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García-Rudolph A, Wright MA, Yepes C, Murillo N, Conesa L, Soriano I, Bautista R, Opisso E, Tormos JM, Medina J. Effectiveness and efficiency of telerehabilitation on functionality after spinal cord injury: A matched case-control study. PM R 2023. [PMID: 38155582 DOI: 10.1002/pmrj.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and health outcomes in patients with spinal cord injury (SCI). The clinical effectiveness of teleSCI is not known. OBJECTIVES To compare independence in activities of daily living and mobility capacity in patients following teleSCI and matched controls undergoing traditional rehabilitation. DESIGN Matched case-control study. SETTING TeleSCI occurring in home setting (cases) versus traditional rehabilitation on inpatient unit (controls). PARTICIPANTS Forty-two consecutive patients with SCI followed with teleSCI were compared to 42 historical rehabilitation inpatients (controls) matched for age, time since injury to rehabilitation admission, level of injury (paraplegia/tetraplegia), complete or incomplete injury, and etiology (traumatic/nontraumatic). The teleSCI group (n = 42) was also compared to the complete cohort of historical controls (n = 613). INTERVENTIONS The teleSCI group followed home-based telerehabilitation (3.5 h/day, 5 days/week, 67 days average duration) and historical controls followed in-person rehabilitation. MAIN OUTCOME MEASURE(S) The Functional Independence Measure (FIM), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI). We formally compared gains, efficiency and effectiveness. International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS) were used. RESULTS The teleSCI group (57.1% nontraumatic, 71.4% paraplegia, 73.8% incomplete, 52.4% AIS grade D) showed no significant differences compared with historical controls in AIS grades, neurological levels, duration, gains, efficiency and effectiveness in FIM, SCIM, or WISCI, although the teleSCI cohort had significantly higher admission FIM scores compared with the complete cohort of historical controls. CONCLUSIONS TeleSCI may provide similar improvements in mobility and functional outcomes as traditional rehabilitation in medically stable patients (predominantly with paraplegia and motor incomplete SCI) when provided with appropriate support and equipment.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Mark Andrew Wright
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Carlos Yepes
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Narda Murillo
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Lucas Conesa
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Ignasi Soriano
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Raquel Bautista
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Josep Maria Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Josep Medina
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
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Bigford GE, Betancourt LF, Charlifue S, Nash MS. Therapeutic Lifestyle Intervention Targeting Enhanced Cardiometabolic Health and Function for Persons with Chronic Spinal Cord Injury in Caregiver/Care-Receiver Co-Treatment: A Study Protocol of a Multisite Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6819. [PMID: 37835090 PMCID: PMC10572441 DOI: 10.3390/ijerph20196819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Chronic spinal cord injury (SCI) significantly accelerates morbidity and mortality, partly due to the increased risk of cardiometabolic diseases (CMD), including neurogenic obesity, dyslipidemia, and impaired glucose metabolism. While exercise and dietary interventions have shown some transient benefits in reducing CMD risk, they often fail to improve clinically relevant disease markers and cardiovascular events. Moreover, SCI also places caregiving demands on their caregivers, who themselves experience health and functional decline. This underscores the need for more substantial interventions that incorporate appropriate physical activity, heart-healthy nutrition, and behavioral support tailored to the SCI population. OBJECTIVES This randomized clinical trial (RCT) protocol will (1) assess the health and functional effects, user acceptance, and satisfaction of a 6-month comprehensive therapeutic lifestyle intervention (TLI) adapted from the National Diabetes Prevention Program (DPP) for individuals with chronic SCI and (2) examine the impact of a complementary caregiver program on the health and function of SCI caregivers and evaluate user acceptance and satisfaction. Caregivers (linked with their partners) will be randomized to 'behavioral support' or 'control condition'. METHODS Dyadic couples comprise individuals with SCI (18-65 years, >1-year post-injury, ASIA Impairment Scale A-C, injury levels C5-L1) and non-disabled SCI caregivers (18-65 years). Both groups undergo lock-step circuit resistance training, a calorie-restricted Mediterranean-style diet, and 16 educational sessions focused on diet/exercise goals, self-monitoring, psychological and social challenges, cognitive behavioral therapy, and motivational interviewing. The outcome measures encompass the cardiometabolic risks, cardiorespiratory fitness, inflammatory stress, multidimensional function, pain, life quality, independence, self-efficacy, program acceptance, and life satisfaction for SCI participants. The caregiver outcomes include multidimensional function, pain, quality of life, independence, and perceived caregiver burden. DISCUSSION/CONCLUSIONS This study evaluates the effects and durability of a structured, multi-modal intervention on health and function. The results and intervention material will be disseminated to professionals and consumers for broader implementation. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02853149 Registered 2 August 2016.
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Affiliation(s)
- Gregory E. Bigford
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (L.F.B.); (M.S.N.)
| | - Luisa F. Betancourt
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (L.F.B.); (M.S.N.)
| | | | - Mark S. Nash
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (L.F.B.); (M.S.N.)
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33101, USA
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Skiadopoulos A, Famodimu GO, Solomon SK, Agarwal P, Harel NY, Knikou M. Priming locomotor training with transspinal stimulation in people with spinal cord injury: study protocol of a randomized clinical trial. Trials 2023; 24:145. [PMID: 36841773 PMCID: PMC9960224 DOI: 10.1186/s13063-023-07193-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND The seemingly simple tasks of standing and walking require continuous integration of complex spinal reflex circuits between descending motor commands and ascending sensory inputs. Spinal cord injury greatly impairs standing and walking ability, but both improve with locomotor training. However, even after multiple locomotor training sessions, abnormal muscle activity and coordination persist. Thus, locomotor training alone cannot fully optimize the neuronal plasticity required to strengthen the synapses connecting the brain, spinal cord, and local circuits and potentiate neuronal activity based on need. Transcutaneous spinal cord (transspinal) stimulation alters motoneuron excitability over multiple segments by bringing motoneurons closer to threshold, a prerequisite for effectively promoting spinal locomotor network neuromodulation and strengthening neural connectivity of the injured human spinal cord. Importantly, whether concurrent treatment with transspinal stimulation and locomotor training maximizes motor recovery after spinal cord injury is unknown. METHODS Forty-five individuals with chronic spinal cord injury are receiving 40 sessions of robotic gait training primed with 30 Hz transspinal stimulation at the Thoracic 10 vertebral level. Participants are randomized to receive 30 min of active or sham transspinal stimulation during standing or active transspinal stimulation while supine followed by 30 min of robotic gait training. Over the course of locomotor training, the body weight support, treadmill speed, and leg guidance force are adjusted as needed for each participant based on absence of knee buckling during the stance phase and toe dragging during the swing phase. At baseline and after completion of all therapeutic sessions, neurophysiological recordings registering corticospinal and spinal neural excitability changes along with clinical assessment measures of standing and walking, and autonomic function via questionnaires regarding bowel, bladder, and sexual function are taken. DISCUSSION The results of this mechanistic randomized clinical trial will demonstrate that tonic transspinal stimulation strengthens corticomotoneuronal connectivity and dynamic neuromodulation through posture-dependent corticospinal and spinal neuroplasticity. We anticipate that this mechanistic clinical trial will greatly impact clinical practice because, in real-world clinical settings, noninvasive transspinal stimulation can be more easily and widely implemented than invasive epidural stimulation. Additionally, by applying multiple interventions to accelerate motor recovery, we are employing a treatment regimen that reflects a true clinical approach. TRIAL REGISTRATION ClinicalTrials.gov NCT04807764 . Registered on March 19, 2021.
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Affiliation(s)
- Andreas Skiadopoulos
- grid.254498.60000 0001 2198 5185Klab4Recovery Research Program, The City University of New York, College of Staten Island, Staten Island, NY USA ,grid.254498.60000 0001 2198 5185Department of Physical Therapy, College of Staten Island, The City University of New York, Staten Island, NY USA
| | - Grace O. Famodimu
- Spinal Cord Damage Research Center, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY USA
| | - Shammah K. Solomon
- grid.254498.60000 0001 2198 5185Klab4Recovery Research Program, The City University of New York, College of Staten Island, Staten Island, NY USA ,grid.254498.60000 0001 2198 5185Department of Physical Therapy, College of Staten Island, The City University of New York, Staten Island, NY USA
| | - Parul Agarwal
- grid.59734.3c0000 0001 0670 2351Population Health Science & Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, Manhattan, NY USA
| | - Noam Y. Harel
- Spinal Cord Damage Research Center, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY USA ,grid.59734.3c0000 0001 0670 2351Population Health Science & Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, Manhattan, NY USA
| | - Maria Knikou
- Klab4Recovery Research Program, The City University of New York, College of Staten Island, Staten Island, NY, USA. .,Department of Physical Therapy, College of Staten Island, The City University of New York, Staten Island, NY, USA. .,PhD Program in Biology and Collaborative Neuroscience Program, Graduate Center of The City University of New York and College of Staten Island, Manhattan & Staten Island, NY, USA.
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Skiadopoulos A, Famodimu GO, Solomon SK, Agrawal P, Harel NY, Knikou M. Priming locomotor training with transspinal stimulation in people with spinal cord injury: study protocol of a randomized clinical trial. RESEARCH SQUARE 2023:rs.3.rs-2527617. [PMID: 36824823 PMCID: PMC9949167 DOI: 10.21203/rs.3.rs-2527617/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background The seemingly simple tasks of standing and walking require continuous integration of complex spinal reflex circuits between descending motor commands and ascending sensory inputs. Spinal cord injury greatly impairs standing and walking ability, but both improve with locomotor training. However, even after multiple locomotor training sessions, abnormal muscle activity and coordination persist. Thus, locomotor training alone cannot fully optimize the neuronal plasticity required to strengthen the synapses connecting the brain, spinal cord, and local circuits and potentiate neuronal activity based on need. Transcutaneous spinal cord (transspinal) stimulation alters motoneuron excitability over multiple segments by bringing motoneurons closer to threshold, a prerequisite for effectively promoting spinal locomotor network neuromodulation and strengthening neural connectivity of the injured human spinal cord. Importantly, whether concurrent treatment with transspinal stimulation and locomotor training maximizes motor recovery after spinal cord injury is unknown. Methods Forty-five individuals with chronic spinal cord injury are receiving 40 sessions of robotic gait training primed with 30 Hz transspinal stimulation at the Thoracic 10 vertebral level. Participants are randomized to receive 30-minutes of active or sham transspinal stimulation during standing or active transspinal stimulation while supine followed by 30-minutes of robotic gait training. Over the course of locomotor training, the body weight support, treadmill speed, and leg guidance force are adjusted as needed for each participant based on absence of knee buckling during the stance phase and toe dragging during the swing phase. At baseline and after completion of all therapeutic sessions, neurophysiological recordings registering corticospinal and spinal neural excitability changes along with clinical assessment measures of standing and walking, and autonomic function via questionnaires regarding bowel, bladder and sexual function are taken. Discussion The results of this mechanistic randomized clinical trial will demonstrate that tonic transspinal stimulation strengthens corticomotoneuronal connectivity and dynamic neuromodulation through posture-dependent corticospinal and spinal neuroplasticity. We anticipate that this mechanistic clinical trial will greatly impact clinical practice because in real-world clinical settings, noninvasive transspinal stimulation can be more easily and widely implemented than invasive epidural stimulation. Additionally, by applying multiple interventions to accelerate motor recovery, we are employing a treatment regimen that reflects a true clinical approach. Trial registration ClinicalTrials.gov: NCT04807764; Registered on March 19, 2021.
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Affiliation(s)
| | | | | | - Parul Agrawal
- Icahn School of Medicine at Mount Sinai Department of Population Health Science and Policy
| | - Noam Y Harel
- James J Peters VAMC: James J Peters VA Medical Center
| | - Maria Knikou
- College of Staten Island School of Health Sciences
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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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Benedicto AJ, Foresti AG, Fernandes MVF, Miri AL, Lopes EL, Souza RBD. Análise da independência funcional em indivíduos com lesão da medula espinal. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35146.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Resumo Introdução A lesão da medula espinal (LME) muda radicalmente a vida da pessoa devido às alterações na dinâmica corporal, levando à incapacidades e redução da funcionalidade. Objetivo Analisar a independência funcional de indivíduos com LME e comparar os grupos. Métodos Indivíduos com LME foram entrevistados sobre sua independência funcional por meio da versão brasileira do Spinal Cord Independence Measure - Self-Reported Version (brSCIM-SR) e posteriormente seus respectivos domínios e subdomínios foram comparados entre os grupos diagnósticos, tempo de lesão e gênero. Resultados A amostra foi composta por 50 indivíduos com idade de 40,92 ± 13,93 anos, prevalecendo homens e diagnóstico de paraplegia. Na maioria dos domínios do brSCIM-SR todos os entrevistados atingiram boa independência no autocuidado, na respiração e controle esfincteriano e no total do brSCIM-SR, exceto na mobilidade. Na paraplegia, as LMEs crônicas e ambos os sexos alcançaram excelente independência na maioria dos subdomínios e no total do instrumento. Valores significantemente baixos foram encontrados na tetraplegia e nas LMEs recentes no subdomínio autocuidado. Na maioria dos subdomínios, a tetraplegia atingiu valores significativamente inferiores. Nos subdomínios da respiração e controle esfincteriano, os participantes eram independentes na função respiração, mas nas tetraplegias apresentaram significativa depen-dência nas transferências para o vaso sanitário. Na mobilidade houve grande dependência nos itens subir e descer escadas e transferir-se do chão para a cadeira de rodas. Conclusão Os indivíduos com LME demonstra-ram boa independência funcional, com pior desempenho na tetraplegia e lesões recentes, mas a mobilidade apresentou parcial dependência nos participantes.
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Benedicto AJ, Foresti AG, Fernandes MVF, Miri AL, Lopes EL, Souza RBD. Functional independence analysis in persons with spinal cord injury. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract Introduction Spinal cord injury (SCI) radically changes a person’s life because of alterations in body dynamics, leading to disabilities and reduced functionality. Objective To analyze the functional independence of individuals with spinal cord injury and compare the groups. Methods Individuals with SCI were interviewed about their functional independence using the Brazilian version of the Spinal Cord Independence Measure - Self-Reported Version (brSCIM-SR) and later their respective domains and subdomains were compared between diagnostic groups, time since injury and sex. Results The sample consisted of fifty individuals aged 40.92 ± 13.93 years, predominantly men and diagnosed with paraplegia. In most brSCIM-SR domains, all respondents achieved good independence in self-care, respiration and sphincter management, and in the total brSCIM-SR, except for mobility. In paraplegia, chronic SCIs and both sexes achieved excellent independence in most subdomains and in the total. Significantly low values were found for tetraplegia and recent SCI in the self-care subdomain. In most subdomains, tetraplegia reached significantly lower values. In the subdomains of respiration and sphincter management, the participants were independent in the breathing function, but in tetraplegia, they showed significant dependence on transfer to the toilet. In terms of mobility, there was great dependence on the items going up and down stairs and transfer from the floor to the wheelchair. Conclusion The brSCIM-SR measures the degree of functionality, allowing health professionals and the patient to quantify and locate the items that indicate their deficits or gains during the rehabilitation process. Here, individuals with SCI showed good functional independence, with worse performance in the tetraplegia and recent injury groups: however, mobility showed partial dependence in the participants.
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Use of the modified Constraint Induced Movement Therapy Protocol to improve function of the predominant arm, on a patient with Incomplete Spinal Cord Injury. A Case Report. Am J Phys Med Rehabil 2021; 101:e62-e64. [PMID: 34864765 DOI: 10.1097/phm.0000000000001936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In this case study, an off label modified Constraint Induced Movement Therapy (mCIMT) protocol was applied in a 28-year male patient with incomplete tetraplegia C5 ASIA D as a facilitator to enhance predominant upper arm function and regain important Activities of Daily Living (ADLs). The patient was ambulatory for short distances with arm crutches but could not perform important ADLs due to the involvement of his right arm, autonomy and function were impaired. A 10 weeks protocol of mCIMT was performed, with two daily sessions for 30 min each, a sling was used to constrain the less affected arm, and exercises of the predominant hand were performed. Spasticity was managed with botulinum toxin injections. After 5 weeks, the patient was able to use a spoon, perform intermittent catheterization, dress upper body, and use the right arm to feed himself. The protocol was concluded without further amelioration. The mCIMT is also a valuable facilitator for incomplete tetraplegia.
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Sawada T, Okawara H, Matsubayashi K, Sugai K, Kawakami M, Tashiro S, Nori S, Tsuji O, Nagoshi N, Matsumoto M, Nakamura M. Influence of body weight-supported treadmill training with voluntary-driven exoskeleton on the quality of life of persons with chronic spinal cord injury: a pilot study. Int J Rehabil Res 2021; 44:343-349. [PMID: 34483288 DOI: 10.1097/mrr.0000000000000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate whether body weight-supported treadmill training with voluntary-driven exoskeleton body weight-supported treadmill training (VDE-BWSTT) improves the quality of life (QOL) of persons with chronic spinal cord injury (SCI). Nineteen individuals with chronic SCI with walking limitation underwent a total of 20 sessions of VDE-BWSTT using the hybrid assistant limb. The QOL was measured using the Short Form-36v2 (SF-36v2) questionnaire at preintervention and postintervention. The Walking Index for SCI-II (WISCI-II), Functional Independence Measure (FIM) motor score, and Neuropathic Pain Symptom Inventory (NPSI) self-questionnaire were also administered/completed. In SF-36v2, the mean values of all subscales in our participants were lower than those in healthy individuals. None of the measures showed significant improvement, even in individuals with some residual walking ability (baseline WISCI-II score of 6 or higher). In the correlation analysis between the baselines WISCI-II, FIM, or NPSI values and the mean SF-36v2 subscale changes throughout the training, the baseline FIM motor score was positively correlated with the mean changes in Role Emotional and Mental Health. In addition, NPSI was negatively correlated with the mean change in Vitality and Mental Health. In our protocol, although VDE-BWSTT did not improve the QOL of persons with chronic SCI, those with higher functional independence or lower pain at preintervention likely improved. Further study with combination of task-specific training or pain-targeting treatment with more patients should be considered to more effectively improve their QOL.
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Affiliation(s)
- Tomonori Sawada
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Hiroki Okawara
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Kohei Matsubayashi
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center
| | - Keiko Sugai
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine
| | - Syoichi Tashiro
- Department of Rehabilitation, Kyorin University, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine
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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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Eaton R, Duff J, Wallace M, Jones K. The value of the whole picture: rehabilitation outcome measurement using patient self-report and clinician-based assessments after spinal cord injury. Spinal Cord 2021; 60:71-80. [PMID: 34616008 DOI: 10.1038/s41393-021-00677-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/13/2021] [Accepted: 07/23/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is a retrospective longitudinal study. OBJECTIVES To explore the relative impact and contribution of using both the Spinal Cord Independence Measure III (SCIM) and Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) to assess rehabilitation outcome following an acute spinal cord injury (SCI). SETTING The study was performed at National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK. METHODS A patient self-report SMS-NAC and clinician-rated SCIM were administered on admission and discharge from the NSIC as part of standardised care. This paper presents a retrospective analysis of the rehabilitation outcomes of 195 people with spinal cord injury (PwSCI) following their first admission. RESULTS In both measures, PwSCI improved from admission to discharge. Individuals with higher SCI obtained lower scores in both measures, at both admission and discharge. The SMS-NAC demonstrated the greatest increase in knowledge and skill for PwSCI who had higher and more complete injuries. On the SCIM, PwSCI who had lower and less complete injuries demonstrated the greatest increase in outcome. CONCLUSIONS Overall, both measures demonstrated responsiveness to change during SCI rehabilitation and enable clinicians to systematically determine areas to focus rehabilitation effort. The relative strengths and contribution to delivering person-centred care for each are identified. The SMS-NAC enables clinicians to record, for people with higher injuries, their subjective self-report of skill and knowledge gains from rehabilitation that may be missed with other measures. Consequently, using both is encouraged in appreciation of the value of recording verbal (instructional) independence as well as functional (physical) independence.
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Affiliation(s)
- Rebecca Eaton
- NSIC, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Jane Duff
- NSIC, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK.
| | - Martha Wallace
- NSIC, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Kevin Jones
- NSIC, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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Al’joboori Y, Massey SJ, Knight SL, Donaldson NDN, Duffell LD. The Effects of Adding Transcutaneous Spinal Cord Stimulation (tSCS) to Sit-To-Stand Training in People with Spinal Cord Injury: A Pilot Study. J Clin Med 2020; 9:jcm9092765. [PMID: 32858977 PMCID: PMC7565331 DOI: 10.3390/jcm9092765] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023] Open
Abstract
Spinal cord stimulation may enable recovery of volitional motor control in people with chronic Spinal Cord Injury (SCI). In this study we explored the effects of adding SCS, applied transcutaneously (tSCS) at vertebral levels T10/11, to a sit-to-stand training intervention in people with motor complete and incomplete SCI. Nine people with chronic SCI (six motor complete; three motor incomplete) participated in an 8-week intervention, incorporating three training sessions per week. Participants received either tSCS combined with sit-to-stand training (STIM) or sit-to-stand training alone (NON-STIM). Outcome measures were carried out before and after the intervention. Seven participants completed the intervention (STIM N = 5; NON-STIM N = 2). Post training, improvements in International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor scores were noted in three STIM participants (range 1.0–7.0), with no change in NON-STIM participants. Recovery of volitional lower limb muscle activity and/or movement (with tSCS off) was noted in three STIM participants. Unassisted standing was not achieved in any participant, although standing with minimal assistance was achieved in one STIM participant. This pilot study has shown that the recruitment of participants, intervention and outcome measures were all feasible in this study design. However, some modifications are recommended for a larger trial.
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Affiliation(s)
- Yazi Al’joboori
- Department of Medical Physics & Biomedical Engineering, UCL, London WC1E 6BT, UK; (N.d.N.D.); (L.D.D.)
- Aspire CREATe, UCL, Stanmore HA7 4LP, UK;
- Correspondence: ; Tel.: +44-020-3108-4083
| | | | - Sarah L. Knight
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK;
| | - Nick de N. Donaldson
- Department of Medical Physics & Biomedical Engineering, UCL, London WC1E 6BT, UK; (N.d.N.D.); (L.D.D.)
| | - Lynsey D. Duffell
- Department of Medical Physics & Biomedical Engineering, UCL, London WC1E 6BT, UK; (N.d.N.D.); (L.D.D.)
- Aspire CREATe, UCL, Stanmore HA7 4LP, UK;
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Yoo HJ, Lee S, Kim J, Park C, Lee B. Development of 3D-printed myoelectric hand orthosis for patients with spinal cord injury. J Neuroeng Rehabil 2019; 16:162. [PMID: 31888695 PMCID: PMC6937865 DOI: 10.1186/s12984-019-0633-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/12/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is a severe medical condition affecting the hand and locomotor function. New medical technologies, including various wearable devices, as well as rehabilitation treatments are being developed to enhance hand function in patients with SCI. As three-dimensional (3D) printing has the advantage of being able to produce low-cost personalized devices, there is a growing appeal to apply this technology to rehabilitation equipment in conjunction with scientific advances. In this study, we proposed a novel 3D-printed hand orthosis that is controlled by electromyography (EMG) signals. The orthosis was designed to aid the grasping function for patients with cervical SCI. We applied this hand exoskeleton system to individuals with tetraplegia due to SCI and validated its effectiveness. METHODS The 3D architecture of the device was designed using computer-aided design software and printed with a polylactic acid filament. The dynamic hand orthosis enhanced the tenodesis grip to provide sufficient grasping function. The root mean square of the EMG signal was used as the input for controlling the device. Ten subjects with hand weakness due to chronic cervical SCI were enrolled in this study, and their hand function was assessed before and after wearing the orthosis. The Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) was used as the primary outcome measure. Furthermore, improvements in functional independence in daily living and device usability were evaluated. RESULTS The newly developed orthosis improved hand function of subjects, as determined using the TRI-HFT (p < 0.05). Furthermore, participants obtained immediate functionality on eating after wearing the orthosis. Moreover, most participants were satisfied with the device as determined by the usability test. There were no side effects associated with the experiment. CONCLUSIONS The 3D-printed myoelectric hand orthosis was intuitive, easy to use, and showed positive effects in its ability to handle objects encountered in daily life. This study proved that combining simple EMG-based control strategies and 3D printing techniques was feasible and promising in rehabilitation engineering. TRIAL REGISTRATION Clinical Research Information Service (CRiS), Republic of Korea. KCT0003995. Registered 2 May 2019 - Retrospectively registered.
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Affiliation(s)
- Hyun-Joon Yoo
- Department of Biomedical Science and Engineering (BMSE), Institute Integrated Technology (IIT), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005 South Korea
| | - Sangbaek Lee
- Department of Biomedical Science and Engineering (BMSE), Institute Integrated Technology (IIT), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005 South Korea
| | - Jongheon Kim
- Department of Mechanical Engineering, Inha University, 100, Inha-ro, Michuhol-gu, Incheon, 22212 South Korea
| | - Chanki Park
- School of Mechanical Engineering, Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005 South Korea
| | - Boreom Lee
- Department of Biomedical Science and Engineering (BMSE), Institute Integrated Technology (IIT), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005 South Korea
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14
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Unai K, Uemura O, Takemura R, Kawakami M, Liu M. Association Between SCIM III Total Scores and Individual Item Scores to Predict Independence With ADLs in Persons With Spinal Cord Injury. Arch Rehabil Res Clin Transl 2019; 1:100029. [PMID: 33543058 PMCID: PMC7853332 DOI: 10.1016/j.arrct.2019.100029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To clarify the activities of daily living (ADL) structure of persons with spinal cord injury (SCI) by analyzing the associations between the Spinal Cord Independence Measure III (SCIM III) total score and individual SCIM III item scores. Design A retrospective survey. Setting A national hospital with 2 SCI units in Japan. Participants Inpatients (N=81) within 60 days of SCI onset were included (men, 84%). The mean age was 62 years. Of these, 63 persons had incomplete SCI (47 persons had tetraplegia). Interventions Not applicable. Main Outcome Measure SCIM III was used to assess the ADL independence level on a monthly basis during hospitalization. SCIM III data were analyzed with ordinal logistic analyses. Results The analyses revealed that SCIM III total scores accounted for the probabilities of individual SCIM III item scores. Goodness-of-fit of each logistic model by Wald test was significant (P<.001, R2McFadden=0.183-0.598). Some items in the self-care domain showed a shallow (ie, less steep) logistic curve. Regarding the feeding item, a total score of 80 was needed to attain the complete independence level, while patients with a total score >10 attained modified independence level. Conclusions The SCIM III total score can provide information on the probability and degree of difficulty of attaining independence for each item. Therefore, the present total SCIM III scores could be the indication for ADL attainment. In addition, the higher total SCIM III score and the probability of individual items score are useful for planning efficient rehabilitative approaches, considering the degree of difficulty of attaining independence for each item. Moreover, our results show good generalizability across patients with complete and incomplete SCI.
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Affiliation(s)
- Kei Unai
- National Hospital Organization Murayama Medical Center, Gakuen, Musashimurayama, Tokyo, Japan
| | - Osamu Uemura
- National Hospital Organization Murayama Medical Center, Gakuen, Musashimurayama, Tokyo, Japan
- Corresponding author Osamu Uemura, MD, PhD, National Hospital Organization Murayama Medical Center, 2-37-1, Gakuen, Musashimurayama, Tokyo 208-0011, Japan.
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
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15
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Badhiwala JH, Wilson JR, Kwon BK, Casha S, Fehlings MG. A Review of Clinical Trials in Spinal Cord Injury Including Biomarkers. J Neurotrauma 2019; 35:1906-1917. [PMID: 29888678 DOI: 10.1089/neu.2018.5935] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Acute traumatic spinal cord injury (SCI) entered the arena of prospective, randomized clinical trials almost 40 years ago, with the undertaking of the National Acute Spinal Cord Study (NASCIS) I trial. Since then, a number of clinical trials have been conducted in the field, spurred by the devastating physical, social, and economic consequences of acute SCI for patients, families, and society at large. Many of these have been controversial and attracted criticism. The current review provides a critical summary of select past and current clinical trials in SCI, focusing in particular on the findings of prospective, randomized controlled trials, the challenges and barriers encountered, and the valuable lessons learned that can be applied to future trials.
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Affiliation(s)
- Jetan H Badhiwala
- 1 Division of Neurosurgery, Department of Surgery, University of Toronto , Toronto, Ontario, Canada
| | - Jefferson R Wilson
- 1 Division of Neurosurgery, Department of Surgery, University of Toronto , Toronto, Ontario, Canada
| | - Brian K Kwon
- 2 Vancouver Spine Surgery Institute, Department of Orthopedics, University of British Columbia , Vancouver, British Columbia, Canada
| | - Steven Casha
- 3 Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Michael G Fehlings
- 1 Division of Neurosurgery, Department of Surgery, University of Toronto , Toronto, Ontario, Canada
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16
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Kooijmans H, Post M, Motazedi E, Spijkerman D, Bongers-Janssen H, Stam H, Bussman H. Exercise self-efficacy is weakly related to engagement in physical activity in persons with long-standing spinal cord injury. Disabil Rehabil 2019; 42:2903-2909. [PMID: 30907149 DOI: 10.1080/09638288.2019.1574914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: Many people with a long-standing spinal cord injury have an inactive lifestyle. Although exercise self-efficacy is considered a key determinant of engaging in exercise, the relationship between exercise self-efficacy and physical activity remains unclear. Therefore, this study examines the relationship between exercise self-efficacy and the amount of physical activity in persons with long-standing spinal cord injury.Methods: This cross-sectional study included 268 individuals (aged 28-65 years) with spinal cord injury ≥ 10 years and using a wheelchair. Physical activity was measured with the Physical Activity Scale for Individuals with Physical Disabilities. Exercise self-efficacy was assessed with the Spinal cord injury Exercise Self-Efficacy Scale. Univariate and multivariable regression analyses were performed to test for the association between exercise self-efficacy and physical activity, controlling for supposed confounders.Results: Univariate regression analysis revealed that exercise self-efficacy was significantly related to the level of daily physical activity (β = 0.05; 95% CI 0.04-0.07; 15% explained variance; p < 0.001). In multivariable regression analysis exercise self-efficacy remained, explaining a significant additional amount of the variance (2%; p < 0.001) of physical activity.Conclusion: Exercise-self efficacy is a weak but independent explanatory factor of the level of physical activity among persons with long-standing spinal cord injury. Longitudinal trials are needed to study the impact of interventions targeting an increase of exercise self-efficacy on the amount of physical activity performed.Implications for rehabilitationPre-intervention levels of exercise-self-efficacy might mediate the effectiveness of interventions that aim at increasing physical activities in people with a long-standing spinal cord injury.Enhancing exercise-self efficacy may improve levels of physical activity, even in people with a long-standing spinal cord injury.When it comes to enhancing physical activity, efforts to enhance non-structured daily physical activities such as household activities and gardening might be as important as efforts to enhance sports and other physical exercise.
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Affiliation(s)
| | - Marcel Post
- De Hoogstraat Center of Excellence in Rehabilitation Medicine, Utrecht, Netherlands
| | - Ehsan Motazedi
- Plant Sciences Group, Wageningen University and Research, Wageningen, Netherlands
| | | | | | - Henk Stam
- Erasmus MC, Rehabilitation Medicine, Rotterdam, Netherlands
| | - Hans Bussman
- Erasmus MC, Rehabilitation Medicine, Rotterdam, Netherlands
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Sørensen L, Månum G. A single-subject study of robotic upper limb training in the subacute phase for four persons with cervical spinal cord injury. Spinal Cord Ser Cases 2019; 5:29. [PMID: 31240123 PMCID: PMC6462035 DOI: 10.1038/s41394-019-0170-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/22/2022] Open
Abstract
Study design Single-subject design, standard training ("B") compared with Robotic training ("C"). Objectives To explore the impact of robotic training on upper limb function, activities of daily living (ADL) and training experience in subacute tetraplegic inpatients. Setting Inpatient subacute Norwegian spinal cord injury (SCI) unit. Methods Four participants (C4-7, AIS A-C) completed 11 sessions of robotic training using a passive robotic exoskeleton (Armeo Spring®). Descriptive statistics and visual analyses were used for comparing standard occupational therapy and robotic training. Outcome measures included the Spinal Cord Independence Measure (SCIM-III), the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), and a questionnaire. Results All of the participants exhibited an increase in assessments of upper limb function (GRASSP-total) right side (0.4%-61.2%), and all except for one participant (-8%) showed an increase on their left side (20.9%-106.2%). Three out of four participants had improvements in ADL function SCIM-III (ranging from 5.6% to 46.7%). Results demonstrated improvements during the robotic intervention period in five out of 28 measurements. The participants enjoyed the exercise, and found it motivating and relevant to their injury (median ranged from 3.5 to 6.5 on a 0-7 scale). Conclusions Three out of four participants improved upper limb function and ADL independence, but the study could not confirm that improvements were due to the robotic intervention. The participants enjoyed the robotic training and found it relevant to their injury.
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Affiliation(s)
| | - Grethe Månum
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
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18
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Kooijmans H, Post MWM, Stam HJ, van der Woude LHV, Spijkerman DCM, Snoek GJ, Bongers-Janssen HMH, van Koppenhagen CF, Twisk JW, Bussmann JBJ. Effectiveness of a Self-Management Intervention to Promote an Active Lifestyle in Persons With Long-Term Spinal Cord Injury: The HABITS Randomized Clinical Trial. Neurorehabil Neural Repair 2018; 31:991-1004. [PMID: 29256337 DOI: 10.1177/1545968317736819] [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: 11/17/2022]
Abstract
BACKGROUND Most people with long-term spinal cord injury (SCI) have a very inactive lifestyle. Higher activity levels have been associated with health benefits and enhanced quality of life. Consequently, encouraging an active lifestyle is important and behavioral interventions are needed to establish durable lifestyle changes. OBJECTIVE The Healthy Active Behavioral Intervention in SCI (HABITS) study was aimed to evaluate the effectiveness of a structured self-management intervention to promote an active lifestyle in inactive persons with long-term SCI. METHODS This assessor-blinded randomized controlled trial was conducted at 4 specialized SCI units in the Netherlands. Sixty-four individuals with long-term SCI (>10 years), wheelchair-user and physically inactive, were included. Participants were randomized to either a 16-week self-management intervention consisting of group meetings and individual counseling and a book, or to a control group that only received information about active lifestyle by one group meeting and a book. Measurements were performed at baseline, 16 weeks, and 42 weeks. Primary outcome measures were self-reported physical activity and minutes per day spent in wheelchair driving. Secondary outcomes included perceived behavioral control (exercise self-efficacy, proactive coping), stages of change concerning exercise, and attitude toward exercise. RESULTS Mixed models analyses adjusted for age, sex, level of SCI, time since injury, baseline body mass index, and location did not show significant differences between the intervention and control groups on the primary and secondary outcomes ( P ≥ .05). CONCLUSIONS A structured 16-week self-management intervention was not effective to change behavior toward a more active lifestyle and to improve perceived behavioral control, stages of change, and attitude.
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Affiliation(s)
- Hedwig Kooijmans
- 1 Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marcel W M Post
- 2 University Medical Center Utrecht and De Hoogstraat, Utrecht, Netherlands.,3 University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Henk J Stam
- 1 Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | | | - Govert J Snoek
- 5 Roessingh Rehabilitation Center, Enschede, Netherlands
| | | | | | - Jos W Twisk
- 8 VU University Medical Center, Amsterdam, Netherlands
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Nene AV, Rainha Campos A, Grabljevec K, Lopes A, Skoog B, Burns AS. Clinical Assessment of Spasticity in People With Spinal Cord Damage: Recommendations From the Ability Network, an International Initiative. Arch Phys Med Rehabil 2018; 99:1917-1926. [PMID: 29432722 DOI: 10.1016/j.apmr.2018.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
Abstract
A thorough assessment of the extent and severity of spasticity, and its effect on functioning, is central to the effective management of spasticity in persons with spinal cord damage (SCD). These individuals however do not always receive adequate assessment of their spasticity. Inadequate assessment compromises management when the effect of spasticity and/or need for intervention are not fully recognized. Assessment is also central to determining treatment efficacy. A barrier to spasticity assessment has been the lack of consensus on clinical and functional measures suitable for routine clinical practice. To extend on existing work, a working group of the Ability Network identified and consolidated information on possible measures, and then synthesized and formulated findings into practical recommendations for assessing spasticity and its effect on function in persons with SCD. Sixteen clinical and functional measures that have been used for this purpose were identified using a targeted literature review. These were mapped to the relevant domains of the International Classification of Functioning, Disability and Health to assess the breadth of their coverage; coverage of many domains was found to be lacking, suggesting a focus for future work. The advantages, disadvantages, and usefulness of the measures were assessed using a range of criteria, with a focus on usefulness and feasibility in routine clinical practice. Based on this evaluation, a selection of measures suitable for initial and follow-up assessments are recommended. The recommendations are intended to have broad applicability to a variety of health care settings where people with SCD are managed.
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Affiliation(s)
- Anand V Nene
- Roessingh Center for Rehabilitation, Roessingh Research & Development, Enschede, The Netherlands, Canada.
| | | | | | - Arminda Lopes
- Centre of Physical and Rehabilitation Medicine of the South, São Brás de Alportel, Portugal, Canada
| | - Bengt Skoog
- Sahlgrenska University Hospital, Gothenburg, Sweden, Canada
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Robot-Assisted Training of Arm and Hand Movement Shows Functional Improvements for Incomplete Cervical Spinal Cord Injury. Am J Phys Med Rehabil 2017; 96:S171-S177. [DOI: 10.1097/phm.0000000000000815] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mehta S, Janzen S, McIntyre A, Iruthayarajah J, Loh E, Teasell R. Are Comorbid Pain and Depressive Symptoms Associated with Rehabilitation of Individuals with Spinal Cord Injury? Top Spinal Cord Inj Rehabil 2017; 24:37-43. [PMID: 29434459 DOI: 10.1310/sci16-00027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To examine the difference in functional outcomes and therapy intensity among individuals with spinal cord injury (SCI) with comorbid depression and pain symptoms compared to those without these symptoms. Methods: A retrospective chart review was conducted of 100 patients admitted to a specialized SCI inpatient rehabilitation unit. Standard demographic factors were collected. Patients were divided into 2 groups: those with comorbid depression and pain symptoms and those without. Outcomes were compared between the 2 groups using analysis of covariance (ANCOVA). Age, gender, level of injury, severity of injury, and FIM® admission were included in the model as covariates. Main outcomes included FIM® discharge, length of stay (LOS), intensity of therapy (total physical therapy time [PTt] and total occupational therapy time [OTt]), living arrangement, and vocational status. Results: No significant difference was seen between the 2 groups in FIM® discharge or OTt; however, those in the comorbidity group required significantly greater PTt than those without (p = .002). Those in the comorbid group also spent longer in inpatient rehabilitation (p = .005). The groups did not differ in postdischarge living arrangements or vocational status. Conclusion: Inpatient rehabilitation physical therapy and LOS differ substantially among individuals with comorbid depression and pain symptoms. This comorbidity may have a negative impact on functional recovery such that individuals may require more physical therapy time and longer LOS. This may also point to the increased resources required to manage individuals with SCI and comorbid depression and pain symptoms.
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Affiliation(s)
| | | | | | | | - Eldon Loh
- Parkwood Institute, London, Ontario, Canada
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22
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Khurana M, Walia S, Noohu MM. Study on the Effectiveness of Virtual Reality Game-Based Training on Balance and Functional Performance in Individuals with Paraplegia. Top Spinal Cord Inj Rehabil 2017; 23:263-270. [PMID: 29339902 DOI: 10.1310/sci16-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To determine whether there is any difference between virtual reality game-based balance training and real-world task-specific balance training in improving sitting balance and functional performance in individuals with paraplegia. Methods: The study was a pre test-post test experimental design. There were 30 participants (28 males, 2 females) with traumatic spinal cord injury randomly assigned to 2 groups (group A and B). The levels of spinal injury of the participants were between T6 and T12. The virtual reality game-based balance training and real-world task-specific balance training were used as interventions in groups A and B, respectively. The total duration of the intervention was 4 weeks, with a frequency of 5 times a week; each training session lasted 45 minutes. The outcome measures were modified Functional Reach Test (mFRT), t-shirt test, and the self-care component of the Spinal Cord Independence Measure-III (SCIM-III). Results: There was a significant difference for time (p = .001) and Time × Group effect (p = .001) in mFRT scores, group effect (p = .05) in t-shirt test scores, and time effect (p = .001) in the self-care component of SCIM-III. Conclusions: Virtual reality game-based training is better in improving balance and functional performance in individuals with paraplegia than real-world task-specific balance training.
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Affiliation(s)
| | - Shefali Walia
- ISIC Institute of Rehabilitation Sciences, New Delhi, India
| | - Majumi M Noohu
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
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You JS, Kim YL, Lee SM. Effects of a standard transfer exercise program on transfer quality and activities of daily living for transfer-dependent spinal cord injury patients. J Phys Ther Sci 2017; 29:478-483. [PMID: 28356635 PMCID: PMC5361014 DOI: 10.1589/jpts.29.478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/01/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The objective of this study was to analyze the effect of a standard transfer
exercise program on the transfer quality and activities of daily living (ADL) in
wheelchair-dependent spinal cord injury patients. [Subjects and Methods] We randomly
divided 22 patients into 2 groups. During the intervention period, one group received
treatment with both conventional physical therapy and a standard sitting pivot transfer
exercise program (experimental group, n=12) and the other group was managed solely with
conventional physical therapy (control group, n=10). The standard transfer exercise
program comprised of an independent and a dependent program. Exercises were conducted 30
minutes daily, 3 times per week, over a period of 6 weeks. All subjects were tested using
a transfer assessment instrument (TAI) and spinal cord independence measure (SCIM) before
and after the intervention. [Results] Compared to the control group, the intervention
group scored higher on both the transfer assessment instrument (TAI Part 1, Part 2, TAI
total score) and spinal cord independence measure tests (SCIM mobility room and toilet
score; SCIM total score). [Conclusion] In conclusion, the standard transfer exercise
program is an effective tool which improves transfer quality and the ability of
wheelchair-dependent spinal cord injury patients to carry out their ADLs.
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Affiliation(s)
- Ji-Sung You
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - You Lim Kim
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Suk Min Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Shank CD, Walters BC, Hadley MN. Management of acute traumatic spinal cord injuries. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:275-298. [PMID: 28187803 DOI: 10.1016/b978-0-444-63600-3.00015-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute traumatic spinal cord injury (SCI) is a devastating disease process affecting tens of thousands of people across the USA each year. Despite the increase in primary prevention measures, such as educational programs, motor vehicle speed limits, automobile running lights, and safety technology that includes automobile passive restraint systems and airbags, SCIs continue to carry substantial permanent morbidity and mortality. Medical measures implemented following the initial injury are designed to limit secondary insult to the spinal cord and to stabilize the spinal column in an attempt to decrease devastating sequelae. This chapter is an overview of the contemporary management of an acute traumatic SCI patient from the time of injury through the stay in the intensive care unit. We discuss initial triage, immobilization, and transportation of the patient by emergency medical services personnel to a definitive treatment facility. Upon arrival at the emergency department, we review initial trauma protocols and the evidence-based recommendations for radiographic evaluation of the patient's vertebral column. Finally, we outline closed cervical spine reduction and various aggressive medical therapies aimed at improving neurologic outcome.
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Affiliation(s)
- C D Shank
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA
| | - B C Walters
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA
| | - M N Hadley
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA.
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Slavin MD, Ni P, Tulsky DS, Kisala PA, Heinemann AW, Charlifue S, Fyffe DC, Graves DE, Marino RJ, Morse LR, Rosenblum D, Tate D, Worobey LA, Dawson MB, Jette AM. Spinal Cord Injury–Functional Index/Assistive Technology Short Forms. Arch Phys Med Rehabil 2016; 97:1745-1752.e7. [DOI: 10.1016/j.apmr.2016.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 10/21/2022]
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Grassner L, Wutte C, Klein B, Mach O, Riesner S, Panzer S, Vogel M, Bühren V, Strowitzki M, Vastmans J, Maier D. Early Decompression (< 8 h) after Traumatic Cervical Spinal Cord Injury Improves Functional Outcome as Assessed by Spinal Cord Independence Measure after One Year. J Neurotrauma 2016; 33:1658-66. [DOI: 10.1089/neu.2015.4325] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lukas Grassner
- Center for Spinal Cord Injuries, Trauma Center Murnau, Germany
- Department of Neurosurgery, Trauma Center Murnau, Germany
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Austria
| | - Christof Wutte
- Department of Neurosurgery, Trauma Center Murnau, Germany
| | - Barbara Klein
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Austria
| | - Orpheus Mach
- Center for Spinal Cord Injuries, Trauma Center Murnau, Germany
| | - Silvie Riesner
- Center for Spinal Cord Injuries, Trauma Center Murnau, Germany
| | - Stephanie Panzer
- Department of Radiology, Trauma Center Murnau, Germany
- Institute of Biomechanics, Trauma Center Murnau and Paracelsus Medical University Salzburg, Murnau, Germany
| | - Matthias Vogel
- Center for Spinal Cord Injuries, Trauma Center Murnau, Germany
| | - Volker Bühren
- Center for Spinal Cord Injuries, Trauma Center Murnau, Germany
| | | | - Jan Vastmans
- Center for Spinal Cord Injuries, Trauma Center Murnau, Germany
| | - Doris Maier
- Center for Spinal Cord Injuries, Trauma Center Murnau, Germany
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Wang JC, Chan RC, Tsai YA, Huang WC, Cheng H, Wu HL, Huang SF. The influence of shoulder pain on functional limitation, perceived health, and depressive mood in patients with traumatic paraplegia. J Spinal Cord Med 2015; 38:587-92. [PMID: 25296991 PMCID: PMC4535800 DOI: 10.1179/2045772314y.0000000271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To assess whether functional activity, perceived health, and depressive symptoms differ between individuals with traumatic paraplegia with and without shoulder pain. DESIGN Cross sectional and comparative investigation using the unified questionnaire. SETTING Neural Regeneration and Repair Division unit of Taipei Veterans General Hospital in Taiwan. PARTICIPANTS Seventy-six patients with paraplegia (23 with and 53 without shoulder pain) who had experienced spinal cord injury at American Spinal Injury Association Impairment Scale T2 to T12 neurologic level (at least 6 months previously). OUTCOME MEASURES Spinal Cord Independence Measure (SCIM), a single item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Patient Health Questionnaire-9 (PHQ-9) depression scale. RESULTS Shoulder pain was prevalent in 30% patients. Patients with shoulder pain had significantly worse perceived health and greater depressive symptoms than those without. No significant difference was found in functional ability between groups. Greater shoulder pain intensity was related to higher depressive scores (r=0.278, P=0.017) and lower self-perceived health scores (r=-0.433, P<0.001) but not SCIM scores (P=0.342). CONCLUSION Although shoulder pain was unrelated to functional limitation, it was associated with lower perceived health and higher depressive mood levels.
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Affiliation(s)
| | | | | | | | | | - Han-Lin Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Fong Huang
- Correspondence to: Shih-Fong Huang, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei City 11217, Taiwan, ROC.
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Harvey LA, Anderson KD. The spinal cord independence measure. J Physiother 2015; 61:99. [PMID: 25801929 DOI: 10.1016/j.jphys.2015.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/04/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lisa A Harvey
- Sydney Medical School/Northern, University of Sydney, Sydney, Australia
| | - Kim D Anderson
- Department of Neurological Surgery, University of Miami, Miami, USA
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Jones ML, Evans N, Tefertiller C, Backus D, Sweatman M, Tansey K, Morrison S. Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: results from a randomized clinical trial. Arch Phys Med Rehabil 2014; 95:2239-46.e2. [PMID: 25102384 DOI: 10.1016/j.apmr.2014.07.400] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/03/2014] [Accepted: 07/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation. DESIGN Randomized controlled trial with delayed treatment design. SETTING Outpatient program in a private, nonprofit rehabilitation hospital. PARTICIPANTS Volunteer sample of adults (N=48; 37 men and 11 women; age, 18-66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI). INTERVENTIONS A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression. MAIN OUTCOME MEASURES Neurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check). RESULTS Significant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1±6.3 vs 0.9±5.0; P=.024] and lower extremity motor score [4.2±5.2 vs -0.6±4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P=.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P=.002). CONCLUSIONS ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.
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Affiliation(s)
- Michael L Jones
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
| | - Nicholas Evans
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | | | - Deborah Backus
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Mark Sweatman
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Keith Tansey
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Sarah Morrison
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
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Furlan JC, Hitzig SL, Craven BC. The influence of age on functional recovery of adults with spinal cord injury or disease after inpatient rehabilitative care: a pilot study. Aging Clin Exp Res 2013; 25:463-71. [PMID: 23784728 DOI: 10.1007/s40520-013-0066-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 02/04/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The impact of age on functional recovery after spinal cord injury/disease (SCI/D) is still unclear. Given this, we sought to examine the potential influence of patient's age on functional recovery following SCI/D. METHODS This retrospective cohort study included consecutive adults with SCI/D admitted to a tertiary rehabilitation center from January 2003 to April 2004. The main outcome was functional recovery during inpatient rehabilitation. Functional recovery was assessed using the Spinal Cord Independence Measure (SCIM) and Functional Independence Measure (FIM). FIM and SCIM mean admission scores were subtracted from mean discharge scores and compared to thresholds for minimal clinically important differences. Potential confounders included gender, mechanism of SCI/D, level, and severity of SCI/D. RESULTS There were 30 patients (11 females, 19 males; ages 30-83 years) with traumatic (n = 11) or non-traumatic SCI/D (n = 19). Mean baseline SCIM and FIM scores were 55.1 ± 4.3 and 82.7 ± 3.6, respectively. After a mean follow-up time of 71 days, patients achieved a mean SCIM of 70.6 ± 4.2 and mean FIM score of 107.3 ± 2.8. SCIM scores were not associated with age in the analyses either using univariate analysis (p = 0.137) or regression analysis (p = 0.215). FIM scores were not associated with age either using univariate analysis (p = 0.266) or regression analysis (p = 0.551). CONCLUSIONS Our results indicate that age is not associated with functional recovery after rehabilitation for SCI/D. Clinicians and allied health professionals should have a greater awareness of the potential of adult patients with SCI/D to achieve functional recovery regardless of age.
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Affiliation(s)
- Julio C Furlan
- Toronto Western Research Institute, University Health Network, 399 Bathurst Street, McL 12-407, Toronto, ON M5T 2S8, Canada.
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Wirth B, van Hedel H, Curt A. Foot control in incomplete SCI: distinction between paresis and dexterity. Neurol Res 2013; 30:52-60. [DOI: 10.1179/174313208x297030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chafetz RS, Gaughan JP, Calhoun C, Schottler J, Vogel LC, Betz R, Mulcahey MJ. Relationship between neurological injury and patterns of upright mobility in children with spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 19:31-41. [PMID: 23678283 DOI: 10.1310/sci1901-31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The predictors and patterns of upright mobility in children with a spinal cord injury (SCI) are poorly understood. OBJECTIVE The objective of this study was to develop a classification system that measures children's ability to integrate ambulation into activities of daily living (ADLs) and to examine upright mobility patterns as a function of their score and classification on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam. METHODS This is a cross-sectional, multicenter study that used a convenience sample of subjects who were participating in a larger study on the reliability of the ISNCSCI. A total of 183 patients between 5 and 21 years old were included in this study. Patients were asked if they had participated in upright mobility in the last month and, if so, in what environment and with what type of bracing. Patients were then categorized into 4 groups: primary ambulators (PrimA), unplanned ambulators (UnPA), planned ambulators (PlanA), and nonambulators. RESULTS Multivariate analyses found that only lower extremity strength predicted being a PrimA, whereas being an UnPA was predicted by both lower extremity strength and lack of preservation of S45 pinprick sensation. PlanA was only associated with upper extremity strength. CONCLUSIONS This study introduced a classification system based on the ability of children with SCI to integrate upright mobility into their ADLs. Similar to adults, lower extremity strength was a strong predictor of independent mobility (PrimA and UnPA). Lack of pinprick predicted unplanned ambulation, but not being a PrimA. Finally, upper extremity strength was a predictor for planned ambulation.
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Affiliation(s)
- Ross S Chafetz
- Shriners Hospitals for Children , Philadelphia, Pennsylvania
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Hadley MN, Walters BC, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Theodore N. Clinical Assessment Following Acute Cervical Spinal Cord Injury. Neurosurgery 2013; 72 Suppl 2:40-53. [DOI: 10.1227/neu.0b013e318276edda] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Beverly C. Walters
- Division of Neurological Surgery
- Department of Neurosciences, Inova Health System, Falls Church, Virginia
| | | | - Sanjay S. Dhall
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Daniel E. Gelb
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - R. John Hurlbert
- Department of Clinical Neurosciences, University of Calgary Spine Program, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Curtis J. Rozzelle
- Division of Neurological Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Timothy C. Ryken
- Iowa Spine & Brain Institute, University of Iowa, Waterloo/Iowa City, Iowa
| | - Nicholas Theodore
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
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Kooijmans H, Post MWM, van der Woude LHV, de Groot S, Stam HJ, Bussmann JBJ. Randomized controlled trial of a self-management intervention in persons with spinal cord injury: design of the HABITS (Healthy Active Behavioural Intervention in SCI) study. Disabil Rehabil 2012; 35:1111-8. [PMID: 23033846 DOI: 10.3109/09638288.2012.718406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the effectiveness of a 16-week self-management intervention on physical activity level and self-management skills (self-efficacy, proactive coping and problem solving skills) in persons with chronic SCI. METHOD AND DESIGN Multicenter randomized controlled trial (RCT). Eighty persons with a SCI for at least 10 years and aged 18 to 65 will randomly be assigned to the intervention (self-management) or the control group (information provision). During the 16-week self-management intervention (one home-visit, five group and five individual sessions) active lifestyle will be stimulated and self-management skills will be taught. Data will be collected at baseline (T0), 16 (T1) and 42 (T2) weeks after baseline. Primary outcome measure is level of daily physical activity (self-report/objectively measured). Secondary outcome measures are self-managements skills, stage of behaviour change and attitude. CONCLUSION This is the first RCT on self-management in people with chronic spinal cord injury. This trial will provide knowledge on the effects of a self-management intervention on physical active lifestyle in persons with a long-term SCI.
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Affiliation(s)
- H Kooijmans
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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36
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[Acute traumatic spinal cord injuries: Epidemiology and prospects]. Neurochirurgie 2012; 58:293-9. [PMID: 22959585 DOI: 10.1016/j.neuchi.2012.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 06/26/2012] [Accepted: 06/27/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Specify the epidemiological data on the acute spinal cord injuries and define a group of patients that could benefit from cellular transplantation therapy designed with the aim of repair and regeneration of damaged spinal cord tissues. MATERIAL AND METHODS Five years monocentric (Gui-de-Chauliac Hospital, Montpellier, France) retrospective analysis of patients suffering from spinal cord injury (SCI). Spinal cord injured-patients, defined as sensory-motor complete, underwent a clinical evaluation following American Spinal Injury Association (ASIA) and functional type 2 Spinal Cord Independence Measure (SCIM2) scorings as well as radiological evaluation through spinal cord magnetic resonance imaging (MRI). RESULTS One hundred and fifty-seven medical records were reviewed and we selected and re-examined 20 patients with complete thoracic spinal cord lesion. Clinical and radiological evaluations of these patients demonstrated, in 75 % of the cases, an absence of clinical progression after a mean of 49months. Radiological abnormalities were constantly present in the initial (at the admission to hospital) and control (re-evaluation) MRI and no reliable predictive criteria of prognosis had been found. DISCUSSION/CONCLUSION We compare our results to the literature and discuss advantages and limits of cellular transplantation strategies for these patients.
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Association between the Functional Independence Measure following spinal cord injury and long-term outcomes. Spinal Cord 2012; 50:728-33. [DOI: 10.1038/sc.2012.50] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Diffusion-weighted MR imaging within 24 h post-injury after traumatic spinal cord injury: a qualitative meta-analysis between T2-weighted imaging and diffusion-weighted MR imaging in 18 patients. Spinal Cord 2012; 50:426-31. [DOI: 10.1038/sc.2011.168] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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The Timed Manual Wheelchair Slalom Test: A Reliable and Accurate Performance-Based Outcome Measure for Individuals With Spinal Cord Injury. Arch Phys Med Rehabil 2011; 92:1339-43. [DOI: 10.1016/j.apmr.2011.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 02/08/2011] [Accepted: 02/12/2011] [Indexed: 11/22/2022]
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Thietje R, Giese R, Pouw M, Kaphengst C, Hosman A, Kienast B, van de Meent H, Hirschfeld S. How does knowledge about spinal cord injury-related complications develop in subjects with spinal cord injury? A descriptive analysis in 214 patients. Spinal Cord 2010; 49:43-8. [PMID: 20820180 DOI: 10.1038/sc.2010.96] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Monocentric cohort study. OBJECTIVE To investigate the acquisition of knowledge about spinal cord injury (SCI)-related complications in SCI patients. SETTING Level 1 trauma center. METHODS All patients with a traumatic or non-traumatic SCI were included in the study. Data were collected at admission, post-admission at 1 and 3 months and post-discharge at 6, 18 and 30 months. The discharge of all patients was between 3 and 6 months post-admission. Knowledge about pressure ulcers and bladder management was tested using the 'Knowledge' score. This score has a minimum and maximum of 0 and 20 points. To detect differences across the multiple time intervals, the Friedman test was used. Differences in the number of patients with poor (0-8), average (9-12) and good knowledge (13-20) between the different age classifications (age at injury) were calculated using a χ (2)-test. RESULTS A total of 214 patients were included. At discharge subjects had increased their knowledge score to 11.2 compared with 5.4 on admission (P < 0.001). After 30 months, however, the mean score decreased to 10.8 points. At the time of discharge, the number of patients who achieved poor, average or good knowledge were 48 (22.4%), 65 (30.4%) and 101 (47.2%), respectively. Subjects of ∼50 years old and tetraplegics had better (P < 0.001) knowledge compared with subjects of ∼50 years old and paraplegics, respectively. CONCLUSION In this study, less than 50% of SCI patients had good knowledge about bladder management and pressure ulcers after being discharged.
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Affiliation(s)
- R Thietje
- BG Trauma Hospital Hamburg, Centre for Spinal Injuries, Hamburg, Germany.
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Furlan JC, Noonan V, Singh A, Fehlings MG. Assessment of disability in patients with acute traumatic spinal cord injury: a systematic review of the literature. J Neurotrauma 2010; 28:1413-30. [PMID: 20367251 DOI: 10.1089/neu.2009.1148] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Given the importance of accurately and reliably assessing disability in future clinical trials, which will test therapeutic strategies in acute spinal cord injury (SCI), we sought to appraise comprehensively studies that focused on the psychometric properties (i.e., reliability, validity, and responsiveness) of all previously used outcome measures in the SCI population. The search strategy included Medline, CINAHL, EMBASE, and Cochrane databases. Two reviewers independently assessed each study regarding eligibility, level of evidence (using Sackett's criteria), and quality. Of 363 abstracts captured in our search, 36 full articles fulfilled the inclusion and exclusion criteria. Eight different outcome measures were used to assess disability in the SCI population, including Functional Independence Measure (FIM), Spinal cord Injury Measure (SCIM), Walking Index for Spinal Cord Injury (WISCI), Quadriplegia Index of Function (QIF), Modified Barthel Index (MBI), Timed Up & Go (TUG), 6-min walk test (6MWT), and 10-m walk test (10MWT). While 19 of 36 studies provided level-4 evidence, the remaining 17 articles were classified as level-2b evidence. Most of the instruments showed convergent construct validity in the SCI population, but criterion validity was not examined due to the lack a gold standard for assessment of disability. All instruments were tested in the rehabilitation and/or community setting, but only FIM was examined in the acute care setting. Based on our results of quality assessment, the SCIM has the most appropriate performance regarding the instrument's psychometric properties. Nonetheless, further investigations are required to confirm the adequate performance of the SCIM as a comprehensive measure of functional recovery in patients with SCI in rehabilitative care. The expert panel of the Spinal Cord Injury Solutions Network (SCISN) that participated in the modified Delphi process endorsed these conclusions.
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Affiliation(s)
- Julio C Furlan
- Department of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
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Abstract
La lesión medular es una entidad neurológica causante de importantes procesos de discapacidad. Su incidencia en el país puede estar cercana a los mayores estimativos mundiales debido a las condiciones actuales de violencia. El aumento de la expectativa de vida de esta población —gracias a los avances tecnológicos y científicos en prevención, atención y manejo de complicaciones— lleva a la necesidad de proveer servicios de rehabilitación integrales que trasciendan los aspectos funcionales y permitan la inclusión social. Para este propósito es necesario un abordaje integral de la situación, que en el ámbito de la evaluación debe incluir no sólo la estimación de la condición de salud, sino todo lo relacionado con el funcionamiento de las personas en su vida diaria. La clasificación internacional del funcionamiento, la discapacidad y la salud, brinda un marco conceptual para abordar la discapacidad y el funcionamiento humano relacionado con la salud desde un enfoque biopsicosocial que articula las dimensiones corporal, individual y social de las personas y su relación con los factores del ambiente. Este enfoque de abordaje, plasmado en el instrumento de evaluación denominado WHO-DAS II, se considera un referente importante para evaluar la discapacidad asociada a la lesión medular.
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Invernizzi M, Carda S, Milani P, Mattana F, Fletzer D, Iolascon G, Gimigliano F, Cisari C. Development and validation of the Italian version of the Spinal Cord Independence Measure III. Disabil Rehabil 2010; 32:1194-203. [DOI: 10.3109/09638280903437246] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Parameters for positive outcome of the in-hospital rehabilitation of spinal cord lesion patients: the Boberg Quality Score. Spinal Cord 2010; 48:537-41. [DOI: 10.1038/sc.2009.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hawryluk GWJ, Rowland J, Kwon BK, Fehlings MG. Protection and repair of the injured spinal cord: a review of completed, ongoing, and planned clinical trials for acute spinal cord injury. Neurosurg Focus 2009; 25:E14. [PMID: 18980474 DOI: 10.3171/foc.2008.25.11.e14] [Citation(s) in RCA: 185] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Over the past 2 decades, advances in understanding the pathophysiology of spinal cord injury (SCI) have stimulated the recent emergence of several therapeutic strategies that are being examined in Phase I/II clinical trials. Ten randomized controlled trials examining methylprednisolone sodium succinate, tirilizad mesylate, monosialotetrahexosylganglioside, thyrotropin releasing hormone, gacyclidine, naloxone, and nimodipine have been completed. Although the primary outcomes in these trials were laregely negative, a secondary analysis of the North American Spinal Cord Injury Study II demonstrated that when administered within 8 hours of injury, methylprednisolone sodium succinate was associated with modest clinical benefits, which need to be weighed against potential complications. Thyrotropin releasing hormone (Phase II trial) and monosialotetrahexosylganglioside (Phase II and III trials) also showed some promise, but we are unaware of plans for future trials with these agents. These studies have, however, yielded many insights into the conduct of clinical trials for SCI. Several current or planned clinical trials are exploring interventions such as early surgical decompression (Surgical Treatment of Acute Spinal Cord Injury Study) and electrical field stimulation, neuroprotective strategies such as riluzole and minocycline, the inactivation of myelin inhibition by blocking Nogo and Rho, and the transplantation of various cellular substrates into the injured cord. Unfortunately, some experimental and poorly characterized SCI therapies are being offered outside a formal investigational structure, which will yield findings of limited scientific value and risk harm to patients with SCI who are understandably desperate for any intervention that might improve their function. Taken together, recent advances suggest that optimism for patients and clinicians alike is justified, as there is real hope that several safe and effective therapies for SCI may become available over the next decade.
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Affiliation(s)
- Gregory W J Hawryluk
- Division of Genetics and Development, Toronto Western Research Institute, Toronto, Ontario, Canada
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Leung AKL, Wong AFY, Wong ECW, Hutchins SW. The Physiological Cost Index of walking with an isocentric reciprocating gait orthosis among patients with T(12) - L(1) spinal cord injury. Prosthet Orthot Int 2009; 33:61-8. [PMID: 19235067 DOI: 10.1080/03093640802562368] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to compare the Physiological Cost Index of walking with a reciprocating gait orthosis to that of walking with bilateral knee-ankle-foot orthoses (KAFOs) by subjects with paraplegia resulting from T(12) - L(1) spinal cord lesions. METHODOLOGY Six chronic paraplegic subjects who had T(12) - L(1) spinal cord lesions and who previously wore bilateral KAFOs were recruited. Each subject was fitted with an isocentric reciprocating gait orthosis (IRGO) and received a standardized training program. Subjects were then asked to walk using the two orthotic devices along a 40 m rectangular pathway at a speed that was comfortable for them. The walking speed was measured using a stop watch, and a Polar Heart Rate Monitor was used to measure the heart rate of the subjects. The Physiological Cost Index (PCI) was calculated for comparison. RESULTS Ambulation using the IRGO (10.46 +/- 2.00 m/min) was significantly faster (p = 0.009) than ambulation using the bilateral KAFOs (5.51 +/- 4.30 m/min). The PCI demonstrated when walking with the IRGO (2.85 +/- 0.77 beats/m) was significantly lower (p = 0.0306) than that of the bilateral KAFOs (6.77 +/- 3.28 beats/m). CONCLUSION Paraplegic patients with T(12) - L(1) spinal cord lesions walk faster and more efficiently using the isocentric reciprocating gait orthosis as compared to using the bilateral KAFOs.
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Affiliation(s)
- Aaron K L Leung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
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Ankle paresis in incomplete spinal cord injury: relation to corticospinal conductivity and ambulatory capacity. J Clin Neurophysiol 2008; 25:210-7. [PMID: 18677185 DOI: 10.1097/wnp.0b013e318183f4e3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There is limited data on the relation of corticospinal tract conductivity to clinical measures in incomplete spinal cord injury. This study examined the relationship of muscle strength to corticospinal tract input assessed by motor evoked potentials (MEPs) during static and dynamic conditions and to gait. Dorsiflexor strength was established by manual muscle test, maximal voluntary contraction, and maximal movement velocity, the latter being acquired during auditory-paced ankle movements. MEPs were elicited during isometric contractions with constant or continuously increasing ankle joint torque. Gait was assessed by quantifying its speed and independence. Linear regression analyses showed that maximal movement velocity was related to the MEP latencies and amplitudes in the dynamic condition (R(2)(adj.) = 0.62) and to the MEP latencies in the static condition (R(2)(adj.) = 0.45). Maximal voluntary contraction was only related to the MEP latencies in the static (R(2)(adj.) = 0.45) and the dynamic condition (R(2)(adj.) = 0.21), whereas manual muscle test did not show any relationship to the MEPs. In incomplete spinal cord injury patients, the dynamic measure maximal movement velocity might be a useful clinical assessment of corticospinal tract function. Clinical studies on recovery and repair of corticospinal tract function in spinal lesions could substantially benefit from implementing dynamic measures in the clinical assessment protocol.
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Affiliation(s)
- Volker Dietz
- Spinal Cord Injury Centre, Balgrist University Hospital, Forchstr 340 8008 Zürich, Switzerland.
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Mackay-Sim A, Féron F, Cochrane J, Bassingthwaighte L, Bayliss C, Davies W, Fronek P, Gray C, Kerr G, Licina P, Nowitzke A, Perry C, Silburn PAS, Urquhart S, Geraghty T. Autologous olfactory ensheathing cell transplantation in human paraplegia: a 3-year clinical trial. Brain 2008; 131:2376-86. [PMID: 18689435 PMCID: PMC2525447 DOI: 10.1093/brain/awn173] [Citation(s) in RCA: 295] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Olfactory ensheathing cells show promise in preclinical animal models as a cell transplantation therapy for repair of the injured spinal cord. This is a report of a clinical trial of autologous transplantation of olfactory ensheathing cells into the spinal cord in six patients with complete, thoracic paraplegia. We previously reported on the methods of surgery and transplantation and the safety aspects of the trial 1 year after transplantation. Here we address the overall design of the trial and the safety of the procedure, assessed during a period of 3 years following the transplantation surgery. All patients were assessed at entry into the trial and regularly during the period of the trial. Clinical assessments included medical, psychosocial, radiological and neurological, as well as specialized tests of neurological and functional deficits (standard American Spinal Injury Association and Functional Independence Measure assessments). Quantitative test included neurophysiological tests of sensory and motor function below the level of injury. The trial was a Phase I/IIa design whose main aim was to test the feasibility and safety of transplantation of autologous olfactory ensheathing cells into the injured spinal cord in human paraplegia. The design included a control group who did not receive surgery, otherwise closely matched to the transplant recipient group. This group acted as a control for the assessors, who were blind to the treatment status of the patients. The control group also provided the opportunity for preliminary assessment of the efficacy of the transplantation. There were no adverse findings 3 years after autologous transplantation of olfactory ensheathing cells into spinal cords injured at least 2 years prior to transplantation. The magnetic resonance images (MRIs) at 3 years showed no change from preoperative MRIs or intervening MRIs at 1 and 2 years, with no evidence of any tumour of introduced cells and no development of post-traumatic syringomyelia or other adverse radiological findings. There were no significant functional changes in any patients and no neuropathic pain. In one transplant recipient, there was an improvement over 3 segments in light touch and pin prick sensitivity bilaterally, anteriorly and posteriorly. We conclude that transplantation of autologous olfactory ensheathing cells into the injured spinal cord is feasible and is safe up to 3 years of post-implantation, however, this conclusion should be considered preliminary because of the small number of trial patients.
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Affiliation(s)
- A Mackay-Sim
- National Centre for Adult Stem Cell Research, Eskitis Institute for Cell and Molecular Therapies, Griffith University, Brisbane, Qld, Australia.
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Read MS, Sisto SA, Ditunno J. Standardized Ambulation Assessments Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2008. [DOI: 10.1310/sci1401-39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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