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Biomedical subjects

M Dijkers

Publications and source records attributed to M Dijkers.

At least 19 recordsLinked to original sources
PubMed1999

Access to the environment and life satisfaction after spinal cord injury.

OBJECTIVE: To determine the potential relation between satisfaction with life after spinal cord injury and access to the environment as measured by selected items from the Craig Handicap Assessment and Reporting Technique (CHART). DESIGN: Prospective, correlational/predictive study using cross-sectional and longitudinal data from 18 Model Spinal Cord Injury Systems of Care. SUBJECTS: Adult persons with traumatic-onset spinal cord injury (n = 650) evaluated at 1 or 2 years postinjury. OUTCOME MEASURE: Satisfaction With Life Scale (SWLS). PREDICTOR VARIABLES: Demographic characteristics, impairment and disability classifications. medical complications, rehabilitation insurance status, occupational status as measured by the CHART Occupation Scale, self-perceived health (from SF-36), and access to the environment as measured by items from the CHART Mobility Scale. RESULTS: Access to the environment was positively and linearly associated with satisfaction with life, demonstrated both positive and negative change over time, and was positively associated with subject's neurologic status. Access to the environment added to the explanatory model to predict life satisfaction even after all other independent measures were accounted for. CONCLUSION: Access to the environment (an "outside the person" factor) is important in predicting satisfaction with life for persons with spinal cord injury. The measure of access to the environment developed here is promising and worthy of further exploration and expansion.

Activities of Daily Living↗
PubMed1998

Brain injury as a result of violence: preliminary findings from the traumatic brain injury model systems.

OBJECTIVES: To identify possible risk factors that may predispose individuals to violent traumatic brain injury (TBI) and to determine the effect of etiology of injury on outcomes. STUDY DESIGN: Prospective, longitudinal multicenter study. SETTING: TBI Model Systems (TBIMS) located at Wayne State University/Rehabilitation Institute of Michigan, Detroit, MI; The Institute for Rehabilitation and Research, Houston, TX; Medical College of Virginia, Richmond, VA; and Santa Clara Valley Medical Center, San Jose, CA. SUBJECTS: Individuals treated in the four TBIMS programs between 3/89 and 9/96 who met the criteria for inclusion in the TBIMS National Database and for whom the etiology was known (n=812). MAIN OUTCOME MEASURES: Functional Independence Measure, Alcohol Quantity Frequency Variability Index, Community Integration Questionnaire. RESULTS: Individuals who incur violence-related TBI tend to be male, nonwhite, unmarried, living alone, less educated, and unemployed at time of injury. They tend to have less severe brain injuries and better motor function at the time of admission to inpatient rehabilitation. At 1 year postinjury, they score lower on community integration measures; however, no difference exists in functional status. Etiology of injury was found to only play a minor role in the prediction of social and productive integration at 1 year postinjury. CONCLUSIONS: Survivors of violent and nonviolent TBI have similar functional outcomes; however, they differ in preinjury and postinjury socio-economic characteristics, injury severity, and postinjury community integration. Socio-economic factors appear to play a large role in the risk for violent injury and in community integration following injury.

Activities of Daily Living↗
PubMed1997

Quality of life after spinal cord injury: a meta analysis of the effects of disablement components.

While objective measures of impairment, disability and handicap can serve as outcome measures for the providers of medical and vocational rehabilitation services, for persons with spinal cord injury (SCI) themselves the only relevant measure of quality of life (QOL) is their own judgment as to their well-being. Subjective QOL in persons with SCI has been measured as happiness, psychological well-being morale and life satisfaction. Various studies have reported inconclusive or contradictory findings, likely due to small sample size, sample composition, measures used and other methodological issues. A meta analysis was performed to try to resolve these apparent discrepancies. A total of 22 studies with an average sample size of 102, was retrieved. Information on the relationship between QOL and impairment, disability, and handicap, if provided, was abstracted. Findings include the following: persons with SCI tend to report lower subjective well-being than non-disabled people; the relationship between impairment and QOL is weak (mean correlation: -0.05: 95% confidence interval: -0.12 to 0.02), and generally not found to be statistically significant; the association between disability and QOL is somewhat stronger (mean r: -0.21; confidence interval: -0.27 to -0.14), but not found consistently; the relationship between QOL and (aspects of) handicap is strongest (range for mean r: -0.17 to -0.48), and fairly consistently found. The number of studies available is too small to make analysis of factors that explain contradictory findings possible. Further use of subjective QOL measures in research on long-term outcomes of SCI is recommended, in order to properly reflect the perspective of the patients/clients themselves.

Adult↗
PubMed1996

Precise localization of the motor nerve branches to the hamstring muscles: an aid to the conduct of neurolytic procedures.

OBJECTIVE: To identify the precise locations of the motor branches and motor points to the hamstring musculature and define these locations in relation to bony landmarks. DESIGN: Descriptive study of adult cadaver limb dissection. The number, location, and course of the motor branches and motor points to each hamstring muscle from the sciatic nerve were defined relative to bony landmarks. SETTING: Department of anatomy at a university school of medicine. PARTICIPANTS: Anatomic dissection of 30 adult cadaver limbs (17 individuals) was completed. Adult cadavers were selected randomly without regard to gender, age, and race. Exclusion criteria included femoral fracture, surgery, inability to obtain neutral position, and posterior thigh trauma. MAIN OUTCOME MEASURE: A descriptive anatomic study based on linear measures in centimeters from bony landmarks. RESULTS: Two zones located along a line from the ischial tuberosity to the lateral femoral condyle were observed to exist. Zone one, containing the first motor branch to the biceps long head and semitendinosus, is found at approximately 20% (6.9cm +/- 1.8 and 7.1cm +/- 2.2 from the ischial tuberosity, respectively) of femur length along the stated line. Zone two, containing the primary branch to the semimembranosus and the secondary branches to the biceps and semitendinosus, is found at approximately 33% (13.1cm +/- 3.6, 12.6cm +/- 3.9, and 14.3cm +/- 3.9 from the ischial tuberosity, respectively) of femur length. CONCLUSIONS: The drawing of one surface line, when combined with our anthropometric observations, should increase the ease and accuracy with which motor branch blocks to the hamstrings are performed.

Adult↗
PubMed1995

Hip joint center location from palpable bony landmarks--a cadaver study.

An anatomical anthropometric study of adult human cadaveric pelves was performed to investigate the relationship between hip joint center (HJC) and selected aspects of pelvic geometry. Sixty-five pelves (35 female and 30 male) were examined. Measurements of pelvic geometry and HJC (center of bony acetabular rim) were taken from bony landmarks of de-fleshed pelves. Correlation analysis revealed that HJC cannot be accurately located as a function of pelvic width alone, but requires estimation as a function of pelvic height and depth as well. HJC was optimally located relative to the respective ASIS: 14% of pelvic width medial (mean error 0.58 cm), 34% of pelvic depth posterior (mean error 0.30 cm), and 79% of pelvic height inferior (mean error 0.35 cm). No significant differences were found between males and females in HJC estimation.

Aged↗
PubMed1995

Reasoning and the art of therapy for spinal cord injury.

In this pilot study, qualitative methodology was used to examine the clinical reasoning of four experienced occupational therapists as they presented and modified therapeutic activities to treat patients with spinal cord injuries. The therapists demonstrated the multi-layered thinking discovered in previous research, but hierarchical structuring of knowledge emerged as an unexpectedly dominant theme in their reasoning. Examples of hierarchical thinking about therapeutic activity included creating mental files of therapy tasks and materials sequenced from elementary to advanced and determining the level of difficulty at which to present an activity in order to build the patient's skills in a stepwise manner. The therapists reported that they learned to make decisions about the use of activities in treatment by observing skilled clinicians and by treating patients.

Activities of Daily Living↗
PubMed1994

Predicting depression and psychological distress in persons with spinal cord injury based on indicators of handicap.

This study examined whether experiences of handicap influence levels of depression and distress among persons with spinal cord injury (SCI) during the years after initial discharge from rehabilitation. SCI outpatients (163), who had received inpatient treatment at one of two rehabilitation centers in Michigan and who were between 2 to 7 years since injury, participated in the study. Measures of depression, of psychological distress and of handicap were collected during 2 consecutive years utilizing the Zung Self-Rating Scale, the Brief Symptom Inventory and the Craig Handicap Assessment and Reporting Technique (CHART) in conjunction with the Perceived Handicap Questionnaire (PHQ), respectively. According to the study's findings, depressed/distressed SCI subjects reported spending more hours in bed (P < 0.01), fewer days out of the house (P < 0.03) and receiving more paid personal care assistance (P < 0.02) than did other subjects. They also expended more for general medical expenses (P < 0.001) and reported less access to readily available transportation (P < 0.003). CHART total scores, reflecting a simple objective measure of handicap as described by Whiteneck et al. (Whiteneck GG, Charlifue SW, Gerhart KA, Overholser JD, Richardson GN: Guide for Use of the CHART: Craig Handicap Assessment and Reporting Technique. Craig Hospital, CO, 1988) were significantly associated with both distress and depression as measured during the second year of data collection. Other significant predictors of depression and distress included subjects' self-perceived handicap (measured by the PHQ), gender, marital status and age.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1994

Predicting bowel and bladder continence from cognitive status in geriatric rehabilitation patients.

Incontinence in an elderly person is frequently an important factor in deciding whether to institutionalize the patient. This study examined the association between cognition and continence in geriatric patients admitted to an inpatient rehabilitation unit. It was hypothesized that admission cognitive status would help predict discharge bowel and bladder continence and would account for significant unique variance beyond that explained by admission continence status. The Dementia Rating Scale (DRS) was administered to 103 consecutive subjects admitted to a geriatric rehabilitation unit. Admission and discharge bowel and bladder status ratings were made using the Functional Independence Measure. Multiple stepwise regression analysis found admission incontinence status coupled with the DRS Initiation/Preservation (IP) subtest significantly predicted bowel and bladder management status at discharge. The IP subtest accounted for a significant but modest amount of unique variance beyond the admission continence status.

Activities of Daily Living↗
PubMed1991

Spinal cord injury surveillance in the United States: an overview.

In the United States, injuries are the leading cause of premature lost years of life, surpassing cancer and heart disease combined. Public health surveillance of injuries such as spinal cord injury (SCI) has recently begun to evolve, following decades of experience with similar methods for infectious and chronic disease conditions. In 1985, the Federal Government's Centers for Disease Control began to promote the development of surveillance systems for sentinel injuries at both the state and national level. Many states have developed, or are in the process of developing, statewide registries for SCI. The rationale behind the establishment of these registries is 4-fold: (1) to identify SCI persons in order to facilitate and coordinate provision of health and other services; (2) to gather accurate data for injury prevention efforts and planning for needed services; (3) to evaluate services provided, and (4) to document outcome and cost-effectiveness of care systems. The purpose, content and scope of these registries are reviewed in detail.

Data Collection↗
PubMed1991

The value of serial leg measurements for monitoring deep vein thrombosis in spinal cord injury.

Deep vein thrombosis (DVT) is a common complication of spinal cord injury (SCI). Many specialized SCI nursing units use serial leg measurements to establish clinical diagnosis of DVT, in spite of extensive studies showing that clinical signs and symptoms of DVT have a specificity and sensitivity hardly better than chance. For 30 patients who spent 920 days in an SCI intensive care unit, we collected daily serial calf and thigh measurements and the results of radiofibrinogen uptake test (RFUT) performed about every third day. Three criteria for clinical diagnosis of DVT found in the literature were used: an increase from baseline, an increase from the previous day or a right-left difference of a specific minimal size. The cut-off points for minimal size used were also those suggested by the literature: over .5 inch, over 1 cm, or 1.2 cm and over for women, 1.5 cm and over for men. We found such changes or differences correlated weakly or not at all with RFUT results, and symptomatic increases or differences occurred very frequently. Major factors presumably underlying the variability of measurements and their lack of sensitivity and specificity are: premorbid leg asymmetry; atrophy of the legs after SCI; true changes in circumference due to factors other than DVT; and lack of measurement reliability. It was concluded taking serial leg measurements is of no value in the SCI population. For those reluctant to abandon tradition, suggestions are provided for improving the quality of measurements and related decision making. Further research is needed.

Adolescent↗
PubMed1990

Differences between rehabilitation disciplines in views of depression in spinal cord injury patients.

Reports based on clinical impressions have suggested that depression after spinal cord injury (SCI) is a near-universal phenomenon; however, studies using objective methods and strict criteria have not confirmed this. The aim of this study was to explore the experiences and opinions of rehabilitation clinicians with the depressed mood in their SCI patients. A questionnaire was completed by 149 staff members of various disciplines working in four specialised SCI rehabilitation centres. We found that the disciplines vary in the symptomatology they observe (nurses most, physicians and mental health professionals least), and that these differences to some degree correspond to variations in the estimate of the frequency and intensity of depression in the average patient. The amount of staff experience was found not to be a factor. The implications of these findings for theories of staff expectations regarding patient mood states and the functioning of the clinical team are discussed.

Adult↗
PubMed1989

A controlled study of neuropsychological deficits in acute spinal cord injury patients.

According to a number of studies, between 40% and 60% of acute traumatic spinal cord injury (SCI) patients demonstrate cognitive dysfunction resulting from various forms of cerebral damage, including concurrent or premorbid closed head injury, chronic alcohol or substance abuse, and other causes. However, applicability of findings from these reports has been limited due to the use of inadequate neuropsychological testing techniques and the lack of control data. In a collaborative investigation, 81 acute SCI patients and 61 non-injured control subjects between 18 and 55 years of age completed a comprehensive motor-free neuropsychological test battery, including: Halstead Category Test (HCT), Vocabulary Subtest (VOCAB) of the Wechsler Adult Intelligence Scale - Revised; Mental Control (MC) Subtest, and Initial and Recall trials of Logical Memory (LM) and Paired Associates (PA) Subtests of the Wechsler Memory Scale; and the 8 trials of the Rey Auditory Verbal Learning Test (RAVLT). Percentages of retained information on the LM and PA were also calculated. Impairment levels for each test were defined as values which exceeded two standard deviations (one-tailed) from the control mean. Based on this definition, the prevalence of neuropsychological abnormality on each test ranged between 10% and 40%. Mean performance levels of patients were significantly more impaired than those of control subjects for all tests except for the Interference trial of the RAVLT and for the percentages of retained information on the LM and PA subtests. Comparison of test results of SCI patients with those of control subjects demonstrates that poor attention span and limited initial learning ability are frequent problems among SCI patients. Other common neuropsychological deficits among these patients include poor concentration ability, impaired memory function, and altered problem solving ability. These deficits may interfere with rehabilitation following SCI.

Adolescent↗
PubMed1988

Closed head injury in acute traumatic spinal cord injury: incidence and risk factors.

Investigators estimate that 15% to 50% of all patients with spinal cord injury (SCI) also incur a closed head injury (CHI), but studies have been hampered by design flaws, including retrospective assessment and inconsistent definition of CHI. We conducted a prospective study of combined CHI and SCI among 82 SCI patients consecutively admitted at two hospitals within 24 hours of injury. The purpose of the study was to determine the incidence and duration of loss of consciousness and posttraumatic amnesia (PTA), and to establish the risk factors for combined CHI and SCI. The overall incidence of CHI as defined by the presence of PTA of any duration was 49%. There was a significantly increased risk of CHI for patients involved in traffic accidents (risk ratio = 3.7; 95% confidence interval 1.8 to 7.2). There was no increased risk associated with level of injury (quadriplegic vs paraplegic; risk ratio = 1.2; 95% confidence interval = 0.8 to 1.8). All SCI patients, regardless of level of injury, deserve systematic evaluations for CHI in their acute care evaluations.

Adult↗
PubMed1988

Galveston Orientation and Amnesia Test: its utility in the determination of closed head injury in acute spinal cord injury patients.

The incidence of closed head injury (CHI) associated with acute spinal cord injury (SCI) has been estimated at 40% to 50%. Closed head injury can be defined as the presence of loss of consciousness (LOC) and/or posttraumatic amnesia (PTA). Consequently, one of the difficulties in establishing a diagnosis of CHI is determining the existence of PTA in those patients without documented LOC. Previous work described the inconsistent evaluation of PTA in the SCI population. This study was conducted to evaluate the utility of the Galveston Orientation and Amnesia Test (GOAT) in establishing the diagnosis of CHI in a series of acute traumatic SCI patients. The GOAT was administered serially for three to five days to 34 patients admitted to our hospital. When information derived from the GOAT was added to that derived from review of medical records alone, the observed incidence of PTA (and by implication CHI) increased significantly (McNemar statistic = 6.4; p = 0.01). The GOAT is a quick, simple, and reproducible evaluation of spheres of orientation, which is extremely helpful in diagnosis of PTA in this population. This instrument should be used to evaluate patients at high risk for head injury. Although abnormalities in the GOAT evaluation may also be attributable to factors other than CHI (eg, hypoxia, medication effects), such findings provide evidence suggestive of CHI. This will help determine which patients require a more detailed neuropsychologic assessment.

Adult↗