Journal of rehabilitation research and development
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We analyzed healthcare costs and medical conditions for 2,008 veterans with spinal cord injuries and disorders (SCI/Ds) near end of life. The average age at SCI/D onset and/ or occurrence was 42 years and at death was 66 years. ⋯ The average cost was $24,900 in the second year before end of life and reached $61,900 in the final year. Before end of life, costs accelerated during the final year from $3,100 in month 12 to $14,600 in the final month.
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Computer-controlled electrical stimulation (ES)-induced leg cycle ergometer (ES-LCE) exercise can be beneficial for individuals with spinal cord injury (SCI), but exercise performance is often insufficient for eliciting continuous gains in cardiopulmonary training adaptations. The first purpose of this study was to determine whether a modified ES-LCE improved exercise performance and responses compared with the standard ES-LCE. Modifications to the ES-LCE included increased ES current amplitude (140-300 mA), added shank muscle activation, and increased ES firing angle ranges (+55 degrees). ⋯ No significantly different peak values for power output and stroke volume were found for the two systems, but the modified ES-LCE elicited significantly higher peak values for oxygen uptake (+22%), carbon dioxide production (+51%), pulmonary ventilation (+37%), cardiac output (+32%), heart rate (+19%), and blood lactate concentration (+50%). Power output, metabolic rate, and lower-limb muscle strength increased significantly following training. This study showed that an ITP with the modified ES-LCE can elicit marked improvements in ES-LCE performance (peak power output), peak metabolic and cardiorespiratory responses, and muscle strength in men with SCI, even in those subjects whose performance has plateaued during training on the standard ES-LCE.
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Physical activity (exercise) serves primary, secondary, and tertiary roles in the prevention of falls among older adults. In its primary role, physical activity can prevent the onset of pathology and system impairments that lead to disability and increased risk for falls. Slowing the progression of disease and system impairments is its secondary role, while its tertiary role lies in the restoration of function to a level that allows for more autonomy in the performance of essential activities of daily living. ⋯ As the level of risk increases, however, more tailored and progressive exercise programs that target the physical risk factors associated with falls are more effective in lowering fall risk. Adopting a multifactorial intervention approach with exercise as an integral component may also be necessary at the highest levels of risk. Although more labor intensive, multifactorial approaches, if carefully staged, should still be considered the most effective intervention approach for older adults identified at high risk for falls.