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Study design:Cross-sectional study. Objectives:(1) To assess the relationship between bladder management methods and the health-related quality of life (HRQL) in patients with spinal cord injury (SCI). (2) To identify any correlation between the two questionnaires used to assess the quality of life (one validated for SCI and one validated for bladder symptoms). Setting:Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Middlesex, UK. Methods:This study is based on two questionnaires with results collected from 142 people with SCI. The two questionnaires were based on information from the Short-Form 36-Item Health Survey (SF-36) and the King's Health Questionnaire and included demographic characteristics, bladder management methods and the frequency of incontinence. Results:There is a moderate correlation between the results of the SF-36 and the King's Health Questionnaire. Only 21% SCI patients report normal voiding without any other form of bladder management. The type of bladder management may influence the HRQL in patients with SCI. Clean intermittent catheterization by attendant, indwelling transurethral catheterization and indwelling suprapubic catheterization are the three groups with the worst mental status. In addition, the frequency of incontinence is a strong influence on HRQL.Conclusions:The results of this study may provide a general baseline HRQL for patients with SCI. Our findings show the relationships between bladder management methods and quality of life in patients with SCI. In addition, the impact of incontinence on quality of life was also confirmed. [ABSTRACT FROM AUTHOR]

Study design:Multi-centre, single cohort.Objectives:To assess the needs, perceived environmental barriers, level of participation and psychological function of spinal cord injured patients living in the community 3–18 months after discharge.Setting:The National Spinal Injuries Centre, Stoke Mandeville, UK.; Princess Royal Spinal Injuries Centre, Sheffield UK.; Midlands Centre for Spinal Injuries, Oswestry, UK.Method:Participants sustaining injury aged 18 or above were recruited from one of three spinal cord injuries units 3–18 months after discharge. Postal packs containing questionnaires, consent forms and information were distributed and a 2-week reminder was sent.Results:Main findings showed community needs to be generally well addressed however psychosocial needs were rated significantly lower than physical. Responses suggested no environmental impact on participation levels, however, qualitative data highlighted delays in accommodation, adaptations and availability of equipment to interfere with transition to community living. A substantial amount of respondents reported significant impact on independence and activity from secondary conditions and pain. Nearly all the sample reported dissatisfaction with their sexual life and these needs were not well addressed.Conclusions:Societal participation continues to be affected by secondary conditions and pain, whereas delays in equipment and structural adaptations impact on the transition to community living. Sexual needs and problems remain an issue for the spinal cord injured population and a need which is left unaddressed in the community. [ABSTRACT FROM AUTHOR]

Study design:Investigation of bowel function in 55 patients and 26 healthy volunteers using radiological, anorectal physiological and laser Doppler blood flow monitoring.Objectives:Bowel dysfunction is common after spinal cord injury (SCI). We aimed to determine whether hindgut testing of autonomic innervation provides insight into presence of symptoms, altered motor function (transit) and level of injury.Setting:St Mark's Hospital, UK and The Spinal Injuries Unit, Royal National Orthopaedic Hospital, UK.Methods:A total of 55 patients with chronic complete SCI and 26 healthy volunteers were studied. Twenty-four patients had lesions above T5 and 31 had lesions below T5. Thirty-five patients complained of constipation: 75% (18/24) of patients with lesions above T5 and 55% (17/31) of those with lesions below T5. Gut transit, rectal electrosensitivity and rectal blood flow were measured.Results:Slow gut transit occurred in 65% of patients and in all the 35 patients complaining of constipation. Delay was pancolonic. All patients had an elevated sensory threshold. The threshold was significantly higher in those with subjective constipation (P<0.01), slow transit (P<0.04) and high SCI (P=0.046). Mucosal blood flow was lower in SCI patients with constipation (P<0.04) and slow transit (P<0.03). It was higher than normal in high-SCI volunteers (P=0.056), reflecting loss of sympathetic inhibition.Conclusions:In SCI, subjective constipation correlates closely with slow gut transit. Delay is pancolonic, regardless of the site of lesion. Sensory testing provides evidence for completeness of lesion, offering further evidence for pain transmission through sympathetic pathways. Studies in SCI patients provide further evidence of mucosal blood flow as a marker of altered autonomic innervation.Spinal Cord (2009) 47, 623–627; doi:10.1038/sc.2009.14; published online 10 March 2009 [ABSTRACT FROM AUTHOR]

This article looks at medical imaging options after a patient has suffered injury to the neck. Decisions about which imaging to use must be based on clinical assessment of the patient and information about the nature of the injury. The Canadian cervical spine rules and the NEXUS (national emergency x radiography utilization study) rules are both used to make decisions on imaging choices. The guidelines of the National Institute for Health and Clinical Excellence in Great Britain is an adaptation of the two guidelines. Plain x-rays are the most commonly used imaging sources but they can often be hard to read and injuries are often misrepresented. Computer tomography and magnetic resonance imaging are discussed along with their benefits and limitations.

Objectives: To estimate the point prevalence of pressure sores in a community sample of spinal cord injured patients who were followed up by a spinal injuries unit and to evaluate whether self-management strategies were associated with decreased risk of pressure sores. Setting: A regional spinal injuries unit, UK. Design: Postal questionnaire survey. Main outcome measure: Presence of pressure sores. Subjects: All patients who were being followed up on a regular basis by the unit. Results: Out of 760, 520 replied to the questionnaire; 472 were eligible for analysis. Point prevalence of pressure sores was 23% (99). Failure to inspect the skin daily for pressure damage was associated with decreased prevalence of pressure sores (odds ratio (OR) 0.5; 95% confidence interval (CI) 0.2-0.83). Those who inspected their skin daily, however, had a higher proportion of stage I pressure sores, but this was not statistically significant. Smoking (OR 1.8; 95% CI 1-3.3) and pre-existing medical problems (OR 1.8; 95% CI 1-3) were associated with increased prevalence of pressure sores. Regular lifting of weight at least once in an hour while seated, age, gender, neurological level, employment status, living alone and faecal and urinary incontinence were not significant predictors of pressure sores. Conclusions: Nearly one-quarter of participants had pressure sores at the time of the survey. Periodic weight lifts and daily inspection of skin for pressure damage were not associated with decreased prevalence of pressure sores in this sample. However, those who inspected skin daily tended to detect pressure damage early. [ABSTRACT FROM AUTHOR]

Part II. Examines the factors which influence people with spinal cord injury in Great Britain to change their wheelchair from that with which they were issued upon discharge from a spinal injuries unit. Establishment of baseline provision before the introduction of the wheelchair voucher scheme; Correlation of the timing of the change of wheelchair to age, gender and level of injury.

Surveys the use of wheelchairs and the preferences of people with spinal cord injury in Great Britain. Importance of appropriate provision of wheelchairs to patients discharged from spinal injuries unit; Evolution of wheelchair design; Influence of the desire of wheelchair athletes to improve their sports performance.

Focuses on occupational therapy for spinal cord injury patients in Great Britain. Level of physical independence on tetraplegic patients; Importance of splints for tetraplegic patients on carrying the normal daily activities; Encouragement of patients on recreation activities. INSETS: Wheelchairs and cushions;Activities of daily living.

Focuses on the social needs of patients with spinal cord injury in Great Britain. Finance for rehabilitation; Adapting homes for the patients; Employment for severely disabled people.