Displaying publications 1 - 20 of 75 in total

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  1. Izma MKO, Zulkharnain I, Ramli B, Muhamad AR, Harwant S
    Med J Malaysia, 2003 Mar;58(1):105-10.
    PMID: 14556334
    SCIWORA or Spinal Cord Injury Without Radiological Abnormality; is a pre-MRI term that includes injuries to the spinal cord in the absence of radiological (plain radiographs, tomographs and CT scans) evidence of injury to the spinal column or cord. It occurs in skeletally immature spines because of the inherent plasticity of the bony structures in this age group. The prognosis is dependent on the extent of cord damage, and the role of active management is limited. A high index of suspicion is needed to establish a diagnosis. This diagnostic accuracy can be improved with the free availability of MRI scanning for the spines. We describe three cases of SCIWORA with a minimum follow-up of three years and a review of current literature.
    Matched MeSH terms: Spinal Cord Injuries/pathology*; Spinal Cord Injuries/radiography*; Spinal Cord Injuries/therapy
  2. Hoad W
    Matched MeSH terms: Spinal Cord Injuries
  3. Hamdan PNF, Hamzaid NA, Abd Razak NA, Hasnan N
    J Sport Health Sci, 2022 Nov;11(6):671-680.
    PMID: 33068748 DOI: 10.1016/j.jshs.2020.10.002
    BACKGROUND: Due to its clinically proven safety and health benefits, functional electrical stimulation (FES) cycling has become a popular exercise modality for individuals with spinal cord injury (SCI). Since its inception in 2013, the Cybathlon championship has been a platform for publicizing the potential of FES cycling in rehabilitation and exercise for individuals with SCI. This study aimed to evaluate the contribution of the Cybathlon championship to the literature on FES cycling for individuals with SCI 3 years pre and post the staging of the Cybathlon championship in 2016.

    METHODS: Web of Science, Scopus, ScienceDirect, IEEE Xplore, and Google Scholar databases were searched for relevant studies published between January 2013 and July 2019. The quality of the included studies was objectively evaluated using the Downs and Black checklist.

    RESULTS: A total of 129 articles on FES cycling were retained for analysis. A total of 51 articles related to Cybathlon were reviewed, and 14 articles were ultimately evaluated for the quality. In 2017, the year following the Cybathlon championship, Web of Science cited 23 published studies on the championship, which was almost 5-fold more than that in 2016 (n = 5). Training was most often reported as a topic of interest in these studies, which mostly (76.7%) highlighted the training parameters of interest to participating teams in their effort to maximize their FES cycling performance during the Cybathlon championship.

    CONCLUSION: The present study indicates that the Cybathlon championship in 2016 contributed to the number of literature published in 2017 on FES cycling for individuals with SCI. This finding may contribute to the lessons that can be learned from participation in the Cybathlon and potentially provide additional insights into research in the field of race-based FES cycling.

    Matched MeSH terms: Spinal Cord Injuries*
  4. Koh KB, Vaikunthan R, Sengupta S
    Med J Malaysia, 1988 Sep;43(3):246-9.
    PMID: 3241584
    Matched MeSH terms: Spinal Cord Injuries/etiology*; Spinal Cord Injuries/radiography
  5. Karimi M, Omar AH, Fatoye F
    NeuroRehabilitation, 2014 Jan 1;35(2):325-40.
    PMID: 24990035 DOI: 10.3233/NRE-141124
    Spinal cord injury (SCI), damage to spinal cord, influences the ability of the subjects to stand and walk. Moreover, they have some problems such as osteoporosis, muscle spasm, joint contracture and bowel and bladder function. These subjects use various orthoses and undergo different rehabilitation programmes to restore their ability. It is controversial whether use of aforementioned methods improves the physiological health of SCI individuals and improves their ability to ambulate or not. Therefore, the aim of this review was to investigate the effectiveness of assistive devices to restore their physiological health and their functional ability in patients with SCI.
    Matched MeSH terms: Spinal Cord Injuries/rehabilitation*
  6. Nor Azlin MI, Abd Rahman R, Abdul Karim AK, Sulaiman AS, Mahdy ZA
    J Obstet Gynaecol, 2013 Aug;33(6):631-2.
    PMID: 23919870 DOI: 10.3109/01443615.2013.807781
    Matched MeSH terms: Spinal Cord Injuries*
  7. Suhaida SS, Engkasan JP
    Med J Malaysia, 2012 Dec;67(6):616-7.
    PMID: 23770957 MyJurnal
    A 48-year-old male with complete tetraplegia C6 presented with sweating and flushing of the right half of the face and neck that recurred when lying in supine and left lateral positions. The symptoms subsided immediately upon sitting upright or lying in a right lateral position. The symptoms were associated with occasional mild head discomfort rather than headache and were accompanied by marked elevation of blood pressure, which was 190-200/120-130 mmHg compared to his previous baseline blood pressure of 80-90/50-70 mmHg, and he had a heart rate of 60-70 beats per minute. We believe that post-traumatic syringomyelia, found upon further investigation, was the cause of the Autonomic dysreflexia (AD) in this patient. He was advised to avoid the positions causing the symptoms and the progression of symptoms was monitored regularly. AD might not have been diagnosed in this patient because of the atypical and unusual presentations. Therefore, knowledge and a heightened level of awareness of this possible complication are important when treating individuals with spinal cord injury (SCI).
    Matched MeSH terms: Spinal Cord Injuries*
  8. Patar A, Dockery P, Howard L, McMahon SS
    J Anat, 2019 02;234(2):244-251.
    PMID: 30417349 DOI: 10.1111/joa.12909
    Spinal cord injury (SCI) is a devastating disorder that has a poor prognosis of recovery. Animal models of SCI are useful to understand the pathophysiology of SCI and the potential use of therapeutic strategies for human SCI. Ex vivo models of central nervous system (CNS) trauma, particularly mechanical trauma, have become important tools to complement in vivo models of injury in order to reproduce the sequelae of human CNS injury. Ex vivo organotypic slice cultures (OSCs) provide a reliable model platform for the study of cell dynamics and therapeutic intervention following SCI. In addition, these ex vivo models support the 3R concept of animal use in SCI research - replacement, reduction and refinement. Ex vivo models cannot be used to monitor functional recovery, nor do they have the intact blood supply of the in vivo model systems. However, the ex vivo models appear to reproduce many of the post traumatic events including acute and secondary injury mechanisms. Several well-established OSC models have been developed over the past few years for experimental spinal injuries ex vivo in order to understand the biological response to injury. In this study, we investigated cell viability in three ex vivo OSC models of SCI: stab injury, transection injury and contusion injury. Injury was inflicted in postnatal day 4 rat spinal cord slices. Stab injury was performed using a needle on transverse slices of spinal cord. Transection injury was performed on longitudinal slices of spinal cord using a double blade technique. Contusion injury was performed on longitudinal slices of spinal cord using an Infinite Horizon impactor device. At days 3 and 10 post-injury, viability was measured using dual staining for propidium iodide and fluorescein diacetate. In all ex vivo SCI models, the slices showed more live cells than dead cells over 10 days in culture, with higher cell viability in control slices compared with injured slices. Although no change in cell viability was observed between time-points in stab- and contusion-injured OSCs, a reduction in cell viability was observed over time in transection-injured OSCs. Taken together, ex vivo SCI models are a useful and reliable research tool that reduces the cost and time involved in carrying out animal studies. The use of OSC models provides a simple way to study the cellular consequences following SCI, and they can also be used to investigate potential therapeutics regimes for the treatment of SCI.
    Matched MeSH terms: Spinal Cord Injuries*
  9. Ibitoye MO, Hamzaid NA, Abdul Wahab AK, Hasnan N, Olatunji SO, Davis GM
    Comput Biol Med, 2020 02;117:103614.
    PMID: 32072969 DOI: 10.1016/j.compbiomed.2020.103614
    BACKGROUND AND OBJECTIVE: Using traditional regression modelling, we have previously demonstrated a positive and strong relationship between paralyzed knee extensors' mechanomyographic (MMG) signals and neuromuscular electrical stimulation (NMES)-assisted knee torque in persons with spinal cord injuries. In the present study, a method of estimating NMES-evoked knee torque from the knee extensors' MMG signals using support vector regression (SVR) modelling is introduced and performed in eight persons with chronic and motor complete spinal lesions.

    METHODS: The model was developed to estimate knee torque from experimentally derived MMG signals and other parameters related to torque production, including the knee angle and stimulation intensity, during NMES-assisted knee extension.

    RESULTS: When the relationship between the actual and predicted torques was quantified using the coefficient of determination (R2), with a Gaussian support vector kernel, the R2 value indicated an estimation accuracy of 95% for the training subset and 94% for the testing subset while the polynomial support vector kernel indicated an accuracy of 92% for the training subset and 91% for the testing subset. For the Gaussian kernel, the root mean square error of the model was 6.28 for the training set and 8.19 for testing set, while the polynomial kernels for the training and testing sets were 7.99 and 9.82, respectively.

    CONCLUSIONS: These results showed good predictive accuracy for SVR modelling, which can be generalized, and suggested that the MMG signals from paralyzed knee extensors are a suitable proxy for the NMES-assisted torque produced during repeated bouts of isometric knee extension tasks. This finding has potential implications for using MMG signals as torque sensors in NMES closed-loop systems and provides valuable information for implementing this method in research and clinical settings.

    Matched MeSH terms: Spinal Cord Injuries*
  10. Abd Aziz M, Hamzaid NA, Hasnan N
    J Vis Exp, 2022 Nov 11.
    PMID: 36440840 DOI: 10.3791/63149
    Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of arm support, in particular, is a significant assistive factor while executing SitTS movement in SCI population. In addition, the application of functional electrical stimulation (FES) onto quadriceps and gluteus maximus muscles is one of the prescribed management for incomplete SCI to improve muscle action for simple lower limb movements. However, the relative contribution of upper and lower extremities during SitTS has not been thoroughly investigated. Two motor incomplete SCI paraplegics performed repetitive SitTS to fatigue exercise challenge. Their performance was investigated as a mixed-method case-control study comparing SitTS with and without the assistance of FES. Three sets of SitTS tests were completed with 5-min resting period allocated in between sets, with mechanomyography (MMG) sensors attached over the rectus femoris muscles bilaterally. The exercise was separated into 2 sessions; Day 1 for voluntary SitTS and Day 2 for FES-assisted SitTS. Questionnaires were conducted after every session to gather the participants' input about their repetitive SitTS experience. The analysis confirmed that a SitTS cycle could be divided into three phases; Phase 1 (Preparation to stand), Phase 2 (Seat-off), and Phase 3 (Initiation of hip extension), which contributed to 23% ± 7%, 16% ± 4% and 61% ± 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs' Medical Research Council (MRC) muscle grade. In particular, the applied arm forces start to increase clearly when the leg forces start to decline during standing. This finding is supported by the significantly reduced MMG signal indicating leg muscle fatigue and their reported feeling of tiredness.
    Matched MeSH terms: Spinal Cord Injuries*
  11. Mat Rosly M, Mat Rosly H
    Physiother Theory Pract, 2023 Jan;39(1):208-218.
    PMID: 34842507 DOI: 10.1080/09593985.2021.2001881
    INTRODUCTION: Exergaming is a type of serious game that requires active bodily movements for video gameplay. This game-based exercise is gaining interest as a form of leisure activity of moderate-vigorous dose intensity.

    OBJECTIVE: This case report sought to assess the effects of exergaming training (i.e. Move Boxing, Move Tennis, and Move Gladiator Duel) on aerobic capacity, feasibility, enjoyment and motivation in two individuals with spinal cord injury (SCI).

    CASE DESCRIPTIONS: Two males with SCI at the level of L4 and T10, aged 32 and 39, respectively, underwent home-based exergaming training sessions over a period of 12-18 weeks, conducted within moderate-vigorous intensity training zones for health improvements as recommended by health guidelines. Their peak oxygen consumption (VO2), physical activity levels and perceived enjoyment were evaluated before, during and after the completion of the training.

    OUTCOMES: Participant peak VO2 improved (effect size g = 2.7) from their baseline values (Participant A: 16.0 ± 0.7 mL/kg/min to 41.7 ± 8.1 mL/kg/min; Participant B: 13.5 ± 0.8 mL/kg/min to 32.7 ± 5.2 mL/kg/min), with an increase in overall weekly physical activity levels. Both participants maintained a relatively high level of enjoyment scores throughout their training period (mean: 31.9 ± 3.2, p = .56, 95% CI 0.22-1.0).

    CONCLUSION: A home-based exergaming training program improved aerobic capacity and level of physical activity, while maintaining adherence to the exercise within a relatively high perception of enjoyment for these two participants. The relatively high enjoyment scores maintained throughout the duration of the exergaming training period suggested its feasibility as a home-based exercise program and perceived as enjoyable by these individuals.

    Matched MeSH terms: Spinal Cord Injuries*
  12. Hamdan PNF, Hamzaid NA, Hasnan N, Abd Razak NA, Razman R, Usman J
    Sci Rep, 2024 Mar 18;14(1):6451.
    PMID: 38499594 DOI: 10.1038/s41598-024-56955-w
    Literature has shown that simulated power production during conventional functional electrical stimulation (FES) cycling was improved by 14% by releasing the ankle joint from a fixed ankle setup and with the stimulation of the tibialis anterior and triceps surae. This study aims to investigate the effect of releasing the ankle joint on the pedal power production during FES cycling in persons with spinal cord injury (SCI). Seven persons with motor complete SCI participated in this study. All participants performed 1 min of fixed-ankle and 1 min of free-ankle FES cycling with two stimulation modes. In mode 1 participants performed FES-evoked cycling with the stimulation of quadriceps and hamstring muscles only (QH stimulation), while Mode 2 had stimulation of quadriceps, hamstring, tibialis anterior, and triceps surae muscles (QHT stimulation). The order of each trial was randomized in each participant. Free-ankle FES cycling offered greater ankle plantar- and dorsiflexion movement at specific slices of 20° crank angle intervals compared to fixed-ankle. There were significant differences in the mean and peak normalized pedal power outputs (POs) [F(1,500) = 14.03, p 
    Matched MeSH terms: Spinal Cord Injuries*
  13. Ramakrishnan K, Chung TY, Hasnan N, Abdullah SJ
    Spinal Cord, 2011 Jul;49(7):812-6.
    PMID: 21221119 DOI: 10.1038/sc.2010.186
    STUDY DESIGN: Cross-sectional survey.
    OBJECTIVES: To determine the employment outcomes of persons with spinal cord injury (SCI) and to investigate the impact of various demographic, injury-related and work-related variables on these outcomes.
    SETTING: People living with SCI in Malaysia who are members of a disability support organization.
    METHODS: A total of 84 members of the Malaysian Spinal Injury Association, who have had traumatic SCI for at least 2 years and were between 15 and 64 years of age at the time of study, were interviewed through phone using a questionnaire to identify the association between demographic, injury-related and work-related variables and employment outcomes.
    RESULTS: The return to work rate in this study was 57.1% (employed at the time of study). The overall employment rate after SCI was 76.2% (worked at some point after injury). Those who were younger at time of injury (<20 years of age), able to drive a modified vehicle, independent in personal care and mobility were positively related to being employed. On the other hand, being hospitalized in the preceding 1 year and receiving financial incentives were negatively related to employment.
    CONCLUSION: Functional independence, especially ability to drive, was strongly associated with return to work and should be one of the priority goals of comprehensive rehabilitation of persons with SCI. The negative impact of recent hospitalization as well as financial compensation needs to be probed further.
    Matched MeSH terms: Spinal Cord Injuries/economics; Spinal Cord Injuries/epidemiology*; Spinal Cord Injuries/rehabilitation*
  14. Anjum A, Yazid MD, Fauzi Daud M, Idris J, Ng AMH, Selvi Naicker A, et al.
    Int J Mol Sci, 2020 Oct 13;21(20).
    PMID: 33066029 DOI: 10.3390/ijms21207533
    Spinal cord injury (SCI) is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions. Its pathophysiology comprises acute and chronic phases and incorporates a cascade of destructive events such as ischemia, oxidative stress, inflammatory events, apoptotic pathways and locomotor dysfunctions. Many therapeutic strategies have been proposed to overcome neurodegenerative events and reduce secondary neuronal damage. Efforts have also been devoted in developing neuroprotective and neuro-regenerative therapies that promote neuronal recovery and outcome. Although varying degrees of success have been achieved, curative accomplishment is still elusive probably due to the complex healing and protective mechanisms involved. Thus, current understanding in this area must be assessed to formulate appropriate treatment modalities to improve SCI recovery. This review aims to promote the understanding of SCI pathophysiology, interrelated or interlinked multimolecular interactions and various methods of neuronal recovery i.e., neuroprotective, immunomodulatory and neuro-regenerative pathways and relevant approaches.
    Matched MeSH terms: Spinal Cord Injuries/metabolism*; Spinal Cord Injuries/pathology; Spinal Cord Injuries/therapy
  15. Mat Rosly M, Halaki M, Hasnan N, Mat Rosly H, Davis GM, Husain R
    Spinal Cord, 2018 08;56(8):806-818.
    PMID: 29410495 DOI: 10.1038/s41393-018-0068-0
    STUDY DESIGN: Cross-sectional.
    OBJECTIVES: An epidemiological study describing leisure time physical activities (LTPA) and the associations of barriers, sociodemographic and injury characteristics to moderate-vigorous aerobic exercise participation among individuals with spinal cord injury (SCI) in a developing Southeast Asian country.
    SETTING: SCI community in Malaysia.
    METHODS: The study sample consisted of 70 participants with SCI. Questionnaires were distributed containing an abbreviated Physical Activity Scale for Individuals with Physical Disabilities (items 2-6) and the Barriers to Exercise Scale using a 5-tier Likert format. Statistical analyses were χ2 tests, odds ratios, and binary forward stepwise logistic regression to assess the association and to predict factors related to participation in moderate-vigorous intensity aerobic exercise (items 4 and 5).
    RESULTS: Seventy-three percent of the study sample did not participate in any form of moderate or vigorous LTPA. The top three barriers to undertaking LTPA (strongly agree and agree descriptors) were expensive exercise equipment (54%), pain (37%) and inaccessible facilities (36%). Participants over the age of 35 years, ethnicity, health concerns, perceiving exercise as difficult and indicating lack of transport were significantly different (p 
    Matched MeSH terms: Spinal Cord Injuries/epidemiology*; Spinal Cord Injuries/physiopathology; Spinal Cord Injuries/psychology; Spinal Cord Injuries/rehabilitation
  16. Ooi AL, Julia PE
    Spinal Cord, 2011 Dec;49(12):1203-5.
    PMID: 21788957 DOI: 10.1038/sc.2011.81
    Case report.
    Matched MeSH terms: Spinal Cord Injuries/complications*
  17. Das AK, Gopurappilly R, Parhar I
    Curr Stem Cell Res Ther, 2011 Jun;6(2):93-104.
    PMID: 21190537
    Spinal cord injuries (SCIs) are a common form of trauma that leaves a huge trail of morbidity and human suffering in its wake. They occur mostly among the young, causing severe physical, psychological, social and economic burdens. The treatment of this condition has rather been disappointing; most of the management strategies being mainly supportive and prophylactic. In recent years there has been an emerging interest in the use of stem cells to regenerate the nervous tissue that has been damaged or lost. Although there has been much hype and unfounded hope, modest successes have been witnessed, and it is possible that these therapeutic strategies may have much more to offer in the future. This paper will review the current strategies of exploring cell-based therapies, mainly different types of stem cells to treat SCI along with the evidence that has been accumulated over the past decade in a rational bench-to-bedside approach. Furthermore, critical aspects such as the mode of delivery and ethical considerations are also discussed along with feasible suggestions for future translational research to provide a contextual picture of the current state of advancements in this field. The impediments to regeneration in the site of injury are briefly explained along with the benefits and drawbacks of different cell types used in the treatment of this condition. We hope that this review will offer a significant insight into this challenging clinical condition.
    Matched MeSH terms: Spinal Cord Injuries/therapy*
  18. Ibitoye MO, Hamzaid NA, Hasnan N, Abdul Wahab AK, Davis GM
    PLoS One, 2016;11(2):e0149024.
    PMID: 26859296 DOI: 10.1371/journal.pone.0149024
    BACKGROUND: Rapid muscle fatigue during functional electrical stimulation (FES)-evoked muscle contractions in individuals with spinal cord injury (SCI) is a significant limitation to attaining health benefits of FES-exercise. Delaying the onset of muscle fatigue is often cited as an important goal linked to FES clinical efficacy. Although the basic concept of fatigue-resistance has a long history, recent advances in biomedical engineering, physiotherapy and clinical exercise science have achieved improved clinical benefits, especially for reducing muscle fatigue during FES-exercise. This review evaluated the methodological quality of strategies underlying muscle fatigue-resistance that have been used to optimize FES therapeutic approaches. The review also sought to synthesize the effectiveness of these strategies for persons with SCI in order to establish their functional impacts and clinical relevance.

    METHODS: Published scientific literature pertaining to the reduction of FES-induced muscle fatigue was identified through searches of the following databases: Science Direct, Medline, IEEE Xplore, SpringerLink, PubMed and Nature, from the earliest returned record until June 2015. Titles and abstracts were screened to obtain 35 studies that met the inclusion criteria for this systematic review.

    RESULTS: Following the evaluation of methodological quality (mean (SD), 50 (6) %) of the reviewed studies using the Downs and Black scale, the largest treatment effects reported to reduce muscle fatigue mainly investigated isometric contractions of limited functional and clinical relevance (n = 28). Some investigations (n = 13) lacked randomisation, while others were characterised by small sample sizes with low statistical power. Nevertheless, the clinical significance of emerging trends to improve fatigue-resistance during FES included (i) optimizing electrode positioning, (ii) fine-tuning of stimulation patterns and other FES parameters, (iii) adjustments to the mode and frequency of exercise training, and (iv) biofeedback-assisted FES-exercise to promote selective recruitment of fatigue-resistant motor units.

    CONCLUSION: Although the need for further in-depth clinical trials (especially RCTs) was clearly warranted to establish external validity of outcomes, current evidence was sufficient to support the validity of certain techniques for rapid fatigue-reduction in order to promote FES therapy as an integral part of SCI rehabilitation. It is anticipated that this information will be valuable to clinicians and other allied health professionals administering FES as a treatment option in rehabilitation and aid the development of effective rehabilitation interventions.

    Matched MeSH terms: Spinal Cord Injuries/physiopathology*
  19. Ramli N, Merican AM, Lim A, Kumar G
    Eur Radiol, 2001;11(10):2011-4.
    PMID: 11702136
    Brown-Sequard syndrome (BSS) is a unilateral cord injury characterised by an ipsilateral motor deficit with contralateral pain and temperature hypoaesthesia. Although there are a variety of causes, the majority of cases are generally of neoplastic origin or are traumatic in origin. We describe a rare cause of Brown-Sequard syndrome as a result of post-traumatic arachnoiditis. Magnetic resonance imaging with the use of thin-slice high-resolution constructive interference in steady state (CISS) and T2-weighted spin-echo sequence were used to demonstrate the cause and appearance of the lesion in the spinal canal and was useful in the assessment and management of the patient. This case illustrates the usefulness of the CISS sequence in MRI for elucidating arachnoiditis.
    Matched MeSH terms: Spinal Cord Injuries/complications*
  20. Bibi S, Rasmussen P, McLiesh P
    Int J Orthop Trauma Nurs, 2018 Aug;30:31-38.
    PMID: 29934253 DOI: 10.1016/j.ijotn.2018.05.002
    BACKGROUND: Nurses are involved in delivering care for patients following acute traumatic spinal cord injury throughout the entire care journey. An injury of this type is significant for the individual and their family and can be challenging for nurses delivering care for patients with life changing injuries, especially for nurses new to this setting. There is a lack of research that examines the experience of nurses caring for these patients in the acute setting.

    METHOD: A hermeneutic phenomenological approach was used to understand the experience of nurses caring for patients in the acute setting who had sustained a traumatic spinal injury with associated neurological deficit. Using the phenomenological approach guided by the insight of Gadamer and Max Van Manen, participants with a broad range of experience were recruited and interviewed. The responses were transcribed into a text and subjected to hermeneutic analysis. Burnard's (1991) 14-step process and the hermeneutic approach were used to interpret and understand the phenomenon of interest.

    CONCLUSION: The study highlights the experience and challenges of providing care to these individuals. Although patients had significant physical disabilities and were often dependent physically, the nurses' concerns were directed more towards fulfilling their psychological needs. Nurses identified grieving patients and felt their role was to provide realistic hope to motivate them. They felt an internal tension regarding desensitisation towards their patients, but this was often an internal protective mechanism to deal with the significance of the events surrounding these patients. Nurses new to this setting took time to learn the routines and manage the unique challenges effectively. Caring for these patients gave the nurses the opportunity to understand their patients and their families, and appreciate that both groups will fluctuate in their behavior throughout the acute process, as they adjust to grief and loss.

    Matched MeSH terms: Spinal Cord Injuries/nursing*
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