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Abou L, Rice LA. The associations of functional independence and quality of life with sitting balance and wheelchair skills among wheelchair users with spinal cord injury. J Spinal Cord Med 2024; 47:361-368. [PMID: 35389324 PMCID: PMC11044718 DOI: 10.1080/10790268.2022.2057721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT/OBJECTIVE To examine the associations of functional independence and quality of life (QOL) with sitting balance and wheelchair skills among individuals living with Spinal Cord Injury (SCI) who use a wheelchair full time. METHODS Secondary data analysis of a total of 59 wheelchair users living with SCI. Eighteen individuals were included in all analyses involving sitting balance. Demographics information and characteristics of SCI were collected through a survey. Participants reported their wheelchair skills performance, confidence, and capacity; functional independence; and QOL using the Wheelchair Skills Test Questionnaire (WST-Q) 5.0, Spinal Cord Independence Measure (SCIM III), and World Health Organization QOL (WHOQOL-BREF), respectively. Sitting balance was assessed remotely using the Function in Sitting Test (FIST). Correlations between variables were analyzed using the Spearman rank correlation test. RESULTS All the measures of SCIM III (total, selfcare, and mobility) correlated with the FIST (ρ = 0.52-0.66, p < 0.01 and p < 0.05). SCIM III-Mobility correlated with WST-performance, capacity, and confidence (ρ = 0.38-0.51, p < 0.01). WHOQOL-physical health and environment significantly correlated with WST-capacity and confidence (ρ = 0.26-0.33, p < 0.05). The FIST, WST-Performance, and level of injury did not correlate with any WHOQOL domain. CONCLUSIONS Lower functional independence and mobility are associated with poor sitting balance and poor wheelchair skills. Higher QOL may be associated with higher wheelchair skills. Future research is warranted to examine these relationships longitudinally to establish causality.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Laura A. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Loni E, Moein S, Bidhendi-Yarandi R, Akbarfahimi N, Layeghi F. Changes in functional independence after inpatient rehabilitation in patients with spinal cord injury: A simultaneous evaluation of prognostic factors. J Spinal Cord Med 2024; 47:369-378. [PMID: 35485922 PMCID: PMC11044766 DOI: 10.1080/10790268.2022.2064264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the improvements of functional independence following inpatient rehabilitation and compare those improvements between different levels and severities of Spinal Cord Injury (SCI). Prognostic factors affecting the patient's outcomes were also studied. SETTINGS Rofeideh Rehabilitation Hospital. OUTCOME MEASURES Spinal Cord Independence Measure version III (SCIM III), and Functional Independence Measure (FIM). METHOD In this retrospective cohort study, 180 patients with SCI were enrolled to record their functional independence upon admission and discharge, and the changes were compared between different levels and severities of injury using non-parametric tests. The prognostic factors of outcomes were studied by generalized estimating equation (GEE) analysis. RESULTS The independence changes were significant for all the severities (American Spinal Injury Association Impairment Scale (AIS)) and levels of injury except for the patients with AIS A and B at upper cervical levels (P < 0.05). The level of injury, AIS, Length of Stay (LOS), and pressure ulcer had a significant prognostic value on patient's outcomes. Furthermore, there was a significant difference between different levels of injury with the same AIS grade in functional improvement (P < 0.05), while there was a significant difference between AIS groups with the same level of injury only at upper and middle cervical lesions (P < 0.05). CONCLUSION Recording the values of functional independence before and after rehabilitation in individuals with SCI can help clinicians approximately expect the outcomes of future patients. Moreover, a deeper study of the prognostic factors can provide a more logical expectation of rehabilitation outcomes.
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Affiliation(s)
- Elham Loni
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Clinical Research Development Center of Rofeideh Rehabilitation Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sahel Moein
- Clinical Research Development Center of Rofeideh Rehabilitation Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nazila Akbarfahimi
- Department of Occupational Therapy, Rofeideh Rehabilitation Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereydoun Layeghi
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Clinical Research Development Center of Rofeideh Rehabilitation Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Mputu Mputu P, Beauséjour M, Richard-Denis A, Fallah N, Noonan VK, Mac-Thiong JM. Classifying clinical phenotypes of functional recovery for acute traumatic spinal cord injury. An observational cohort study. Disabil Rehabil 2024:1-8. [PMID: 38390856 DOI: 10.1080/09638288.2024.2320267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Identify patient subgroups with different functional outcomes after SCI and study the association between functional status and initial ISNCSCI components. METHODS Using CART, we performed an observational cohort study on data from 675 patients enrolled in the Rick-Hansen Registry(RHSCIR) between 2014 and 2019. The outcome was the Spinal Cord Independence Measure (SCIM) and predictors included AIS, NLI, UEMS, LEMS, pinprick(PPSS), and light touch(LTSS) scores. A temporal validation was performed on data from 62 patients treated between 2020 and 2021 in one of the RHSCIR participating centers. RESULTS The final CART resulted in four subgroups with increasing totSCIM according to PPSS, LEMS, and UEMS: 1)PPSS < 27(totSCIM = 28.4 ± 16.3); 2)PPSS ≥ 27, LEMS < 1.5, UEMS < 45(totSCIM = 39.5 ± 19.0); 3)PPSS ≥ 27, LEMS < 1.5, UEMS ≥ 45(totSCIM = 57.4 ± 13.8); 4)PPSS ≥ 27, LEMS ≥ 1.5(totSCIM = 66.3 ± 21.7). The validation model performed similarly to the original model. The adjusted R-squared and F-test were respectively 0.556 and 62.2(P-value <0.001) in the development cohort and, 0.520 and 31.9(P-value <0.001) in the validation cohort. CONCLUSION Acknowledging the presence of four characteristic subgroups of patients with distinct phenotypes of functional recovery based on PPSS, LEMS, and UEMS could be used by clinicians early after tSCI to plan rehabilitation and establish realistic goals. An improved sensory function could be key for potentiating motor gains, as a PPSS ≥ 27 was a predictor of a good function.
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Affiliation(s)
- Pascal Mputu Mputu
- Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Marie Beauséjour
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
- CHU Sainte-Justine, Montreal, Canada
| | - Andréane Richard-Denis
- Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montreal, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
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Kato C, Uemura O, Sato Y, Tsuji T. Functional Outcome Prediction After Spinal Cord Injury Using Ensemble Machine Learning. Arch Phys Med Rehabil 2024; 105:95-100. [PMID: 37714506 DOI: 10.1016/j.apmr.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/13/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES To establish a machine learning model to predict functional outcomes after SCI with Spinal Cord Independence Measure (SCIM) using features present at the time of rehabilitation admission. STUDY DESIGN A retrospective, single-center study. The following data were collected from the medical charts: age, sex, acute length of stay (LOS), level of injury, American Spinal Injury Association Impairment Scale (AIS), motor scores of each key muscle, Upper Extremity Motor Score (UEMS), Lower Extremity Motor Score (LEMS), SCIM total scores, and subtotal scores on admission and discharge. Based on the multivariate linear regression analysis, age, acute LOS, UEMS, LEMS, and SCIM subtotal scores were selected as features for machine learning algorithms. Random forest, support vector machine, neural network, and gradient boosting were used as the base models and combined using ridge regression as a metamodel. SETTING A spinal center in Tokyo, Japan. PARTICIPANTS Participants were individuals with SCI admitted to our hospital from March 2016 to October 2021 for the first rehabilitation after the injury. They were divided into 2 groups: training (n=140) and testing (n=70). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The root-mean-square error (RMSE), R2, and Mean Absolute Error (MAE) were used as accuracy measures. RESULTS RMSE, R2, and MAE of the meta-model using the testing group were 9.7453, 0.8835, and 7.4743, respectively, outperforming any other single base model. CONCLUSIONS Our study revealed that functional prognostication could be achieved using machine-learning methods with features present at the time of rehabilitation admission. Goals can be set at the beginning of rehabilitation. Moreover, our model can be used to evaluate advanced medical treatments, such as regenerative medicine.
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Affiliation(s)
- Chihiro Kato
- National Hospital Organization Murayama Medical Center, Tokyo, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Osamu Uemura
- National Hospital Organization Murayama Medical Center, Tokyo, Japan.
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Kato C, Uemura O, Sato Y, Tsuji T. Decision Tree Analysis Accurately Predicts Discharge Destination After Spinal Cord Injury Rehabilitation. Arch Phys Med Rehabil 2024; 105:88-94. [PMID: 37714507 DOI: 10.1016/j.apmr.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/13/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES To predict discharge destination after spinal cord injury (SCI) rehabilitation. STUDY DESIGN A retrospective, single-center study. We collected the following data from medical charts: age, sex, living arrangement before injury, acute length of stay (LOS), level of injury on admission, American Spinal Injury Association Impairment Scale (AIS) on admission, Upper Extremity Motor Score (UEMS) on admission, Lower Extremity Motor Score on admission (LEMS), Spinal Cord Independence Measure (SCIM) scores on admission and discharge, and discharge destination. A decision tree algorithm was used to establish prediction models in a train-test split manner using features on admission or discharge. SETTING A spinal center in Tokyo, Japan. PARTICIPANTS Participants were individuals with SCI admitted to our hospital from March 2016 to October 2021 for the first rehabilitation after the injury. The study included 210 participants divided into 2 groups: training (n=140) and testing (n=70). Random sampling without replacement was used. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Prediction accuracy was evaluated with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (AUC). RESULTS AIS was significantly different between the groups. The prediction model using total SCIM scores on discharge (D-Classification and Regression Tree [CART]) revealed that a cut-off value of 40 accurately predicted the discharge destination. In contrast, the prediction model using features on admission (A-CART) revealed that subtotal SCIM mobility scores of 5, age of 74 years, and UEMS of 23 were significant predictors. Sensitivity, specificity, PPV, NPV, and AUC of D-CART and A-CART were 0.837, 0.810, 0.911, 0.680, and 0.832 and 0.857, 0.810, 0.913, 0.708, and 0.869, respectively. CONCLUSIONS D-CART and A-CART showed comparable prediction accuracies. This suggests that, even during the early stages of rehabilitation, it is possible to predict the discharge destination.
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Affiliation(s)
- Chihiro Kato
- National Hospital Organization Murayama Medical Center, Tokyo, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Osamu Uemura
- National Hospital Organization Murayama Medical Center, Tokyo, Japan.
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Paglierani P, Marani M, Maietti E, Kiekens C, Negrini S, Baroncini I. Prognostic validity of trunk control scales for mobility in individuals with motor complete thoracic SCI: a prospective cohort study. Spinal Cord 2023; 61:529-535. [PMID: 37648753 DOI: 10.1038/s41393-023-00929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To investigate the sensitivity to change and prognostic validity of Trunk Control Test (TCT) and Thoracic-Lumbar Control Scale (TLC) in terms of mobility in persons with motor complete thoracic spinal cord injury (SCI). SETTING Participants were recruited at an Italian SCI rehabilitation facility from October 2015 to January 2020. METHODS Inclusion criteria were acute traumatic or non-traumatic event and T1-L1 neurological level. Trunk control and mobility were assessed at baseline, discharge, and at 6 and 18-month follow-ups. Mobility was measured using Spinal Cord Independence Measure III mobility subscale. Linear regression models were used to analyze changes in trunk control and mobility over time, and the relationship between these measures. RESULTS The 39 participants were predominantly male, with a mean age of 38 years. Trunk control improved during rehabilitation, at 6-month follow-up, and remained stable thereafter, according to TCT and TLC scales. A higher baseline TCT score was associated with improvements in mobility at discharge and at follow-ups. Baseline TLC score and its change during rehabilitation were unrelated with changes in mobility. CONCLUSIONS Results suggest that the TCT and TLC scales are useful to capture changes in trunk control during the acute and subacute phases. Improvements in functional mobility are however associated with TCT score only, suggesting the potential of this test as a useful prognostic indicator. Further research with larger sample sizes is warranted to determine whether these findings are consistent across neurological level strata.
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Affiliation(s)
| | | | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Abou L, Rice LA. Predictors of participation enfranchisement of wheelchair users with spinal cord injury in the United States. J Spinal Cord Med 2023; 46:789-797. [PMID: 35749681 PMCID: PMC10446797 DOI: 10.1080/10790268.2022.2087336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
CONTEXT/OBJECTIVE To investigate predictors of participation enfranchisement of individuals living with spinal cord injury (SCI) who use a wheelchair full-time. DESIGN Secondary data analysis of a cross-sectional study. SETTING Community, United States. PARTICIPANTS Participants were 59 wheelchair users (median age of 52.5 years, IQR = 21) with chronic SCI (>1 year after injury). INTERVENTIONS No intervention. MAIN OUTCOME MEASURES Participation enfranchisement was measured using the enfranchisement scale of the Community Participation Indicators (CPI). Dependent variables included importance of participation (CPI-Importance) and control over participation (CPI-Control) subscales of the CPI. Independent variables included demographics and clinical characteristics (age, sex, time since injury, level of injury), wheelchair skills, mobility level, symptoms of depression, and environmental barriers. Backward multivariable linear regression analyses were carried-out to identify predictors of CPI-Importance and CPI-Control. RESULTS Five predictors including mobility level, wheelchair skills, sex, level of injury, and symptoms of depression explained 57% (F = 14; P < 0.01) of the variance in CPI-Importance. Three predictors including mobility level, symptoms of depression, and environmental barriers explained 60% (F = 27; P < 0.01) of the variance in CPI-Control. CONCLUSION This study provides evidence of potential modifiable factors such as mobility, wheelchair skills, environmental barriers, and symptoms of depression that can influence importance of participation and control over participation of wheelchair users with SCI. The models presented in this study can serve as a conceptual framework to design effective interventions to improve participation enfranchisement of wheelchair users with SCI.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Laura A. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Kim RY, Thielen CC, Heydeman G, Mulcahey MJ. Standardized administration and scoring guidelines for the Spinal Cord Independence Measure Version 3.0 (SCIM-III). Spinal Cord 2023; 61:296-306. [PMID: 36966259 DOI: 10.1038/s41393-023-00891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/22/2023] [Accepted: 03/10/2023] [Indexed: 03/27/2023]
Abstract
STUDY DESIGN Qualitative studies. OBJECTIVE To develop clear and specific administration and scoring procedures for the Spinal Cord Independence Measure Version 3.0 as a performance-based and interview assessment. SETTING Research lab. METHODS Modified Delphi Technique survey methods were used in this study. Previously developed SCIM-III administration and scoring procedures for performance-based and interview versions were presented to clinicians experienced in SCI and SCIM-III using the Qualtrix (Qualtrics, Provo, UT) online survey platform. Summary and descriptive statistics were used to assess the percent agreement survey responses. RESULTS Three survey rounds were necessary to achieve 80% agreement or above for the performance-based version. Two survey rounds were necessary to achieve 80% agreement or above on the interview version. CONCLUSIONS This study describes the development of standardized administration and scoring procedures for the self-care and mobility sub-scales of the SCIM-III as a performance-based and interview version.
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Affiliation(s)
- Rachel Y Kim
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Christina Calhoun Thielen
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - M J Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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Oraee-Yazdani S, Tavanaei R, Rezaee-Naserabad SS, Khannejad S, Alizadeh Zendehrood S, Yazdani KO, Zali A. Safety and Potential Efficacy of Selective Dorsal Rhizotomy in Adults with Spinal Cord Injury-Induced Spasticity: An Open-Label, Non-Randomized, Single-Arm Trial. World Neurosurg 2023; 170:e806-e816. [PMID: 36460198 DOI: 10.1016/j.wneu.2022.11.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Despite the abundant literature on the use of selective dorsal rhizotomy (SDR) in spastic cerebral palsy, no investigation has evaluated its use in adult patients with chronic spinal cord injury (SCI)-induced spasticity. The present investigation aimed to evaluate the safety and potential efficacy of SDR in chronic SCI-induced spasticity for the first time. METHODS In this open-label, single-arm, non-randomized clinical trial, all patients were assigned to the single study intervention arm and underwent SDR. The primary outcome measure was the safety profile of SDR. Secondary outcome measures were Modified Ashworth Scale, Penn Spasm Frequency Scale, visual analog scale for spasticity, Spinal Cord Injury Spasticity Tool, Spinal Cord Independence measure version III, and Short Form 36 Health Survey Questionnaire. RESULTS Six patients with cervical SCI and 4 with thoracic SCI were allocated to the single study intervention arm. No adverse event attributable to the SDR was found. Moreover, all secondary outcome measures of the study improved significantly over the study period (P < 0.001). Multiple regression analysis also found a significant association between level of injury and changes in average Modified Ashworth Scale scores (P = 0.041), Spinal Cord Injury Spasticity Tool score (P = 0.013), and Spinal Cord Independence measure version III total (P = 0.002) and mobility domain scores (P = 0.004) at 12-month postoperatively. CONCLUSIONS This clinical trial indicated that SDR is a safe and potentially effective procedure in patients with severe and intractable SCI-induced spasticity. However, future clinical trials with larger sample sizes and adequate power are required to validate our findings regarding efficacy.
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Affiliation(s)
- Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Roozbeh Tavanaei
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Saeed Rezaee-Naserabad
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samin Khannejad
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Alizadeh Zendehrood
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Oraii Yazdani
- Department of cardiovascular diseases, Zahedan University of Medical Science, Zahedan, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Amatachaya S, Khamnon N, Wattanapan P, Wiyanad A, Thaweewannakij T, Namwong W. Reference Values and Cutoff Scores of the Spinal Cord Independence Measure III to Determine Independence for Wheelchair Users and Ambulatory Individuals With Spinal Cord Injury. Arch Phys Med Rehabil 2023; 104:83-89. [PMID: 36228763 DOI: 10.1016/j.apmr.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/13/2022] [Accepted: 09/07/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To establish the reference values and optimal cutoff scores of the Spinal Cord Independence Measure Version III (SCIM III) to indicate independence of wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI). DESIGN A cross-sectional study. SETTING Tertiary rehabilitation center and communities. PARTICIPANTS A total of 309 (168 WU and 141 AM) participants with SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) SCIM III scores. RESULTS Participants with greater levels of independence had significantly higher SCIM III scores, both total and subitem scores (P<.05). The SCIM III scores of ≥55 and ≥75 were optimal indicators of modified independence in WU and AM individuals, respectively (sensitivity and specificity >93%, AUC>.95). In addition, scores of 90 were proved to be excellent indicators for independence of AM individuals (sensitivity 94%, specificity 100%, AUC=.99). CONCLUSIONS The present findings provide the reference values of SCIM III scores covering WU and AM individuals with SCI at various levels of independence as well as optimal cutoff scores to indicate independence of these individuals. These data can be used as standard criteria for data comparison with patients' ability, and target functional values for individuals with SCI in clinical-, community-, and home-based settings.
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Affiliation(s)
- Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Narongsak Khamnon
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand; School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Pattra Wattanapan
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand; Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Arpassanan Wiyanad
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Thiwabhorn Thaweewannakij
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Wilairat Namwong
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
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Rau Y, Thietje R, Schulz AP, Auerswald M, Böthig R, Hirschfeld S. The Correlation between Cervical Fusion Length and Functional Outcomes in Patients with Traumatic Spinal Cord Damage—A Registry-Based Cohort Study. J Clin Med 2022; 11:jcm11195867. [PMID: 36233733 PMCID: PMC9570914 DOI: 10.3390/jcm11195867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
This study aims to assess if there is an evident correlation between fusion length and rehabilitation success after trauma to the cervical spine that could potentially be used to predict functional outcomes. This monocentric study was conducted in the Spinal-Cord-Injury center of the Berufsgenossenschaftliches Klinikum Hamburg. Data sets of 199 patients from the Spinal-Cord-Injury center admitted between the beginning of 2003 and the end of 2018 were subjected to statistical analyses. The Spinal Cord Independence Measure II (SCIM II) difference between admission and discharge was chosen as the primary outcome variable of a multiple linear regression analysis, including several other variables. The length of fusion, SCIM at admission and the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) values at admission could be identified as significant predictors. The cervical fusion length could be identified as an independent predictor of the functional outcome within our model. This correlation most likely mediates for the range of motion as well as partly for injury severity. This is much harder to evaluate in a newly admitted rehabilitation patient than a single numerical value that represents its rehabilitative implications, such as fusion length. Together with an initial assessment of the SCIM and ISNCSCI, it provides a solid basis for outcome prediction.
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Affiliation(s)
- Yannick Rau
- Faculty of Medicine, Universität zu Lübeck, 23562 Lübeck, Germany
- Spinal-Cord-Injury Center, BG Klinikum Hamburg, 21033 Hamburg, Germany
- Correspondence:
| | - Roland Thietje
- Faculty of Medicine, Universität zu Lübeck, 23562 Lübeck, Germany
- Spinal-Cord-Injury Center, BG Klinikum Hamburg, 21033 Hamburg, Germany
| | - Arndt-Peter Schulz
- Faculty of Medicine, Universität zu Lübeck, 23562 Lübeck, Germany
- Zentrum Klinische Forschung, BG Klinikum Hamburg, 21033 Hamburg, Germany
| | - Marc Auerswald
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Hamburg, 21033 Hamburg, Germany
| | - Ralf Böthig
- Spinal-Cord-Injury Center, BG Klinikum Hamburg, 21033 Hamburg, Germany
| | - Sven Hirschfeld
- Faculty of Medicine, Universität zu Lübeck, 23562 Lübeck, Germany
- Spinal-Cord-Injury Center, BG Klinikum Hamburg, 21033 Hamburg, Germany
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Kasch H, Løve US, Jønsson AB, Severinsen KE, Possover M, Elmgreen SB, Forman A. Effect of pelvic laparoscopic implantation of neuroprosthesis in spinal cord injured subjects: a 1-year prospective randomized controlled study. Spinal Cord 2022; 60:251-255. [PMID: 34429511 PMCID: PMC8904257 DOI: 10.1038/s41393-021-00693-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN 1-year prospective RCT. OBJECTIVE Examine the effect of implantable pulse generator and low-frequency stimulation of the pelvic nerves using laparoscopic implantation of neuroprosthesis (LION) compared with neuromuscular electrical stimulation (NMES) in SCI. METHODS Inclusion criteria: traumatic spinal cord injury (SCI), age 18-55 years, neurological level-of-injury Th4-L1, time-since-injury >1 year, and AIS-grades A-B. Participants were randomized to (A) LION procedure or (B) control group receiving NMES. PRIMARY OUTCOME MEASURE Walking Index for Spinal Cord Injury (WISCI-II), which is a SCI specific outcome measure assessing ability to ambulate. SECONDARY OUTCOME MEASURES Spinal Cord Independence Measure III (SCIM III), Patient Global Impression of Change (PGIC), Penn Spasm Frequency Scale (PSFS), severity of spasticity measured by Numeric Rating Scale (NRS-11); International Spinal Cord Injury data sets-Quality of Life Basic Data Set (QoLBDS), and Brief Pain Inventory (BPI). RESULTS Seventeen SCI individuals, AIS grade A, neurological level ranging from Th4-L1, were randomized to the study. One individual was excluded prior to intervention. Eight participants (7 males) with a mean age (SD) of 35.5 (12.4) years were allocated to the LION procedure, 8 participants (7 males) with age of 38.8 (15.1) years were allocated to NMES. Significantly, 5 LION group participants gained 1 point on the WISCI II scale, (p < 0.013; Fisher´s exact test). WISCI II scale score did not change in controls. No significant changes were observed in the secondary outcome measures. CONCLUSION The LION procedure is a promising new treatment for individuals with SCI with significant one-year improvement in walking ability.
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Affiliation(s)
- Helge Kasch
- grid.416838.00000 0004 0646 9184Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Uffe Schou Løve
- grid.416838.00000 0004 0646 9184Department of Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Anette Bach Jønsson
- grid.416838.00000 0004 0646 9184Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Eg Severinsen
- grid.416838.00000 0004 0646 9184Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marc Possover
- Possover International Medical Centre, Zürich, Switzerland
| | | | - Axel Forman
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Khatri P, Jalayondeja C, Dhakal R, Groves CC. Functional outcome following inpatient rehabilitation among individuals with complete spinal cord injury in Nepal. Spinal Cord Ser Cases 2021; 7:93. [PMID: 34620844 PMCID: PMC8497563 DOI: 10.1038/s41394-021-00452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Descriptive study. OBJECTIVES To describe functional outcomes using Spinal Cord Independence Measure III (SCIM III) following inpatient rehabilitation among individuals with complete spinal cord injury (SCI) in the low-income setting of Nepal; to evaluate functional changes from rehabilitation admission to discharge and to compare functional outcomes between neurological levels of injury (NLI) at discharge. SETTING Spinal Injury Rehabilitation Centre (SIRC), Kavrepalanchowk, Nepal. METHODS We present data of all individuals with complete SCI who completed rehabilitation at SIRC in 2017. Data collected included: demographics, aetiology, neurological assessment, admission/discharge SCIM III scores, and length of stay. Data were analyzed using descriptive statistics. Pre/post-SCIM III scores were analyzed using Related-Samples Wilcoxon signed-rank test. Comparative analysis between NLIs was done using the Kruskal Wallis ANOVA test followed by pairwise Mann-Whitney U tests. RESULTS Ninety-six individuals were included. Mean (SD) age was 33.5 (14.2) years, with a male/female ratio of 3.4:1. Median admission and discharge total SCIM III scores for cervical, thoracic and lumbosacral levels were 10 and 21, 16 and 61, and 41 and 79.5, respectively. Median total SCIM III score change between admission and discharge were 11 (p = 0.003), 43 (p < 0.001) and 40 (p = 0.068) for cervical, thoracic and lumbar groups, respectively. CONCLUSIONS This study is the first of its kind to describe functional outcomes among individuals with complete SCI in the low-income setting of Nepal. All SCI groups showed a positive trend in SCIM III from admission to discharge, with improvements reaching statistical significance among groups with cervical and thoracic NLIs.
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Affiliation(s)
- Prakriti Khatri
- Spinal Injury Rehabilitation Centre, Sanga, Nepal.
- Faculty of Physical Therapy, Mahidol University, Salaya, Thailand.
| | | | - Raju Dhakal
- Department of Physical Medicine & Rehabilitation, Spinal Injury Rehabilitation Centre, Sanga, Nepal
| | - Christine C Groves
- Department of Physical Medicine & Rehabilitation, Spinal Injury Rehabilitation Centre, Sanga, Nepal
- Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
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Dengler J, Mehra M, Steeves JD, Fox IK. Evaluation of Functional Independence in Cervical Spinal Cord Injury: Implications for Surgery to Restore Upper Limb Function. J Hand Surg Am 2021; 46:621.e1-621.e17. [PMID: 33454154 DOI: 10.1016/j.jhsa.2020.10.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 08/18/2020] [Accepted: 10/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To help individuals make informed choices regarding the optimal type and timing of restorative surgical treatment for cervical spinal cord injury (SCI), more precise information is needed on their ability to perform activities of daily living. The goal of this work was to describe functional independence achieved by individuals with differing levels of cervical SCI. METHODS Using the comprehensive European Multicenter Study of Spinal Cord Injury dataset, analysis was undertaken of individuals with traumatic SCI, motor-level C5-C8. Data on feeding, bladder management, and transfers (bed to wheelchair) were compared between individuals with different levels of injury. Subgroup analyses of symmetrical and asymmetrical SCI and between complete and incomplete SCI were performed. The impact of age, sex, and time postinjury on functional independence was ascertained. RESULTS Data were available for individuals with symmetrical (n = 204) and asymmetrical (n = 95) patterns of SCI. Independence with feeding, urinary function, and transfer ability was increased in individuals with strong finger flexion. Unexpectedly, the presence of strong elbow extension did not uniformly result in the ability to transfer independently. There was no change in any of the analyzed activities between 6 and 12 months postinjury. CONCLUSIONS People with cervical SCI who gain finger flexion have greater independence with feeding, urinary, and transfer activities. Restoration of finger flexion should be a reconstructive priority for individuals with midcervical-level SCI. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Jana Dengler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario
| | | | - John D Steeves
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Healthcare System, St. Louis, MO.
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Olaleye OA, Zaki DA, Hamzat TK. Expectations of individuals with neurological conditions from rehabilitation: A mixed-method study of needs. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1498. [PMID: 33604478 PMCID: PMC7876967 DOI: 10.4102/sajp.v77i1.1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/08/2020] [Indexed: 11/01/2022] Open
Abstract
Background Knowledge of the specific expectations of patients with neurological conditions (NCs) from rehabilitation helps in setting attainable goals. Such expectations may vary from situation to situation. There are no studies investigating rehabilitation expectations amongst individuals with NCs in Nigeria. Objectives The aim of our study was to explore the rehabilitation expectations of individuals with NCs. Method This convergent mixed-methods study comprised a cross-sectional survey of 105 individuals with NCs and two sessions of Focus Group Discussions (FGDS) amongst eight individuals with NCs. The modified Needs Assessment Questionnaire was used to assess rehabilitation needs as a proxy for rehabilitation expectations, whilst disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Quantitative data were summarised using descriptive statistics and analysed using inferential statistics at p < 0.05. Thematic analysis was conducted on the qualitative data. Results Sixty-one (58.1%) stroke survivors, 33 (31.4%) individuals with spinal cord injury (SCI) and 11 (10.5%) with traumatic brain injury (TBI) aged 46.48 ± 15.91 were surveyed. The need for social/recreational activity was the most expressed need (100%) amongst the participants. Mobility was reported as an important need constituting a barrier to enjoying life by 93 (88.6%) participants. Individuals with SCI expressed the greatest needs compared with the other two groups. Needs were significantly correlated with severity of disability (p < 0.05). Four overarching themes (physical health, financial, healthcare services/rehabilitation and emotional/social) representing major areas of needs emerged from the FGD data. Conclusion Individuals with NCs in Nigeria have specified expectations of rehabilitation. Disability was a major driver of these expectations, irrespective of NC subtype. Clinical implications Rehabilitation programmes for individuals with NCs should target expressed needs or expectations of each patient cohort and minimise disabilities associated with these conditions.
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Affiliation(s)
- Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| | - Desmond A Zaki
- Department of Physiotherapy, Benue State University Teaching Hospital, Markurdi, Nigeria
| | - Talhatu K Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
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Peñaloza-Polo P, Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Saavedra-Santana P, Delgado-Duque I. [Factors associated with functional improvement in patients with cervical spinal cord injuries]. Rehabilitacion (Madr) 2020; 55:118-124. [PMID: 33168183 DOI: 10.1016/j.rh.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. MATERIAL AND METHODS We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. RESULTS Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. CONCLUSIONS Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays.
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Affiliation(s)
- P Peñaloza-Polo
- Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas, España.
| | - E Bárbara-Bataller
- Unidad de Lesionados Medulares Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, España
| | - J L Méndez-Suárez
- Unidad de Lesionados Medulares Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, España
| | - C Alemán-Sánchez
- Unidad de Lesionados Medulares Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, España
| | - P Saavedra-Santana
- Área de Estadística e Investigación Operativa del Departamento de Matemáticas, Universidad de Las Palmas de Gran Canaria, Las Palmas, España
| | - I Delgado-Duque
- Servicio de Rehabilitación, Hospital Universitario Insular de Gran Canaria, Las Palmas, España
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Armandei M, Saberi H, Derakhshanrad N, Yekaninejad M. Pivotal Role of Cervical Rotation for Rehabilitation Outcomes in Patients with Subaxial Cervical Spinal Cord Injury. Neurochirurgie 2020; 66:247-251. [DOI: 10.1016/j.neuchi.2020.04.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/10/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
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Muscle Strength Cutoff Points for Functional Independence and Wheelchair Ability in Men With Spinal Cord Injury. Arch Phys Med Rehabil 2020; 101:985-993. [DOI: 10.1016/j.apmr.2020.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 11/18/2019] [Accepted: 01/08/2020] [Indexed: 11/20/2022]
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Are Body Composition, Strength, and Functional Independence Similarities Between Spinal Cord Injury Classifications? A Discriminant Analysis. J Sport Rehabil 2020; 29:277-281. [PMID: 30676212 DOI: 10.1123/jsr.2018-0244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/04/2018] [Accepted: 12/06/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT There seems to be no consensus on which aspects better distinguish the different levels of spinal cord injury regarding body composition, strength, and functional independence. OBJECTIVE The study aimed to determine which variables better differentiate tetraplegia (TP) from paraplegia and high paraplegia (HP) from low paraplegia (LP). DESIGN Cross-sectional study. SETTING Rehabilitation hospital network. PATIENTS Forty-five men with spinal cord injury, n = 15 for each level (TP, HP, and LP) causing complete motor impairment (American Spinal Injury Association Impairment Scale: A or B) were enrolled in the study. MAIN OUTCOME MEASURES The 1-maximum repetition test, functional independence measure, spinal cord independence measure, and body composition (skinfold sum, body fat percentage, and body mass index) were assessed. Discriminant analysis was carried out using the Wilks lambda method to identify which strength and functional variables can significantly discriminate subjects for injury classification (TP, HP, and LP). RESULTS The discriminant variable for TP versus HP was body mass index and for TP versus LP was 1-maximum repetition (P ≤ .05). There were no variables that discriminated HP versus LP. CONCLUSIONS The discriminant variables for TP versus HP and TP versus LP were body mass index and 1-maximum repetition, respectively. The results showed that HP and LP are similar for strength and functional variables.
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Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome. Spinal Cord 2020; 58:768-777. [PMID: 31996778 DOI: 10.1038/s41393-020-0421-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 12/18/2022]
Abstract
STUDY DESIGN Multicenter prospective observational study of people with acute traumatic spinal cord injury (TSCI) admitted to rehabilitation. OBJECTIVES To update epidemiological characteristics of a TSCI Italian population and verify the impact of patient characteristics at admission on two outcomes: functional gain (SCIM III) and discharge destination. SETTING Thirty-one SCI centers for comprehensive rehabilitation in 13 Italian regions. METHODS All consecutive individuals admitted with acute TSCI were enrolled from October 1, 2013 to September 30, 2014; data were recorded on rehabilitation admission and discharge. Functional gain and discharge destination were identified as outcome measures and statistically analyzed with patient characteristics at admission to identify early outcome predictors. RESULTS Five hundred and ten individuals with TSCI met inclusion criteria; falls represented the most frequent etiology (45%). On admission, AIS A-B-C tetraplegia was reported in 35% of cases; AIS A-B-C paraplegia in 40%; AIS D paraplegia/tetraplegia in 25%. The majority were discharged home (72%). The mean (SD) SCIM gain was 38 ± 26 points. A predictive model was found for discharge setting: individuals with fall-related injuries, severe SCI (AIS A-B-C tetraplegia), tracheal cannula or indwelling catheter on admission, were less likely to be discharged home (OR 95% CI 0.15 [0.06, 0.35]). A model with a lower predictive power was found for SCIM gain, with lower score expected for females, older age, higher severity of SCI, a longer onset of injury admission interval (OAI), and mechanical ventilation on admission. CONCLUSIONS Prognostic factors in early rehabilitation are still hard to identify, making it difficult to correctly approach customized rehabilitation.
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21
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Rahimi M, Torkaman G, Ghabaee M, Ghasem-Zadeh A. Advanced weight-bearing mat exercises combined with functional electrical stimulation to improve the ability of wheelchair-dependent people with spinal cord injury to transfer and attain independence in activities of daily living: a randomized controlled trial. Spinal Cord 2019; 58:78-85. [PMID: 31312016 DOI: 10.1038/s41393-019-0328-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE To determine the effects of advanced weight-bearing mat exercises (AWMEs) with/without functional electrical stimulation (FES) of the quadriceps and gastrocnemius muscles on the ability of wheelchair-dependent people with spinal cord injury (SCI) to transfer and attain independence in activities of daily living (ADLs). SETTING An outpatient clinic, Iran. METHODS People with traumatic chronic paraplegia (N = 16) were randomly allocated to three groups. The exercise group (EX; N = 5) performed AWMEs of quadruped unilateral reaching and tall-kneeling for 24 weeks (3 days/week). Sessions were increased from 10 min to 54 min over the 24-week period. The exercise-FES group (EX + FES; N = 5) performed AWMEs simultaneously with FES of the quadriceps and gastrocnemius muscles. The control group performed no exercise and no FES (N = 6). The primary outcomes were the total Spinal Cord Independence Measure-III (SCIM-III) to reflect independence with ADL, and the sum of the four SCIM-III transfer items to reflect ability to transfer. There were six other outcomes. RESULTS The mean (95% CI) between-group differences of the four transfer items of the SCIM-III for the EX vs. control group was 1.8 points (0.2-3.4), and for the EX + FES vs. control group was 2 points (0.4-3.6). The equivalent differences for the total SCIM-III scores were 2.7 points (-0.6-6.0) and 4.1 points (0.8-7.4), respectively. There were no significant between-group differences for any other outcomes. CONCLUSIONS Advanced weight-bearing mat exercises improve the ability of wheelchair-dependent people with SCI to transfer and attain independence in ADL.
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Affiliation(s)
- Mostafa Rahimi
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Giti Torkaman
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Mojdeh Ghabaee
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghasem-Zadeh
- Departments of Medicine and Endocrinology, Austin Health, The University of Melbourne, Melbourne, VIC, Australia
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Using a logarithmic model to predict functional independence after spinal cord injury: a retrospective study. Spinal Cord 2019; 57:1048-1056. [DOI: 10.1038/s41393-019-0315-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/09/2022]
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Mashola MK, Mothabeng DJ. Associations between health behaviour, secondary health conditions and quality of life in people with spinal cord injury. Afr J Disabil 2019; 8:463. [PMID: 31309047 PMCID: PMC6620481 DOI: 10.4102/ajod.v8i0.463] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/15/2019] [Indexed: 11/19/2022] Open
Abstract
Background The development of secondary health conditions (SHCs) after spinal cord injury (SCI) is common and can affect an individual’s emotional well-being, and his or her health-related quality of life (QOL). Little is known about relationships between performing health-benefiting behaviours and the presence (or absence) of SHCs and QOL, particularly in South Africa. Objectives This research study was conducted in order to determine the associations between health behaviour, SHCs and QOL in people with SCI (PWSCI). Method This cross-sectional study included 36 PWSCI discharged from a private rehabilitation facility in Pretoria, South Africa. The PWSCI completed questionnaires pertaining to lifestyle, independence, presence of SHCs, social support and QOL. Data were analysed using descriptive and inferential statistics such as correlation tests and chi-square test of independence (x2) using the SPSS v25. Moderate, moderately high and high correlations are reported (Pearson r ≥ 0.4). Results were significant if p < 0.05. Results Participation in health-benefiting behaviour was associated with increased QOL (r = 0.457, p < 0.01) and increased social support from family and friends (r = 0.425, p < 0.01), which was associated with increased QOL (r = 0.671, p < 0.001). Not participating in specific neuromusculoskeletal health behaviours was found to be associated with the overall presence of SHCs (r = -0.426, p < 0.01). Conclusions Participating in health-benefiting behaviour can reduce the development of SHCs and subsequently increase QOL in PWSCI. Health professionals must focus on minimising the development of SHCs by providing specific education on good health-benefiting behaviour.
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Affiliation(s)
- Mokgadi K Mashola
- Department of Physiotherapy, University of Pretoria, Pretoria, South Africa
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Santamaría AJ, Benavides FD, DiFede DL, Khan A, Pujol MV, Dietrich WD, Marttos A, Green BA, Hare JM, Guest JD. Clinical and Neurophysiological Changes after Targeted Intrathecal Injections of Bone Marrow Stem Cells in a C3 Tetraplegic Subject. J Neurotrauma 2018; 36:500-516. [PMID: 29790404 DOI: 10.1089/neu.2018.5716] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
High-level quadriplegia is a devastating condition with limited treatment options. Bone marrow derived stem cells (BMSCs) are reported to have immunomodulatory and neurotrophic effects in spinal cord injury (SCI). We report a subject with complete C2 SCI who received three anatomically targeted intrathecal infusions of BMSCs under a single-patient expanded access investigational new drug (IND). She underwent intensive physical therapy and was followed for >2 years. At end-point, her American Spinal Injury Association Impairment Scale (AIS) grade improved from A to B, and she recovered focal pressure touch sensation over several body areas. We conducted serial neurophysiological testing to monitor changes in residual connectivity. Motor, sensory, and autonomic system testing included motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), electromyography (EMG) recordings, F waves, galvanic skin responses, and tilt-table responses. The quality and magnitude of voluntary EMG activations increased over time, but remained below the threshold of clinically obvious movement. Unexpectedly, at 14 months post-injury, deep inspiratory maneuvers triggered respiratory-like EMG bursting in the biceps and several other muscles. This finding means that connections between respiratory neurons and motor neurons were newly established, or unmasked. We also report serial analysis of MRI, International Standards for Neurological Classification of SCI (ISNCSCI), pulmonary function, pain scores, cerebrospinal fluid (CSF) cytokines, and bladder assessment. As a single case, the linkage of the clinical and neurophysiological changes to either natural history or to the BMSC infusions cannot be resolved. Nevertheless, such detailed neurophysiological assessment of high cervical SCI patients is rarely performed. Our findings indicate that electrophysiology studies are sensitive to define both residual connectivity and new plasticity.
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Affiliation(s)
- Andrea J Santamaría
- 1 The Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida
| | - Francisco D Benavides
- 1 The Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida
| | - Darcy L DiFede
- 2 Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Aisha Khan
- 2 Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Marietsy V Pujol
- 2 Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - W Dalton Dietrich
- 1 The Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida.,3 Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Antonio Marttos
- 4 Surgical Critical Care, University of Miami, Miller School of Medicine, Miami, Florida
| | - Barth A Green
- 3 Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Joshua M Hare
- 2 Interdisciplinary Stem Cell Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - James D Guest
- 1 The Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida.,3 Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida
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Derakhshanrad N, Saberi H, Yekaninejad MS, Joghataei MT, Sheikhrezaei A. Granulocyte-colony stimulating factor administration for neurological improvement in patients with postrehabilitation chronic incomplete traumatic spinal cord injuries: a double-blind randomized controlled clinical trial. J Neurosurg Spine 2018; 29:97-107. [DOI: 10.3171/2017.11.spine17769] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVEGranulocyte-colony stimulating factor (G-CSF) is a major growth factor for activation and differentiation of granulocyte colonies in the bone marrow. This cytokine has been widely and safely employed in different conditions over many years. The purpose of this study was to investigate the efficacy of G-CSF administration for traumatic spinal cord injury (TSCI).METHODSThis double-blind parallel randomized, placebo-controlled, clinical trial, a phase III study, was performed from June 2013 to June 2016 in the Brain and Spinal Cord Injury Research (BASIR) center at Tehran University of Medical Sciences (TUMS). It included 120 patients with incomplete chronic TSCI, American Spinal Injury Association (ASIA) Impairment Scale (AIS) B, C, or D, of at least 6 months’ duration. Sixty patients were allocated into the treatment group and 60 patients into the control group. All the patients had completed an outpatient rehabilitation program in the postacute period and were in a neurological and functional plateau. Patients were assessed with the ASIA grading system, the Spinal Cord Independence Measure (SCIM-III), and the International Association of Neurorestoratology-Spinal Cord Injury Functional Rating Scale (IANR-SCIFRS) just before intervention and at 1, 3, and 6 months after 7 subcutaneous administrations of 300 μg/day of G-CSF in the treatment group and placebo in the control group (administered once per day over the course of 1 week). Randomization was performed with randomized block design, and the patients and evaluators were blinded regarding the treatment groups. One patient did not receive the entire allocated intervention and 5 patients were lost to follow-up. Thus data from 114 patients were included in the analysis.RESULTSOne hundred twenty patients were randomized and allocated into the study groups. Among them, 56 patients (93.3%) in the G-CSF group and 58 patients (96.6%) in the placebo group completed the study protocol. After 6 months of follow-up, AIS in the placebo group remained unchanged, whereas in the G-CSF group, 1 patient improved from AIS B to C, and 4 patients improved from AIS C to D. The mean (± SE) improvement in ASIA motor score in the G-CSF group was 5.5 ± 0.62, which was significantly more than in the placebo group (0.77 ± 0.20) (p < 0.001). The mean light touch and pinprick sensory scores, respectively, increased by 6.1 ± 1.1 and 8.7 ± 1.5 in the G-CSF group and by 1.3 ± 0.52 and 0.89 ± 0.44 scores in the placebo group (p < 0.001). Evaluation of functional improvement by the IANR-SCIFRS instrument revealed significantly more improvement in the G-CSF group (3.5 ± 0.37) than in the placebo group (0.41 ± 0.12) (p < 0.001). Also, a significant difference was observed in functional improvement between the 2 groups as measured by SCIM-III instrument (7.5 ± 0.95 vs 2.1 ± 0.51, p < 0.001).CONCLUSIONSAdministration of G-CSF for incomplete chronic spinal cord injuries is associated with significant motor, sensory, and functional improvement.Clinical trial registration no.: IRCT201108297441N1 (www.irct.ir)
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Affiliation(s)
- Nazi Derakhshanrad
- 1Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences
| | - Hooshang Saberi
- 1Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences
- 2Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences
| | - Mir Saeed Yekaninejad
- 3Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences; and
| | - Mohammad Taghi Joghataei
- 4Cellular and Molecular Research Center and
- 5Neuroscience Department, School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Sheikhrezaei
- 2Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences
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Mulcahey MJ, Thielen CC, Sadowsky C, Silvestri JL, Martin R, White L, Cagney JA, Vogel LC, Schottler J, Davidson L, Parry I, Taylor HB, Higgins K, Feltz ML, Sinko R, Bultman J, Mazurkiewicz J, Gaughan J. Despite limitations in content range, the SCIM-III is reproducible and a valid indicator of physical function in youths with spinal cord injury and dysfunction. Spinal Cord 2017; 56:332-340. [PMID: 29269778 DOI: 10.1038/s41393-017-0036-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Multi-center, repeated measures OBJECTIVES: Evaluate psychometric properties of the SCIM-III in children. SETTING Seven facilities in North America METHODS: One-hundred and twenty-seven youths, mean age of 10.8 years and chronic spinal cord injury/dysfunction completed two administrations of the Spinal Cord Independence Measure-III (SCIM-III). Mean, standard deviation, range values were calculated for SCIM-III total and subscales for the entire sample, four age groups and injury characteristics. Test-retest reliability, concurrent validity, and floor and ceiling effects were examined. RESULTS Total SCIM-III and self-care (SC) subscale scores for the youngest age group were lower than those for the three older age groups. There were statistically significant differences in SC subscale scores between neurological level (NL) C5-T1 and T2 -T12; C5-T1 and L1-S4/5; and T2-T12 and L1-S4/5 and in in-room, and indoor/outdoor mobility subscale scores between C1-C4 and T2-T12; C1-C4 and L1-S4/5; C5-T1 and T2-T12; C5-T1 and L1-S4/5; and T2-T12 and L1-S4/5. All scores between motor complete and motor incomplete differed. Test-retest reliability was good (ICC values = > 0.84) and there was moderate to strong correlation between SCIM-III and the FIM® Instrument (r = 0.77-0.92). Ceiling effects were present in the SC subscale for the oldest age group (24%) and for NL L1-S4/5 (35.5%) and in in-room mobility subscale for 6-12 (45.7%), 13-15 (30.43%) and 16-17 (60%) ages, paraplegia (42.4%), tetraplegia (37.1%), incomplete injuries (50%), and T2-T12 (38%) and L1-S4/5 (100%) NL. CONCLUSION Despite limitations in content range, the SCIM-III is reproducible, and a valid indicator of physical functioning in youth with SCI/D 6 years of age and older. SPONSORSHIP The study was funded by the Craig H. Neilsen Foundation, Spinal Cord Injury Research on the Translation Spectrum, Senior Research Award Grant #282592 (Mulcahey, PI).
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Affiliation(s)
- M J Mulcahey
- Thomas Jefferson University, Philadelphia, PA, USA. .,Shriners Hospitals for Children, Philadelphia, PA, USA.
| | | | | | | | - Rebecca Martin
- Kennedy Krieger Rehabilitation Institute, Baltimore, MD, USA
| | - Lauren White
- Kennedy Krieger Rehabilitation Institute, Baltimore, MD, USA
| | - Julie A Cagney
- Kennedy Krieger Rehabilitation Institute, Baltimore, MD, USA
| | | | | | | | - Ingrid Parry
- Shriners Hospitals for Children, Sacramento, CA, USA
| | | | | | | | | | - Jackie Bultman
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | | | - John Gaughan
- Thomas Jefferson University, Philadelphia, PA, USA
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Catharine Craven B, Kurban D, Farahani F, Rivers CS, Ho C, Linassi AG, Gagnon DH, O'Connell C, Ethans K, Bouyer LJ, Noonan VK. Predicting rehabilitation length of stay in Canada: It's not just about impairment. J Spinal Cord Med 2017; 40:676-686. [PMID: 28899285 PMCID: PMC5778931 DOI: 10.1080/10790268.2017.1368962] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Current tertiary Spinal Cord Injury (SCI) rehabilitation funding and rehabilitation length of stay (R-LOS) in most North American jurisdictions are linked to an individual's impairment. Our objectives were to: 1) describe the impact of relevant demographic, impairment and medical complexity variables at rehabilitation admission on R-LOS among adult Canadians with traumatic SCI; and 2) identify factors which extend R-LOS. METHODS Data from 1,376 adults with traumatic SCI were obtained via chart abstraction and administrative data linkage from 15 Rick Hansen SCI Registry sites (2004-2014). Variables included age, sex, neurological impairment (level, severity), rehabilitation onset days, R-LOS, Glasgow Coma Score (GCS) at admission, prior ventilation or endotracheal tube (Vent/ETT), or indwelling bladder catheter at acute discharge, pain interference score, intensive care unit (ICU) length of stay (LOS), and lower extremity motor scores (LEMS) at rehabilitation admission. Variables related to R-LOS in bivariate analysis were included in multivariate analysis to determine their impact on R-LOS. RESULTS Prior Vent/ETT tube, indwelling bladder catheter, GCS, LEMS, and neurological impairment were related to R-LOS in bivariate analysis. Multivariate linear regression analyses identified five variables as significant predictors: age, Vent/ETT for >24 hours in acute care, indwelling bladder catheter at acute discharge, LEMS, and NLI/AIS subgroup at rehabilitation admission explained 32% of the variation in R-LOS (p<0.001). CONCLUSIONS Based on the enclosed formula, and knowledge of an individual's age at injury, spinal cord impairment (level and severity), prior Vent/ETT, presence of an indwelling bladder catheter, and LEMS at admission, administrators and clinicians may readily identify patients for whom an extended R-LOS beyond conventional LOS targets is likely.
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Affiliation(s)
- B. Catharine Craven
- Brain and Spinal Cord Rehabilitation Program, Toronto, ON, Canada,Neural Engineering & Therapeutics Team, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Dept. of Medicine, Division of PM&R, University of Toronto, Toronto, ON, Canada,University Health Network Toronto Rehab Lyndhurst Centre, Toronto, ON, Canada
| | | | - Farnoosh Farahani
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Carly S. Rivers
- Rick Hansen Institute, Vancouver, BC, Canada,Correspondence to: Carly S. Rivers, Rick Hansen Institute, 6400 Blusson Spinal Cord Centre, Vancouver, BC, Canada.
| | - Chester Ho
- Allied Health, AHS Calgary Zone, Calgary, AB, Canada,Division of Physical Medicine & Rehabilitation, Dept of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - A. Gary Linassi
- Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, Canada,Spinal Cord Injury and Amputation Programs, Saskatoon Health Region, Saskatoon, SK, Canada
| | - Dany H. Gagnon
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Colleen O'Connell
- Physical Medicine & Rehabilitation, Dalhousie University, Faculty of Medicine, Fredericton, NB, Canada
| | - Karen Ethans
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Laurent J. Bouyer
- Department of Rehabilitation, Université Laval & Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - Vanessa K. Noonan
- Rick Hansen Institute, Vancouver, BC, Canada,University of British Columbia, Vancouver, BC, Canada
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Hwang S, Kim A, Moon S, Kim J, Kim J, Ha Y, Yang O. The Development of Korean Rehabilitation Patient Group Version 1.0. HEALTH POLICY AND MANAGEMENT 2016. [DOI: 10.4332/kjhpa.2016.26.4.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ribeiro Neto F, Guanais P, Lopes GH, Dornelas E, de Campos Barbetta D, Coutinho AC, Gonçalves CW, Gomes Costa RR. Influence of Relative Strength on Functional Independence of Patients With Spinal Cord Injury. Arch Phys Med Rehabil 2016; 98:1104-1112. [PMID: 27717738 DOI: 10.1016/j.apmr.2016.08.483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/29/2016] [Accepted: 08/25/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the influence of strength values and fat mass on functional independence of men with different spinal cord injury (SCI) levels. DESIGN Cross-sectional study. SETTING Hospital network. PARTICIPANTS Men with SCI (N=45). INTERVENTIONS Subjects were assessed in functional independence scales, a 1 repetition maximum (1RM) test, and body composition to detect absolute and relative strength: 1RM divided by body mass (BM) and lean body mass (LBM), respectively. MAIN OUTCOME MEASURES Stepwise multiple regression analysis was used to verify the influence of predictors on functional independence (FIM and Spinal Cord Independence Measure [SCIM] scale and subscales). Receiver operating characteristic curves were created to identify cutoff points of strength for functional independence. RESULTS The best models for FIM total, FIM mobility, and SCIM total used 1RM as the best predictor (adjusted R2=.75, .67, and .65, respectively; P<.05). Relative strength (1RM/LBM) was the best predictor for SCIM mobility (adjusted R2=.62, P<.05). A FIM score of 69 has a 1RM cutoff point of 50.1kg, and a FIM score of 76 has cutoff points of .73 for 1RM/BM and .91 for 1RM/LBM. A SCIM score of 68 has cutoff points for 1RM, 1RM/BM, and 1RM/LBM of 50.1kg, .77, and .92, respectively. CONCLUSIONS Cutoff points of relative strength should be used as determinant variables for independence, health, or sports performance. This study may contribute to more adequate guidance of physical activity during a rehabilitation program and after discharge.
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Affiliation(s)
| | | | - Guilherme H Lopes
- College of Physical Education, University of Brasília, Brasília/DF, Brazil
| | - Elisa Dornelas
- SARAH Rehabilitation Hospital Network, Brasília/DF, Brazil
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Nitsch KP, Stipp KL. Measurement Characteristics and Clinical Utility of the Spinal Cord Independence Measure-III Among Individuals With Spinal Cord Injury. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Warner N, Ikkos G, Gall A. Spinal cord injury rehabilitation and mental health, SCReaM. Spinal Cord 2016; 55:307-313. [DOI: 10.1038/sc.2016.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 05/28/2016] [Accepted: 06/05/2016] [Indexed: 11/09/2022]
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Derakhshanrad N, Vosoughi F, Yekaninejad MS, Moshayedi P, Saberi H. Functional impact of multidisciplinary outpatient program on patients with chronic complete spinal cord injury. Spinal Cord 2015; 53:860-5. [DOI: 10.1038/sc.2015.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 06/26/2015] [Accepted: 07/01/2015] [Indexed: 11/09/2022]
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Hastings BM, Ntsiea MV, Olorunju S. Factors that influence functional ability in individuals with spinal cord injury: A cross-sectional, observational study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2015; 71:235. [PMID: 30135873 PMCID: PMC6093142 DOI: 10.4102/sajp.v71i1.235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/14/2015] [Indexed: 11/27/2022] Open
Abstract
Background Spinal cord injuries result in devastating impairments that can produce severe functional limitations. However, few documented studies have investigated the levels of function and factors that influence functional ability at discharge from in-patient rehabilitation facilities in Gauteng following such injuries. This necessitated further investigation. Method Fifty participants were recruited for this cross-sectional, observational study. Participants were recruited from one private and one government spinal rehabilitation unit in Gauteng. A custom-developed questionnaire was used to establish the physical and demographic characteristics of the sample, whilst existing classification scales and measures were used to establish the degree of a lesion and a patient’s associated functional ability. Data were analysed using descriptive statistics. Multiple regression analysis was performed to determine factors that influenced the level of functional ability. Results Patients achieved an average functional independence score of 64.6 (± 27.6) at discharge according to the Spinal Cord Independence Measure III. Longer stays at rehabilitation facilities were associated with higher scores, whereas scores decreased with increasing patient age. Pressure sores and spasticity affected scores negatively. The type of funding also influenced patients’ scores, with government funding being associated with the best outcome. Both the degree and the level at which the injury occurred could be considered predictive measures that influenced functional independence scores. Conclusion Most participants were not functionally independent at discharge. Factors such as patient age, length of rehabilitation, presence of pressure sores or spasticity, degree of motor ability and location of the injury should be considered in tailoring rehabilitation therapy.
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Affiliation(s)
- Bronwyn M Hastings
- Department of Physiotherapy, University of the Witwatersrand, South Africa
| | | | - Steve Olorunju
- Biostatistics Unit, South African Medical Research Council, South Africa
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Mulcahey MJ, Calhoun CL, Sinko R, Kelly EH, Vogel LC. The spinal cord independence measure (SCIM)-III self report for youth. Spinal Cord 2015; 54:204-12. [PMID: 26078233 DOI: 10.1038/sc.2015.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/10/2015] [Accepted: 05/12/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN The items and response scales of the Spinal Cord Independence Measure (SCIM-III) self report (SR) were exposed to formal cognitive testing with children with SCI, and in parallel a survey using the modified Delphi Technique was conducted to engage content experts in an iterative critical review of the SCIM-III SR. OBJECTIVES To evaluate the validity of the SCIM-III SR for pediatric utilization. SETTING United States of America. METHODS Formal cognitive testing was conducted with 17 youths with SCI and required them to read and answer each SCIM-III SR item aloud. Think aloud methodology was used to record details about how youths understood and interpreted items and why they selected a given response. The interviews were audiotaped and transcribed verbatim. Content analysis focused on identifying words that children could not read or understand. In parallel, the Modified Delphi Technique engaged expert therapists to critically review the SCIM-III SR for pediatric utilization. RESULTS Every SCIM-III SR item and response scale required modification before children were able to read, understand and respond to them. Youth encountered difficulties because of vague terms, medical jargon and complex words and phrases. Three iterative Delphi rounds were required before achieving 80% agreement that items and response scales were written well for children. CONCLUSION Our findings informed modifications to every SCIM-III SR item and response scale, producing a pediatric version of the tool that we formally refer to as the SCIM-III SR-Youth (SCIM-III SR-Y). SPONSORSHIP The study was funded by the Craig H Neilsen Foundation, Spinal Cord Injury Research on the Translation Spectrum, Senior Research Award #282592 (Mulcahey, PI).
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Affiliation(s)
- M J Mulcahey
- Department of Occupational Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - C L Calhoun
- Department of Occupational Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - R Sinko
- Department of Occupational Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - E H Kelly
- Shriners Hospitals for Children, Chicago, IL, USA.,Marquette University, Milwaukee, WI, USA
| | - L C Vogel
- Shriners Hospitals for Children, Chicago, IL, USA.,Rush Medical College, Chicago, IL, USA
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Saberi H, Derakhshanrad N, Yekaninejad MS. Comparison of neurological and functional outcomes after administration of granulocyte-colony-stimulating factor in motor-complete versus motor-incomplete postrehabilitated, chronic spinal cord injuries: a phase I/II study. Cell Transplant 2014; 23 Suppl 1:S19-23. [PMID: 25302604 DOI: 10.3727/096368914x684943] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Granulocyte-colony-stimulating factor (G-CSF) is a major growth factor in the activation and differentiation of granulocytes. This cytokine has been widely and safely employed in different disease conditions over many years. The administration of the growth factors in spinal cord injury (SCI) has been reported elsewhere; here we have tried to see the effect of SCI severity on the neurological outcomes after neuroprotective treatment for SCI with G-CSF. Seventy-four consecutive patients with SCI of at least 6 months' duration, with stable neurological status in the last 3 months, having informed consent for the treatment were included in the study. All the patients had undergone at least 3 months of standard rehabilitation. Patients were assessed by the American Spinal Injury Association (ASIA) scale, Spinal Cord Independence Measure (SCIM) III, and International Association of Neurorestoratology-Spinal Cord Injury Functional Rating Scale (IANR-SCIFRS) just before intervention and periodically until 6 months after subcutaneous administration of 5 µg/kg per day of G-CSF for 7 consecutive days. Multiple linear regression models were performed for statistical evaluation of lesion completeness and level of injury on changes in ASIA motor, light touch, pinprick, IANR-SCIFRS, and SCIM III scores, as a phase I/II comparative study. The study consisted of 52 motor-complete and 22 motor-incomplete SCI patients. There was no significant difference regarding age and sex, chronicity, and level of SCI between the two groups. Motor-incomplete patients had significantly more improvement in ASIA motor score compared to the motor-complete patients (7.68 scores, p < 0.001); also they had significant improvement in light touch (6.42 scores, p = 0.003) and pinprick sensory scores (4.89 scores, p = 0.011). Therefore, G-CSF administration in motor-incomplete SCIs is associated with significantly higher motor improvement, and also the higher the initial ASIA Impairment Scale (AIS) grade, the less would be the final AIS change, and incomplete cases are more welcome into the future studies. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation.
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Affiliation(s)
- Hooshang Saberi
- Brain and Spinal Injuries Research Center (BASIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Hansebout RR, Hansebout CR. Local cooling for traumatic spinal cord injury: outcomes in 20 patients and review of the literature. J Neurosurg Spine 2014; 20:550-61. [PMID: 24628130 DOI: 10.3171/2014.2.spine13318] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECT In this prospective study, the authors offered protocol-selected patients a combination of parenteral steroids, decompression surgery, and localized cooling to preserve viable spinal cord tissue and enhance functional recovery. METHODS After acquiring informed consent, the authors offered this regimen with localized deep cord cooling (dural temperature 6°C) to 20 patients with a neurologically complete spinal cord injury to begin within 8 hours of injury. After decompression, the cord was locally cooled through the intact dura using a suspended extradural saddle at the site of injury for up to 4 hours, during which time spinal fusion was performed. Sensation and motor function were evaluated directly after the injury and again over a year later. The patients were evaluated using the 2011 amendment to the American Spinal Injury Association (ASIA) Impairment Scale. RESULTS Eighty percent of the 20 patients (12 with cervical and 4 thoracic injuries) with an initial neurologically complete cord injury had some recovery of sensory or motor function. All patients initially had ASIA Grade A impairment. Of 14 patients with quadriplegia, 5 remained ASIA Grade A, 5 improved to ASIA Grade B, 3 to ASIA Grade C, and 1 to ASIA Grade D. The remaining 6 patients had suffered a thoracic spinal cord injury, and of these 2 remained ASIA Grade A, 1 recovered to ASIA Grade B, 2 to ASIA Grade C, and 1 ASIA Grade D. All considered, of 20 patients, 35% remained ASIA Grade A, 30% improved to ASIA Grade B, and 25% to ASIA Grade C. Impairment in 2 (10%) of 20 patients improved to ASIA Grade D. The mean improvement in neurological level of injury in all patients was 1.05, the mean improvement in motor level was 1.7, and the mean improvement in sensory level was 2.8. Two patients recovered the ability to walk, 2 could extend their legs, 5 could sense bladder fullness, and 3 had partial ability to void voluntarily. Four males recovered subnormal ability to have voluntary erection sufficient for limited sexual activity. CONCLUSIONS The authors present here results of 20 patients with neurologically complete spinal cord injury treated with a combination of surgical decompression, glucocorticoid administration, and regional hypothermia. These patients experienced a better recovery than might have been expected had traditional forms of treatment been used. The benefit of steroid treatment for cord injury has been debated in the last decade, but the authors feel that research into the effects of cord cooling should be expanded. Given that the optimal neuroprotective temperature after acute trauma has not yet been defined, and may well be below that which is considered safely approachable through systemic cooling, methods that allow for the early attainment of such a temperature locally should be further explored. The results are encouraging enough to suggest the undertaking of controlled clinical trials of treatment using localized spinal cord cooling, where such treatment can be instituted within hours following injury.
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Affiliation(s)
- Robert R Hansebout
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada; and
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Scivoletto G, Glass C, Anderson KD, Galili T, Benjamin Y, Front L, Aidinoff E, Bluvshtein V, Itzkovich M, Aito S, Baroncini I, Benito-Penalva J, Castellano S, Osman A, Silva P, Catz A. An International Age- and Gender-Controlled Model for the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI). Neurorehabil Neural Repair 2014; 29:25-32. [DOI: 10.1177/1545968314524631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. A quadratic formula of the Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) has previously been published. This formula was based on a model of Spinal Cord Independence Measure (SCIM95), the 95th percentile of the SCIM III values, which correspond with the American Spinal Injury Association Motor Scores (AMS) of SCI patients. Objective. To further develop the original formula. Setting. Spinal cord injury centers from 6 countries and the Statistical Laboratory, Tel-Aviv University, Israel. Methods. SCIM95 of 661 SCI patients was modeled, using a quantile regression with or without adjustment for age and gender, to calculate SCI-ARMI values. SCI-ARMI gain during rehabilitation and its correlations were examined. Results. A new quadratic SCIM95 model was created. This resembled the previously published model, which yielded similar SCIM95 values in all the countries, after adjustment for age and gender. Without this adjustment, however, only 86% of the non-Israeli SCIM III observations were lower than those SCIM95 values ( P < .0001). Adding the variables age and gender to the new model affected the SCIM95 value significantly ( P < .04). Adding country information did not add a significant effect ( P > .1). SCI-ARMI gain was positive (38.8 ± 22 points, P < .0001) and correlated weakly with admission age and AMS. Conclusions. The original quadratic SCI-ARMI formula is valid for an international population after adjustment for age and gender. The new formula considers more factors that affect functional ability following SCI.
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Affiliation(s)
| | - Clive Glass
- North West Regional Spinal Injuries Centre, Southport, UK
| | | | | | | | - Lilach Front
- Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Elena Aidinoff
- Tel Aviv University, Tel Aviv, Israel
- Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Vadim Bluvshtein
- Tel Aviv University, Tel Aviv, Israel
- Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Malka Itzkovich
- Tel Aviv University, Tel Aviv, Israel
- Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Sergio Aito
- Careggi University Hospital, Florence, Italy
| | | | - Jesùs Benito-Penalva
- Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Aheed Osman
- Midlands Centre for Spinal Injuries, Oswestry, UK
| | - Pedro Silva
- Centro de Medicina de Reabilitação da Região Centro—Rovisco Pais (CMRRC-RP) Tocha, Portugal
| | - Amiram Catz
- Tel Aviv University, Tel Aviv, Israel
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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Zarco-Periñan MJ, Barrera-Chacón MJ, García-Obrero I, Mendez-Ferrer JB, Alarcon LE, Echevarria-Ruiz de Vargas C. Development of the Spanish version of the Spinal Cord Independence Measure version III: cross-cultural adaptation and reliability and validity study. Disabil Rehabil 2013; 36:1644-51. [DOI: 10.3109/09638288.2013.864713] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Derakhshanrad N, Saberi H, Yekaninejad MS, Eskandari G, Mardani A, Rahdari F, Meybodi KT. Safety of granulocyte colony-stimulating factor (G-CSF) administration for postrehabilitated motor complete spinal cord injury patients: an open-label, phase I study. Cell Transplant 2013; 22 Suppl 1:S139-46. [PMID: 23992648 DOI: 10.3727/096368913x672109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Granulocyte colony-stimulating factor (G-CSF) is a major growth factor in the activation and differentiation of granulocytes. This cytokine has been widely and safely employed in different conditions over many years. In this translational study, G-CSF is administered to 19 patients with chronic motor complete spinal cord injury, and outcomes are reported. All 19 patients received subcutaneous G-CSF (5 µg/kg per day) for 5 days and were followed for at least 6 months. The American Spinal Injury Association (ASIA) scale was used for motor and sensory assessment, and the International Association of Neurorestoratology-Spinal Cord Injury Functional Rating Scale (IANR-SCIFRS) and the Spinal Cord Independence Measure (SCIM) III were used to assess improvements in the ability to perform basic daily tasks. At the 6-month follow-up, upper extremity motor scores improved by 10, which was statistically significant (p = 0.007), whereas there were no significant changes in lower extremity motor scores. Also, the median of light touch sensory scores improved by 5 (p = 0.001). Pinprick sensory scores significantly improved (p = 0.002). The median increment in SCIM III total score was 7 (p = 0.001). The improvements in bladder and bowel management as well as moderate distance mobility subscales were also significant (p < 0.05). Total IANR-SCIFRS scores changed from 17 to 32, which was statistically significant (p = 0.001); again the bladder and bowel management subscale improvements were statistically significant (p < 0.05). Mild side effects of the G-CSF treatment such as bone pain, rash, fever, neuropathic pain, and spasticity were noted in a few patients; all of them resolved after 1 week. Our results indicate that G-CSF administration is a safe process and is associated with neurological as well as functional improvement. This manuscript is published as part of the International Association of Neurorestoratology (IANR) supplement issue of Cell Transplantation.
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Scivoletto G, Tamburella F, Laurenza L, Molinari M. The spinal cord independence measure: how much change is clinically significant for spinal cord injury subjects. Disabil Rehabil 2013; 35:1808-13. [DOI: 10.3109/09638288.2012.756942] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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