| Foreword |
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ix | |
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| Preface |
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xi | |
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Barry Goldstein and Margaret C. Hammond |
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| Physical Rehabilitation as an Agent for Recovery After Spinal Cord Injury |
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183 | |
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Andrea L. Behrman and Susan J. Harkema |
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The initial level of injury and severity of volitional motor and clinically detectable sensory impairment has been considered the most reliable for predicting neurologic recovery of function after spinal cord injury (SCI). |
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This consensus implies a limited expectation for physical rehabilitation interventions as important in the facilitation of recovery of function. |
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The development of pharmacologic and surgical interventions has always been pursued with the intent of altering the expected trajectory of recovery after SCI, but only recently physical rehabilitation strategies have been considered to improve recovery beyond the initial prognosis. |
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This article reviews the recent literature reporting emerging activity-based therapies that target recovery of standing and walking based on activity-dependent neuroplasticity. |
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A classification scheme for physical rehabilitation interventions is also discussed to aid clinical decision making. |
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| Acute Respiratory Infections in Persons with Spinal Cord Injury |
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203 | |
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Respiratory disorders are the leading cause of death for persons with both acute and chronic spinal cord injury (SCI), and much of the morbidity and mortality associated with respiratory disorders is related to acute respiratory infections. |
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Pneumonia is the best recognized respiratory infection associated with mortality in this population. |
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Recent evidence supports some management strategies that differ from those recommended for the general population. |
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Upper respiratory tract infections and acute bronchitis may be precipitating factors in the development of pneumonia or ventilatory failure in patients with chronic SCI. |
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This review emphasizes management principles for treatment and prevention of respiratory infections in persons with SCI. |
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| Pain Following Spinal Cord Injury |
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217 | |
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Pain is one of the most common, severe, and treatment-resistant complications that follows SCI. |
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Recent years have seen a surge of research on methods for assessing and treating spinal cord injury pain. |
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In this article, pain after SCI is reviewed in terms of nature, scope, assessment techniques, and treatment strategies. |
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| The Prevention and Treatment of Pressure Ulcers |
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235 | |
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Chester H. Ho and Kath Bogie |
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Pressure ulcers remain a significant secondary complication for many individuals with spinal cord injury (SCI). |
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Technological advances have the potential to affect both the prevention and treatment of pressure ulcers. |
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The focus of this article is hi-tech devices and methodologies. |
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The current state-of-the-art methods are discussed and conceptual approaches are presented. |
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| Neurogenic Bladder in Spinal Cord Injury |
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255 | |
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Gregory Samson and Diana D. Cardenas |
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In the past, renal failure was the leading cause of death after spinal cord injury (SCI). |
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Today mortality from SCI has declined dramatically partly owing to the improved management of urologic dysfunction associated with SCI. |
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The goals of bladder management in spinal cord injury patients are intended to (1) ensure social continence for reintegration into community, (2) allow low-pressure storage and efficient bladder emptying at low detrusor pressures, (3) avoid stretch injury from repeated overdistension, (4) prevent upper and lower urinary tracts complications from high intravesical pressures, and (5) prevent recurrent urinary tract infections. |
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This article provides an overview of neurogenic bladder dysfunction associated with SCI and current management options. |
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| Autonomic Nervous System Dysfunction After Spinal Cord Injury |
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275 | |
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Susan V. Garstang and Stacey A. Miller-Smith |
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The autonomic nervous system (ANS) plays a key role in the regulation of many physiologic processes, mediated by supraspinal control from centers in the central nervous system. |
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The role of autonomic dysfunction in persons with spinal cord injuries is crucial to understand because many aspects of the altered physiology seen in these individuals are directly caused by ANS dysregulation. |
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| Preventive Care in Spinal Cord Injuries and Disorders: Examples of Research and Implementation |
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297 | |
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Frances M. Weaver and Sherri L. LaVela |
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Individuals with disabilities are less likely to receive preventive care services than those in the general population. |
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Prevention is very important in persons with spinal cord injuries and disorders for both common conditions such as respiratory infections and for conditions common in spinal cord disorders such as neurogenic bowel, because these individuals are at increased risk for negative outcomes. |
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Clinical practice guidelines provide evidence-based recommendations for patient care. |
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However, dissemination of guidelines is not sufficient to increase use of recommended care. |
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Implementation research has identified strategies to increase use of evidence-based care and subsequently improve patient outcomes. |
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| Cardiovascular Health and Fitness in Persons with Spinal Cord Injury |
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317 | |
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Timothy D. Lavis, William M. Scelza, and William L. Bockenek |
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There are many issues after spinal cord injury that have an impact on cardiovascular health and fitness. |
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This article discusses many of the secondary conditions and changes that occur and how they are affected by maintenance of an active lifestyle. |
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It also discusses many of the benefits and difficulties individuals face in maintaining a regular exercise program after spinal cord injury. |
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| Obesity After Spinal Cord Injury |
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333 | |
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America is in the midst of an obesity epidemic, and individuals who have spinal cord injury (SCI) are perhaps at greater risk than any other segment of the population. |
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Recent changes in the way obesity has been defined have lulled SCI practitioners into a false sense of security about the health of their patients regarding the dangers of obesity and its sequelae. |
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This article defines and uses a definition of obesity that is more relevant to persons who have SCI, reviews the physiology of adipose tissue, and discusses aspects of heredity and environment that contribute to obesity in SCI. |
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The pathophysiology of obesity is discussed relative to health risks for persons who have SCI, particularly those contributing to cardiovascular disease. |
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Prevalence of obesity and its comorbidities are discussed and management options reviewed. |
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| Index |
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353 | |
