Post traumatic paraplegics living in Athens: the impact of pressure sores and UTIs on everyday life activities

The influence of a contoured seating base on pressure distribution and discomfort

PURPOSE

This research paper examines how contouring of a wheelchair seating base can help prevent pressure sores by distributing pressure over the buttocks. Contouring wheelchair cushioning is already done to some extent and has proved to be beneficial for pressure distribution. We researched the effect of contouring the seating base, and whether contouring the seating base affects effectiveness in pressure distribution and perceived discomfort.

MATERIALS & METHODS

13 healthy participants performed a within-subject experiment with three differently contoured seating bases. Perceived comfort and seating pressure were measured for each condition.

RESULTS

Results indicate that a more contoured base is positive for both comfort and increased pressure distribution.

CONCLUSIONS

Contoured seating bases can provide increased comfort and improved pressure distribution over flat seating bases. Future research should examine the effect of contouring on stability, as well as compare the effects of contoured seating bases and contoured cushions.Implications for rehabilitationWe evaluated the comfort and pressure characteristics of three differently contoured hard seating bases for a wheelchair. The outcomes of the research shows that providing increased contour to seatings could be beneficial to reduce pressure peaks in the buttocks.Contour in the seating is conventionally created by shaping the cushions, this research shows the possibility of using a hard base underneath a cushion to create the desired contour.

Physical therapists' perceptions about patients with incomplete post-traumatic paraplegia adherence to recommended home exercises: a qualitative study

BACKGROUND

The overall purpose of physical therapy for patients with spinal cord injury is to improve health-related quality of life. However, poor adherence is a problem in physical therapy and may have negative impact on outcomes.

OBJECTIVES

To explore the physical therapists' perspectives about patients with incomplete post-traumatic paraplegia adherence to recommended home exercises.

METHODS

A qualitative content analysis was conducted. Data were collected in a convenience sample using semi-structured interviews. Thirteen registered physical therapists in Athens area participated in the study.

RESULTS

Five categories emerged from the data: (1) reasons to recommend home exercise by the physical therapist; (2) obstacles to recommend home exercise by the physical therapist; (3) methods addressing these obstacles; (4) the family's role in the adherence to recommended home exercise; and (5) the impact of financial crisis in adherence to recommended home exercise. All participants found the recommended home exercises essential to rehabilitation and health maintenance, and they value their benefits. They also expressed the obstacles that need to be faced during rehabilitation process in order to promote adherence.

CONCLUSION

Physical therapists should take into account the different obstacles that may prevent patients with incomplete post-traumatic paraplegia adherence to recommended home exercises. These involve the patients and their families, while, financial crisis has also an impact in adherence. In order to overcome these obstacles and increase adherence, communication with patient and family while taking into account the individual's needs, capacities, and resources are essential.

Identifying and classifying quality of life tools for neurogenic bladder function after spinal cord injury: A systematic review

OBJECTIVE

To identify and classify quality of life (QoL) tools for assessing the influence of neurogenic bladder after spinal cord injury/disease (SCI).

DESIGN

Systematic Review Methods: Medline/Pubmed, CINAHL, and PsycInfo were searched using terms related to SCI, neurogenic bladder and QoL. Studies that assessed the influence neurogenic bladder on QoL (or related construct) in samples consisting of ≥50% individuals with SCI were included. Two independent reviewers screened titles and abstracts of 368 identified references; 118 full-text articles were assessed for eligibility, and 42 studies were included. Two reviewers independently classified outcomes as objective (societal viewpoint) or subjective (patient perspective) using a QoL framework.

RESULTS

Ten objective QoL measures were identified, with the Medical Outcomes Short Form (SF-36/SF-12) used most frequently. Fourteen subjective QoL measures were identified; 8 were specific to neurogenic bladder. Psychometric evidence for SCI-specific neurogenic bladder QoL tools was reported for the Quality of Life Index (QLI), Qualiveen, Bladder Complications Scale, Spinal Cord Injury-Quality of Life (SCI-QOL) Bladder Management Difficulties, and the SCI-QOL Bladder Management Difficulties-Short Form. The QLI and Qualiveen showed sensitivity to neurogenic bladder in experimental designs.

CONCLUSION

Several objective and subjective tools exist to assess the influence of neurogenic bladder on QoL in SCI. The QLI and Qualiveen, both subjective tools, were the only validated SCI-specific tools that showed sensitivity to neurogenic bladder. Further validation of existing subjective SCI-specific outcomes is needed. Research to validate objective measures of QoL would be useful for informing practice and policy related to resource allocation for bladder care post-SCI.

The Relationship between Engagement in Occupations and Pressure Sore Development in Saudi Men with Paraplegia

Various research studies have explored the factors that predispose people with spinal cord injuries to pressure sore development. Two hundred risk factors have been associated with pressure sore occurrence. One of the variables commonly reported to affect pressure sore occurrence is a decreased level of activity (Vidal and Sarrias 1991, Fuhrer et al 1993). This concurs with the philosophy of occupational therapy that a reduction in activity can generate pathology (Miller et al 1988).

This research study investigated whether decreased participation in occupational activities (work, leisure and activities of daily living) was related to pressure sore occurrence in paraplegic men. The sample was selected randomly from the occupational therapy discharge files of a rehabilitation facility in Saudi Arabia. The data were collected by means of a telephone questionnaire from a total of 58 men, over a 3-month period.

The study showed that there was a large increase in unemployment in paraplegic men following injury (from 10% to 59%) and, as might be expected, manual workers were more vulnerable than office workers. The study found no significant association between pressure sore occurrence and whether or not the individual was employed. However, it showed a statistically significant association between unemployment and pressure sores severe enough to lead to hospitalisation. The study also found a statistically significant association between individuals' independence in activities of daily living and the number of pressure sores that they had reported in the last 2 years.

These findings indicate the potential importance of clients remaining occupationally active for their wellbeing and the significant contribution that occupational therapists can make by enabling rehabilitation of occupational activities.

Identifying and classifying quality-of-life tools for assessing pressure ulcers after spinal cord injury

CONTEXT

Although pressure ulcers may negatively influence quality of life (QoL) post-spinal cord injury (SCI), our understanding of how to assess their impact is confounded by conceptual and measurement issues. To ensure that descriptions of pressure ulcer impact are appropriately characterized, measures should be selected according to the domains that they evaluate and the population and pathologies for which they are designed.

OBJECTIVE

To conduct a systematic literature review to identify and classify outcome measures used to assess the impact of pressure ulcers on QoL after SCI.

METHODS

Electronic databases (Medline/PubMed, CINAHL, and PsycInfo) were searched for studies published between 1975 and 2011. Identified outcome measures were classified as being either subjective or objective using a QoL model.

RESULTS

Fourteen studies were identified. The majority of tools identified in these studies did not have psychometric evidence supporting their use in the SCI population with the exception of two objective measures, the Short-Form 36 and the Craig Handicap Assessment and Reporting Technique, and two subjective measures, the Life Situation Questionnaire-Revised and the Ferrans and Powers Quality of Life Index SCI-Version.

CONCLUSION

Many QoL outcome tools showed promise in being sensitive to the presence of pressure ulcers, but few of them have been validated for use with SCI. Prospective studies should employ more rigorous methods for collecting data on pressure ulcer severity and location to improve the quality of findings with regard to their impact on QoL. The Cardiff Wound Impact Schedule is a potential tool for assessing impact of pressure ulcers-post SCI.

The quality of life of persons with TBI in the process of a comprehensive rehabilitation program

BACKGROUND

The aim of the research was to evaluate the effectiveness of the phased rehabilitation program in patients after traumatic brain injury, one developed by the authors and controlled by the strategic plan, pertaining to their quality of life compared to patients treated according to a standard, phased rehabilitation program.

MATERIAL/METHODS

The study included 40 patients of post traumatic brain injury treated at the Rehabilitation Clinic of the L. Rydygier Academy of Medical Sciences in Bydgoszcz and the Department of Medical Rehabilitation of the Cracow Rehabilitation Centre. An experimental group included 20 patients rehabilitated by a strategic approach and a control group consisted of 20 patients treated before the introduction of this approach. In assessing the effectiveness of rehabilitation, a structured interview was used with clinical observation and the Battery of Quality of Life Assessment. The study was conducted twice: before and after eight weeks of rehabilitation.

RESULTS

The quality of life of people after brain injury is affected by self-service difficulties, difficulties in meeting the physiological needs and loss of psychophysical comfort, decreased mobility, impaired cognitive functions and executive and social functions. There is no consistency between the stated (subjective) level of quality of life of the patient, and the depth of objectively measured disability resulting from the injury sustained.

CONCLUSIONS

A rehabilitation program controlled by a strategic plan, in collaboration with the patient treated subjectively is more effective in improving the quality of life, since the cooperating patient is more motivated to carry out individually designed goals. A rehabilitation program based on a strategic plan is worthy of recommendation for the treatment and improvement of patients after cranio-cerebral trauma.

An evaluation of the strategic approach to the rehabilitation of traumatic brain injury (TBI) patients

BACKGROUND

The objective of our study was to evaluate a goal-driven strategic plan for the step-by-step rehabilitation of traumatic brain injury (TBI) patients, with effectiveness measured in terms of quality of life, as compared to patients treated according to a standard, progressive rehabilitation program.

MATERIAL/METHODS

We studied 40 patients after TBI awakened from a long-term coma. The patients were divided into two equal groups: a control group (n=20) involving patients treated before the introduction of the strategic approach, and an experimental group (n=20) involving patients rehabilitated under the strategic approach. In evaluating the effectiveness of rehabilitation we used a structured interview with clinical observation and a scale for assessing the quality of life of patients after TBI.

RESULTS

The deterioration in the quality of life of TBI patients is mainly related to difficulties in satisfying physiological needs, self-care, reduced mobility and disorders of cognitive, regulatory, and social functions. In both groups, the feature most susceptible to rehabilitation related change was movement, while the least susceptible functions were associated with the use of different means of transport. This change is significantly greater in persons in the experimental group, as compared to controls.

CONCLUSIONS

We found that a rehabilitation program controlled by a strategic plan, with the cooperation of the patient, is more effective in improving the quality of life, as the patient is more self-motivated to individually designed objectives.

Quality of life, social participation, appraisals and coping post spinal cord injury: a review of four community samples

STUDY DESIGN

Cross-sectional or psychotherapy, questionnaire.

OBJECTIVES

To examine the community needs of people with spinal cord injury (SCI) across four European countries and to identify areas of unmet needs. It is intended that this information will be of use to rehabilitation professionals in fostering greater social participation among SCI individuals.

SETTING

United Kingdom, Germany, Austria and Switzerland.

METHODS

Self-report questionnaires were sent to 1000 people with SCI resident in the community in the UK, Germany, Austria and Switzerland. Questionnaires measured current needs, community integration, mood, appraisals, coping strategies, functional independence and perceived manageability.

RESULTS

Occupation, sexual activity and pain relief were areas indicative of highest community needs in all four countries. Most participants were psychologically well adjusted and socially integrated into the community. Well-addressed needs were skin management, wheelchair needs and accommodation. Some differences that occurred in certain areas across the four countries were found.

CONCLUSION

This study has highlighted that the main areas of unmet needs for a European community sample of people with SCI includes levels of occupation, sexual activity and pain relief. The findings will be of interest to those involved in rehabilitation of newly as well as long-term injured people and demonstrate the need to consistently re-address such issues as part of a person's long-term rehabilitation in order to achieve and maximise effective social participation.

Disordered control of the urinary bladder after human spinal cord injury: what are the problems?

Spinal cord injury has a profound impact on the storage and voiding functions of the urinary bladder. Loss of autonomic and somatic control mechanisms leads to hypo- or hyperactivity of the bladder wall and sphincters causing problems that range from incontinence to complete loss of the capacity to empty the bladder. This chapter outlines the types of bladder dysfunction that occur after spinal cord injury, their relative prevalence and current practices used to manage the problems. With all the interventions that are available, management of bladder function often still remains a compromise, as the medications and physical interventions available may stimulate or block components of the voiding reflex, but are often not fully restorative in this effort.

Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living

OBJECTIVES

To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI).

DESIGN

Cross-sectional survey.

SETTING

General community, international.

PARTICIPANTS

Volunteers (N=352) with SCI for more than 20 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The need for more help with ADLs.

RESULTS

The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI.

CONCLUSIONS

People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time.

The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured persons: Part III. Medical complications and associated factors

STUDY DESIGN

To study the short- and long-term medical complications encountered in tetraplegic spinal cord injured persons (TSCI) and to give prominence to both the medical and socio-economic factors with which they are respectively associated.

METHODS

The Tetrafigap Study is a multicentre epidemiological survey carried out using self-administered questionnaires studying the global long-term outcome of TSCI patients after the initial phase of rehabilitation.

RESULTS

The data for 1668 patients were analyzed. The rate of rehospitalizations was 74.4% with on average three stays per patient and as reported causes, in descending order: urinary complications, systematic follow-up, pressure sores, respiratory complications, contractures, bowel complications, pains and secondary fractures of the lower limbs. At the time of the survey, 84.7% of patients mentioned awkward contractures, 73.8% pains, 55.9% embarrassing urinary leakage and 14.1% pressure sores. With regard to persons suffering from complete motor lesion, urinary complications and pressure sores were more frequently reported, whereas for persons suffering from incomplete motor lesions, awkward contractures and pains were more frequent. In the elderly, pains were more often mentioned, and pressure sores and pain were also the most common in patients coming from lower socio-professional status. Contractures and pain decreased with time. All these complications but pressure sores and pain are statistically interrelated.

CONCLUSION

The medical complications of spinal cord injured persons are frequent, they are linked to biological, psychological and environmental factors, and are interrelated. Therefore, seeking mid- and long-term risk factors must be given priority in order to better adapt attempts at increasing secondary prevention.

Living with a pressure ulcer: a descriptive study of patients' experiences

This qualitative study explored the perceptions and feelings of patients with pressure ulcers. Five participants who had suffered from pressure ulcers extending into the subcutaneous tissue and deep fascia were interviewed. A semi-structured interview technique was used, in which participants were asked a series of open questions based on the reviewed literature and the author's clinical experience. Content analysis was used to analyse the interview transcripts. The following themes emerged: pain, exudate levels, loss of independence, emotional factors, worry about healing, relationships, body image and social isolation.