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Lee SJ, Yoo J, Park S, Shin JC. Concordance between needle electromyography and manual muscle test findings for muscles with motor grades 0 and 1. PM R 2024; 16:210-218. [PMID: 37376753 DOI: 10.1002/pmrj.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION When it is difficult to determine whether a muscle is grade 0 or 1, manual muscle test (MMT) accuracy can be further improved by using needle electromyography (EMG) as a supplementary and confirmatory examination tool. OBJECTIVE To evaluate concordance between needle EMG and MMT findings for key muscles with motor grades 0 and 1 on the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) examination, and to potentially improve the prognosis for grade 0 muscles with proven muscle activity based on needle EMG findings. DESIGN A retrospective analysis. SETTING Inpatient tertiary rehabilitation facility. INTERVENTIONS Not applicable. PATIENTS One hundred seven patients with spinal cord injury (SCI) admitted for rehabilitation (n = 1218 key muscles, grades 0 or 1). MAIN OUTCOME MEASURES Inter-rater reliability between MMTs and needle EMG was analyzed using Cohen's kappa coefficient (κ). A Mantel Haenszel linear-by-linear association chi-square test was used to determine whether the presence of motor unit action potentials (MUAPs) in muscles graded 0 on the initial MMT at admission was associated with MMT grades at discharge and readmission. RESULTS Moderate-to-substantial agreement between needle EMG and MMT findings was observed (κ = 0.671, p < .01). Concerning key upper and lower extremity muscles, moderate and substantial agreement was identified, respectively. The lowest agreement was noted for C6 muscles. During follow up, 68.8% of muscles with proven MUAPs showed improved motor grades. CONCLUSIONS At initial assessment, distinguishing between motor grades 0 and 1 is imperative because motor grade 1 muscles are more likely to have a better prognosis for improvement. Moderate-to-substantial agreement was observed between MMT and needle EMG findings. The MMT is a reliable method of muscle grading, yet needle EMG may be of value in certain clinical situations to evaluate for the presence of MUAPs when evaluating motor function.
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Affiliation(s)
- Su Ji Lee
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeehyun Yoo
- Department of Rehabilitation, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Seongeun Park
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Cheol Shin
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kurban D, Davidson RA, Smith KM, Carlson M, Joseph J, Elliott S, Noonan VK, Fallah N, Krassioukov AV. Construct validity of the international standards to document remaining autonomic function after spinal cord injury (ISAFSCI) (1st edition). Spinal Cord 2023; 61:644-651. [PMID: 37814014 DOI: 10.1038/s41393-023-00932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
STUDY DESIGN Observational study. OBJECTIVES To assess the construct validity of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) (2012 1st Edition). SETTING Two Canadian spinal cord injury (SCI) centers. METHODS Data were collected between 2011-2014. Assessments included the ISAFSCI, standardized measures of autonomic function and a clinical examination. Construct validity of ISAFSCI was assessed by testing a priori hypotheses on expected ISAFSCI responses to standard measures (convergent hypotheses) and clinical variables (clinical hypotheses). RESULTS Forty-nine participants with an average age of 45 ± 12 years were included, of which 42 (85.7%) were males, 37 (77.6%) had a neurological level of injury at or above T6, and 23 (46.9%) were assessed as having motor and sensory complete SCI. For the six General Autonomic Function component hypotheses, two hypotheses (1 clinical, 1 convergent) related to autonomic control of blood pressure and one clinical hypothesis for temperature regulation were statistically significant. In terms of the Lower Urinary Tract, Bowel and Sexual Function component of the ISAFSCI, all the hypotheses (5 convergent, 3 clinical) were statistically significant except for the hypotheses on female sexual items (2 convergent, 2 clinical), likely due to small sample size. CONCLUSION The construct validity of ISAFSCI (2012 1st Edition) for the General Autonomic Function component was considered to be weak while it was much stronger for the Lower Urinary Tract, Bowel and Sexual Function component based on a priori hypotheses. These results can inform future psychometric studies of the ISAFSCI (2021 2nd Edition).
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Affiliation(s)
| | - Ross A Davidson
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Karen M Smith
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, Canada
| | - Marie Carlson
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | | | - Stacy Elliott
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.
- GF Strong Rehabilitation, Vancouver Coastal Health Authority, Vancouver, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
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Cerpa M, Zuckerman SL, Lenke LG, Kelly MP, Yaszay B, Newton P, Sponseller P, Erickson M, Garg S, Pahys J, Samdani A, Cahill P, McCarthy R, Bumpass D, Sucato D, Boachie-Adjei O, Shah S, Gupta M. Myelopathic Patients Undergoing Severe Pediatric Spinal Deformity Surgery Can Improve Neurologic Function to That of Non-Myelopathic Patients by 1-Year Postoperative. Global Spine J 2023; 13:1384-1393. [PMID: 34409864 PMCID: PMC10416607 DOI: 10.1177/21925682211034837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Multi-center, prospective, observational cohort. OBJECTIVE To compare myelopathic vs. non-myelopathic ambulatory patients in short- and long-term neurologic function, operative treatment, and patient-reported outcomes. METHODS Pediatric deformity patients from 16 centers were enrolled with the following inclusion criteria: aged 10-21 years-old, a Cobb angle ≥100° in either the coronal or sagittal plane or any sized deformity with a planned 3-column osteotomy, and community ambulators. Patients were dichotomized into 2 groups: myelopathic (abnormal preoperative neurologic exam with signs/symptoms of myelopathy) and non-myelopathic (no clinical signs/symptoms of myelopathy). RESULTS Of 311 patients with an average age of 14.7 ± 2.8 years, 29 (9.3%) were myelopathic and 282 (90.7%) were non-myelopathic. There was no difference in age (P = 0.18), gender (P = 0.09), and Risser Stage (P = 0.06), while more patients in the non-myelopathic group had previous surgery (16.1% vs. 3.9%; P = 0.03). Mean lower extremity motor score (LEMS) in myelopathic patients increased significantly compared to baseline at every postoperative visit: Baseline: 40.7 ± 9.9; Immediate postop: 46.0 ± 7.1, P = 0.02; 1-year: 48.2 ± 3.7, P < 0.001; 2-year: 48.2 ± 7.7, P < 0.001). The non-myelopathic group had significantly higher LEMS immediately postoperative (P = 0.0007), but by 1-year postoperative, there was no difference in LEMS between groups (non-myelopathic: 49.3 ± 3.6, myelopathic: 48.2 ± 3.7, P = 0.10) and was maintained at 2-years postoperative (non-myelopathic: 49.2 ± 3.3, myelopathic: 48.2 ± 5.7, P = 0.09). Both groups improved significantly in all SRS domains compared to preoperative, with no difference in scores in the domains for pain (P = 0.12), self-image (P = 0.08), and satisfaction (P = 0.83) at latest follow-up. CONCLUSION In severe spinal deformity pediatric patients presenting with preoperative myelopathy undergoing spinal reconstructive surgery, myelopathic patients can expect significant improvement in neurologic function postoperatively. At 1-year and 2-year postoperative, neurologic function was no different between groups. While non-myelopathic patients had significantly higher postoperative outcomes in SRS mental-health, function, and total-score, both groups had significantly improved outcomes in every SRS domain compared to preoperative.
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Affiliation(s)
- Meghan Cerpa
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Scott L. Zuckerman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Lawrence G. Lenke
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Michael P. Kelly
- Department of Orthopaedics, Washington University, St. Louis, MO, USA
| | - Burt Yaszay
- Rady Children’s Hospital, San Diego, CA, USA
| | | | | | - Mark Erickson
- Children’s Hospital Colorado Aurora, Aurora, CO, USA
| | - Sumeet Garg
- Children’s Hospital Colorado Aurora, Aurora, CO, USA
| | - Joshua Pahys
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | - Amer Samdani
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | | | - Richard McCarthy
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - David Bumpass
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daniel Sucato
- Texas Scottish Rite Hospital for Children Dallas, TX, USA
| | | | - Suken Shah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Munish Gupta
- Department of Orthopaedics, Washington University, St. Louis, MO, USA
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Boukebous B, Serfaty L, Hodges-Tai TRR, Baker JF, Moyer JD, Rousseau MA. The Associative Pattern Between Segmental Arterial Damage and Complete Neurological Disorder After Spinal Cord Injury: A Case-Control Study. Cureus 2023; 15:e35918. [PMID: 36911583 PMCID: PMC9996064 DOI: 10.7759/cureus.35918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION The prevalence of vascular trauma surrounding the thoracic spine following Spinal Cord Injury (SCI) is unknown. The potential for neurologic recovery is uncertain in many cases; in some cases, neurologic assessment is not possible, for example, in severe head injury or early intubation, and detection of segmental artery injury may help as a predictive factor. OBJECTIVE To assess the prevalence of segmental vessel disruption in two groups, with and without neurologic deficit. MATERIAL AND METHODS This is a retrospective cohort study, with a group SCI American Spinal Injury Association (ASIA) E and a group SCI ASIA A. All patients had a high-energy thoracic or thoracolumbar fracture from T1 to L1. Patients were matched 1:1 (one ASIA A matched with one ASIA E) according to the fracture type, age, and level. The primary variable was the assessment of the presence/disruption of the segmental arteries, bilaterally, around the fracture. Analysis was performed twice by two independent surgeons in a blinded fashion. RESULTS Both groups had 2 type A, 8 type B, and 4 type C fractures. The right segmental artery was detected in 14/14 (100%) of the patients with ASIA E and in 3/14 (21%) or 2/14 (14%) of the patients with ASIA A, according to the observers, p=0.001. The left segmental artery was detectable in 13/14 (93%) or 14/14 (100%) of the patients ASIA E and in 3/14 (21%) of the patients ASIA A for both observers. All in all, 13/14 of the patients with ASIA A had at least one segmental artery undetectable. The sensibility varied between 78%to 92%, and the specificity from 82% to 100%. The Kappa Score varied between 0.55 and 0.78. CONCLUSION Segmental arteries disruption was common in the group ASIA A. This may help to predict the neurological status of patients with no complete neurological assessment or potential for recovery post-injury.
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Affiliation(s)
- Baptiste Boukebous
- Orthopaedics and Traumatology, Waikato District Health Board, Hamilton, NZL
| | - Lorenzo Serfaty
- Orthopedics and Traumatology, Bichat-Claude Bernard Hospital, Paris, FRA
| | - Te Ra R Hodges-Tai
- Orthopedics and Traumatology, Waikato District Health Board, Hamilton, NZL
| | - Joseph F Baker
- Orthopaedics and Traumatology, Waikato District Health Board, Hamilton, NZL
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Vora I, Kline DK, McCauley CA, Link A, Asiello JD, Gaudino SG, Reilly WJ, Keilty MS, Banks RE, Kimberley TJ. Psychometric properties of light touch-pressure somatosensory measures in adults with neurological disorders: A systematic review. Clin Rehabil 2023:2692155231152417. [PMID: 36794517 DOI: 10.1177/02692155231152417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To critically appraise the psychometric properties of light touch-pressure somatosensory assessments to provide guidance for tool selection for research or clinical purposes. DATA SOURCES MEDLINE, CINAHL, and PsycInfo were searched for research indexed from January 1990-November 2022. English language and human subject filters were applied. "Somatosensation", "psychometric property", and "nervous system-based health condition" search terms were combined. Grey literature and manual searches were conducted to ensure thoroughness. REVIEW METHODS The reliability, construct validity, and/or measurement error of light touch-pressure assessments was reviewed in adult populations with neurological disorders. Reviewers individually extracted and managed data including patient demographics, assessment characteristics, statistical methods, and psychometric properties. Methodological quality of results was evaluated using an adapted version of the COnsensus-based Standards for the selection of health Measurement INstruments checklist. RESULTS Thirty-three of 1938 articles were included for review. Fifteen light touch-pressure assessments demonstrated good or excellent reliability. Further, five of those 15 assessments achieved adequate validity and one of the 15 assessments achieved adequate measurement error. Over 80% of the summarized study ratings were determined to be of low or very low quality. CONCLUSION We recommend using electrical perceptual tests, the Semmes-Weinstein Monofilaments, the Graded and Redefined Assessment of Strength, Sensibility, and Prehension, and the Moving Touch Pressure Test given that they demonstrated good to excellent results in three psychometric properties. No other assessment achieved adequate ratings in more than two psychometric properties. This review highlights a fundamental need to develop sensory assessments that are reliable, valid, and sensitive to change.
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Affiliation(s)
- Isha Vora
- Department of Rehabilitation Sciences, 15646MGH Institute of Health Professions, Boston, MA, USA
| | - Danielle K Kline
- Department of Rehabilitation Sciences, 15646MGH Institute of Health Professions, Boston, MA, USA
| | - Colleen A McCauley
- Department of Physical Medicine and Rehabilitation, 440489Spaulding Rehabilitation Hospital Cape Cod, Cape Cod, MA, USA
| | - Angela Link
- Department of Physical Medicine and Rehabilitation, 621778Spaulding Rehabilitation Hospital Boston, Boston, MA, USA
| | - Jessica D Asiello
- Department of Occupational Therapy, 2348Massachusetts General Hospital, Boston, MA, USA.,Department of Occupational Therapy, 15646MGH Institute of Health Professions, Boston, MA, USA
| | | | - William J Reilly
- Department of Physical Medicine and Rehabilitation, 621777Spaulding Rehabilitation Hospital Cambridge, Cambridge, MA, USA
| | - Matthew S Keilty
- Department of Physical Medicine and Rehabilitation, 440489Spaulding Rehabilitation Hospital Cape Cod, Cape Cod, MA, USA
| | - Russell E Banks
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, 15646MGH Institute of Health Professions, Boston, MA, USA.,Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
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Furbish CL, Anderson RK, Field-Fote EC. Accuracy of self-reported severity and level of spinal cord injury. Spinal Cord 2022; 60:934-941. [PMID: 36097066 PMCID: PMC9464614 DOI: 10.1038/s41393-022-00855-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022]
Abstract
Study design Observational. Objectives To assess accuracy of self-reported level of injury (LOI) and severity in individuals with chronic spinal cord injury (SCI) as compared with clinical examination. Setting An SCI Model System Hospital. Methods A 20-item survey evaluated demographics, physical abilities, and self-reported injury level and severity. A decision tree algorithm used responses to categorize participants into injury severity groups. Following the survey, participants underwent clinical examination to determine current injury level and severity. Participants were later asked three questions regarding S1 sparing. Chart abstraction was utilized to obtain initial injury level and severity. Injury level and severity from self-report, decision tree, clinical exam, and chart abstraction were compared. Results Twenty-eight individuals participated. Ninety-three percent correctly self-reported anatomical region of injury (ROI). Self-report of specific LOI matched current clinical LOI for 25% of participants, but matched initial LOI for 61%. Self-report of ASIA Impairment Scale (AIS) matched clinical AIS for 36%, but matched initial AIS for 46%. The injury severity decision tree was 75% accurate without, but 79% accurate with additional S1 questions. Self-report of deep anal pressure (DAP) was correct for 86% of participants, while self-report of voluntary anal contraction (VAC) was correct for 82%. Conclusion Individuals with SCI are more accurate reporting ROI than specific LOI. Self-reported injury level and severity align more closely with initial clinical examination results than current exam results. Using aggregate data from multiple questions can categorize injury severity more reliably than self-report. Using this type of decision tree may improve injury severity classification in large survey studies.
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Tefertiller C, Rozwod M, VandeGriend E, Bartelt P, Sevigny M, Smith AC. Transcutaneous Electrical Spinal Cord Stimulation to Promote Recovery in Chronic Spinal Cord Injury. FRONTIERS IN REHABILITATION SCIENCES 2022; 2. [PMID: 36004322 PMCID: PMC9396932 DOI: 10.3389/fresc.2021.740307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To evaluate the impact of using transcutaneous electrical spinal cord stimulation (TSCSTSCS) on upper and lower extremity function in individuals with chronic spinal cord injury (SCI). Design: Prospective case series. Setting: SCI specific rehabilitation hospital. Participants: A convenience sample (N = 7) of individuals with tetraplegia who had previously been discharged from outpatient therapy due to a plateau in progress. Interventions: Individuals participated in 60 min of upper extremity (UE) functional task-specific practice (FTP) in combination with TSCS and 60 min of locomotor training in combination with TSCS 5x/week. Main Outcome Measures: The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS), LE motor score (LEMS), sensation (light touch and pin prick), Nine-Hole Peg Test, 10 meter walk test, 6 min walk test, and 5 min stand test. Results: Seven individuals (four motor complete; three motor incomplete) completed 20–80 sessions UE and LE training augmented with TSCS and without any serious adverse events. Improvements were reported on the CUE-T in all seven individuals. Two individuals improved their ASIA impairment scale (AIS) classification (B to C; C to D) and two individuals improved their neurologic level of injury by one level (C4–C5; C5–C6). Sensation improved in five individuals and all four who started out with motor complete SCIs were able to voluntarily activate their LEs on command in the presence of stimulation. Conclusion: Individuals with chronic SCI who had previously demonstrated a plateau in function after an intensive outpatient therapy program were able to improve in a variety of UE and LE outcomes in response to TSCS without any adverse events. This was a small pilot study and future fully powered studies with comparative interventions need to be completed to assess efficacy.
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Affiliation(s)
- Candace Tefertiller
- Craig Hospital, Englewood, CO, United States
- *Correspondence: Candace Tefertiller
| | | | | | | | | | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, CO, United States
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Tefertiller C, Bartelt P, Stobelaar M, Charlifue S, Sevigny M, Vande Griend E, Rozwod M. Improving Upper Extremity Strength, Function, and Trunk Stability Using Wide-Pulse Functional Electrical Stimulation in Combination With Functional Task-Specific Practice. Top Spinal Cord Inj Rehabil 2022; 28:139-152. [PMID: 35521056 PMCID: PMC9009203 DOI: 10.46292/sci21-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To evaluate upper extremity (UE) function, strength, and dynamic sitting balance in individuals with spinal cord injury (SCI) who received an intensive outpatient therapy program focused on UE training augmented with wide pulse/high frequency functional electrical stimulation (WPHF-FES). Methods This prospective case series was conducted in an outpatient (OP) clinic in an SCI-specific rehabilitation hospital. Participants were a convenience sample (N = 50) of individuals with tetraplegia receiving OP therapy focused on UE recovery. Individuals participated in 60 minutes of UE functional task-specific practice (FTP) in combination with WPHF-FES 5 times/week for an average of 72 sessions. The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS) and the modified functional reach (MFR). Results Fifty individuals (13 motor complete; 37 motor incomplete SCI) completed an OP UE training program incorporating WPHF-FES and were included in this analysis. On average, participants demonstrated significant improvements in the total CUE-T score of 14.1 (SD = 10.0, p < .0001) points; significant changes were also noted in UEMS and MFR, improving an average of 4.6 (SD = 5.2, p < .0001) points and 13.6 (SD = 15.8, p < .0001) cm, respectively. Conclusion Individuals with tetraplegia demonstrated significant improvements in UE strength, function, and dynamic sitting trunk balance after receiving UE training augmented with WPHF-FES. Future comparative effectiveness studies need to be completed to guide efficacious treatment interventions in OP therapy.
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Affiliation(s)
| | - Patricia Bartelt
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
| | - Maureen Stobelaar
- Department of Occupational Therapy, Craig Hospital, Englewood, Colorado
| | | | - Mitch Sevigny
- Research Department, Craig Hospital, Englewood, Colorado
| | | | - Meghan Rozwod
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
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What should be clarified when learning the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) among medical students. Spinal Cord Ser Cases 2021; 7:68. [PMID: 34333517 DOI: 10.1038/s41394-021-00431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/08/2022] Open
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Wyndaele JJ, Wyndaele MIAJ, Sakakibara R. Testing sensation of gently squeezing the testes has diagnostic value in spinal cord injury men. Spinal Cord Ser Cases 2021; 7:67. [PMID: 34330888 PMCID: PMC8324907 DOI: 10.1038/s41394-021-00430-5] [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: 04/10/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Determine the diagnostic value of testing the sensation of squeezing the testes. SETTING Research group run by the University of Antwerp. METHODS During the clinical examination, it was evaluated if male spinal cord injury (SCI) patients felt gentle squeezing of the testes. The outcome was related to the type of SCI, to the sensations of the light touch of the dermatomes of the perineum, of bladder filling, of overactive detrusor (DOA) contractions during urodynamics, and of electrosensation elicited in different parts of the lower urinary tract. The neurological pathways elicited by these tests were compared. RESULTS Seventy-four patients were included, mean age 46 ± 17 years, a number of weeks post SCI 318 ± 586. Sensation in the testes was present in 72.2%. In patients with AIS A, the sensation was found positive in 41%, while all with AIS B-D felt the sensation. Testes sensation was strongly correlated with the sensation of touch of the perineum and with the filling sensation during cystometry, proving a dorsal column pathway. The sensation of DOA contractions and electrosensation in the bladder, bladder neck/proximal, and distal urethra were not significantly related to the outcome of the testicular examination, showing that anterior and lateral spinothalamic pathways were not involved CONCLUSIONS: Our data show that sensation from gently squeezing the testes informs about the dorsal column from spinal cord level T10-L2 upwards. The test can help refine the neurologic diagnosis after SCI. We advocate to include this easy-to-do test in the neuro-urologic clinical examination.
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Affiliation(s)
| | | | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Tokyo, Japan
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Lena E, Baroncini I, Pavese C, Musumeci G, Volini S, Masciullo M, Aiachini B, Fizzotti G, Puci MV, Scivoletto G. Reliability and validity of the international standards for neurological classification of spinal cord injury in patients with non-traumatic spinal cord lesions. Spinal Cord 2021; 60:30-36. [PMID: 34326462 DOI: 10.1038/s41393-021-00675-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective, observational study. OBJECTIVES The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) represent the gold standard for the assessment of patients with spinal cord injury (SCI) and their measurement properties have been evaluated in patients with traumatic lesions. Albeit the ISNCSCI are widely used also for the assessment and prognosis of patients with non-traumatic SCI, a validation of this grading system in this sample has never been performed. Therefore, the aim of this study is to evaluate the measurement properties of the ISNCSCI in a population of persons with non-traumatic SCI. SETTING Three Italian rehabilitation hospitals. METHODS The sample included 140 patients with non-traumatic SCI of different etiology, level and grade, for a total of 169 evaluations performed by two examiners. Cronbach's Alpha was used to evaluate the internal consistency of the ISNCSCI various components. The agreement between two examiners of each center in the definition of different components was used to assess the inter-rater reliability. The construct validity was evaluated through the correlation of the ISNCSCI with the Spinal Cord Independence Measure (SCIM). RESULTS The ISNCSCI showed substantial internal consistency, and substantial inter-rater agreement for AIS grade, cumulative motor and sensory scores. The motor scores for upper and lower extremity showed fair to moderate correlation with SCIM self-care and motility subscores, respectively. The ISNCSCI total motor score correlated with the total SCIM score. CONCLUSIONS Our study demonstrates that the ISNCSCI are a valid and reliable tool for the assessment of patients with non-traumatic SCI.
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Affiliation(s)
| | | | - Chiara Pavese
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Neurorehabilitation and Spinal Unit, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | | | - Marcella Masciullo
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation SpiRe lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Beatrice Aiachini
- Neurorehabilitation and Spinal Unit, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Gabriella Fizzotti
- Neurorehabilitation and Spinal Unit, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Mariangela V Puci
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giorgio Scivoletto
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy. .,Spinal Rehabilitation SpiRe lab, IRCCS Fondazione Santa Lucia, Rome, Italy.
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Heutehaus L, Schuld C, Solinas D, Hensel C, Kämmerer T, Weidner N, Rupp R, Franz S. Revisiting the Examination of Sharp/Dull Discrimination as Clinical Measure of Spinothalamic Tract Integrity. Front Neurol 2021; 12:677888. [PMID: 34276538 PMCID: PMC8280296 DOI: 10.3389/fneur.2021.677888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/26/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: Revisiting the sharp/dull discrimination as clinical measure of spinothalamic tract function considering the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Three clinically relevant factors were evaluated as to their impact on reliability: (1) the localization of dermatomes in relation to the sensory level, (2) the examination tool, and (3) the threshold of correct answers for grading of a preserved sharp/dull discrimination. Design: Prospective monocentric psychometric study. Setting: Spinal Cord Injury Center, Heidelberg University Hospital, Germany. Participants: Convenient sample of 21 individuals with subacute spinal cord injury (age: 31–82 years) and 20 individuals without spinal cord injury (age: 24–63 years). Assessment: All participants underwent three assessments for sharp/dull discrimination, applying five commonly used examination tools in seven dermatomes, performed by three trained examiners under conditions in accordance with ISNCSCI. Main Outcome Measures: Assessment of interrater reliability by determining both the Fleiss kappa (κ) coefficient and the percentage agreement between raters. Data were dichotomized regarding the ISNCSCI threshold. Results: Interrater reliability in individuals with SCI was overall substantial (κ = 0.68; CI 0.679–0.681) and moderate (κ = 0.54; CI 0.539–0.543) in dermatomes below the sensory level. All applied tools led to at least moderate reliability below the sensory level (lowest κ = 0.44; CI 0.432–0.440), with the officially endorsed safety pin achieving the highest (substantial) reliability (κ = 0.64; CI 0.638–0.646). Percentage agreement differed between non-SCI (97.3%) and formally intact above level dermatomes in SCI (89.2%). Conclusions: Sharp/dull discrimination as a common clinical examination technique for spinothalamic tract function is a reliable assessment. Independent from the used examination tools, reliability was substantial, with the medium-sized safety pin delivering the most favorable results. Notwithstanding this, all other tools could be considered if a safety pin is not available. Regarding interrater reliability and guessing probability, a threshold of 80% correct responses for preserved sharp/dull discrimination appears to be most suitable, which is in line with current clinical approaches and ISNCSCI. The causal attribution of the identified differences in sharp/dull discrimination between clinically intact dermatomes of individuals with SCI and unaffected dermatomes of individuals without SCI requires future work. Clinical Trial Registration Number (German Clinical Trials Register): DRKS00015334 (https://www.drks.de).
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Affiliation(s)
- Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniela Solinas
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Cornelia Hensel
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Kämmerer
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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Senju Y, Mukaino M, Prodinger B, Selb M, Okouchi Y, Mizutani K, Suzuki M, Yamada S, Izumi SI, Sonoda S, Otaka Y, Saitoh E, Stucki G. Development of a clinical tool for rating the body function categories of the ICF generic-30/rehabilitation set in Japanese rehabilitation practice and examination of its interrater reliability. BMC Med Res Methodol 2021; 21:121. [PMID: 34126940 PMCID: PMC8204586 DOI: 10.1186/s12874-021-01302-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background The International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool used to assess the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of nine ICF categories from the component “body functions” and 21 from the component “activities and participation”. This study aimed to develop a rating reference guide for the nine body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide. Methods The development of the first version of the rating reference guide involved the following steps: (1) a trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight into the use of the guide in practice. The reference guide was modified based on the raters’ feedback in the field test, and an inter-rater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights. Results The first version of the rating reference guide was successfully developed and tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.53 to 0.78. Relative improvements in the weighted kappa coefficients were observed in seven out of the nine categories. Consequently, seven out of nine categories were found to have a weighted kappa coefficient of 0.61 or higher. Conclusions In this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to substantial interrater agreement, which encouraged the use of the ICF in rehabilitation practice.
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Affiliation(s)
- Yuki Senju
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Birgit Prodinger
- Faculty of Applied Health and Social Sciences, Technical University of Applied Sciences Rosenheim, Rosenheim, Germany.,Swiss Paraplegic Research, Nottwil, Switzerland.,ICF Research Branch, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Melissa Selb
- Swiss Paraplegic Research, Nottwil, Switzerland.,ICF Research Branch, Nottwil, Switzerland
| | - Yuki Okouchi
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Kouji Mizutani
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Megumi Suzuki
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Shin Yamada
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Mie, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland.,ICF Research Branch, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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14
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Naga ANE, Tavolaro C, Agel J, Zhou H, Bellabarba C, Bransford RJ. Incidence and degrees of neurologic decline following thoracic costotransversectomy. Spine J 2021; 21:937-944. [PMID: 33453386 DOI: 10.1016/j.spinee.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/21/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Thoracic costotransversectomies (TCT) are amongst the most invasive spine procedures performed. Of greatest concern to the patient and surgeon is the risk of iatrogenic neurologic injury associated with these procedures. Most available studies limit their assessment of neurologic function to nonspecific scales such as the broader ASIA scoring system of A to E and have not comprehensively described the rates of iatrogenic injury following these procedures by looking more precisely with ASIA motor scoring (0-100) which allows for more in-depth analysis. PURPOSE The purpose of this study is to investigate the rates and degree of iatrogenic neurologic decline following TCT and subsequent rates and degree of motor recovery. STUDY DESIGN/SETTING Retrospective medical record review at a single institution. PATIENT SAMPLE Around 116 consecutive patients undergoing TCT operations. OUTCOME MEASURES Neurological changes from preprocedure to final follow-up assessed by lower extremity motor score. METHODS A retrospective chart review of patients undergoing TCT between May 2008 and April 2018 was carried out. Clinical, surgical, and intraoperative neuromonitoring data were collected. Patients who demonstrated an initial postoperative decline in lower extremity motor scores (LEMS) were followed through their final follow up to assess recovery. RESULTS Around 116 patients underwent TCT between T2 and T12 between May 2008 and April 2018. Seven (6.0%) patients demonstrated an immediate postoperative decline as defined by a drop of more than 4 points (mean 15.1; range 5-50) in motor score. All patients who demonstrated an initial postoperative motor score decline returned to within 4 LEMS points of their preoperative LEMS by final follow up. IOMN changes were noted only in half of all monitored patients who were noted to have a decline. CONCLUSIONS In our series, 6.0% of patients undergoing TCT experienced an initial decline in motor score with 94.0% demonstrating an unchanged or improved examination compared to preoperative exam. In our series, all patients who exhibited a decline recovered to within 4 points of the preoperative motor score within the first year postoperatively.
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Affiliation(s)
- Ashraf N El Naga
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Celeste Tavolaro
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Julie Agel
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Haitao Zhou
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Carlo Bellabarba
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Richard J Bransford
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA.
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Ramey WL, Chapman JR. Spinal Cord Injury Clinical Classification Systems: What Is Available and a Proposed Alternative. Neurosurg Clin N Am 2021; 32:333-340. [PMID: 34053721 DOI: 10.1016/j.nec.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spinal cord injury (SCI) remains a challenging disease in terms of surgical decision-making and improving neurologic outcome. As we have now entered a new era founded on routine "big data" capture, more advanced and meaningful yet simplified SCI classification systems and outcome measurement tools would be helpful to determine the efficacy of potential therapeutics in future clinical trials and registries. The proposed classification herein focuses on gross sensorimotor, sacral function below the injured level via an easy-to-use scoring system yielding grades 1 to 4 of injury severity. Such an optimized SCI scoring system would enhance real-time analytics and offer superior outcomes modeling.
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Affiliation(s)
- Wyatt L Ramey
- Department of Neurosurgery, Banner University of Arizona Medical Center - Tucson, PO Box 245070, 1501 North Campbell Avenue, Room 4303, Tucson, AZ 85724-5070, USA.
| | - Jens R Chapman
- Department of Neurosurgery, Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA 98122, USA
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16
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Kirshblum S, Snider B, Eren F, Guest J. Characterizing Natural Recovery after Traumatic Spinal Cord Injury. J Neurotrauma 2021; 38:1267-1284. [PMID: 33339474 PMCID: PMC8080912 DOI: 10.1089/neu.2020.7473] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The predominant tool used to predict outcomes after traumatic spinal cord injury (SCI) is the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), in association with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). These measures have evolved based on analyses of large amounts of longitudinal neurological recovery data published in numerous separate studies. This article reviews and synthesizes published data on neurological recovery from multiple sources, only utilizing data in which the sacral sparing definition was applied for determination of completeness. Conversion from a complete to incomplete injury is more common in tetraplegia than paraplegia. The majority of AIS conversion and motor recovery occurs within the first 6-9 months, with the most rapid rate of motor recovery occurring in the first three months after injury. Motor score changes, as well as recovery of motor levels, are described with the initial strength of muscles as well as the levels of the motor zone of partial preservation influencing the prognosis. Total motor recovery is greater for patients with initial AIS B than AIS A, and greater after initial AIS C than with motor complete injuries. Older age has a negative impact on neurological and functional recovery after SCI; however, the specific age (whether >50 or >65 years) and underlying reasons for this impact are unclear. Penetrating injury is more likely to lead to a classification of a neurological complete injury compared with blunt trauma and reduces the likelihood of AIS conversion at one year. There are insufficient data to support gender having a major effect on neurological recovery after SCI.
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Affiliation(s)
- Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersy, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Brittany Snider
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Fatma Eren
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - James Guest
- Neurological Surgery, Miller School of Medicine, Miami, Florida, USA
- The Miami Project to Cure Paralysis, Miami, Florida, USA
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17
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Santamaria AJ, Benavides FD, Saraiva PM, Anderson KD, Khan A, Levi AD, Dietrich WD, Guest JD. Neurophysiological Changes in the First Year After Cell Transplantation in Sub-acute Complete Paraplegia. Front Neurol 2021; 11:514181. [PMID: 33536992 PMCID: PMC7848788 DOI: 10.3389/fneur.2020.514181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Neurophysiological testing can provide quantitative information about motor, sensory, and autonomic system connectivity following spinal cord injury (SCI). The clinical examination may be insufficiently sensitive and specific to reveal evolving changes in neural circuits after severe injury. Neurophysiologic data may provide otherwise imperceptible circuit information that has rarely been acquired in biologics clinical trials in SCI. We reported a Phase 1 study of autologous purified Schwann cell suspension transplantation into the injury epicenter of participants with complete subacute thoracic SCI, observing no clinical improvements. Here, we report longitudinal electrophysiological assessments conducted during the trial. Six participants underwent neurophysiology screening pre-transplantation with three post-transplantation neurophysiological assessments, focused on the thoracoabdominal region and lower limbs, including MEPs, SSEPs, voluntarily triggered EMG, and changes in GSR. We found several notable signals not detectable by clinical exam. In all six participants, thoracoabdominal motor connectivity was detected below the clinically assigned neurological level defined by sensory preservation. Additionally, small voluntary activations of leg and foot muscles or positive lower extremity MEPs were detected in all participants. Voluntary EMG was most sensitive to detect leg motor function. The recorded MEP amplitudes and latencies indicated a more caudal thoracic level above which amplitude recovery over time was observed. In contrast, further below, amplitudes showed less improvement, and latencies were increased. Intercostal spasms observed with EMG may also indicate this thoracic “motor level.” Galvanic skin testing revealed autonomic dysfunction in the hands above the injury levels. As an open-label study, we can establish no clear link between these observations and cell transplantation. This neurophysiological characterization may be of value to detect therapeutic effects in future controlled studies.
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Affiliation(s)
- Andrea J Santamaria
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Francisco D Benavides
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Pedro M Saraiva
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Kimberly D Anderson
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Aisha Khan
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,Miller School of Medicine, The Interdisciplinary Stem Cell Institute, The University of Miami, Miami, FL, United States
| | - Allan D Levi
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - W Dalton Dietrich
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - James D Guest
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
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18
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Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study. Spinal Cord 2020; 59:693-699. [PMID: 33024298 PMCID: PMC8021607 DOI: 10.1038/s41393-020-00561-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 01/07/2023]
Abstract
Study design Retrospective. Objectives Primary: to assess if axial damage ratios are predictors of future walking after spinal cord injury (SCI), and if they add any predictive value if initial neurological impairment grades are available. Secondary: to determine if lateral spinal cord regions are predictors of future lower extremity motor scores (LEMS). Setting University/hospital. Methods Axial T2-weighted MRIs were used. Axial damage ratios and non-damaged lateral cord volumes were calculated. Each participant answered at 1 year after SCI, “Are you able to walk for 150 feet? (45.72 meters)” For the secondary aim, right and left LEMS were used. Results In total, 145 participants were selected. Individuals that could walk had smaller ratios than those that were unable. Walking and axial damage ratios were negatively correlated. A 0.374 ratio cut-off showed optimal sensitivity/specificity. When initial neurological grades were used, axial damage ratios did not add predictive value. Forty-two participants had LEMS available and were included for the secondary aim. Right cord regions and right LEMS were positively correlated and left regions and left LEMS, but these variables were also correlated with each other. Conclusions Axial damage ratios were significant predictors of walking ability 1 year after SCI. However, this measure did not add predictive value over initial neurological grades. Lateral cord regions correlated with same-side LEMS, but the opposite was also found, calling this biomarker’s specificity into question. Axial damage ratios may be useful in predicting walking after SCI if initial neurological grades are unavailable. Sponsorship This research was funded by a National Institutes of Health award, National Institute of Child Health and Development—NIH R03HD094577.
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Abstract
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI. The advent of spinal instrumentation has improved the surgical treatment of spinal fractures and the ability to manage SCI patients with spinal mechanical instability. There has been a concomitant improvement in the nonsurgical care of these patients with particular focus on care delivered in the pre-hospital, emergency room, and intensive care unit (ICU) settings. This article represents an overview of the critical aspects of contemporary traumatic SCI care and notes areas where further research inquiries are needed. We review the pre-hospital management of a patient with an acute SCI, including triage, immobilization, and transportation. Upon arrival to the definitive treatment facility, we review initial evaluation and management steps, including initial neurological assessment, radiographic assessment, cervical collar clearance protocols, and closed reduction of cervical fracture/dislocation injuries. Finally, we review ICU issues including airway, hemodynamic, and pharmacological management, as well as future directions of care.
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20
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Bye E, Glinsky J, Yeomans J, Hungerford A, Patterson H, Chen L, Harvey L. The inter-rater reliability of the 13-point manual muscle test in people with spinal cord injury. Physiother Theory Pract 2019; 37:1126-1131. [PMID: 31674263 DOI: 10.1080/09593985.2019.1685033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To determine the inter-rater reliability of the 13-point manual muscle test (MMT) in two upper limb muscle groups of people with tetraplegiaSetting: The study was conducted at three spinal cord injury (SCI) units.Participants: Sixty people with complete or incomplete tetraplegia.Methods: The inter-rater reliability of the 13-point MMT was investigated. Strength of the elbow flexors and/or wrist extensors in people with tetraplegia was measured by two physiotherapists on the same day.Results: The weighted kappa coefficient (95% confidence interval) reflecting the agreement between the two strength assessments by two different assessors for the wrist extensors and elbow flexors were 0.96 (0.93 to 0.99) and 0.94 (0.89 to 0.99), respectively. Repeat measurements by different physiotherapists were within 1 of 13 points of each other 82% of the time for wrist extensors and 87% of the time for the elbow flexors.Conclusion: The 13-point MMT is a reliable measure of strength in the wrist extensors and elbow flexors of people with tetraplegia.
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Affiliation(s)
- Elizabeth Bye
- John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia.,Spinal Injury Unit, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Joanne Glinsky
- John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia
| | - Jayne Yeomans
- Spinal Injury Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Helen Patterson
- Spinal Injury Unit, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Lydia Chen
- John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia.,Spinal Injury Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Lisa Harvey
- John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia
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21
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Repeated transspinal stimulation decreases soleus H-reflex excitability and restores spinal inhibition in human spinal cord injury. PLoS One 2019; 14:e0223135. [PMID: 31557238 PMCID: PMC6762874 DOI: 10.1371/journal.pone.0223135] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/14/2019] [Indexed: 12/12/2022] Open
Abstract
Transcutaneous spinal cord or transspinal stimulation over the thoracolumbar enlargement, the spinal location of motoneurons innervating leg muscles, modulates neural circuits engaged in the control of movement. The extent to which daily sessions (e.g. repeated) of transspinal stimulation affects soleus H-reflex excitability in individuals with chronic spinal cord injury (SCI) remains largely unknown. In this study, we established the effects of repeated cathodal transspinal stimulation on soleus H-reflex excitability and spinal inhibition in individuals with and without chronic SCI. Ten SCI and 10 healthy control subjects received monophasic transspinal stimuli of 1-ms duration at 0.2 Hz at subthreshold and suprathreshold intensities of the right soleus transspinal evoked potential (TEP). SCI subjects received an average of 16 stimulation sessions, while healthy control subjects received an average of 10 stimulation sessions. Before and one or two days post intervention, we used the soleus H reflex to assess changes in motoneuron recruitment, homosynaptic depression following single tibial nerve stimuli delivered at 0.1, 0.125, 0.2, 0.33 and 1.0 Hz, and postactivation depression following paired tibial nerve stimuli at the interstimulus intervals of 60, 100, 300, and 500 ms. Soleus H-reflex excitability was decreased in both legs in motor incomplete and complete SCI but not in healthy control subjects. Soleus H-reflex homosynaptic and postactivation depression was present in motor incomplete and complete SCI but was of lesser strength to that observed in healthy control subjects. Repeated transspinal stimulation increased homosynaptic depression in all SCI subjects and remained unaltered in healthy controls. Postactivation depression remained unaltered in all subject groups. Lastly, transspinal stimulation decreased the severity of spasms and ankle clonus. The results indicate decreased reflex hyperexcitability and recovery of spinal inhibitory control in the injured human spinal cord with repeated transspinal stimulation. Transspinal stimulation is a noninvasive neuromodulation method for restoring spinally-mediated afferent reflex actions after SCI in humans.
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22
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Pavese C, Bachmann LM, Schubert M, Curt A, Mehnert U, Schneider MP, Scivoletto G, Finazzi Agrò E, Maier D, Abel R, Weidner N, Rupp R, Kessels AG, Kessler TM. Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study. Neurorehabil Neural Repair 2019; 33:902-910. [DOI: 10.1177/1545968319868722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95% CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95% CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.
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Affiliation(s)
- Chiara Pavese
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Martin Schubert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Armin Curt
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Marc P. Schneider
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | | | | | | | | | - Rüdiger Rupp
- Heidelberg University Hospital, Heidelberg, Germany
| | | | - Thomas M. Kessler
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Grasse KM, Hays SA, Rahebi KC, Warren VS, Garcia EA, Wigginton JG, Kilgard MP, Rennaker RL. A suite of automated tools to quantify hand and wrist motor function after cervical spinal cord injury. J Neuroeng Rehabil 2019; 16:48. [PMID: 30975167 PMCID: PMC6458684 DOI: 10.1186/s12984-019-0518-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/27/2019] [Indexed: 01/15/2023] Open
Abstract
Background Cervical spinal cord injury (cSCI) often causes chronic upper extremity disability. Reliable measurement of arm function is critical for development of therapies to improve recovery after cSCI. In this study, we report a suite of automated rehabilitative tools to allow simple, quantitative assessment of hand and wrist motor function. Methods We measured range of motion and force production using these devices in cSCI participants with a range of upper limb disability and in neurologically intact participants at two time points separated by approximately 4 months. Additionally, we determined whether measures collected with the rehabilitative tools correlated with standard upper limb assessments, including the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) and the Jebsen Hand Function Test (JHFT). Results We find that the rehabilitative devices are useful to provide assessment of upper limb function in physical units over time in SCI participants and are well-correlated with standard assessments. Conclusions These results indicate that these tools represent a reliable system for longitudinal evaluation of upper extremity function after cSCI and may provide a framework to assess the efficacy of strategies aimed at improving recovery of upper limb function. Electronic supplementary material The online version of this article (10.1186/s12984-019-0518-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katelyn M Grasse
- The University of Texas at Dallas, Texas Biomedical Device Center800 West Campbell Road, Richardson, TX, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Seth A Hays
- The University of Texas at Dallas, Texas Biomedical Device Center800 West Campbell Road, Richardson, TX, 75080-3021, USA. .,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX, 75080-3021, USA. .,The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, Richardson, TX, 75080-3021, USA.
| | - Kimiya C Rahebi
- The University of Texas at Dallas, Texas Biomedical Device Center800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Victoria S Warren
- The University of Texas at Dallas, Texas Biomedical Device Center800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Elizabeth A Garcia
- The University of Texas at Dallas, Texas Biomedical Device Center800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Jane G Wigginton
- The University of Texas at Dallas, Texas Biomedical Device Center800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center800 West Campbell Road, Richardson, TX, 75080-3021, USA.,The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Robert L Rennaker
- The University of Texas at Dallas, Texas Biomedical Device Center800 West Campbell Road, Richardson, TX, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX, 75080-3021, USA.,The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
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Dupépé EB, Davis M, Elsayed GA, Agee B, Kirksey K, Gordon A, Pritchard PR. Inter-rater reliability of the modified Medical Research Council scale in patients with chronic incomplete spinal cord injury. J Neurosurg Spine 2019; 30:515-519. [PMID: 30660112 DOI: 10.3171/2018.9.spine18508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to determine the inter-rater reliability of the modified Medical Research Council (MRC) scale for grading motor function in patients with chronic incomplete spinal cord injury (SCI). METHODS Two neurosurgical residents and 2 faculty members performed motor examinations in 6 chronic incomplete SCI patients for a total of 156 muscle groups. Examinations were performed using the modified MRC grading scale during routine clinic visits for each patient. Informed consent was obtained prior to enrollment. Patients with American Spinal Injury Association (ASIA) Impairment Scale grade A (ASIA A) injuries were excluded. Inter-rater reliability coefficients were calculated using Kendall's coefficient of concordance (W) and intraclass correlation coefficients (ICCs). RESULTS Sixty-four percent of the tested variables demonstrated extremely strong (W 0.71-0.9) or strong (0.51-0.7) inter-rater reliability using Kendall's coefficient of concordance and an ICC corresponding to excellent (ICC > 0.75) or fair to good (ICC 0.4-0.75) inter-rater reliability. An additional 7% showed poor inter-rater reliability (ICC < 0.4). The remaining variables tested did not reach statistical significance. CONCLUSIONS The inter-rater reliability of the modified MRC scale was found to be high in the majority of tested variables, but the results suggest that discrepancy among trained observers does exist. Reliability was greatest in the lower-extremity muscle groups and least in the upper-extremity muscle groups in patients with chronic incomplete SCI.
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Affiliation(s)
| | | | | | | | - Keneshia Kirksey
- 2Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Amber Gordon
- 3Baptist Medical Group-Neurosurgery, Pensacola, Florida
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Vural M, Yalcinkaya EY, Celik EC, Gunduz B, Bozan A, Erhan B. Assessment of quality of life in relation to spasticity severity and socio-demographic and clinical factors among patients with spinal cord injury. J Spinal Cord Med 2018; 43:193-200. [PMID: 30508404 PMCID: PMC7054937 DOI: 10.1080/10790268.2018.1543093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To assess the impact of spasticity severity as well as socio-demographic and clinical factors on quality of life (QOL) and to identify factors predicting poor QOL among patients with spinal cord injury (SCI)Design: Descriptive cross-sectional study.Setting: Tertiary care clinic in Istanbul, Turkey.Participants: A total of 110 patients with SCI (mean (SD) age: 43.8 (14.7) years, 58.2% were males) were enrolled.Assessments: The American Spinal Injury Association (ASIA) Impairment Scale (AIS), Modified Ashworth Scale (MAS) and Turkish version of the World Health Organization Quality of life questionnaire (WHOQOL-BREF) were utilized to determine the SCI category, severity of spasticity and QOL scores, respectively.Outcome measures: The WHOQOL-BREF scores were evaluated with respect to the severity of spasticity, aetiology and duration of SCI, AIS category and method of bladder management.Results: The mean (SD) physical health (41.9 (15.3) vs. 46.5 (10.9), P = 0.029), social relationships (45.6 (20.2) vs. 53.8 (17.3), P = 0.025) and total WHOQOL-BREF scores were significantly lower in patients with more severe spasticity. Multivariate linear regression analysis revealed that severity of spasticity was a significant predictor of decreased WHOQOL-BREF total scores, physical domain scores and social relations domain scores by 11.381 (P = 0.007), 11.518 (P = 0.005) and 17. 965 (P = 0.004), respectively.Conclusion: In conclusion, addressing QOL in relation to severity of spasticity for the first time among Turkish SCI patients, our findings revealed a negative impact of the spasticity severity on the WHOQOL-BREF scores, particularly for physical health and social relationship domains.
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Affiliation(s)
- Meltem Vural
- University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey,Correspondence to: Meltem Vural, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training Hospital, Zuhuratbaba Mh. Tevfik Saglam Cd. No:11 Bakirkoy, Istanbul, Turkey.
| | - Ebru Yilmaz Yalcinkaya
- University of Health Sciences, Istanbul Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Evrim Coskun Celik
- University of Health Sciences, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Berrin Gunduz
- University of Health Sciences, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Bozan
- Mardin Kiziltepe State Hospital, Mardin, Turkey
| | - Belgin Erhan
- University of Health Sciences, Istanbul Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
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Abstract
Objective/Context To highlight questions with regards to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and provide historical perspectives to help SCI professionals gain fuller insights into the classification system. Methods Frequently asked questions to the ISNCSCI were collected and a review of literature and personal communications with International Standards committee members and Chairs were undertaken. Results Background and explanations for nine questions, detailing decision processes and challenging classification rules are presented. Conclusion While the ISNCSCI can be challenging, this background and historical explanation may provide a greater understanding and the ability to critically analyze this classification system.
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Affiliation(s)
- Ryan Solinsky
- Kessler Institute for Rehabilitation West Orange, New Jersey, USA,Rutgers New Jersey Medical School, Department of PM&R, Newark, New Jersey, USA,Correspondence to: Ryan Solinsky, Kessler Institute for Rehabilitation West Orange, NJ 07052, USA; Rutgers New Jersey Medical School, Department of PM&R 90 Bergen St. DOC Suite 3203 Newark, NJ 07103, USA.
| | - Steven C. Kirshblum
- Kessler Institute for Rehabilitation West Orange, New Jersey, USA,Rutgers New Jersey Medical School, Department of PM&R, Newark, New Jersey, USA
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Clinical efficacy of upper limb robotic therapy in people with tetraplegia: a pilot randomized controlled trial. Spinal Cord 2018; 57:49-57. [DOI: 10.1038/s41393-018-0190-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 11/08/2022]
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Providing Culturally Competent Acute Care Physical Therapy for a Complex Medical Patient of Amish Heritage. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Absoud M, Brex P, Ciccarelli O, Diribe O, Giovannoni G, Hellier J, Howe R, Holland R, Kelly J, McCrone P, Murphy C, Palace J, Pickles A, Pike M, Robertson N, Jacob A, Lim M. A multicentre randomiSed controlled TRial of IntraVEnous immunoglobulin compared with standard therapy for the treatment of transverse myelitis in adults and children (STRIVE). Health Technol Assess 2018. [PMID: 28639937 DOI: 10.3310/hta21310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Transverse myelitis (TM) is an immune-mediated disorder of the spinal cord that affects adults and children and that causes motor, sensory and autonomic dysfunction. There is a prolonged recovery phase, which may continue for many years. Neuromyelitis optica (NMO) is an uncommon relapsing inflammatory central nervous system condition in which TM can be the first presenting symptom. As TM and NMO affect many patients in the prime of their working life, the disorder can impose a significant demand on health resources. There are currently no robust controlled trials in children or adults to inform the optimal treatment of TM. However, treatment with intravenous immunoglobulin (IVIG) is being effectively used in the management of a range of neurological conditions. Although other interventions such as plasma exchange (PLEX) in addition to intravenous (IV) methylprednisolone therapy can be beneficial in TM, PLEX is costly and technically challenging to deliver in the acute setting. IVIG is more readily accessible and less costly. OBJECTIVE To evaluate whether additional and early treatment with IVIG is of extra benefit in TM compared with standard therapy with IV steroids. DESIGN A multicentre, single-blind, parallel-group randomised controlled trial of IVIG compared with standard therapy for the treatment of TM in adults and children. PARTICIPANTS Patients aged ≥ 1 year diagnosed with either acute first-onset TM or first presentation of NMO. Target recruitment was 170 participants (85 participants per arm). INTERVENTIONS Participants were randomised 1 : 1 to treatment with IV methylprednisolone only or treatment with IV methylprednisolone plus 2 g/kg of IVIG in divided doses within 5 days of the first commencement of steroid therapy. MAIN OUTCOME MEASURES Primary outcome measure - American Spinal Injury Association (ASIA) Impairment Scale at 6 months post randomisation, with a good outcome defined by a two-grade change. Secondary and tertiary outcome measures - ASIA motor and sensory scales, Expanded Disability Status Scale, health outcome, quality of life, Client Service Receipt Inventory and International Spinal Cord Injury Pain, Bladder and Bowel Basic Data Sets. RESULTS In total, 26 participants were screened and two were randomised into the study. With the limited sample size, treatment effect could not be determined. However, we identified barriers to accrual that included strict inclusion criteria, the short enrolment window, challenges associated with the use of the ASIA Impairment Scale as an outcome measure and estimation of the incidence of TM. CONCLUSIONS The study did not reach the end point and the effect of IVIG in TM/NMO could not be determined. Investigators should be aware of the potential challenges associated with carrying out a rare disease trial with a short enrolment window. The study question is one that still necessitates investigation. Preliminary work to ameliorate the effect of the barriers encountered in this study is vital. TRIAL REGISTRATION EudraCT 2014-002335-34, ClinicalTrials.gov NCT02398994 and Current Controlled Trials ISRCTN12127581. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 31. See the NIHR Journals Library website for further project information. Funding was also received from Biotest AG, Germany (supply of IVIG) and the Transverse Myelitis Society (excess research cost to facilitate study initiation).
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Affiliation(s)
- Michael Absoud
- Department of Children's Neurosciences, Evelina Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
| | - Peter Brex
- Department of Neurology, King's College Hospital NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
| | - Olga Ciccarelli
- University College London Institute of Neurology, London, UK
| | - Onyinye Diribe
- Department of Children's Neurosciences, Evelina Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK.,King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gavin Giovannoni
- Centre for Neuroscience and Trauma, Blizard Institute, University of London and Barts Health NHS Trust, London, UK
| | - Jennifer Hellier
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosemary Howe
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rachel Holland
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joanna Kelly
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul McCrone
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jackie Palace
- Department of Neurology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrew Pickles
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Pike
- Department of Paediatric Neurology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Neil Robertson
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff and Vale University Health Board, Cardiff, UK
| | - Anu Jacob
- The Walton Centre, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ming Lim
- Department of Children's Neurosciences, Evelina Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
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Yugué I, Okada S, Maeda T, Ueta T, Shiba K. Sensitivity and specificity of the 'knee-up test' for estimation of the American Spinal Injury Association Impairment Scale in patients with acute motor incomplete cervical spinal cord injury. Spinal Cord 2017; 56:347-354. [PMID: 29284793 DOI: 10.1038/s41393-017-0046-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE Precise classification of the neurological state of patients with acute cervical spinal cord injury (CSCI) can be challenging. This study proposed a useful and simple clinical method to help classify patients with incomplete CSCI. SETTING Spinal Injuries Centre, Japan. METHODS The sensitivity and specificity of the 'knee-up test' were evaluated in patients with acute CSCI classified as American Spinal Injury Association Impairment Scale (AIS) C or D. The result is positive if the patient can lift the knee in one or both legs to an upright position, whereas the result is negative if the patient is unable to lift the knee in either leg to an upright position. The AIS of these patients was classified according to a strict computerised algorithm designed by Walden et al., and the knee-up test was tested by non-expert examiners. RESULTS Among the 200 patients, 95 and 105 were classified as AIS C and AIS D, respectively. Overall, 126 and 74 patients demonstrated positive and negative results, respectively, when evaluated using the knee-up test. A total of 104 patients with positive results and 73 patients with negative results were classified as AIS D and AIS C, respectively. The sensitivity, specificity, positive predictive and negative predictive values of this test for all patients were 99.1, 76.8, 82.5 and 98.7, respectively. CONCLUSIONS The knee-up test may allow easy and highly accurate estimation, without the need for special skills, of AIS classification for patients with incomplete CSCI.
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Affiliation(s)
- Itaru Yugué
- Department of Orthopaedic Surgery, Spinal Injuries Centre, Iizuka, Fukuoka, Japan.
| | - Seiji Okada
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Spinal Injuries Centre, Iizuka, Fukuoka, Japan
| | - Takayoshi Ueta
- Department of Orthopaedic Surgery, Spinal Injuries Centre, Iizuka, Fukuoka, Japan
| | - Keiichiro Shiba
- Department of Orthopaedic Surgery, Spinal Injuries Centre, Iizuka, Fukuoka, Japan
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Armstrong AJ, Clark JM, Ho DT, Payne CJ, Nolan S, Goodes LM, Harvey LA, Marshall R, Galea MP, Dunlop SA. Achieving assessor accuracy on the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord 2017. [DOI: 10.1038/sc.2017.67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Traumatic spinal cord injury (SCI) has devastating consequences for the physical, social and vocational well-being of patients. The demographic of SCIs is shifting such that an increasing proportion of older individuals are being affected. Pathophysiologically, the initial mechanical trauma (the primary injury) permeabilizes neurons and glia and initiates a secondary injury cascade that leads to progressive cell death and spinal cord damage over the subsequent weeks. Over time, the lesion remodels and is composed of cystic cavitations and a glial scar, both of which potently inhibit regeneration. Several animal models and complementary behavioural tests of SCI have been developed to mimic this pathological process and form the basis for the development of preclinical and translational neuroprotective and neuroregenerative strategies. Diagnosis requires a thorough patient history, standardized neurological physical examination and radiographic imaging of the spinal cord. Following diagnosis, several interventions need to be rapidly applied, including haemodynamic monitoring in the intensive care unit, early surgical decompression, blood pressure augmentation and, potentially, the administration of methylprednisolone. Managing the complications of SCI, such as bowel and bladder dysfunction, the formation of pressure sores and infections, is key to address all facets of the patient's injury experience.
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Davidson RA, Carlson M, Fallah N, Noonan VK, Elliott SL, Joseph J, Smith KM, Krassioukov AV. Inter-Rater Reliability of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury. J Neurotrauma 2017; 34:552-558. [DOI: 10.1089/neu.2016.4489] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ross A. Davidson
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Center, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Marie Carlson
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Center, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Vancouver Spine Surgery Institute, Department of Orthopedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Vanessa K. Noonan
- Vancouver Spine Surgery Institute, Department of Orthopedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Stacy L. Elliott
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Center, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Jay Joseph
- Department of Physical Medicine and Rehabilitation, Queens University, Kingston, Ontario, Canada
| | - Karen M. Smith
- Department of Physical Medicine and Rehabilitation, Queens University, Kingston, Ontario, Canada
| | - Andrei V. Krassioukov
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Center, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
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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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Evaluating the Functionality and Usability of Two Novel Wheelchair Anti-Rollback Devices for Ramp Ascent in Manual Wheelchair Users With Spinal Cord Injury. PM R 2016; 9:483-493. [PMID: 27664403 DOI: 10.1016/j.pmrj.2016.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 09/08/2016] [Accepted: 09/10/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Difficulty ascending ramps and inclines with a manual wheelchair adversely affects the everyday mobility and overall quality of life of manual wheelchair users. Currently, various anti-rollback devices are available to assist manual wheelchair users to ascend ramps and inclines. However, these devices have 2 main shortcomings: restriction to backward motion limiting recovery from an overturning wheelchair, which is a safety concern; and difficulty in engaging/disengaging the device while on the ramp. OBJECTIVE To evaluate the functionality and usability of 2 novel wheelchair anti-rollback devices developed to address these shortcomings (prototypes "Wheel" and "Brake"). DESIGN Cross-sectional. SETTING Rehabilitation research facility. PARTICIPANTS Twelve adult participants with chronic spinal cord injury. METHODS Participants completed training and tested with both the wheelchair anti-rollback devices on a 7.3-m-long ramp. MAIN OUTCOME MEASUREMENTS Number of stops, perceived physical exertion, pain, and ease of use of these devices as participants maneuvered their wheelchairs up a 7.3-m ramp were assessed. Participants also evaluated their satisfaction with the usability of both the devices using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST 2.0). RESULTS Both prototypes evaluated overcame the limitations of the existing anti-rollback devices. Nonparametric statistical tests showed that participants rated both prototypes similarly for the overall functional and usability aspects. However, the participants' satisfactory rating were higher for the prototype "Brake" than for the prototype "Wheel" based on a functional aspect (ie, engaging/disengaging easiness), and higher for Wheel than for Brake, based on a usability aspect (prototype size). CONCLUSIONS The qualitative and quantitative outcomes of this investigation, based on the usability and functional evaluations, provided useful information for the improvement in the design of both anti-rollback devices, which may allow manual wheelchair users to manage ramp ascent more safely and easily. Further evaluations with a different SCI population is recommended. LEVEL OF EVIDENCE IV.
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Reliability of TMS metrics in patients with chronic incomplete spinal cord injury. Spinal Cord 2016; 54:980-990. [DOI: 10.1038/sc.2016.47] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/18/2016] [Accepted: 02/28/2016] [Indexed: 12/26/2022]
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Walden K, Bélanger LM, Biering-Sørensen F, Burns SP, Echeverria E, Kirshblum S, Marino RJ, Noonan VK, Park SE, Reeves RK, Waring W, Dvorak MF. Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Spinal Cord 2016; 54:197-203. [PMID: 26323348 PMCID: PMC5399136 DOI: 10.1038/sc.2015.137] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/28/2015] [Accepted: 06/24/2015] [Indexed: 12/21/2022]
Abstract
STUDY DESIGN Validation study. OBJECTIVES To describe the development and validation of a computerized application of the international standards for neurological classification of spinal cord injury (ISNCSCI). SETTING Data from acute and rehabilitation care. METHODS The Rick Hansen Institute-ISNCSCI Algorithm (RHI-ISNCSCI Algorithm) was developed based on the 2011 version of the ISNCSCI and the 2013 version of the worksheet. International experts developed the design and logic with a focus on usability and features to standardize the correct classification of challenging cases. A five-phased process was used to develop and validate the algorithm. Discrepancies between the clinician-derived and algorithm-calculated results were reconciled. RESULTS Phase one of the validation used 48 cases to develop the logic. Phase three used these and 15 additional cases for further logic development to classify cases with 'Not testable' values. For logic testing in phases two and four, 351 and 1998 cases from the Rick Hansen SCI Registry (RHSCIR), respectively, were used. Of 23 and 286 discrepant cases identified in phases two and four, 2 and 6 cases resulted in changes to the algorithm. Cross-validation of the algorithm in phase five using 108 new RHSCIR cases did not identify the need for any further changes, as all discrepancies were due to clinician errors. The web-based application and the algorithm code are freely available at www.isncscialgorithm.com. CONCLUSION The RHI-ISNCSCI Algorithm provides a standardized method to accurately derive the level and severity of SCI from the raw data of the ISNCSCI examination. The web interface assists in maximizing usability while minimizing the impact of human error in classifying SCI. SPONSORSHIP This study is sponsored by the Rick Hansen Institute and supported by funding from Health Canada and Western Economic Diversification Canada.
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Affiliation(s)
- K Walden
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - L M Bélanger
- Rick Hansen Institute, Vancouver, British Columbia, Canada
- Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - F Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Havnevej, Hornbaek, Denmark
| | - S P Burns
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - E Echeverria
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - S Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, West Orange, NJ, USA
| | - R J Marino
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - V K Noonan
- Rick Hansen Institute, Vancouver, British Columbia, Canada
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - S E Park
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - R K Reeves
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - W Waring
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M F Dvorak
- Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
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Hahn EA, Garcia SF, Lai JS, Miskovic A, Jerousek S, Semik P, Wong A, Heinemann AW. Measuring Access to Information and Technology: Environmental Factors Affecting Persons With Neurologic Disorders. Arch Phys Med Rehabil 2016; 97:1284-94. [PMID: 26903144 DOI: 10.1016/j.apmr.2016.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/19/2016] [Accepted: 01/29/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop and validate a patient-reported measure of access to information and technology (AIT) for persons with spinal cord injury, stroke, or traumatic brain injury. DESIGN A mixed-methods approach was used to develop items, refine them through cognitive interviews, and evaluate their psychometric properties. Item responses were evaluated with the Rasch rating scale model. Correlational and analysis-of-variance methods were used to evaluate construct validity. SETTING Community-dwelling individuals participated in telephone interviews or traveled to the academic medical centers where this research took place. PARTICIPANTS Individuals with a diagnosis of spinal cord injury, stroke, or traumatic brain injury (aged ≥18y, English speaking) participated in cognitive interviews (n=12 persons), field testing of the items (n=305 persons), and validation testing of the final set of items (n=604 persons). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A set of items to measure AIT for people with disabilities. RESULTS A user-friendly multimedia touchscreen was used for self-administration of the items. A 23-item AIT measure demonstrated good evidence of internal consistency reliability, and content and construct validity. CONCLUSIONS This new AIT measure will enable researchers and clinicians to determine to what extent environmental factors influence health outcomes and social participation in people with disabilities. The AIT measure could also provide disability advocates with more specific and detailed information about environmental factors to lobby for elimination of barriers.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Sofia F Garcia
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jin-Shei Lai
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ana Miskovic
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
| | - Sara Jerousek
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
| | - Patrick Semik
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
| | - Alex Wong
- Department of Occupational Therapy and Neurology, Washington University School of Medicine, St. Louis, MO
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
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Hales M, Biros E, Reznik JE. Reliability and Validity of the Sensory Component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): A Systematic Review. Top Spinal Cord Inj Rehabil 2015; 21:241-9. [PMID: 26363591 DOI: 10.1310/sci2103-241] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Since 1982, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) has been used to classify sensation of spinal cord injury (SCI) through pinprick and light touch scores. The absence of proprioception, pain, and temperature within this scale creates questions about its validity and accuracy. OBJECTIVE To assess whether the sensory component of the ISNCSCI represents a reliable and valid measure of classification of SCI. METHODS A systematic review of studies examining the reliability and validity of the sensory component of the ISNCSCI published between 1982 and February 2013 was conducted. The electronic databases MEDLINE via Ovid, CINAHL, PEDro, and Scopus were searched for relevant articles. A secondary search of reference lists was also completed. Chosen articles were assessed according to the Oxford Centre for Evidence-Based Medicine hierarchy of evidence and critically appraised using the McMasters Critical Review Form. A statistical analysis was conducted to investigate the variability of the results given by reliability studies. RESULTS Twelve studies were identified: 9 reviewed reliability and 3 reviewed validity. All studies demonstrated low levels of evidence and moderate critical appraisal scores. The majority of the articles (~67%; 6/9) assessing the reliability suggested that training was positively associated with better posttest results. The results of the 3 studies that assessed the validity of the ISNCSCI scale were confounding. CONCLUSIONS Due to the low to moderate quality of the current literature, the sensory component of the ISNCSCI requires further revision and investigation if it is to be a useful tool in clinical trials.
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Affiliation(s)
- M Hales
- Discipline of Physiotherapy, James Cook University, Townsville, Queensland, Australia
| | - E Biros
- Discipline of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - J E Reznik
- Discipline of Physiotherapy, James Cook University, Townsville, Queensland, Australia
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Marino RJ, Kern SB, Leiby B, Schmidt-Read M, Mulcahey MJ. Reliability and validity of the capabilities of upper extremity test (CUE-T) in subjects with chronic spinal cord injury. J Spinal Cord Med 2015; 38:498-504. [PMID: 25297342 PMCID: PMC4612205 DOI: 10.1179/2045772314y.0000000272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine the reliability and validity of the capabilities of upper extremity test (CUE-T), a measure of functional limitations, in patients with chronic tetraplegia. DESIGN Repeated measures. SETTING Outpatient rehabilitation center. PARTICIPANTS Fifty subjects (36 male/14 female) with spinal cord injury (SCI) of ≥1-year duration participated. Subjects were 17-81 years old (mean 48.1 ± 18.2); neurological levels ranged from C2 through T6, American Spinal Injury Association Impairment Scale grades A-D. INTERVENTIONS Not applicable. OUTCOME MEASURES Intraclass correlation coefficients (ICC), weighted kappa and repeatability values for CUE-T; Spearman correlations of CUE-T with upper extremity motor scores (UEMS), and self-care and mobility portions of the Spinal Cord Independence Measure, vIII (SCIM III). RESULTS Score ranges for UEMS were 8-50, CUE-T 7-135, self-care SCIM 0-20, and mobility SCIM 0-40. The ICC values for total, right, and left side scores were excellent (0.97-0.98; 95% confidence interval 0.96-0.99). Item weighted kappa values were ≥0.60 for all but five items, four of which were right and left pronation and supination. Repeatability of total score was 10.8 points, right and left sides 6.3 and 6.1 points. Spearman correlations of the total CUE-T with the UEMS and SCIM self-care and mobility scores were 0.83, 0.70, and 0.55 respectively. CONCLUSIONS The CUE-T displays excellent test-retest reliability, and good-excellent correlation with impairment and capacity measures in persons with chronic SCI. After revising pronation and supination test procedures, the sensitivity to change should be determined.
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Affiliation(s)
- Ralph J. Marino
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA,Correspondence to: Ralph J. Marino, Thomas Jefferson University, 132 South 10th Street, 375 Main Building, Philadelphia, PA 19107, USA.
| | - Stephen B. Kern
- Department of Occupational Therapy, College of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin Leiby
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - M. J. Mulcahey
- Department of Occupational Therapy, College of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
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Hastings BM, Ntsiea MV, Olorunju S. Factors that influence functional ability in individuals with spinal cord injury: A cross-sectional, observational study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2015; 71:235. [PMID: 30135873 PMCID: PMC6093142 DOI: 10.4102/sajp.v71i1.235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/14/2015] [Indexed: 11/27/2022] Open
Abstract
Background Spinal cord injuries result in devastating impairments that can produce severe functional limitations. However, few documented studies have investigated the levels of function and factors that influence functional ability at discharge from in-patient rehabilitation facilities in Gauteng following such injuries. This necessitated further investigation. Method Fifty participants were recruited for this cross-sectional, observational study. Participants were recruited from one private and one government spinal rehabilitation unit in Gauteng. A custom-developed questionnaire was used to establish the physical and demographic characteristics of the sample, whilst existing classification scales and measures were used to establish the degree of a lesion and a patient’s associated functional ability. Data were analysed using descriptive statistics. Multiple regression analysis was performed to determine factors that influenced the level of functional ability. Results Patients achieved an average functional independence score of 64.6 (± 27.6) at discharge according to the Spinal Cord Independence Measure III. Longer stays at rehabilitation facilities were associated with higher scores, whereas scores decreased with increasing patient age. Pressure sores and spasticity affected scores negatively. The type of funding also influenced patients’ scores, with government funding being associated with the best outcome. Both the degree and the level at which the injury occurred could be considered predictive measures that influenced functional independence scores. Conclusion Most participants were not functionally independent at discharge. Factors such as patient age, length of rehabilitation, presence of pressure sores or spasticity, degree of motor ability and location of the injury should be considered in tailoring rehabilitation therapy.
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Affiliation(s)
- Bronwyn M Hastings
- Department of Physiotherapy, University of the Witwatersrand, South Africa
| | | | - Steve Olorunju
- Biostatistics Unit, South African Medical Research Council, South Africa
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Four weeks of functional electrical stimulated cycling after spinal cord injury: a clinical cohort study. Int J Rehabil Res 2015; 37:243-50. [PMID: 24802976 DOI: 10.1097/mrr.0000000000000062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the efficacy and the effects of functional electrical stimulated cycling (FES cycling) in patients with spinal cord injury during their rehabilitation in a special acute care unit. Thirty patients [10 with American Spinal Injury Association Impairment Scale (AIS) grade A, three with AIS grade B, 15 with AIS grade C, two with AIS grade D] aged 44±15.5 years and 2 (median) (interquartile range, 1.0-4.25) months after spinal cord injury were included in the study. The patients participated in a 20-min FES-cycling program 2 days per week for 4 weeks during their acute inpatient rehabilitation. The influence on muscle cross-section, muscle and leg circumference, spasticity, and the walking ability parameter (distance, time, aids) was measured. Muscle stimulation intensity and output parameters (pedalling time and distance) were also recorded. Spasticity decreased during hip abduction and adduction (70 and 98.1%, respectively). Spasticity during knee flexion and knee extension decreased by 66.8 and 76.6%, and a decrease was found during dorsal foot extension (67.8%; for all, P<0.05). Presession-postsession comparisons showed that after 4 weeks of FES cycling, an increase in the circumference of the cross-sectional area of 15.3% on the left and of 17% on the right m. rectus femoris could be observed in group AIS A+B. In the AIS C+D group, the circumference of the left m. rectus femoris increased by 25% and that of the right m. rectus femoris by 21% (for all, P<0.05). The results of the study show that FES cycling in combination with function-oriented physiotherapy and occupational therapy can have a positive influence on spasticity, walking ability, and muscular reactivation. It seems to support circulatory processes within the rehabilitation of paraplegics already after a 4-week intervention.
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Galea MP, Dunlop SA, Marshall R, Clark J, Churilov L. Early exercise after spinal cord injury ('Switch-On'): study protocol for a randomised controlled trial. Trials 2015; 16:7. [PMID: 25563584 PMCID: PMC4320571 DOI: 10.1186/1745-6215-16-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 12/15/2014] [Indexed: 01/09/2023] Open
Abstract
Background Spinal cord injury (SCI) leads to a profound muscular atrophy, bone loss and bone fragility. While there is evidence that exercising paralysed muscles may lead to reversal of muscle atrophy in the chronic period after SCI, there is little evidence that exercise can prevent muscle changes early after injury. Moreover, whether exercise can prevent bone loss and microarchitectural decay is not clear. Methods/Design A multi-centre, parallel group, assessor-blinded randomised controlled trial will be conducted. Fifty participants with acute spinal cord injury will be recruited from four SCI units in Australia and New Zealand. Participants will be stratified by site and AIS status and randomised to an experimental or control group. Experimental participants will receive a 12-week programme of functional electrical stimulation (FES)-assisted cycling. Control participants will receive a 12-week programme of passive cycling. The primary outcome is muscle cross-sectional area of the thigh and calf measured using magnetic resonance images (MRI) of the leg. Secondary outcomes include serum biomarkers of SCI osteoporosis (sclerostin, P1NP and β-CTX), markers of immune function (IL-6, IL-10, FGF2, INF-γ, TNF-α), neurological function, body composition, depression and quality of life. Leg MRIs will be measured by a single blinded assessor based in Melbourne. Serum samples will be analysed in a central laboratory. All other characteristics will be measured at baseline and 12 weeks by blinded and trained assessors at each site. The first participant was randomised on 27 November 2012. Discussion The results of this trial will determine the relative effectiveness of a 12-week programme of FES-assisted cycling versus passive cycling in preventing muscle atrophy and maintaining skeletal integrity after spinal cord injury. Trial registration ACTRN12611001079932 (18 October 2011)
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Affiliation(s)
- Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC 3010, Australia.
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Hammond ER, Recio AC, Sadowsky CL, Becker D. Functional electrical stimulation as a component of activity-based restorative therapy may preserve function in persons with multiple sclerosis. J Spinal Cord Med 2015; 38:68-75. [PMID: 24976037 PMCID: PMC4293536 DOI: 10.1179/2045772314y.0000000238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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 examine the effect of functional electrical stimulation (FES) cycling on disability progression in persons with multiple sclerosis (MS). DESIGN Retrospective cohort, 40 participants with mean follow-up of 15 months. Setting International Center for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore, a rehabilitation referral center. PARTICIPANTS Forty consecutive persons with MS undergoing rehabilitation from 2007 to 2011, with at least two evaluations based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Interventions FES cycling as part of activity-based restorative therapy interventions. OUTCOME MEASURES Change in Expanded Disability Status Scale (EDSS) and ISNCSCI motor, light touch, and pin prick scores from baseline to latest evaluation. RESULTS In 71% of patients, activity-based rehabilitation included FES cycling. There was no disability progression on the EDSS. Lower extremity motor scores improved or stabilized in 75% of patients with primary progressive MS (PPMS), 71.4% with secondary progressive MS (SPMS), and 54.5% with relapsing remitting MS (RRMS). Among patients with improved or stabilized lower extremity motor function, PPMS recorded a mean 9% improvement, SPMS 3% and RRMS 6%. In PPMS, use of FES showed trend towards improvement in motor scores (P = 0.070). CONCLUSIONS FES as part of activity-based rehabilitation may help preserve or improve neurological function in patients with MS.
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Affiliation(s)
| | | | | | - Daniel Becker
- Correspondence to: Daniel Becker, Johns Hopkins School of Medicine, International Neurorehabilitation Institute, 1300 York Road, Building A, Suite 300, Lutherville, MD 21093, USA.
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Schuld C, Franz S, van Hedel HJA, Moosburger J, Maier D, Abel R, van de Meent H, Curt A, Weidner N, Rupp R. International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms. Spinal Cord 2014; 53:324-31. [DOI: 10.1038/sc.2014.221] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 11/03/2014] [Accepted: 11/11/2014] [Indexed: 12/14/2022]
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Krishna V, Andrews H, Varma A, Mintzer J, Kindy MS, Guest J. Spinal cord injury: how can we improve the classification and quantification of its severity and prognosis? J Neurotrauma 2014; 31:215-27. [PMID: 23895105 DOI: 10.1089/neu.2013.2982] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The preservation of functional neural tissue after spinal cord injury (SCI) is the basis for spontaneous neurological recovery. Some injured patients in the acute phase have more potential for recovery than others. This fact is problematic for the construction of clinical trials because enrollment of subjects with variable recovery potential makes it difficult to detect effects, requires large sample sizes, and risks Type II errors. In addition, the current methods to assess injury and recovery are non-quantitative and not sensitive. It is likely that therapeutic combinations will be necessary to cause substantially improved function after SCI, thus we need highly sensitive techniques to evaluate changes in motor, sensory, autonomic and other functions. We review several emerging neurophysiological techniques with high sensitivity. Quantitative methods to evaluate residual tissue sparing after severe acute SCI have not entered widespread clinical use. This reduces the ability to correlate structural preservation with clinical outcome following SCI resulting in enrollment of subjects with varying patterns of tissue preservation and injury into clinical trials. We propose that the inclusion of additional measures of injury severity, pattern, and individual genetic characteristics may enable stratification in clinical trials to make the testing of therapeutic interventions more effective and efficient. New imaging techniques to assess tract injury and demyelination and methods to quantify tissue injury, inflammatory markers, and neuroglial biochemical changes may improve the evaluation of injury severity, and the correlation with neurological outcome, and measure the effects of treatment more robustly than is currently possible. The ability to test such a multimodality approach will require a high degree of collaboration between clinical and research centers and government research support. When the most informative of these assessments is determined, it may be possible to identify patients with substantial recovery potential, improve selection criteria and conduct more efficient clinical trials.
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Affiliation(s)
- Vibhor Krishna
- 1 Department of Neurosciences, Medical University of South Carolina , Charleston, South Carolina
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Feasibility of using training cases from International Spinal Cord Injury Core Data Set for testing of International Standards for Neurological Classification of Spinal Cord Injury items. Spinal Cord 2014; 52:919-22. [DOI: 10.1038/sc.2014.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/28/2014] [Accepted: 07/07/2014] [Indexed: 11/08/2022]
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Kalsi-Ryan S, Wilson J, Yang JM, Fehlings MG. Neurological Grading in Traumatic Spinal Cord Injury. World Neurosurg 2014; 82:509-18. [DOI: 10.1016/j.wneu.2013.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/10/2012] [Accepted: 01/03/2013] [Indexed: 01/25/2023]
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