Mary Joan Roach

Employment after spinal cord injury: an analysis of cases from the model spinal cord injury systems

OBJECTIVE To describe the relationship of multiple biographic, injury-related, and educational factors with employment outcomes after spinal cord injury (SCI). DESIGN Cross-sectional. SETTING Data were collected through 18 model SCI systems, a nationwide network of hospitals that treat approximately 14% of all SCIs in the United States. PARTICIPANTS A total of 3,756 persons with traumatic SCI who completed the Form II data collection during their annual follow-up at years 1, 2, 5, 10, 15, 20, or 25 years (the most recent Form II was accepted). MAIN OUTCOME MEASURES The Model Systems Forms I and II were used to identify biographic, injury-related status, employment at injury, and productivity status upon follow-up (Form I is used to elicit basic demographic and discharge information, whereas Form II is used to track multiple outcomes during annual follow-ups). The Craig Handicap Assessment Reporting Technique (CHART) was used to assess hours spent in gainful employment and other productive activities. RESULTS CHART data revealed only a modestly higher Employment rate (24.8%) than that of the traditional single Form II item (22%). Being Caucasian, younger at injury, having lived more years with SCI, having a less severe injury, and having more years of education were all predictive of being employed. Violence at injury was associated with lower employment rates (only 12.9% employed), especially among Caucasians (only 24% employed). Being employed at injury was associated with a greater probability of postinjury employment, but only in the first few years after injury. Among employed participants, women and those who had been injured fewer years averaged fewer hours spent at work. CONCLUSIONS Findings were consistent with those in previous studies. Interventions to improve employability should focus on education and the needs of individuals from minority backgrounds.

Social and personal consequences of acquired bowel dysfunction for persons with spinal cord injury

Abstract Background: Traditional literature regarding acquired bowel dysfunction for persons with spinal cord injury (SCI) has focused on clinical assessments of bowel dysfunction and bowel management programs. These studies make reference to the effects of bowel dysfunction on quality of life (QOL), but none systematically study the relationship. This study develops 4 scales that measure impediment to community integration (ICI) due to bowel dysfunction and then examines the relationship between bowel dysfunction, ICI, and QOL. Methods: A structured telephone survey was conducted with a convenience sample of 103 SCI consumers. Survey questions documented bowel dysfunction (ie, severity and number of accidents), bowel management (ie, how often bowels are evacuated), ICI , and satisfaction with 4 life domains. Results: Correlation analyses showed that subjective bowel dysfunction severity and number of days per month a respondent had to stay home because of lack of bowel control were associated with barriers to personal relationships, feelings about self, and home life. Also, the number of bowel accidents per month was associated with feelings about self. ICI scales were shown to be related to lower levels of satisfaction with free time, friendships. family life, and life in general. No statistically significant relationships were found between bowel dysfunction and satisfaction with life. Conclusion: Bowel dysfunction is a barrier to community integration and is related to low leve ls of life satisfaction. Also , it is possible to quantify ICI related to bowel dysfunction. Educational programs can reduce the stigma associated with bowel dysfunction. Further research into the intricate relationships between bowel problems, barriers to participation in the community, and life satisfaction is needed.

Patient preferences for next generation neural prostheses to restore bladder function

Study design:A survey administered to 66 individuals with spinal cord injury (SCI) implementing a choice-based conjoint (CBC) analysis. Six attributes with three levels each were defined and used to generate choice sets with treatment scenarios. Patients were asked to choose the scenario that they preferred most.Objectives:To determine the utility weights for treatment characteristics as well as the overall preference for the three types of neural prostheses (NP), that is Brindley, rhizotomy-free Brindley, and pudendal nerve stimulation. Earlier studies have revealed the importance of restoration of bladder function, but no studies have been performed to determine the importance of NP features.Setting:Two academic affiliated medical systems’ SCI outpatient and inpatient rehabilitation programs, Cleveland, OH.Methods:CBC analysis followed by multinomial logit modeling. Individual part-worth utilities were estimated using hierarchical Bayes.Results:Side effects had the greatest significant impact on subject choices, followed by the effectiveness on continence and voiding. NPs with rhizotomy-free sacral root stimulation were preferred (45% first choice) over pudendal afferent nerve stimulation (39% second choice) and sacral root stimulation with rhizotomy (53% third choice). Almost 20% did not want to have an NP at all times.Conclusion:CBC has shown to be a valuable tool to support design choices. The data showed that persons would prefer a bladder NP with minimally invasive electrodes, which would give them complete bladder function, with no side effects and that can be operated by pushing a button and they do not have to recharge themselves.

Community Social Structure as an Indicator of Social Integration and Its Effect on Quality of Life for Persons with a Spinal Cord Injury

This research examines the association between community social structure, as measured by neighborhood socioeconomic status and community participation, and satisfaction with life for persons with a spinal cord injury (SCI). Using information for a sample of 139 persons with an SCI, hierarchical regression analysis was employed to analyze the data. Results indicated that community social structure influences satisfaction with life for persons with an SCI. This research suggests that community structure variables are important for investigating outcomes in persons with an SCI and that future research needs to investigate other community structure variables.

The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization

Sacral pressure ulcers are a significant problem following spinal cord injury and are felt to be in part due to the high interface-pressures generated while strapped to the spine board. The objective of this study was to determine sacral interface-pressure and sensing area in healthy volunteers on a spine board and the effects of a gel pressure dispersion liner. Thirty-seven volunteers were placed on a pressure-sensing mat between the subject and the spine board. Measurements were carried out with and without a gel liner. Pressures and sensing area were recorded every minute for 40 minutes. The highest pressure was generated at the sacral prominence of each subject. Mean interface-pressures were higher on the spine board alone than with the gel liner (p < .0001). Overall, mean sensing area was lower on the spine board than with the gel liner (p < .0001). Standard spinal immobilization causes high sacral interface-pressures. The addition of a gel liner on the spine board decreased overall mean sacral pressures and increased mean sensing area. Generation of sacral pressure ulcers may be related to the initial interface-pressures generated while the patient is strapped to the spine board. The addition of a gel liner may reduce the incidence of sacral pressure ulcers.

Opportunities in Community Placement: An Innovative Personal Care Assistant Training Program in the Inner City

Traditional medical rehabilitation models attempt to produce positive outcomes through training of the disabled individual. This article describes the development and preliminary experience of a regional collaborative project aimed at improving community integration and rehabilitation outcomes by changing the environment of persons with spinal cord injury (SCI), targeting individuals in the inner city with injuries occurring as a result of violence. This 5-year project matched individuals with complementary types of disabilities, and a group of individuals with a wide range of cognitive, mental health, and sensory disabilities were trained to serve as personal care assistants for SCI patients. A dual benefit is attained by enhancing employment opportunities for one group while addressing the pressing need for quality personal care assistants for those with severe physical impairments.

Redesign of a spine board: Proof of concept evaluation

ABSTRACT Sacral pressure ulcers are a significant problem in individuals following spinal cord injury (SCI) and are felt to be in part due to the high interface-pressures applied to the body while lying on a standard spine board (SSB) during emergency transport. The aim of the present study was to assess the interface pressures and sensing areas between the body and the SSB and two proof of concept spine board prototypes (P-1 and P-2). Ten able-bodied individuals were assessed on each board. Interface pressures and sensing area were recorded every minute over 15 minutes. The highest pressure was generated at the sacral-iliac region. The mean of the peak pressures on the SSB, P-1, and P-2 was 288.6, 202.8, and 102.8 mmHg, respectively. The mean of the sensing areas on the SSB, P-1, and P-2 was 78.2, 98.5, and 109.4 in2, respectively. An analysis using pairwise comparisons test showed the interface pressures were significantly reduced (p = 0.003) and the sensing area was significantly increased (p < 0.001) on P-2 in the sacral-iliac location. This study’s procedures can be used when determining critical factors to guide the redesign of an SSB that reduces interface pressure and increases sensing area.

Poster 382: Protein-Energy Malnutrition: Relationship of Prealbumin and BMI Among Individuals With Spinal Cord Injury

cant differences in other hormone levels were demonstrated. Conclusions: Men with SCI have a smaller prostate and testicular volume than those without. These hormonal discordance and prostatic and testicular changes suggested that this is a neuroendocrine complicated process. Furthermore, life expectancy in SCI patients has improved significantly, the need to screen SCI patients for the occurrence of prostate diseases, whether or not there is an enlargement, should not be disregarded.