| ABSTRACTS for 2004 meeting | ||
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O22 Environmental Factors and Their Role in Participation and Life Satisfaction After Spinal Cord Injury Author(s): Gale Whiteneck1; Susan Charlifue1; Michele Mead2; Marcel Dijkers3; Denise Tate4; Tamara Bushnik5; Martin Forchheimer4 Name of ISCoS Member (Author): Susan Charlifue Main institution where the work was done: 1Craig Hospital; 2Virginia Commonwealth University; 3Mount Sinai School of Medicine; 4University of Michigan; 5Santa Clara Valley Medical Center Objectives: To investigate environmental barriers reported by people with spinal cord injury (SCI) and to determine the relative impact of environmental barriers compared to demographic and injury characteristics and activity limitations in predicting variation in participation and life satisfaction among people with SCI. Design: Cross-sectional follow-up survey. Setting: 16 designated SCI Model Systems of care in USA. Participants: 2,726 people with SCI who were administered the Craig Hospital Inventory of Environmental Factors - Short Form (CHIEF-SF) in 2000 through 2002 as part of routine follow-up. Interventions: Not applicable. Main Outcome Measures: The CHIEF-SF, the Craig Handicap Assessment and Reporting Technique - Short Form and the Satisfaction with Life Scale. Results: The top five environmental barriers reported by individuals with SCI, in descending order of importance, were the natural environment, transportation, need for help in the home, availability of health care, and governmental policies. The CHIEF-SF subscales accounted for only 4% or less of variation in participation, but they accounted for 10% of the variation in life satisfaction. Conclusions: The inclusion of environmental factors in models of disability was supported, but environmental factors were found to be more strongly related to life satisfaction than to societal participation. O23 Physical Activity and Fitness: Priorities Identified by Persons Living with Spinal Cord Injury Author(s): Christine Carpenter, Catherine Backman, Sue Forwell, Lyn Jongbloed in collaboration with the British Columbia Paraplegic Association Advisory Committee Name of ISCoS Member (Author): Christine Carpenter Main institution where the work was done: The University of British Columbia, Vancouver, B.C. Canada Physical activity and fitness was one of the community rehabilitation priorities for persons living with spinal cord injury (SCI) identified by participants in a research project conducted in collaboration with a consumer organization. A cross-sectional survey was designed based on twelve broad areas of interest identified from an earlier qualitative focus group study, the literature and consumer advisors. The self-administered survey included items that addressed each area of interest and demographic information. As a surrogate for ‘successful living’ two measures were incorporated: the Satisfaction with Life Scale and the Happiness Scale. A number of open-ended questions permitted a subjective response. The survey was pilot-tested for clarity and relevance with 32 persons with SCI and subsequently revised. The survey was mailed by the organization to all 914 members with a disability. Quantitative data analysis included descriptive and correlational analysis and the narrative data was analyzed thematically. The response rate was 46% with data being entered from 355 (44%) surveys. Being physical active was important to a majority of respondents with an average rating of 7.9 on a scale of 1 to 10 (10 = very important). Respondents identified a diversity of physical activities with fitness being associated with gyms and community facilities. A number of facilitators (primarily related to transportation, availability and accessibility) and barriers (level of SCI, pain and lack of facilities and resources) to participation were identified. Participation in fitness or sports activities emerged as major theme associated with positive social and community involvement. O24 Cardiovascular disease and risk factors among individuals with chronic spinal cord injury Author(s): G. Zeilig, MD, A. Keren-Yaar, MD, A. Ohry, MD, H. Weingarden, MD, Y. Drori, MD Name of ISCoS Member (Author): G. Zeilig, A. Ohry, MD Main institution where the work was done: Department of Neurological Rehabilitation; The Chaim Sheba Medical Center, Israel Objective: To compare rates of cardiovascular disease (CVD) and risk factors among chronic spinal cord injury (CSCI) patients with matched general population. Background: Individuals with CSCI are assumed to be more susceptible to CVD than matched peers. Presumed pathophysiologic factors include the metabolic characteristics and passive life style of CSCI leading to atherosclerosis. Nevertheless, epidemiological evidence in the medical literature is sparse and inconclusive.Population and Methods: Longitudinal survey of 98 men with complete traumatic CSCI studied 15 years ago. None had signs of CVD when first studied. Current status regarding CVD was determined by review of individual medical records, periodic laboratory tests, a demographic / health status questionnaire, and general population health survey. Results: Data on 88 patients were available. 73 (average age 54.9) living and 15 died (age 62.8) Of the surviving, 24.3 % had CVD, 21.4 % hypertension, and 8.9 % diabetes. Of the deceased, 4 died from CVD, 3 others had hypertension or CVD; the cause of death was not available for 3 patients. Discussion and conclusion: Compared to the general population, there appears to be a higher incidence of CVD, and for the risk factors. The implications of the findings will be discussed. O25 NEUROGENIC DETRUSOR OVERACTIVITY IN SPINAL CORD INJURIED (SCI) PATIENTS: FIVE YEARS EXPERIENCE USING ENGLISH BOTULINUM-TOXIN-A TREATMENT Author(s): Del Popolo G., Li Marzi V., Panariello G., Lombardi G. Name of ISCoS Member (Author): Del Popolo G. Main institution where the work was done: NeuroUrology, Spinal Unit- Florence (Italy) Objectives: We evaluated clinical results using English Botulinum Toxin A (BTX-A) to treat neurogenic detrusor overactivity (NDO) with different dosages after first and multiple re-injections. Materials and Methods: From 1999 we treated with BTX-A injection into detrusor muscle 178 patients. 93 SCI patients with NDO treated with English BTX-A only, 63 males and 30 females (mean age 37.5 years). 17 (18.2%) cervical lesion, 65 (69.8%) dorsal, and 11 (11.8%) lumbar. The dosages were 500, 750, 1000 U.I. Bladder diary and urodynamic were performed pre-treatment and during follow up. Re-injections were planned at recurrence of urinary incontinence. Results: We recorded an average improvement of bladder capacity of 210.5 ml at least for a period of 4 months with a significant decrease in mean maximum Pdet from 60 to 20 cmH2O. A total of 199 treatments were performed, duration time is reported in figure. Five (5.3%) patients referred transient hypostenia, from 2 to 4 weeks, with reduced supralesional muscle force. It depends on two main variables: high dosage BTX-A used in patients with cervical lesion. Our study is the first in literature that demonstrate efficacy and tolerability of English BTX-A after repeated detrusor injection too. Fig.: Mean duration time per each treatment.
O26 O27 O28 CORRELATION BETWEEN NEUROLOGICAL DATA, BLADDER MANAGEMENT AND URODYNAMIC FUNCTION IN TRAUMATIC SPINAL CORD INJURED PATIENTS Author(s): Sofia Gonçalves, Maria João Andrade Name of ISCoS Member (Author): Maria João Andrade Main institution where the work was done: Physical Medicine and Rehabilitation Department – General Hospital Santo António The optimal method of bladder management in Spinal Cord injured patients must be based on urodynamics characteristics, to prevent renal related morbidity and mortality. To investigate the effects of bladder management on bladder compliance and urological complications, the authors retrospectively reviewed 96 patients with TSCI admitted to a Department of Physical Medicine and Rehabilitation, between January 1993 and December 2003. Clinical data registered during primary rehabilitation, 1 and 3 years after injury was collected from the hospital charts, including the neurological status according to the American Spinal Injury Association (ASIA) guidelines, bladder management method, radiographic and urodynamic investigation and urological complications. For analysis patients were grouped by gender, level and completeness of injury. Our preliminary data supports the need for close surveillance and follow-up after TSCI rehabilitation. O29 Impacts of Functional Improvement after Olfactory Ensheathing Cells Transplantation for Chronic Spinal Cord Injury Author(s): Hongyun Huang, Hongmei Wang, Lin Chen, Bo Xiu, Binchen Li, Rui Wang, Jian Zhang, Feng Zhang, Zheng Gu, Ying Li & Yinglun Song Name of ISCoS Member (Author): Hongyun Huang Main institution where the work was done: Beijing Chaoyang Hospital Affiliated of Capital University of Medical Science Objective To explore the impacts of functional improvement after olfactory ensheathing cells (OECs) transplantation for chronic spinal cord injury. Methods Olfactory bulbs were harvested and trypsinized down to single OECs. They were cultured for 2-3 weeks and ready for use. Three hundred patients with 222 cases complete and 78 cases incomplete chronic spinal cord injury volunteered for the OECs transplantation. The procedure was performed from half year to 31 years (mean 3.1 years) after injury. The OECs were transplanted by injection into opposing ends of the injury site. All patients were followed up to 2-8 weeks after the transplantation and assessed by ASIA standard. The different impacts such as: age, time after injury & gender were compared for the functional improvement after OEC transplantation. Results The neurological functions partially improved by ASIA standard, which were motor score from 39.1±20.6 to 45.9±20.3 (P <0.001); light touch score from 51.7±24.9 to 63.4±23.0 (P<0.001); pin prick score from 53.0±24.2 to 65.3±22.7 (P <0.001). There was no significant difference for the functional improvement by comparison with different age, different time after injury & gender. Conclusion OECs transplantation can partially improve neurological functions for chronic spinal cord injury. Age, time after injury & gender were not impacts of the functional improvement after OEC transplantation. O30 / 253
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