Spinal Cord Injury-Past, Present, and Future

Donovan, William H.

doi:10.1080/10790268.2007.11753918

Cited by 86 publications

(72 citation statements)

References 113 publications

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“…Prior to World War II (WWII), persons who sustained a spinal cord injury (SCI) could expect to survive only weeks, and even if the odds of survival had been in their favor, no rehabilitative care was available that would have allowed them to pursue ordinary life aims [1]. Owing to advances in emergency medicine, antibiotics, and other aspects of acute medical care, thousands of veterans who sustained an SCI in the conflicts of WWII were able to return home.…”

Section: Introductionmentioning

confidence: 99%

Activity and participation after spinal cord injury: State-of-the-art report

Ullrich¹,

Spungen²,

Atkinson³

et al. 2012

JRRD

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Abstract-The importance of activities and community participation for persons with spinal cord injury (SCI) has been recognized for decades and yet theoretical and empirical advances have been limited. This report summarizes the recommendations for researchers on the topic of measuring activity and participation among persons with SCI formulated by the Spinal Cord Injury workgroup at the State-of-the-Art Conference on Outcome Measures in Rehabilitation held in January 2010. Activity and participation were defined as independent constructs ideally measured in reference to personal values and environmental influences. Measures of activity, participation, and factors influencing activity and participation are reviewed and critiqued. Gaps in available measures are described, measures in development are discussed, and suggestions for future research are made.

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Section: Introductionmentioning

confidence: 99%

Activity and participation after spinal cord injury: State-of-the-art report

Ullrich¹,

Spungen²,

Atkinson³

et al. 2012

JRRD

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“…3 The maintenance of adequate vascular perfusion 8 and the decompression of the spinal cord 6 are 2 important aspects of the clinical management of the acutely spinal cord-injured patient that have received considerable attention in the past 2 decades, largely due to the belief that they have an influence on neurologic recovery.…”

mentioning

confidence: 99%

Intrathecal pressure monitoring and cerebrospinal fluid drainage in acute spinal cord injury: a prospective randomized trial

Kwon¹,

Curt

Bélanger

et al. 2009

SPI

165

115

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Object Ischemia is an important factor in the pathophysiology of secondary damage after traumatic spinal cord injury (SCI) and, in the setting of thoracoabdominal aortic aneurysm repair, can be the primary cause of paralysis. Lowering the intrathecal pressure (ITP) by draining CSF is routinely done in thoracoabdominal aortic aneurysm surgery but has not been evaluated in the setting of acute traumatic SCI. Additionally, while much attention is directed toward maintaining an adequate mean arterial blood pressure (MABP) in the acute postinjury phase, little is known about what is happening to the ITP during this period when spinal cord perfusion pressure (MABP − ITP) is important. The objectives of this study were to: 1) evaluate the safety and feasibility of draining CSF to lower ITP after acute traumatic SCI; 2) evaluate changes in ITP before and after surgical decompression; and 3) measure neurological recovery in relation to the drainage of CSF. Methods Twenty-two patients seen within 48 hours of injury were prospectively randomized to a drainage or no-drainage treatment group. In all cases a lumbar intrathecal catheter was inserted for 72 hours. Acute complications of headache/nausea/vomiting, meningitis, or neurological deterioration were carefully monitored. Acute Spinal Cord Injury motor scores were documented at baseline and at 6 months postinjury. Results On insertion of the catheter, mean ITP was 13.8 ± 1.3 mm Hg (± SD), and it increased to a mean peak of 21.7 ± 1.5 mm Hg intraoperatively. The difference between the starting ITP on catheter insertion and the observed peak intrathecal pressure after decompression was, on average, an increase of 7.9 ± 1.6 mm Hg (p < 0.0001, paired t-test). During the postoperative period, the peak recorded ITP in the patients randomized to the no-drainage group was 30.6 ± 2.3 mm Hg, which was significantly higher than the peak intraoperative ITP (p = 0.0098). During the same period, the peak recorded ITP in patients randomized to receive drainage was 28.1 ± 2.8 mm Hg, which was not statistically higher than the peak intraoperative ITP (p = 0.15). Conclusions The insertion of lumbar intrathecal catheters and the drainage of CSF were not associated with significant adverse events, although the cohort was small and only a limited amount of CSF was drained. Intraoperative decompression of the spinal cord results in an increase in the ITP measured caudal to the injury site. Increases in intrathecal pressure are additionally observed in the postoperative period. These increases in intrathecal pressure result in reduced spinal cord perfusion that will otherwise go undetected when measuring only the MABP. Characteristic changes in the observed intrathecal pressure waveform occur after surgical decompression, reflecting the restoration of CSF flow across the SCI site. As such, the waveform pattern may be used intraoperatively to determine if adequate decompression of the thecal sac has been accomplished.

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“…In the US, access to post-acute care is fragmented, and often hinges on individual insurance coverage or premorbid financial resources [21,22]. In the UK, services are integrated in the National Health Service, where emergency, post-acute care, rehabilitation, and even wheelchair provision are all free at the point of need.…”

Section: Introductionmentioning

confidence: 99%

A comparison of perceptions of quality of life among adults with spinal cord injury in the United States versus the United Kingdom

et al. 2017

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Purpose To identify which aspects of life are most important to adults with spinal cord injury (SCI) and compare perspectives in the United States and the United Kingdom. Methods We conducted 20 in-depth interviews with adults with SCI (ten in the US and ten in the UK). Verbatim transcriptions were independently analyzed line-by-line by two coders using an inductive approach. Codes were grouped into themes about factors that constitute and affect quality of life (QOL). Results Five overarching themes emerged: describing QOL in the context of SCI; functional adjustment; medical care; financial resources; and socio-political issues. Twenty subthemes emerged on factors that affect QOL. Participants in both samples identified medical care as a key influence on QOL. The US group talked about a predominantly negative influence (e.g., fragmented primary and specialist care, insurance constraints, bureaucracy), whereas UK interviewees mentioned a predominantly positive influence (e.g., universal provision, including free and continuous care, free wheelchairs and home care, and length of rehabilitation commensurate with level of injury). Functional adjustment, such as physical and mental adjustment post-discharge and aging with SCI, was another important contributor to QOL, and varied by country. Most US interviewees reported poor knowledge about self-care post-discharge and poor quality of home adaptations compared to the UK group. Conclusions For adults living with SCI, good QOL is essential for successful rehabilitation. Differences between interviewees from the two countries in perceived medical care and functional adjustment suggest that factors affecting QOL may relate to broader health system characteristics.

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Spinal Cord Injury-Past, Present, and Future

Cited by 86 publications

References 113 publications

Activity and participation after spinal cord injury: State-of-the-art report

Activity and participation after spinal cord injury: State-of-the-art report

Intrathecal pressure monitoring and cerebrospinal fluid drainage in acute spinal cord injury: a prospective randomized trial

A comparison of perceptions of quality of life among adults with spinal cord injury in the United States versus the United Kingdom

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