Objective: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. Design: Multicentre longitudinal study. Subjects: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. Methods: Assessments at the start of active rehabilitation (n = 212), 3 months later (n = 143), at discharge (n = 191) and 1 year after discharge (n = 143). Results: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications. Conclusion: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations.

Study design: Review of publications. Objective: To assess the level of physical capacity (peak oxygen uptake, peak power output, muscle strength of the upper extremity and respiratory function) in wheelchair-dependent persons with a spinal cord injury (SCI). Setting: Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Methods: Pubmed (Medline) search of publications from 1980 onwards. Studies were systematically assessed. Weighted means were calculated for baseline values. Results: In tetraplegia, the weighted mean for peak oxygen uptake was 0.89 l/min for the wheelchair exercise test (WCE) and 0.87 l/min for arm-cranking or hand-cycling (ACE). The peak power output was 26 W (WCE) and 40 W (ACE). In paraplegia, the peak oxygen uptake was 2.10 l/min (WCE) and 1.51 l/min (ACE), whereas the peak power output was 74 W (ACE) and 85 W (WCE). In paraplegia, muscle strength of the upper extremity and respiratory function were comparable to that in the able-bodied population. In tetraplegia muscle strength varied greatly, and respiratory function was reduced to 55-59% of the predicted values for an age-, gender-and height-matched able-bodied population. Conclusions: Physical capacity is reduced and varies in SCI. The variation between results is caused by population and methodological differences. Standardized measurement of physical capacity is needed to further develop comparative values for clinical practice and rehabilitation research.

No abstract

No abstract

Objectives: To assess organisational and patient specific limitations and safety of magnetic resonance imaging (MRI) as the first line investigation for hospital admitted stroke patients. Methods: Consecutive patients admitted with acute stroke were assessed and an attempt was made to perform MRI in all patients. Oxygen saturation and interventions required during scanning were recorded. Results: Among 136 patients recruited over 34 weeks, 85 (62%) underwent MRI. The patients' medical instability (15 of the 53 not scanned), contraindications to MRI (six of the 53 not scanned), and rapid symptom resolution (10 of the 53 not scanned) were the main reasons for not performing MRI. Of the 85 patients who underwent MRI, 26 required physical intervention, 17 did not complete scanning, and 11 of the 61 who had successful oxygen saturation monitoring were hypoxic during MRI. Organisational limitations accounted for only 13% of failures to scan. Conclusions: Up to 85% of hospital admitted acute stroke patients could have MRI as first line imaging investigation, but medical instability is the major limitation. Hypoxia is frequent in MRI. Patients should be monitored carefully, possibly by an experienced clinician, during scanning. M agnetic resonance imaging (MRI) has been advocated as a method of improving the selection of patients with stroke for thrombolysis.1 However, MRI has more contraindications, is more difficult to perform in ill patients, and takes longer than computed tomography scanning.The current issue is to determine the proportion of patients with acute stroke in whom MRI is achievable, and how to identify (in the acute situation) those in whom MRI is unlikely to be successful. Studies of imaging appearances in selected patients, 2 or which were retrospective but gave no indication of the actual number of suspected strokes not referred for MRI in the same time period, 3 4 have not provided such information. One recent prospective study found that 20% of 144 stroke patients recruited ''at the hospital door'' could not have MRI (of whom half had MRI contraindications and half were medically unstable).5 No study has investigated whether MRI is safe in acute stroke.We aimed to determine: (1) whether it was possible to use MRI as the first line assessment for all suspected acute strokes, and (2) the limitations and safety of MRI in acute stroke. METHODSFrom among all consecutive admissions to our hospital (population served, 500 000) with suspected acute stroke, patients were eligible for the MRI feasibility study if they could be assessed by a clinical research fellow and scanned within 24 hours of stroke, and the clinical diagnosis was probable or definite stroke (transient ischaemic attacks and obvious non-strokes were excluded).We recorded time of stroke and assessment, clinical features, neurological deficit (National Institutes of Health Stroke Scale Score (NIHSS): http://www.strokecenter.org/ trials/scales/) and stroke subtype. 6 An experienced neurologist assessed the risk of complications occurring duri...

Background and Purpose-Stroke remains primarily a clinical diagnosis, with information obtained from history and examination determining further management. We aimed to measure inter-rater reliability for the clinical assessment of stroke, with emphasis on items of history, timing of symptom onset, and diagnosis of stroke or mimic. We explored reasons for poor reliability. Methods-The study was based in an urban hospital with an acute stroke unit. Pairs of observers independently assessed suspected stroke patients. Findings from history, neurological examination, and the diagnosis of stroke or mimic, were recorded on a standard form. Reliability was measured by the statistic. We assessed the impact of observer experience and confidence, time of assessment, and patient-related factors of age, confusion, and aphasia on inter-rater reliability. Results-Ninety-eight patients were recruited. Most items of the history and the diagnosis of stroke were found to have moderate to good inter-rater reliability. There was agreement for the hour and minute of symptom onset in only 45% of cases. Observer experience and confidence improved reliability; patient-related factors of confusion and aphasia made the assessment more difficult. There was a trend for worse inter-rater reliability among patients assessed very early and very late after symptom onset. Conclusions-Clinicians should be aware that inter-rater reliability of the clinical assessment is affected by a variety of factors and is improved by experience and confidence.

Resistive inspiratory muscle training has a positive short-term effect on inspiratory muscle function in people with SCI who have impaired pulmonary function during inpatient rehabilitation.

No abstract