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O12 Determining the duration of anticoagulation in patients with spinal cord injury at risk for venous thrombo-embolism Author(s): Arundhati Perkash Name of ISCoS Member (Author): Inder Perkash Main institution where the work was done: VA SCI Service ,Palo Alto The incidence of venous thrombo-embolism is very high in patients of spinal cord injury but it also exists in chronic phase though to a much less degree. The anticoagulation is given as prophylaxis in high risk patients and as therapy first followed by prophylaxis in those who develop episode of venous thrombo-embolism. The duration for which such therapy should be given has so far remains controversial. Current recommendations are: for prophylaxis a fixed duration of anti- coagulation of 6 to 12 weeks following SCI in acute patients and 3 to 6 months following an episode of venous thrombo-embolism in either acute or chronic patients. However this results in recurrence in some patients. We implemented a program of ongoing monitoring of hyper-coagulability which determines the period of anticoagulation in each individual patients on the basis of combined clinical and laboratory evaluation. The key elements of monitoring were (1) Clinical presence of significant inflammation, venous obstruction or immobility. (2)The laboratory tests: D-Dimers, fibrinogen, erythrocyte sedimentation rate and tests for hereditary or acquired factors causing hyper-coagulable state. Anticoagulation was implemented till the patient was considered to be at risk. With this approach the rate of initial and recurrent thrombosis has been less than 1% in our unit. The system of evaluation, the useful ranges for laboratory parameters and patient examples will be prese O13 Blockage of interleukine-6 receptor ameliorates functional recovery in spinal cord injury Author(s): Seiji Okada, Masaya Nakamura, Yoshiyuki Ohsugi, Yukihide Iwamoto, Kazuyuki Yoshizaki, Yoshiaki Toyama, Hideyuki Okano, Name of ISCoS Member (Author): Masaya Nakamura Main institution where the work was done: Department of Physiology, Department of Orthopaedic Surgery, Keio University Endogenous neural stem/progenitor cells (NSPC) have recently been shown to differentiate exclusively into astrocytes, but not into neurons after spinal cord injury (SCI). The microenvironment of spinal cord, especially inflammatory cytokines that dramatically increase in acute phase can be considered as this important cause. Interleukin-6, which had been proved to induce NSPC to the astrocytic differentiation trough the JAK/STAT pathway in vitro study, also play a central role as pro-inflammatory cytokines. In this study, we investigated whether blockade of IL-6 trans signaling can diminish astrogliosis and ameliorate functional recovery in SCI. Immediately after contusive SCI with a modified NYU impactor, mice were intraperitoneally injected with a single dose of MR16-1 (rat anti-IL-6 receptor antibody), and the lesions were assessed histologically and the functional recovery was evaluated. MR16-1 not only suppressed the astrocytic-diffentiation-promoting effect of IL-6 signaling in vitro, but inhibited the development of astrogliosis after SCI in vivo. MR16-1 also decreased the number of invading inflammatory cells and severity of connective tissue scar formation. In addition, we observed significant functional recovery in the mice treated with MR16-1 compared with the control mice. These findings suggest that neutralization of IL-6 signaling in the acute phase of SCI represents an attractive option for the treatment of SCI. O14 PROTOCOL OF SCREENING AND NUTRITIONAL ASSESSMENT IN PATIENTS WITH SPINAL CORD INJURY (SCI) K. ATHANASSOPOULOS1., M. MICHA1., Y. DIONYSSIOTIS1, G. LYGIZOS1,E. MARAGKOUDAKI1, L. LILI1, D. MENEGATOU2, E. NIKOLOPOLOU – DEROU2,& K. PETROPOULOU1 Name of ISCoS Member (Author): 1B' Department of P & R M – National Rehabilitation Center, Ilion – Athens.2 Department of Biopathology – National Rehabilitation Center, Ilion – Athens. PROTOCOL OF SCREENING AND NUTRITIONAL ASSESSMENT IN PATIENTS WITH SPINAL CORD INJURY (SCI) AIM : The presentation of our protocol for screening and nutritional assessment after SCI in both the acute and chronic phase. MATERIAL & METHODS : We studied 47 SCI – patients hospitalized in our department since January 2003, 29 male and 18 female with a mean age : 42 years. The assessment of their nutritional status was based on : 1) medical and dietary history, 2) physical examination : muscle wasting, loss of subcutaneous fat, spasticity, 3) anthropometric data, 4) laboratory data : complete blood count, total protein, albumin, 24h urine urea, 5) identification of risk factors impairing nutritional status : multiple trauma, depression, infection. RESULTS : Out of 47 patients, 35 (75%) were nutritionally compromised, 83% in the acute phase (< 6 months post injury) and 55% suffered a complete lesion.20 patients (57%) received specific formulas, as they were recently introduced in our protocol. 63% had pressure ulcers, 52% infections, 52% multiple trauma, and 35% depression. CONCLUSIONS : Though the pressure ulcers are considered as a major risk factor, the nutrition care plan should incorporate all the stress factors, to reduce the complications and enhance the rehabilitation outcome. Nutritional therapy is of major importance for recovery and optimization of function and should be coordinated with the other rehabilitation priorities. O15 ”Spinal Cord injury registry for cervical spinal cord injuries in New South Wales Rugby Union and Rugby League players who have suffered permanent neurological deficit.” Name of ISCoS Member (Author) John D. Yeo1 AO, MB,MS, DPRM, FRACS, FACRM, FAFRM, J.G.Berry2 BHSc (Hons), R.A.Cripps2 BSc, MA, PhD and J.E. Harrison2 MBBS, MPH, FAFPHM Main institution where the work was done: The Royal North Shore Hospital of SydneyPacific Highway, St. Leonards, NSW 2065, AUSTRALIA This paper will present statistics with trends in the incidence of serious spinal cord injury in team contact sports between 1986 and 2003. The paper will identify the number of cases from the registry as well as recording the number of registered players in each code. The incident rate in both codes will be compared on an annual basis over this period and related to the introduction of safety programs and interventions introduced in an attempt to produce a reduction in spinal cord injury. The average incidence of spinal cord injury in both these sporting codes over the period 1986-2003 was 0.31 cases/10,000 players per year. The “safety” interventions include the introduction of new rules for scrimmaging, prevention of illegal tackles, education programs particularly for school children with emphasis on physical preparation including strengthening exercises for the paraspinal and strap muscles in the neck. 1 Correspondence to Associate Professor John D. Yeo, North Shore Medical Centre, 66 Pacific Highway, St. Leonards, 2065 2 Flinders University Research Centre for Injury Studies, Mark Oliphant Building, Laffer drive, Bedford Park, SA, 5042 O16 DEVELOPMENT OF AN EVIDENCE-BASED WHEELCHAIR PRESENTER PROGRAM IN SCHOOLS TO ADDRESS RISK-TAKING AND INJURY PREVENTION Author(s): J Middleton, D Nisbet, K Abbott, C Dell, A Deans Name of ISCoS Member (Author): JW Middleton Main institution where the work was done: Youthsafe Organisation, 600 Victoria Rd, Ryde, Sydney, Australia There remains a strong interest in wheelchair users presenting injury prevention messages in schools, although to date the effectiveness of such programs in reducing injury has not been proven. An evaluation of the Spinesafe Education Program in NSW, Australia, against the evidence for preventing injuries to young people indicated changes to the existing wheelchair presenter program were necessary to truly impact on risk-taking behaviours. The findings indicated that for effective delivery the program should be linked to the school curriculum, use a variety of teaching and learning strategies, be able to be delivered by teachers and must not be a stand-alone session. By partnering with the State Department of Education and the Roads and Traffic Authority an innovative new program for school students aged 12-14 years has been developed as part of the Youthsafe program. An initial feasibility study, piloting a session in 10 metropolitan schools, demonstrated positive results with feedback from students and teachers used to further improve educational resources. The new session can be delivered by teachers or wheelchair presenters, incorporates a range of teaching and learning strategies and is now an integral part of a comprehensive road safety resource package available to all schools in NSW. O17 Quality of life of people with spinal cord injuries: a comparative study of three community samples. Author(s): Tasiemski T, Kennedy P, Gardner BP Name of ISCoS Member (Author): Tasiemski T Main institution where the work was done: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK Objectives To explore objective and subjective quality of life (QOL) of individuals with spinal cord injuries (SCI) living in three different British regions: South East (SE), East Midlands (EM) and Scotland (SC). Design Cross-sectional cohort study. Method 585 SCI outpatients (SE = 304, EM = 201, SC = 80) who fulfilled the following criteria: SCI at level C5 or below, wheelchair dependant, aged 18-50 at the time of injury, at least 1 year post-injury, completed a 26-item demographic postal questionnaire and the Life Satisfaction Questionnaire. Ten QOL indicators were used to describe the differences between the three regions. Results Significant differences were found with rates of employment post-injury. The highest employment rate was found in SE (42.8%), less in SC (32.5%) and least in EM (23.9%) region. Overall, 46.5% of all respondents (SE = 49.0%, EM = 46.3%, SC = 37.5%) were satisfied with their life as a whole. Significant differences amongst the regions were found with regard to two specific domains of life satisfaction: family life and contacts with friends. Conclusion In general, educational achievements and employment rates in SCI individuals reflected the regional trends for the general population. Life satisfaction was found to be lower than previous findings. O18 Health Status, Community Integration and Economic Risk Factors for Mortality After Spinal Cord Injury Author(s): Michael J. DeVivo, James S. Krause, Amie B. Jackson Name of ISCoS Member (Author): Michael J. DeVivo Main institution where the work was done: University of Alabama at Birmingham The purpose of this study was to examine the association of health, community integration, and economic status with life expectancy among persons with spinal cord injury. 5,947 persons injured since 1973 who were treated at model spinal cord injury systems in the United States and received a routine annual examination between November 1995 and March 2002 were included in the study. Data collected during the annual examination included demographic and injury severity information, rehospitalizations and days spent in a nursing home during the previous year, presence of pressure sores, self-reported health status, the Craig Handicap Assessment and Reporting Technique (CHART), and type of health insurance. Mortality through 2003 was determined by routine follow-up and the Social Security Death Index. A logistic regression model was developed to estimate the chance of dying in any given year based on 27,580 person-years of follow-up. After adjusting for demographics and injury severity, health status indicators, CHART subscales, and type of insurance all had small but statistically significant (20-70%) effects on the annual likelihood of dying. Life expectancy estimates could vary substantially when most indicators pointed in the same direction. Consideration of these factors should result in more accurate estimates of life expectancy. O19 Factors predicting quality of life among people with long-term spinal cord injury Author(s): Gerhart, Kenneth A1; Pham Bowman, Hang T1; Glass, Clive3; McColl, Mary Ann4 ; Savic, Gordana2; Whiteneck, Gale G1; Name of ISCoS Member (Author):Glass C3; Savic G2 Main institution where the work was done:1Craig Hospital, Englewood, USA; 2National Spinal Injuries Centre, Stoke Mandeville, UK; 3Regional Spinal Injuries Centre, Southport, UK; ; 4Queen’s University, Kingston, Canada Aim: To identify specific quality of life (QoL) predictors in people with long-term spinal cord injury (SCI). Method: 141 participants in a British, population-based, longitudinal study completed Flanagan’s Quality of Life and Individual Needs Questionnaire1 in 1999 by ranking both the importance of and their satisfaction with 15 key life areas. Scores for these rankings, and a product score of importance and satisfaction were entered into stepwise regression against three QoL measures that were collected in both 1999 and 2002: (1) a simple self-rating; (2) the Life Satisfaction Index;2 and (3) the Index of Psychological Well-Being.3 Results: The sample was 86% male. Mean age in 1999 was 59; average duration of SCI was 36 years. The product of the importance of and satisfaction with friendships positively predicted all three QoL measures in both time periods (p<.01 in 1999; p<.05 in 2002). The importance of learning, job satisfaction, and the product of the importance of and satisfaction with material possessions predicted two of the QoL measures in 1999 (p<.01), while satisfaction with one’s relationship with his/her spouse and the importance of learning predicted scores on two of the three measures in 2002 (p<.01). Conclusions: The importance that people with long-term SCI place on key life areas, and their satisfaction with those areas, do predict their QoL. In particular, the combined effect of the importance of and satisfaction with friendships and the importance of learning seem to be most strongly related to QoL over time. References: 1 Flanagan JC. A research approach to improving our quality of life. American Psychologist 1978;2:138-1472 Neugarten BL, Havighurst RJ, Tobin SS. The measurement of life satisfaction. Journal of Gerontology. 1961; 16:134-43.3 Berkman PL. Measurement of mental health in a general population survey. American Journal of Epidemiology. 1971;94(2):105-111. Acknowledgements: Supported by Ontario Neurotrauma Foundation, Canada and partly by Centers for Disease Control, USA and National Institute on Disability and Rehabilitation Research, USA. O20 Life after Spinal Cord Injury: Ranked Priorities Identified by British Columbians with SCI living in the Community Author(s): Susan Forwell, Catherine Backman, Christine Carpenter, Lyn Jongbloed in collaboration with the BCPA Rehabilitation Advisory Committee Name of ISCoS Member (Author): Christine Carpenter (author) Peter Wing, Bert Foreman, Clare Weeks (collaborators) Main institution where the work was done: School of Rehabilitation Sciences – University of British Columbia, Canada A cross-sectional postal survey was conducted with members of the British Columbia (Canada) Paraplegic Association to explore facilitators and hindrances to participating in life after spinal cord injury (SCI) and how these differed for sub-groups of respondents. Survey items included employment, social/community participation, computer technology, transportation/accessibility, physical fitness, accessing information, home support, relationships, life satisfaction, and accessing professional services. 969 surveys were mailed (though 104 undeliverable). 401 were returned (46% response rate), with 355(41%) sufficient for analysis. Men comprised 70% of the cohort having a mean age of 48 years, while 44 years was the mean age for women with both groups having a mean duration of 13 years living with SCI. All urban and rural health regions in the province were represented. Respondents indicated their highest priorities were: lobbying government for funding and management of home support (44%), advocating for equitable income policies (39%), educating employers and co-workers (34%) and educating health care providers about SCI (27%). 26% of the cohort identified the priorities: improving access to fitness facilities and public spaces and information for people with SCI. There were differences in priorities for men and women and for those living in rural and urban health regions. This study has implications for professional and service providers as well as organizations and policy makers who advocate for persons with SCI living in the community. |
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