Neuropathic pain post spinal cord injury part 1: systematic review of physical and behavioral treatment. Functional electrical stimulation therapy for grasping in traumatic incomplete spinal cord injury: randomized control trial. Lipid profile in spinal cord-injured women with different injury levels. Spinal Cord Injury Rehabilitation Evidence: Methods of the SCIRE Systematic Review. Sexuality and sexual life in women with spinal cord injury: a controlled study. Client-Centered Occupational Therapy for Individuals with Spinal Cord Injury Application of functional neuromuscular stimulation to children with spinal cord injuries: candidate selection for upper and lower extremity research Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial Beneficial effects of the melanocortin alpha-melanocyte-stimulating hormone on clinical and neurophysiological recovery after experimental spinal cord injury. Improving the quality of life of caregivers of persons with spinal cord injury: a randomized controlled trial. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Respiratory Complications of Spinal Cord Injury Does consumption of polyunsaturated fatty acids influence on neurorehabilitation in traumatic spinal cord-injured individuals? a double-blinded clinical trial The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: Two years' follow‐up of the randomized controlled trial The Severity of Bowel Dysfunction in Patients with Neurogenic Bladder. The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review. A comparative study of steroid therapy in acute experimental spinal cord injury. Restoring voluntary grasping function in individuals with incomplete chronic spinal cord injury: pilot study. Quality of life in patients with spinal cord injury receiving VIAGRA® (sildenafil citrate) for the treatment of erectile dysfunction The association of sports and physical recreation with life satisfaction in a community sample of people with spinal cord injuries. The need for manual evacuation and oral laxatives in the management of neurogenic bowel dysfunction after spinal cord injury: a randomized controlled trial of a stepwise protocol What are the factors that influence physical activity participation in individuals with depression? A review of physical activity correlates from 59 studies. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy.
BACKGROUND Neuropathic pain has various physiologic and psychosocial aspects . Hence , there is a growing use of adjunct nonpharmacological therapy with traditional pharmacotherapy to reduce neuropathic pain post spinal cord injury ( SCI ) . OBJECTIVE The purpose of this study was to conduct a systematic review of published research on nonpharmacological treatment of neuropathic pain after SCI . METHODS MEDLINE , CINAHL , EMBASE , and PsycINFO data bases were search ed for articles addressing nonpharmacological treatment of pain post SCI . Articles were restricted to the English language . Article selection was conducted by 2 independent review ers with the following inclusion criteria : the subjects participated in a treatment or intervention for neuropathic pain ; at least 50 % of the subjects had an SCI ; at least 3 subjects had an SCI ; and a definable intervention was being studied . Data extracted included study design , study type , subject demographics , inclusion and exclusion criteria , sample size , outcome measures , and study results . R and omized controlled trials ( RCTs ) were assessed for quality using the Physiotherapy Evidence Data base ( PEDro ) assessment scale . Levels of evidence were assigned to each intervention using a modified Sackett scale . RESULTS The 16 articles selected for this review fell into 1 of 2 categories of nonpharmacological management of pain after SCI : physical and behavioral treatments . The pooled sample size of all studies included 433 participants . Of the 16 studies included , 7 were level 1 , 3 were level 2 , and 6 were level 4 studies . CONCLUSIONS Physical interventions demonstrated the strongest evidence based on quality of studies and numbers of RCTs in the nonpharmacological treatment of post-SCI pain . Of these interventions , transcranial electrical stimulation had the strongest evidence of reducing pain . Despite a growing body of literature , there is still a significant lack of research on the use of nonpharmacological therapies for SCI pain The purpose of this single-site r and omized control trial was to assess the short-term and long-term efficacy of functional electrical stimulation ( FES ) therapy over conventional occupational therapy in improving voluntary h and function in incomplete C4-C7 spinal cord injury individuals . All 22 participants recruited in this r and omized control trial received treatment for both the left and right upper extremities . Every participant , irrespective of group allocation , received one dose ( 60 min per day , 5 days per week for the duration of 8 weeks ) of conventional occupational therapy for h and function . Of the 22 participants , 12 individuals received an additional dose of conventional occupational therapy , while the remaining 10 participants received a dose of FES h and therapy . The primary outcome measure was Functional Independence Measure ( FIM ) self-care subscore . The secondary outcome measures were Spinal Cord Independence Measure ( SCIM ) self-care subscore and Toronto Rehabilitation Institute H and Function Test ( TRI-HFT ) . The participants who received FES therapy showed significantly greater improvements in h and function at discharge , and were able to maintain their gains at long-term follow-up as assessed using FIM self-care subscore , SCIM self-care subscore , and TRI-HFT . The FES therapy effectively increased independence and thereby improved quality of life of individuals with tetraplegia when compared with conventional occupational therapy Background . In dependence on their injury level , male subjects with spinal cord injury ( SCI ) exhibit a less favorable lipoprotein profile than control persons . The impairment of the sympathetic nervous system and the fact that persons with spinal cord injury are subject to extreme physical inactivity may have an influence on their lipid profile and lipoprotein(a ) concentration . It has been shown that sex-specific differences in hormonal regulation are responsible for differences in lipoprotein levels between nondisabled men and women . However , the role of hormones on lipoprotein levels has not been investigated in female subjects with spinal cord injury . Methods . Therefore , we performed a detailed investigation regarding the lipid profile in 32 premenopausal women with spinal cord injury ranging from tetraplegia to low paraplegia and in 36 control subjects .  VO(2max ) was determined by a wheelchair ergometry with stepwise increase in work load . Result . VO(2max ) was significantly higher in paraplegics than in tetraplegics but significantly lower than in control subjects . Paraplegics had significantly higher low-density lipoprotein levels than both tetraplegics and control persons . The lipid profile of female tetraplegics was characterized by elevated triglycerides . An association between high-density lipoprotein levels and spinal cord injury or the level of the injury was not observed . No significant difference in lipoprotein(a ) was found within SCI individuals as well as between SCI individuals and control persons indicating the predominant genetic determination of lipoprotein(a ) and the thus related cardiovascular risk . Conclusion . Despite the extreme reduction of VO(2max ) , the assumed physical inactivity and low serum catecholamine levels due to the impairment of the sympathetic nervous system , female tetraplegic persons did not show an adverse lipoprotein profile with respect to high-density lipoprotein cholesterol levels . If the higher low-density lipoprotein cholesterol concentrations in female with spinal cord injury with low lesion levels or the elevated TG levels in female tetraplegics bare relevance with respect to an increased cardiovascular risk in this population needs to be clarified in further longitudinal investigations The Spinal Cord Injury Rehabilitation Evidence ( SCIRE ) is a synthesis of the research evidence underlying rehabilitation interventions to improve the health of people living with SCI . SCIRE covers a comprehensive set of topics and in this issue we present six papers relevant to SCI rehabilitation clinicians ( SCI inpatient rehabilitation practice s , gait strategies , upper extremity reconstructive surgery , spasticity treatments , cardiovascular health and bone health ) . The SCIRE used a systematic and well-defined protocol to assess and synthesize the evidence . Each article was scored for its method ological quality using either the Physiotherapy Evidence Data base ( PEDro ) Score for r and omized controlled trials or the Downs and Black Tool for other types of studies . Following the individual study assessment , conclusions were drawn about the accumulated studies for each topic of interest based on the levels of evidence , quality of studies and concurring evidence . The SCIRE project was design ed for health professionals to inform them of best practice OBJECTIVE To describe sexual life in women with spinal cord injury . DESIGN Controlled cross-sectional , question naire . PARTICIPANTS AND METHODS Women , 18 - 65 years , treated at spinal cord centres in Sweden , Denmark , Norway , Finl and and Icel and . 545 women ( 57 % ) completed the question naires . The age-matched control group consisted of 507 women . The 104-item Spinal Cord Injury Women Question naire , was design ed to assess different dimensions of sexuality . RESULTS 80 % of the women with spinal cord injury had engaged in sex after the injury . Reasons for not wanting or not having the courage to be intimate and sexual were physical problems , low sexual desire , low self-esteem and feelings of being unattractive . The motivations of both the women with spinal cord injury and controls to engage in sexual activity were intimacy-based rather than primarily sexual . Being in the right mood both before and during sex to become receptive to sexual stimulation was important . CONCLUSION For women who are able to overcome the physical restrictions and mental obstacles due to injury , it is possible to regain an active and positive sexual life together with a partner . Sexual information and counselling should be available both during initial rehabilitation and later when the women have returned to their homes A r and omized controlled trial investigated the effect of client-centered Occupational Therapy on individuals with spinal cord injuries ( SCI ) . Twenty-one subjects , 4 to 6 months post acute rehabilitation , received eight in-home , client-centered Occupational Therapy sessions or eight visits from social visitors . The Functional Independence Measure ( FIM ) , the Craig H and icap Reporting and Assessment Technique ( CHART ) , the Role Checklist and the Life Satisfaction Inventory-A ( LSIA )  were administered pre and post interventions . Analyses showed no differences between groups on the CHART and the FIM ; the Role Checklist showed the Occupational Therapy group took on a limited number of new life roles ; however , a statistically significant difference was found between groups post intervention for LSIA ( p < 0.05 ) This paper summarizes the results of screening for participation in research programs involving functional neuromuscular stimulation ( FNS ) . It examines the characteristics of a group of children and teenagers with spinal cord injuries ( SCI ) identified as potential c and i date s for FNS  as defined by the rigorous inclusion criteria of the research studies . One hundred and thirteen children and teenagers under the age of 20 with cervical , thoracic or lumbar level spinal cord injuries were examined for inclusion in an experimental program of FNS to provide st and ing , walking , or prehension . Although biased towards adolescents with complete midthoracic and midcervical injuries , the age , sex , injury level , etiology , and neurological status of the sample coincided with previously published reports and consisted predominantly of teenage males injured in motor vehicle or sports related accidents . Approximately half of the individuals examined were physically appropriate for research participation without preparatory intervention . Treatment options to prepare individuals for FNS were identified in 25 % of those considered inappropriate at the initial evaluation , indicating that the potential user population of clinical systems may be larger than estimates obtained from research applications . Peripheral denervation was the single most prevalent physical impediment to the application of FNS . Although the incidence of lower motor neuron ( LMN ) involvement was similar in subjects with tetraplegia and paraplegia , those with cervical lesions more frequently exhibited other medical complications that interfered with the application of FNS .  Surgical procedures involving transfer of paralyzed but excitable muscles were identified in almost one third of the c and i date s with tetraplegia who were excluded due to denervation . Of those physically appropriate , psychological factors eliminated several c and i date s from consideration . Such concerns may also be addressed with suitable intervention in preparation for the clinical application of FNS . Almost 50 % of those appropriate for FNS research elected to participate in the programs , with those declining citing the hospitalization , time and travel commitments as the primary factors influencing their decisions . Results suggest that FNS for st and ing , walking and h and grasp may be an option for a significant percentage of the pediatric SCI population Abstract Objective To compare two forms of device-specific training – body-weight-supported ( BWS ) ambulation on a fixed track ( TRK ) and BWS ambulation on a treadmill ( TM ) – to comprehensive physical therapy ( PT ) for improving walking speed in persons with chronic , motor-incomplete spinal cord injury ( SCI ) . Methods Thirty-five adult subjects with a history of chronic SCI ( > 1 year ; AIS ‘ C ’ or ‘ D ’ ) participated in a 13-week ( 1 hour/day ; 3 days per week ) training program . Subjects were r and omized into one of the three training groups . Subjects in the two BWS groups trained without the benefit of additional input from a physical therapist or gait expert . For each training session , performance values and heart rate were monitored . Pre- and post-training maximal 10-m walking speed , balance , muscle strength , fitness , and quality of life were assessed in each subject . Results All three training groups showed significant improvement in maximal walking speed , muscle strength , and psychological well-being . A significant improvement in balance was seen for PT and TRK groups but not for subjects in the TM group . In all groups , post-training measures of fitness , functional independence , and perceived health and vitality were unchanged . Conclusions Our results demonstrate that persons with chronic , motor-incomplete SCI can improve walking ability and psychological well-being following a concentrated period of ambulation therapy , regardless of training method . Improvement in walking speed was associated with improved balance and muscle strength . In spite of the fact that we withheld any formal input of a physical therapist or gait expert from subjects in the device-specific training groups , these subjects did just as well as subjects receiving comprehensive PT for improving walking speed and strength . It is likely that further modest benefits would accrue to those subjects receiving a combination of device-specific training with input from a physical therapist or gait expert to guide that training OBJECTIVE Melanocortins , peptides related to melanocyte-stimulating hormone ( MSH ) and corticotropin ( ACTH ) , exhibit neurotrophic and neuroprotective activity in several established models of peripheral and central nervous system damage . The beneficial effects of melanocortins on functional recovery after experimental brain damage and central demyelinating diseases have prompted us to investigate alpha MSH treatment in a weight drop model of traumatic spinal cord injury in rats . METHODS In two independent r and omized blinded experiments , treatment with either alpha MSH ( 75 micrograms/kg of body weight administered subcutaneously every 48 h for 3 weeks after trauma ) or single high-dose ( 30 mg/kg , 30 min after injury ) methylprednisolone was compared with saline treatment in rats subjected to a moderately severe 20-gcm weight drop injury . Spinal cord function was monitored using behavioral , electrophysiological , and histological parameters . RESULTS In both experiments , alpha MSH significantly improved recovery , as illustrated by Tarlov scores , thoracolumbar height , and amplitude of rubrospinal motor evoked potentials . The magnitude of the alpha MSH effect on motor performance was comparable with the one observed after treatment with methylprednisolone . CONCLUSION The reproducible neurological and electrophysiological improvement in spinal cord function of animals treated with alpha MSH  suggests a new lead in the treatment of traumatic spinal cord injury OBJECTIVE To assess the efficacy of two psychosocial interventions for caregivers of older persons with spinal cord injury ( SCI ) . DESIGN A multisite , three-group , r and omized controlled trial comparing two active intervention conditions with each other and to an information-only control group .  One hundred seventy-three caregiver and care-recipient dyads were r and omly assigned to one of three conditions : a caregiver-only treatment condition in which caregivers received a multicomponent intervention based on their risk profile ; a dual-target condition in which the caregiver intervention was complemented by a treatment targeting the care recipient , design ed to address both caregiver and care recipient risk factors ; and an information-only control condition in which the caregiver received st and ard printed information about caregiving , SCI , and aging . OUTCOME MEASURES A multivariate outcome comprised of six indicators linked to the goals of the interventions was the primary outcome of the study . The multivariate outcome included measures of depressive symptoms , burden , social support and integration , self-care problems , and physical health symptoms . RESULTS At 12 months , caregivers in the dual-target condition had improved quality of life as measured by our multivariate outcome when compared to the control condition . Using the dyad as the unit of analysis , the dual-target condition was superior to both the control condition and the caregiver-only condition in our multivariate outcomes analysis . Dyads enrolled in the dual-target condition had significantly fewer health symptoms than control condition and caregiver-only condition participants and were less depressed when compared to participants in the caregiver-only condition . In follow-up analyses we found that a higher proportion of caregivers in the dual-target condition had clinical ly significant improvements in depression , burden , and health symptoms when compared with the caregiver-only condition . CONCLUSION Caregivers are in need of and can benefit from interventions that help them manage the medical and functional limitations of the care recipient . Intervention strategies that target both the caregiver and care recipient are particularly promising strategies for improving the quality of life of caregivers Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Impairments in respiration result ing from  spinal cord injury ( SCI ) result in medical consequences that are leading causes of morbidity , mortality , and economic burden . Pulmonary complications of SCI include increased risk of pulmonary infection and death , and higher rates of symptoms of respiratory dysfunction . Inspiratory capacity is diminished in individuals with higher level lesions , contributing to microatelectasis , dyspnea with exertion , and , in those with more severe impairments , respiratory insufficiency . Muscles of expiration are impaired in many individuals with spinal cord injury ( eg , injury > T8 ) with profound effects on cough effectiveness and , presumably , on clearance of secretions and susceptibility to lower respiratory tract infections . In persons with SCI , quality of life is diminished by respiratory symptoms that include cough , phlegm , and wheezing ( 1,2 ) . In those with higher lesions , asthma-like disorders of airway function have been described , which are prevented by cholinergic antagonists . This abnormality has been attributed to the unopposed effects of parasympathetic innervation on respiratory smooth muscle result ing from disruption of sympathetic efferents ( 3 ) . Hope for reductions in the impact of these many respiratory complications comes from new technologies that support respiration , continued growth of knowledge about the specific characteristics and impact of the respiratory complications of SCI , and interventions to reduce their severity . From a more fundamental viewpoint , gains in function of respiratory musculature after SCI , whether occurring spontaneously or stimulated by rehabilitation paradigms , point to the plasticity of the nervous system and its ability to form new connections after SCI . In this issue of the Journal of Spinal Cord Medicine are 7 articles about aspects of respiratory complications of SCI , which provide a perspective of current knowledge about respiratory complications and progress toward current treatments and prevention . Four research articles provide new information about the nature of these complications , the technologies to relieve them , and the neurobiology by which new connections formed within the spinal cord may limit them . Smith and coworkers report on visit rates for respiratory complications based upon analysis of administrative data for more than 18,000 veterans with SCI over a 5-year period . Although the findings of this study are limited by missing information on the level and completeness of injury and , potentially , on visits to non-VA healthcare providers for respiratory symptoms , it has unique strengths including the large number of subjects and availability of comparable data for able-bodied veterans . In agreement with two smaller prospect i ve studies , the authors reported a positive relationship between level and completeness of injury . Risks of pneumonia were increased 2-fold as compared with able-bodied veterans . A significant number of visits were for influenza , raising an intriguing question as to how the rising rates of influenza vaccination in veterans with SCI will affect this respiratory complication . Additionally , smoking has been shown to adversely affect lung function in persons with SCI ( 4 ) raising questions regarding risks of respiratory illness posed by tobacco use for individuals with SCI .  Neuroprostheses employing functional electrical stimulation carry the potential to improve cough and ventilation . Phrenic nerve pacing provides at least partial ventilator independence for some individuals with higher lesions . Technologies that improve cough or ventilation would be expected to result in further long-term reductions in morbidity due to respiratory complications of SCI . Progress toward this goal will require development of electrodes ; control systems for arrays of multiple electrodes to intercostal muscles , abdominal muscles , or both ; and an underst and ing of which muscles of respiration must be stimulated and when . In this issue , Walters and coworkers have demonstrated the feasibility of using microstimulators for activation of abdominal and intercostal muscles and the diaphragm . On the one h and , this finding might be expected to exp and the repertoire of devices available for the design of future neuroprostheses to support respiration and cough . However , as acknowledged by the authors , much work remains to be done before microstimulators become st and ard tools for implementation of neuroprostheses in this setting . In mammals , hemisection of the cervical spinal cord has been observed to be followed by spontaneous recovery of contraction of the ipsilateral diaphragm result ing from crossover of motor pathways to activate the phrenic nucleus ipsilateral to the hemisection ( crossed phrenic pathway ) . Work in this field represents an intriguing intersection of the fields of SCI research , respiratory physiology , and the neurobiology of neuroplasticity . Recruitment of this pathway requires specific adaptations within the spinal cord . Insights into the molecular basis for these adaptations are provided by two studies in this issue of the Journal . Evidence that upregulation of the NR2A subunit of the NMDA receptor stimulates such neuroplasticity comes from studies by Alilain and Goshgarian demonstrating that upregulation of this subunit facilitates recovery of motor activity of the ipsilateral phrenic nerve . Petrov and coworkers have explored the molecular basis for findings that adenosine-receptor agonists such as theophylline  accelerate ipsilateral phrenic nerve activity . These authors suggest that this effect of theophylline results from preserving normal expression of the A1-adenosine receptor subtype in phrenic nerve motor neurons . Unfortunately , as noted by Zimmer in this issue , damage to the cervical spinal cord in humans with SCI may be too extensive to expect to see the crossed phrenic pathway . Current knowledge regarding treatment of respiratory complications of SCI is review ed by Berly and Shem and by Zimmer and coworkers . What is clear from this work is that much progress has been made in developing supportive care to minimize the impact of respiratory complications over the first days or weeks after injury . Morbidity and mortality due to pulmonary infection have proved to be more challenging problems to address . In this regard , one intervention with proven efficacy in other population s is vaccination against influenza virus and Streptococcus pneumoniae . Despite the progress in immunizing persons with SCI against influenza , approximately one third to one half ( depending on age , smoking history , and other factors ) are not vaccinated even with intensive vaccination paradigms ( 5 ) . The findings of Trautner and coworkers reported in this issue indicate that one rational way to improve patient acceptance is administration to insensate regions . Individuals with SCI have benefited from advances in pulmonary research ; however , progress has been slow toward reducing the impact of chronic impairments in cough ; symptoms of cough , wheeze , phlegm , and dyspnea ; and ventilatory impairments in persons with higher lesions . Areas where rigorous study is needed to develop evidence of efficacy and establish treatment guidelines include presence or absence of benefit for respiratory muscle strength training , cough-assistive devices , and noninvasive ventilation Study design : A double-blinded r and omized clinical trial . Objectives : The anti-inflammatory and neuroprotective effect of omega-3 fatty acids have been shown so far , but still its influence on clinical measures in spinal cord-injured human models were not known . We tried to investigate changes in disability and dependency scores in chronic traumatic spinal cord-injured patients after 14 months of ω-3 fatty-acid consumption . Methods : Main inclusion criteria were : traumatic spinal cord injury ( SCI ) and post injury duration longer than 1 year .  Disability and dependency was assessed using UK Functional Independence Measure and Functional Assessment Measure ( FIM+FAM ) scale . MorDHA capsules ( 435 mg of docosahexaenoic acid and 65 mg of eicosapentaenoic acid ) were administered in treatment group , whereas control group received placebo capsules for 14 months . UK FIM+FAM scale were estimated before intervention and at the end of the trial . Results : Fifty-four patients in treatment group and 50 patients in placebo group completed the trial . Highest scores were detected in cognitive domain in both groups before and after intervention . Most dependency was observed in locomotion subscale and secondly in sphincter control . Scores of none of these components were changed by ω-3 fatty-acid consumption . Conclusion : Although omega-3 fatty acids have been shown to have neuroprotective effect in acute phase of SCI , it seems that they have no significant influence in chronic inflammatory state of SCI . The positive effect of ω-3 fatty acid in chronic neurorecovery process , if exists , is weaker to exert any significant improvement in UK FIM+FAM scores in spinal cord-injured individuals Chronic reflex sympathetic dystrophy is a painful , disabling disorder for which no treatment with proven effect is available . We performed a r and omized trial in a 2 to 1 ratio of patients , in which 36 patients were treated with spinal cord stimulation and physical therapy ( SCS+PT ) , and 18 patients received solely PT . Twenty‐four SCS+PT patients were given a permanent spinal cord stimulation system after successful test stimulation ; the remaining 12 patients received no permanent system . We assessed pain intensity , global perceived effect , functional status , and health‐related quality of life . Patients were examined before r and omization , before implantation , and also at 1 , 3 , 6 , 12 , and 24 months thereafter . At 2 years , three patients were excluded from the analysis . The intention‐to‐treat analysis showed improvements in the SCS+PT group concerning pain intensity ( −2.1 vs 0.0 cm ; p < 0.001 ) and global perceived effect ( 43 % vs 6 % “ much improved ” ; p = 0.001 ) . There was no clinical ly important improvement of functional status . Health‐related quality of life improved only in the group receiving spinal cord stimulation . After careful selection and successful test stimulation , spinal cord stimulation results in a long‐term pain reduction and health‐related quality of life improvement in chronic reflex sympathetic dystrophy PURPOSE Patients with neurological conditions often experience severe debilitating lower urinary and bowel dysfunction in addition to the physical disabilities . However , only the bladder has received the attention of medical providers with neurogenic bowel being poorly understood and characterized . MATERIAL S AND METHODS This is a cross-sectional analysis of a prospect i ve institutional neurogenic bladder data base from 2010 to 2013 . RESULTS Of the 175 patients 60.6 % had traumatic spinal cord injury and 18.3 % had multiple sclerosis . Median ± SD FISI ( Fecal Incontinence Severity Index ) scores were 18.0 ± 1.39 ( moderate ) . The median neurogenic bowel dysfunction score was 11.0 ± 0.63 ( moderate ) . Those scores were worse in those patients with spinal cord injury and spina bifida compared to those with other diseases and in younger patients ( each p = 0.020 ) , and those in the spinal cord injury group with higher levels of injury ( p = 0.0046 ) . Based on the Bristol stool scale 65 % of patients had abnormal stool consistency , mostly constipation . None of the FISI , Bristol or neurogenic bowel dysfunction scores correlated significantly with SF-12 ® quality of life measures . However , bladder symptom scores on M-ISI ( Michigan Incontinence Symptom Index ) ( p = 0.05 ) and AUA-SI ( American Urological Association symptom index ) ( p = 0.03 ) correlated with FISI severity while the neurogenic bowel dysfunction score correlated with M-ISI ( ρ = 0.29 , p = 0.02 ) . Patients with abnormal stool consistency on the Bristol scale reported more urgency and stress incontinence on M-ISI . CONCLUSIONS Bowel dysfunction is common among patients with neurogenic bladder . Those with worse bladder symptoms also experience worse bowel dysfunction . This highlights the importance of addressing both bowel and bladder dysfunction in this often poorly understood population OBJECTIVE The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life ( QoL ) , readmission rates and healthcare costs for adults with heart failure ( HF ) living independently in the community . METHOD A systematic review of r and omised control trials was undertaken . Using the search terms nurse , education , heart failure , hospitalisation , readmission , rehospitalisation , economic burden , cost , expenditure and quality of life in PubMed , CINAHL and Google Scholar data bases were search ed . Papers pertaining to  nurse-led 1:1 HF disease management of education of adults in the community with a history of HF were review ed . RESULT The results of this review identified nurse-led education sessions for adults with HF contribute to reduction in hospital readmissions , reduction in hospitalisation and a cost benefit . Additionally , higher functioning and improved QoL were also identified . CONCLUSION These results suggest that nurse-led patient education for adults with HF  improves QoL and reduces hospital admissions and readmissions . PRACTICE IMPLICATION S Nurse-led education can be delivered utilising diverse methods and impact to reduce readmission as well as hospitalisation Steroids are commonly used in the treatment of acute spinal cord injury patients although a review of the literature fails to define a consistent regimen for administration with regard to optimal preparation or dosage or schedule . This study was design ed to evaluate the effect of exogenous steroids on the outcome of experimental spinal cord injury and the effect of experimental spinal cord injury on endogenous cortisol production . Thirty female rhesus monkeys received a 660 gm cm lesion to the T10 spinal cord . They were r and omly placed into one of six groups of five animals each . Two groups were controls used to assess the endogenous cortisol response to spinal cord injury . These animals received no steroids . The other four groups received one of two commonly used steroid preparations . All animals were evaluated serially for neurological status using motor testing and for general physical status . Serial cortisol determinations were obtained for an eight-week post injury period . The steroid groups showed some benefit from treatment when compared to the untreated controls . There were no significant differences in physical condition between treated and control groups . Of special interest was the response of endogenous cortisol production to spinal cord injury . Early cortisol elevation following injury peaked by eight hours and then precipitously dropped to baseline levels before 24 hours following injury BACKGROUND Functional electrical stimulation ( FES ) therapy has been shown to be one of the most promising approaches for improving voluntary grasping function in individuals with subacute cervical spinal cord injury ( SCI ) . OBJECTIVE To determine the effectiveness of FES therapy , as compared to conventional occupational therapy ( COT ) , in improving voluntary h and function in individuals with chronic ( ≥24 months post injury ) , incomplete ( American Spinal Injury Association Impairment Scale [ AIS ] B-D ) , C4 to C7 SCI . METHODS Eight participants were r and omized to the  intervention group  ( FES therapy ; n = 5 ) or the  control group ( COT ; n = 3 ) . Both groups received 39 hours of therapy over 13 to 16 weeks . The primary outcome measure was the Toronto Rehabilitation Institute-H and Function Test ( TRI-HFT ) , and the secondary outcome measures were Grade d Redefined Assessment of Strength Sensibility and Prehension ( GRASSP ) , Functional Independence Measure ( FIM ) self-care subscore , and Spinal Cord Independence Measure ( SCIM ) self-care subscore . Outcome assessment s were performed at baseline , after 39 sessions of therapy , and at 6 months following the baseline assessment . RESULTS After 39 sessions of therapy , the intervention group improved by 5.8 points on the TRI-HFT 's Object Manipulation Task , whereas the control group changed by only 1.17 points . Similarly , after 39 sessions of therapy , the intervention group improved by 4.6 points on the FIM self-care subscore , whereas the control group did not change at all . CONCLUSION The results of the pilot data justify a clinical trial to compare FES therapy and COT alone to improve voluntary h and function in individuals with chronic incomplete tetraplegia Study design : A multicenter , r and omized , double-blind , placebo-controlled , flexible-dose , two-way crossover study conducted June 1996 through January 1997 . Objectives : To evaluate the effect of sildenafil citrate ( VIAGRA ® ) on the quality of life ( QoL ) of men with erectile dysfunction ( ED ) caused by spinal cord injury ( SCI ) . Setting : Study centers in Australia , Belgium , France , Germany , Norway , Sweden and the United Kingdom . Methods : Questions 13 and 14 of the 15-item International Index of Erectile Function ( IIEF ) addressed QoL issues directly related to ED in 178 men with SCI . A 5-item question naire addressing concerns that men had about their erection problems was also used to evaluate the impact of ED on QoL. Several commonly used psychometric instruments , including the Medical Outcomes Survey ( MOS ) Short Form-12 , Psychological General Well-Being Index , and MOS Family Survey , assessed general QoL issues . Results : Significant improvements were seen for overall satisfaction with sex life ( IIEF Q13 ) , sexual relationship with partner ( IIEF Q14 ) , and concerns about erectile problems ( P<0.0001 ) . Improvements were reported in scores for the generic QoL parameters of mental health , well-being , depression , and anxiety ( P<0.05 sildenafil versus placebo ) . Conclusion : Treatment with sildenafil can significantly improve key QoL parameters in men with ED caused by SCI.Sponsorship : This study was funded by Pfizer The purpose of this study is to assess satisfaction with life domains in people with spinal cord injuries ( SCI ) and investigate whether participation in sports and physical recreation is associated with life satisfaction in SCI . 1,748 r and omly selected participants with SCI who fulfilled the criteria : SCI at level C5 or below , wheelchair dependent ; aged 18 - 50 at the time of injury ; at least 1 year post-injury , were approached to take part in this study . Completed replies were received from 985 individuals with SCI ( 198 women , 798 men ) . The measures used included the  Sports Participation Question naire , the Life Satisfaction Question naire and the Hospital Anxiety and Depression Scale . The numbers of hours participating in sports decreased significantly after injury . There was a greater decrease in numbers participating in team sports in comparison to the decrease seen in numbers participating in individual sports . The highest level of satisfaction existed within social domains such as : family life and contacts with friends . The lowest level of satisfaction was found in regard to the participant 's sexual life and vocational situation . Higher satisfaction with life in general was demonstrated in respondents with SCI involved in sports or physical recreation compared to those not participating in physical activities Study design : R and omised controlled trial . Objectives : High- quality evidence for interventions in  bowel management ( BM )  after spinal cord injury ( SCI ) is lacking and BM programs are developed empirically . This r and omized , controlled trial compared usual care with a stepwise protocol based on earlier published work to examine whether systematic use of less invasive interventions could reduce the need for oral laxatives and invasive interventions such as manual evacuation , and improve BM outcomes in individuals with chronic SCI . Setting : United Kingdom . Methods : In all , 68 individuals were recruited ( 35 in intervention group ) , median age 47 years ( range 24–73 years ) , median duration of injury 16 years ( range 1–47 years ) . Bowel diaries were maintained for a maximum of 6 weeks while the intervention group followed a stepwise protocol design ed to test interventions singly and in combination . Measures of quality of life and preferences for different bowel care interventions were recorded . Results : The stepwise protocol did not improve BM outcomes ; fecal incontinence was more frequent ( P=0.04 ) ; the need for oral laxatives and invasive interventions was not reduced ( P=0.4 ) . Bowel care took consistently longer in the intervention group . Conclusions : The study findings support the need for manual evacuation in BM and provide evidence of acceptability of the technique to SCI individuals . For some individuals oral laxatives are an essential part of management . The results are in contrast with previous studies in younger sample s with shorter duration of injury BACKGROUND The present review systematic ally evaluates correlates of physical activity across the socio-ecological model for people with depression . SUBJECTS AND METHODS Two independent review ers search ed Embase , PubMed , and CINAHL from their inception until May 2015 , combining the medical subject heading ' depression ' or ' depressive ' with ' physical activity ' or ' exercise ' . Data were extracted by the same independent research ers and summarized according to the socio-ecological model . RESULTS Fifty-nine papers involving 101,539 persons with depression were eligible and enabled us to evaluate 42 correlates . Correlates that were consistently ( n ≥ 4 ) associated with lower physical activity participation in depressed persons were a higher level of depressive symptoms , a higher body mass index , the presence of physical co-morbidity and a lower self-efficacy . The role of social , environmental and policy factors on  physical activity participation is unknown and should be addressed in future research . CONCLUSION In persons with depression  physical activity participation  is a complex behavior that is influenced by many different factors . Significant correlates should be confirmed in prospect i ve studies . Interventions to improve modifiable physical and mental health variables in people with depression should be developed and evaluated BACKGROUND Chronic reflex sympathetic dystrophy ( also called the complex regional pain syndrome ) is a painful , disabling disorder for which there is no proven treatment . In observational studies , spinal cord stimulation has reduced the pain associated with the disorder . METHODS We performed a r and omized trial involving patients who had had reflex sympathetic dystrophy for at least six months . Thirty-six patients were assigned to receive treatment with spinal cord stimulation plus physical therapy , and 18 were assigned to receive physical therapy alone .  The spinal cord stimulator was implanted only if a test stimulation was successful . We assessed the intensity of pain ( on a visual-analogue scale from 0 cm [ no pain ] to 10 cm [ very severe pain ] ) , the global perceived effect ( on a scale from 1 [ worst ever ] to 7 [ best ever ] ) , functional status , and the health-related quality of life . RESULTS The test stimulation of the spinal cord was successful in 24 patients ; the other 12 patients did not receive implanted stimulators . In an intention-to-treat analysis , the group assigned to receive spinal cord stimulation plus physical therapy had a mean reduction of 2.4 cm in the intensity of pain at six months , as compared with an increase of 0.2 cm in the group assigned to receive physical therapy alone ( P<0.001 for the comparison between the two groups ) . In addition , the proportion of patients with a score of 6 ( " much improved " ) for the global perceived effect was much higher in the spinal cord stimulation group than in the control group ( 39 percent vs. 6 percent , P=0.01 ) . There was no clinical ly important improvement in functional status . The health-related quality of life improved only in the 24 patients who actually underwent implantation of a spinal cord stimulator . Six of the 24 patients had complications that required additional procedures , including removal of the device in 1 patient . CONCLUSIONS In carefully selected patients with chronic reflex sympathetic dystrophy , electrical stimulation of the spinal cord can reduce pain and improve the health-related quality of life
Although there was a lack of consensus among the selected studies , the majority of them presented a strong correlation between physical activity and variables of quality of life and /or functional independence .
Thus , physical activity appears to have an important influence on social relationships , functional independence , psychological factors , and physical aspects , which can enhance quality of life and independence in the performance of daily activities
This study aim ed to perform a systematic review of studies that address the influence of physical activity on the quality of life and functional independence of adult individuals with spinal cord injury .