Tem-se observado a importÃncia da espiritualidade, religiosidade e crenÃas para superar momentos difÃceis. Desse modo, este trabalho objetivou avaliar a influÃncia da espiritualidade, religiosidade e crenÃas pessoais na qualidade de vida de pessoas com lesÃo medular (LM). Trata-se de um estudo exploratÃrio de corte longitudinal, com abordagem quantitativa, realizado na cidade de Fortaleza - CE, em duas fases, no ambiente hospitalar e depois com os mesmos pacientes, em seu domicÃlio, por meio de contato telefÃnico. A populaÃÃo alvo do estudo foi constituÃda de 55 pessoas no ambiente hospitalar, mas somente 49 participaram da segunda fase. Foram aplicados dois instrumentos; um para traÃar os perfis sociodemogrÃfico e clÃnico e o instrumento de Qualidade de vida da OrganizaÃÃo Mundial da SaÃde - MÃdulo Espiritualidade, ReligiÃo e CrenÃas Pessoais - WHOQOL-SRPB, o qual apresenta oito facetas, totalizando 32 itens com respostas em escala Likert. Foram realizadas anÃlises exploratÃrias mediante uso de distribuiÃÃes de frequÃncias univariadas e medidas descritivas. Os aspectos Ãticos foram respeitados, conforme a ResoluÃÃo 466/12 do Conselho Nacional de SaÃde (BRASIL, 2012), e aprovado pelo comità de Ãtica da UFC com protocolo n 338.980 e do comità coparticipante (IJF) com o n 348.114. A validaÃÃo da consistÃncia interna das respostas obtidas e cÃlculo dos escores das respectivas dimensÃes da escala foram verificados em ambas as fases do estudo e mostrou ser excelente. Para comparaÃÃo dos valores mÃdios dos grupos (hospitalizados e no domicÃlio) foi utilizado o Teste T de Wilcoxon. Confirmam-se os altos escores obtidos nos domÃnios da WHOQOL-SRPB, em ambas as fases, nas quais os domÃnios que mais se destacaram foram os relacionados com a esperanÃa e otimismo, forÃa espiritual e fÃ. Em relaÃÃo Ãs modificaÃÃes dos escores durante as duas faces os domÃnios que demostraram diferenÃa estatÃstica significante foi os domÃnios, sentido na vida e forÃa espiritual, acredita-se que essa diferenÃa ocorreu devido à mudanÃa de ambiente, no qual a pessoa ainda estar passando pelo perÃodo de adaptaÃÃo. Portanto, espera-se que este estudo possa despertar os enfermeiros para a reflexÃo sobre a relevÃncia do cuidado espiritual e emocional das pessoas com LM. / The importance of spirituality, religiosity and beliefs to overcome difficulties has been noted. The aim of this study was to evaluate the influence of spirituality, religiosity and personal beliefs in the life quality of people who had a spinal cord injury (SCI). This is an exploratory longitudinal study with a quantitative approach, conducted in the city of Fortaleza - CE, in two phases: in the hospital and then with the same patients, in their homes, through telephone contact. The studyâs target population consisted of 55 people in the hospital, but only 49 participated in the second phase. In order to meet the aims of this study, two instruments were applied; one to trace the socio-demographic and clinical profiles and the Quality of Life instrument of the World Health Organization - Module Spirituality, Religion and Personal Beliefs - WHOQOL-SRPB WHO, which features eight factors, totalling 32 items on the Likert scale, where 1 represents never and 5 indicates always. Exploratory analyzes were performed by using univariate frequency distribution, descriptive measures and the Box Plot graph. The validation of the internal consistency of the responses and calculation of the scores of the respective dimensions of scale WHOQOL-SRPB were verified in both phases of the study. The ethical aspects were observed, according to Resolution 466/12 of the National Health Council (BRAZIL, 2012), and approved by the ethics committee of the UFC with Protocol 338 980 and committee co-participant (IJF) with paragraph 348 114. The validation of the internal consistency of the responses and calculate the scores of the respective dimensions of the scale were observed in both phases of the study and proved to be excellent. The Wilcoxon T test â a non parametric test for paired samplesâ comparison â was used to compare the average values of the groups (hospitalized and at home). High scores were obtained from WHOQOL-SRPB domains, in both phases, in which the ones that stood out were those related to hope and optimism, spiritual strength and faith. Regarding changes in scores for the two sides domains that demonstrated a statistically significant difference was domains, meaning in life and spiritual strength, it is believed that this difference was due to the change of environment in which the person is still going through the period adaptation. Therefore, it is expected that this study lead nurses to the reflection on the relevance of spiritual and emotional care of people with SCI and to the practice of mutual respect.

The South African Professional Board for Emergency Care prehospital Clinical Practice Guideline (CPG) recommends that emergency medical services (EMS) make use of the National Emergency X Radiography Utilization Study (NEXUS) rule and Canadian C-spine Rule (CCSR) when managing traumatic spinal injury. However, the safety and effectiveness of prehospital clinical spinal clearance or spinal motion restriction (SMR) decision support tools within poorly resourced settings are unclear. We conducted a scoping review on clinical spinal clearance and selective SMR decision support tools which aimed at identifying possible barriers to their implementation, safety, and effectiveness when used by EMS personnel. Studies were included if they described the use of clinical spinal clearance or SMR decision tools in first line management of blunt trauma patients by medical practitioners in the Emergency Department (ED) or by EMS personnel working in a prehospital setting. After screening, 42 documents fulfilled the inclusion criteria. Several selective SMR decision support tools have been implemented in the prehospital setting, the most common of which were those based on the NEXUS and the CCSR tools. Only one study evaluated the safety and efficacy of the NEXUS rule when used by EMS personnel. The limited prehospital literature available investigating either the NEXUS rule or CCSR therefore makes it difficult to determine its appropriateness for adoption and implementation by EMS personnel in other prehospital settings such as that of South Africa. Furthermore, commonly found prehospital NEXUS-based decision tools presented with unique challenges related to the subjective nature of some of the individual components of the decision tool. This leaves the decision tool open to interpretation by examiners and is especially relevant in settings, such as South Africa, where there are many different levels in scope of practices. This increases the risk of the patient being either under-triaged or over-triaged. More studies are therefore needed to definitively assess for the safety, efficacy and effectiveness of clinical spine clearance within the prehospital setting. It is believed that a selective SMR decision tool which has more specific instructions for the prehospital practitioner may be able to accommodate such challenges and is an area which needs further investigation.

Over 260,000 Americans are living with a traumatic spinal cord injury (SCI). Medical advances have increased the longevity of individuals living with SCI into middle age and beyond. The majority of these individuals are living with an incomplete SCI (NSCISC, 2012), and the proportion of incomplete injuries is rising (DeVivo, 2012). There is little research that specifically examines the changes in physical function experienced by individuals aging with a traumatic incomplete SCI. The purpose of this qualitative descriptive study was to describe the changes in physical function experienced by participants with a traumatic incomplete SCI aging through middle age. Data were collected through moderately structured individual interviews (N=17), in either a face-to-face (n=6) or an email (n=11) format. The seventeen participants ranged in age from 35 to 65 years, with a 16 to 36 year duration of injury. Participants described changes in various body systems and recalled the timing of those changes as they transitioned through their middle years. Qualitative content analysis revealed that participants described primarily gradual changes including decreased muscle strength, decreased endurance, weight gain, and wear and tear changes. When asked to identify sources of information about physical changes, participants predominantly emphasized their lack of knowledge about anticipated changes. Further content analysis revealed three themes related to this transition. Participants likened their experience to travelling through uncharted territory. They described strategies for living in uncharted territory that help them to prevent or manage changes in physical function, with sub-themes of being vigilant in their self-assessment and self-management practices, investing time in figuring out what changes they experienced and why those changes happened, and staying positive. They also described the importance of recognizing the impact of changes. These findings provide a foundation for understanding this age-related transition, and identify the need for further research to support effective self-management strategies and efficient mechanisms for disseminating this knowledge to people with SCI, their caregivers and families. In acute and chronic patient care settings, nurses are well-positioned to be a valuable support and information source for individuals living with an incomplete SCI.

Spinal Cord Injury (SCI) is a physically debilitative impairment with a poor prognosis that disrupts the connection between the brain and body. Reduced somatic and autonomic nervous system control over motor and sensory function of muscles and organs causes paralysis and dysregulation of physiological systems. Complications, such as deep vein thromboses, urinary tract infections, and chronic pain, often cause high, life-long economic burdens. Seniors with SCI also have an increased risk of developing cognitive decline. Development of Major Neurocognitive Disorder (Dementia) is characterized by a reduced ability to perform daily activities. In addition to the physical impairments due to SCI, older adults would experience further decreased quality of life. There are various postulations about what contributes to an increased risk of cognitive decline in SCI patients, although the specific mechanism is uncertain. This research project is focused on examining whether blood pressure dysregulation may play a key role in inducing cognitive decline in older adults with SCI. To fulfill this goal, published reviews and clinical and laboratory data from 1997 to 2023 have been analytically reviewed following the presentation of background physiological and pathophysiological information. The outcomes demonstrated that SCI above T6 leads to an increased risk of blood pressure dysregulation and other conditions associated with an increased risk of cognitive decline, including orthostatic hypotension, vascular dementia, and deficient dynamic cerebral autoregulation. Overall, the findings suggest that blood pressure dysregulation that causes cerebral hypoperfusion may be a major contributor to cognitive decline in older adults with SCI.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Licentiatavhandling (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 3 uppsatser.

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.

Diss. Linköping : Univ., 2002.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Spinal Cord Injuries (SCIs) are debilitating injuries where damage to the spinal cord causes a loss of mobility and feeling in muscles innervated below the injury point. Tetraplegia refers to an SCI in the cervical region of the spinal cord that impacts on the functionality of all four limbs. ‘Complete’ tetraplegia results in complete paralysis of the legs, partial or complete paralysis of the arms and trunk, and in the most severe cases, the neck. The independence of people living with tetraplegia is heavily dependent on assistive and mobility devices. Understanding the strength characteristics of people with tetraplegia is crucially important for the suitable and effective design of mobility and rehabilitative devices such as wheelchairs. A study using a stationary dynamometer and video capture measured kinetic and kinematic characteristics of wheelchair propulsion for 15 subjects with C5-C7 tetraplegia. This study differentiated between subjects with different injuries, at two different test resistances, and was more comprehensive than other reported studies on MWC propulsion. Some of the subjects in the study with C5-C6 injuries had no elbow extension capability, while others had undergone a deltoids-to-triceps tendon transfer procedure called TROIDS, which restores some elbow extension capability. No differences were found in any of the push phase metrics between those who had undergone the TROIDs procedure, and those who had not, suggesting that TROIDs provides no significant benefit for mobility. As expected, subjects with C7 tetraplegia recorded velocity and power outputs significantly higher than those for subjects with C5-C6 tetraplegia. To better understand the strength characteristics over the full range of motion in the sagittal plane, and thus potentially modify the design of mobility devices to better suit these characteristics, a novel method for gathering strength data in multiple directions and positions was developed. This method had advantages over other commonly used methods. In particular, it was inclusive of complex muscle and joint interactions that would otherwise be very difficult to build into a model. Sagittal horizontal push strength was measured using this method for 8 able bodied and 4 tetraplegic subjects. There were clear trends in the data from the able-bodied subjects, and a fourth order polynomial (R-squared = 0.8) was fitted to the data for modelling purposes. Data for the tetraplegic subjects varied significantly from the able-bodied data, but inter-individual variation was such that no model would provide a satisfactory fit to the data indicating a very high degree of patient-specific behaviour. One multi-directional data set, consisting 1584 measurements in the sagittal plane, was gathered for an able-bodied subject. The main trends in this measured data were successfully captured by a model consisting of twelve fourth-order polynomials. Building on these measurements, and employing a human model in the constraint modelling environment, SWORDS, this thesis develops a conceptual design tool for comparing the effectiveness of different hand force paths. Initial simulations using hypothetical hand paths indicated that the proposed method for predicting the direction of the applied force needs to be verified, and likely refined, for hand paths that differ significantly from the traditional wheelchair push-rim path. This proposed procedure has the potential to be a powerful tool for optimising and modifying the design of wheelchairs or human powered devices to utilise previously untapped abilities for any given population.