[Assessment of functional abilities, handicap and quality of life in patients with spinal cord injuries]

Factors influencing the severity of long-term sequelae in fishermen-divers with neurological decompression sickness

INTRODUCTION

Numerous studies have been conducted to identify the factors influencing the short-term prognosis for neurological decompression sickness (DCS). However, the long-term sequelae are rarely assessed. The purpose of this study to investigate the factors likely to influence the long-term prognosis.

METHODS

Twenty-seven Vietnamese fishermen-divers who on average 9 (SD 6) years beforehand had presented with neurological DCS and ongoing sequelae, were questioned and examined. The severity of the initial clinical profile was quantified using a severity score. The long-term sequelae were clinically evaluated by looking for a motor or sensory deficit or muscular spasticity, and by applying a severity score for the sequelae which focussed on gait and sphincter disorders.

RESULTS

An initial severity score of ≥ 15 is significantly associated with a risk of serious long-term sequelae [OR = 13.7 (95% CI 2.4 to 79.5)]. Furthermore, certain treatment practices such as in-water recompression to depths > 17 metres' seawater breathing air are significantly associated with more serious sequelae. The practice of intensive non-standardised hyperbaric oxygen sessions over prolonged durations (median 30 days [IQR 19.5]) delayed after the initial accident (median 4 days [IQR 6]) also seems unfavourable.

CONCLUSION

This study establishes a link between the initial DCS severity and the long-term sequelae causing severe gait disorders and sphincter incontinence. Furthermore, this work suggests that certain detrimental treatment practices should be modified. During this field study, we also found that it was possible to reduce sequelae of these divers by offering them an individual programme of self-rehabilitation.

Towards personalized care for persons with spinal cord injury: a study on patients' perceptions

OBJECTIVE/BACKGROUND

A newly designed Spinal Cord Unit (SCU) was set up at the Orthopedic Traumatology Center (OTC), Turin, Italy, in July 2007. With the relocation of the SCU came the need to reorganize and improve the delivery of its services. The study reported here is a preliminary part of a project entitled 'Experimentation and evaluation of personalized healthcare for patients with spinal cord injury', which is a component of an overarching program of targeted research into healthcare funded by the Piedmont Region in 2006. The aim of this study was to assess the perception of care by patients with spinal cord injury (SCI) by collecting important data in order to determine whether an integrated and personalized care pathway could be effective both in hospital and in a rehabilitation setting.

DESIGN

Qualitative research study. The interview format was based on a narrative approach.

METHODS

Qualitative in-depth semi-structured interviews were conducted with 21 patients with SCI. Qualitative content analysis was used to identify categories and themes arising from the data.

RESULTS

Six main categories emerged from the perspectives of patients: expectations of rehabilitation care, impact and welcome, relationship with nurses and their involvement in treatment, relationship with physical therapists and participation in rehabilitation programs, relationship with physicians and their availability and attendance, and imparting of information on injury and rehabilitation outcomes. Care was the aspect new patients admitted to the SCU found most important. When closer relationships with staff formed, the healthcare professionals became an essential support. Patients with SCI commonly stated that receiving explicit information was necessary for accepting their condition.

CONCLUSIONS

Analysis of the patients' perceptions revealed a wealth of details on their experience in the SCU and the need for flexible planning of care time in particular. Incorporating the patients' perceptions into a new care model could increase professionals' awareness of patients' needs and provide a useful basis for constructing a personalized care plan.

Braun's flexor tendons transfer in disabled hands by central nervous system lesions

INTRODUCTION

Since Braun's article, the nonfunctional hand of brain-injured patients has not been the subject of many publications. The objective of surgical treatment is to open the hand for hygiene and cosmetic reasons. The technique consists in lengthening the extrinsic flexor tendons group.

HYPOTHESIS

The purpose of this work is to assess eventual functional benefits from superficialis-to-profundus tendon transfer according to Braun.

MATERIAL AND METHODS

Our series comprised 15 patients aged a mean 55 years, operated using the Braun procedure for a nonfunctional hand (19 hands). Additional procedures were performed as required by the local condition (neurotomy of the deep branch of the ulnar nerve, wrist fusion, tenotomy of the flexors of the wrist and flexor pollicis longus, tenodesis of the extensors of the wrist). The results were assessed by the analysis of finger opening ability and by a specific scoring system (Mini Hand Score; MHS) rated from 6 (no discomfort) at 20 (major discomfort).

RESULTS

The mean follow-up was 6 months. We observed imperfect results: thumb opening incapacity, spasticity of the intrinsic flexors, and hyperextension of the wrist. The preoperative MHS was a mean 13.87 out of 20 and the postoperative MHS was 9.67 out of 20, with a very substantial difference.

DISCUSSION

Our easy-to-use system for evaluating the nonfunctional hand (MHS) was shown to be very effective in demonstrating the improvement of the postoperative result. The originality of our series was to show that Braun's original operation goals were only exceptionally and remotely achieved and that an additional technical procedure must be nearly systematically considered. All the patients in our series were followed up in multidisciplinary team visits where the patient's family and caretakers were encouraged to give their point of view. Level of evidence Level IV. Retrospective study.

Total knee arthroplasty in a spinal cord-injured patient: a case report

Patients with spinal cord injuries are prone to knee hydrarthrosis (also known as "water on the knee"), which can cause pain, functional impairment and the restriction of social activities. Total knee arthroplasty is a potentially appropriate treatment. Here, we report on a patient presenting partial T12 AIS grade C paraplegia who was able to walk with two forearm crutches, an ankle-foot orthosis on the right leg and a knee-ankle-foot orthosis on the left leg. Thirteen years after the spinal cord injury, the patient presented with septic arthritis of the right knee, complicated by recurrent hydrarthrosis during standing and walking. Arthroscopy revealed advanced osteoarthritis. Total knee arthroplasty was performed, with very good functional and social outcomes two and half years after surgery.

[Subjective experience and disability work: qualitative analysis among 17 paraplegic patients]

This paper presents a phenomenological study illustrative how paraplegia may have a serious debilitating impact on the sufferer's subjective experience. Exploratory interviews were conducted with seventeen patients and the transcripts subjected to qualitative analysis. The interpretative phenomenological analysis points to the powerful ways in which paraplegia has negative impact on patients' experience and well-being. Some of the participants describe two major approaches of their situation: dimensional (the links between disability and society, others and self) and temporal (the "disability work"). The results section gives a detailed account of these processes at work. The results are then considered in relation to relevant constructs in the literature, including grief work, illness work and identity, adaptation and acceptance.

[Impact of physical activity on the autonomy and the quality of life of patients with spinal cord injury]

OBJECTIVE

To assess the effect of regular physical activity on the autonomy and the quality of life of Tunisian patients with spinal cord injury.

METHODS

The study relates to 25 paraplegic divided into two groups: 10 paraplegic sportsmen and 15 sedentary paraplegics among whom we assess the degree of the autonomy with the Functional Independence Measure and the quality of life with the quality of life questionnaire SF36 in its Arabic version.

RESULTS

The result analysis shows a significant difference of the total score of the Functional Independence Measure between the two groups, the sporting paraplegic having developed a better autonomy on the daily activities than the nonsporting paraplegics with a total average score of 115.10 against 93.87 (p<0.001). A significant difference is noted, mainly in the headings "personal care" and ',"mobility". Concerning the shutter "quality of life", the scores of various dimensions of scale SF36 were higher in the sporting paraplegic with significant difference in the headings bodily pain (p<0.01), vitality (p<0.04) and global physical score (p<0.008).

CONCLUSION

This study enabled us to show that the regular physical activity as well had a positive effect on optimization of the functional capacities of paraplegic as on the improvement of its quality of life, thus, supporting a better socioprofessional reintegration.

How do C6/C7 tetraplegic patients grasp balls of different sizes and weights? Impact of surgical musculo-tendinous transfers

STUDY DESIGN

Prospective control cohort study.

OBJECTIVES

To develop a new test to analyse qualitatively grasping strategies in C6/C7 tetraplegic patients, and to quantify the effect of musculo-tendinous transfers.

SETTING

France.

METHODS

Twelve C6/C7 tetraplegic adults (17 arms; 31.3+/-7.9 years) and 17 healthy subjects (30.9+/-9.4 years) completed the study. We assessed participants' ability to grasp, move and release standardized balls of variable sizes and weights.

OUTCOME MEASURES

Failures, movement duration (MD), grip patterns, forearm orientation during transport.

RESULTS

In patients as well as in controls, the number of digits involved in prehension increased proportionally to the size and weight of the ball. C6 non-operated tetraplegic patients failed 38.2% of the tasks. They frequently used supine transport (51.4% of successful tasks). MD was longer, with a large distribution of values. The presence of active elbow extension poorly influenced the amount of failure nor grip configuration, but significantly reduced MD and supine transport (34%). Patients who were evaluated after hand surgery showed a trend towards improved MD and more frequent completion (failure 30%), especially for middle-sized and middle-weighted balls. Grip patterns were deeply modified, and all transports were made in pronation.

CONCLUSION

The 'Tetra Ball Test' evidences the characteristics of grasping in tetraplegic patients and those influenced by surgery. It may be useful in understanding effects of surgical procedures. This preliminary study must be completed to evaluate the quantitative responsiveness and reproducibility of this test and to develop instrumented electronic balls to optimise it.

[Satisfaction with technological equipment in individuals with tetraplegia following spinal cord injury]

OBJECTIVE

To measure the acquisition, use and satisfaction with high technology equipment by spinal cord injured tetraplegic subjects.

DESIGN AND SETTING

A questionnaire was mailed to 102 tetraplegic subjects who were hospitalised in the rehabilitation center of Kerpape (Ploemeur, France) between 1998 and 2004, and 59 subjects responded. The questionnaire asked about the use of telephones, computers, wheelchairs and environmental controls at home.

RESULTS

When a piece of equipment was acquired, it was very often used. Patient satisfaction with equipment was 79.3%. Home phones and mobile phones were often used with options such as hands-free devices (78 and 59% respectively). A total of 64.4% of subjects acquired a manual wheelchair and 61% a power wheelchair. The most commonly acquired options on the power wheelchairs were the powered recline (73,7%) and tilt (71,1%) systems. All options were used but all were more desired than acquired. A total of 27.1% of subjects desired a pushrim-activated power-assist wheelchair, but only 15.3% had acquired one; 695% of subjects had a computer. Communication was the first use for the computer (82.5%); 49.2% of subjects had acquired an environmental control system, but 20% desired one. The first reason for lack of acquisition was financial difficulties but also accessibility and information problems. The factor that influenced the acquisition and need for equipment was the degree of spinal cord injury. No other factor reduced patient satisfaction with equipment.

CONCLUSION

Patients were satisfied with the equipment they acquired. But their needs, especially wheelchair options and environmental control systems, were not satisfied.