CDE Detailed Report

For each bowel care facilitator indicate if it was used regularly within the past three months.

Respiratory insufficiency is common following spinal cord lesions. Ventilatory assistance devices include, but are not limited to: mechanical ventilators, phrenic nerve stimulators, diaphragmatic pacers, external negative pressure devices, and bi-level positive airway pressure (BiPAP). These devices do not include routine administration of oxygen, intermittent positive pressure breathing (IPPB), or continuous positive airway pressure (CPAP). Wording of this variable reflects the International Spinal Cord Injury Core Data Set for the type of ventilatory assistance used to sustain respiration at discharge after the initial rehabilitation period following the spinal lesion (DeVivo et al. 2006). As the situation may have changed since discharge from the initial inpatient period the question is asked.

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Normal refers to normal antegrade ejaculation occurring after a similar amount of sexual stimulation as prior to spinal cord lesion.
Reduced/altered, refers to ejaculation that is possible after sexual stimulation, but is changed after the spinal cord lesion in either time required to ejaculate, or changes in semen volume, color, or quality.
Absent refers to an absence of external semen propulsion to sexual stimulation following the spinal cord lesion despite attempts to ejaculate.
Unknown refers to reports by individuals that they have not been sexually active thus they do not know if they are able to achieve ejaculation after the spinal cord lesion.

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Being able to distinguish between single versus multiple levels of spinal column injury is often challenging. Critical to this distinction is the fact that a single injury may occur; i) at one vertebral level (e.g. C6 Burst Fracture); ii) at a single motion segment (e.g. a C5-6 bilateral facet dislocation) where a motion segment is defined as two adjacent vertebrae and their interconnecting discs and
ligamentous structures; or iii) over two or more adjacent and contiguousmotion segments (e.g. a "teardrop" fracture of C6 where the injury spans C5-C7). Alternately, a multiple level injury consists of two or more single column injuries separated by at least one completely intact vertebra or motion segment(e.g. a C5-6 facet dislocation and a C2 hangman's fracture).

For each event related to cardiovascular function after spinal cord lesion record whether it was experienced by the participant.
These time-limited cardiovascular events with long-term sequelae should have their dates documented to be able to compute the time since injury and to identify the data collected in relation to various time points. If more than one episode has occured the last one has to be documented.

Choose one
Many individuals with SCI lack any awareness of the need to defecate. Others have indirect symptoms. These are mainly abdominal cramping or discomfort and spasms of the abdominal muscles or lower extremities. Autonomic symptoms including headache, perspiration, piloerection, and chills before or during defecation are common, especially in individuals with lesions above Th6 (Krogh et al. 1997). Autonomic symptoms are often unpleasant to the individual and may indicate insufficient bowel emptying. Lack of awareness of the need to defecate is especially common in individual with complete lesions and increases the risk of fecal incontinence. Symptoms may change with time and in the present data set they are given for the last four weeks.

Choose one

For each type of cardiovascular function after spinal cord lesion record whether it was experienced by the participant within the last three months.
Cardiac conditions: Subjective symptoms related to the heart that occur post-spinal cord lesion should be documented (e.g. abnormal heart rates/rhythm, angina, palpitation etc.).
Orthostatic hypotension: Symptomatic or asymptomatic decrease in blood pressure usually exceeding 20 mmHg systolic or 10 mmHg diastolic on moving from the supine to an upright position.
Dependent oedema: A clinically detectable increase in extracellular fluid volume localized in a dependent area, such as a limb, characterized by swelling or pitting.
Hypertension: (arterial blood pressure >140/90 mmHg). The diagnosis of hypertension in individual with SCI should be considered after careful monitoring and documentation of the level of arterial blood pressure and exclusion of possible elevation of BP due to episodes of AD.
Autonomic dysreflexia: A constellation of signs and/or symptoms in SCI above T5-6 spinal cord segments in response to noxious or non-noxious stimuli below the level of injury defined by an increase in systolic blood pressure (> 20mm Hg above baseline), and which may include one of the following symptoms: headache, flushing and sweating above the level of the lesion, vasoconstriction below the level of the lesion, and dysrhythmia. This syndrome may or may not be symptomatic and may occur at any time following SCI.

Choose one main method
Individuals with SCI may use a combination of bowel emptying rocedures. For practical purposes one should be defined as the Main method. Supplementary methods should be performed at least once every week. More than one supplementary method can be used. The choice of defecation method and bowel care procedures may change with time and in the present data set they are given for the last four weeks. Digital ano-rectal stimulation is digital triggering of rectal
contractions and anal relaxation and thus rectal emptying.
Digital evacuation is the need to dig out stools with a finger. Mini enema (or Clysma) contains 150 ml or less and enema contain > 150 ml.
In individuals having a colostomy, this is always considered the main method for defecation.

Check box for Unknown

1 – Most cephalic spinal column injury involving one or more adjacent vertebral levels and/or one or more adjacent and contiguous motion segments.
2 – If there are two or more discrete spinal column injuries, this is the second most cephalic spinal column injury involving one or more adjacent vertebral levels and/or one or more adjacent and
contiguous motion segments separated by at least one intact vertebral level to the above or below spinal column injury.
3, 4, etc. If there are three or more discrete spinal column injuries, this is the third, fourth, etc. most cephalic spinal column injury involving one or more adjacent vertebral levels and/or one or more
adjacent and contiguous motion segments separated by at least one intact vertebral level to the above or below spinal column injury.
99 - Unknown

Choose one. If a preexisting or concomitant sexual problem is present it is not possible to determine the exact impact of the spinal cord lesion on sexual function and the data should be appropriately identified. Unknown refers to individuals who were not sexually active prior to their lesion, thus it would be unknown if sexual dysfunction was present.

Choose one. If a preexisting or concomitant sexual problem is present it is not possible to determine the exact impact of the spinal cord lesion on sexual function and the data should be appropriately identified. Unknown refers to individuals who were not sexually active prior to their lesion, thus it would be unknown if sexual dysfunction was present.

Choose all that apply as more than one supplementary method can be used.

within the last four weeks

Regular use of one or more collecting appliances is to be recorded. For each collecting appliance type indicate if it is used. Individuals with spinal cord lesions that use such appliances less than once a month, "for the sake of safety", and who have no more than exceptional episodes of leakage during a year should be excluded (adapted from Levi and Ertzgaard 1998). For other possible collecting appliances it is recommended to write them in a textfield, from which it will be possible to retrieve more detailed data when necessary.

Choose one - This is to be filled in for each level of injury, starting with the most cephalic injury. Acute injury to the posterior ligamentous complex should be diagnosed clinically or radiographically. Clinical evidence relies on the presence of marked local bruising and/or a palpable interspinous gap possibly with local tenderness. Radiologic diagnosis is dependent on the existence of a widened interspinous space on AP or lateral x-ray or reformatted CT of the spine, or by appropriate MRI. It may also appear as avulsion of a bone from the spinous processes or lamina. When a traumatic injury to the disc and annulus occurs in association with posterior element distraction, subluxation, or dislocation, this will be recorded as a disc and posterior ligamentous complex injury. In the case of multiple spinal column injuries, a separate entry will be filled out for each level of spinal column injury.
Posterior ligamentous complex injury will be defined as the presence of acute disruption or injury to the posterior ligamentous complex through the spinal column from the occiput to the level of the sacrum. Acute injury to the posterior ligamentous complex will
be diagnosed clinically or radiographically. Clinical evidence relies on the presence of marked local bruising and/or a palpable interspinous gap possibly with local tenderness. Radiologic diagnosis is dependent on the existence of a widened interspinous
space on AP or lateral x-ray or reformatted CT of the spine, or by appropriate MRI. It may also appear as avulsion of a bone from the spinous processes or lamina. Disc Injury will be defined as a traumatic disruption of the annulus of the disc through either distraction, translation, or rotation. It will also include a traumatic disc protrusion causing a spinal cord injury. Isolated traumatic disc injuries commonly occur with hyperextension mechanisms in the cervical spine. When a traumatic injury to the disc and annulus occurs in association with posterior element distraction, subluxation, or dislocation, this will be recorded as a disc and posterior ligamentous complex injury. In the case of multiple spinal column injuries, a separate entry will be filled out for each level of spinal column injury.