Background: Previous studies demonstrated that cannabinoids may reduce spasticity in patients with spinal cord injury (SCI); however, the effect of naturally extracted THC:CBD oil, the most commonly used naturally extracted cannabinoids, has yet to be elucidated. Objectives: To assess the effect of a 1:1 THC:CBD oil on reducing spasticity in chronic SCI patients Design: A single-center, placebo-controlled, double-blind crossover clinical trial. Methods: Sixteen chronic SCI patients with intractable spasticity were randomly assigned to either the intervention (1:1 THC:CBD oil) or control (placebo) phase for 1 month, then crossed over. The primary outcome (combined Ashworth Scale [AS] of all involved muscle groups) and the secondary outcomes, including patient-rated visual analog scale (VAS) of spasticity, were assessed before and after both phases and analyzed using a multilevel mixed-effects model. Results: All participants completed the study. The average (SD) dose of THC:CBD oil was 11.6 (1.3) mg. No significant difference in the total AS score for all involved muscle groups was found between the pre- and post-treatment phases, or between the experimental and control phases (all p > 0.05). A significant reduction was observed in the patient rating VAS (effect size = −13.9 [95% CI: −25.5 to −2.3; p = 0.010). Conclusion: In people with chronic SCI who had intractable spasticity, there was no statistically significant effect of 1:1 THC:CBD oil on spasticity-related outcomes, except for patient rating VAS reduction. Further studies are needed to evaluate the efficacy of higher doses of THC (>12 mg/day) and to use patient-reported spasticity scores as the primary outcome measure. Trial registration: The study was registered with the Thai Clinical Trials Registry (TCTR identification number: TCTR20220329001).

Spinal tuberculosis (TB), an extrapulmonary manifestation of TB, primarily involves one or multiple vertebrae, with a high prevalence at the thoracolumbar region, which can compromise spinal cord integrity and result in severe sequelae such as paraplegia, bladder and bowel dysfunction, and mobility limitation. This study aimed to review medical, surgical, and rehabilitation management, clinical outcomes, and prognostic factors of spinal TB with spinal cord injury (SCI). Research was conducted utilizing databases such as PubMed, Google Scholar, and the Cochrane Library to identify original research articles published between 2019 and 2024, along with systematic and narrative reviews, that were relevant to spinal TB and clinical outcomes. Antituberculosis drug therapy, incomplete motor deficits, early onset paraplegia, young age, and good nutritional status provide a better prognosis for neurological and functional recovery. On the other hand, poor prognosis factors are normochromic normocytic anemia, initial lymphocytosis, and fever; in addition, a long duration of disease, poor patient compliance to medications, multidrug-resistant TB, poor nutritional status, and the presence of comorbid systemic diseases are negative predictors for recovery. Insufficient research necessitates further investigation into spinal cord-specific outcomes for spinal TB to improve rehabilitation prognostics. Early intervention and antituberculosis therapy enhance better prognoses for neurological and functional recovery, especially in those with incomplete motor function, young age, good nutritional status, and compliance with treatment.

BACKGROUND: Remunerative employment (RE) is one of the optimal rehabilitation goals for people with spinal cord injury (SCI). However, there has been no study systematically determine the RE status and its related factors in Thais with chronic SCI. OBJECTIVE: To cross-sectionally determine RE statuses and their influencing factors in Thais with chronic SCI. METHODS: Data from a Thai arm of the International Spinal Cord Injury Community Survey (InSCI) were analyzed. The prevalence of RE and related work status were described. RESULTS: Of 223 individuals with chronic SCI whose age was less than 60 years included in this study, 79 (35%) were remunerative employed. Most of them (41, 54%) were self-employed. The most common reason for unemployment was related to health conditions or disabilities. Education year, attending vocational rehabilitation service, and admission≥2 times per year were independent influencing factors of RE with an odds ratio of 1.090, 2.534, and 0.418, respectively. CONCLUSION: Since education and vocational rehabilitation were the modifiable positive influencing factor of employment, educational and vocational rehabilitation programs should be formally established and universally applied together with medical rehabilitation to increase the prevalence of RE in people with SCI in Thailand.

OBJECTIVE:The aim of the study is to determine whether a health service system is an independent influencing factor of having pressure injury problems in individuals with chronic spinal cord injury living in three countries. DESIGN:This is a cross-sectional study. METHODS:Data from the International Spinal Cord Injury Community Survey were analyzed. The pressure injury problems were assessed using the Spinal Cord Injury Secondary Condition Scales (dichotomized to "having problem" and "not having problem"). Health service systems were categorized as an inpatient-oriented spinal cord injury-specialized system and a primary care-oriented system. A directed acyclic graph was applied to create a multivariable logistic regression model to determine the independent influencing factors of pressure injury problems. RESULTS:Of 790 included participants, 277 (35%) had pressure injury problems. Being recruited from countries with inpatient-oriented spinal cord injury-specialized systems (model 1) and visiting rehabilitation medicine/spinal cord injury physicians at least once a year (model 2) is an independent negative correlating factor of pressure injury problems (odds ratio = 0.569 [95% confidence interval = 0.374-0.866] and 0.591 [95% confidence interval = 0.405-0.864], respectively). CONCLUSIONS:Spinal cord injury-specialized health service systems might be a protective factor of pressure injury problems in middle-income country contexts. This result suggests the importance of having spinal cord injury-specialized services in middle-income countries to reduce the prevalence of pressure injury problems. TO CLAIM CME CREDITS:Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES:Upon completion of this article, the reader should be able to: (1) Identify the best strategy for managing pressure injury problems in people with spinal cord injury. (2) Describe common methods for determining health service utilization and evaluating secondary health conditions in people with spinal cord injury. (3) Discuss the advantage of having a SCI-specialized rehabilitation system in middleincome countries as a protective factor from having pressure injury problems. LEVEL:Advanced. ACCREDITATION:The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

OBJECTIVE To assess COVID-19 vaccination status among individuals with spinal cord injury (SCI). DESIGN A cross-sectional study. SETTING Twelve hospitals from all regions of Thailand. PARTICIPANTS One hundred and eighty people with SCI were randomly selected from the Thai SCI registry database. INTERVENTION Not applicable. OUTCOME MEASURES The primary outcome, which was the COVID-19 vaccination status, and the secondary outcomes, which were the number of vaccination doses, satisfaction and dissatisfaction aspects, and barriers to vaccination, were recorded using a specifically developed questionnaire over the telephone during February to March 2022. Data were analyzed using descriptive analyses, bivariate, and multivariable analyses. RESULTS Of the 96 people with SCI who were able to respond, the prevalence of receiving at least one dose was 77% but the prevalence of receiving a booster dose was 20%. Being non-traumatic SCI correlated negatively with having received any vaccination doses when compared to traumatic SCI. Most of the participants were satisfied with the government provision of COVID-19 vaccines. The major barriers to vaccination were problems related to a negative attitude toward the vaccination, followed by transportation difficulties and wheelchair-inaccessible vaccination sites. CONCLUSIONS Seventy-seven percent of people with SCI participating in this study received at least one dose of the COVID-19 vaccine, whereas only 20% of them received a booster dose of the COVID-19 vaccination. To increase the prevalence of vaccination, healthcare providers should deliver the fact regarding COVID-19 vaccination to reduce negative attitudes, as well as remove physical barriers to vaccination places for people with SCI.

ObjectivesTo determine whether attending an SCI-specialized rehabilitation facility (SSRF) is independently associated with having fewer secondary health conditions (SHCs) in middle-income country contexts.Study DesignCross-sectional observational study.SettingFour rehabilitation facilities in Thailand (one SSRF and three non-SSRF).MethodsData from a Thai arm of the International Spinal Cord Injury Community Survey (InSCI) were analyzed. SHCs occurring within the last three months were evaluated using the Spinal Cord Injury Secondary Condition Scale. A causal diagram was applied to create a multivariable regression model to determine the independent effect of attending in the SSRF on having SHC as a single condition and as a sum score.ResultsThree hundred and thirteen individuals with chronic SCI were included in this study. Two hundred and nineteen participants (70%) were recruited from the SSRF. Being recruited from the SSRF was an independent negative correlating factor of the SHC sum score with an unstandardized coefficient of -1.12 (95% CI: -2.00-0.24). Being recruited from the SSRF was also an independent negative correlating factor of having bladder dysfunction, sexual dysfunction, and pressure ulcer SHC with an odds ratio of 0.32 (95% CI: 0.16-0.59), 0.43 (95% CI: 0.22-0.84), and 0.46 (95% CI: 0.24-0.89), respectively.ConclusionAttending an SSRF was significantly associated with having fewer SHCs, specifically, bladder dysfunctions, sexual dysfunctions, and pressure ulcers. These results suggest the importance of having SSRF in middle-income countries for delivering effective care to people with SCI and standardized education to health care providers.

BACKGROUND:The impact of bladder care and urinary complications on quality of life in persons with spinal cord injury who have neurogenic lower urinary tract dysfunction has not been elucidated, especially in those living in low-resource countries.METHODS:This multinational cross-sectional survey was conducted in rehabilitation facilities in Malaysia, Indonesia, and Thailand. Community-dwelling adults with traumatic or nontraumatic spinal cord injury participating in the International Spinal Cord Injury Community Survey from 2017 to 2018 were enrolled. Data regarding bladder management/care, presence of bladder dysfunction, urinary tract infection, and quality of life score were extracted from the International Spinal Cord Injury Community Survey questionnaire. The impact of bladder care and urinary complications on quality of life was determined using univariable and multivariable regression analysis.RESULTS:Questionnaires from 770 adults were recruited for analysis. After adjusting for all demographic and spinal cord injury-related data, secondary conditions, as well as activity and participation factors, urinary tract infection was an independent negative predictive factor of quality of life score ( P = 0.007, unstandardized coefficients = -4.563, multivariable linear regression analysis, enter method).CONCLUSIONS:Among bladder care and urinary complication factors, urinary tract infection is the only factor negatively impacting quality of life. These results address the importance of proper bladder management and urinary tract infection prevention in persons with spinal cord injury to improve their quality of life.

Objective: To investigate the prevalence and influencing factors of spinal cord injury (SCI)-related osteoporosis and fragility fractures in Thai people with chronic spinal cord injury.Design: A cross-sectional, observational study.Setting: Outpatient clinic, Department of Rehabilitation Medicine, Maharaj Nakorn Chiang Mai Hospital.Participants: Thais with chronic spinal cord injury (SCI) (duration of injury at least one year).Intervention: Not applicable.Outcome measures: Dual-energy X-ray absorptiometry (DXA) was performed to measure bone mineral density (BMD) at the hip. Analyses were performed to identify risk factors for SCI-related osteoporosis or fragility fracture development. Thai FRAX® score was calculated with and without BMD and compared for each participant.Results: Among 64 Thais with chronic SCI, the prevalence of SCI-related osteoporosis was 43.8%. Female sex, non-ambulatory status, and at least 10 years duration of spinal cord injury increased the risk of having SCI-related osteoporosis. The prevalence of fragility fracture was 9.4%. Female sex, duration of SCI, and being diagnosed with SCI-related osteoporosis increased the risk of having a fragility fracture. Thai FRAX® score without BMD value underestimated the risk of prevalent fracture in 7.8% of participants.Conclusions: SCI-related osteoporosis and fragility fractures are common in Thais with chronic SCI. Our findings emphasize the importance of SCI-related osteoporosis and fragility fracture surveillance in people with chronic SCI regardless of their ethnicity. FRAX® without BMD calculations could underestimate the risk of fragility fracture in people with chronic SCI. Therefore, further studies are needed to develop an SCI-specific fracture-risk assessment tool using risk factors proposed in previous studies and in this study.

Study design Cross-sectional study. Objectives This study aimed to explore and report on health care and rehabilitation service utilization, rehabilitation service benefits, and levels of satisfaction of individuals with spinal cord injury (SCI) living in communities in Thailand. Setting Four rehabilitation facilities in Thailand, two university hospitals (Maharaj Nakorn Chiang Mai Hospital in Chiang Mai Province and Siriraj Hospital in Bangkok), one large provincial hospital (Ratchaburi Hospital in Ratchaburi Province), and one national rehabilitation institute (Sirindhorn National Medical Rehabilitation Institute in Nonthaburi Province). Methods This study was part of the International Spinal Cord Injury Community Survey (InSCI). Individuals with SCI completed a set of questionnaires, then data related to their health care and rehabilitation services were extracted and analyzed. Results Of the 320 participants, most were male (71%), and the majority were living with paraplegia (73%). In cases of mild illnesses where hospitalization was not required, 46% went to a nearby health service hospital. In cases of serious illnesses where hospitalization was required, 39% went to a higher-level hospital. The majority (80%) were satisfied with their experience with health care services. The three top preferred products and services in descending order were wheelchairs and cushions, increased disability pension, medication and medical equipment including bladder relaxants, urinary catheters and urine bags. Conclusions Individuals with SCI living in communities in Thailand preferred treatment at a nearby district hospital for mild illnesses with one-third transferring to a higher-level hospital for serious illnesses. The majority were satisfied with the health care services and rehabilitation services.

Objective: To investigate quality of life (QoL) and its related factors 1-year after discharge from post-stroke inpatient rehabilitation. Methods: This longitudinal study was performed among 9 rehabilitation centres. Quality of life of stroke patients was evaluated using the WHOQOL-BREF. Its scores ranged from 26-130, with a higher score representing better quality of life. The QoL scores at 1-year follow-up were compared with the scores at discharge. Factors related to quality of life at 1-year after discharge were analysed using univariate and multiple linear regression. Results: One hundred and ninety-seven patients were recruited, with a mean age of 62.3 years. The mean quality of life score at 1-year after discharge was significantly lower than the score at discharge. In multiple linear regression analysis, only 5 factors were associated with quality of life, including having a leisure activity, modified Barthel (Activity of Daily Living, ADL) Index (mBI) at follow-up period, need caregiver, anxiety score, and depression score with the regression coefficient (b) of 6.29 (95%CI: 2.23, 10.35), 0.63 (95%CI: 0.07, 1.20), -7.72 (95%CI: -12.04, -3.40), -0.78 (95%CI: -1.40, -0.17), and -1.14 (95% CI: -1.72, -0.57) respectively. Conclusion: At one year after discharge from inpatient rehabilitation, patients with stroke had poorer quality of life. Factors related to poor quality of life included no leisure activity, and need for caregiver, low functional scores at follow-up, anxiety and depression. Strategies to prevent these factors could enhance QoL of stroke patients.

Objectives: To investigate the experience of environmental barriers by people with spinal cord injury (SCI) across 22 countries. Specific aims were to describe and compare the prevalence of environmental barriers experienced across countries, and to analyze determinants of environmental barriers at individual and country level. Design: Cross-sectional community survey. Participants: Individuals (N = 12,591) living with SCI in the community. Interventions: Not applicable. Main Outcome Measure: Nottwil Environmental Factors Inventory-Short Form. Results: Most barriers were experienced in relation to accessibility, climate, transportation, finances, and state services. More severe barriers were experienced in settings with lower gross domestic product (GDP), which especially refers to medical supplies (gamma = -0.38; P<.001) and finances (gamma= -0.37; P<.001) in this study. However, in a multivariable negative binomial regression using within-between estimation of the number of barriers experienced on the selected predictors, the effect of GDP was reversed when it was adjusted for covariates. On the individual level, the number of experienced barriers decreased with better mental health and greater self-care ability. People with low income, with paraplegia, complete lesions, and more health problems reported more barriers. On the country level, fewer barriers were reported in countries with higher average age, better mental health, and greater self-care ability, as well as in those with a higher percentage of traumatic SCI, paraplegia, and complete lesions. More barriers were reported in countries with a higher percentage of married individuals, lower average household income, higher average time since injury, higher mean vitality scores, and greater income inequality. Conclusions: Study participants reported a significant number of environmental bathers, many of which are modifiable. Complementary interventions are recommended. Within and between country effects of covariates sometimes pointed in different directions, suggesting that countries with a different composition of SCI population also differed in environmental contexts. (C) 2020 by the American Congress of Rehabilitation Medicine

STUDY DESIGN:Case study. OBJECTIVE:To present a framework for developing an International Classification of Functioning, Disability and Health (ICF)-based documentation system in spinal cord injury (SCI)-specific rehabilitation. SETTING:Data collection took place at Maharaj Hospital, Thailand. The preparatory studies and analysis were performed at Swiss Paraplegic Research, Switzerland. METHODS:Data collected from interviews and health records of four SCI cases across the continuum of care (acute, post-acute, early and late long term) were linked to ICF categories using established ICF linking rules. The resulting categories were compared with selected ICF sets (ICF Generic-30, ICF core sets for SCI and multiple sclerosis) to determine the extent of coverage. Furthermore, the context of applicable services was described systematically. RESULTS:Less than half of the ICF categories in the defined ICF sets were covered by clinical assessment tools. Low correspondence was found predominantly in acute and late long-term phase. Least well covered were categories of activities and participations and environmental factors. The correspondence of categories increased when considering the additional ICF categories identified from patient interviews. The description of rehabilitation services provided in each case classified according to the dimensions of service provider, funding, and service delivery. CONCLUSIONS:There is a need to promote the systematic and standardized assessment of functioning among health professionals working in the field of SCI in developing countries. This study describes basic steps toward developing a standardized ICF-based system for assessing and reporting functioning outcomes in SCI rehabilitation and across the continuum of care.

During the pandemic of coronavirus disease 2019, it is possible for rehabilitation physicians and personnel to take care of patients with concurrent spinal cord injury and coronavirus disease 2019. Here, we describe a case of acute cervical spinal cord injury resulting in complete tetraplegia C5 American Spinal Injury Association Impairment Scale A with unrecognized, severe acute respiratory syndrome coronavirus 2 infection. This resulted in large-scale quarantines of related surgical and rehabilitation staff, and the unexpected death of the patient despite receiving the treatments according to the standard guideline. Rehabilitation personnel who take care of acute spinal cord injury patients with coronavirus disease 2019 should consider the effect of spinal cord injury on the course of coronavirus disease 2019, the effect of coronavirus disease 2019 and its treatments on the course of spinal cord injury, and risks of severe acute respiratory syndrome coronavirus 2 transmission between patients and rehabilitation staff, to continue providing safe and effective rehabilitation programs.

Introduction It is difficult to diagnose an acute abdomen condition in people with spinal cord injury due to abnormal sensation below the injured level and multiple co-morbidities. These issues can mislead the exact diagnosis and delay proper treatment. Case presentation A 57-year-old male with C4 AIS C tetraplegia developed nausea and vomiting, abdominal distension and feeding intolerance. Serum electrolytes indicated severe hyponatremia. A provisional diagnosis of pseudo-gut obstruction was made. After the failure of 48 h of conservative treatment with a nasogastric and rectal tube, abdominal CT was performed and revealed sigmoid volvulus. Conclusions Due to the inconclusive clinical features and lack of subjective complaints, early use of CT scan or MRI is preferable in people with SCI who are suspected of an emergency intra-abdominal condition.

Study design Prospective cohort study of the Thai Spinal Cord Injury Registry. Objective To determine whether being admitted to a spinal cord injury (SCI) specialized rehabilitation facility (SSRF) is associated with better functional outcomes. Setting Four rehabilitation facilities in Thailand; one a SSRF and the others non-SSRFs. Methods Data from the one SSRF and three non-SSRFs were extracted from the Thai Spinal Cord Injury Registry. Multivariate regression analysis was used to exclude the effect of confounding factors and prove the independent association of SSRF admission with respect to Spinal Cord Independence Measurement (SCIM) at discharge. Results Among the 234 new SCI inpatients enrolled, 167 persons (71%) had been admitted to the SSRF. The SSRF had a greater proportion of persons with AIS A, B, C tetraplegia and people with AIS D, whereas the non-SSRFs had a higher proportion of patients with AIS A, B or C paraplegia. Patients discharged from the SSRF demonstrated a greater SCIM score improvement than those from the non-SSRFs (24.1 vs 17.0; p = 0.003). By using multivariate regression analysis controlling for age, time from injury to rehabilitation, severity of injury and SCIM score on admission, SSRF admission was found to be an independent predictive factor of SCIM score improvement at discharge ( p = 0.008). Conclusion Admission to an SSRF is associated with better rehabilitation outcomes. This finding supports the importance of SSRF access to improve the functional outcome of patients with SCI.

Global mapping project of ISCoS for traumatic spinal cord injury (T-SCI) highlighted paucity of data from low and middle income countries (LMICs). Recognizing this gap, IDAPP study of one year duration was proposed as the first step to develop an International SCI database.Primary objective was to assess database variables, processes involved and web platform for their suitability with a view to provide guidance for a large scale global project. Secondary objective was to capture demographic and selected injury/safety data on patients with T-SCI with a view to formulate prevention strategies.Nine centers from Asia.All patients with T-SCI admitted for first time were included. International SCI Core Data Set and especially compiled Minimal Safety Data Set were used as data elements. Questionnaire was used for feedback from centers.Results showed relevance and appropriateness of processes, data variables and web platform of the study. Ease of entering and retrieval of data from web platform was confirmed. Cost of one year IDAPP study was USD 7780. 975 patients were enrolled. 790 (81%) were males. High falls (n = 513, 52%) as a cause and complete injuries (n = 547, 56%) were more common. There was a higher percentage of thoracic and lumbar injuries (n = 516, 53%).The study confirms that establishing the SCI database is possible using the variables, processes and web platform of the pilot study. It also provides a low cost solution. Expansion to other centers/regions and including non-traumatic SCI would be the next step forward.

Background:Chemodenervation (CD) involves injecting drugs such as phenol, botulinum toxin, or alcohol to reduce muscle spasticity. However, they interfere with daily activities of children with cerebral palsy (CP). Rehabilitation residency training in Thailand currently requires performing a minimum of five CD procedures. However, the effect of this policy on post-training practice is unknown.Objective:To explore the influence of CD training during residency on post-training clinical practice and their current use of it in treating CP patients.Material and Method:The questionnaires were sent to 431 Thai physiatrists nationwide by both electronic and postal mails. The responses were collected within a three-month period.Results:Of 116 (27%) respondents with usable questionnaires, 85 (73%) were trained during their residency to perform CD and 46 (40%) performed it in their practice. Those trained to perform CD were more likely in their subsequent practice to do so (p = 0.0140), and younger age was associated with performing it (p = 0.0055). The number of CD procedures performed during residency correlated directly with reported confidence in performing the procedure in later practice (p<0.0001). The most common reasons for not performing CD were few CP cases in their care, and unavailable equipment or injection agent.Conclusion:Although only a cross-sectional study, the findings suggest that increasing the number of CD procedures required in rehabilitation residency may increase the use of CD to benefit CP patients in future clinical practice.

Purpose To investigate motor recovery of stroke patients 1 year after rehabilitation. Materials and Methods A cross-sectional study of 192 stroke patients discharged from rehabilitation wards in nine tertiary hospitals was conducted. Motor recovery was assessed using the Brunnstrom motor recovery stages (BMRS), at 6 and 12 months after discharge. Factors related to the BMRS of the hand, arm and leg were analyzed. Results The mean age of patients was 62.2 years (57.3% male). Significantly more patients presented improvement of at least one BMRS of the hand, arm and leg compared with those with decreasing BMRS (p < 0.001). The percentage of patients with BMRS III- VI at 6 months was greater than that at discharge, but the recovery at 12 months was slightly higher than that at 6 months. It seems that motor recovery from stroke was near maximal at six months. Regarding the factors related to motor recovery, only lengths of stay (LOS) <30 d during the first admission and Barthel index at discharge ≥10 were related to the improvement of BMRS of the hand, arm and leg on multivariate analysis. Additionally, no complication at discharge was associated with the improvement of BMRS of the leg. Conclusions Approximately half of our stroke patients had motor improvement of at least one stage of BMRS at one year. Motor recovery after stroke at the end of the first year was associated with shorter LOS during the first admission, higher discharge Barthel index score and absence of complications at discharge.

Background:Swallowing problems are a common symptom in patients suffering from stroke. The severity of swallowing problems associate with age, stroke types, and brain lesion. Early recognition of the problem can prevent complications such as aspiration pneumonia, and malnutrition.Objective:To report the prevalence and the long-term outcome of dysphagia in patients with stroke.Material and Method:Data of patients with stroke admitted at nine rehabilitation wards/centers in Thailand were extracted from the Thai Stroke Rehabilitation Registry (TSRR) I and II (1-year follow-up).Results:Of 327 stroke patients [mean age 62 (SD 12) years and male: female = 193:134], 49 (15%) had swallowingdysfunction at admission. Dysphagic patients had significantly more cognitive impairment (TMSE score <24) than non-dysphagic group (p = 0.01). There was no significant difference in age, gender, onset-admission interval, type of stroke, and modified Barthel Index score (mBI) between the two groups. Moreover, there was no relationship between dysphagia and poor functional outcome (mBI ≤12). One year after discharge, only 214 (65.4%) patients returned for follow-up and sevenpatients (3.27%) had swallowing problem.Conclusion:After a stroke attack, about 15% of patients had swallowing dysfunction. Those with cognitive impairment atadmission were more prone to swallowing functions impairment.

Study design: A cross-sectional study.Objectives: To study prevalence of pressure ulcers (PrUs), quality of life (QoL) and effect of wheelchair cushions used by Thai wheelchair users with chronic spinal cord injury (SCI).Setting: Maharaj Hospital, Chiang Mai, Thailand.Methods: Thai chronic SCI wheelchair users, aged over 18 years and non-ambulatory with ASIA impairment scale A, B or C were recruited. They completed the PrUs questionnaire and rated the EuroQoL-5D and their health status with a visual analog scale (VAS). Demographic data of each participant were extracted from medical records. The EQ-5D health states were transformed to utility scores by using the Thai algorithm and the prevalence of PrUs was reported. The EQ-5D, the utility scores and the health status VAS were compared between those with and without current PrUs and between those participants using foam and air-filled cushions.Results: Of 129 participants, 26.4% had current PrUs at the time of the study, 27.9% had healed PrUs and 45.7% never had PrUs. The median VAS score for health status was 70 (Q1=50, Q3=80). Based on the EQ-5D, only one dimension (anxiety/depression) was significantly different between those with and those without current PrUs (P=0.015). Those using an air-filled cushions had a mean utility score four times higher than of those using a foam cushion (0.131 vs 0.032, P=0.089) but not statistically significant.Conclusions: PrUs are still prevalent among Thai wheelchair users with chronic SCI. Anxiety/depression is associated with current ulcers.