Groah, et al. (2002). 5. Preserving wellness and independence of the aging patient with spinal cord injury: A primary care approach for the rehabilitation medicine specialist.

[Wise Young]

• Groah SL, Stiens SA, Gittler MS, Kirshblum SC and McKinley WO (2002). 5. Preserving wellness and independence of the aging patient with spinal cord injury: A primary care approach for the rehabilitation medicine specialist. Arch Phys Med Rehabil. 83 (3 Pt 2): S82-S89. Summary: Groah SL, Stiens SA, Gittler MS, Kirshblum SC, McKinley WO. Spinal cord injury medicine. 5. Preserving wellness and independence of the aging patient with spinal cord injury: a primary care approach for the rehabilitation medicine specialist. Arch Phys Med Rehabil 2002;83 Suppl 1:S82-9. This self-directed learning module highlights consideration and treatment of individuals with long-term spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the challenges of chronic disease prevention, diagnosis, therapeutic options, and the resultant impact on the person with long-term SCI. With cardiovascular disease becoming a leading cause of mortality in this population, risk factor modification through weight, lipid, and glucose control becomes more important. Likewise, bowel dysfunction increases with duration and severity of SCI. Conservative and surgical management options are discussed. Musculoskeletal repetitive trauma injuries occur commonly in long-term SCI but can be prevented with appropriate lifestyle or equipment modifications. These and other conditions occurring in the person with long-term SCI are closely related to psychosocial function with resultant social isolation, depression, and substance abuse. Thus, identification and surveillance of these comorbidities are addressed, with an emphasis on prevention. OVERALL ARTICLE OBJECTIVE: To summarize the unique medical, psychosocial, and functional needs of the individual with long-term SCI. Copyright 2002 by the American Academy of Physical Medicine and Rehabilitation. Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA (Groah); Department of Rehabilitation Medicine, University of Washington, SCI Unit VA Puget Sound Health Care System, Seattle, WA (Stiens); Department of Physical Medicine and Rehabilitation, Schwab Rehabilitation Hospital, Chicago, IL (Gittler); Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, West Orange, NJ (Kirshblum); and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia (McKinley).

[Wise Young]

• Stiens SA, Kirshblum SC, Groah SL, McKinley WO and Gittler MS (2002). 4. Optimal participation in life after spinal cord injury: Physical, psychosocial, and economic reintegration into the environment. Arch Phys Med Rehabil. 83 (3 Pt 2): S72-S81. Summary: Stiens SA, Kirshblum SC, Groah SL, McKinley WO, Gittler MS. Spinal cord injury medicine. 4. Optimal participation in life after spinal cord injury: physical, psychosocial, and economic reintegration into the environment. Arch Phys Med Rehabil 2002;83 Suppl 1:S72-81. This learner-directed module on spinal cord injury (SCI) presents a variety of perspectives of the process of personal and environmental adaptation for reintegration. Adaptation is unique to each person and does not predictably follow stages. Models used for understanding the process include biopsychosocial, ICIDH-2 (International Classification of Functioning, Disability and Health), and sector divisions of the environment. Home modification requires home (intermediate environment) evaluation and sociospatial behavioral mapping for planning and appropriation of remodeling in proportion to functional need and use. Options for access to the natural environment include specialized wheelchairs, climbing rigging, kayaks, and sail boats. Sports participation with adaptations is expanding and includes a larger variety of organizations and leagues. Economic needs are effectively anticipated with development of a life care plan. Procreative options to overcome infertility after SCI include vibratory stimulation for ejaculation, intravaginal insemination, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. Approaches to requests for withdrawal of life-sustaining care include depression screening, pain evaluation, and assistance in accomplishment of person centered goals. Overall, community reintegration after SCI is continually improving because of better acceptance, accessibility, and technology for building adaptations. OVERALL ARTICLE OBJECTIVES: (a) To review models and theories of medical intervention and disablement and (b) to demonstrate their application in rehabilitation practice by designing unique treatment plans that meet patient person-centered goals. Copyright 2002 by the American Academy of Physical Medicine and Rehabilitation. Department of Rehabilitation Medicine, University of Washington, SCI Unit VA Puget Sound Health Care System, Seattle, WA (Stiens); Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, West Orange, NJ (Kirshblum); Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA (Groah); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia (McKinley); and Department of Physical Medicine and Rehabilitation, Schwab Rehabilitation Hospital, Chicago, IL (Gittler).

[Wise Young]

• Gittler MS, McKinley WO, Stiens SA, Groah SL and Kirshblum SC (2002). 3. Rehabilitation outcomes. Arch Phys Med Rehabil. 83 (3 Pt 2): S65-S71. Summary: Gittler MS, McKinley WO, Stiens SA, Groah SL, Kirshblum SC. Spinal cord injury medicine. 3. Rehabilitation outcomes. Arch Phys Med Rehabil 2002;83 Suppl 1:S65-71. This self-directed learning module highlights rehabilitation outcomes in spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the multiple concerns for functional recovery after SCI, chiefly, the potential for ambulation, upper-extremity recovery, options for functional neuromuscular stimulation (FNS), sexual activity, and optimal outcome after a metastatic lesion. Motor incomplete patients have a better prognosis for ambulation than persons with sensory incomplete injury. Positive predictors for ambulation, including pinprick and lower-extremity motor scores greater than 20, are discussed. Meaningful recovery can occur in the upper extremities for at least 1 year. FNS options have been developed to promote functional control of the upper extremities for persons with tetraplegia, phrenic pacing, and bladder continence. A critical component of an individual's expression of self is his/her sexuality; sexual function after SCI is described in detail, including options for treatment of erectile dysfunction and various birth control methods for women. Expectations for an appropriate rehabilitation stay for a person with metastatic SCI differ for an individual with traumatic SCI. Differences may include changing routine pathways and timelines to focus on patient-centered quality of life for transition to home. OVERALL ARTICLE OBJECTIVE: To identify potential outcomes in ambulation, upper-extremity function, FNS, and sexual function after SCI and after metastatic cancer. Copyright 2002 by the American Academy of Physical Medicine and Rehabilitation. Department of Physical Medicine and Rehabilitation, Schwab Rehabilitation Hospital, Chicago, IL (Gittler); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia, Richmond, VA (McKinley); Department of Rehabilitation Medicine, University of Washington, SCI Unit VA Puget Sound Health Care System, Seattle, WA (Stiens); Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA (Groah); and Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, and University of Medicine and Dentistry of New Jersey-New Jersey Medical School, West Orange, NJ (Kirshblum).

[Wise Young]

• McKinley WO, Gittler MS, Kirshblum SC, Stiens SA and Groah SL (2002). 2. Medical complications after spinal cord injury: Identification and management. Arch Phys Med Rehabil. 83 (3 Pt 2): S58-S64. Summary: McKinley WO, Gittler MS, Kirshblum SC, Stiens SA, Groah SL. Spinal cord injury medicine. 2. Medical complications after spinal cord injury: identification and management. Arch Phys Med Rehabil 2002;83 Suppl 1:S58-64. This is a self-directed learning module that reviews medical complications associated with spinal cord injury (SCI). It is part of a chapter on SCI medicine in the Self-Directed Physiatric Educational Program for practitioners and trainees in physical medicine and rehabilitation. This article includes discussion of common medical complications that impact rehabilitation and long-term follow-up for individuals with SCI. Issues addressed include the rehabilitation approach to SCI individuals with pressure ulcers, unilateral lower-extremity swelling (deep venous thrombosis, heterotopic ossification, fractures), along with the pathophysiology, assessment, and treatment of spasticity, autonomic dysreflexia, orthostatic hypotension, and pain. OVERALL ARTICLE OBJECTIVE: To describe diagnostic and treatment approaches for medical complications common to individuals with SCI. Copyright 2002 by the American Academy of Physical Medicine and Rehabilitation. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia (McKinley); Department of Physical Medicine and Rehabilitation, Schwab Rehabilitation Hospital, Chicago, IL (Gittler); Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, West Orange, NJ (Kirshblum); Department of Rehabilitation Medicine, University of Washington, SCI Unit VA Puget Sound Health Care System, Seattle, WA (Stiens); and Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA (Groah).

[Wise Young]

• Kirshblum SC, Groah SL, McKinley WO, Gittler MS and Stiens SA (2002). 1. Etiology, classification, and acute medical management. Arch Phys Med Rehabil. 83 (3 Pt 2): S50-S57. Summary: Kirshblum SC, Groah SL, McKinley WO, Gittler MS, Stiens SA. Spinal cord injury medicine. 1. Etiology, classification, and acute medical management. Arch Phys Med Rehabil 2002;83 Suppl 1:S50-7. This self-directed learning module highlights basic management and approaches to intervention-both established and experimental. The revised American Spinal Injury Association classification (2000) of spinal cord injury (SCI) further defines the examination and classification guidelines. The incidence of traumatic SCI remains at approximately 10,000 cases per year, with 32 years the average age at injury. Initial management includes establishment of oxygenation, circulation (mean blood pressure >85mmHg), radiographic evaluations for spine instability, intravenous methylprednisolone, and establishment of spinal alignment. Prevention measures for medical complications include pressure relief for skin, thromboembolism prophylaxis, prevention of gastric ulcers, Foley catheter drainage to prevent urine retention, and bowel care to prevent colonic impaction. Nontraumatic SCI from spinal stenosis, neoplastic compression, abscess, or multiple sclerosis becomes more common with aging. Experimental treatments for SCI include antibodies to block axonal growth inhibitors, gangliosides to augment neurite growth, 4-aminopyridine to enhance axonal conduction through demyelinated nerve fibers, and fetal tissue to fill voids in cystic spinal cord cavities. Early comprehensive rehabilitation at a SCI center prevents complications and enhances functional gains. OVERALL ARTICLE OBJECTIVE: To summarize the comprehensive evaluation and management of a newly injured individual. Copyright 2002 by the American Academy of Physical Medicine and Rehabilitation. Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, West Orange, NJ (Kirshblum); Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA (Groah); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia (McKinley); Department of Physical Medicine and Rehabilitation, Schwab Rehabilitation Hospital, Chicago, IL (Gittler); and Department of Rehabilitation Medicine, University of Washington, SCI Unit VA Puget Sound Health Care System, Seattle, WA (Stiens).