FALL 2012

Special points of

interest:

Briefly highlight your point of interest here.

Briefly highlight your point of interest here.

Briefly highlight your point of interest here.

Briefly highlight your point of interest here.

Inside this issue:

Page

Consumer Advi-

sory Panel -

CHORCUP and

RRTC

2

Barbara Delia: A

Passionate Advo-

3

Graduate Sum-

mer Student 2012

4

Healthcare

Access after SCI

Webcast

5

Summer Medical

Student Presenta-

tions

6

RRTC Grand

Rounds

7

Websites 8

Longevity After Injury Project

NEWS & UPDATES

www.longevityafterinjury.com

Risk for Subsequent Injuries After Spinal Cord Injury:

A 10-Year Longitudinal Analysis

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 occur-

rence 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

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.

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 addi-tional injuries after SCI continues to be a significant concern in the years and decades fol-lowing SCI. We believe behavioral and personality factors may be key to preventing addi-

tional injuries after SCI.

On July 12, 2012, our consumer advo-cate, Richard Aust, conducted a meeting

of the consumer advisory panel (CAP) at MUSC in Charleston, SC. Discussion topics focused on CHORCUP-

dissemination and capacity building for historically black colleges and universi-ties (HBCUs). We also reviewed the newly designed website, the current

newsletter, and SCI Resource Sheet

and discussed poverty in the SCI popu-

lation.

The group discussed whether they have

seen any SCI or general disability infor-mation coming from HBCUs. A variety of suggestions were generated to better

connect with HBCUs including: promot-ing SCI research during new student orientation and athletic events, creating awareness of SCI through exhibition

wheelchair basketball games, educating student government associations, and targeting colleges with health programs.

A participant stressed that many HBCUs are extremely underfunded and do not have the resources to promote

disability related research. The group also felt that state Baptist and AME con-ventions were excellent places to create

awareness of SCI research given that HBCUs are used regularly for the con-vention 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 re-views. 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 par-ticipants in South Carolina would be ex-tremely helpful.

The group ended the meeting with a dis-cussion of poverty and SCI and what fac-

tors other than education and employ-ment 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 transpor-

tation, 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 govern-ment assistance programs and or were using these programs prior to their injury were more likely to be living at or below

the poverty level.

Consumer Advisory Panel - CHORCUP and RRTC

Page 2

Charleston CAP meeting

July 12, 2012

“ Providing an

SCI Resource

Sheet to all po-

tential research

participants in

South Carolina

would be ex-

tremely helpful. ”

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 Con-tainer Company for their continued gen-erosity in providing tickets to our group

this year through the Charleston River-

Dogs Corporate Care Program.

CAP at the RiverDogs Game

Steven, Maria and Alex

at the RiverDogs

LONGEVITY AFTER INJURY PROJECT

When you meet Barbara

Delia, it does not take long to realize she is one of those people who is full of enthusi-asm in whatever she is doing

and is always willing to share information, by e mail or phone. She is the peer lead-

er of the South Carolina SCI Association (SCSCIA) Tri-dent Peer Group. The

group meets the 2nd Tues-day each month, 6:30-8:00pm, usually at a local

restaurant.

On September 17, 2007, Barbara had a scooter acci-dent just around the corner

from her home while return-ing from work. The accident resulted in an SCI (T10-11).

Barbara had the good for-tune to receive 45 days of in-

patient therapy at the Shep-herd Center in Atlanta, GA.

She attributes much of her early recovery to the phe-nomenally 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 ef-

fort to re-gain the functional

ability to walk. She is an ad-vocate of an adjustable par-tial 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 inde-pendently for short distanc-

es. 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

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. Bar-bara also has the loving sup-port of her son and daugh-

ter’s families including 4

grand children. She loves to be with her grands since

they always live “in the mo-

ment. “

Barbara’s very active social commitments include swim-

ming/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 train-

ing. Barbara is very proud of her 5 year old Great Dane/Black mix dog, Daisy, espe-cially of the way Daisy sup-

ports her when she stands up by pushing her weight

against her.

Barbara has found the SC Dept. of Vocational Rehabil-itation to be extremely help-

ful in funding the driving adaption of her vehicle and partial funding for her wheel-

chair. 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 im-

portant 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 num-ber 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

A Conversation With Barbara Delia: A Passionate Advocate

“ I want to

give people a

glimpse of

hope. With

hard work

and some

progress, the

possibilities

are endless”

~ Barbara

Delia

Page 3

Barbara enjoying some

conversation at the 2011

SCSCIA Conference

FALL 2012

Study 1 Update: Health behaviors, access to healthcare, and health outcomes: Comparisons of African-

American participants with SCI and TBI with general population data from the

BRFSS.

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 behav-iors 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 collabora-tive study.

In Study 2, we will identify psychologi-

cal, environmental, and behavioral pre-dictors of secondary conditions in un-derserved populations. We will deter-mine the extent to which patterns of

risk and protective factors associated

with secondary conditions are con-

sistent across racial-ethnic groups.

As of September 2012, we collected

547 responses, surpassing our goal of 458. Data collection is currently on-going with our collaborators at Craig

Hospital in Denver, CO (73 respons-es) and at Rancho los Amigos in Downey, CA. (135 responses). All to-taled, we have 756 responses out 834

needed (91%).

Brown, S., Saunders, L.L., & Krause, J.S. (2012). Racial disparities in depres-

sion and life satisfaction after spinal cord injury: A mediational model. Top-ics in Spinal Cord Injury Rehabilitation, 18

(3), 232-240.

Saunders, L.L., Krause, J.S., & Acuna, J. (2012). Association of race, socioeco-nomic 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, phy-

sician visits, and self-reported fitness after spinal cord injury: A cross se-quential analysis of age, years since

injury, and age at injury onset. Archives

of Physical Medicine and Rehabilitation.

Khadidra Washington is a graduate student in the Rehabilitation Counsel-

ing 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 psy-chology. 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. Cassan-dra 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 Indi-

viduals Living with Spinal Cord Injury" and plans to present her results in No-vember at a conference in Florida.

CHORCUP Study Updates

Graduate Summer Student 2012

Khadidra Washington

Page 4 CHORCUP

Recent Publications

Center on

Health

Outcomes

Research and

Capacity

Building for

Underserved

Populations

(CHORCUP)

The 2012 CHORCUP un-dergraduate 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 presenta-

tion day, August 1, 2012.

Chelsea has completed her

freshman year at Spelman College where she is ma-joring in sociology and pre-

medicine. She is interested

in cardiovascular biology. During her summer intern-ship, she completed and presented the results of

her Project: "African-Americans with spinal

cord injury: Will they be more likely to report

risk behaviors for chronic disease than African-Americans in

the general popula-

tion?"

Ene has completed her sophomore year at Spel-man College and is a biolo-

gy major. She would like to go to medical school after graduation from Spel-

man and is interested in

hypertension and obesity. As part of her summer in-ternship, Ene completed

and presented the results of her project: "A Com-parison of the preva-lence of protective

health behaviors among

African Americans with spinal cord injury (SCI) to

African Americans in the

general population"

Ene and Chelsea were inter-viewed by Dr. James Krause,

principal investigator. The students talked about their experience with the CHOR-CUP summer internship and

their future goals. Checkout

the videos:

http://vimeo.com/muscchp/

review/47724727/5826a9c162

Summer Undergraduate Students 2012

Healthcare Access after SCI Webcast

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

As part of our CHORCUP and RRTC grants, our team will be conducting

webcasts related to our research find-ings to provide technical assistance to professionals wishing to develop similar

research programs or prevention strate-gies based on the study results. Our webcasts will also serve to provide rec-ommendations 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 Spi-nal Cord Injury.” The purpose of this

webcast was to: 1. Describe health care access after SCI.

:

Dr. Lee

Saunders

presented

our second

webcast,

“Health

Care Access

after Spinal

Cord

Injury.”

Page 5 FALL 2012

Ene Ekoja

Chelsea Whitlock

Our two summer medical students, who worked on the RRTC grant,

ended their 10-week internship with presentations of their individual pro-jects.

Chandler Church Chandler Church, a medical student

from MUSC, presented on "Post-Hospitalization Mortality after Traumatic Brain Injury, South Carolina 1998-2009." Her study

looked at risk factors for increased

mortality after TBI. Chandler re-ported 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 addi-

tional monitoring than patients with no comorbidities.

James Massaro, also a medical student from MUSC, presented

on "Suicide after Spinal Cord Injury." His project was a literature review aimed at un-

derstanding the risk factors and depth of suicide after SCI. He described how research has illustrated that suicide is a lead-

ing 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 de-crease the risk of suicide after

SCI.

Summer Medical Student Presentations

RRTC Study Updates

Study 2 Update: Association of health ser-

vices with secondary condi-tions: Use of a population-based cohort of persons

with SCI in South Carolina.

The purpose of Study 2 is to evaluate availability of

rehabilitative services and their association with sec-

ondary 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 re-sponses (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 diabe-tes) changes over time in

persons with SCI. We are also examining how meta-

bolic syndrome relates to

other secondary condi-tions and the factors which may predict meta-

bolic syndrome. As of September 2012,

Rancho Los Amigos has collected data on 135 participants.

Study 1 Update: Risk and protective factors for

secondary conditions: A 15-year longitudinal study.

Study 1 aims to identify risk and protective factors for secondary conditions. The knowledge gained will help

to develop prevention strategies targeting the fac-

tors related to the greatest

number of secondary con-ditions.

We are currently making follow up calls to our third mailing cohort.. As of

September 2012, we have 839 out of 1342 respond-ents (63%).

Page 6 RRTC

Rehabilitation Research and

Training

Center on

Secondary

Conditions in

Individuals

with SCI

(RRTC)

James Massaro

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 Uni-versity of Alabama Birming-ham spoke on "Life Expec-

tancy Trends & Cause of Death Following SCI." Dr. DeVivo gave a brief history of SCI and defined SCI Mod-

el Systems programs. SCI Model Systems databases store information on all pa-

tients treated at Model Sys-tems (currently 28 centers) In his research, Dr. DeVivo

has found that life expectan-cy for individuals with SCI

remains significantly below normal with the leading caus-

es of death as pneumonia, external causes, septicemia, and heart disease. Mortality

rates are declining in this population for cancer, heart disease, stroke, arterial dis-eases, pulmonary embolus,

urinary diseases, digestive diseases and suicide but are

increasing for endocrine,

metabolic and nutritional diseases, accidents, nervous system diseases, musculo-

skeletal 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

RRTC Grand Rounds

Page 7

Chandler Church

http://vimeo.com/

muscchp/review/47324565/

b6b7a83615

James Massaro

http://academicdepartment

s.musc.edu/chp/longevity_after_injury/funded_projects/rrtc/

Dr. Chris Gregory

FALL 2012

SCI, secondary health condi-

tions associated with altera-tions in skeletal muscle after SCI, effects of exercise train-

ing on skeletal muscle after SCI, and health related bene-fits 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-

cle strength and size, as well as increased bone loss. His recent research has illustrat-

ed that resistance training in individuals with SCI has shown to increase muscle size, increase bone density,

reduce muscle fatigue, and improve glucose tolerance, thus making resistance train-

ing beneficial to the SCI pop-ulation. Check out the presentation: http://chpondemand.musc.edu/rehab_int/grand_rounds_int/Grand_Rounds_07_17_12.mp4

pression and life satisfac-tion 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 employ-ment and risk of mortality

after spinal cord injury: Effects beyond that of demographic, injury, and

socioeconomic factors.

Saunders, L.L., Krause, J.S., & Acuna, J. (2012).

Association of race, soci-oeconomic status, and

health care access with

pressure ulcers after spi-nal cord injury. Archives of Physical Medicine and Rehabilitation, 93(6), 972-

977.

Brown, S., Krause, J.S., & Saunders, L.L. (2012). Racial disparities in de-

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 in-ternship experiences and

their research projects. Please use the links below to view the videos.

Recent Publications

“Dr. Gregory

spoke on

Therapeutic

Approaches

Targeting

Skeletal

Muscle

Plasticity after

SCI."

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

The Longevity after Injury Project College of Health Professions

77 President St. MSC 700 Charleston, SC 29425-7000

FALL 2012

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 re-search 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

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/

Message from Dr. Jim Krause

LONGEVITY AFTER INJURY PROJECT

RRTC is funded by the

National Institute on Disa-

bility and Rehabilitation

Research (NIDRR #

H133B090005)

CHORCUP is funded by

the National Institute on

Disability and Rehabilita-

tion Research (NIDRR -

#H133A080064).