This study examined the relationship between Bandura' s theory of self-efficacy and the rehabilitation outcome of spinal cord injured persons. The study elicited selfefficacy expectations from fifteen subjects on three occasions: admission and two and four weeks later. Patients rated how they expected to perform six weeks after admission on fifteen rehabilitation behaviors. Patients' ratings were compared to actual performance ratings made by the medical staff on the Barthel Index. Results reveal that subjects' predictions two weeks and four weeks after admission were accurate (r = .74, < .01; r = .89, p < .001, respectively). Findings support the limited applicability of Bandura's theory of spinal cord injury rehabilitation. Recommendations for future research include examining variables which enhance self-efficacy and using a larger, more homogeneous sample.

Sexual function in men with Spinal Cord Injury (SCI) is usually affected to a greater or lesser extent, depending on the type of injury and physiological prerequisites. Social contexts and psychological factors are other aspects that affect sexual function. Sexual dysfunction can lead to an impaired quality of life, depression and other illnesses. Aim: To study reported experiences of sexual function in men with SCI who have participated in The Nordic Spinal Injury Registry (NSCIR) five years follow-up. Design: Quantitative method consisting of a register study based on secondary data. Setting: Information collected from units at Linköping and Umeå, which are two of Sweden's six units of the County Councils' Centers for Spinal Cord Injuries. Sample: Eighty-two men with SCI between ages 19-81 years (mean age: 48 years). Method: A Study of NSCIR´s five years follow-ups regarding the questionnaires for Sexual function and Socio-demographic. Results: Fifty-nine percent (34/58) reported that sexual function was unsatisfactory in relation to intercourse. Almost 80% (55/69) reported experiencing sexual desire after injury. Fifty-four percent (38/70) reported engaging in sexual activity. Conclusions: The results are useful in the aim of developing Spinal Cord Injury care to optimize sexual rehabilitation for men with SCI and to provide a basis for confident and satisfactory sexuality and a better quality of life.

No description available.

Spinal cord injury (SCI) is an acquired physical disability through traumatic injuries such as car accidents and shooting incidents, and non-traumatic injury such as a tumour on the spinal cord, amongst others. Unlike other parts of the body, the spinal cord does not have the ability to repair itself if it is damaged. Consequently, a person who has acquired an SCI will have a physical disability and will be either a paraplegic – paralysis of the lower part of the body, including the legs, or a quadriplegic, which is paralysis of all four limbs. Acquiring a spinal cord injury (SCI) has devastating long-term negative outcomes for the injured person as well as his/her cohabiting partner on a physical, psychological, psychosocial and socio-economical level. Exposure to such prolonged adversity and resulting negative outcomes calls for resilience, namely the ability to positively adapt despite the adversity being exposed to. Not all individuals have the natural ability to “bounce back”, and consequently resilience promotion is imperative. In South Africa, the focus of service delivery in rehabilitation centres is mainly centred on the injured person and consequently the well-being of the spinal cord injured person’s partner (SCIPP) is neglected. Little information is available on resilience-promoting programmes for SCIPPs; thus the main aim of this study was to design and develop a group resilience-promoting programme (GRPP) for SCIPPs. The researcher mainly followed a qualitative research approach and included a small quantitative component. In the context of applied research, an intervention research model comprising six phases was employed. Phase 1, Problem analysis and project planning, was reported on in section A. Manuscript 1 reports on phase 2 (information gathering and synthesis), and consists of a qualitative research synthesis, and mainly aimed at organizing and synthesizing previous research on resilience-promoting processes in order to inform the design and development of a group resilience-promoting programme (GRPP) for SCIPPs. After a systematic review and quality appraisal a total of 74 papers were selected to be quality appraised after abstracts and titles were assessed for relevance. Twenty-one studies were included and synthesized where after an outline for the content of a GRPP for SCIPPs was formulated. Conclusions and recommendations highlight that the formulated GRPP for SCIPPs needs to be further developed into an intervention that could be implemented with SCIPPs. As such, the researcher therefore proceeded with the study (see manuscript 2), aiming in developing small-group programme content and activities (using knowledge gathered from pre-existing interventions; resilience literature; consultations with experts; people living with spinal cord injury (SCI) and personal experience) to promote resilience in SCIPPs. By means of purposive sampling six advisory panel members from a diverse background were interviewed before and after the pilot study with two SCIPPs and one observer to contribute towards the further development of the GRPP for SCIPPs. A six-session GRPP for SCIPPs was formulated, including the following: (1) Information on SCI and resilience; (2) Help SCIPPs understand that their reactions to/emotions regarding these huge changes are normal; (3) Caretaking and support; (4) My dual role; (5) Own caretaking by SCIPPs; and (6) Termination and way forward. The newly developed GRPP for SCIPPs however had to be formally evaluated. Recommendations were made by professionals in the field that the GRPP for SCIPPs should first be subjected to peer review prior to implementing it with the target population. Therefore in manuscript 3 (reporting on phase 5 – evaluation ) the evaluation purpose was to subject the GRPP for SCIPPs to peer review by means of an empirical study with professional role-players (social workers and psychologists) in the field of spinal cord injury, prior to exhibiting it to the target population. The six group sessions were presented to professional role-players (n=12) working within the field of SCI during two 2-day workshops, whereby they were requested to evaluate the content and procedural elements of the GRPP for SCIPPs mainly by means of qualitative research, with a small numerical (quantitative) component. Thematic content analysis and basic descriptive statistics were employed. Overall positive feedback regarding the newly developed intervention was received, with suggested adjustments that needed to be made to the GRPP for SCIPPs prior to formal evaluation with the target group. The GRPP for SCIPPs will further be subjected to expert review in other provinces in South Africa, as the current participants were all from Gauteng. Furthermore, postgraduate students will be recruited to test the programme with the target-population in South Africa for possible further improvement and suggestions, as well as possible expansion to adjust this intervention to meet the needs of male SCIPPs; SCIPs themselves; children of a parent/s living with SCI; and also for post-injury cohabiting relationships, as this intervention might be a starting point for above-mentioned research-opportunities.

Spinal cord injury (SCI) is an acquired physical disability through traumatic injuries such as car accidents and shooting incidents, and non-traumatic injury such as a tumour on the spinal cord, amongst others. Unlike other parts of the body, the spinal cord does not have the ability to repair itself if it is damaged. Consequently, a person who has acquired an SCI will have a physical disability and will be either a paraplegic – paralysis of the lower part of the body, including the legs, or a quadriplegic, which is paralysis of all four limbs. Acquiring a spinal cord injury (SCI) has devastating long-term negative outcomes for the injured person as well as his/her cohabiting partner on a physical, psychological, psychosocial and socio-economical level. Exposure to such prolonged adversity and resulting negative outcomes calls for resilience, namely the ability to positively adapt despite the adversity being exposed to. Not all individuals have the natural ability to “bounce back”, and consequently resilience promotion is imperative. In South Africa, the focus of service delivery in rehabilitation centres is mainly centred on the injured person and consequently the well-being of the spinal cord injured person’s partner (SCIPP) is neglected. Little information is available on resilience-promoting programmes for SCIPPs; thus the main aim of this study was to design and develop a group resilience-promoting programme (GRPP) for SCIPPs. The researcher mainly followed a qualitative research approach and included a small quantitative component. In the context of applied research, an intervention research model comprising six phases was employed. Phase 1, Problem analysis and project planning, was reported on in section A. Manuscript 1 reports on phase 2 (information gathering and synthesis), and consists of a qualitative research synthesis, and mainly aimed at organizing and synthesizing previous research on resilience-promoting processes in order to inform the design and development of a group resilience-promoting programme (GRPP) for SCIPPs. After a systematic review and quality appraisal a total of 74 papers were selected to be quality appraised after abstracts and titles were assessed for relevance. Twenty-one studies were included and synthesized where after an outline for the content of a GRPP for SCIPPs was formulated. Conclusions and recommendations highlight that the formulated GRPP for SCIPPs needs to be further developed into an intervention that could be implemented with SCIPPs. As such, the researcher therefore proceeded with the study (see manuscript 2), aiming in developing small-group programme content and activities (using knowledge gathered from pre-existing interventions; resilience literature; consultations with experts; people living with spinal cord injury (SCI) and personal experience) to promote resilience in SCIPPs. By means of purposive sampling six advisory panel members from a diverse background were interviewed before and after the pilot study with two SCIPPs and one observer to contribute towards the further development of the GRPP for SCIPPs. A six-session GRPP for SCIPPs was formulated, including the following: (1) Information on SCI and resilience; (2) Help SCIPPs understand that their reactions to/emotions regarding these huge changes are normal; (3) Caretaking and support; (4) My dual role; (5) Own caretaking by SCIPPs; and (6) Termination and way forward. The newly developed GRPP for SCIPPs however had to be formally evaluated. Recommendations were made by professionals in the field that the GRPP for SCIPPs should first be subjected to peer review prior to implementing it with the target population. Therefore in manuscript 3 (reporting on phase 5 – evaluation ) the evaluation purpose was to subject the GRPP for SCIPPs to peer review by means of an empirical study with professional role-players (social workers and psychologists) in the field of spinal cord injury, prior to exhibiting it to the target population. The six group sessions were presented to professional role-players (n=12) working within the field of SCI during two 2-day workshops, whereby they were requested to evaluate the content and procedural elements of the GRPP for SCIPPs mainly by means of qualitative research, with a small numerical (quantitative) component. Thematic content analysis and basic descriptive statistics were employed. Overall positive feedback regarding the newly developed intervention was received, with suggested adjustments that needed to be made to the GRPP for SCIPPs prior to formal evaluation with the target group. The GRPP for SCIPPs will further be subjected to expert review in other provinces in South Africa, as the current participants were all from Gauteng. Furthermore, postgraduate students will be recruited to test the programme with the target-population in South Africa for possible further improvement and suggestions, as well as possible expansion to adjust this intervention to meet the needs of male SCIPPs; SCIPs themselves; children of a parent/s living with SCI; and also for post-injury cohabiting relationships, as this intervention might be a starting point for above-mentioned research-opportunities.

published_or_final_version / Social Work / Master / Master of Social Work

Introduction This thesis describes a research study designed to examine the consequences of disability arising out of spinal cord compression secondary to cancer, and to examine the rehabilitation services available to patients. Research aims and questions The study was intended to achieve the following: 1. To ascertain what might constitute effective rehabilitation interventions for patients with metastatic spinal cord compression. 2. To identify the conditions in which these intervention might be delivered. 3. To ground proposals in spinal cord compression patients’ experience of disability. The following research questions were posed: 1. What are the consequences of disability for patients with metastatic spinal cord compression? 2. What strategies do patients themselves use to manage disability? 3. What do health care staff, particularly rehabilitation professionals, understand to be the consequences of disability for this patient group, and correspondingly, what are their views on the significance and provision of rehabilitation? 4. To what extent is rehabilitation being provided to these patients, and with what effect? 5. Where rehabilitation is not being provided, why is this the case? Study design The study had two components: • A series of nine in-depth interview-based case studies, which involved talking to patients about their experiences of living with spinal cord compression, as well as gaining the perspectives of family members and the health professionals who provided care and services. • A retrospective audit of the medical records of 73 spinal cord compression patients admitted to a radiotherapy in-patient unit (the Frank Ellis Unit at the Churchill Hospital in Oxford) over a two year period (July 2003 – June 2005), identifying disability-related problems and the measures taken to address them. This was a Phase I modelling study in terms of the Medical Research Council’s framework for evaluating complex interventions, with Pawson and Tilley’s (1997) Context-Mechanism-Outcome configuration adopted as a conceptual basis for data collection. Within-case analysis was informed by George and Bennett’s (2004) account of process tracing, and between-case analysis was modelled on the constant comparative method of Glaser and Strauss (1967) with an analysis of narrative as a variation on that theme. Results Disability is a serious problem for patients with spinal cord compression, but it is one problem among many others, not the least of which are the physical and emotional consequences of life-threatening illness. In response to disability, patients ‘twin-track’ their attitudes to it, acknowledging but also resisting the idea of themselves as disabled, and adopting a series of psychological devices to manage the tension. In effect, patients recognise that something significant has changed and that, as a consequence, new self-management skills must be learned, functional boundaries must be explored, useful information must be sought. At the same time, they display a determination to hold on to an established identity, associated with a sense of normality. This identity embraces the idea of competence and resourcefulness, the events, activities and pleasures that one looks forward to, and the wish to avoid burdening others. It is not a ‘disabled’ identity. To some extent, these two attitudes are in tension, as one acknowledges disability while the other, implicitly or explicitly, resists it. Consequently, patients try to find ways of resolving this tension, by ‘revising downwards’ their expectations, by constantly deferring the anticipated pleasures, and by avoiding situations in which their abilities might be put to the test, or the sense of normality be disconfirmed. Health care professionals are likely to construe the patient’s response as indicative of a certain type of character – ‘realistic’ on one hand, and ‘unrealistic’ on the other. They do not see ‘acknowledging / not acknowledging’ as twin facets of a complex response to circumstances, or as something which every patient engages in to one degree or another. Patients are motivated not to recognise rehabilitation as something they need, a view which is confirmed by the cursory form of rehabilitation experienced in hospital, and by the marginal significance attributed to it by nursing and medical staff. On discharge, hospital staff assume that rehabilitation needs will be identified in the community, although the way in which community rehabilitation services are organised virtually guarantees that this will not happen, unless a specific referral is made (as it is in only 5% of cases). The patient, meanwhile, remains unaware of the potential value of rehabilitation, and has no incentive to request rehabilitation if no-one offers it. They are consequently unprepared for life post-discharge, and assume that they (and their families) must manage on their own. Conclusions Like the patients, health care professionals may have to ‘twin-track’ if they are to provide rehabilitation in a way that is acceptable to patients with metastatic spinal cord compression. Instead of categorising patients as ‘realistic’ or ‘unrealistic’, they should work towards sustaining patients’ ‘positive illusions’, while at the same time taking whatever opportunities arise to enhance the patient’s day-to-day ability to function in a ‘safe’ space. This entails revising some deeply entrenched ideas about working with patients who have a disability: patient-centredness, the importance of goal setting, and the need for adjustment.

Après un traumatisme de la moelle épinière (TM), l’ischémieest un facteur d’aggravation des lésions. Cette ischémie peut être aggravée par l’augmentation depression du liquide cérébro-spinal (LCS) par le biais d’un effet tamponnade. Or chez l’homme,après un TM avec préservation de l’intégrité de la dure-mère, la pression de LCS augmentesignificativement. On suppose donc que le maintien d’une pression de LCS à des valeursphysiologique pourrait être une méthode de limitation de l’ischémie post-traumatique et doncd’amélioration du pronostic fonctionnel. Afin de pouvoir réaliser une étude expérimentale de cesphénomènes, nous avons consacré la première partie expérimentale de cette thèse à la mise au pointd’un modèle de TM à dure-mère intacte chez le rat permettant la mesure simultanée de la pressionde LCS et de la perfusion médullaire. Nous avons confirmé expérimentalement que la pression deLCS augmente après TM. Dans la seconde partie expérimentale, nous avons mis au point unetechnique expérimentale de quantification spatiale et temporelle de la perfusion médullaire grâce àl’échographie de contraste. Cette technique permettait aussi un suivi en temps réel de l’évolution dusaignement intra-parenchymateux induit par le TM. Dans la troisième partie expérimentale, nousavons utilisé notre modèle couplé avec l’échographie de contraste et le laser Doppler pour évaluerles effets de la noradrénaline injectée à la phase aigüe d’un TM sur la perfusion médullaire et lesaignement intra-parenchymateux. Nous avons montré que la noradrénaline augmentait trèslégèrement le flux sanguin superficiel mais pas le flux sanguin profond et qu’elle augmentait lataille du saignement. / After spinal cord injury (SCI), ischaemia aggravates lesions.Increase in cerebrospinal fluid (CSF) pressure can worsens ischaemia through a tamponnade effect.In humans, it has been shown that after SCI with intact dura mater, CSF pressure significantlyincreases. Therefore, preserving CSF pressure within a physiological range may limit post-traumaischaemia and improve neurological outcome. In order to experimentally study these phenomenon,we have dedicated the first part of that work to create a model of SCI in rats preserving dura’sintegrity and allowing simultaneous measurement of spinal cord blood flow (SCBF) and CSFpressure. We have confirmed that CSF pressure increases after SCI with intact dura. In the secondexperimental part, we have developed a technique allowing to perform spatial and temporalmeasurement of SCBF thanks to contrast enhanced ultrasonography (CEU). Moreover, thistechnique allows real-time measurement of the size of the parenchymal hemorrhage. In the thirdexperimental part, we have used our experimental model in association with CEU and LaserDoppler to assess the effects of early injection of norepinephrine on SCBF and parenchymalhemorrhage. We found that norepinephrine induces a slight increase in superficial SCBF while itdoesn’t modify deep SCBF and significantly increases the size of parenchymal hemorrhage.

Spinal cord injury is one of the most catastrophic events that may befall a human being. As greater numbers of disabled young adults survive for longer periods, the need for long-term care at home increases. However, self-satisfaction and perceived quality of their care at home are thus important of study. The study had two purposes which included: (1) to describe what factors influence self-satisfaction and perceived quality of care provided for individuals who have had spinal cord injury, and (2) to generate the Learned Response Model that describes the relationships among factors essential for self-satisfaction and perceived quality of care provided for persons with spinal cord injury in the home. A correlation design with a causal modeling methodology was used. Eighty spinal cord injured persons were obtained from six rehabilitation sites in Arizona. Six instruments were utilized to collect data: (1) Knowledge of Disability Questionnaire (KDQ), (2) Stressful Life Events Questionnaire (SLEQ), (3) Activities of Daily Living Scale (ADLS), (4) Involvement of Significant Others Questionnaire (ISOQ), (5) Self-Satisfaction Questionnaire (SSQ), and (6) Perceived Quality of Care Scale (PQCS). Data analysis included use of descriptive statistics to summarize the sample in terms of demographic variables and theoretical and empirical model testing using multiple regression techniques and residual analysis. The study findings indicated that stressful life events was found to have direct negative impact upon perceived quality of care. Activities of daily living and involvement of significant others were found to be moderators relative to self-satisfaction. These variables also interacted together relative to self-satisfaction and perceived quality of care. Involvement of significant others was found to have a significant, but weak, moderation effect relative to the relationship of stressful life events with perceived quality of care.

Background Anticipatory and compensatory balance responses are used by the central nervous system (CNS) to preserve balance, hence they significantly contribute to the understanding of physiological mechanisms of postural control. It is well established that various sensory systems contribute to the regulation of balance. However, it is still unclear which role each individual sensory system (e.g. plantar mechanoreceptors) plays in balance regulation. This becomes also evident in various patient populations, for instance in diabetics with reduced plantar sensitivity. To investigate these sensory mechanisms, approaches like hypothermia to deliberately reduce plantar afferent input have been applied. But there are some limitations regarding hypothermic procedures in previous studies: Not only plantar aspects of the feet might be affected and maintaining the hypothermic effect during data collection. Therefore, the aim of the present study was to induce a permanent and controlled plantar hypothermia and to examine its effects on anticipatory and compensatory balance responses. We hypothesized deteriorations in anticipatory and compensatory balance responses as increased center of pressure excursions (COP) and electromyographic activity (EMG) in response to the hypothermic plantar procedure. 52 healthy and young subjects (23.6 ± 3.0 years) performed balance tests (unexpected perturbations). Subjects’ foot soles were exposed to three temperatures while standing upright: 25, 12 and 0 °C. COP and EMG were analyzed during two intervals of anticipatory and one interval of compensatory balance responses (intervals 0, 1 and 2, respectively). Results Similar plantar temperatures confirmed the successful implementation of the thermal platform. No significant COP and EMG differences were found for the anticipatory responses (intervals 0 and 1) under the hyperthermia procedure. Parameters in interval 2 showed generally decreased values in response to cooling. Conclusion No changes in anticipatory responses were found possibly due to sensory compensation processes of other intact afferents. Decreased compensatory responses may be interpreted as the additional balance threat, creating a more cautious behavior causing the CNS to generate a kind of over-compensatory behavior. Contrary to the expectations, there were different anticipatory and compensatory responses after reduced plantar inputs, thereby, revealing alterations in the organization of CNS inputs and outputs according to different task difficulties.