AIM:To assess the prevalence of bowel dysfunction in hemiplegic patients, and its relationship with the site of neurological lesion, physical immobilization and pharmacotherapy.

Spinal cord injuries (SCI) often have psychological consequences, primarily anxiety and depression, which may interfere with rehabilitation possibilities, with adjustment to the impairment and therefore with the possibility of returning to previous familiar social life and work. To assess the degree of anxiety and depression in SCI patients, and to study the factors contributing to their genesis, 100 SCI in-and out-patients were administered questionnaires for self-rating anxiety and depression. A group of newly injured patients was followed up for a year after their discharge to study the evolution of the two psychological syndromes. These two psychological pathologies in SCI patients were respectively 13% (anxiety) and 16% (depression). Some characteristics were signi®cantly associated with a higher risk of developing psychological distress: the presence of severe complications, the lack of autonomy, and low educational level. We did not observe any modi®cation of the psychological picture over time. The lack of reduction in anxiety and depression over time could mean that the two pathologies are maintained by the obstacles SCI patients meet every day resulting from their neurological de®cit. Our data justify the provision of psychological services for SCI patients in the rehabilitation centres; these services should still be available to the patients even after discharge.

Objective: To examine the in¯uence of social, physical and psychological factors in determining the usage/non usage of reciprocating gait orthosis (RGO) in spinal cord injury (SCI) patients. Design: Prospective clinical trial. Setting: A large rehabilitation hospital in Rome, Italy. Participants: Twenty four SCI patients of traumatic aetiology (all ful®lling the criteria to prescribe the device). Methods: Social, physical and neurological examination according to ASIA standards; psychological enquiry by means of the Eysenck Personality Questionnaire (EPQ) and the scale for self rating anxiety and depression of the Cognitive Behavioural Assessment. Results: After 1 year follow up 11 (46%) of our patients no longer used the RGO. There was no statistically signi®cant dierence between patients who used the RGO and those who rejected the orthosis with regard to social and physical data. There was a signi®cant dierence (P=0.005 at the end of training and P=0.003 at 1 year follow up) with regard to functional ambulation level. With regard to psychological enquiry RGO-non users showed a higher frequency of values over the mean in the E scale (extroversion) of the EPQ than RGO-users (P=0.05). Conclusions: None of the identi®ed parameters were useful to predict the use/rejection of the orthosis. Although they need to be con®rmed, our psychological data suggest that extensive psychological testing could be useful to sharpen the ability to predict. Spinal Cord (2000) 38, 555 ± 558

These findings demonstrate that sports activity is associated with better psychological status in SCI patients, irrespective of tetraplegia and paraplegia, and that psychological benefits are not emphasized by demographic factors.