A Prospective Study of Health and Risk of Mortality After Spinal Cord Injury

Krause, James S.; Carter, Rickey E.; Pickelsimer, Elisabeth; Wilson, Dulaney A.

doi:10.1016/j.apmr.2007.11.062

Cited by 149 publications

(126 citation statements)

References 34 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…Not all attrition could be attributed to mortality, as only a limited number of factors were significantly related to attrition, whereas a much wider array of predictive factors has been identified in previous research. 12,13 There were several similarities with the earlier research over shorter intervals. [7][8][9] In addition to the aforementioned survivor effect, there was a combination of favorable and unfavorable changes.…”

Section: Discussionsupporting

confidence: 55%

Natural course of life changes after spinal cord injury: a 35-year longitudinal study

Krause

Bozard

2011

Spinal Cord

View full text Add to dashboard Cite

Objectives: To identify the natural course of changes in participation, employment, health and subjective quality of life over a 35-year interval among participants with spinal cord injury (SCI). Methods: Participants were enrolled in 1973 from a specialty hospital in the Midwestern United States and assessed again approximately 35 years later. The inclusion criteria were the following: having traumatic SCI; being 18 years of age or older; and a minimum of 2 years having elapsed post injury. There were 64 participants who responded on both occasions. Average age at follow-up was 61.5 years, with 41.1 years having passed since SCI onset. The Life Situation Questionnaire was used to measure outcomes. Results: Attrition analyses indicated that those who participated at follow-up were younger and had better overall outcomes at baseline (1973) when compared with those who dropped out of the study. Longitudinal analyses indicated a mixed pattern of favorable and unfavorable changes over the 35 years. The overall social participation decreased over time, although the sitting tolerance and hours spent in gainful employment increased. Non-routine physician visits increased. Satisfaction with employment improved over time, whereas satisfaction with social life, sex life and health declined. Self-reported adjustment improved, but the prediction of future adjustment in 5 years declined. Conclusion: Our study suggests that the natural course of SCI is marked by a survivor effect, whereby those with better outcomes are more likely to survive to follow-up, and a mixed pattern of favorable and unfavorable changes. Rehabilitation professionals should work to promote favorable outcomes in areas of strength, as well as minimize the likelihood of adverse outcomes. Spinal Cord (2012) 50, 227-231; doi:10.1038/sc.2011.106; published online 27 September 2011Keywords: spinal cord injury; aging; social participation; employment; quality of life; adjustment INTRODUCTIONSpinal cord injury (SCI) results in immediate and generally permanent changes to all aspects of life. The rehabilitation process is heavily focused on the time shortly after injury, including inpatient rehabilitation and transition to the community. However, life typically continues for years and even decades after SCI onset. What is the natural course of life changes after SCI? Answering this relatively simple and straightforward question requires a longitudinal investigation of changes in multiple life areas over time.It is tempting to conceptualize the natural course of SCI entirely in terms of aging. As the years pass, an individual's chronological age increases, but so does the number of years after injury. 1 Broader environmental changes also take place, such as those related to rehabilitation practices, medical and technological innovations, and funding practices. Longitudinal studies document the natural course of changes in life outcomes over a particular period of time reflecting a combination of factors, which may not easily be parceled into separate effects.Seve...

show abstract

Section: Discussionsupporting

confidence: 55%

Natural course of life changes after spinal cord injury: a 35-year longitudinal study

Krause

Bozard

2011

Spinal Cord

View full text Add to dashboard Cite

show abstract

“…6 An intervention that effectively prevents, attenuates or reverses bone loss is therefore highly desirable.…”

Section: Spinal Cord Series and Casesmentioning

confidence: 99%

FES-rowing attenuates bone loss following spinal cord injury as assessed by HR-pQCT

Gibbons

Beaupré

Kazakia

2016

Spinal Cord Ser Cases

View full text Add to dashboard Cite

Neurologically motor complete spinal cord injury (SCI) presents a unique model of bone loss whereby specific regional sites are exposed to a complete loss of voluntary muscle-induced skeletal loading against gravity. This results in a high rate of bone loss, especially in the lower limbs where trabecular bone mass decreases by~50-60% and cortical bone mass decreases by 25-34% before the rate of bone loss slows. These SCI-induced losses that are likely superimposed on continual age-related bone losses, increase the risk of low-impact fragility fracture. The fracture incidence 20 years post SCI is reported to be 4.6% per year. An intervention that effectively prevents, attenuates, or reverses bone loss is therefore highly desirable. We present a case study of an individual with chronic complete SCI, where bone loss has been attenuated following long-term functional electrical stimulation (FES)-rowing training. In this case study, we characterize the ultradistal tibia and ultradistal radius of the FES-rower with chronic complete SCI using high-resolution-peripheral quantitative computed tomography. These data are compared with a group of FESuntrained individuals with chronic complete SCI and to a normative non-SCI cohort. The evidence suggests, albeit from a single individual, that long-term FES-rowing training can attenuate bone loss secondary to chronic complete SCI. Indeed, key FES-rower's bone metrics for the ultradistal tibia more closely resemble normative age-matched values, which may have clinical significance since the majority of fragility fractures in chronic SCI occur in the lower extremities. Neurologically motor complete spinal cord injury (SCI) presents a unique model of bone loss whereby specific regional sites are exposed to a complete loss of voluntary muscle-induced skeletal loading against gravity. The initial loss of bone mineral content is estimated to approach 4% per month in trabecular sites, and 2% per month in cortical sites. Spinal Cord Series and Cases1 Trabecular bone mass is estimated to decrease by 48% of pre-injury values in the femur, reaching a new slower rate of loss by 3 years and 58% in the tibia by 5 years. Cortical bone mass decreases by 34% of pre-injury values in the femur by 5 years, and 25% in the tibia by 7 years.2 These losses are likely superimposed on continual age-related bone loss.3 SCIinduced bone loss often leads to the development of osteoporosis, which increases the risk of low-impact fragility fracture. 4 The fracture incidence 20 years post SCI is reported to be 4.6% per year.5 Thus, even active individuals with complete SCI at age 20 undergoing conventional standard of care have a very high likelihood of sustaining a fragility fracture in their lifetime, markedly affecting quality of life and increasing the risk of mortality. 6 An intervention that effectively prevents, attenuates or reverses bone loss is therefore highly desirable. 7One such intervention under investigation is functional electrical stimulation (FES) rowing. 8 In the present configuration, FES...

show abstract

“…Forstyrret autonom regulering av mukøst og lymfoid vev og forandret signalering til immunregulerende nevroner i sentralnervesystemet bidrar sannsynligvis (43). Urinveisinfeksjoner bidrar til økt morbiditet og mortalitet etter ryggmargsskade (2,16,44). Dette skyldes først og fremst skadens forstyrrelse av den nervøse reguleringen av nedre urinveier som medfører resturin og som nødvendiggjør bruk av urinveiskatetre.…”

Section: Diskusjonunclassified