Study design: Cross-sectional survey. Objectives: To investigate factors related to length of time between spinal cord injury (SCI) onset and start of first post-injury employment. Setting: Persons living with SCI in the community who are members of a disability support organization. Methods: Participants were randomly selected from the membership list of a non-governmental voluntary organization. They met the following four criteria: traumatic SCI, minimum of 15 years of age at the time of survey, a minimum of 2 years after SCI and had been employed for some time since SCI. The main outcome measure was time (in years) from injury onset to beginning first post-injury job. Results: Participants averaged 4.9 years (s.d. 5.1) from the time of SCI to their first post-injury job, with a range of 3 months to 20 years. Fifty percent of the participants who eventually returned to work had done so by 4 years. Return to pre-injury employer and employment were associated with early return, whereas having less years in education and being older at the time of injury were associated with longer time to return to work. Conclusion: Rehabilitation team need to consider return to employment as a realistic goal even many years after SCI. Perhaps a focus on returning more people to their pre-injury employer and employment with added focus and input from rehabilitation team for those with lower education status and older age at time of injury might expedite the process of reintegration.

Study design: This study is a cross-sectional, face-to-face interview. Objectives: To examine the sexual activity in a sample of Malaysian women with traumatic spinal cord injuries (SCIs), identify the physical and psychological barriers to it, and explore their experiences with sexual counseling and rehabilitation. Setting: This study was conducted at the Spinal Rehabilitation Unit of a teaching hospital. Methods: All women who attended scheduled check-ups, over 1 year, and who met the inclusion criteria (age above 18 years, spinal injury of traumatic aetiology, living in the community and having completed the rehabilitation) were consecutively included in a face-to-face interview using a selfconstructed questionnaire. Sociodemographic and disability-related variables, barriers to sexual activity/ satisfaction and experiences of sexual rehabilitation services were obtained. Results: During the study period, 33/36 subjects were recruited. Although 67% indicated interest in sexual activity, only 24% was sexually active. The frequency of sexual activity declined after the injury, from 4.6 times per month to 1.5 times per month. Feeling unattractive, unable to satisfy the partner and less confident about sexual ability were top three psychological barriers to sexual activity, and the top three physical barriers were impaired genital sensation, positioning and vaginal lubrication. In all, 50% received some sexual information during rehabilitation. Rehabilitation professionals were expected to initiate sexual counseling by 62.5% of subjects. Conclusion: The effect of SCIs on sexual function is tremendous. Sexual counseling services must be improved and take into account the impact of psychological factors.

Case report: A case of progressive sacral swelling in a paraplegic man who sustained spinal cord injury 14 years ago is presented. Although his clinical features were suggestive of pseudomeningocoele, we were unable to confirm the diagnosis preoperatively. Conclusion: Traumatic spinal pseudomeningocoele is very rare. Even with the available modern diagnostic imaging techniques, it is still difficult to diagnose a spinal pseudomeningocoele.

Study design: A cross-sectional experimental study. Objective: The purpose of this study is to examine the benefit of elastic abdominal binders on voluntary cough in persons with spinal cord injury. Setting: Spinal rehabilitation unit in a teaching hospital. Methods: We measured voluntary cough peak expiratory flow rate (in 21 subjects with spinal cord injury, (18 tetraplegia, 3 paraplegia) under three conditions: without abdominal binder as the baseline, with single-strap abdominal binder and triple-strap abdominal binder. Results:The results showed that the mean cough peak expiratory flow rate in all subjects without abdominal binder was 277.1 l per min. There was a significant increase in flow rate with the use of abdominal binders: 325.7 l per min with single-strap abdominal binder and 345.2 l per min with triplestrap abdominal binder (Po0.05, paired t-test). The mean cough peak expiratory flow rate in tetraplegic subjects using triple-strap abdominal binders was significantly higher compared with those using single-strap abdominal binders (322.1 l per min and 299.4 l per min, respectively). Conclusion: Abdominal binders can be used as an effective method to improve cough ability in spinal cord injured patients, with triple-strap abdominal binder achieving greater cough peak expiratory flows.