Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations of Saskatchewan: a prospective outcomes study

Background

People of Aboriginal (Indigenous) ancestry are more likely to experience traumatic spinal cord injury (TSCI) than other Canadians; however, outcome studies are limited. This study aims to compare Aboriginal and non-Aboriginal populations with acute TSCI with respect to preinjury baseline characteristics, injury severity, treatment, outcomes and length of stay.

Methods

This was a retrospective analysis of participants with a TSCI who were enrolled in the prospective Rick Hansen Spinal Cord Injury Registry (RHSCIR), Saskatoon site (Royal University Hospital), between Feb. 13, 2010, and Dec. 17, 2016. Demographic, injury and management data were assessed to identify any differences between the populations.

Results

Of the 159 patients admitted to Royal University Hospital with an acute TSCI during the study period, 62 provided consent and were included in the study. Of these, 21 self-identified as Aboriginal (33.9%) and 41 as non-Aboriginal (66.1%) on treatment intake forms. Compared with non-Aboriginal participants, Aboriginal participants were younger, had fewer medical comorbidities, had a similar severity of neurologic injury and had similar clinical outcomes. However, the time to discharge to the community was significantly longer for Aboriginal participants (median 104.0 v. 34.0 d, p = 0.016). Although 35% of non-Aboriginal participants were discharged home from the acute care site, no Aboriginal participants were transferred home directly.

Conclusion

This study suggests a need for better allocation of resources for transition to the community for Aboriginal people with a TSCI in Saskatchewan. We plan to assess outcomes from TSCI for Aboriginal people across Canada.

Epidemiology of traumatic spinal cord injury in New Zealand (2007-2016)

AIM

To investigate the epidemiology of traumatic spinal cord injury (TSCI) in New Zealand over a 10-year period.

METHODS

Ambispective data of all new patients admitted to New Zealand's two spinal rehabilitation units between January 2007 and December 2016 (n=929) were collated. Variables assessed included age at injury, gender, ethnicity, date of injury, aetiology, length of hospital stay, injury level, neurological status on discharge and discharge destination.

RESULTS

The incidence of TSCI averaged 22 (95% CI 21-24) per million, increasing 6% a year. The average incidence for Māori (29 per million people (95% CI 25-34)) was 1.8 times higher than New Zealand European (16 per million people (95% CI 15-18)), and show an increase of 14% a year. The median age of TSCI increased from 43 to 48 years. Overall, falls (32%), transport (32%) and sports (22%) were the most common causes of TSCI. Cervical TSCI (54%) were most common, particularly in older adults (70% over 75 years) and Māori (61%) and Pacific Island (72%) patients. Surgical rates remained stable (77%) but length of stay in hospital decreased over the study period.

CONCLUSIONS

The demographic of TSCI is changing in New Zealand. The median age of patients is increasing, as is the incidence, particularly for women, older adults and Māori patients.

Racial and Ethnic Differences in Obesity in People With Spinal Cord Injury: The Effects of Disadvantaged Neighborhood

OBJECTIVE

To examine the role of neighborhood in the relation between race and obesity in people with spinal cord injury (SCI).

DESIGN

A cross-sectional analysis of survey data from National SCI Database linked with neighborhood data from American Community Survey by census tract.

SETTING

A total of 17 SCI Model Systems centers.

PARTICIPANTS

Individuals (N=3385; 2251 non-Hispanic whites, 760 non-Hispanic blacks, 374 Hispanics) who completed a follow-up assessment during 2006-2017 (mean duration of injury, 8.3±9.9y) and resided in 2934 census tracts.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Body mass index (BMI) (kg/m2).

RESULTS

The overall prevalence of obesity was 52.9% (BMI≥25.0) and 23.3% (BMI≥30.0). Hispanics were 67.0% more likely to be obese (BMI≥30.0 kg/m2) relative to non-Hispanic whites (odds ratio, 1.67; 95% confidence interval, 1.27-2.18), after controlling for demographic and injury-related characteristics. Most of the non-Hispanic blacks (66.8%) were living in neighborhoods with high concentrated disadvantaged index (CDI), compared to 35.0% of Hispanics and 9.2% of non-Hispanic whites living in this similar neighborhood status (P<.0001). After accounting for CDI, the odds of being obese in Hispanics decreased (odds ratio, 1.51; 95% confidence interval, 1.15-1.99). Regardless of race and ethnicity, people with SCI from disadvantaged neighborhoods were 42.0%-70.0% more likely to be obese than those from minimal CDI neighborhoods.

CONCLUSIONS

Neighborhood characteristics partially diminish racial differences in obesity. Weight management for the SCI population should target those who are Hispanic and living in the disadvantaged neighborhoods.

Racial Differences in Weight Gain: A 5-Year Longitudinal Study of Persons With Spinal Cord Injury

OBJECTIVE

To assess racial differences in body mass index (BMI) change over 5 years among people with spinal cord injury (SCI).

DESIGN

Multicenter longitudinal study.

SETTING

Spinal Cord Injury Model Systems centers.

PARTICIPANTS

Individuals (N=437; 313 non-Hispanic white, 81 non-Hispanic black, and 43 Hispanic; 335 men; mean age, 41.3±13.5y) who incurred an SCI from 1974 to 2010 and completed 2 follow-up assessments within 5 years between October 1, 2006 and September 18, 2015 (mean duration of injury, 9.1±9.6y at the start of the 5-year follow-up).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

BMI (in kilograms per meters squared).

RESULTS

The mean BMI of 437 participants increased from 26.4±6.3 to 27.0±6.4kg/m² over 5 years (P=.002). The greatest increase was noted for Hispanics (2.0±5.7kg/m²; P=.02), followed by non-Hispanic whites (0.6±3.9kg/m²; P=.01) and non-Hispanic blacks (0.01±3.7kg/m²; P>.99). The differences in BMI increase across racial groups were significant (P=.03) in those with paraplegia (American Spinal Injury Association Impairment Scale A, B or C), those who were underweight or of normal weight at baseline, and those within 10 years of their injury. Such racial differences remained significant after taking into account demographic and injury characteristics.

CONCLUSIONS

Our study findings provide a foundation for future research to explore risk and protective factors that contribute to racial differences in weight gain after SCI, which help alert health care professionals to a high-risk group for obesity prevention and management.

Depressive symptomatology after spinal cord injury: A multi-center investigation of multiple racial-ethnic groups

OBJECTIVE

To identify (1) racial-ethnic differences in depressive symptomatology after spinal cord injury (SCI) and (2) the relationship of multiple additional factors to depressive symptoms, including health behaviors, employment, fatigue, and pain interference.

DESIGN

Cross-sectional Setting: Data were collected at 3 specialty hospitals in different regions of the USA (Southeastern, Mountain, Western).

PARTICIPANTS

Participants (N = 1,063) were identified from outpatient records of the 3 hospitals with oversampling of racial-ethnic minority groups.

INTERVENTIONS

N/A Main Outcome Measure(s): The outcome, depressive symptomatology, was measured by the Older Adult Health and Mood Questionnaire (OAHMQ). Participant demographic and injury characteristics were measured as statistical controls, as well as other variables including health behavior factors, depression/stress relief medication usage, fatigue, and pain interference. The multivariate analyses were developed using OLS regression models and logistic regression models.

RESULTS

Employment was protective for depressive symptomatology, whereas fatigue, pain interference, and binge drinking were risk factors for higher OAHMQ scores. Although there were no bivariate racial-ethnic differences in depressive symptoms, fatigue and pain interference had suppression effects on the relationship between race-ethnicity and depressive symptomatology. After controlling for fatigue and pain interference, Hispanic participants had significantly lower OAHMQ scores and lower odds of probable major depression (PMD) than non-Hispanic Whites and Blacks.

CONCLUSIONS

Fatigue and pain interference are associated with both race-ethnicity and depressive symptomatology. Assuming the same level of fatigue and pain interference, Hispanics will have a lower risk of depressive symptoms than non-Hispanic Whites and Blacks.

Epidemiological characteristics of adult SCIWORA in Tianjin, China: a preliminary study

INTRODUCTION

The epidemiology of spinal cord injury without radiographic abnormality (SCIWORA) is less frequently reported in adults as compared with children. The annual incidence of SCIWORA was approximately 5.74% per million in Tianjin from 2004 to 2008. Importantly, the epidemiological characteristics of adult SCIWORA may be different from that in children. The aim of this study was to evaluate the radiological-clinical data of patients with adult SCIWORA, and to relatively analyze the epidemiological features.

MATERIALS AND METHODS

Inpatients with cervical SCIWORA who were 16 and above in Tianjin were admitted in municipal hospitals in Tianjin from 2004 to 2008; all the patients received MRI scanning in sagittal and axial views. Epidemiological characteristics, such as injury origin, injury level or severity, neurological scale and MRI feature were acquired.

RESULTS

In total, 203 patients were enrolled. The average age among the adult groups was 55.9 years (men 55.8 years, women 53.6 years). SCIWORA occurred more commonly in adults in the 46-60 age group, and falls were the leading cause of injury (52.2%), followed by vehicular injury (28.6%). The most predominantly affected level was C4/5 (48.7%), followed by C5/6 (30.5%) and C3/4 (12.8%), respectively. The occurrence of central cord syndrome (50.2%) with posterior longitudinal ligament tear (43.8%) was relatively higher than other injury patterns.

CONCLUSION

It is clear that adult cervical SCIWORA is different from that in the pediatric group. Our study highlights the epidemiological properties of adult SCIWORA in Tianjin, China. Differing from other reports, particularly epidemiology study, we represent the first report regarding adult SCIWORA from China. As the geriatric population increases, it is very important to set up an individualized evaluation system based on a nationally scaled epidemiological database. The results from our study will be useful in assisting in the creation of such a database.

Quality of life among the traumatic spinal cord injured patients

OBJECTIVES

To study the quality of life among the traumatic spinal cord injured patients and to identify the factors related with the quality of life in the good level of such patients.

MATERIAL AND METHOD

The traumatic SCI patients who had been treated in the Department of Rehabilitation Medicine, Siriraj Hospital, Bangkok, Thailand from January 2003 until August 2009 were interviewed for the demographic data. The injury related data were obtained from the medical records. The WHOQOL-BREF-Thai was used to acquire the QOL score, which would be interpreted as poor fair, and good QOL level according to the questionnaire. The Center for Epidemiologic Studies Depression scale and the modified Barthel Index (BI) were used to assess depression, and functional disability respectively. The median split method was used to divide the participants into two groups as good and poor QOL groups. The Chi-square and Independent Sample t-test were performed to determine the difference between these two groups and multivariate logistic regression was used to analyze the factors associated with the good QOL. P-value < 0.05 was accepted as statistical significance.

RESULTS

Sixty-seven patients (49 males and 18 females) with a mean age 36.54 +/- 11.46 years old participated the present study. They suffered from traffic accident 67.2%, gunshot 16.4%, fall from a height 11.9%, and others 4.5%. The injury levels were cervical 31.3%, thoracic 50.7%, and lumbosacral 18%. Most of them (60.6%) had incomplete lesion. Eighteen patients (26.1%) reported depression. The mean BI score was 69.71 +/- 29.42. Three (4.5%), forty-nine (73.1%), and fifteen (22.4%) participants reported their QOL score in the range of poor, fair and good levels respectively. Using the median split method, participants with a score over 82 were classified as having good QOL groups and the rest were classified as having poor QOL group. When considering the score in each domain of the WHOQOL questionnaire, the differences between the good and poor QOL groups had statistical significance. The sufficient income (OR 13.67, 95% CI: 3.1-60.22, p = 0.001), having no depression (OR 7.6, 95% CI: 1.17-49.22, p = 0.033), and being employed (OR 6.88, 95% CI: 1.44-32.94, p = 0.016) were significantly related with the good QOL.

CONCLUSION

Most of the SCI patients determined their QOL as fair level. Sufficient income, having no depression, and being employed were associated with the good QOL.

Do racial and ethnic minority patients fare worse after SCI?: a critical review of the literature

A number of researchers have identified differences in SCI outcomes between racial and ethnic groups, but findings have never been synthesized to give clinicians and researchers a coherent picture of the problem. The goals of the current project were to (1) conduct a critical literature review of studies specifically investigating racial and ethnic disparities in spinal cord injury care, services, and outcomes; (2) explore possible causative factors that may explain these disparities; (3) propose strategies that may reduce disparities and improve access, service, and outcomes for minority patients with SCI; and (4) generate ideas for future research in this area. A search using MEDLINE/PubMed, PsycINFO, CINAHL, and HealthSource resulted in 49 articles discussing hospital, mental health, physical functioning, employment, quality of life, and family outcomes. Results indicated that after an SCI, racial and ethnic minority groups have shorter hospital lengths of stay, higher rehospitalizations rates, higher levels of depression, more days in poor health, greater degrees of unemployment, more difficulties with mobility, lower self-reported subjective well-being and quality of life and life satisfaction, and greater risk of marital breakup. A variety of causative factors, intervention strategies, and directions for future research are presented.

An analysis of the length of stay in traumatic and non-traumatic spinal cord injured patients. A rehabilitation unit experience in Saudi Arabia

OBJECTIVE

To determine and analyze the influence of age, gender, type of injury, and ethnicity in the length of stay (LoS) of in-patient rehabilitation unit patients after traumatic spinal cord injury (TSCI) and non- traumatic spinal cord injury (NTSCI).

METHODS

We conducted a retrospective study of all patients who completed the TSCI and NTSCI rehabilitation program at Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia from January 2005 to October 2008. Admission records of 495 traumatic spinal cord injured (male 404, female 91; mean age 34.30.68 years) and 126 non-traumatic spinal cord injured patients (male 81, female 45; mean age 451.56 years) were identified. We excluded patients aged < or = 10 and > or = 81 years due to the small proportion. The influence of age, gender, type of injury, and ethnic differences in the LoS were analyzed.

RESULTS

Compared with TSCI, patients with NTSCI had a significantly (p=0.035) shorter LoS (58.8+/-1.68, 46.2+/-2.1). The frequency of the TSCI was higher in the 21-30 age groups and lower in the 71-80 age group. Compared with TSCI, the frequency of NTSCI was less in all age groups. The LoS of male was longer than the female in all age groups. The LoS of Saudi patients were higher in TSCI (p=0.021) and NTSCI rehabilitation program compared with the non-Saudis.

CONCLUSION

The results of the study suggest that the gender, types of injury, and ethnicity differences were influencing factors of LoS of traumatic and non traumatic spinal cord injured patients.

Influence of season, ethnicity, and chronicity on vitamin D deficiency in traumatic spinal cord injury

BACKGROUND

Inadequate levels of vitamin D increase the risk of osteoporosis, a highly prevalent condition in patients with traumatic spinal cord injury (SCI). Reduced sunlight and dark skin further contribute to low vitamin D levels.

OBJECTIVES

To compare serum 25-hydroxy vitamin D [vitamin D25(OH)] levels in acute and chronic SCI and to explore seasonal and ethnic differences among patients with acute and chronic SCI.

PATIENTS/METHODS

Patients (N=96) aged 19 to 55 years with C3-T10 motor complete SCI participated. Acute SCI was 2 to 6 months after injury, whereas chronic SCI was at least 1 year from injury. Serum vitamin D25(OH), calcium, and parathyroid hormone were drawn dUring summer or winter months. Vitamin D deficiency (<13 ng/mL), insufficiency (<20 ng/mL), and subtherapeutic (<32 ng/mL) levels were compared for all groups. A 3-way analysis of covariance was adopted to determine significant main effects of season, chronicity, and ethnicity. Interactions between season and chronicity, season and ethnicity, and chronicity and ethnicity were evaluated. Evaluation of a 3-way interaction among season, chronicity, and ethnicity was completed.

RESULTS

In summer, 65% of patients with acute SCI and 81% of patients with chronic SCI had subtherapeutic vitamin D levels, whereas in winter, 84% with acute SCI and 96% with chronic SCI had vitamin D25(OH) (<32 ng/mL). Lower vitamin D25(OH) levels were observed in African Americans relative to whites. Significant main effects were noted for season (P = 0.017), chronicity (P = 0.003), and ethnicity (P < 0.001). However, interactions between 2 or more factors were not found.

CONCLUSIONS

Vitamin D insufficiency and deficiency are found in the majority of patients with chronic SCI and in many with acute SCI. Initial screening for serum vitamin D25(OH) levels should be performed early in rehabilitation. Periodic monitoring in the chronic setting is highly recommended.

Dimensions of quality of life for Chinese adults with spinal cord injury: A qualitative study

PURPOSE

The purpose of this study was to explore meaning and components of quality of life (QOL) perceived by Chinese adults with a spinal cord injury (SCI) and to examine the frame of reference that this population used to assess quality of their life.

METHOD

A qualitative research approach was used. Six focus group interviews were conducted with 40 adults with SCI from a northeastern city in China. A content analysis was conducted on interview data to determine meaning and components of QOL perceived by the participants.

RESULTS

Participants defined QOL as satisfaction with one's life, which might vary from person to person and change when the circumstance changed. They identified 18 QOL components that could be grouped into five domains: physical, psychological, economic, social well-being, and a least restrictive environment. When assessing quality of their life, participants used both internal (comparing with oneself) and external (comparing with others) comparisons.

CONCLUSIONS

The results of this study contribute to the understanding of dimensions of QOL for people with SCI in China. Although several domains of QOL identified in the present study were similar to those found in previous studies conducted elsewhere, several unique components of QOL, such as relationship with extended family and neighbours, government support, peace in the world and the nation, were identified by the participants. These components appeared to be related to the Chinese culture and socioeconomic system. Specific QOL measurements that address these unique components are needed when assessing QOL of this population.

Perceived information needs of community-dwelling persons with chronic spinal cord injury: findings of a survey and impact of race

OBJECTIVE

To examine the perceived information needs of community-dwelling individuals with chronic spinal cord injury (SCI) and to determine factors that influence these needs.

DESIGN AND PARTICIPANTS

Cross-sectional survey mailed to 620 persons with chronic SCI who completed acute inpatient rehabilitation.

RESULTS

Of 103 (17%) returned surveys, 82 contained complete information and were useable for this study. Individuals with chronic SCI (M time since injury = 7 +/- 6 years) endorsed a multitude of information needs across a broad range of domains. Participant endorsements were most commonly observed in the areas of aging (73%), research (72%), financial aid (66%), and education (63%). Independent variables expected to influence information needs, including Internet use, whether the rehabilitation specialist also served as the primary care physician, and time since injury, showed no significant effect. Race/ethnicity was found to predict perceived information needs, with nonwhite participants endorsing a significantly greater degree of needs than white participants in 11 of 23 (48%) domains.

CONCLUSIONS

Perceived information needs of community-dwelling persons with SCI are not fully met years after discharge from acute inpatient rehabilitation, which may have implications with respect to psychological adjustment. Race/ethnicity appears to exert a significant influence on the endorsement of perceived information needs, but this finding must be investigated further considering other possible mediating/moderating variables. Results must be considered in light of the relatively low response rate of eligible participants.

Sexuality after spinal cord injury: the Greek male's perspective

OBJECTIVE

This study explored how Greek men with spinal cord injury experience sexuality.

METHODS

Six men with spinal cord injury acted as key informants and data collection consisted of in-depth unstructured interviews, field notes, and a reflective log. The transcribed interviews were analyzed thematically.

RESULTS

The themes that emerged were: Barriers, Metamorphoses, and Enjoying. Sexuality was important in the life of the informants and they were engaged in various patterns of adaptation. Rather than impairment as such, certain social beliefs and values prevalent in Greek society were found to act upon the informants in compromising ways.

CONCLUSION

The results suggest that the process of reclaiming one's sexuality is a process of meaning-finding. The data support a conclusion that occupational therapists should respect the cultural nature of sexuality. Moreover, the topic of sexuality should be approached in a holistic manner, perceiving it as extending in a continuum, which may be positively or negatively affected as a result of an acquired impairment.

Racial disparities in health outcomes after spinal cord injury: mediating effects of education and income

OBJECTIVE

The purpose of this study was to investigate heath disparities as a function of race and gender and the extent to which socioeconomic factors mediate disparities among participants with spinal cord injury.

DESIGN

Survey methodology. Cross-sectional data.

SETTING

A large Southeastern specialty hospital.

PARTICIPANTS

There were 1342 participants in the current analysis, all of whom were identified from patient records. There were 3 inclusion criteria: (a) traumatic SCI, (b) at least 18 years of age at the time of study, and (c) injury duration of more than 1 year.

MAIN OUTCOME MEASURES

Six outcomes were measured, including 3 general outcomes (self-ratings, days impacted by poor health, days impacted by poor mental health) and 3 that reflect utilization of services (hospitalizations, days hospitalized, and nonroutine physician visits in the past 2 years).

RESULTS

RESULTS of multivariate analysis of variance (MANOVA) indicated significant main effects for both race and gender. Follow-up tests identified racial disparities on 3 of the 6 outcomes, whereas gender disparities were observed for a single outcome. Years of education and household income mediated interrelationships between race and health (but not gender) as racial disparities disappeared after consideration of these factors.

CONCLUSIONS

These findings suggest the need to work more diligently to promote better health outcomes among African Americans and to further investigate how socioeconomic factors and access to health care related to diminished health outcomes among African Americans with spinal cord injury.

Cross-cultural differences in preference for recovery of mobility among spinal cord injury rehabilitation professionals

STUDY DESIGN

Direct observation of a constrained consensus-building process in three culturally independent five-person panels of rehabilitation professionals from the US, Italy and Canada.

OBJECTIVES

To illustrate cultural differences in belief among rehabilitation professionals about the relative importance of alternative functional goals during spinal cord injury (SCI) rehabilitation.

SETTING

Spinal Cord Injury Units in Philadelphia-USA, Rome-Italy and Vancouver-Canada.

METHODS

Each of the three panels came to independent consensus about recovery priorities in SCI utilizing the features resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) assuming different stages of recovery.

RESULTS

Sphincter management was of primary importance to all three groups. The Italian and Canadian rehabilitation professionals, however, showed preference for walking over wheelchair mobility at lower stages of assumed recovery, whereas the US professionals set wheelchair independence at a higher priority than walking.

CONCLUSIONS

These preliminary results suggest cross-cultural recovery priority differences among SCI rehabilitation professionals. These dissimilarities in preference may reflect disparities in values, cultural expectations and health care policies.

Perceived quality of care and outcomes following spinal cord injury: minority status in the context of multiple predictors

OBJECTIVE

To determine whether patients with spinal cord injury (SCI) who are members of minority groups experience a disadvantage with regard to quality of care, and investigate predictors of perceived quality of care and indicators of outcome.

DESIGN

Correlational analysis of longitudinal data.

SAMPLE

One hundred and forty-three individuals with SCI in the first year following injury (43.3% tetraplegia, 56.7% paraplegia; 53.6% of total had complete injuries).

SETTING

Hospital and postdischarge (usually outpatient) care at 3 SCI model systems.

MAIN OUTCOME MEASURES

Perceived quality of acute, rehabilitative, and continuing care rated by patients according to standard format. Objective indicators of amount of care (eg, length of stay [LOS], charges) and outcomes (eg, medical complications, Functional Independence Measure [FIM] scores, a life satisfaction measure [the Diener Scale], and the Craig Handicap and Reporting Technique [CHART; a community participation scale]).

RESULTS

Minorities did not report statistically significant differences in perceived quality of care or other indicators (eg, amount of care, medical complications, FIM gain, life satisfaction, and CHART scores) compared with other groups. Severity of injury affected LOS and activity outcomes. Satisfaction with medical care before the injury significantly predicted perceived quality of acute hospital care, inpatient rehabilitation, and continuing care (P < 0.03, 0.02, and 0.02, respectively).

CONCLUSION

A number of factors may affect variations in perceived quality of care and outcomes, but ethnicity is not always the most important predictor. Asking patients about their satisfaction with previous care can assist in distinguishing satisfaction with current care from pre-existing biases.

Race, employment, and spinal cord injury

OBJECTIVES

To examine issues of employment and race for persons with spinal cord injury (SCI), by assessing the type of work that was being done before and after injury and by placing this in the context of patterns for the general population.

DESIGN

Retrospective, cross-sectional analysis.

SETTING

Centers funded as part of the federally sponsored Model Spinal Cord Injury Systems (MSCIS) Project.

PARTICIPANTS

Two samples: 5925 African Americans and whites with SCI who are part of the MSCIS and a subset of 577 people with SCI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Demographic information, occupational status, employment rate, job census codes, Craig Hospital Assessment and Reporting Technique-Short Form, and Satisfaction With Life Scale.

RESULTS

Racial disparities were found in employment rates before injury and at 1, 5, 10, 15, and 20 years after SCI. Differences were also found in the types of jobs that were held before SCI with patterns for participants similar to those of African Americans and whites in the general population. No differences were found in the types of jobs held by African Americans and whites with SCI at 1 year after injury. After injury, African Americans had lower economic self-sufficiency scores, regardless of employment status, and lower social integration scores among those who were not employed.

CONCLUSIONS

Racial disparities found in employment patterns among persons with SCI mirrored patterns among the general population.

Medical procedures, complications, and outcomes for patients with spinal cord injury: A multicenter investigation comparing African Americans and whites

OBJECTIVE

To examine the role of race on rehabilitation outcomes for a matched sample of patients with spinal cord injury (SCI).

DESIGN

African Americans and whites with SCI were matched based on age group, level and completeness of injury, and sponsor of care to retrospectively analyze the impact of race.

SETTING

Eighteen medical centers in the federally sponsored Model Spinal Cord Injury Systems project.

PARTICIPANTS

A total of 628 adults with SCI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Medical procedures and complications; American Spinal Injury Association motor index, and FIMT instrument scores at admission and discharge; and discharge dispositions.

RESULTS

Analysis revealed race-related differences in spinal surgeries, laparotomies, traction during acute care, and method of bladder management at discharge. In most cases, these were explained by cause of injury rather than direct affects of race. No differences were found with regard to medical complications functional outcomes, or discharge disposition.

CONCLUSIONS

Although differences exist in the medical procedures given to African Americans and whites with SCI, they are generally accounted for by cause of injury rather than the direct affects of race.

Outcomes after spinal cord injury: comparisons as a function of gender and race and ethnicity

OBJECTIVE

To identify gender and racial and ethnic differences in subjective well-being (SWB), participation, and general health ratings in participants with spinal cord injury (SCI).

DESIGN

A multisite, cross-sectional study that used stratified sampling to identify and maximize participation among groups of people traditionally underrepresented in SCI research.

SETTING

Four Model Spinal Cord Injury Systems participated in the data collection. The primary site was a large southeastern specialty hospital; the other 3 were in the western and mountain regions of the United States.

PARTICIPANTS

A total of 512 participants, 475 of whom were included in the analysis. This group included relatively equal portions of whites, African Americans, American Indians, and Hispanics. Approximately 40% of the sample was women.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The primary outcome measures included 2 measures of SWB (Life Situation Questionnaire-Revised, Older Adult Health and Mood Questionnaire), 1 measure of participation (Craig Handicap Assessment and Reporting Technique), and several items from the Behavioral Risk Factor Surveillance System.

RESULTS

The majority of racial and ethnic differences in SWB related to specific life areas (eg, economics, employment), rather than more global outcomes (eg, engagement, health), with whites generally reporting the best outcomes, followed by African Americans. American Indians, and whites generally reported the highest participation scores, whereas limited differences were noted between the racial and ethnic groups on health indicators. Women reported lower satisfaction with health, more poor mental health days, and lower SWB related to home life, but higher SWB related to interpersonal relations.

CONCLUSIONS

There are racial and ethnic differences in outcomes after SCI focused primarily on subjective outcomes in areas in which racial and ethnic minorities have traditionally been disadvantaged. The results of this study direct rehabilitation professionals to the outcomes that need to be targeted for intervention to eliminate inequities in outcomes for all persons with SCI.

Subjective well-being among African-Americans with spinal cord injury: an exploratory study between men and women

OBJECTIVE

The purpose of this study was to identify gender differences in subjective well-being among 309 African-American participants with spinal cord injury (SCI).

DESIGN

Cross-sectional.

SETTING

A Southeastern specialty hospital.

PARTICIPANTS

There were a total of 309 participants, all of whom were African-Americans. All participants had traumatic SCI, were at least 18 years or older at the time of the study, and a minimum of one year had passed since SCI onset.

MAIN OUTCOME MEASURES

Measures of subjective well-being included the Life Situation Questionnaire--Revised, Purpose in Life scale, and the Older Adult Health and Mood Questionnaire.

RESULTS

Multiple gender differences were observed, with women reporting higher scores on depressive symptoms and negative affect, but lower scores on purpose in life. Other significant findings were observed related to self-reported problems, with men reporting greater problems with pressure ulcers and sexual issues and women reporting greater problems in several areas related to coping and affect. The only gender difference in life satisfaction indicated greater satisfaction with sex life among women.

CONCLUSION

It is clear from the findings that differences do exist among male and female African-Americans with spinal cord injuries. More research is needed to definitively outline differences.

Breast and gynecologic health-screening behaviors among 191 women with spinal cord injuries

OBJECTIVE

The purpose of this study was to advance the understanding of preventive health behaviors of women with spinal cord injury (SCI) by comparing the frequency of preventive health behaviors (a) between women with SCI and women in the general population, and (b) among women with SCI as a function of race/ethnicity and socioeconomic status (SES).

DESIGN

Telephone interviews.

PARTICIPANTS

191 women with SCI who had been treated at 1 of 4 Model SCI Systems hospitals. The sample included 66 white women, 59 African American women, 22 American Indian women, and 44 Hispanic women.

MAIN OUTCOME MEASURE

The Behavioral Risk Factor Surveillance System.

RESULTS

Study participants reported significant differences in their frequency of either mammograms or Pap smears when compared with the general population. However, no significant differences were found among study participants when rates were compared by race/ethnicity to the general population. Also, no differences were found among the women with SCI as a function of race/ethnicity or income level.

CONCLUSION

The results are encouraging, because no deficits in preventive health care were identified among women with SCI as a function of race/ethnicity or SES.

The importance of cultural assessment

This article presents the importance of cultural assessment to care of patients in general, with a description of the background development of the Sharma Cultural Assessment Instrument and its potential application to care of persons with spinal cord impairment (SCI). A description is presented of the research questions, methods, and results of the doctoral study in which the instrument was originally developed, as well as the explanation of why particular parts of the instrument are significant to care of the patient. A description of how cultural assessment data had an impact on care of a particular geriatric patient is used as an example of the importance of this additional information. The significance of cultural data for care of the person with an SCI concerns such areas as explanatory models, fears and concerns, and the relationship of the nurse with the culturally diverse patient.

Impact of minority status following traumatic spinal cord injury

OBJECTIVE

To interpret the data from the Spinal Cord Injury-Model Systems as it applies to demographics, incidence and functional outcomes of minority patients with spinal cord injury.

DESIGN

Retrospective analysis of patients admitted to acute inpatient rehabilitation Spinal Cord Injury Model Systems Centers.

RESULTS

Descriptive statistics including means, standard deviations, and proportions were computed for all relevant variables. Participants were grouped into two categories for purposes of analysis, non-minorities (white) and minorities, who were >90% African American. Differential statistics were used for comparisons with regard to demographics, etiology, sponsor of care, length of stay, charges, ASIA Motor Index scores, and FIM scores. Categorical data was analyzed using chi-square analyses while continuous data were analyzed using ANOVA procedures. Analyses revealed significant differences between minorities and non-minorities in terms of age at injury, gender, marital status, employment status, education level, health insurance provider, injury severity, etiology, and discharge disposition.

CONCLUSION

Analysis of the data indicates that violence is the leading single cause of spinal cord injury in minority patients admitted to the model systems centers. The majority of patients who sustained spinal cord injury secondary to violence were minorities with the following demographics: young, single, unemployed males, with less than a high school education, residing in an urban area.

Race: predictor versus proxy variable? Outcomes after spinal cord injury

OBJECTIVE

To examine the impact of race on acute, rehabilitation, and long-term outcomes after spinal cord injury (SCI).

DESIGN

Two case control studies (study 1: acute and rehabilitation outcomes, study 2: long-term outcomes) in which white and nonwhite individuals were matched case for case on multiple demographic, medical, and geographic characteristics with the rationale being that a case-control methodology would increase the internal validity of the design, thereby increasing confidence in the assertion that any between-group differences observed may be specifically attributed to race.

SETTING

Data drawn from the Spinal Cord Injury Model Systems. Institutional practice and general community.

PARTICIPANTS

Study 1: 187 pairs of individuals, study 2: 158 pairs of matched individuals.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Outcome measures assessed included economic (eg, cost of care), treatment-related (eg, length of hospital stay), functional (eg, FIM instrument), and medical (eg, number of medical complications) variables, as well as self-reported life satisfaction, level of handicap, and mental and physical health.

RESULTS

In study 1, none of the outcome measures differed significantly across racial groups. Similarly, study 2 failed to indicate significant differences in any of the outcome variables across racial groups, with the exception that nonwhites were at increased risk of greater self-reported handicap in the area of mobility. Power analyses indicated these finding were not merely the result of inadequate power.

CONCLUSION

For the outcomes assessed in studies 1 and 2, race appeared to act primarily as a proxy for other variables (eg, injury severity, age, educational achievement), which in turn may be associated with poor outcome after SCI. Theoretical implications and recommendations are discussed.

Re-examining the psychology of spinal cord injury: a meaning centered approach from a cultural perspective

OBJECTIVES

To examine the impact of SCI from a non-Western cultural perspective.

SETTING

India.

METHODS

A philosophical approach.

CONCLUSION

Management of the individual with spinal cord injury needs to take in to account the individual's beliefs and cultural context.

How does spinal cord injury affect marital relationship? A story from both sides of the couple

PURPOSE

To explore the impact of spinal cord injury (SCI) upon the family and marital relationship in Hong Kong.

METHOD

Semi-structured interviews were conducted on 66 persons with SCI and 40 spouses. Qualitative information on family and marital relationships, life satisfaction, social functioning and leisure activities was transcribed and analysed.

RESULTS AND CONCLUSION

It was found that the impact of the SCI was manifested in different but interrelated aspects onto the individuals and their spouses. However, many of the problems were due to the lack of communication between them. Rehabilitation professionals should then treat the couple as a single unit in order to facilitate mutual understanding and get rid of any distorted perception.

Coping with spinal cord injury: personal and marital adjustment in the Hong Kong Chinese setting

STUDY DESIGN

A cross-sectional retrospective study was carried out with structured questionnaires and semi-structured interviews on 66 persons with spinal cord injury (SCI) and 40 spouses.

OBJECTIVES

The study aimed to explore the psychosocial adjustment of Hong Kong Chinese couples at the post SCI stage. An important study interest was the impact of care-giving in spouses of persons with SCI.

SETTING

Three major regional rehabilitation centres and one community resource centre in Hong Kong.

METHODS

A set of psychometric measures tapping different aspects of psychological functioning was included. These were locus of control (Levenson's Internality, Powerful Others, and Chance Scale), perceived social support (Provision of Social Relationship), coping strategies (Ways of Coping Checklist), marital adjustment (Dyadic Adjustment Scale), caregiving burden (Caregiver Burden Inventory), depression (Beck Depression Inventory), life satisfaction (Satisfaction with Life Situation), and social role adjustment (Katz Adjustment Scale - Relative Form).

RESULTS

Persons with SCI with pre-injury marriage were more depressed (P<0.05) as compared with those with post-injury marriage. However, the two groups did not differ in terms of satisfaction with life situation and social role dissatisfaction. The spouses in the preinjury marriage reported a significantly higher score in time-dependent burden than those in the post-injury marriage (P<0.05). Care-giving burden was associated with locus of control, social support, and modes of coping (P<0.05).

CONCLUSION

The impact of SCI is a long-lasting effect not limited to the patients but also extending to their spouses. Findings from the adjustment outcomes and coping styles of persons with SCI and their spouses indicate that they are not passive victims. A similar injury may produce different outcomes in different individuals. Rehabilitation professionals should thus be alert to both the couple's differing needs and idiosyncrasies in their helping process.

Health behaviors among American Indians with spinal cord injury: comparison with data from the 1996 Behavioral Risk Factor Surveillance System

OBJECTIVE

To identify patterns of health behaviors and health outcomes among a sample of American Indian men with spinal cord injury.

DESIGN

Telephone interviews with all participants, except those who did not have telephones (they returned materials by mail).

SETTING

Large rehabilitation hospital in the Western mountain region of the United States.

PARTICIPANTS

Seventy-six American Indian men with traumatic SCI of at least 1 year in duration.

MAIN OUTCOME MEASURE

Selected health-related behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) were used to assess health behaviors and general health outcomes among the American Indian SCI sample and to compare findings with those from American Indian men without SCI based on nationwide BRFSS data.

RESULTS

The study participants reported lower overall health and satisfaction with health care than the non-SCI BRFSS group. They also reported a different pattern of health behaviors, including a greater frequency of inoculations for flu and pneumonia but a lower rate of HIV testing and cholesterol screening. A smaller percentage of American Indians used alcohol, but those who did reported more heavy drinking.

CONCLUSIONS

American Indians with SCI are more likely to receive health care consistent with the prevention of secondary conditions of SCI (eg, pneumonia), but less likely to receive basic health screens intended to prevent chronic health diseases.

Postrehabilitation outcomes after spinal cord injury caused by firearms and motor vehicle crash among ethnically diverse groups

OBJECTIVES

To determine the differential effects of impairment, disability, etiology, and selected preinjury and social factors on medical complications, medical resources use, and handicap after rehabilitation for spinal cord injury (SCI).

DESIGN

Survey including interview and medical record review.

SETTING

Model SCI Care System centered at an urban, public medical center.

PARTICIPANTS

A volunteer convenience sample of 164 men, ages 18 to 35yrs at injury, with SCI caused by firearms or motor vehicle crash.

MAIN OUTCOME MEASURES

Mean numbers of documented complications, pressure sore episodes, nonroutine clinic visits, postrehabilitation hospitalization days per year, assessment by Functional Independence Measure (FIM), and total score on the Craig Handicap Assessment and Reporting Technique (CHART).

RESULTS

Significant factors for postrehabilitation complications were discharge FIM (p < .001) and injury duration (p = .046); for pressure ulcer episodes, they were injury completeness (p < .001), drug abuse following injury (p = .005), and ethnicity (p = .043); for average annual nonroutine clinic visits, they were complications (p < .001), pressure ulcer episodes (p < .001), duration of injury (p = .001), and pain (p = .052); for hospitalization, they were pressure ulcer episodes (p < .001) and complications (p = .043); for CHART scores, they were discharge FIM (p < .001), preinjury education (p < .001), hospitalization (p = .007), chronic pain (p = .01), longest time at one job (p = .02), completeness of injury (p = .042), and preinjury employment (p = .049).

CONCLUSIONS

Disability is the most important factor in postrehabilitation outcomes for SCI, followed by injury completeness, which is also associated with multiple outcomes. Postinjury but not preinjury drug abuse is adversely associated with outcomes. Etiology and ethnicity are not important determinates of outcome.

Dimensions of subjective well-being after spinal cord injury: an empirical analysis by gender and race/ethnicity

OBJECTIVE

The purpose of this study was twofold: (1) to identify the underlying dimensions of subjective well-being after spinal cord injury (SCI), and (2) to develop reliable scales based on measurement of these dimensions.

DESIGN

A field study was conducted by surveying the subjective well-being of two large samples of participants with SCI. Principal axis factor analysis with varimax rotation was applied to participant responses to 50 subjective well-being items.

SETTING

All participants were selected from the outpatient files of two midwestern rehabilitation hospitals and from a large southeastern rehabilitation hospital.

PARTICIPANTS

There were a total of 1,032 participants, 435 from the Midwest and 597 from the Southeast.

MAIN OUTCOME MEASURES

The Life Situation Questionnaire-revised version (LSQ-R) was used to measure subjective well-being. It included two prominent sections, one for life satisfaction (20 items) and the other for self-reported problems (30 items).

RESULTS

Seven subjective well-being factor scales were identified across the full participant sample: Engagement, Negative Affect, Health Problems, Career Opportunities, Finances, Living Circumstances, and Interpersonal Relations. The average alpha coefficient was .86 for the factor scales. Separate analyses of the midwestern and southeastern samples suggested stability of the factor structure, although gender and race/ ethnicity were related to subtle differences in subjective well-being.

CONCLUSIONS

The results suggest that rehabilitation professionals need to pay attention to multiple aspects of subjective well-being after SCI.

Ethnicity effect on the serum lipid profile in persons with spinal cord injury

OBJECTIVE

The potential effect of ethnicity on the serum lipid profile and lipoprotein(a) [Lp(a)] was studied in a population with chronic spinal cord injury (SCI).

STUDY DESIGN

The distribution and correlates of high density lipoprotein (HDL) cholesterol and Lp(a) were studied in a population of 600 subjects with chronic SCI.

RESULTS

Mean +/- SEM serum HDL cholesterol was significantly higher in the African American group than in the white and Latino groups (47 +/- 1 vs 40 +/- 1 and 38 +/- 1 mg/dL, p < .0001, respectively). The African American group had a lower serum total to HDL cholesterol ratio than white and Latino groups (4.46 +/- .153 vs 5.18 +/- .168 and 5.40 +/- .140 mg/dL, p < .01, respectively). Mean serum Lp(a) levels were significantly higher in the African American group than in Latino or white groups (29 +/- 2 vs 18 +/- 1 and 15 +/- 1 mg/dL, p < .0001, respectively). Age, duration of SCI, and level and completeness of lesion had no significant effect on serum Lp(a) level.

CONCLUSIONS

In a population with chronic SCI, those in the African American group had the highest serum HDL cholesterol concentrations, the lowest serum total to HDL cholesterol ratios, and elevated levels of serum Lp(a) compared with the Latino and white groups. In a population of individuals with chronic SCI, ethnicity was shown to have a major effect on serum lipids and may be used to assist in the determination of cardiovascular risk.

Firearm versus motor vehicle related spinal cord injury: preinjury factors, injury characteristics, and initial outcome comparisons among ethnically diverse groups

OBJECTIVE

To determine the extent to which individuals with spinal cord injuries caused by firearms differed from those caused by motor vehicle crash (MVC) in terms of selected preinjury factors, injury characteristics and related treatment, and outcomes at discharge from rehabilitation; and to determine the effect of ethnicity on preinjury factors and outcome.

DESIGN

Survey including interview of former rehabilitation inpatients and medical records review.

SETTING

Model Spinal Cord Injury Care System centered at an urban, public rehabilitation medical center.

PARTICIPANTS

Volunteer convenience sample of 164 men who were between the ages of 18 and 35 years at the time of injury and who were injured by firearm or MVC between January 1, 1980 and December 31, 1989. Subjects had completed rehabilitation at a rehabilitation center; they were non-Latino White, African-American, or Latino. Subjects were contacted by mail and telephone. The sample was comprised of 26% of the potential participants; however, differential follow-up rates were highly consistent with distribution of primary characteristics within the population of potential candidates.

MAIN OUTCOME MEASURES

The Functional Independence Measure (FIM) and total and rehabilitation lengths of stay were the outcome measures. Groups and outcomes were also compared in terms of preinjury education, employment, and indicators of antisocial behavior, as well as neurological deficit, associated injuries, and surgical treatment.

RESULTS

The firearm and MVC groups were different in terms of ethnic distribution. There were no non-Latino Whites in the firearm group and few African-Americans in the MVC group. With the exception of preinjury education, nonparametric and univariate tests showed differences between the firearm and MVC groups in terms of preinjury employment and indicators of antisocial behavior, associated injuries, surgical treatment, neurological deficit, and lengths of stay. Changes in FIM scores, however, were not different between etiologic or ethnic groups. Multiple regression indicated that injury severity accounted for the largest variance in outcomes and that preinjury factors, etiology, and ethnicity did not contribute significantly to the variance in outcome measures.

CONCLUSIONS

Although preinjury factors are associated with ethnicity and minorities have higher proportions of SCI caused by firearms, these factors do not significantly influence rehabilitation outcomes at discharge. The primary factors influencing rehabilitation outcomes are related to the deficits, associated physical injuries, and related treatments common to the causes of the injury.

Vitamin D deficiency in veterans with chronic spinal cord injury

Chronic spinal cord injury (SCI) is associated with osteopenia, increasing the prevalence of long-bone fractures. Although disuse may be the primary cause of osteopenia, identification of any additional mechanisms of bone loss may lead to potential therapeutic interventions. We investigated the relationships of serum calcium (Ca), phosphorus (PO4), albumin, alkaline phosphatase (Alk P), and parathyroid hormone (PTH) with serum 25-hydroxyvitamin D [25(OH)D] in 100 subjects with chronic SCI and 50 control subjects. in a subgroup of 50 subjects with SCI and 50 control subjects, we correlated these parameters with serum 1,25-dihydroxyvitamin D [1,25(OH)2D]. Mean ages for the group with SCI and the controls were the same. In subjects with SCI, the duration of injury was 20 +/- 1 years (mean +/- SD). Thirty-two of 100 subjects with SCI, as compared with eight of 50 controls, had serum 25(OH)D levels less than the normal range (chi2 = 4.36, P < .05). In subjects with SCI, a negative correlation was demonstrated between serum 25(OH)D and PTH (r = .29, P < .005). Mean serum 1.25(OH)2D levels were significantly elevated in subjects with SCI as compared with controls (61 +/- 21 v 46 +/- 18 pg/mL, P < .0005). Twenty of 50 subjects with SCI had serum 1.25(OH)2D levels greater than 62 pg/mL, as compared with 10 of 50 controls (chi2 = 4.76 P < .05). A positive correlation was found between serum PTH and 1,25(OH)2D in subjects with SCI and controls (r = .41, P < .005 and r = .30, P < .05, respectively). Twelve subjects with SCI had serum PTH levels greater than the normal range. In this high-serum PTH subgroup, serum 15(OH)D concentration was significantly lower (P < .05) and serum 1,25(OH)2D and Alk P concentrations were significantly higher (P < .005 and P < .05, respectively) as compared with the subgroup with serum PTH values within the normal range. In subjects with SCI, 17 had a serum Ca concentration less than 8.5 mg/dL. In persons with SCI, depressed levels of serum 25(OH)D, as well as other factors, may result in forces inclined to reduce the serum calcium concentration. A state of mild secondary hyperparathyroidism may result, thus increasing the conversion of serum 25(OH)D to 1.25(OH)2D. These data suggest that in chronic SCI subjects, as in the general population, secretion of PTH and the increase of circulating 1.25(OH)2D are subject to control by negative-feedback mechanisms. Higher levels of serum PTH would be expected to accelerate bone resorption of a skeleton already regionally osteoporotic as a consequence of the bone mineral loss due to acute immobilization.

Vertebral fracture prevalence in women in Hiroshima compared to Caucasians or Japanese in the US

BACKGROUND

Although vertebral fractures are very common among elderly Caucasian women, no studies have compared the prevalence to that among Asian populations. Any observed differences in prevalence might lead to the identification of important environmental and/or genetic factors. We therefore compared the prevalence of vertebral fractures among US Caucasians to native Japanese and Japanese immigrants in Hawaii using a standardized approach.

METHODS

Spinal radiographs of women aged > 50 years were obtained from native Japanese in Hiroshima, Japanese-Americans in Hawaii, and North American Caucasians in Minnesota between 1982 and 1991. Fractures were defined as vertebral heights > 3 standard deviations (SD) below the vertebra-specific mean.

RESULTS

Compared to Japanese-Americans, odds ratios (OR) and 95% confidence intervals (CI) for prevalent vertebral fractures were 1.8 (95% CI: 1.3-2.5) for native Japanese women and 1.5 (95% CI: 1.1-2.1) for Minnesota Caucasians. The OR tended to be higher when comparing the prevalence of two or more fractures per person: OR = 3.2 (95% CI: 2.0-5.3) for native Japanese and OR = 1.9 (95% CI: 1.2-3.2) for Minnesota Caucasians. Similar results were observed for native Japanese using a fracture definition of > or = 4 SD below the mean, but the OR for Caucasians was reduced to 1.2 (95% CI: 0.6-2.3).

CONCLUSION

The observation that, among these three populations, hip fracture incidence is lowest but spine fracture prevalence is greatest among native Japanese suggests that different risk factors may be responsible.

[Nursing diagnosis of sexual dysfunction. Defining characteristics in patients with spinal cord injuries]

The alterations of sexual function after spinal cord injury demands assistance because of cultural, psychological and biological aspects to keep. This study shows the defining characteristic, relacioned to nursing diagnosis sexual dysfunction (NANDA), in spinal cord injured patients on rehabilitation program.

Spinal cord injury in youth

To identify special characteristics of the pediatric spinal cord-injured (SCI) population, we analyzed a database of 1,770 traumatic SCI patients; 88 (5%) fell into the two pediatric subgroups: 0-12 years (n = 26) and 13-15 years (n = 62) at time of injury. Differences between age groups were identified with regard to demographics, neurologic characteristics, associated injuries and complications, and management. Mode level of bony injury was C2 in preteens, C4 in teens, and C4-C5 in adults. Scoliosis developed far more frequently in children, particularly preteens (23%), than in adults (5%). Violent etiologies, predominantly gunshots, accounted for a disproportionate share of injuries to preteens (19%) and African-Americans (28%), as compared with adults (12%) and Caucasians (7%). This last finding underscores the urgent need to mount a response to the nationwide proliferation of gunshot-related SCI in children and minorities.

Spinal cord injury care system: fifteen-year experience at the Rehabilitation Institute of Chicago

A statistical study of 15 years of the spinal cord injury care system of the Rehabilitation Institute of Chicago is reported. The Rehabilitation Institute of Chicago (RIC) is the rehabilitation component of the Midwest Regional Spinal Cord Injury Care System, a collaborative programme with Northwestern Memorial Hospital and Northwestern University. Data are reported on 1382 patients, a representative sample of the over 2000 patients treated since the inception of the centre. The sample was predominantly male (83%, N = 1147) and caucasian (64%, N = 888). The most common aetiology was motor vehicle accidents (36%, N = 505). During the 15-year period there were significant decreases in both acute and rehabilitation lengths of stay. Ninety three per cent of the patients were discharged home. Rehabilitation benefits were demonstrated by improvements in the Modified Barthel Index. The research, educational and clinical programmes are described.