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Bakgrund: Trauma är den vanligaste orsaken till uppkomsten av en ryggmärgsskada och drabbar främst personer i en aktiv ålder. Beroende på skadans placering och omfattning medför den en förlamning i olika grader. Ju högre upp den sitter desto större och allvarligare komplikationer. Ryggmärgsskadan medför en rad olika kroppsliga komplikationer för de drabbade personerna, exempelvis smärta, trycksår, problem med mage och tarm samt urinvägarna. Studien kan bidra till ökad kunskap och förståelse för den ryggmärgsskadades livsvärld samt behov av stöd och vård. Syfte: Att belysa patienters upplevelser av att leva med en förvärvad ryggmärgsskada. Metod: En kvalitativ studie baserad på narrativer tagna utifrån bloggar. Resultat: Analysen resulterade i tre huvudteman: När livet tar en ny vändning, När kroppen sviker och Hälso- och sjukvården och andra organisationer. Utifrån dessa teman skapades sju underteman: Lära känna sig själv på nytt, Att se det positiva även i det svåra, Viljan till att ta sig framåt i livet, En förändrad kropp, Att vara beroende av andra, Det goda mötet och När stödet utifrån behoven brister. Konklusion: Studien bidrar till ökad kunskap om hur patienter upplever livet efter en ryggmärgsskada, då det medför en stor förändring i livet både fysiskt, psykiskt och själsligt. Då möten med Hälso -och sjukvård inte alltid upplevs som positiva, är ökad förståelse samt kunskap av vikt för att sjuksköterskan ska kunna ge en så god vård som möjligt utifrån ett personcentrerat förhållningssätt. / Background: Trauma is the most common cause of a spinal cord injury and mainly affects people of active age. Depending on the location and extent of the damage, it causes paralysisto varying degrees. The higher up it is, the greater and more serious complications. The spinal cord injury causes a number of different physical complications for the affected persons, such as pain, pressure ulcers, problems with the stomach and intestines and the urinary tract. The study can contribute to increased knowledge and understanding of the spinal cord injured person's world of life as well as the need for support and care. Aim: To illustrate patients’ experiences of living with an acquired spinal cord injury.  Method: A qualitative study based on narratives based on blogs. Findings: The analysis resulted in three main themes: When life takes a new turn, When the body betrays and Health care and other organizations. Based on these themes, seven subthemes were created: Getting to know oneself again, Seeing the positive even in the difficult, The will to move forward in life, A changed body, Being dependent on others, The good meeting and When the support based on needs is lacking. Conclusion: The study contributes to increased knowledge about how patients experience life after spinal cord injury, as it leads to major change in life both physically, psychologically and mentally. As meetings with Health- and medical care are not always perceived as positive, increased understanding and knowledge is important for the nurse to be able to provide as good care as possible based on a person-centered approach.

京都大学 / 新制・課程博士 / 博士(理学) / 甲第23461号 / 理博第4755号 / 新制||理||1682(附属図書館) / 京都大学大学院理学研究科生物科学専攻 / (主査)教授 高田 昌彦, 准教授 宮地 重弘, 教授 古市 剛史 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DGAM

Background and Purpose: People living with SCI (PLWSCI) have to cope with various challenges when they return home after institutionalized rehabilitation, especially with integrating back into and participating in their communities. To date no study has been conducted in South Africa to empirically measure community integration or to evaluate factors affecting the community integration of PLWSCI. The purpose of the study was to investigate factors influencing the community participation of PLWSCI after rehabilitation. Methodology: A cross-sectional, analytical research design employing both qualitative and quantitative approaches was used. Data collection: Phase one: Participants were identified from the databases of two rehabilitation centers, and the snow balling technique. Data were collected by implementing: the socio-demographic and injury profile (SDIP), the Return to Normal Living Index (RNLI), the Spinal Cord Injury Measure – version II (SCIM II) and the Craig Hospital Inventory of Environmental Factors – short form (CHIEF-SF). Phase two: In-depth face to face interviews were conducted with a purposely selected sample group from participants of phase one of the study to determine how participants perceive their community participation. Data Analysis: Phase one: Data were analyzed using version 17 of the Statistical Package for the Social Sciences (SPSS 17). Descriptive statistics, T- tests, Pearson productmoment correlation coefficients and one way analysis of variance (ANOVA), with Bonferroni adjustments for multiple comparisons, was done to examine demographic characteristics and participants’ community participation. Data from Phase 2 was subjected to data-reducing procedures using qualitative techniques. Results – Phase One One hundred and sixty PLWSCI (134 males and 26 females) from the Tshwane metropolitan area participated in this phase of the study. The participants were predominantly young, male, unemployed and single and their major cause of SCI was road traffic accidents, which accounted for 71% of the injuries. The participants’ satisfaction with their community participation was generally low, only 20% expressed satisfaction with their community participation. Satisfaction with community participation was significantly associated with the participants’ race, level of education, employment, educational qualifications, years of living with SCI, level of SCI, health complications, perceived health status, functional ability and perceived environmental factors such as physical (structural and geographic) barriers and lack of transport. Results – Phase 2 Fifteen PLWSCI participated in interviews. Two themes influencing participation were identified from the interview transcripts: Personal factors (coping skills, rehabilitation experience, future aspirations, personal needs, psycho-emotional issues and meaningful use of time) and Environmental factors (attitudes of others, social support and accessibility issues). Conclusion The results of the two phases revealed that community participation of PLWSCI was mainly related to three major categories of factors: personal factors, disability-related factors and environmental factors. Satisfaction with community participation was greater in participants who had been living with SCI for longer periods, had more years of basic education, were not black Africans, lived in suburbs, and were employed. A positive outlook on life and engagement in creative activities during free time enhanced community participation. Disability-related factors included level of SCI, functional ability and perceived general health influenced satisfaction with community participation. Community participation was greater in participants who experienced fewer environmental barriers. “Attitudes of members of society”, “accessibility of the environment” and “social support” influenced the participants’ satisfaction with community participation. A framework for facilitating community participation of PLWSCI was developed. Strategies to be implemented by various multi-sectoral stakeholders to enhance community participation are proposed.p> / Thesis (PhD)--University of Pretoria, 2011. / Physiotherapy / Unrestricted

Employment rates for veterans with spinal cord injuries remain low despite legislation aimed at helping individuals with significant barriers to employment succeed in finding competitive work. As access to services and resultant outcomes become more scrutinized, the need for Rehabilitation Counselors to efficiently allocate resources grows more vital to the cause. Existing research supports a mediated path model of rehabilitation counselor clinical judgment asserting observations of disability severity, intelligence, and psychosocial adjustment lead to inferences of functional status and attribution thereof, which collectively influence predictions of successful rehabilitation. The current study investigated the variance attributable to this clinical judgement model in relation to access to services and successful employment outcomes in an implementation study of the Individualized Placement and Support Model of supported employment with a sample of veterans living with spinal cord injuries. The reduced model fit the data well, Chi-square (6, N=213) = 3.391, P=.758, CFI =1, RMSEA=.00, Hoelter .05 =788. Disability Severity was found to have an indirect effect on employment, .095 P<.05. Significant direct effects for disability severity on functional status, education on competitive employment, functional status on competitive employment, and minutes on competitive employment. The results indicate time as a resource was allocated equitably among participants in the first thirty days in regard to the exogenous variables in this study. The reduced model accounted for 8.6% of the observed variance in the data.

A spinal cord injury (SCI) is a damage to the spinal cord that causes permanent or temporary changes in motor and sensory functions. In humans, the traumatic impact to spinal cord is mostly directed from the ventral part of the spinal column, even though SCI models are principally directed from the dorsal part of the spinal column due to easier surgery. The aim of the work described in this thesis was to develop clinically more relevant, easily reproducible and relatively inexpensive model of the ventral spinal cord lesion in rats which replicates SCI in humans as closely as possible by its pathology, completeness, level and regeneration. For the surgery we used a modification of a balloon- compression technique. The balloon of the 2F embolectomy Fogarty's catheter was placed to the anterior epidural space via laminectomy at the level of T10 and when the final position of the catheter was achieved at the spinal level T8 in front of the anterior median fissure, a balloon was rapidly inflated with 10 μl or 15 μl of water for 5 minutes. Other two groups - laminectomy only and ventral placement of the catheter without inflation were used as controls. The motor functions were evaluated by the BBB test and ladder walking test. In BBB test we observed significantly impaired motor functions in the 15 μl...

The central nervous system (CNS) is susceptible to several disorders that can affect the structure or function of the brain or spinal cord, such as stroke and spinal cord injury (SCI). CNS disorders are complex, frequently causing failure of cognitive, motor and sensory functions. Unfortunately, there are only a few care alternatives for patients with CNS disorders, due to the limited capacity of the CNS to spontaneously regenerate; what expresses the need to develop innovative solutions, such as scaffolds that also could act as drug delivery systems to promote tissue and functional repairs in the CNS. To achieve this goal, three main projects were developed in this thesis. In the first project, a novel drug releasing duraplasty that can be applied as part of decompressive craniectomy (DC) was designed and tested. While DC can significantly reduce the risk of death, this procedure does not reverse the stroke damage. Thus, biosynthesized cellulose (BC) was used to produce a new duraplasty loaded with growth factors. The in vivo animal studies revealed that our duraplasty had excellent biocompatibility when implanted onto rodents’ brains. In the second project, BC tubes were prepared and nerve growth factor was incorporated into the tubes to be used as potential nerve guides to assist with the reconstitution of nerve tissues across SCI lesion. Physical and mechanical properties of the drug delivery systems produced were evaluated and compared to the neural native tissue. In addition, cell cultures demonstrated that growth factors released from both drug delivery systems were bioactive for over 7 days. In the third project, linear and 2-branched peptides were synthesized as potential bioactive molecules to improve tissue regeneration. These peptides, containing the RGDS sequence, were synthesized through Solid Phase Peptide Synthesis and characterized by mass spectrometry, high-performance liquid chromatography, and their conformational structures were analyzed by an energy minimized 3D model. In summary, this thesis explores the use of BC as drug releasing systems, which are promising and clinically relevant strategies to enhance nerve regeneration for many patients facing physical, mental and financial strains due to stroke, SCI or other difficult-to-cure injuries to the CNS.

Modest recovery of somatic function after incomplete spinal cord injury (SCI) has been widely demonstrated. Recently we have shown that spontaneous recovery of baroreflex regulation of sympathetic activity also occurs in rats. Dietary restriction in the form of every other day fasting (EODF) has been shown to have beneficial effects on the recovery of motor function after SCI in rats. The goal of this study was to determine if EODF augments the improvement of baroreflex regulation of sympathetic activity after chronic left thoracic (T8) surgical spinal hemisection. To determine this, we performed baroreflex tests on ad-lib fed or EODF rats 1 week or 7 weeks after left T8 spinal hemisection. One week after T8 left hemisection baroreflex testing revealed that gain of baroreflex responsiveness, as well as the ability to increase renal sympathetic nerve activity (RSNA) at low arterial pressure, was significantly impaired in the ad-lib fed but not the EODF rats compared with sham lesioned control rats. However, baroreflex tests performed 7 weeks after T8 left hemisection revealed the inability of both ad-lib and EODF rats to decrease RSNA at elevated arterial pressures. While there is evidence to suggest that EODF has beneficial effects on the recovery of motor function in rats, EODF did not significantly improve the recovery of baroreflex regulation of sympathetic activity.

Mechanical ventilation (MV) is widely used in spinal injury patients to compensate for respiratory muscle failure. MV is known to induce lung inflammation, while spinal cord injury (SCI) is known to contribute to local inflammatory response. Interaction between MV and SCI was evaluated in order to assess the impact it may have on the pulmonary inflammatory profile. Sprague Dawley rats were anesthetized for 24 h and randomized to receive either MV or not. The MV group included C4–C5 SCI, T10 SCI and uninjured animals. The nonventilated (NV) group included T10 SCI and uninjured animals. Inflammatory cytokine profile, inflammation related to the SCI level, and oxidative stress mediators were measured in the bronchoalveolar lavage (BAL). The cytokine profile in BAL of MV animals showed increased levels of TNF-α, IL-1β, IL-6 and a decrease in IL-10 (P = 0.007) compared to the NV group. SCI did not modify IL-6 and IL-10 levels either in the MV or the NV groups, but cervical injury induced a decrease in IL-1β levels in MV animals. Cervical injury also reduced MV-induced pulmonary oxidative stress responses by decreasing isoprostane levels while increasing heme oxygenase-1 level. The thoracic SCI in NV animals increased M-CSF expression and promoted antioxidant pulmonary responses with low isoprostane and high heme oxygenase-1 levels. SCI shows a positive impact on MV-induced pulmonary inflammation, modulating specific lung immune and oxidative stress responses. Inflammation induced by MV and SCI interact closely and may have strong clinical implications since effective treatment of ventilated SCI patients may amplify pulmonary biotrauma.

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