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O45 Pain in People with Long Standing Spinal Cord Injury Author(s): Savic G1, Charlifue S2, Glass C3, O’Brien P4, Pham-Bowman H2, McColl MA4 Name of ISCoS Member (Author):Savic G1, Charlifue S2, Glass C3 Main institution where the work was done:1National Spinal Injuries Centre, Stoke Mandeville, UK, 2Craig Hospital, Englewood, USA, 3Regional Spinal Injuries Centre, Southport, UK, 4Queen’s University, Kingston, Canada Aim: To look at prevalence, change over time and effects of pain in a sample of people with long standing spinal cord injury (SCI). Method: 373 participants from UK, USA and Canada were interviewed in the 2002 follow-up of the International Study of Ageing with SCI. Results: The sample was 85% male, mean age was 58.7 and mean duration of injury 35.9 years. 35.5% were tetraplegic, 43.7% paraplegic and 20.8% incomplete. Pain was reported by 327 participants (87.7%). The most common types of painref were secondary, mechanical and deafferentation. Pain negatively affected all activities of daily life, life satisfaction, quality of life and depression. Management strategies included medication (55.6%), lifestyle changes (21.9%), technical adaptations (21.3%), coping (17.4%) and alternative therapies (12.8%). Younger participants, females and Canadians reported higher levels of pain, greater negative impact on daily life and more use of management strategies, while older participants more frequently reported increasing levels of pain. Level of injury did not influence any of the above. Conclusions: Pain is an issue in majority of patients with long standing SCI, tends to increase over time and has a negative effect on daily life, life satisfaction, quality of life and depression. Reference: Siddall PJ and Loeser JD. Pain following spinal cord injury. Spinal Cord 2001; 39: 63-73. Acknowledgements: Supported by Ontario Neurotrauma Foundation, Canada and partly by Centers for Disease Control, USA and National Institute on Disability and Rehabilitation Research, USA. O46 SURVEY OF THE USE OF STANDING APPARATUS – IMPACT OF ORTHOSTATIC HYPOTENSION SECONDARY TO SPINAL CORD INJURY Author(s): R Chelvarajah, EAL Chung, SL Knight, FRI Middleton, MD Craggs Name of ISCoS Member (Author): MD Craggs Main institution where the work was done:Spinal Research Centre, Royal National Orthopaedic Hospital, Stanmore, United Kingdom Introduction: Upright posture confers numerous medical and social benefits to a spinal cord injured (SCI) patient. However, doing so is limited in many (particularly if a high lesion and complete) by symptoms of orthostatic hypotension (OH). Amongst these patients, rehabilitation can be prolonged and social integration may be more difficult. Objective: Ascertain the number of spinal cord injured patients reluctant to try the standing frame or wheelchair because of their fear of OH symptoms. Also, determine the proportion of standing apparatus users in which symptomatic OH has restricted their use. Method: Population-based survey conducted by Internet-accessible electronic questionnaire. Results: 293 respondents. Mean age 44.6; 76% male. Median time from injury: 7 years. 38% suffered with OH; majority were complete injuries and all (except one – T12) were T5 or above level. 52% replied that were using standing wheelchairs or frames. Of these, 59 (20% of total) stated that OH symptoms were limiting the use of their upright apparatus. Of those who did not use standing wheelchairs or frames, 16 (5.5% of total) reported that this was because of the fear of worsening their OH. Conclusion: OH restricts standing apparatus use in a significant proportion (a total of 25.5% of respondents in this survey) of SCI patients. New treatments that offer control of blood pressure when becoming upright are needed. O47 Quality of life measurements among male Israeli paraplegics Author(s): Feig G, Shenkman Y, Zeilig G, Ohry A & Solomon Z Name of ISCoS Member (Author): Zeilig G, Ohry A Main institution where the work was done: The Shapell School of Social Work, Tel Aviv University & The Department of Neuro-Rehabilitation, Sheba Medical Center, Tel Hashomer, ISRAEL The legal system in Israel differentiates between four groups of disabled people: Defense Ministry insured – DMI, Work Accident Disability – WAD, Car Accident Disability – CAD, and Non Specified Disabled – NSD.Despite the fact that the disabled are entitled to the same medical and rehabilitation services, differences between these four groups can already be seen in the early stages of hospitalization. The purpose of the paper is to study the impact of these differences on the paraplegics’ quality of life. There were 82 paraplegics: 24 DMI, 21 WAD, 19 NSD, 18 CAD. Age range: 18-55. Treatment completed at least five years prior to the research. Five questionnaires were used: the SCI QU-23, the SCL-90, the Psycho-Social Adaptation to Illness, the World Assumption Scale and a life situation questionnaire. The DMI and NSD had less hospitalizations and problems regarding employment when compared with CAD and WAD. The NSD and WAD reported a better family situation and a better perception of their social life. The NSD and the WAD reported fewer signs of psychiatric stress compared with CADNo significant differences were found in signs of mental stress between the NSD and others. No differences were found in life assumptions in the four groups. O48 Long term urological outcome of paediatric spinal cord injury. Author(s): Mr Patki P. Mr.Hamid R. Mr Bycroft J. Mr Somayaji S Mr Shah J Prof. Craggs M. Name of ISCoS Member (Author):Prof Michael Craggs Main institution where the work was done:Spinal injuries unit, RNOH Stanmore INTRODUCTION Outcomes of neuro-urological management of paediatric spinal cord injury (SCI) patients. PATIENTS AND METHODS Ten SCI patients (2 cervical, 7 thoracic, 1 lumbar), six males, four females, mean age at injury, 13.6 years (6 complete / 4 incomplete), followed, for mean period of 13.1 years. Three diagnostic subgroups - neurogenic detrusor overactivity (NDO), acontractile detrusor and low compliance. Complications and operative procedures noted. RESULTS In NDO, (n=6) initial management, supra pubic catheterisation (SPC), (n=1), condom drainage (n=2), urge voiding (n=2) and self-intermittent catheterisation (SIC), (n=1) changed to, ileal conduit (n=1), SARSI (n=1), SIC (n=3) and urge voiding (n=1). Complications were reflux, kidney scarring with decreased GFR, hydronephrosis, kidney and bladder stones and small capacity bladder. Operations included, ileal conduit , sacral anterior root stimulator implant (SARSI), sphincterotomy with stent, STING, Cystolitholapaxy. In acontractile detrusor, (n=2), management was SIC and complications were small noncompliant bladder, stress incontinence. Operations, Mitrofanoff and clam ileocystoplasty. In low compliance, (n=2) management included SIC and urge voiding with SIC. Complications were urethro-perineal fistula, kidney stone. CONCLUSION Bladder management in paediatric SCI is dependent on level of injury and changing bladder neurology. Complications are avoided by regular follow up and management based on up to date investigations O49 Reliability Levels of the ASIA Motor and Sensory Examination in Physician versus Physical Therapist Examiners Author(s): Linda Jones, PT, MS, Ralph J. Marino, MD, Steven Kirshblum, MD, Joseph Tal, PhD Name of ISCoS Member (Author): Linda Jones, PT, MS (membership to be submitted) Main institution where the work was done: Kessler Institute for Rehabilitation, West Orange, NJ Objectives: 1) Assess reliability of motor and sensory examination of the International Standards for Classification of Spinal Cord Injury (SCI), 2) Assess differences in reliability between physician and physical therapist examiners. Methods: Sixteen examiners (8 physicians, 8 physical therapists), with a minimum of two years clinical SCI experience, examined three in a pool of 16 SCI patients. The study was done in preparation for Proneuron’s Phase II autologous incubated macrophage study for treatment of acute SCI patients. Inter-rater reliabilities were assessed using intraclass correlations (Model 1). Results: The intraclass correlations were high: 0.97 for motor scores; 0.96 for light touch scores; and 0.88 for pinprick scores. Computing individual examiner intraclass reliabilities (across three patients) we obtained coefficients of 0.91-1.00 for motor; 0.62-1.00 for light touch; and 0.56-0.99 for pin prick. Differences between physicians and physical therapists were non-significant. The correlation between light touch and pin prick reliabilities was 0.70 (p = 0.003). Conclusions: 1) The scales are generally reliable, exceeding normally recommended reliability values, and appropriate for clinical trials, 2) The few low examiner reliabilities observed are not attributable to professional training (physician versus physical therapist), 3) Examiners who were reliable on light touch tended to be reliable on pin prick and vice versa. Supported by Proneuron Biotechnologies O50 Accuracy of ASIA Impairment Scale of Spinal Cord Injury Using the 2002 Standards Author(s): Linda Jones, PT, MS, Ralph J. Marino, MD, Steven Kirshblum, MD, Joseph Tal, PhD Name of ISCoS Member (Author): Linda Jones, PT, MS (membership to be submitted) Main institution where the work was done: Kessler Institute for Rehabilitation, West Orange, NJ Background: Despite its widespread use, the accuracy of the AIS (American Spinal Injury Association Impairment Scale) classification of spinal cord injury (SCI) using the 2002 International Standards for Neurological Classification (the Standards) has not been evaluated. Methods: Eight physicians attending an investigators meeting for the Proneuron Phase II autologous incubated macrophage study for treatment of SCI Patients participated in a study of AIS grade reliability. Each physician determined AIS grade on 15 sample cases. For each of these cases, an expert analyst’s AIS grade was used as the comparison standard. Results: Overall Kappa for agreement between physicians and the expert opinion was 0.685 (p < 0.001). Individual physician Kappas ranged between 0.444 and 0.907. The overall proportion of correct responses across physicians and cases was 77.5%. However, accuracy varied by true patient grade: 97.5%, 66.7%, 67.5%, 68.7% for Grades A, B, C, and D respectively (p = 0.003). Agreement for Grade A cases was higher than that for other Grades (p < 0.05), which did not differ significantly among themselves. Conclusions: 1) The reliability of the AIS, as measured by Kappa, is reasonable on average but should be improved. 2) Reliability training should focus on Grades B, C and D, as physicians already demonstrate high accuracy in determining Grade A. Supported by Proneuron Biotechnologies |
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