Longevity After Injury Project NEWS & UPDATES www.longevityafterinjury.com FALL 2012
Risk for Subsequent Injuries After Spinal Cord Injury: A 10-Year Longitudinal Analysis
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Research Highlight
Injuries can affect anyone at any time. Although common, many injuries can be prevented. After SCI, additional injuries are often reported. An injury may include a broken bone, burn, or cut occurring as a result of an accident or event such as a fall, collision, car wreck, or act of violence. Often, injuries are related to an individual’s personality and behaviors. The Longevity After Injury Project recently completed a study to look at the risk of injuries after SCI over time. In our longitudinal study, we gathered information from participants at one point in time (baseline), and then again 10 years later. We looked at the yearly occurrence of injuries and injury related hospitalizations after SCI. We also looked to see if the occurrence of injuries had changed over the 10 years. Finally, we looked at behavioral and psychological risk factors for injuries. Below are some of our study results. Future injuries after SCI are an extremely common secondary condition. Compared to baseline, there was an increase in the rates of additional injuries and injury
Inside this issue: Page
Consumer Advisory Panel CHORCUP and RRTC
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related hospitalizations: More than 23% of the participants reported at least 1 injury within the past year. 11% reported 2 or more injuries. 7% reported at least one injury-related hospitalization. Participants who initially reported an additional injury after SCI were about 2 times more likely to report an injury 10 years later. Binge drinking, psychotropic prescription medication use, and several personality factors (impulsive sensation seeking, anxiety, aggression-hostility, activity level, and sociability) were related to injuries and injury related hospitalizations.
Barbara Delia: A 3 Passionate AdvoGraduate Sum4 mer Student 2012 Healthcare Access after SCI Webcast
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Summer Medical 6 Student Presentations RRTC Grand Rounds
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Websites
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An important finding from our study is that the yearly occurrence of additional injuries is significantly higher than previously reported. Based on our study results, the risk for additional injuries after SCI continues to be a significant concern in the years and decades following SCI. We believe behavioral and personality factors may be key to preventing additional injuries after SCI.
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LONGEVITY AFTER INJURY PROJECT
CAP at the RiverDogs Game
Steven, Maria and Alex at the RiverDogs
On Thursday August 16, 2012, our team sponsored the last of three annual outings to a Charleston RiverDogs baseball game for the consumer advisory panel (CAP). Team and CAP members enjoyed another breezy night to watch the exciting ballgame, entertainment between inning festivities, and lively conversations. The RiverDogs won
3-1 against Augusta by belting several home runs. The outings continue to be a summer highlight for our CAP members and research team staff. We would like to take this opportunity to thank the Charleston RiverDogs and Fennel Container Company for their continued generosity in providing tickets to our group this year through the Charleston RiverDogs Corporate Care Program.
Consumer Advisory Panel - CHORCUP and RRTC On July 12, 2012, our consumer advocate, Richard Aust, conducted a meeting of the consumer advisory panel (CAP) at MUSC in Charleston, SC. Discussion topics focused on CHORCUPdissemination and capacity building for historically black colleges and universities (HBCUs). We also reviewed the newly designed website, the current newsletter, and SCI Resource Sheet and discussed poverty in the SCI population.
Charleston CAP meeting The group discussed whether they have July 12, 2012 seen any SCI or general disability information coming from HBCUs. A variety “ Providing an of suggestions were generated to better connect with HBCUs including: promotSCI Resource ing SCI research during new student orientation and athletic events, creating Sheet to all poawareness of SCI through exhibition wheelchair basketball games, educating tential research student government associations, and targeting colleges with health programs. participants in A participant stressed that many HBCUs are extremely underfunded and South Carolina do not have the resources to promote would be exdisability related research. The group also felt that state Baptist and AME contremely helpful. � ventions were excellent places to create awareness of SCI research given that HBCUs are used regularly for the convention locations. It was suggested that minority students be targeted to pursue
SCI research as a college track at the high school level. The redesigned website, newsletter and SCI Resource Sheet received positive reviews. The CAP liked the vast variety of information available on the website from the consumer resources to the research publications. The group was impressed by the SCI Resource Sheet and felt that providing it to all potential research participants in South Carolina would be extremely helpful. The group ended the meeting with a discussion of poverty and SCI and what factors other than education and employment significantly contribute to poverty. Participants suggested that the following additional factors may affect the outcome of SCI and poverty: lack of community supports (church, friends), lack of family support, excess # of children in the household, fear of losing benefits, no health care available to them at work due to pre-existing condition, lack of transportation, negative outlook and depression due to the inability to adjust to SCI. In addition, it was noted that people who grew up in families who accessed government assistance programs and or were using these programs prior to their injury were more likely to be living at or below the poverty level.
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FALL 2012
A Conversation With Barbara Delia: A Passionate Advocate When you meet Barbara Delia, it does not take long to realize she is one of those people who is full of enthusiasm in whatever she is doing and is always willing to share information, by e mail or phone. She is the peer leader of the South Carolina SCI Association (SCSCIA) Trident Peer Group. The group meets the 2nd Tuesday each month, 6:308:00pm, usually at a local restaurant. On September 17, 2007, Barbara had a scooter accident just around the corner from her home while returning from work. The accident resulted in an SCI (T10-11). Barbara had the good fortune to receive 45 days of inpatient therapy at the Shepherd Center in Atlanta, GA. She attributes much of her early recovery to the phenomenally supportive people she met there, especially 2 quadriplegic patients who made her realize just how blessed she was and how much she could still do. Barbara is tireless in her effort to re-gain the functional ability to walk. She is an advocate of an adjustable partial weight bearing device known as the Up N Go. According to Barbara, the best part of using an Up N GO is that it allows her to walk with support independently for short distances. Barbara attends health
fairs as a volunteer Up N Go representative. As she puts it, “I want to give people a glimpse of hope. With hard work and some progress, the possibilities are endless.” Barbara’s husband, Sam, is
Barbara enjoying some conversation at the 2011 SCSCIA Conference
her pillar of support, and she readily admits that he keeps her life stable enough that she is able to help other people with their needs. You will usually find Sam grilling at one of the semi-annual Peer Group picnics, always with a smile on his face. Barbara also has the loving support of her son and daughter’s families including 4 grand children. She loves to be with her grands since they always live “in the moment. “ Barbara’s very active social commitments include swimming/using the gym at the YMCA, Red Hats Women's Club, visiting newly injured
patients at local hospitals, participating in our CAP meetings and bringing her dog, Daisy, to RALLY for obedience and agility training. Barbara is very proud of her 5 year old Great Dane/ Black mix dog, Daisy, especially of the way Daisy supports her when she stands up by pushing her weight against her. Barbara has found the SC Dept. of Vocational Rehabilitation to be extremely helpful in funding the driving adaption of her vehicle and partial funding for her wheelchair. In addition, Barbara is working with a counselor to secure employment. Barbara always tries to live by the motto “ you have to do the best with what you have.” Don’t worry about what you can’t do. Focus on what you can do. She feels that it is extremely important to socially network with other people. She has received many calls from newly injured SCI patients over the years as a result of them getting her phone number from others she has met during her travels. If I know Barbara, she will continue to support people with SCI around the Charleston area for many years to come. Keep smiling Barbara.
~ Richard Aust
“ I want to give people a glimpse of hope. With hard work and some progress, the possibilities are endless” ~ Barbara Delia
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CHORCUP
CHORCUP Study Updates Study 1 Update: Health behaviors, access to healthcare, and health outcomes: Comparisons of AfricanAmerican participants with SCI and TBI with general population data from the BRFSS.
Center on Health Outcomes Research and Capacity Building for Underserved Populations (CHORCUP)
Khadidra Washington
Study 1 compares African-American health behaviors, access to services, and the prevalence of chronic diseases with the general population. We will identify the extent to which disparities observed in the general population are magnified after injury. We will use this new knowledge to promote healthier behaviors and reduce chronic diseases among African�Americans with SCI and TBI. As of September 2012, we collected 503/500 surveys (101%) and are finished collecting data. We are cleaning the data in preparation for analysis.
Study 2 Update: Race-ethnicity and risk of adverse health outcomes after SCI: A multisite collaborative study. In Study 2, we will identify psychological, environmental, and behavioral predictors of secondary conditions in underserved populations. We will determine the extent to which patterns of risk and protective factors associated with secondary conditions are consistent across racial-ethnic groups. As of September 2012, we collected 547 responses, surpassing our goal of 458. Data collection is currently ongoing with our collaborators at Craig Hospital in Denver, CO (73 responses) and at Rancho los Amigos in Downey, CA. (135 responses). All totaled, we have 756 responses out 834 needed (91%).
Graduate Summer Student 2012
Recent Publications
Khadidra Washington is a graduate student in the Rehabilitation Counseling program at South Carolina State University (SCSU). After obtaining her Masters of Art in Rehabilitation Counseling, Khadidra plans to enroll in a Clinical Psychology doctoral program with a specialization in positive psychology. This summer she participated in the 10 week CHORCUP internship to gain a better understanding of SCI research. Khadidra worked closely with Dr. David Staten and Dr. Cassandra Sligh-Conway at SCSU 3 days per week and at MUSC 2 days per week. Khadidra completed her project: "How a Low Socioeconomic Status Affects the Quality of Life among Individuals Living with Spinal Cord Injury" and plans to present her results in November at a conference in Florida.
Brown, S., Saunders, L.L., & Krause, J.S. (2012). Racial disparities in depression and life satisfaction after spinal cord injury: A mediational model. Topics in Spinal Cord Injury Rehabilitation, 18 (3), 232-240. Saunders, L.L., Krause, J.S., & Acuna, J. (2012). Association of race, socioeconomic status, and health care access with pressure ulcers after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 93(6), 972-977. Krause, J.S., Cao, Y., & Bozard, J.L. (in press). Changes in hospitalization, physician visits, and self-reported fitness after spinal cord injury: A cross sequential analysis of age, years since injury, and age at injury onset. Archives of Physical Medicine and Rehabilitation.
FALL 2012
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Summer Undergraduate Students 2012 The 2012 CHORCUP undergraduate students were Chelsea Whitlock and Ene Ekoja. Chelsea and Ene participated in the 10-week summer internship to gain a better understanding of SCI research. The students each completed a project and presented their results on the student presentation day, August 1, 2012.
cord injury: Will they be more likely to report risk behaviors for chronic disease than African-Americans in the general population?"
African Americans with spinal cord injury (SCI) to African Americans in the general population" Ene and Chelsea were interviewed by Dr. James Krause, principal investigator. The students talked about their experience with the CHORCUP summer internship and their future goals. Checkout the videos:
Ene has completed her Chelsea Whitlock sophomore year at Spelman College and is a biology major. She would like to go to medical school Chelsea has completed her after graduation from Spelhttp://vimeo.com/muscchp/ freshman year at Spelman man and is interested in review/47724727/5826a9c162 College where she is mahypertension and obesity. joring in sociology and pre- As part of her summer inmedicine. She is interested ternship, Ene completed and presented the results in cardiovascular biology. Ene Ekoja During her summer intern- of her project: "A Comship, she completed and parison of the prevapresented the results of lence of protective her Project: "Africanhealth behaviors among Americans with spinal
Healthcare Access after SCI Webcast As part of our CHORCUP and RRTC grants, our team will be conducting webcasts related to our research findings to provide technical assistance to professionals wishing to develop similar research programs or prevention strategies based on the study results. Our webcasts will also serve to provide recommendations to broader audiences including consumers and their families, service providers, and policymakers. On Tuesday, May 29, 2012, Dr. Lee Saunders presented our second webcast, “Health Care Access after Spinal Cord Injury.” The purpose of this webcast was to: 1. Describe health care access after SCI.
2. Assess secondary health conditions as a function of access to health care after SCI. 3. Identify the extent to which black persons with SCI have equal access to health care compared to black persons in the general population. Please use the following link to view the entire webcast: http://chpondemand.musc.edu/ rehab_int/saunders_webcast.mp4
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Dr. Lee Saunders presented our second webcast, “Health Care Access after Spinal Cord Injury.”
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RRTC
RRTC Study Updates Study 1 Update: Risk and protective factors for secondary conditions: A 15year longitudinal study.
Rehabilitation Research and Training Center on Secondary Conditions in Individuals with SCI (RRTC)
Study 1 aims to identify risk and protective factors for secondary conditions. The knowledge gained will help to develop prevention strategies targeting the factors related to the greatest number of secondary conditions. We are currently making follow up calls to our third mailing cohort.. As of September 2012, we have 839 out of 1342 respondents (63%).
Study 2 Update: Association of health services with secondary conditions: Use of a populationbased cohort of persons with SCI in South Carolina. The purpose of Study 2 is to evaluate availability of rehabilitative services and their association with secondary conditions using participants from the state of South Carolina. In July 2012, we mailed the first survey to our third mailing cohort. As of September 2012, we have 746 out of 950 responses (79%).
Study 3 Update: Risk of Metabolic Syndrome: A 17-year longitudinal study. The goal of Study 3 is to identify how metabolic syndrome (which can lead to heart disease and diabetes) changes over time in persons with SCI. We are also examining how metabolic syndrome relates to other secondary conditions and the factors which may predict metabolic syndrome. As of September 2012, Rancho Los Amigos has collected data on 135 participants.
Summer Medical Student Presentations Our two summer medical students, who worked on the RRTC grant, ended their 10-week internship with presentations of their individual projects.
mortality after TBI. Chandler reported that having any comorbid condition increased the risk for mortality. Other risks include TBI severity, injuries, fall, and male gender. Her research illustrated that preexisting comorbidities have negative impact on TBI. These patients will require additional monitoring than patients with no comorbidities.
Chandler Church Chandler Church, a medical student from MUSC, presented on "PostHospitalization Mortality after Traumatic Brain Injury, South Carolina 1998-2009." Her study looked at risk factors for increased
James Massaro, also a medical student from MUSC, presented on "Suicide after Spinal Cord Injury." His project was a literature review aimed at understanding the risk factors and depth of suicide after SCI. He described how research has illustrated that suicide is a leading cause of death in individuals after SCI and there are specific risk factors that have a higher incidence of suicide. This is important to note so prevention can focus on risk awareness for patients, health care providers, and patients’ families to decrease the risk of suicide after SCI.
James Massaro
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FALL 2012
RRTC Grand Rounds As part of the RRTC grant, we are committed to hosting a Grand Rounds seminar every 4 months throughout the 5 years of the grant. The Grand Rounds will focus on topics related to SCI with a target audience of MUSC and other local hospitals and health care clinicians and researchers. May Grand Rounds On Tuesday, May 1, 2012, Dr. Mike DeVivo from University of Alabama Birmingham spoke on "Life Expectancy Trends & Cause of Death Following SCI." Dr. DeVivo gave a brief history of SCI and defined SCI Model Systems programs. SCI Model Systems databases store information on all patients treated at Model Systems (currently 28 centers) In his research, Dr. DeVivo has found that life expectancy for individuals with SCI
remains significantly below normal with the leading causes of death as pneumonia, external causes, septicemia, and heart disease. Mortality rates are declining in this population for cancer, heart disease, stroke, arterial diseases, pulmonary embolus, urinary diseases, digestive diseases and suicide but are increasing for endocrine, metabolic and nutritional diseases, accidents, nervous system diseases, musculoskeletal diseases, and mental disorders. Check out the presentation: https://tegr.it/y/g1mo July Grand Rounds On Tuesday, July 17, 2012, Chris Gregory, PT, PhD, from MUSC, presented on "Therapeutic Approaches Targeting Skeletal Muscle Plasticity after SCI." Dr. Gregory discussed skeletal muscle adaptations following
SCI, secondary health conditions associated with alterations in skeletal muscle after SCI, effects of exercise training on skeletal muscle after SCI, and health related benefits of exercise in persons with SCI. He discussed how, after SCI, there is an increase in muscle fatigue and muscle injury and a decrease in mus- Dr. Chris Gregory cle strength and size, as well as increased bone loss. His recent research has illustrat“Dr. Gregory ed that resistance training in individuals with SCI has spoke on shown to increase muscle size, increase bone density, Therapeutic reduce muscle fatigue, and Approaches improve glucose tolerance, thus making resistance trainTargeting ing beneficial to the SCI popSkeletal ulation. Check out the presentation: Muscle http:// chpondemand.musc.edu/ rehab_int/grand_rounds_int/ Grand_Rounds_07_17_12.mp4
Recent Publications Saunders, L.L., Krause, J.S., & Acuna, J. (2012). Association of race, socioeconomic status, and health care access with pressure ulcers after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 93(6), 972977. Brown, S., Krause, J.S., & Saunders, L.L. (2012). Racial disparities in de-
pression and life satisfaction after spinal cord injury: A mediational model. Topics in Spinal Cord Injury Rehabilitation, 18(3), 232-240. Krause, J.S., & Saunders, L.L. (e-pub ahead of print). Gainful employment and risk of mortality after spinal cord injury: Effects beyond that of demographic, injury, and socioeconomic factors.
Plasticity after SCI."
Chandler Church Spinal Cord, first published online May 1 2012, doi: 10.1038/sc.2012.49. Interviews with Medical Students Dr. Krause interviewed our two summer medical students about their internship experiences and their research projects. Please use the links below to view the videos.
http://vimeo.com/ muscchp/ review/47324565/ b6b7a83615 James Massaro http:// academicdepartment s.musc.edu/chp/ longevity_after_injur y/funded_projects/ rrtc/
LONGEVITY AFTER INJURY PROJECT
FALL 2012
The Longevity after Injury Project College of Health Professions 77 President St. MSC 700 Charleston, SC 29425-7000
EMAIL: sciresearchteam@musc.edu PHONE: (843) 792-2605 TOLL FREE: 1-866-313-9963 FAX: (843) 792-5649 OFFICE HOURS: 8 a.m. to 5 p.m. Eastern Standard Time, Monday-Friday
Message from Dr. Jim Krause
RRTC is funded by the National Institute on Disability and Rehabilitation Research (NIDRR # H133B090005)
We would like to take this opportunity to thank those of you who have participated in our research. Our goal is to help improve the health, function, quality of life, and longevity of people with SCI through research and education. We have made great progress together this year and will let you know about future SCI research studies as they become available.
Websites CHORCUP is funded by the National Institute on Disability and Rehabilitation Research (NIDRR #H133A080064).
All three of our team websites have recently gotten an updated look: Longevity After Injury Project: http://www.longevityafterinjury.com CHORCUP: http://academicdepartments.musc.edu/chp/longevity_after_injury/ funded_projects/chorcup/index.htm RRTC: http://academicdepartments.musc.edu/chp/longevity_after_injury/ funded_projects/rrtc/ BLOG: http://sciandtbiresearch.blogspot.com/