Cardiovascular control in the human is significantly impaired after spinal cord injury(SCI) having a direct effect on the sympathetic nervous system (SNS) causing an inability toregulate vasoconstriction below the level of the lesion. The effects of SCI on the two majorcomponents of blood pressure regulation, control of plasma volume and neural control of theheart and peripheral vasculature are poorly understood. In particular, no index to diagnosedisorders to autonomic control of the heart and vasculature has been developed. The presentstudy primarily utilized noninvasively acquired, easily accessible variables that may havepromise as indicators of autonomic activity for assessing the level of autonomic injury andrecovery of visceral control following SCI. The most significant results and the clearestdifferences between the three groups (able-bodied, paraplegic and tetraplegic) were evident inspectral analysis obtained in the frequency domain: Arterial blood pressure and lower body (at aregion on the shin) skin perfusion spectral power in the low frequency (LF) region are ofsignificance. These variables could be good discriminators of the three groups, as well as showlevel of SCI and autonomic function.

En femtedel av de som drabbas av ryggmärgsskada i Sverige är kvinnor. Ryggmärgsskadan kan orsaka åtskilliga problem för kvinnorna när det gäller deras sexliv och sexualitet, både fysiska och psykiska. Kvinnor med ryggmärgsskada har stigmatiserats av samhället i fråga om deras önskan och behov att ett sexliv. Forskning om kvinnornas erfarenheter av sin sexualitet är bristfällig. En översikt av den forskning som finns skulle bidra till att få ett bredare perspektiv inom området. Syftet i studien var därför att belysa vad kvinnor med ryggmärgsskada har för erfarenheter av sin sexualitet. Metoden var en litteraturöversikt som inkluderade elva vetenskapliga artiklar. Dessa var både kvantitativa och kvalitativa. Resultaten visade att mer än hälften av kvinnor med ryggmärgsskada var nöjda med sitt sexliv. Kvinnorna behövde tid att anpassa sig efter skadan och för att bygga upp den sexuella självkänslan. Detta kunde medföra att kvinnorna med ryggmärgsskada skapade sig positiva erfarenheter som bidrog till ett tillfredsställande sexliv. Kvinnorna längtade efter intimitet och var både innovativa och positivt inställda till att övervinna svårigheter som skadan medförde gällande sexlivet. Rådgivningen som kvinnor får gällande sin sexualitet och sexliv bör vara anpassad till kvinnorna som individer och fasen av rehabilitering som de befinner sig i. / In Sweden, a fifth of the people with a spinal cord injury are women. The injury causes several difficulties for the women, both physical and psychological. Women are often stigmatized by the society in terms of not being thought to desire or need a sex life. There is not enough research done about how women experience their own sexuality. The aim of the study was hence to illustrate how women with spinal cord injury experience their sexuality. The method used was a literature review where 11 quantitative and qualitative articles were included. The results showed that more than half of the women with spinal cord injury were satisfied with their sex life. The women longed for intimacy; they were innovative and had positive attitudes towards overcoming the sexual difficulties the injury brought about. However, the women needed time for adjustment to be able to have a satisfying sex life. The counseling women get about their sexuality and sex life should be adjusted to fit the women as individuals. It also needs to be presented in the right way during the right phase that the women are in.

Bakgrund: Immobilisering är en vedertagen omvårdnadsåtgärd inom dagens prehospitala traumavård, detta trots att det inte finns några randomiserade kontrollerade studier angående åtgärden. Många studier har dock visat att riskerna med immobilisering är många varför det är viktigt att undersöka omvårdnadshandlingen närmare. Syfte: Syftet med studien var att undersöka förekomsten av radiologiskt fastställda spinala skador hos patienter som immobiliserats prehospitalt efter trauman, samt på vilka indikationer denna immobilisering gjordes. Metod: En kvantitativ retrospektiv studie där 288 journaler granskades i ambulansens journalsystem MobiMed 3.0 och i sjukhusets journalsystem Cosmic. Därefter analyserades resultaten i SPSS deskriptivt och grafiskt, med chi2-test samt med oberoende t-test. Resultat: Resultatet visade att av de 246 patienter som genomgått en radiologisk undersökning fanns en konstaterad spinal skada hos 48 patienter, vilket motsvarade cirka 17 %. Alla inkluderade patienter hade varit utsatta för trubbigt våld och den vanligaste indikationen för immobilisering var smärta/ömhet över kotpelaren. Medelåldern hos patienterna med spinala skador var signifikant högre än medelåldern hos de utan spinala skador och en signifikant skillnad fanns mellan patienterna med spinal skada och utan spinal skada och samtidig smärta/ömhet över kotpelaren. Slutsats: Ett större antal patienter uppvisade skador i denna studie jämfört med tidigare studier, hos den stora majoriteten fanns dock inga spinala skador. Detta innebär att patienterna utsätts för en potentiellt onödig omvårdnadsåtgärd som är svagt vetenskapligt underbyggd och medför ett flertal risker. Fler studier inom området behövs för att kunna minska patienters potentiella lidande i och med att immobiliseras prehospitalt. / Background: Spinal immobilization is an established practice in today’s prehospital trauma care. This even though there is a lack of randomized controlled studies regarding this practice. Many studies points to the risks regarding spinal immobilization why it is of importance to further examine the practice. Aim: The aim of this study was to investigate the incidence of radiologically confirmed spinal injuries in patients immobilized after prehospital trauma and on what indications this immobilization was done Method: A quantitative retrospective study of 288 medical records acquired from the ambulance medical record system Mobimed 3.0 and the hospital's medical record Cosmic were examined. The results were analyzed in SPSS descriptive and graphic, with chi2-test and independent t-test. Result: The results show that of the 246 patients who underwent a radiological examination, 46 had a spinal injury, approximately 17 %. All of the included patients had been exposed to blunt trauma and the most common indication for immobilization was pain/tenderness over the spine. The mean age of the patients with spinal injuries was significantly higher than the mean age of those without spinal injuries. A significant difference was also found between patients with pain/tenderness over the spine and spinal injury and those without spinal injury. Conclusion: A greater number of patients had a spinal injury in this study compared with previous studies, although the majority of the patients had no spinal injury. This means that the majority of the patients were exposed to a potentially unnecessary procedure that lacks scientifically evidence. More studies about immobilization are required to reduce the patients' potential suffering in connection with prehospital immobilization.

The purpose of this thesis project was to determine the precision error of dual-energy x-ray absorptiometry (DXA) derived bone mineral density (BMD) at regions of interest (ROI) that are clinically relevant to persons with spinal cord injury (SCI), and secondarily to compare the precision error between a group of persons who are able-bodied and a group of persons with chronic SCI. Over 2 visits, four DXA scans at sites of the distal femur, proximal tibia, and calcaneus were completed in 10 persons who are able-bodied and 10 persons with chronic SCI. Using forearm sub region analysis, we measured the BMD and calculated the precision error for a total of 7 ROI at these sites. Despite a lower BMD at every ROI in the group of persons with chronic SCI compared to the group of persons who are able-bodied (range, 33 – 56%), the relative precision error was similar between groups. However, there was a trend for greater precision error in persons with SCI at a whole bone ROI of the distal femur (RMS-CV of 8.40% vs. 5.63%) and a ROI of the posterior calcaneus body (RMS-CV of 3.52% vs. 1.78%) when compared to persons who are able-bodied. Further, the ROI of the posterior calcaneus body appeared to have a lower precision error in persons who are able-bodied (RMS-CV, 1.78%) than the distal femur and proximal tibia (RMS-CV range 3.26 – 5.63%). The results from this study suggest that the precision error of DXA derived BMD is similar between persons with SCI and persons who are able-bodied, and that the posterior calcaneus body may be a more precise site than the distal femur and proximal tibia.

Background/Objectives: Individuals with a spinal cord injury (SCI) experience reductions in lower-extremity muscle mass and increased fatty-infiltration of skeletal muscle, predisposing them to an increased risk of specific secondary health conditions. To date, few investigations have prospectively examined changes in muscle in the chronic stage of SCI. Peripheral quantitative computed tomography (pQCT) is an imaging technique capable of measuring lower-extremity skeletal muscle cross-sectional area (CSA) and muscle density, the latter is a surrogate measure of muscle fatty infiltration. The purpose of this project was to a) determine the magnitude of muscle CSA and muscle density reduction in a chronic-SCI population with diverse impairments; b) identify demographic and injury characteristics associated with muscle CSA and density status; and c) determine if muscle CSA and muscle density change over a two-year period following chronic-paralysis and if so, what factors are associated with the changes. Materials and Methods: Seventy individuals [50/20 m/f, mean (± SD) age 48.9 ± 11.5 years; duration of injury 15.5 ± 10.0 years] with chronic (>2 years post-injury) SCI (C1-T12, AIS A-D) were enrolled in a two-year cohort study. Muscle CSA and muscle density values were calculated from pQCT scans of the 66%-site of the calf obtained at baseline and two follow-up visits separated by one year. Possible correlates of muscle CSA and density selected a priori included: gender, age, height, weight, waist circumference, age at injury, level of injury, injury duration, leg spasm frequency and severity scale score (SFSS), ISNCSCI calf-muscle lower-extremity motor score (cLEMS), wheelchair use, serum vitamin D level, and physical activity level. Dependent t-tests were used to compare muscle CSA and muscle density values of participants with complete and incomplete-SCI to age, gender, and height matched able-bodied controls. Multiple linear regression models were used to determine correlates of muscle CSA and muscle density. Repeated measures analysis of variance (rANOVA) were used to examine change in muscle CSA and density over the two-year study duration and multiple linear regression models were created to determine correlates of muscle CSA and density change from baseline. Results: Individuals with motor-complete SCI had a 45% reduction in muscle CSA and a 32% reduction in muscle density relative to controls. Participants with motor-incomplete SCI had a 17% reduction in muscle CSA and a 14% reduction in muscle density relative to controls. A reduced height, waist circumference, cLEMS, and wheelchair use were associated with a smaller muscle CSA in the best-fitting regression model (R2 = 0.66; p<0.0001). In the best-fitting regression model for muscle density, increased age, a lower cLEMS, reduced SFSS, fewer minutes of daily vigorous physical activity, and wheelchair use were associated with a lower muscle density (R2= 0.37; p<0.001). A high degree of individual variability in muscle CSA change (mean ± SD: -1.9 ± 6.2cm2; range: -22.6 to 8.5 cm2) and muscle density change (mean ± SD: -1.2 ± 3.28mg/cc; range: -8.6 to 6.4 mg/cc) was observed in those with both complete and incomplete SCI over the two-year study duration. rANOVA indicated a significant reduction in both muscle CSA and density after controlling for individual variability. A greater waist circumference at baseline was weakly associated with a reduction in muscle CSA (R2 = 0.14, p<0.05), and a lower weight and waist circumference at baseline were associated with a reduction in muscle density (R2 = 0.26, p < 0.001 and R2 = 0.20, p < 0.01, respectively). Conclusion: Age, completeness of injury, spasticity, physical activity participation, and ambulation ability were identified as potential clinical predictors of muscle status in individuals with chronic-SCI. Muscle CSA and density does not reach a “steady-state” after chronic-SCI. Further investigation is needed to determine the mechanisms responsible muscle CSA and density change in order to prevent continued reductions after chronic-SCI.

The overall aim of this study is to explore the subjective experiences of psychotherapeutic interventions and the sense-making process in a group of persons paralysed as a consequence of violence-related gunshot injury. An available and purposive sample of ten participants was selected from public and private hospitals in and around Johannesburg, and from the Association for the Physically Disabled in South Africa. Three females and seven males, between the ages of 26 and 43 years, took part in the research. The participants had all suffered penetrative damage to the spinal cord in the thoracic region as a result of violence related gunshot injury, and are therefore classified as having paraplegia The participants' gunshot injuries had been sustained in incidents ranging from attempted hijacking and armed robbery, to being caught in crime-related crossfire. In-depth interviews were conducted with the participants. A narrative approach was used to examine participants' unique stories, utilising a systematic form of narrative analysis. The thesis consists of three articles, namely 1) The subjective experience of psychotherapeutic interventions in the rehabilitation of persons paralysed as a result of violence-related gunshot injuries; 2) Making sense of paraplegia caused by violence-related gunshot injury; and 3) Therapeutic guidelines for the management of persons paralysed as a result of violence-related gunshot injuries. The findings of article 1 reveal that paraplegic persons had both positive and negative experiences during their hospital rehabilitation. Ultimately, however, positive experiences compensated for negative experiences. This suggests that in the absence of psychotherapeutic interventions, psychosocial adjustment may possibly not be facilitated. The second article indicates that although several barriers prevented participants from making sense of their trauma, meaningful relationships, spiritual growth and a greater appreciation of the value of life were still possible. in the final article guidelines were put forward that include meeting the holistic and adjustment needs of paraplegic persons. Future research is suggested and limitations acknowledged. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2006.

The purpose of this research was to develop a theoretical understanding of the influences on participation for individuals with spinal cord injury (SCI) from a self-perceived perspective, with particular focus on the role of assistive technology (AT) in self-perceived participation. The theoretical underpinning, symbolic interactionism, was used to gain an understanding of the ways that adults with SCI ascribe meaning to the interaction between themselves and their unique environments in a process of participation. A grounded theory study of 19 adults with SCI was conducted. Participants engaged in individual in-depth interviews, used photovoice as a framework for taking photographs of aspects of their environment that promoted and restricted participation, and engaged in focus groups. The constructed grounded theory is summarized as follows: Negotiating the Body-environment Interface is a continuous process for those living with a SCI. Despite the relative stability of their changed body, they Live in a Changed World, one perceived differently after SCI. Four sets of strategies are used by individuals to interact within their unique environments: creating an accessible proximal environment; using AT and adaptations; advocating and educating; and gaining information and knowledge. Strategies were selected to engage in a Process of Participation, a process that consisted of a sense of inclusion, autonomy, accomplishment, and reciprocity. Intervening conditions were the physical (architectural, natural), socio-cultural (social supports, societal attitudes), and institutional (services, policies) environmental aspects that served as barriers or facilitators to the process of participation. The study has added to the growing body of literature on self-perceived participation that forefronts the sense of connectivity and engagement people feel within their environment. The findings highlighted how AT holds unique meaning, and how decisions around use of technology for participation is influenced by personal factors, and physical, socio-cultural, and institutional environments. A new definition of AT was constructed that acknowledges the environmental influences and importance of self-perceived participation as an outcome of AT use. This research highlights the instrumental role of the environment in supporting self-perceived participation of adults with SCI. Further research on developing ways to create inclusive and supportive environments for assistive technology users is warranted.

Spinal cord injury (SCI) is uniquely devastating. Cellular transplantation strategies for SCI are showing promise. Little, however, is known about how transplanted neural precursor cells (NPCs) enhance functional recovery or the mechanisms by which they interact with the host spinal cord. Better understanding of these critical issues may lead to improved strategies to enhance recovery after SCI. Given this background, I hypothesized that NPCs mediate functional recovery by a number of mechanisms including trophin production, neuroprotection, modulation of the host inflammatory response or glial scarring, and/or remyelination. I thus endeavored to characterize trophin production by NPCs in vitro and in vivo in rats with clip compression SCI of the thoracic spinal cord, to determine if preservation of host cells and tissue contribute to functional recovery and to determine how NPC transplantation influences the host inflammatory response and glial scarring. Here I present unique and novel insights into NPC-host interactions following SCI. We show that NPCs are poised to provide trophic support to the injured spinal cord. We also show that the combination of NPCs, pharmacotherapy and trophin infusion is associated with sparing of grey and white matter, enhanced numbers of oligodendrocytes but not axons as well as an increased inflammatory response. To assess the potential impact of myelination as a mechanism underlying NPC-mediated functional recovery after SCI, experiments were undertaken using NPCs derived from shiverer mutant mice unable to produce central myelin. These experiments showed that while NPCs from wild-type mice generate myelin and mediate functional recovery after SCI; transplanted shiverer NPCs impede neurobehavioural recovery. In summary, my work provides unique insights into the functional effects of NPC transplantation after SCI. Of importance, this thesis provides novel evidence that remyelination is a key mechanism of action by which NPCs mediate recovery after SCI. Hence, this work has important implications for patients with SCI.

The role of gap junctions in modulating the dynamics of axonal dysfunction in spinal cord white matter injury remains uncertain; hence, I examined the functional role and changes in expression of gap junctions following CNS injury. I hypothesized that inhibition of gap junctions improves axonal conduction during oxygen and glucose deprivation (OGD) in vitro. Carbenoxolone and octanol, gap junction blockers, did not change CAP amplitude in non-injured tissue, yet they significantly reduced the extent of its decline during OGD. No difference in mRNA expression of connexins 32, 36 was found. However, during OGD in the presence of gap junction blockers, expression of connexins 30, 43 was downregulated. Immunohistochemistry confirmed the presence of connexins in spinal cord slices: connexins 30, 43 overlapping with GFAP, connexin 32 with MBP and connexin 36 with CC1. Thus, blocking gap junctions enhances axonal conduction during OGD and promotes dynamic changes in connexin mRNA expression.

Spinal cord injury (SCI) is uniquely devastating. Cellular transplantation strategies for SCI are showing promise. Little, however, is known about how transplanted neural precursor cells (NPCs) enhance functional recovery or the mechanisms by which they interact with the host spinal cord. Better understanding of these critical issues may lead to improved strategies to enhance recovery after SCI. Given this background, I hypothesized that NPCs mediate functional recovery by a number of mechanisms including trophin production, neuroprotection, modulation of the host inflammatory response or glial scarring, and/or remyelination. I thus endeavored to characterize trophin production by NPCs in vitro and in vivo in rats with clip compression SCI of the thoracic spinal cord, to determine if preservation of host cells and tissue contribute to functional recovery and to determine how NPC transplantation influences the host inflammatory response and glial scarring. Here I present unique and novel insights into NPC-host interactions following SCI. We show that NPCs are poised to provide trophic support to the injured spinal cord. We also show that the combination of NPCs, pharmacotherapy and trophin infusion is associated with sparing of grey and white matter, enhanced numbers of oligodendrocytes but not axons as well as an increased inflammatory response. To assess the potential impact of myelination as a mechanism underlying NPC-mediated functional recovery after SCI, experiments were undertaken using NPCs derived from shiverer mutant mice unable to produce central myelin. These experiments showed that while NPCs from wild-type mice generate myelin and mediate functional recovery after SCI; transplanted shiverer NPCs impede neurobehavioural recovery. In summary, my work provides unique insights into the functional effects of NPC transplantation after SCI. Of importance, this thesis provides novel evidence that remyelination is a key mechanism of action by which NPCs mediate recovery after SCI. Hence, this work has important implications for patients with SCI.