F-4-04-07
Cervical Cord Injuries in Older Patients: Patterns of Injuries and Outcomes
Yen-Ho Wang; (National Taiwan University Hospital, Taiwan), Tyng-Guey Wang, Huey-Wen Liang, Jin-Shin Lai, I-Nan Lien.
Objective: To compare etiological factors and functional outcome for patients (aged 50 years or older and less than 50 years) with cervical cord injuries (CCI) in a rehabilitation ward.
Method: We studied 132 victims with spinal cord injury (SCI) admitted our hospital between 1989 and 1994. Most of them were aged less than 40 years and 66 of them with CCI. Twenty-eight patients aged 50 years or older (from 50 to 73 years; mean = 62.1) were the first group of this study; most of them (87.5%) were male. Thirty-eight patients younger than 50 years (from 18 to 49 years; mean = 34.4) were me second group and male was predominant (97.4%). The cause of injury and functional outcome of rehabilitation were studied. All subjects received X-ray film examinations, and 49 of them received CT and/or MRI additionally.
Result: The most common cause of CCI for two groups was traffic accident (53.6% vs 57.9%). There were 11 (39.3%) and 2 (5.3%) subjects suffered from fall, respectively. No any fracture or dislocation was revealed in 26 patients and 15 of them were older group. Spur formation was found in 16 patients of group one, only 5 in group two. Besides, 13 (46.4%) and 26 (68.4%) patients received surgery, respectively. There are 60 subjects of two groups completed rehabilitation training programs with hospitalization days ranged from 14 to 124 days (n = 24, mean = 67.8) and from 22 to 166 days (n = 36, mean = 84.1), respectively. One subject in the first group died from acute respiratory failure in the hospital. Fourteen (63.6%) and 12 (70.6%) subjects with incomplete paralysis reached the goal of functional walking. respectively.
Conclusion: 1) the ratio of quadriplegia to paraplegia is higher in older SCI; 2) traffic accident was the primary cause of CCI regardless of age, but falling was another important one for the older group; 3) in older SCI, the abnormal x-ray findings is less than younger group and much few received operation; 4) many subjects with incomplete paralysis is two groups could reach the goal of functional walking.
F-4-05-01
QUALITY OF LIFE (QOL) FOR THE VENTILATOR ASSISTED PATIENT (VAP): HOW PATIENTS DEFINE IT.
T. Hilton, B. Huiskes, B. Nelson, Loma Linda University Medical Center, Loma Linda CA., USA
Home Mechanical Ventilation (HMV) is an important option for the long term care of patients with chronic respiratory failure. Our HMV team conducted a qualitative research study to determine QOL as defined by the patients. A patient group of ten adult ventilator dependent patients who were at home for at least three months were selected. Seven open ended questions were developed and audiotaped interviews were conducted. QOL was subject to a number of internal and external influences. Internal influences included psychosocial adaptation, transcendence/spiritual issues, life cycle timing and energy. External influences included caregivers, home environment, mobility access, social network, finances and complexity care. Other factors affecting QOL included level of independence, personal meaningful enterprise, depth of relationships, interests, normalization of life, body image and ability to communicate. The overarching determinants of how quality of life was the patient's will to live, motivation and hope for the future.
