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1. Volume 21 Issue 2 Spring 2012 INSIDE Pain and SCI does not have specific triggers Shoulder pain inal cord in Department of Rehabilitation Medicine e Ultralight Wheelchair Skills From Rehab to Real World 4 e Literature review 2 abstracts of SCI research 6 Pain is an unfortunate but common reality for people living with spinal cord injury SCI Persons with SCI may suffer with musculoskeletal pain affecting the muscles bones or joints neuropathic nerve pain or both Musculoskeletal pain is typically described as dull or achy occurs above the level of injury and is usually triggered by specific movements of a joint or body region In contrast neuropathic pain usually occurs at or below the level of injury is often described as burning or stabbing and People understandably worry about developing shoulder pain after SCI because it is such a common problem and can be so disabling Surveys have found that it af ay UW Medicine SCHOOL OF MEDICINE By Deborah Crane MD MPH Assistant Professor Rehabilitation Medicine University of Washington fects 30 60 of the SCI population It is thought that using the arms for propelling a wheelchair or performing transfers over time leads to injuries and arthritic changes in the shoulders Tears to the rotator cuff tendons of the muscles that support the shoulder are a com mon culprit but other causes of shoulder pain after SCI inc2. already have pain what can I do See a physical therapist to make sure your wheelchair still fits you properly Improper wheelchair fit can cause or worsen pain and injury to the shoulders and arms Review safe transfer and wheelchair propulsion techniques with a physical therapist Consider how many times each day you are transferring how far each day you are pushing your wheelchair how you disassemble and store your wheelchair in the car and what sorts of activities you do for work and fun Could any of 2 e VOLUME 21 ISSUE 2 SPINAL CORD INJURY UPDATE SPRING 2012 these activities be causing you harm What can you do to reduce the stress you are putting on your body Talk to your SCI doctor and therapists about changes you can make in your daily life to reduce harm and pain Treatments Treatment options for upper limb pain may include therapeu tic exercise weight loss heat or ice medications injections or surgery This will depend on the cause of your pain and what you and your doctor decide is the most appropriate treatment for you Rest is often the best thing for musculoskeletal pain Unfortu nately it is very difficult to rest your upper limbs if you have an SCI because you rely on your arms to transfer push a wheel chair walk with crutches etc If pain and injury are severe enough you may need to con sider switching to a power wheelchair at least for part of the time Power wheelchairs will help to
3. you while you are learning these skills Spotting is es pecially important while you are working on getting your balance in a wheelie Stationary wheelie amp pop ups Training progression involves three phases take off balance and landing Balancing in a wheelie surface bal ance tipping back Have a spotter put you back in your balance point on your back wheels so you can see how far back it is Smith said Usually it s farther back than you might expect Popping into a wheelie partial versus full It s good to practice going into a partial wheelie where you re popping up but not all the way to your balance point Smith said Partial wheelies help you go over obstacles and with being able to time a pop up so you can go up a curb Landing a wheelie push forward on the rim as you land to soften the impact Take off strategies Backward pull back and then push forward on the rims Forward push forward on the rims to pop up This strategy may be CONTINUED ON NEXT PAGE spinal cord injury UPDATE slower and require more force but it enables pop ups during forward propulsion and in tight spaces Self recovery pull back on the rims to tip forward out of a wheelie Safe falls There is no ideal way to fall safely Smith said If you are falling backward try to keep your head as far forward as you can so the frame hits the ground first and do some com bina
4. Y E Pregnancy outcomes by intravaginal and intrauterine insemination in 82 couples with male factor infertility due to spinal cord injuries Eighty two male patients with spinal cord injuries and their female partners received infertility services in this study Sperm were obtained by masturbation in 4 men 4 9 penile vibratory stimulation in 42 men 51 2 and electroejaculation in 36 men 43 9 Intravaginal insemina tion IVI performed mostly at home was undertaken in 45 couples 7 of whom 37 8 achieved 20 pregnancies Intrauterine insemination lUl was performed in 57 couples 14 of whom 24 6 achieved 19 pregnancies Overall 18 live births occurred by IVI and 21 occurred by IUI The authors conclude that IVI and IUl are reasonable options for this patient population and should be used before proceeding to assisted reproductive technologies ART Kathiresan AS Ibrahim E Aballa TC et al Fertil Steril 201 Aug 96 2 328 3 1 E Assessing and conceptualizing orgasm after a spinal cord injury A total of 97 men with SCI underwent sexual stimulation using various techniques natural stimulation vibrostimulation or vibrostimulation combined with midodrine Injury level ranged from C2 to S5 and involved both complete 49 and incomplete 51 lesions Among the 89 92 who achieved ejaculation 50 experienced autonomic hyperreflexia AHR also known as autonomic dysreflexia or AD at ejaculation and 39 did not Significa
5. all to motivate people with SCD to improve their skin care seek treatment for depression and appropriately use the healthcare system This system supplements face to face health care with a clinician It uses a digitized human voice and functions as an at home monitor educator and counselor for reinforcing or changing health related behaviors Individuals with SCD pilot tested the system and provided feedback Results of a randomized controlled trial using this system will test whether the intervention will successfully promote self manage ment in a cost effective manner Houlihan BV Jette A Paasche Orlow M et al Am J Phys Med Rehabil 201 Sep 90 9 756 64 E Necrotizing fasciitis in patients with spinal cord injury an analysis of 25 patients A retrospective chart review found 25 SCI patients 19 with paraple gia and 6 with tetraplegia who were treated for necrotizing fasciitis during a 9 month period Necrotizing fasciitis NF is an infection that causes tissue to die sometimes called flesh eating bacteria In 18 cases NF developed due to pressure sores Grade 4 pressure sores were identified in 15 cases and grade 3 pressure sores in 3 cases The incidence of developing NF is significantly higher in patients with grade 4 pressure sores than in those with a lower grade lesion The most common bacteria were streptococci During the hospital stay six patients developed sepsis and two died because of septic multi organ failu
6. an really go wrong Even if it goes smoothly there is a lot of wear and tear on your arms Watch the video on our website http sci washington edu info forums reports wc_skills_201 l asp especially your shoulders Like using escalators below going up and down stairs is the kind of skill you might want to know about just for emergencies if youre in a building and there s a fire and the elevators stop working Escalators Some places will ask you not to go on an escala tor because they re afraid you ll get stuck Smith said You need to ascend and descend facing up Timing and trunk position are important There is a risk of falling or getting stuck so proceed with caution Outdoor Skills Uneven terrain snow grass gravel sand You pop up into your wheelie and keep the front wheels up as you propel forward Smith said This is a dynamic wheelie and is very labor in tensive because there s a lot more fric tion to push against Consider knobby tires or larger casters for these activi ties Also be aware that some surfaces can damage wheelchair components Depressions potholes grates Pop into a partial or full wheelie which lifts your casters out of the depression and go across on your rear wheels Freeing wheels from being stuck in a grate or hole rock side to side Raised obstacles roots railroad tracks hoses Pop your casters over the obsta cle
7. cles 2_spr_remodel asp Resources A word about contractors When looking for a contractor it s important to find someone who really listens to you and is sensitive to your specific needs Dean Sander says The remodel has to work It s not just aesthetics Sander is happy to talk to people in the Seattle area about ac cessible remodel questions He can be reached at 425 443 6204 or dean_sander hotmail com Accessible Home Design 2nd Edition Paralyzed Veterans of America order at www pva org or call 888 860 7244 Master Builders Association of King and Snohomish County provides practical information and referrals about home building and remodeling Contact them at 425 451 7920 or http www masterbuildersinfo com Home Adaptations amp Modifications after SCI SCI Forum presentation June 12 2007 Northwest Regional SCI System http sci washington edu info forums reports home_mod_07 asp See more resources on our website at http sci washington edu resources housing asp DEPARTMENT OF REHABILITATION MEDICINE e 3 forum report The SCI Forum is an evening presentation and discussion series on topics of interest to persons with spinal cord injury and their family members friends caregiv ers and health care providers held at the University of Washington Medical Center To learn about upcoming SCI Forums read reports of past forums watch forum videos or subscribe to the SCI Forum mai
8. eelchair maneuvering skills after hand surgery Improvements were also observed in their ability to perform tests that were impos sible to perform before surgery The type of reconstruction and level of injury affected the degree of improvement achieved Hand and arm function are highly prioritized goals in this population and increased mobility is a crucial factor in living a more active life Lamberg AS Frid n J J Rehabil Med 2011 Jul 43 8 714 9 6 e VOLUME 21 ISSUE 2 SPINAL CORD INJURY UPDATE SPRING 2012 E A cross sectional study of demographic and morphologic features of rotator cuff disease in paraplegic patients Shoulder pain affects up to 67 of the SCI population a rate that is four times higher than the able bodied population In this study 317 individuals with paraplegia between T2 and L3 underwent clinical exams and magnetic resonance imaging MRI of both shoulders Participants averaged 26 7 years of wheelchair dependency range 5 56 years While 161 patients 51 had no rotator cuff tears 156 49 had tears in one unilateral 20 or both bilateral 29 shoulders Patients with bilateral tears were older and had been injured longer than those with unilateral or no tears In patients with unilateral tears a full thick ness rupture of the supraspinatus tendon was found in 67 whereas a partial rupture was detected in 33 Of the patients with bilateral tears 75 presented with a full thickness rupture and 25 wit
9. electrical stimulation in pediatric spinal cord injury Muscle atrophy wasting is common in people with SCI and has nega tive health effects such as increased risk for cardiovascular disease insulin resistance glucose intolerance and type 2 diabetes Children with SCI also are at higher risk for these problems and intervening at an earlier age may be beneficial Functional electrical stimulation while cycling FESC can increase muscle mass and strength in adults with SCI and this study examined whether it can be helpful for children with SCI Thirty children with SCI aged 5 13 were randomly assigned to do FESC passive cycling no electrical stimulation or electrical stimulation without cycling ES at home for hour 3 times per week After 6 months tests showed that children receiving either FESC or ES exercise had changes in muscle size stimulated strength or both The ES group had greater changes in quadriceps muscle size and the FESC group had greater changes in strength These changes may decrease their risk of cardiovascular disease insulin resistance glucose intolerance and type 2 diabetes Children in the PC group had no improvements Johnston TE Modlesky CM Betz RR Lauer RT Arch Phys Med Rehabil 201 Dec 92 12 193 7 43 E Increased aerobic fitness after neuromuscular electrical stimulation training in adults with spinal cord injury Fourteen participants with SCI 14 1 1 ASIA A and B completed training of a new ne
10. er wheelchair fulltime After that he started looking for a house to buy one that could be remodeled for maximum accessibility and indepen dence wanted a one level 2 3 bedroom 2 bath house with a l car attached garage for storage and 2 car detached garage for his accessible van In June 2010 he found what he was looking for in southwest Seattle Although it was useless for a wheelchair user when bought it could see the potential if it was done correctly and the price was right he said CONTINUED ON PAGE 3 spinal cord injury UPDATE CONTINUED FROM PAGE Arm and hand pain The shoulder is not the only upper limb joint at risk for injury Elbow pain is present for 5 16 of those with SCI It is commonly caused by tennis elbow ulnar nerve injury bursitis and arthritis It is likely that more than 10 of persons with SCI have hand and wrist pain Carpal tunnel syndrome when increased pres sure in the wrist puts pressure on the median nerve is over whelmingly the most common cause of pain in this region The risk for developing carpal tunnel syndrome increases the longer a person has been living with SCI Extreme wrist extension bending the hand back a position often used when transfer ring or propelling a wheelchair is the likely cause of carpal tunnel syndrome Arthritis ulnar nerve injuries and tendinopa thies injuries or degenerative changes to tendons also cause hand and wrist pain i
11. ess complex methods for achieving bladder colonization with E coli HU2117 are under investigation Darouiche RO Green BG Donovan WH et al Urology 201 I Aug 78 2 341 6 Epub 2011 Jun 17 TECHNOLOGY AND MOBILITY E Technology for mobility in SCI 10 years from now A person s level of disability is an interaction between their impairment and the environment Technology impacts this in a number of ways and has the potential to fully eliminate disability The authors believe technology will eventually allow complete independence someday but economic factors and systems of care will impact the extent to which individuals with SCI will fully benefit from technological advances The authors review expected advances in specific areas of technology such as power sources processing sensors and software and describe the ways specific devices will be impacted by them They also discuss the social context of technology for mobility and how the political social and economic environment is likely to impact advances Although technology advances are exciting a large challenge for the research community will be how to effectively apply and deploy this technology Advances occurring in the next 10 years that reduce cost of technol ogy may be more important to the population with SCI than brand new technologies Boninger M French J Abbas J et al Spinal Cord 2012 Jan 17 ELECTRICAL STIMULATION E Muscle changes following cycling and or
12. flex your trunk and use push strength or momentum to go over the obstacle with the rear wheels as your casters land beyond the obstacle Hills and ramps Crossing a slope push faster with one hand than the other Going up If you don t have enough balance or momentum and you can t stay forward enough to go up hills get your chair configuration and fit evaluated by a therapist You might want to consider mechanical assist or power assist options such as hill climbers Magic Wheels or even a power chair Going down pop into a wheelie while you re on a level area find your balance point and lean back as you UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE An descend letting the rims slowly slide through your hands Descending in a wheelie allows you to control your speed a little better Smith said and if the hill is really steep it keeps you from pitching over as you go down Plastic rims will burn when descending quickly so use gloves to increase your power and decrease burning A word about chest straps Even if it gives you some stability on the levels if you re always cinched down into the backrest with the chest strap you can t lean forward and back enough to keep your balance with many of these skills Smith said Curbs going up Timing of caster pop up Low or late pop up may result in casters hitting the curb abruptly stopping the wheelchair High or early po
13. h a partial rup ture These findings support the theory of wear and tear in patients with spinal cord injury and that the occurrence of cuff tears depends on the duration of wheelchair dependency as well as age Akbar M Brunner M Balean G et al J Shoulder Elbow Surg 201 Oct 20 7 1 108 13 Epub 2011 Jul 2 AUTONOMIC DYSREFLEXIA E Autonomic dysreflexia current evidence related to unstable arterial blood pressure control among athletes with spinal cord injury Spinal cord injury is commonly associated with a range of autonomic dysregulation that can interfere with cardiovascular bladder bowel temperature and sexual function Individuals with a cervical or high thoracic SCI face lifelong abnormalities in systemic arterial pressure control In general their resting arterial pressure is lower than that in able bodied individuals and is commonly associated with persistent orthostatic intolerance In addition they experience fleeting episodes of life threatening hypertension known as autonomic dysreflexia AD which often is associated with disturbances in heart rate and rhythm AD occurs in up to 90 of individuals with a cervical or high thoracic SCI and requires immediate medical attention During athletic activities self induced AD is used by some individuals to improve their perfor mance a technique known as boosting For health safety reasons boosting is officially banned by the International Paralympic Commit
14. id Larry gave me a free hand to do what thought was best Sander stripped the house down to the studs and rebuilt the whole interior He had done ADA compliance work in the past and was familiar with the codes But ADA is just a standard he said It doesn t necessarily work for the individual For example there s an ADA compliant toilet but the flush is on the right and Mohrman can only use his left hand since the injury l wanted to make sure everything worked for Larry he said l walked through the place daily and put myself in his position He removed walls between several rooms enlarged interior door openings to 36 inches added concrete ramps and landings with guard rails at both outside doors installed lever style door handles and made all the floors hardwood or linoleum In the kitchen he installed a roll under sink and stove top custom cabinets and counters and positioned the oven at a height that was accessible from a wheel chair See photo upper right The main bathroom has a custom concrete sloping base roll in shower See before and after photos of Larry Mohrman s remodel on our website at durable porcelain tile throughout the bath floor and shower walls cathe dral ceiling both remote and rain sensor controlled skylight and single handle faucets and shower mixer valves The house has addition al accessibility features such a
15. l F Salinas Huertas S Garcia Masso X Gonzalez L M Transdermal nitroglycerine treatment of shoulder tendi nopathies in patients with spinal cord injuries Spinal Cord 2011 48 1014 19 Goldstein B Musculoskeletal conditions after spinal cord injury Phys Med Rehabil Clin N Am February 2000 I 1 1 91 108 Goldstein B Young J Escobedo E Rotator cuff repairs in individuals with paraple gia Am J Phys Med Rehabil July August 997 76 4 3 16 322 Hastings J and B Goldstein Paraplegia and the shoulder Phys Med Rehabil Clin N Am 2004 14 699 718 Krause JS Aging after spinal cord injury an exploratory study Spinal Cord 2000 38 77 83 Nepomuceno C PR Fine JS Richards H Gowens SL Stover U Rantanuabol R Houston Pain in patients with spinal cord injury Arch Phys Med Rehabil Dec 1979 60 12 605 9 Nichols PJ PA Norman JR Ennis Wheelchair user s shoulder Shoulder pain in patients with spinal cord lesions Scand J Rehabil Med 1979 1 1 29 32 Nyland J K Robinson D Caborn E Knapp T Brosky Shoulder rotator torque and wheelchair dependence differences of National Wheelchair Basketball Association players Arch Phys Med Rehabil Apr 1997 78 4 358 363 CONTINUED ON BACK PAGE CONTINUED FROM PAGE I His contractor friend Dean Sander checked it out before closing and said Sure can make this work My goal was to make it accessible convenient safe and fully useable on a budget Sander sa
16. ling list go to http sci washington edu info forums Ultralight Wheelchair Skills From Rehab to Real World Presented by Flisa Smith DPT on November 8 2011 at Harborview Medical Center Watch the video of this presentation online at http sci washington edu info forums reports wc_skills_201 asp The wheelie an essential skill A wheelie is the act of balancing on your rear wheels Wheelies may look like tricks but they are the essential building blocks of community wheelchair skills said Elisa Smith physical therapist at Har borview Medical Center Unfortunately many people don t learn this skill before they are discharged home from rehab and then have few opportunities to learn them later on Rehab stays now are getting so short that therapists only have time to focus on basic transfers caregiver training and testing different chairs Smith said There isn t much time to practice many ultralight wheelchair skills while still in the hospital Once patients get home there may not be many therapists in their communities who are familiar with wheelchair skills Newly injured patients often assume wheelies are simply tricks and not essen tial to their rehab Smith said People will say to me don t care about tricks right now just had this major tragedy in my life and don t want to focus on 939 doing stunts Other patients are just too over whelmed and fea
17. lude impingement pinching of the tendons arthritis inflammation of the joint biceps tendonitis pain in the tendon that attaches the biceps muscle to the shoulder and bursitis inflammation of the bursa sac that cushions the joint In addition muscular shoulder pain may occur when a person is forced to use his or her shoulder muscles to maintain posture or has muscle imbalances due to the SCI CONTINUED ON PAGE 2 New remodel new independence Like many others who become paralyzed suddenly due to injury or disease Larry Mohrman could no longer live in his house after sustaining a C 5 incomplete spinal cord injury in 2003 It was a two story home with the main living quarters on the top floor not at all wheelchair accessible he said A contractor friend told me remodeling it would be too expensive and suggested that sell the house and buy another one later that could be remodeled more cheaply and easily Mohrman went to live in an adult family home after leaving rehab He worked hard at regaining as much recovery as pos sible After 2 years was able to walk 200 feet with a walker but still used a wheelchair for his primary mobility He moved to an apartment where he was able to live independently In 2007 however fate struck another blow A car hit me while was in a crosswalk in my wheelchair This caused further injury and can no longer stand balance or walk due to spastic ity Now use a pow
18. n the SCI population Back and neck pain Many people with SCI also have back and neck pain Depend ing on level of injury this may be neuropathic or nerve pain musculoskeletal pain or both After SCI individuals may develop spine deformities that can cause pain including scoliosis curving of the spine or kyphosis hump back Frequently people with SCI complain of a ring of fire or iron corset around their shoulders or torso which typically occurs at the level where their sensation changes from normal to abnormal This can be very painful and at times very difficult to treat How can I avoid upper limb pain For those with relatively new SCls hoping to prevent upper limb pain there are some things you can do Try to maintain a healthy body weight As you gain weight transferring and propelling your wheelchair become more difficult and puts greater strain on your shoulders arms and wrists Make sure your wheelchair fits you properly For manual wheelchair users check that the wheel axle position and seat height are correct for you For all wheelchair users your seating system should provide enough trunk support so you don t rely on your shoulder muscles to keep you upright Maintain good technique for transfers and wheelchair pro pulsion If you walk using canes or crutches a physical therapist can show you how to use good biomechanics so you don t harm your upper body joints I
19. ntly more sensations were described at ejaculation than with sexual stimulation alone Men with SCI who experienced AHR at ejaculation reported significantly more cardiovas cular muscular autonomic and dysreflexic responses than those who did not There was no difference between men with complete and those with incomplete lesions The findings show that the questionnaire is a useful tool to assess orgasm and to guide patients in identifying the bodily sensations that accompany or build up to orgasm The findings also support the hypothesis that orgasm may be related to the pres ence of AHR in individuals with SCI Courtois F Charvier K V zina JG et al BJU Int 201 Nov 08 10 1624 33 ARM HAND amp SHOULDER E Changes in skills required for using a manual wheelchair after reconstructive hand surgery in tetraplegia Surgical reconstruction of arm and hand function has developed tre mendously over the last decade Several studies have documented the functional improvements after surgery and rehabilitation better control and strength of elbow extensors lateral pinch grip function and open ing of the hand In this study 16 individuals with C5 C7 tetraplegia underwent a total of 23 grip and or elbow extension reconstruction surgeries to improve arm and or hand function Functional tests of wheelchair control were performed before and 12 months after the reconstructive surgery Sixty eight percent of the individuals improved their wh
20. p up may result in rear wheels hitting the curb too soon decreasing momentum Practice going up to the curb and popping up without worrying about getting on top of it so you can get comfortable with the timing of the pop up and with how high you need to get the casters up Smith said Rear wheel ascension getting the rear wheels up on the curb after your casters are up there depends on wheelchair pitch angle velocity trunk position and hand position eR Da jp ieee dL f A 2 i a K SS Curbs going down Face forward for improved visibility and shock absorption and to avoid flipping over backward see photo above If you do go down backward flex your trunk to avoid flipping Descending backward can cause more pain and discomfort than descend ing forward because the shock goes through the front casters which can t absorb it as well as the rear wheels DEPARTMENT OF REHABILITATION MEDICINE 5 literature review The articles previewed below were selected from a_recent screening of the National Library of Medicine database for articles on spinal cord injury In the judgment of the editors they include potentially useful information on the diagnosis or management of spinal cord injury You may obtain copies of the complete articles through your local medical library or from UW Health Sciences Library Document Service http www lib washington edu ill SEXUAL FUNCTION amp FERTILIT
21. rdier CH Fann JR Tate DG et al Arch Phys Med Rehabil 201 2 93 5 775 78 1 UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE DEPARTMENT OF REHABILITATION MEDICINE e 7 Spinal Cord Injury Update is supported by grant HI33N1 10009 from the National Institute of Dis ability and Rehabilitation Research NIDRR U S Department of Educa tion Office of Special Education and Rehabilitative Services OSERS to the Northwest Regional Spinal Cord Injury System one of 14 model SCI care systems nationwide Project Director Charles Bombardier PhD Editorial Board of Advisors Charles Bombardier PhD Stephen Burns MD Chris Garbaccio Barry Goldstein MD PhD Jeanne Hoff man PhD Cathy Warms PhD ARNP CRRN To add your name to the mail ing list contact the editor Cynthia Salzman at the University of Wash ington Department of Rehabilitation Medicine Box 356490 Seattle WA 98195 6490 206 685 3999 csalzman u washington edu Visit our website http sci washington edu Upper Limb Pain in SCI CONTINUED FROM PAGE 2 Popowitz RL et al Rotator cuff repair in spinal cord injury patients J Shoulder Elbow Surg 2003 2 4 327 32 Preservation of Upper Limb Function Following Spinal Cord Injury A Clinical Practice Guideline for Health Care Professionals Consortium for Spinal Cord Injury Medicine Clinical Practice Guidelines 2005 1 48 Rehak DC Wrist Problems for Gymnasts Hughston Health Alert Fall 2002 http
22. re The authors recommend that close clinical and laboratory moni toring of all patients with grade 3 or 4 pressure sores is appropriate so that any early clinical signs of NF can be recognized and evaluated for early and aggressive treatment Citak M Backhaus M Tilkorn DJ et al Spine 2011 Aug 15 36 18 E 1225 9 ADJUSTMENT E An exploration of modifiable risk factors for depression after spinal cord injury Which factors should we target A total of 244 community dwelling individuals with SCI 77 men 61 white mean age 43 ly 43 with tetraplegia who were at least month postinjury completed questionnaires on depression PHQ 9 physical activity International Physical Activity Questionnaire IPAQ pleasant and rewarding activities Environment Rewards Observation Scale EROS and self efficacy to manage the effects of SCI Modified Lorig Chronic Disease Self Management Scale The study found that more severe depression was associated with being 20 to 29 years of age not completing high school not working or attending school and being 4 or fewer years post SCl Having rewarding activities and to a lesser extent having confidence in one s abilities to manage SCI were associated with being less depressed Treatments designed to increase the level of rewarding activities and positive reinforcement in the daily lives of people with SCI may be an especially promising approach to treating depression in this population Bomba
23. reduce repetitive strain and overuse conserve energy and improve speed and ease of travel ling over different distances and types of terrain Of course there are downsides to using a power wheelchair and you will need to discuss the pros and cons with your health provider Finally keep in mind that recovery from an upper limb injury or surgery may take a long time Even after relatively minor sur gery you may need to stay in the hospital for a while so you can adequately rest your upper limbs to allow for healing prevent skin break down and get help accomplishing basic daily activities Resources Preservation of Upper Limb Function What you should know A Guide for People with Spinal Cord Injury Consortium of Spinal Cord Medicine Paralyzed Veterans of America 2008 www pva org 888 860 7244 References Bayley JC Cochran TP Sledge CV The weight bearing shoulder The impingement syndrome in paraplegics Bone Joint Surg Am June 1987 69 5 676 8 Boninger ML RA Cooper B Fay A Koontz Musculoskeletal pain and overuse injuries Spinal Cord Medicine Principles and Practice Ed VW Lin New York Demos 2003 527 534 Escobedo EM JC Hunter MC Hollister RM Patten B Goldstein MR imaging of rotator cuff tears in individuals with paraplegia AJR Am J Roentgenol April 1998 168 919 923 Gabel GT Gymnastic wrist injuries Clin Sports Med July 1998 17 3 611 621 Giner Pascual M Alcanuis Alberola M Quero
24. rful in the early weeks They can t imagine doing anything outside of the hospital by themselves Smith said They ll say I m always going to have somebody pushing my chair so don t need to learn how to do this on my own or It seems like wheelies are impossible lm just getting used to a chair and don t want to do anything where I m going to put myself at risk for falling back and hitting my head or losing 999 control of the chair Why learn wheelies Choosing the best wheelchair The more skills you learn the more you understand how a chair needs to fit you and what kinds of features and acces 4 e VOLUME 21 ISSUE 2 SPINAL CORD INJURY UPDATE sories you want Smith said Then when you are talking to therapists or vendors you are more likely to get a chair that is ideally set up for you Improved quality of life Several studies have shown that learning wheelies and related skills can improve your quality of life because they help you be more independent and more active in the community such as going to school work and social activities And if you get invited to a barbecue at a friend s house you will be able to go through the grass to get to the back yard Smith said Less pain fewer falls For example if you are able to pop a wheelie to hop off a curb at an intersec tion you can see the traffic and have more control of the chair and be less likely
25. s keyed alike locks for all entrances and remote controlled garage doors and gas fireplace It was also rebuilt to be energy efficient Sander has worked on many big projects over j the years including sev we e eral multi million dollar private homes and said not one has meant more to me than this one It opened my eyes and made me aware of what a person with a disability has to go through in life I ve never seen Larry happier He s indepen dent again Mohrman agrees It s all perfectly done he said He hopes that by sharing his remodel experience with others with SCI they can see what is possible and how changes in their home can vastly improve their independence comfort and quality of life http sci washington edu info newsletters articles 2_spr_remodel asp The front of Larry Mohrman s remod eled house left shows the accessible ramp and entry The back entry was also remodeled with a new ramp and doorway Single keyed alike access for all entrances provides accessibility and security UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE spinal cord injury UPDATE Larry Mohrman s kitchen was completely torn apart and remodeled to be completely accessible to him Now he can roll his wheelchair under the stove sink and counter and the oven for easy reach Upper cabinets have pull down accessible shelf racks See more photos at http sci washington edu info newsletters arti
26. tee Medical_practitioners who are involved in the care of wheelchair athletes should be aware of the unique cardiovascular dysfunction that results from SCI and may occur at any time even with seemingly harm less triggers Prompt recognition and management of these conditions including episodes of AD could be life saving Krassioukov A Clin J Sport Med 2012 Jan 22 1 39 45 UROLOGICAL PROBLEMS E Multicenter randomized controlled trial of bacterial inter ference for prevention of urinary tract infection in patients with neurogenic bladder This study involved individuals with neurogenic bladder due to spinal cord injury and a history of recurrent urinary tract infections UTIs Participants were randomized to receive a bladder inoculation of either Escherichia coli HU2 1 7 experimental group or sterile saline control group Urine cultures were obtained weekly during the first month and then monthly for year Of I7 patients colonized with E coli HU21 17 and the 10 control patients 5 29 and 7 70 developed more than episode of UTI respectively The average number of episodes of UTI per year was also lower in the experimental than in the control group spinal cord inj ury UPDATE CONTINUED FROM PREVIOUS PAGE E coli HU2117 did not cause symptomatic UTI The authors conclude that bladder colonization with E coli HU2117 safely reduces the risk of symptomatic UTI in patients with spinal cord injury Effective but l
27. tion of blocking your knees so they don t hit you in the face and blocking your head or block ing your head with both arms Dynamic wheelie A dynamic wheelie is moving or propel ling while balancing on your rear wheels You can go forward backward turn and pivot in place Practice going forward by setting up a slalom course to propel around obstacles in a wheelie Reverse is the most difficult and requires a lot of practice because pulling back to go in reverse tips the chair for ward out of a wheelie Smith said Indoor Skills Thresholds or flooring transitions perform a partial pop up to ascend Thick carpet propel in a wheelie Tight spaces restrooms elevators back into the space and turn in a wheelie No hands wheelie against wall back up against a wall tip back and lock your wheels The idea with a no hands wheelies is that you can lean back and not have to be balancing your chair Smith said This can be good for read ing making phone calls or giving your back a rest It can be used for pressure reliefs and provides a better neck posi tion for looking up during conversa tions Stairs Stairs are challenging and can be risky Smith said Doing stairs is one of the most physically demanding skills It s not just about balance and technique like most of these other skills Stairs especially going up takes a tremendous amount of arm strength and it c
28. to tip over than if you back down the curb Where to learn wheelies If you didn t learn these skills while still in rehab or if you want to improve your skills you can get help and informa tion from a variety of sources such as Physical therapists see your physi cal therapist in your clinic or other outpatient setting Wheelchair Skills Training Pro gram www wheelchairskillsprogram ca from Dalhousie University Canada This website features how to videos and detailed descriptions of many wheelchair skills The Manual Wheelchair Training Guide by P Axelson et al Ist ed San Francisco CA PAX Press 1998 Other wheelchair users Visit online forums such as Rutgers CareCure Forum http sci rutgers edu forum Local events like the UW s SCI Fo rums http sci washington edu info forums and SCI Support Group http sci washington edu info sig asp SPRING 2012 Wheelchair skills Following is a brief summary of the wheelchair skills and techniques presented at this forum Watch the video to get the full descriptions and see demonstrations of these different skills Caution Consult with your physician and physical therapist before attempting any of these wheelchair skills Always use a physical therapist or trained spotter to prevent falls while learning wheelchair skills like the ones described here A therapist also can train a family member or friend to help spot
29. uromuscular electrical stimulation NMES system designed to improve aerobic fitness in persons with SCI For the train ing four electrodes were placed on the quadriceps and hamstrings muscle groups and subtetanic contractions were elicited using the NMES device Participants did the training unsupervised at home for hour 5 days wk for 8 weeks A treadmill wheelchair propulsion exercise test with simultaneous cardiopulmonary gas exchange analysis found a significant increase in Vo 2 peak and HRpeak between baseline and follow up testing This novel form of NMES is an effective method of improving aerobic fitness in a sedentary adult SCI population Compili ance with training was high possibly indicating the convenience of using this system Results compare favorably with current functional electrical stimulation exercise systems This system offers a portable and con venient method of aerobic exercise with the potential to provide the associated health benefits of exercise to the SCI population Carty A McCormack K Coughlan GF et al Arch Phys Med Rehabil 2012 Mar 21 PRESSURE ULCERS E A telerehabilitation intervention for persons with spinal cord dysfunction Pressure ulcers and depression are common preventable conditions in people with spinal cord dysfunction SCD However few success ful low cost preventive approaches have been identified The authors developed a dynamic automated telephone calling system termed Care C
30. www hughston com hhala_ 5_4_3 htm Schwarzkopf R C Ishak M Elman J Gelber DN Strauss LM Jazrawi Distal clavicular osteolysis a review of the literature Bull NYU Hosp Jt Dis 2008 66 2 94 101 Sie IH RL Waters RH Adkins H Gellman Upper extremity pain in the postrehabilitation spinal cord injured patient Arch Phys Med Rehabil Jan 1992 73 1 44 8 Silfverskiold J RL Waters Shoulder pain and functional disability in spinal cord injury patients Clin Orthop Relat Res Nov 1991 272 141 5 Subbarao JV J Klopfstein J R Turpin Prevalence and impact of wrist and shoulder pain in patients with spinal cord injury J Spinal Cord Med Jan 1995 18 1 9 13 Thomason K IM Emran D Chan Shortening osteotomy for the treatment of spinal neuroarthropathy fol lowing spinal cord injury A case report and literature review Eur Spine J 2007 6 Suppl 3 318 321 Wylie EJ TM Chakera Degenerative joint abnormalities in patients with paraplegia of duration greater than 20 years Paraplegia Apr 1998 26 2 101 6 Read the newsletter online at http 4ci washington edu info newsletters c9 Wad VM NE S dIYd ebeisod SN 510 1WOJdUON MAAN AAAA AN icleg aaLrsgagnoay ADIAYRS SSAYaAaGV 0679 66186 UOIsUIYseAA 2 2295 O6P9SE XOg SUNIP W UONeUIqeysy NOLDONIHSVM JO ALISYSAINA T JOQUINNY Z DWINJOA ZI QZ suluds zepdnN Aunfuy puoy jeuids
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