Sophie Jörgensen

Exercise and sport for persons with spinal cord injury.

This review article provides an overview of the evidence that links exercise and sports participation to physical and psychological well‐being among people with spinal cord injury. Two aspects of physical well‐being are examined, including the prevention of chronic disease and the promotion of physical fitness. Multiple aspects of psychosocial well‐being are discussed, including mental health, social participation, and life satisfaction. The review concludes with future research recommendations and a discussion of challenges and opportunities for using exercise and sports to promote health and well‐being among people living with spinal cord injury.

Secondary Health Conditions, Activity Limitations, and Life Satisfaction in Older Adults With Long-Term Spinal Cord Injury

Many individuals with a spinal cord injury (SCI) have lived several decades with their injury, leading to a need for a deeper understanding of factors associated with healthy aging in people with long‐term SCI.

The Swedish Aging with Spinal Cord Injury Study (SASCIS): Methodology and initial results.

Advances in acute treatment, physiatric care, and rehabilitation have improved survival greatly after spinal cord injury (SCI) and increased longevity. This has led to a need for an in‐depth understanding of factors associated with healthy aging in people with long‐term SCI.

Mid-term follow-up of patients with permanent sequel due to spinal cord ischemia after advanced endovascular therapy for extensive aortic disease

Study design:Observational study.Objectives:Thoraco-abdominal endovascular aortic aneurysm repair (TAEVAR) can be used to treat patients with extensive and complex aortic disease, however, at the risk of spinal cord ischemia (SCI). The aim of this follow-up study was to evaluate the life satisfaction in patients with SCI after TAEVAR.Setting:Among 83 patients undergoing TAEVAR between 2009 and 2012 at the Vascular Centre, Malmö, Sweden, 29 developed SCI in-hospital and at follow-up (median 26 months), eight had died and three had no complaints.Methods:Patients diagnosed with permanent (n=10) and transient (n=8) SCI were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were compared with reference samples.Results:Mid-term mortality in patients with permanent SCI (7/17) was higher than those with transient SCI (1/12) (P=0.035). Ten patients had permanent T1-S5 SCI, two were classified as ASIA Impairment Scale (AIS) A, one as AIS B and seven as AIS D at hospital discharge. Patients diagnosed with transient SCI had residual neurological deficits in the legs (n=8), urge incontinence (n=3) and fecal leakage (n=2) at follow-up. Patients with SCI had lower self-rated life satisfaction in terms of ‘life as a whole’, ‘sexual life’, ‘somatic health’ and ‘psychological health’ but better in the ‘economy’ domain.Conclusion:Assessment of life satisfaction at mid-term follow-up suggests that all patients with SCI in-hospital, whether permanent or transient, should have a multi-disciplinary follow-up regime. Most patients diagnosed with transient neurological deficits had an overlooked permanent, less severe, SCI.

Leisure time physical activity among older adults with long-term spinal cord injury

Study design:Cross-sectional.Objectives:To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs).Setting:Home settings in southern Sweden.Methods:Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1–L5, American Spinal Injury Association Impairment Scale A–D). Associations were analyzed statistically using hierarchical multivariable regression.Results:Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0–171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0–140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants.Conclusion:Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.

Housing accessibility and its associations with participation among older adults living with long-standing spinal cord injury

Objectives: To describe the housing situation and aspects of participation among older adults living with long-standing spinal cord injury (SCI) with attention to SCI severity, and to examine whether and how objective housing accessibility (based on objectively measurable criteria) is associated with aspects of participation. Design: Cross-sectional study utilizing the assessment tools Impact on Participation and Autonomy (IPA) and Housing Enabler (HE). Adjusting for demographic, social and injury related data, associations between objective housing accessibility and aspects of participation were analyzed by means of ordinal regression models. Setting: Home and community settings. Participants: Older adults (≥ 50 years) (N = 123), with a traumatic or non-traumatic SCI for at least 10 years. To make comparisons within the sample, three groups of SCI severity were formed using the American Spinal Injury Association (ASIA) Impairment Scale. Results: Housing adaptations and environmental barriers were common and differed between SCI severity groups; those with AIS D injuries had fewer adaptations and more environmental barriers indoors. A majority of the participants in the total sample perceived their participation as good or very good in most of the IPA activities studied. Accessibility indoors was significantly associated with autonomy indoors (P = 0.009), family role (P = 0.002) and participation problems (P = 0.004); more accessibility problems were associated with less participation and more participation problems. Conclusion: This study indicates that optimizing the housing environment for older adults with SCI can potentially increase their participation and make them more autonomous. Further studies based on longitudinal data are needed to determine the causality of the associations identified.

Mobility Device Use and Exploration of Housing Accessibility for Powered Mobility Device Users among People Ageing with Spinal Cord Injury

Aim: To describe the use of mobility devices among people ageing with spinal cord injury (SCI), with a specific focus on use of powered mobility devices (PMD) and housing accessibility. Method: Data on the use of walking aids (cane, crutch/es or rollator), manual wheelchair and powered wheelchair/scooter were utilized. To describe functional limitations, environmental barriers and the magnitude of accessibility problems in the home and the closest exterior surroundings for each individual, the Housing Enabler instrument was used. Descriptive statistics were used for data analysis. Results: Mobility devices: Among participants with paraplegia, the manual wheelchair was the most frequently used mobility device indoors, and among participants with tetraplegia, it was the PMD. The PMD was the most common mobility device used outdoors among those with tetraplegia, and among participants with paraplegia. Housing accessibility: In exterior surroundings, refuse bin difficult to reach was the environmental barrier that generated the most accessibility problems, while at entrances doors that cannot be fastened in open position was identified as the most severe environmental barrier. Indoors, the environmental barrier that generated the most accessibility problems was wall-mounted cupboard and shelves placed high. Conclusion: To enable optimal use of the PMD in the home and close neighborhoods, and support everyday activity and participation for people ageing with SCI, it is vital to take into account not only personal and environmental aspects but also the mobility device in question. Though, it could be discussed if all the environmental barriers identified in this study, actually are problems for users of a PMD, since some of them might be possible to overcome.

Depressive symptoms among older adults with long-Term spinal cord injury : Associations with secondary health conditions, sense of coherence, coping strategies and physical activity

OBJECTIVES To assess the presence of depressive symptoms among older adults with long-term spinal cord injury and investigate the association with sociodemographic and injury characteristics; and to determine how potentially modifiable factors, i.e. secondary health conditions, sense of coherence, coping strategies and leisure-time physical activity, are associated with depressive symptoms. DESIGN Cross-sectional study. SUBJECTS A total of 122 individuals (70% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years. METHODS Data from the Swedish Aging with Spinal Cord Injury Study, collected using the Geriatric Depression Scale-15, the 13-item Sense of Coherence Scale, the Spinal Cord Lesion-related Coping Strategies Questionnaire and the Physical Activity Recall Assessment for people with Spinal Cord Injury. Associations were analysed using multivariable linear regression. RESULTS A total of 29% reported clinically relevant depressive symptoms and 5% reported probable depression. Sense of coherence, the coping strategy Acceptance, neuropathic pain and leisure-time physical activity explained 53% of the variance in depressive symptoms. CONCLUSION Older adults with long-term spinal cord injury report a low presence of probable depression. Mental health may be supported through rehabilitation that strengthens the ability to understand and confront life stressors, promotes acceptance of the injury, provides pain management and encourages participation in leisure-time physical activity.

Poster 434 The Swedish Version of the Physical Activity Recall Assessment for People With Spinal Cord Injury (PARA-SCI-S)

marked progressive weakness with conservative management. The most common presenting symptoms for both the surgically treated and conservative groups were pain and weakness. Symptoms from the syringomyelia persisted whether or not the patient had surgery. One patient who had shunt placement had improvement of his sensory level but experienced new pain from lumbar arachnoiditis. There was no change in Functional Independence Measure scores or visual analog pain scale. Conclusions: There was no difference in outcomes between surgical management with a shunt versus conservative management. Limitations include small population size, all male patients, limited data collection from annual examinations, and difficulty in following up patients consistently over several years. Benefits of surgical intervention are still unclear. Additional studies are warranted because this may optimize treatment options for patients with a spinal cord injury and syringomyelia.

Cardiovascular Risk Factors Among Older Adults With Long-Term Spinal Cord Injury

Individuals with spinal cord injury (SCI) now live longer, which increases the risk of cardiovascular disease. Knowledge of cardiovascular risk factors amenable to intervention are therefore needed to support their healthy aging.