Search

Treatments for chronic pain in persons with spinal cord injury (SCI) have been less than effective. Cranial electrotherapy stimulation (CES), a noninvasive technique that delivers a microcurrent to the brain via ear clip electrodes, has been shown to effectively treat several neurological and psychiatric disorders. The present study examined the effects of daily 1-hour active CES or sham CES treatment (randomly assigned) for 21 days on pain intensity and interference with activities in 38 males with SCI. The active CES group (n = 18) reported significantly decreased daily pain intensity compared with the sham CES group (n = 20) (mean change: active CES = '0.73, sham CES = '0.08; p = 0.03). Additionally, the active CES group reported significantly decreased pain interference ('14.6 pre- vs postintervention, p = 0.004) in contrast to the nonsignificant decrease in the sham CES group ('4.7 pre- vs postintervention, p = 0.24). These results suggest that CES can effectively treat chronic pain in persons with SCI. [ABSTRACT FROM AUTHOR]

To assess prevalence and characteristics of individual chronic (>6 mo) pain components in the veteran spinal cord injury (SCI) population, we conducted a telephone survey with 348 (66%) of 530 veterans with SCI who received care from one regional Department of Veterans Affairs SCI center during a 3 yr period. The short-form McGill Pain Questionnaire was used to assess qualitative properties of the pain experience. Other questions were used to assess frequency, duration, intensity, exacerbating factors, and effects on daily activities. Of the participants, 75% reported at least one chronic pain component. The majority (83%) of the chronic pain components occurred daily (mean = 27.4 d/mo) and lasted most of the day (mean = 17.4 h/d). Mean pain intensity in the week before the interview averaged 6.7 (on a 0 to 10 scale), while worst pain intensity averaged 8.6. Two-thirds (67%) of the chronic pain components interfered with daily activities. The most commonly selected pain descriptors were 'aching,' 'sharp,' 'hot-burning,' and 'tiring-exhausting.' More research is needed to identify better ways to prevent, assess, and treat chronic pain in the veteran SCI population. [ABSTRACT FROM AUTHOR]

OBJECTIVE: A study was undertaken to assess the association of preoperative and postoperative hemoglobin levels with rehabilitation outcomes, age, and selected co-morbidities DESIGN: Charts of 49 patients admitted to rehabilitation after total knee arthroplasty due to degenerative joint disease were reviewed. Outcome measures included rehabilitation admission and discharge motor FIMtrade mark scores, motor FIM gain, and rehabilitation length of stay. RESULTS: Patients with higher preoperative hemoglobin levels had higher rehabilitation admission motor FIM scores (r=0.38, P<0.01) and lower motor FIM gains (r=-0.45, P<0.001). Patients who had higher hemoglobin levels at rehabilitation admission had higher admission motor FIM scores and shorter length of stay. Patients with diabetes had lower preoperative hemoglobin levels. Patients with hypertension had longer length of stay. Older patients had lower admission and discharge motor FIM scores and longer length of stay. CONCLUSIONS: Patients admitted to rehabilitation after total knee replacement have the potential to improve motor function, regardless of their preoperative and rehabilitation admission hemoglobin levels and the decrease in hemoglobin levels. However, those admitted to rehabilitation with lower hemoglobin levels, those with lower admission motor FIM scores, those who are older, and those who have hypertension may expect longer hospital stays to reach their functional goals. [ABSTRACT FROM AUTHOR]

We undertook a telephone survey to examine perceived stress among 165 veterans with spinal cord injury (SCI) who received care from a Department of Veterans Affairs Medical Center. Measures included Perceived Stress Scale, Hassles Scale, Center for Epidemiologic Studies Depression Scale, Short-Form State-Trait Anxiety Inventory, Satisfaction with Life Scale, and Short-Form Interpersonal Support Evaluation List. The mean perceived stress score for our sample of veterans with SCI (17.3) was higher than the means for men from the general population (12.1) and nonveteran men with SCI (13.9). Physical abilities, health, and financial issues were frequently reported hassles. Stress was related positively to depressive symptomatology and anxiety and negatively to life satisfaction. The association of hassles with measures of psychological well-being was partially mediated by perceived stress. The association of perceived stress with depression and anxiety varied as a function of social support, suggesting that those with low social support are the most vulnerable to the negative impact of stress on their psychological well-being. Stress management programs designed specifically to meet the needs of veterans with SCI are needed. [ABSTRACT FROM AUTHOR]

A study was undertaken to determine the technical acceptability of information available via a customized telerehabilitation system regarding patients with lower-limb ulcers or recent lower-limb amputations receiving care at a Veterans Affairs Medical Center. Among the 54 participants, 57 wounds (39 ulcers, 19 amputation incisions) were evaluated by means of still photographs and skin temperature data sent via ordinary telephone lines. Three experienced clinicians served as raters. Intrarater agreements and McNemar chi square tests were assessed between decisions made after telerehabilitation sessions and decisions made by the same rater after in-person sessions. Interrater agreements and k coefficients were assessed between two raters for both telerehabilitation and in-person sessions. The intrarater agreement on 57 wounds for the primary rater was 93%, and the McNemar test indicated no significant difference in the ratings (p < 0.63). Interrater agreement on 18 wounds was 78% (kappa = 0.55, p < 0.02) for the telerehabilitation sessions and 89% (kappa = 0.77, p < 0.001) for the in-person sessions. Most qualitative comments by three clinicians on picture quality (54/63 = 86%) and temperature data (39/44 = 88%) were favorable (good to excellent). The information yielded from this study provides evidence that the telerehabilitation system has the potential to present sufficient information to experienced clinicians so they can make informed decisions regarding wound management. The next phase of the study will include in-home trials and improvements in the technology. [ABSTRACT FROM AUTHOR]

This longitudinal study was designed to test the hypothesis that persons who consistently report pain at three (women) or four (men) measurement points across 10 years (1988 to 1998) are different both physically and psychologically from those who inconsistently or never report pain. Participants were 96 persons with spinal cord injury (SCI) living in the community who participated at every measurement point. Measures included consistency of reports of pain (i.e., reported having had problems with pain in the 12 months prior to all, some, or no measurement points); demographic and injury-related data; and measures of physical and psychological health, function, and social support. Of the 96 participants, approximately half of the men and three-fourths of the women consistently reported pain at each point. Phase 1 predictors of the consistency of pain reports for men were being less impaired, being more independent, experiencing more stress, and receiving less social support. Women consistently reporting pain had more stress at Phase 1 than women inconsistently reporting pain. Persons with SCI at risk for chronic pain should be identified and referred to a multidisciplinary pain management program. [ABSTRACT FROM AUTHOR]

Veterans with spinal cord injury (SCI) who received care at the Houston Department of Veterans Affairs Medical Center were interviewed about their use of formal and informal assistance to meet their daily physical needs. Informal caregivers were found to play an important role in the daily care of veterans with SCI, with 37% receiving some informal, unpaid assistance-with personal care. Primary informal caregivers were mostly women, had a mean age of 53, and provided an average of almost 12 hours of care a day. Nearly one-third of participants rated their primary caregiver as being only in fair or poor health, and one-fourth thought their caregiver was unlikely to be able to provide the same level of care 5 years from now. Of particular concern, more than half reported that they did not have anyone else willing and able to provide assistance if their primary family caregiver became permanently unable to care for them. [ABSTRACT FROM AUTHOR]

Pressure ulcers are a major complication of spinal cord injury (SCI) and have a significant effect on general health and quality of life. The objectives of this retrospective chart review were to determine prevalence, duration, and severity of pressure ulcers in veterans with SCI and to identify predictors of (1) outcome in terms of healing without surgery, not healing, or referral for surgery; (2) number of visits veterans made to the SCI outpatient clinic or received from home care services for pressure ulcer treatment; and (3) number of hospital admissions and days hospitalized for pressure ulcer treatment. From a sampling frame of 553 veterans on the Houston Veterans Affairs Medical Center SCI roster, 215 (39%) were reported to have visited the clinic or received home care for pressure ulcers (ICD-9 code 707.0 = decubitus, any site) during the 3 years studied (1997, 1998, and 1999). From this sample, 102 veterans met the inclusion criteria for further analyses, 56% of whom had paraplegia. The duration of ulcers varied greatly from 1 week to the entire 3-year time-frame. Overall, Stage IV pressure ulcers were the most prevalent as the worst ulcer documented. Number and severity of ulcers predicted outcome and healthcare utilization. This study illustrates the magnitude of the pressure ulcer problem among veterans with SCI living in the community. Reducing the prevalence of pressure ulcers among veterans with SCI will have a significant impact on the Department of Veterans Affairs' financial and social resources. Innovative approaches are needed to reduce pressure ulcer risk in veterans with SCI. [ABSTRACT FROM AUTHOR]

Objective. This paper describes an educational model for increasing and retaining the knowledge of pressure ulcer prevention and management in veterans with spinal cord injury (SCI) or multiple sclerosis (MS) who have had surgical repair of a pressure ulcer. It also describes the correlates of pressure ulcer knowledge at admission and discharge. Methods. Before pressure ulcer surgery, 41 male veterans with SCI or MS were randomized to either an intervention group or a control group. A pressure ulcer prevention knowledge test was administered before surgery and at discharge from the hospital, as well as at 3, 6, 12, and 24 months after discharge for the intervention group and at the end of participation for the control group. Other measures obtained at admission included health locus of control and health beliefs. Near the end of their hospital stay, participants of the intervention group received 4 hours of structured, individualized education on the prevention of pressure ulcers while participants of the control group received standard education. Results. Results indicated that participants in the intervention group gained more knowledge during hospitalization than did those in the control group. Lower admission knowledge scores were related to the 'chance' dimension of locus of control, nonbelief that an ulcer would interfere 'a lot' in one's life, and nonbelief that daily skin checks make 'a lot' of difference in whether one gets an ulcer. Lower discharge knowledge scores were related to older age, older age at onset, a greater number of previous pressure ulcer surgeries, and nonbelief that daily skin checks make 'a lot' of difference in whether one gets an ulcer. Both groups retained most of their discharge knowledge up to 24 months postdischarge or to discontinuation because of recurrence. Conclusions. Enhanced, individualized education about pressure ulcer prevention and management was effective in improving pressure ulcer knowledge during hospitalization for surgical repair of a pressure ulcer. The effect of the intervention on recurrence of pressure ulcers will be addressed in future reports. [ABSTRACT FROM AUTHOR]

According to societal stereotypes, women with physical disabilities are asexual and therefore do not date. Another stereotype, and a fear of many women with disabilities, is that no one will want to date them because they have a disability. Consequently, little is known about their dating behaviors. Qualitative research methods were used to code and analyze 31 in-depth interviews of women with a variety of disabling conditions. Themes emerging from their stories indicated that the timing of onset of disability, and the response to disability of family, friends, and society in general, were critical in establishing patterns of dating behavior for women with physical disabilities. [ABSTRACT FROM AUTHOR]

A cross-sectional study of 189 community-dwelling persons with spinal cord injury (SCI) (a) assessed levels of dietary and serum lipids, (b) determined the proportion of persons whose levels were out of the recommended/desired range, and (c) identified predictors of dietary and serum lipids. Lipid levels were out of range for a substantial proportion of the sample. Older persons were likely to have higher serum cholesterol and higher triglyceride levels than younger persons. Men tended to have higher intake of dietary cholesterol and lower levels of HDL than women. Caucasians and Hispanic-Americans tended to have higher triglycerides than African-Americans. Persons who had lived with SCI less time tended to have higher saturated fat intake and higher triglycerides than those who had lived with it longer. Greater saturated fat intake was associated with higher serum cholesterol after controlling for age. Studies are needed that test the effectiveness of various interventions on controlling dietary and serum lipids for persons with SCI. [ABSTRACT FROM AUTHOR]

The final report of the National Study on Women with Disabilities provides an overview of the research conducted from 1992 to 1996 at the Center for Research on Women with Disabilities. The report addresses the methodologies used in the recruitment of women and reviews the various analyses conducted on the data. In addition, the report provides a discussion of recruitment techniques used for nondisabled women and the analysis used for this population as well. It provides a summary of findings in the areas of sense of self, relationships, information about sexuality, sexual functioning, pregnancy, sexually transmitted diseases, abuse, chronic conditions, health maintenance behaviors, gynecologic health, and health care utilization. [ABSTRACT FROM AUTHOR]

A study of dating issues for 250 single women with physical disabilities and 180 single women without disabilities was undertaken to determine (a) differences between women with and without disabilities and (b) predictors of dating outcomes for women with disabilities. A survey was sent to a national sample of women with disabilities along with a similar survey to give to a female friend without a disability. Dating outcomes included (a) satisfaction with dating frequency, (b) perceived constraints on attracting partners, (c) perceived personal barriers to dating, (d) perceived societal barriers to dating, and (e) perceived communication problems. Women with disabilities were disadvantaged on all but (e). Between 21% and 47% of the variance in the outcomes was accounted for in multiple regression analyses. Potential interventions suggested by the findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Levodopa treatment has been shown to improve gait spatio-temporal characteristics in both forward and backward walking. However, effect of levodopa on gait variability during backward walking compared with forward walking has not been reported., Aims of Study: To study the effects of levodopa on gait variability of forward and backward walking in individuals with Parkinson's disease (PD)., Methods: Forty individuals with PD were studied. Their mean age was 68.70 ± 7.46 year. The average time since diagnosis was 9.41 ± 5.72 year. Gait variability was studied while 'OFF' and 'ON' levodopa when the participants walked forward and backward at their usual speed. Variability in step time, swing time, stride length, double support time, and stride velocity were compared between medication condition and walking direction., Results: Variability of step time, swing time, stride length, and stride velocity decreased significantly during forward and backward walks (P < 0.001; P < 0.001; P = 0.003, P = 0.001, respectively) after levodopa administration. Variability of double support time was not changed after levodopa administration (P = 0.054)., Conclusions: Levodopa had positive effects on gait variability of forward and backward walking in individuals with PD. However, variability in double support time was not affected by the levodopa., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To investigate the relationships between falls, fear of falling, and activity limitations in individuals with Parkinson's disease (PD)., Design/methods: Cross-sectional study of individuals with mild to moderate PD (N = 83). Associations among demographic data, fall frequency, disease severity, motor impairment, ability to perform activities of daily living (ADL), Activities Balance Confidence Scale, Iowa Fatigue Scale, Comorbidity Index, and Physical Activity Scale for Elders were studied., Results: Frequent fallers had more ADL limitations than nonfallers (p < .001) and rare fallers (p = .004). Frequent fallers reported a lower percentage of ability to perform ADL than nonfallers (p = .003). Frequent fallers and rare fallers were less physically active than nonfallers (p = .015 and p = .040, respectively). Frequent fallers and rare fallers reported a higher level of fear of falling than nonfallers (p = .031 and p = .009, respectively)., Conclusions: Falls and fear of falling were associated with more ADL limitations and less physical activity after adjusting for physical impairments.

Background: Chronic low back pain (CLBP) is common and results in significant costs to individuals, families and society. Although some research supports the efficacy of hypnosis for CLBP, we know little about the minimum dose needed to produce meaningful benefits, the roles of home practice and hypnotizability on outcome, or the maintenance of treatment benefits beyond 3 months., Methods: One hundred veterans with CLBP participated in a randomized, four-group design study. The groups were (1) an eight-session self-hypnosis training intervention without audio recordings for home practice; (2) an eight-session self-hypnosis training intervention with recordings; (3) a two-session self-hypnosis training intervention with recordings and brief weekly reminder telephone calls; and (4) an eight-session active (biofeedback) control intervention., Results: Participants in all four groups reported significant pre- to post-treatment improvements in pain intensity, pain interference and sleep quality. The hypnosis groups combined reported significantly more pain intensity reduction than the control group. There was no significant difference among the three hypnosis conditions. Over half of the participants who received hypnosis reported clinically meaningful (≥ 30%) reductions in pain intensity, and they maintained these benefits for at least 6 months after treatment. Neither hypnotizability nor amount of home practice was associated significantly with treatment outcome., Conclusions: The findings indicate that two sessions of self-hypnosis training with audio recordings for home practice may be as effective as eight sessions of hypnosis treatment. If replicated in other patient samples, the findings have important implications for the application of hypnosis treatment for chronic pain management., (© 2014 European Pain Federation - EFIC®)

Objective: To identify determinants for the use of a walking device in persons with Parkinson's disease (PD)., Design: Cross-sectional study of participants with PD., Setting: Laboratory., Participants: Persons with PD (N=85; 60 men) were studied. Their mean age was 69.4±8.9 years. The average time since diagnosis was 7.9±5.3 years., Interventions: Not applicable., Main Outcome Measures: Age, sex, disease duration, disease severity, and motor impairment were recorded. Participants were asked whether they usually used any walking device (eg, cane or walker) and were categorized as either an "independent walker" or a "device walker." Clinical balance measures including functional reach, turn duration, 5-meter timed Up and Go (5m-TUG) test, and Activities-specific Balance Confidence (ABC) scale were investigated for their contribution to the prediction of walking with a device., Results: Thirty-one participants (36.5%) reported that they usually used a walking device. Classification and regression tree analysis determined that the 5m-TUG test and the ABC scale were important factors in differentiating participants who used a walking device from those who did not. Critical thresholds included 13 seconds for the 5m-TUG test and a score of 75 for the ABC scale in determining device walking. Using only these 2 determinants, the classification and regression tree model correctly classified 81% of the patients as either independent or needing a walking device., Conclusion: The 5m-TUG test and the ABC scale may be useful in clinical assessments of the need for a walking device in persons with PD., (Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To study the relationship of fear of falling (FoF) with gait characteristics and balance in individuals with Parkinson's disease (PD)., Method: Seventy-nine non-demented individuals (62 males) with PD were studied. Their mean age was 69.22 ± 8.93 years. The average time since diagnosis was 8.27 ± 5.31 years. FoF was assessed by the Activities-specific Balance Confidence (ABC) Scale in which high scores indicate less FoF. Gait was measured using a computerized walkway. Balance was measured by timed tests including the 5-step test, 360 degree turn, timed sideways walk, and timed up and go test. Participants were divided into two groups based on their ABC score (high FoF, ABC score <69; low FoF, ABC score ≥69). Gait characteristics and balance measures of the two groups were compared., Results: Gait speed and stride length for forward walking (p < 0.0005 for both) and backward walking (p = 0.001 and 0.002, respectively) were lower for those with a high level of FoF compared to those with a low level of FoF. The time to take five steps (p = 0.025), time to turn (p < 0.0005), time to walk sideways (p = 0.001), and time to complete the up and go test (p = 0.003) were longer in those with a high level of FoF than in those with a low level of FoF. Number of steps to complete the turn (p = 0.001) and steps to walk sideways (p = 0.002) were greater in those with a high level of FoF than in those with a low level FoF., Conclusions: Gait and balance of individuals with PD with a high level of FoF were poorer than those with a low level of FoF, regardless of previous fall history. Implications for Rehabilitation The results demonstrates that fear of falling (FoF) is related to gait and balance in individuals with PD. Clinicians should be aware that FoF has a negative impact on gait and balance in individuals with PD.

Purpose: Compare predictive validity (relative to psychological well-being) of long and short versions of 2 measures of social support for persons with spinal cord injury (SCI)., Research Method: Sixty-nine men with SCI completed (a) a long and short version of the Interpersonal Support Evaluation List (ISEL), (b) a structured interview regarding the frequency with which a person receives 11 kinds of support from each of their most important supporters (maximum of 5), and (c) a global measure of the same 11 kinds of support. Approximately 3 years later they completed 4 measures of psychological well-being--the Center for Epidemiologic Studies Depression scale (CESD), the Life Satisfaction Index A (LSIA), the Perceived Stress Scale (PSS), and the Rosenberg Self-Esteem Scale (RSES). Comparisons were made among the social support measures with regard to their ability to predict each of the 4 measures of psychological well-being at a later point in time., Results: The long version of the ISEL had more predictive power than the long version of the structured interview., Conclusions: The long version of the ISEL is a good choice for measuring social support in persons with SCI and the short ISEL may be an acceptable choice when minimizing respondent burden is critical if the number of response options is increased to 4., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Purpose: To study the reliability of a Non-Instrumented Walk Test in individuals with Parkinson's disease (PD)., Method: Thirty individuals (21 Males) with PD were studied. Their mean age was 68.90 ± 9.28 years. The average time since diagnosis was 8.75 ± 5.68 years. The reliability of the manual Non-Instrumented Walk Test was studied while "OFF" and "ON" dopaminergic medication. Subjects walked at their self-selected, usual speed during a Non-Instrumented Walk Test and while walking on a computerized instrumented walkway. Intraclass correlation coefficients (ICCs) were calculated and means were compared for three gait parameters as measured by the two methods., Results: During "OFF" medication testing, ICCs between the Non-Instrumented Walk Test and the instrumented measures for gait speed, cadence and stride length were 0.96 (p < 0.0005), 0.72 (p = 0.001) and 0.97 (p < 0.0005), respectively. During "ON" medication testing, the ICCs were 0.96 (p < 0.0005), 0.86 (p < 0.0005) and 0.96 (p < 0.0005), respectively. The means of the non-instrumented measures tended to be lower than those obtained on the instrumented walkway., Conclusions: The Non-Instrumented Walk Test is a quick, simple and inexpensive gait evaluation for individuals with PD. The method is sufficiently reliable to be used clinically in this population during different medication cycles., Implications for Rehabilitation: • The Non-Instrumented Walk Test in individuals with PD is reliable. • Results supported the use of the measure. This simple walk test is quick and easy to administer in both clinical and community settings.

Objective: To characterize non-motor symptoms in individuals with Parkinson's disease (PD) who experience falls compared to those who do not fall., Methods: Fifty-four individuals with PD were studied. Thirty-six were fallers and 18 were non-fallers. Fatigue was assessed by the Iowa Fatigue Scale. Excessive daytime sleepiness was assessed by the Epworth Sleepiness Scale, and depressive symptomatology was assessed by the short-form Center for Epidemiologic Studies Depression Scale., Results: Compared to non-fallers, fallers had more severe disability, greater general physical fatigue (p = 0.024), lower energy levels (p = 0.042) and less productivity (p = 0.007). Fallers had more depressive symptomatology than the non-fallers (p = 0.01). Excessive daytime sleepiness was not different between the two groups (p = 0.695)., Conclusions: Individuals with PD who fell had more severe motor and non-motor symptoms than those who did not fall. These non-motor symptoms included physical fatigue, energy, productivity and depressive symptomatology., (Copyright © 2012 S. Karger AG, Basel.)

Objectives: To study the effects of levodopa and walking speed on gait variability in individuals with Parkinson's disease (PD)., Methods: Thirty-three individuals with PD were studied. Their mean age was 70.61±9.23 year. The average time since diagnosis was 9.65±5.80 year. Gait variability was studied while 'OFF' and 'ON' dopaminergic medication when the subjects walked at their usual and fastest speeds., Results: Variability of step time, double support time, stride length and stride velocity decreased significantly (P=0.037; P=0.037; P=0.022; P=0.043, respectively) after dopaminergic treatment. When subjects increased walking speed, the variability of stride length and stride velocity decreased significantly (P=0.038 and P=0.004, respectively) both while 'OFF' and 'ON' levodopa. Increasing walking speed did not change the variability of step time and double support time regardless of medication status., Conclusions: Levodopa decreased gait variability in persons with PD. Stride length and stride velocity variability appeared to be speed dependent parameters, whereas, the variability of step time and double support time appeared to be speed independent measures. Levodopa had positive effects on gait stability in PD.

Introduction: Backward walking is difficult for persons with Parkinson's disease (PD). It is unknown how levodopa influences backward gait patterns, especially when compared to forward gait patterns., Purpose: Investigate the effects of levodopa on forward and backward gait patterns in individuals with PD., Design: A repeated measures design was used., Methods: The sample consisted of 21 individuals with PD (15 males, 6 females). Their mean age was 70.24 ± 8.69 yr. The average time since diagnosis was 11.81 ± 5.49 years. The median of the Hoehn and Yahr stage while 'ON' medication was 2.57. Gait patterns during forward and backward walking at a self-selected comfortable speed were recorded before and after taking levodopa on the same day., Results: Levodopa significantly increased gait speed and stride length and decreased the percent of the gait cycle (%GC) spent in double support. Gait speed and stride length were greater and the %GC spent in double support was less during forward walking compared with backward walking. Cadence was not changed by levodopa or walking direction., Conclusions: Levodopa improved gait characteristics during backward walking in a manner similar to that during forward walking in persons with PD.

Background: Chronic pain is a significant problem for many individuals following spinal cord injury (SCI). Unfortunately, SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments. Cranial electrotherapy stimulation (CES) has been effective in managing some types of pain. It involves the application of a small amount of current through the head via ear clip electrodes., Objective: Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain., Study Design: Multi-site, double-blind, sham-controlled study., Participants: Adults with SCI and chronic neuropathic pain at or below the level of injury were randomized to receive active or sham CES., Intervention: Application of active CES or sham CES 1 hour daily for 21 days. Six-month open-label phase to assess 'as-needed' CES use., Outcome Measures: Change in pre- to post-session pain ratings as well as change in pain intensity, pain interference, pain quality, pain beliefs and coping strategies, general physical and mental health status, depressive symptomatology, perceived stress, and anxiety pre- to post-treatment., Results: The active group reported a significantly greater average decrease in pain during daily treatments than the sham group (Kruskal-Wallis chi-square = 4.70, P < 0.05). During the 21-day trial, there was a significant group × time interaction for only one outcome variable; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did (F = 8.50, P < 0.01, d = 0.59)., Conclusions: On average, CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects. Individual results varied from no pain relief to a great deal of relief.

Objective: To test the efficacy and safety of a cannabinoid, dronabinol, compared with an active control, diphenhydramine, in relieving neuropathic pain in persons with spinal cord injury., Design: A randomized, controlled, double-blind, crossover pilot study., Results: Seven adults with spinal cord injury and neuropathic pain below the level of injury participated. Two participants withdrew while receiving dronabinol, their first medication. For the remaining five participants, change in pain on a scale of 0-10 from baseline to the end of the maintenance phase did not differ significantly between the two medications (mean change, dronabinol: 0.20 ± 0.837, range = -1.00 to 1.00; diphenhydramine: -1.80 ± 2.490, range = -6.00 to 0; Wilcoxon Z = 1.63, P = 0.102). Similar results were found when the average of the two ratings during the maintenance phase was used (dronabinol: -0.20 ± 0.671, range = -0.50 to 1.00; diphenhydramine: -1.40 ± 1.245, range = -3.50 to -0.50; Wilcoxon Z = 1.60, P = 0.109). The most common side effects were dry mouth, constipation, fatigue, and drowsiness for both medications., Conclusions: On average, dronabinol was no more effective than diphenhydramine for relieving chronic neuropathic pain below the level of injury.

Objectives. To assess the feasibility of treating musculoskeletal pain in the lower back and/or lower extremities in persons with Parkinson's disease (PD) with cranial electrotherapy stimulation (CES). Design. Randomized, controlled, double-blind trial. Setting. Veterans Affairs Medical Center, Community. Participants. Nineteen persons with PD and pain in the lower back and/or lower extremities. Thirteen provided daily pain rating data. Intervention. Of the thirteen participants who provided daily pain data, 6 were randomly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks. They recorded their pain ratings on a 0-to-10 scale immediately before and after each session. Main Outcome Measure. Average daily change in pain intensity. Results. Persons receiving active CES had, on average, a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES (Wilcoxon Z = -2.20, P = .028). Conclusion. Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain. A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES. Guidelines for future studies are provided.

Purpose: To investigate the effect of red and green light beams on gait and freezing of gait (FOG) in persons with Parkinson's disease (PD)., Methods: Seven persons with PD who experienced FOG participated in the study. Gait and turning performances were studied while walking with canes with red, green, and no light beams while "off" and "on" anti-Parkinsonian medications. Gait speed, cadence, and stride were recorded. Time and number of freezing episodes were recorded during a 50-foot walk and a 360° turn., Results: During 'off' medication, compared to no light, stride length improved when using the green light, but not the red. During the 50-foot walk, freezing episodes were reduced when using the green light compared to both the red and no light. During the 360° turn, time, number of steps and number of freezing episodes were reduced using the green light compared to the red and no light. During 'on' medication, gait speed and stride length improved more with the green light compared to the red. Neither color showed any effect on cadence during either medication state., Conclusion: A green light improved gait and alleviate FOG in persons with PD better than a red light or no light.

Purpose: To compare walking characteristics of individuals with Parkinson's disease (PD) using a new walking aid, the WalkAbout, with usual walking., Method: Fifteen subjects with PD were recruited. Subjects walked in their usual fashion and then walked again in the WalkAbout. Gait parameters, 5-min walk, and oxygen consumption were recorded., Results: Stride lengths were shorter when using the WalkAbout. On an average, the distance walked in 5 min and the oxygen uptake was not different when walking with the WalkAbout compared with the usual walk. Eight subjects (responders) walked further with the WalkAbout compared to their usual walk (164.90 +/- 55.72 m vs. 140.82 +/- 55.94 m). Seven subjects (non-responders) walked a shorter distance while using the WalkAbout compared to their usual walk (241.79 +/- 73.06 m vs. 281.24 +/- 82.83 m). Compared to non-responders, responders were older, had more severe disability, and were more likely to use an assistive device for walking. Responders walked more slowly, had a shorter stride length, and walked shorter distances in 5 min than non-responders., Conclusion: The WalkAbout may help persons with PD who have more severe disability to walk farther. These data could be beneficial in selecting a helpful walking aid for persons with PD.

Objective: To test the hypothesis that enhanced education and structured follow-up after pressure ulcer surgery will result in fewer recurrences., Design: Randomized controlled trial., Setting: Veterans Affairs medical center., Participants: Forty-nine veteran men with spinal cord injury or dysfunction were approached on admission for pressure ulcer surgery. Five never had surgery, 2 refused to participate, and one withdrew. Forty-one were randomized into 3 groups. Three participants' ulcers did not heal, so follow-up could not begin., Interventions: Group 1 received individualized pressure ulcer education and monthly structured telephone follow-up (n=20); group 2 received monthly mail or telephone follow-up without educational content (n=11); and group 3 received quarterly mail or telephone follow-up without educational content (n=10). Follow-up continued until recurrence, death, or 24 months., Main Outcome Measure: Time to pressure ulcer recurrence., Results: Group 1 had a longer average time to ulcer recurrence or end of study than groups 2 and 3 (19.6 mo, 10.1 mo, 10.3 mo; P=.002) and had a smaller rate of recurrence (33%, 60%, 90%; P=.007). Survival analysis confirmed these findings (P=.009)., Conclusions: Individualized education and structured monthly contacts may be effective in reducing the frequency of or delaying pressure ulcer recurrence after surgical repair of an ulcer.

Objective: To test the hypotheses that both amitriptyline and gabapentin are more effective in relieving neuropathic pain than an active placebo, diphenhydramine., Design: Randomized, controlled, double blind, triple crossover 8-week trial., Setting: Veterans Affairs medical center., Participants: Community dwelling adults with spinal cord injury (N=38) were recruited by telephone, letters, and flyers., Intervention: Eight-week trial each of amitriptyline, gabapentin, and diphenhydramine., Main Outcome Measures: Pain intensity measured with a 10-cm visual analog scale (VAS) and an 11-point (0-10) numeric rating scale (NRS) and depressive symptomatology measured with the Center for Epidemiologic Studies Depression Scale-Short Form (CESD-SF)., Results: Baseline VAS scores for participants with low (< 10) CESD-SF scores was 4.61 and for those with high scores (> or = 10) it was 7.41. At week 8, in participants with high baseline CESD-SF scores, amitriptyline (mean, 4.21) was more effective than diphenhydramine (mean, 6.67; P=.035), and there was a nonsignificant trend suggesting that amitriptyline may be more effective than gabapentin (mean, 6.68; P=.061). Gabapentin was no more effective than diphenhydramine (P=.97). There was no significant difference among the medications for those with lower CESD-SF scores. Results could not be attributed to dropout rates, order or dose of medications, amount of medication taken for breakthrough pain, or side effects., Conclusions: Amitriptyline is more efficacious in relieving neuropathic pain than diphenhydramine at or below the level of spinal cord injury in people who have considerable depressive symptomatology.

Objective: To assess gender differences in academic progress and attitudes toward promotion in academic physical medicine and rehabilitation (PM&R)., Design: A survey was sent to members of the Association of Academic Physiatrists (AAP). Questions addressed demographics, job description, hours worked, childcare responsibilities, publications, career aspirations, mentoring, and familiarity with promotion and tenure policies. Respondents were also asked about the relative importance of career aspects including the perceived benefits of and obstacles to promotion. Responses were anonymous., Results: Women spent less time on scholarly activities. Women considered the fact that they disliked writing and did not know how to do research to be more important obstacles to promotion than did men. Women were more likely to have part-time appointments and lower academic rank. They had fewer children at home but greater responsibility for child care. Women were less likely to aspire to become full professor, they met less often with their department chair/supervisor, and they published fewer papers. Men and women reported equal career satisfaction., Conclusions: There are several gender differences in the values, attitudes, and priorities in academic PM&R. Women respondents were generally less interested in traditional academic pursuits than were their male counterparts.

This pilot study assessed the role of Healing Touch (HT), an energy-based therapy, in modulating chronic neuropathic pain and the associated psychological distress from post spinal cord injury. Twelve veterans were assigned to either HT or guided progressive relaxation for six weekly home visits. The instruments selected showed sensitivity, although there was a large variation among the groups. There was a significant difference in the composite of interference on the Brief Pain Inventory (t = -2.71, p = .035). The mean score of the fatigue subscale of the Profile of Moods decreased (ns) in the HT group and in the subscale of confusion yet remained stable in the control group. The Diener Satisfaction With Life Scale showed increased well-being in the HT group and no change in the control group. Participants reported various experiences with HT sessions indicating that it may have benefit in the complex response to chronic pain.

Objective: To determine the effect of low ejection fraction (35%)., Design: A retrospective chart review of the 332 stroke patients admitted to the inpatient rehabilitation unit of an acute tertiary general hospital during a 36-mo period. A total of 262 (79%) of these patients (126 men and 136 women) had an ejection fraction study performed and are the subjects of this analysis. They were classified into two groups: low ejection fraction (n = 36) and high ejection fraction (n = 226). The main outcome measures included discharge total FIM score, FIM gain, FIM efficiency, length of stay, and discharge disposition., Results: Patients with low ejection fraction had lower discharge FIM scores (82.9 vs. 89.1, t = 2.09, P < 0.04), lower FIM gain (15.9 vs. 19.3, t = 1.99, P < 0.05), and lower FIM efficiency (1.2 vs. 1.7, t = 232, P < 0.03), and they were less likely to return home (69% vs. 85%, chi 2= 5.25, P < 0.04) as compared with patients with high ejection fraction. Lengths of stay were not significantly different between the two groups., Conclusion: Compared with patients in the high ejection fraction cohort, the low ejection fraction subjects had lower discharge FIM scores, FIM gains, and FIM efficiency. However, almost 70% progressed well enough to be discharged to home. Low ejection fraction in stroke patients may well serve as an indicator of a patient population with greater medical and social needs.

Objectives: To determine serum levels of vitamins A, C, and E among individuals with spinal cord injury (SCI) living in the community, to compare these levels with general population norms, and to assess their association with demographic and injury-related data (age at onset, time since onset, level and completeness of injury), function, nutritional behaviors, and health status., Design: Descriptive and correlational., Setting: General community., Participants: A total of 110 adults (> or =18y) with traumatic SCI of at least 2 years in duration living within a 13-county area in Texas., Interventions: Not applicable., Main Outcome Measures: Demographic information, age at onset, time since onset, American Spinal Injury Association (ASIA) total motor index score, ASIA impairment score, assay of serum vitamins, FIM trade mark instrument motor items, Health-Promoting Lifestyle Profile nutrition subscale, Medical Outcomes Study 36-Item Short-Form Health Survey general health subscale, and pressure ulcer occurrence in past 12 months., Results: Many (16%-37%) of the participants had serum levels below the reference range for each vitamin. Being older at onset or less impaired was associated with higher serum vitamin A levels. Higher levels of serum vitamin A also were related to better function and health status and with not having a pressure ulcer within the past 12 months. Being older or older at onset was associated with higher serum levels of vitamin E. No relationships with vitamin C were found., Conclusions: Vitamin levels may be related to function, general health, and pressure ulcer incidence in persons with SCI. Further study is needed to determine effective interventions to improve vitamin levels and determine the effect of such improvements on overall health and rehabilitation outcomes.

Objectives: To determine if shoulder pain and range-of-motion (ROM) problems can be predicted by demographic, injury-related, body weight, and radiographic data over 3 years and to determine the relationships among these shoulder problems and functional limitations, disability, and perceived health., Design: A longitudinal, 2-panel study in which data were collected at 2 points in time, 3 years apart., Setting: The community., Participants: Eighty-nine adult men with traumatic spinal cord injury (SCI) in the Houston-Galveston, TX, area., Main Outcome Measures: The acromioclavicular (AC) and the glenohumeral (GH) joints were x-rayed on plain film in standard anteroposterior position. Functional limitations were determined with the FIM instrument; disability was measured with the Craig Handicap Assessment and Reporting Technique (CHART)., Results: Thirty percent had shoulder pain and 22% had shoulder ROM problems. Men with shoulder pain had lived longer with SCI, were more likely to report shoulder ROM problems, had lower CHART mobility scores, and were more likely to rate their health as fair than those without shoulder pain. Shoulder ROM problems were more common among men who were older, had AC joint narrowing, had lower FIM scores, and reported poorer health., Conclusion: Shoulder pain and ROM problems were relatively prevalent. Demographic, injury-related, and radiographic variables were identified that were predictive of these problems over a period of at least 3 years. The shoulder problems were related to functional limitations, disability, and perceived health.