Timothy Geraghty

Health-related outcomes of people with spinal cord injury - a 10 year longitudinal study

Study Design: Longitudinal panel design over 10 years.Objectives: To describe the health outcomes for people with spinal cord injury and identify how indicators of health change over time.Setting: Queensland, Australia.Methods: A structured interview consisting of measures of perceived health, medical service utilization, hospitalization and pressure sore occurrence was administered on six occasions over 10 years after discharge from the hospital following the initial rehabilitation episode.Results: The majority of respondents were relatively healthy over the course of the 10-year study and required minimal medical interventions or hospitalization. There was however a group of up to 20% of respondents who required extensive medical intervention, including hospitalization and pressure sore management.Conclusion: The findings have significant implications for health-care policy and strategic planning for the ongoing management of spinal cord injury. A biopsychosocial approach combining patient education, cognitive behavioral interventions, screening and treatment for affective disorders and environmental interventions is recommended to facilitate optimal health outcomes for people with spinal cord injury over the long term.

The Development of a Scale to Assess the Training Needs of Professionals in Providing Sexuality Rehabilitation Following Spinal Cord Injury

The training needs of rehabilitation professionals in the area of sexuality and sexual function, particularly following spinal cord injury (SCI) has received little attention in the literature. Specifically, there is negligible theoretical discussion related to staff training needs, as well as a paucity of standardised scales to measure these needs. A conceptual model was developed encompassing staff knowledge, comfort, and attitudes towards sexuality following SCI. Using this model, a scale was developed, evaluated, and refined. Factor analysis supported the construct validity of the scale in measuring the existing conceptual model outlined but highlighted the existence of a separate construct related to personal approaches from clients. The subsequently named Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale (KCAASS) demonstrated high levels of internal consistency across the four conceptual domains. The KCAASS has utility for rehabilitation facilities interested in identifying and targeting training initiatives related to addressing client sexuality needs following SCI.

Sleep-disordered breathing in spinal cord injured patients: A short-term longitudinal study

Background and objective:  Previous studies have demonstrated an increased incidence of sleep apnoea in spinal cord‐injured patients. Many of these studies were performed in long‐term, stable spinal cord injury (SCI). The aims of this study were: (i) to determine the prevalence of sleep‐disordered breathing (SDB) in acute SCI; (ii) to document the change in SDB over time during the rehabilitation period; and (iii) to correlate the degree of SDB with ventilatory parameters.

Towards healthy professional-client relationships: the value of an interprofessional training course.

Boundary violations that threaten professional-client relationships are rarely discussed at the coalface. There is an assumption that healthcare practitioners have the skills necessary to manage professional boundary dilemmas with clients. The issue, if addressed, is usually confined to discipline specific education and training. A one-day Professional Boundaries for Health Professionals (PBHP) training program was developed in response to real life practice dilemmas experienced by health practitioners across the continuum of care. The program was delivered to 109 participants throughout the state of Queensland, Australia, from government and non-government organizations. Participants were doctors, nurses, allied health (physiotherapists, occupational therapists, social workers, psychologists, dietitians, speech therapists), therapy assistants and personal care staff from a diverse range of hospital and community settings. Evaluations of PBHP suggest that the interprofessional learning context was valued with specific advantages identified in the use of adult learning approaches, the teaching of ethical decision making principles, the value of supervision and peer support and the opportunities provided for critical reflection. The effectiveness of training for healthcare practitioners in this area is discussed as a meaningful way of developing skills and engendering collaborative relationships between professional (e.g., occupational therapist, social worker) and paraprofessional (e.g., therapy assistant, personal care worker) groups. A combination of intensive training in professional boundaries and opportunities for ongoing professional development are important for all health practitioners.

Outcome of the acute abdomen in patients with previous spinal cord injury

Background: Patients with spinal cord injury (SCI) have always posed difficulties for the diagnosis of an acute abdomen. The aim of the present study was to define this problem retrospectively at Princess Alexandra Hospital and to assess the results of treatment for these patients.

Early decompression following cervical spinal cord injury: examining the process of care from accident scene to surgery

Early decompression may improve neurological outcome after spinal cord injury (SCI), but is often difficult to achieve because of logistical issues. The aims of this study were to 1) determine the time to decompression in cases of isolated cervical SCI in Australia and New Zealand and 2) determine where substantial delays occur as patients move from the accident scene to surgery. Data were extracted from medical records of patients aged 15-70 years with C3-T1 traumatic SCI between 2010 and 2013. A total of 192 patients were included. The median time from accident scene to decompression was 21 h, with the fastest times associated with closed reduction (6 h). A significant decrease in the time to decompression occurred from 2010 (31 h) to 2013 (19 h, p = 0.008). Patients undergoing direct surgical hospital admission had a significantly lower time to decompression, compared with patients undergoing pre-surgical hospital admission (12 h vs. 26 h, p < 0.0001). Medical stabilization and radiological investigation appeared not to influence the timing of surgery. The time taken to organize the operating theater following surgical hospital admission was a further factor delaying decompression (12.5 h). There was a relationship between the timing of decompression and the proportion of patients demonstrating substantial recovery (2-3 American Spinal Injury Association Impairment Scale grades). In conclusion, the time of cervical spine decompression markedly improved over the study period. Neurological recovery appeared to be promoted by rapid decompression. Direct surgical hospital admission, rapid organization of theater, and where possible, use of closed reduction, are likely to be effective strategies to reduce the time to decompression.

Optimizing speech production in the ventilator‐assisted individual following cervical spinal cord injury: a preliminary investigation

BACKGROUND Mechanical ventilation is commonly used during the acute management of cervical spinal cord injury, and is required on an ongoing basis in the majority of patients with injuries at or above C3. However, to date there have been limited systematic investigations of the options available to improve speech while ventilator-assisted post-cervical spinal cord injury. AIMS To provide preliminary evidence of any benefits gained through the addition of positive end expiratory pressure (PEEP) and/or a tracheostomy speech valve to the condition of leak speech. METHODS & PROCEDURES Speech production in the three conditions was compared in two ventilator-assisted participants using a series of instrumental and perceptual speech measures. OUTCOMES & RESULTS The addition of PEEP or the use of a speech valve resulted in speech that was superior to leak speech for both participants; however, individual variation was present. CONCLUSIONS & IMPLICATIONS Leak speech alone or with the addition of PEEP or a tracheostomy speech valve can facilitate functional communication for the ventilated patient, though PEEP and valve speech were found to be superior in the current study. These findings will be of assistance for clinicians counselling the growing population of patients who may require tracheostomy positive pressure ventilation long-term regarding communication options.

Too hot to handle: Reflections on professional boundaries in practice

Professional boundaries between practitioners and clients are essential to the delivery of ethical and professional health services yet often prove difficult to address. A research agenda was initiated comprising a literature review, needs assessment, the development, implementation and evaluation of a Professional Boundaries for Health Practitioner (PBHP) training course. This agenda led the authors to critically reflect on the barriers of rumours, dismissiveness and time that were identified to the provision of training in this field. From these reflections, an interprofessional training framework was developed. This paper focuses on the importance of two facets of reflective practice in this process. These were (1) the importance of the integration of reflection and critical thinking skills in practitioner training; (2) critical reflection undertaken by the authors in identifying barriers to practitioner participation in work based training and determining the scope and nature of training that enhances ethical practices and meets practitioner needs.

Assessing Professional Boundaries in Clinical Settings: The Development of the Boundaries in Practice Scale

This article reports on the Boundaries in Practice (BIP) Scale developed to measure knowledge, comfort, ethical decision making, and experience. Few instruments used in studies conducted on professional/ client boundaries have been validated. The BIP demonstrated sound face, content and construct validity, and adequate internal consistency reliability. The BIP Scale provides the first reliable and valid means of investigating multiple boundary domains across health disciplines and teams. The sensitivity and complexity of boundary issues and the serious consequences of breaches highlight the importance of a valid and reliable measure in building empirical knowledge in this field.

Correspondence re "evidence-based scientific exercise guidelines for adults with spinal cord injury: An update and new guideline"

ESSA recommends a single exercise prescription that will confer good health, while the New Guidelines (NG) recommend two different prescriptions: one to achieve fitness benefits and a separate one to achieve cardiometabolic health benefits; the volume of aerobic exercise recommended by ESSA is 150 min of moderate-intensity exercise (MIE)/wk, considerably larger than the NG, which recommend at least 40 min of MIE/wk (fitness benefits) or at least 90 min of MIE/wk (cardiometabolic health benefit); the NG recommendations are presented as “minimum thresholds”, implying that the sub-threshold volumes will not confer fitness/health benefits. In contrast, ESSA recognises that many “Beginning Clients” will initially be unable to safely meet the recommended volume and these clients will derive benefit from very small, progressive increases in exercise volume (e.g. 5 min/day).