneumonia.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2015Car transfer and wheelchair loading techniques in independent drivers with paraplegiaJournalJ75722Frontiers in Bioengineering and Biotechnology3139https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585017/Article describes techniques and factors influencing car transfer and wheelchair loading for 29 individuals with paraplegia driving their own vehicles and using their personal wheelchairs. Sedans were the most common vehicle driven. Just over half of drivers placed their right leg only into the vehicle prior to transfer. Overall, the leading hand was most frequently placed on the driver's seat prior to transfer and the trailing hand was most often place on the wheelchair seat. Vehicle height influenced leading hand placement but not leg placement such that drivers of higher profile vehicles were more likely to place their hand on the driver's seat than those who drove sedans. Body lift time was negatively correlated with level of injury and age and positively correlated with vehicle height and shoulder abduction strength. Drivers who transferred with their leading hand on the steering wheel had significantly higher levels of shoulder pain than those who placed their hand on the driver's seat or overhead. The majority of participants used both hands to load their wheelchair frame, and overall, most loaded their frame into the back versus the front seat. Sedan drivers were more likely to load their frame into the front seat than drivers of higher profile vehicles. Average time to load the wheelchair frame (10.7 seconds) was 20 percent of the total wheelchair loading time and was not related to shoulder strength, frame weight, or demographic characteristics. Those who loaded their wheelchair frame into the back seat had significantly weaker right shoulder internal rotators.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2016Compensatory strategies during manual wheelchair propulsion in response to weakness in individual muscle groups: A simulation studyJournalJ75717Clinical Biomechanics3334-41https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821704/Study used musculoskeletal modeling and forward dynamics simulations of manual wheelchair propulsion to identify compensatory strategies to overcome weakness in individual muscle groups and identify specific strategies that may increase injury risk. Identifying these strategies can provide the rationale for the design of targeted rehabilitation programs aimed at preventing the development of pain and injury in manual wheelchair users. Muscle-actuated forward dynamics simulations of manual wheelchair propulsion were analyzed to identify compensatory strategies in response to individual muscle group weakness using individual muscle mechanical power and stress as measures of upper extremity demand. The simulation analyses found the upper extremity to be robust to weakness in any single muscle group as the remaining groups were able to compensate and restore normal propulsion mechanics. The rotator cuff muscles experienced relatively high muscle stress levels and exhibited compensatory relationships with the deltoid muscles. These results emphasize the importance of strengthening the rotator cuff muscles and supporting muscles whose contributions do not increase the potential for impingement (i.e., the thoracohumeral depressors) and minimize the risk of upper extremity injury in manual wheelchair users.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2014Aging with SCI: Good news, bad newsJournalJ69371New Mobility2525149-53Article examines issues that wheelchair users may face as they get older while living with a spinal cord injury (SCI). Many of the problems are in line with what research reports for their non-disabled peers. Tips for coping with the problems and informational websites are provided.Rocky Mountain Regional SCI SystemYesdevopsadmin
2014Associations with chest illness and mortality in chronic spinal cord injuryJournalJ70178Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)376662-669Study identified factors associated with chest illness and examined relationship between chest illness and mortality in chronic spinal cord injury (SCI). Between 1994 and 2005, 430 adults at least 4 years post SCI, with a mean age of 52 years, underwent spirometry, completed a health questionnaire, and reported any chest illness resulting in time off work, indoors at home, or in bed in the preceding 3 years. Deaths through 2007 were identified. Logistic regression assessed relationships with chest illness at baseline and Cox regression assessed the relationship between chest illness and mortality. Chest illness was reported by 139 participants (32.3 percent). Personal characteristics associated with chest illness were current smoking, chronic obstructive pulmonary disease (COPD), and heart disease. Adjusting for age, subjects reporting previous chest illness had a non-significantly increased hazard ratio (HR) for mortality (1.30). In a multivariable model, independent predictors of mortality were greater age, SCI level and completeness of injury, diabetes, a lower percent-predicted forced expiratory volume in 1 second, heart disease, and smoking history. Adjusting for these covariates, the effect of a previous chest illness on mortality was attenuated (HR = 1.15). In chronic SCI, chest illness in the preceding 3 years was not an independent risk factor for mortality and was not associated with level and completeness of SCI, but was associated with current smoking, physician-diagnosed COPD, and heart disease history.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2016Characteristics of individuals with spinal cord injury who use cannabis for therapeutic purposesJournalJ73143Topics in Spinal Cord Injury Rehabilitation22112-MarStudy described the characteristics of individuals with spinal cord injury (SCI) who self-reported use of cannabis for therapeutic purposes (CTP) and examined correlations with health behaviors and health indicators. This was a secondary analysis of data from a cross-sectional study involving community-dwelling individuals with chronic SCI and neurogenic bladder and bowel, at least 5 years post injury. Data were collected via structured interviews. Of the 244 subjects in the sample, 92.2 percent lived in states that, at the time of the study, permitted the use of CTP; 22.5 percent reported using CTP at least monthly to relieve pain and spasticity. Of those 54 participants, 52.7 percent were daily users. While 23.0 percent of non-CTP users reported having prescriptions for at least one opioid-based medication, 38.1 percent of CTP users did so, suggesting that CTP use does not mitigate opioid use. Users were more likely to be single and live alone, report more bladder complications, and perceive their psychosocial functioning as more compromised than non-users. Results suggest that a relatively large percentage of individuals with chronic SCI use CTP on a regular basis and they may be more vulnerable to complications and to risk factors for substance use disorders in SCI, such as social isolation. Although the generalizability of these findings is limited by the sampling strategies and the eligibility criteria of the larger study, CTP use should be assessed and considered when planning health interventions.University of Michigan SCI Model SystemYesdevopsadmin
2016Cross-sectional associations of pulmonary function with systemic inflammation and oxidative stress in individuals with chronic spinal cord injuryJournalJ76022Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)393344-352Study evaluated the associations of biomarkers of inflammation (C-reactive protein [CRP], interleukin-6 [IL-6]) and novel markers of global oxidative stress with spirometric and lung volume measures in individuals with chronic spinal cord injury (SCI). Systemic inflammation, and to a lesser extent oxidative stress, have been associated with reduced pulmonary function. One-hundred thirty-seven men with chronic SCI provided a blood sample, completed health questionnaires, and underwent pulmonary function testing, including helium dilution measurement of functional residual capacity (FRC). Outcomes measures included: percent-predicted forced vital capacity in one second (FEV1), percent-predicted forced vital capacity (FVC), FEV1/FVC, percent-predicted residual volume, percent-predicted FRC, and percent-predicted total lung capacity. General linear models were used to model associations between increasing quartiles of inflammation or oxidative stress with each outcome measure. After adjustment for a number of confounders, participants with higher levels of CRP and IL-6 had lower percent-predicted FEV1 and FVC measurements. There were no clear patterns of association with any of the oxidative stress biomarkers or other outcome measures. Results of this study indicated that increased systemic inflammation was associated with reductions in FEV1 and FVC independent of a number of covariates (SCI level and severity, doctor-diagnosed chronic obstructive pulmonary disease, body mass index, cigarette smoking, and statin use). Although the mechanism is uncertain, these findings suggest that reductions in pulmonary function in SCI are associated with systemic inflammation. However, there were no consistent associations between pulmonary function measures and biomarkers of global oxidative stress.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2014Assessment of neuromuscular conditions using ultrasoundJournalJ69552Physical Medicine and Rehabilitation Clinics of North America253531-543Article examines the nature of musculoskeletal injuries and pain syndromes affecting the upper extremities in people with spinal cord injury (SC) and discusses how these complaints are being evaluated using ultrasound. Upper-extremity pain is common in patients with SCI and can cause significant morbidity. Most structures involved are tendons, ligaments, and nerves. Ultrasound is a cheap, accurate, and accessible modality to complement the physical examination in these patients. Although current studies have focused on characterizing the changes in patients with SCI with exercise, or comparison of changes with able-bodied control groups, ultrasound has the potential to do so much more. There is significant evidence that this modality can recognize the major pathologic processes in the SCI population, but most studies have not included this population. In addition, newer ultrasound modalities, including elastography ultrasound, might be more sensitive in identifying early changes in tendons and nerves, and may lead to early intervention, thus preventing significant morbidity.South Florida SCIMSYesdevopsadmin
2016Breaking the news: A pilot study on patient perspectives of discussing prognosis after traumatic spinal cord injuryJournalJ74736Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)392155-161Study assessed patient perspectives or preferences on when and how professionals should deliver news to patients regarding poor prognosis for neurological recovery after severe (neurologically complete) traumatic spinal cord injury (SCI). Sixty subjects with a motor-complete SCI for at least 3 months were recruited from three geographically different acute rehabilitation centers to complete an online survey to obtain retrospective information on their experiences of receiving poor prognosis. A mixed-methods approach was used to obtain data on individual experiences and a combination of quantitative and qualitative analyses was used to assess patterns in individual responses. Sixty individuals were recruited for the study and 56 participants completed the survey. Most heard their prognosis from a physician, in the acute care hospital (61 percent), with the patient initiating the conversation (64 percent). The majority of patients surveyed report wanting to know their prognosis early after injury and to hear the information by a physician in a clear and sensitive manner. There were no differences in patient experience nor recommendations based on demographic background (i.e., sex, age, race, or education level).Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2018Comparing blunt and penetrating trauma in spinal cord injury: Analysis of long-term functional and neurological outcomesJournalJ78722Topics in Spinal Cord Injury Rehabilitation242121-132Study compared baseline characteristics and neurological and functional outcomes for patients with penetrating spinal cord injury (PSCI) and blunt spinal cord injury (BSCI). Data for 5,316 participants with BSCI and 1,062 with PSCI were extracted from the Spinal Cord Injury Model Systems database from January 1994 to January 2015. Participant injury and demographic characteristics were recorded. Outcomes were measured using the International Standards for Neurological Classification of Spinal Cord Injury and Functional Independence Measure (FIM) motor scores. Outcomes for patients with American Spinal Injury Association Impairment Scale (AIS) complete injuries were analyzed separately from incomplete injuries at three time points: acute hospitalization, SCI rehabilitation, and 1-year follow-up. Patients with PSCI compared to those with BSCI were more likely to present with complete injuries (56.8 vs 35.9 percent) and were less likely to undergo spine surgery (19.6 vs 80.6 percent). For incomplete injuries, no significant differences were observed between groups in FIM scores or AIS grade improvement at 1 year. For complete injuries, patients with BSCI showed an increased one-grade (15.7 vs 9.1 percent) and three-grade (5.4 vs 1.9 percent) AIS improvement at 1 year. Multivariate regression analysis demonstrated an independent effect for BSCI on AIS improvement at 1 year. Patient with PSCI had more complete injuries and lower surgery rates. Patients with complete BSCI showed greater AIS improvement at 1 year, and incomplete injuries show no difference in neurological improvement between groups. Overall, patients with PSCI demonstrated worse functional outcomes at 1 year.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2016Developing artificial neural network models to predict functioning one year after traumatic spinal cord injuryJournalJ74694Archives of Physical Medicine and Rehabilitation97101663-1668, 1668.e1-1668.e3Study developed mathematical models for predicting level of independence with specific functional outcomes 1 year after discharge from inpatient rehabilitation for spinal cord injury (SCI). Specifically, the study compared the accuracy and performance of statistical analyses using artificial neural networks (ANNs) and logistic regression methods to estimate longer-term ambulation and non-ambulation outcomes. Participants were 3,142 subjects with traumatic SCI who contributed data to the National SCI Model Systems Database longitudinal outcomes studies. Outcome measures included self-reported ambulation ability and Functional Independence Measure-derived indices of level of assistance required for self-care activities (bed-chair transfers, bladder and bowel management, eating, and toileting). Results indicated that the models for predicting ambulation status were highly accurate (>85 percent case classification accuracy; areas under the receiver operating characteristic curve were between .86 and .90). Models for predicting non-ambulation outcomes were moderately accurate (76 to 86 percent case classification accuracy; areas under the receiver operating characteristic curve between .70 and .82). The performance of models generated by ANNs closely paralleled the performance of models analyzed using logistic regression constrained by the same independent variables. With further prospective validation, such predictive models may allow clinicians to use data available at the time of admission to inpatient SCI rehabilitation to accurately predict longer-term ambulation status, and whether individual patients are likely to perform various self-care activities with or without assistance from another person.New England Spinal CenterYesdevopsadmin
2015Aging and spinal cord injury: External causes of injury and implications for preventionJournalJ72827Topics in Spinal Cord Injury Rehabilitation213218-226Study documents the causes and usual circumstances surrounding the occurrence of spinal cord injury (SCI) among the elderly. Data on individuals injured in 2005 or later were retrieved from the National SCI Database. Demographics, injury profiles, and external causes of injury were compared between the study group (1,079 adults over 60 years of age) and a reference group (3,579 adults aged 16-45 years) using chi square and Student t tests. Among the elderly, falls were the most common etiology of SCI (60 percent), followed by transport accidents (24 percent) and complications of medical and surgical care (12 percent). In the younger group, transport accidents were the most common etiology of SCI (49 percent), followed by falls (22 percent) and assault (21 percent). Falls on the same level (30 percent), from stairs and steps (22 percent), and other slipping, tripping, and stumbling (11 percent) were the most common mechanisms of falls in the elderly group. Among motor vehicle accidents, car occupant injured in a collision with another car was the most common mechanism of injury among the elderly (28 percent). These findings suggest that there is an urgent need for effective fall prevention programs among the elderly to reduce SCI in this expanding population. Details on the mechanisms of falls and other major causes of SCI among the elderly provided in this study should inform the development of future interventions for high-risk persons, activities, and environments.National SCI Statistical CenterYesdevopsadmin
2014Association of Internet use and depression among the spinal cord injury populationJournalJ68258Archives of Physical Medicine and Rehabilitation952236-243Study examined the relationship between the frequency of Internet use and depression among people with spinal cord injury (SCI). A total of 4,618 people with SCI who had been admitted to one of the regional centers in the SCI Model Systems were interviewed. The frequency of Internet use and the severity of depressive symptoms were measured simultaneously by the interview. Internet use was reported as daily, weekly, monthly, or none. The depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9), with 2 published criteria being used to screen for depressive disorder. The diagnostic method places more weight on nonsomatic items, and the cut-off method that determines depression by a (PHQ-9) score ≥10 places more weight on somatic factors. The average scores of somatic and nonsomatic items represented the severity of somatic and nonsomatic symptoms, respectively. The multivariate logistic regression model indicated that daily Internet users were less likely to have depressive symptoms if the diagnostic method was used. The linear multivariate regression analysis indicated that daily and weekly Internet usage were associated with fewer nonsomatic symptoms; no significant association was observed between daily or weekly Internet usage and somatic symptoms. Overall, results suggest that people with SCI who used the Internet daily were less likely to have depressive symptoms.Yesdevopsadmin
2016Changing demographics and injury profile of new traumatic spinal cord injuries in the United States, 1972-2014JournalJ74687Archives of Physical Medicine and Rehabilitation97101610-1619Study documented trends in the demographic and injury profile of new spinal cord injury (SCI) cases over time. Data were collected from the National SCI Database for 30,881 patients with traumatic SCI who received care from 1 of 28 SCI Model Systems centers throughout the United States. To evaluate trends in demographic (age, sex, race, education level, employment, marital status) and injury factors (etiology and severity of injury), data were grouped by decade of injury (1972-1979, 1980-1989, 1990-1999, 2000-2009, 2010-2014). Results indicated that age at injury has increased from 28.7 years in the 1970s to 42.2 years during 2010 to 2014. This aging phenomenon was noted for both sexes, all races, and all etiologies except acts of violence. The percentage of racial minorities expanded continuously over the last 5 decades. Virtually among all age groups, the average education levels and percentage of single/never married status have increased, which is similar to the trends noted in the general population. Although vehicular crashes continue to be the leading cause of SCI overall, the percentage has declined from 47.0 percent in the 1970s to 38.1 percent during 2010 to 2014. Injuries caused by falls have increased over time, particularly among those aged ≥46 years. Progressive increases in the percentages of high cervical and motor incomplete injuries were noted for various age, sex, race, and etiology groups. These findings highlight the need for geriatrics expertise and intercultural competency of the clinical team in the acute and rehabilitation care for SCI.National SCI Statistical CenterYesdevopsadmin
2017Psychometric properties of the satisfaction with life scale in people with traumatic brain, spinal cord, or burn injury: A national institute on disability, independent living, and rehabilitation research model system studyJournalJ76319AssessmentStudy evaluated the measurement properties of the Satisfaction With Life Scale (SWLS), developed to quantify global quality of life and satisfaction. SWLS data were obtained from 17,897 individuals enrolled in the Model Systems funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). They included 8,566 people with spinal cord injury (48 percent), 7,941 with traumatic brain injury (44 percent), and 1,390 with burn injury (8 percent), 1 year after injury. Measurement invariance across the groups, unidimensionality, local independence, reliability from a classical test and item response theory (IRT) framework, and fit to a unidimensional IRT model were analyzed. The results support unidimensionality and local independence of the SWLS. Reliability was adequate from a classical test and IRT perspective. IRT analysis found that the SWLS could be improved by using only five response categories rather than seven and by removing the fifth item, “If I could live my life over, I would change almost nothing.” This item functions poorly and reduces instrument reliability. With these revisions, the SWLS is a useful instrument to monitor an important outcome of trauma rehabilitation.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2017Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trialJournalJ76835Neuroscience Letters65819-26Study assessed the direct and long-term effects of transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) on pain, quality of life (QOL), and life satisfaction following spinal cord injury (SCI). A two-phase randomized sham-controlled clinical trial was performed in which patients received 5 days of tDCS followed by a 3-month follow-up period (Phase I); then, Phase II consisted of 10 days of tDCS with an 8-week follow-up period. Level of pain was assessed with the visual analogue scale. Patients’ QOL and life satisfaction were also evaluated using the Patient Health Questionnaire (PHQ-9) and the Satisfaction With Life Scale (SWLS), respectively. Thirty-three patients were randomized to receive either active or sham tDCS in Phase I and 9 patients were enrolled in Phase II. Linear regression models showed a treatment effect of reduced pain at 1-week follow-up for Phase I and at 4-week follow-up for Phase II. The overall level of pain was significantly lower for the active group, compared to sham, in Phase II. No significant changes were found for the PHQ-9 or SWLS at any time points. Results indicated that tDCS does seem to be a promising tool to manage pain in patients with SCI and repeated stimulation sessions are needed to induce long-lasting effects. Based on the study protocol, it appears that adding a second treatment period could induce long-lasting effects.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2014A prospective, multicenter, phase I matched comparison group trial of safety, pharmacokinetics, and preliminary efficacy of rilzole in patients with traumatic spinal cord injuryJournalJ70831Journal of Neurotrauma313239-255http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904533/Study investigated the pharmacokinetics, safety, and effects of riluzole, a sodium-channel blocking medication, on neurological outcome in acute spinal cord injury (SCI). Thirty-six patients (28 cervical and 8 thoracic), enrolled at 6 North American Clinical Trials Network (NACTN) sites, received 50 milligrams of riluzole twice daily, within 12 hours of SCI, for 14 days. Peak and trough plasma concentrations were quantified on days 3 and 14. Peak plasma concentration (Cmax) and systemic exposure to riluzole varied significantly between patients. On the same-dose basis, Cmax did not reach levels comparable to those in patients with amyotrophic lateral sclerosis. Riluzole plasma levels were significantly higher on day 3 than on day 14, resulting from a lower clearance and a smaller volume of distribution on day 3. Rates of medical complications, adverse events, and progression of neurological status were evaluated by comparison with matched patients in the NACTN SCI Registry. Medical complications in riluzole-treated patients occurred with incidences similar to those in patients in the comparison group. Mild-to-moderate increase in liver enzyme and bilirubin levels were found in 14 to 70 percent of patients for different enzymes. Three patients had borderline severe elevations of enzymes. No patient had elevated bilirubin on day 14 of administration of riluzole. There were no serious adverse events related to riluzole and no deaths. The mean motor score of 24 cervical injury riluzole-treated patients gained 31.2 points from admission to 90 days, compared to 15.7 points for 26 registry patients, a 15.5-point difference. Patients with cervical injuries treated with riluzole had more-robust conversions of impairment grades to higher grades than the comparison group.Kentucky Regional Spinal Cord Injury Model SystemYesdevopsadmin
2014A more perfect union: Reports from an interdisciplinary primary care clinic for patients with spinal cord injuryJournalJ73516Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)374368-369The authors, an internist and a physiatrist, reflect on a year-long experience of cooperatively caring for patients with spinal cord injury in an interdisciplinary setting.Kentucky Regional Spinal Cord Injury Model SystemYesdevopsadmin
2009The SCIRehab project: Classifications and quantification of spinal cord injury rehabilitation treatmentsJA Journal of Spinal Cord Medicine323249-50Whiteneck G., Dijkers M., Gassaway J., Lammertse D.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2009The Prevalence of Morbid Obesity in Acute Inpatient Rehabilitation: A Review of the Medicare DatabaseJA AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION883S48White K.C., Deutsch A., Chen D.Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2009Wheelchair Breakdown Frequency for Wheelchair Users with SCIJA Journal of Spinal Cord Medicine32 461Nagy J., Nemunaitis G., Roach M., Winslow A., Marlow J., Boninger M., Oyster M.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2009Reliability and validity of the International Spianl Cord Injury Basic Pain Data Set items as self-report measuresJAJ58412Spinal Cord48 230-238Objective: To evaluate the psychometric properties of a subset of International Spinal Cord Injury Basic Pain Data Set (ISCIBPDS) items that could be used as self-report measures in surveys, longitudinal studies and clinical trials. Setting: Community. Methods: A subset of the ISCIBPDS items and measures of two validity criteria were administered in a postal survey to 1 84 individuals with spinal cord injury (SCI) and pain. The responses of the participants were evaluated to determine: (1) item response rates (as an estimate of ease of item completion); (2) internal consistency (as an estimate of the reliability of the multiple-item measures); and (3) concurrent validity. Results: The results support the utility and validity of the ISCIBPDS items and scales that measure pain interference, intensity, site(s), frequency, duration and timing (time of day of worst pain) in individuals with SCI and chronic pain. The results also provide psychometric information that can be used to select from among the ISCIBPDS items in settings that require even fewer items than are in the basic data set. Spinal Cord (201 0) 48, 230-238; doi: 1 0.1 038/sc.2009. 1 1 2; published online 29 September 2009 Keywords: spinal cord injury; pain; pain assessment; reliability; validityJensen M.P., Widerstrom-Noga E., Richards J.S., Finnerup N.B., Biering-Sorensen F., Cardenas D.D.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2009Weight loss solutionsJAJ57363Paraplegia News63 36-37Holicky, R.Rocky Mountain Regional SCI SystemYesdevopsadmin
2010Relationship of spasticity to soft tissue body composition and the metabolic profile in persons with chronic motor complete spinal cord injuryJAJ58416JOURNAL OF SPINAL CORD MEDICINE33115-JunBackground/Objective: To determine the effects of spasticity on anthropometrics, body composition (fat mass [FM] and fat-free mass [FFM]), and metabolic profile (energy expenditure, plasma glucose, insulin concentration, and lipid panel) in individuals with motor complete spinal cord injury (SCI). Methods: Ten individuals with chronic motor complete SCI (age, 33 ± 7 years; BMI, 24 ± 4 kg/m2; level of injury, C6-Tl l ; American Spinal Injury Association A and B) underwent waist and abdominal circumferences to measure trunk adiposity. After the first visit, the participants were admitted to the general clinical research center for body composition (FFM and FM) assessment using dual energy x-ray absorptiometry. After overnight fasting, resting metabolic rate (RMR) and metabolic profile (plasma glucose, insulin, and lipid profile) were measured. Spasticity of the hip, knee, and ankle flexors and extensors was measured at 6 time points over 24 hours using the Modified Ashworth Scale. Results: Knee extensor spasticity was negatively correlated to abdominal circumferences (r = -0.66, P =0.038). After accounting for leg or total FFM, spasticity was negatively related to abdominal circumference (r = -0.67, P = 0.03). Knee extensor spasticity was associated with greater total %FFM (r = 0.64; P =0.048), lower %FM (r = -0.66; P = 0.03), and lower FM to FFM ratio. Increased FFM (kg) was associated with higher RMR (r = 0.89; P = 0.0001). Finally, spasticity may indirectly influence glucose homeostasis and lipid profile by maintaining FFM (r = -0.5 to -0.8, P < 0.00 1 ). Conclusion: Significant relationships were noted between spasticity and variables of body composition and metabolic profile in persons with chronic motor complete SCI, suggesting that spasticity may play a role in the defense against deterioration in these variables years after injury. The exact mechanism is yet to be determined.Gorgey A.S., Chiodo A.E., Zemper E.D., Hornyak J.E., Rodriguez G.M., Gater D.R.University of Michigan SCI Model SystemYesdevopsadmin
2009Validity, Accuracy, and Predictive Value of Urinary Tract Infection Signs and Symptoms in Individuals with Spinal Cord Injury on Intermittent CatheterizationJAJ57886Journal of Spinal Cord Medicine325568-73Background/Objective: To determine the validity, accuracy, and predictive value of the signs and symptoms of urinary tract infection (UTI) for individuals with spinal cord injury (SCI) using intermittent catheterization (IC) and the accuracy of individuals with SCi on IC at predicting their own UTI. Design: Prospective cohort based on data from the first 3 months of a I -year randomized controlled trial to evaluate UTI prevention effectiveness of hydrophilic and standard catheters. Participants: Fifty-six community-based individuals on IC. Main Outcome Measures: Presence of UTI as defined as bacteriuria with a colony count of at least 1 05 colony-forming units/mL and at least 1 sign or symptom of UTI. Methods: AnalysiS of monthly urine culture and urinalysis data combined with analysis of monthly data collected using a questionnaire that asked subjects to self-report on UTI signs and symptoms and whether or not they felt they had a UTI. Results: Overall, "cloudy urine" had the highest accuracy (83.1 %), and "leukocytes in the urine" had the highest sensitivity (82.8%) The highest specificity was for "fever" (99.0%); however, it had a very low sensitivity (6.9%). Subjects were able to predict their own UTI with an accuracy of 66.2%, and the negative predictive value (82.8%) was substantially higher than the positive predictive value (32.6%). Conclusions: The UTI signs and symptoms can predict a UTI more accurately than individual subjects can by using subjective impressions of their own signs and symptoms. Subjects were better at predicting when they did not have a UTI than when they did have a UTI.Massa L., Hoffman J., Cardenas D.NWestSCINodevopsadmin
2009Relationship between Knowledge of Employment-Related Public Policies and Occupational Outcome among Individuals with Spinal Cord InjuryJAJ57979Journal of Applied Rehabilitation Counseling40416-SepThis study assessed whether knowledge of employment-related public policies was related to occupational outcome among people with spinal cord injury (SCI) and explored factors that facilitated their engagement in occupational activities. The sample was 57 individuals with SCI. Knowledge of public policies was assessed using a 16-item questionnaire covering legislation and programs including the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Trial Work Period, and the Ticket to Work - Work Incentives Improvement Act of 1999. Computer use and participation in educational activities at a time of injury were significantly related to occupational outcome. No significant relationship was observed between knowledge of the assessed public poliCies and occupational outcome. These policies can facilitate developing skills and obtaining goods and supports that can be important for positive occupational outcome subsequent to a life changing impairment such as SCI. Future research that evaluates what information is most importantfor whom and how to communicate it most effectively is warranted.Forchheimer, M.B., Farrell, D.J., Tate, D.G.University of Michigan SCI Model SystemNodevopsadmin
2009Midodrine as a Cause of Severe Bradycardia in Paraplegia: A Case ReportJA American Journal of Physical Medicine and Rehabilitation88 S33Harrington A.L., Smith J.S., Nemunaitis G.A.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2009Physiologic Impact of Neuromuscular Electrical Stimulation on Trunk StabilityJA Journal Of Spinal Cord Medicine32 468Nemunaitis G., Triolo R., Boggs L., Murray L., Miller M., Roach M., Nagy J., Marlow J., Nicolacakis K., Mejia M.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2010Manually-assisted versus robotic-assisted body weight-supported treadmill training in spinal cord injury: what is the role of each?JA PMR23214-216Hornby T., Reinkensmeyer D., Chen D.Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2010Physiatrists as Pain Medicine PhysiciansJAJ58732Physical Medicine and Rehabilitation23171-173Chiodo, A.E.University of Michigan SCI Model SystemYesdevopsadmin
2010Laid-back recreationJA Paraplegia News64 32-36Holicky, R.Rocky Mountain Regional SCI SystemYesdevopsadmin
2009Outcome measures in spinal cord injury: recent assessments and recommendations for future directionsJAJ57113Spinal Cord47 582-591Study design: Review by the spinal cord outcomes partnership endeavor (SCOPE), which is a broadbased international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations. Objectives: Assessment of current and evolving tools for evaluating human spinal cord injury (SCI) outcomes for both clinical diagnosis and clinical research studies.Methods: a framework for the appraisal of evidence of metric properties was used to examine outcome tools or tests for accuracy, sensitivity, reliability and validity for human SCI. Results: Imaging, neurological, functional, autonomic, sexual health, bladder/bowel, pain and psychosocial tools were evaluated. Several specific tools for human SCI studies have or are being developed to allow the more accurate determination for a clinically meaningful benefit (improvement in functional outcome or quality of life) being achieved as a result of a therapeutic intervention. Conclusion: Significant progress has been made, but further validation studies are required to identify the most appropriate tools for specific targets in a human SCI study or clinical trial. Spinal Cord (2009) 47, 582–591; doi:10.1038/sc.2009.18; published online 21 April 2009Alexander M.,Anderson K.,Biering-Sorensen F.,Blight A.,Brannon R.,Bryce G.,Creasey A.,Catz A.,Curt A.,Donovan W.,Ditunno J.,Ellaway P.,Finnerup N.,Graves D.,Haynes B.,Heinemann A.,Jackson A.,Johnston M.,Kalpakjian C.,Kleitman N.,Krassioukov A.,Krogh K,LamUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2010Intrathecal Baclofen for Spasticity Management: A Comparative Analysis of Spasticity of Spinal vs Cortical OriginJAJ58944JOURNAL OF SPINAL CORD MEDICINE33116-21This study sought to clarify the prospective and concurrent associations of posttraumatic stress disorder (PTSD) and pain with functioning and disability after burn injury. The sample was composed of consecutive patients admitted to a regional burn center with major burn injuries (N = 171 ) who were followed at 1 , 6, 12, and 24 months postdischarge. The predictor measures were the McGill Pain Questionnaire and Davidson Trauma Scale, and the outcome measures were Short Form-36 Health Survey subscales administered at 6, 12, and 24 months after discharge. Linear mixed -effects analyses were conducted to evaluate pain and PTSD as predictors of functional outcomes. Higher PTSD symptom severity socm after hospital discharge was prospectively related to poorer physical and social functioning and greater psychosocial disability (P < .001). However, significant PTSD-by-time interactions a1ro predicted future physical functioning and disability, indicating that the deleterious effects of early PTSD were anleliorated by time. In addition, at each follow-up, PTSD symptoms were conCWTently related to greater physical and psychosocial disability, poorer social functioning, and less vitality (P < .001). More severe pain at each follow-up, but not PTSD, was correlated with poorer concurrent physical functioning (P < .002). Significant interaction tenns indicated that the concurrent effect of PTSD on psychosocial disability, social functioning, and vitality attenuated during the 24-month recovery period. These findings suggest that assessing PTSD and pain following burn injury may aid in predicting future functioning. Future work should confinn this and evaluate whether aggressively treating both PTSD and pain helps improve functioning after major burn injury. (J Bum Care Res 2010;31:13-25)Saval A., Chiodo A.E.University of Michigan SCI Model SystemYesdevopsadmin
2010Oral baclofen administration in persons with chronic spinal cord injury does not prevent the protective effects of spasticity on body composition and glucose homeostasisJAJ58409Spinal Cord482160-65Study design: Correlation study. Objectives: To determine the effects of oral baclofen on body composition (fat mass (FM), fat-free mass (FFM)), extra- and intracellular fluid compartments and glucose homeostasis (plasma glucose and plasma insulin concentrations) in individuals with spinal cord injury (SCI) after controlling for spasticity. Settings: Laboratory settings at the University of Michigan, MI, USA. Methods: Fifteen individuals with chronic motor complete SCI (32±8 years old, 25±5 kg/m2, C6-T11, American Spinal Injury Association A and B) underwent multifrequency bioelectrical impedance analysis to measure body composition and body fluid compartments. Spasticity of the hip, knee and ankle flexors and extensors was measured using a modified Ashworth Scale and the dose of daily oral baclofen was recorded. After overnight fasting, plasma glucose and insulin sensitivity were measured in response to an oral glucose tolerance test. Results: Oral baclofen dose was positively related to body mass index, but not to extensor or flexor spasticity. The dose of baclofen seemed to be correlated to extensor spasticity after considering spasticity per FFM. The increased dose of oral baclofen was positively associated with increased FFM,extra- and intracellular fluid compartments and total body water, but not with FM. Oral baclofen dose was negatively associated with the homeostatic model assessment index. Conclusion: Administration of oral baclofen did not attenuate the protective effects of spasticity on body composition and metabolic profile after SCI. The possibility that oral baclofen could exert an independent protective effect needs to be further investigated.Gorgey, A.S., Chiodo, A.E., Gater, D.R.University of Michigan SCI Model SystemYesdevopsadmin
2009Evacuation Readiness for Wheelchair UsersJA Journal Of Spinal Cord Medicine32 462Nemunaitis G., Boninger M., Nagy J., Oyster M., Marlow J., Roach M., McClure L.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2009Cold face test in persons with spinal cord injury: age versus inactivityJA Clinical Autonomic Research194221-229Wecht J.M., Weir J.P., Demeersman R.E., Schilero G.J., Handrakis J.P., Lafountaine M.F., Cirnigliaro C.M., Kirshblum S.C., Bauman W.A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2010ICF Core Sets for individuals with spinal cord injury in the long-term contextJA Spinal Cord484305-312Cieza A., Kirchberger I., Biering-Sorensen F., Baumberger M., Charlifue S., Post M.M.W., Campbell R., Kovindha A., Ring H., Sinnott A., Kostanjsek N., Stucki G.Rocky Mountain Regional SCI SystemYesdevopsadmin
2009Effect of tire type on manual wheelchair propulsion kinematics in persons with spinal cord injuryJA Archives of Physical Medicine and Rehabilitation9010E14Kwarciak A., Yarossi M., Ramanujam A., Sisto S.A., Forrest G., Dyson-Hudson T.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2010ICF Core Sets for individuals with spinal cord injury in the early post-acute contextJA Spinal Cord484297-304Kirchberger I., Cieza A., Biering-Sorensen F., Baumberger M., Charlifue S., Post M.M.W., Campbell R., Kovindha A.,Ring H., Sinnott A., Kostanjsek N., Stucki G.Rocky Mountain Regional SCI SystemYesdevopsadmin
2009Effect of Lower Limb Positioning on Seated Interface Skin PressuresJA Journal of Spinal Cord Medicine32 477-478Sidhu K., Frost F., Nemunaitis G., Nagy J., Mejia M.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2009Evaluation of wheelchair tire rolling resistance using dynamometer-based coast-down testsJAJ58227Journal of Rehabilitation Research and Development467931-938The objective of this study was to compare the rolling resistance of four common manual wheelchair tires (two pneumatic and two airless solid) and the solid tires used on a commercially available force- and moment-sensing wheel. Coast-down tests were performed with a wheelchair positioned on a two-drum dynamometer. Within each of three load conditions, tire type had a significant effect on rolling resistance (p < 0.001). The pneumatic tires had smaller rolling resistances and were less affected by load increases than the solid tires. Within the two tire types, higher air pressure or firmness and lower profile tread corresponded to less rolling resistance. Wheelchair users, clinicians, and researchers must consider the effect of tire type on wheelchair rolling resistance when selecting a manual wheelchair tire.Kwarciak A.M., Yarossi M., Ramanujam A., Dyson-Hudson T.A., Sisto S.A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2009Dual Energy X-ray Absorptiometry Overestimates Bone Mineral Density of the Lumbar Spine in Persons with Spinal Cord InjuryJA Spinal Cord478628-633Bauman W.A., Schwartz E., Song I.S.Y., Kirshblum S., Cirnigliaro C., Morrison N., Spungen A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2010Evaluating the qulity of acute rehabilitation care for pains with spinal cord injury: an extended Donabedian modelJA Quality Management in Health Care19147-61Qu H., Shewchuk R.M., Chen Y., Richards J.S.,University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2009Depressive symptoms and pain evaluations among persons with chronic pain: catastrophizing, but not pain acceptance, shows significant effectsJA Pain1473-Jan147-152Richardson E., Ness T., Doleys D., Banos J., Cianfrini L., Richards J.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2010Identification of the most common problems in functioning of individuals with spinal cord injury using the International Classification of Functioning, Disability and HealthJAJ58411Spinal Cord483221-229Study design: Cross-sectional, multicenter study. Objectives: To identify the most common problems of individuals with spinal cord injury (SCI) in the early post-acute and the long-term context, respectively, using the International Classification 01 Functioning, Disability and Health (lCF) as a frame of relerence. Setting: International. Methods: The functional problems of individuals with SCI were recorded Using the 264 ICF categories on the second level of the classification. Prevalence of impairment was reported along with their 95% confidence intervals. Data were stratified by context. Results: Sixteen study centers in 1 4 countries collected data of 489 individuals with SCI in the early post-acute context and 559 in the long-term context, respectively. Impairments in thirteen ICF categories assigned to Body functions and Body structures were more frequently reported in the longterm context, whereas limitations/restrictions in 34 ICF categories assigned to Activities and Partidpation were more frequently found in the early post-acute context. Eleven ICF categories from the component Environmental Factors were more frequently regarded as barriers, facilitators or both by individuals with SCI in the early post-acute context as compared with individuals with SCI in the long-term context. Only two environmental factors were more relevant for people with SCI in the iong,term context than in the early post-acute context. Conclusion: The study identified a large variety of functional problems reflecting the complexity of SCI and indicated differences between the two contexts. The ICF has potential to provide a comprehensive Iramework for the description of functional health in individuals with SCI worldwide. Spinal Cord (2010) 48, 221-229; doi:l0.l 038/sc.2009.1 1 6; published online 1 5 September 2009 Keywords: cross-sectional study; rehabilitation; ICFKirchberger I, Biering-Sorensen F, Charlifue S, Baumberger M, Campbell R, Kovindha A, Ring H, Sinnott A, Scheuringer M, Stucki GRocky Mountain Regional SCI SystemYesdevopsadmin
2009Carpal tunnel syndrome in manual wheelchair ussers with spinal cord injury: A cross-sectional multicenter studyJAJ57863American Journal of Physical Medicine & Rehabilitation88121007-16Objective: To investigate relationships between carpal tunnel syndrome, functional status, subject demographics, physical examination findings, and median nerve conduction study findings in manual wheelchair users with paraplegia. Design: Multicenter cross-sectional study. One hundred twenty-six manual wheelchair-using individuals with chronic paraplegia answered self-administered questionnaires on demographics, symptoms, and functional status. They underwent physical examination specific for carpal tunnel syndrome and upper-limb nerve conduction studies. Results: Fifty-seven percent of subjects had symptoms (72.2% bilateral); hand numbness was most common. Sixty percent of subjects had carpal tunnel syndrome physical examination findings (59.2% bilateraJ). Those with physical examination findings were more likely to have longer duration of injury (P =0.003). Seventy-eight percent of subjects had electrophysiologic evidence of median mononeuropathy. Symptomatic subjects had significantly greater medianulnar motor latency difference in the dominant hand (P = 0.02) and smaller compound muscle action potential amplitudes bilaterally (dominant hand, P =0.01; nondominant hand, P = 0.04). Persons with carpal tunnel syndrome symptoms and physical examination findings had significantly worse functional status (symptoms, P < 0.001 ; physical examination, P = 0.02) and symptom severity scores (symptoms, P < 0.001 ; physical examination, P = 0.01), but a similar difference between subjects with and without median mononeuropathy was not seen. Logistic regression analysis revealed that the presence of symptoms was predicted by median-ulnar motor latency difference in the dominant hand (odds ratio, 4.38; 95% confidence interval 1.72-11.14) and sensory nerve action potential amplitude in the nondominant hand (odds ratio, 0.97; 95% confidence interval, 0.94- 0.99). Conclusions: The interaction among symptoms, physical examination, and nerve conduction study findings is complex. Carpal tunnel syndrome and median mononeuropathy are highly prevalent and functionally significant. This study highlights the need for primary prevention and patient education for preserving upper-limb function. Spinal Cord Injuries, Paraplegia, Carpal Tunnel Syndrome, Median Nerve, Neuropathy, Cumulative Trauma Disorders, Wheelchairs.Yang J., Boninger M.L., Leath J.D., Fitzgerald S.G., Dyson-Hudson T.A., Chang M.W.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2010Alcohol abuse and SCIJA Paraplegia News64128-30Holicky, R.Rocky Mountain Regional SCI SystemYesdevopsadmin
2010Aging with spinal cord injuryJAJ58937PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA212383-402Traumatic spinal cord injury (SCI) was long ago thought of as ‘‘an ailment not to be treated.’’1 Since World War II, this once always fatal condition has reaped the benefits from advances in emergency and acute management, to the extent that people with SCI are surviving the early years posttrauma. Further advances in rehabilitative interventions, assistive technology to enhance independence, and early identification of secondary conditions enables those with SCI to live many years, often into their seventh and eighth decades. Several studies suggest that survival is influenced by the level and severity of injury,2–4 age at injury,5–8 and decade of injury.9–12 Individuals with higher level, more neurologically complete lesions (ie, no or limited motor or sensory preservation below the level of lesion), and those injured at older ages have higher mortality rates in general. Those that live into their middle and older years with relatively stable health and functional abilities, however, experience the physical deterioration that naturally occurs with aging. Of note, the recent pattern of individuals incurring SCI is shifting with the mean age at onset increasing.13–15 With this trend, the effects of aging may appear more quickly post-SCI. In addition, there may be numerous psychosocial changes associated with functional decline, alterations in family and social support structures, and potential depletion of economic resources. It is useful for individuals with SCI and their health care team to know what changes may be expected as the individual ages, to identify possible preventive strategies to minimize the effects of aging.Charlifue S., Jha A., Lammertse D.Rocky Mountain Regional SCI SystemYesdevopsadmin
2011Predictors of marital longevity after new spinal cord injuryJAJ60736Spinal Cord491120-124Study examined the relationship of demographic and injury characteristics, self-rated health, physical functioning, and life satisfaction to the duration of marriage 1 to 15 years after spinal cord injury (SCI) among individuals who were married at the time of injury. Survival analysis was chosen to determine the predictors related to marital longevity, which is defined as non-occurrence of divorce after injury. Potential predictor variables were demographics and injury characteristics, level of handicap, self-perceived health, and functional independence. A total of 2,327 subjects were included in the analyses. Results indicated at age at injury, being Caucasian versus African American, having a college versus high school education, having ‘other’ employment status versus being unemployed, and having higher social integration and improved or stable self-rated health versus poor health were all significant factors that delayed the time of divorce after injury. Contrary to expectations, level of injury, function, mobility and independence were not significant predictors of marriage longevity.Karana-Zebari, D., de Leon, M.B., Kalpakjian. C.Z .University of Michigan SCI Model SystemYesdevopsadmin
2011Changes in employment status and earnings after spinal cord injury: A pilot comparison from pre to post injuryJAJ61421Topics in Spinal Cord Injury Rehabilitation16474079Study identified changes in employment status and earnings after spinal cord injury (SCI). Interview data were collected collaboratively at 3 centers designated as SCI Model Systems. The employment rate substantially decreased from 83.3 percent at injury to 24.5 percent at follow-up (average of 3.8 years post injury). There were no significant differences in conditional earnings (earnings among those employed) between the 2 times of measurement. However, there was a significant decrease in unconditional earnings (allocating $0 for those unemployed). Those who returned to their preinjury employer reported greater conditional earnings. The findings suggest that SCI presents a significant barrier to vocational functioning.Krause, J. S., Edles, P., & Charlifue, S.Yesdevopsadmin
2011Future directions for spinal cord injury research: Recent developments and model systems contributionsJAJ60590Archives of Physical Medicine and Rehabilitation923509-515Article discusses future directions in spinal cord injury (SCI) from a perspective of biomedical, psychosocial, and technological research. This discussion is based both on recent developments from various fields of knowledge and, more specifically, on SCI Model Systems’ research contributions to medical rehabilitation. Biomedical research includes: (1) the process of moving from the bench to bedside and harnessing knowledge from basic science to produce new clinical treatment options for SCI during the life span; (2) the rapid proliferation of clinical trials aimed at neurologic recovery; (3) the growth of new technologies to restore and improve function; and (4) the challenges of developing relevant outcome measures to evaluate efficacy and effectiveness of interventions. Recent progress in psychosocial research has contributed significantly to understanding of the many factors associated with disability during the life course, the importance of quality of life issues, and the value of activity, participation, and the environment in promoting successful rehabilitation outcomes following SCI. Technology and bioengineering advances are discussed in relation to access to high-quality technology; restoration and replacement of movement; and technology to enhance rehabilitation outcomes.Tate, D, Boninger, M, Jackson, AYesdevopsadmin
2011The SCIRehab project: Treatment time spent in SCI rehabilitation: Inpatient treatment time across disciplines in spinal cord injury rehabilitationJAJ61085Journal of Spinal Cord Medicine342133-148Study examined the time spent on rehabilitation treatments for patients treated by specialty rehabilitation inpatient programs. Data were collected from 600 patients with traumatic SCI admitted to six rehabilitation centers during the first year of enrollment in the SCIRehab project. Time spent on various therapeutic activities was documented by each rehabilitation clinician after each patient encounter. Patients were grouped by neurologic level and completeness of injury. Total time spent by each rehabilitation discipline over a patient's stay and total minutes of treatment per week were calculated. Ordinary least squares stepwise regression models were used to identify patient and injury characteristics associated with time spent in rehabilitation treatment overall and within each discipline. Results indicated that the average length of stay (LOS) was 55 days, during which 180 hours of treatment were received, or 24 hours per week. Extensive variation was found in the amount of treatment received, between and within neurologic groups. Total hours of treatment provided throughout a patient's stay were primarily determined by LOS, which in turn was primarily predicted by medical acuity. Variation in treatment intensity was not well explained by patient and injury characteristics. In accordance with practice-based evidence methodology, the next step in the SCIRehab study will be to determine which treatment interventions are related with positive outcomes (at 1 year post injury), after controlling for patient and injury differences.Whiteneck G, Gassaway J, Dijkers M, Backus D, Charlifue S, Chen D, Hammond FM, Hsieh C-H, Smout RYesdevopsadmin
2011Participation as an outcome measure in psychosocial oncology: Content of cancer-specific health-related quality of life instrumentsJAJ63069Quality of Life Research20101617-1727Study examined the extent to which the concept and domains of participation as defined in the International Classification of Functioning, Disability and Health (ICF) are represented in general cancer-specific health-related quality of life (HRQOL) instruments. Using the ICF linking rules, two coders independently extracted the meaningful concepts of ten instruments and linked these to ICF codes. The proportion of concepts that could be linked to ICF codes ranged from 68 to 95 percent. Although all instruments contained concepts linked to Participation, the instruments covered only a small part of all available ICF codes. The proportion of ICF codes in the instruments that were participation related ranged from 3 to 35 percent. “Major life areas” was the most frequently used Participation chapter, with “remunerative employment” as the most used ICF code. Findings suggest that general cancer-specific HRQOL instruments only assess social life of cancer patients to a limited degree. This study’s information on the content of these instruments may guide researchers in selecting the appropriate instrument for a specific research purpose.van der Mei, S, Dijkers, M, Heerkens, Y Yesdevopsadmin
2011Marital status, marital transitions, well-being, and spinal cord injury: An examination of the effects of sex and timeJAJ60580Archives of Physical Medicine and Rehabilitation923433-440Study examined the effects of marital status, marital transitions, and sex on the well-being of individuals with spinal cord injury (SCI) in the years since injury, examining the applicability of the marital resource and crisis models for this population. The marital resource model holds that marriage has substantial benefits for well-being over not being married; the marital crisis model contends that marital dissolution leads to poorer well-being. Participants included 4,864 men and 1,277 women who sustained traumatic SCI and completed a minimum of 1 follow-up interview between 1 year and 15 years after injury. Life satisfaction, depressive symptoms, and self-perceived health status were evaluated using linear mixed models for longitudinal data. In general, well-being improved over time following injury. Hypothesis testing supported the marital crisis model, as marital loss through being or becoming separated or divorced and being or becoming widowed, had the most consistent and negative impact across well-being outcomes, whereas being or becoming married had an advantage for only lower depression symptoms over time. However, marital dissolution or loss did not have a uniformly adverse impact on well-being outcomes, and this effect often was moderated by sex, such that widows had higher depressive symptoms and poorer self-perceived health than widowers, but separated or divorced women had higher life satisfaction and self-perceived health than men. Irrespective of sex, being separated or divorced versus being single was associated with higher depressive symptoms over time.Kalpakjian, CZ., Houlihan, B, Meade, MA., Karana-Zebari, D, Heinemann, A, Dijkers, M, Wierbicky, J, Charlifue, S Yesdevopsadmin
2010Effects of etiology on inpatient rehabilitation outcomes in 65- to 74-year-old patients with incomplete paraplegia from a nontraumatic spinal cord injuryJAJ58945PM&R26504-513Study examined differences in rehabilitation outcomes for older patients with a nontraumatic spinal cord injury (NT-SCI) for 5 etiologic diagnoses: degenerative spinal disease (DSD), malignant spinal tumor, benign spinal tumor, vascular ischemia, and spinal abscess. Data were obtained from a total of 1,780 Medicare beneficiaries (65 to 74 years old) with incomplete paraplegia attributable to NT-SCI who were discharged from 479 inpatient rehabilitation facilities. Length of stay (LOS), discharge Functional Independence Measure (FIM) instrument motor item and subscale scores, and discharge destination were the data analyzed. Results indicated that demographic characteristics varied by etiology group. Mean rehabilitation stays ranged from 13.3 days for DSD to 26.4 days for vascular ischemia. Adjusted data showed stays differed across etiology groups. Adjusted discharge mean self-care and mobility subscores revealed that patients with DSD and benign tumor were more independent than patients with a malignant tumor or spinal abscess. Patients with vascular ischemia were more dependent in mobility than the DSD and benign tumor groups. Etiologic differences in independence in discharge FIM modifiers were present for walking, bladder and bowel management, and bowel accidents/continence, but not bladder accidents. The percent of patients discharged to a community residence ranged from 59.3 to 92.6 percent. Adjusted data showed that significantly larger percentages of patients in the DSD and malignant tumor groups than in the spinal abscess group were discharged to a community residence. The findings indicate that there are etiologic differences in demographics, rehabilitation LOS, functional outcomes, and discharge destination in elderly patients with NT-SCI.Kay E, Deutsch A, Chen D, Manheim L, Rowles DMidwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2010A phase 2 autologous cellular therapy trial in patients with acute, complete spinal cord injury: Pragmatics, recruitment, and demographicsJAJ59832Spinal Cord4811798-807Article presents a post hoc analysis of a Phase 2, randomized controlled cellular therapy trial in acute, complete spinal cord injury (SCI). It describes challenges unique to this study, proposes potential strategies to overcome these challenges, and reviews subject recruitment and demographics. Subjects were recruited to one of six international study centers. Of the 1816 patients pre-screened, 53.7 percent did not meet initial study criteria, primarily due to an injury outside the time window (14 days) or failure to meet neurological criteria (complete SCI between C5 motor/C4 sensory and T11). Magnetic resonance imaging (MRI) data were obtained on 339 patients; 51.0 percent were ineligible based on imaging criteria. Of the 75 participants enrolled, 25 failed screening (SF), leaving 50 randomized. The primary reason for SF was based on the neurological exam, followed by failure to meet MRI criteria. Of the 50 randomized subjects, there were no significant differences in demographics in the active versus control arms. In those participants for whom data was available, 93.8 percent (45 of 48) of randomized participants received steroids before study entry, whereas 94.0 percent (47 of 50) had spine surgery before study enrollment. The “funnel effect” (large numbers of potentially eligible participants with a small number enrolled) impacts all trials, but was particularly challenging in this trial due to eligibility criteria and logistics. Data collected may provide information on current practice patterns and the issues encountered and addressed may facilitate design of future trials.Jones, L. A. T., Lammertse, D. P., Charlifue, S. B., Kirshblum, S. C., Apple, D. F., Ragnarsson, K. T., Poonian, D., Betz, R. R., Knoller, N., Heary, R. F., Choudhri, T. F., Jenkins III, A. L., Falci, S. P., Snyder, D. A..Yesdevopsadmin
2011The SCIRehab project: Treatment time spent in SCI rehabilitation: Occupational therapy treatment time during inpatient spinal cord injury rehabilitationJAJ61087Journal of Spinal Cord Medicine342162-175Study examined the type and distribution of occupational therapy (OT) activities provided during inpatient spinal cord injury (SCI) rehabilitation and identified predictors (patient and injury characteristics) of the amount of time dedicated to OT treatment activities. Data were collected from 600 patients with traumatic SCI admitted to six rehabilitation centers during the first year of enrollment in the SCIRehab project. Occupational therapists documented 32,512 therapy sessions including time spent and specifics of each therapeutic activity. Analysis of variance and contingency tables/chi-square tests were used to test differences across neurologic injury groups for continuous and categorical variables. Results indicated that SCIRehab patients received a mean total of 52 hours of OT over the course of their rehabilitation stay. Statistically significant differences among four neurologic injury groups were seen in time spent on each OT activity. The activities that consumed the most OT time were strengthening/endurance exercises, activities of daily living (ADLs), range of motion (ROM)/stretching, education, and a grouping of therapeutic activities that included tenodesis training, fine motor activities, manual therapy, vestibular training, edema management, breathing exercise, cognitive retraining, visual/perceptual training desensitization, and don/doff adaptive equipment. Seventy-seven percent of OT work occurred in individual treatment sessions, with the most frequent OT activity involving ADLs. The variation in time (mean minutes per week) spent on OT ROM/stretching, ADLs, transfer training, assessment, and therapeutic activities can be explained in part by patient and injury characteristics, such as admission Functional Independence Measure score, neurologic injury group, and the medical severity of illness score.Foy T, Perritt G, Thimmaiah D, Heisler L, Offutt JL, Cantoni K, Hseih CH, Gassaway J, Ozelie R, Backus DYesdevopsadmin
2011Depression after spinal cord injury: Comorbidities, mental health service use, and adequacy of treatmentJAJ60570Archives of Physical Medicine and Rehabilitation923352-360Study assessed depression rates and psychiatric comorbid conditions, mental health service use, and adequacy of depression treatment in depressed and non-depressed adults with spinal cord injury (SCI). Participants were 947 community-residing people with traumatic SCI recruited from the Project to Improve Symptoms and Mood after SCI (PRISMS). Outcome measures included the Patient Health Questionnaire-9 Depression Scale, a psychiatric history questionnaire, the Cornell Service Index (mental health service use), and current medication use. Results indicated that the prevalence of probable major depression was 23 percent. There was a high lifetime prevalence of other psychiatric conditions, particularly anxiety disorders. In depressed participants, 29 percent currently were receiving any antidepressant and 11 percent were receiving guideline level antidepressant dose and duration, whereas 11 percent had been receiving any psychotherapy in the past 3 months and 6 percent had been receiving guideline-level psychotherapy in the past 3 months. Serotonergic antidepressants and individual psychotherapy were the most common types of treatment received, and there was a wide range of provider types and treatment settings. Demographic and clinical variables were not associated with receipt of mental health service or guideline-level care. Findings from this study document the low rate of mental health treatment for persons with SCI and probable major depression. These findings have implications for improving the effectiveness of depression treatment in people with SCI.Fann, J.R., Bombardier, C.H., Richards, J.S., Tate, D.G., Wilson, C.S., Temkin, N.Yesdevopsadmin
2011Measuring participation enfranchisementJAJ60928Archives of Physical Medicine and Rehabilitation924564-571Study developed a measure of participation enfranchisement that assesses the extent to which people with and without disabilities feel they participate in the community in a manner that is personally valuable, as opposed to assessing actual performance of community-based activities. A draft instrument was pilot-tested with 326 adults who had sustained stroke, spinal cord injury, traumatic brain injury, or other disabling condition, as well as a general population sample. A revised version of the instrument was administered to a statewide sample drawn from the 2006 Colorado Behavioral Risk Factors Surveillance System that included 461 persons with and 451 without self-identified activity limitations. Multidimensional scaling, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), followed by rating scale analysis were used to evaluate the psychometric properties of the instrument. EFA identified 3 participation enfranchisement factors that describe perceived choice and control, contributing to one’s community, and feeling valued; the factors were supported marginally by CFA. Rating scale analysis revealed marginal person separation and no misfitting items. The 19 enfranchisement items describe aspects of participation that may prove useful in characterizing longer-term rehabilitation outcomes.Heinemann AW, Lai J-S, Magasi S, Hammel J, Corrigan JD, Bogner JA, Whiteneck GGYesdevopsadmin
2011The association of race, cultural factors, and health-related quality of life in persons with spinal cord injuryJAJ60581Archives of Physical Medicine and Rehabilitation923`441-448Study examined the association of race and cultural factors with quality-of-life factors (participation, life satisfaction, perceived health status) in people with spinal cord injury (SCI). Data were collected from 275 people with SCI at 6 national SCI Model Systems centers who completed measures of: (1) participation (Craig Handicap Assessment and Reporting Technique Short Form), (2) satisfaction (Satisfaction With Life Scale), and (3) perceived health status (2 items from 36-Item Short Form Health Survey). Results showed that African Americans with SCI reported more experiences of discrimination in health care, greater perceived racism, more health care system distrust, and lower health literacy than Whites. Participants who reported experiencing more discrimination in health care reported better occupational functioning. Those who perceived more racism in health care settings reported better occupational functioning and greater perceived health. Those who reported more distrust in the health care system reported better current health compared with 1 year ago. Those who reported better communication with their health care provider reported higher levels of mobility and better general health. In summary, higher levels of perceived discrimination and racism and better communication with health care providers were associated with an increase in participation and functioning and improvements in perceptions of well-being. These associations are different from those reported in other study populations and warrant confirmation in future prospective studies.Myaskovsky, L, Burkitt, K, Lichy, A, Ljungberg, I, Fyffe, D, Ozawa H, Switzer, G, Fine, M, Boninger, MYesdevopsadmin
2011Inpatient and postdischarge rehabilitation services provided in the first year after spinal cord injury: Findings from the SCIRehab studyJAJ60571Archives of Physical Medicine and Rehabilitation923361-368Study examined the amount and type of therapy services received in inpatient and post-discharge settings during the first year after spinal cord injury (SCI). Data were obtained from 493 patients with traumatic SCI admitted to 6 rehabilitation centers participating in the SCIRehab study. Inpatient data were collected prospectively by the treating clinicians; post-discharge service data were collected by patient self-report during follow-up interviews. The total hours of therapy during initial inpatient rehabilitation and after discharge up to the first anniversary of injury were calculated by service type: physical therapy (PT), occupational therapy (OT), speech therapy, recreation therapy, psychology, social work/case management, and nursing education. Of the total hours spent on these rehabilitation interventions during the first year after injury, 44 percent occurred after discharge from inpatient rehabilitation. Participants received 56 percent of their PT hours after discharge and 52 percent of their OT hours, but only a minority received any post-discharge services from other rehabilitation disciplines. While wide variation was found in the total hours of inpatient treatment across all disciplines, the variation in the total hours of post-discharge services was greater, with the interquartile range of post-discharge services being twice that of the inpatient services.Whiteneck G, Gassaway J, Dijkers M, Lammertse D, Hammond F, Heinemann A, Backus D, Charlifue S, Ballard P, Zanca JYesdevopsadmin
2010Spinal cord injury: Rehabilitation medicine quick referenceJAR09061 240 ppThis book provides quick answers for practitioners involved with diagnosing and treating common or more complex spinal cord injuries (SCI). Presented in a consistent 2-page, outline format for maximum clinical utility, the book is organized into three sections addressing more than one hundred various topics related to SCI. The first section covers the medical and psychological conditions associated with SCI. The second section discusses common interventions while the last outlines expected functional outcomes.Bryce, TMount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2011Mechanical ventilation, health, and quality of life following spinal cord injuryJAJ60583Archives of Physical Medicine and Rehabilitation923457-463Study examined perceived quality of life (QOL) at 1 year postinjury in people with tetraplegia who required mechanical ventilation assistance at discharge from rehabilitation and those who did not. Data were drawn from the SCI Model Systems National Database for 1,635 people with tetraplegia who completed a 1-year follow-up interview, including 79 people who required at least some use of a ventilator at discharge from rehabilitation. Measures used to assess health and QOL included: (1) Satisfaction With Life Scale (SWLS); (2) Craig Handicap Assessment and Reporting Technique (CHART)-Short Form Physical Independence, Mobility, Social Integration, and Occupation subscales; (3) Patient Health Questionnaire-9 (PHQ-9); and (4) Medical Outcomes Study 36-Item Short-Form Health Survey self-perceived health status. Significant differences were found between the ventilator-user (VU) group and non-ventilator users (NVU) for cause of trauma, proportion with complete injury, neurologic impairment level, and number of rehospitalizations. The NVU group had significantly higher SWLS and CHART Social Integration scores than the VU group after controlling for selected covariates. The NVU group also had more positive perceived health status compared with a year previously and a lower incidence of depression assessed by using the PHQ-9 than the VU group. There were no significant differences between groups for perceived current health status. Overall, people who did not require mechanical ventilation at discharge from rehabilitation post-SCI reported generally better health and improved QOL compared with those who required ventilator assistance at 1 year postinjury.Charlifue S, Apple D, Burns SP, Chen D, Cuthbert JP, Donovan WH, Lammertse DP, Meade MA, Pretz CR Yesdevopsadmin
2011Obesity and inpatients rehabilitation outcomes for patients with a traumatic spinal cord injuryJAJ60574Archives of Physical Medicine and Rehabilitation923384-390Study examined the effect of obesity on change in self-care and mobility ratings and community discharge for patients with traumatic spinal cord injury (SCI). Data were analyzed for 1,524 patients with a new traumatic SCI discharged from Model Systems rehabilitation centers between October 2006 and October 2009. The primary outcomes examined were change in Functional Independence Measure (FIM) self-care and mobility ratings and discharge destination. Separate analyses were conducted by neurologic category: paraplegia incomplete, paraplegia complete, tetraplegia incomplete, and tetraplegia complete. Of all patients with traumatic SCI, approximately 25 percent were obese at admission. Patients who were obese were more likely to be married and slightly older than nonobese patients. In patients with paraplegia incomplete, obese patients had lower FIM self-care and mobility score gains than normal-weight patients. For patients with paraplegia complete, obese patients had significantly lower self-care and mobility score gains. For patients with tetraplegia incomplete and tetraplegia complete, FIM self-care and mobility ratings for obese patients were not significantly different from ratings for normal-weight patients. Within each neurologic category, the percentage of patients discharged to the community was not significantly different for non-obese and obese patients. Obesity appears to be a barrier to meeting self-care and mobility functional goals for patients with paraplegia in inpatient SCI rehabilitation.Stenson, K, Deutsch, A, Heinemann, A, Chen, DMidwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2010Bladder management following spinal cord injury: What you should know: A guide for people with spinal cord injuryJAO18407 This consumer guide explains bladder management options for people with spinal cord injuries (SCI). The publication, which is the companion book to the clinical practice guideline, “Bladder Management for Adults with Spinal Cord Injury”, provides an overview of the urinary tract system, discusses common bladder issues and concerns, bladder-emptying techniques, and medications. The guide also describes different surgical procedures to assist with gaining more control over poorly functioning bladders and provides advice to those who are considering a bladder management program.Linsenmeyer, T., Maddox, T., Chambers, L., Cowell, F., DuBose, J., Dyson-Hudson, T.A., Tevnan, K. Wilber, T.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2011The SCIRehab project: Treatment time spent in SCI rehabilitation: Physical therapy treatment time during inpatient spinal cord injury rehabilitationJAJ61086Journal of Spinal Cord Medicine342149-161Study determined the nature and distribution of activities during physical therapy (PT) delivered in inpatient spinal cord injury (SCI) rehabilitation and identified predictors (patient and injury characteristics) of the amount of time spent in PT for specific treatment activities. Data were collected from 600 patients from six inpatient SCI centers enrolled in the SCIRehab study. Physical therapists documented details, including time spent, of treatment provided during 37,306 PT sessions that occurred during inpatient SCI rehabilitation. Ordinary least squares regression models associated patient and injury characteristics with time spent in specific PT activities. Results showed that SCIRehab patients received a mean total of 55.3 hours of PT over the course of their rehabilitation stay. Significant differences among four neurologic groups were seen in the amount of time spent on most activities, including the most common PT activities of strengthening exercises, stretching, transfer training, wheelchair mobility training, and gait training. Most PT work (77 percent) was provided in individual therapy sessions; the remaining 23 percent was done in group settings. Patient and injury characteristics explained only some of the variations seen in time spent on wheelchair mobility, transfer and bed mobility training, and range of motion/ stretching.Taylor-Schroeder S, LaBarbera J, McDowell S, Zanca JM, Natale A, Mumma S, Gassaway J, Backus DYesdevopsadmin
2011Medical and psychosocial complications associated with method of bladder management after traumatic spinal cord injuryJAJ60582Archives of Physical Medicine and Rehabilitation923449-456Study examined the effect of bladder management method on medical complications (renal calculi or decubitus ulcers), number of hospital days, and psychosocial factors in people with spinal cord injury (SCI). Data for 24,762 patients with new traumatic SCI enrolled in the National SCI Database entire data set forms I and II were analyzed. Patients were stratified according to the bladder management method recorded at each time of data collection into 1 of 4 groups as follows: indwelling catheterization, spontaneous voiding, condom catheterization, and intermittent catheterization. Medical complications, including pressure ulcer number and grade of worst ulcer, kidney stones, and hospitalizations, as well as psychosocial factors (satisfaction with life, perceived health status, societal participation), were stratified by bladder management method. Results were adjusted for level and completeness of neurologic injury and other confounding and modifying factors. Results showed that, compared with other forms of bladder management, use of an indwelling catheter was associated with more pressure ulcers and longer and more hospitalizations for all causes and urology-specific causes. Indwelling catheter use was associated with the lowest levels of participation, but similar satisfaction with life and perceived health status.Cameron, A.P., Wallner, L.P., Forchheimer, M.B., Clemens, J.Q., Dunn, R.L., Rodriguez, G., Chen, D., Horton, J. III, and Tate, D.G.University of Michigan SCI Model SystemYesdevopsadmin
2010Issues affecting the selection of participation measurement in outcomes research and clinical trialsJAJ59473Archives of Physical Medicine and Rehabilitation919, Supplement 1S54-S59Article provides an overview of conceptual and methodological issues affecting participation measurement and offer guidance to researchers wishing to incorporate participation measures in their work. Examples of the development and use of participation measures are presented to: (1) outline the types and characteristics of participation measures, (2) enumerate various uses of participation measures in disability and rehabilitation research, (3) discuss appropriate matching of the type of participation measure with the research task, and (4) offer recommendations for future participation research. Participation measures are used in individual and population assessments, observational research, and interventional research. Selection of a participation measure for use in a specific study requires an understanding of the characteristics of available tools and the nature of the research design, but most importantly, it requires matching the instrument to the specific research question or hypothesis. Instruments assessing participation are currently appropriate as secondary outcomes in trials evaluating interventions targeting activity limitation, and they will become appropriate as primary outcomes when interventions are tested that target participation directly.Whiteneck, GGYesdevopsadmin
2011Emergency evacuation readiness of full-time wheelchair users with spinal cord injuryJAJ60588Archives of Physical Medicine and Rehabilitation923491-498Study examined the number of full-time wheelchair users with spinal cord injuries (SCI) who felt they could evacuate from various locations and have a plan for evacuation. Data were obtained from 487 subjects from 6 SCI Model System centers who use a wheelchair more than 40 hours a week. Questions regarding evacuation preparedness were asked during regularly scheduled data collection periods. Descriptive statistics were calculated for the percentage of wheelchair users who: (1) felt they would be able to safely evacuate their home, place of work, and town or city in the event of an emergency; (2) had a plan for safe evacuation; or (3) reported a need for assistive technology and human assistance to evacuate from various locations in the event of an emergency. The highest percentage of participants felt they would be able to safely evacuate and had a plan for work evacuation. The lowest percentage of participants reported they could evacuate from their city/town in the event of an emergency and had a plan to evacuate their city/town in the event of a natural disaster. A large percentage of participants’ evacuation plans relied heavily on human assistance. The findings suggest that a large discrepancy exists between the perception that one can evacuate and actually having a plan. The perception that one can evacuate without a plan or the use of assistive technology is an area of concern that must be further addressed by educators. Education must emphasize the need to have a defined evacuation plan and effective utilization of assistive technology.McClure LA, Boninger ML, Oyster ML, Roach MJ, Nagy J, Nemunaitis G University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2011Patterns, predictors, and associated benefits of driving a modified vehicle after spinal cord injury: Findings from the national spinal cord injury model systemsJAJ60586Archives of Physical Medicine and Rehabilitation923477-483Study investigated the patterns, predictors, and benefits associated with driving a modified vehicle for people with spinal cord injury (SCI). Data on driving, employment, and community reintegration post-SCI were drawn from the National Model SCI Systems Database for 3,726 people with SCI at 16 Model SCI Systems throughout the United States. The study found that 36.5 percent of the sample drove a modified vehicle after SCI. Significant predictors of driving a modified vehicle post-SCI included married at injury, younger age at injury, associate’s degree or higher before injury, paraplegia, a longer time since the injury, non-Hispanic race, white race, male sex, and using a wheelchair for more than 40 hours a week after the injury (accounting for 37 percent of the variance). Higher activity of daily living independence (in total motor function) at hospital discharge also increased the odds of driving. Driving increased the odds of being employed at follow-up by almost 2 times compared with not driving after injury (odds ratio, 1.85). Drivers tended to have higher community reintegration scores, especially for community mobility and total community reintegration. Driving was also associated with small health-related quality-of-life gains, including less depression and pain interference and better life satisfaction, general health status, and transportation availability scores. The associated benefits of driving and the relatively low percentage of drivers post-SCI in this study provide evidence for the need to increase rehabilitation and assistive technology services and resources in the United States devoted to facilitating driving after SCI.Norweg A, Jette A, Houlihan B, Ni P, Boninger MSpaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2010Spinal cord medicine: principles and practice, second editionJAR09059 1175 ppEncompassing all of the diseases and disorders that may affect the proper functioning of the spinal cord or spinal nerves, this comprehensive volume provides a state of the art review of the principles of care and best practices for restoring function and quality of life to patients with spinal cord injuries. Expert contributors from multiple disciplines cover topics ranging from acute medical and surgical management of specific problems to cutting-edge research, bladder, bowel and sexual dysfunction, neurologic and musculoskeletal issues, advanced rehabilitation techniques and technologies, functional outcomes, and psychosocial care. Each section has been reorganized to better present information and the Second Edition brings in many new authors and topics, more diagrams, illustrations, and tables to solidify concepts, and contains 18 entirely new chapters.Lin, VW, Bono, CM, Cardenas, DD, Frost, FS, Hammond, MC, Lindblom, LB, Perkash, I, Stiens, SA, Woolsey, RM (Eds.)Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2011Investigation of factors associated with manual wheelchair mobility in persons with spinal cord injuryJAJ60587Archives of Physical Medicine and Rehabilitation923484-490Study measured the wheelchair mobility of people with a spinal cord injury (SCI), and assessed the relationship between wheelchair mobility and demographics, type of manual wheelchair, and participation. Participants were 132 people with SCI from 6 Model SCI Systems who used a manual wheelchair as their primary means of mobility. Wheelchair-related mobility characteristics were measured by a data-logging device and community participation was measured by the short form of the Craig Handicap Assessment Recording Technique (CHART). Age was found to be significantly related to average speed traveled per day. Whites were found to travel significantly further and accumulate more minutes per day compared with minorities. Participants who were employed traveled significantly further, faster, and for more minutes per day than those who were not employed. A moderate relationship was found between wheelchair mobility data and CHART total score. Results suggest a need for future investigation of the factors that influence wheelchair mobility and community participation of persons with SCI. Findings indicate the efficacy of a quantitative method to track wheelchair mobility in community settings, which could serve as a way of identifying community participation for people with SCI and possibly uncovering additional aspects of participation.Oyster, M.L., Karmarkar, A.M., Patrick, M., Read, M.S., Nicolini, L., Boninger, M.L. Yesdevopsadmin
2010Research update: Up in smoke?JAJ58892PN: Paraplegia News64640-41Article discusses a new video that explains how smoking makes it more difficult to prevent secondary medical complications for people with spinal cord injury (SCI). The video, "Smoking's Effects on Secondary Complications of Spinal Cord Injury", can be viewed and downloaded at no cost by visiting: www.spinalcord.uab.edu/smoking . The web site also provides links to other smoking-related information.Klebine, PUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2011The SCIRehab project: Analyzing multidisciplinary inpatient spinal cord injury rehabilitation treatment -- second phaJAJ61084Journal of Spinal Cord Medicine342131-132This commentary provides an overview of the SCIRehab Project, designed to identify which of the many spinal cord injury (SCI) inpatient rehabilitation interventions are associated most strongly with positive outcomes at 1 year post-injury. Discussion focuses on the second phase of SCIRehab, which involves the analysis of treatment provided by each rehabilitation discipline. Subsequent articles in this journal issue provide details of the treatment processes and variations in interventions associated with patient characteristics.Whiteneck G, Gassaway J, Dijkers MP, Hammond FM, Lammertse DPYesdevopsadmin
2010The relationship of age-related factors to psychological functioning among people with disabilitiesJAJ58930Physical Medicine and Rehabilitation Clinics of North America212281-297Article reviews the literature on psychological functioning (with a focus on depression) and aging in people with spinal cord injury and those with multiple sclerosis. It includes a discussion of positive psychological concepts such as posttraumatic growth and benefit finding, which are particularly important given that most individuals achieve healthy psychological adjustment despite the challenges of aging and disability.Bombardier, C, Ehde, D, Stoelb, B, Molton INorthwest Regional Spinal Cord Injury SystemYesdevopsadmin
2011Advancing the measurement of participationJAJ60925Archives of Physical Medicine and Rehabilitation924540-541Author provides commentary on 3 articles in this journal issue that are the result of close collaboration among investigators interested in improving the conceptualization and measurement of participation. These articles offer: (1) a new tool for measuring participation, the Participation Assessment with Recombined Tools-Objective (PART-O), which combines items from widely used instruments in traumatic brain injury rehabilitation research; (2) two methods of scoring 17 items of PART-O, assessing relatively objective social role performance and yielding 3 subscale scores, as well as 2 alternative total scores (including 1 incorporating the concept of balance among types of participation); and (3) 19 enfranchisement items assessing the degree to which people with disability perceive they have the freedom to engage in social roles of their choosing while being accepted and valued by others. These 3 articles are available under accession numbers J60926, J60927, and J60928.Whiteneck, GG, Bogner, JA, Heinemann, AWYesdevopsadmin
2011Cell telephone ownership and social integration in persons with spinal cord injuryJAJ60585Archives of Physical Medicine and Rehabilitation923472-476Study determined the prevalence and demographic characteristics associated with cell telephone ownership and investigated whether cell telephone ownership has a positive relationship with social integration among people with spinal cord injury (SCI). Demographic and clinical data were obtained for 7,696 people with traumatic SCI who were entered into the National SCI Database and completed a follow-up interview from April 2004 through April 2009. In April 2004, the question about cell telephone ownership was first entered into the database. Social integration was measured using the Craig Handicap Assessment Reporting Technique Social Integration subscale. Analysis revealed that 73 percent of participants owned a cell telephone. Individuals who were younger, employed, achieved education beyond grade school, and had computer and e-mail access were more likely to own cell telephones. Not owning a cell telephone decreased the likelihood of belonging to the high-social-integration group compared with the low-integration group. People with low or medium social integration scores were less likely to own a cell telephone than those who had high social integration scores. In this study, owning a cell telephone increased the likelihood of being more socially integrated compared with non-cell telephone ownership.Roach MJ, Harrington A, Powell H, Nemunaitis GNortheast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2010Opportunities for CAT applications in medical rehabilitation: Development of targeted item banksJAJ60768Journal of Applied Measurement113315-330Article describes how patient feedback in medical rehabilitation can guide item bank development so that more sensitive outcome measures can be developed. The authors present a comprehensive method for approaching qualitative data and developing targeted item banks for computerized adaptive testing (CAT) applications that can be used for individuals with spinal cord injury, traumatic brain injury, and other disabilities.Kisala, P. & Tulsky, D.S. Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2010A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushionsJAJ60517Journal of the American Geriatrics Society58122308-2314Study evaluated the efficacy of skin protection wheelchair seat cushions in preventing pressure ulcers in the elderly nursing home population. Participants were 232 nursing home residents, aged 65 and older, who used wheelchairs for 6 or more hours per day. All participants were provided with a fitted wheelchair and randomly assigned to a skin protection cushion (SPC) or segmented foam cushion (SFC). The SPC group received an air, viscous fluid and foam, or gel and foam cushion. The SFC group received a 7.6-cm crosscut foam cushion. Pressure ulcer incidence for wounds near the ischial tuberosities (IT ulcers) were measured over 6 months. Secondary analysis was performed on combined IT ulcers and ulcers over the sacrum and coccyx (sacral ulcers). One hundred eighty participants reached a study end point, and 42 were lost to follow-up. Ten did not receive the intervention. There were eight (6.7 percent) IT ulcers in the SFC group and one (0.9 percent) in the SPC group. There were 21 (17.6 percent) combined IT and sacral ulcers in the SFC group and 12 (10.6 percent) in the SPC group. The results indicate that skin protection cushions used with fitted wheelchairs lower pressure ulcer incidence for elderly nursing home residents and should be used to help prevent pressure ulcers.Brienza D, Kelsey S, Karg P, Allegretti A, Olson M, Schmeler M, Zanca J, Geyer MJ, Kusturiss M, Holm MMount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2011The impact of sacral sensory sparing in motor complete spinal cord injuryJAJ60573Archives of Physical Medicine and Rehabilitation923376-383Study examined the effect of sensory sparing on completion of rehabilitation on neurologic, functional, and social outcomes reported at 1 year in people with motor complete spinal cord injury (SCI). Secondary analysis was conducted of data submitted to the National SCI Statistical Center Database. Of the 4,106 patients evaluated with American Spinal Injury Association Impairment Scale (AIS) grade A or B (a motor complete injury) at the time of discharge between 1997 and 2007, a total of 2,331 completed a 1-year follow-up interview and 1,284 had complete data for neurologic (AIS grade, injury level) variables at 1 year. Outcome measures included AIS grade at 1 year, bladder management, hospitalizations, perceived health status, Functional Independence Measure motor items, the Satisfaction With Life Scale, depressive symptoms, and social participation. Compared with subjects with AIS grade A at discharge, those with AIS grade B were less likely to require indwelling catheterization and be hospitalized and more likely to perceive better health; report greater functional independence (self-care, sphincter control, mobility, locomotion); and report social participation in the first year after injury. A greater portion of individuals with AIS grade B at discharge had improved neurologic recovery at 1 year postinjury than those with AIS grade A. Significant AIS group differences in 1-year outcomes related to physical health were maintained after excluding people who improved to motor incomplete status for only bladder management and change in perceived health status.Kirshblum, S., Botticello, A., Lammertse, D.P., Marino, R.J., Chiodo, A.E., Jha, A., Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2011Reliability and validity analysis of the transfer assessment instrumentJAJ60589Archives of Physical Medicine and Rehabilitation923499-508Study investigated the safety, feasibility, validity, and the intrarater and interrater reliability of the Transfer Assessment Instrument (TAI), a newly developed outcome measure to assess the quality of transfers performed by full-time wheelchair users. Testing was performed at the 2009 National Veterans Wheelchair Games in Spokane, Washington, and involved a convenience sample of 40 full-time wheelchair users who performed sitting pivot or standing pivot transfers. Four physical therapist rated each transfer; 3 used the TAI and one used a global rating scale, a visual analog (VAS) scale. Intraclass correlation coefficients (ICCs) for reliability and Spearman correlation coefficients for concurrent validity between the TAI and the global assessment scale were calculated. No adverse events occurred during testing. Reliability and validity testing found the TAI to have acceptable interrater and a wide range of intrarater reliability. Intrarater ICCs for 3 raters ranged between .35 and .89, and the interrater ICC was .642. Correlations between the TAI and a global assessment VAS ranged between .19 and .69. Item analyses of the tool found a wide range of results, from weak to good reliability. Evaluators found the TAI to a safe, quick outcome measure that uses equipment typically found in a clinical setting and does not ask participants to perform new skills.McClure, L, Boninger, M, Ozawa, H, Koontz, AUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2011The SCIRehab project: Treatment time spent in SCI rehabilitation: Therapeutic recreation treatment time during inpatient rehabilitationJAJ61088Journal of Spinal Cord Medicine342176-185Study examined the amount of time spent on specific therapeutic recreation (TR) activities during inpatient rehabilitation for spinal cord injury (SCI). Data were collected from 600 patients with traumatic SCI admitted to six rehabilitation centers during the first year of enrollment in the SCIRehab project. Certified therapeutic recreation specialists documented time spent on each of a set of specific TR activities during each patient encounter. Patterns of time use are described, for all patients and by neurologic category. Ordinary least-squares stepwise regression models are used to identify patient and injury characteristics predictive of total treatment time (overall and average per week) and time spent in TR activities. Results indicated that 94 percent of patients enrolled in the SCIRehab study participated in TR. Patients received a mean total of 17.5 hours of TR; significant differences were seen in the amount of time spent in each activity among and within neurologic groups. The majority (76 percent) of patients participated in at least one structured therapeutic outing. Patient and injury characteristics explained little of the variation in time spent within activities.Gassaway J, Dijkers M, Rider C, Edens K, Cahow C, Joyce JYesdevopsadmin
2010Bladder management after spinal cord injury in the United States 1972 to 2005JAJ60657Journal of Urology1841213-217Study examined how bladder management is accomplished in patients with spinal cord injury and what factors influence the type of management used. Using data from the National Spinal Cord Injury Database from 1972 to 2005, the bladder management method was determined at discharge from rehabilitation and at 5-year intervals over a 30-year period. At discharge from rehabilitation for 24,762 patients, the selection of bladder management with a condom catheter decreased steadily from a peak of 34.6 percent in 1972 to a low of 1.50 percent in 2001. The use of clean intermittent catheterization increased from 12.6 percent in 1972 to a peak of 56.2 percent in 1991. Indwelling catheter use initially decreased from 33.1 percent in 1972 to 16.5 percent in 1991, but increased to 23.1 percent in 2001. Of 12,984 individuals with follow-up data, those originally using an indwelling catheter for bladder management were unlikely to switch to another method, with 71.1 percent continuing to use an indwelling catheter at 30 years. Most individuals using clean intermittent catheterization and condom catheterization at discharge home did not continue to use these methods. More research on the safety of each of these methods needs to be performed to provide better guidance to aid with this decision.Cameron, A., Wallner, L., Tate, D., Sarma, A., Rodriguez, G., and Clemens, J.University of Michigan SCI Model SystemYesdevopsadmin
2011The influence of secondary conditions on job acquisition and retention in adults with spinal cord injuryJAJ60579Archives of Physical Medicine and Rehabilitation923425-434Study examined the associations of job acquisition and job retention to health status as represented by secondary conditions, hospitalizations, and nursing home stays for adults with spinal cord injury (SCI). Two samples of adults participating in the SCI Model Systems were recruited for the study. The first sample consisted of 9,501 participants who reported being unemployed at follow-up; the second sample consisted of 5,150 participants who reported working at follow-up. The outcome variables were job acquisition (change from not working at 1 anniversary of injury to working at the following data collection) and job retention (maintenance of work between 2 assessment periods).Discrete time hazard modeling was used to assess how secondary conditions affect job acquisition. After controlling for the effects of demographic and injury characteristics, hospitalizations within the last 12 months were associated with decreased chance of having obtained employment. Hierarchic logistic regression analyses were used to examine job retention. Hospitalizations and the presence of pressure ulcers were associated with lower odds of job retention once demographic and injury characteristics were controlled. Secondary conditions from the previous assessment period were not significantly related to either job acquisition or job retention after the variance from demographic and injury characteristics and current secondary conditions were controlled.Meade, MA, Forchheimer, MB, Krause, JS, Charlifue, SYesdevopsadmin
2011Characteristics and outcomes of aged Medicare beneficiaries with a traumatic spinal cord injury: 2002-2005JAJ61416Topics in Spinal Cord Injury Rehabilitation16417-26This study identified trends in the sociodemographic and clinical characteristics and outcomes of aged Medicare patients with a new traumatic spinal cord injury (SCI) discharged from inpatient rehabilitation facilities (IRFs) in the United States during the years 2002 through 2005. A secondary analysis of Medicare claims and assessment data was conducted. Three types of data files were used in the analyses: (1) the Medicare Provider Analysis and Review file (claims data); (2) the Inpatient Rehabilitation Facility - Patient Assessment Instrument file (assessment data); and (3) the Denominator file. Results indicated that the number of aged Medicare fee-for-service patients with a recent traumatic SCI treated in IRFs increased from 608 in 2002 to 840 in 2005. Each year, more than half of patients presented with incomplete cervical level injuries. The mean case mix index increased from 1.87 to 2.03 during the 4 years, and the percentage of patients discharged to the community decreased from 62.7 in 2002 to 55.5 in 2005. The median price of an IRF hospital stay was $16,995 in 2002 and $21,625 in 2005.Deutsch A, Almagor O, Rowles D, Pucci D, Chen DMidwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2011United States (US) multi-center study to assess the validity and reliability of the spinal cord independence measure (SCIM III)JAJ61985Spinal Cord498880-885Study assessed the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in people with spinal cord injury (SCI). Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM) was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III. Total agreement between raters was above 70 percent on most SCIM III tasks and all kappa coefficients were statistically significant. The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach's alpha was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8. For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM. Results suggest that the SCIM III is a reliable and valid measure of functional change in SCI.Anderson KD, Acuff ME, Arp BG, Backus D, Chun S, Fisher K, Fjerstad JE, Graves DE,Greenwald K, Groah SL, Harkema SJ, Horton JA 3rd, Huang MN, Jennings M, Kelley KS, Kessler SM, Kirshblum S, Koltenuk S, et al.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2011The SCIRehab project: Treatment time spent in SCI rehabilitation: Speech language pathology treatment time during inpatient spinal cord injury rehabilitation: The SCIRehab project.JAJ61089Journal of Spinal Cord Medicine342186-195Study examined the nature and distribution of speech-language pathology (SLP) activities delivered during inpatient SCI rehabilitation and identified predictors (patient and injury characteristics) of the amount of time spent in specific SLP treatment activities. Data were collected from 600 patients with traumatic SCI admitted to six rehabilitation centers during the first year of enrollment in the SCIRehab project. SLPs documented the details of assessment and treatment and time spent on each of a set of specific SLP activities during each patient encounter. Ordinary least squares stepwise regression models are used to identify patient and injury characteristics predictive of treatment time in the specific SLP activities identified. SLP consults were requested for 40 percent of SCIRehab patients. Fifty-seven percent of these patients received intense therapy (defined as more than five sessions during the rehabilitation stay); the remainder received primarily evaluation or less intense services (one to five sessions). The patients who participated in intense treatment received a mean total of 16.1 hours of SLP; significant differences were seen in the amount of time spent in each activity among neurological injury groups. Cognitive-communication and swallowing therapy were the most common SLP activities. Patient and injury characteristics explained a portion of the variation in time spent on cognitive-communication therapy but did not explain the variation in time spent on swallowing and other SLP treatment activities.Brougham R, David DS, Adornato V, Gordan W, Dale B, Georgeadis AC, Gassaway JYesdevopsadmin
2016Current research outcomes from the spinal cord injury model systemsJournalJ74686Archives of Physical Medicine and Rehabilitation97101607-1609Article provides an overview of the journal issue focusing on research outcomes from the Spinal Cord Injury Model Systems (SCIMS) program. The program’s goals are to demonstrate a comprehensive system of care for people with spinal cord injury (SCI) and conduct research to improve the health and quality of life of people with SCI. The 26 articles published in this issue represent different stages of SCIMS research. Nine articles reflect SCIMS site-specific projects that involve 1 center’s patient population, 4 result from collaborative modules that involve several SCIMS centers, 2 build on a large-scale multisite collaborative project, and the others are based in full or part on National SCI Database data. The articles comprising this issue demonstrate the depth and breadth of work conducted by the SCIMS program, from epidemiology to randomized controlled trials, from descriptive analysis to artificial neural network methodology, from neurologic classification to community integration, and from health services research to assistive technology for mobilityNational SCI Statistical CenterYesdevopsadmin
2011Cut point determination in the measurement of pain and its relationship to psychosocial and functional measures after traumatic spinal cord injury: A retrospective model spinal cord injury system analysisJAJ60578Archives of Physical Medicine and Rehabilitation923419-424Study evaluated potential pain cutoff scores reflecting mild, moderate, and severe pain in the spinal cord injury (SCI) population and determined the relationship between the derived cutoff scores and both psychosocial and functional outcome measures. The data analyzed were extracted from the SCI Model Systems database for 6,096 adults with American Spinal Injury Association Impairment Scale (AIS) grades A through D. Outcome measures included: a numeric rating scale (NRS) of pain severity, a NRS of pain interference, the Satisfaction With Life Scale, the Patient Health Questionnaire-9, the Craig Handicap Assessment and Reporting Technique Short-Form (CHART-SF), the motor component of the Functional Independence Measure (FIM-motor), and employment. Analysis revealed that the best set of pain severity cutoff points are 1 to 3, 4 to 6, and 7 to 10. This was validated by randomly assigning sample members to 2 groups and replicating. There were significant differences in all outcomes as a function of pain severity grouping, although they explained little of the variance in FIM-motor and CHART-SF Physical Independence scale scores. Neurologic status differed significantly between pain groups, with incongruence between pain severity and interference in people in the AIS grade D group, who reported the greatest pain interference and least pain severity. These groupings differentiate psychosocial well-being better than activity limitations. They do not provide a comprehensive pain assessment, for which pain type, location, and interference are likely to be necessary.Forchheimer MB, Richards JS, Chiodo A, Bryce T, Dyson-Hudson TAYesdevopsadmin
2011Do communities matter after rehabilitation? The effect of socioeconomic and urban stratification on well-being after spinal cord injuryJAJ60584Archives of Physical Medicine and Rehabilitation923464-471Study assessed the influence of community-level socioeconomic status (SES) and urban composition on well-being after spinal cord injury (SCI) rehabilitation. Data were obtained from 1,454 patients with traumatic SCI from two centers participating centers in the SCI Model Systems program. Dichotomous measures of perceived health (ill versus good health), life satisfaction (dissatisfied versus satisfied), and depressive symptoms (presence of a syndrome versus not) were used to assess well-being. Multilevel logistic regression was used to model community effects on each indicator of well-being. Results showed that the likelihood of ill health and dissatisfaction with life in people with SCI, but not depressive symptoms, varied across communities. Community SES was related inversely to the odds of reporting ill health. However, the odds for dissatisfaction were higher in persons with SCI living in high SES and urban communities. Associations between community predictors and dissatisfaction with life were sustained after controlling for individual differences in injury severity, SES, and demographics, whereas individual SES was a stronger predictor of ill health than community SES. The findings suggest that community stratification influences the likelihood for diminished well-being for persons with SCI after rehabilitation. Understanding the contribution of communities in long-term outcomes after SCI rehabilitation is needed to inform future interventions aimed at preventing disability in this population.Botticello A, Chen Y, Cao Y, Tulsky DS Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2011A longitudinal study of depression from 1 to 5 years after spinal cord injuryJAJ60577Archives of Physical Medicine and Rehabilitation923411-418Study examined the course of probable major depression among a group of 1, 035 participants with spinal cord injury (SCI) from 16 SCI Model System centers who were assessed at 1 and 5 years after injury. Probable major depression, defined as Physician Health Questionnaire-9 score of 10 or higher, was found in 21 percent of participants at year 1 and 18 percent at year 5. Similar numbers of participants had improvement (25 percent) or worsening (20 percent) of symptoms over time, with 8.7 percent depressed at both 1 and 5 years. Increased pain, worsening health status, and decreasing unsafe use of alcohol were identified as risk factors for the development of depression at 5 years. No predictors of improvement in depression were found. To address this high prevalence of depression, the authors recommended that clinicians use these risk factors and ongoing systematic screening to identify those at risk for depression.Hoffman, J., Bombardier, C.H., Graves, D.E., Kalpakjian, C., Krause,J.Yesdevopsadmin
2011Weight matters: Physical and psychosocial well being of persons with spinal cord injury in relation to body mass indexJAJ60575Archives of Physical Medicine and Rehabilitation923391-398Study examined the influence of body mass index (BMI) on physical and psychosocial health and functioning among people with spinal cord injury (SCI). A total of 1,381 people (1,107 men and 274 women), who received follow-up in 2006 to 2009, were recruited from 16 SCI Model Systems throughout the United States. Participants were classified into 1 of the 4 BMI categories based on self-reported height and measured weight: underweight, normal, overweight, and obese. Outcomes included measures of physical health and functioning (rehospitalization, pain, self-perceived health, and the Functional Independence Measure); and psychosocial well-being (the Craig Handicap Assessment and Reporting Technique, Patient Health Questionnaire-9, and the Diener’s Satisfaction With Life Scale. The prevalence of underweight, overweight, and obesity was 7.5 percent, 31.4 percent, and 22.1 percent, respectively, which varied by age, sex, marital status, education, and neurologic impairment. For those with tetraplegia and functional motor complete injuries, rehospitalization occurred more frequently among obese persons, while days rehospitalized were the longest among underweight persons. Pain was more severe in those classified as obese. Community mobility was lower in the underweight, overweight, and obese groups than in those with normal weight. There was no significant association between BMI and self-perceived health, functional independence, health status, and satisfaction with life beyond the effect of neurologic impairment.Chen Y, Cao Y, Allen V, Richards JSUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2011Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: An update from the national spinal cord injury databaseJAJ60572Archives of Physical Medicine and Rehabilitation923369-375Study describes changes in upper- (UEMS) and lower-extremity (LEMS) motor scores, the American Spinal Injury Association Impairment Scale (AIS) grade, and motor level in people with traumatic tetraplegia from the National Spinal Cord Injury Database. Data were extracted for 1,436 subjects with tetraplegia with at least 2 examinations, the first within 7 days of injury. For subjects initially classified as AIS grade A, 22 percent converted to AIS grade B or better by rehabilitation discharge; 30 percent converted to grade B by 1 year, with 8 percent to grade C and 7.1 percent to grade D. Conversion from complete to motor incomplete was not related to timing of the initial examination or initial neurologic level. For AIS grade B, 34 percent remained motor complete, 30 percent became AIS grade C, and 37 percent became grade D by 1 year. Although 82.5 percent of those with AIS grade C improved to AIS grades D and E, mean 1-year UEMS score was only 35 points. UEMS scores in patients with AIS grade A increased a mean of 9 to 11 points, except for C1 to C3 and C8 to T1 motor levels (gain, 2 to 3 points). Motor level was unchanged or ascended in 35 percent and improved 1 level in 42 percent, 2 levels in 14 percent, and more than 2 levels in 9 percent. Motor zone of partial preservation of 2 segments or more was associated with gain of 2 or more motor levels, with a relative risk of 5.0.Marino, R.J., Burns, S., Graves, D.E., Leiby, B.E., Kirshblum, S., Lammertse, D.P.Yesdevopsadmin
2011Impact of Medicare prospective payment system on acute rehabilitation outcomes of patients with spinal cord injuryJAJ60569Archives of Physical Medicine and Rehabilitation923346-351Study examined the impact of Medicare’s inpatient rehabilitation facility (IRF) prospective payment system (PPS) on inpatient rehabilitation outcomes for patients with traumatic spinal cord injury (SCI). A sample of 296 Medicare and 3,110 non-Medicare patients was selected from the National SCI Statistical Center Database from 1996 to 2006. The main outcomes of interest were Functional Independence Measure (FIM) Motor score change and length of stay (LOS). Analysis revealed that LOS decreased by about 5.8 days a year for Medicare patients and about 1.3 days a year for non-Medicare patients after PPS implementation. Although significant decreases in LOS were observed for Medicare patients after IRF PPS implementation, Medicare patients’ improvements in motor function did not decrease. Non-Medicare patients with SCI also experienced shortened stays after Medicare IRF PPS implementation, but had equivalent FIM score gains compared with their counterparts who received inpatient rehabilitation care before PPS implementation. In summary, IRF PPS implementation was associated with shorter stays, but was not associated with lower functional improvement.Qu H, Shewchuk RM, Chen Y, Deutsch AMidwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2011Costs of care following spinal cord injuryJAJ61414Topics in Spinal Cord Injury Rehabilitation1649-JanStudy developed new estimates of the costs of care following spinal cord injury in the United States (US). Information from the National Spinal Cord Injury Statistical Center database was supplemented where necessary with estimates from a previous comprehensive study of lifetime costs updated for inflation to 2009 US dollars. Overall mean first-year charges were $523,089. Mean annual charges over the remainder of life were $79,759. Charges varied substantially by injury severity. These estimates are considerably higher than the inflation-adjusted estimates from a previous study.DeVivo MJ, Chen Y, Mennemeyer ST, Deutsch AMidwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2012Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab projectJAJ65340Journal of Spinal Cord Medicine356503-526Study examined the effects of the type and quantity of physical therapy (PT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics on outcomes at the time of discharge and at 1 year post-injury. Physical therapists delivering routine care documented details of PT interventions provided. Regression modeling was used to predict outcomes for 75 percent of participants; models were validated with the remaining 25 percent. Injury subgroups were also examined: motor complete low tetraplegia, motor complete paraplegia, and American Spinal Injury Association (ASIA) Impairment Scale (AIS) D motor incomplete tetra-/paraplegia. PT treatment variables explained more variation in three functionally homogeneous subgroups than in the total sample. Among patients with motor complete low tetraplegia, higher scores for the transfer component of the discharge motor Functional Independence Measure (FIM) were strongly associated with more time spent working on manual wheelchair skills. Being male was the most predictive variable for the motor FIM score at discharge for patients with motor complete paraplegia. Admission ASIA lower-extremity motor score (LEMS) and change in LEMS were the factors most predictive for having the primary locomotion mode of "walk" or "both” (walk and wheelchair) on the discharge motor FIM for patients with AIS D injuries. Results indicate that injury classification influences type and quantity of PT interventions during inpatient SCI rehabilitation and is a strong predictor of outcomes at discharge and 1 year post-injury. The impact of PT treatment increases when patient groupings become more homogeneous and outcomes become specific to the groupings.Teeter L, Gassaway J, Taylor S, LaBarbera J, McDowell S, Backus D, Zanca J, Natale A, Cabrera J, Smout R, Kreider S, Whiteneck GYesdevopsadmin
2013Risk factors for mortality after spinal cord injury in the USAJAJ66459Spinal Cord515413-418Study evaluated three sets of risk and protective factors in relation to mortality after spinal cord injury (SCI): basic demographic and injury severity variables, socio-environmental factors, and health and secondary conditions. Assessment of these variables enhances the ability to identify individuals at risk for excess mortality. A total of 8,183 adults with traumatic SCI who received at least one follow-up evaluation between November 1995 and October 2006 from one of the 20 SCI Model Systems of care in the United States were included in the study. There were 76,262 person-years and 1,381 deaths at the end of June 2011. Mortality status determined by National Death Index and Social Security Death Index searches. Three successive sets of risk factors were evaluated with a logistic regression model on person-year observations to estimate the chance of dying in any given year. Several biographic and injury, socio-environmental, and health factors were significantly related to the odds of mortality. A history of pneumonia or kidney calculus was associated with greater odds of mortality, whereas deep vein thrombosis was not. Poor general health, decline in health over the past year, hospitalization, and a grade 3 or 4 pressure ulcer were also related to mortality. Consistent with a mediating effect, odds ratios declined with the addition of each successive set of factors.Cao, Y., Krause, J.S., & DiPrio, N.D. Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2013Causes of spinal cord injuryJAJ65441Topics in Spinal Cord Injury Rehabilitation1918-JanStudy analyzed the specific causes of spinal cord injury (SCI) by age, sex, race, ethnicity, day and month of injury, and neurologic outcomes, using data from the National SCI Database and the National Shriners SCI Database. A total of 7,834 participants who had a traumatic SCI from 2005 to 2011 with known etiology were included in the analyses. Thirty-seven causes of injury documented in the databases were stratified by personal characteristics using descriptive analysis. The most common causes of SCI were automobile crashes (31.5 percent) and falls (25.3 percent), followed by gunshot wounds (10.4 percent), motorcycle crashes (6.8 percent), diving incidents (4.7 percent), and medical/surgical complications (4.3 percent), which collectively accounted for 83.1 percent of total SCIs since 2005. Automobile crashes were the leading cause of SCI until age 45 years, whereas falls were the leading cause after age 45 years. Gunshot wounds, motorcycle crashes, and diving caused more SCIs in males than females. The major difference among race/ethnicity was in the proportion of gunshot wounds. More SCIs occurred during the weekends and warmer months, which seemed to parallel the increase of motorcycle- and diving-related SCIs. Level and completeness of injury are also associated with etiology of injury. The findings suggest that prevention strategies should be tailored to the targeted population and major causes to have a meaningful impact on reducing the incidence of SCI.Chen Y, Tang Y, Vogel LC, DeVivo MJ Yesdevopsadmin
2012Development and initial evaluation of the spinal cord injury-functional indexJAJ64792Archives of Physical Medicine and Rehabilitation93101733-1750Article describes the calibration of the Spinal Cord Injury-Functional Index (SCI-FI) and reports on the initial psychometric evaluation of the SCI-FI scales in each content domain. SCI-FI instrument data were obtained from 855 participants with traumatic spinal cord injury (SCI) recruited from 6 SCI Model Systems and stratified by diagnosis, severity, and time since injury. Item response theory analyses confirmed the unidimensionality of 5 SCI-FI scales: basic mobility (54 items), fine motor function (36 items), self-care (90 items), ambulation (39 items), and wheelchair mobility (56 items). All SCI-FI scales revealed strong psychometric properties. High correlations of scores on simulated computer adaptive testing (CAT) with the overall SCI-FI domain scores indicated excellent potential for CAT to accurately characterize functional profiles of adults with SCI. Overall, there was very little loss of measurement reliability or precision using CAT compared with the full item bank; however, there was some loss of reliability and precision at the lower and upper ranges of each scale, corresponding to regions where there were few questions in the item banks. The use of CAT to administer the SCI-FI will minimize assessment burden, while allowing for the comprehensive assessment of the functional abilities of adults with SCI.Jette A, Tulsky DS, Ni P, Kisala PA, Slavin M, Dijkers MP, Heinemann AW, Tate DG, Whiteneck G, Charlifue S, Houlihan B, Williams W, Kirshblum S, Dyson-Hudson T, Zanca J, Fyffe DYesdevopsadmin
2013Locomotor step training with body weight support improves respiratory motor function in individuals with chronic spinal cord injuryJAJ68179Respiratory Physiology and Neurobiology1893491-497Study investigated the extent to which manually assisted locomotor training (LT) with body weight supported treadmill stepping can change respiratory function in individuals with chronic spinal cord injury (SCI). Surface electromyographic (sEMG) measures of respiratory muscles activity during respiratory tasks were obtained from 8 individuals with chronic SCI before and after approximately 62 sessions of the LT. Standard spirometry testing performed before and after LT was used to measure the following pulmonary function outcomes: forced vital capacity (FVC), forced expiratory volume one second (FEV1), maximum inspiratory pressure (PImax), and maximum expiratory pressure (PEmax). Results showed that FVC, FEV1, PImax, PEmax, amount of overall sEMG activity, and rate of motor unit recruitment were significantly increased after LT. These results suggest that these improvements induced by the LT are likely the result of neuroplastic changes in spinal neural circuitry responsible for the activation of respiratory muscles preserved after injury.Ovechkin AV, Terson de Paleville D, Harkema SJ, Aslan SC, Stephens DP, McKay WBSoutheastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2012Development and Initial Evaluation of the Spinal Cord Injury-Functional Index (SCI-FI)JA Archives of Physical Medicine and Rehabilatation93101733-1750OBJECTIVES: To describe the calibration of the Spinal Cord Injury-Functional Index (SCI-FI) and report on the initial psychometric evaluation of the SCI-FI scales in each content domain. DESIGN: Cross-sectional survey followed by calibration data simulations. SETTING: Inpatient and community settings. PARTICIPANTS: A sample of participants (N=855) with traumatic spinal cord injury (SCI) recruited from 6 SCI Model Systems and stratified by diagnosis, severity, and time since injury. INTERVENTIONS: None. MAIN OUTCOME MEASURE: SCI-FI instrument. RESULTS: Item response theory analyses confirmed the unidimensionality of 5 SCI-FI scales: basic mobility (54 items), fine motor function (36 items), self-care (90 items), ambulation (39 items), and wheelchair mobility (56 items). All SCI-FI scales revealed strong psychometric properties. High correlations of scores on simulated computer adaptive testing (CAT) with the overall SCI-FI domain scores indicated excellent potential for CAT to accurately characterize functional profiles of adults with SCI. Overall, there was very little loss of measurement reliability or precision using CAT compared with the full item bank; however, there was some loss of reliability and precision at the lower and upper ranges of each scale, corresponding to regions where there were few questions in the item banks. CONCLUSIONS: Initial evaluation revealed that the SCI-FI achieved considerable breadth of coverage in each content domain and demonstrated acceptable psychometric properties. The use of CAT to administer the SCI-FI will minimize assessment burden, while allowing for the comprehensive assessment of the functional abilities of adults with SCI. Jette AM, Tulsky DS, Ni P, Kisala PA, Slavin MD, Dijkers MP, Heinemann AW, Tate DG, Whiteneck G, Charlifue S, Houlihan B, Williams S, Kirshblum S, Dyson-Hudson T, Zanca J, Fyffe D.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2012Spinal cord injury-functional index: Item banks to measure physical functioning in individuals with spinal cord injuryJAJ64791Archives of Physical Medicine and Rehabilitation93101722-1732Article describes the development and evaluation of the Spinal Cord Injury-Functional Index (SCI-FI), a new measurement system of physical functioning for people with spinal cord injury (SCI). Specifically, the goals of the study were to develop a comprehensive set of items that assess multiple aspects of physical functioning relevant to the lives of people with SCI, and to evaluate the underlying conceptual structure of physical functioning in these individuals. Item pools of physical functioning were developed, refined, and field tested in a large sample of 855 individuals with traumatic SCI stratified by diagnosis, severity, and time since injury. Confirmatory factor analysis (CFA) indicated that a 5-factor model, including basic mobility, ambulation, wheelchair mobility, self-care, and fine motor function, had the best model fit and was most closely aligned conceptually with feedback received from individuals with SCI and SCI clinicians. When just the items making up basic mobility were tested in CFA, the fit statistics indicated strong support for a unidimensional model. Similar results were demonstrated for each of the other 4 factors, indicating unidimensional models. Though unidimensional or 2-factor (mobility and upper extremity) models of physical functioning make up outcomes measures in the general population, the underlying structure of physical function in SCI is more complex. A 5-factor solution allows for comprehensive assessment of key domain areas of physical functioning. These results informed the structure and development of the SCI-FI measurement system of physical functioningTulsky DS, Jette AM, Kisala PA, Kalpakjian C, Dijkers MP, Whiteneck G, Ni P, Kirshblum S, Charlifue S, Heinemann AW, Forchheimer M, Slavin MD, Houlihan B, Tate DG, Dyson-Hudson T, Fyffe D, Williams S, Zanca JYesdevopsadmin
2012Neuromodulation of lower limb motor control in restorative neurologyJAJ68170Clinical Neurology and Neurosurgery1145489-497Article reviews the literature on methods for the restoration of the neuromuscular lower-limb functions. One consequence of central nervous system injury or disease is the impairment of neural control of movement, resulting in spasticity and paralysis. To enhance recovery, restorative neurology procedures modify altered, yet preserved nervous system function. This article focuses on functional electrical stimulation (FES) and spinal cord stimulation (SCS) that utilize remaining capabilities of the distal apparatus of spinal cord, peripheral nerves and muscles in upper motor neuron dysfunctions. FES for the immediate generation of lower-limb movement along with current rehabilitative techniques is reviewed. The potential of SCS for controlling spinal spasticity and enhancing lower-limb function in multiple sclerosis and spinal cord injury (SCI) is discussed. The necessity for precise electrode placement and appropriate stimulation parameter settings to achieve therapeutic specificity is elaborated. This will lead to the human work of epidural and transcutaneous stimulation targeting the lumbar spinal cord for enhancing motor functions in people with SCI, supplemented by pertinent human research of other investigators. The authors conclude that the concept of restorative neurology recently received new appreciation by accumulated evidence for locomotor circuits residing in the human spinal cord. Technological and clinical advancements need to follow for a major impact on the functional recovery in individuals with severe damage to their motor system.Minassian K, Hofstoeter U, Tansey KE Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2013A pilot study of a telehealth intervention for persons with spinal cord dysfunctionJA Spinal Cord519715-720Study design:Single-blind randomized controlled trial of 6 months' duration.Objectives:To evaluate the efficacy of a novel telehealth intervention, 'CareCall', on reducing pressure ulcers and depression and enhancing the use of appropriate health care.Setting:General community, Massachusetts and Connecticut, United StatesMethods:'CareCall' is an automated, interactive voice response system that combines patient education, cognitive behavioral interventions, screening and referrals, with alerts to a nurse telerehabilitation coordinator for direct non-emergent phone follow up. Participants consisted of a convenience sample of 142 persons with multiple sclerosis or spinal cord injury using a wheelchair >6?h per day. The intervention group received CareCall (n=71) The control group received usual care (n=71). The main outcome measures were: The pressure ulcer scale for healing tool, Patient Health Questionnaire-9 depression scale, Cornell Services Index and Craig Hospital Inventory of Environmental Factors-Short Form Question 5.Results:CareCall achieved a reduction in presence of pressure ulcers at 6 months in women (PHoulihan BV, Jette A, Friedman RH, Paasche-Orlow M, Ni P, Wierbicky J, Williams K, Ducharme S, Zazula J, Cuevas P, Rosenblum D, Williams S.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2013B-cell maturation antigen, a proliferation-inducing ligand, and b-cell activating factor are candidate mediators of spinal cord injury-induced autoimmunityJAJ66930Journal of Neurotrauma3067-JanStudy investigated the molecular signaling pathways and mechanisms by which autoimmunity is induced after spinal cord injury (SCI), with the goal of identifying potential targets in therapies designed to reduce tissue damage and inflammation in the chronic phase of SCI. To that end, an exploratory microarray analysis of peripheral blood mononuclear cells was performed to identify differentially expressed genes in chronic SCI. The results identified a gene network associated with lymphoid tissue structure and development that was composed of 29 distinct molecules and five protein complexes, including two cytokines, a proliferation-inducing ligand (APRIL) and B-cell–activating factor (BAFF), and one receptor, B-cell maturation antigen (BMCA) involved in B cell development, proliferation, activation, and survival. Real-time polymerase chain reaction analysis from ribonucleic acid samples confirmed upregulation of these three genes in SCI. It is believed that this is the first report that peripheral blood mononuclear cells produce increased levels of BAFF and APRIL in chronic SCI. This finding provides evidence of systemic regulation of SCI-autoimmunity via APRIL and BAFF mediated activation of B cells through BMCA and points toward these molecules as potential targets of therapies designed to reduce neuroinflammation after SCI.Saltzman J, Battaglino RA, Salles L, Jha P, Sudhakar S, Garshick E, Stott HL, Zafonte R, Morse LRYesdevopsadmin
2012Profiling motor control in spinal cord injury: Moving towards individualized therapy and evidence-based care progressionJAJ64699Journal of Spinal Cord Medicine355305-309This article, based on the keynote address at the 5th National Spinal Cord Injury Conference in Toronto, addresses methods to neurophysiologically characterize patients after spinal cord injury and proposes how those methods could be used to individualize therapeutic interventions and monitor their efficacy over the course of neurorehabilitation.Tansey, KESoutheastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2013Participation in organized sports is positively associated with employment in adults with spinal cord injuryJAJ66462American Journal of Physical Medicine and Rehabilitation925393-401Study examined the relationship between participation in organized sports programs and employment in 149 adults with chronic spinal cord injury (SCI). Motor level and completeness of injury were confirmed by physical examination. Information related to demographics, employment, level of education, body mass index, duration of injury, participation in individually planned exercise, and participation in organized sports was obtained using a standardized questionnaire. Multivariable logistic regression analyses were used to assess associations between subjects’ characteristics and employment status. In univariate analyses, employment was associated with younger age and a higher level of education, whereas obesity decreased the likelihood of employment. Participation in organized sports approached significance. In the multivariable analysis and after adjusting for age, education, and body mass index, participation in organized sports was significantly associated with employment. Sex, duration of injury, wheelchair use, and participation in individually planned exercise were not significantly associated with employment. Results showed that in the adults with chronic SCI, participation in organized sports was positively associated with employment. Further studies are necessary to determine the causative nature of this association and how various factors related to sports participation may contribute.Blauwet C, Sudhakar S, Doherty A, Garshick E, Zafonte R, Morse LRYesdevopsadmin
2009Risk of mortality after spinal cord injury: An 8-year prospective studyJAJ57328Archives of Physical Medicine and Rehabilitation90101708-1715Objective: To evaluate a theoretical model for mortality after spinal cord injury (SCI) by sequentially analyzing 4 sets of risk factors in relation to mortality (ie, adding 1 set of factorsto the regression equation at a time) Design: Prospective cohort study of data collected in late 1997 and early 1998 with mortality status ascertained in December 2005. We evaluated the significance of 4 successive sets of predictors (biographic and injury, psychologic and environmental, behavioral, health and secondary conditions) using Cox proportional hazards modeling and built a full model based on the optimal predictors. Setting: A specialty hospital. Participants: Adults (N=1386) with traumatic SCI, at least 1 year postinjury, participated. There were 224 deaths. After eliminating cases with missing data, there were 1209 participants, with 179 deceased at fo llow-up. Interventions: Not applicable. Main Outcome Measures: Mortality status was determined using the National Death Index and the Social Security Death Index. Results: The final model included 1 environmental variable (poverty), 2 behavioral factors (prescription medication use, binge drinking), and 4 health factors or secondary condItIons(hospitalizations, fractures/amputations, surgedes for pressure ulcers, probable major depression). Conclusions: The results supported the major premise of the theoretical model that lisk factors are more important the more proximal they are in a tbeoretical chain of events leading to mortality. According to this model, mortality results from declining health, precipitated by high-risk behav iors. These findings may be used to target those who are at high risk for early mortaiity as well as to direct intelventions to the particular risk factor. Key Words: Health; Life expectancy; Mortality; Rehabilitation; Risk; Spinal cord injuries. © 2009 by the American Congress of Rehabilitation MedicineKrause J.S., Zhai Y., Saunders L.L., & Carter R.E.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2010Menopause Characteristics and Subjective Symptoms in Women with and without Spinal Cord InjuryJAJ58626Archives of Physical Medicine and Rehabilitation914562-569Objective: To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI). Design: Prospective cohort (4 data collection periods across 4 years). Setting: Community. Participants: Women (n 62) with SCI (injury levels C6–T12, nonambulatory, 36mo postinjury; 86.1% retention) and women without SCI (n 66; 92.9% retention) with intact ovaries,not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed. Interventions: None. Main Outcome Measures: Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms). Results: The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P .263), nor did age at FMP (P .643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P .001), bladder infections (P .001), and diminished sexual arousal (P .012). Women without SCI had significantly greater bother of vasomotor symptoms (P .020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness. Conclusions: Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers.Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition.Kalpakjian C., Quint E., Bushnik T., Rodriguez G., and Terrill, M.University of Michigan SCI Model SystemYesdevopsadmin
2009Hydrophilic catheters versus noncoated catheters for reducing the incidence of urinary tract infections: a randomized controlled trialJAJ57322Archives of Physical Medicine and Rehabilitation90101668-71Objective: To test the hypotheses that hydrophilic catheters reduce the incidence of symptomatic urinary tract infections (UTIs) in persons with spinal cord injury on self-intermittent catheterization (IC). Design: Randomized controlled trial. Setting: Community. Participants: Subjects (N=56) on IC with recurrent UTIs and who met eligibility cIitelia. Intervention: Use of hydrophilic catheters for rc. Main Outcome Measure: Symptomatic UTIs treated with antibiotics. Results: Of the 56 subjects enrolled, 45 completed the study (22 in the b-eatrnent group, 23 in the coutrol group). There were 110 significant differences in demographics, including sex, between the treatment group and the controls except for more tetraplegic subjects in the control group (PCardenas D, Hoffman JNWestSCIYesdevopsadmin
2009Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factorsJAJ57356Archives of Physical Medicine and Rehabilitation9011 SupplS22-35For rehabilitation and disability research, participation and environment are 2 crucial constlUcts that have been placed center stage by the International Classification of Functioning. Disability and Health (ICF). However, neither construct is adequately conceptualized by the ICF, and both are difficult to measure. This article addresses conceptual and methodologIc issues related to these ICF constructs, and recommends an improved distinction between activities and participation as well as elaboration of environment. A divisIon of the combmed ICF categories for activity and p31ticipation into 2 separate taxonomies is proposed to guide future research, The issue of measuring participation from objective and subjective perspectives is examined, and maintaining these distinct conceptual domains in the measurement of participation is recommended. The methodological issues contributing to the difficulty of measuring participation are discussed, including potential dimensionality, alternative metrics, and the appropriateness of various measurement models, For environment, the need for theory to focus research on those aspects of the environment that interact with individuals' impairments and functional limitations in affecting activities and participation is discussed, along with potential measurement models for those aspects, The limitations resulting from reliance on research participants as reporters on their own environment are set forth. Addressing these conceptual and methodological issues is required before the measurement of participation and environmental factors can advance and these important constructs can be used more effectively in rehabilitation and disability observational research and trials. Key Words: Enviromnent; Reproducibility of results; Rehabilitation; Social environment.Whiteneck G., Dijkers M.P.Yesdevopsadmin
2010Walking Index for Spinal Cord Injury Version 2 (WISCI-II) with repeatability of the 10-m walk time: inter- and intrarater reliabilitiesJAJ57866AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION89115-JulObjective: To demonstrate the inter-/intrarater reliability of the Walking Index for Spinal Cord Injury version 2 scale and the repeatability of the time to walk 10 m in chronic subjects. Design: In this reliability study, 26 subjects from the United States and Italy with spinal cord injury/disorder were tested by two blinded raters on two separate days to determine self-selected and maximum Walking Index for Spinal Cord Injury levels and the time to complete a 10-m walk. Subjects were progressed from self-selected to maximum Walking Index for Spinal Cord Injury incrementally until they failed the higher level. Intraclass correlations were calculated for Walking Index for Spinal Cord Injury levels and repeatability coefficients for the 10-m time. Results: Twenty-two of 26 subjects showed increases of one to eight levels from self-selected to maximum Walking Index for Spinal Cord Injury, whereas 10-m walking time remained relatively unchanged (n=15) or increased markedly (n=7). Inter- and intrarater reliabilities were 1.00 for the self-selected Walking Index for Spinal Cord Injury level. Intrarater reliability for the maximum level was 1.0; interrater reliability was 0.98. Repeatability coefficients for time to walk 10 m were smaller (better) at self-selected than at maximum Walking Index for Spinal Cord Injury and on the same day than on different days. On same-day assessments, repeatability coefficients were 18%–20% of 10-m walk time, excluding subjects with discrepant Walking Index for Spinal Cord Injury levels (n=2). For different-day assessments, repeatability coefficients were 27%–35% of 10-m walk time. Conclusions: The determination of both self-selected and maximum Walking Index for Spinal Cord Injury levels is highly reliable, whereas 10-m walking time is more variable. Walking “profiles” of speed at self-selected and maximum Walking Index for Spinal Cord Injury may better characterize walking ability than a single Walking Index for Spinal Cord Injury level.Marino R.J., Scivoletto G., Patrick M., Tamburella F., Read M.S., Burns A.S., Hauck, W., Ditunno, J.F.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2010Daily stepping in individuals with incomplete spinal cord injuryJAJ58102Physical Therapy902224-235Background: In individuals with motor incomplete spinal cord injury (SCI), ambulatory function determined in the clinical setting is related to specific measures of body structure and function and activity limitations, although few studies have quantified the relationship of these variables with daily stepping (steps/day). Objective: The aim of this study was to quantify daily stepping in ambulatory individuals with SCI and its relationship with clinical walking performance measures and specific demographics, impairments, and activity limitations. Design: A cross-sectional study was performed to estimate relationships among clinical variables to daily stepping in self-identified community versus non–community (household) walkers. Methods: Average daily stepping was determined in 50 people with chronic, motor incomplete SCI. Data for clinical and self-report measures of walking performance also were collected, and their associations with daily stepping were analyzed using correlation and receiver operating characteristic (ROC) analyses. Relationships between daily stepping and the measures of demographics, impairments, and activity limitations were identified using correlation and regression analyses. Results: The ROC analyses revealed a significant discriminative ability between self-reported community and non–community walkers using clinical gait measures and daily stepping. Stepping activity generally was low throughout the sample tested, however, with an average of approximately 2,600 steps/day. Knee extension strength (force-generating capacity) and static balance were the primary variables related to daily stepping, with metabolic efficiency and capacity and balance confidence contributing to a lesser extent. Limitations: The small sample size and use of specific impairment-related measures were potential limitations of the study.Conclusions: Daily stepping is extremely limited in individuals with incomplete SCI, with a potentially substantial contribution of impairments in knee extension strength and balance.Saraf P., Rafferty M.R., Kahn J.H., Moore J.L., Hendron K., Leech K., Hornby T.G.Midwest Regional Spinal Cord Injury Care SystemYesdevopsadmin
2009Wheelchair breakdowns, consequences and impact on people with traumatic spinal cord injuryJA Archives of Physical Medicine and Rehabilitation90 2034-38OBJECTIVES: To investigate the frequency of repairs that occurred in a 6-month period and the consequences of breakdowns on wheelchair users living with spinal cord injuries (SCIs), and to determine whether certain wheelchair and subject characteristics are associated with an increased number of repairs and adverse consequences. DESIGN: Convenience sample survey. SETTING: Sixteen Model Spinal Cord Injury Systems Centers that are part of the national database funded through the Department of Education, National Institute on Disability and Rehabilitation Research. PARTICIPANTS: People with SCI who use a wheelchair for more than 40h/wk (N=2213). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The frequency of wheelchair repairs and occurrence of adverse consequences caused by a wheelchair breakdown in a 6-month period. RESULTS: Within a 6-month period, 44.8% of full-time wheelchair users completed a repair, and 8.7% had an adverse consequence occur. People who use power wheelchairs required significantly more repairs (PMcClure, L.A., Boninger, M.L., Oyster, M.L., Williams, S., Houlihan, B., Lieberman, J.A., Cooper, R.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2010Outcome measures: evolution in clinical trials of neurological/functional recovery in spinal cord injuryJAJ59522Spinal Cord48 674-684The need to determine the beneficial effect of the treatment of spinal cord injury (SCI) requires clearly defined standardized measures of the severity of injury and how well the the function is restored. Improved neurological recovery should be linked to increased capacity to perform tasks such as walking, reaching and grasping, which results in meaningful gains in mobility and self-care. Measurements of recovery, capacity, mobility and self-care are the outcomes used to determine the benefits from the treatment and have evolved over the last century with contributions by the mentors and proteges of Sir Ludwig Guttmann, whom we honor today. Randomized clinical trials in the past 20 years have taught us many lessons as to which outcome measures have the greatest validity and reliability. The International Standards for Neurological Classification of SCI have become the clinical gold standard for the measurement of severity, but would benefit from pathophysiological surrogates to better understand the mechanisms of recovery. Measurements of walking capacity have emerged as valid/reliable/ responsive and upper extremity measures are in development, which help distinguish neurological improvement from rehabilitation adaptation. Performance of self-care and mobility has been linked to capacity and severity outcomes. In addition, new partnerships betweeen clinical trial entities, professional societies, industry and federal agencies should facilitate identification of priorities and uniformity of measurement standards. Our ultimate goal is to improve the quality of life of those individuals with SCI whom we serve, but we must focus our investigative efforts carefully, systematically and rigorously as clinical scientists. Spinal Cord (2010), 48, 674-684; doi:10.1038/sc.2009.198; published online 2 February 2010. Keywords: outcome measures; spinal cord injury; neurological recovery; guttmann; standardized measures; domain of functionDitunno, J.F.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2009SCIRehab: The occupational therapy taxonomyJAJ56874Journal of Spinal Cord Medicine323283-296Background/Objective: Lack of a classification system for occupational therapy (OT) rehabilitation interventions for traumatic spinal cord injury (SCI) rehabilitation in the United States makes conducting outcomes research difficult. This article describes an OT SCI rehabilitation taxonomy (system to categorize and classify treatments). Methods: OT clinicians and researchers from 6 SCI rehabilitation centers developed a taxonomy to describe details of each OT session. This effort is part of the SCIRehab study, which uses the practice-based evidence, observational researchmethodology toexamine current treatmentprocesses without changingexistingpractice. Results: The OT taxonomy consists of 26 OT activities (eg, training on activities of daily living,communication, home management skills, wheelchair mobility, bed mobility, transfers, balance, strengthening, stretching, equipment evaluation, and community reintegration). Time spent on each activity is documented along with therapeutic interventions used to facilitate the activity. Treatment descriptions are enhanced further with identification of assistance needs, patient direction of care, and family involvement, which help to describe and guide OT activity selection. The OT taxonomy documentation process includes all OT rehabilitation interventions for patients with SCI while maintaining efficiency in data collection. Conclusion: The electronic documentation system is being used at 6 centers for all OT sessions with 1,500 patients with acute traumatic SCI. It is the largest known attempt to document details of the comprehensive OT rehabilitation process for patients with SCI in the United States.Ozelie R., Sipple C., Foy T., Cantoni K., Kellogg K., Lookingbill J., Backus D., Gassaway J.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2010Prediction of somatic and non-somatic depressive symptoms between inpatient rehabilitation and follow-upJAJ58413Spinal Cord48 239-244The United States is undergoing a transformative shift in the demographic composition of adults. Indeed, there is an emergent and staggering rate of growth in the percentage of adults aged 65 years or older and this has been termed the Graying of America. The proportion of the population aged 65 years or older is projected to increase from 12.4% in 2000 to 19.6% in 2030.1 This reflects a twofold increase in the number of persons aged 65 years or older from nearly 35 million in 2000 to an estimated 71 million in 2030.1 One of the fastest growing segments of the United States population is those aged 80 years or older. The number of persons in this age group is expected to more than double from 9.3 million in 2000 to 19.5 million in 2030.1 The growing percentage and number of older adults is expected to be accompanied by a considerable burden on the public health system, and the medical and social services.1 This burden is associated with a disproportionate rate of chronic disease conditions among older adults (eg, cancers, diabetes, and stroke) that will represent a primary source of health care services and costs. Of further importance, agingand chronic disease conditions are primary correlates of disablement and compromised quality of life (QOL), and this underscores the importance of identifying factors that might promote healthy aging (ie, optimal mental and physical well-being and function in older adults). Physical activity behavior is associated with reduced risks of chronic disease conditions (obesity, heart disease, hypertension, diabetes, depression, and certain cancers) and premature mortality, and might be positively associated with functional limitations, disability, and QOL in older adults.2–5 This article provides a brief and focused overview of physical activity behavior and its association with functional limitations, disability, and QOL in older adults.Krause, J.S., Reed, K.S., & McArdle, J.J.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2009A new approach to studying the content and outcomes of spinal cord injury rehabilitationJAJ56871Journal of Spinal Cord Medicine323251-259Background/Objective: Limited research evidence is available to show the effectiveness of the many specific interventions provided in spinal cord injury (SCI) rehabilitation; what is available typically focuses on effects of the full rehabilitation package but not specific therapy interventions, medical procedures, patient education, or counseling. Given the problems of conducting randomized controlled trials (RCTs) in rehabilitation, practice-based evidence (PBE) research has been suggested as an alternative methodology for identifying which rehabilitation interventions are associated most strongly with positive outcomes, after controlling for patient differences. Using the PBE research methodology, the SCIRehab project attempts to ‘‘open the black box’’ of acute SCI rehabilitation, provide detailed information on treatments delivered by all rehabilitation disciplines, and contribute to outcomes-based guidelines for clinical decision-making. Methods: The SCIRehab project includes 1,500 patients with acute SCI, consecutively admitted to 1 of 6 US inpatient rehabilitation facilities. Details of the rehabilitation process are captured by clinicians from multiple disciplines documenting their interventions in handheld personal digital assistants after sessions with their patients. Outcome data are abstracted from medical records (clinical outcomes data) and obtained from patient interviews at 6 and 12 months after injury. Extensive patient, injury, and other treatment characteristics are abstracted from medical records. SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. Results: SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. These findings are presented in a series of 9 articles. Conclusions: To date, SCIRehab’s major contribution is a system for categorizing specific contributions of each discipline and a technology for documenting that detail. After data collection is complete, future manuscripts will relate those process elements to outcomes. The SCIRehab Project is an important step toward establishing outcomes-based guidelines for SCI rehabilitation. Whiteneck G., Dijkers M., Gassaway J., Jha A.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2009SCIRehab: The Physical Therapy TaxonomyJAJ56873Journal of Spinal Cord Medicine323270-282Background/Objective: Outcomes research is in need of a classification system of physical therapy (PT) interventions for acute traumatic spinal cord injury (SCI) rehabilitation in the United States. The objective of this study was to describe a taxonomy (system to categorize and classify interventions) to examine the effects of PT interventions on rehabilitation outcomes. Methods: The SCIRehab study uses the rigorous observational practice-based evidence methodology to examine current treatment processes without changing existing practice. PT clinicians and researchers from 6 centers developed a taxonomy to describe details of each PT session. Results: The PT taxonomy consists of 19 treatment activities (eg, bed mobility, transfers, wheelchair mobility, strengthening and stretching exercises) and supplementary information to describe the associated therapeutic interventions. Details that focus on patient assistance needs and family involvement are included as additional descriptors to help to describe and justify PT activity selection. Time spent on each activity is used as the measure of intensity.Conclusion: The detailed PT taxonomy documentation process, which offers efficiency in data collection, is being used for all PT sessions with 1,500 patients with acute traumatic SCI at the 6 participating centers. It might be the first attempt to document the many details of the PT rehabilitation process for patients with SCI in the United States.Natale A., Taylor S., LaBarbera J., Mumma S., Bensimon L., McDowell S., Mumma S., Backus D., Zanca J., Gassaway J.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2009Relationship between knowledge of employment related public policies and occupational outcome among individuals with spinal cord injury.Journal Journal of Applied Rehabilitation Counseling40 416-SepThis study assessed whether knowledge of employment-related public policies was related to occupational outcome among people with spinal cord injury (SCI) and explored factors that facilitated their engagement in occupational activities. The sample was 57 individuals with SCI. Knowledge of public policies was assessed using a 16-item questionnaire covering legislation and programs including the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Trial Work Period, and the Ticket to Work - Work Incentives Improvement Act of 1999. Computer use and participation in educational activities at a time of injury were significantly related to occupational outcome. No significant relationship was observed between knowledge of the assessed public poliCies and occupational outcome. These policies can facilitate developing skills and obtaining goods and supports that can be important for positive occupational outcome subsequent to a life changing impairment such as SCI. Future research that evaluates what information is most importantfor whom and how to communicate it most effectively is warranted. Forchheimer, M.B., Farrell, D.J., Tate, D.G.University of Michigan SCI Model SystemYesdevopsadmin
2009Patient health Questionnaire-9 in spinal cord injury: an examination of factor structure as related to genderJAJ57039Journal of Spinal Cord Medicine322147-56Background/Objective: Despite the attention depression after spinal cord injury (SCI) has received, research and clinical practice have been hampered by inadequate emphasis on reliable and valid measurement. Assessment of symptoms in persons with SCI is challenged by the presence of ‘‘transdiagnostic’’ symptoms and unexamined effects of gender. The objective of this study was to examine the factor structure of the Patient Health Questionnaire-9 (PHQ-9; the 9-item depression scale of the Patient Health Questionnaire) and determine whether the structure replicates across gender. Methods: A total of 1,168 women and men were matched on level/completeness of SCI, follow-up year,and age to create 584 pairs. Exploratory factor analysis examined 1- and 2-factor models and congruence in 2 randomly split half samples to establish congruence of the factor solution and replication across gender. Results: The 1- and 2-factor solutions fit the structure of the items accounting for 41% to 51% of original item variance. Congruence between random samples was uniformly high for the 1-factor solution (r ¼ 0.791–0.948) but variable for the 2-factor solution. Although congruence was high for the combined sample and men (r ¼ 0.90–0.97 and 0.71–0.94, respectively), it was variable for women (r ¼ 0.29–0.85). Conclusions: Although there was support for the 1-factor structure of the PHQ within and between sexes, the low congruence between sexes and within women for the 2-factor structure indicates potentially important differences about how certain symptoms may be experienced or interpreted differently by men and women with SCI. Future research should focus on where sexes diverge in cognitive, affective, and somatic dimensions of depressive symptoms and whether sex-specific or sex-neutral measures are warranted.Kalpakjian C., Toussaint L., Albright K., Bombardier C., Krause J., Tate D.NWestSCIYesdevopsadmin
2010A Descriptive Study on Vitamin D Levels in Individuals with Spinal Cord Injury in an Acute Inpatient Rehabilitation SettingJA PM&R23202-8Nemunaitis G., Mejia M., Nagy J., Johnson T., Chae J., Roach M.J.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2010A structural analysis of health outcomes after spinal cord injuryJAJ58417Journal of Spinal Cord Medicine33122-32Background/Objective: Tilt and recline variable position seating systems are most commonly used for pressure relief to decrease potential for skin breakdown. This study provides quantitative information on the magnitudes of loading on the seat and back during phases of tilt, recline, and standing. The objective of this study was to show that the amount of force reduction at the seat would differ across these 3 methods within their respective clinical ranges. Participants: Six able-bodied (AB) subjects (2 men, 4 women) with a median age of 25 years, and 10 subjects (8 men, 2 women) with spinal cord injury (SCl) with a median age of 35.5 years. Methods: Subjects sat on a power wheelchair with Tekscan pressure mats placed underneath a foam backrest and cushion. Data were collected at 5 positions for each method. Order qf position and method tested were randomized. Linear regressions were used to calculate the relationships of normalized seat and backrest forces to seat and backrest angles for each chair configuration. Results: Normalized seat loads had strong linear relationships with the angles of change in tilt, recline, and standing for both groups. Maximum decreases in seat load occurred at full standing and full recline in the SCI subjects and in full standing in the AB subjects. Loads linearly increased on the back during tilt and recline and linearly decreased during standing for both groups. Conclusions: Standing and recline offered similar seat load reductions at their respective terminal positions. Standing also reduced loading on the backrest. Recognizing that each method had clinical benefits and drawbacks, the results of this study indicate that tilt, recline, and standing systems should be considered as a means of weight shifting for wheelchair users.Krause J.S., Reed K.S., & McArdle J.J.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2010Forgiveness and health related outcomes among people with spinal cord injuryJAJ58374Disability and Rehabilitation325360-366Purpose. As motor vehicle accidents and violence cause the majority of spinal cord injuries (SCI) sustained in the USA and people with SCI will likely struggle with emotional issues related to the offender, the purpose of this exploratory study was to examine potential salutary effects of forgiveness among people with SCI incurred traumatically. Specifically, we hypothesized that forgiveness would have positive associations with health-related outcomes. Method. A community-based sample of 140 adults (19–82 years of age) with SCI completed a self-report survey regarding dispositional forgiveness of self and others, health behavior, health status, and life satisfaction. Hierarchical multiple regression analyses were employed to examine the relationships in question. Results. After controlling for demographic variables, forgiveness of self was significantly associated with health behavior and life satisfaction (uniquely accounting for 7% and 13% of the variance, respectively) and forgiveness of others was significantly associated with health status (uniquely accounting for 9% of the variance). Conclusion. Results suggest that forgiveness may play a role in the health and life satisfaction of people with traumatic SCI, with the benefit depending on the type of forgiveness offered.Webb, J.R., Toussaint, L., Kalpakjian, C.Z., Tate, D.G.University of Michigan SCI Model SystemYesdevopsadmin
2010Race-ethnicity, education, and employment after SCIJAJ57807Rehabilitation Counseling Bulletin53278-86The objective of this article was to identify the relationship between race-ethnicity and employment after spinal cord injury (SCI), while evaluating interrelationships with gender, injury severity, and education. The authors used a cohort design using the most current status from a post-injury interview from the National SCI Statistical Center. Participants included 14,454 adults ages 18 to 64, at least 1 year post-injury, not currently students or homemakers, and with residual impairment. Primary outcome was self-reported gainful employment. A total of 26.8% were working, and Caucasians were most likely to work followed by Hispanics and African Americans. Education and injury severity were strong predictors of working but did not attenuate the relationship between race and working. African American women were more likely to work than African American men, but this relationship was not significant for other race groups. Further research is needed to identify modifiable risk factors that can decrease the gap in post-injury employment between African Americans and other races.Krause J.S., Saunders L.L., & Staten D.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2009Validity, accuracy, and predictive value of urinary tract infection signs and symptoms in individuals with spinal cord injury on intermittent catheterization.Journal Journal of Spinal Cord Medicine32 5568-73https://pubmed.ncbi.nlm.nih.gov/20025153/BACKGROUND/OBJECTIVE: To determine the validity, accuracy, and predictive value of the signs and symptoms of urinary tract infection (UTI) for individuals with spinal cord injury (SCI) using intermittent catheterization (IC) and the accuracy of individuals with SCI on IC at predicting their own UTI. DESIGN: Prospective cohort based on data from the first 3 months of a 1-year randomized controlled trial to evaluate UTI prevention effectiveness of hydrophilic and standard catheters. PARTICIPANTS: Fifty-six community-based individuals on IC. MAIN OUTCOME MEASURES: Presence of UTI as defined as bacteriuria with a colony count of at least 10(5) colony-forming units/mL and at least 1 sign or symptom of UTI. METHODS: Analysis of monthly urine culture and urinalysis data combined with analysis of monthly data collected using a questionnaire that asked subjects to self-report on UTI signs and symptoms and whether or not they felt they had a UTI. RESULTS: Overall, "cloudy urine" had the highest accuracy (83.1%), and "leukocytes in the urine" had the highest sensitivity (82.8%). The highest specificity was for "fever" (99.0%); however, it had a very low sensitivity (6.9%). Subjects were able to predict their own UTI with an accuracy of 66.2%, and the negative predictive value (82.8%) was substantially higher than the positive predictive value (32.6%). CONCLUSIONS: The UTI signs and symptoms can predict a UTI more accurately than individual subjects can by using subjective impressions of their own signs and symptoms. Subjects were better at predicting when they did not have a UTI than when they did have a UTI. Massa, L., Hoffman, J., Cardenas, D.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2009SCIRehab: The speech language pathology taxonomyJAJ56876Journal of Spinal Cord Medicine323306-317Introduction: Outcomes research for speech language pathology (SLP) interventions for acute traumatic spinal cord injury (SCI) rehabilitation in the US is difficult because of the lack of a treatment classification system (taxonomy). Objective: To describe a taxonomy developed by speech language pathologists (SLPs) to examine the effects of SLP interventions on SCI rehabilitation outcomes. Methods: The SCIRehab study uses practice-based evidence, a rigorous observational methodology that examines treatment processes without specifying or requiring specific therapeutic interventions. Speech language pathology lead clinicians and researchers at 6 US SCI centers developed a detailed SLP taxonomy documentation process that is comprehensive of SLP interventions for patients with SCI. Results: The SLP taxonomy consists of 7 intervention categories that address deficits (speech production for patients with artificial airway, motor speech and voice, swallowing, cognitive-communication, and communication) and the associated exercises and tasks that patients perform. Time is recorded for each category, and supplementary information focuses on cueing needs and family involvement that helps to describe and guide intervention selection. The SCIRehab project is enrolling 1,500 patients with acute traumatic SCI at 6 inpatient rehabilitation facilities. Conclusions: Speech language pathology taxonomy information is being captured for the SCIRehab patients who are referred for SLP services; this may be the first attempt to document the many details of the SLP rehabilitation process for patients with SCI in the US.Gordan W., Dale B., Brougham R., Spivak-David D., Georgeadis A., Adornato V., Gassaway J.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2010Developing a contemporary functional outcome measure for spinal cord injury researchJAJ58415Spinal Cord483262-267Study design: This study used qualitative analysis of focus group discussions. Objective: The primary objective was to select functional activities to include in an item pool, which is the first step in developing a spinal cord injury computer adaptive test (SCI-CAT). Setting: This multisite study was conducted at six US National Spinal Cord Injury Model Systems Programs. Methods: Focus group discussions, which included persons with tetraplegia and paraplegia and clinicians, were conducted. Transcripts were analyzed using grounded theory approach. Functional activities were identified, binnedl winnowed, written as functional items, and cognitively tested. Results:' Focus group discussion analysis identified 326 functional activity items that fit into categories outlined in the International Classification of Functioning, Disability and Health (ICF) framework: Mobility (1 93 items), including assessment of functioning in a manual (44 items) and power wheelchair (1 9 items); self-care (1 09 items); and communication (1 9 items). Items related to sexual function were also identified (5 items). Conclusion: The SCI-CAT item pool includes items that assess functional activities important to persons with SCI. Items cover a wide range of functional ability and reflect most ICF categories. The Spinal Cord (201 0) 48, 262-267; doi:1 0.1 038/sc.2009.1 3 1 ; p.blished online 20 October 2009 Keywords: spinal cord injury; outcome measure; functional assessment; item response theory; computer adaptive testing SCI-CAT pool is currently being field tested to develop a calibrated item bank. Further development will yield a CAT of functional activities appropriate for SCI research.Slavin M., Kisala P., Jette A., & Tulsky D.Yesdevopsadmin
2009SCIRehab: clinical taxonomy development and application in spinal cord injury rehabilitation researchJAJ56872Journal of Spinal Cord Medicine323260-269Background/Objective: Applying practice-based evidence research methodology to spinal cord injury (SCI) rehabilitation requires taxonomy (typology or classification) of rehabilitation interventions provided by every discipline contributing to SCI rehabilitation. The rehabilitation field currently lacks such taxonomy. Methods: SCIRehab project researchers and clinicians representing 7 rehabilitation disciplines from 6 US inpatient SCI rehabilitation facilities worked in discipline groups during 2 face-to-face meetings and weekly discipline-specific teleconferences for 9 months to identify key contributions of each discipline to SCI rehabilitation and to develop a classification of treatment interventions used by each discipline. These clinician groups were charged with designing documentation systems that collected enough details to describe treatment adequately while not imposing an unrealistic data collection burden on clinicians. Completed documentation systems were programmed onto handheld personal digital assistants (PDAs) to facilitate data entry by clinicians at the point of care. Results: Seven discipline-specific SCI rehabilitation taxonomies were developed that describe and quantify intervention activities (major categories of treatment offered by the discipline) and the activity-specific details (variables deemed important to fully describe the interventional process). Much treatment information is unique to each discipline; some is common across disciplines. Conclusions: The taxonomies provide a format with which clinicians document actual interventions performed with or for patients. The SCIRehab project has developed the first comprehensive multidisciplinary taxonomy for describing the details of the SCI rehabilitation process and designed a PDA-based documentation system based on that taxonomy that allows clinicians to describe the specifics of their interactions with their patients.Gassaway J., Whiteneck G., Dijkers M.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2010Role-Playing Simulation as an Educational Tool for Health Care Personnel: Developing an Embedded Assessment FrameworkJA CYBERPSYCHOLOGY & BEHAVIOR132217-224Libin Z.A., Lauderdale M., Milo, Y., Shamloo C., Spencer R., Green B., ...Groah S.National Capitol Spinal Cord Injury Model SystemYesdevopsadmin
2010Objective and subjective measures: Assessment of three measures of participation among people with spinal cord injuriesJAJ58334Topics in Spinal Cord Injury Rehabilitation15416-25This article reviews three measures of participation in a large spinal cord injury sample: the Craig Handicap Assessment and Reporting Technique Short Form (CHART-SF), the PAR-PRO, and the Community Integration Measure (CIM). The first two are based on quantitative assessment and the CIM is subjective. The PAR-PRO and CIM demonstrated adequate reliability. Factor analysis of the CIM indicated that it measures a single construct. A five-factor solution was obtained for the PAR-PRO, the interpretation of which was unclear. The CHART scales and PAR-PRO were more closely associated with functional measures and the CIM with scores measuring quality of life. All measures were associated with health perceptions. Keywords: CHART-SF, Community Integration Measure, ICF, PAR-PRO, participation, reliability, subjective assessment, quality of life, validityForchheimer, M.Yesdevopsadmin
2010Foreword in Contemporary Perspectives on Participation in the Context of SCI RehabilitationJA Topics in Spinal Cord Injury Rehabilitation154vii-viiiAlbright, K. and Tate D.G.University of Michigan SCI Model SystemYesdevopsadmin
2009Prevalence of chronic Pain after spinal cord injury: a systematic reviewJA Journal of Rehabilitation Research and Development46 13-30Published studies have reported widely divergent estimates of the prevalence of chronic pain among individuals with (traumatic) spinal cord injury (SCI). To develop an estimate based on a synthesis of the research, we used searches of MEDLINE, CINAHL, PsycINFO, and other bibliographic databases and an ancestor search to identify articles published since 1966 in any language that reported a pain prevalence rate for at least 30 subjects with certain or likely traumatic SCI. Data on sample makeup, study quality indicators, and pain prevalence were abstracted independently by two researchers. A total of 42 studies reported pain prevalence rates that ranged from 26% to 96%, with a fairly even spread between these extremes. The reported rate did not appear to be related to study quality. Pain prevalence in the combined samples did not appreciably differ between males and females, those with complete versus incomplete SCI, and those with paraplegia versus tetraplegia. We conclude that too much heterogeneity was present in the reports to calculate a post-SCI pain prevalence rate using meta-analytic methods. Further research is needed to determine whether rates are related to sample makeup (e.g., average subject age), research methods used (e.g., telephone interview vs self-report instruments), or even the definition of "chronic" pain.Dijkers, M., Bryce, T., Zanca, J.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2009A Preliminary Model of Wheelchair Service DeliveryJA Archives of Physical Medicine & Rehabilitation90 1030-1038Objective: To integrate and expand on previously published models of wheelchair service delivery, and provide a preliminary framework for developing more comprehensive, descriptive models of wheelchair service delivery for adults with spinal cord injury within the U.S. health care system. Design: Literature review and a qualitative analysis of indepth interviews. Setting: Not applicable. Participants: Ten academic, clinical, regulatory, and industry experts (Department of Veterans Affairs [VA] and non-VA) in wheelchair service delivery. Interventions: Not applicable. Main Outcome Measures: Interviewees were asked to discuss the full range of variables and stakeholders involved in wheelchair service delivery, and to limit their scope to the provision of primary subsequent or replacement chairs (not backup chairs) to adults within the United States. Results: Most experts we interviewed stressed that clients who require a wheelchair play a central role in the wheelchair service delivery process. Providers (including clinicians, rehabilitation engineers, and rehabilitation counselors) are also critical stakeholders. More so than in other health care settings, suppliers play an integral role in the provision of wheelchairs to clients and may significantly influence the appropriateness of the wheelchair provided. Suppliers often have a direct role in wheelchair service delivery through their interactions with the clinician and/or client. This model also identified a number of system-level factors (including facility administration and standards, policies, and regulations) that influence wheelchair service delivery and ultimately the appropriateness of the wheelchair provided. Conclusions: We developed a detailed, descriptive model of wheelchair service delivery that integrates the delivery process and device outcomes, and includes the patient-level, providerlevel, and system-level factors that may directly influence those processes and outcomes. We believe that this detailed model can help clinicians and researchers describe and consider the complexities of wheelchair service delivery. It can be used to identify factors that may be related to disparities in wheelchair service delivery and in the appropriateness of the wheelchair prescribed. Further, this model can help researchers and clinicians identify factors that may be related to disparities in wheelchair service delivery, and intervene to reduce such disparities.Eggers, S., Myaskovsky, L., Burkitt, K., Tolerico, M., Switzer, G., Fine, M., Boninger, M. University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2008Predictors of Ventilator Weaning in High Cervical Spinal Cord Injured PersonsJA Journal of Spinal Cord Medicine31172-77Background/Objective: To evaluate which tests best predict the ability of patients with ventilatordependent tetraplegia to wean from the ventilator. Methods: Retrospective review of patients. Participants: Twenty-six ventilator-dependent patients with tetraplegia admitted to a university inpatient spinal cord–injury rehabilitation unit with American Spinal Injury Association (ASIA) injury levels C2 to C6, A or B. Results: Failure to wean off the ventilator completely was predicted by absence of motor unit recruitment of one hemidiaphragm or at least moderate decreased recruitment with needle electromyography (EMG) in both hemidiaphragms. Phrenic nerve conduction studies would have predicted that all patients who weaned off the ventilator would have failed. Fluoroscopic examination of the diaphragm and bedside spirometry were not as good predictors of ability to wean, failing to predict accurately in 44% and 19% of cases, respectively. ASIA examination was also not entirely predictive, and any outliers that may have been expected to wean based on ASIA examination (ie, C4 or lower neurological levels) were predicted not to wean by needle electromyography. Conclusions: Negative inspiration force diaphragm needle EMG best predicted the ability to wean from the ventilator. Bedside spirometry (negative inspiratory force and forced vital capacity) is an accurate bedside measure of a patient’s readiness to wean. Fluoroscopic examination of the diaphragm and phrenic nerve conduction studies were not helpful in determining weaning potential in ventilator-dependent patients with cervical spine injury.Chiodo, A., Scelza, W., Forchheimer, M.University of Michigan SCI Model SystemYesdevopsadmin
2008Analyzing trauma narratives: Introducing the narrative form index and matrixJA Rehabilitation Psychology (Special issue: Methodological Advances)533400-411Purpose:Narrative form research is introduced as a unique, qualitative approach to studying narrative material, particularly trauma narratives. This methodology incorporates new analytic tools: Narrative Form Index (NFI) and Narrative Form Index Matrix (NFIM). Research Method/Design: The NFI is a standard set of narrative terms that provides a critical inventory of forms useful in processing the structure, context, and whole elements of narratives. The NFIM uses forms inventoried in the NFI as variables for finding, connecting, and displaying relevant narrative text within a matrix. Together, these companion analytic tools allow for the direct transmission of meaningfully sifted narrative data. Results: Employing the NFI and NFIM in relation to a research transcript, the authors demonstrate how narrative material is identified for inclusion in a matrix. Once arranged in a matrix, rich narrative data is available for further analysis. Conclusions/Implications: Content and form analysis and direct transmission of narrative data embodied in this approach provide salient and accurate results in qualitative data management and inference. The analytic tools described have applications for rehabilitation research and practice and can be downloaded from the authors' Web site.Albright, K.J., Duggan, C.H., Epstein, MJ.University of Michigan SCI Model SystemYesdevopsadmin
2008Outcome measures for gait and ambulation in the spinal cord injury populationJA Journal of Spinal Cord Medicine31 487-499Background: At the 2006 National Institute on Disability and Rehabilitation Research (NIDRR) sponsored pre-conference on spinal cord injury (SCI) outcomes, several gait and ambulation measures were evaluated for utility in clinical practice, validity, and reliability as research measurement tools. The Conference Subcommittee on Gait and Ambulation chose to review the Walking Index for Spinal Cord Injury II (WISCI II), 50-Foot Walk Test (50FTWT), 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), and Functional Independence Measure-Locomotor (FIM-L). Methods: A subcommittee of international experts evaluated each instrument for test construct, administration, population applicability, reliability, sensitivity to change, and validity. Evaluations for each outcome measure were compiled, distributed to the whole committee, and then further reviewed with addition of comments and recommendations for consensus. An audience of experts voted on the validity and usefulness of each measure. Results: WISCI II and 10MWT were found to be the most valid and clinically useful tests to measure improvement in gait for patients with SCI. FIM-L had little utility and validity for research in SCI. 6MWT and 50FTWT were found to be useful but in need of further validation or changes for the SCI population. Conclusion: A combination of the 10MWT and WISCI II would provide the most valid measure of improvement in gait and ambulation in as much as objective changes of speed, and functional capacity allow for interval measurement. To provide the most comprehensive battery, however, it will be important to include a measure of endurance such as the 6MWT. Further validation and study should be devoted to WISCI II, 10MWT, and 6MWT as primary outcome measures for gait in SCI.Jackson, A. B., Ditunno, J. F., Read, M. S., Williams, S., Donovan, W., Boninger, M., Schmeler, M., Carnel, C.Yesdevopsadmin
2008Using the ICF to code and analyse women's disability narrativesJA Disability and Rehabilitation3012978-990PURPOSE: This article describes the use of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) as a conceptual framework for processing and analyzing the narratives of 50 community-dwelling women with a spinal cord injury. The women were participants in a federally-funded study of stress and coping over the life course. METHOD: The paper describes the development of a coding scheme and data reduction techniques used to process qualitative data. RESULTS: The initial results of three phases of data analysis are then presented: (i) the construction of matrices to display data so as to permit pattern finding; (ii) the mapping of specific ICF codes to text to produce a more finely grained analysis of environment-related stressors, and (iii) a thematic analysis of text depicting the dynamics of person-environment interaction. CONCLUSIONS: Of potential value to the further elaboration of the ICF is a fleshing out of the personal factors component of the ICF and the provision of a context-driven, process view of person-environment interaction. It is hoped that this article will stimulate continued discussion of person-level factors. The concept of coupling suggests also a need to focus research attention on the bi-directional and ever evolving linkages connecting person to environment.Duggan, C.H., Albright, K.J., Lequerica, A.H.University of Michigan SCI Model SystemYesdevopsadmin
2009Measuring Depression in Persons with Spinal Cord Injury: A Systematic ReviewJA Journal of Spinal Cord Medicine32 40353Background/Objective: Depression has been studied extensively among people with spinal cord injury (SCI). However, basic questions persist regarding the reliability and validity of depression measurement in the context of SCI. The objective of this study was to evaluate the state of knowledge of depression measurement in persons with SCI. Methods: English-language peer-reviewed citations from MEDLINE, CINAHL, PsycINFO, ProQuest, Google Scholar, and Web of Science from 1980 to present. Two reviewers screened 377 abstracts on SCI and depression topics to identify 144 containing classifiable psychometric data. All 144 were reviewed by 6 reviewers. Twenty-four studies reporting psychometric data on 7 depression measures in SCI samples were identified, including 7 validity studies. Results: Reliability data were limited to internal consistency and were consistently good to excellent across 19 studies. Validity data were limited to concurrent validity, construct validity, and/or clinical utility in 10 studies. Measures were comparable with respect to internal consistency, factor structure, and clinical utility. Results are limited to peer-reviewed, English literature, and studies were not judged for quality. Conclusions: Greater attention should be paid to the psychometric evaluation of established measures. Although existing evidence may not justify universal screening, we recommend depression screening in clinical practice when patients may be seen by nonpsychology personnel. There is insufficient evidence to recommend one screening measure over another. Therefore, selection of measures will depend on clinician preferences. Psychometric studies are needed to show test–retest reliability, criterion validity, and sensitivity to change to improve depression recognition and treatment.Kalpakjian, C., Bombardier, C. H., Schomer, K., Brown, P. A., Johnson, K. L.University of Michigan SCI Model SystemYesdevopsadmin
2009The PHQ-9 in spinal cord injury: An examination of factor structure as related to genderJA Journal of Spinal Cord Medicine32 147-156Background/Objective: Despite the attention depression after spinal cord injury (SCI) has received, research and clinical practice have been hampered by inadequate emphasis on reliable and valid measurement. Assessment of symptoms in persons with SCI is challenged by the presence of ‘‘transdiagnostic’’ symptoms and unexamined effects of gender. The objective of this study was to examine the factor structure of the Patient Health Questionnaire-9 (PHQ-9; the 9-item depression scale of the Patient Health Questionnaire) and determine whether the structure replicates across gender. Methods: A total of 1,168 women and men were matched on level/completeness of SCI, follow-up year, and age to create 584 pairs. Exploratory factor analysis examined 1- and 2-factor models and congruence in 2 randomly split half samples to establish congruence of the factor solution and replication across gender. Results: The 1- and 2-factor solutions fit the structure of the items accounting for 41% to 51% of original item variance. Congruence between random samples was uniformly high for the 1-factor solution (r ¼ 0.791–0.948) but variable for the 2-factor solution. Although congruence was high for the combined sample and men (r ¼ 0.90–0.97 and 0.71–0.94, respectively), it was variable for women (r ¼ 0.29–0.85). Conclusions: Although there was support for the 1-factor structure of the PHQ within and between sexes, the low congruence between sexes and within women for the 2-factor structure indicates potentially important differences about how certain symptoms may be experienced or interpreted differently by men and women with SCI. Future research should focus on where sexes diverge in cognitive, affective, and somatic dimensions of depressive symptoms and whether sex-specific or sex-neutral measures are warranted.Kalpakjian, C., Toussaint, L., Albright, K., Bombardier, C,, Krause, J., Tate, D.University of Michigan SCI Model SystemYesdevopsadmin
2008Computer and Internet Use by Persons After Traumatic Spinal Cord InjuryJA Archives of Physical Medicine & Rehabilitation89 1492-1498Objective: To determine whether computer and internet use by persons post spinal cord injury (SCI) is sufficiently prevalent and broad-based to consider using this technology as a long-term treatment modality for patients who have sustained SCI. Design: A multicenter cohort study. Setting: Twenty-six past and current U.S. regional Model Spinal Cord Injury Systems. Participants: Patients with traumatic SCI (N 2926) with follow-up interviews between 2004 and 2006, conducted at 1 or 5 years postinjury. Interventions: Not applicable. Results: Results revealed that 69.2% of participants with SCI used a computer; 94.2% of computer users accessed the internet. Among computer users, 19.1% used assistive devices for computer access. Of the internet users, 68.6% went online 5 to 7 days a week. The most frequent use for internet was e-mail (90.5%) and shopping sites (65.8%), followed by health sites (61.1%). We found no statistically significant difference in computer use by sex or level of neurologic injury, and no difference in internet use by level of neurologic injury. Computer and internet access differed significantly by age, with use decreasing as age group increased. The highest computer and internet access rates were seen among participants injured before the age of 18. Computer and internet use varied by race: 76% of white compared with 46% of black subjects were computer users (P .001), and 95.3% of white respondents who used computers used the internet, compared with 87.6% of black respondents (P .001). Internet use increased with education level (P .001): eighty-six percent of participants who did not graduate from high school or receive a degree used the internet, while over 97% of those with a college or associate’s degree did. Conclusions: While the internet holds considerable potential as a long-term treatment modality after SCI, limited access to the internet by those who are black, those injured after age 18, and those with less education does reduce its usefulness in the short term for these subgroups.Goodman, N., Jette, A., Houlihan, B., Williams, S.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2009Clinical relevance of gait research applied to clinical trials in spinal cord injuryJA Brain Research Bulletin78135-42Abstract not availableDitunno, J., Scivoletto, G.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2007Masculine role variables and outcomes among men with spinal cord injuryJA Disability & Rehabilitation29 625-633Purpose. Few studies have considered the impact of masculine role variables on outcome and adjustment to SCI among men. The present study examined the relations among SCI, views of masculinity, psychological adjustment, and rehabilitation outcomes among men with SCI. Method. The sample included 20 men with SCI receiving inpatient rehabilitation, with a mean age of 45 years. Data included demographic variables as well as Conformity to Masculine Norms Inventory (CMNI), Gender Role Conflict Scale (GRCS), Functional Independence Measure (FIM), and Satisfaction with Life Scale ratings, and change in marital status. Results. The findings revealed that satisfaction with life was positively related to scores on the CMNI Violence scale, FIM change from admission to discharge was positively related to the CMNI Emotional Control scale and negatively related to the CMNI Dominance scale. Change in marital status was inversely related to the CMNI Emotional Control and Primacy of Work scales and the GRCS Restricted Emotionality and Power, Success, and Competition scales. Conclusions. The findings show that certain aspects of the traditional masculine role (i.e., ability to modulate strong emotions) may be adaptive in the rehabilitation process, whereas other aspects (i.e., a dominant interpersonal style) may present a barrier to effective rehabilitation.Schopp, L.H., Good, G.E., Barker, K.B., Mazurek, M.O., Hathaway, S.L.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2009Healthcare HotlineJA Paraplegia News63428-29Abstract not availableHolicky, R,Rocky Mountain Regional SCI SystemYesdevopsadmin
2007Preliminary reliability and validity of a spinal cord injury secondary conditions scaleJA Journal of Spinal Cord Medicine30 131-139Background/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 timepoints 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.Kalpakjian, C., Scelza, W., Forchheimer, M., Toussaint, L.University of Michigan SCI Model SystemYesdevopsadmin
2008UntetheringJA Paraplegia News621264-65Abstract not availableHolicky, R.Rocky Mountain Regional SCI SystemYesdevopsadmin
2006Engineering better wheelchairs to enhance community participationJA IEEE transactions on neural systems and rehabilitation engineering14 438-455Abstract—With about 2.2 million Americans currently using wheeled mobility devices, wheelchairs are frequently provided to people with impaired mobility to provide accessibility to the community. Individuals with spinal cord injuries, arthritis, balance disorders, and other conditions or diseases are typical users of wheelchairs. However, secondary injuries and wheelchair-related accidents are risks introduced by wheelchairs. Research is underway to advance wheelchair design to prevent or accommodate secondary injuries related to propulsion and transfer biomechanics, while improving safe, functional performance and accessibility to the community. This paper summarizes research and development underway aimed at enhancing safety and optimizing wheelchair design.Cooper, R., Boninger, M., Spaeth, D., Ding, D., Guo, S., Koontz, A., Fitzgerald, S., Cooper, R., Kelleher, A., Collins, D.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2007The Relationship of Spirituality and Depression to Health Among People with Spinal Cord InjuryJA Topics in Spinal Cord Injury12 23-24This article evaluates the dynamics of spirituality in an aging sample of individuals with spinal cord injury (SCI). We found that the Functional Assessment of Chronic Illness Therapies—Spiritual (FACIT-SP), a commonly used measure of spirituality in other populations, is a valid instrument when used among people with SCI. Age and chronicity did not appear to be associated with spiritual well-being, which was predictive of perceived health status. FACIT-SP scores also explained a significant amount of the variance in scores on the Life Situation Index–Z (LSI-Z), a measure of global life satisfaction, incremental to that explained by measures of depression, perceived health status, and interpersonal support.Forchheimer, M.B., Tate, D.G.University of Michigan SCI Model SystemYesdevopsadmin
2008Standardized ambulation assessments following spinal cord injuryJA Topics Spinal Cord Injury Rehabilitation14139-60During a time of intense interest in neural recovery, there is strong emphasis on quantification of clinical outcomes. To promote responsible outcome measurement, a review of commonly used ambulation assessments was conducted, with an emphasis on application to the population with spinal cord injury (SCI). Each ambulation/walking assessment tool addressed includes a description of the examination, review of statistical support, and information on the utility of the assessment. Ambulation assessment measures are categorized by the variable being measured and considered for use either independently or in combination. In summary, no one assessment quantifies all parameters of ambulation, and comprehensive measurement is completed by using a combination of ambulation/walking assessments to document improvement in walking function after an SCI.Schmidt-Read, M., Sisto, S.A., Ditunno, J.F.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2007Masculine roles and rehabilitation outcomes among men with spinal cord and traumatic brain injuriesJA Men and Masculinities29 625-633Abstract not availableGood, G.E., Schopp, L.H., Thomson, D., Hathaway, S., Sanford-Martens, T., Mazurek, M., Mintz, L.M.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2007Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trialJA Neurorehabilitation & Neural Repair216539-550Objective. To demonstrate criterion (concurrent and predictive) and construct validity of the Walking Index for Spinal Cord Injury (WISCI) scale and other walking measures in the Spinal Cord Injury Locomotor Trial (SCILT). Design. Prospective multicenter clinical trial of a walking intervention for patients with acute traumatic spinal cord injury (SCI). Participants/Methods. Body weight-supported treadmill training was compared to overground mobility training in 146 patients with incomplete SCI (C4 to L3) enrolled within 8 weeks of onset and treated for 12 weeks. Primary outcome measures were the Functional Independence Measure (FIM), 50-foot walking speed (50FW-S), and 6-minute walking distance (6MW-D), tested 3, 6, and 12 months after entry. Secondary measures were the Lower Extremity Motor Score (LEMS), Berg Balance Scale (BBS), WISCI, and FIM locomotor score (LFIM), assessed at 6 centers by blinded observers. Data for the 2 arms were combined since no significant differences in outcomes had been found. Results. Correlations with WISCI at 6 months were significant with BBS (r = .90), LEMS (r = .85), LFIM (r = .89), FIM (r = .77), 50FW-S (r = .85), and 6MW-D (r = .79); similar correlations occurred at 3 and 12 months. Correlations of change scores from baseline WISCI were significant for change scores from baseline of LEMS/BBS/LFIM. Correlation of baseline LEMS and WISCI at 12 months were most significant (r = .73). The R2 of baseline LEMS explained 57% of variability of WISCI levels at 3 months. Conclusion. Concurrent validity of the WISCI scale was supported by significant correlations with all measures at 3, 6, and 12 months. Correlation of change scores supports predictive validity. The LEMS at baseline was the best predictor of the WISCI score at 12 months and explained most of the variance, which supported both predictive and construct validity. The combination of the LEMS, BBS, WISCI, 50FW-S, and LFIM appears to encompass adequate descriptors for outcomes of walking trials for incomplete SCI.Ditunno, J.F., Barbeau, H., Doblin, B.H., Elashoff, R., Harkema, S., Marino, R.J., , Hauck, W.W., Apple, D, Basso, D.M., Behrman, A., Deforge, D., Fugate, L., Saulino, M., Scott, M., Chung, J.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2007Romantic attachment in individuals with physical disabilitiesJA Rehabilitation Psychology52 184-195Objective: To examine the relationship between adult attachment style and physical disability in intimate romantic relationships. Method: Participants were 50 individuals with adult-onset spinal cord injuries (SCI) and 50 individuals with congenital disabilities (CON) living in the community. The main outcome measures were adult attachment style and dyadic relationship adjustment. Results: Participants with SCI and CON did not differ in rates of secure versus insecure attachment, and the rates of neither group differed significantly from rates reported for persons without disability. Dyadic adjustment was clearly predicted by attachment variables and differed between the participants with SCI and those with CON; individuals with SCI reported greater total dyadic adjustment. Avoidance showed a strong negative association with dyadic satisfaction, but no association was found with dyadic cohesion. Social participation variables were associated with dyadic adjustment. For instance, mobility was positively associated with dyadic satisfaction. Conclusions: Dyadic adjustment in people with disabilities, as in other groups, is affected by attachment style, but disability and social participation variables may also affect dyadic adjustment. Clinicians should consider differences in attachment styles among persons with disabilities and their implications for intimate close relationships.Hwang, K., Johnston, M., Smith, J.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2007The assessment of walking capacity using the walking index for spinal cord injury: self-selected versus maximal levelsJA Archives of Physical Medicine & Rehabilitation886762-767Objectives: To assess (1) the frequency and magnitude of differences between self-selected and maximal walking capacity following spinal cord injury (SCI) by using the Walking Index for Spinal Cord Injury (WISCI) and (2) how these levels differ in efficiency and velocity. Design: Prospective cohort. Setting: Academic medical center. Participants: Fifty people with chronic incomplete SCI. Interventions: Not applicable. Main Outcome Measures: Subjects ambulated at the level used in the community (self-selected WISCI) and the highest level possible (maximal WISCI). Velocity (in m/s), Physiological Cost Index (PCI), and Total Heart Beat Index (THBI) were calculated. Differences were compared using the paired t test (parametric) or Wilcoxon signed-rank test (nonparametric). Results: For 36 subjects, maximal WISCI was higher than self-selected WISCI; 21 subjects showed an increase of 3 levels or more. Ambulatory velocity was higher for self-selected WISCI compared with maximal WISCI (.68m/s vs .56m/s, P .001). PCI and THBI at self-selected WISCI were lower than at maximal WISCI (PCI, 0.99 beats/m vs 1.48 beats/m, P .001; THBI, 3.39 beats/m vs 4.75 beats/m, P .001). Conclusions: Many people with chronic SCI are capable of ambulating at multiple levels. For these people, ambulation at self-selected WISCI was more efficient as evidenced by greater velocity and decreased PCI and THBI. The findings have implications for assessing walking capacity within the context of clinical trials.Kim, M.O., Burns, A.S., Ditunno, J.F., Marino, R.J.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2009Implanted Electrical Stimulation of the Trunk for Seated Postural Stability and Function After Cervical Spinal Cord Injury: A Single Case StudyJA Archives of Physical Medicine & Rehabilitation90 340-347Objectives: To explore and quantify the physical and functional effects of stabilizing the torso with electrical stimulation of the paralyzed hip and trunk musculature after motor complete tetraplegia. Design: Single-subject case study with repeated measures and concurrent controls. Setting: Academic outpatient rehabilitation center. Participants: Forty-four-year– old man with C4 American Spinal Injury Association grade A tetraplegia 20 years postspinal cord injury. Intervention: A surgically implanted multichannel pulse generator and intramuscular stimulating electrodes to activate lumbar erector spinae, quadratus lumborum, and gluteus maximus muscles bilaterally. Main Outcome Measures: Outcomes assessed with and without stimulation included (1) spinal alignment and pelvic orientation, (2) pulmonary function and ventilatory volumes, (3) forward bimanual reaching distance, (4) seated stability and resistance to externally applied disturbances, (5) maximal force and speed of rowing-like movements, and the ability to (6) independently return to an erect seated position from full forward or lateral flexion and (7) roll in bed without assistance.Triolo, R., Boggs, L., Miller, M., Nemunaitis, G., Nagy, J., Bailey, S.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2006Masculine roles and rehabilitation outcomes among men recovering from serious injuriesJA Psychology of Men and Masculinity7 165-176Conceptions of masculinity were investigated for their potential relations to both help-seeking and health outcomes among men who experienced traumatic brain or spinal cord injuries. Results indicated that 9 of 17 masculinity-related indicators correlated negatively with attitudes toward psychological help-seeking. Regarding outcomes, desire for status and success correlated positively with ratings of improvement in functional independence from initial hospitalization to one-year follow-up. Conversely, the belief that men should have power over women correlated negatively with life satisfaction, and masculine role conflict correlated negatively with perception of environmental barriers to successful functioning in the community. Suggestions for practice and further research are discussed.Good, G.E., Schopp, L.H., Thomson, D., Hathaway, S., Sanford-Martens, T., Mazurek, M., Mintz, L.M.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2009The walking index for spinal cord injuryJA Australian J Physiotherapy55166Abstract not availableHarvey, L., Marino, R.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2007Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injuryJA Spinal Cord454304-9Study design: Cross-sectional and longitudinal design. Objectives: (1) To quantify skeletal muscle cross-sectional area (CSA) after correcting for intramuscular fat (IMF) in thigh muscle groups 6 weeks after incomplete spinal cord injury (SCI), (2) to monitor the changes in muscle CSA and IMF after 3 months from the initial measurement. Setting: Academic institution Athens, GA, USA. Methods: Six incomplete SCI patients (2874 years, 17875 cm and 7876 kg, mean7SE, C7 to L3, American Spinal Injury Association B or C) were tested at 571 weeks and 3 months after the initial measurement. T1-weighted magnetic resonance images were taken of both thighs. Six able-bodied (AB) controls were matched in age, sex, height and weight (2974 years, four male and two female subjets, 17975 cm and 7776 kg). Results: At 6 weeks post-injury, muscle CSA was 8274 cm2 in incomplete SCI and 123721 cm2 in AB controls (P¼0.04). IMF CSA was 5.271.3 and 2.370.6 cm2 in incomplete SCI and AB controls, respectively (P¼0.03). Relative IMF was three-fold higher (P¼0.03) in the SCI group versus AB controls (5.871.4 versus 2.070.6%). After 3 months, IMF increased 26% in the SCI group compared to the initial measurement (P¼0.02). Conclusions: Skeletal muscle atrophy is associated with greater IMF accumulation in SCI group 6 weeks post-injury compared to AB controls. Moreover, IMF continues to increase over time in incomplete SCI.Gorgey, A.S., Dudley, G.A.University of Michigan SCI Model SystemYesdevopsadmin
2009Guideline-driven assessment of cardiovascular disease and related risks after spinal cord injuryJA Topics in Spinal Cord Injury Rehabilitation14332-45Screening for cardiovascular disease (CVD) risks is an essential process in pursuing effective primary and secondary prevention. Risks can be determined from patient history and fasting lipid levels. Use of a multifactorial regression algorithm such as the Framingham model improves risk prediction but may contain quirks when used for risk estimation of persons with spinal cord injury (SCI). The gold standard for risk assessment and defining need for primary or secondary disease prevention is the National Cholesterol Education Program Adult Treatment Guidelines. Use of these tools by health practitioners will ensure best practice care of persons with SCI who require CVD disease intervention.Dyson-Hudson, T.A., Nash, M.S.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2009Online Health and Wellness SeriesJA Paraplegia News63742-43Abstract not availableHolicky, R.Rocky Mountain Regional SCI SystemYesdevopsadmin
2009Reply to JJ van MiddendorpJA Spinal Cord474347--348Abstract not availableDitunno, P.L., Patrick, M., Stineman, M., Ditunno, J.F.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2006Shoulder joint kinetics and pathology in manual chair usersJA Clinical Biomechanics88 781-9Background. Manual wheelchair users rely heavily on their upper limbs for independent mobility which likely leads to a high prevalence of shoulder pain and injury. The goal of this study was to examine the relationship between shoulder forces and moments experienced during wheelchair propulsion and shoulder pathology. Methods. Kinetic and kinematic data was recorded from 33 subjects with paraplegia as they propelled their wheelchairs at two speeds (0.9 and 1.8 m/s). Shoulder joint forces and moments were calculated using inverse dynamic methods and shoulder pathology was evaluated using a physical exam and magnetic resonance imaging scan. Findings. Subjects who experienced higher posterior force (Odds Ratio (OR) = 1.29, P = 0.03), lateral force (OR = 1.35, P = 0.047), or extension moment (OR = 1.35, P = 0.09) during propulsion were more likely to exhibit coracoacromial ligament edema. Individuals who displayed larger lateral forces (OR = 4.35, P = 0.045) or abduction moments (OR = 1.58, P = 0.06) were more likely to have coracoacromial ligament thickening. Higher superior forces (OR = 1.05, P = 0.09) and internal rotation moments (OR = 1.61 P = 0.02) at the shoulder were associated with increased signs of shoulder pathology during the physical exam. Interpretation. Specific joint forces and moments were related to measures of shoulder pathology. This may indicate a need to reduce the overall force required to propel a wheelchair in order to preserve upper limb integrity. Potential interventions include changes to wheelchair setup, propulsion training, or alternative means of mobility.Mercer, J., Boninger, M., Koontz, A., Armfield, D, Ren, D., Dyson-Hudson, T., Cooper, R.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2007Dynamic loading performance of fasciocutaneous flaps and implications for gaitJA Clin Biomech224478-485BACKGROUND: Recent advancements in microsurgery allow the free tissue transfer for reconstruction of soft-tissue defects on the plantar surface of the foot. Fasciocutaneous flaps are one available option to the reconstructive surgeon. However, their functional weight-bearing capabilities have never been adequately evaluated. This study investigated the dynamic loading performance of selected fasciocutaneous flaps during walking using instrumented gait analysis. METHODS: We investigated 6 feet with reconstructed heels along with their contralateral normal feet. A control group of normals was included also. Time-distance, ground reaction force parameters and plantar foot pressure distribution were evaluated. Data were normalized to account for anthropometric variations. A series of t-tests were used to investigate contrasts. FINDINGS: Walking velocity of injured subjects was decreased (PKarakostas, T., Hsiang, S. M., Sarantopoulos, C., Krause, J.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2007Self-reported problems after spinal cord injury: Implications for rehabilitation practiceJA Topics in Spinal Cord Injury Rehabilitation12335-44The purpose of this study was to identify self-reported problems among people with spinal cord injury (SCI), their relationship with aging after SCI, and how they change over time. Data on self-reported problems were collected during the second and third stages of a longitudinal aging study. Factor analysis of the stage 2 data revealed 4 factors reflective of emotional adaptation, dependency, health problems, and the environment. Four scales were developed based on this analysis. Comparisons of scale scores over time and between cohorts based on years post injury failed to reach significance. Areas in which participants cited the greatest number of problems included pain, lack of income and money problems, spasticity, stress and worries, and their sex lives. The results of these comparisons suggest that at least a portion of people with SCI experience significant problems in a number of areas of life, resulting in ongoing stress. These problems do not appear to be highly correlated with aging, suggesting they will not necessarily become more problematic, nor are they likely to self-remediate.Krause, J. S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2007A pilot study of factors associated with falls in individuals with incomplete spinal cord injuryJA J Spinal Cord Med303243-250BACKGROUND/OBJECTIVE: To determine factors associated with falls among a sample of ambulatory individuals with incomplete spinal cord injury (SCI). STUDY DESIGN: Cross-sectional mail survey. METHODS: A survey instrument of participant characteristics and fall-related variables was developed using relevant items from existing measures and was mailed to 221 individuals with incomplete SCI, who were identified from records of a large specialty hospital in the southeastern United States. Of the 221 prospective participants, 119 completed the questionnaire (54%). Multivariable logistic regression models were used to determine factors that were independently associated with having had a fall in the past year. RESULTS: After adjusting for covariates, having fallen in the past year was significantly (P < 0.05) associated with greater numbers of medical conditions (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.0-1.7), having arthritis (OR = 3.4, 95% CI = 1.2-9.6), experiencing dizziness (OR = 5.6, 95% Cl = 1.1-27.7), greater numbers of days with poor physical health (OR = 1.1; 95% Cl = 1.0-1.3), and the restriction of community activities because of fear of falling (OR = 1.5, 95% CI = 1.1-2.1). The multivariable models also showed that the odds of having fallen were significantly lower among those with better current perceived physical health (OR = 0.5; 95% Cl = 0.3-0.9), those with better perceived health compared to a year ago (OR = 0.4; 95% Cl = 0.2-0.8), individuals who exercised more frequently (OR = 0.2; 95% CI = 0.1-0.7), and those who used a walker (OR = 0.3; 95% CI = 0.1-0.9). CONCLUSIONS: Results suggest that interventions that address exercise frequency, walker use, and dizziness have promise for reducing falls for individuals with incomplete SCI.Brotherton, S. S., Krause, J. S., Nietert, P. J.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2007Pain interference in ambulatory spinal cord injuryJA Topics in Spinal Cord Injury Rehabilitation12391-96Objectives: The purpose of this study was to compare pain interference scores as a function of dependence in ambulation, as defined by need of assistance from another person, and to identify the association of pain interference with aging parameters (current age, years since injury). Method: Secondary analysis of existing survey data of 363 participants with spinal cord injury (SCI) from the Midwestern and Southeastern United States who have participated in a 30-year study of aging after SCI. Results: Participants who were independent of personal assistance in ambulation reported lower levels of pain interference on each of the 6 life areas of the Brief Pain Inventory and were less likely to use prescription medication to treat pain (p Krause, J. S., Morrisette, D., Brotherton, S., Karakostas, T., Apple, D.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2008Relationship of perceived barriers to employment and return to work five years later: A pilot study among 343 participants with spinal cord injuryJA Rehabilitation Counseling Bulletin512118-121The authors identified perceived barriers to employment in 1998 among 343 unemployed participants with spinal cord injury and correlated these data with employment status 5 years later. Actively looking for work was associated with the greatest likelihood of employment. Health factors, not disincentives or resources, were the primary barriers to employment at follow-up.Krause, J. S., Pickelsimer, E.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2007Does pain interference mediate the relationship of independence in ambulation with depressive symptoms after spinal cord injury?JA Rehabilitation Psychology Psychology522162-169Purpose/Objective: To test a mediational model that hypothesizes pain interference mediates the relationship between ambulatory status and depressive symptoms among participants with traumatic spinal cord injury (SCI). Research Method/Design: Responses to the Brief Pain Index (pain interference) and the Older Adult Health and Mood Questionnaire (depressive symptoms) were obtained from 1,545 adults with SCI. Logistic regression was used to calculate the odds of clinically significant symptomatology and probable major depression as a function of independence in ambulation and to evaluate the extent to which pain interference mediated the relationship between ambulation and a depressive diagnosis. Results: Partially dependent ambulators reported significantly greater odds of clinically significant symptomatology (2.30) and probable major depression (2.00) compared with independent ambulators prior to evaluation of pain interference (comparisons of wheelchair users with independent ambulators were not significant). However, these relationships were no longer significant after controlling for pain interference. Conclusions/Implications: Pain interference appears to mediate the relationship between ambulatory status and depressive symptoms after SCI.Krause, J. S., Brotherton, S., Morrisette, D., Newman, S., Karakostas, T.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2006Cross-cultural differences in preference for recovery of mobility among spinal cord injury rehabilitation professionalsJA Spinal Cord449567-575STUDY DESIGN: Direct observation of a constrained consensus-building process in three culturally independent five-person panels of rehabilitation professionals from the US, Italy and Canada. OBJECTIVES: To illustrate cultural differences in belief among rehabilitation professionals about the relative importance of alternative functional goals during spinal cord injury (SCI) rehabilitation. SETTING: Spinal Cord Injury Units in Philadelphia-USA, Rome-Italy and Vancouver-Canada. METHODS: Each of the three panels came to independent consensus about recovery priorities in SCI utilizing the features resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) assuming different stages of recovery. RESULTS: Sphincter management was of primary importance to all three groups. The Italian and Canadian rehabilitation professionals, however, showed preference for walking over wheelchair mobility at lower stages of assumed recovery, whereas the US professionals set wheelchair independence at a higher priority than walking. CONCLUSIONS: These preliminary results suggest cross-cultural recovery priority differences among SCI rehabilitation professionals. These dissimilarities in preference may reflect disparities in values, cultural expectations and health care policies.Ditunno, P., Patrick, M., Stineman, M., Morganti, B., Townson, A., Ditunno, J.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2007Quality of life and health in the last years after spinal cord injuryJA Topics in Spinal Cord Injury Rehabilitation12377-90Method: To answer the question of what people with spinal cord injury (SCI) can likely expect in terms of quality of life (QOL) and health as they approach the end of life, longitudinal data from the Spinal Cord Injury Model Systems Collaborative Aging Study were examined. Result: Over the course of the study, only 1 in 4 reported poor or fair QOL and health and provide reassurance that life with SCI can be both healthy and of a good quality, even in the last years of life.Whiteneck, G., Forchheimer, M., Krause, J. S.Yesdevopsadmin
2006An examination of depression through the lens of spinal cord injuryJA Womens Health Issues16 380-388Purpose. This study describes the prevalence of probable major depressive disorder (MDD) as well as other depressive disorders (ODD) and severity of depressive symptoms in a national sample of women with spinal cord injury (SCI) and compares them with a case-matched sample of men with SCI. Methods. A sample of 585 women was drawn and case-matched with men from the SCI Model System National SCI Database according to level/completeness of injury, follow-up year, and age. The outcome measure of depression was the Patient Health Questionnaire. Main Findings. Prevalence rates for women were 7.9% for probable MDD and 9.7% for ODD; rates for men were 9.9% and 10.3%, respectively. Logistic regression revealed that women who were divorced or at year 1 follow-up had a higher odds of having probable MDD (odds ratio [OR], 3.4 and 2.9, respectively). Employed women and men had significantly lower odds of probable MDD (OR, 0.274 and 0.358, respectively). Statistically significant differences were not found in gender comparisons for either probable MDD or symptom severity, which also were not associated with injury characteristics. Conclusion. The most significant, and unexpected, research finding is the absence of gender differences in probable MDD and symptom severity. Results challenge notions that depression will necessarily follow SCI; that injury characteristics determine the development and severity of depression; and that women experience a greater burden of depression than men. The main clinical implication is that depression screening and referral should be a routine feature of health care for women living with SCI, as well as for their male counterparts. Furthermore, nearly one fourth of women and men reported experiencing some or greater difficulty in daily life and relationships in the absence of probable depressive disorder, warranting monitoring of subsyndromal depression as well.Kalpakjian, C., Albright K.University of Michigan SCI Model SystemYesdevopsadmin
2008Validation of the walking index for spinal cord injury in a US and European clinical populationJA Spinal Cord463181-188OBJECTIVE: To demonstrate the prospective construct validity of the walking index for spinal cord injury (WISCI) in US/European clinical population. DESIGN: Prospective Cohort in Denmark, Germany, Italy and the USA. PARTICIPANTS/METHOD: Participants with acute complete/incomplete (ASIA Impairment Scale (AIS) A, B, C and D) traumatic spinal cord injuries were enrolled from four centers. Lower extremity motor scores (LEMS), WISCI level and Locomotor Functional Independence Measure (LFIM) levels were assessed with change in ambulatory status. WISCI progression was assessed for monotonic direction of improvement (MDI). LEMS were correlated to WISCI/LFIM. Use of walking aids/braces were analyzed. RESULTS: One hundred and seventy participants were enrolled and 20 excluded. Of the 150 participants (USA 112/150; Europe 38/150) (AIS A=59, B=19, C=32, D=40), LEMS and WISCI assessments were performed initially and at final assessment (3-12 months post injury) or until maximum WISCI score of 20. Eighty-five percent of motor complete (66/78) and 10% (7/72) of motor incomplete participants showed no progression (73/150). Of the remaining participants (77/150) who improved, 81% (62/77) showed MDI. However, the deviation from MDI occurred only at one time-point in 10/15 participants. LEMS correlated with WISCI at initial and final assessment (0.47 and 0.91 PDitunno, J. F., Scivoletto, G., Patrick, M., Biering-Sorensen, F., Abel, R., Marino, R.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2008Reliability and repeatability of the motor and sensory examination of the international standards for neurological classification of spinal cord injuryJA J Spinal Cord Med312166-170OBJECTIVE: To determine the reliability and repeatability of the motor and sensory examination of the International Standards for Classification of Spinal Cord Injury (SCI) in trained examiners. PARTICIPANTS/METHODS: Sixteen examiners (8 physicians, 8 physical therapists) with clinical SCI experience and 16 patients participated in a reliability study in preparation for a clinical trial involving individuals with acute SCI. After a training session on the standards, each examiner evaluated 3 patients for motor, light touch (LT), and pin prick (PP). The following day, 15 examiners reevaluated one patient. Interrater reliability was determined using intraclass correlation coefficients (1-way, random effects model). Intrarater reliability was determined using a 2-way random effects model. Repeatability was determined using the method of Bland and Altman. RESULTS: Patients were classified as complete tetraplegia (n = 5), incomplete tetraplegia (n = 5), complete paraplegia (n = 5), and incomplete paraplegia (n = 1). Overall, inter-rater reliability was high: motor = 0.97, LT = 0.96, PP = 0.88. Repeatability values were small in patients with complete SCI (motor < 2 points, sensory < 7 points) but large for patients with incomplete SCI. Intra-rater reliability values were > or = 0.98 for patients with complete SCI. CONCLUSIONS: The summed scores for motor, LT, and PP in subjects with complete SCI have high inter-rater reliability and small repeatability values. These measures are appropriately reliable for use in clinical trials involving serial neurological examinations with multiple examiners. Further research in subjects with incomplete SCI is needed to determine whether repeatability is acceptably small.Marino, R. J., Jones, L., Kirshblum, S., Tal, J., Dasgupta, A.Yesdevopsadmin
2007Living well: Measuring participation after SCIJA Paraplegia News611022-24Abstract not availableHolicky, R.Rocky Mountain Regional SCI SystemYesdevopsadmin
2007Arm crank ergometry and shoulder pain in persons with spinal cord injuryJA Archives of Physical Medicine and Rehabilitation88121727-1729OBJECTIVE: To determine whether a primary fitness program utilizing arm crank ergometry would cause increased shoulder pain in persons with spinal cord injury (SCI). DESIGN: Cohort study. SETTING: Clinical research center. PARTICIPANTS: People (N=23) with chronic SCI (>1 y) who were participating in a weight loss study to compare the effectiveness of diet only (1000 kcal/d for 12 wk) versus diet with arm crank ergometry (1000 kcal/d and arm crank ergometry 3 times a week for 12 wk). INTERVENTION: Arm crank ergometry. MAIN OUTCOME MEASURE: Changes in shoulder pain intensity using the Wheelchair User's Shoulder Pain Index (WUSPI). RESULTS: After adjusting for baseline scores, there was no significant difference between the 2 groups on postintervention WUSPI scores (F(1,20)=.85, P=.37, partial eta2=.04). The strength of the relationship between group assignment (diet only vs diet and arm crank ergometry) and final WUSPI score was weak, as assessed by a partial eta2, with group assignment accounting for 4% of the variance on the WUSPI. The adjusted means were lower in the diet and arm crank ergometry group (mean, 7.84) than in the diet only group (mean, 12.22); however, these differences did not appear to be clinically significant. CONCLUSIONS: A primary fitness program using arm crank ergometry does not increase shoulder pain in people with SCI who use wheelchairs. Further investigation with a larger group and what constitutes clinically significant changes on the WUSPI is warranted to confirm our results.Dyson-Hudson, T. A., Sisto, S. A., Bond, Q., Emmons, R., Kirshblum, S. C.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2007Pain after spinal cord injury: An evidenced-based review for clinical practice and research. Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures meetingJA J Spinal Cord Med305421-440BACKGROUND/OBJECTIVES: To examine the reliability, validity, sensitivity, and practicality of various outcome measures for pain after spinal cord injury (SCI), and to provide recommendations for specific measures for use in clinical trials. DATA SOURCES: Relevant articles were obtained through a search of MEDLINE, EMBASE, CINAHL, and PubMed databases from inception through 2006. STUDY SELECTION: The authors performed literature searches to find articles containing data relevant to the reliability and validity of each pain outcome measure in SCI and selected non-SCI populations. DATA EXTRACTION: After reviewing the articles, an investigator extracted information utilizing a standard template. A second investigator reviewed the chosen articles and the extracted pertinent information to confirm the findings of the first investigator. DATA SYNTHESIS: Taking into consideration both the quantity and quality of the studies analyzed, judgments on reliability and validity of the measures were made by the two investigators. Based upon these judgments, recommendations were formulated for use of specific measures in future clinical trials. In addition, for a subset of measures a voting process by a larger group of SCI experts allowed formulation of recommendations including determining which measures should be incorporated into a minimal dataset of measures for clinical trials and which ones need revision and further validity and reliability testing before use. CONCLUSIONS: A 0-10 Point Numerical Rating Scale (NRS) is recommended as the outcome measure for pain intensity after SCI, while the 7-Point Guy/Farrar Patient Global Impression of Change (PGIC) scale is recommended as the outcome measure for global improvement in pain. The SF-36 single pain interference question and the Multidimensional Pain Inventory (MPI) or Brief Pain Inventory (BPI) pain interference items are recommended as the outcome measures for pain interference after SCI. Brush or cotton wool and at least one high-threshold von Frey filament are recommended to test mechanical allodynia/hyperalgesia while a Peltier-type thermotester is recommended to test thermal allodynia/hyperalgesia. The International Association for the Study of Pain (IASP) or Bryce-Ragnarsson pain taxonomies are recommended for classification of pain after SCI, while the Neuropathic Pain Scale (NPS) is recommended for measuring change in neuropathic pain and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) for quantitating neuropathic and nociceptive pain discrimination.Bryce, T. N., Norrbrink, Budh, C., Cardenas, D. D., Dijkers, M., Felix, E. R., Finnerup, N. B., Kennedy, P., Lundeberg, T., Richards, J. S., Rintala, D. H., Siddall, P., Widerstrom-Noga, E.Yesdevopsadmin
2008Trends and issues in wheelchair technologiesJA Assistive Technology20261-72There is an overwhelming need for wheelchairs and the research and development required to make them safer, more effective, and widely available. The following areas are of particular importance: practitioner credentials, accreditation, device evaluation, device user training, patient education, clinical prescribing criteria, national contracts, and access to new technology. There are over 170 U.S. wheelchair manufacturers with a total reported income of $1.33 billion. However, of these companies, only five had sales in excess of $100 million. Wheelchairs account for about 1% of Medicare spending. Use of assistive technology is an increasingly common way of adapting to a disability. The emergence of advanced mobility devices shows promise for the contribution of engineering to the amelioration of mobility impairments for millions of people who have disabilities or who are elderly. Some of the trends in wheelchairs are going to require new service delivery mechanisms, changes to public policy, and certainly greater coordination between consumers, policy makers, manufacturers, researchers, and service providers.Cooper, R. A., Cooper, R., Boninger, M. L.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2007Multisite comparison of wheelchair propulsion kinetics in persons with paraplegiaJA J Rehabil Res Dev443449-458A multisite collaborative study is being conducted on the association between propulsion biomechanics and upper-limb injuries. This substudy compared subject characteristics and pushrim kinetics across three sites and identified early on in the main study any differences that could affect interpretation of the findings or data pooling. A total of 42 manual wheelchair users with paraplegia (14 from each site) performed 0.9 m/s and 1.8 m/s steady state propulsion trials and an acceleration-brake-coastdown trial on a wheelchair dynamometer while propulsion forces and moment about the hub were measured with a SmartWheel. Significant differences between two sites were found in peak and average resultant force (p < 0.05), peak and average moment at the slower steady state speed (p < 0.005), and peak and average torque at the faster steady state speed (p = 0.06). Subjects at the site with significantly lower forces and torques had a slower deceleration rate during coastdown compared with the subjects at the other two sites (p < 0.001). These results imply that rolling resistance is lower at one of the sites and likely due to differences in dynamometer properties. A mechanical method was used to site-normalize the data and enable data pooling for future analyses.Koontz, A. M., Yang, Y., Price, R., Tolerico, M. L., Digiovine, C. P., Sisto, S. A., Cooper, R. A., Boninger, M. L.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2007Living well: Revamping rehabJA Paraplegia News61714-17Abstract not availableHolicky, R.Rocky Mountain Regional SCI SystemYesdevopsadmin
2007Domains of outcomes in spinal cord injury for clinical trials to improve neurological functionJA J Rehabil Res Dev441113-122Selecting appropriate outcome measures in spinal cord injury clinical trials that aim to improve spinal cord function is a challenging task. Proving that an intervention has the intended effect on neurological functioning is insufficient. Any improvement must be shown to be clinically significant-that is, makes a change in the life of the person. Rehabilitation, which seeks to maximize function despite residual impairments, complicates this task. Small improvements in function due to a spinal cord intervention may be masked by improvements in function due to rehabilitation, particularly in the initial rehabilitation phase of care. Understanding outcome domains in models of disablement will facilitate selection or development of assessment tools appropriate for the trial in question. This article describes an expanded World Health Organization model of functioning that defines the domains of Impairment, Capability/Functional Limitation, and Activity, as well as the subdomains of Capacity and Performance, and gives examples of measurement instruments in use or under development in each domain.Marino, R. J.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2008Functional electrical stimulation after spinal cord injury: Current use, therapeutic effects and future directionsJA Spinal Cord464255-274Repair of the injured spinal cord by regeneration therapy remains an elusive goal. In contrast, progress in medical care and rehabilitation has resulted in improved health and function of persons with spinal cord injury (SCI). In the absence of a cure, raising the level of achievable function in mobility and self-care will first and foremost depend on creative use of the rapidly advancing technology that has been so widely applied in our society. Building on achievements in microelectronics, microprocessing and neuroscience, rehabilitation medicine scientists have succeeded in developing functional electrical stimulation (FES) systems that enable certain individuals with SCI to use their paralyzed hands, arms, trunk, legs and diaphragm for functional purposes and gain a degree of control over bladder and bowel evacuation. This review presents an overview of the progress made, describes the current challenges and suggests ways to improve further FES systems and make these more widely available.Ragnarsson, K. T.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2007Assessing the mobility characteristics and activity levels of manual wheelchair usersJA Journal of Rehabilitation Research and Development444561-572Although engaging in an active lifestyle is beneficial for maintaining quality of life, a majority of wheelchair users are inactive. This study investigated the mobility characteristics and activity levels of manual wheelchair users in the residential setting and at the National Veterans Wheelchair Games (NVWG). Demographic factors that may have influenced activity in the home environment were also identified. Fifty-two manual wheelchair users completed a brief survey, and their activity was monitored with a custom data logger over a period of 13 or 20 days. We found that they traveled a mean +/- standard deviation of 2,457.0 +/- 1,195.7 m/d at a speed of 0.79 +/- 0.19 m/s for 8.3 +/- 3.3 h/d while using their primary wheelchair in the home environment. No significant differences in mobility characteristics or activity levels were found for level of spinal cord injury or disability. We also found that subjects traveled significantly farther and faster and were active for more hours during an average day at the NVWG than in the home environment (p < 0.001). We found that manual wheelchair users who were employed covered more distance, accumulated more minutes, and traveled a greater average maximum distance between consecutive stops than those who were unemployed. Results from this study provide a better understanding of the activity levels achieved by manual wheelchair users and insight into factors that may influence this activity.Tolerico, M. L., Ding, D., Cooper, R. A., Spaeth, D. M., Fitzgerald, S. G., Cooper, R., Kelleher, A., Boninger, M. L.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2008Shoulder biomechanics during the push phase of wheelchair propulsion: A multisite study of persons with paraplegiaJA Archives of Physical Medicine and Rehabilitation894667-676OBJECTIVES: To present a descriptive analysis and comparison of shoulder kinetics and kinematics during wheelchair propulsion at multiple speeds (self-selected and steady-state target speeds) for a large group of manual wheelchair users with paraplegia while also investigating the effect of pain and subject demographics on propulsion. DESIGN: Case series. SETTING: Three biomechanics laboratories at research institutions. PARTICIPANTS: Volunteer sample of 61 persons with paraplegia who use a manual wheelchair for mobility. INTERVENTION: Subjects propelled their own wheelchairs on a dynamometer at 3 speeds (self-selected, 0.9m/s, 1.8m/s) while kinetic and kinematic data were recorded. MAIN OUTCOME MEASURES: Differences in demographics between sites, correlations between subject characteristics, comparison of demographics and biomechanics between persons with and without pain, linear regression using subject characteristics to predict shoulder biomechanics, comparison of biomechanics between speed conditions. RESULTS: Significant increases in shoulder joint loading with increased propulsion velocity were observed. Resultant force increased from 54.4+/-13.5N during the 0.9m/s trial to 75.7+/-20.7N at 1.8m/s (PCollinger, J. L., Boninger, M. L., Koontz, A. M., Price, R., Sisto, S. A., Tolerico, M. L., Cooper, R. A.Yesdevopsadmin
2008Functional recovery measures for spinal cord injury: An evidence-based review for clinical practice and researchJA Journal of Spinal Cord Medicine312133-144BACKGROUND/OBJECTIVE: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome measures designed to assess functional status relevant to SCI are important to develop. METHOD: Evaluation of currently available SCI functional outcome measures by a multinational work group. RESULTS: The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel Index (MBI), the Functional Independence Measure (FIM), the Quadriplegia Index of Function (QIF), and the Spinal Cord Independence Measure (SCIM). The MBI and the QIF were found to have minimal evidence for validity, whereas the FIM and the SCIM were found to be reliable and valid. The MBI has little clinical utility for use in the SCI population. Likewise, the FIM applies mainly when measuring burden of care, which is not necessarily a reflection of functional recovery. The QIF is useful for measuring functional recovery but only in a subpopulation of people with SCI, and substantial validity data are still required. The SCIM is the only functional recovery outcome measure designed specifically for SCI. CONCLUSIONS: The multinational work group recommends that the latest version of the SCIM (SCIM III) continue to be refined and validated and subsequently implemented worldwide as the primary functional recovery outcome measure for SCI. The QIF may continue to be developed and validated for use as a supplemental tool for the nonambulatory tetraplegic population.Anderson, K., Aito, S., Atkins, M., Biering-Sorensen, F., Charlifue, S., Curt, A., Ditunno, J., Glass, C., Marino, R., Marshall, R., Mulcahey, M. J., Post, M., Savic, G., Scivoletto, G., Catz, A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2007Neuroimaging in traumatic spinal cord injury: An evidence-based review for clinical practice and researchJA J Spinal Cord Med303205-214OBJECTIVE: To perform an evidence-based review of the literature on neuroimaging techniques utilized in spinal cord injury clinical practice and research. METHODS: A search of the medical literature for articles on specific neuroimaging techniques used in SCI resulted in 2,302 published reports. Review at the abstract and full report level yielded 99 clinical and preclinical articles that were evaluated in detail. Sixty nine were clinical research studies subjected to quality of evidence grading. Twenty-three articles were drawn from the pre-clinical animal model literature and used for supportive evidence. Seven review articles were included to add an element of previous syntheses of current thinking on neuroimaging topics to the committee process (the review articles were not graded for quality of evidence). A list of clinical and research questions that might be answered on a variety of neuroimaging topics was created for use in article review. Recommendations on the use of neuroimaging in spinal cord injury treatment and research were made based on the quality of evidence. RESULTS: Of the 69 original clinical research articles covering a range of neuroimaging questions, only one was judged to provide Class I evidence, 22 provided Class II evidence, 17 Class III evidence, and 29 Class IV evidence. RECOMMENDATIONS: MRI should be used as the imaging modality of choice for evaluation of the spinal cord after injury. CT and plain radiography should be used to assess the bony anatomy of the spine in patients with SCI. MRI may be used to identify the location of spinal cord injury. MRI may be used to demonstrate the degree of spinal cord compression after SCI. MRI findings of parenchymal hemorrhage/ contusion, edema, and spinal cord disruption in acute and subacute SCI may contribute to the understanding of severity of injury and prognosis for neurological improvement. MRI-Diffusion Weighted Imaging may be useful in quantifying the extent of axonal loss after spinal cord injury. Functional MRI may be useful in measuring the anatomic functional/metabolic correlates of sensory-motor activities in persons with SCI. MR Spectroscopy may be used to measure the biochemical characteristics of the brain and spinal cord following SCI. Intraoperative Spinal Sonography may be used to identify spinal and spinal cord anatomy and gross pathology during surgical procedures. Further research in these areas is warranted to improve the strength of evidence supporting the use of neuroimaging modalities. Positron Emission Tomography may be used to assess metabolic activity of CNS tissue (brain and spinal cord) in patients with SCI.Lammertse, D., Dungan, D., Dreisbach, J., Falci, S., Flanders, A., Marino, R., Schwartz, E.Rocky Mountain Regional SCI SystemYesdevopsadmin
2008Acupuncture study hypotheses should rely on scientific, not imaginary, models author replyJA Archives of Physical Medicine and Rehabilitation891194-195N/ADyson-Hudson, T. A., Komaroff, E.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2008Living well: ICF focus groupsJA Paraplegia News62415-16Abstract not availableHolicky, R.Rocky Mountain Regional SCI SystemYesdevopsadmin
2008Technology for mobility and quality of life in spinal cord injuryJA IEEE Eng Med Biol Mag27256-68The purpose of this article is to provide a review of mobility devices available for the rehabilitation of individuals with (spinal cord injury) SCI. The technologies that improve mobility and potentially enhance community participation that will be discussed include those devices that are used to improve ambulation, wheeled mobility, and functional electrical stimulation (FES) systems. This review should provide a guide to biomedical engineers to understand the tools developed, the design characteristics, and the functionality of such technologies that strive to improve functional mobility of individuals with SCI. This review is not intended to suggest the optimal device(s) geared for a given individual with SCI. Conversely, since it is important to match the person with the technology, the purpose of this review is to offer a series of mobility options that may be available to a person with SCI.Sisto, S. A., Forrest, G. F., Faghri, P. D.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2007Spinal cord injury pain classification: History, current trends, and commentaryJA Topics in Spinal Cord Injury Rehabilitation13219-JanPain following spinal cord injury (SCI) has been well described in the literature over the years, but both SCI pain research and clinical care have been hampered by the lack of a uniform method for assessing pain. There have been a large number of proposed classification systems published, but no consensus to date on what criteria are required for each subtype of pain or the procedures to be used to make that determination. Accordingly, the literature is filled with descriptions of clinical series and some controlled trials of the treatment of SCI pain with no clear idea as to what percentage of the sample experienced neuropathic pain, musculoskeletal pain, or both. The more recent literature has been more specific with trials directed at specific subtypes of SCI pain. In this article, we review the history of SCI classification schemes, describe current efforts to develop a unified classification scheme and an accompanying set of diagnostic procedures, and describe international efforts along these lines. We also describe translational work related to SCI pain and the benefits and shortcomings of current animal models of SCI pain. Finally, several of the authors provide comments on the direction they think the field needs to take to continue to move this line of inquiry further.Richards, J. S., Siddall, P., Bryce, T., Dijkers, M., Cardenas, D. D.Yesdevopsadmin
2007Development of a complementary and alternative medicine program in an acute rehabilitation settingJA SCI Nursing24 9-MayAbstract not availableChase, T.Yesdevopsadmin
2008Who wants to walk? Preferences for recovery after SCI: A longitudinal and cross-sectional studyJA Spinal Cord467500-506STUDY DESIGN: Cross-sectional and longitudinal direct observation of a constrained consensus-building process in nine consumer panels and three rehabilitation professional panels. OBJECTIVES: To illustrate differences among consumer and clinician preferences for the restoration of walking function based on severity of injury, time of injury and age of the individual. SETTING: Regional Spinal Cord Center in Philadelphia, USA. METHODS: Twelve panels (consumer and clinical) came to independent consensus using the features-resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) at different stages of recovery. RESULTS: Walking is given priority early in the game by eight out of nine consumer panels and by two out of three professional panels. The exception consumer panel (ISCIDitunno, P. L., Patrick, M., Stineman, M., Ditunno, J. F.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2008Breaking the news in spinal cord injuryJA J Spinal Cord Med31112-JulBreaking the bad news in terms of prognosis for significant motor recovery following a neurologically complete spinal cord injury (SCI) is one of the most difficult tasks for the spinal cord medicine specialist. Learning the skills to facilitate this communication is extremely important to better assist patients to understand their prognosis as well as foster hope for their future. If bad news is delivered poorly it can cause confusion and long-lasting distress and resentment; if done well, it may assist understanding, adjustment, and acceptance. This article provides the physician who cares for patients with SCI with some concepts to consider when discussing prognosis with patients and their families.Kirshblum, S., Fichtenbaum, J.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2008Living well: Life after high-level SCIJA Paraplegia News62136-37Abstract not availableHolicky RRocky Mountain Regional SCI SystemYesdevopsadmin
2007Acupuncture for chronic shoulder pain in persons with spinal cord injury: A small-scale clinical trialJA Archives of Physical Medicine and Rehabilitation88101276-1283OBJECTIVE: To determine the efficacy of acupuncture in the treatment of chronic musculoskeletal shoulder pain in subjects with spinal cord injury (SCI). DESIGN: Randomized, double blind (participants, evaluator), placebo (invasive sham) controlled trial. SETTING: Clinical research center. PARTICIPANTS: Seventeen manual wheelchair-using subjects with chronic SCI and chronic musculoskeletal shoulder pain. INTERVENTIONS: Participants were randomly assigned to receive 10 treatments of either acupuncture or invasive sham acupuncture (light needling of nonacupuncture points). MAIN OUTCOME MEASURE: Changes in shoulder pain intensity were measured using the Wheelchair User's Shoulder Pain Index. RESULTS: Shoulder pain decreased significantly over time in both the acupuncture and the sham acupuncture groups (P=.005), with decreases of 66% and 43%, respectively. There was no significant difference between the 2 groups (P=.364). There was, however, a medium effect size associated with the acupuncture treatment. CONCLUSIONS: There appears to be an analgesic effect or a powerful placebo effect associated with both acupuncture and sham acupuncture. There was a medium treatment effect associated with the acupuncture, which suggests that it may be superior to sham acupuncture. This observation, along with the limited power, indicates that a larger, more definitive randomized controlled trial using a similar design is warranted.Dyson-Hudson, T. A., Kadar, P., LaFountaine, M., Emmons, R., Kirshblum, S. C., Tulsky, D., Komaroff, E.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2007Post-acute rehabilitation research and policy recommendationsJA Archives of Physical Medicine and Rehabilitation88111535-1541This article summarizes the research and health policy recommendations developed by participants at the symposium "State-of-the-Science on Post-Acute Rehabilitation: Setting a Research Agenda and Developing an Evidence Base for Practice and Public Policy," held in February 2007. A diverse group of participants represented federal government agencies, private insurers, professional organizations, providers of rehabilitation services, patients and their advocates, and health researchers. During roundtable discussions and theme-specific break-out sessions, participants were asked to consider 5 major topics regarding postacute rehabilitation care: (1) the extent of our knowledge, (2) the limitations of our knowledge, (3) the barriers that limit research, (4) research priorities to reduce these obstacles and assemble needed evidence, and (5) the major policy implications. Several key themes emerged: the need for improved measures, particularly of case-mix factors and treatment ingredients; the need for a more uniform and coherent system of postacute rehabilitation care to facilitate gathering of common data; the need to attend to underutilization as well as overutilization of rehabilitation services; the need for cooperation among payers, providers, and researchers to advance a rehabilitation effectiveness research agenda; and the desire to develop payment policies that are based on research evidence.Clohan, D. B., Durkin, E., Hammel, J., Murray, P., Whyte, J., Dijkers, M., Gans, B. M., Graves, D. E., Heinemann, A., Worsowicz, G.Yesdevopsadmin
2008Outcomes of posterior spinal fusion and instrumentation in patients with continuous intrathecal baclofen infusion pumpsJA Spine334E94-9Caird, M.S., Palanca, A.A., Garton, H., Hensinger, R.N., Ayyangar, R.N., Drongowski, A., Farley, F.A.University of Michigan SCI Model SystemYesdevopsadmin
2007Durable medical equipment for children with spinal cord dysfunction: Implications of age and level of injuryJA J Spinal Cord Med30 S172-S177BACKGROUND: Children with spinal cord dysfunction interact with their environment in different ways than their able-bodied peers. To enable them to participate in typical, age-appropriate activities, they must be provided with various types of equipment. Choosing from available options involves a team approach. SUMMARY: This article discusses general types of durable medical equipment for mobility (wheelchairs, strollers, standers), communication (including augmentative communication devices and computers), self-care, and recreation. Provision of this equipment for these children enhances their ability to learn and to take part in everyday activities and improves their quality of life.Nelson, V.S.University of Michigan SCI Model SystemYesdevopsadmin
2008Detection of pediatric cervical spine injuryJA Neurosurgery623700-708OBJECTIVE: In evaluating the pediatric cervical spine for injury, the use of adult protocols without sufficient sensitivity to pediatric injury patterns may lead to excessive radiation doses. Data on injury location and means of detection can inform pediatricspecific guideline development. METHODS: We retrospectively identified pediatric patients with codes from the International Classification of Diseases, 9th Revision, for cervical spine injury treated between 1980 and 2000. Collected data included physical findings, radiographic means of detection, and location of injury. Sensitivity of plain x-rays and diagnostic yield from additional radiographic studies were calculated. RESULTS: Of 239 patients, 190 had true injuries and adequate medical records; of these, 187 had adequate radiology records. Patients without radiographic abnormality were excluded. In 34 children younger than 8 years, National Emergency X-Radiography Utilization Study criteria missed two injuries (sensitivity, 94%), with 76% of injuries occurring from occiput–C2. In 158 children older than 8 years, National Emergency X-Radiography Utilization Study criteria identified all injured patients (sensitivity, 100%), with 25% of injuries occurring from occiput–C2. For children younger than 8 years, plain-film sensitivity was 75% and combination plain-film/occiput–C3 computed tomographic scan had a sensitivity of 94%, whereas combination plain-film and flexionextension views had 81% sensitivity. In patients older than 8 years, the sensitivities were 93%, 97%, and 94%, respectively. CONCLUSION:Younger children tend to have more rostral (occiput–C2) injuries compared with older children. The National Emergency X-Radiography Utilization Study protocol may have lower sensitivity in young children than in adults. Limited computed tomography from occiput–C3 may increase diagnostic yield appreciably in young children compared with flexion-extension views. Further prospective studies, especially of young children, are needed to develop reliable pediatric protocols.Garton, H.J.L., Hammer, M.University of Michigan SCI Model SystemYesdevopsadmin
2008Ways of coping and perceived stress in women with spinal cord injuryJA Journal of Health Psychology133348-354Using a cross-sectional design, this research aimed to assess whether a three-factor model of Positive Reappraisal, Escape-Avoidance, and Seeking Social Support based on the Ways of Coping Questionnaire (WOCQ) appropriately depicts coping within a sample of women with spinal cord injury (SCI). Forty-four community-dwelling women with spinal cord injury were interviewed from two urban rehabilitation facilities in the Midwestern United States. The main outcome measures used were the Perceived Stress Scale (PSS) and the WOCQ. The Positive Reappraisal, Escape-Avoidance, and Seeking Social Support scales of the WOCQ significantly accounted for variance in perceived stress. These three scales appear to be most relevant to perceived stress in women with SCI. Implications for coping research in this population are discussed.Lequerica, A.H., Forchheimer, M., Toussaint, L., Tate, D.G., Roller, S.University of Michigan SCI Model SystemYesdevopsadmin
2007Kinematics and muscle activity of individuals with incomplete spinal cord injury during treadmill stepping with and without manual assistanceJA Journal of Neuroengineering and Rehabilitation4 32BACKGROUND: Treadmill training with bodyweight support and manual assistance improves walking ability of patients with neurological injury. The purpose of this study was to determine how manual assistance changes muscle activation and kinematic patterns during treadmill training in individuals with incomplete spinal cord injury. METHODS: We tested six volunteers with incomplete spinal cord injury and six volunteers with intact nervous systems. Subjects with spinal cord injury walked on a treadmill at six speeds (0.18-1.07 m/s) with body weight support with and without manual assistance. Healthy subjects walked at the same speeds only with body weight support. We measured electromyographic (EMG) and kinematics in the lower extremities and calculated EMG root mean square (RMS) amplitudes and joint excursions. We performed cross-correlation analyses to compare EMG and kinematic profiles. RESULTS: Normalized muscle activation amplitudes and profiles in subjects with spinal cord injury were similar for stepping with and without manual assistance (ANOVA, p > 0.05). Muscle activation amplitudes increased with increasing speed (ANOVA, p < 0.05). When comparing spinal cord injury subject EMG data to control subject EMG data, neither the condition with manual assistance nor the condition without manual assistance showed a greater similarity to the control subject data, except for vastus lateralis. The shape and timing of EMG patterns in subjects with spinal cord injury became less similar to controls at faster speeds, especially when walking without manual assistance (ANOVA, p < 0.05). There were no consistent changes in kinematic profiles across spinal cord injury subjects when they were given manual assistance. Knee joint excursion was approximately 5 degrees greater with manual assistance during swing (ANOVA, p < 0.05). Hip and ankle joint excursions were both approximately 3 degrees lower with manual assistance during stance (ANOVA, p < 0.05). CONCLUSION: Providing manual assistance does not lower EMG amplitudes or alter muscle activation profiles in relatively higher functioning spinal cord injury subjects. One advantage of manual assistance is that it allows spinal cord injury subjects to walk at faster speeds than they could without assistance. Concerns that manual assistance will promote passivity in subjects are unsupported by our findings.Domingo, A., Sawicki, G.S., Ferris, D.P.University of Michigan SCI Model SystemYesdevopsadmin
2008Depression in men with spinal cord injury: Rethinking the "Strong Silent Type."JA Psychosocial Processes20273-80Abstract not availableKalpakjian, C.University of Michigan SCI Model SystemYesdevopsadmin
2008Current utilization of reconstructive upper limb surgery in tetraplegiaJA Hand Clinics222169-173Despite improved surgical techniques and postoperative management protocols for tetraplegic patients undergoing upper extremity functional reconstruction, recent studies have shown that these procedures are profoundly underutilized in the United States. The complex disabilities of tetraplegic patients limit their ability to independently obtain treatment information and travel to medical destinations to receive reconstructive procedures, thus making them a vulnerable patient population susceptible to physician influence regarding treatment decisions. Based on the results of previous research, we believe that increased collaboration among treating physician specialties will enhance patient access to surgical reconstruction.Squitieri, L., Chung, K.C.University of Michigan SCI Model SystemYesdevopsadmin
1998Empowerment theory for rehabilitation research: Conceptual and methodological issuesJAJ37477.Rehabilitation Psychology4313-16.Article describing a conceptual framework for assessing individual psychological empowerment in rehabilitation outcome research. The article reviews recent examples of empirical studies of empowerment in the rehabilitation literature, and discusses empowerment theory before presenting its general framework for the construct of psychological empowerment. The authors argue that psychological empowerment must be conceptualized differently for specific contexts and populations, and that therefore a generic global measure of psychological empowerment is neither possible nor desirable.Zimmerman, M. A., Warschausky, S.University of Michigan SCI Model SystemYesdevopsadmin
2008Improving the efficiency of screening for major depression in people with spinal cord injuryJA Journal of Spinal Cord Medicine312177-184BACKGROUND/OBJECTIVE: To investigate the metric properties, relative efficiency, sensitivity and specificity, and positive predictive value of a short form of the Patient Health Questionnaire-9 (PHQ-9) that may be used as a screening test for depression. METHODS: Data from the National Spinal Cord Injury Statistical Center Database containing 3,652 records with complete data for the PHQ-9 were analyzed using Confirmatory Factor Analysis, Item Response Theory Graded Response Model analysis, and sensitivity and specificity analysis of classification. RESULTS: A scale comprised of items 1, 2, and 6 from the PHQ-9 has a relative efficiency of 0.66 compared to the 9-item scale. Using this 3-item scale and a cutoff score of 3 or more provides specificity of 0.93 and sensitivity of 0.87; a cutoff of 4 provides specificity of 0.95 and sensitivity of 0.82. The shorter version of the scale reduces the effect of response bias caused by gender. The relative efficiency of the 9-item scale is 0.88 for women compared to men; the 3-item scale increases the relative efficiency to 0.93. CONCLUSION: A 3-item scale provides adequate information for clinical screening purposes. Cutoff scores of either 3 or 4 are acceptable and present options for decision making within a particular clinical setting. Additionally, the 3-item scale reduces the effect of gender of the respondent on the score obtained.Graves, D. E., Bombardier, C. H.Yesdevopsadmin
1994Alcohol use and traumaJAJ36890.Academic Emergency Medicine12171-74Article highlights the role of alcohol use in trauma. Clinical studies that explore the effects of acute and chronic alcohol use on the response to injury are discussed. Potential mechanisms, both physiologic and cellular, by which alcohol may enhance injury are reviewed. Advances in the identification of alcohol abuse in trauma victims and the use of early alcohol counseling are discussed. Areas for future investigations are proposed. This document is included in NCDDR's Guide to Substance Abuse and Disability Resources produced by NIDRR Grantees, number D.15.Zink, B. J., Maio, R. F.University of Michigan SCI Model SystemYesdevopsadmin
1996Alcohol, central nervous system injury, and time to death in fatal motor vehicle crashesJAJ36885.Alcoholism: Clinical and Experimental Research2091518-22Retrospective study examines data from 401 motor vehicle crashes (MVC) in Michigan (1985-1991) to determine whether alcohol-intoxicated MVC fatalities with central nervous system injuries (CNSI) were more likely to die in the immediate postinjury period than victims with CNSI who were sober. Medical examiner records were reviewed for age, blood-alcohol concentration (BAC), and time to death (TTD). Injury severity, anatomical profile scores and G scores (which relate the anatomical profile component value to survival probability) were calculated and used to identify CNSI subjects. Alcohol cases with BAC greater than/equal to 100 mg/dl (n=99) were significantly younger and more frequently had TTD less than 1 hour than sober cases (n=233): odds ratio 1.62 [0.95 CI(1.02 to 2.56)]. Overall, CNSI cases (n=297) were significantly younger and had fewer thoracic injuries, but did not differ significantly according to TTD, compared to non-CNSI cases. However, alcohol-related CNSI cases (n=77) were more than twice as likely to have TTD less than 1 hour: odds ratio 2.04[0.95 CI(1.13 to 3.70)]. For alcohol related isolated CNSI cases, the odds ratio for TTD less than 1 hour, compared with non-isolated CNSI cases was 8.25 (0.95 CI; 0.66 to 102.5). Injury Severity score, anatomical profile, and G scores were not significantly different for alcohol and non alcohol CNSI cases, whether isolated or non-isolated. These data suggest that alcohol intoxication is associated with increased frequency of early death in MVC victims with CNSI, despite a lack of detectable differences in anatomical injury scoring. This document is included in NCDDR's Guide to Substance Abuse and Disability Resources produced by NIDRR Grantees, number D.8.Zink, B. J.University of Michigan SCI Model SystemYesdevopsadmin
1994Measuring what matters: key rehabilitation outcomesJAJ28984.Archives of Physical Medicine and Rehabilitation75101073-1076Discusses the key rehabilitation outcomes that should be measured to adequately document the impact of rehabilitation in a person's life. The author proposes a model of rehabilitation outcomes that builds on the concepts of impairment, disability, and handicap from the World Health Organization's model of disablement. The model identifies handicap as a key outcome, emphasizes the lifetime nature of disabling conditions, and recognizes the importance of an individual's subjective perceptions as legitimate outcomes. This view of the rehabilitation process provides a logical connection between rehabilitation interventions and the ultimate concern with quality of life. This article describes each component of the model and discusses the implications for practice and research.Whiteneck, G. G.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1994Pressure ulcers: a reviewJAJ28980.Archives of Physical Medicine and Rehabilitation758908-917Review of the literature on pressure ulcer development and clinical management. The following topics are discussed: 1) etiologic factors; 2) persons at risk for pressure ulcer development; 3) systems for the description/classification of pressure ulcers; 4) pathologic tissue changes; 5) complications; 6) medical management; 7) treatment of the ulcer; 8) research on a possible role for growth factors in pressure ulcer treatment; 9) surgical treatment; and 10) techniques and products for pressure ulcer prevention.Yarkony, G. M.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2001Supported employment: New directions for the new millenniumJAJ44786.In P. Wehman (Ed.), Supported employment in business: Expanding the capacity of workers with disabilities (pp. 3-21). St. Augustine, FL: Training Resource Network, IncN/A 21-MarChapter describes how supported employment works and examines resources for improving quality employment outcomes. Four major categories of work supports are available: agency-mediated, business-mediated, government-mediated, and consumer/family/community-mediated. Authors discuss each of these categories and the subcategories within them.Wehman, Paul, Bricout, JohnVCU Model Spinal Cord Injury CenterYesdevopsadmin
1999Colostomies: the good, the bad, and the uglyJAJ36690.PN/Paraplegia News53441-44Article provides an overview of colostomies. Pointing to research that shows nearly three-quarters of spinal cord injury (SCI) survivors who have received colostomies have reported an improved quality of life this article explains how the digestive system works, exactly what a colostomy is and what function it serves, and dietary effects on bowel management. Changing attitudes are discussed explaining how the procedure which is still used mainly for people who have exhausted other options is now opening up for other patients due to increased attention to quality of life issues. Down sides are presented briefly. A few suggestions are offered as to whom to contact for their opinions when considering the procedure.Weitzenkamp, D., Gerhart, K.Rocky Mountain Regional SCI SystemYesdevopsadmin
2004Quantifying environmental factors: A measure of physical, attitudinal, service, productivity, and policy barriersJAJ46618.Archives of Physical Medicine and Rehabilitation8581324-1335Article describes the development and testing of questionnaire designed to assess environmental barriers encountered by people with and without disabilities. Disability experts developed items for the Craig Hospital Inventory of Environmental Factors (CHIEF) to measure the frequency and magnitude of environmental barriers reported by individuals. Factor analysis yielded 5 subscales measuring: (1) attitudes and support, (2) services and assistance, (3) physical and structural, (4) policy, (5) work and school environmental barriers. The CHIEF total score had high test-retest reliability and high internal consistency, but lower participant-proxy agreement. Significant differences were found in the scores among people with known differences in disability levels and disability categories.Whiteneck, Gale G., Harrison-Felix, Cynthia L., Mellick, David C., Brooks, C. A., Charlifue, Susan B., Gerhart, Ken A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2003Competitive employment: Has it become the "first choice" yet?JAJ46671.Journal of Disability Policy Studies143163-173Article discusses the underlying core values critical to programs that effectively promote competitive employment through the use of supported employment for individuals with disabilities. Authors describe 10 quality indicators that can be used to assess supported employment programs: (1) meaningful competitive employment in integrated work setting; (2) informed choice, control, and satisfaction; (3) level and nature of supports; (4) employment of individuals with significant disabilities; (5) amount of hours worked weekly; (6) number of persons from program working regularly; (7) well-coordinated job retention system; (8) employment outcome monitoring and tracking system. (9) integration and community participation; and (10) employer satisfaction.Wehman, Paul, Revell, W. Grant, Brooke, ValerieVCU Model Spinal Cord Injury CenterYesdevopsadmin
1999Predicting community reintegration after spinal cord injury from demographic and injury characteristicsJAJ37960.Archives of Physical Medicine and Rehabilitation80111485-1491Study examining the influence of demographic factors and injury characteristics on the community reintegration of persons with spinal cord injury (SCI). Data are from 1, 2, 5, 10, 15, and 20 year follow-up of 3,835 persons with SCI. Factors examined included neurological classification, age, years post-injury, sex, ethnicity, and education. These factors were found to explain some but not most of the variance in physical independence, mobility, occupation, social integration, and economic self-sufficiency.Whiteneck, G., Tate, D., Charlifue, S.Rocky Mountain Regional SCI SystemYesdevopsadmin
2004Geriatric rehabilitation. 1. Social and economic implications of agingJAJ50182.Archives of Physical Medicine and Rehabilitation857, Suppl 3S3-S6Article focuses on the epidemiology of aging, the economics of aging, informal and formal social support systems, ageism and societal issues, and care and treatment settings. This article is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education program for practitioners and trainees in physical medicine and rehabilitation and geriatric medicine.Worsowicz, Gregory M., Stewart, Deborah G., Phillips, Edward M., Cifu, David X.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1997Recovery following spinal cord injuryJAJ33979.American Rehabilitation22413-19Article about the recovery of general motor function, ambulation, and other activities of daily living following spinal cord injury (SCI). The authors first discuss how recovery from spinal cord injury can be measured, then present information about recovery by patient category (complete paraplegia, incomplete paraplegia, complete tetraplegia, and incomplete tetraplegia). Findings are based on an 8-year prospective study.Waters, R. L., Sie, I. H., Adkins, R. H., Yakura, J. S.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
1998The big bad bowelsJAJ36058.PN/Paraplegia News521034-35Article offering advice for persons with spinal cord injury (SCI) on management of bowel function, including constipation, incontinence, impaction, and diarrhea.Weitzenkamp, D.Rocky Mountain Regional SCI SystemYesdevopsadmin
2001Role of survey research in assessing rehabilitation outcomesJAJ41700.American Journal of Physical Medicine and Rehabilitation804305-309Article on survey research as a technique for studying rehabilitation outcomes. The value of survey research is defended, methods are discussed, and examples are given of successful survey research efforts related to rehabilitation outcomes.Whiteneck, G. G., Gerhart, K. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2003Assessment of a holistic wellness program for persons with spinal cord injuryJAJ46984.American Journal of Physical Medicine and Rehabilitation8212957-968Study examined the effectiveness of a comprehensive and integrated wellness program for adults with spinal cord injury (SCI). Forty-three adults with SCI were randomly assigned to either intervention or control groups. The intervention consisted of six 4-hour workshops over a 3-month period, focusing on physical activity, nutrition, lifestyle management, and prevention of secondary conditions. Outcomes were measures using standardized physical and psychosocial measures. Control subjects participated in the same before and after assessments but received no intervention. Comparison of within-group results showed that the intervention group reported fewer and less severe secondary conditions by the end of the study. Significant improvements were also found in health-related self-efficacy and health behaviors. Although no significant differences were found between groups, analysis suggested participation in the wellness program may be associated with improved health behaviors.Zemper, Eric D., Tate, Denise G., Roller, Sunny, Forchheimer, Martin, Chiodo, Anthony, Nelson, Virginia S., Scelza, WilliamUniversity of Michigan SCI Model SystemYesdevopsadmin
2006The ticket to work program: Marketing strategies and techniques to enhance implementationJAJ50390.Journal of Vocational Rehabilitation24145-63Article describes strategies to expand participation in the Ticket to Work (TTW) Program by Social Security Administration beneficiaries and to increase the number and diversity of employment networks (ENs). Direct mail, web-based outreach, targeted marketing to selected opinion makers, specialized media outlets, and a number of other marketing strategies are critiqued and analyzed. The 2 main marketing issues related to ENs are: (1) there are not enough quality ENs, and (2) the ENs in place are not taking tickets and making a sufficient number of placements for the TTW program to be successful. The main marketing issue for reaching beneficiaries is recognizing that marketing the TTW involves first marketing employment. Marketing considerations for beneficiaries must recognize and address the employment-related fears, interests, and support needs of ticket recipients.Wehman, Paul, Revell, W. GrantVCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Environmental factors and their role in participation and life satisfaction after spinal cord injuryJAJ46774.Archives of Physical Medicine and Rehabilitation85111793-1803Study identified environmental factors perceived as barriers in the daily lives of people with spinal cord injuries (SCI) and examined the relative impact of environmental barriers compared with personal characteristics, impairment, and activity limitations on societal participation and life satisfaction. In a survey of more than 2,700 people with SCI, about 20 percent said none of the 12 environmental factors they were asked about were barriers to them. The top 5 barriers reported, in descending order, were the natural environment, transportation, help at home, health care, and government policies. These barriers appear to be more related to physical impairments, activity limitations, and life satisfaction than to societal participation.Whiteneck, Gale, Meade, Michelle A., Dijkers, Marcel, Tate, Denise G., Bushnik, Tamara, Forchheimer, Martin B.Yesdevopsadmin
2005Student with low-incidence disabilitiesJAJ50201.In J. Wood (Ed.), Teaching Students in Inclusive Settings: Adapting and Accommodating Instruction (5th Edition). Prentice HallN/A 56-87Chapter provides teachers with explicit instructions and examples for working with students with low-incidence disabilities, including mental retardation, autism spectrum disorders, sensory impairment, and significant orthopedic and other health impairments. The text describes the basic characteristics associated with each type of disability, presents instructional techniques and other strategies to help students learn, and offers guidelines for working with families.Wood, Judy W.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2001Upper extremity changes with SCI contrasted to common aging in the musculoskeletal systemJAJ41217.Topics in Spinal Cord Injury Rehabilitation6361-68Article reviewing the effects of aging of the musculoskeletal system in individuals with spinal cord injury (SCI). The discussion focuses on the upper extremity because the arms are more important to the function of persons with SCI and because shoulders and arms are more susceptible to problems as persons with SCI become older. Strategies to decrease pain in the upper extremity are discussed.Waters, R. L., Sie, I. H.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2006Job coaches: A workplace supportJAJ50983.American Journal of Physical Medicine and Rehabilitation858704Article explains the role of a job coach in providing workplace supports for people with disabilities.Wehman, Paul H., Targett, Pamela S., Cifu, David X.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1997Elaborating the model of disablementJAJ33705.Assessing Medical Rehabilitation Practices: The Promise of Outcomes ResearchM. J. Fuhrer (Ed.) 91-102Describes the World Health Organization (WHO) model for describing the consequences of disability, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Examines how the ICIDH can be used as a basis for medical rehabilitation outcomes research.Whiteneck, G. G., Fougeyrollas, P., Gerhart, K. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2002Sudden onset of cervical spondylotic myelopathy during sleep: A case reportJAJ50132.Archives of Physical Medicine and Rehabilitation833427-429Article describes the case of a 56-year-old man with acute onset motor-complete tetraplegia caused by cervical spondylotic myelopathy. The subject developed tetraplegia during a 1-hour nap, with no volitional control of his upper or lower limbs, impaired sensation below the clavicles, and increased muscle tone. Magnetic resonance imaging of the cervical spine revealed canal stenosis and increased T2 signal of the spinal cord, suggesting cord infarction caused by compression. Rehabilitation for this patient required the expertise of multiple disciplines, including respiratory, speech, physical, and occupational therapy.Young, Irene A., Burns, Stephen P., Little, James W.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
1997Transition into supported employment for young adults with severe disabilities: current practices and future directionsJAJ32991.Journal of Vocational Rehabilitation8165-74Provides an overview of transition from school to adulthood as it relates to young adults with disabilities. Discusses the relationship of supported employment to achieving successful employment outcomes through implementation of the Individuals with Disabilities Education Act (IDEA). Describes the success of supported employment as a means of providing services, and educational models that are most effective in achieving community integrated employment outcomes.Wehman, P., Revell, W. G.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2002Predictors of personal care assistance for people with spinal cord injuryJAJ44380.Archives of Physical Medicine and Rehabilitation83101399-1405Study identifies predictors of personal care assistance (PCA) use among people with spinal cord injury (SCI). Data regarding potential predictors of PCA use and outcome measures of daily hours of paid, unpaid, and occasional PCA services were taken from the National Spinal Cord Injury Database. The ability to perform activities of daily living was found to be the strongest predictor of PCA use among people with SCI.Weitzenkamp, D. A., Whiteneck, G. G., Lammertse, D. P.Rocky Mountain Regional SCI SystemYesdevopsadmin
2000The rehabilitation of people with traumatic brain injuryJAR08399.N/AN/A Booklet is designed to be a reference guide for professionals involved in the treatment of individuals with traumatic brain injury (TBI). Topics covered include: epidemiology, pathophysiology, and surgical management of TBI; the initial rehabilitation medicine consultation; cognitive rehabilitation; neuropsychological and neuropharmacological intervention; management of seizures, upper motor neuron syndrome and spasticity, heterotopic ossification, contracture management, and impairments of smell and vision; community reintegration; and assessment of mild and pediatric TBI.Woo, Buck H., Nesathurai, ShankerSpaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
1995Motor recovery following spinal cord injury caused by stab wounds: a multicenter studyJAJ29955.Paraplegia33298-101Describes a prospective multicenter study that involved nine centers participating in the National Model Spinal Cord Injury System program. The study investigated neurological deficit and recovery patterns following spinal cord injury (SCI) from stab wounds. Subjects were 32 individuals with SCI following stab wounds. Detailed motor examinations were completed upon admission to the system and at 1 year following date of injury. Each of the 10 key muscle groups representing myotomes from C5 to S1 was tested bilaterally on a standard six-point manual muscle testing scale, and bladder control status and ambulatory status were also assessed at each point in time. Data analysis indicated that 63 percent of the subjects presented with motor incomplete lesions on initial examination, and 4 of the 7 who initially presented with motor complete paraplegia were motor incomplete at followup. A total of 50 percent of those with motor incomplete lesions had asymmetrical motor patterns indicative of a Brown-Sequard Syndrome. Though the percentage of subjects sustaining an incomplete SCI injury following stab injury was higher than the percentage of incomplete lesions related to other etiologies, the amount of motor recovery when controlling for level and completeness of injury was not higher than previously reported for other etiologies.Waters, R. L., Sie, I., Adkins, R. H., Yakura, J. S.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2000Employment satisfaction of individuals with spinal cord injuryJAJ38942.Journal of Physical Medicine and Rehabilitation792161-169Study examining quality of life (QOL) and work satisfaction of 109 employed and unemployed individuals with spinal cord injury (SCI). Data were collected using an employment satisfaction survey. It was found that most of the employed respondents wished to changes jobs or some aspect of their jobs such as duties, supervisor, or hours worked. Respondents who were not working attributed their unemployment to ongoing health problems, lack of transportation, and concern about losing disability benefits. Other themes that emerged included the need for more comprehensive training for medical providers about SCI, the need for more communication between individuals with SCI and family members, and the need for an increase in the flexibility and availability of support services.Wehman, P., Wilson, K., Parent, W., Sherron-Targett, P., McKinley, W.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1997Evaluating outcome after spinal cord injury: what determines success? 1996 Donald Munro LectureJAJ35071.Journal of Spinal Cord Medicine202179-185Lecture on the definition and measurement of success after spinal cord injury (SCI), delivered at a 1996 meeting of the American Paraplegia Society. Discusses definitions in terms of the World Health Organization (WHO) Model of Disablement and in terms of subjective well-being. Discusses measurements of impairment, disability, handicap, subjective well-being, and health status, as well as determinants of successful outcomes in these five areas of measurement. The author concludes that program evaluation standards for SCI care should be expanded to include measures of handicap, subjective well-being, and health status, as well as environmental factors which influence those outcomes. To measure the environment, it will be necessary to follow patients longer, in fact, for a lifetime.Whiteneck, G. G.Rocky Mountain Regional SCI SystemYesdevopsadmin
2002Return to work after spinal cord injury: A review of recent researchJAJ44665.NeuroRehabilitation173177-186Article reviews research regarding demographics, occupational characteristics, workplace accommodations, quality of life, physical functioning, and other variables that affect return to work for individuals with spinal cord injury (SCI). Demographic variables that affect return to work include age at injury onset, chronological age, gender, education, ethnicity, marital status, and pre-injury work intensity. Others include life satisfaction and adjustment after SCI.Yasuda, Satoko, Wehman, Paul, Targett, Pamela, Cifu, David X., West, MichaelVCU Model Spinal Cord Injury CenterYesdevopsadmin
2000Strategies for funding supported employment: A review of federal programsJAJ44785.Journal of Vocational Rehabilitation143179-182Provides an overview of major federal funding sources for supported employment programs. Sources described include: (1) Title I of the Rehabilitation Act, (2) Title VI of the Rehabilitation Act, (3) Developmental Disabilities funds, (4) Title XIX of the Social Security Act, (5) the Ticket to Work and Work Incentive Improvement Act, (6) Social Security Work Incentives, (7) Work Investment Act, and (8) Welfare to Work initiatives.Wehman, Paul, Revell, GrantVCU Model Spinal Cord Injury CenterYesdevopsadmin
2001Ageing with spinal cord injury: Cross-sectional and longitudinal effectsJAJ42418.Spinal Cord396301-309Study aimed at separating the cross-sectional and longitudinal components of aging with spinal cord injury (SCI). Cross-sectional effects of age and years post-injury (YPI) were compared to longitudinal change in outcomes for 315 people who underwent SCI prior to 1971. Results indicate that outcomes frequently changed longitudinally without showing any cross-sectional differences. Cross-sectional age was more commonly associated with the worsening of a condition while cross-sectional YPI was commonly associated with improvement. After controlling for cross-sectional effects, psychological measures generally showed minor deterioration, measures of community integration both improved and deteriorated, upper extremity pain increased, lower extremity pain decreased, and participants tended to quit smoking.Weitzenkamp, D. A., Jones, R. H., Whiteneck, G. G., Young, D. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2004Using the absorbed power method to evaluate effectiveness of vibration absorption of selected seat cushion during manual wheelchair propulsionJAJ50054.Medical Engineering and Physics269799-806Study examined the effects of 4 of the most commonly prescribed seat cushions on the transmission of whole-body vibrations during manual wheelchair propulsion. Participants were asked to propel their wheelchair over a simulated activities-of-daily-living obstacle course while acceleration and force data were recorded. The course included small, medium, and large sinusoidal bumps; a ramp, a curb drop, carpeting, dimple strip, door threshold, and rumble strip. The mean absorbed power was evaluated for the entire course, descending the curb drop, and traversing the rumble strip. Results showed no significant difference between the cushions for the total absorbed power or the curb drop or the rumble strip. Overall, the Invacare Pindot cushion recorded the lowest values for peak-absorbed power while traversing the curb drop and the Varilite Solo produced the lowest absorbed powers for each of the measured variables.Wolf, Erik, Cooper, Rory A., DiGiovine, Carmen P., Boninger, Michael L., Guo, SongfengUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
1999Emergency, acute, and surgical management of spine traumaJAJ37946.Archives of Physical Medicine and Rehabilitation80111383-1390Study assessing trends in emergency, acute, and surgical management of spinal cord injury (SCI), and examining the relationships between surgery and the occurrence of specific complications (post-operative wound infections, pressure ulcers, deep vein thrombophlebitis, pulmonary embolism, and pneumonia or atelectasis). Data are from the National SCI Model Systems Database, supplemented by data from the Midwest Regional SCI Care System. Includes data on frequency of various etiologies as well as various surgical procedures and complications.Waters, R. L., Meyer Jr, P. R., Adkins, R. H., Felton, D.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2005Productive work and employment for persons with traumatic brain injury: What have we learned after 20 years?JAJ48886.Journal of Head Trauma Rehabilitation202115-127Article reviews published literature as well as information from the Rehabilitation Services Administration 911 and the Social Security Administration Benefits Planning, Assistance and Outreach databases to describe return-to-work outcomes over the past 2 decades for individuals with traumatic brain injury (TBI). Over the years, there has been a shift toward examining employment as interactions between the needs and motivations of those with TBI and the use of supported employment, rather than the symptoms or conditions. Implications and recommendations for research, policy, and employment practices are discussed.Wehman, Paul, Targett, Pam, West, Mike, Kregel, JohnVCU Model Spinal Cord Injury CenterYesdevopsadmin
2007Ultrasound imaging of acute biceps tendon changes after wheelchair sportsJAJ52168.Archives of Physical Medicine and Rehabilitation883381-385Study examined acute changes in the biceps tendon after a high-intensity wheelchair propulsion activity. The biceps tendon was imaged with ultrasound before and after subjects participated in wheelchair basketball or quad rugby. The average diameter of the tendon and the echogenicity ratio were calculated. Acute changes in biceps tendon properties were found after exercise. The echogenicity ratio of the tendon significantly decreased from 1.97 to 1.73 after the event. The diameter of the biceps tendon increased from 4.60 to 4.82 mm. The change in tendon diameter positively correlated with the time of play.van Drongelen, S., Boninger, M., Impink, B., Khalaf, TUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2001Hierarchical linear modeling of FIM instrument growth curve characteristics after spinal cord injuryJAJ41671.Archives of Physical Medicine and Rehabilitation823329-334Study examining the recovery of functional independence following spinal cord injury (SCI) as a continuous process using growth curve analysis. A retrospective database review of functional outcome assessment data was conducted for a cohort of 142 individuals admitted to a rehabilitation unit during 1986-1994. Results show that functional recovery can be modeled as a decelerating rather than simple linear function. Predictors of functional independence recovery characteristics, such as rate of recovery and plateau, included age, sex, and education.Warschausky, S., Kay, J. B., Kewman, D. G.University of Michigan SCI Model SystemYesdevopsadmin
2004Patterns of alcohol and substance use and abuse in persons with spinal cord injury: Risk factors and correlatesJAJ46778.Archives of Physical Medicine and Rehabilitation85111837-1847Article describes patterns of alcohol and substance use and abuse as they relate to demographic and injury characteristics, as well as to key medical and psychosocial outcomes, among participants with spinal cord injury (SCI) from 16 Model SCI Systems. Analysis of the data revealed that 14 percent of the subjects were likely to abuse alcohol, based on the CAGE questionnaire responses, and 11 percent reported using illegal drugs, mainly marijuana. At-risk drinkers and substance users tended to be younger, single, male, less educated and reported more pain and lower satisfaction with life. Those who drank without indication of problem drinking had better occupation outcomes. Limitations of the study and directions for future research are discussed.Tate, Denise G., Forchheimer, Martin B., Krause, James S., Meade, Michelle A., Bombardier, Charles H.Yesdevopsadmin
2003Measurement of quality of life in rehabilitation medicine: Emerging issuesJAJ45688.Archives of Physical Medicine and Rehabilitation844, Suppl 2S1-S2Introduces a series of articles that present issues related to new advances in the measurement of quality of life (QOL) in rehabilitation medicine. Articles review issues such as measuring QOL from the individual's perspective, adapting instruments for different cultures, and using advanced techniques to build a computer-adapted measurement system.Tulsky, David S., Rosenthal, MitchellNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1997Cough in spinal cord injured patients: the relationship between motor level and peak expiratory flowJAJ33634.Spinal Cord355299-302Examines the ability of people with higher level spinal cord injury (SCI) to cough independently. Argues that cough efficacy and motor level are correlated.Wang, A. Y., Jaeger, R. J., Yarkony, G. M., Turba, R. M.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
1996Spinal cord injuries due to violenceJAJ33975.American Rehabilitation223 Examines the incidence and demographics of spinal cord injuries (SCI) among civilians caused by violence, drawing from data in the Model Spinal Cord Injury Systems Spinal Cord Injuries Data Base. Notes trends related to issues including: sex; race and ethnicity; age at time of injury; education level at time of injury; employment history at time of injury; arrest history of injured persons; and outcomes as measured by length of hospital stay at time of injury and the Functional Independence Measure (FIM). Discusses implications for SCI prevention programs.Waters, R. L., Cressy, J., Adkins, R. H.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2004A pilot study of functional access to public buildings and facilities for persons with impairmentsJAJ47531.Disability and Rehabilitation265280-289Survey study measured functional access to public buildings and facilities for people with and without disabilities. Participants included: one person who used a wheelchair, one with a mobility impairment who did not use a wheelchair, one with a visual impairment, and one with no known impairments (control). Functional access was measured by the number of tasks performed, the time and distance required to complete the building challenges, and reports of barriers and facilitators for each building challenge and task. The wheelchair user demonstrated a lower task performance (81 percent) in comparison to the control subject (100 percent) or the person with mobility impairment (97 percent) or the one with a visual impairment (98 percent). There was little difference in mean values for time and distance to complete tasks. More barriers were reported by the person with visual impairment, the wheelchair user, and the non-wheelchair user; highest facilitators were reported by the person with visual impairment and the wheelchair user. The control reported the lowest barriers and facilitators.Thapar, Neela, Warner, Grace, Drainoni, Mari-Lynn, Williams, Steve R., Ditchfield, Holly, Wierbicky, Jane, Nesathurai, ShankerSpaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2000Depression measures in outcomes researchJAJ40848.Archives of Physical Medicine and Rehabilitation8112S2, S53-S62Article reviewing and evaluating measures used to screen for depression in disability outcomes research. The review focuses on the Brief Symptom Inventory (BSI) and the Center for Epidemiologic Studies - Depression scale (CES-D). Other screening measures examined include the Zung Self-Rating Depression Scale (SDS), Beck Depression Inventory (BDI), Depression Adjective Check List (DACL), Talbieh Brief Distress Inventory (TBDI), Medical-Based Emotional Distress Scale (MEDS), Sickness Impact Profile (SIP), and the SF-36. The authors find that some problems exist with the application of these measures to persons with disabilities (e.g., overlap between symptoms of depression and indicators of physical impairment). Further evaluation of the psychometric properties of these measures among persons with disabilities is recommended.Vahle, V. J., Andresen, E. M., Hagglund, K. J.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1996Psychosocial factors in rehabilitation of the child with a spinal cord injuryJAJ37489. In R. R. Betz & M. J. Mulcahey (Eds.), The child with a spinal cord injury: Shriner's Hospital for Crippled Children SymposiumN/A 471-482Chapter from a symposium on children with spinal cord injuries (SCI), focusing on empirical studies related to psychosocial factors in the rehabilitation of children with SCI.Warschausky, S., Engel, L., Kewman, D., Nelson, V. S.University of Michigan SCI Model SystemYesdevopsadmin
2002Quality of life, life satisfaction, and spirituality: Comparing outcomes between rehabilitation and cancer patientsJAJ44438.American Journal of Physical Medicine and Rehabilitation816400-410Study examines factors related to quality of life, life satisfaction, and spirituality in cancer patients compared to patients with a traditional rehabilitation diagnosis (spinal cord injury, amputations, and polio). Group differences were found across life satisfaction, spiritual well-being, and the quality of life measures used in the study. In general, cancer patients reported higher scores on all measures than did rehabilitation subjects. Age, marital status, work status, social functioning, and functional well-being were found to be associated with total quality of life.Tate, Denise G., Forchheimer, MartinUniversity of Michigan SCI Model SystemYesdevopsadmin
2002Quality of life measurement in rehabilitation medicine: Building an agenda for the futureJAJ44399.Archives of Physical Medicine and Rehabilitation8312Suppl 2, S1-S3Article summarizes information presented at a conference convened to discuss the state of the science of measuring quality of life (QOL) in rehabilitation medicine. The 5 topic areas discussed included: (1) general versus target measurement, (2) QOL in policy development, (3) measuring QOL from the patient's perspective, (4) cultural aspects of QOL measurement, and (5) the future of QOL research.Tulsky, D. S., Rosenthal, M.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1997Crash characteristics and injuries of victims impaired by alcohol versus illicit drugsJAJ36893.Accident Analysis & Prevention296817-827Study examines blood samples from 894 patients presenting to two Emergency Departments for treatment of motor vehicle injuries sustained in passenger cars, station wagons, vans and pick-ups. Blood samples were tested for alcohol and other drugs and these results were related to demographic characteristics, including prior history of alcohol and drug use, crash characteristics, and injury characteristics. Alcohol was associated with more severe crashes, but other drugs, in the absence of alcohol, were not. Crashes involving drugs but no alcohol were very similar to those involving neither alcohol nor drugs. This document is included in NCDDR's Guide to Substance Abuse and Disability Resources produced by NIDRR Grantees, number D.19.Waller, P. F., Blow, F. C., Maio, R. F., Singer, K., Hill, E. M., Schaefer, N.University of Michigan SCI Model SystemYesdevopsadmin
1996Motor recovery following spinal cord injury associated with cervical spondylosis: a collaborative studyJAJ33006.Spinal Cord3412711-715Discusses a multicenter study conducted within the National Model Spinal Cord Injury System program examining neurological deficits and recovery patterns following spinal cord injury (SCI). Specifically examines recovery of patients with SCI and cervical spondylosis without spinal fracture. Details methodology including: the use of the American Spinal Injury Association (ASIA) standards for neurological and functional classification of SCI; upper extremity motor scores (UEMS); lower extremity motor scores (LEMS); and the ASIA motor score (AMS). Discusses findings. Results indicate that individuals with SCI associated with spondylosis can usually expect to double their original AMS score by 1 year after injury.Waters, R. L., Adkins, R. H., Sie, I. H., Yakura, J. S.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2000Personality disorder characteristics and adjustment following spinal cord injuryJAJ39950.Topics in Spinal Cord Injury Rehabilitation6154-65Pair of studies examining relationships between personality disorder characteristics, pressure sores, and emotional adjustment among persons with spinal cord injury (SCI). The first study examined rates of personality disorder characteristics (impulsivity, poor social judgement, interpersonal turmoil, and maladaptive coping strategies) in individuals recovering from surgery for severe pressure sores and individuals with recent-onset SCI. The second study examined the relation of the same characteristics to emotional adjustment and pressure sore occurrence among persons with recent-onset SCI. Results indicate that personality disorder characteristics may be observed among many persons with SCI, but may not be predictive of pressure sore development.Temple, R. O., Elliott, T. R.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2001Chronic pain associated with spinal cord injuries: A community surveyJAJ41783.Archives of Physical Medicine and Rehabilitation824501-508Study examining the prevalence of pain among persons with spinal cord injury (SCI) living in the community. Data are from 384 responses to a mail survey of individuals with SCI age > 18 living in the Pacific Northwest (64% return rate). It was found that 79% reported current pain, and that prevalence rates were higher for respondents with less education and respondents not employed or in school. The most common locations were the back (61%), hips and buttocks (61%), and feet (58%). Upper extremity pain was experienced currently by 69%. Individuals with quadriplegia were significantly more likely to have neck and shoulder pain. On average, respondents reported high levels of pain intensity and moderate levels of interference with activities of daily living (ADL). Treatments were rated as only somewhat helpful.Turner, J. A., Cardenas, D. D., Warms, C. A., McClellan, C. B.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2005Quality of life in persons with long-term mechanical ventilation or tetraplegic SCI without LTMVJAJ47085.Topics in Spinal Cord Injury Rehabilitation103 94-101Study examined the quality of life (QOL) and experiences with caregiving among people using long-term mechanical ventilation (LTMV) compared to patients with tetraplegic spinal cord injury (SCI) not using LTMV. QOL was conceptualized in 3 distinct ways: health-related QOL, global cognitive appraisal, and individualized/judgmental. Caregiving was assessed in terms of the intensity and quality of the caregiving relationship. No significant differences in QOL were observed between the 2 groups. Differences in caregiving were found, and caregiving was associated with cognitively appraised QOL.Warschausky, Seth, Dixon, Pamela, Forchheimer, Martin, Nelson, Virginia S., Park, Curie, Gater, David, Tate, DeniseMount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2001Health-related quality of life and life satisfaction for women with spinal cord injuryJAJ42429.Topics in Spinal Cord Injury Rehabilitation7115-JanStudy examining the role of selected factors such as age, time since injury, and neurological status on the health-related quality of life (QOL) and life satisfaction of women with spinal cord injury (SCI), and comparing the role of these factors in men and women with SCI. Data from 580 women and 2,307 men in the SCI Model System Database were analyzed. Findings suggest that women with SCI reported lower levels of mental health-related QOL but greater overall life satisfaction than men. Older women with SCI reported lower physical health QOL compared to younger women.Tate, D. G., Forchheimer, M.University of Michigan SCI Model SystemYesdevopsadmin
2002The impacts of the model SCI system: Historical perspectiveJAJ46222.Journal of Spinal Cord Medicine254310-315Introductory article provides an overview of a special series on the Model Spinal Cord Injury System (MSCIS) and presents a brief history of the program. The MSCIS maintains a national database, participates in independent and collaborative research, and provides continuing education relating to SCI. MSCIS is funded by grants awarded in 5-year cycles by the National Institute on Disability and Rehabilitation Research. In the 2000 to 2005 cycle, 16 programs received funding as model system.Tulsky, David S.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2005Acute ventilator management and weaning in individuals with high tetraplegiaJAJ46960.Topics in Spinal Cord Injury Rehabilitation1037-JanArticle describes patient characteristics and respiratory issues in individuals with high tetraplegia. Authors describe techniques used in successful ventilator weaning and present outcome data from their experiences. A team approach to ventilator management that is focused on the patient is essential to anticipate and prevent pulmonary complications.Wallbom, Agnes S., Naran, Bindu, Thomas, EvelynSanta Clara Valley Medical Center Model SCI SystemYesdevopsadmin
1998Postrehabilitation outcomes after spinal cord injury caused by firearms and motor vehicle crash among ethnically diverse groupsJAJ35843.Archives of Physical Medicine and Rehabilitation79101237-1243Study comparing post-rehabilitation outcomes for spinal cord injury (SCI) caused by firearms versus motor vehicle crash. Data were collected through interviews and reviews of medical records from 164 men with SCI age 18-35, to determine the differential effects of impairment, disability, etiology, and selected preinjury and social factors on medical complications, medical resources use, and handicap after rehabilitation. The authors conclude that disability is the most important factor in post-rehabilitation outcomes for SCI, followed by injury completeness. Post-injury but not pre-injury drug abuse is adversely associated with outcomes. Etiology and ethnicity are not important determinants of outcome.Waters, R. L., Adkins, R. H., Sie, I., Cressy, J.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
1998Pain rehabilitation 1: definitions and diagnosis of painJAJ35237.Archives of Physical Medicine and Rehabilitation793Supp1, S49-S53Self-directed learning module on the definition and diagnosis of acute, subacute, and chronic pain. This article is part of the chapter on pain in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Topics include: defining acute, subacute, and chronic pain; subtype diagnoses; differentiation of pain generators; cost-effectiveness of diagnostic testing; and the minimum data set necessary prior to treatment.Taub, N. S., Worsowicz, G. M., Gnatz, S. M., Cifu, D. X.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1997Overcoming obstacles to community reentry for persons with spinal cord injury: assistive technology, ADA and self-advocacyJAJ34253.Journal of Vocational Rehabilitation92171-186Provides overview of the impact of assistive technology (AT) on people with spinal cord injuries (SCI). Examines the impact of the Americans with Disabilities Act (ADA) on AT provision. Discusses self-empowerment and self advocacy for people with SCI to evaluate and secure appropriate AT. Describes a model workshop, the SCI Self-Advocacy Institute, held in November 1996.Turner, E., Wehman, P., Wallace, J. F., Webster, M. K., O'Bryan, J., O'Mara, S., Parent, W.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2002Treatments for chronic pain associated with spinal cord injuries: Many are tried, few are helpfulJAJ50729.Clinical Journal of Pain183154-163Two groups of people with spinal cord injury (SCI) and chronic pain were surveyed regarding the frequency of use of different pain treatments and the perceived helpfulness of these treatments. The most commonly reported treatments were oral medications and physical therapy. Medication types included nonsteroidal anti-inflammatory drugs, acetaminophen, and opioids. The treatments rated as most helpful were opioid medications, physical therapy, and diazepam therapy. Those rated as least helpful were spinal cord stimulation, counseling or psychotherapy, administration of acetaminophen, and administration of amitriptyline. Alternative treatments reported as most helpful were massage therapy and use of marijuana. Acupuncture was tried by many but was rated as only moderately helpful. The findings indicate that multiple pain treatments were tried by people with SCI-related pain, but only a few were rated as helpful.Warms, Catherine A., Turner, Judith A., Marshall, Helen M., Cardenas, Diana D.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
1998Enhancing community reintegration after inpatient rehabilitation for persons with spinal cord injuryJAJ35397.Topics in Spinal Cord Injury Rehabilitation4142-55Tate, D. G., Forchheimer, M.University of Michigan SCI Model SystemYesdevopsadmin
1996Challenges to clinical deployment of upper limb neuroprosthesesJAJ31271.Journal of Rehabilitation Research and Development332111-122This paper describes the use of functional neuromuscular stimulation (FNS) to provide upper limb function to individuals with tetraplegia, focusing on trials by three clinical research groups: (1) a hybrid noninvasive push-button surface electrode system built into a cosmetic forearm splint (Israel); (2) a respiration-controlled 30-channel percutaneous system (Japan), and (3) an 8-channel implantable system under the control of voluntary muscles (Case Western Reserve University). Barriers and challenges to the implementation of such systems are discussed (e.g., complexity of FNS systems and the unique characteristics of the individuals for whom they are designed).Triolo, R., Nathan, R., Handa, Y., Keith, M., Betz, R. R., Carroll, S., Kantor, C.Northeast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2003Peer review: Issues in physical medicine and rehabilitationJAJ46989.American Journal of Physical Medicine and Rehabilitation8210790-802Article discusses some of the issues regarding the peer-review process and suggests guidelines for new and established reviewers in the area of rehabilitation research. Issues concerning study design research methods, statistical input, biases, authorship, and ethics are discussed. Authors also provides suggestions for editorial aspects of the peer-review process for physical medicine and rehabilitation research journals.Wagner, Amy K., Boninger, Michael L., Levy, Charles, Chan, Leighton, Gater, David, Kirby, R. LeeYesdevopsadmin
2004Associations between family and child adjustment following traumatic injury of brain versus spineJAJ50319.SCI Psychosocial Process17297-105.Study compared the relationships between family and individual adjustment in families with a child with traumatic brain injury (TBI) versus spinal cord injury (SCI). Family adjustment was measured in terms of level of family stress and family empowerment. Participants included 32 families, including 18 children with TBI and 14 children with SCI. Group difference in levels of family stress, family empowerment, and child adjustment were not significant. However, family indices correlated with child adjustment in the SCI group but not in the TBI group. Implications for rehabilitation and research are discussed.Warschausky, Seth, Majchrzak, Nicola E., Lifford, Michelle, Dixon, Pamela, Tate, DeniseUniversity of Michigan SCI Model SystemYesdevopsadmin
2003An integrative conceptual framework of disabilityJAJ46611.American Psychologist584289-295Article examines future directions for disability and rehabilitation research. Authors recommend that new research directions include life span issues, biomedicine, biotechnology, and the efficacy and effectiveness of current interventions. Discussion also emphasizes the need for greater interdisciplinary collaborations and consumer participation in research.Tate, Denise G., Pledger, ConstanceUniversity of Michigan SCI Model SystemYesdevopsadmin
2003A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: Implications for treatment matchingJAJ45045.Archives of Physical Medicine and Rehabilitation843358-364Describes clinically meaningful and empirically valid types of alcohol use among people with recent traumatic brain or spinal cord injury that are responsive to specific forms of treatment. Four types were identified using cluster analysis based on preinjury alcohol consumption, alcohol problems, and alcohol dependence. The 4 types corresponded to those with a history of (1) alcohol abuse; (2) alcohol dependence; (3) alcohol dependence in remission, partial remission, or relapsed; and (4) normal or nondrinkers. The presence of these 4 types emphasizes the need for specific treatments such as education, motivational interventions, formal substance abuse treatment, and relapse prevention.Turner, Aaron P., Bombardier, Charles H., Rimmele, Carl T.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2001Epidemiology of extraspinal fractures associated with acute spinal cord injuryJAJ43300.Spinal Cord3911589-594Study examines the frequency and related characteristics of concurrent extraspinal fractures among patients with acute spinal cord injury (SCI). Of 5,711 study participants, 1,585 (28 percent) had extraspinal fractures; 580 (37 percent) had more than one fracture site. The most common region of fractures was the chest, followed by lower extremity, upper extremity, head, other, and pelvis. Those patients with multiple fractures were more likely to be white, male, paraplegic, and injured in motor vehicle crashes.Wang, C. M., Chen, Y., DeVivo, M. J., Huang, C. T.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1996Outcome measures in quality of lifeJAJ30969.Topics in Stroke Rehabilitation2417-JanTate, D. G., Dijkers, M., Johnson-Greene, L.University of Michigan SCI Model SystemYesdevopsadmin
2003Purpose in life as a mediator of adjustment after spinal cord injuryJAJ47041.Rehabilitation Psychology482100-108Study investigated whether purpose in life mediates the relationship between each of the independent variables of functional disability, locus of control, and personality; and the dependent variable of adjustment after spinal cord injury (SCI). Four measures were used in the study: (1) the Purpose in Life scale, (2) the Ladder of Adjustment, (3) the Zuckerman-Kuhlman Personality Questionnaire, and (4) the Multidimensional Health Locus of Control scale. Functional disability was assessed by whether the injury resulted in paraplegia or tetraplegia. Analyses revealed that purpose in life is a powerful predictor of adjustment after SCI, mediating the effects of personality variables and locus of control. Functional disability did not correlate with either purpose in life or adjustment.Thompson, Nancy J., Coker, Jennifer, Krause, James S., Henry, ElseSoutheastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2002Spinal cord injury medicine. 4. Optimal participation in life after spinal cord injury: Physical, psychosocial, and economic reintegration into the environmentJAJ43092.Archives of Physical Medicine and Rehabilitation833Suppl 1, S72-S81Stiens, Steven A., Kirshblum, Steven C., Groah, Suzanne L., McKinley, William O., Gittler, Michelle S.Yesdevopsadmin
2004Successful work supports for persons with SCI: Focus on job retentionJAJ47097.Journal of Vocational Rehabilitation21119-26Targett, Pamela S., Wehman, Paul H., McKinley, William O., Young, Cynthia L.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2002Access to health care services among people with rehabilitation needs receiving MedicaidJAJ44307.Rehabilitation Psychology472204-218.Shigaki, C. L., Hagglund, K. J., Clark, M., Conforti, K.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2004Participation in recreation and sports for persons with spinal cord injury: Review and recommendationsJAJ45484.NeuroRehabilitation192121-129Slater, Daniel, Meade, Michelle A.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2002Incidence and clinical correlates of increased serum creatine kinase levels in persons with spinal cord injuryJAJ45953.Journal of Spinal Cord Medicine253156-160Szlachic, Yaga, Adkins, Rodney H., Waters, Robert L., Govindarajan, Sugantha, Wang, Jiangnan, Yee, Florence, Greenwood, JohnSouthern California Spinal Cord Injury Model SystemYesdevopsadmin
1998Foreword: community reintegrationJAJ37473.Topics in Spinal Cord Injury Rehabilitation41vi-viiiTate, D. G.University of Michigan SCI Model SystemYesdevopsadmin
2002Documentation of the impact of spinal cord injury on female sexual function: The female spinal sexual function classificationJAJ45772.Topics in Spinal Cord Injury Rehabilitation8163-73Sipski, Marca L., Alexander, Craig J.Yesdevopsadmin
2004Geriatric rehabilitation. 2. Physiatric approach to the older adultJAJ50183.Archives of Physical Medicine and Rehabilitation857, Suppl 3S3-S6Stewart, Deborah G., Phillips, Edward M., Bodenheimer, Carol F., Cifu, David X.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Return to work for persons with spinal cord injury: Designing work supportsJAJ45805.NeuroRehabilitation192131-139Targett, Pam, Wehman, Paul, Young, CynthiaVCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Spinal cord injury rehabilitation: State of the scienceJAJ50656.American Journal of Physical Medicine and Rehabilitation854310-342Sipski, Marca L., Richards, J. ScottSouth Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2000The effect of dietary intervention on lipid profiles in individuals with spinal cord injuryJAJ45934.Journal of Spinal Cord Medicine24126-29Szlachcic, Yaga, Adkins, Rodney H., Adal, Teenie, Yee, Florence, Bauman, William, Waters, Robert L.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
1994The use of the cage questionnaire to assess alcohol abuse among spinal cord injury personsJAJ27725.Journal of Rehabilitation60131-35Tate, D. G.University of Michigan SCI Model SystemYesdevopsadmin
1993Sexual activities, response and satisfaction in women pre-and post- spinal cord injuryJAJ26379.Archives of Physical Medicine and Rehabilitation74101025-1029Sipski, M. L., Alexander, C. J.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2005Upper limb strength in individuals with spinal cord injury who use manual wheelchairsJAJ49477.Journal of Spinal Cord Medicine28126-32Souza, Aaron L., Boninger, Michael L., Fitzgerald, Shirley G., Shimada, Sean D., Cooper, Rory A., Ambrosio, FabrisiaUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2005Functional vocational assessment for individuals with spinal cord injuryJA833J of Vocational Rehabilitation223149-161Targett, P., Wehman, P., McKinley, W., Young, C.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Effects of gender on neurologic and functional recovery after spinal cord injuryJAJ46777.Archives of Physical Medicine and Rehabilitation85111826-1836Sipski, Marca L., Jackson, Amie B., Gomez-Marin, Orlando, Estores, Irene, Stein, AdamYesdevopsadmin
2004Systematic care management: Clinical and economic analysis of a national sample of patients with spinal cord injuryJAJ46814.Topics in Spinal Cord Injury Rehabilitation10217-34Sundance, Paula, Cope, D. Nathan, Kirshblum, Steven, Parsons, Kenneth C., Apple, David F.Texas Model Spinal Cord Injury SystemYesdevopsadmin
1994Predicting depression and psychological distress in persons with spinal cord injury based on indicators of handicapJAJ28626.American Journal of Physical Medicine and Rehabilitation733175-183Tate, D., Forchheimer, M., Maynard, F., Dijkers, M.University of Michigan SCI Model SystemYesdevopsadmin
2006Effects of level and degree of spinal cord injury on male orgasmJAJ51792.Spinal Cord4412798-804Sipski, M., Alexander, C. J., Gomez-Marin, O.South Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2004The therapeutic challenges of dual diagnosis: TBI/SCIJAJ48680.Brain Injury18121297-1308Sommer, Jacqueline L., Witkiewicz, Patti M.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2003Successful work supports for persons with spinal cord injuryJAJ47542.Psychosocial Process16111-MayTargett, Pam, Wehman, PaulVCU Model Spinal Cord Injury CenterYesdevopsadmin
1991Rehabilitation of patients with spinal cord diseaseJAJ21406.Neurologic Clinics93705-725Sipski, M. L., Hendler, S., DeLisa, J. A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1999History, implementation, and current status of the National Spinal Cord Injury DatabaseJAJ37944.Archives of Physical Medicine and Rehabilitation80111365-1371Stover, S. L., DeVivo, M. J., Go, B. K.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1998Community needs assessment survey of people with spinal cord injury: an early follow-up studyJAJ35064.Journal of Vocational Rehabilitation102169-177Targett, P. S., Wilson, K., Wehman, P., McKinley, W. O.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2003Cardiovascular effects of sildenafil in men with SCIs at and above T6JAJ45146.Topics in Spinal Cord Injury Rehabilitation8326-34Sipski, Marcalee, Alexander, Craig, Guo, Xiahuo, Gousse, Angelo, Zlamal, RaymondSouth Florida Traumatic Brain Injury Model SystemYesdevopsadmin
1994The value of routine chest roentgenograms on admission for rehabilitation after traumatic spinal cord injuryJAJ27575.American Journal of Physical Medicine & Rehabilitation73284-88Sliwa, J. A., Mason, K., Yarkony, G., Press, J., Lovell, L.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2002Gabapentin in the treatment of neuropathic pain after spinal cord injury: A prospective, randomized, double-blind, crossover trialJAJ45949.Journal of Spinal Cord Medicine252100-105Tai, Qing, Kirshblum, Steven, Chen, Boqing, Millis, Scott, Johnston, Mark, DeLisa, Joel A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1993Long-term use of computerized bicycle ergometry for spinal cord injured subjectsJAJ24737.Archives of Physical Medicine and Rehabilitation743 Sipski, M. L., Alexander, C. J., Harris, M.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2000Perceived accessibility versus actual physical accessibility of healthcare facilitiesJAJ38366.Rehabilitation Nursing2519-JunSanchez, J., Byfield, G., Brown, T. T., LaFavor, K., Marphy, D., Laud, P.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2003A rationale and training agenda for rehabilitation informatics: Roadmap for an emerging disciplineJAJ51356.NeuroRehabilitation182159-170.Schopp, Laura H., Hales, Joseph W., Brown, Gordon D., Quetsch, Joseph L.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2007A longitudinal study of joint pain following SCI: Concurrent trends in participation, depression, and the effects of smokingJAJ51771.Topics in Spinal Cord Injury Rehabilitation12345-55Richardson, E, Richards J, Sutphin S.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2004Verbal learning ability and adjustment to recent-onset spinal cord injuryJAJ46985.Rehabilitation Psychology494288-294Schmitt, Margaret M., Elliott, Timothy R.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1997Comparison of long-term renal function after spinal cord injury using different urinary management methodsJAJ34289.Archives of Physical Medicine and Rehabilitation789992-997Sekar, P., Wallace, D. D., Waites, K. B., DeVivo, M. J., Lloyd, L. K., Stover, S. L., Dubovsky, E. V.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2004Medical complications after spinal cord injury: Spasticity, pain, and endocrine/metabolic changesJAJ46851.Topics in Spinal Cord Injury Rehabilitation10286-106Ragnarsson, Kristjan T., Stein, Adam B., Spungen, Ann M., Bauman, William A.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2004Geriatric rehabilitation. 3. Physical medicine and rehabilitation interventions for common disabling disordersJAJ50184.Archives of Physical Medicine and Rehabilitation857, Suppl 3S12-S17Roig, Randolph L., Worsowicz, Gregory M., Stewart, Deborah G., Cifu, David X.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Masculine role adherence and outcomes among men with traumatic brain injuryJAJ51871.Brain Injury20111155-1162Schopp, L.H., Good, G.E., Barker, K.B., Mazurek, M.O., Hathaway, S.L.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2006Neuroarthropathy of the wrist in paraplegia: A case reportJAJ51480.Journal of Spinal Cord Medicine294436-439Shem, K.Santa Clara Valley Medical Center Model SCI SystemYesdevopsadmin
2004The epidemiology of secondary conditions following spinal cord injuryJAJ48017.Topics in Spinal Cord Injury Rehabilitation10115-29Richards, J. Scott, Waites, Ken, Chen, Yu Ying, Kogos, Steve, Schmitt, M. M.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2005Perceived barriers to exercise in people with spinal cord injuryJAJ49432.American Journal of Physical Medicine and Rehabilitation848576-583Scelza, William M., Kalpakjian, Claire Z., Zemper, Eric D., Tate, Denise G.University of Michigan SCI Model SystemYesdevopsadmin
2001Age-related differences in length of stays, hospitalization costs, and outcomes for an injury-matched sample of adults with paraplegiaJAJ44670.Journal of Spinal Cord Medicine244241-250Seel, Ronald T., Huang, Mark E., Cifu, David X., Kolakowsky-Hayner, Stephanie A., McKinley, William O.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Research-generated knowledge relating to spinal cord injury, traumatic brain injury, and burn injury: 1999-2004.JAJ50654.Journal of Physical Medicine and Rehabilitation854289-291Ragnarsson, Kristjan T.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2000Social and personal consequences of acquired bowel dysfunction for persons with spinal cord injuryJAJ45930.Journal of Spinal Cord Medicine234263-269Roach, Mary J., Frost, Frederick S., Creasey, GrahamNortheast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
2007Life activities among individuals with spinal cord injury living in the community: Perceived choice and perceived barriersJAJ52179.Rehabilitation Psychology52182-88Schopp, Laura H., Clark, Mary J., Hagglund, Kristofer J., Sherman, Ashley K., Stout, Brian J., Gray, David B., Boninger, Mike L.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2005Factors associated with dysphagia in individuals with high tetraplegiaJAJ46961.Topics in Spinal Cord Injury Rehabilitation10318-AugShem, Kazuko, Castillo, Kathleen, Nara, BinduSanta Clara Valley Medical Center Model SCI SystemYesdevopsadmin
1999Access to the environment and life satisfaction after spinal cord injuryJAJ37962.Archives of Physical Medicine and Rehabilitation80111501-1506Richards, J. S., Bombardier, C. H., Tate, D., Dijkers, M., Gordon, W., Shewchuk, R., DeVivo, M. J.Yesdevopsadmin
1999Return to school after spinal cord injuryJAJ37175.Archives of Physical Medicine and Rehabilitation808885-888Sandford, P. R., Falk-Palec, D. J., Spears, K.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2007Spinal cord infarction secondary to cocaine useJAJ52109.American Journal of Physical Medicine and Rehabilitation862158-160Schreiber, Adam L., Formal, Christopher S.Regional SCI Center of the Delaware ValleyYesdevopsadmin
1995Impact of spinal cord injury on the life roles of womenJA1519American Journal of Occupational Therapy498780-786Quigley, M. C.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2002Psychometric properties of a Spanish-language version of the community integration questionnaire (CIQ)JAJ44306.Rehabilitation Psychology472144-164Rintala, D. H., Novy, D. M., Garza, H. M., Young, M. E., High Jr, W. M., Chiou-Tan, F. Y.Texas Model Spinal Cord Injury SystemYesdevopsadmin
2007Evaluation of a consumer-personal assistant training projectJAJ52327.Disability and Rehabilitation295403-410Schopp, Laura H., Clark, Mary J., Hagglund, Kristofer J., Mokelke, Emily K., Stout, Brian J., Mazurek, Micah O.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2003Movement disorders sourcebookJAR08310.N/AHEALTH REFERENCE SERIESFIRST EDITION Shannon, Joyce B.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2005Spinal cord injury pain: Impact, classification, treatment trends, and implications from translational researchJAJ49150.Rehabilitation Psychology50299-102Richards, J. ScottUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2000Use of capsaicin in the treatment of radicular pain in spinal cord injuryJAJ45929.Journal of Spinal Cord Medicine234238-243Sandford, Paul R., Benes, Paula S.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2001Gender differences in cognitive and emotional adjustment to traumatic brain injuryJAJ43723.Journal of Clinical Psychology in Medical Settings83181-188Schopp, L. H., Shigaki, C. L., Johnstone, B., Kirkpatrick, H. A.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2003Interrater reliability of the international association for the study of pain and Tunks' spinal cord injury pain classification schemes. AmericanJAJ45966.Journal of Physical Medicine and Rehabilitation826437-440Putzke, John D., Richards, J. Scott, Ness, Timothy, Kezar, LauraUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2005Low-impact wheelchair propulsion: Achievable and acceptableJAJ49744.Journal of Rehabilitation Research and Development42321-34Richter, W. Mark, Zxelson, Peter W.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2006Testosterone levels among men with spinal cord injury admitted to inpatient rehabilitationJAJ50981.American Journal of Physical Medicine and Rehabilitation858678-684Schopp, L.H., Clark, M.J., Hagglund, K. J., Sherman, A. K., Childers, M. K.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2004Social problem solving abilities and psychosocial impairment among individuals recuperating from surgical repair for severe pressure soresJAJ51360.NeuroRehabilitation193259-269Shanmugham, Kalpana, Elliott, Timothy R., Palmatier, AndrewUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2000Cost effectiveness of supported employment programs: What we need to do to improve outcomesJAJ44784.Journal of Vocational Rehabilitation143173-178Revell, Grant, Kregel, JohnVCU Model Spinal Cord Injury CenterYesdevopsadmin
1999Recent demographic and injury trends in people served by the Model Spinal Cord Injury Care SystemsJAJ37945.Archives of Physical Medicine and Rehabilitation80111372-1382Study of trends in demographics and injury characteristics of persons with spinal cord injury (SCI). Data are from a consecutive case series of 25,054 persons admitted to Model SCI Care Systems around the United States between 1973 and 1998. Changes and continuities during this period are noted regarding age at injury, male-to-female ratio, etiology, month and day of week of occurrence, race-ethnicity, and completeness and location of injury.Nobunaga, A. I., Go, B. K., Karunas, R. B.Yesdevopsadmin
2000Prevalence of secondary conditions in veterans with spinal cord injury and their interference with life activitiesJAJ39948.Topics in Spinal Cord Injury Rehabilitation6134-42Study examining secondary conditions in 91 veterans age 22-80 with spinal cord injury (SCI), including prevalence and effects on activities of daily living (ADL). It was found that spasms were the most common secondary condition over 12 months and had the highest rate of chronic occurrence. Other secondary conditions reported by at least 50% of participants were repetitive stress injury and fatigue. Bowel problems and respiratory infections ranked highest among reported secondary conditions for their interference with important activities.Prysak, G. M., Andresen, E. M., Meyers, A. R.University of Washington Traumatic Brain Injury Model SystemYesdevopsadmin
2002Predictors of life satisfaction: A spinal cord injury cohort studyJAJ44214.Archives of Physical Medicine and Rehabilitation834555-561Study identifies demographic, medical, perceived health, and handicap predictors of life satisfaction 2 years after spinal cord injury, as well as the predictors of change in life satisfaction from year 1 to year 2. Factors associated with an increased risk of lower self-reported life satisfaction included being male and unemployed, with poor perceived health, decreased mobility, and decreased social integration. Only mobility and perceived health were found to be consistent predictors of life satisfaction at year 2, as well as change in satisfaction from year 1 to year 2.Putzke, J. D., Richards, J. S., Hicken, B. L., DeVivo, M. J.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2004Long-term outcome of children with high tetraplegia and ventilator dependenceJAJ46891.Journal of Spinal Cord Medicine27Supplement 1S93-S97Prospective data collection and retrospective chart reviews were conducted to examine the physical outcomes and quality of life (QOL) for children with spinal cord injury (SCI) and long-term mechanical ventilation. Of the 49 children, 25 were alive, 16 died following initial hospital discharge, and 8 were lost to follow-up. Forty had high tetraplegia, 7 had low tetraplegia, and 2 had paraplegia. Survival after SCI ranged from 2 to 23 years in those who died. Interviews were conducted with survivors to examine their daily activities, perceptions of their QOL, and their health and medical complications. Overall, these children had done remarkably well medically and psychologically.Nelson, Virginia S., Dixon, Pamela J., Warschausky, Seth A.University of Michigan SCI Model SystemYesdevopsadmin
2006Towards the development of an effective technology transfer model of wheelchairs to developing countriesJAJ50177.Disability and Rehabilitation: Assistive Technology12-Jan103-110Paper describes a framework to transfer and/or deliver wheelchair technology to developing countries. The framework is based on a literature review conducted by the authors, their personal experiences with wheelchair technology transfer to developing countries, and their combined expertise in the areas of service delivery, manufacturing, engineering, and assistive technology. Descriptions and examples of 5 potential models are presented: (1) charitable model, (2) workshop model, (3) manufacturing model, (4) globalization model, and (5) multi-modal model. The authors present a framework that compares the important characteristics of each model: required input, sustainability, appropriateness, and the potential impact.Pearlman, Jon, Cooper, Rory A., Zipfel, Emily, Cooper, Rosemarie, McCartney, MarkNorthwest Regional Burn Model SystemYesdevopsadmin
2001Pain after spinal cord injury: Important predictors, outcomes, and future directions in cost-effectiveness analysisJAJ43048.Topics in Spinal Cord Injury Rehabilitation7284-92Article providing a summary of three important areas of research on pain after SCI: Methodological concerns, risk factors associated with the development of pain after SCI, and the impact of pain across quality of life (QOL) domains. In addition, an overview of cost-effectiveness analysis is provided.Putzke, J. D., Richards, J. S.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2004Pediatric spinal cord injury: Evidence-based practice and outcomesJAJ46822.Topics in Spinal Cord Injury Rehabilitation10269-78Article describes the epidemiology of spinal cord injury (SCI) in children and discusses new surgical and rehabilitation techniques for select aspects of pediatric SCI care. Some of the outcomes of adults with childhood-onset SCI are discussed, the estimated lifetime costs of SCI in children are presented, and the priorities for rehabilitation and research teams are outlined.Mulcahey, M. J., Anderson, Caroline J., Vogel, Lawrence C., DeVivo, Michael J., Betz, Randal R., McDonald, CraigUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1998Orthostatic hypotension in spinal cord injuryJAJ35399.Topics in Spinal Cord Injury Rehabilitation4173-80Article on orthostatic hypotension (symptomatic low blood pressure upon standing) in persons with spinal cord injury (SCI). The article first describes the treatment of a patient with orthostatic hypotension after SCI, then discusses aspects of the condition in the context of a review of the relevant medical literature. Aspects discussed include neurophysiology, blood pressure management with positional changes, blood pressure management after SCI, and treatment of orthostatic hypotension.Nobunaga, A. I.University of Michigan SCI Model SystemYesdevopsadmin
2004The effect of electrically induced lower extremity ergometry on an ischial pressure ulcer: A case studyJAJ47612.Journal of Spinal Cord Medicine272143-147Case study demonstrated the use of electrically induced lower extremity ergometry (EILEE) to facilitate the healing of an ischial pressure ulcer in a man with spinal cord injury (SC). The pressure ulcer had responded slowly and inconsistently to conventional treatment for 23 months. Following the EILEE treatment, the pressure ulcer healed completely in 6.5 months.Pollack, Susan F., Ragnarsson, Kristjan T., Djikers, MarcelMoss Traumatic Brain Injury Model SystemYesdevopsadmin
2000The impact of pain in spinal cord injury: A case-control studyJAJ40757.Rehabilitation Psychology454386-401Study examining the impact of pain on function across multiple quality of life (QOL) domains among individuals with spinal cord injury (SCI). It was found that pain has a consistent detrimental impact on functional status across multiple QOL domains even after controlling for multiple demographic and medical characteristics known to be associated with self-reported QOL.Putzke, J. D., Richards, J. S., Dowler, R. N.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1996Habilitation of the child with chronic pulmonary failureJAJ37493.Pulmonary rehabilitationA. P. Fishman (Ed.) 565-574Chapter from a book on pulmonary rehabilitation, focusing on habilitation of children with chronic pulmonary failure. Topics include: causes of pulmonary failure in children; making the decision for home ventilation; goals of home mechanical ventilation; long-term ventilation in children; facilitating oral communication in children using trach positive-pressure ventilation; habilitation in the hospital; and transition from hospital to home, community, and school.Nelson, V. S.University of Michigan SCI Model SystemYesdevopsadmin
2000Rough sets: A knowledge discovery technique for multifactorial medical outcomes. AmericanJAJ38560.Journal of Physical Medicine and Rehabilitation791100-108Article presenting the fundamentals of rough set theory in a non-technical manner, and outlining how it can be used for data mining and knowledge discovery in databases. An example is given of the use of rough set theory to mine a spinal cord injury (SCI) database to extract rules that can be used to predict ambulation by patients with SCI.Ohrn, A., Rowland, T.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2001Nursing home residence: Quality of life among individuals with spinal cord injuryJAJ42217.American Journal of Physical Medicine and Rehabilitation806404-409Study comparing quality of life (QOL) of individuals with spinal cord injury (SCI) living in nursing homes versus those living in the community. Participants were 37 nursing home residents and 37 community residents matched demographically and by injury characteristics. Results from measures including the Satisfaction With Life Scale and the Craig Handicap Assessment and Reporting Technique (CHART) indicate that the nursing home residents demonstrated significantly lower QOL across multiple domains compared to their community-dwelling counterparts.Putzke, J. D., Richards, J. S.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2003Cultural competence in the multidisciplinary rehabilitation setting: Are we falling short of meeting needs?JAJ45749.Archives of Physical Medicine and Rehabilitation8481240-1245Article discusses issues relevant to rehabilitation providers who want to develop or improve their cultural competence in their practice and service delivery. Two case scenarios illustrate complex issues presented by increasing numbers of minority patients in medical rehabilitation. Professional codes of conduct and current practices regarding diversity education are discussed for 3 rehabilitation disciplines: physiatry, rehabilitation psychology, and nursing. Challenges faced by rehabilitation providers as they strive to become more culturally competent include: (1) continuing education in language and cultural issue, (2) assessment instruments appropriate for diverse patient populations, (3) majority versus minority population values and beliefs, (4) impact of the immigration and acculturation experiences, (5) health care and insurance coverage issues, (6) attitudes and beliefs about disability, and (7) past experiences with medical professionals and systems.Niemeier, Janet P., Burnett, Derek M., Whitaker, Doris A.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Geriatric rehabilitation. 4. Physical medicine and rehabilitation interventions for common age-related disorders and geriatric symptomsJAJ50185.Archives of Physical Medicine and Rehabilitation857, Suppl 3S18-S22Article describes physical medicine and rehabilitation (PM&R) interventions for age-related physiological changes. Discussion specifically focuses on interventions for mobility alterations, activities of daily living limitations, osteoporosis, cognitive and behavioral changes, bladder changes, and bowel changes. This article is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education program for practitioners and trainees in PM&R and geriatric medicine.Phillips, Edward M., Bodenheimer, Carol F., Roig, Randolph L., Cifu, David X.Rocky Mountain Regional SCI SystemYesdevopsadmin
2000Quality of life after spinal cord injury: developmental issues in late adolescence and young adulthoodJAJ40129.Topics in Spinal Cord Injury Rehabilitation6 S155-169Study using a cross-sectional design to examine overall quality of life (QOL) and specific age-related tasks (e.g., dating, paid employment), among young adults with traumatic-onset spinal cord injury (SCI). Participants were 630 individuals age 18-27, who were divided into 4 groups based on age (18-22, 23-27) and injury duration (1-2 years, 5 or more years). Results indicate that higher overall QOL was positively associated with longer injury duration, Analysis of specific tasks showed a combination of injury duration, age, and interaction effects. This paper is part of the Proceedings of the Howard H. Steel Conference on Pediatric Spinal Cord Injury, held December 3-5, 1999 in Rancho Mirage, CA.Putzke, J. D., Richards, J. S., Dowler, R. N.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2003Fall-related fractures in persons with spinal cord impairment: A descriptive analysisJAJ50058.SCI Nursing20130-37Study describes the incidence, etiology, location of fracture, treatment, and health care utilization of fall-related fracture in patients with spinal cord impairments (SCI). A retrospective review of 45 patients with SCI who sustained fractures, nonconcomitant with the onset of their initial injury, was completed at a Veterans Health Administration hospital over a 10-year period. Of the 24 veterans who sustained fall-related fractures, 3 (12 percent) were found to have repeated falls with fractures. Falls were sustained during transfer activities (44 percent), transferring or riding in a vehicle (30 percent), moving in bed (22 percent), propelling (15 percent), reaching (11 percent), and showering (7 percent). Factors contributing to falls included loss of balance, equipment failure, muscle spasms, excessive speed, not wearing protective straps, and narcolepsy. The 24 subjects sustained 31 fractures in 27 fall episodes. Lower extremity fractures accounted for 97 percent of the injuries and a fractured 7th rib accounted for one injury. Tibial fractures occurred more frequently than femoral or ankle fractures. Four (15 percent) fall episodes resulted in bilateral fractures. The treatment of choice was to immobilize the fractured extremity with a soft, well-padded splint. Over 80 percent of the patients with fall-related fractures were hospitalized with a mean of 66 inpatient days per patient.Nelson, Audrey, Ahmed, Shahbaz, Harrow, Jeffrey, Fitzgerald, Shirley, Sanchez-Anguiano, Aurora, Gavin-Dreschnack, DeborahUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2003Transverse myelitis secondary to coexistent lyme disease and babesiosisJAJ46244.Journal of Spinal Cord Medicine262168-171Case report describes a patient with transverse myelitis associated with coexistent Lyme disease and babesiosis. Transverse myelitis is a demyelinating (loss of the fatty tissue around the nerves) disorder of the spinal cord. Babesiosis is a rare, severe, and sometimes fatal tick-borne disease caused by Babesia microti, a microscopic parasite that infects red blood cells. This is believed to be the first documented case of tranverse myelitis and babesiosis.Oelson, Christina V., Sivalingam, Jocelyn J., O'Neill, Bryan J., Stass, William E., Jr.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2002Race: Predictor versus proxy variable? Outcomes after spinal cord injuryJAJ44389.Archives of Physical Medicine and Rehabilitation83111603-1611Two studies examine the influence of race on acute, rehabilitation, and long-term care outcomes after spinal cord injury (SCI). Whites and nonwhites were matched case-for-case on numerous demographic, medical, and geographic characteristics. Study 1 examined medical complication, functional, and economic outcomes during acute and rehabilitation care. Study 2 examined outcomes at annual follow-up interviews, as well as self-reported life satisfaction, level of handicap, and mental and physical health. None of the outcome measures differed significantly across racial group in study 1. Also, no significant differences were found across racial groups in study 2, except that whites reported greater handicap in the area of mobility.Putzke, J. D., Hicken, B. L., Richards, J. S.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2000Psychological adaptation among racial and ethnic minority individuals following spinal cord injury: A proposed culturally inclusive ecological modelJAJ38701.Rehabilitation Psychology45189-100Article proposing a culturally inclusive ecological model of spinal cord injury (SCI) adaptation. The model is intended to integrate and extend existing literature in order to examine racial/ethnic and other factors leading to differential psychosocial outcomes.Neville, H. A.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1999The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilatorsJAJ36570.Spinal Cord374284-288A retrospective study examined medical records of 42 patients with ventilator dependent C3-4 tetraplegia to compare patient weaning differences related to ventilator tidal volumes. The patients were divided into two groups: those with a large tidal volume (>20 mls/kg of body weight) and a smaller tidal volume (Peterson, W. P., Barbalata, L., Brooks, C. A., Gerhart, K. A., Mellick, D. C., Whiteneck, G. G.Rocky Mountain Regional SCI SystemYesdevopsadmin
2001Gunshot versus nongunshot spinal cord injury: Acute care and rehabilitation outcomesJAJ41972.American Journal of Physical Medicine and Rehabilitation805366-370Study examining the impact of gunshot etiology on outcomes of acute and rehabilitation care for spinal cord injury (SCI). Data are from a total of 212 pairs of patients admitted to an SCI Model System between 1988-1999. Patients with gunshot-caused SCI were matched with patients with non-gunshot-caused SCI with respect to age, education, sex, race, marital status, occupational status at time of injury, and injury level. There were significant differences between the two groups in rates of spinal surgery and charges for acute care, but no differences in length of stay (LOS), charges for rehabilitation care, or postrehabilitation discharge placement.Putzke, J. D., Richards, J. S., Devivo, M. J.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2002A comparison of 2 circuit exercise training techniques for eliciting matched metabolic responses in persons with paraplegiaJAJ43750.Archives of Physical Medicine and Rehabilitation832201-209Study compared the effects of circuit resistance training (CRT) on a multistation isointertial exercise system (MultiGym) or on a customized system of resistance bands (ElasticGym) by persons with paraplegia. No significant effects of test condition were observed on acute metabolic response or heart rate. Average rating of perceived exertion was significantly higher in testing under the ElasticGym condition.Nash, M. S., Jacobs, P. L., Woods, J. M., Clark, J. E., Pray, T. A., Pumarejo, A. E.South Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2002Neural space integrity of the lower cervical spine: Effect of normal range of motionJAJ50731.Spine276587-595Study investigated to determine which cervical positions during normal range of motion might place the neural tissues of the spine at increased risk of injury. The authors instrumented 17 human cadaver spines with specially designed intervertebral foramen occlusion transducers and a spinal canal occlusion transducer. The specimens were loaded with pure bending motions to produce simulated physiologic motions of the lower cervical spine. The resulting occlusion profiles for the intervertebral foramen and spinal canal were recorded along with the 6-degree-of-freedom position of the cervical spine. Because these occlusion measurements describe the ability of the spine to preserve the space for the neural structure, the authors define this neuroprotective role of the vertebral column as neural space integrity. No significant change in the spinal canal integrity was detected for any physiologic motion; however, intervertebral foramen integrity was significantly altered in extension, ipsilateral bending, a combined ipsilateral bending and extension, and combined contralateral bending with extension when compared with intact neutral position. Subsequent changes in neural space integrity may be regarded as resulting from normal human cervical spine motion.Nuckley, David J., Konodi, Mark A., Raynak, Geoffrey C., Ching, Randal P., Mirza, Sohail K.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2003Age and spinal cord injury: An emphasis on outcomes among the elderlyJAJ46230.Journal of Spinal Cord Medicine26137-44Study examined the effects of age across a variety of outcomes among individuals with spinal cord injury (SCI). Outcome measures included the Functional Independence Measure, the Satisfaction With Life Scale, the Craig Handicap Assessment and Reporting Technique, and the Short Form-12. Results showed that older age was consistently associated with decreased outcomes across most domains assessed, particularly in the areas of physical independence, mobility, occupational functioning, and social integration. However, regression analysis indicated that the amount of unique variance that could be specifically attributed to age was relatively small. Self-reported mental health and economic functioning were relatively unrelated to age.Putzke, John D., Barrett, John J., Richards, J. Scott, DeVivo, Michael J.Southeastern Michigan Traumatic Brain Injury System Yesdevopsadmin
1996High tetraplegia.JAJ37491.The child with a spinal cord injury: Shriner's Hospital for Crippled Children SymposiumRR Betz and MJ Mulcahey, eds. 773-790Chapter from a symposium on children with spinal cord injuries (SCI), focusing on high tetraplegia (injury at a neurological level of C4 and above). Discusses issues related to ventilation, communication, assistive technology (AT) and equipment, therapy, seating and positioning, and transportation.Nelson, V. S., Driver, L. E., Backer, G., Hilker, D. F., Howell, B., Wolfe, B. B.University of Michigan SCI Model SystemYesdevopsadmin
1997Protocol for ventilator management in high tetraplegiaJAJ35107.Topics in Spinal Cord Injury Rehabilitation23101-106Article about the use of mechanical respirators to deliver respiratory assistance via a tracheostomy to persons with high tetraplegia. It focuses on the efficacy of high-volume respiration for clearing atelectasis and on speeding the ventilator weaning process. The authors present and discuss a theoretical rationale for the Rocky Mountain Regional Spinal Injury system for ventilator-dependent patients with tetraplegia, in which the tidal volume of the ventilator is increased by 100 cc and the ventilator flow rate is increased by 10 L/mm at periodic intervals.Peterson, P., Brooks, C. A., Mellick, D., Whiteneck, G.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2000Predictors of pain 1 year post-spinal cord injuryJAJ45935.Journal of Spinal Cord Medicine24147-53Study examined the validity of using a broad range of demographic and medical characteristics to predict subsequent development of pain 1 year after spinal cord injury (SCI). Data were drawn from a single item on the Short Form-12 of the Medical Outcomes Survey that assessed the extent to which pain interfered with daily activities. Results indicated that increasing age, less education, Medicaid coverage, an incomplete lesion, or being married or unemployed were all related to an increased likelihood of self-reported pain interference. Age and occupational status appeared to be the best predictors of pain interference 1 year after onset of injury.Putzke, John D., Richards, J. Scott, DeVivo, Michael J.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2003An exploratory examination of an academic PM&R inpatient consultation serviceJAJ50131.Disability and Rehabilitation257354-359.The demographic profiles of patients receiving inpatient physiatric consultations at a major teaching hospital over a 33-month period were analyzed. A comparison was also made between alternate methods of delivering physiatric consultation. During the study period, a change was made in the service delivery process for providing consultations. During the first 18 months of the study, a rotating faculty model was used whereby different physical medicine and rehabilitation (PM&R) faculty members covered the consultation service on different days of the week. During the last 15 months, a single faculty member was assigned to provide primary coverage for the service. Results showed that only 8 percent of the patients admitted during the study period received PM&R consultations. Referrals increased by 75 percent with the implementation of the full-time consultation practice model.Musick, David W., Nickerson, Robert B., McDowell, Susan M., Gater, David R.University of Michigan SCI Model SystemYesdevopsadmin
1999Medical complications in violence-induced spinal cord injuryJAJ37056.Topics in Spinal Cord Injury Rehabilitation4351-61Article discusses the incidence and management of associated medical issues in individuals with violence-related spinal cord injury. Penetrating wounds carry a heavy prognosis, and coexisting injuries along with post-traumatic complications increase the likelihood of morbidity and mortality. Changes in prehospital management, emergency department, and acute hospital care are discussed. Several factors play an important role in determining early treatment priorities. A systems approach, utilizing a specialized health care group consisting of physicians, nurses, therapists, and other health care specialists, is advocated to provide for the continuum of care throughout the life of the individual with SCI.McKinley, W. O., Johns, J. S.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Vocational rehabilitation services for individuals with spinal cord injuryJAJ51851.Journal of Vocational Rehabilitation25111-MarIndividuals with spinal cord injury were surveyed regarding the types of vocational services they had or were interested in receiving. Results from 445 eligible respondents between the ages of 18 and 64 years old are presented. Approximately 32 percent of respondents reported receiving at least 1 job-related service. The most frequently utilized services were vocational counseling about job opportunities or how to get a job (19.8 percent), followed by vocational assessment services (15.5 percent). Whites were more likely to receive services than non-Whites. The services that respondents were most interested in receiving included assistance with developing a new job skill (24.2 percent), assistance with finding a job (21.3 percent), and retirement planning (19.3 percent). No gender differences were found between individuals who did and did not receive services.Meade, M.A., Armstrong, A., Barrett, K., Ellenbogen, P.S., Jackson, M.N.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1997Psychosocial interventions in the rehabilitation of people with spinal cord injury: A comprehensive methodological inquiryJAJ37479.SCI Psychosocial Process10258-66Article reviewing the literature on the effectiveness of psychosocial interventions in the rehabilitation of persons with spinal cord injury (SCI). Each study was evaluated according to 36 methodological criteria, and the mean scores and percentage of studies with a score of 3 or greater are given for each criterion. Mean effect size scores were estimated for experimental and quasi-experimental intervention studies, and found to be in the medium range.McAweeney, M. J., Tate, D. G., McAweeney, W.University of Michigan SCI Model SystemYesdevopsadmin
1999The "Boston Model" of managed care and spinal cord injury: A cross-sectional study of the outcomes of risk-based, prepaid, managed careJAJ37955.Archives of Physical Medicine and Rehabilitation80111450-1456Article presenting preliminary comparative data on health-related outcomes for people with spinal cord injury (SCI) participating in a pre-paid, risk-based, managed care plan (BCMG, or Boston's Community Medical Group). Participants were 45 persons with SCI who received care from BCMG, and 69 who received health care from other sources. Data on processes of care (access) and several outcome measures favor the managed care plan.Meyers, A. R., Bisbee, A., Winter, M.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
1996Rehabilitative functional outcome of patients with neoplastic spinal cord compressionJAJ32437.Archives of Physical Medicine and Rehabilitation779892-895Five year review presents rehabilitation functional outcome of individuals with neoplastic spinal cord compressions. Chart review and survey of patients or families provided data. Spinal cord compression is characterized by pain, weakness, autonomic dysfunction and sensory loss with possible complications of paralysis of muscles related to the level of spinal cord involvement, impairments of bladder, bowel, sexual function and a decrease in functional mobility. In this review, the most common metastasis was to prostate, lung or breast. The most common level of spinal cord involvement was the thoracic spine level. Comprehensive inpatient rehabilitative efforts in this review led to improved patient continence, self care abilities, and mobility. Eighty-four percent of the study patients returned home after rehabilitation. A follow up indicated a maintenance of improved levels of functioning.McKinley, W. O., Conti-Wyneken, A. R., Vokac, C. W., Cifu, D. X.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Community integration following SCIJAJ50330.NeuroRehabilitation19279-80Article introduces journal issue that addresses community integration following spinal cord injury (SCI). Community integration emphasizes the ability to participate in community life activities, remain active in family and recreational events, and access local activities and resources, including health care and employment. Three key areas of community integration are highlighted: the impact of personal characteristics, the effect of the environment, and the benefits of the activities themselves.McKinley, William O., Meade, Michelle A.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2004A preliminary study of acute family needs after spinal cord injury: Analysis and implicationsJAJ47804.Rehabilitation Psychology492150-155Study evaluated the perceived importance of family members' needs and the extent to which they were met during patients' acute rehabilitation following spinal cord injury (SCI). Family members of 17 inpatients completed the Family Needs Questionnaire (FNQ). Results showed that 18 of the 40 FNQ items were rated as most important or very important by all of the respondents. "Health information needs" were rated as most important and "instrumental support needs" were rated as the least important. "Involvement with care needs" were most often met, whereas "emotional support needs" were most often unmet.Meade, Michelle A., Taylor, Laura A., Kreutzer, Jeffrey S., Marwitz, Jennifer H., Thomas, VeraVCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Assistive technology and computer adaptations for individuals with spinal cord injuryJAJ45482.NeuroRehabilitation192141-146Article describes that impact of assistive technology (AT) on the employment status and quality of life of individuals with spinal cord injury (SCI). AT and computer adaptations can help people with SCI to compensate for functional limitations, overcome barrier to employability, enhance technical capacities and computer utilization, and improve the ability to compete for gainful competitive employment. Case studies illustrate the use of AT in the workplace.McKinley, William, Tewksbury, Michael A., Sitter, Pat, Reed, Jennifer, Floyd, ShawnVCU Model Spinal Cord Injury CenterYesdevopsadmin
1999Long-term medical complications after traumatic spinal cord injury: A regional model systems analysisJAJ37949.Archives of Physical Medicine and Rehabilitation80111402-1410Study of incidence, risk factors, and trends for long-term secondary medical complications after traumatic spinal cord injury (SCI). Data from the National SCI Statistical Center on patients injured 1973-1998 were reviewed. Complications examined included pneumonia/atelectasis, autonomic dysreflexia, deep venous thrombosis, pulmonary embolism, pressure ulcers, fractures, and renal calculi. Pressure ulcers, autonomic dysreflexia, and pneumonia/atelectasis were found to be the most common secondary complications. Risk factors included complete injury, tetraplegia, older age, concomitant illness, and violent injury.McKinley, W. O., Jackson, A. B., Cardenas, D. D., DeVivo, M. J.Yesdevopsadmin
2002Spinal stenosis vs traumatic spinal cord injury: A rehabilitation outcome comparisonJAJ44780.Journal of Spinal Cord Medicine25128-32Study compares the rehabilitation outcomes of patients with spinal stenosis-induced spinal cord injury (SCI) to those with traumatic SCI. Main outcome measures included rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, rehabilitation charges, and discharge disposition rates. Patients with tetraplegic spinal stenosis SCI had significantly shorter rehabilitation stays, and lower FIM change and FIM efficiency scores. Individuals with paraplegic spinal stenosis SCI also had significantly lower FIM changes scores; however, no significant differences were found for rehabilitation LOS, charges, FIM efficiency, or discharge-to-home rates.McKinley, William O., Tewksbury, Michael A., Mujteba, Nayyer M.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1996Identifying the unmet independent living needs of persons with spinal cord injuryJAJ32284.Journal of Rehabilitation62329-34Study investigating the unmet independent living needs of persons with spinal cord injury (SCI). Subjects were 127 persons who completed inpatient rehabilitation at one of two Model SCI Care Systems. All subjects were between the ages of 17 and 65 at the time of their injuries, lacked any evidence of substantive cognitive deficits or psychiatric disorder, and had no previous motor impairments. Results showed that persons who reported unmet needs were disproportionately at the two ends of the impairment spectrum: those with minimal deficits and those with severe impairments. Although some unmet needs were reported in every area of independent living examined, unmet needs for peer recreation and peer support groups were the greatest. Recommendations for policymakers and researchers are offered.McAweeney, M. J., Forchheimer, M., Tate, D. G.University of Michigan SCI Model SystemYesdevopsadmin
2000Enabling our instruments: Accommodation, universal design, and access to participation in researchJAJ40842.Archives of Physical Medicine and Rehabilitation8112S2, pS5-S9Article discussing barriers to full participation of people with disabilities in research concerning health services and health outcomes. Barriers discussed include random digit dialing (RDD) methodologies that exclude people who screen calls or don't respond quickly to a ringing telephone, use of self-administered questionnaires that people with certain disabilities may find difficult, use of time measures that are not appropriate for persons with relapsing-remitting conditions or memory problems, and instruments such as the SF-36 that ask about the ability to walk when mobility is the real issue. Solutions are suggested for each of these barriers.Meyers, A. R., Andreson, E. M.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
1998Comparison of rehabilitation outcomes in violent versus non-violent traumatic SCIJAJ43094.Journal of Spinal Cord Medicine21132-36Article presents the results of a study comparing the rehabilitation outcomes of individuals with violent versus nonviolent traumatic spinal cord injury (SCI). Twenty-seven patients with SCI caused by gunshot wound, stabbing, or assault and 27 patients with SCI caused by motor vehicle accidents or falls participated in the study. Analysis of the demographic data revealed that the violent traumatic SCI group tended to be younger, non-white, unmarried, and unemployed. While the violently injured group had slightly longer acute care stays, the 2 groups had similar rehabilitation lengths of stay, functional improvements, hospital costs, and home discharge rates.McKinley, William O., Cifu, David X., Keyser-Marcus, Lori, Wilson, KristiVCU Model Spinal Cord Injury CenterYesdevopsadmin
1999Substance abuse, violence, and outcome after traumatic spinal cord injuryJAJ36994.Journal of Physical Medicine and Rehabilitation784306-312Study examines admission toxicology (drug and alcohol) screens from 87 consecutive rehabilitation medicine patients diagnosed with acute traumatic spinal cord injury (SCI). Forty-six patients (53%) presented with positive toxicology screens (alcohol-44%, drug-30%, both-26%). Of patients with positive alcohol screens, 75% met state criteria for intoxication (blood alcohol level 0.08 mg/dl or greater). Compared to those with negative screens, patients with positive screens were significantly younger or unmarried (pMcKinley, W. O., Kolakowsky, S. A., Kreutzer, J. S.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Race, employment, and spinal cord injuryJAJ46771.Archives of Physical Medicine and Rehabilitation85111782-1792Study examined the issues of employment and race for African Americans with spinal cord injury (SCI) by assessing job classification and occupational status before and after injury. Racial disparities were found in employment rates before and after injury. Differences were also found in the types of jobs held before SCI with patterns similar to those for the general population. No differences were found in the types of jobs held at 1 year after injury by African Americans and whites with SCI. After injury, African Americans had lower economic self-sufficiency scores, regardless of employment status, and lower social integration scores among those who were not employed. Implications of the findings and recommendations for future research are discussed.Meade, Michelle A., Lewis, Allen, Jackson, M. Njeri, Hess, David W.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injuryJAJ46776.Archives of Physical Medicine and Rehabilitation85111818-1825Study compared neurologic, medical, and functional outcomes of patients with acute spinal cord injury (SCI) who underwent surgery less than 72 hours after injury (early) versus those who had surgical treatment after 72 hours (late) and those who received non-surgical treatment. Neurologic outcomes were assessed with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) motor and sensory levels, and motor index score. Medical complications examined included pneumonia, deep vein thrombosis and pulmonary embolism, pressure ulcers, autonomic dysreflexia, and rehospitalization. Functional outcomes included length of stay, hospital charges, and Functional Independence Measure (FIM) motor scores. Results showed that subjects in the early group were more likely to be women, have paraplegia, and have SCI caused by motor vehicle collisions. The non-surgical group was more likely to be older and have more incomplete injuries. ASIA motor index improvements were more likely in the non-surgical group. No differences between groups were found for changes in neurologic levels, AIS grade, or FIM motor efficiency.McKinley, William, Meade, Michelle A., Kirshblum, Steven, Barnard, BarbaraVCU Model Spinal Cord Injury CenterYesdevopsadmin
2003Serum levels of vitamins A, C, and E in persons with chronic spinal cord injury living in the communityJAJ45732.Archives of Physical Medicine and Rehabilitation8471061-1067This study compares serum levels of vitamins A, C, and E among individuals with spinal cord injury (SCI) to those levels normally found in the general population and describes their association with demographic and injury-related data, health status, nutritional behaviors, and occurrence of pressure ulcers. A significant number of participants (16 to 37 percent) had serum levels below the norm for each vitamin. Being older or older at onset of injury was associated with higher serum levels of vitamins A and E. Vitamin A was also related to better function and health status and with not having a pressure ulcer with the past 12 months. No relationships were found with vitamin C.Moussavi, Robabeh M., Garza, Hector M., Eisele, Susan G., Rosriguez, Gladys, Rintala, Diana H.Texas Model Spinal Cord Injury SystemYesdevopsadmin
2000Neoplastic vs. traumatic spinal cord injury: An inpatient rehabilitation comparisonJAJ38939.Journal of Physical Medicine and Rehabilitation792138-144Study comparing demographics, injury characteristics, and functional outcomes of individuals with neoplastic spinal cord compression and those with traumatic spinal cord injury (SCI). Data are from a prospective 5-year comparison of 34 individuals with neoplastic spinal cord compression and 159 individuals with SCI. It was found that participants with neoplastic spinal cord compression were older, more often female, more often unemployed, more often had paraplegia involving the thoracic spine, and more often had incomplete injuries. Their rehabilitation length of stay (LOS) was shorter and their FIM change scores were lower. However, FIM efficiencies and discharge to home rates of the 2 groups were similar.McKinley, W. O., Huang, M. E., Tewksbury, M. A.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2002Comparison of medical complications following nontraumatic and traumatic spinal cord injuryJAJ44781.Journal of Spinal Cord Medicine25188-93Study compares the incidence of medical complications secondary to spinal cord injury (SCI) in patients with nontraumatic and traumatic SCI. Prospective data collected included medical complications, injury characteristics, demographics, and rehabilitation outcomes. Individuals with traumatic SCI developed medical complications at a higher frequency in the following areas: deep vein thrombosis, pressure ulcers, autonomic dysreflexia, pneumonia, orthostatic hypotension, and spasticity. Individuals with nontraumatic SCI were more likely to have wound infections during rehabilitation. No significant differences were found between the 2 groups in the incidence of depression, urinary tract infection, heterotopic ossification, pain at admission, and gastrointestinal bleeding.McKinley, William O., Tewksbury, Michael A., Godbout, Christopher J.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2000A model of outcomes research: Spinal cord injuryJAJ40850.Archives of Physical Medicine and Rehabilitation8112S2, S81-S90Reviews tools that have been or may be used to measure the outcomes of spinal cord injury (SCI), in order to illustrate how the principles and practices of outcome research can be applied to the sequelae of a specific disability. Reviews databases, generic outcome measures, condition-specific outcome measures for SCI, and tools measuring pain, psychologic distress, and health-related quality of life (HRQOL). Special attention was paid to data sources, the need for methodological accommodations, the research balance between generic and condition-specific measures, and outcome measurements particularly relevant to persons with SCI.Meyers, A. R., Andresen, E. M., Hagglund, K. J.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2002Nontraumatic spinal cord injury: Etiology, incidence, and outcomeJAJ50200.In S. Kirshblum, D. I. Campagnolo, J. A. DeLisa (Eds.), Spinal cord medicine. Philadelphia : Lippincott Williams & WilkinsN/A 471-479Chapter reviews the literature pertaining to the incidence, demographics, clinical presentations, and outcomes for nontraumatic spinal cord injury (SCI). The more common causes of nontraumatic SCI include spinal stenosis, cancerous compression, vascular ischemia, and multiple sclerosis. Other etiologies include inflammatory diseases of infectious and noninfectious nature, motor neuron diseases, radiation myelopathy, syringomyelia, paraneoplastic syndrome, vitamin B12 deficiency, Friedreich ataxia, and compression secondary to rheumatoid arthritis.McKinley, William O.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1996Spasticity management via intrathecal baclofen pumpJAJ37057.Multiple Sclerosis Primer131Article reports on the use and effectiveness of intrathecal baclofen (Lioresal --registered trademark) for the treatment of spinal spasticity. First-line treatment for spasticity usually includes therapeutic stretching, positioning, and physical modalities (heat,cold). Oral spasticity medications represent the next line of treatment and include baclofen, diazepam, dantrolene sodium, and clonidine. For individuals in whom these treatments are ineffective, intrathecal delivery of baclofen via a subcutaneous pump and catheter system is an option approved by the FDA in 1992. Potential candidates are first assessed in the office setting and later scheduled for a "test dose" of intrathecal baclofen (50-100 micrograms) via lumbar puncture. Clinical response can be seen in hours and "responders" can receive the surgical implant as early as the next day. Bypassing the blood-brain barrier by the implantation allows low overall daily doses which are well tolerated with little or no side effects. Regulation and dosage adjustment can be managed by the physician with a laptop computer and a radiotelemetry wand. Pumps need refilling every 1-3 months, may need to be replaced every 4-5 years, and intermittent follow-up with patients should be maintained.McKinley, W. O., Kinder, D.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Medical procedures, complications, and outcomes for patients with spinal cord injury: A multicenter investigation comparing African Americans and whitesJAJ47484.Archives of Physical Medicine and Rehabilitation853368-375Study examined differences in rehabilitation outcomes for African American and whites with spinal cord injury. Outcomes compared included medical procedures and complications, the American Spinal Injury Association motor index, Functional Independence Measure scores at admission and discharge, and discharge dispositions. Analysis revealed differences in spinal surgeries, laparotomies, traction during acute care, and method of bladder management at discharge between African Americans and whites; however, these differences were generally accounted for by cause of injury rather than the direct effects of race. No differences were found regarding medical complications, functional outcomes, or discharge disposition.Meade, Michelle A., Cifu, David X., Seel, Ronald T., McKinley, William O., Kreutzer, Jeffrey S.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Incidence, etiology, and risk factors for fever following acute spinal cord injuryJAJ51918.Journal of Spinal Cord Medicine (JSCM) (formerly Journal of the American Paraplegia Society295501-506The medical records for both acute care and rehabilitation admissions over a 2-year period were retrospectively reviewed to identify the incidence, etiology, and risk factors for fevers in adults with traumatic spinal cord injury (SCI). The incidence of fever was 60.4 percent for acute care and 50 percent for rehabilitation. Respiratory and urinary tract were the most common identifiable fever etiologies. Unidentified etiologies were common and were associated with lower temperature elevation and shorter fever duration. Cause of injury and completeness of injury may comprise additional risk factors. These factors should be considered when initiating cost-efficient fever workup in individuals with SCI.McKinley, W., McNamee, S., Meade, M., Abdul, N.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1995Improved quality of life and sexuality with continent urinary diversion in quadriplegic women with umbilical stomaJAJ29778.Archives of Physical Medicine and Rehabilitation768758-762Researchers, focusing on quality of life issues, offered continent urinary diversion using an umbilical stoma to three women with quadriplegia who required cystectomy for end-stage neurogenic vesical dysfunction complicated by urethra destruction following chronic indwelling catheterization. All three subjects were opposed to having an incontinent abdominal urinary stoma. All three subjects had minimal dexterity, so the umbilicus was chosen as the site of the urostomy because of ease of catheterization and cosmetic appearance. Followup of the subjects ranged from 18-30 months. Reservoir capacity ranged from 550 to 800mL without evidence of reflux or stomal leakage. The incidence of symptomatic autonomic dysreflexia and urinary tract infection decreased in all subjects following surgery. Two of the subjects who were sexually active increased their frequency of sexual activity, and both reported improved sexual enjoyment. In all three subjects body image and satisfaction with urologic management increased.Moreno, J. G., Chancellor, M. B., Karasick, S., King, S., Abdill, C. K., Rivas, D.Regional SCI Center of the Delaware ValleyYesdevopsadmin
1999Neoplastic versus traumatic spinal cord injury: An outcome comparison after inpatient rehabilitationJAJ37620.Archives of Physical Medicine and Rehabilitation80101253-1257Study comparing outcomes of inpatient rehabilitation for persons with neoplastic spinal cord compression (SCC) and traumatic spinal cord injury (SCI). Outcome measures were examined for 29 SCC and 29 SCI patients matched for age, level of injury, and impairment classification. Measures examined included length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, and discharge rates to home.McKinley, W. O., Huang, M. E., Brunsvold, K. T.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1998Rehabilitation outcome of individuals with nontraumatic myelopathy resulting from spinal stenosisJAJ37059.Journal of Spinal Cord Medicine212131-136Study examines outcomes from 46 patients (19 cervical; 27 lumbar) following surgical decompression for myelopathy or cauda equina syndrome resulting from spinal stenosis (SS). Compared to patients with traumatic spinal cord injury (SCI), patients with SS were significantly older (mean age 68 vs. 39 years), more frequently retired/unemployed (89% vs. 43%), more often married (56% vs. 36%), and less often male (54% vs. 82%) but with similar ethnicity. Signficant changes in Functional Independent Measurement (FIM) scores were noted after rehabilitation for the SS patients in the categories of self-care, sphincter control, and mobility/locomotion. Additionally, outcome comparisons with a group of traumatic SCI patients who had similar motor function revealed similar lengths of stay, discharge FIM scores, and discharge-to-community rates. These results indicate that individuals with weakness secondary to SS represent a significant portion of individuals with SCI, make significant functional gains following rehabilitation, and achieve similar functional outcomes compared to individuals with traumatic SCI.McKinley, W. O., Tellis, A. A., Cifu, D. X., Johnson, M. A., Kubal, W. S., Keyser-MaMarcus, L., Musgrove, J. J.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2000From function to felicitude: Physical disability and the search for happiness in health services researchJAJ40325.American Journal on Mental Retardation1055342-351Article discussing methodological issues related to measurement of felicitude (happiness) as an outcome for people with physical or intellectual impairments. The author reviews outcome measures for injuries and chronic illnesses and finds that measures have tended to focus on negative rather than positive outcomes. Research concerning the epidemiology of felicitude among persons with disabilities is then reviewed.Meyers, A. R.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
1998Innovations in the care of individuals with spinal cord injuryJAJ35062.Journal of Vocational Rehabilitation102153-157Article discussing recent innovations in the management of individuals with spinal cord injury (SCI), such as: (1) cost-effective health services via 'clinical pathways' and 'case management' approaches over the conitnuum of care; (2) recent clinical research into key prognostic indicators for neurological recovery after SCI; (3) innovations in the care and treatment of medical complications resulting from SCI; (4) recent and future advances in electrical stimulation to muscles and nerves to assist movement and functional control; and (5) ongoing basic science and clinical research dealing with the repair and cure of SCI. The author predicts that these and other innovations will enhance the delivery of coordinated, comprehensive, and cost-effecient care for people with SCI.McKinley, W. O.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1999Clinical presentations, medical complications, and functional outcomes of individuals with gunshot wound-induced spinal cord injuryJAJ36844.American Journal of Physical Medicine and Rehabilitation782102-107Study examining characteristics and outcomes of spinal cord injuries (SCI) resulting from gunshot wounds. Demographic, clinical, and outcome data were collected on 49 individuals with gunshot-wound induced SCI who were found in a review of 217 traumatic SCI rehabilitation admissions to a tertiary care hospital during a 5-year period. Comparisons were made between the gunshot wound-induced SCI and nonviolent traumatic SCI groups. It was found that the two groups differed demographically and in severity of injury, with the gunshot wound-induced SCI group having more paraplegia and complete SCI. However, the two groups had similar lengths of stay, Functional Independence Measure (FIM) scores, and discharge to home rates.McKinley, W. O., Johns, J. S., Musgrove, J. J.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Work intensity and variations in health and personal characteristics of individuals with spinal cord injuryJAJ51852.Journal of Vocational Rehabilitation25113-19Article provides a retrospective analysis of data from 436 individuals with spinal cord injury (SCI) between the ages of 18 and 64 years old who participated in a larger project examining the needs of individuals with SCI. This study examined how participants differed on demographic and health-related factors based on their level of employment (unemployed, part-time, or full-time). Significant differences were found between groups with regard to race, marital status, total number of medical problems, receipt of vocational services, and severity of injury. In addition, individuals who were employed (full- or -part-time) were more likely to have health insurance than unemployed individuals. Those working full-time were significantly more likely to have dental insurance, less likely to have been unable to get needed medical care, and less likely to have problems with either uncontrolled spasticity or chronic pain in the past 12 months, compared to the other 2 groups.Meade, M.A., Barrett, K., Ellenbogen, P.S., Jackson, M.N.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2003Age-related outcomes in persons with spinal cord injury: A summary paperJAJ47560.NeuroRehabilitation18 83-90Paper summarizes findings from studies examining the role of age at injury on the rehabilitation outcomes of patients with spinal cord injury (SCI). Article presents information patient characteristics, treatment, and outcome variables, including demographic factors, lengths of stay, treatment charges, neurological outcomes, functional outcomes, and discharge disposition. This information may assist in determining the appropriateness of a referral to inpatient rehabilitation.McKinley, William, Cifu, David, Seel, Ronald, Huang, Mark, Kreutzer, Jeffrey, Drake, David, Meade, MichelleVCU Model Spinal Cord Injury CenterYesdevopsadmin
2000Predictors of secondary conditions in a sample of independently living adults with high-level spinal cord injuryJAJ39945.Topics in Spinal Cord Injury Rehabilitation618-JanStudy examining factors contributing to secondary conditions in adults with spinal cord injury (SCI). Hierarchical multiple regression analysis was used with data collected from 117 individuals with predominantly high level SCI. Two independent predictors of a greater number of secondary conditions were identified: more difficulty with instrumental activities of daily living (IADL), and more difficulty with accessing medical care. Three other variables were marginal predictors of more secondary conditions: inadequate access to transportation, tobacco-smoking, and race (white).Meyers, A. R., Mitra, M., Walker, D. K., Wilber, N., Allen, D.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2002Spinal cord injury medicine. 2. Medical complications after spinal cord injury: Identification and managementJAJ43090.Archives of Physical Medicine and Rehabilitation833Suppl 1, S58-S64Self-directed learning module reviews the diagnosis and treatment of medical complications associated with spinal cord injury (SCI). Describes treatment approaches for common medical complications that impact rehabilitation, including pressure ulcers, unilateral lower-extremity swelling, spasticity, autonomic dysreflexia, orthostatic hypotension, and pain.McKinley, William O., Gittler, Michelle S., Kirshblum, Steven C., Stiens, Steven A., Groah, Suzanne L.Yesdevopsadmin
1999Nontraumatic spinal cord injury: incidence, epidemiology, and functional outcomeJAJ36759.Archives of Physical Medicine and Rehabilitation806619-623Five year prospective study identifies and compares the incidence, demographics, neurologic presentation, and functional outcome of individuals with nontraumatic spinal cord injury (SCI) to individuals with traumatic SCI. Of 220 adult SCI admissions at a level I trauma center of a regional SCI model system, 39% were nontraumatic in etiology (spinal stenosis 54%, tumor 26%). Demographic comparisons between groups revealed more women, married persons, older persons, and retired persons in the nontraumatic SCI group. Less severe neurologic impairment patterns were observed in the nontraumatic SCI group. This group also was more likely to present with paraplegia than with tetraplegia, and motor incomplete lesions than complete lesions. Despite the older age of the nontraumatic SCI group, these individuals achieved significant Functional Independent Measure (FIM) scores during rehabilitation. Other notable subgroup differences in FIM scores are discussed. The results suggest that nontraumatic SCI patients can achieve outcomes similar to patients with traumatic SCI. Limitations and future research issues are considered.McKinley, W. O., Seel, R. T., Hardman, J. T.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1997Parathyroid hormone suppression in spinal cord injury patients is associated with the degree of neurologic impairment and not the level of injuryJAJ33718.Archives of Physical Medicine and Rehabilitation787692-696Using a retrospective analysis of clinical and biochemical data obtained from hospital records, argues that suppression of the parathyroid-vitamin D axis after spinal cord injury (SCI) is associated with the degree of neurologic impairment and not level of injury.Mechanick, J. I., Pomerantz, F., Flanagan, S., Stein, A., Gordon, W. A., Ragnarsson, K. T.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
1996Late return of diaphragm function in a ventilator-dependent patient with a high cervical tetraplegia: Case report, and interactive reviewJAJ37058.Spinal Cord3410626-629Article presents case study of an individual with ventilator-dependent high cervical tetraplegia who was maintained on a ventilator for five years after sustaining a C3-C4 vertebral fracture with a complete high cervical tetraplegia. Diaphragmatic fluoroscopic evaluation at the initial injury revealed a non functioning diaphragm, and the patient was subsequently discharged home on a portable ventilator. Respiratory evaluation 5 years post injury, including diaphragmatic fluoroscopy, transcutaneous phrenic nerve conduction studies, and pulmonary function tests, revealed intact phrenic nerve function bilaterally with spontaneous diaphragmatic motion. Ventilator use was weaned and diaphragmatic muscle strengthening was achieved. This case report emphasizes the importance of re-evaluation of respiratory function and in particular, phrenic nerve viability and diaphragm function in patients with high cervical tetraplegia in light of potential neurologic recovery.McKinley, W. O.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2003Spinal cord medicine: Principles and practiceJAR08355.N/AN/A i-xxiv, 1-1043Textbook designed for physicians, research scientists, and other health care professionals involved in the management of individuals with spinal cord injury (SCI) multiple sclerosis, and other spinal cord disorders. Begins with a review of the history of spinal cord medicine, anatomy and physiology, spinal cord imaging, epidemiology, and functional outcomes. Topics covered in subsequent chapters include acute SCI managements and surgical considerations; medical management; management of the bladder, bowel, and sexual dysfunction; neurologic aspects of spinal cord care; musculoskeletal care; rehabilitation; recent advances in spinal cord research; special topics in spinal cord medicine; psychosocial issues and support environment. Includes bibliographical references and index.Lin, Vernon W., Cardenas, Diana D., Cutter, Nancy C., Frost, Frederick S., Hammond, Margaret C., Lindblom, Laurie B., Perkash, Inder, Waters, Robert, Woolsey, Robert M.Yesdevopsadmin
1995EMS providers do not accurately note motor-vehicle crash patients with positive serum alcohol concentrationsJAJ36894.Prehospital and Disaster Medicine102 Retrospective cohort study examines the accuracy of prehospital emergency care providers (PHECPs) in identifying motor vehicle crash victims who had positive serum alcohol concentrations. Data gathered included ambulance report forms and hospital records. Variables that were abstracted included the Revised Trauma Score (RTS), the PHECPs' impression of alcohol use, and serum alcohol concentrations. Sensitivity, specificity, predictive values (positive and negative) and 0.95 confidence intervals were calculated for the PHECPs' ability to identify patients with a serum alcohol concentration above 0. The relationship between the impressions of alcohol use and the RTS was analyzed with chi-square testing: a p-value of more than 0.05 was considered statistically significant. The study suggests that PHECPs cannot accurately identify crash victims with positive serum alcohol concentrations. Signficant study limitations include selection bias and retrospective design. Suggestions for future studies are discussed. This document is included in NCDDR's Guide to Substance Abuse and Disability Resources produced by NIDRR Grantees, number D.21, and 2nd Ed, number D.26.Maio, R. F., Wu, A., blow, F. C., Zink, B.University of Michigan SCI Model SystemYesdevopsadmin
2005Neurorehabilitation of spinal cord injuries following lightning and electrical traumaJAJ51362.NeuroRehabilitation20114-SepArticle discusses the neurorehabilitation management of injuries to the spinal cord resulting from lightning and electrical trauma. Knowledge of the various neurological presentations and the potential for associated trauma to the nervous system, skin, musculoskeletal system, and cardiovascular system should guide the clinical assessment and treatment approach.Lammertse, Daniel P.Rocky Mountain Regional SCI SystemYesdevopsadmin
1996Halo use in children.JAJ37487.The child with a spinal cord injury: Shriner's Hospital for Crippled Children SymposiumRR Betz and MJ Mulcahey, eds. 61-68Chapter from a symposium on children with spinal cord injuries (SCI), focusing on use with children of the halo, an external skeletal fixation device intended for immobilization of the cervical spine. Discusses the implications of differences in physiology and biomechanics between children and adults; techniques of application; and results, including complications.Loder, R. T.University of Michigan SCI Model SystemYesdevopsadmin
2004Metric properties of the ASIA motor score: Subscales improve correlation with functional activitiesJAJ46775.Archives of Physical Medicine and Rehabilitation85111804-1810Study examined the value of using American Spinal Injury Association (ASIA) motor subscores rather than the total ASIA motor score to predict functional abilities as measured using motor Functional Independence Measure (FIM) scores. Discharge data from subjects with traumatic spinal cord injury (SCI) included in the National SCI Database were used in the analysis. Results showed that the use of separate ASIA upper-extremity and lower-extremity motor scores instead of a single ASIA motor score improved prediction of motor FIM scores.Marino, Ralph J., Graves, Daniel E.Yesdevopsadmin
2002Occult maxillary sinusitis as a cause of fever in tetraplegia: 2 case reportsJAJ50128.Archives of Physical Medicine and Rehabilitation833430-432Brief report is presented to increase awareness of occult maxillary sinusitis as a potential cause of fever in recently injured patients with tetraplegia. Two cases are reported of patients with tetraplegic spinal cord injury who presented with fever of unknown origin. Common caused of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. After extensive work-up they were diagnosed with occult maxillary sinusitis. Patients with tetraplegia often undergo nasotracheal and nasogastric tube placement, which may result in mucosal irritation and nasal congestion. These factors, in combination with poor sinus drainage related to supine position, predispose them to developing maxillary sinusitis. Treatment options include removal of all nasal tubes, initiation of topical decongestants, and systemic antibiotic treatment.Lew, Henry L., Han, Jay, Robinson, Lawrence R., Britell, Catherine, Perkash, InderNorthwest Regional Spinal Cord Injury SystemYesdevopsadmin
1997Alcohol abuse/dependence in motor vehicle crash victims presenting to the emergency departmentJAJ36882.Academic Emergency Medicine44256-262Prospective cohort study seeks to determine the prevalence of current alcohol abuse/alcohol dependence (AA/AD) among the full injury range of emergency department (ED), motor vehicle crash (MVC) patients, and in addition, compares AA/AD and non-AA/AD patient characteristics. From 1,161 patients studied, the weighted prevalence of current AA/AD was 22.5%; 53% of these patients were released from the ED. Almost 45% of the patients with current AA/AD did not have a positive blood/alcohol content (BAC) at the time of ED evaluation (range 1-325 minutes after crash; average 58 minutes). When controlling for BAC and AA/AD, greater injury severity and culpability were associated with a positive BAC, but not with current AA/AD. It was concluded that almost 23% of ED MVC patients have current AA/AD, and BAC testing does not accurately identify these patients. Intervention strategies must be directed to both admitted and released patients. This document is included in NCDDR's Guide to Substance Abuse and Disability Resources produced by NIDRR Grantees, 2nd Ed, number D.4.Maio, R. F., Waller, P. F., Blow, F. C., Hill, E. M., Singer, K. M.University of Michigan SCI Model SystemYesdevopsadmin
1997Recovery of neurologic function in spinal cord injury: a review of new and experimental therapiesJAJ35106.Topics in Spinal Cord Injury Rehabilitation2395-100Article reviewing research on medical treatment (including drug therapies) intended to improve neurological function in acute and chronic spinal cord injury (SCI). Acute therapies discussed include the drugs methylprednisolone, gangliosides, and tirilazad mesylate. Chronic therapies discussed include nerve growth factors and tissue implantation (peripheral nerve implants and fetal neuronal cell implants). Also discusses recent work in neurophysiology that may eventually lead to therapies.Lammertse, D. P.Rocky Mountain Regional SCI SystemYesdevopsadmin
2002Impact of a1-blockers in men with spinal cord injury and upper tract stasisJAJ45950.Journal of Spinal Cord Medicine252124-128Study examined the impact of a-blockers on the upper urinary tracts in men with spinal cord injury (SCI) who used reflex voiding for bladder management. Part 1 of the study evaluated the effectiveness of a1-blockers on upper tract stasis. Part 2 of the study evaluated the effectiveness of a1-blockers on urodynamic parameters in men with and without resolution of stasis. Urodynamic parameters evaluated included mean changes in opening pressure, maximum detrusor voiding pressure, and duration of uninhibited contraction. Results showed that a-blockade therapy was effective in resolving upper tract stasis in 8 of the 10 men. The only urodynamic parameter that significantly changed in those with resolution of stasis was the duration of uninhibited contractions.Linsenmeyer, Todd A., Horton, John, Benevento, JosephNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1999Neurologic recovery after traumatic spinal cord injury: Data from the Model Spinal Cord Injury SystemsJAJ37947.Archives of Physical Medicine and Rehabilitation80111391-1396Study of neurological recovery based on data from the Model Spinal Cord Injury (SCI) Systems concerning 3,585 individuals with traumatic SCI admitted between 1988 and 1997. The study examined changes in neurological impairment category; differences between neurological, sensory, and motor levels; changes in Frankel grade and AIS grade; and motor score changes. The effects of ethnicity, neurological impairment category, sex, and etiology were also examined.Marino, R. J., Ditunno Jr, J. F., Donovan, W. H., Maynard Jr, F.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2007Sexuality after spinal cord injury: A conceptual model based on women's narrativesJAJ52175.Rehabilitation Psychology52144-55Interviews were conducted with 24 women with spinal cord injury to investigate how women with SCI experience their sexuality. A conceptual model of sexual domains was proposed based on content analysis of the narratives. The proposed domains are: (1) self- versus other focus, (2) genital versus whole-body focus, (3) physical sex versus holistic intimacy, (4) sexuality as a bodily versus mental phenomenon, (5) exuberance versus negativity, and (6) past versus present focus. The domains are defined and illustrated with excerpts from the narratives.Leibowitz, Ruth Q., Stanton, Annette L.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1994Injury type, injury severity, and repeated occurrence of alcohol-related trauma in adolescentsJAJ36899.Alcoholism: Clinical and Experimental Research182261-4Study compares injured adolescents presenting to an emergency room with a positive serum alcohol concentration (SAC+) with those injured adolescents with a negative serum alcohol concentration (SAC-). Retrospective data was used from 176 injured patients (ages 13-18), who were admitted consecutively to a university hospital for two entire years (1989 and 1990). SAC was available for 106 of these 176 patients. Information collected included mechanism/severity of injury, outcome, SAC, length of stay, psychiatric history, prior or subsequent admission for injury, and hospital charges. More than one-third of those tested for SAC had a positive SAC. SAC+ patients had a greater probability of having a psychiatric history and more frequently had a prior or subsequent injury. Furthermore, only 34% of SAC+ patients were referred for counseling. It was concluded that a SAC should be obtained on all adolescents admitted for trauma, that adolescents presenting with injuries and a positive SAC should be referred for alcohol and psychiatric assessment, and that injured adolescents may be at increased risk for repeat injuries in the future. This document is included in NCDDR's Guide to Substance Abuse and Disability Resources produced by NIDRR Grantees, number D.28 and in NCDDR's Guide to Substance Abuse and Disability Resources produced by NIDRR Grantees, 2nd Ed, number D.33.Maio, R. F., Portnoy, J., Blow, F. C., Hill, E. M.University of Michigan SCI Model SystemYesdevopsadmin
2005Barriers and satisfaction associated with personal assistance services: Results of consumer and personal assistant focus groups.JAJ49329.Occupation, Participation and Health (OTJR) (formerly The Occupational Therapy Journal of Research)25266-74Data transcribed from 5 focus groups describe the barriers and satisfaction expressed by consumers with spinal cord injuries and personal assistants related to the provision of personal assistance services. Results indicated that both groups experienced problems with the consumer-personal assistant relationship, inadequate reimbursement, and restrictive policies. Consumers also reported challenges in finding reliable personal assistants, and personal assistants reported job burnout. Both groups experienced satisfaction when a positive working relationship existed.Matsuda, Sandra J., Clark, Mary J., Schopp, Laura H., Hagglund, Kristofer J., Mokelke, Emily K.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2001Rey Auditory Verbal Learning Test (AVLT) performance in individuals with recent-onset spinal cord injuryJAJ42772.Rehabilitation Psychology463247-261Study to determine Rey Auditory Verbal Learning Test (AVLT) normative data for persons with recent-onset spinal cord injury (SCI). Participants were 184 persons (133 males and 51 females) with recent-onset SCI, who were assessed with the Rey AVLT during inpatient rehabilitation. Results show general trends toward decreased recall with increasing age and increased recall with increasing education level. Gender differences were not detected. Average scores by age and education are presented in separate tables.Kurylo, M., Temple, R. O., Elliott, T. R., Crawford, D.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2003Smoking and obstructive lung dysfunction in persons with chronic spinal cord injuryJAJ46229.Journal of Spinal Cord Medicine26128-35Study examined the relationship between measures of forced vital capacity and the risk for developing obstructive lung dysfunction in patients with spinal cord injury (SCI). Lung function data from patients at the Bronx Veterans Affairs Medical Center in New York (NY) and the Rancho Los Amigos National Rehabilitation Center in Los Angeles (LA) were analyzed in relation to their age, SCI characteristics, and smoking status. NY smokers showed a significant decline in forced vital capacity with increasing age. LA current smokers, who were generally younger and smoked less, showed a less clear age-related decline. NY and LA former smokers and those who never smoked showed no significant age-related declines, except that NY former smokers with paraplegia showed borderline-significant excess age-related decline, which was less than that in NY current smokers.Linn, William S., Spungen, Ann M., Gong, Henry, Jr., Bauman, William A., Adkins, Rodney H., Waters, Robert L.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2003International standards for neurological classification of spinal cord injuryJAJ46236.Journal of Spinal Cord Medicine26Supplement 1S50-S56Presents guidelines for assessing the neurological status of patients with spinal cord injury (SCI), as well as a standard approach to using such data for classifying and quantifying the injury. The goal is that both the measurement technique and the use of the resulting data, clinically and in research, should be consistent across practitioners and researchers.Marino, Ralph J., Barros, Tarcisio, Biering-Sorensen, Fin, Donovan, William H., Graves, Daniel E., Haak, Michael, Hudson, Lesley M., Priebe, Michael M.Yesdevopsadmin
2005Sexual rehabilitation services after spinal cord injury: What do women want?JAJ50111.Sexuality and Disability23281-107Semi-structured interviews were conducted with 24 women with spinal cord injury (SCI) to better understand their experiences and concerns related to inpatient sexual rehabilitation. Topics included the amount and type of inpatient sexual education and counseling experiences, sexual concerns after injury, and suggestions regarding sexual rehabilitation approaches and activities. Themes emerging from the data included the importance of timing and honoring individual differences. Only 2 women reported receiving in-depth sexual rehabilitation services. Participants spoke of shifting priorities and perceptions about sexuality over time and provided suggestions about how inpatient facilities and healthcare providers could accommodate and encourage women's sexual priorities and needs.Leibowitz, Ruth Q.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2002Cervical spine injuries in patients 65 years old and older: Epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuriesJAJ50730.American Journal of Roentgenology1783573-577Study describes the types and distribution of cervical spine injuries in elderly patients over a 5-year period. For each patient, initial admission imaging studies were reviewed and injuries were classified. Mechanism of injury (falling from a standing or seated height versus higher energy mechanism) and initial clinical and neurological status were recorded. Analysis compared injury data in patients with different trauma mechanisms and injury data in different age groups: young elderly (65 to 75 years old) versus old elderly (over 75). Results showed that 95 of the 149 patients (64 percent) had upper cervical spine injuries. Fifty-nine patients (40 percent) had multi-level injuries. The main causes for cervical spine injuries were motor vehicle crashes for the young elderly and falls from standing or seated height among the old elderly. Independent of age, patients older than 75 years and patients who fell from standing height were more likely to have injuries of the upper cervical spine.Lomoschitz, F. M., Blackmore, C. C., Mirza, S. K., Mann, F. A.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2005Reliability and validity of a self-report FIM (FIM-SR) in persons with amputation or spinal cord injury and chronic painJAJ48883.American Journal of Physical Medicine and Rehabilitation843167-176Study examined the psychometric properties of a self-report version of the Functional Independence Measure, called FIM-SR, in a group of people with spinal cord injury (SCI) and a group with amputations. Reliability was estimated using Cronbach's alpha and test-retest correlation coefficients. Validity was examined by comparing FIM-SR scores with the Craig Handicap Assessment and Reporting Technique (CHART), by comparing the CHART scores between the participants with SCI and amputation, and by comparing CHART scores between subjects with different levels of SCI. results indicate that the FIM-SR motor scales and the total FIM-SR score are reliable and valid measures of perceived functional independence in people with SCI. However, the entire FIM-SR in the amputation group, and the FIM-SR cognitive scales in the SCI sample seem to be less useful measures of functioning due to subjects reporting high levels of independence.Masedo, Ana I., Hanley, Marisol, Jensen, Mark P., Ehde, Dawn, Cardenas, Diana D.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2000Pulmonary function in chronic spinal cord injury: A cross-sectional survey of 222 southern California adult outpatientsJAJ39670.Archives of Physical Medicine and Rehabilitation816757-763.Study evaluating risk factors for respiratory morbidity in adults with spinal cord injury (SCI). Data are from convention spirometric testing of pulmonary function in 222 adults with SCI of less than 1 year duration, not using mechanical respiration, including 98 with quadriplegia and 124 with paraplegia. Results indicate that pulmonary function is compromised in most lesions of the spinal cord, even in those with paraplegia. Factors affecting function loss included completeness of injury, level of injury, duration of injury, and smoking.Linn, W. S., Adkins, R. H., Gong Jr, H., Waters, R. L.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
1995Elbow extension using anterior deltoids and upper pectorals in spinal cord-injured subjectsJA1231Archives of Physical Medicine & Rehabilitation765426-432Reports a study that evaluated the electromyographic (EMG) activity in a voluntary kinetic closed chain elbow extension of individuals with C6 motor level spinal cord injuries. Subjects were from a regional spinal cord injury center and had a C6 motor level on the right side. A total of six subjects came for testing. All subjects performed a series of isometric elbow extension contractions of 25 percent, 50 percent, and 75 percent of maximum voluntary contraction (MVC) as measured by a force transducer. Researchers measured surface EMG of the right elbow extensor, anterior deltoid, and upper pectoral muscles using the root mean square (rms) of the amplitude of the motor unit activity as the parameter of muscle activity. Statistical analysis indicated that for each muscle tested, there was significantly greater rms activity for each percentage of MVC except between 50 percent and 75 percent MVC of the elbow extensor muscle. The elbow extensor muscle had minimal EMG activity as compared to the amplitude of the rms activity of the anterior deltoid and upper pectoral muscles for each percentage of MVC. The study indicates that the anterior deltoid and upper pectoral muscles exert an isometric elbow extension force for individuals with C6 quadriplegia.Marciello, M. A., Herbison, G. J., Cohen, M. E., Schmidt, R.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2004Research from the model spinal cord injury systems: Findings from the current 5-year grant cycleJAJ46764.Archives of Physical Medicine and Rehabilitation85111737-1739Article presents a brief history of the Model Spinal Cord Injury Systems (MSCIS) program and highlights findings from the research articles included in this journal issue. In the current 5-year grant cycle, 2000 to 2005, there are 16 regional MSCIS centers. In addition to establishing a comprehensive system of care, grantees contribute patient data to the National Spinal Cord Injury Database, which is recognized internationally as the authoritative source of information about epidemiology and outcomes in SCI.Lammertse, Daniel P., Jackson, Amie B., Sipski, Marca L.Yesdevopsadmin
1996Imaging of the pediatric spine.JAJ37486.The child with a spinal cord injury: Shriner's Hospital for Crippled Children SymposiumRR Betz and MJ Mulcahey, eds. 47-60Chapter from a symposium on children with spinal cord injuries (SCI), focusing on diagnostic imaging of the cervical spine. Discusses indications for radiographs and computerized tomography (CT), then describes normal and abnormal radiographic anatomy for children with regard to atlanto-occipital and atlanto-dens interval (ADI), pseudosubluxation and pseudostability, cervical spine motion, cervical spine curvature, skeletal growth and growth centers, and anterior sort tissue widening.Loder, R. T.University of Michigan SCI Model SystemYesdevopsadmin
1995Superiority of motor level over single neurological level in categorizing tetraplegiaJAJ30234.Paraplegia339510-513Study compares motor level (MT) classification and neurological level (NL) classification as determinates of functional ability for tetraplegia. Explanation is provided on how both measures are used to correlate impairment with self care function. The Quadriplegia Index of Function (QIF) is used to measure clinically important changes in function. This study classified subjects with tetraplegia for their feeding QIF activities. The correlation of the QIF feeding score with the subjects ML and NL demonstrated a higher correlation of the ML to feeding activities. Discussion of the study and its limitations are presented.Marino, R. J., Rider-Foster, D., Maissel, G., Ditunno, J. F.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2003Just for womenJAJ47106.PN/Paraplegia News571165-67Presents 2 articles relevant to women with spinal cord injuries (SCI). The first article discusses the underrepresentation of women in SCI research and what can be done about it. The second article briefly discusses the menopause experience for women with SCI and the use of hormone replacement therapy.Klebine, Phil, Hale, PegUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1998Dimensions of subjective well-being after spinal cord injury: an empirical analysis by gender and race/ethnicityJAJ35487.Archives of Physical Medicine and Rehabilitation798900-909Article about a study of the underlying dimensions of subjective well-being after spinal cord injury (SCI), and about the development of a reliable scale for measuring subjective well-being. Two large samples of persons with SCI (one in the midwest, the other in the southeast) were asked to complete a survey containing 50 subjective well-being items, and factor analyses were conducted for the whole sample and for geographic, racial/ethnic (Caucasian and minority), and gender subsamples. Seven subjective well-being factor scales were identified across the full participant sample: Engagement, Negative Affect, Health Problems, Career Opportunities, Finances, Living Circumstances, and Interpersonal Relations. The average alpha coefficient was .86 for the factor scales. Gender and race/ethnicity factor analyses revealed subtle differences in subjective well-being.Krause, J. S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2000Depression after spinal cord injury: Relation to gender, ethnicity, aging, and socioeconomic indicatorsJAJ40055.Archives of Physical Medicine and Rehabilitation8181099-1109Study investigating the relation among aging, sex, ethnicity, socioeconomic indicators, and depressive symptoms after spinal cord injury (SCI). Participants were 1,391 individuals with SCI age > 18 who completed a demographic survey and the Older Adult Health and Mood Questionnaire. Results indicate that depressive symptoms are common following SCI and are related to aging, sex, ethnicity, education, and income.Krause, J. S., Kemp, B., Coker, J.Yesdevopsadmin
2002Clinical activities of the model spinal cord injury systemJAJ46225.Journal of Spinal Cord Medicine254339-344Article reviews the clinical activities of the Model Spinal Cord Injury System (MSCIS). Clinical benefits derived from MSCIS funding are classified into 5 different areas: (1) shift of spinal cord care from individual centers to a systems approach, (2) data collection as a stimulus for improved clinical care, (3) service comprehensiveness to improve clinical care, (4) research as a stimulus for improved clinical care, and (5) dissemination of MSCIS research findings for educational purposes and to improve care provided by all SCI centers.Kirshblum, Steven C.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2006Racial disparities in health outcomes after spinal cord injury: Mediating effects of education and incomeJAJ50485.Journal of Spinal Cord Medicine (JSCM) (formerly Journal of the American Paraplegia Society29117-25Study investigated health disparities as a function of race and gender and the extent to which socioeconomic factors mediate disparities among people with spinal cord injury. Six outcomes were measured: self-rated health, poor physical health days in the past month, poor mental health days in the past month, number of non-routine physician visits, number of hospitalizations, and days hospitalized. Predictive factors in the analyses included socioeconomic indicators and social support. Results of multivariate analysis of variance indicated significant main effects for both race and gender. Racial disparities were observed in 3 of the 6 health outcomes examined, whereas gender disparities were observed for only 1 outcome (number of non-routine physician visits). African Americans reported a greater number of poor health days, more hospitalizations, and a greater number of days hospitalized. Years of education and household income mediated interrelationships between race and health such that race was no longer associated with these outcomes after consideration of these factors.Krause, J. S., Broderick, L. E., Saladin, L. K., Broyles, J.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2002Shoulder kinematics and kinetics during two speeds of wheelchair propulsionJAJ48907.Journal of Rehabilitation Research and Development396635-650Study measured and compared shoulder joint forces and moments during manual wheelchair propulsion at a slow and a moderate speed. A motion analysis system captured movements of the upper limbs and the SmartWheel system simultaneously recorded pushrim kinetics as 27 individuals propelled their wheelchairs at 2 constant speeds: 0.9m/s (2 mi/h) and 1.8 m/s (4 mi/h). Analysis revealed that all shoulder parameters were stable and consistent between strokes and speeds. The shoulder exhibited a greater range of motion and forces and moments at the shoulder were greater during the faster speed trial. Peak posterior forces occurred near the end of the propulsion phase, and at the same time, the shoulder was maximally flexed and minimally abducted.Koontz, Alicia M., Cooper, Rory A., Boninger, Michael L., Souza, Aaron L., Fay, Brian T.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2004Factors associated with risk for subsequent injuries after traumatic spinal cord injuryJAJ46713.Archives of Physical Medicine and Rehabilitation8591503-1508Subjects with preexisting spinal cord injury (SCI) participated in this study to identify the annual incidence and risk factors for subsequent injuries after SCI. Subjects were asked to report the number of injuries in the past year that were severe enough to require treatment in a clinic, emergency department, or hospital, as well as any injury that resulted in hospitalization. Risk measures included the Behavioral Risk Factor Surveillance System, the CAGE alcohol-screening questionnaire, the Zuckerman-Kuhlman Personality Questionnaire, the Multidimensional Health Locus of Control scale, and prescription medicine usage. Nineteen percent of the subjects reported at least 1 injury within the past year, with an annual incidence rate of .33 when considering those with multiple injuries. Twenty-seven percent of those with at least 1 injury reported 1 or more injury-related hospital admissions. Being younger, having a more severe injury, higher sensation seeking scores, heavy drinking, and using prescription medicines for pain, spasticity, depression, and sleep were associated with a greater risk of subsequent injuries.Krause, James S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
1998Employment after spinal cord injury: differences related to geographic region, gender, and raceJA1099Archives of Physical Medicine & Rehabilitation796615-624Article comparing employment outcomes after spinal cord injury (SCI) as a function of several important participant characteristics, including race, sex, age at injury, education, and geographical location (Southeastern US versus Midwestern US). Participants included 1032 individuals with SCI 596 from the Southeast and 435 from the Midwest. It was found that on the average, currently employed participants were Caucasian, were younger when injured, had paraplegia, and had completed more years of education. Geographic differences in employment rates disappeared when controlled for multiple factors, including years of education. However, even after controlling for years of education, Caucasian participants were 2.8 times more likely than minority participants to be working at the time of the study.Krause, J. S., Sternberg, M., Maides, J., Lottes, S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2000Consumers + research = risks & rewards.JAJ39280.PN/Paraplegia News54519-20Article briefly introducing consumers to research on spinal cord injury (SCI) now being conducted at Model SCI Care Systems and collected at the National Spinal Cord Injury Statistical Center (NSCISC). Includes contact information for Model Systems that are conducting research and may be seeking consumer participants or advisors.Klebine, P.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1998Aging and life adjustment after spinal cord injuryJAJ35065.Spinal Cord365320-328Article about a study comparing life adjustment of persons with spinal cord injury (SCI) in relation to chronological age, age at time of injury, time since injury, and percentage of life with SCI. Data are from 435 participants with SCI who completed the Life Situations Questionnaire-Revised (LSQ-R), a measure of multiple SCI outcomes. Results indicated that being injured later in life is associated with a lower overall level of subjective well-being, poorer health, and a less active lifestyle. However, subjective well-being appears to improve throughout the life-cycle, even beyond 30 years post-injury, thus neutralizing the adverse impact of age at onset on subjective well-being, though not on health or activities. The authors conclude that rehabilitation professionals need to pay special attention to problems presented by being injured after the age of 40, particularly as related to activities.Krause, J. S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2004Health status, community integration, and economic risk factors for mortality after spinal cord injuryJAJ46768.Archives of Physical Medicine and Rehabilitation85111764-1773Study examined the impact of health, community integration and economic factors on subsequent mortality and life expectancy among people with spinal cord injury (SCI). Mortality was determined by routine follow-up of people with SCI enrolled in the National SCI Database and information from the Social Security Death Index. A logistic regression model based on the full set of predictor variables was developed to estimate the chance of dying in any given year. After adjusting for demographic characteristics and injury severity, health status indicators, measures of community integration, and economic status indicators all had statistically significant effects on the likelihood of dying during the next year.Krause, James S., DeVivo, Michael J., Jackson, Amie B.Yesdevopsadmin
2004Patterns of recurrent pressure ulcers after spinal cord injury: Identification of risk and protective factors 5 or more years after onsetJAJ46601.Archives of Physical Medicine and Rehabilitation8581257-1264A mail survey was used to identify factors associated with the presence or absence of recurrent pressure ulcers among participants with spinal cord injury (SCI) who were at least 5 years postinjury. Of the 826 subjects who participated, 633 reported a history of pressure ulcers that could be classified into 1 of 5 options, ranging form never having any pressure ulcers to having almost continuous pressure ulcers. Those who never had them or had them for a short period after SCI onset were classified as nonrecurrent, whereas those who reported at least 1 per year were classified as recurrent. Logistic regression analysis was used to identify the risk and protective behaviors associated with recurrent pressure ulcer history. Results indicted that several general behaviors, including lifestyle, exercise, and diet, were protective factors for recurrent pressure ulcers. None of the prevention behaviors generally recommended during inpatient rehabilitation were associated with pressure ulcer history. Only number of cigarettes smoke and use of medication for sleep were identified as high-risk behaviors.Krause, James S., Broderick, LynneSoutheastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2004Late neurologic recovery after traumatic spinal cord injuryJAJ46810.Archives of Physical Medicine and Rehabilitation85111811-1817Article presents data on neurologic status at 1 and 5 years after a traumatic spinal cord injury (SCI). Patient data were collected and analyzed to determine the degree of late conversion (after 1 year postinjury) from a neurologically complete to an incomplete lesion, and to compare the motor level, motor index scoring, and neurologic level of injury, from 1 year postinjury to the evaluation at year 5. Ninety-four percent of patients who had a neurologically complete injury at 1 year remained complete at 5-year follow-up. People with complete and incomplete injuries had similar improvements in motor level, but subjects with an incomplete injury had a greater chance of improvements in neurologic level of injury and motor index scores.Kirshblum, Steven, Millis, Scott, McKinley, William, Tulsky, DavidYesdevopsadmin
2004Subjective well-being among African Americans with spinal cord injury: An exploratory study between men and womenJAJ50331.NeuroRehabilitation19281-89Study identified gender differences in subjective well-being among African Americans with spinal cord injury (SCI). Measures of subjective well-being included the Life Situation Questionnaire-Revised, the Purpose in Life Scale, and the Older Adult Health and Mood Questionnaire. Results showed that women reported higher scores on depressive symptoms and negative affect, but lower scores on purpose in life. Women reported having significantly more problems than men with pain, depression, family, sadness, stress, and worries. Men reported greater problems with pressure ulcers and sexual issues.Krause, James S., Broderick, Lynne E., Broyles, JoySoutheastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2002Post-injury substance abuse among persons with brain injury and persons with spinal cord injuryJAJ47539.Brain Injury167583-592Study compared post-injury patterns of alcohol and drug use among rehabilitation patients with spinal cord injury (SCI) and traumatic brain injury (TBI), matched for age, sex, race, and mechanism of injury. Data are from 52 patients in an urban rehabilitation center designated as a model system of care for TBI and SCI. It was found that people with SCI were more likely to drink on a daily basis and to use illicit drug than were people with TBI. Pre-injury drinking and drug use rates differed from post-injury rates for both groups; either people choose to abstain completely or appear to use alcohol frequently.Kolakowsky-Hayner, Stephanie A., Gourley Iii, Eugene V., Kreutzer, Jeffrey S., Marwitz, Jennifer H., Meade, Michelle A., Cifu, David X.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2002Accuracy of life expectancy estimates in life care plans: Consideration of nonbiographical and noninjury factorsJAJ44139.Topics in Spinal Cord Injury Rehabilitation7459-68.This article reviews methods for determining life expectancy in life care plans and critiques the strengths and limitations of each method. Statistical methods that use biographic and injury characteristics to modify estimates from standard life table, estimates based on clinical experience, and the use of standard life tables are discussed.Krause, J. S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
1997Aging and adjustment after spinal cord injury: the roles of chronologic age, time since injury, and environmental changeJAJ34821.Rehabilitation Psychology424287-302Article about a study identifying relationships between aging and long-term adjustment after spinal cord injury (SCI). The study aimed to isolate the influence of three factors: (1) chronological age, (2) time since injury, and (3) environmental change between different times of measurement (1985 and 1994). Two samples completed the Life Situtation Questionnaire in 1985 and 1994. It was found that time since injury was positively correlate with adjustment, and age was negatively correlated with adjustment. Environmental change between 1985 and 1994 was associated with a deterioration in subjective well-being. The authors conclude that the way people adjust as they age with SCI is significantly influenced by change in their environment.Krause, J. S., Sternberg, M.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
1999Food for thoughtJAJ38296.Paraplegia News531220-21Article about good nutrition as a means of weight control for persons with spinal cord injury (SCI). The article suggests that the key to good nutrition is finding a method that works for you as an individual. Examples are given of methods followed by different individuals with SCI.Klebine, P.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1998Activity patterns after spinal cord injury: relationship to gender and raceJAJ35396.Topics in Spinal Cord Injury Rehabilitation4131-41Study of the relationships between gender, race, and activity patterns in persons with spinal cord injury (SCI). Data were obtained from 597 participants with SCI, all of whose injuries occurred at least 2 years prior to the study. With the exception that women spent more hours out of bed than men, gender differences pertained more to types of activities than overall activity level. Whites reported a higher average daily sitting tolerance and a greater frequency of weekly outings, while minority participants reported spending more time exercising. Whites were more likely to participate in recreational and business organizations, as well as organizations for persons with disabilities, while minority group members were more likely to belong to church organizations. Implications for rehabilitation professionals are discussed.Krause, J. S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2000Health outcomes among American Indians with spinal cord injuryJAJ39881.Archives of Physical Medicine and Rehabilitation817924-931Study to identify risk factors for poor health outcomes and secondary conditions among Native Americans with spinal cord injury (SCI). Data are from comprehensive telephone interviews with 97 Native Americans with traumatic SCI at least 1 year post-injury. Seven outcome variables were examined: self-rated health; health status compared with 1 year ago; number of poor health days in the past month; number of poor mental health days in the past month; number of days in the past month in which poor health disrupted normal activities; number of pressure sores in the past year; and number of post-SCI injuries in the past year. These were related to biographical, injury-related, psychosocial, and behavioral predictors, including selected items from the Behavioral Risk Factor Surveillance Survey (BRFSS). Results indicated that depressive symptoms, post-SCI injuries, alcohol abuse, and older age were predictors of poorer health outcomes.Krause, J. S., Coker, J. L., Charlifue, S., Whiteneck, G. G.Yesdevopsadmin
2004Outcomes after spinal cord injury: Comparisons as a function of gender and race and ethnicityJAJ47482.Archives of Physical Medicine and Rehabilitation853355-362Study examined gender and racial and ethnic differences in subjective well-being, community participation, and self-reported general health ratings among 4 groups of participants with spinal cord injury: whites, African American, American Indians, and Hispanics. About 40 percent of the total sample was female. Participants completed measures of subjective well-being, participation, and health behaviors outcomes. Race and ethnicity were much more highly correlated with the study outcomes than was gender. Racial and ethnic differences in outcomes related to health were less substantial than those related to subjective well-being. Few gender differences were found, however, women showed greater negative affect and depression, but had higher interpersonal relation scores.Krause, James S., Broderick, LynneSoutheastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2001Electrodiagnostic changes of the lower limbs in subjects with chronic complete cervical spinal cord injuryJAJ42006.Archives of Physical Medicine and Rehabilitation825604-607Study examining electrodiagnostic changes in the lower limbs as measured by nerve conduction studies (NCS) and electromyography in individuals with chronic complete quadriplegia due to spinal cord injury (SCI). Participants were 25 individuals at a Model SCI Rehabilitation Center. Statistically significant differences in NCS responses in the lower limbs were found relative to normal control values, but only the frequency of responses elicited an the decreased compound muscle action potential (CMAP) of the peroneal nerve were clinically significant. Spontaneous activity was present in many of the lower extremity muscles of participants. Predominantly axonal changes were evident in individuals with chronic complete quadriplegia.Kirshblum, S., Lim, S., Garstang, S., Millis, S.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1999Pre-injury substance abuse among persons with brain injury and persons with spinal cord injuryJAJ42143.Brain Injury138571-581Study comparing pre-injury patterns of alcohol and illicit drug use among rehabilitation patients with spinal cord injury (SCI) and traumatic brain injury (TBI), matched for age, sex, race, and mechanism of injury. Data are from 52 patients in an urban rehabilitation center designated as a model system of care for TBI and SCI. It was found that 81% of participants with TBI and 96% with SCI reported pre-injury alcohol use, while 42% with TBI and 57% with SCI reported heavy pre-injury use of alcohol. Marijuana use was reported by 27% of participants with SCI and 19% of participants with TBI, while heroin use was reported by 12% of participants with SCI versus 4% of participants with TBI. This document is included in NCDDR's Guide to Substance Abuse and Disability Resources Produced by NIDRR Grantees, 2nd edition, number D.43., and in NCDDR's Guide to Traumatic Brain Injury Resources Produced by NIDRR Grantees, number C.34.Kolakowsky-Hayner, S. A., Gourley Iii, E. V., Kreutzer, J. S., Marwitz, J. H., Cifu, D. X., McKinley, W. O.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2001Aging and self-reported barriers to employment after spinal cord injuryJAJ41220.Topics in Spinal Cord Injury Rehabilitation63102-115Study examining relationships between self-reported barriers to employment after spinal cord injury (SCI) and two aging-related factors (age at injury onset and years since injury). Data are from 790 responses to a survey of 899 unemployed individuals with SCI. Findings indicate that both aging factors were related to increased self-perceived barriers to employment after SCI.Krause, J. S.Yesdevopsadmin
1998Locus of control and life adjustment: relationship among people with spinal cord injuryJAJ34997.Rehabilitation Counseling Bulletin413162-172Article about the relationship of life adjustment after spinal cord injury (SCI) and 3 components of locus of control (LOC): internality, chance, and powerful others. Of the 127 study participants, those who were older at injury, had fewer years of education, or were from minority backgrounds reported less favorable LOC scores. Locus of control was correlated with several aspects of life adjustment: internality was positively correlated with subjective well-being, and and powerful others was negatively correlated with health indicators. The authors conclude that rehabilitation counseling would be enhanced by using LOC to predict risk for adverse outcomes.Krause, J. S., Stanwyck, C. A., Maides, J.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2002Comparison of the revised 2000 American spinal injury association classification standards with the 1996 guidelines.JAJ44446.American Journal of Physical Medicine and Rehabilitation817502-505Study compared the revisions made in 2000 of the American Spinal Cord Injury Association (ASIA) classification of motor incomplete injuries to the 1996 guidelines. No significant difference were found between the 1996 and the 2000 classification guidelines or in predicting neurologic recovery at 1 year after injury.Kirshblum, Steven C., Memmo, Pietro, Kim, Nancy, Campagnolo, Denise, Millis, ScottNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1999Health behaviors among American Indians with spinal cord injury: Comparison with data from the 1996 Behavioral Risk Factor Surveillance SystemJAJ37953.Archives of Physical Medicine and Rehabilitation80111435-1440Study of health behaviors and health outcomes among a sample of Native American men with spinal cord injury (SCI). Data are from telephone interviews or mail surveys of 76 Native American men with traumatic SCI at least 1 year in duration. Comparisons were made to Native American men without SCI based on national BRFSS data. Differences between the 2 groups were found in reported health status, satisfaction with health care, health behaviors such as receipt of inoculations and screening tests, and alcohol use.Krause, J. S., Coker, J., Charlifue, S., Whiteneck, G. G.Yesdevopsadmin
1996Employment after spinal cord injury: transition and life adjustmentJAJ31506.Rehabilitation Counseling Bulletin394 This study set out to determine the validity of two competing hypotheses regarding employment adjustment and spinal cord injury (SCI) as follows: 1) are better adjusted people more likely to obtain employment or 2) does the experience of becoming employed enhance post-SCI adjustment. Subjects were 301 persons with SCI from an outpatient clinic at a large mid-western university hospital. They were initially mailed a Life Situation Questionnaire (LSQ, Crewe & Krause, 1991) and then 11 years later were mailed the same questionnaire. A total 142 participants returned usable materials from both questionnaires. Results showed a positive transition from unemployment to employment resulted in enhanced adjustment. Termination of employment appeared to correlate with declines in adjustment. The author concludes the results are more consistent with the hypotheses that becoming employed leads to better adjustment.Krause, J. S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
1997Adjustment after spinal cord injury: relationship to participation in employment or educational activitiesJAJ33359.Rehabilitation Counseling Bulletin403202-214Article about a study comparing the life adjustment of participants with spinal cord injury (SCI) who were either (a) gainfully employed, (b) unemployed but attending school, or (c) unemployed and not attending school. The Multidimensional Adjustment Profile (MAP) was administered to a sample of 362 participants. Multivariate analyses of variance with follow-up Bonferroni correction were used to compare the scores on seven outcome scales between the three groups. The employed participants reported superior adjustment scores to the students on only one scale, Career Satisfaction. In contrast to the unemployed nonstudents, the students reported higher overall adjustment scores and fewer problems with skills deficit. Results point to the strong association of both education and employment with quality of life after SCI.Krause, J. Stuart, Anson, Carol A.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2001Ethical issues in rehabilitation: Conceptualizing the next generation of challengesJAJ43370.American Journal of Physical Medicine and Rehabilitation8011848-851Presents commentary on the evolving ethics of rehabilitation care, moving toward a philosophy that sees its goals as removing barriers to independent living and facilitating community integration. Article discusses methods to promote client autonomy and states that more research is needed to determine the best time to present information to the client, the best manner in which to present it, and the best person to present it.Kuczewski, M., Fiedler, I.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2004New rehabilitation interventions in spinal cord injuryJAJ46884.Journal of Spinal Cord Medicine274342-350Kirshblum, StevenNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2003Respiratory healthJAJ45536.PN/Paraplegia News57626-28Recommends ways to prevent respiratory complications for people with spinal cord injury (SCI). Individuals with SCI have increased risk for developing respiratory complications due to a loss of respiratory-muscle control. Suggests ongoing preventive measures including daily breathing exercises.Klebine, Phil, Lindsey, LindaUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1998Skin Sores after Spinal Cord Injury: Relationship to Life AdjustmentJAJ34561.Spinal Cord36151-56Article reporting on a study of the relationship between the number of skin sores, and the number of days adversely impacted by skin sores, and multiple indicators of life adjustment after spinal cord injury (SCI). It was found that among the 1017 participants in the study both the number of skin sores and the number of days adversely impacted by skin sores were correlated with poorer adjustment in nearly every area of life studied.Krause, J. S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
1999Employment after spinal cord injury: An analysis of cases from the Model Spinal Cord Injury SystemsJAJ37961.Archives of Physical Medicine and Rehabilitation80111492-1500Study describing the relationship of multiple biographical, injury-related, and educational factors to employment outcomes after spinal cord injury (SCI). Data were collected from 3,756 persons with SCI through 18 model SCI systems. Logistic regression analysis revealed significant effects of a number of factors, including race-ethnicity, violent etiology, sex, and education.Krause, J. S., Kewman, D., DeVivo, M. J., Maynard, F., Coker, J., Roach, M. J., Ducharme, S.Yesdevopsadmin
2002Spinal cord injury medicine. 1. Etiology, classification, and acute medical managementJA Archives of Physical Medicine and Rehabilitation833Suppl 1, S50-S57Self-directed learning module highlights the comprehensive evaluation, classification, and management of a newly diagnosed spinal cord injury (SCI). Reviews the American Spinal Injury Association examination and classification guidelines. Discusses prevention measures, as well as established and experimental treatments for SCI.Kirshblum, Steven C., Groah, Suzanne L., McKinley, William O., Gittler, Michelle S., Stiens, Steven A.Yesdevopsadmin
1999Depression and subjective well-being among 97 American Indians with spinal cord injury: A descriptive studyJAJ39577.Rehabilitation Psychology444354-372Study examining clinical and nonclinical aspects of depression and subjective well-being (SWB) among a sample of Native Americans with spinal cord injury (SCI), including factors associated with depression and SWB. Data are from a health-related interview (with measures of depression and SWB) completed via telephone or mail by 97 Native American adults with SCI. Most participants lived on reservations. Results indicate that participants had higher levels of depression and lower level of SWB in 5 of 8 areas compared to non-Native American populations in previous studies. Predictors of higher depression and lower SWB included health status, activity patterns, social support, years of education, and frequency of alcohol use.Krause, J. S., Coker, J., Charlifue, S., Whiteneck, G. G.Yesdevopsadmin
2005A kinetic analysis of manual wheelchair propulsion during start-up on select indoor and outdoor surfacesJA1539J Rehabil Res Dev424447-458The objective of this study was to conduct a kinetic analysis of manual wheelchair propulsion during start-up on select indoor and outdoor surfaces. Eleven manual wheelchairs were fitted with a SMART(Wheel) and their users were asked to push on a course consisting of high- and low-pile carpet, indoor tile, interlocking concrete pavers, smooth level concrete, grass, hardwood flooring, and a sidewalk with a 5-degree grade. Peak resultant force, wheel torque, mechanical effective force, and maximum resultant force rate of rise were analyzed during start-up for each surface and normalized relative to their steady-state values on the smooth level concrete. Additional variables included peak velocity, distance traveled, and number of strokes in the first 5 s of the trial. We compared biomechanical data between surfaces using repeated-measures mixed models and paired comparisons with a Bonferroni adjustment. Applied resultant force (p = 0.0154), wheel torque (p < 0.0001), and mechanical effective force (p = 0.0047) were significantly different between surfaces. The kinetic values for grass, interlocking pavers, and ramp ascent were typically higher compared with tile, wood, smooth level concrete, and high- and low-pile carpet. Users were found to travel shorter distances up the ramp and across grass (p < 0.0025) and had a higher stroke count on the ramp (p = 0.0124). While peak velocity was not statistically different, average velocity was slower for the ramp and grass, which indicates greater wheelchair/user deceleration between strokes. The differences noted between surfaces highlight the importance of evaluating wheelchair propulsion ability over a range of surfaces.Koontz, A. M., Cooper, R. A., Boninger, M. L., Yang, Y., Impink, B. G., van der Woude, L. H.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
1996Self-perceived reasons for unemployment cited by persons with spinal cord injury: relationship to gender, race, age, and level of injuryJAJ30712.Rehabilitation Counseling Bulletin (ARCA393 Study examines the reasons unemployed persons with spinal cord injury (SCI) give for their jobless status and whether demographics is a determining factor in these beliefs. Questionnaire results were returned from 231 participants. Physical inability to perform job tasks was reason cited by 60% of participants for not working at the same job after injury. Loss of benefits was cited by 28% and workplace inaccessibility by 23%. Few participants attributed there unemployment to lack of motivation or disinterest. Authors emphasize that more resources should be placed on long-term rehabilitation as opposed to the period immediately after injury.Krause, J. S., Anson, C. A.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2000Supported employment benefit-cost analysis: Preliminary findingsJAJ44783.Journal of Vocational Rehabilitation143153-161Research on the benefits and costs of supported employment is reviewed. Article discusses the overall cost efficiency of supported employment programs, state variations in the costs, and the impact of the Home and Community Based Waiver on costs of supported employment.Kregel, John, Wehman, Paul, Revell, Grant, Hill, Janet, Cimera, RobertVCU Model Spinal Cord Injury CenterYesdevopsadmin
2002Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: A preliminary studyJAJ44396.Archives of Physical Medicine and Rehabilitation83121774-1776Kirschblum, S. C., House, J. G., O'Connor, K. C.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2004A demographic profile of new traumatic spinal cord injuries: Change and stability over 30 yearsJAJ46765Archives of Physical Medicine and Rehabilitation85111740-1748.Jackson, Amie B., Dijkers, Marcel, DeVivo, Michael J., Poczatek, Robert B.Yesdevopsadmin
1997Collaborative admission and discharge planning for the individual with high tetrapegia and ventilator dependencyJAJ35100.Topics in Spinal Cord Injury Rehabilitation2310-JanJohnson, K., Tracy, P., Riccio, S. N., Jones, S., Grant, T.Rocky Mountain Regional SCI SystemYesdevopsadmin
2004Treatment of major depression in individuals with spinal cord injuryJAJ47319.Journal of Spinal Cord Medicine27122-28Kemp, Bryan J., Kahan, Jason S., Krause, James S., Adkins, Rodney H., Nava, GabrielYesdevopsadmin
1996Functional evaluation of spasticity and its effect on rehabilitationJAJ37488.R. R. Betz & M. J. Mulcahey (Eds.) The Child with a Spinal Cord Injury: Shriner's Hospital for Crippled Children SymposiumN/A 255-260Hurvitz, E. A., Nelson, V. S.University of Michigan SCI Model SystemYesdevopsadmin
2000One program's experience of OSCE vs. written board certification resultsJAJ40400.Archives of Physical Medicine and Rehabilitation795462-467Jain, S. S., DeLisa, J. A., Nadler, S., Kirshblum, S., Banerjee, S. N., Eyles, M., Johnston, M., Smith, A. C.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2005Health literacy, morbidity, and quality of life among individuals with spinal cord injuryJAJ49484.Journal of Spinal Cord Medicine283230-240Johnston, Mark V., Diab, Marguerite E., Kim, Sung-Soo, Kirshblum, StevenNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2002Acute predictors of return to employment after traumatic brain injury: A longitudinal follow-upJAJ44220.Archives of Physical Medicine and Rehabilitation835635-641Keyser-Marcus, L. A., Bricout, J. C., Wehman, P., Campbell, L. R., Cifu, D. X., Englander, J., High, W., Zafonte, R. D.VCU Model Spinal Cord Injury CenterNodevopsadmin
1994Predicting unplanned hospitalizations in persons with spinal cord injuryJAJ28995.Archives of Physical Medicine and Rehabilitation75111182-1188Ivie, C. S., DeVivo, M. J.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1997Ventilator weaning for the patient with high-level tetraplegiaJAJ35101.Topics in Spinal Cord Injury Rehabilitation2320-NovJohnson, K., Grant, T., Peterson, P.Rocky Mountain Regional SCI SystemYesdevopsadmin
2003Predictors of success for state vocational rehabilitation clients with traumatic brain injuryJAJ45019.Archives of Physical Medicine and Rehabilitation842161-167Johnstone, Brick, Vessell, Ron, Bounds, Thomas, Hoskins, Sue, Sherman, AshleyMissouri Model Spinal Cord Injury SystemYesdevopsadmin
2004Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injuryJAJ46783.Archives of Physical Medicine and Rehabilitation85111859-1864Hunt, Peter C., Boninger, Michael L., Cooper, Rory A., Zafonte, Ross D., Fitzgerald, Shirley G., Schmeler, Mark R.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
1993Cough in spinal cord injured patients: comparison of three methods to produce coughJAJ26366.Archives of Physical Medicine and Rehabilitation74121358-1361Jaeger, R. J., Turba, R. M., Yarkony, G. M., Roth, E. J.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2005Preventive services and health behaviors among people with spinal cord injuryJAJ49478.Journal of Spinal Cord Medicine28143-54.Johnston, Mark V., Diab, Marguerite E., Chu, Bong-Chul, Kirshblum, StevenNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1995Juvenile rheumatoid arthritis and neuromuscular conditions: scoliosis, spinal cord injury, and muscular dystrophyJAJ37485.Handbook of pediatric psychology, 2nd edM. C. Roberts (Ed.) 384-402Kewman, D. G., Warschausky, S. A., Engel, L.University of Michigan SCI Model SystemYesdevopsadmin
1998Supported employment and assistive technology for persons with spinal cord ijury: three illustrations of successful work supportsJAJ35061.Journal of Vocational Rehabilitation102141-152.Inge, K. J., Wehman, P., Strobel, W., Powell, D., Todd, J.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2007Symptom burden in persons with spinal cord injuryJAJ52412.Archives of Physical Medicine and Rehabilitation885638-645Jensen, Mark P., Kuehn, Carrie M., Amtmann, Dagmar, Cardenas, Diane D.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2003Financial and vocational outcome 1 year after traumatic brain injuryJAJ45029.Archives of Physical Medicine and Rehabilitation842238-241Johnstone, Brick, Mount, David, Schopp, Laura H.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1999A multicenter study of women's self-reported reproductive health after spinal cord injuryJAJ37951.Archives of Physical Medicine and Rehabilitation80111420-1428Jackson, A. B., Wadley, V.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2002Objective and subjective handicap following spinal cord injury: Interrelationships and predictorsJAJ45947.Journal of Spinal Cord Medicine25122-NovJohnston, Mark, Nissim, Elizabeth N., Wood, Kenneth, Hwang, Karen, Tulsky, DavidNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1998Suicide in SCI: A psychological autopsyJAJ37476.Rehabilitation Psychology432143-151Kewman, D. G., Tate, D. G.University of Michigan SCI Model SystemYesdevopsadmin
1996Vocational rehabilitation for persons with spinal cord injuries and other severe physical disabilitiesJAJ33978.American Rehabilitation224 Inge, K., Wehman, P., Kregel, J., Targett, P. S.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2005Chronic pain in individuals with spinal cord injury: A survey and longitudinal studyJAJ50114.Spinal Cord4312704-712Jensen, M. P., Hoffman, A. J., Cardenas, D. D.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2004Perceived quality of care and outcomes following spinal cord injury: Minority status in the context of multiple predictorsJAJ48241.Journal of Spinal Cord Medicine273241-251Johnston, Mark V., Wood, Kenneth, Millis, Scott, Page, Steve, Chen, DavidNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2005Reproductive issues for women with spina bifidaJAJ49479.Journal of Spinal Cord Medicine28181-91Jackson, Amie B., Sipski, Marca L.South Florida Traumatic Brain Injury Model SystemYesdevopsadmin
1996Cost of traumatic spinal cord injury in a population-based registryJAJ32309.Spinal Cord348470-480Johnson, R. L., Brooks, C. A., Whiteneck, G. G.Rocky Mountain Regional SCI SystemYesdevopsadmin
2004Aging with a disability: What the clinician needs to knowJAR08464.N/AN/A Kemp, Bryan J., Mosqueda, LauraSouthern California Spinal Cord Injury Model SystemYesdevopsadmin
2002Upper-extremity deep vein thrombosis associated with peripherally inserted central catheters in acute spinal cord injury: A report of 2 casesJAJ50134.Archives of Physical Medicine and Rehabilitation8391313-1316Hyman, Garrett S., Cardenas, Diana D.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
1997Development of an objective structured clinical examination (OSCE) for physical medicine and rehabilitation residentsJAJ37310.Journal of Physical Medicine and Rehabilitation762102-106Jain, S. S., Nadler, S., Eyles, M., Kirshblum, S., DeLisa, J. A., Smith, A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1992Measurement standards for interdisciplinary medical rehabilitationJAJ23656.Archives of Physical Medicine and Rehabilitation7312-SS3-23Johnston, M. V., Keith, R. A., Hinderer, S. R., Gonnella, C.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1997What consumers tell usJAJ35109.Topics in Spinal Cord Injury Rehabilitation23118-123Holicky, R.Rocky Mountain Regional SCI SystemYesdevopsadmin
1999Characteristics of the Functional Independence Measure in traumatic spinal cord injuryJAJ37958.Archives of Physical Medicine and Rehabilitation80111471-1476Hall, K. M., Cohen, M. E., Wright, J., Call, M., Werner, P.Yesdevopsadmin
2004Psychological well-being and intensity of employment in individuals with a spinal cord injuryJAJ47564.Topics in Spinal Cord Injury Rehabilitation9410-JanHess, David W., Meade, Michelle A., Forchheimer, Martin, Tate, Denise G.Yesdevopsadmin
2004A comparison of consumer-directed and agency-directed personal assistance services programsJAJ47686.Disability and Rehabilitation269518-527Hagglund, Kristofer J., Clark, Mary J., Farmer, Janet E., Sherman, Ashley K.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1998Relationships among community reintegration, coping strategies, and life satisfaction in a sample of persons with spinal cord injuryJAJ35398.Topics in Spinal Cord Injury Rehabilitation4156-72Hansen, N. S., Forchheimer, M., Tate, D. G., Luera, G.University of Michigan SCI Model SystemYesdevopsadmin
1996Physical medicine and rehabilitation workforce study: the supply of and demand for physiatristsJAJ34164.Archives of Physical Medicine and Rehabilitation771526-536Hogan, P. F., Dobson, A., Haynie, B., DeLisa, J. A., Gans, B., Grabois, M., LaBan, M. M., Melvin, J. L., Walsh, N. E.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2003Gazing into the crystal ball: Health care, health policy, and rehabilitation for spinal cord injuryJAJ45778.Topics in Spinal Cord Injury Rehabilitation9163-73Hagglund, Kristofer J., Stout, Brian J., Frank, Robert G.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2003Neuropsychological impairments after spinal cord injury: A comparative study with mild traumatic brain injuryJAJ47027.Rehabilitation Psychology483151-156Hess, David W., Marwitz, Jennifer H., Kreutzer, Jeffrey S.VCU Model Spinal Cord Injury CenterYesdevopsadmin
1996Rehabilitation psychology practice, ethics and a changing health environmentJAJ31510.Rehabilitation Psychology411 Hagglund, K., Frank, R.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1999Follow-up study of individuals with high tetraplegia (C1-C4) 14 to 24 years post-injuryJAJ37963.Archives of Physical Medicine and Rehabilitation80111507-1513.Hall, K. M., Knudsen, S. T., Wright, J., Charlifue, S. W., Graves, D. E., Werner, P.Yesdevopsadmin
2004Nitrite and leukocyte dipstick testing for urinary tract infection in individuals with spinal cord injuryJAJ47610.Journal of Spinal Cord Medicine272128-132Hoffman, Jeanne M., Washwani, Rohini, Kelly, Eve, Dixit, Bonnie, Cardenas, Diana D.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
1998Community reintegration for persons with spinal cord injury living in rural AmericaJAJ35663.Topics in Spinal Cord Injury Rehabilitation4228-40Hagglund, K. J., Clay, D. L., Acuff, M.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2003Autonomic dysreflexia: Incidence in persons with neurologically complete and incomplete tetraplegiaJAJ46250.Journal of Spinal Cord Medicine263244-247.Helkowski, Wendy M., Ditunno, John F., Jr., Boninger, MichaelYesdevopsadmin
1999Ageing with spinal cord injury: The impact of spousal supportJAJ37470.Disability and Rehabilitation216-May250-257Holicky, R., Charlifue, S.Rocky Mountain Regional SCI SystemYesdevopsadmin
1997Rural healthcare initiatives in spinal cord injuryJAJ33982.American Rehabilitation2316-FebHagglund, K., Clay, D. L.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1997Follow-up study of individuals with high tetraplegia (C1-C4) 10 to 21 years postinjuryJAJ35108.Topics in Spinal Cord Injury Rehabilitation23107-117Hall, K. M., Harper, B., Whiteneck, G. G.Yesdevopsadmin
2001Bladder management and quality of life after spinal cord injuryJAJ43507.American Journal of Physical Medicine and Rehabilitation8012916-922Hicken, B. L., Putzke, J. D., Richards, J. S.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2005Consumer-assistant education to reduce the occurrence of urinary tract infections among persons with spinal cord injuryJAJ46964.Topics in Spinal Cord Injury Rehabilitation10353-62Hagglund, Kristofer J., Clark, Mary J., Schopp, Laura H., Sherman, Ashley K., Acuff, Michael E.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1999Extending the continuum of care after spinal cord injury through telerehabilitationJAJ38440.Topics in Spinal Cord Injury Rehabilitation5320-NovHauber, R. P., Jones, M. L., Temkin, A. J., Vesmarovich, S., Phillips, V. L.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2003Establishing a support network for caregiversJAJ47105.Paraplegia News571118-19Holicky, RichardRocky Mountain Regional SCI SystemYesdevopsadmin
1998The Craig Handicap Assessment and Reporting Technique (CHART): metric properties and scoringJAJ36063.Journal of Rehabilitation Outcomes Measurement22539-49Hall, K. M., Dijkers, M., Whiteneck, G., Brooks, C. A., Krause, J. S.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2000Predictors for return to work after spinal cord injury: A 3-year multicenter analysisJAJ38760.Archives of Physical Medicine and Rehabilitation813359-363Hess, D. W., Ripley, D. L., McKinley, W. O., Tewksbury, M.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2004The current state of personal assistance services: Implications for policy and future researchJAJ50334.NeuroRehabilitation192115-120Hagglund, Kristofer J., Clark, Mary J., Mokelke, Emily K., Stout, Brian J.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2002Personal assistance services in patients with SCI: Modeling an appropriate level of care in a life care planJAJ44137.Topics in Spinal Cord Injury Rehabilitation7438-48Harrell, T. W., Krause, J. S.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
1998Bowel management in children and adolescents with spinal cord injuryJAJ37483.Journal of Spinal Cord Medicine21 335-341Goetz, L. L., Hurvitz, E. A., Nelson, V. S., Waring Iii, W.University of Michigan SCI Model SystemYesdevopsadmin
2004Enhancing community re-integration following spinal cord injuryJAJ50333.NeuroRehabilitation192103-113Forchheimer, Martin, Tate, Denise G.University of Michigan SCI Model SystemYesdevopsadmin
2002Excess risk of bladder cancer in spinal cord injury: Evidence for an association between indwelling catheter use and bladder cancerJAJ43769.Archives of Physical Medicine and Rehabilitation833346-351Groah, S. L., Weitzenkamp, D. A., Lammertse, D. P., Whiteneck, G. G., Lezotte, D. C., Hamman, R. F.Rocky Mountain Regional SCI SystemYesdevopsadmin
2004Risk factors for osteoporosis at the knee in the spinal cord injury populationJAJ48237.Journal of Spinal Cord Medicine273202-206Garland, Douglas E., Adkins, Rodney H., Kushwaha, Vivek, Stewart, CharlesSouthern California Spinal Cord Injury Model SystemYesdevopsadmin
1999Correlates of stress in long-term spinal cord injuryJAJ36432.Spinal Cord373183-190Gerhart, K. A., Weitzenkamp, D. A., Kennedy, P., Glass, C. A., Charlifue, S. W.Rocky Mountain Regional SCI SystemYesdevopsadmin
2006Construct validity and dimensional structure of the ASIA motor scaleJAJ50486.Journal of Spinal Cord Medicine (JSCM) (formerly Journal of the American Paraplegia Society29139-45Graves, Daniel E., Frankiewicz, Ronald G., Donovan, William H.Texas Model Spinal Cord Injury SystemYesdevopsadmin
1998Long-term survival in spinal cord Injury: a fifty year investigationJAJ35023.Spinal Cord364266-274Frankel, H. L., Coll, J. R., Charlifue, S. W., Whiteneck, G. G., Gardner, B. P., Jamous, M. A., Krishnan, K. R., Nuseibeh, I., Savic, G., Sett, P.Rocky Mountain Regional SCI SystemYesdevopsadmin
2005The natural history of bone loss in the lower extremity of complete spinal cord-injured malesJAJ49100.Topics in Spinal Cord Injury Rehabilitation11148-60Garland, Douglas E., Adkins, Rodney H., Stewart, Charles A.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
1998Pain rehabilitation 5: pain assessment and management of cmmon disordersJAJ35239.Archives of Physical Medicine and Rehabilitation793Supp1, S74-S76Gnatz, S. M., Brown, S. E., Atchison, J. W., Taub, N. S., Worsowicz, G. M.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2002Spinal cord injury medicine. 5. Preserving wellness and independence of the aging patient with spinal cord injury: A primary care approach for the rehabilitation medicine specialistJAJ43093.Archives of Physical Medicine and Rehabilitation833Suppl 1, S82-S89Groah, Suzanne L., Stiens, Steven A., Gittler, Michelle S., Kirshblum, Steven C., McKinley, William O.Yesdevopsadmin
2001Bone loss at the knee in spinal cord injuryJAJ41215.Topics in Spinal Cord Injury Rehabilitation6337-46.Garland, D. E., Adkins, R. H.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
1995Utilization and effectiveness of methylprednisolone in a population-based sample of spinal cord injured personsJAJ29961.Paraplegia336 Gerhart, K. A., Johnson, R. L., Menconi, J., Hoffman, R. E., Lammertse, D. P.Rocky Mountain Regional SCI SystemYesdevopsadmin
2005The construct validity and explanatory power of the ASIA motor score and the FIM: Implications for theoretical models of spinal cord injuryJAJ48961.Topics in Spinal Cord Injury Rehabilitation10465-74Graves, Daniel E.Texas Model Spinal Cord Injury SystemYesdevopsadmin
1996Case management and critical pathways: links to quality care for persons with spinal cord injuryJAJ33980.American Rehabilitation22420-25Fox, S. W., Anderson, B. J., McKinley, W. O.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2005Fracture threshold and risk for osteoporosis and pathologic fractures in individuals with spinal cord injuryJAJ49130.Topics in Spinal Cord Injury Rehabilitation11161-69Garland, Douglas E., Adkins, Rodney H., Stewart, Charles A.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
19981998 Self-Assessment Examination for Practitioners: Pain RehabilitationJAJ35240.Archives of Physical Medicine and Rehabilitation793Supp1, S77-S82.Gnatz, S. M.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2003Factors associated with survival after bladder cancer in spinal cord injuryJAJ46751.Journal of Spinal Cord Medicine264339-344Groah, Suzanne L., Lammertse, Daniel P.Rocky Mountain Regional SCI SystemYesdevopsadmin
1993Delivery of primary care to the physically challengedJAJ26312.Archives of Physical Medicine and Rehabilitation7412-SS-15 - S-19Gans, B. M., Mann, N. R., Becker, B. E.University of Michigan SCI Model SystemYesdevopsadmin
2000How much help should you hire?JAJ38962.PN/Paraplegia News54416-17Gerhart, K. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2003Renal ultrasound correlates with renal nuclear scan in upper tract surveillance of spinal-cord injured patientsJAJ45143.Topics in Spinal Cord Injury Rehabilitation837-JanGousse, Angelo E., Meinbach, David S., Kester, Robert R., Razdan, Sanjay, Kim, Sandy S., Pareek, Kapil, Leboeuf, Line, Weinstein, David A., Sipski, MarcaleeSouth Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2007Psychosocial factors associated with obesity in spinal cord injuryJAJ52425.Topics in Spinal Cord Injury Rehabilitation12494-104Forchheimer, M., , Kalpakjian, C., Tate, D., Chiodo, A.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2004Bone loss at the os calcis compared with bone loss at the knee in individuals with spinal cord injuryJAJ48238.Journal of Spinal Cord Medicine273207-211Garland, Douglas E., Adkins, Rodney H., Scott, Michael, Singh, Harwinder, Massih, Maliheh, Stewart, CharlesSouthern California Spinal Cord Injury Model SystemYesdevopsadmin
2002Spinal cord injury medicine. 3. Rehabilitation outcomesJAJ43091.Archives of Physical Medicine and Rehabilitation833Suppl 1, S65-S71Gittler, Michelle S., McKinley, William O., Stiens, Steven A., Groah, Suzanne L., Kirshblum, Steven C.Yesdevopsadmin
2000The ankle brachial index in chronic spinal cord injury: A pilot studyJAJ45932.Journal of Spinal Cord Medicine234284-288Grew, Marianne, Kirshblum, Steven C., Wood, Ken, Millis, Scott R., Ma, RexNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1997Assessing medical rehabilitation practices: the promise of outcomes researchJAR07739.N/AN/A Fuhrer, Marcus J.Yesdevopsadmin
1999Skin: "I can't take the pressure!"JAJ36692.PN/Paraplegia News53533-36Gerhart, K. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
1996Community integration of individuals with spinal cord injuriesJAJ33983.American Rehabilitation231 Gordon, W. A., Brown, M.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2004Gender differences in community integration after spinal cord injuryJAJ46861.Topics in Spinal Cord Injury Rehabilitation102163-174Forchheimer, Martin B., Kalpakjian, Claire Z., Tate, Denise G.University of Michigan SCI Model SystemYesdevopsadmin
2003Development of a compact chin-operated force-sensing joystickJAJ50052.Saudi Journal of Disability Rehabilitation94212-217Guo, Songfeng, Grindle, Garrett, Cooper, Rory A.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2001Bone loss with aging and the impact of SCIJAJ41216.Topics in Spinal Cord Injury Rehabilitation6347-60Garland, D. E., Adkins, R. H., Rah, A., Stewart, C. A.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2003Transforming psychological practice and societyJAJ46613.American Psychologist584305-312Gill, Carol J., Kewman, Donald G., Brannon, Ruth W.University of Michigan SCI Model SystemYesdevopsadmin
2001Gender-related differences in acute rehabilitation lengths of stay, charges, and functional outcomes for a matched sample with spinal cord injury: A multicenter investigationJAJ44667.Archives of Physical Medicine and Rehabilitation8291181-1187Greenwald, Brian D., Seel, Ronald T., Cifu, David X., Shah, Anjali N.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2005Inflammatory C-reactive protein and cytokine levels in asymptomatic people with chronic spinal cord injuryJAJ48657.Archives of Physical Medicine and Rehabilitation862312-317Frost, Frederick, Roach, Mary Jo, Kushner, Irving, Schreiber, PeterNortheast Ohio Regional Spinal Cord Injury SystemYesdevopsadmin
1997Quality of life: the danger of differing perceptionsJAJ35104.Topics in Spinal Cord Injury Rehabilitation2378-84Gerhart, K. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
1999Economics of managed care in spinal cord injuryJAJ37954.Archives of Physical Medicine and Rehabilitation80111441-1449Fiedler, I. G., Laud, P. W., Maiman, D. J., Apple, D. F.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2000Charcot shoulder joint associated with syringomyelia: A case reportJAJ44669.Journal of Spinal Cord Medicine234234-237Drake, David F., McKinley, William O.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2002Rehabilitation of the older stroke patient: Functional outcome and comparison with younger patientsJAJ44752.American Journal of Physical Medicine and Rehabilitation8112881-889Ergeletzis, Dimitrios, Kevorkian, C. George, Rintala, DianaTexas Model Spinal Cord Injury SystemYesdevopsadmin
2005Issues in maintenance and repairs of wheelchairs: A pilot studyJAJ50596.Journal of Rehabilitation Research and Development426853-862Fitzgerald, Shirley G., Collins, Diane M., Cooper, Rory A., Tolerico, Michelle, Kelleher, Annmarie, Hunt, Peter, Martin, Stephanie, Impink, Bradley, Cooper, RosemarieUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2002Presidential address: Defining our common ground to reach new horizonsJAJ44305.Rehabilitation Psychology472131-143Elliott, T. R.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1997Barriers to employment in spinal cord injury.JAJ38731.8th World Congress of the International Rehabilitation Medicine Association (IRMA VIII), Kyoto, Japan, Aug. 31-Sept. 4 1997N/A 807-810Fiedler, I., Indermuehle, D.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2004Use of the SF-36 among persons with spinal cord injuryJAJ47619.American Journal of Physical Medicine and Rehabilitation835390-395Forchheimer, Martin, McAweeney, Mary, Tate, Denise G.Yesdevopsadmin
2004Patterns of Internet use by persons with spinal cord injuries and relationship to health-related quality of lifeJAJ46796.Archives of Physical Medicine and Rehabilitation85111872-1879Drainoni, Mari-Lynn, Houlihan, Bethlyn, Williams, Steve, Vedrani, Mark, Esch, David, Lee-Hood, Elizabeth, Weiner, CherylSpaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2001Emergencies in Chronic Spinal Cord Injury PatientsJAR08249.N/A3rd ed. Eltorai, I. M., Schmitt, J. K.Yesdevopsadmin
2003A pilot study on community usage of a pushrim-activated, power-assisted wheelchairJAJ47476.Assistive Technology152113-119Fitzgerald, Shirley G., Arva, Julianna, Cooper, Rory A., Dvorznak, Michael J., Spaeth, Donald M., Boninger, Michael L.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
1999Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury - 1990-1997JAJ37956.Archives of Physical Medicine and Rehabilitation80111457-1463Eastwood, E. A., Hagglund, K. J., Ragnarsson, K. T., Gordon, W. A., Marino, R. J.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
1996Assistive devices: empowerment issuesJAJ33981.American Rehabilitation224 Fiedler, I.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2005The relationship of blood alcohol concentration to impairment severity in spinal cord injuryJAJ50070.Journal of Spinal Cord Medicine284303-307Forchheimer, Martin, Cunningham, Rebecca M., Gater Jr, David R., Maio, Ronald F.University of Michigan SCI Model SystemYesdevopsadmin
2001Impact of demographic and medical factors on satisfaction with life after spinal cord injury: A normative studyJAJ45939.Journal of Spinal Cord Medicine24287-91Dowler, Rachael, Richards, Scott, Putzke, John D., Gordon, Wayne, Tate, DeniseUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2003Managing spasticity in spinal cord injury: Safe administration of bridge boluses during intrathecal baclofen pump refillsJAJ46226.Journal of Spinal Cord Medicine2612-4.Elovic, Elie, Kishblum, Steven C.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2002Sexual health after spinal cord injury: A longitudinal studyJAJ44233.Archives of Physical Medicine and Rehabilitation8381043-1051Fisher, T. L., Laud, P. W., Byfield, M. G., Brown, T. T., Hayat, M. J., Fiedler, I. G.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2004Shoulder pain in chronic spinal cord injury, part I: Epidemiology, etiology, and pathomechanicsJAJ47318.Journal of Spinal Cord Medicine27117-AprDyson-Hudson, Trevor A., Kirshblum, Steve C.Yesdevopsadmin
2004Durability, value, and reliability of seated electric powered wheelchairsJAJ47709.Archives of Physical Medicine and Rehabilitation855805-814Fass, Megan V., Cooper, Rory A., Fitzgerald, Shirley G., Schmeler, Mark, Rentschler, Andrew J., Duncan, JohnUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2002Prevalence of hepatitis C infection in a large urban hospital-based sample of individuals with spinal cord injuryJAJ44390.Archives of Physical Medicine and Rehabilitation83111620-1623Fong, T. L., Adkins, R. H., Govindarajan, S., Post, S., Waters, R. L.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
1999Caregiver social problem-solving abilities and family member adjustment to recent-onset physical disabilityJAJ39563.Rehabilitation Psychology441104-123Elliott, T. R., Shewchuk, R. M., Richards, J. S.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2002Improved intralimb coordination in people with incomplete spinal cord injury following training with body weight support and electrical stimulationJAJ46086.Physical Therapy827707-715Field-Fote, Edelle Carmen, Tepavac, DejanSouth Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2005Social problem-solving abilities and psychological adjustment of persons in low vision rehabilitation.JAJ49445.Rehabilitation Psychology503232-238Dreer, Laura E., Elliott, Timothy R., Fletcher, Donald C., Swanson, MarshaUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2004Women's issues after SCIJAJ46852.Topics in Spinal Cord Injury Rehabilitation102107-125Estores, Irene M., Sipski, Marca L.South Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2004The GAMECycle exercise system: Comparison with standard ergometryJAJ47024.Journal of Spinal Cord Medicine275453-459Fitzgerald, Shirley G., Cooper, Rory A., Thorman, Tricia, Cooper, Rosemarie, Guo, SongFeng, Boninger, Michael L.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2002Alcohol abuse history and adjustment following spinal cord injuryJAJ44303.Rehabilitation Psychology473278-290Elliott, T. R., Kurylo, M., Chen, Y., Hicken, B.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1996Quality of life after spinal cord injuryJAJ33976.American Rehabilitation223 Addresses quality of life (QOL) issues for people with disabilities as determined by a study analyzing longitudinal data in the National Spinal Cord Injury (SCI) Model Systems Data Base. Factors in assessing QOL and well-being are discussed. For objective QOL, summaries of data about residence, employment, education, and marital status are presented. A discussion of subjective QOL draws from several cross sectional studies and addresses the impact of level of impairment, disability, and handicap; family roles; occupation; and social integration. Issues of aging, adjustment to SCI, and age at injury are also addressed. Includes selection of quotes on QOL from people with SCI.Dijkers, M.University of Michigan SCI Model SystemYesdevopsadmin
1999Predicting recovery after spinal cord injury: a rehabilitation imperativeJAJ36493.Archives of Physical Medicine and Rehabilitation804361-364Article summarizing current knowledge about the likelihood of functional recovery after spinal cord injury (SCI), including recovery of the ability to walk and to perform activities of daily living (ADL) and self care, with discussion of the significance of SCI lesion level.Ditunno Jr, J. F.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2002The business of health care: Maximizing outcomes for providers and patientsJAJ45948.Journal of Spinal Cord Medicine25269Editorial briefly discusses the concept of health care as a business. Author describes patients' and physicians' responsibilities for ensuring optimal care while considering the economic impact of that care.DeLisa, Joel A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1999Recent trends in mortality and causes of death among persons with spinal cord injuryJAJ37950.Archives of Physical Medicine and Rehabilitation80111411-1419Study identifying and quantifying trends in mortality and causes of death among persons with spinal cord injury (SCI). Data were collected for a cohort of 28,239 consecutive persons admitted to a model SCI system or a Shriner's Hospital within 1 year of injury. Findings suggest that mortality rates after the first anniversary of injury decreased from 1973 to 1992 but increased from 1993 to 1998 relative to the previous 5-year period. Respiratory disease was the only cause of death for which the relative odds increased significantly during the latest time period.DeVivo, M. J., Krause, J. S., Lammertse, D. P.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2005Quality of life of individuals with spinal cord injury: A review of conceptualization, measurement, and research findingsJAJ49749.Journal of Rehabilitation Research and Development42387-110Literature review examines how quality of life (QOL) is defined and measured for individuals with spinal cord injury (SCI). Three different conceptualizations of QOL are reviewed: (1) QOL as subjective well-being, (2) QOL as achievement, and (3) QOL as utility. Most of the commonly used QOL instruments can be assigned to a specific conceptualization. Findings indicate that regardless of the conceptualization used, people with SCI tend to report fewer feeling of well-being; score lower on physical, mental, and social health and in other domains considered important to QOL; and have a state of health that is preferred much less compared to the average person without disabilities.Dijkers, Marcel P. J. M.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2003Methods for a randomized trial of weight-supported treadmill training versus conventional training for walking during inpatient rehabilitation after incomplete traumatic spinal cord injuryJAJ46175.Neurorehabilitation and Neural Repair173153-167Article describes the design and methodology of the Spinal Cord Injury Locomotor Trial (SCILT), the first multisite, randomized controlled trial in the United States to examine the effects of body weight-supported treadmill training (BWSTT) on locomotion after spinal cord injury. BWSTT allows physical therapists to systematically train patients to walk on a treadmill at increasing speeds typical of community walking with increasing weight bearing. Within 8 weeks of a SCI, 146 subjects entered 12 weeks of intervention. Subjects were randomly assigned to a conventional therapy program for mobility versus the same intensity and duration of a combination of BWSTT and over-ground locomotor retraining. The 2 single-blinded primary outcome measures are the level of independence for ambulation and for those who are able to walk, the maximal speed for walking 50 feet, assessed at 6 and 12 months after randomization.Dobkin, Bruce H., Apple, David, Barbeau, Hugues, Basso, Michele, Behrman, Andrea, Deforge, Dan, Ditunno, John, Dudley, Gary, Elashoff, Robert, Fugate, Lisa, Harkema, Susan, Saulino, Michael, Scott, MichaelSoutheastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
2000Certifying and measuring competency in the United StatesJAJ40368.Archives of Physical Medicine and Rehabilitation8191236-1241Article discussing the process of certification in physical medicine and rehabilitation by the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education. Topics include the basic requirements for certification, a written examination outline, subspecialties, and proposed requirements for subspecialty certification.DeLisa, J. A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1997Causes and costs of spinal cord injury in the United StatesJAJ34435.Spinal Cord3512809-813Using the National Spinal Cord Injury Statistical Center (NSCISC) database, analyzes the direct costs of spinal cord injury. Includes the costs of: hospitalization and medical care; attendant and in-home care; physician and outpatient services; equipment purchase, rental, and repair; supplies; medications; environmental modifications at work, home, and for vehicles; nursing home care; vocational rehabilitation services; and miscellaneous items. Provides summary of costs by cause of injury.DeVivo, M. J.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2004Relationships between level of disability and receipt of preventive health servicesJAJ47702.Archives of Physical Medicine and Rehabilitation855749-757National survey data was analyzed to examine the relationships between level of disability and receipt of certain preventive health services, including colorectal, cervical, and breast cancer screenings, and influenza and pneumococcal vaccination. Results indicated that people with mild and moderate disability received flu and pneumonia vaccinations somewhat more frequently than people without disabilities, but people with the most severe disabilities received vaccinations least frequently. Women with disabilities received fewer pap tests and clinical breast exams. Authors conclude that severity of disability is related to receipt of certain preventive services, but not necessarily in a simple way.Diab, Marguerite E., Johnston, Mark V.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2003A view of the future model spinal cord injury system through the prism of past achievements and current challengesJAJ46237.Journal of Spinal Cord Medicine262110-115Article examines contributions of the Model Spinal Cord Injury System (MSCIS) program toward the evaluation and care of individuals with spinal cord injury (SCI) and discusses challenges to the program's future. The information is based on retrospective review of the literature and integration of recent reported findings from panel presentation and publications regarding the MSCIS from 2000 through 2005. Achievements in service comprehensiveness, dissemination and education activities, and research contributions are discussed.Ditunno, John F., Jr., Apple, David F., Burns, Anthony S., Donovan, William H., Hagglund, Kristofer J., Lammertse, Daniel P., Ragnarsson, Kristjan J., Waters, Robert L., Tate, Denise G., Tulsky, David S.Yesdevopsadmin
2002Quality of life for individuals with SCI: Let's keep up the good workJAJ45946.Journal of Spinal Cord Medicine2511Editorial briefly discusses research concerning quality of life (QOL) for individuals with spinal cord injury (SCI). Author specifically addresses a study that explored the relationships between objective and subjective indicators of QOL. He emphasizes that future research should focus on outcome measures that consider the needs of the individual.DeLisa, Joel A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1995Outcomes of post-spinal cord injury marriagesJAJ29402.Archives of Physical Medicine and Rehabilitation762130-138Study comparing the divorce rate among persons who got married after spinal cord injury (SCI) with that of the non-SCI population of comparable age and gender and exploring the factors associated with increased likelihood of divorce. Subjects were 622 persons enrolled in the National Spinal Cord Injury Statistical Center data set since 1973. These individuals were followed between 1 and 15 years (mean of 3.5 years) after their marriage. The status of each marriage was determined at the time of the most recent routine annual follow up examination. Overall, 126 divorces occurred whereas 74 were expected based on 2,190 person-years of follow up and age-sex specific annual divorce rates for the United States population. Men and remarried persons had divorce rates 2.07 and 1.80 times higher, respectively, than women and persons married for the first time. The divorce rate was lower among college graduates than among those with less education and it was lower among persons with lumbosacral injuries than among those with higher injury levels.DeVivo, M. J., Hawkins, L. N., Richards, J. S., Go, B. K.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2003A computer adaptive testing simulation applied to the FIM instrument motor componentJAJ45049.Archives of Physical Medicine and Rehabilitation843384-393Study investigates whether computer adaptive testing (CAT) can be used to decrease the number of Functional Independence Measure (FIM) instrument motor component items administered in assessing people with spinal cord injury (SCI). Six FIM items were selected for each subject for the CAT simulation. Separate estimates of motor ability for admission, discharge, and follow-up data derived from the 6 items were compared with estimates derived from the 13 FIM motor items. Results indicate that CAT can be used to shorten the FIM.Dijkers, Marcel P.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2000Recovery of upper extremity strength in complete and incomplete tetraplegia: A multicenter studyJAJ39087.Archives of Physical Medicine and Rehabilitation814389-393Study examining upper extremity motor recovery of individuals with quadriplegia with both complete and incomplete injuries, to determined whether it is possible to predict which individuals would recover a motor level and at what time. Data were collected through examination of 167 individuals with acute quadriplegia following spinal cord injury (SCI). Findings indicate that for the C4 level, rate of recovery of the biceps was 70% for complete injuries and 90% for incomplete; for the C5 group, the recovery rate for the extensor carpi radialis was 75% for complete injuries and 90% for incomplete; and the C6 group, the recovery rate for the triceps was 85% for complete injuries and 90% for incomplete injuries.Ditunno Jr, J. F., Cohen, M. E., Hauck, W. W., Jackson, A. B., Sipski, M. L.Regional SCI Center of the Delaware ValleyYesdevopsadmin
1997Practice and career satisfaction among physiatrists: A national survey. AmericanJAJ37309.Journal of Physical Medicine and Rehabilitation76290-101Article presenting results of a national survey of physiatrists concerning their career satisfaction and current practice patterns. Data are from 208 responses to a questionnaire mailed to 400 members of the American Academy of Physical Medicine and Rehabilitation. Areas of satisfaction and dissatisfaction were identified, along with overall levels of satisfaction. Several hypotheses about factors that might be expected to affect satisfaction, such as bureaucratization and payment denials, were evaluated and not confirmed. Other data include: whether respondents believed their residency training had adequately prepared them for their work; respondents' ratings of the difficulty caused by aspects of their work; and likelihood of leaving practice in 2 years.DeLisa, J. A., Kirshblum, S., Jain, S. S., Campagnolo, D. I., Johnston, M., Wood, K. D., Findley, T.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2004Epidemiology of spinal cord injury in children and adolescentsJAJ46888.Journal of Spinal Cord Medicine27Supplement 1S4-S10Study describes the unique aspects of the epidemiology of childhood-onset spinal cord injury among children and adolescents. The characteristics of subjects with SCI included in either the Shriners Hospitals for Children database or the National SCI Statistical Center database from 1973 through 2002 were evaluated based on age at the time of injury: (1) 0 to 5 years, (2) 6 to 12 years, (3) 13 to 15 years, (4) 16 to 21 years, and (5) 22 years and older. Males comprised a consistently decreasing proportion of new cases of SCI with advancing age, ranging from 51 percent among those aged 0 to 5 years to 83 percent among those between 16 and 21 years of age. The proportion of SCI due to motor vehicle crashes was higher among children and adolescents than in adults. Injuries due to sports, violence, and medical or surgical complications were more significant in teenagers than in adults. Violence was the leading cause of SCI among African American and Hispanic teenage males, whereas vehicular crashes are more common among African American and Hispanic men 22 years of age and older.DeVivo, Michael J., Vogel, Lawrence C.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2003Use of topiramate for spinal cord injury-related painJAJ46756.Journal of Spinal Cord Medicine264401-403.Article presents the clinical histories of 2 people with pain following spinal cord injury who were treated with the antiepileptic drug, topiramate. Topiramate was well tolerated and effective in reducing pain in both patients.Dinoff, Beth L., Richards, Scott, Ness, Timothy J.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2001Spinal cord medicine: Physician scientists can make a differenceJAJ45942.Journal of Spinal Cord Medicine243137Editorial discusses ways to increase the number of physician scientists involved in clinical research in spinal cord medicine. Active recruitment, a supportive environment, model training programs, and adequate opportunities for research are needed to enhance the progress of developing better and faster recovery interventions.DeLisa, Joel A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1993Causes of death during the first 12 years after spinal cord injuryJAJ24739.Archives of Physical Medicine and Rehabilitation743248-254Study of 9,135 spinal cord injured persons identifies risk factors and causes for mortality over an eleven year period. Primary cause of death for the 9.3% of the studied group that died was related to diseases of the respiratory system. The causes of death are correlated to age groups, extent of spinal cord injury, length of time post injury, and secondary causes of death. Methods for improving prevention of the primary causes for death and management of contributing complications will improve the life expectancy for spinal cord injured persons.DeVivo, M. J., Black, K. J., Stover, S. L.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1999Community integration: conceptual issues and measurement approaches in rehabilitation researchJAJ36388.Journal of Rehabilitation Outcomes Measurement3139-49Article on the definition and measurement of community integration, with a focus on potential applications in research on persons with spinal cord injury (SCI). Different ways of conceptualizing and operationalizing community integration are discussed, along with related concepts such as handicap, instrumental activities of daily living (IADL's), independent living, social health, social adjustment, and quality of life (QOL).Dijkers, M.University of Michigan SCI Model SystemYesdevopsadmin
2005Neurological and functional capacity outcome measures: Essential to spinal cord injury clinical trialsJAJ49745.Journal of Rehabilitation Research and Development42335-42Article reviews research on neurological and functional recovery following spinal cord injury (SCI). Discussion focuses on the strategy for executing clinical trials and evaluating new interventions. Understanding the clinical course of recovery, recognizing accurate examination skills, and appropriately using outcome measures are some of the tools SCI rehabilitation clinicians need to participate in these trials.Ditunno Jr, John F., Burns, Anthony S., Marino, Ralph J.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2004Shaping the future of medical rehabilitation research: Using the interdisciplinary research modelJAJ47500.Archives of Physical Medicine and Rehabilitation854531-537John Stanley Coulter Memorial Lecture addresses the requirements for developing a framework for interdisciplinary rehabilitation research. The needs for funding, clinical trials, staffing, education, and infrastructure in medical rehabilitation research are examined from the author's perspective as a researcher, chief executive officer, department chair, and dean.DeLisa, Joel A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1992A cross-sectional study of the relationship between age and current health status for persons with spinal cord injuriesJAJ24077Paraplegia3012820-827Study examines the health status of persons as they age who had spinal cord injuries many years ago. Health status data collected yearly on persons (N= 11,117) who had a traumatic spinal cord injuries between 1973 and 1989 is analyzed. The most significant predictor of health status is current age, with persons in the highest age group having the lowest level of health status. A higher likelihood of nursing home care and lower evidence of independence than the general population is observed.DeVivo, M. J., Shwechuk, R. M., Stover, S. L., Black, K. J., Go, B. K.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2003Integrated control and related technology of assistive devicesJAJ47473.Assistive Technology15289-97Article provides an overview of the benefits of an integrated control system in which a single interface is used to operate 2 or more assistive devices. Research is reviewed regarding the Multiple Master Multiple Slave (M3S) protocol, integrated communication and environmental control, integrated computer access, and integrated wheelchair guidance systems.Ding, Dan, Cooper, Rory A., Kaminski, Beth Ann, Kanaly, John R., Allegretti, Ana, Chaves, Eliana, Hubbard, SandyUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2002Prevalence of upper motor neuron vs lower motor neuron lesions in complete lower thoracic and lumbar spinal cord injuriesJAJ46219.Journal of Spinal Cord Medicine254289-292Study examined the incidence and etiology of lower motor neuron (LMN), upper motor neuron (UMN), and mixed lesions in patients with complete thoracic and lumbar spinal cord injuries (SCI) for the following neurologic levels: T7 - T9, T10 - T12, and L1 - L3. Results showed the distribution of LMN, UMN, and mixed lesions were as follows: in the T7 - T9 group, 7.3 percent were LMN, 85.5 percent UMN, and 7.3 percent mixed; in the T10 - T12 group, 57 percent LMN, 17.7 percent UMN, and 25.3 percent mixed; and in the L1 - L3 group, 95.5 percent LMN, 0 percent UMN, and 4.5 percent mixed. Findings indicate that the type of lesion cannot be determined based on the neurological level of injury.Doherty, Jeanne G., Burns, Anthony S., O'Ferrall, Dermot M., Ditunno, John F., Jr.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2001Spinal cord injury medicine: Meeting the challenges of a growing subspecialtyJAJ45937.Journal of Spinal Cord Medicine24273Editorial describes the role of spinal cord injury medicine (SCIM) as a subspecialty in the field of physical medicine and rehabilitation. Author discusses certification requirements for SCIM and the need for more qualified physicians in the field.DeLisa, Joel A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2002Estimating life expectancy for use in determining lifetime costs of careJAJ44138.Topics in Spinal Cord Injury Rehabilitation7449-58Article describes methods for estimating life expectancy, an essential component for developing the life care plan of individuals with spinal cord injury (SCI). Estimates based on age at injury, neurologic level of lesion, completeness of injury, ventilator dependency, and the amount of time since injury are published annually by the National Spinal Cord Injury Statistical Center (NSCISC).Devivo, M. J.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1997Quality of life after spinal cord injury: a meta analysis of the effects of disablement componentsJAJ34438.Spinal Cord3512829-840Examines studies of quality of life (QOL) to determine the the relationship between QOL and various factors for people with spinal cord injuries (SCI). Studied factors include: degree of impairment; disability status; and occupational, family, mobility, social integration and social support status. Discusses findings in relation to previous studies and implications for future research.Dijkers, M.University of Michigan SCI Model SystemYesdevopsadmin
2001Multicenter clinical trials to establish the benefit of early intervention in spinal cord injuryJAJ42739.American Journal of Physical Medicine and Rehabilitation809713-716Article reviewing lessons for future research learned from recent clinical trials assessing the efficacy of early intervention in spinal cord injury (SCI). The author draws from his own experience of recent trials and from a workshop on clinical trials in rehabilitation sponsored by the National Center for Medical Rehabilitation Research. The discussion emphasizes considerations that should be examined by rehabilitation investigators who use impairment, functional limitation, and functional capacity as clinical outcome measures.Ditunno Jr, J. F.Regional SCI Center of the Delaware ValleyYesdevopsadmin
2003Evolution in medicine: The dynamics of authorshipJAJ46245.Journal of Spinal Cord Medicine263185Editorial on the importance of establishing authorship for paper submitted to journals for publication. The most widely acknowledged guidelines establish 3 criteria for authorship: (1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published.DeLisa, Joel A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1997Prevention of spinal cord injuries that occur in swimming poolsJAJ34140.Spinal Cord358509-515Presents statistics surrounding incidence of spinal cord injuries (SCI) caused by accidents in swimming pools, including demographics of injured people as well as circumstances surrounding accidents. Discusses implications for SCI prevention programs and the need for further research into the mechanism of injuries (i.e. whether injuries occur on impact with the water or when a person's head hits the bottom of the pool).DeVivo, M. J., Sekar, P.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
1999Short versions of the telephone Motor Functional Independence Measure for use with persons with spinal cord injuryJAJ37959.Archives of Physical Medicine and Rehabilitation80111477-1484Study to determine if the motor ability of persons with spinal cord injury (SCI) can be reliably estimated using a subset of the 13 Functional Independence Measure (FIM) items. FIM item subsets of 5, 6, or 7 items were generated using each of 5 strategies, and motor ability estimates obtained using these 15 subsets were compared to estimates obtained using the full set of 13 FIM items for 4,128 persons with SCI. All the subsets had high interclass correlation coefficients (ICC), with the best being a 7-item subset chosen through individual optimization.Dijkers, M. P. J. M., Yavuzer, G.University of Michigan SCI Model SystemYesdevopsadmin
2009Beyond the evidence-based practice paradigm to achieve best practice in rehabilitation medicine: A clinical reviewJAJ60191Physical Medicine and Rehabilitation110941-950Objective: Best practice is a practice that, on rigorous evaluation, demonstrates success, has had an impact, and can be replicated. It is differentiated from its constituent parts, evidence-based practice and knowledge translation, by its general meaning and global purview. The purpose of this clinical review is to provide transparency to the concept and achievement of best practice in the context of rehabilitation medicine. The authors will review and analyze the roles of evidence-based practice and knowledge translation in rehabilitation medicine as they work to support best practice. Challenge areas will be discussed, including an evidential hierarchy in need of update, a lack of “high-level” research evidence, and delays in translating evidence to practice. Last, the authors will argue that rehabilitation medicine is well-positioned to effect change by promoting inclusion of emerging research methodologies and analytic techniques that better capture contextspecific rehabilitation evidence, into the evidential hierarchy. Achieving best practice isdependent on this, as well as alignment of all key stakeholders, ranging from the patient, researchers and clinicians, to policymakers, payers, and others. Groah, S.L., Libin, A., Lauderdale, M., Krol, T., DeJong, G., & Hsieh, J.National Capitol Spinal Cord Injury Model SystemYesdevopsadmin
2001Peer review of clinical research applications: Leveling the playing fieldJAJ45943.Journal of Spinal Cord Medicine244229Editorial briefly discusses issues concerning the qualifications of peer reviewers who review grant proposals for clinical research. Author addresses inequities in the peer review process between basic science and clinical research.DeLisa, Joel A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1999Discharge disposition from model spinal cord injury care system rehabilitation programsJAJ36927.Archives of Physical Medicine and Rehabilitation803785-790Case control study identifies and quantifies factors associated with discharge to a nursing home from a cohort of 16,633 consecutively discharged patients with spinal cord injuries between 1973 and 1996. Overall, 4.3% of patients were discharged to a nursing home. Factors that were significantly associated (pDeVivo, M. J.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2003Use of the Independence 3000 IBOT transporter at home and in the communityJAJ46234.Journal of Spinal Cord Medicine26179-85Study examined the use of the Independence 3000 IBOT Transporter, an electronically stabilizing, wheeled mobility device for people with disabilities. It operates in 4 functions: standard, balance, 4-wheel, and remote. Trained clinicians observed as participants used the IBOT to perform a series of activities, including holding eye-level discussion with colleagues and shopping by balancing on 2 wheels, going up and down steep ramps, traveling on outdoor surfaces, and climbing curbs. The balance and 4-wheel functions were helpful and worked well. The IBOT required attention to control in the standard function. The seat height was too high for most tables and desks, and the IBOT was challenging to use in the bathroom.Cooper, Rory A., Boninger, Michael L., Cooper, Rosemarie, Dobson, Annmarie R., Kessler, Jeanette, Schmeler, Mark, Fitzgerald, Shirley G.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2003Differential responses to measures of gait performance among healthy and neurologically impaired individualsJAJ46639.Archives of Physical Medicine and Rehabilitation84121774-1779Study compared gait performance during a 5-minute walk among healthy subjects, people with spinal cord injury (SCI), and stroke survivors while investigating whether evaluating oxygen consumption during this test provides additional information about the subject's performance. Participants were fitted with a portable gas analyzer and walked on a 5-meter walkway for 5 minutes. Measures of walk distance, gait speed, gait energy expenditure, and gait cost were obtained, along with measures of ventilation, ventilation and carbon dioxide production slope, oxygen pulse, and heart rate. The SCI group walked less than the stroke survivors or the healthy group but had higher energy demands, as shown by gait energy expenditure and gait costs. Compared with the healthy group, the stroke group had higher ventilation and ventilation and carbon dioxide production slope. The results suggest that metabolic assessment during the 5-minute walk test is feasible with patients with neurological impairment.da Cunha-Filho, Inacio T., Henson, Helene, Qureshy, Huma, Williams, Amanda L., Holmes, Sally A., Protas, Elizabeth J.Texas Model Spinal Cord Injury SystemYesdevopsadmin
1997Approaching health and wellness issues for those with high-level spinal cord injuryJAJ35103.Topics in Spinal Cord Injury Rehabilitation2359-63Article exploring the possibilities for including health promotion strategies in the rehabilitation of persons with high level spinal cord injuries (SCI). Discusses the concept of health promotion and its application to persons with high level SCI, along with ways of achieving health and wellness cost-effectively.Chase, T. M.Rocky Mountain Regional SCI SystemYesdevopsadmin
1999Determining impairment following spinal cord injuryJAJ47557.Physical Medicine and Rehabilitation Clinics of North America123603-612Article discusses issues involved in determining the ability of an individual with spinal cord injury (SCI) to return to work and his or her degree of impairment and disability. The determination of impairment and disability can be accomplished by general categorization of an individual's neurological and functional level. Secondary conditions occasionally arise which require a more functionally oriented and perhaps interdisciplinary evaluation to assess disability. On the other hand, an evaluation of handicap requires an understanding of the natural recovery and the common complications after SCI, and a more detailed knowledge of the field of vocational rehabilitation.Cifu, David X., Wehman, Paul, McKinley, William O.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Advances in electric-powered wheelchairsJAJ50437.Topics in Spinal Cord Injury Rehabilitation11415-29Article focuses on key innovations in powered wheelchair technology. The authors discuss a number of advances, including: (1) commercial innovations, (2) advanced controls, (3) communication technologies, (4) frame designs and flexible structures, (5) standards and testing, and (6) drive-train technologies. A discussion of the basics of electric-powered wheelchair operation is included, while the authors point to implications for future innovations.Cooper, R.A., Cooper, R., Tolerico, M., Guo, S., Ding, D., Pearlman, J.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2002Perceptions of environmental safety among individuals with spinal cord injuryJAJ44457.American Journal of Physical Medicine and Rehabilitation8110798-800Reports results of survey to assess the perception of safety among individuals with spinal cord injury (SCI) living in the community. Questions related to demographics; physical mobility; crime, fire, and transportation safety; stress status; and general feelings of safety. The results indicate that most individuals with SCI perceive themselves as relatively safe in their environment. Respondents expressed a need for education in the area of fire safety.Cesar, Karen W., Garavan, Rebecca, Laud, Prakash, Hayat, Matthew, Fiedler, Irma G.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2000Continuous passive motion after total knee arthroplastyJAJ40396.Archives of Physical Medicine and Rehabilitation795421-426Study to determine the effects of continuous passive motion (CPM) on the amount of knee flexion in patients with total knee arthroplasty in a rehabilitation setting. The 51 participants in the study were divided into two groups with one group receiving CPM for 5 consecutive hours per day plus physical therapy (PT) and the other group receiving only PT. Knee flexion measurements were taken at admission, on the third and seventh day, and upon discharge. Results found no significant difference in passive range of motion between the two groups.Chen, B., Zimmerman, J. R., Soulen, L., DeLisa, J. A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2003Pittsburgh wheelchair and seating biomechanics research programJAJ51007.Journal of the Society of Biomechanisms Japan273144-157Article presents an overview of the wheelchair and seating biomechanics research program at the University of Pittsburgh. The program includes studies to prevent secondary conditions due to wheelchair and seating use, to reduce the incidence of accidental injuries, and to improve access to technologies that promote community participation. Projects involving wheelchair propulsion, transfer biomechanics, modeling and simulation, wheelchair driving accidents, wheelchair transportation, rider comfort and whole-body vibration exposure, head/neck operated interfaces, hand operated interfaces, soft-tissue analysis and wound prevention, exercise systems, wheelchair sports studies, and clinical applications are described.Cooper, Rory A., Boninger, Michael L., Brienza, David M., van Roosmalen, Linda, Koontz, Alicia M., LoPresti, Edmund, Spaeth, Donald M., Bertocci, Gina E., Guo, Songfeng, Buning, Mary-Ellen, Schmeler, Mark, Geyer, Mary Jo, Fitzgerald, Shirley G., Ding, DanUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
1996Orthotic prescriptions.JAJ37490.In R. R. Betz & M. J. Mulcahey (Eds.), The child with a spinal cord injury: Shriner's Hospital for Crippled Children SymposiumN/A 537-554Chapter from a symposium on children with spinal cord injury (SCI), focusing on orthotic management. The chapter provides descriptions of lower extremity orthoses, compares orthotic choices for children with various levels of SCI, and discusses writing the orthotic prescription.Creitz, L., Nelson, V. S., Haubenstricker, L., Backer, G.University of Michigan SCI Model SystemYesdevopsadmin
1999Longitudinal outcomes in spinal cord injury: Aging, secondary conditions, and well-beingJAJ37952.Archives of Physical Medicine and Rehabilitation80111429-1434Study of the degree to which current age, duration of injury, and neurological status affect the frequency of secondary health and psychosocial conditions in persons with long-term spinal cord injury (SCI), using both longitudinal and cross-sectional analysis. Data were collected from 439 individuals with SCI, initially at their 5th, 10th, and 15th anniversaries of injury, and then at their 10th, 15th, and 20th anniversaries. Different patterns were found in psychosocial and secondary health conditions related to neurological group, duration of injury, and age.Charlifue, S. W., Weitzenkamp, D. A., Whiteneck, G. G.Rocky Mountain Regional SCI SystemYesdevopsadmin
1999Age, outcome, and rehabilitation costs after tetraplegia spinal cord injuryJAJ44372.NeuroRehabilitation123177-185Study examines the relationship between age, functional outcome, hospital length of stay (LOS), and hospital charges after spinal cord injury (SCI). Two thousand ninety-nine consecutive patients with tetraplegia were assessed in acute care and inpatient rehabilitation. Age differences were examined by separating the sample into 11 age categories and conducting analysis on treatment, medical expense, and outcome measures, which included the American Spinal Cord Injury Association (ASIA) motor index score and the Functional Independence Measure (FIM). Analyses revealed that patients aged 35-55 showed the greatest improvement and patients aged 70 and older showed the least improvement. Patients aged 18-34 had longer inpatient rehabilitation stays than patients aged 35-64 and incurred higher rehabilitation medical expenses than patients aged 65 and older. Patients younger than 30 were more likely to be discharged to non-institutional settings. Acute care outcome and charges and functional independence were unrelated to age.Cifu, David X., Seel, Ronald T., Kreutzer, Jeffrey S., Marwitz, Jennifer, McKinley, William O., Wisor, DouglasVCU Model Spinal Cord Injury CenterYesdevopsadmin
2003Wheelchairs and seatingJAJ50962.In V. W. Lin et al. (Eds.), Spinal cord medicine: Principles and practice. New York: Demos Medical Publishing, IncN/A 635-654Chapter summarizes information on the various types of manual and power wheelchairs, hybrid wheelchairs, and robotic wheeled mobility systems. The importance of the wheelchair-user interface is discussed, including ride comfort and durability, proper selection of wheelchair accessories, and powered wheelchair access devices. Wheelchair and seating measurements and a variety of cushions and postural supports are also reviewed.Cooper, Rory A., Boninger, Michael L., Cooper, Rosemarie, Thorman, TriciaUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2004Toward a taxonomy of rehabilitation interventions: Using an inductive approach to examine the "Black Box" of rehabilitationJAJ47519.Archives of Physical Medicine and Rehabilitation854678-686Article describes the development of a taxonomy of rehabilitation interventions based on an inductive approach. Authors: (1) outline experiences in developing taxonomies in other health care fields, (2) describe the deductive and inductive approaches to developing a rehabilitation intervention taxonomy, (3) discuss the larger study on stroke rehabilitation outcomes that led to the proposed approach, (4) present an example of the classification system used in that study, (5) introduce proposed criteria for an intervention classification system and discuss the limitations of the current study to these criteria, (6) discuss the implications for the development of clinical practice guidelines and electronic medical records, and (7) identify some of the implications for rehabilitation research.DeJong, Gerben, Horn, Susan D., Gassaway, Julie A., Slavin, Mary D., Dijkers, Marcel P.Yesdevopsadmin
2003Osteoporosis in acute spinal cord injuryJAJ45775.Topics in Spinal Cord Injury Rehabilitation9126-35Article describes the bone-related metabolic changes that occur in patients with spinal cord injury (SCI). It discusses potential mechanisms for the development of osteoporosis, and provides current recommendations for prevention and treatment of bone loss in acute SCI.Chen, Bojun, Stein, AdamMount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2004Bioengineering and spinal cord injury: A perspective on the state of the scienceJAJ46885.Journal of Spinal Cord Medicine274351-364.Article reviews the application of advances in bioengineering research within the assistive technology (AT) industry for people with spinal cord injury (SCI). Current research and development activities include wheelchair technology and transportation safety, seating and soft-tissue biomechanics; neuroprostheses; robotic systems for gait training and manipulation; computer access and environmental control systems; and accessibility of the built environment. Advances in power electronics, telecommunications, controls, sensors, and flexible manufacturing have just begun to be applied AT for people with SCI.Cooper, Rory A.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2004Clinical applications of electrical stimulation after spinal cord injuryJAJ46886.Journal of Spinal Cord Medicine274365-375Article reviews current applications of electrical stimulation after spinal cord injury (SCI) and identifies future directions for research and clinical utility. Electrodes on the skin, percutaneous fine wires, or stimulators fully implanted within the body can provide stimulation. Electrical stimulation has been used to exercise paralyzed muscles and reverse wasting; improve strength, endurance, and cardiovascular fitness; and reduce the progression of osteoporosis. Other potential therapeutic uses being investigated include reduction of spasticity, prevention of deep vein thrombosis, and improvement of tissue health. Stimulation has also been shown to restore respiratory, bladder, bowel, sexual, and limb function in people with SCI.Creasey, Graham H., Ho, Chester H., Triolo, Ronald J., Gater, David R., DiMarco, Anthony F., Bogie, Kath M., Keith, Michael W.University of Michigan SCI Model SystemYesdevopsadmin
2004Aging with spinal cord injury: Changes in selected health indices and life satisfactionJAJ46781.Archives of Physical Medicine and Rehabilitation85111848-1853Study documented the impact of age, age at injury, years postinjury, and injury severity on changes over time in selected physical and psychosocial outcomes of people aging with spinal cord injury. Data was collected from the National Spinal Cord Injury Database. Outcomes of interest at 5, 10, 15, 20, and 25 years postinjury included: number of pressure ulcers, number of times rehospitalized, perceived health status, satisfaction with life, and pain during the most recent follow-up year. Analysis revealed that the frequency of rehospitalizations and number of days rehospitalized decreased and the number of pressure ulcers increased as time passed. The previous existence or poor rating of pressure ulcers, poor perceived health, the perception of pain, and lower life satisfaction was the best predictor of that outcome.Charlifue, Susan, Lammertse, Daniel P., Adkins, Rodney H.Yesdevopsadmin
1999Age, outcome, and rehabilitation costs after paraplegia caused by traumatic injury of the thoracic spinal cord, conus medullaris, and cauda equinaJAJ43095.Journal of Neurotrauma169805-815.Study examines the effects of age on neurologic and functional outcome, hospitalization length of stay (LOS), and hospital charges after spinal cord injury (SCI). Two thousand one hundred sixty-nine consecutive patients with paraplegia were assessed in acute care and inpatient rehabilitation. Outcome measures included the American Spinal Cord Injury Association (ASIA) motor index score, the Functional Independence Measure (FIM), LOS, discharge disposition, and hospital charges. Age differences were examined by separating the sample into 11 age categories for analysis. Significant differences between age categories were found for the following treatment measures: ASIA motor index scores at acute-care admission and at discharge, rehabilitation LOS, inpatient rehabilitation charges, total LOS, total hospitalization charges, FIM scores at inpatient rehabilitation admission and discharge, FIM change, and FIM efficiency. Findings indicate that age appears to adversely affect functional outcome, rehabilitation LOS, and hospital costs.Cifu, David X., Huang, Mark E., Kolakowsky-Hayner, Stephanie A., Seel, Ron T.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Use of the INDEPENDENCE 3000 IBOT transporter at home and in the community: A case reportJAJ50178.Disability and Rehabilitation: Assistive Technology12-Jan111-117Case study reports on the use of the INDEPENDENCE 3000 IBOT Transporter (IBOT) at home and in the community with an expert wheelchair user. The IBOT was operated in 4 functions: standard, four-wheel, balance, and remote. The IBOT was somewhat difficult to control in standard function but the balance and 4-wheel functions were helpful and worked well. The subjects used the IBOT to perform a variety of activities including holding eye-level discussions with colleagues and shopping by balancing on 2 wheels, going up and down steep ramps, traversing outdoor surfaces, and climbing curbs. The seat height was too high for most tables and desks, and transfers were more difficult than with other wheelchairs. It was difficult to use the IBOT in the bathroom, and the subject preferred to use his personal wheelchair for transfers into the shower.Cooper, R. A., Boninger, M. L., Cooper, R., Kelleher, A.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
1999Upper extremity pain after spinal cord injuryJAJ36433.Spinal Cord373191-195Study of the frequency and severity of upper extremity pain in persons with spinal cord injury (SCI), and its association with functional activities. Types of treatments received by patients with SCI for upper extremity pain and the benefits of these treatments were also identified. Data are from 130 responses to a questionnaire mailed to 170 persons with SCI. It was found that the majority of respondents had upper extremity pain, and that this pain interfered with activities of daily living (ADL).Dalyan, M., Cardenas, D. D., Gerard, B.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
1995Geographic variation in preventable deaths from motor vehicle crashesJAJ36896.Journal of Trauma: Injury, Infection, and Critical Care382228-232Retrospective cohort study examines autopsy results from motor vehicle crash (MVC) victims from three rural and one nonrural county in order to test the hypothesis that the preventable death rate (PDR) is higher and anatomical injury severity is lower for rural compared to nonrural MVC fatalities. Using the Abbreviated Injury Scale, 1985 version (AIS-85), Injury Severity Scores (ISSs) and Anatomical Profile G scores were calculated. ISSs of Chen, B., Maio, R. F., Green, P. E., Burney, R. E.University of Michigan SCI Model SystemYesdevopsadmin
2004Relationship between regional bone density measurements and the time since injury in adults with spinal cord injuriesJAJ47210.Archives of Physical Medicine and Rehabilitation85159-64Article describes study conducted to determine the bone mineral density (BMD) of the legs, arms, and trunk region of a group of adults with spinal cord injury (SCI) and to determine the relationship between regional BMD values and the time since injury. BMD measurements were determined by total-body, dual-energy x-ray absorptiometry scans, and percentage-matched BMD. The relationship between percentage-matched BMD values and time since injury was determined by linear regression analyses. Results showed that the regional percentage-matched BMD values were significantly inversely related to the time since injury.Clasey, Jody L., Janowiak, Adrienne L., Gater, David R.University of Michigan SCI Model SystemYesdevopsadmin
2005Virtual reality and computer-enhanced training applied to wheeled mobility: An overview of work in PittsburghJAJ49813.Assistive Technology172159-170Article provides an overview of ongoing research efforts to develop virtual reality applications and devices for mobility skills assessment and training, exercise training, and environment assessment. Virtual reality offers wheelchair users a tool for training in different environments without any indoor or outdoor physical constraints. This research is conducted by the University of Pittsburgh Model Center for Spinal Cord Injury.Cooper, Rory A., Ding, Dan, Simpson, Richard, Fitzgerald, Shirley G., Spaeth, Donald M., Guo, Songfeng, Koontz, Alicia M., Cooper, Rosemarie, Kim, Jongbae, Boninger, Michael L.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2001Factors affecting employment following spinal cord injury: A qualitative studyJAJ43603.Rehabilitation Psychology464400-416Study examines factors influencing successful return to work following spinal cord injury (SCI). Six employed and 6 unemployed persons with SCI were matched based on education, race, age, gender, time since injury, and level of function. These participants were interviewed and the data transcribed regarding work history, family life, impact of disability, role models, barriers to employment, and satisfaction with vocational rehabilitation services received. Psychological and environmental factors were found to be the strongest moderating variables affecting employment. Key psychological factors associated with employment were optimism, self-esteem, achievement orientation, and role models. Key environmental factors were monetary incentives, disincentives, access, and accommodation.Chapin, M. H., Kewman, D. G.University of Michigan SCI Model SystemYesdevopsadmin
2003Urinary stone formation after spinal cord injury: Risk and risk factorsJAJ45144.Topics in Spinal Cord Injury Rehabilitation8319-AugArticle reviews research findings regarding the frequency of and risk factors for kidney and bladder stones in individuals with spinal cord injury (SCI). Potential risk factors before and after the first year postinjury and possible environmental influences are discussed.Chen, Yuying, DeVivo, Michael J., Lloyd, L. KeithUniversity of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2004Preliminary assessment of a prototype advanced mobility device in the work environment of veterans with spinal cord injuryJAJ50057.NeuroRehabilitation192161-170Based on observations by trained clinicians and responses to a survey completed by subjects with spinal cord injury (SCI), this study assessed the potential for the Independence 3000 IBOT Transporter (IBOT) to improve employment satisfaction for veterans who use wheelchairs at work. The IBOT is an electronically stabilizing, wheeled mobility device for people with disabilities. It operates in 4 functions: standard, balance, 4-wheel, and remote. Four men with SCI used the devices to hold eye-level discussions with colleagues, climb stairs, ascend steep ramps, and negotiate curbs. The participants rates the ease of use and function of the IBOT favorably. Half of the users felt that the IBOT would help them at work and all thought it should be made available to veterans who use wheelchairs. A larger study is recommended to determine if the IBOT affects work performance and the ability to return to work.Cooper, Rory A., Boninger, Michael L., Cooper, Rosemarie, Fitzgerald, Shirley G., Kellerher, AnnmarieUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
1997Diagnosis and treatment of esophageal perforations in cervical spinal cord injuryJAJ35102.Topics in Spinal Cord Injury Rehabilitation2341-48Article about the diagnosis and treatment of esophageal perforations in patients with cervical spinal cord injury (SCI). Data are from a retrospective review of the records of 33 patients admitted for rehabilitation from 1975 to 1995 who had complications of esophegeal injury. A table shows, for each of the 33 patients, data about the patient's SCI, the method of diagnosing the esophageal injury, the diagnosis made, and the primary patient complaint. Difficulties of diagnosis are discussed, along with factors supporting a suspicion of esophageal injury (injury factors, signs and symptoms, and diagnostic workup). Medical and surgical interventions are listed.Dahlberg, C., Lanig, I. S., Kenna, M., Long, S.Rocky Mountain Regional SCI SystemYesdevopsadmin
2004Assessing the influence of wheelchair technology on perception of participation in spinal cord injuryJAJ46782.Archives of Physical Medicine and Rehabilitation85111854-1858.Survey investigated wheelchair and related factors that affect the participation of individuals with spinal cord injury (SCI) in daily activities performed in the home, community, and during transportation. Subjects were asked 5 questions within each setting related to their perceived reason for functional limitations. Results revealed that the wheelchair was the most commonly cited factor limiting participation, followed by physical impairment, and physical environment.Chaves, Eliana S., Boninger, Michael L., Cooper, Rosemarie, Fitzgerald, Shirley G., Gray, David B., Cooper, Rory A.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2004Job experiences of personal assistants employed in a consumer-directed personal assistance service programsJAJ48290.Rehabilitation Nursing295174-179Twenty-four individuals who were employed by consumers as paid personal assistants were interviewed by telephone regarding training and supervision issues, their relationship with the consumer, and their level of job satisfaction. Participants reported being well trained and competent and nearly 62 percent reported receiving very little or no supervision, with 88 percent being very satisfied with the amount of supervision received. They reported high levels of satisfaction with their relationship with their employers and with their jobs in general, despite dissatisfaction with low wages. Authors conclude that further research is needed to identify strategies for increasing the supply of personal assistants.Clark, Mary J., Hagglund, Kristofer J., Stout, Brian J.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2002Performance assessment of a pushrim-activated power-assisted wheelchair control systemJAJ50051.IEEE Transactions on Control Systems Technology101121-126Study compared torque data obtained with a pushrim-activated power-assisted wheelchair (PAPAW) to that of traditional manual wheelchair propulsion among subjects with spinal cord injury. The PAPAW is a hybrid between a manual wheelchair and an electric-powered wheelchair and its shared control system must account for human behavior and user interaction with the device. The human power is delivered by the arms through the pushrims while the electric power is delivered by a battery through 2 electric motors. The PAPAW uses a form of gain scheduling based on events recorded from the pushrim torque. Comparisons were made for 2 speeds at normal resistance. Results showed that the peak torque was reduced by more than 50 percent and the time on the rim was nearly doubled with the PAPAW. These changes have been shown to significantly reduce the strain on the upper extremities commonly associated with secondary disabling conditions.Cooper, Rory A., Corfman, Thomas A., Fitzgerald, Shirley G., Boninger, Michael L., Spaeth, Donald M., Ammer, William, Arva, JuliannaUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
1995Compliance and complications of clean intermittent catheterization in the spinal cord injured patientJAJ37484.Paraplegia33 161-163Study assessing the compliance rate and urological complication rate for persons with spinal cord injury (SCI) using clean intermittent catheterization (CIC). Data were collected over 5.9 years from 89 individuals with SCI. Rates for specific types of complication were compared with rates found in previous studies. The authors conclude that CIC can provide optimum management of the lower urinary tract in persons with SCI.Chai, T., Chung, A. K., Belville, W. D., Faerber, G. J.University of Michigan SCI Model SystemYesdevopsadmin
1999Medical complications during acute rehabilitation following spinal cord injury - Current experience of the Model SystemsJAJ37948.Archives of Physical Medicine and Rehabilitation80111397-1401Study examining the frequency of common medical complications during acute rehabilitation in persons with new spinal cord injury (SCI), based on analysis of data on 1,649 new entries from 1996 through mid-1998 into the National SCI Statistical Center (NSCISC) database. Conditions examined included pressure ulcers, autonomic dysreflexia, deep vein thrombosis (DVT), pulmonary embolism, atelectasis/pneumonia, cardiopulmonary arrest, gastrointestinal hemorrhage, and renal complications. Some complications have declined in frequency, but others have increased. The authors attribute the increases to continued declining lengths of stay (LOS) in acute care after SCI.Chen, D., Apple Jr, D. F., Hudson, L. M., Bode, R.Yesdevopsadmin
2002Mothers with spinal cord injuries: Impact on marital, family, and children's adjustmentJournalJ43558.Archives of Physical Medicine and Rehabilitation83124-30Study investigate how mothers with spinal cord injury (SCI) adjust to parenting, their marriages, and their families, and how their children adjust to their mothers' disability. The experimental group consisted of 88 mothers with SCI, 46 of their partners, and 31 of their children. The control group was composed of 84 healthy mothers, 33 partners, and 28 of their children. Mothers in both groups completed a series of questionnaires. Depending on the age of the child, the questionnaires were completed by either the child or the mother. Participation from partners was optional. Gender role identify, self-esteem, children's adjustment, children's attitude toward mother and father, dyadic and family adjustment, parenting stress, and parenting satisfaction were measured. No significant differences were found between mothers with SCI and able-bodied mothers or between children raised in families with mothers with and without SCI. The results challenge the negative stereotypes regarding disability and parenting.Alexander, C. J., Hwang, K., Sipski, M. L.Yesdevopsadmin
2002Impact of minority status following traumatic spinal cord injuryJournalJ44666.NeuroRehabilitation173187-194Study examined the demographic characteristics, incidence rates, and functional outcomes of minority patients with traumatic spinal cord injury (SCI). Information was collected on admission to and discharge from acute care and inpatient rehabilitation units. Analysis of the data indicated that violence is the leading single cause of SCI in minority patients. Minorities who sustain a violence-related SCI were more likely to be young, single, unemployed males, with less than a high school education, residing in an urban area.Burnett, Derek M., Kolakowsky-Hayner, Stephanie A., White, Joy M., Cifu, David X.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Treatments for chronic pain in persons with spinal cord injury: A survey studyJournalJ50771.Journal of Spinal Cord Medicine (JSCM) (formerly Journal of the American Paraplegia Society292109-117Study participants were asked whether they had ever received any 1 of 26 different pain treatments, including 10 oral medications, 8 other standard pain treatment modalities, 7 alternative pain treatments, or any other treatment for pain. Participants also indicated the amount of relief each treatment provided and the length of time that any pain relief usually lasts. The medications tried most often were nonsteroidal anti-inflammatory drugs and acetaminophen. Opioids produced the greatest degree of pain relief but were unlikely to be continued by those who tried them. Although 38 percent of respondents had tried gabapentin, only 17 percent were still using it, and average pain relief was only moderate. Seventy-three percent of the respondents had tried at least 1 of the alternative pain treatments; the most frequently tried were massage, marijuana, and acupuncture. The relief from most treatments tended to last only minutes or hours; however, pain relief from treatments such as massage, acupuncture, and hypnosis was reported to last for days in 25 to 33 percent of those who tried these treatments.Cardenas, Diana D., Jensen, Mark P.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2005Pushrim biomechanics and injury prevention in spinal cord injury: Recommendations based on CULP-SCI investigationsJournalJ49743.Journal of Rehabilitation Research and Development42320-SepArticle presents practical recommendations related to wheelchair setup and propulsion based on work completed at the University of Pittsburgh and the Pittsburgh Veterans Administration for the Collaboration on Upper Limb Pain in SCI (CULP-SCI) study. Authors recommend that wheelchair users take long, smooth propulsive strokes that use as much of the pushrim as possible to minimize both the cadence and the peak forces applies. Lower peak force, slower cadence, and a circular propulsive stroke in which the hand falls below the pushrim during recovery may help prevent injury.Boninger, Michael L., Koontz, Alicia M., Sisto, Sue Ann, Dyson-Hudson, Trevor A., Chang, Michael, Price, Robert, Cooper, Rory A.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2005Living well: Spinal-cord cysts and tetheringJournalJ49175.PN/Paraplegia News59680-81Article describes changes to the spinal cord following spinal cord injury (SCI). These changes usually involve scarring of the cord, referred to as tethering, or the development of a fluid-filled space, or cyst, above or below the level of the original injury. Signs and symptoms and treatment for spinal-cord cysts and tethering are discussed.Brooks, C. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
1999Perception versus reality: Inpatient sexual health needs of individuals with acute spinal cord injuryJournalJ38732.SCI Psychosocial Process1218-JanStudy of the perceived sexual health needs of newly injured persons with spinal cord injury (SCI). Data are from a survey of 42 newly injured persons just prior to discharge from a model SCI center's inpatient rehabilitation program. Results suggest that inpatients underestimate the impact SCI may have on their ability to function sexually. A gap appeared to exist between participants' perception and the reality of physiological sexual competency. The authors conclude that many newly injured persons with SCI would benefit if sexuality education services and information were provided post-discharge.Byfield, M. G., Brown, T. T., La Favor, K. M., Murphy, D., Laud, P., Fiedler, I.Wisconsin Model Construct for Community Integration in SCIYesdevopsadmin
2004Four-legged assistantsJournalJ47798.PN/Paraplegia News58420-21Article discusses the value of service dogs as assistants to people with mobility limitations. Author offers advice on determining the need for, selecting, and caring for a service animal.Brooks, C. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2001Predicting "charge outliers" after spinal cord injury: A multicenter analysis of demographics, injury characteristics, outcomes, and rehabilitation chargesJournalJ41240.Archives of Physical Medicine and Rehabilitation821114-119Study examining demographic and injury factors associated with hospital charges for persons with new spinal cord injury (SCI). The objectives were (1) to describe the distribution of charges, (2) to determine which demographic and injury characteristics are associated with charge outlier status, and (3) to identify a model that uses demographic and injury characteristics to predict charge outlier status. Data was analyzed for 13,392 patients admitted to 24 acute, intensive, interdisciplinary rehabilitation settings after traumatic SCI between November 1972 and August 1986. Statistically significant results were found between SCI charge outliers and non-outliers based on ethnicity, education, employment, level of injury, American Spinal Injury Association (ASIA) impairment classification, and sponsor of hospitalization (government insurance, private insurance, worker's compensation, or self-pay). A model for the prediction of SCI charge outlier status was defined.Burnett, D. M., Cifu, D. X., Kolakowsky-Hayner, S., Kreutzer, J. S.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2004Etiology and incidence of rehospitalization after traumatic spinal cord injury: A multicenter analysisJournalJ46767.Archives of Physical Medicine and Rehabilitation85111757-1763Data from 8,668 people with spinal cord injury (SCI) were analyzed to determine the frequency and reasons for rehospitalizations reported during the 1st, 5th, 10th, 15th, and 20th follow-up years. Study also examined the association between rehospitalization and demographics, neurologic category, payer sources, length of stay, discharge functional status, and discharge residence. The most common reason for rehospitalization was diseases of the genitourinary system, including urinary tract infections. Respiratory diseases tended to be more likely in patients with tetraplegia, whereas patients with paraplegia were more likely to be readmitted for pressure ulcers. In year 1, both state and federal programs and HMOs had higher rates of rehospitalizations than private insurance. The rate of rehospitalization was significantly higher at years 1, 5, and 20 for those patients who were discharged to skill nursing facilities. Lower motor score using the Functional Independence Measure was predictive of rehospitalization. The average LOS per rehospitalization at the 5-year follow-up was approximately 12 days.Cardenas, Diana D., Hoffman, Jeanne M., Kirshblum, Steven, McKinley, WilliamNorthwest Regional Spinal Cord Injury SystemYesdevopsadmin
2004Relation between median and ulnar nerve function and wrist kinematics during wheelchair propulsionJournalJ48125.Archives of Physical Medicine and Rehabilitation8571141-1145Study analyzed median and ulnar nerve function and their relationship with the range of motion (ROM) of the wrist during wheelchair propulsion. The kinematic data of 35 manual wheelchair users with spinal cord injury were analyzed. Subjects also underwent bilateral nerve conduction studies to determine if nerve function was related to wrist ROM. Results indicated a significant, positive correlation between flexion and extension ROM and both ulnar and median motor amplitude. Subjects using a greater ROM showed better nerve function than those subjects propelling with a smaller ROM.Boninger, Michael L., Impink, Bradley G., Cooper, Rory A., Koontz, Alicia M.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2005Living well: Help for aches and painsJournalJ49463.PN/Paraplegia News59848-49Article discusses the use of manual therapy to treat musculoskeletal following spinal cord injury. Treatment includes specific exercises and movements to stretch joints and soft tissues, as opposed to exercises that build strength. Tips are offered for finding a therapist certified to administer manual therapy.Brooks, C. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2005Longitudinal study of individuals with high tetraplegia (C1-C4) 14 to 24 years postinjuryJournalJ46972.Topics in Spinal Cord Injury Rehabilitation10379-93Study describes the outcomes of individuals with high tetraplegia who were 14 to 24 years postinjury and were interviewed at 3 time periods after injury. The outcome measures examined included demographics, characteristics of personal assistance care, psychosocial variables, and time utilization. Results indicated that participants appeared to be functioning well in more areas of their lives. For those indicator that changed over time, the spinal cord injury itself, not necessarily a high tetraplegic injury, and/or the aging process could account for the change.Bushnik, Tamara, Charlifue, SusanSanta Clara Valley Medical Center Model SCI SystemYesdevopsadmin
2004Environmental barriersJournalJ47155.PN/Paraplegia News58111-OctArticle briefly discusses research on environmental factors that act as barriers in the daily lives of people with spinal cord injuries (SCI). In a survey of more than 2,700 people with SCI, about 20 percent said none of the 12 environmental factors they were asked about were barriers to them. Results also indicted that people who had been injured the longest reported fewer barriers and were more satisfied with their quality of life.Brooks, C. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2006Assessment of pain after SCI in clinical trialsJournalJ50395.Topics in Spinal Cord Injury Rehabilitation11350-68Article reviews various measures of pain and pain treatments and examines their usefulness in clinical trials on pain after spinal cord injury (SCI). Authors conclude that sufficient knowledge does exist on SCI pain and its measurement to make treatment progress possible.Bryce, T. N., Dijkers, P. J. M.Mount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2004Gender and minority differences in the pain experience of people with spinal cord injuryJournalJ46769.Archives of Physical Medicine and Rehabilitation85111774-1781Study examined gender and minority differences in the prevalence and severity of pain in people with spinal cord injury (SCI) as reported in follow-up surveys. Pain prevalence ranged from 81 percent at 1 year post injury to 82.7 percent at 25 years. Pain prevalence was significantly lower among non-whites, although they tended to report a higher average pain severity score when pain was present. People with SCI who were employed at the time of injury, who had more than a high school education, and who were not tetraplegic reported a higher prevalence of pain. Overall, women with SCI were no more likely to report pain or more severe pain than men.Cardenas, Diana D., Bryce, Thomas N., Shem, Kazuko, Richards, J. Scott, Elhefni, HanaaYesdevopsadmin
2003Shoulder magnetic resonance imaging abnormalities, wheelchair propulsion, and genderJournalJ46386.Archives of Physical Medicine and Rehabilitation84101615-1620Study examined the relationship between wheelchair pushrim biomechanics and progressive shoulder injury in manual wheelchair users. Biomechanical data were obtained on 14 subjects with spinal cord injury who used manual wheelchairs. Magnetic resonance images (MRIs) of both shoulders were completed for each subject on 2 occasions, approximately 2 years apart. Differences between the first and second and MRI scores were calculated and subjects were divided into 2 groups based on change in score. Seven subjects were in the group with worsening scores (MRI+) and 7 were in the group with improving or unchanging scores. There were significantly more women in the MRI+ group. This group used significantly greater force directed toward the axle to propel their wheelchairs at the time of the first MRI.Boninger, Michael L., Dicianno, Brad E., Cooper, Rory A., Towers, Jeffrey D., Koontz, Alicia M., Souza, Aaron L.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2005Living well: Baby, it's cold outsideJournalJ48605.PN/Paraplegia News59266-67Article describes the effects of cold-weather temperatures on the body temperatures of people with spinal cord injury (SCI). Generally, after SCI, body temperature had a tendency to take on the temperature of the environment. Author offers advice for how to keep warm.Brooks, C. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
1997The physiatrist as primary care physician for the disabled: A commentary.JournalJ37311.American Journal of Physical Medicine and Rehabilitation762149-153Article discussing issues related to the role of specialists in physical medicine and rehabilitation (PM&R) as primary care providers for persons with disabilities. Topics include: the meaning of primary care; "state of the art" in primary care for persons with disabilities; survey data on physiatrists' interest in being primary care providers for persons with disabilities; and potential problems and concerns in developing PM&R as a primary care specialty. The article concludes with recommendations (academic, political/administrative, and practitioner).Buschbacher, R. M., DeLisa, J. A., Kevorkian, C. G.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2002Efficacy of amitriptyline for relief of pain in spinal cord injury: Results of a randomized controlled trialJournalJ50732.Pain963365-373Study assessed whether amitriptyline, a tricyclic antidepressant, is effective in relieving chronic pain and improving pain-related physical and psychosocial dysfunction in people with spinal cord injury (SCI). Eighty-four participants with SCI and chronic pain were randomized to a 6-week trial of amitriptyline or an active placebo, benztropine mesylate. All pre- and post-treatment assessments were conducted by evaluators blind to the allocation. Regression analyses were conducted to examine whether there was a medication group effect on the primary (average pain intensity) and secondary outcome measures. No significant differences were found between the groups in pain intensity or pain-related disability post-treatment, in either intent-to-treat analyses or analyses of study completers. These findings do not support the use of amitriptyline in the treatment of chronic pain in this population.Cardenas, Diana D., Warms, Catherine A., Turner, Judith A., Marshall, Helen, Brooke, Marvin M., Loeser, John D.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2004Sitting and standing tolerance in patients with chronic back pain: Comparison between physician prediction and covert observationJournalJ47713.Archives of Physical Medicine and Rehabilitation855837-839Continuous sitting and standing tolerance was measured by: (1) covert observation of 154 patients with chronic back pain and (2) blinded expert physician prediction based on complete history and physical examination. One hundred twenty-four of the 154 patients (80.5 percent) were able to sit continuously for 60 minutes or more and to stand continuously for 30 minutes or more while being covertly observed. Physician prediction showed poor correlation to covert observation for sitting and standing tolerance. Overall, physicians under-predicted the ability to sit 60 or more minutes and to stand 30 or more minutes.Brokaw, Jason P., Walker, William C., Cifu, David X., Gardner, MarieVCU Model Spinal Cord Injury CenterYesdevopsadmin
2006Reliability of the Bryce/Ragnarsson spinal cord injury pain taxonomyJournalJ50772.Journal of Spinal Cord Medicine292118-132Study examined the interrater reliability of the Bryce/Ragnarsson spinal cord injury (SCI) pain taxonomy (BR-SCI-PT). Thirty-nine physicians specializing in SCI evaluated 135 vignettes, each of which described a person with SCI with one or more different etiologic subtypes of pain. Physician classifications were compared with those made by the investigators. Of 179 pain descriptions, 83 percent were categorized correctly to one of the 15 BR-SCI-PT pain types; 93 percent were categorized correctly with respect to the level (above, at, or below neurological level of injury), whereas 90 percent were categorized correctly as being either nocioceptive or neuropathic. Subjects expressed a generally high confidence in the accuracy of their classifications.Bryce, T., Dijkers, M., Ragnarsson, K., Stein, A., Chen, BMount Sinai Hospital Spinal Cord Injury Model SystemYesdevopsadmin
2003Spinal cord injury computer-assisted instruction for medical studentsJournalJ45361.American Journal of Physical Medicine and Rehabilitation824316-319Study evaluated the effectiveness of a computer-assisted instruction program to improve the spinal cord injury knowledge base of fourth-year medical students. Effectiveness was determined based on pretest and posttest scores and overall user satisfaction assessments. Results indicated that mean posttest scores were significantly higher than mean pretest scores. Course evaluations indicated positive ratings in all areas, including applicability and usability.Campagnolo, Denise I., Stier, Kyle T., Sanchez, William, Foye, Patrick M., DeLisa, Joel A.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2003Investigating neck pain in wheelchair usersJournalJ45244.American Journal of Physical Medicine and Rehabilitation823197-202Questionnaires and physical exams were used to evaluate neck pain in a group of wheelchair users. Main outcome measures included reported neck pain, visual analog scale of neck complaints, the Neck Disability Index, and physical exam findings of trigger points. Of the 68 participants, 66.2 percent reported experiencing neck pain since becoming a wheelchair user and 60.3 percent reported pain during the past month. Of those who reported neck pain, 60 percent visited the doctor for the pain and 40 percent limited their daily activities because of the pain. Trigger-point palpation reproduced pain in 53.5 percent of those participants who experienced pain in the 24 hours preceding the examination.Boninger, Michael L., Cooper, Rory A., Fitzgerald, Shirley G., Lin, Jessica, Cooper, Rosemarie, Dicianno, Brad, Liu, BettyUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2005Living well: A gift of peaceJournalJ50112.PN/Paraplegia News591241-43Article provides strategies and tools for people with spinal cord injury (SCI) to use to manage stress. It defines stress, describes its impact on the mind and body, and discusses ways to ease its effects.Brooks, C. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2000Gender and its impact on postacute secondary medical complications following spinal cord injuryJournalJ39951.Topics in Spinal Cord Injury Rehabilitation6166-75Study examining differences by sex in the occurrence of postacute secondary complications following spinal cord injury (SCI). Participants were 2,618 individuals 1 year post-injury, and 6,090 individuals 5 years and more post-injury. A sub-group of the second group included 78 individuals 10 years and more post-injury. Men with SCI were matched, case for case, to women with SCI based on age at follow-up, marital status, educational background, category of neurologic impairment at rehabilitation discharge, American Spinal Injury Association (ASIA) impairment scale, etiology of injury, bladder management at rehabilitation discharge, and ventilator use at rehabilitation discharge. Results showed that sex was largely unrelated to subsequent development of medical complications.Burns, A. S., Putzke, J. D., Richards, J. S., Jackson, A. B.University of Alabama at Birmingham Spinal Cord Injury Model System Yesdevopsadmin
2002Classification of chronic pain associated with spinal cord injuriesJournalJ44393.Archives of Physical Medicine and Rehabilitation83121708-1714The purpose of this study is to (1) test the interrater reliability of a classification system for chronic pain in people with spinal cord injuries and (2) determine the frequency and characteristics of various types of pain categorized by this system. Two investigators categorized pain independently based on responses to questionnaires and personal interviews. Strength of agreement was substantial among the 68 pain problems categorized with the questionnaires; however, there were 8 that could not be categorized on the basis of survey questions alone. Of the 15 persons who were interviewed in person, all 43 pain problems were categorized and strength of agreement was substantial. The most common worst pain was SCI pain, followed by mechanical spine pain.Cardenas, D. D., Turner, J. A., Warms, C. A., Marshall, H. M.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2003Breast and gynecologic health-screening behaviors among 191 women with spinal cord injuriesJournalJ46242.Journal of Spinal Cord Medicine262145-149Study examined the preventive health behaviors of women with spinal cord injury (SCI) by comparing the frequency of mammograms or Pap smears between women with SCI and women in the general population, and among women with SCI as a function of racial/ethnic status and socioeconomic status (income and education level). Participants were interviewed by telephone. Overall, women with SCI were less likely to obtain routine health screening than women in the general population. However, no differences were found among study participants as a function of race/ethnicity or socioeconomic status.Broderick, Lynne E., Krause, James S.Yesdevopsadmin
1998Pain rehabilitation 2 : Documentation of acute, subacute, and chronic painJournalJ35238.Archives of Physical Medicine and Rehabilitation793S54-S59Self-directed learning module on the documentation of acute, subacute, and chronic pain. Topics in the module include: self-report tools; physical and functional tools; expert testimony; and medicolegal aspects. This module is part of the chapter on pain in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.Brown, S. E., Atchison, J. W., Gnatz, S. M., Cifu, D. X.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
2002Appropriateness of the Ilfeld psychiatric symptom index as a screening tool for depressive symptomatology in persons with spinal cord injuryJournalJ45951.Journal of Spinal Cord Medicine252129-132Study compared the efficacy of the Ilfeld Psychiatric Symptom Index to the Zung Self-Rating Depression Scale in identifying depressive symptoms in people with spinal cord injury (SCI). Thirty-nine subjects SCI and 20 age-matched control subjects completed both screening measures and total scores for both scales were analyzed. Results showed a low level of agreement between scales. The Ilfeld classified 79 percent of the SCI group and 75 percent of the controls as depressed, whereas 8 percent of the SCI group and none of the controls were depressed according to the Zung scale. The Ilfeld screens for a broad range of symptoms; however, the somatic symptom items may have caused an overestimation of psychologic symptoms in both the SCI and control groups.Campagnolo, Denise I., Filart, Rosemarie A., Millis, Scott R., Lann, Danielle E.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2003Musculoskeletal pain and overuse injuriesJournalJ50961.In V. W. Lin et al. (Eds.), Spinal cord medicine: Principles and practice. New York: Demos Medical Publishing, IncN/A 527-534Chapter examines issues regarding the diagnosis, etiology, treatment, and prevention of musculoskeletal pain and overuse injuries in individuals with spinal cord injury (SCI). The relationship between pain and injuries of the shoulder, elbow, wrist, back and neck are discussed in detail. Options for treatment and prevention of musculoskeletal injuries in SCI include exercise, modalities, modification of activity, bracing, medications, injections, diet, and surgery.Boninger, Michael L., Cooper, Rory A., Fay, Brian, Koontz, AliciaUniversity of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2005Gardening: Can ya dig it?JournalJ48712.PN/Paraplegia News59314-20Article discusses the healing benefits of gardening. The horticultural program for people with spinal cord injury program at Craig Hospital in Englewood, California is described. A list of resources for additional information and adapted tools and equipment is included.Brooks, C. A.Rocky Mountain Regional SCI SystemYesdevopsadmin
2003Threats to "informed" advance directives for the severely physically challenged?JournalJ45691.Archives of Physical Medicine and Rehabilitation844, Suppl 2S23-S28Article discusses issues concerning advance directives for patients with neuromuscular weakness. Advance directives contain guidelines for withholding or withdrawing life-sustaining treatment for terminal conditions. Author discusses the need for proper patient counseling regarding the availability of noninvasive respiratory muscle aids, life satisfaction versus quality of life, and utilization of patient-directed personal assistance services for patients considering advance directives.Bach, John R.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2004Geriatric rehabilitation. 5. The societal aspects of disability in the older adultJournalJ50186.Archives of Physical Medicine and Rehabilitation857, Suppl 3S23-S26Article discusses the societal aspects of disability in older adults. It focuses ethics related to competency, elder abuse, sexuality, community integration, work, leisure skills, and the issue of driving a motor vehicle. This article is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education program for practitioners and trainees in physical medicine and rehabilitation and geriatric medicine.Bodenheimer, Carol F., Roig, Randolph L., Worsowicz, Gregory M., Cifu, David X.VCU Model Spinal Cord Injury CenterYesdevopsadmin
2005Effect of a pushrim-activated power-assist wheelchair on the functional capabilities of persons with tetraplegiaJournalJ48819.Archives of Physical Medicine and Rehabilitation863380-386Study assessed the ability to perform activities of daily living (ADLs) using a pushrim-activated power-assisted wheelchair (PAPAW) compared to a traditional manual wheelchair among subjects with tetraplegia. Participants propelled both their own manual wheelchairs and a PAPAW 3 times over an ADL course. Primary variables that were compared between the 2 wheelchairs were participants' mean heart rate, time to complete the course, perceived level of difficulty in completing each task, and ergonomic preferences between the wheelchairs. Results showed that participants demonstrated a significant decrease in mean heart rate throughout all 3 trials when using the PAPAW. The amount of assistance needed by participants, the responses to ergonomic questions, and the overall time to complete the ADL course did not differ significantly between the 2 wheelchairs.Algood, S. David, Cooper, Rory A., Fitzgerald, Shirley G., Cooper, Rosemarie, Boninger, Michael L.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
1994Pulmonary function and sleep disordered breathing in patients with traumatic tetraplegia: a longitudinal studyJournalJ27616.Archives of Physical Medicine and Rehabilitation753279-284Study examining longitudinal changes in nocturnal blood gas tensions in 10 individuals with complete C4 to C7 motor quadriplegia who were at least 6 months postinjury. The mean age was 41.2 years and mean time since injury was 7.7 years at the initial evaluation. Subjects were reevaluated 5 years later, at a mean of 11.6 years postinjury. When initially evaluated, all subjects had normal daytime blood gases. However, 6 subjects (60%) had nocturnal oxyhemoglobin desaturations (dSATs) below 90%, 3 (30%) had mean nocturnal oxyhemoglobin saturation (SAT) below 90% for 10% or more of at least one hour, and 4 had maximum end tidal carbon dioxide tensions (EtCO2) greater than 45mmHg. At followup, subjects' vital capacities had improved significantly by a mean of 1242mL without treatment, and daytime blood gases were still normal for 9 of the 10 subjects. However, 5 subjects (50%) had an increased number of transient nocturnal dSATs and 8 of 9 (88%) restudied by capnography were hypercapnic. The results indicate that nocturnal dSAT and hypercapnia may be common in quadriplegia and may increase with age despite significant increases in vital capacity.Bach, J. R., Wang, T. G.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2004Do preinjury alcohol problems predict poorer rehabilitation progress in persons with spinal cord injury?JournalJ46712.Archives of Physical Medicine and Rehabilitation8591488-1492Study investigated whether a history of alcohol-related problems is associated with progress during inpatient rehabilitation among people with spinal cord injury (SCI). Analysis revealed that problem drinkers had significantly lower Functional Independence Measure admission, discharge, and efficiency scores and a longer rehabilitation length of stay than those without a history of problem drinking. Implications of the study and the need for additional research are discussed.Bombardier, Charles H., Stroud, Michael W., Esselman, Peter C., Rimmele, Carl T.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2004Social security legislation creates ticket to work and work incentives improvement actJournalJ47567.Topics in Spinal Cord Injury Rehabilitation9426-32Article describes elements of the Ticket to Work and Work Incentives Improvement Act, legislation drafted by the Social Security Administration to reduce financial disincentives to return to work for recipients of Supplemental Security Income and Social Security Disability Insurance. The legislation created 3 new entities: (1) the Ticket to Work and Self-Sufficiency Program, (2) Protection and Advocacy for Beneficiaries of Social Security, and (3) Benefits Planning, Assistance, and Outreach (BPAO). Case study describes one SCI catastrophic care hospital's BPAO program in Georgia.Atwell, Sally, Hudson, Lesley M.Southeastern Regional Spinal Cord Injury Model SystemYesdevopsadmin
1999Model spinal cord injury system trends, and implications for the futureJournalJ37964.Archives of Physical Medicine and Rehabilitation80111514-1521Article analyzing trends in the medical care of persons with spinal cord injury (SCI), based on records of the federally-designated Model Spinal Cord Injury Systems. The article first discusses the history of data collection by the Model SCI Systems, then discusses trends related to acute SCI management, clinical outcomes, quality-of-life outcomes (including community integration and employment), health care reimbursement (including managed care).Becker, B. E., DeLisa, J. A.University of Michigan SCI Model SystemYesdevopsadmin
2003Spinal muscular atrophy type 1 quality of lifeJournalJ45235.American Journal of Physical Medicine and Rehabilitation822137-142Study compared healthcare professionals' assessment of the quality of life of children with spinal muscular atrophy type 1 to that of the children's caregivers. Generally, caregivers reported a significantly more positive assessment of QOL than did the clinicians.Bach, John R., Vega, Jose, Majors, Jennifer, Friedman, AlNorthern New Jersey Spinal Cord Injury SystemYesdevopsadmin
1998Alcohol use and readiness to change after spinal cord injuryJournalJ35750.Archives of Physical Medicine and Rehabilitation7991110-1115Article reporting on a survey intended to determine the level of alcohol use and motivation to change drinking habits among persons with recent spinal cord injury (SCI). Data are from a survey of 68 persons with recent SCI during inpatient rehabilitation. It was found that soon after SCI, most at-risk drinkers are at least considering changes in their alcohol use. The authors conclude that this may represent an under utilized window of opportunity to implement interventions designed to reduce alcohol abuse.Bombardier, C. H., Rimmele, C. T.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
2000Health related quality of life outcome measuresJournalJ40846.Archives of Physical Medicine and Rehabilitation8112S2, S30-S45Article reviewing measures of generic health-related quality of life (HRQOL) that have been or might be used to measure outcomes in disability outcomes research, including Medical Outcomes Study Short-Form Health Survey (SF-36), Sickness Impact Profile (SIP), and Quality of Well-Being (QWB) Scale. The authors conclude that none of these tools appears to measure HRQOL without some potential biases for people with disabilities.Andresen, E. M., Meyers, A. R.Spaulding New England Regional Spinal Cord Injury CenterYesdevopsadmin
2003Access to health care services among people with chronic or disabling conditions: Patterns and predictorsJournalJ46363.Archives of Physical Medicine and Rehabilitation84101417-1425.National survey examined the patterns and predictors of access to a variety of specific health care services among adults with cerebral palsy, multiple sclerosis, spinal cord injury, or arthritis. Participants in managed care and traditional fee-for-service health plans answered questions concerning their need for and access to services from primary care doctors and specialists, rehabilitative services, assistive equipment, and prescription medication. Results showed that respondents covered by fee-for-service health plans were more likely than those covered by managed care organizations to receive needed services form specialists. Only half of the respondents received rehabilitative services as needed. Respondents with the poorest health and the lowest incomes were the least likely to receive all health services examined.Beatty, Phillip W., Hagglund, Kristofer J., Neri, Melinda T., Dhont, Kelley R., Clark, Mary J., Hilton, Shelley A.Missouri Model Spinal Cord Injury SystemYesdevopsadmin
1994Life satisfaction and well-being measures in ventilator assisted individuals with traumatic tetraplegiaJournalJ28024.Archives of Physical Medicine and Rehabilitation756626-632Study evaluating life satisfaction and well being in 87 individuals with traumatic tetraplegia two years or more postinjury. Forty two ventilator assisted individuals with tetraplegia (VAITs) and 45 autonomously breathing individuals with tetraplegia (ABITs) completed standard psychosocial instruments. Major findings include the following: 1) the VAITs' life satisfaction and other well being and quality of life indicators were generally positive; 2) the VAITs were significantly more satisfied with their housing, family life, and jobs than were the ABITs; 3) 23.8% of the VAITs expressed general dissatisfaction with their lives compared with 35.6% of the ABITs; 4) life satisfaction and quality of life of the VAITs was significantly underestimated by a control group of health care professionals; 5) the control group and the ABITs significantly overestimated the distress which the VAITs associated with ventilator use as compared with loss of upper extremity function; and 6) life satisfaction and well being correlated best with family and social interaction.Bach, J. R., Tilton, M. C.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2004Symptoms of major depression in people with spinal cord injury: Implications for screeningJournalJ46766.Archives of Physical Medicine and Rehabilitation85111749-1756Presents psychometric data on the Patient Health Questionnaire-9 (PHQ-9), a measure used to identify major depressive disorder (MDD) in people with spinal cord injury (SCI). Data collected from 849 participants 1 year after SCI were used to compute descriptive statistics on rates of depressive symptoms and probable MDD, evaluate internal consistency and construct validity, and analyze the accuracy of individual items as predictors of MDD. Exactly 11.4 percent of participants met the criteria for probable MDD. Probable MDD was associated with poorer subjective health, lower satisfaction with life, and more difficulty in daily role functioning. Probable MDD was not related to most demographic or injury-related variables. The findings provide evidence that the PHQ-9 may be useful in identifying probable MDD in people with SCI.Bombardier, Charles H., Richards, J. Scott, Krause, James S., Tulsky, David, Tate, Denise G.Yesdevopsadmin
2005Biomechanics and strength of manual wheelchair usersJournalJ50075.Journal of Spinal Cord Medicine285407-414Study examined the relationship between shoulder strength and pushrim biomechanical variables in manual wheelchair users. Peak isokinetic shoulder strength variables (flexion, extension, abduction, adduction, internal rotation, and external rotation) were tested in 22 manual wheelchair users. Kinematic and kinetic data were collected as subjects propelled their own wheelchairs at 2 speeds (2 and 4 miles per hour) for 20 seconds. Peak isokinetic forces in the cardinal planes were correlated with pushrim biomechanical variables including tangential force, radial force, axial force, total force, fraction of effective force, and cadence. All peak torque variables correlated significantly with tangential force, radial force and total force, but were not significantly correlated with axial force, fraction of effective force, or cadence. There were no relationships found between muscle strength ratios and any pushrim biomechanical variables.Ambrosio, Fabrisia, Boninger, Michael L., Souza, Aaron L., Fitzgerald, Shirley G., Koontz, Alicia M., Cooper, Rory A.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2001Carbohydrate and lipid metabolism in chronic spinal cord injuryJournalJ45945.Journal of Spinal Cord Medicine244266-277Literature review examines the prevalence of abnormalities of carbohydrate and lipid metabolism among people with spinal cord injury (SCI). Compared to the able-bodied population, people with SCI are more likely to have oral carbohydrate intolerance, insulin resistance, elevated low-density lipoprotein cholesterol, and reduced high-density lipoprotein cholesterol, which are risk factors associated with diabetes and heart disease.Bauman, William A., Spungen, Ann M.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
1994Ethical considerations in the management of individuals with severe neuromuscular disordersJournalJ27583.Archives of Physical Medicine and Rehabilitation732134-140Discusses ethical issues in the management of persons with severe neuromuscular disorders. The authors suggest that, despite the many recent management advances for individuals with severe neuromuscular disease, quality of life cannot be assured by medical advances or technology. Furthermore, they contend that quality of life issues are often judged by nondisabled persons and used inappropriately to justify withholding or implementing life sustaining technologies. Although the Americans with Disabilities Act (ADA) has made important strides in preventing discrimination against people with disabilities, it does little to protect persons who are sequestered in institutions or home custodial care due to the lack of a national personal assistance services policy. The authors suggest that physical medicine and rehabilitation specialists who train their clients to take responsibility for their own care need to take a more active role in advocating for the services needed to enable them to live an independent and meaningful life in the community.Bach, J. R., Barnett, V.Northern New Jersey Spinal Cord Injury SystemYesdevopsadmin
2000Alcohol and traumatic disabilityJournalJ42141.R. G. Frank & T. R. Elliott (Eds.), Handbook of rehabilitation psychology. Washington, DC: American Psychological AssociationN/A 399-416Book chapter on the role of alcohol in rehabilitation of persons with traumatic brain injury (TBI) and spinal cord injury (SCI), including pre- and post-injury alcohol problems and intoxication. The prevalence of alcohol abuse and the effects of alcohol-related factors on rehabilitation outcomes are discussed, and methods for screening, assessment, and intervention are described. This document is included in NCDDR's Guide to Substance Abuse and Disability Resources Produced by NIDRR Grantees, 2nd edition, number A.1.Bombardier, C. H.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
1997The advanced practice nurse in rehabilitation as an interdisciplinary team leaderJournalJ33399.In K. Johnson (Ed.), Core curriculum for advanced practice nursing in rehabilitation. Glenview, IL: Rehabilitation Nursing FoundationN/A 161-167Chapter from a book of core curricula for advanced practice nurses (APN's) in rehabilitation, presenting a curriculum for APN's as interdisciplinary team leaders in rehabilitation. Presents learning objectives and outlines the following topics: concepts, definitions, historical theories, and current research related to team function; styles of effective team leaders; team development and facilitation; and the role of the APN in rehabilitation as a team leader.Allison, P.Rocky Mountain Regional SCI SystemYesdevopsadmin
2004Prevention and treatment of heterotopic ossification after spinal cord injuryJournalJ46887.Journal of Spinal Cord Medicine274376-382Article discusses the etiology, prevention, and clinical management of heterotopic ossification (HO) after spinal cord injury (SCI). Although the cause of HO after SCI remains unknown, trauma and overexpression of bone morphogenic proteins in traumatized soft tissue appear to play important roles. Preventive use of nonsteroidal antiinflammatory drugs (NSAIDs) reduces the incidence and severity of HO. Patients who develop symptoms of HO should have a bone scintigraphy. Those patients with positive scintigraphic findings of HO should be tested for serum creatine phosphokinase (CPK) and C-reactive protein (CRP) levels. Regardless of the CPK level, all patients with positive bone scintigraphy require NSAID treatment until serum CRP is normalized.Banovac, Kresimir, Sherman, Andrew L., Estores, Irene M., Banovac, FilipSouth Florida Traumatic Brain Injury Model SystemYesdevopsadmin
1999Just for women: understanding female sexualityJournalJ37172.PN/Paraplegia News53771Article on orgasm in women with spinal cord injury (SCI). Summarizes the results of 2 studies concerning the ability of women with SCI to achieve orgasm, including the percentage who reported that they could achieve orgasm, regions of stimulation, and autonomic dysreflexia following orgasm.Northwest Regional Spinal Cord Injury SystemYesdevopsadmin
1998Spinal cord injury identified with violence: community reintegration in urban areasJournalJ35662.Topics in Spinal Cord Injury Rehabilitation4218-27Article re-analyzing data from a study comparing outcomes for persons with spinal cord injury (SCI) related to firearms versus SCI caused by motor vehicle crashes. The initial analysis of data from 164 men with SCI (77 motor vehicle injuries and 87 firearm injuries) showed little difference on the 3 outcome measures used: the Beck Depression Inventory, the civilian version of the Mississippi Scale of Posttraumatic Stress Disorder (M-PTSD), and a measure of community reintegration. The participants were then reclassified into 3 grouups based on gang involvement and incarceration history. It was found that unlike groups characterized by etiology alone, the groups characterized by indicators of antisocial behavior showed significant differences on all 3 outcome measures. The authors conclude that treatment decisions based on etiology should be avoided. Impairment, disability, education, employment history, and history of antisocial behavior are the most important factors associated with community reintegration. This document is included in NCDDR's Guide to Substance Abuse and Disability Resources Produced by NIDRR Grantees, number D.41, and 2nd Ed, number D.48.Adkins, R. H., Hume, B., Nabor, M., Waters, R. L.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2004Impact of a pushrim-activated power-assisted wheelchair on the metabolic demands, stroke frequency, and range of motion among subjects with tetraplegiaJournalJ46784.Archives of Physical Medicine and Rehabilitation85111865-1871Study compared outcomes between pushrim-activated power-assisted wheelchair (PAPAW) and traditional manual wheelchair propulsion among subjects with tetraplegia. Participants propelled both their own manual wheelchairs and a PAPAW through slight, moderate, and high resistances on a wheelchair dynamometer. Primary variables that were compared between the 2 trials were participants' mean oxygen consumption, ventilation, heart rate, mean stroke frequency, and maximum upper-extremity joint range of motion (ROM). Results showed that participants demonstrated a significant decrease in mean oxygen consumption and ventilation throughout all the trials when using the PAPAW. Mean heart rate was significantly lower when using the PAPAW for the high resistance trial. Stroke frequency was significantly lower when using the PAPAW for the slight and moderate resistance conditions. Overall joint ROM was lower when using the PAPAW.Algood, S. David, Cooper, Rory A., Fitzgerald, Shirley G., Cooper, Rosemarie, Boninger, Michael L.University of Pittsburgh Model Center on Spinal Cord InjuryYesdevopsadmin
2004Research and interpretation perspectives on aging related physical morbidity with spinal cord injury and brief review of systemsJournalJ50323.NeuroRehabilitation19113-MarArticle examines various factors that affect the design, analysis, and interpretation research on aging with spinal cord injury (SCI). These include factors that apply to aging in the general population, such as the effects of chronological age and the effects associated with the historical period in which the research takes place. Factors specifically related to SCI include duration of injury, age at injury, level and completeness of injury, and gender. Research specific to a particular physiological system and related morbidity in those aging with SCI is currently limited to the musculoskeletal, cardiovascular, and respiratory systems. There have been no aging-related SCI studies specifically pertaining to the skin, nervous, endocrine, or immune systems.Adkins, Rodney H.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
2002Mothers with spinal cord injuries: Impact on marital, family, and childrens adjustmentJournalJ43558.Archives of Physical Medicine and Rehabilitation83124-30Study investigate how mothers with spinal cord injury (SCI) adjust to parenting, their marriages, and their families, and how their children adjust to their mothers' disability. The experimental group consisted of 88 mothers with SCI, 46 of their partners, and 31 of their children. The control group was composed of 84 healthy mothers, 33 partners, and 28 of their children. Mothers in both groups completed a series of questionnaires. Depending on the age of the child, the questionnaires were completed by either the child or the mother. Participation from partners was optional. Gender role identify, self-esteem, children's adjustment, children's attitude toward mother and father, dyadic and family adjustment, parenting stress, and parenting satisfaction were measured. No significant differences were found between mothers with SCI and able-bodied mothers or between children raised in families with mothers with and without SCI. The results challenge the negative stereotypes regarding disability and parenting.Alexander, C. J., Hwang, K., Sipski, M. L.Yesdevopsadmin
2001Research issues in aging studies associated with SCIJournal3Top Spinal Cord Inj Rehabil63128-135There are many research issues associated with the scientific study of aging in the general population that also relate to the study of aging with spinal cord injury (SCI). However, the recognition of these issues has been limited in SCI aging research. These issues, which include era and survivor effects, have implications for design, analysis, and interpretation of SCI aging research, which, in turn, have implications for planning, policy, and development of long- and short-term clinical intervention strategies. Several factors specifically relate to SCI that have implications for design, analysis, and interpretation of SCI aging research. These include duration of injury, age at injury, and neurological impairment or level and completeness of injury.Adkins, R. H.Southern California Spinal Cord Injury Model SystemYesdevopsadmin
1993Intrathecal baclofen: does tolerance occur?JournalJ25578.Paraplegia318516-520Study examined the relationship between time and required intrathecal baclofen dose necessary for keeping spasticity at an acceptable level. The study also investigated whether tolerance was a factor in the study subjec