I ORAL PRESENTATIONS

Topic 8: Free Papers
Chair: Waghi El Masri, Sergio Aito

19/8 Minocycline Effect on Spinal Cord Injury in Rats

Hyun-Yoon Ko, Jae Hyeok Chang, Yong Beom Shin
Pusan National University College of Medicine

Objective: To observe minocycline effect on functional motor recovery after traumatic
spinal cord injury (SCI) in rats.

Method: Forty Sprague-Dawley rats were divided into four groups (10 rats each group)
according to administration of minocycline and height of drop impact on the spinal cord:
2.5 cm drop impact and minocycline administration (group 1); 2.5 cm drop impact with
no minocycline (group 2); 5 cm drop impact and minocycline administration (group 3); 5
cm drop impact with no minocycline (group 4). Rats received traumatic SCI by the
force-calibrated weight drop device and were treated with the treadmill or minocycline
(90 mg/kg immediately after SCI and 45 mg/kg bid for the following one day).
Functional motor recovery was evaluated by the Basso-Beattie-Bresnahan (BBB)
locomotor rating scale at the 1st, 7th, 14th, 21st, and 28th day after SCI.

Results: The BBB scores were significantly higher in group 1 and 3 compared with
those in group 2 and 4 after SCI.

Conclusion: The BBB scores were significantly higher in minocycline treated groups at
twenty eight days after SCI. We concluded that minocycline have beneficial effects on
the recovery cascade after SCI in rats.

20/8 The study of the proliferation of reactive astrocytes and the
expression of Nestin in adult rats following spinal cord injury
caused by compression

Xijing He, Pinglin Yang, Haopeng Li, Binshang Lan, Jianqiang Qu, Puwei Yuan,
Guoyu Wang
Orthopaedic Department, Second Hospital, Xian Jiaotong University, China

Objective: To explore the expression of Nestin and glial fibrillary acidic protein (GFAP)
and to investigate their spatial induction profile at different times following SCI in adult
rats.

Methods: Male Sprague-Dawley rats were divided into normal and injury groups. SCI
model was established by aneurysm clip compression. The injury group was
subdivided into 1d, 3d, 5d, 7d, 14d, 28d and 56d subgroups (n=7) according to the time
post injury. The expression and proliferation of Nestin and GFAP were shown with the
analytical system of photographs,immunohistochemistry and double immunofluorescent
labelling techniques combined with confocal laser scanning microscope
analysis.

Results: In the normal group, the expression of Nestin was hardly seen but low
expression of GFAP was seen. The injury and adjacent to the injury sites demonstrated
a dramatic increase in Nestin expression 24 hours after compression and GFAP
expression 3 days after compression. Double immunofluoscent labelling showed that
Nestin positive cells were mostly co-stained with GFAP, a astrocyte marker. Significant
proliferation was observed after 3-7 days and decreased with time. Compared with the
normal group, the differences were significant (P<0.05).

Conclusion: Nestin and GFAP co-stained positive cells have the characteristics of
embryonic cells of neuroprotection and repair against compression damage.

21/8 The Role of the Thoracic Spinal Cord in Hemodynamic Regulation:
A Proposed Model

A Catz,1,2 V Bluvshtein,1 I Pinhas,3 S Akselrod,3 I Gelernter,4 T Nissel,5 Y
Vered,5 N Bornstein,2,5 AD Korczyn2,5
1Loewenstein Rehabilitation Hospital, Raanana; 2Sackler Faculty of Medicine,
3The Center for Medical Physics, Faculty of Exact Sciences, and 4The Statistical
Laboratory, School of Mathematics, Faculty of Exact Sciences, Tel-Aviv
University, Tel-Aviv; 5Tel-Aviv Medical Center, Tel-Aviv, Israel.

To assess the role of the thoracic spinal cord in hemodynamic regulation, heart rate
(HR), blood pressure (BP), and cerebral blood flow velocity (CBFV) were continuously
measured in 13 healthy people, 10 patients with T4-T6 ASIA A paraplegia, and 11
patients with C4-C7 ASIA A or B tetraplegia. The measurements were performed at
supine rest, at 35o head-up tilt (HUT), after a standard meal, and during hand and foot
ice water immersion.

The following findings significantly characterized the group with the mid-thoracic spinal
cord lesion (SCL):

1. BP decreased following liquid meal ingestion only in this group;
2. HR increased after the liquid meal in this group more than in the other groups;
3. the calculated cerebral vascular resistance index (CVRi) decreased following liquid
meal ingestion only in this group;
4. CBFV increased during contralateral ice-water foot immersion only in this group;
5. HR LF/HF (heart rate variation low-high frequency ratio by spectral analysis) and
HR increases were not correlated at HUT only in this group.
These and additional findings demonstrated the importance of an intact thoracic
spinal cord for hemodynamic regulation, and were the basis for a proposed model
of two vasomotor centers, at T1-T4 and below T6.

22/8 Impaired Ventilation and Cerebral Blood Flow Velocity in Patients
with Spinal Cord Lesion

Bluvshtein V1., Pinhas I.3, Akselrod S3., Bornstein N2., Nussel T2., Korcin
AD2., Catz A.1
Loewenstein Hospital, The Department of Spinal Rehabilitation.
Tel-Aviv Medical Center, Sacler Faculty of Medicine.
The Center for Medical Physics, Tel-Aviv University

Background: Motor and autonomic impairment following spinal cord lesion (SCL) may
cause physiological changes of the cardiovascular and respiratory systems, including
hypotension, a decrease in cerebral blood flow (CBF), and reductions of respiratory
volumes.

In healthy people, tilting is followed by minor blood pressure and cerebral blood flow
changes, and by mild hyperventilation and CO2 decrease. In patient with tetraplegia,
however, tilting may be followed by prominent decrease in blood pressure and
respiratory volumes, while reports on CBF and vascular resistance are diverse.

Aim: To examine the hypothesis that a respiratory impairment may determined the
nature of the CBF regulation in patients with SCL, the relationship between venous
PCO2 and the change in the cerebrovascular resistance index (CVRi) was studied in
such patients during tilt.

Material-Methods: Ten tetraplegic and nine paraplegic patients with T6 level and
higher level were examined and ten healthy people as control group. All patients were
scored as ASIA A or B and were examined in two position lying prone and 30o tilt. It
was continuously measured BP, HR, Cerebral blood flow velocity (CBFV) and
respiratory tests were examined FVC, FEV1 and PCO2 in venous blood.

Result: Unlike in healthy controls, a positive linear correlation was found in patients
with tetraplegia between PCO2 and the change in CVRi during tilt (r=0.77; p=0.016).
This finding may indicated that unlike in healthy people, in patients with tetraplagia
changes in cerebral vascular resistance affect respiratory volumes and CO2 level, and
it does not support the hypothesis that a respiratory impairment determines the nature
of CBF regulation in patients with SCL. It may also imply that CBF degrease during an
orthostatic challenge is an additional factor, which is decreasing respiratory efficacy in
patients with tetraplegia

23/8 Endoscopic anterior spinal decompression

Michael Potulski, Doris Maier, Jan Vastmans
SCI Center - Trauma Center Murnau, Murnau, Germany

Object. The effect of a spinal decompression in the treatment of thoracolumbar
fractures with neurological deficits is discussed controversially. Standard technique is
the posterior decompression in the context of the acute treatment with a reposition and
stabilization. The posterior approach allows to push backward retropulsed bone
fragments after a laminectomy. In the majority of cases the postoperative CT shows
furthermore a narrowing of the spinal canal. Many authors confirm the own estimation,
that the anterior decompression is more reliable for spinal canal clearance. Traditional
anterior-access procedures are associated with significant complications. Endoscopy-
guided spinal approaches can reduce these morbidities. This study was conducted to
demonstrate the effectiveness of endoscopic spinal canal decompression.

Method. Forty patients with thoracolumbar canal narrowing underwent endoscopic
anterior spinal canal decompression in the context of interbody reconstruction and
stabilization. The mean follow-up period was 48 months. Neurological examinations,
Frankel grades, radiological studies, and intraoperative findings were prospectively
collected.

Results. A total of 65% of patients with incomplete neurological deficit improved
neurologically. The complication rate was 16.2% and included one reintubation, three
pleural effusions, one intercostal neuralgia, and one persistent lesion of the
sympathetic chain.

Conclusion. In comparison with the posterior access the anterior decompression
demonstrated an excellent spinal canal clearance. The observed recoveries of the
neurological deficit could be an indication to the effectiveness of this technique.

24/8 Lipid profiles during rehabilitation of people with a spinal cord injury.

S de Groot, AJ Dallmeijer, , OJ Kilkens, MWM Post, ELD Angenot, FWA
Asbeck, AV Nene, LHV van der Woude
Rehabilitation Center Amsterdam
Institute of Fundamental and Clinical Human Movement Sciences

Purpose: To determine the course of lipid profiles during rehabilitation of persons with a
spinal cord injury (SCI).

Method: In a Dutch multi-center prospective cohort study lipid profiles (total cholesterol
(TC), HDL-C and LDL-C) of 188 subjects with SCI (77 with tetraplegia) were measured
at the start of active rehabilitation (t1), 3 months later (t2) and at discharge of clinical
rehabilitation (t3). ‘Percentage subjects at risk’ (TC > 6.2 mmol/l, HDL-C < 0.9 mmol/l,
LDL = 4.1 mmol/l) were calculated for t1, t2 and t3.

Results: Percentages at risk at t1, t2 and t3 were for HDL-C 33, 24 and 20%, for TC 10,
7 and 9%, and for LDL 10, 6 and 7% respectively. Mean HDL-C improved significantly
from 1.03 (t1) to 1.13 (t2) and 1.19 mmol/l (t3). Mean TC and LDL-C showed no
significant changes during rehabilitation. HDL-C was significantly higher for persons
with incomplete lesions compared to those with complete lesions.

Conclusions: Depressed levels of HDL-C, but normal TC and LDL-C were found at the
start of active rehabilitation. HDL-C increased during rehabilitation, but at discharge still
20% was at increased risk for coronary heart diseases. Lesion characteristics were of
minor influence on the course of lipid profiles.

25/8 Normocapnic hyperpnea training in acute spinal cord injury.

S. Van Houtte, Y.C. Vanlandewijck, C. Kiekens, R. Gosselink
Faculty of Kinesiology and Rehabilitation Sciences, Department of
Rehabilitation Sciences, K.U.Leuven and Physical Medicine and Rehabilitation,
University Hospital Pellenberg, Belgium

The aim of the present study was to investigate the effects of normocapnic hyperpnea
(NH) training in acute spinal cord injury (SCI, time to lesion > 6 weeks). Patients (n=14)
were randomized between control (C) and experimental (E) group and evaluated for
vital capacity (VC), maximal voluntary ventilation (MVV), inspiratory muscle strength
(PImax), expiratory muscle strength (PEmax) and respiratory endurance test (RET)
before, after 8 weeks of training and after 8 weeks follow-up. Similarly, quality of life
and incidence of respiratory complications were evaluated. NH was performed with a
self-developed device which consists of a rebreathing bag connected to a mouthpiece.
Patients trained 30 min, four times a week. C patients trained at a constant ventilation
of 15 (4) % MVV whereas E patients increased training ventilation from 30 (8) % MVV
towards 40 (11) % MVV. Mann-Whitney U tests revealed significantly improved MVV,
PEmax and duration of RET after 8 weeks of training and after 8 weeks follow-up
(p<0.05). There were no differences concerning quality of life. Respiratory
complications were reported more frequently in the C group compared to the E group.

In conclusion, NH training in patients with SCI improved expiratory muscle strength and
respiratory muscle endurance.

26/8 Handbike – Outcome of a mobility equipment study 1995 - 2004

O. Mach, D. Maier, M. Potulski
Berufsgenossenschaftliche Unfallklinik
Professor-Küntscher-Straße 8, D-82418 Murnau

Study design: Retrospective investigation with standardised questionnaire

Objectives: To quantify and point out the nessessary use of wheelchairadapted
handbikes for people with spinal cord injury in their daily life. Interesting points are
compliance, purpose, social, physical and emotional factors.

Setting: Spinal cord trauma center, Murnau, Germany

Methods: In all, 113 patients were interviewed, 21 female and 92 male, who have
been in the trauma center during their prime rehabilitation in the years 1995 to 2004.

Results: 83 responded (>70%), 65 having one handbike, 8 having more than one and
10 having none. The average use is 72 days/year and the average distance covered
1200 km/year. The motives are joy of motion and being able to spend leisuretime
combined with the effects of training. Important social aspects are, that handbike can
be used alone, together with the family and on excursions with friends. Physical and
emotional satisfaction is experienced by continued use at home.

Conclusions: Wheelchairadapted handbikes can improve quality of life, especially when
prescribed in early rehabilitation.

27/8 The European FP5-project RISE - FES of denervated degenerated
musculature: project structure and technological aspects

Mayr W, Hofer C, Rafolt D, Bijak M, Lanmueller H, Reichel M, Sauermann S,
Unger E, Kern H
Center of Biomedical Engineering and Physics, Vienna Medical University
Waehringer Guertel 18-20/4L, A-1090 Vienna, Austria

Recent experimental and clinical work gives strong evidence that functional electrical
stimulation (FES) is a powerful tool for regeneration, functional restoration and
maintenance of denervated musculature, a fact that for various reasons was not
recognized in the past.

Based on these promising preliminary findings the European project RISE was
established within the 5th Framework Program to develop an efficient rehabilitation
method and the associated technical equipment for the treatment of flaccid paraplegia.
The project started with November 2001, has a lifetime of 4 years and includes 18
contractors from Austria, UK, Italy, Germany, Slovenia and Island.
2 of the 5 work-packages are dedicated development of novel stimulation and
measurement solutions. An effective stimulator for activation of denervated skeletal
muscles via surface electrodes requires biphasic long-duration impulses with 10 300ms
and amplitudes of up to ± 100 V (± 250 mA). These demands rise safety issues in the
design and application of both the stimulator and the electrodes. Within RISE
sufficiently working prototype equipment was developed and is being clinically tested.
For data assessment also alternative approaches are necessary. A new pendulum
technique allows the recording of minimal force development changes in even longterm
denervated degenerated muscles (DDM), a twitch force sensor applied to the
patella provides accurate data on the dynamic status of the denervated quadriceps
muscle.

28/8 The Course of BMD and Biochemical Bone Markers in Early
Postmenopausal Spinal Cord Injured Women

Berit Broholm, Jan Pødenphant, Fin Biering-Sørensen.
Clinic for Spinal Cord Injured, Rigshospitalet, Copenhagen

Method: 11 spinal cord injured women more than two years after injury were recruited
by questionnaires. The women were early postmenopausal one to seven years after
menopause (median 4 years). In a 30 months longitudinal study bone mineral density
(BMD) of the spine, hip and tibia by DEXA-scanning and bone markers of urine and
blood samples were measured every six months. Data were statistically analysed by
repeated measures analysis of variance.

Results: We found a significant increase in markers of bone formation and a tendency
towards increased bone resorption. There was no significant fall but a tendency to a
decrease in BMD of trochanter, femoral neck and tibia. BMD of the spine was
unchanged.

Conclusion: There is an increased bone turnover and a tendency towards decreasing
BMD at all sites but the spine in SCI females in the first years after menopause.

Mean values all patients in percentage of T0
T30
months
p-value
BMD Femoral neck 92 0.16
BMD Trochanter 94 0.14
BMD Spine 99 0.29
BMD Tibia 97 0.14
Osteocalcin 136 0.01
Alk. phosphatase 108 0.05
Hydroxyprolin / Creatinin 294 0.10
Calcium / Creatinin 206 0.06

29/8 Pain and its impact in adults with pediatric-onset spinal cord injury

L C Vogel, C J Anderson, K M Willis; R R Betz, C M McDonald
Shriners Hospitals for Children

Objective: Determine prevalence, predictive factors, and impact of pain on participation
and quality of life in adults with pediatric-onset spinal cord injury.

Design: Prospective telephone surveys

Methods: Individuals sustained SCI £ 18 years old and were ³ 24 years old. Structured
interview with standardized measures.

Results: 317 subjects, mean age at injury 14 years and at interview 27 years. Pain at
any site affected 70%. Sites most commonly affected were shoulder (48%), elbow
(14%), wrist (10%).

In multiple regression analyses, pain at any site was associated with race, paraplegia,
decreased physical independence, decreased perceived mental and physical health,
and substance abuse. Shoulder pain was associated with complete SCI, decreased
perceived mental and physical health and increased independent living. Elbow pain
was associated with older age at interview and increased independent living. Wrist pain
was associated with younger age at injury, paraplegia, decreased perceived physical
health, and fewer pressure ulcers. In predictive models for independent living,
employment or life satisfaction, shoulder and elbow pain were predictive factors for
independent living; whereas, pain at any site or wrist pain were not predictive of these
3 outcomes.

Conclusion: Pain is a common complication and is associated with a variety of
demographic, participation and quality of life factors.

30/8 Cannabis in medicine: new insight and therapeutic approaches

Susanne Luz1, Mark Mäder2
1Seidel-Klinik Bad Bellingen, Multidisciplinary Center for Spinal, Neuromuscular,
and Rheumatic Diseases, 79415 Bad Bellingen, Germany
2Rehab Basel, Center for SCI and Head Injury, 4055 Basel, Switzerland

Cannabis has a long history of therapeutic use. The isolation and synthesis of pure
cannabinoids and the discovery of cannabinoid receptors have renewed the interest in
medical use. The FDA (Food and Drug Administration) has approved Marinol®
(dronabinol, delta-9-THC) for the treatment of nausea and vomiting associated with
cancer chemotherapy, and also to counteract weight loss in anorexia and cachexia of
AIDS patients. _9–THC the main psychoactive cannabinoid of cannabis has been
shown to have beneficial effects in the treatment of spasticity of different origin. As an
example for medical use of cannabinoids and the appearing side effects we are
presenting the results of our study at the REHAB Basel. The aim of the study was to
assess the effectiveness and safety of _9–THC (Dronabinol, Marinol® capsules) and
THC-hemisuccinate suppositories (THC-HS) for the treatment of spasticity in patients
with SCI as a homogeneous population of patients. The results demonstrate a
significant therapeutic effect of _9–THC (Dronabinol, Marinol ®) as well as THC-HS in
patients with SCI.

31/8 Medical decision making in SCI medicine demonstrated by patient
preferences for reconstructive upper extremity surgery in tetraplegia.

Govert J. Snoek MD, Janine A. van Til MSc PT, Maarten J. IJzerman PT PhD
Roessingh Research and Development. PO Box 310, 7500AH Enschede, The
Netherlands; ++31 53 4875777; g.snoek@rrd.nl.

Objective: to demonstrate the use of medical decision making techniques in SCI
medicine

Method: determination of the effect of treatment characteristics of upper extremity (UE)
interventions on the decision of tetraplegic subjects for surgery, using a discrete choice
experiment (DCE). Treatment characteristics were formulated and used to establish
different treatment scenarios. Conjoint analysis was used to determine the preference
for the scenarios and the relative importance of treatment characteristics on the
decision for reconstructive surgery.

Results: 47 tetraplegic subjects with C5-6 lesions, motor group M1-4 were selected.
Relative importance of treatment characteristics were: intervention type (surgery or
surgery with FES implant) 13%, number of operations 15%, in patient rehabilitation
period 22%, ambulant rehabilitation period 9%, complication rate 15%, improvement of
elbow function 10%, improvement of hand function 15%. An inpatient rehabilitation
period to a maximum of 4 weeks increased preference for treatment with 32 %. One
instead of two operative procedures increased the preference with 25%.

Discussion: DCE are applicable in SCI medicine to study the effect of health outcome
and non-health outcome factors on the decision to undergo therapy. Non-health
outcome factors indicating the intensity of treatment are as important as or even more
important than functional outcome in deciding for reconstructive UE surgery in
tetraplegia.

32/8 Measurement properties of the Van Lieshout Test for hand function
of persons with tetraplegia

M.W.M. Post, G. van Lieshout, H.A.M. Seelen, G.J. Snoek, M. IJzerman, C.
Pons
IRv, Institute for Rehabilitation Research; Hoensbroek; The Netherlands

The Van Lieshout Test (VLT) is a functional capacity scale with 20 tasks to assess
arm/hand function of persons with tetraplegia due to spinal cord injury. The quality of
task performance is scored on a hierarchic 0-5 scale. The research version of the VLT
consists of 10 tasks. The inter-rater reliability and validity of the research-VLT were
examined in two cross-sectional studies (inter-rater N=12; validity N=55) of persons
with tetraplegia living in the community. In the validity study, scores on the VLT were
compared to the Grasp-Release Test (GRT, criterion measure) and to measures of
impairment and disability.

Results: Inter-rater reliability was excellent (ICC=0.98-0.99). Internal consistency was
good (Cronbach’s alpha 0.88-0.94). Convergent validity with the GRT was good with
correlations of 0.87 (left hand) and 0.90 (right hand). Correlations with the International
Classification were 0.67 and 0.85 respectively, and correlations with FIM-self-care and
FIM-transfer scales were between 0.61 and 0.72. In conclusion, The VLT appears a
reliable and valid test. Its responsiveness is under investigation. English and German
versions and an instruction CD-ROM are available and a website is under construction.

33/8 Photo Documentation for Scoring the Walking Index for Spinal Cord
Injury (WISCI): Inter Rater Reliability Study

John F. Ditunno, Jr., M.D., Mary Patrick, R.N., Patricia Ditunno, Ph.D, Ralph
Marino, M.D., Mary Schmidt, MS, PT
Regional SCI Center of Delaware Valley, Thomas Jefferson University Hospital
and Magee Rehabilitation Hospital, Philadelphia, Pennsylvania, USA

To determine the accuracy of scoring the WISCI scale from photo documentation a
reliability study was performed by 3 independent concurrent raters. Three physical
therapists were trained in the WISCI scale and asked to review and assign WISCI
levels from photos of 84 unknown subjects with acute traumatic SCI (ASIA A - D).
Photo documentation was performed with any change in walking status up to 1 year
post SCI. Since some photos did not fit an assigned WISCI level, rules for adjudication
were given to the therapists in a manual with instructions. A computer-generated
program randomly shuffled the 276 photos from 84 subjects to determine the order of
presentation for rating. Agreement with the gold standard was 89%, 91%, and 93% for
three judges (91% average) and intra-class correlation was 0.83. Agreement with the
gold standard was 95.7% for the photos on the WISCI scale and 57.8% for photos
needing adjudication. Most errors for assigned WISCI levels were due to photographs
that didn’t clearly show braces or physical assistance versus supervision.
Photo documentation is a reliable method for assigning WISCI levels for use in clinical
trials. Photos however, must clearly show devices, assistance, and braces at defined
WISCI levels.

34/8 SCIM III Reliability And Validity: A Multi-Center International Study

Malka Itzkovich, O.T, M.A., Amiram Catz, M.D., Fin Biering-Sørensen, M.D.
Spinal Rehabilitation Department, Loewenstein Hospital, Raanana, Israel, Clinic
for Para- and Tetraplegia, Copenhagen University Hospital, Copenhagen, Denmark

In collaboration with:
Dr. C Weeks (Vancouver Canada), Dr. C Craven (Toronto, Canada), Ms. MT
Laramee (Montreal, Canada), Dr. E Glaser (Greifswald, Germany), Dr. G Zeilig
(Tel-Hashomer, Israel), Ms. I Gelernter (Tel-Aviv, Israel), Dr. S Aito (Florence,
Italy), Dr. G Scivoletto (Santa Lucia, Italy), Dr. L Tesio (Milan, Italy), Mr. M
Mecci, Dr. RJ Chadwick, Middlesbrough (UK), Mr. WS El Masry, Mr. A Osman
(Oswestry, UK), Dr. CA Glass, Mr. BM Soni (Southport UK), Mr. B Gardner, Dr.
G Savic (Stoke-Mandeville UK).

Objective: To examine the third version of the Spinal Cord Independence Measure
(SCIM III) in a broad international population of spinal cord injured patients.

Setting: 13 spinal cord units in 6 countries.

Design: A multi-center cohort study.

Methods: 429 patients were enrolled in the study and were assessed with FIM and
SCIM in the first week after admission to rehabilitation and in the last week before
discharge.

Data analysis: The validity and reliability of the scale were tested using Rasch
analysis and conventional statistics, including total agreement, intraclass correlation,
and McNemar test.

Results: The fit of the observed data to the Rasch model was found to be good, with
infit indices below 1.2 for most SCIM items, indicating satisfactory undimensionality of
the various subscales of the SCIM profile. Total agreement ranged between 77.3% and
96.5% for all the SCIM tasks, with Kappa values of 0.643-0.840, and the intraclass
correlation coefficient was 0.911-0.945. SCIM III was found more sensitive than FIM to
functional changes in the subscales for respiration and sphincter management and for
indoor and outdoor mobility (p<0.001).

Conclusions: Despite inter-cultural differences between the participating units, the
multi-center international study supports SCIM III validity and reliability.

35/8 Sacral Nerve Roots Stimulation for Ischial Pressure and Blood
Perfusion changes in SCI

LQ Liu, SL Knight, GP Nicholson, R Chelvarajah , FRI Middleton, A Gall , M
Ferguson-Pell , MD Craggs
Spinal Research Centre, Royal National Orthopaedic Hospital & Institute of
Urology &Nephrology, University College of London

Introduction
Sacral nerve roots stimulation (SNRS) is proposed for ischial pressure ulcer (PU)
prevention in SCI. The aim was to investigate the acute effects of SNRS on ischial
pressure (IP) and ischial blood perfusion (IBP) in SCI.

Method
5 SCI patients (T5-C4 injury) and 5 SCI patients ( T3-T10 injury ) with a SARS implant
were recruited. Sacral FMS was delivered through a large circular coil (Medtronic
Dantec MagPro); FES was applied via a Finetech-Brindley SARSI. IP were measured
by interface pressure mapping (Xsensor). IBP were measured using Tissue
Reflectance Spectrometry (MCS521 ZEISS).

Results
With optimal FMS, 27% reduction of IT peak pressure was achieved (157.6 mmHg±
16.0 vs 115.5 mmHg± 11.5, p=0.006) in 5 SCI patients; With optimal FES, 33%
reduction of IT peak pressures was achieved (148.6 mmHg±10.0 vs. 99.8mmHg± 6.7,
p=0.002) in 5 SCI with a SARSI; IBP significantly increased (IHB 2.08au ± 0.02 vs
2.12au ±0.01, P=0.04; IOX 1.22au ± 0.15 vs 1.7au ±0.17, P=0.04) for the whole group.

Conclusion
SNRS can significantly reduce IP and increase IBP. In addition to these beneficial
effects, chronic stimulation via a SARSI may be useful for building gluteal muscle bulk
and improve vascularisations to prevent PU in SCI.

36/8 Health Complications and Quality of Life With Tetraplegia and Long-
Term Mechanical Ventilation (Ltmv): A Cross-Cultural Study

C Glass PhD2; S Warschausky,PhD1; M Forchheimer, MPP1; V Nelson, MD,
MPH1; D Gater, MD1
1University of Michigan, Ann Arbor, Michigan, USA; 2North West Regional Spinal
Injuries Centre, Southport District General Hospital, England

Introduction: Recent findings indicate no significant differences in health, secondary
complications or self-perceived quality of life (QoL) for people with tetraplegia not
requiring LTMV, and those ventilated; quality of care-giving is the key predictor of QoL.
This cross-cultural study examines care-giving, health complications and QoL for LTMV
and non-LTMV people in England and the United States.

Method: Participants; 43 U.S.A. and 30 from England. Health complications assessed
using variables from Model Systems SCI dataset. QoL instruments were the
Satisfaction with Life Scale (SWLS) and modified Schedule for Evaluation of Individual
QoL (SEIQoL). Care-giving assessed with modified Quality of Care-giving Measure.

Results and Conclusion: No significant group differences in age, age at onset of SCI
and/or LTMV, gender or percent of sample on LTMV. Although no significant
differences in hours of daily assistance, British sample had more caregivers and more
unpaid assistants. No significant differences in health complications (eg. decubitus
ulcers, pneumonia, spasticity or acquired scoliosis). Global ratings of QoL did not
differ, but more detailed ratings based on a self-identified hierarchy of values and life
domains indicated higher satisfaction amongst British participants. Similar health
status in both groups identified, despite differences in health care systems and nature
of personal assistance. Subtle QoL differences are discussed in terms of content of
self-identified needs and fulfilment.

37/8 Comparison of Coping Mechanisms and Emotional states of the
Spinal Cord Injury Patients and the Caregivers based on their Physical Conditions

N.Paker, Y. Altuncu, S. Aydil, M. Erbil, D. Soy
Istanbul Physical Medicine and Rehabilitation Training Center, Amerikan
Hospital

Objective: To examine the correlation between individuals with spinal cord injuries
(SCI) and their caregivers in terms of their coping and emotional states with respect to
their physical conditions.

Design: Cross-sectional study analysed with a set of structured questionnaires and
semi-structured interviews

Subjects: 31 patients with SCI and their caregivers

Outcome measures: Ways of Coping Questionnaire, Hospital Anxiety and Depression
Scale, physical capacity measures (FIM, ASIA)

Results: No significant difference was found between individuals with SCI and
caregivers in terms of their emotional state and coping mechanism. The coping
mechanisms and emotional states of the people with SCI and the caregivers were not
correlated with the physical status of patients.

Conclusion:
Adaptation to SCI is a complex psycho-social process that is explained not only in
relation to the physical effect of injury but also variability in emotional adjustment of the
individual and caregivers as a system. The enhancement in understanding of
psychological and emotional consequences of the SCI facilitates a better quality of life
within the health care system. An important task for the rehabilitation in the recovery
process is to create an ongoing mutual adjustment plan for integrating environmental
and individual specific conditions within the definition of health.

38/8 Relations between coping strategies and health-related quality of life

ML Elfström, M Kreuter, A Rydén, C Taft, M Sullivan
Health Care Research Unit, Institute of Internal Medicine, Sahlgrenska
Academy at Göteborg University, Sweden

Although the use of appropriate coping strategies has been suggested to be a key
factor in determining successful adjustment to severe physical illness/disability, little
systematic support for this link has been found. We investigated relationships between
spinal cord lesion(SCL)-related coping strategies and health-related quality of life
(HRQL) when controlling for sociodemographic, disability-related and social support
variables. The sample comprised 256 persons with traumatically acquired SCL (_ 1
yr.) from a typical rural/urban Swedish area in a cross-sectional design. Coping
measure was the SCL-related Coping Strategies Questionnaire (SCL CSQ). Outcome
measures were the Spinal Cord Injury Quality of Life Questionnaire (SCI QL-23) and
the Short-Form 36 Health Survey version 2.0 (SF-36 v2.0), covering lesion-specific
complaints/consequences, general health aspects and overall quality of life. Multiple
regressions were performed. Coping strategies were clear correlates of HRQL when
sociodemographic, disability-related and social support variables were controlled. The
relationship between coping strategies and HRQL was: the more revaluation of life
values (Acceptance) and the fewer tendencies towards dependent behaviour (Social
reliance) the better HRQL. Our results suggest that greater focus needs to be directed
to coping strategies and to ways of facilitating adaptive outcomes in rehabilitation.

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