S-3-02-05
THE CLINICAL PROFILE OF NEUROPATHIC BLADDER IN SPINAL CORD INJURED PATIENTS
Gunes Yavuzer, Safiye Tuncer, Nihat Artken, Atilla Elhan, Tansu Arasil.
Ankara University, Ankara, Turkey
Clinical characteristics, bladder dysfunction types by urodynamic investigations, methods of bladder management and urinary complications of thirty-six spinal cord injury patients (9 quadriplegics and 29 paraplegics) with neuropathic bladder were studied. ASIA Impairment Scales and Functional Independence Measure scores of patients were also examined. Mean follow up time was 43 months. Most of the patients were young (70% under 40) men (60%) having complete (50%) spinal cord injury. The common type of bladder dysfunction was found to be detrusor arefiexia (59%) in admission and detrusor hyperrefiexia (44%) in follow-ups. Detrusor sphincter dyssinergia was observed in only 7 (20%) patients. Thirty-two (86%) of patients had admitted to the hospital with indwelling catheter. At discharge only 9 had indwelling catheters, 14 patients were on intermittent clean catheterisation and 8 of the patients gained spontaneous micturation. The most common experienced complication was repeated lower urinary infections (100%). Stone formation was observed in 6, hydronephrosis in 2 (5%) and vesicouretheral reflux in 1 (2%) patients. Oxybutinin hydrochloride 5-20mg/day orally was used in 23 patients having high detrussor pressures and low capacity in cystometric evaluations. Statistically significant correlation were found between ASIA Impairment Scale Scores and both bladder dysfunction types and methods of bladder management (p<0.01). The management of neuropathic bladder dysfunction is a crucial component of spinal cord injury rehabilitation and requires long term follow up.
SP-3-02-B-O1
COGNITIVE REHABILITATION: HOW IT IS AND HOW IT MIGHT BE
Wilson B. A. (Medical Research Council: Applied Psychology Unit)
This paper suggests there are, at present, four main kinds of cognitive rehabilitation programme for brain injured people. The first attempts to rehabilitate cognitive deficits through drills and exercises. The second uses theoretical models from cognitive psychology to identify deficits in order to remediate them. The third is primarily a patient driven approach that uses a combination of learning theory, cognitive psychology and neuropsychology to identify and remediate cognitive difficulties. The fourth is the 'holistic' approach that has, as its basic philosophy, a belief that cognitive functions cannot be divorced from emotion, motivation or other non-cognitive functions, and consequently all aspects of functioning should be addressed in rehabilitation programmes. Despite some overlap between these approaches, there are major differences. The two main arguments offered in this paper are (a) that the first two approaches do not lead to good clinical rehabilitation practice; and (b) that a synthesis of the second two approaches would result in the best cognitive rehabilitation model.
