Suzanne Groah

The SCI Exercise Self-Efficacy Scale (ESES): development and psychometric properties

BackgroundRising prevalence of secondary conditions among persons with spinal cord injury (SCI) has focused recent attention to potential health promotion programs designed to reduce such adverse health conditions. A healthy lifestyle for people with SCI, including and specifically, the adoption of a vigorous exercise routine, has been shown to produce an array of health benefits, prompting many providers to recommend the implementation of such activity to those with SCI. Successfully adopting such an exercise regimen however, requires confidence in ones ability to engage in exercise or exercise self-efficacy. Exercise self-efficacy has not been assessed adequately for people with SCI due to a lack of validated and reliable scales, despite self efficacys status as one of the most widely researched concepts and despite its broad application in health promotion studies. Exercise self efficacy supporting interventions for people with SCI are only meaningful if appropriate measurement tools exist. The objective of our study was to develop a psychometrically sound exercise self-efficacy self-report measure for people with SCI.MethodsBased on literature reviews, expert comments and cognitive testing, 10 items were included and made up the 4-point Likert SCI Exercise Self-Efficacy Scale (ESES) in its current form. The ESES was administered as part of the first wave of a nationwide survey (n = 368) on exercise behavior and was also tested separately for validity in four groups of individuals with SCI. Reliability and validity testing was performed using SPSS 12.0.ResultsCronbachs alpha was .9269 for the ESES. High internal consistency was confirmed in split-half (EQ Length Spearman Brown = .8836). Construct validity was determined using principal component factor analysis by correlating the aggregated ESES items with the Generalised Self Efficacy Scale (GSE). We found that all items loaded on one factor only and that there was a statistically significant correlation between Exercise Self-Efficacy Scale (ESES) and Generalised Self Efficacy Scale (GSE) (Spearman RHO = .316; p < .05; n = 53, 2-sided).ConclusionPreliminary findings indicate that the ESES is a reliable instrument with high internal consistency and scale integrity. Content validity both in terms of face and construct validity is satisfactory.

Nutrient Intake and Body Habitus After Spinal Cord Injury: An Analysis by Sex and Level of Injury

Abstract Background/Objectives: To examine nutrient intake and body mass index (BMI) in the spinal cord injury (SCI) population according to level of injury and sex. Design: Cross-sectional study conducted at 2 SCI treatment centers. Participants/Methods: Seventy-three community-dwelling individuals with C5-T12 ASIA Impairment Scale (AIS) A or B SCI. Subjects were divided into 4 groups: male tetraplegia (N = 24), male paraplegia (N = 37), female tetraplegia (N = 1), and female paraplegia (N = 11). Mean age was 38 years; 84% were male; 34% were white, 41 % were African American, and 25% were Hispanic. Participants completed a 4-day food log examining habitual diet. Dietary composition was analyzed using Food Processor II v 7.6 software. Results: Excluding the 1 woman with tetraplegia, total calorie intake for the other 3 groups was below observed values for the general population. The female paraplegia group tended to have a lower total calorie intake than the other groups, although macronutrient intake was within the recommended range. The male tetraplegia group, male paraplegia group, and the 1 woman with tetraplegia all had higher than recommended fat intake. Intake of several vitamins, minerals, and macronutrients did not meet recommended levels or were excessively low, whereas sodium and alcohol intake were elevated. Using adjusted BMI tables, 74.0% of individuals with SCI were overweight or obese. Conclusions: Women with paraplegia tended to maintain healthier diets, reflected by lower caloric and fat intakes, fewer key nutrients falling outside recommended guidelines, and less overweight or obesity. Individuals with tetraplegia tended to take in more calories and had higher BMIs, and using adjusted BMI, the majority of the population was overweight or obese. The majority of people with SCI would benefit from nutritional counseling to prevent emerging secondary conditions as the population with SCI ages.

Spinal cord injury and aging challenges and recommendations for future research

ABSTRACTPopulation aging, caused by reductions in fertility and increasing longevity, varies by country and is anticipated to continue and to reach global proportions during the 21st century. Although the effects of population aging have been well documented for decades, the impact of aging on people with spinal cord injury (SCI) has not received similar attention. It is reasonable to expect that population aging features such as the increasing mean age of the population, share of the population in the oldest age groups, and life expectancy would be reflected in SCI population demographics. Although the mean age and share of the SCI population older than 65 yrs are increasing, data from the National Spinal Cord Injury Statistical Center suggest that life expectancy increases in the SCI population have not kept the same pace as those without SCI in the last 15 yrs. The reasons for this disparity are likely multifactorial and include the changing demographics of the SCI population with more older people being injured; susceptibility of people with SCI to numerous medical conditions that impart a health hazard; risky behaviors leading to a disproportionate percentage of deaths as a result of preventable causes, including septicemia; changes in the delivery of health services during the first year after injury when the greatest resources are available; and other unknown factors. The purposes of this paper are (1) to define and differentiate general population aging and aging in people with SCI, (2) to briefly present the state of the science on health conditions in those aging with SCI, and finally, (3) to present recommendations for future research in the area of aging with SCI.

United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III)

Study design:Multi-center, prospective, cohort study.Objectives:To assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in persons with spinal cord injury (SCI).Setting:Inpatient rehabilitation hospitals in the United States (US).Methods:Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM), the default functional measure currently used in most US hospitals, was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III.Results:Total agreement between raters was above 70% on most SCIM III tasks and all κ-coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach’s-α was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8 (P<0.001). For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM (P<0.0001).Conclusion:Overall, the SCIM III is a reliable and valid measure of functional change in SCI. However, improved scoring instructions and a few modifications to the scoring categories may reduce variability between raters and enhance clinical utility.

Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury.

PURPOSE The purpose of this study was to describe cardiometabolic risk factors and risk clustering in people with spinal cord injury (SCI). METHODS This was a cross-sectional study of 121 subjects aged 18 to 73 years (mean, 37 ± 12 years) with chronic, motor complete SCI between C5 and T12. Assessments included demographic, social, and medical history; physical, anthropometric, and blood pressure assessments; fasting serum assays including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides, and hemoglobin A1c; calculated low-density lipoprotein cholesterol (LDL-C); and an oral glucose tolerance test. Framingham risk scores (FRSs) for each subject were calculated on the basis of Third National Cholesterol Education Program Adult Treatment Panel algorithm. RESULTS According to FRSs, 90.1%, 8.3%, and 1.7% were classified in the low-, medium-, and high-risk groups, respectively. The most prevalent cardiometabolic risk factors were overweight/obesity (74%), elevated LDL-C (64%), low HDL-C (53%), elevated systolic blood pressure (SBP, 33%), and elevated TC (30%). Stratification by level of injury demonstrated significant differences between paraplegic and tetraplegic participants in SBP (120 vs 99 mm Hg, P = .0001), 2-hour glucose (101.37 vs 137.93 mg/dL, P = .0001), and 2-hour insulin (47.45 vs 94.36 μIU/mL, P = .024). In addition, triglycerides, fasting insulin, body mass index, LDL-C, hemoglobin A1c, and insulin resistance were significantly associated with FRS. CONCLUSIONS Ten percent of young people with SCI are at moderate to high risk for long-term hard cardiac events. Overweight/obesity, LDL-C, HDL-C, SBP, and TC were the most prevalent risk factors. Carbohydrate metabolism is preferentially affected in persons suffering from tetraplegia, indicating a need for impairment-specific risk assessment.

Secondary health conditions in individuals aging with SCI: Terminology, concepts and analytic approaches

Study design:Literature review.Objectives:Utilizing individuals with spinal cord injury (SCI) as a representative population for physical disability, this paper: (1) reviews the history of the concept of secondary conditions as it applies to the health of individuals aging with long-term disabilities; (2) proposes a definition of secondary health conditions (SHCs) and a conceptual model for understanding the factors that are related to SHCs as individuals age with a disability; and (3) discusses the implications of the model for the assessment of SHCs and for developing interventions that minimize their frequency, severity and negative effects on the quality of life of individuals aging with SCI and other disabilities.Methods:Key findings from research articles, reviews and book chapters addressing the concept of SHCs in individuals with SCI and other disabilities were summarized to inform the development of a conceptual approach for measuring SCI-related SHCs.Conclusions:Terms used to describe health conditions secondary to SCI and other physical disabilities are used inconsistently throughout the literature. This inconsistency represents a barrier to improvement, measurement and for the development of effective interventions to reduce or prevent these health conditions and mitigate their effects on participation and quality of life. A working definition of the term SHCs is proposed for use in research with individuals aging with SCI, with the goal of facilitating stronger evidence and increased knowledge upon which policy and practice can improve the health and well-being of individuals aging with a disability.

Use of a multi-spectral camera in the characterization of skin wounds

Skin breakdown is a prevalent and costly medical condition worldwide, with the etiologic and healing processes being complex and multifactorial. Quantitative assessment of wound healing is challenging due to the subjective measurement of wound size and related characteristics. We propose that in vivo spectral reflectance measurements can serve as valuable clinical monitoring tool/device in the study of wound healing. We have designed a multi spectral camera able to acquire 18 wavelength sensitive images in a single snapshot. A lenslets array in front of a digital camera is combined with narrowband filters (bandwidth 10 nm) ranging from 460 to 886 nm. Images taken with the spectroscopic camera are composed of 18 identical sub-images, each carrying different spectral information, that can be used in the assessment of skin chromophores. A clinical trial based on a repeated measures design was conducted at the National Rehabilitation Hospital on 15 individuals to assess whether Poly Carboxy Methyl Glucose Sulfate (PCMGS, CACIPLIQ20), a bio-engineered component of the extracellular matrix of the skin, is effective at promoting healing of a variety of wounds. Multi spectral images collected at different wavelengths combined with optical skin models were used to quantify skin oxygen saturation and its relation to the traditional measures of wound healing.

Automating activity-based interventions: The role of robotics

We have seen a continued growth of robotic devices being tested in neurorehabilitation settings over the last decade, with the primary goal to improve upper- and lower-motor function in individuals following stroke, spinal cord injury, and other neurological conditions. Interestingly, few studies have investigated the use of these devices in improving the overall health and well-being of these individuals despite the capability of robotic devices to deliver intensive time-unlimited therapy. In this article, we discuss the use of robotic devices in delivering intense, activity-based therapies that may have significant exercise benefits. We also present preliminary data from studies that investigated the metabolic and cardiac responses during and after 6 months of lower-limb robotic training. Finally, we speculate on the future of robotics and how these devices will affect rehabilitation interventions.

Serum lipid concentrations among persons with spinal cord injury - A systematic review and meta-analysis of the literature

BACKGROUND Lipid optimization comprises a therapeutic cornerstone of primary and secondary cardiovascular disease prevention. This systematic review and meta-analysis sought to clarify patterns of lipid profiles in spinal cord injury (SCI) patients compared to able-bodied individuals as well as among subgroups of SCI patients stratified by sex, activity level, race, and level of injury. METHODS Searches were conducted in PubMed, CINAHL, PsycINFO, and EMBASE. The initial literature search broadly identified peer-reviewed studies that examined cardiovascular risk factors in SCI. A total of 50 studies were ultimately identified that focused on lipid levels in SCI. Demographic data (including subject age, duration of injury, height, weight, and body mass index [BMI]) and lipid values were extracted for able-bodied individuals and subjects with SCI. Statistical analyses included t-testing and analysis of variance (ANOVA). RESULTS Compared with controls, individuals with SCI had significantly lower total cholesterol (TC) (183.4 mg/dL versus 194.9 mg/dL, p = 0.019) and high-density lipoprotein cholesterol (HDL-C) (41.0 mg/dL versus 49.6 mg/dL, p < 0.001) and higher TC/HDL-C ratios (4.5 versus 4.0, p = 0.002), though no significant differences were found for triglyceride (TG) and non-HDL-C values. CONCLUSIONS SCI represents an increasingly common chronic condition, now secondarily characterized by heightened CVD risk potentially in part due to unique lipid profiles characterized primarily by low HDL-C and an increased TC/HDL-C ratio. As other at-risk patient populations have received increased acknowledgment with more stringent lipid panel screening at earlier ages and increased frequency, we would propose that the same be implemented for the SCI population until more-specific CVD risk stratification guidelines are established for this population.

Intensive electrical stimulation attenuates femoral bone loss in acute spinal cord injury.

To determine whether intensive electrical stimulation (ES) can reduce femoral bone mineral density (BMD) loss in acute spinal cord injury (SCI).