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Study design: International multicentre cross-sectional study. Objectives: To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. Setting: Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age. Methods: An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. Results: The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. Conclusions: As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.

Peer support is founded on key principles of respect, shared responsibility, and mutual understanding. At Santa Clara Valley Medical Center, the coordinator of the peer support program and a rehabilitation psychologist implement a training program. Peer support is an integral part of rehabilitation; it is even more important for the person with high tetraplegia (C4 and above). Individuals with high tetraplegia face unique challenges in coping with the functional impairments that accompany high cervical injuries. Peer support volunteers provide the newly injured patient and family with personal insight and techniques on managing activities of daily living and maximizing quality of life.

Individuals with high tetraplegia, C1-C4, are living longer due to improvements in medical and rehabilitation care, as well as technology. It is unclear whether this increased longevity is associated with good subjective quality of life and full participation in family and community living. This study describes the outcomes of a group of 63 individuals with high tetraplegia who were interviewed at three phases: 5.3 ± 2.4 years, 13.1 ± 2.5 years, and 18.9 ± 2.6 years postinjury. The measures included demographics, characteristics of assistance with care, psychosocial variables, and time utilization. The results indicate that this group of individuals with high tetraplegia appeared to be functioning well in most areas of their lives. For those indicators that showed change over time, the SCI itself, not necessarily a high tetraplegic injury, and/or the aging process could account for the change. This study suggests that increases in longevity have provided individuals with high tetraplegia the opportunity to live rich and fulfilled lives.

Bushnik T, Hanks RA, Kreutzer J, Rosenthal M. Etiology of traumatic brain injury: characterization of differential outcomes up to 1 year postinjury. Arch Phys Med Rehabil 2003;84:255-62. Objective:To characterize outcomes after traumatic brain injury (TBI) resulting from vehicular crashes, violence, falls, or other causes. Design:Prospective, multicenter, longitudinal. Setting:Seventeen Traumatic Brain Injury Model Systems. Participants:A total of 1170 individuals with moderate to severe TBI with data from initial medical and rehabilitation stays and 1-year follow-up. Interventions:Not applicable. Main Outcome Measures:At rehabilitation discharge, FIM[trade ] instrument, Disability Rating Scale (DRS), and Rancho Los Amigo Levels of Cognitive Functioning Scale. At 1 year postinjury, FIM, DRS, Community Integration Questionnaire (CIQ), employment, residence, marital status, and seizure occurrence. Results:The 4 etiology groups could be distinguished based on premorbid characteristics. Severity of injury indices indicated that individuals in vehicular crashes showed a trend toward incurring more severe injuries than the other 3 groups. At rehabilitation discharge, there were no functional differences between groups. At 1 year postinjury, the groups could be differentiated: individuals in violence-related TBI had higher unemployment rates and lower CIQ scores; persons in vehicular crashes reported the best functional and psychosocial outcomes; and individuals in the falls and other groups had outcomes lying between the vehicular and violence groups. Conclusion:This study elucidated important differences between persons with violence-related TBI and those with non[ndash ]violence-related TBI. Further research is needed to find effective interventions to address these differences. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Burnett DM, Kolakowsky-Hayner SA, Slater D, Stringer A, Bushnik T, Zafonte R, Cifu DX. Ethnographic analysis of traumatic brain injury patients in the national Model Systems database. Arch Phys Med Rehabil 2003;84:263-7. Objective:To compare demographics, injury characteristics, therapy service and intensity, and outcome in minority versus nonminority patients with traumatic brain injury (TBI). Design:Retrospective analysis. Setting:Twenty medical centers. Participants:Two thousand twenty patients (men, n=1518; women, n=502; nonminority, n=1168; minority, n=852) with TBI enrolled in the Traumatic Brain Injury Model Systems database. Interventions:Not applicable. Main Outcome Measures:Age, gender, marital status, education, employment status, injury severity (based on Glasgow Coma Scale [GCS] admission score, length of posttraumatic amnesia, duration of unconsciousness), intensity (hours) of therapy rendered, rehabilitation length of stay (LOS), rehabilitation charges, discharge disposition, postinjury employment status, FIM[trade ] instrument change scores, and FIM efficiency scores. Independent sample ttests were used to analyze continuous variables; chi-square analyses were used to evaluate categorical data. Results:Demographics: overall, minorities were found to be mostly young men who were single, unemployed, and less well educated, with a longer work week if employed when injured. Etiology: motor vehicle crashes (MVCs) predominated as the cause of injury for both groups; however, minorities were more likely to sustain injury from acts of violence and auto-versus-pedestrian crashes. Minorities also had higher GCS scores on admission and shorter LOS. Rehabilitation services: significant differences were found in the types and intensity of rehabilitation services provided; these included physical therapy, occupational therapy, and speech-language pathology, but not psychology. Conclusion:Minority patients who sustain TBI generally tend to be young men with less social responsibility. Although MVCs predominate as the primary etiology, acts of violence and auto-versus-pedestrian incidents are more common in the minority population. Minorities tend to have higher GCS scores at admission. Also, the type and intensity of rehabilitation services provided differed significantly for the various interdisciplinary subspecialties. Rehabilitation charges, discharge disposition, and postinjury employment status were similar for the 2 groups, even though LOS is typically 3 to 4 days shorter for the minority group. A more detailed investigation is warranted to explain these findings. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Hanks RA, Wood DL, Millis S, Harrison-Felix C, Pierce CA, Rosenthal M, Bushnik T, High WM Jr, Kreutzer J. Violent traumatic brain injury: occurrence, patient characteristics, and risk factors from the Traumatic Brain Injury Model Systems project. Arch Phys Med Rehabil 2003;84:249-54. Objectives:To examine the occurrence of and characteristics associated with violent traumatic brain injury (TBI) in the Traumatic Brain Injury Model Systems (TBIMS) project for 4 of the 5 original Model Systems centers and to determine the patient characteristics of this group, as well as the risk factors for sustaining such an injury. Design:Prospective evaluation of individuals with violent TBI over a 10-year period. Setting:Four TBIMS centers. Participants:A total of 1229 individuals who received acute hospitalization and inpatient rehabilitation care for TBI. Interventions:Not applicable. Main Outcome Measure:The occurrence of a violent TBI. Results:Twenty-six percent of the participants in the TBIMS project sustained a violent TBI. This type of injury was more common in African-American men who were single and slightly older than the average TBI patient, were unemployed before injury, and had had a previous TBI. A higher injury rate was noted in the earlier part of the evaluation period. Those who sustained a violent TBI had higher levels of caregiver burden and disability, as well as decreased productivity and community reintegration at rehabilitation discharge and at 1 and 2 years postinjury. Conclusions:The occurrence of violent TBI in the TBIMS project is consistent with national trends of decreasing incidence of violent injuries in the 1990s. These results present a profile of those who have been injured through violence. The relative risks for sustaining such an injury appear to be well defined when considering demographic and temporal factors. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Hart T, Whyte J, Polansky M, Millis S, Hammond FM, Sherer M, Bushnik T, Hanks R, Kreutzer J. Concordance of patient and family report of neurobehavioral symptoms at 1 year after traumatic brain injury. Arch Phys Med Rehabil 2003;84:204-13. Objective:To determine concordance between patient and family report of neurobehavioral symptoms and problems across 6 domains of function and 3 levels of injury severity at 1 year after traumatic brain injury (TBI). Design:Prospective longitudinal design with follow-up between 10 and 14 months postinjury. Setting:Seventeen Traumatic Brain Injury Model Systems centers. Participants:A total of 267 adults with primarily moderate and severe TBI who had completed self-ratings and whose neurobehavioral symptoms had also been rated by their significant others. Interventions:Not applicable. Main Outcome Measures:Neurobehavioral Functioning Inventory[ndash ]Revised, a 70-item scale with subscales assessing frequency of symptoms in motor, somatic, memory and attention, depression, communication, and aggression domains. Results:Twenty-three items showed significant differences or trends between the self- and other ratings; 18 of these were in the direction of the injured individual reporting less frequent problems. Differences were most pronounced on the depression, aggression, and memory and attention subscales. On the latter 2 subscales, patient-family concordance was higher for those with less severe injuries. However, severity effects were not clear cut. Analyses of selected rating patterns indicating clinically significant [ldquo ]underreporting[rdquo ] of symptoms revealed that these affected the depression, aggression, and memory and attention subscales more than the motor or somatic subscales. Conclusions:At 1 year post-TBI, concordance between self- and other report of neurobehavioral symptoms was moderately high overall, but varied by symptom domain. For persons with moderate and severe TBI, reports from significant others may be needed for a full picture of the range, severity, and clinical importance of the patient's emotional, behavioral, and cognitive difficulties. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Quality of life (QOL) for individuals with spinal cord injury (SCI) is influenced by issues related to dependence, as well as age and years postinjury. Individuals with complete, high tetraplegia (C1-C4) are greatly dependent on others for all routine activities of daily living. It is hypothesized that better access to equipment, increased independence, and participation will improve QOL. During three study phases, extending up to 24 years postinjury, 58 individuals answered questions about equipment access, participation in leisure/work activities, and QOL. The major influence on participation is age (younger people participate in more activities) not equipment. Access to a modified van was associated in Phases 2 and 3 with better QOL ratings but not with increased participation. Future studies are required to more closely examine the interaction between income, as well as other factors, and the specific ramification(s) that improve QOL for aging individuals with high tetraplegia.

The purpose of this study was to investigate the effect of a relatively novel technology, functional magnetic stimulation (FMS), on gastrointestinal transit of liquids in rats. Orogastric gavage with technetium‐99 solution was used to assess gastric emptying and gastrointestinal transit time in 92 rats. FMS was performed over the anterior cervical and/or dorsal thoracolumbar regions using a figure‐8 coil. Stimulation protocols were 1, 2, or 4 h in length. FMS accelerated gastric emptying and decreased gastrointestinal transit time. The acceleration was dependent on the stimulation parameters used as well as on the duration of the protocol; high levels of FMS produced a quicker effect, whereas lower levels were effective at later times. This study provides evidence that FMS could be an alternative or adjunct therapy to treat disorders in gastrointestinal motility. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 919–924, 2000

Biochemical and immunofluorescence analyses revealed that phosphodiesterase variants encoded by thePDE4Dgene are targeted to discrete subcellular structures. In quiescent FRTL-5 thyroid cells, the rolipram-sensitive phosphodiesterase (PDE) activity (cAMP-PDE) was recovered both in the soluble and particulate fractions of the homogenate. Although an immunoreactive 93-kDa PDE (PDE4D3) variant was recovered in both compartments, a 105-kDa variant with the properties of PDE4D4 was recovered mostly in the particulate fraction. The PDE4D3 form was readily solubilized with nonionic detergents. Conversely, the PDE4D4 form required buffers containing ionic detergents for extraction, suggesting that different mechanisms target these variants to insoluble structures. A 15-min stimulation with thyroid-stimulating hormone (TSH) led to an activation of the cAMP-PDE in both compartments and was correlated with a shift in electrophoretic mobility of the PDE4D3 polypeptide. Long term incubation with TSH caused an increase of the PDE activity in the soluble fraction and the appearance of a 68-kDa immunoreactive polypeptide with the properties of PDE4D2. Immunofluorescence analysis showed, in addition to diffuse staining, a signal localized on regions adjacent to the plasma membrane on cytoskeletal structures and in a perinuclear region of quiescent cells. Long term incubation with TSH caused an increase in the immunofluorescence signal in the soluble compartment. These data demonstrate that three PDE4D splicing variants are targeted to discrete subcellular compartments and that hormones cause the activation of these isoforms in a temporally and spatially dependent manner.

Bushnik T. Introduction: the Traumatic Brain Injury Model Systems of care. Arch Phys Med Rehabil 2003;84:151-2. The Traumatic Brain Injury Model Systems of Care (TBIMS) is a program that has been funded by the National Institute on Disability and Rehabilitation Research (US Department of Education) since 1987. The program is a collaborative effort of rehabilitation centers across the United States to further knowledge about the natural history of recovery and outcomes over the life course of individuals with traumatic brain injury, as well as to provide comprehensive services across the continuum of care and to foster innovative research programs. This introduction describes the underlying principles of the TBIMS program and the research initiatives carried out in the 1997/1998[ndash ]2002 funding cycle. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation