The Influence of Age at Time of Spinal Cord Injury on Rehabilitation Outcome

DeVivo, Michael J.; Kartus, Paula L.; Rutt, Richard D.; Stover, Samuel L.; Fine, Philip R.

doi:10.1001/archneur.1990.00530060101026

Cited by 148 publications

(73 citation statements)

References 28 publications

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“…The external causes found in this study were largely in accordance with those found in earlier reports 1,[34][35][36][37] except from violence 9,38,39 and perinatal injury, [40][41][42] which did not occur in the present study.…”

Section: Discussionsupporting

confidence: 92%

Pediatric spinal cord injury in Sweden: incidence, etiology and outcome

Augutis

Levi

2003

Spinal Cord

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Section: Discussionsupporting

confidence: 92%

Pediatric spinal cord injury in Sweden: incidence, etiology and outcome

Augutis

Levi

2003

Spinal Cord

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“…Owing to the need of a prolonged rehabilitation stay, the risk of severe complications, the increased burden of care at discharge and the loss of productivity of these patients, spinal cord lesions result in extremely high costs to society. 1 Therefore, special efforts should be made to improve rehabilitation outcomes and to prevent complications and related medical problems.…”

Section: Introductionmentioning

confidence: 99%

Effects on age on spinal cord lesion patients' rehabilitation

et al. 2003

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Study design: The present study was undertaken to focus the age-related characteristics of a population of traumatic and nontraumatic spinal cord patients. Objectives: to examine demographic, injury and outcome characteristics of older adults with spinal cord lesions as a result of trauma and nontrauma, and to compare these characteristics with those of younger patients in matched cohorts. Setting: Spinal Cord Unit, Fondazione Santa Lucia IRCCS, a large rehabilitation hospital of the centre-south of Italy. Methods: In total, 284 consecutive newly injured patients with traumatic and nontraumatic spinal cord lesions were retrospectively reviewed and divided according to age into two groups: under 50 years (group 1) and over 50 years (group 2). The following information was collected: onset of lesion to admission; injury variables: aetiology, level, associated injuries, medical complications and surgical intervention; length of stay; American Spinal Injury Association (ASIA) impairment and motor scores; Barthel Index (BI) and Rivermead Mobility Index (RMI) to assess independence in daily living; Walking Index for Spinal Cord Injury to assess ambulation; patients destination at discharge. In a subset of 130 subjects, a block design, matching procedure was used to control for the covariant effects of injury characteristics, time from lesion and aetiology on age effects. Results: In the entire group of 284 patients, older subjects had a higher probability of having incomplete tetraplegia of nontraumatic origin; they also showed a shorter length of stay and a higher rate of complications. In the matched cohorts, younger patients showed better neurologic recovery (intended as ASIA impairment grade improvement and motor scores increase), significantly higher Barthel Index and RMI at discharge, a higher level of independence in spontaneous bladder and bowel management and a higher frequency of independent walking. Conclusion: Older individuals with spinal cord injury and disease do well, but have a less favourable outcome in regard to walking, bladder and bowel independence than younger subjects and have more associated medical problems. Different rehabilitative strategies, therefore, are required for older subjects, which maximises the shorter length of stay and provides the necessary medical care and increased physical assistant resources following discharge.

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“…1,3 Older adults with SCI (de®ned as 55 years and older) have a lower survival rate following their injury than younger adults. 4,5 There are also notable di erences between older and younger adults in the occurrence of secondary complications following SCI. The greater risk of developing several conditions, including myocardial infarction, hypertension, diabetes, pressure sores, and the increased requirement for mechanical ventilatory support have all been associated with acquiring a SCI later in life.…”

Section: Introductionmentioning

confidence: 99%

“…The greater risk of developing several conditions, including myocardial infarction, hypertension, diabetes, pressure sores, and the increased requirement for mechanical ventilatory support have all been associated with acquiring a SCI later in life. 5,8 Additionally, the cause of death in SCI persons also appears to be age related, with respiratory complications being more common in older adults, while subsequent injuries and suicides are more common in younger adults. 6,7 Susceptibility to illness is one of the many consequences of ageing.…”

Section: Introductionmentioning

confidence: 99%

“…5,9,15 Therefore, the same level of physical functioning post-injury should not be anticipated ± as they are with population focused scales when comparing rehabilitation gain or rehabilitation outcome in older and younger adults with SCI. Secondly, injury characteristics di er between younger and older adults with older adults being more likely to sustain an incomplete cervical lesion than younger individuals 4,5,9 and injury characteristics seriously a ect the degree of physical independence following injury. Due to the heterogeneous nature of SCI's there is great diversity in what would constitute a successful outcome within the spinal cord injured population.…”

Section: Introductionmentioning

confidence: 99%

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Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury

et al. 2002

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Objective: To evaluate rehabilitation outcome in a representative sample of older and younger SCI patients. Design: Case series, consecutive sample, survey. Setting: Tertiary care, spinal cord injury unit (National Spinal Injuries Centre), Stoke Mandeville Hospital. Participants: One hundred and forty-seven male and 45 female newly injured in-patients (consisting of 152 younger adults, age range=16 to 54, and 40 older adults, age range=55 to 85) admitted between 1995 and 1999. Intervention: All patients were actively participating in a comprehensive, multidisciplinary Goal Planning and Needs Assessment rehabilitation programme. Main outcome measure: The Needs Assessment Checklist. Speci®cally designed and developed for the spinal cord injured population, this clinical assessment tool provides a way of assessing and ensuring that rehabilitation programmes are geared toward each patient's individual needs, providing the patient with the skills appropriate to their level of lesion. As part of ongoing psychometric analyses of the Needs Assessment Checklist, internal consistency reliability coe cients are reported for this measure. Results: The type and cause of injury for the older adult group in this study was comparable with previous research. Older adults' rehabilitation gains were comparable to those of the younger age group. Younger adults were more mobile initially after their injury. However, when the two groups were matched for injury characteristics etc. the only di erences in ®nal outcome between older and younger adults were in skin management ability. Both groups showed signi®cant improvements in all areas of need in the period between mobilisation and entering the pre-discharge ward. Conclusion: These results highlight important considerations for the rehabilitation of older adults and emphasise the need for active, individually tailored rehabilitation programmes. There are speci®c areas of need (i.e. skin management) where older adults do not achieve comparable levels of independence. Special attention needs to be paid to the problems presented by SCI older adults and e orts should be made to better prepare rehabilitation professionals to adapt to age speci®c di erences.

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The Influence of Age at Time of Spinal Cord Injury on Rehabilitation Outcome

Cited by 148 publications

References 28 publications

Pediatric spinal cord injury in Sweden: incidence, etiology and outcome

Pediatric spinal cord injury in Sweden: incidence, etiology and outcome

Effects on age on spinal cord lesion patients' rehabilitation

Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury

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