EVALUATION OF CARDIAC DYSRHYTMIAS AND AUTONOMIC DYSFUNCTION IN CHRONIC SPINAL CORD INJURY
G. DEMIREL*, S. DEMIREL**, H. YILMAZ*; N. KESIKTAS*, V. AKKAYA**, F.KORKUT**; *Istanbul Phys. Med & Rehab Centre, **Istanbul Univ, Medical Faculty, Cardiovas Research Centre, Turkey
The purpose of this study is to evaluate cardiac dysrhythmias and autonomic nervous system (ANS) dysfunction in chronic SCI patients.
Methods: We assessed 20 (10 paraplegics, 10 quadroplegics)chronic SCI patients and 10 age-matched healthy controls for cardiac dysrhythmia using 24 hours Holter recordings during daily life. We evaluated ANS function by heart-rate variability (HRV).
Results: Maximum heart rate was lower in the quadriplegic group compared to controls (124.1±11.2 v.s 139.4±10.9, p<0.05). For the time domain analysis SDANN (94.5±26.4 v.s 131.1±15.1, p<0.001) and SDNN (110.1±29.2 v.s 143.6±19.1, p<0.05) were significantly lower in quadriplegics compared to controls. In the subgroup analysis of quadriplegics, SDANN (74.0±17.9 v.s 115.0±14.2 p<0.001) and SDNN (90.2±21.1 v.s 130.0±22.0 p<0.05) were significantly lower in complete quadriplegics compared to incomplete quadriplegics.
Conclusions: Our findings suggest that SCI at tile cervical level can disrupt symphatetic flow while leaving parasymphatetic flow undisturbed. Time and frequency domain analysis is a simple and reliable technique for evaluating autonomic function in this patient group.
ANXIETY AND DEPRESSION IN SPINAL CORD INJURY
G. DEMIREL, H. YILMAZ, N. KESIKTAS, Istanbul Phys Med and Rehab Centre, Istanbul, Turkey
Purpose: In this study, we evaluated the extent of anxiety and depression in SCI patients and the factors contributing to their genesis were also investigated. Methods: The present study assessed 25 patients with SCI. We used the Functional Indepence Measurements (FIM), and the Zung, Hamilton, Beck Depression Inventory and the State Trait Anxiety Inventory (STAI). The patient's demographic characteristics (birth places, marital status, religious beliefs, educational levels, occupations) and alcohol-drug abuse were also examined using a questionnaire.
Results: Anxiety (52%) and depression (61%) were observed. The patients who were single, divorced or less educated were more depressed (p<0.05). Subjects with complete lesions tended to be more depressed (p<0.001). FIM scores were higher in patients without depression (p <0.001). Zung, Beck and Hamilton depression inventory scores showed strong correlation (p<0.001) and STAI was significantly correlated with each of the depression scores (p<0.05). There was a strong correlation between time from injury and STAI (p<.001). Patients with severe complications such as pain, spasticity, pressure sores and paraostheoarthopathies were significantly more anxious and more depressed (p<0.001).
Conclusion: Patients who have lesser social support, and whose functional status are poorer are more prone to psychological problems.